Africa: Pins and needles as well as numbness in my toes, feet, arms and hands

[Africa]

I am a 44 year old woman and have been on 10mg of Paroxetine (Paxil) for 8 years and in February this year decided to slowly start weaning off. I dropped to 7.5mg one day a week for a month and once I had got to 7.5 mg 7 days a week I started to drop to 5mg one day a week for a month. I am now on 5mg Monday to Thursday and still on 7.5mg Friday to Sunday. I was absolutely fine until two weeks ago when I started having a crawling feeling on the bridge of my nose and between my eyebrows. Then two days later I woke up with pins and needles in all my toes which eventually spread to under my feet. My toes also most always feel cold. I have also started with pins and needles in my left fingers and hand. I went in to see the doctor when this started and explained to her that I was weaning off Paxil but she didn't say anything about it. She did all the blood tests necessary which all came back normal. I called her again this week to say that I am really worried and she said she will put me in the system to see a neurologist in a couple of months.

 

I am absolutely beside myself and have made an appointment to see a private Neurologist in January which will be costly as I am not on a medical insurance. I just wondered if anyone else may have these withdrawal symptoms from tapering off Paxil? I have the pins and needles constantly under my feet although the tingles on my face come and go during the day. I feel fine within myself but I am obviously very anxious because of the physical symptoms.

Edited August 5, 2016 by scallywag
tags updated

[KarenB]

Hi Africa and welcome to s/a,

 

All sorts of tingles and pins and needles are common withdrawal symptoms.  I get a strange feeling on the end of my nose.  Have a read through this thread to see what people have been experiencging:  http://survivingantidepressants.org/index.php?/topic/6548-paresthesia-pins-needles-numbness-tingling-burning-sensations/

 

It's probably due to the fact that even though you aimed for a slow taper, it was a bit faster than is recommended here.  A 10% taper each 4-6 weeks seems to be what most people can handle.  The most important consideration is to keep your central-nervous-system stable.  This is why going up and down in doses isn't a good idea.  If you can start having the same dose each day, you might find some improvement.  Skipping doses can also cause problems.  You might find this link useful:  Keep http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/   

 

I'm not surprised you are beside yourself - this can be really frightening if you don't know what's happening to you or why.  Have a read of these links and then come back to this thread to ask any questions you may have.  Once we get your CNS stabilised by holding at the same daily dose for a good while, then we could look at making a gentle tapering plan with you.  It's going to be okay - it just takes time.

 

You could also add a signature so we can see your details at a glance whenever you post.

 

Best wishes,

KarenB

[nz11]

Welcome Africa,

I had trouble tapering too ...i had no idea what i was doing and the doc never gave me a taper schedule or advice just said take as much as you want when i told him i wanted off. I didnt find online support till i had jumped off and all hell broke loose.

You are lucky you found sa at this early stage because in my experience things may get a lot worse than nerve twitchings.

As Karen says these are signs of wdl symptoms and well worth your while to checkout those great links.

One i found very informative is also this one

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

Just a comment on the neurologist visit ...esp if you think it is costly. You could always put it on hold. The chances are everything will come back ok. 

You can alleviate the anxiousness because you know this is the withdrawal. You may find that once you pick a dose and stick to it daily things will settle down.

Then you can proceed with the 10 % taper method.

 

There is so much to look forward to in withdrawal (not), try not to get  scared by nerve twitchings/pins and needles.   i still have them and i am drug free 5 years.

These are neuro-toxic drugs they have impaired the cns and brain as such the body is waking up to the fact it is not getting its normal drug fix anymore.

You will be ok ..this is your lucky day ..you found sa!

[Africa]

Hi Karen

 

Thank you so much for this information and allowing me to join this incredible forum. I really appreciate your advice and feel a lot more relaxed knowing that I'm not the only person going through this. After reading the advice on tapering Paxil I've realised that I have gone way too quickly even though I thought it was slow. I'm going to go up slightly to 7.5mg every day and then do the taper the stable way!

 

You have been a life saver and I can't thank you enough. I will keep posting about my journey as I think with many it can be a long one. 

 

Best wishes

 

Brigitte

[Africa]

Hi NZ11

 

Thank you so much for your kind words, advice and support. This was definitely my lucky day finding sa!!

 

I had no idea how to taper and don't think my GP new much about Paxil and I just did it on my own. I'm going to go back up to 7.5mg Monday to Friday and then do the 10% taper method the more stable way. I think I will wait before I see a neurologist as it does seem like these pins and needles are withdrawal symptoms.

 

I have been in such a state for the last few weeks and completely overwhelmed with fear and anxiety. This forum has been such a life saver and I am so grateful that I've found it.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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[FunkyBaboon]

Hi Africa and welcome to the forum!

 

From reading your posts I'm not entirely sure whether you came up with your previous tapering method by yourself or whether it was suggested to you by a healthcare professional. Nevertheless, it's very common for GPs (in the UK at least) to suggest that people start dropping their doses by either skipping days or doing as you were doing introducing one day per week at a lower dose and then gradually over subsequent weeks starting to introduce an extra day one by one until you reach the point where every single day of the week is at the lower dose. This may not cause huge side effects for some people who either had a fairly small lifetime exposure to these kinds of drugs (like a very short course of anti-depressants, in the region of a few months) or who have genetically fairly resilient nervous systems but for many people this kind of tapering causes all kinds of horrendous withdrawal symptoms as the blood concentration of the drug fluctuates wildly. Hence, the lovely folks who run this forum recommend the 10% steady state (taking the same amount each day) drop per 4-6 weeks.

 

In the past (and some continuing) I have suffered with all of the symptoms you mention. I've had the sensation that I've had bugs crawling on my skin, suffered with terribly cold hands & feet (still do), Raynaud's phenomenon, nerve pain mainly in my right arm but I've also had it in the tips of my fingers and toes along with burning sensations, numbness and at one point I totally lost sensation. Mine started as a result of coming off Citalopram, not from Paroxetine like you (although I have taken Paroxetine in the past), but they're all SSRIs and capable of much the same kind of withdrawal symptoms.

 

When I was at my worst with all of these symptoms, I hadn't discovered survivingantidepressants.org yet and I was petrified as to what my symptoms meant and spent weeks going for all kinds of tests with GPs and specialists. I saw somebody in the musculoskeletal department in outpatients who suggested that I might have peripheral neuropathy, which sent me into a complete panic because I read up on that and really scared myself. My subsequent nerve conduction studies showed there was no evidence of peripheral neuropathy, thank god. I had whole batches of blood tests checking for things like Lyme disease, lupus, HIV, various autoimmune diseases all of which came back clear. I saw a neurologist (privately, because of how petrified I was) thinking I might have a disease of some kind in my brain and had an MRI of my brain, which again came back clear. I also saw a rheumatologist, who confirmed that I did have Raynaud's but couldn't explain the rest of my problems, suggested it might be chronic fatigue or fibromyalgia.

 

The closest thing to a real diagnosis that I was given was by my neurologist who told me that he could see that I was experiencing some pretty severe symptoms but couldn't explain them using a disease model because my scans came back clear so he told me that I had Functional Neurological Disorder and pointed me at http://www.neurosymptoms.org/. I recently wrote a post in the symptoms forum explaining that in a little more detail and you might be interested to read a bit more about that there:

 

Neurologist's diagnosis of Functional Neurological Disorder and referral to http://neurosymptoms.org

 

Eventually after I went back on another antidepressant drug (Nortryptyline) all of my symptoms started to subside and are now much, much better than they were and I'm following the advice here and it is working out much better this time around. Check out my intro post if you want to know more about my experiences with all of this.

 

Although in my opinion (and I'm not a doctor) you are most likely experiencing these problems due to your Paroxetine dose reduction, it is probably best that whilst you still experience the symptoms you have right now you let your doctor perform any tests they feel necessary to rule things out for your own peace of mind. I suspect that once you stay on a consistent daily dose for a few weeks these things will probably start to resolve themselves.

 

Once again I'd like to welcome you to the forum and I concur that it's great that you've found it now whilst you can still transition over to a safer, slower taper. Here's hoping that everything starts getting much better for you from now on !! 

 

Good luck and best wishes,

Funky

[Africa]

Hi Funky

 

Thank you so much for your reply and invaluable information. I am just so relieved to have come across sa and to be able to discuss what is happening to our bodies with such supportive people.

 

My GP wanted me to taper Paroxetine a lot faster and just from what I had read I then made up my own tapering method. Since coming across sa I now realise I haven't been doing it right. Emotionally I was quite stable until I started getting the physical symptoms! The symptoms for example the pins and needles in my toes happened overnight. I woke up one morning 2 weeks ago and all 10 toes were almost numb and this feeling gradually spread to under my feet over the next day. These have remained although the tingles on the bridge of my nose come and go. Also, sometimes when I'm sitting my legs feel tingly and I start to worry that I'm not going to be able walk. I have been beyond scared and find I am in constant panic mode! 

 

I've kept my appointment with the neurologist for the 4 January because I'm not feeling confident enough to cancel it right now but after the responses I have had and read I feel more relaxed knowing that theses symptoms that I'm getting are from withdrawal effects of Paroxetine. I did check the link you sent on neurosymptoms and found it very interesting. Do you think these symptoms will go away? Because my anxiety is spiralling at the moment, I keep thinking it's going to get worse.

 

Thank you again for your time and support

 

Best wishes

 

Africa

[FunkyBaboon]

Hey Africa,

 

You're definitely doing the right thing by keeping the private neurologist appointment. It's important that you get checked out in any way that is suggested by your doctor and due to waiting lists for NHS these days going private is necessary if you need to be seen sooner and given how frightened you must be feeling right now I can only imagine you want to be seen right away, I certainly did!

 

So what are you taking right now? Are you taking the 7.5mg just Monday to Friday and taking a different dose at the weekend still?

 

I'd suggest if you're experiencing these kinds of symptoms then keeping on a consistent daily dose will be very important to stabilise your nervous system. I'm not sure exactly what that dose should be though given that you've been taking 7.5mg for half the week and 5mg for the other half. I've not much experience in these kinds of recommendations because I've only recently joined the forum myself so I'm hoping one of the mods or Altostrata will be along shortly with the best advice on the consistent dose you could try.

 

When you stabilise on a consistent dose, which may take a few weeks then I'm pretty sure your physical symptoms will also start to abate. Personally, my symptoms stopped at the numbness and loss of sensation I never lost the function of any of my limbs..

 

Keep us updated with your progress and I'm really rooting for you to get some much needed improvement soon! I know how scared you must feel, I was there too.

 

Take care

Funky

[Africa]

Hi Funky

 

Thanks for replying and I' m really happy things have worked out well for you. I called my GP this morning as even though I am seeing someone privately I still need a referral from her. She made me so anxious again by saying that she didn't know whether the symptoms I'm showing are from withdrawal as I have been tapering slowly. I tried to explain to her that actually I should not be on different levels of paroxetine on different days but I don't think she knows lot about this drug. She said that I should go up to 10mg again instead of 7.5mg and see whether the symptoms go away. I don't really want to go back to 10mg although I'm so frightened now that I'm tempted.

 

I will keep you all updated and thanks again for the support.

 

Take care

 

Africa

[FunkyBaboon]

I'm sorry I might have got confused with where you're based. I seemed to remember your profile saying England but then I reread some of your posts and noticed things that suggest you're overseas like USA or something. If so, ignore my waffle about NHS ☺

[Africa]

Hi Funky

 

I live in the South West of England so know the NHS really well. I'm originally from South Africa but have been living in the UK for 8 years now.

 

Take care

 

Africa

[AliG]

Hi Africa ,

 

It seems like you have been on 7.5mg partially for a while . You started tapering in February ?  If your symptoms are manageable, I would stick with this dose , otherwise you're going back to where you started. You have adjusted slightly , even though you were alternating doses, which is destabilizing for your C.N.S.  It will be easier to taper off later, from this amount ,  in a slow and controlled manner. What are your symptoms , now ?

 

Ali

[Africa]

Hi Ali

 

Thank you, I also thought going back up to 7.5mg is better than going back to 10mg. It took 28 weeks to get from 10mg to 7.5mg. I dropped 2.5mg every 4 weeks for 1 day a week and then started dropping to 5mg 1 day a week for 4 weeks. Yesterday I started back on 7.5mg. (I only managed to get to 5mg on a Mon, Tue, Wed and Thursday)

 

My toes are still very tingly especially in the morning and I have a burning and tingly feeling under my feet. I still get tingles on the bridge of my nose that come and go during the day. This afternoon I am starting to feel very anxious as my left arm feels sore as well as the joints. The palm of my hands also feel tingly and when I use them they seem to burn and feel sensitive, The tips of my fingers also sometimes feel tingly.

 

I wish this would all go away as it's so frightening.

 

Thanks

 

Africa

[Africa]

Hi everyone, can anyone help.

 

My feet were very cold today and when I took my socks off there was a big red lump on my big toe. I then had a warm shower and my feet came up in red welts everywhere. My feet are so sensitive and tingly and cold.

Has this happened to anyone?

 

Thanks

 

Africa

[brassmonkey]

Hi Africa--  Welcome to the group.  I'm sorry to hear that you've hit a snag in your taper.  First off, don't panic, what you're feeling and experiencing is to be expected.  WD will do some pretty strange things to a person.  During my taper I had the pins and needles thing on and off for a long time when I went from 15mg down to about 4mg, then it started to really settle out.  I still get it off and on but not nearly as bad.  I still have trouble with my hands being cold.

 

The taper schedule you tried earlier in the year looks like it was a bit too fast, and the alternating doses like that can cause a lot of trouble later, as you are finding out.  I think your updose to 7.5mg was a good idea, but there is no need to go any higher.  It is going to take several days, at least four, before the drug level becomes steady state in your blood.  Once that happens then things can start to stabilize, and that can take several weeks to several months.  But as you stabilize the symptoms should fade to a much more tolerable level.  Once you're stabilized, then we can help you work out a taper that will get you off of this stuff with a minimum of trouble.  Here is a thread or two that will help explain things a bit more:

 

What is withdrawal syndrome?

 

Why taper by 10% of my dosage?

 

Tips for tapering off Paxil (paroxetine)

 

Thank you for filling in a signature block, it really helps us to help you.

[FunkyBaboon]

Hi Africa,

 

My feet get cold very easily and when they do they tend to go much paler - both things that never happened pre-withdrawal. If I then take a shower when they're in this state then they tend to go blotchy I have red patches in amongst the whiteness... they have looked like this (blotchy feet) on many occasions.

 

When I stabilise at a particular dose for a while then all of these symptoms calm down a lot but every time I drop a dose it all comes back with a vengeance until I stabilise again.

 

Problem with antidepressants when we take them is they are not selective in the parts of the body or brain that they affect, they affect the whole brain globally including parts that were never intended to receive a therapeutic affect so they can end up affecting our blood pressure, our heart rate, our temperature regulation and blood vessel control systems and our sensory systems. This is why they come with such a large number of potential side effects listed in their instructions because of how global their action actually is. The doctors and specialists I've met tend to downplay all of the potential downsides and purport them as safe and non-addictive, something that I've since realised is pretty misleading.

 

Hang in there Africa!!

 

Funky

[Africa]

Hi Funky and Brassmonkey

 

Thank you for your advice, reassurance and the links you have sent. I really don't think I would have been able to have done this without everyone's support on this site. 

 

I used a hot water bottle last night to warm my feet up and I was really surprised at how sensitive I was even to the warmth. My feet and hands are not as cold now but just have that burning/tingling feeling.

 

I am staying on the 7.5mg  everyday so hopefully I'll be able to see some change.

 

Thank you again. It means so much to me.

 

Africa

[JanCarol]

Hey Africa - welcome to SA, I'm glad you found us (though sorry you had to).

 

NZ11 posted a great link above that you can use to check your symptoms.  When you have something new or surprising happen to you, please check http://survivingantidepressants.org/index.php?/topic/2390-dr-joseph-glenmullens-withdrawal-symptom-checklist/

 

to see if your symptoms can be explained there.

 

The list has many symptoms on it - but sometimes a new one will crop up which is not on the list.

 

I'm hoping it will ease your mind to know that others have had these symptoms before.

[Africa]

Hi JanCarol

 

Thank you so much and for your support. I have printed the withdrawal symptoms and placed them where I can see them for when I need reassurance.

 

These physical symptoms have been the worst for me but I have gone back up to 7.5mg of Paroxetine and will reduce much slower when I am ready.

 

Take care

 

Africa

[FunkyBaboon]

How have you been today Africa?

[Africa]

Hi Funky

 

Thank you for asking. My feet seemed to be better than yesterday - not so tingly underneath. My toes still feel tingly, cold and have pins and needles and I have also had a strange feeling between my eyebrows. It almost feels like a big welt which is slightly numb (there is no welt though)

I keep reading the withdrawal symptoms of Paroxetine and what other people have said just to reassure myself. I am definitely staying on the 7.5mg and really hope things improve. I have to stop myself thinking that these symptoms will never go away or that I have some serious neurological disease. Because I get so anxious I start thinking that maybe I do have something wrong and Paroxetine has been masking it! I really just have to try and stay positive and remember I didn't have these symptoms before I went on this drug although easier said than done.

 

Thank you so much again for your support and advice. I couldn't have done this without all of you.

 

Africa

[Africa]

Hi Funky

 

Have you found sensitive skin a withdrawal symptom? I have just got out the shower this evening and my chest and face are very red and hot. It almost feels like an allergy but it's not. That must have been the welt feeling on my forehead.

 

Africa

[SquirrellyGirl]

Hi Africa, 

 

I'm glad you are here!  When wondering about symptoms, it helps to remember that there are nerves throughout our bodies, especially in the skin - sense of touch/pain and all.  So, it stands to reason that hot water could overstimulate those nerves in the skin while they are cattywampus from the changing levels of neurotransmitters due to the drug level fluctuations.  I'm sure you will check out ok at the neurologist, so just be assured that all these weird nervy symptoms are due to your system trying to regain some kind of homeostasis.  
 

I think it is also helpful for folks to learn that just because one neurotransmitter is being blocked, serotonin in the case of SSRIs and norepinephrine additionally in SNR!s, doesn't mean that a whole bunch of other ones aren't affected too.  This is due to feedback and interactions between them, not to mention their effect on enzymes and hormones in the body.  Everything is interconnected.  So, an artificial change in one due to the drug's action can cause repercussions throughout the nervous system and body systems.

 

A lot of gals find that things get really weird around their cycles while in WD or tapering, because the same is true in reverse, changes in hormones affecting everything else with the changes in neurotransmitters due to monkeying with the drug LOL!  

 

That's a pretty sloppy and probably not totally accurate explanation but you get the gist.

 

SG

[FunkyBaboon]

Hey Africa,

 

I get that the redness and sensitivity in my hands and feet when exposed to hot water but not really anywhere else. Everybody is different though. I think what is happening is your blood vessels are over dilating allowing a lot of blood to come to the surface of the skin, which is giving the redness and the sensitivity.

 

One thing I've found useful when wondering if people have had a particular side affect is to use Google to search survivingantidepressants.org. If you want to find posts that mention sensitive skin just type this into the Google search box:

 

sensitive skin site:survivingantidepressants.org

 

So basically whatever you want to find type it and then put site:survivingantidepressants.org after it.

 

I just did a quick search for "sensitive skin" using the above technique and it seems quite a few are getting that as a result of withdrawal.

 

Hope that helps!

[Africa]

Hi SquirrellyGirl

 

Thank you for your great explanation! I am so glad and relieved I am here too!

 

You all seem so knowledgeable with SSRIS and I have learnt so much in the last few days. I can't believe how little I know and I've been on this drug for eight years! I've never been so anxious in my life before and just feeling so emotional. I'm angry with myself for going onto Paroxetine not knowing what it was all about and now wonder if I'll ever be able to get off them completely.

 

My skin calmed down about half an hour after my shower but I can definitely feel like it's very sensitive. These physical symptoms are so frightening for me but listening to everyone's advice and support has been unbelievably reassuring.

 

I can't thank you enough

 

Africa

[nz11]

So FunkyBaboon what i think you are trying to say is ....there is enough 'food for Africa' at sa !

[Africa]

Hi FunkyBaboon

 

Thank you for this and I'm going to start Googling  now! I still have the red feet and hands after my warm shower but the red blotches on my entire face and chest just appeared today. it's almost like an allergic reaction. I'm so glad I had the advice to go back up to 7.5mg everyday and I just hope my body starts to stabilise soon.

 

Thank you so much for your help. You are all incredible.

 

Africa

[JanCarol]

Hey Africa:

 

 

You all seem so knowledgeable with SSRIS and I have learnt so much in the last few days. I can't believe how little I know and I've been on this drug for eight years! I've never been so anxious in my life before and just feeling so emotional. I'm angry with myself for going onto Paroxetine not knowing what it was all about and now wonder if I'll ever be able to get off them completely.

 

Don't blame yourself.  Really, none of us knew - including our DOCTORS!  And they have a duty-of-care thingy that they SHOULD know, but they don't.

 

You'll be able to get off, if that is what you want.  Those of us who taper slowly and carefully are able to reduce and then eliminate the drugs.  The reason we taper slowly, is to control the symptoms instead of letting them control us.  We choose when to have symptoms, and time our tapers around our lives, instead of following a doctor's calendar of "off the drug in a month" or whatever.

 

You have been careful with your taper to this point, all you need now is to hold, slow it down, wait for your brain to catch up before going again at a gentler pace.  You will get better!

[Africa]

Hi JanCarol

 

Thank you so much for your encouraging words. I woke up this morning and was blotchy all over my face and chest. It really does look like I'm having an allergic reaction. It's winter in England so I have the heating on and I have a really thick blanket over me. I'm assuming the heat aggravated my skin and caused a reaction. I panicked as usual but now that I've cooled down the welting has settled.

 

I called the doctor first thing this morning as I was beyond beside myself and she told me she thought I was having a reaction to the stress I am under and to take an antihistamine. I just don't think some doctors have any idea of what this drug is capable of doing to our bodies but all I know is that I definitely want to get it out my system. I need to stabilise first and then at least I know I have the support of all of you to eventually get off it.  

 

Thank you again

 

Africa

[AliG]

Hi Africa ,

 

It is so easy to panic over these symptoms, but if you can just stop and take a breath and read back over some of the links you have been given , and also explore some new ones , you will see all the " wild & wacky " symptoms , are completely " normal "  around here, in withdrawal.

 

You seem to have stabilized on 7.5mg . Give it time.

 

Have you read this  :  http://survivingantidepressants.org/index.php?/topic/6548-paresthesia-pins-needles-numbness-tingling-burning-sensations/

 

                                 http://survivingantidepressants.org/index.php?/topic/2390-dr-joseph-glenmullens-withdrawal-symptom-checklist/

 

This might help to reassure you.

Ali

[Africa]

Hi Ali

 

Thank you so much. When I start getting sore feet, prickly fingers etc I do just read back on these links to try and calm myself down. The tingling on my face is a bit better today but then the pins and needles under my feet and fingers seem to be worse than yesterday. I suppose it all takes time to settle.

 

I appreciate your support

 

Africa

[FunkyBaboon]

How are you measuring your 7.5mg doses?

[Africa]

Hi Funky

 

I'm using my pill cutter and cutting my 10mg tablet in half and then the one half I cut in half again. I try and get it as accurate as possible. Do you think that's okay?

 

Africa

[nz11]

it sounds an ok approach to me...at this stage.

 

some are weighing and some are taking liquid.

 

I think going foward when dose drops get smaller liquid may be a good way to go.

eg it mat not be so easy to get your next drop done accurately by eye estimation..... 6.75mg

 

Can u switch to liq at 7.5 in the next wee while.

[nz11]

I can't believe how little I know and I've been on this drug for eight years! I've never been so anxious in my life before and just feeling so emotional. I'm angry with myself for going onto Paroxetine not knowing what it was all about and now wonder if I'll ever be able to get off them completely.

 

Dont worry you and the everyone else ...we were all the same i took it for a similar period and didnt even know it was an ad didnt know what on earth an ssri was or that i was swallowing one. When taper hell hit i asked the doc if he was aware of any problems with people getting off this drug he said 'well if there were problems people would be suing the drug companies ...' i took it i was the problem and so started to look into it for myself stumbled upon a online suport read terrible stories about a drug called paxil ...was so glad i wasnt taking that ....then the bombshell fell ...i learnt paroxetine is paxil and so was aropax !

 

Dont worry about it after hanging around this forum for 10 mins you'll know heaps more than those people with lots of letters after their names.

[FunkyBaboon]

Given the symptoms you've been getting I'd suggest it's pretty important that your doses are as close to the same as possible. Like the others say pill cutting should be fine for now if you're getting it exact as you can but it may be worth thinking about getting some scales or using liquid when you get lower down.

 

I personally use a digital scale (http://www.amazon.co.uk/gp/product/B00ESHDGOI?psc=1&redirect=true&ref_=oh_aui_detailpage_o08_s00) that measures milligrams to try and get my fractions of pills as accurate as possible. Here is a post about using a digital scale to weigh out doses:

 

Using a digital scale to measure doses

 

Weighing out the doses is a pain in the arse ( ) but it helps get the doses exact.

 

I also use cellulose capsules to put crumbs and bits of pills into so that I can make up a couple of weeks worth of pills at a time so that it's a job once every now and again.