Cymbalta
How it works
Inhibits reuptake of serotonin and norepinephrine. First-line for chemotherapy-induced peripheral neuropathy (CIPN).
ASCO 2020 recommends duloxetine for established painful CIPN (Level 2 evidence) — NOT for prophylaxis. Start 30 mg daily, titrate to 60 mg over 1–2 weeks. Reduce to 30 mg/day if eGFR 30–50; avoid if eGFR < 30.
Dosing
Typical doses
- 30–60 mg PO daily
Schedule
- Once daily morningfixed
Side Effects
- •Nausea (usually resolves in 1–2 weeks)
- •Dry mouth, sweating
- •Dizziness, drowsiness
- Serotonin syndrome (with SSRIs or other serotonergic agents)
Monitoring
- Neuropathy grade monthly — efficacy takes 2–4 weeks