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Tips for tapering off Cymbalta (duloxetine)


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#1 Altostrata

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Posted 06 May 2011 - 11:26 AM

Cymbalta comes in 20 mg, 30 mg, and 60 mg capsules. Full prescribing information: http://pi.lilly.com/us/cymbalta-pi.pdf

Cymbalta is tricky to taper. It does not come in liquid form and cannot be compounded into a liquid. To protect the drug, each bead inside the gelatin capsule has an enteric coating to protect the drug from stomach acid, which would destroy the drug. (It is absorbed further down in the digestive tract.) The pellets cannot be dissolved in any liquid without destroying the active ingredient.

You cannot crush the pellets (see http://survivinganti...ndpost__p__3021 ) or dissolve them in a solution -- the drug would never get into your system, it would be destroyed in your stomach and you would have immediate cold-turkey withdrawal.

Of course, the range of dosages from the manufacturer is inadequate for very gradual tapering.

And, like all psychiatric drugs, do not take Cymbalta in alternating dosages. Its half-life is very short, about 12 hours. It is metabolized via the liver enzymes P450 1A2 (substrate, inhibitor) and 2D6 (inhibitor).

See Doctor is shocked at severe Cymbalta withdrawal symptoms

Reduce by 10% per month to start
As with any neurologically active drug, a conservative taper is the safest way to go off Cymbalta. Some people find they can go faster and some people find they have to go slower -- they can only tolerate decreases of a fraction of a milligram at a time.

A conservative taper for Cymbalta, like other psychiatric drugs is: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

See Why taper by 10% of my dosage?

Cymbalta CANNOT be compounded into a liquid or dissolved in a liquid
The pellets in the capsule cannot be dissolved in a liquid; this would destroy the active ingredient.
 

Opening capsules and counting out beads
Like Effexor XR, some people have tapered by opening the Cymbalta capsule and taking out the beads to gradually reduce the dosage. (See http://survivinganti...ndpost__p__2985 for the technique.)

The number of beads in each Cymbalta capsule will vary within a given dosage and across dosages. The capsules are filled by weight. Count your beads carefully. Put unused beads into a clean, dry, capped prescription bottle marked with the dosage of the original capsule and expiration date. You might want to use them later. Do not mix beads from capsules of different dosages, such as 30mg and 60mg.

 

NOTE When you are taking loose beads, put them in an empty capsule to swallow them. Gelatin capsules and vegetarian capsules are available at health food store. The FDA reports here http://www.fda.gov/d...s/ucm103473.pdf there have been some instances of the beads causing throat irritation when swallowed without a capsule.
 

Dividing contents of capsules into empty gelatin capsules
To make counting of the beads easier, this technique may work with Cymbalta, see details at
http://survivinganti...ndpost__p__3033

Opening capsules and weighing beads
Eventually, as you remove more and more beads, it may become too confusing and time-consuming to count out them. You may wish to weigh them instead, see Using a digital scale to measure doses and Counting beads in a capsule versus weighing.

Dividing contents of capsules into apple juice or applesauce
Follow the instructions above for dividing the contents of a capsule and put your reduced dose apple juice or applesauce.

---------
It has been scientifically demonstrated that the Cymbalta pellets survive being put into apple juice or applesauce but NOT chocolate pudding:

http://www.ncbi.nlm....pubmed/18691989

Clin Ther. 2008 Jul;30(7):1300-8.

In vitro stability, potency, and dissolution of duloxetine enteric-coated pellets after exposure to applesauce, apple juice, and chocolate pudding.

CONCLUSIONS:

Results from this study found that the enteric coating of duloxetine pellets mixed with applesauce or apple juice was not negatively affected. The pellets were stable at room temperature for < or = 2 hours and should quantitatively allow delivery of the full capsule dose, provided that the pellet integrity is maintained (ie, not crushed, chewed, or otherwise broken). Therefore, mixing duloxetine pellets with applesauce or apple juice appears to be an acceptable vehicle for administration. However, exposing the pellets to chocolate pudding damaged the pellets' enteric coating, suggesting that pudding may be an unacceptable vehicle for administration.
---------

Have a compounding pharmacy make up capsules of smaller dosages
For precise dosing, a compounding pharmacy will accurately weigh the doses and put them into capsules for you. See http://survivinganti...ndpost__p__3001

Reduce by micro-taper
The very smallest dose of Cymbalta is one bead. Some people find they can better tolerate a reduction of one bead at a time rather than a 10% decrease. You may be able to make reductions of one bead more frequently; try reducing by one bead a week for a while to see what your tolerance is. See http://survivinganti...or-5-decreases/
 
Do not reduce by one bead a day. This is too fast, you may develop withdrawal symptoms before you know what's happening.
 
Switch to Prozac
Like its fellow SNRI Effexor, withdrawal from Cymbalta can be very difficult. Recently, I asked a knowledgeable doctor about how he switches patients to Prozac.

He said if the dosage of Cymbalta is "normal" -- 30mg-40mg -- he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Cymbalta.

Later, taper off Prozac. He acknowledged Prozac can have its withdrawal problems, but given Prozac's long half-life, gradual tapering should be much easier than tapering off Cymbalta. And, at least Prozac comes in a liquid.

He confirmed that Cymbalta cannot be compounded because the pellets are enteric-coated to get the medication past the stomach acid, which destroys it. Other than the Prozac switch, he said counting pellets is the only way to taper.
 
See more about the Prozac switch http://survivinganti...ng-with-prozac/


Edited by Altostrata, 09 August 2014 - 09:54 AM.
updated information

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#2 Baxter

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Posted 16 May 2011 - 10:54 AM

This info looks correct if not exactly great news for those of us on the sh*t. I would have loved to have had Cynmbalta compounded instead of trying to count the little rascals daily while my cats and puppy "assisted" or rattled the door (distracting me and making me lose count) if I shut them out. cymbalta sucks, sucks, sucks.

 

My only advice to anybody who has a long a/d history is to crawl down. The w/d effects take months to subside sometimes. My rule of thumb is to wait until I felt recovered from the w/d symptoms before dropping even before I went on hiatus. Sometimes it took three or four months (even before this past year) until the internal turmoil/jitters/akathesia and insomnia abated. Most people don't believe it, even in poop-out you still need to crawl down. The more of a nerve ball you are the slower you should go.

 

I have been at 30 mg since July 2010. As I adjust to living with a partner instead of a housemate, burying my cats, re-doing my kitchen, I am too - wound up I guess to work on the taper. Even though I feel like Cym. continues to rot my brain. As soon as SO is more settled, the kitchen is fully functional, and the dog is not so - buoyant - I may try again. I wonder sometimes about the Prozac switch. But I don't think it would be helpful while I am still working.

 

I was on tricyclics, then MAOis back in the 1980s - because Prozac made me too anxious when it was the only wonder drug. I am a wicked nerve ball, always have been. In fact, the first year I was on paxil was my first experience with pleasure/peace of mind...ha, the things we learn on our travels.

 

My typical post-taper symptoms include: headache sweats nausea, heartburn increased anxiety increased jitters increased restlessness insomnia racing thoughts decreased attention span decreased short term memory brain fog difficulties with my balance irritability (worsens as my taper progresses)

 

I have been trying to do 20 minutes of mindfulness meditation every morning (achieving 4 times a week), and avoiding processed foods and artificial sweetners. (I confess I am a horrible sugar addict.) I have found that the closer to a protein/vegetable/fruit diet I stay (not terribly successful many times) the better I feel. I haven't been able to be totally pure, but I do eat a lot of fresh, raw or simply prepared vegetables. And I try my best to put my food $$ to organic for the 12 fruits and veggies that are the most soaked with pesticide.

 

After trying all the supplement recommendations that circulate in withdrawal circles - vitamins, Magnesium, Whey protein isolate, fish oils, melatonin and so on, I take NOTHING now, because either the substance made me more anxious (fish oil, multi vits with Bs, melatonin) or did nothing (whey protein, Mag, C, other supplements) I focus on my diet, getting outside every day even just for a few minutes and meditating.

 

The other major health issue for me, insomnia, is somewhat better after 10 months at one level. I invested in room darkening shades, ear plugs, and I try to turn off the computer and the tv before 8 pm. I do get enough sleep often enough in the past 3-4 months. I have a decent life, though I am still on 30mg.

 

My pause in tapering has probably been very helpful in allowing the poor receptors in my brain to repopulate in peace for a while. I would urge anybody who is trying to figure out if they want to taper to approach it from a harm reduction position rather than an absolute, get off of this sh*t as quickly as possible.


Edited by Petu, 16 January 2014 - 04:06 AM.
fixed text

ct Serax and Inderol April 2007
Cymbalta 60mg to 30mg 2007-2010
July 2010 - June 2011 on hiatus due to worsening w/d symptoms
June 2011 - 28mg Cymbalta

#3 Healing

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Posted 16 May 2011 - 11:08 AM

Thanks for this very helpful information for Cymbalta taperers, Baxter -- and for taperers in general. You are doing an incredible job! You have learned so much about how to handle this. I think harm reduction is a great philosophy in general -- just taking one, gentle step at a time away from what's harming us and toward whatever our goals are. More power to you! :)
1996-97 - Paxil x 9 months, tapered, suffered 8 months withdrawal but didn't know it was withdrawal, so...
1998-2001 - Zoloft, tapered, again unwittingly went into withdrawal, so...
2002-03 - Paxil x 20 months, developed severe headaches, so...
Sep 03 - May 05 - Paxil taper took 20 months, severe physical, moderate psychological symptoms
Sep 03 - Jun 05 - took Prozac to help with Paxil taper - not recommended
Jul 05 to date - post-taper, severe psychological, moderate physical symptoms, improving very slowly

#4 TonyG

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Posted 16 June 2011 - 04:21 PM

Has anyone experienced increased inflamation such as carpal tunnel or pinched nerve symptoms after starting to taper down off an antidepressant such as Cymbalta? It seems odd that I suddenly developed carpal tunnel and increased symptoms from a pinched neck nerve right after starting to taper. I've read some evidence that depression can cause inflamation in parts of the body, so I'm wondering about the possible connection.

#5 Altostrata

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Posted 16 June 2011 - 04:29 PM

With withdrawal, a lot of us seemed to develop aches and tingling pain in hands, arms, back, and shoulders, particularly on mousing side (in my case, my right hand does the mousing). Withdrawal seems to aggravate or stimulate hypersensitivity to pain in some areas, with symptoms that can be mistaken for fibromyalgia. (Others develop chronic fatigue-like patterns; both fibromyalgia and chronic fatigue syndrome have an autonomic component.) I found acupuncture to be helpful to relieve the symptoms I had (painful tingling in hands, arms, shoulder). How is your taper going, Tony? At what rate are you decreasing? Do you have any other symptoms?
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#6 TonyG

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Posted 18 June 2011 - 05:15 AM

I'm taking 30 mg Cymbalta about a month now, this after alternating days at 60 mg and 30 mg at the advice of my psychiatrist, which made me feel miserable. I still have fatigue and weakness but it's not as bad. My symptoms of numbness and weakness in my hands seem to be from carpal tunnel and a pinched nerve in my neck-- I'm being evaluated now by a neurologist so we'll see. Soon I'll reduce the Cymbalta to about 28 mg.

#7 Altostrata

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Posted 22 August 2011 - 08:48 AM

Did some surfing and found someone who had counted the pellets in Cymbalta capsules: Cymbalta size and number of pellets 30mg=250 pellets (approx.) 20mg=166 pellets 15mg=125 pellets 10mg=83 pellets 5mg=42 pellets Before you go by this, count the pellets in a couple of your capsules and verify. Please post your results in this topic!
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#8 CymbaltaDrone

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Posted 24 August 2011 - 01:36 PM

I'm coming off Cymbalta right now, too.

I'm recording my case history and experiene coming off it here in my introductory posting:

http://survivinganti...-without-drugs/

Short story: On Cymbalta 60 mg for 3 yrs. Dropped to 30 mg one month ago. Stopped (almost) altogether 2 weeks ago. Have taken three ~15 mg doses over the last 2 weeks when discontinuation symptoms became intolerable. The most recent of these was 5 days ago.

After that last dose of ~15mg 5 days ago, I experienced (as expected) progressively worse discontinuation symptoms (also listed on my intro page) on days 3 and 4. THey got very bad yesterday afternoon but I was out and about with no access to meds so I had to push through it. By the time I got home in the evening the crisi had passed and I've felt better since. I realise that this goes against the tapering recommendations on this site, but since I have arrived where I am rather unintentionally I am going to continue to see what pans out. Perhaps this is the end of it for me - I can always hope!
CymbaltaDrone
(almost) drug free since mid August 2011
Cymbalta 3 yrs in combo with Wellbutrin 2yrs, Seroquel "as needed"
Zoloft prescribed a couple of times during teens

You are your own best - and possibly only - health advocate. Nobody cares as much about your health and wellbeing as you do, no matter what they may tell you. You cannot sit back and just "trust" the experts, who may well not care about your health at all.

Psychiatry is a horrific fraud being perpetuated on our civilisation. One day, I'm sure it will be exposed. Until then, we've got to share our stories and help each other as we are able.


#9 Altostrata

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Posted 25 August 2011 - 03:19 PM

You could be lucky, CD -- and I sure hope so -- but I would not recommend your method for everyone. What we know of the nervous system is that it doesn't like sudden changes. Tapering should lead it down the incline gradually, so it can adjust along the way. Jolting back and forth in dosage -- definitely not a gradual incline. However, everyone is different and your nervous system may recover quickly.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#10 Altostrata

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Posted 30 September 2011 - 03:15 PM

TonyG, I moved your post to your update topic http://survivinganti...ch__1#entry3788
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#11 Altostrata

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Posted 20 April 2012 - 10:22 AM

Having difficulty getting off Cymbalta, one of our members cross-tapered from Cymbalta to Celexa, see http://survivinganti...dpost__p__20652
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#12 Altostrata

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Posted 25 February 2013 - 09:45 AM

Pancho, I moved your post here http://survivinganti...o-off-cymbalta/
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#13 chronic

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Posted 05 March 2013 - 09:00 AM

I just opened my Cymbalta 60 mg capsule and counted the contents. I found approximately 190 tiny pellets inside. Ten percent would be 19-20 pellets, so to taper by ten percent drops, remove 19-20 pellets at first drop. Decreases become progressively smaller in number of pellets. or: (190 - 19 = 181) (181 - 18 = 163) (163 - 16 = 147) (147 - 15 = 132) (132 - 13 = 119) etc This would give over 15 steps if you really decreased only 10% each step. Probably most people can taper it faster, don't you think? Even 20% drops gives over 14 levels, although they are small changes near the end. ( 190, 152, 122, 98, 78, 62, 50, 40, 32, 26, 21, 17, 14, 11 granules per level is 20% less each level ) I see my doc next week and will be interested to see what he recommends. Bet he wants me to keep on the same old dose. We shall see.

#14 Altostrata

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Posted 05 March 2013 - 11:47 AM

People vary in their tolerance for dosage reduction. Your plan sounds like a good one, try it for a couple of months and see how you do. You may be able to speed up (make reductions every 3 weeks, then every 2 weeks) or you may need to slow down. A taper takes as long as it takes. chronic, please start a topic for yourself in the Intro forum and let us know what your doctor says.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#15 TiredofCymbalta

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Posted 04 April 2013 - 10:48 AM

I found this group a few months ago and have started the taper down method listed on here. I was on 60mg for 8 years, to 40mg for a year, then down to 30 mg for a month, down to 20 for the last month. I am now tapering down to 15 mg for a month. This method is so far working great for me!!!! Very little withdrawl symptoms!!!! I am very thankful to have found this site and to have found suggestions to weaning off the drug from hell as I call it. My Dr. had no clue as to how to help me wean off Cymbalta. Again I am very glad to have found this group!!!!!

#16 Altostrata

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Posted 04 April 2013 - 02:24 PM

Thank you, TiredofCymbalta. When you have a chance, please open a topic for yourself in our Introductions forum and let us know how your taper is going.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#17 dazygirl

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Posted 24 June 2013 - 06:33 PM

I am also very glad to have found this site! I cannot believe ALL THE GREAT INFORMATION! It's Awesome! Thank you


prozac many years

effexor cr a year?

cymbalta 60.mg  2-3 years

cymbalta 30mg. for  9 days. 9th day june 23rd 2013

started fluoxetine 10mg on day 8 of cymbalta 30mg. june 22nd 2013

risperidone 1mg. for 2-3 years

clonazepam 1mg. per day for 2-3 years

alpralozam as needed 1 year


#18 jcon13

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Posted 12 August 2013 - 04:51 PM

As I wrote in my introduction, my doctor originally told me to taper from a daily 60mg cymbalta dose to taking 30mg for a week and then stopping.  I experienced extreme side effects, so much so that I went back to taking 60mg/day until I could speak to another doctor who has some expertise in SSRIs (I've learned more on this site than my doctor seems to know).  

 

When I was taking 30mg/day, I would feel fine for around half a day, and then all of a sudden my lips would begin to tingle and I would get light headed and I knew the side effects were coming, so I would take another 30mg and after around 1hr I would feel better.  Now that I'm back up to 60mg/day, I'm still experiencing this effect of the onset of symptoms, except that it takes longer, usually around 22hrs after the previous dose.  

 

When I was on my original dose of 60mg/day (prior to attempting a taper), I never felt like I was "on the clock" with the cymbalta.  Now it's come to the point where I'm carrying my pills around with me just in case the symptoms come on earlier than expected, because I cannot function if I let them get to full strength.  It makes sense to me that I would experience this phenomenon when I downgraded to 30mg/day with the half life of the drug, but I don't understand why I'm still experiencing it now that I'm back to 60mg/day.  It makes me feel like there has been some permanent changes made in my brain.  Curious if anyone has experienced anything similar to this.  Thank you.

 

Justin


Cymbalta 60mg for 9 months foReflex Sympathetic Dystrophy

Attempting to wean off

Withdrawal symptoms:

Brain zaps

anxiety

insomnia

agitation

tingling lips

light head

restlessness

jitters


#19 Altostrata

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Posted 13 August 2013 - 08:11 AM

It's because your system was destabilized by the drop from 60mg to 30mg. This will cause you to be more sensitive to when the Cymbalta is wearing off. Hopefully, as you continue to consistently take it, your system will adapt to 60mg Cymbalta as a steady state.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#20 cathylp

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Posted 19 September 2013 - 06:05 AM

I have been on 120 mg of Cymbal ta every day off & on for 12 years for my fibromyalgia. In March last year my son died & Viibryd 40 mg was added.I am seeing the doctor today about getting off them both. My MDD is doing well but the cymbalta is just not helping the fibrous anymore so I decided this was a good time to get off all the poison. I'll let you know how it goes.

#21 Altostrata

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Posted 19 September 2013 - 11:03 AM

Thanks, cathy. That is a very high dose of Cymbalta! Please start a topic for yourself in the Introductions forum to track your progress.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#22 Fighter44

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Posted 04 December 2013 - 11:24 AM

Cathylp,  I am also on a high dose of Cymbalta - 120 mg.  It has been very helpful for depression and anxiety.  However, I am working on tapering down a bit.  Want to see what might be a maintenance dose.

 

The effects I am having:  My med person and I have moved me to 100 mg.  It has been 5 or 6 days.  I have had some of the withdrawal symptoms about which others have written.  Had a few zaps the first day.  Tired in the afternoons most of the days.  Good energy the first two hours of the last two days.  Easy access to tears, but the darkness. Quicker to getting irritable. 

 

What has been helping:  Breathing helps.  I have a light I use in the am's to help me on gloomy days (we are in later fall right now).  Exercise helps.  Compassion for myself helps.   A guided imagery recording helps.  I will talk about it to my counselor today.  My partner and I cuddle.  If I feel tears, I let them come.  No matter there is no reason for them.  It is just the chemistry talking.  I work out in the mornings when I can.  I hug the dog.  Not crazy, not lazy, just adjusting.


MDD First episode 1993                   imipramine - good - off after 15 months

MDD                       2002                   Prozac - bad; Zoloft - good - off after 13 months

MDD/A                    2005                   Zoloft - on

MDD/A                    2006                   Zoloft - pooped out; Lexapro - bad; Cymbalta - good

MDD/A                    2007                   Cymbalta + Lamictal + Abilify (poor) + Lorazepam

MDD/A                    2008 - 2011        Cymbalta + Lamictal +Seroquel + Lorazepam

MDD/A remission   2011 - 2013         120 mg Cymbalta + 200 mg Lamictal

MDD/A remission   2014                     tapered to 60 mg Cymbalta + 150 mg Lamictal by June.


#23 jvalhop

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Posted 02 January 2014 - 08:07 AM

(Tapering from Cymbalta) After reading many of these posts, I contacted my dr. immediately after experiencing major dabilitating side effects, which not only physically brought me to my knees, but mentally as well... i mentioned the Prozac connection I had read here, and we decided to start that right away.. In the meantime, I reach out to others I know who have experienced this, and I try to act opposite, and sometimes think opposite of what I'm doing and thinking.  I started recording  all the things I've accomplished during the day despite my aches/pains/fears, and I've recorded the symptoms I've experienced as well.  My dr conversed with a collegue and decided to jump me right to the 20mg of Prozac, as I am counting beads of Cymbalta at this point and am around 10ish mg of... I've always been med sensitive and am with this taper as well.. My pharmacist is also a friend and great resource and once I explained the plan she was giddy, and happy to see that the chemistry makes sense and the withdrawals should fade... and then, my intention, though probably slower than others, i will begin the taper of Prozac.  What a ride.....I'm calling it a final farewell and letting go to many things....


after getting sober cold turkey, I experienced withdrawal and was thrown numerous meds to cure my "anxiety/depression."

I was put on Cymbalta 5 1/2 years ago.

 

My highest dosage was 60mgs.  I started tapering from 60mg in August 2013

I tapered down to alternating doses of roughly 10mg (I counted beads) and zero.- every other day, starting the week before Christmas 2013

Once I went without Cymbalta all withdrawal effects started so I went back to 10mg everyday.

Now, my doctor has me back up to 20mg of Cymbalta, and we've added Prozac

I've been on 10 mg of Prozac for 3 days, and 20mg for one day.. 

and anxiously awaiting the final tapering of Cymbalta....

 

 


#24 Altostrata

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Posted 02 January 2014 - 09:04 AM

Good luck. Given your drug sensitivities, 20mg Prozac may be too much. Please consider 10mg.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#25 jvalhop

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Posted 03 January 2014 - 05:57 AM

I talked to my pharmacist and she mentioned taking 10mg prozac one day then 20mg prozac the next....?  alternating.....

 

Also, what does "20mg Prozac may be too much" mean...? Will I physically notice like rapid heart beats, high temperature...?

 

Thanks, -Jen


after getting sober cold turkey, I experienced withdrawal and was thrown numerous meds to cure my "anxiety/depression."

I was put on Cymbalta 5 1/2 years ago.

 

My highest dosage was 60mgs.  I started tapering from 60mg in August 2013

I tapered down to alternating doses of roughly 10mg (I counted beads) and zero.- every other day, starting the week before Christmas 2013

Once I went without Cymbalta all withdrawal effects started so I went back to 10mg everyday.

Now, my doctor has me back up to 20mg of Cymbalta, and we've added Prozac

I've been on 10 mg of Prozac for 3 days, and 20mg for one day.. 

and anxiously awaiting the final tapering of Cymbalta....

 

 


#26 Altostrata

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Posted 03 January 2014 - 02:11 PM

Yes, rapid heart beat, sweating, and sleep disruption could be signs of too high dosage of Prozac or other antidepressants. In general, you will feel overstimulated or oversedated.

As explained carefully above and in many, many other places on this site, we caution against alternating dosages of Prozac or any other psychiatric drug. Consistency of dosing is essential to gradual tapering.

Many doctors, pharmacists, nurses, naturopaths, acupuncturists, homeopaths, herbalists, store clerks, postal carriers, tree trimmers, short-order cooks, etc. will suggest skipping doses or alterating dosages. They are mistaken. That is a way to go off psychiatric drugs that increases the risk of withdrawal syndrome.

If you wish to skip or alternate doses, it's your decision and your risk.

Edited by Altostrata, 14 January 2014 - 04:03 PM.
fixed text

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#27 taltal

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Posted 02 February 2014 - 07:29 AM

I'm starting today to quit Cymbalta from 60 mg.
in my count the full 60 mg capsule have 582 pellet.
(only counted once, so maybe I missed a pellet or two).


#28 Altostrata

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Posted 02 February 2014 - 11:10 AM

taltal, the number of pellets in a capsule varies among manufacturers and even within dosages. Please be conservative in your estimates.

 

Please start a topic for yourself in the Introductions forum and share your tapering progress there.


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#29 Altostrata

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Posted 17 February 2014 - 02:13 PM

crashtest1944, I moved your post to http://survivinganti...ering-cymbalta/


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#30 Urbansound

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Posted 03 May 2014 - 08:02 AM

Cymbalta comes in 20 mg, 30 mg, and 60 mg capsules. [...]

 

Do not reduce by one bead a day. This is too fast, you may develop withdrawal symptoms before you know what's happening.

 

Switch to Prozac
Like its fellow SNRI Effexor, withdrawal from Cymbalta can be very difficult. Recently, I asked a knowledgeable doctor about how he switches patients to Prozac.

He said if the dosage of Cymbalta is "normal" -- 30mg-40mg -- he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Cymbalta.

Later, taper off Prozac. He acknowledged Prozac can have its withdrawal problems, but given Prozac's long half-life, gradual tapering should be much easier than tapering off Cymbalta. And, at least Prozac comes in a liquid.

He confirmed that Cymbalta cannot be compounded because the pellets are enteric-coated to get the medication past the stomach acid, which destroys it. Other than the Prozac switch, he said counting pellets is the only way to taper.

 

See more about the Prozac switch http://survivinganti...ng-with-prozac/

 

Great article by the way, thank you...

 

Care should be taken in the consideration of using the "Switch to SSRI only" method withdrawing from Cymbalta.   Evidence is being found that discontinuation of SNRI bassis, (Cymbalta) has a potential compounding side effect of increasing SSRI mediated complications.  For those on high doses of both Prozac and Cymbalta this can have life threatening potentials if they should find they are among the percentage who deal with greater side effects of discontinuation.

 

Most doctors remain seriously undereducated on these potential cumulative effects which can invite emergency room exposures where even worse complications can arrise from misdiagnosis and improper handling.

 

While the quoted article refers to a doctor noting those on "normal doses", readers should be aware to consider what their individual doses are and understand it can take WEEKS for full side efffects to emerge to a critical level of such error.  This delay can further mislead from the true underlying cause withdrawal causes, especially in a complicated medical profile of multiple Rx's.

 

Reference background... http://www.ncbi.nlm....les/PMC1681629/ noting the effect relative to Venlafaxine, a similar SNRI.



#31 Altostrata

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Posted 03 May 2014 - 09:37 AM

Thank you for that information, Urbansound. You may note that the topic The Prozac switch or "bridging" with Prozac is loaded with caveats.

 

We also suggest attempting a direct taper from Cymbalta (or other antidepressant) is preferable to taking on the risk of a switch to Prozac.

According to the information in The Prozac switch or "bridging" with Prozac, the safest way to accomplish the Prozac switch appears to be a short-term overlap of Cymbalta with a relatively low dose of Prozac, discontinuing the Cymbalta before cumulative effects can occur.


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#32 Gayle

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Posted 02 August 2014 - 03:07 AM

Thank you so much for the great information here.  I plan to start tapering soon and have a question about taking the lower doses.  I understand reducing by only 10% at a time (for long periods of time before decreasing again) is the preferred method.  Is it better to take the beads with applesauce/apple juice or to just put the beads in another empty capsule and swallow it as normal?


Hi, I'm Gayle. Born in and still living in So. Calif.

Addicted to Cymbalta for many years.

Tried to withdraw (incorrectly) earlier this year.

Found y'all.  :c)

Looking for a doctor to help me withdraw safely, and with the least amount of pain and suffering.


#33 Altostrata

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Posted 09 August 2014 - 09:47 AM

I would put them in an empty capsule. Please see the first post in this topic.


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