Symptoms of duloxetine withdrawal

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Symptoms of Duloxetine Withdrawal

Common Duloxetine Withdrawal Symptoms

Abrupt discontinuation of duloxetine, a serotonin-noradrenaline reuptake inhibitor (SNRI), can lead to a range of withdrawal symptoms. In clinical trials, discontinuation-emergent adverse events (DEAEs) were reported by 44.3% of patients who stopped duloxetine abruptly, compared to 22.9% of those on a placebo . The most frequently reported symptoms include dizziness (12.4%), nausea (5.9%), headache (5.3%), paresthesia (2.9%), vomiting (2.4%), irritability (2.4%), and nightmares (2.0%) . These symptoms are generally mild to moderate in severity and often resolve within a week .

Severe and Uncommon Withdrawal Symptoms

In rare cases, duloxetine withdrawal can lead to severe symptoms. A case report described a 61-year-old man who experienced severe vomiting, auditory and visual hallucinations, dizziness, tremor, diaphoresis, leg cramping, and unsteadiness after abruptly discontinuing duloxetine 25. His condition escalated to neuroleptic malignant syndrome (NMS), characterized by marked rigidity, myoclonic jerks, and startle myoclonus, which required emergency treatment 25. Another case involved a patient who experienced severe nausea, unexplained fear, and dizziness intermittently for up to 10 months after stopping duloxetine .

Long-Term Withdrawal Symptoms

Long-term withdrawal symptoms can persist even with gradual tapering. A systematic review found that withdrawal symptoms typically appear within a few days of discontinuation and can last for several weeks . In some cases, symptoms may have a late onset or persist longer, challenging the use of SNRIs as a first-line treatment for mood and anxiety disorders .

Management and Recommendations

To mitigate withdrawal symptoms, it is recommended to gradually reduce the dose of duloxetine over at least two weeks before complete discontinuation 17. This tapering approach helps to minimize the risk and severity of withdrawal symptoms. In cases where severe symptoms occur, reintroducing a lower dose of duloxetine and then tapering off more slowly may be necessary .

Conclusion

Duloxetine withdrawal can lead to a variety of symptoms, ranging from mild to severe. Common symptoms include dizziness, nausea, and headaches, while severe cases may involve hallucinations and neuroleptic malignant syndrome. Gradual tapering of the dose is recommended to minimize withdrawal symptoms. Clinicians should be aware of these potential issues and manage discontinuation carefully to ensure patient safety.

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Most relevant research papers on this topic

Symptoms following abrupt discontinuation of duloxetine treatment in patients with major depressive disorder.

Abrupt discontinuation of duloxetine is associated with a common set of discontinuation-emergent adverse events, suggesting gradual dose reduction is recommended.

Meta-AnalysisHighly Cited

2005·

86citations

·D. Perahia et al.

Concurrent Duloxetine Withdrawal and Neuroleptic Malignant Syndrome Mimicking Creutzfeldt-Jakob Disease: A Case Report (P2.219)

Duloxetine withdrawal can cause severe symptoms, but in this case, it was compounded by neuroleptic malignant syndrome, suggesting iatrogenic causes in suspected Creutzfeldt-Jakob Disease.

Case ReportRigorous Journal

2017·

1citation

·E. Zucker et al.

Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review

Discontinuing SNRIs can cause withdrawal symptoms, with higher prevalence in venlafaxine, and symptoms typically begin within a few days and last a few weeks.

Systematic ReviewHighly Cited

2018·

144citations

·G. Fava et al.

Long-term duloxetine withdrawal syndrome and management in a depressed patient.

Duloxetine withdrawal syndrome can be managed effectively with intermittent doses and supportive care, allowing patients to recover from long-term depression treatment.

Case Report

2014·

4citations

·Yi-Cheng Hou et al.

Duloxetine withdrawal

Duloxetine withdrawal can cause severe symptoms, including Creutzfeldt jakob disease and neuroleptic malignant syndrome, but after treatment and continued withholding of the drug, symptoms resolved.

Case Report

2017·

0citations

Duloxetine Attenuated Morphine Withdrawal Syndrome in the Rat

Chronic administration of duloxetine significantly reduces morphine withdrawal symptoms in rats, potentially due to its regulatory effects on serotonergic and noradrenergic parameters.

RCTAnimal Study

2013·

9citations

·M. Charkhpour et al.

Adverse reactions to duloxetine in depression

Duloxetine is well-tolerated and can be safely administered for depression treatment, with mild to moderate adverse events, but no increase in suicide or suicidal thoughts compared to placebo.

Systematic Review

2011·

30citations

·I. Bitter et al.

Duloxetine in the treatment of generalized anxiety disorder

Duloxetine effectively reduces symptoms of generalized anxiety disorder in short-term treatments, but further evidence is needed for long-term efficacy and safety.

RCTRigorous Journal

2008·

4citations

·Trevor R. Norman et al.

Duloxetine in the treatment of major depressive disorder

Duloxetine at 60 mg qd effectively reduces depression symptoms and improves quality of life, but may cause nausea, dizziness, somnolence, and fatigue.

RCTLarge Human TrialHighly Cited

2007·

181citations

·D. Goldstein

Increased chromogranin a and carcinoid syndrome-like symptoms in a patient treated with duloxetine.

SNRIs can cause symptoms suggestive of serotonin-secreting neuroendocrine neoplasms and elevated chromogranin A levels, leading to unnecessary and expensive diagnostic workups.

Case Report

2014·

4citations

·S. Karger et al.

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