GlobalRPh Renal Dosing Masterv6.6
GlobalRPh source record

Duloxetine (Cymbalta)

GlobalRPh source pageBase record retrieved 2026-09-05See the evidence for this drug1 sources available - open source summaries, references and comparisons
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Usual Dosing (Adults)

Swallow Cymbalta whole without chewing/crushing or opening onto food/liquid, which can affect the enteric coating. Take without regard to meals.

Major depression: 40 mg/day as 20 mg twice daily to 60 mg/day once daily or 30 mg twice daily. Some patients may start 30 mg daily for 1 week before 60 mg daily. Although 120 mg/day was effective, no additional benefit above 60 mg/day was demonstrated; safety >120 mg/day not adequately evaluated.

Generalized anxiety disorder: usually 60 mg daily, or 30 mg daily for 1 week before 60 mg. No demonstrated extra benefit above 60 mg/day despite 120 mg efficacy. If increasing above 60 mg, use increments of 30 mg daily; safety >120 mg/day not adequately evaluated.

Diabetic peripheral neuropathic pain: 60 mg daily; higher doses provide no significant additional benefit and are less tolerated. Consider lower starting dose when tolerability is a concern. With associated renal disease, consider lower starting dose and gradual titration.

Fibromyalgia: start 30 mg daily for 1 week, then 60 mg daily; some respond to 30 mg. No additional benefit above 60 mg even in nonresponders, with more adverse reactions at higher doses.

Renal Dosing

Ordinarily do not use in ESRD or severe impairment (CrCl <30 mL/min). Plasma duloxetine and especially metabolite concentrations increase in ESRD requiring dialysis.

Limited ESRD data: after a single 60 mg dose, Cmax/AUC were approximately 100% higher in chronic intermittent HD than normal function, with similar elimination half-life. AUCs of the major urinary metabolites (4-hydroxy duloxetine glucuronide and 5-hydroxy, 6-methoxy duloxetine sulfate) were 7 to 9 times higher and expected to increase with repeated dosing. Population PK suggests CrCl 30 to 80 mL/min does not significantly affect apparent clearance.

Hemodialysis

Not recommended.

Source revision: Historical source; revision not established here | Retrieved: 2026-09-05. Retrieval date is not the revision date.

Source: https://globalrph.com/renal/duloxetine/

Scope: Preserved historical source; no fresh clinical approval GlobalRPh v6.6.

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Retrieved: 2026-09-05

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Original GlobalRPh protocol

Clinical facts and comments transcribed into a structured reading format. This is not a byte-for-byte HTML archive. Original source: https://globalrph.com/renal/duloxetine/

Usual Dosing (Adults)

Swallow Cymbalta whole without chewing/crushing or opening onto food/liquid, which can affect the enteric coating. Take without regard to meals.

Major depression: 40 mg/day as 20 mg twice daily to 60 mg/day once daily or 30 mg twice daily. Some patients may start 30 mg daily for 1 week before 60 mg daily. Although 120 mg/day was effective, no additional benefit above 60 mg/day was demonstrated; safety >120 mg/day not adequately evaluated.

Generalized anxiety disorder: usually 60 mg daily, or 30 mg daily for 1 week before 60 mg. No demonstrated extra benefit above 60 mg/day despite 120 mg efficacy. If increasing above 60 mg, use increments of 30 mg daily; safety >120 mg/day not adequately evaluated.

Diabetic peripheral neuropathic pain: 60 mg daily; higher doses provide no significant additional benefit and are less tolerated. Consider lower starting dose when tolerability is a concern. With associated renal disease, consider lower starting dose and gradual titration.

Fibromyalgia: start 30 mg daily for 1 week, then 60 mg daily; some respond to 30 mg. No additional benefit above 60 mg even in nonresponders, with more adverse reactions at higher doses.

GRPH-duloxetine-01 · Source section: Usual Dosing (Adults)Renal section finder

Renal Dosing

Ordinarily do not use in ESRD or severe impairment (CrCl <30 mL/min). Plasma duloxetine and especially metabolite concentrations increase in ESRD requiring dialysis.

Limited ESRD data: after a single 60 mg dose, Cmax/AUC were approximately 100% higher in chronic intermittent HD than normal function, with similar elimination half-life. AUCs of the major urinary metabolites (4-hydroxy duloxetine glucuronide and 5-hydroxy, 6-methoxy duloxetine sulfate) were 7 to 9 times higher and expected to increase with repeated dosing. Population PK suggests CrCl 30 to 80 mL/min does not significantly affect apparent clearance.

GRPH-duloxetine-02 · Source section: Renal DosingRenal section finder

Provenance and preservation

Additional summaries stored on this page: 0 official-label, 0 RX List, 0 professional, 0 handbook. Empty additional-source groups are not shown. A missing layer is not a no-adjustment recommendation.

Original source
https://globalrph.com/renal/duloxetine/
Source retrieval
2026-09-05. This is not the source publication or label revision date.
Original source type
globalrph individual
Local text SHA-256
b61d10c5c299808aa0a54e35f1182a2b4f02b4ed89af480499bcdbe58cf53745
Import versus clinical validation
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The original individual GlobalRPh pages commonly cite NIH/NLM DailyMed and instruct readers to review the applicable package insert for updates. That historical reference is preserved as context; it is not counted as an independently retrieved current label.

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