A 48 year old female has a history of diabetic neuropathy and has been placed on Cymbalta (duloxetine). The patient has taken it for three days and is feeling pretty fatigued throughout the day from it. She asks, “How long does it take Cymbalta to work for pain?”
I’ve looked for literature on this in the past, and I can’t seem to find much on this topic. In the absence of side effects, most antidepressants (when used for depression) are given a minimum of 6-8 weeks as an appropriate trial to begin to see benefit. Some might argue to give it 3-6 months especially if a partial response has been noted.
Does this length of 6-8 weeks apply to the analgesic effect of Cymbalta? Again, I don’t think we have a great answer for this one. Not having great clinical literature to help guide our decision, I think a little common sense can get us there.
The patient is having trouble with potential side effects. My first question would be what dose is it? If we started at 60 mg, maybe that is a little too much. Next, I would ask what time she is taking the dose. Most patients will usually take the dose in the morning. If fatigue is bothersome throughout the day, I would consider switching the dosing to the evening.
In summing up this scenario, I would probably encourage the patient to switch the dosing to the evening timeframe and try to continue to take it for at least a couple of weeks unless the side effects become unbearable. I would ideally like to get this patient out to the 6-8 week mark before considering this treatment failure.
Love the blog? Get a free gift simply for following! Over 5,000 medication loving healthcare professional have taken advantage of this!