Regarding Qianyoujie (a medication for depression)
Hello Dr.
Huang: I was originally taking 60mg of Cymbalta daily, but after being hospitalized, my doctor increased the dosage to 120mg.
However, I found online that this dosage is generally not recommended due to uncertainty about its efficacy and the fact that most people cannot tolerate the side effects, which makes me very concerned.
Can taking Cymbalta at this dosage be harmful to my health, especially since it is intended for long-term use? Additionally, what is the maximum dosage for Wellbutrin?
Xia Xia, 10~19 year old female. Ask Date: 2018/06/28
Dr. Huang Jiabin reply Psychiatry
Hello: I believe you have already reviewed the medication's package insert.
Before a drug is officially launched, pharmaceutical companies conduct large-scale human trials to determine the appropriate dosage and efficacy.
Research indeed shows that the benefits of using 60 mg or more of the medication may not outweigh the risks.
This conclusion is based on the "average" results of all participants, so it cannot rule out the possibility that a few individuals with unique physiological characteristics may experience significant benefits from dosages above 60 mg.
Therefore, physicians will assess your specific situation in the clinic and discuss whether to use a dosage that exceeds the recommended maximum.
Of course, higher dosages carry a greater risk of side effects (such as serotonin syndrome, increased blood pressure, etc.) compared to lower dosages, but this also depends on individual physiology.
There are indeed sporadic case reports regarding liver effects.
However, in trials, there was no data indicating that all participants using 120 mg experienced elevated liver function indices.
Therefore, if you have been using 120 mg for a period of time, your symptoms have improved, and there are no significant side effects or abnormal changes in other blood test results, congratulations, your physiology is suitable for using 120 mg.
The medication you mentioned, Fu'an Yuan, is a short-acting benzodiazepine.
These types of medications are primarily used for their sedative and hypnotic effects (and most commonly used sedative-hypnotics today fall into this category).
A unique characteristic of these medications is that when used above a certain dosage, the marginal efficacy tends to decrease; simply put, the increase in effect from taking 4 pills instead of 3 will be less than the increase from taking 2 pills instead of 1.
There may even be a ceiling effect, where beyond a certain dosage, increasing the amount will not yield significant differences.
Of course, the actual threshold varies from person to person (yes, again, it’s something a physician can easily discern).
The downside of short-acting sedative-hypnotics is the potential for developing tolerance (for example, if half a pill used to be effective but now two pills have no effect), and abruptly stopping the medication may lead to withdrawal symptoms such as anxiety and insomnia.
The more you use, the higher the risk of withdrawal.
Therefore, if you are experiencing tolerance, it is advisable to discuss with your physician whether there is still room to increase the dosage, whether to switch to another medication, or to consider combining non-pharmacological treatment methods.
Reply Date: 2018/06/28
More Info
Cymbalta, known generically as duloxetine, is a medication commonly prescribed for conditions such as major depressive disorder, generalized anxiety disorder, fibromyalgia, and neuropathic pain. It is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI), which means it works by increasing the levels of serotonin and norepinephrine in the brain, neurotransmitters that are important for mood regulation and pain perception.
When it comes to dosage, Cymbalta is typically initiated at a lower dose, often around 30 mg to 60 mg per day, and can be gradually increased based on the patient's response and tolerance to the medication. The maximum recommended dose for Cymbalta is generally 120 mg per day, but this should only be done under close medical supervision, especially for patients who may have other underlying health conditions or are taking other medications.
Your concern about the increase in dosage from 60 mg to 120 mg is valid. While some patients may benefit from higher doses, others may experience increased side effects without a corresponding increase in therapeutic benefit. Common side effects of Cymbalta include nausea, dry mouth, constipation, fatigue, dizziness, and increased sweating. More serious side effects can include liver damage, serotonin syndrome (a potentially life-threatening condition caused by excessive serotonin), and increased blood pressure.
It's important to monitor for any adverse effects, especially when increasing the dosage. If you experience severe side effects such as persistent nausea, vomiting, or changes in mood or behavior, it is crucial to contact your healthcare provider immediately. They may consider adjusting the dosage or switching to an alternative medication.
Regarding your question about the maximum dosage of Cymbalta, while the FDA has approved doses up to 120 mg per day, the decision to prescribe this amount should be based on a thorough assessment of the patient's individual health status, previous response to the medication, and potential drug interactions. It is also essential to consider that not all patients will tolerate higher doses well, and some may find that lower doses are more effective with fewer side effects.
In summary, while increasing the dosage of Cymbalta can be beneficial for some patients, it is essential to do so cautiously and under the guidance of a healthcare professional. Regular follow-ups and open communication with your doctor about any concerns or side effects you experience are vital for ensuring the safe and effective use of this medication. If you have any lingering concerns about the safety of taking Cymbalta at a higher dose, do not hesitate to discuss them with your healthcare provider, who can provide personalized advice based on your medical history and current health status.
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