Altostrata

Tips for tapering off Effexor and Effexor XR (venlafaxine)

192 posts in this topic

Question:  I am tapering from 37.5 mg XR 

 

What would be the effect if I went to REGULAR Effexor to taper next?

 

My doctor prescribed me 25mg Effexor but they are regular, not XR.

 

Anyone have experience with that?

Share this post


Link to post
Share on other sites

XR can be   tapered  by counting beads, but regular can be made into a liquid which is much easier

when you get to lower doses. Regular needs to be taken 2x daily because it is released immediately.

 

I've tapered with the beads but if I was to start again I think I would go with tablets if they were available

and make the liquid. 

Share this post


Link to post
Share on other sites

So it's just a matter of how fast or slow it's released and I can actually go to regular from XR without any issues, right?

I am thinking I will go down to about 33 mg next (am currently on 37.5) and take 17mg in the morning, 16mg 12 hours later.  

 

My tablet will be 25mg so I can divide it up into 6, and take 4 of them in the morning, 4 the next time. 

Share this post


Link to post
Share on other sites

If you can divide a tablet up precisely, fine. Otherwise, the liquid is a more accurate way to taper. This becomes important when you get down to very low dosages.

Share this post


Link to post
Share on other sites

You can taper at the rate your nervous system tolerates. However, withdrawal symptoms can take some time to coalesce. If you make a change in dose every couple of days, after 2 or 3 weeks withdrawal might catch up with you. Then you are up the creek.

 

My partner's naturopath has recommended that instead of starting a 10% taper held for a one month period, that he do a 5% cut at 2 week intervals. However, from reading the comments in this thread, I'm wondering if sticking with the 10% is better. If there is frequently a 2 week lag for possible withdrawal symptoms, then maybe one wouldn't know if the symptoms were from the first two weeks' 5% or the second two week 5%. Am I understanding this correctly?

Share this post


Link to post
Share on other sites

LovingSupport, your understanding is correct.

 

Reducing by 5%, though, is less risky than reducing by 10%. So it could work for your partner. That naturopath's advice was not terrible.

Share this post


Link to post
Share on other sites

I am not reducing the effexor by strictly adhering to the 10% method, but I am taking things ultra slow. To be honest I find the 10% method confusing. Instead, I purchased these scales and every three to four weeks I remove slightly more pellets from the capsule. http://www.amazon.co.uk/Neewer-0-001g-20g-Digital-Jewelry-Diamond/dp/B007H4AR28
 

This is what I do. Let's say the capsule weighs 0.650mg. I will open it and remove enough so that it now weighs 0.645mg and stick to that for three to four weeks depending on how I'm feeling. That is how I am tapering and so far it has served me well. I did make the mistake of getting cocky and I started to taper much faster. This led to terrible stomach cramps and headaches so I am now utterly convinced that very slow and steady will win this race.

 

I have been tapering for a year now. When I started, my 150mg capsules weighed in at approximately 0.670mg but by very slowly removing beads using the method outlined above, my capsules now weigh 0.400mg. By anyone's standards this is extremely slow progress but I'm in no hurry. Obviously as I get down to a lower dose I will have to be more careful and take things even slower but at present things are working rather well for me I am glad to say.
 

Share this post


Link to post
Share on other sites

Venlafaxine is tricky and you seem to be doing fine Harmonica, listening to your body is crucial as

you have discovered. I was a bit haphazard with my tapering and not as precise as you are, which led to a too 

fast taper and withdrawal.  You are right about being more careful at the lower doses but you seem to be very

clued up I'm sure you'll be fine.  Keep us updated how it's going.  :)

Share this post


Link to post
Share on other sites

Thanks Mammap. I must say that I am very tempted to speed it up a little. At present I am taking 0.005mg out of each capsule and then stabilising for a month. So a capsule that weighs 0.670mg would then weigh 0.665mg and so on. I think in the new year I am going to start taking out 0.010 each month isntead. Only until I reach a lower dose.

 

Previously when I went too fast I was opening up the capsule each day and taking 3 or four beads out. Then the next day it was 3 or 4 more and so on. I think the issue here was I never gave my body the chance to stabilise which is what cause the problems. After a month or so it all just caught up with my system.

 

My 150mg capsules now weight 0.400mg from the 0.670mg they were when I started my taper. As long as I give myself time to stabilise I'm pretty sure that going to 0.390 next month and then 0.380 the following month will be ok. It would still be less than the 10% I think, at least until I reached a substantially lower dose?

 

Reading the sticky at the top of this page with the graph showing how tapering at small doses can be particularly problematic, this is where I feel I will really need to begin to get ultra slow and careful. http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

When I reach the 0.250 mark I would properly reign it in a bit and slow right down. That's the plan for the new year I think.

Share this post


Link to post
Share on other sites

If you find you have some kind of withdrawal symptoms in the afternoon, you may wish to split the dose. If you are still taking extended-release beads, there may be no need for you to split the dose.

Share this post


Link to post
Share on other sites

I just can't see how such a small dose (even with extended release) could last the full 24 hours without causing some issues. It's seems more logical to me to simply space it out, although as you say, it would be better to try the one dose a day first as this may be ok. No point in complicating things when it's not needed. I might decide to hit the benadryl instead. Although I am a long way off from these decisions.

Share this post


Link to post
Share on other sites

I take only 2 beads now and take them once a day. As you get lower in dose your body adjusts to it.

The coating on the beads is what controls the release of the drug. I do find that an hour before my

dose is due I get a tiny bit fuzzy but I take other stuff too and think it is that which makes me fuzzy

when I need it. 

Share this post


Link to post
Share on other sites

Hi! I'm on Venlafaxine 150mg XT Bluefish. I opened the capsule and expected a lot of beads, but there are only 12 little pills in it. My plan is tot start taking out 1 pill every 2 to 4 weeks. Maybe every two weeks in the beginning and later, every 4 weeks. I don't think I can cut these pills in two, so I'm a bit worried about the withdrawal when I'm further in the process.. Any advice is welcome! :)

Share this post


Link to post
Share on other sites

Taking out 1 of 12 pills is an 8% decrease. That would be fairly safe the first month.

 

The second month, with 11 pills left, you would be decreasing by 1 pill or 9%. The third month, 1 of 10 pills or 10%. Also fairly safe for the second and third months.

 

The fourth month, you'd have 9 pills. Reducing by 1 pill would be a 11% decrease. You might get by with that.

 

The fifth month, you'd have 8 pills. Reducing by 1 pill would be a 12.5% decrease. This is getting a little risky, as we recommend no more than a 10% reduction.

 

I suggest you talk to a pharmacist to find out what happens when you split one of those pills. It could be you have no problems reducing by greater than 10%, but if you do, you might want to have a plan for more gradual tapering after the fourth month.

Share this post


Link to post
Share on other sites

You might also phone the manufacturer and see if you can get any information about the composition of the smaller tablets. Sometimes the time-release mechanism is integrated into the pill and if you cut it, the pieces are still time-release.

 

Please post what you find out here, with the name of the manufacturer.

Share this post


Link to post
Share on other sites

Hey SA people,

 

I tried to use the forum search tool to answer these questions but couldn't find them. Sorry if these were actually covered somewhere!

 

Context: I've been tapering 37.5mg Effexor XR for about 18 months now, using the bead method. Now down to 7 beads, but having trouble.

 

1) Can I send my remaining Effexor XR dose to a lab to measure its concentration? 
With 7 beads left, I don't know how much to measure out for a regular Effexor liquid solution if I was to switch. At this low dosage, accuracy seems to count for a lot. Do I have to taper back up to 37.5mg and switch to the solution? ... :wacko:

 

2) Do repeated failed attempts to taper down have consequences?
For instance, say you taper down 2 beads, and find you can't handle w/d. You add back 2 beads and try again some time later after letting your brain stabilise. Is it easier or harder the second time -- should you always try to 'ride out' the new lower dose no matter how bad the w/d so you don't agitate your brain/sensitivities?

3) Do longer 'holds' actually work with the bead method?
When you only have a few beads left, each successive bead you take out counts for a larger % than the last one. Even if you go through an extra long hold, the dosage drop is still the same amount if you take out a bead, which may be drastic at lower dosages.
Ie is taking the liquid form the only way around this, or can you get away with being more patient with longer holds?

 

Thank you all.

Share this post


Link to post
Share on other sites

Correct, longer holds work. For some drugs that can be tapered only by bead counting (Cymbalta, I'm looking at you), this is about the only way to do it.
 
To find out how much 7 beads represents in milligrams:
 
1) Count the number of beads in a few full 37.5mg capsules.

 

2) Calculate the average number of beads per capsule, e.g. 250 beads. This would be equal to 37.5mg.

 

3) Calculate the number of milligrams represented by 7 beads.

 

4) Figure out how you want to make a liquid from regular Effexor.

 

5) Determine how to take the number of milligrams you found in step #3.

 

Alternatively, do the calculations by weight of beads in 37.5mg without the gelatin capsule. You might ask a pharmacist to weigh the beads from a few full 37.5mg capsules for you, or weigh them yourself with a digital scale (see Using a digital scale to measure doses).

Share this post


Link to post
Share on other sites
2) Do repeated failed attempts to taper down have consequences?

For instance, say you taper down 2 beads, and find you can't handle w/d. You add back 2 beads and try again some time later after letting your brain stabilise. Is it easier or harder the second time -- should you always try to 'ride out' the new lower dose no matter how bad the w/d so you don't agitate your brain/sensitivities?

 

 

If you make small changes, then you will have small consequences.  For example, if you are down to 10 beads and you reduce by 5, and need to updose back to 9 because the cut was to big, this will be 2 big changes and will cause more disruption.  But if you had cut from 10 down to 8 and then needed to go back up to 9, then the disruption would be smaller.

 

If I had tapered down 2 beads and felt I needed to updose, I would first try adding back 1 bead. 

 

If you notice that the intensity of your symptoms are increasing after each cut, then this is usually a sign that you need to make smaller cuts.  The 10% method is a guide, and a suggested starting place.  Everyone needs to pay attention to their own body and symptoms, some people can go faster and some need to go slower, especially as the dose gets lower.  If you are monitoring your symptom pattern after each cut and adjusting your taper accordingly, its less likely there will be failed attempts.

Share this post


Link to post
Share on other sites

Thanks Alto and Petu,

 

I think I'm at the point where even 1 bead is too much of a drop now, at least that's what happened last week. It turns out making a solution may not be an option for me anymore, which means that the only option left would be longer holds. I PRAY you are right about this, or else I'm in trouble! It's too bad you can't crush XR beads. 

 

Petu, I gave a bad example...I'm only removing 1 bead at a time so the only way is to add 1 bead back. I failed doing this last week (went down a bead, then back up). So say I try again in 3 months and I fail again. Does repeatedly yoyo-ing like this make it increasingly harder to drop a bead and stay there, as if your brain 'remembers' and you develop some kind of resistance to dropping? Hope that makes sense.

 

mammaP ... I saw you're near the end of your taper using the bead method as well. How have you been finding it?

Share this post


Link to post
Share on other sites

What you could do is make a liquid from some regular Effexor and take tiny doses occasionally to take the edge off the symptoms you feel when you reduce.

 

This could also be the way you transition off the last bead and onto the liquid.

 

People do this in going off Pristiq, Effexor's sibling, which lacks a range of dosages -- they take tiny crumbs occasionally. This seems to help them get past rough spots.

Share this post


Link to post
Share on other sites

That's a good idea Alto, if I'm able to get a hold of regular Effexor. Not sure how much I would use as a boost. Maybe 10%.


 


Btw, I'm not sure what's happening with me right now... I've been making a journal of my tapering and the effects, which I think is good for everyone to do if they already aren't.


 


About 7 days ago I tapered down a bead. Got increasingly worse symptoms over the next 3 days and had to go back up a bead. The next few days I felt better, everyday better than the last until I was at about 80% on the 4th day. Cool, that's expected. Then out of nowhere, huge anxiety attacks that night, woke up this morning with anxiety and 'brain fog'...head feels this weird pressure as if my brain is straining but doesn't hurt(??). This has never happened before in the past...is this all my previous taperings catching up? Help please!


Share this post


Link to post
Share on other sites

If I were you, I'd stay at 7 beads until you can make liquid from regular Effexor. Once you make it, I might try 0.10mg in the evening, assuming you're taking the bead in the morning.

Share this post


Link to post
Share on other sites

That little eh? But that's interesting combining the capsules with a Effexor solution 'bump'. I read somewhere on here that there's a risk of some side effects when switching from capsule to solution form, but I guess I'll keep you posted on what happens if you take both.

Share this post


Link to post
Share on other sites

The AB rating refers to drugs that may be substituted by the pharmacist.

 

If you were expecting extended-release venlafaxine, it would definitely be dangerous if your prescription was filled with immediate-release venlafaxine, and vice versa.

 

Immediate-release venlafaxine is dosed twice a day. If you take them correctly, you can (carefully) substitute one for the other. We have many people who have finished their tapers off venlafaxine with liquids made from the immediate-release type.

 

I have revised post #1 to explain this. Please re-read it; I hope it's clearer.

Share this post


Link to post
Share on other sites

Thanks Alto,

 

I found some notes that are taken from this site http://www.clinical-depression.co.uk/anti-depressants-withdrawal/

 

They suggest some specific schedules on how to switch from capsule to tablet, amongst other useful info. They also note though:

"Taking a short half life tablet twice per day will lead to little accumulation in the body. Some drugs have

a longer half-life and may remain in the body at significant concentrations for several days. This results in
an accumulation of the drug in the body. Understanding this is particularly important where a medication
like venlafaxine has more than one form. Changing from one form to another at the same dosage level can
lead to major changes in body concentration and withdrawal problems. "
 
So might not be as simple as straight substituting half the XR capsule dose for half the tablet dose for instance. Might even want to updose slightly for the tablet?

You can read the notes here:

Share this post


Link to post
Share on other sites

I don't believe that's correct. It's authored by an interested non-doctor. According to the clinical research, the two types are equivalent. Regular dosing over about 4 days leads to "steady-state" levels in the bloodstream, which go through the same metabolization processes.

 

Switching from an extended-release formulation to immediate-release, or from a tablet to a liquid, can incur idiosyncratic difficulties.

 

We do suggest gradually conversion from Effexor XR to the immediate-release form, converting a part of a dose initially, to allow the body to adjust to the different form.

Share this post


Link to post
Share on other sites

Hi,

Is there anyone on the site who lives in England who is on Venlafaxine XR 37.5 capsules.  When I went to my GP he wasn't helpful and said he needs the name to put on the script.  I said venlafaxine but I suppose he meant the generic name.  Anyone know what they are called so I can ask for them.  The last time he gave me capsules they were the ones with 3 little mini pills inside not the small balls.  I already have my scales.

 

Thanks

 

Myrtle/Poppy

Share this post


Link to post
Share on other sites

Hi, I am  thinking of buying capsules to put the extra balls from the capsule in.  Does anyone know what I should look for, is it gelatin capsules and also I am worried that they will work in the body differently from the ones that come with the initial medication.

 

Poppy

Share this post


Link to post
Share on other sites

Hi Poppy

I buy the gelatin capsules through amazon.

Size 0 to fill in with the effexor beads.

I don't think the capsule itself is a problem because the beads are in themselves time release.

Share this post


Link to post
Share on other sites

Correct, Lexy!

Share this post


Link to post
Share on other sites

Thanks Lexy, it was the size I wasn't sure about but now I know.  I will look to order them.

We did have fun and games opening up the capsules but I am sure it will get better with practice.  We used a icing nozzle as a funnel which worked well.

 

Kindest regards,

Poppy

Share this post


Link to post
Share on other sites

Question about Slow Taper Method for Effexor XR:

My partner has followed the protocol of 10% reductions, first two reductions at 1 month intervals, second two reductions at 3 week intervals, and now is starting on the second reduction of 2 week intervals. My question to you all is this: if he has had almost no withdrawal symptoms so far (2 minor "zaps" during the last four months), is it appropriate to move down to 1 week intervals at the next round?

 

I'm not familiar with all the different AD drugs, and want to make sure that Effexor XR does not tend to be more problematic at 1 week intervals compared to other AD drugs after slow tapering gets the person down to the 1-week level of intervals.

 

Thanks in advance for your input.

Share this post


Link to post
Share on other sites

i think you need to stay at AT LEAST 3 weekly reductions because the reductions are cumulative and as you get lower taking weekly or 2 weekly drops will catch up with you.

 

I also had no withdrawal symptoms as i went down - until i went too far and got anxiety, depression and the works

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now