Cymbalta comes in 20 mg, 30 mg, and 60 mg capsules. Full prescribing information: http://pi.lilly.com/us/cymbalta-pi.pdf
Cymbalta is tricky to taper. It does not come in liquid form and cannot be compounded into a liquid. To protect the drug, each bead inside the gelatin capsule has an enteric coating to protect the drug from stomach acid, which would destroy the drug. (It is absorbed further down in the digestive tract.) The pellets cannot be dissolved in any liquid without destroying the active ingredient.
You cannot crush the pellets (see http://survivinganti...ndpost__p__3021 ) or dissolve them in a solution -- the drug would never get into your system, it would be destroyed in your stomach and you would have immediate cold-turkey withdrawal.
Of course, the range of dosages from the manufacturer is inadequate for very gradual tapering.
And, like all psychiatric drugs, do not take Cymbalta in alternating dosages. Its half-life is very short, about 12 hours. It is metabolized via the liver enzymes P450 1A2 (substrate, inhibitor) and 2D6 (inhibitor).
See Doctor is shocked at severe Cymbalta withdrawal symptoms
Reduce by 10% per month to start
As with any neurologically active drug, a conservative taper is the safest way to go off Cymbalta. Some people find they can go faster and some people find they have to go slower -- they can only tolerate decreases of a fraction of a milligram at a time.
A conservative taper for Cymbalta, like other psychiatric drugs is: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)
See Why taper by 10% of my dosage?
Cymbalta CANNOT be compounded into a liquid or dissolved in a liquid
The pellets in the capsule cannot be dissolved in a liquid; this would destroy the active ingredient.
Opening capsules and counting out beads
Like Effexor XR, some people have tapered by opening the Cymbalta capsule and taking out the beads to gradually reduce the dosage. (See http://survivinganti...ndpost__p__2985 for the technique.)
The number of beads in each Cymbalta capsule will vary within a given dosage and across dosages. The capsules are filled by weight. Count your beads carefully. Put unused beads into a clean, dry, capped prescription bottle marked with the dosage of the original capsule and expiration date. You might want to use them later. Do not mix beads from capsules of different dosages, such as 30mg and 60mg.
NOTE When you are taking loose beads, put them in an empty capsule to swallow them. Gelatin capsules and vegetarian capsules are available at health food store. The FDA reports here http://www.fda.gov/d...s/ucm103473.pdf there have been some instances of the beads causing throat irritation when swallowed without a capsule.
Dividing contents of capsules into empty gelatin capsules
To make counting of the beads easier, this technique may work with Cymbalta, see details at
Opening capsules and weighing beads
Eventually, as you remove more and more beads, it may become too confusing and time-consuming to count out them. You may wish to weigh them instead, see Using a digital scale to measure doses and Counting beads in a capsule versus weighing.
Dividing contents of capsules into apple juice or applesauce
Follow the instructions above for dividing the contents of a capsule and put your reduced dose apple juice or applesauce.
It has been scientifically demonstrated that the Cymbalta pellets survive being put into apple juice or applesauce but NOT chocolate pudding:
Clin Ther. 2008 Jul;30(7):1300-8.
In vitro stability, potency, and dissolution of duloxetine enteric-coated pellets after exposure to applesauce, apple juice, and chocolate pudding.
Results from this study found that the enteric coating of duloxetine pellets mixed with applesauce or apple juice was not negatively affected. The pellets were stable at room temperature for < or = 2 hours and should quantitatively allow delivery of the full capsule dose, provided that the pellet integrity is maintained (ie, not crushed, chewed, or otherwise broken). Therefore, mixing duloxetine pellets with applesauce or apple juice appears to be an acceptable vehicle for administration. However, exposing the pellets to chocolate pudding damaged the pellets' enteric coating, suggesting that pudding may be an unacceptable vehicle for administration.
Have a compounding pharmacy make up capsules of smaller dosages
For precise dosing, a compounding pharmacy will accurately weigh the doses and put them into capsules for you. See http://survivinganti...ndpost__p__3001
Reduce by micro-taper
The very smallest dose of Cymbalta is one bead. Some people find they can better tolerate a reduction of one bead at a time rather than a 10% decrease. You may be able to make reductions of one bead more frequently; try reducing by one bead a week for a while to see what your tolerance is. See http://survivinganti...or-5-decreases/
Do not reduce by one bead a day. This is too fast, you may develop withdrawal symptoms before you know what's happening.
Switch to Prozac
Like its fellow SNRI Effexor, withdrawal from Cymbalta can be very difficult. Recently, I asked a knowledgeable doctor about how he switches patients to Prozac.
He said if the dosage of Cymbalta is "normal" -- 30mg-40mg -- he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Cymbalta.
Later, taper off Prozac. He acknowledged Prozac can have its withdrawal problems, but given Prozac's long half-life, gradual tapering should be much easier than tapering off Cymbalta. And, at least Prozac comes in a liquid.
He confirmed that Cymbalta cannot be compounded because the pellets are enteric-coated to get the medication past the stomach acid, which destroys it. Other than the Prozac switch, he said counting pellets is the only way to taper.
See more about the Prozac switch http://survivinganti...ng-with-prozac/
Edited by Altostrata, 09 August 2014 - 09:54 AM.