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Tips for tapering off Cymbalta (duloxetine)

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felin, you will want to use the same Cymbalta dosage and manufacturer throughout your taper. I would save the beads you do not use in a tightly closed container (such as a medicine container) for future use.

 

Mark the container with the dosage and manufacturer of the original capsule.

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This is a question to everyone who has come off Cymbalta using more ore less a tapering strategy. I see a lot of taperers here and in other places who are still in the process of tapering (myself included - 8,44 mg currently). I was wondering if there is anyone who could share experiences about reaching the end of this journey - completely coming off Cymbalta using a tapering technique. 

 

My question is - can you share experiences on what was the last dose you took before coming completely off and how did your body and mind react to the last taper. (I know the ideal would be to come down to... well probably taking one bead, but I am fairly sure not everyone has the patience in the end).

 

I am wondering whether the final coming off was worse than let's say a 10% taper for you or was it easier towards the end. I myself have intolerable withdrawal symptoms even reducing 5% of the drug. They are unbearable, both physically and mentally. They totally incapacitate me for weeks (I sleep up to 15h a day, terrible brain fog and dizziness up to the point where I cannot walk, of course the brain zaps and lots of pains in different parts of the body etc) (I will not mention the mental effects, they are really bad...) and then on it is still bad but keeps stabilizing very slowly.

 

At this point (after tapering for years) I am seriously considering coming off the 8,44 mg altogether because I am just unable to go through the symptoms that come after a reduction so many times any more. Because the withdrawal symptoms are extreme for me I am thinking it would be better to cut off the drug now at 8,44 mg and hope the nervous system will start balancing itself out than to go through this hell for at least another year (which is the very optimistic time frame).

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My heart goes out to you erer! I have been so ill for so many years and haven't yet begun my tapering. I'm both anxious and scared half to death to get started. I utterly despise what these drugs have done to people. It's like being imprisoned.

 

May I ask at what pace you've gone in tapering Cymbalta? and... how long the coming off symptoms last? Do they ever get better before next reduction?

 

Thank you and again I'm so sorry for what you are going through. It makes me downright angry for you.

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Thank you for the links!

 

 

My heart goes out to you erer! I have been so ill for so many years and haven't yet begun my tapering. I'm both anxious and scared half to death to get started. I utterly despise what these drugs have done to people. It's like being imprisoned.

 

May I ask at what pace you've gone in tapering Cymbalta? and... how long the coming off symptoms last? Do they ever get better before next reduction?

 

Thank you and again I'm so sorry for what you are going through. It makes me downright angry for you.

 

It warms my heart to read your kind words. Your compassion is much appreciated! 

 

I have been tapering at different pace throughout the process. Since the beginning I have made the reductions by 10% or even 5 % when I realised that the symptoms were directly caused by the reductions. I was aware (theoretically) that my symptoms can be caused by the drug, its side effects and withdrawal, but I didn't really believe it for a long time. Or it would be more correct to say I always had doubts whether it was still more me being crazy and ill. 

So for a long time in the beginning (I have been tapering for over 2 years) I kept tapering with intervals that I now realise were not nearly enough for my brain to stabilize, but I was not fully aware that the withdrawal symptoms could be so severe and last for so long that I figured the reason had to be somewhere else. I just tapered according to the planned schedule, keeping aprox. 3 week intervals (and unfortunately, optimistically 2 week intervals).

I also tried micro tapering every week, but needless to say that proved to be harsh on my nervous system and was keeping me in a constant state of agony.

 

During the last 9 months or so I have had to keep longer periods between reductions in order to stabilize (I realised more and more that what I was experiencing was due to the reduction of the medication and the link got clearer by the day), but I cannot even estimate the stabilization point. For some of my friends it is perfectly clear - their withdrawal "cycle" is short and simple: they know that their symptoms will come 1-2 days after the reduction and last for about a week (max).

This is not the case for me. One week for me is the extremely acute period (which would correspond to maybe the 1st 1-2 days of my friends' cycles) and as much as I would like to see a noticeable improvement during week 2, I can only say that it gets slightly better than the extreme, but not nearly enough to function to a standard that would/could be acceptable or tolerable. After recently having a 6 week and a 2 month gap between reductions I can say that during the 2 month gap I guess you cold say that I started to feel like the symptoms were starting to actually stabilize for the fist time for me subjectively. That enabled me to observe how the affects of withdrawal came about abruptly and directly connected to the reduction. 

 

So now I am at the point described in the previous post.

 

I have been so ill for so many years and haven't yet begun my tapering. I'm both anxious and scared half to death to get started. I utterly despise what these drugs have done to people. It's like being imprisoned.

 

 

Do I understand correctly that you would like to start reducing your medication but have been afraid to do it because of the potential withdrawal effects?

 

If that is the case I would suggest you to carefully monitor your symptoms for a while and make a very small reduction (perhaps 5%?) and monitor your symptoms day by day during the weeks following the reduction. From that you can determine whether your reaction to the reduction is acute or perhaps find out that such a small reduction is perfectly tolerable for you. Because, you know, everyone really is so different and it is not entirely impossible that you will be able to tolerate small reductions well or with moderate symptoms.

 

I would really suggest some reading material form the Icarus Project. Straight to the pdf.

I remember reading it when I started tapering but reading it again today gave me a lot of support.

 

I wish you the best of luck trying to figure out this mess the drugs have created for you!

 

---

One thing I want to mention about withdrawal symptom control is that I have one thing that really makes a huge difference: I have been using an essential amino acid complex for a long time to support my nervous system in recovery. I had doubts whether it was helping or not so I quit it for a while (also because it worsens some of my neuralgic pain). When I decided to take the supplement again I was in the middle of the first week of the reduction agony. The amino acids literally made a noticeable difference overnight. So now I am taking it again (only sometimes half the dosage when the pain comes back too harshly. Well, it's a balancing act really - I just try to listen to my body at the current moment to decide what I should do). 

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I'm so grateful to you for taking the time to share your story with me. Truly.

 

I have a few more questions, if you don't mind...

  • How long were you on Cymbalta before you started the tapering and what dosage did you start from?
  • Before Cymbalta, were you on other anti-depressants? (I've been one type of anti-d or another since my early 20's. I'm now 48 yrs old. Couldn't even tell you what all of them were or when I changed from one to another. Terrible terrible memory)
  • Now that you've been tapering for 2 yrs. and you have your body and it's w/d symptoms a bit better figured out, how long would you say tends to be best for you to wait before reducing dosage again? (I know that this varies greatly from person to person)
  • Do you mind sharing what symptoms you have each reduction time, especially that first week? (please don't hold back. I really need honesty)
  • Can I re-use the Cymbalta capsule after I've opened it? If not, what size capsules should I buy. My co-op order is due tomorrow and they offer 2 sizes which are "0" OR "00" and are made of 100% Bovine gelatin. Don't know which size to buy. Is the Bovine gelatin ok?
  • Can you tell me the name of the essential amino acid complex that you take?

To answer your question...Yes, I do want to begin tapering. Yes, I am anxious about the side-effects of withdrawl. However, that will not keep me from getting off of this horrendous drug. The other thing that has kept me from beginning is the initial having to open a capsule and count the beads. Am scared of them going all over the place, etc. How in the world can you count such teeny beads and so many of them?

 

I am beginning to realize that I need to be certain that my body is well taken care of as a support. Diet/supplements, sunshine (for Vitamin D which is huge - I stay indoors almost always), close walk with my God, ample/clean water, activities that bring joy - get to see 2 of my 3 grandbabies' once a week. Aside from God, they are about the only thing right now that brings me that joy.  Is tough to build this foundation when my body has so many other health issues. One step at a time! I get anxious just thinking about it all! (I, now, have no doubt that Cymbalta and/or the Welbutrin that I take, have, in the long run, caused more anxiety within me than I ever had prior). Oh, I also know that I need to exercise, but I don't at all. I am fatigued all day everyday so it's so hard to even think about the exhaustion that exercise will bring. I'm lucky if I get my dishes washed (unlike the real me).

 

If you happen to like Kale, check this out (regarding essential amino acids). Pretty awesome. - http://articles.mercola.com/sites/articles/archive/2013/11/06/kale-benefits.aspx

 

Thank you again for sharing all that you did with me!

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You can reuse the Cymbalta capsule after you've opened it. If you wish to have empty capsules on hand, get the largest ones available, it will be easier for you to manipulate.

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felin, on 31 Mar 2015 - 5:31 PM, said:
 
How long were you on Cymbalta before you started the tapering and what dosage did you start from?
Before Cymbalta, were you on other anti-depressants? (I've been one type of anti-d or another since my early 20's. I'm now 48 yrs old. Couldn't even tell you what all of them were or when I changed from one to another. Terrible terrible memory)

 

 

I'm having a hard time remembering exactly how long I have been taking certain drugs. Seems like forever. I was first prescribed Fluoxetine when I was 17. I am 30 now and for 13 years I have constantly been on and off different antidepressants - the whole spectrum of them. For a very short while I was even on antipsychotics (a month or so). I have always had awful side effects and have discontinued the drugs after a while, switched from one drug to another etc. It wasn't until a few years ago when I finally became aware and educated myself on the topic of antidepressant withdrawal and the harm they cause. (I would really suggest two books for a real eye-opening: Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide, and Crime by Peter R. Breggin and Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker).
 
When I think back on the years on these meds and realising now what they have done with me, it makes me indescribably angry and sad. I have had awful side effects for years and discontinuation effects that I only realise in retrospect for what they were. Last drug I discontinued before Cymbalta was Venlafaxine (Effexor) which is another nightmare next to Cymbalta. Unfortunately then I was not aware of the methods of slow tapering and the discontinuation symptoms literally almost killed me (the "brain zaps", disorientation and dizziness were so severe that I almost tumbled in front of a moving car one day). By then I was already google-smart on the discontinuation side effects these meds have but was still unaware how to slowly taper. 
 
I was very reluctant to start taking Cymbalta but was convinced it was necessary by mu doctor. I started with the idea that I would only be taking the drug for a few months. Well, months become a year before I started tapering. I was taking 60 mg of the drug. 
 
When I started tapering it was very difficult for me to distinguish between the effects of withdrawal symptoms and my usual symptoms. A lot of the time I did not believe that the drug could be causing all the mental and physical symptoms and was afraid that it was just me. By know (as I described in my previous post) I have realised that a lot of this has been the drug's effect, but I am still afraid whether these effects can be undone. I have no way of knowing whether the decade of these drugs has caused permanent damage on my nervous system.
 
I have tapered using different strategies. I have never tapered more than 10% of the last dosage, but I did reduce very often for a long time (after making a schedule I tapered every 2-3 weeks). It was because I could not really believe that my symptoms were so severely caused by the withdrawal. Later when I tried longer stabilizing periods I experienced how the withdrawal effects were sudden and obvious and followed a certain pattern (for Cymbalta and for me it is 1st day - no different, 2nd day slightly lowered mood, mild brain zaps etc, 3rd day - hell!). 
 

felin, on 31 Mar 2015 - 5:31 PM, said:
Now that you've been tapering for 2 yrs. and you have your body and it's w/d symptoms a bit better figured out, how long would you say tends to be best for you to wait before reducing dosage again? (I know that this varies greatly from person to person)
 

 

 

For me there seems to be no "good" time because it really takes me a long time to start recovering from the reduction. As I said I mostly know people who's severe and acute symptoms don't last more than one week. For me everything comes crashing down when I reduce and I really cannot say it gets any "better" for many weeks. I remember feeling a little better after I had not reduced the medicine for 1,5 months and there was a clearer sense of stabilization after 2 months. As I said I have tried tapering 5% and microtapering but the outcome is always a disaster for me. I don't want to scare you because there is no need to assume that it will be like that for you. My case seems to be an example of an extreme one and there is a good chance that when you stick to a small taper (up to 10%), go slow and allow your system to stabilize enough between reductions, you will be ok. 

felin, on 31 Mar 2015 - 5:31 PM, said:
Do you mind sharing what symptoms you have each reduction time, especially that first week? (please don't hold back. I really need honesty)
 

 

 

Seeing that you are already anxious about the symptoms before starting to taper I would definitely suggest just to take it slow, make a very small reduction and see how it goes and not pressure yourself to follow a strict reduction schedule. What dosage are you on currently? Perhaps you could try a reduction just 5% and monitor your symptoms. One possibility is to fill in a check list or create one of your own.
You can add symptoms that are unique in your case. That is what I do.
 
See if you develop any new symptoms during the week(s) following the reduction and if there is any dynamic in them. To what point do they get worse and when do they start getting better? I do understand that it can be difficult to tell the difference between already existing symptoms and new ones that come with the taper but by grading your symptoms on a scale from 0 to 10 you can monitor if they get worse.
 
When I start filling in the form I realise how many symptoms I actually have. Some of them I have grown so used to that I would neglect to mention them if anyone asks. 
 
The first week, on day 3 I start to have terrible crying spells. Literally for days I keep crying. Well, of course not 24/7 but for most part of the first days I am in tears. I am not sure how long that lasts but at least half a week. At some point the crying is replaced by despair and major depressive feelings. This is the worst symptom and the best I know to describe it is that while having this I feel that I cannot bear living for another minute more. I just want the suffering to stop. And it doesn't. And that can get better for half a day or even an entire day, but still last for... well, an unknown amount of time. I know I could handle any kind of symptoms - all the pain and crying and everything, but this is unbearable. The only thing that helps is numbing the feelings with Xanax. I do not drink alcohol but I can totally understand why people would choose to numb their pain with it. I suppose it is not at all different from taking Xanax - they're both a sort of a poison for the body and the brain.
 
From physical symptoms the strongest ones I have is exhaustion (up to the point where it is ridiculous even), I have strong neurological symptoms (brain fog, brain zaps - they are a sort of a mini seizure, extreme sleepiness - sleeping up to 15h a day, not being able to shake the drowsiness and fogginess for the most part of the day, I have strong neural pain in the left side of my body - in the left arm, shoulder, back of the head, behind the eye, vision problems, extreme sensitivity to sounds (!) and a general sensory oversensitivity, nausea of course. Oh, I remembered for some period during the tapering I sweated extremely. I usually sweat really little. I also sweat a lot during the night. The flu-like symptoms occur. Ohwell... the list is so long it is embarrassing. And these symptoms don't really seem to pass fast. They just last and last so that I get to thinking it is ridiculous. But it still keeps happening. Oh and from time to time comes the agitation and irritability. I can feel how my thinking gets impaired - it slows down, the memory gets really-really bad, I cannot remember words and names (I used to think it was just me or a symptom of depression, but now I have established a clear link between the symptoms and the reduction of the meds). 
Oh, and the restless legs of course.
 

 

 

  • Can I re-use the Cymbalta capsule after I've opened it? If not, what size capsules should I buy. My co-op order is due tomorrow and they offer 2 sizes which are "0" OR "00" and are made of 100% Bovine gelatin. Don't know which size to buy. Is the Bovine gelatin ok?

I cannot advise about the sizes of the capsules. I have not reused the beads, I have just poured a certain amount of the beads out of the capsule and closed the capsule again. So I don't know about the capsule materials either.

 

  • Can you tell me the name of the essential amino acid complex that you take?

     

     

This is what I take: http://www.iherb.com/Solgar-Essential-Amino-Complex-90-Veggie-Caps/9819#p=1&oos=1&disc=0&lc=en-US&w=amino%20complex&rc=849&sr=null&ic=1

 

 

 

The other thing that has kept me from beginning is the initial having to open a capsule and count the beads. Am scared of them going all over the place, etc. How in the world can you count such teeny beads and so many of them?

It does seem to be really hard to count the tiny beads. I have tried and it was too much for me. I would suggest the method I personally use (I described it earlier in this topic and others have shared many details about it here. I recommend using some slippery type of paper for that.

 

 

 

 
I am beginning to realize that I need to be certain that my body is well taken care of as a support. Diet/supplements, sunshine (for Vitamin D which is huge - I stay indoors almost always), close walk with my God, ample/clean water, activities that bring joy - get to see 2 of my 3 grandbabies' once a week. Aside from God, they are about the only thing right now that brings me that joy.  Is tough to build this foundation when my body has so many other health issues. One step at a time! I get anxious just thinking about it all! (I, now, have no doubt that Cymbalta and/or the Welbutrin that I take, have, in the long run, caused more anxiety within me than I ever had prior). Oh, I also know that I need to exercise, but I don't at all. I am fatigued all day everyday so it's so hard to even think about the exhaustion that exercise will bring. I'm lucky if I get my dishes washed (unlike the real me).

 

I take supplements every day to support my system in recovery - vitamin D3 5000  IU (it is important to distinguish between D3 and D2), Omega-3, Folate, Magnesium (as magnesium oil applied on skin), Zinc and sometimes a B complex.

 

I personally cannot see how it would be possible to force myself to do physical exercises with this sort of exhaustion. I think I shouldn't. And I try not to feel guilty because the "you should get more exercise, it is good for you" suggestion really does not apply when you can literally not get up from a chair to make a sandwich. When I am feeling better, I take a walk. When I am a wreck, I concentrate on surviving and well... leave the "bonus track of exercising" to those who actually are able to. As you said - one step at a time.

 

I must say that I have noticed a big improvement in the energy department in past few months. I have been gluten free for 6 months now and it is the only thing that is different aside the fact that I take a smaller amount of ADs now than I did 6 months ago.

 

I am really glad that you have these things that bring you joy - your faith and your grandchildren. To tell you the truth I am a bit envious :). I often wish I could believe strongly that all this suffering is for a reason and there is some force somewhere regulating it all. 

 

I also noticed that you said you are talking two AD-s. I think you should look into the suggestions on how to taper when you are taking multiple drugs. One theory is that you should taper one drug at a time, but I have also read opposing suggestions that consider the fact that when you reduce one medicine then the relation between these two drugs will change and this will add to the complexity of the symptoms. I personally do not know which makes more sense. I think this is something everyone should research for themselves and decide how it seems best to proceed.

 

I wish you all the best! If you could find the time to let me know how you are doing with your tapering I would really like that.

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I was in hell before. But it was nothing compared to what I am going through now. Do not do what I did. I have been through a series of stages off hell, but I seriously did not know it could be this bad. After 2 years of tapering I decided to rapidly stop from 8,44 mg of Cymbalta.

If you already know you have a bad reaction to tapering meds, do not attempt to just push through a rapid taper.

 

If you could just read my post in my topic and please reply if you have any suggestions, I would really-really appreciate any support! I will not copy the text here for it may not be the right topic for that. http://survivingantidepressants.org/index.php?/topic/8671-erer-tapering-cymbalta/?p=147291

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http://www.prohealth.com/library/showarticle.cfm?libid=18811
 

Cymbalta Warning: Discontinuing May Result in Severe Withdrawal Symptoms

By Karen Lee Richards • www.ProHealth.com • March 10, 2014

 

In 2008, Cymbalta became the second drug to receive FDA approval for the treatment of fibromyalgia. .... Little did we suspect the misery that could result when those patients wanted to stop taking Cymbalta.

The medical community has long known that abruptly discontinuing any antidepressant can result in Antidepressant Withdrawal Syndrome. That's why patients are (or should be) strongly urged not to suddenly quit taking an antidepressant but to talk with their doctor about gradually tapering off the medication.

Cymbalta Discontinuation Syndrome

However, neither physicians nor patients expected the severity of withdrawal from Cymbalta. In fact, it's bad enough to warrant its own diagnosis – Cymbalta Discontinuation Syndrome. An FDA advisory committee report about Cymbalta Discontinuation Syndrome states, “Much anecdotal evidence has accumulated documenting the injury, distress and life management impacts caused by discontinuation of Cymbalta. The effects of discontinuation can be severe and extend for weeks or even months.”

As you read through patient descriptions of their Cymbalta withdrawal experiences, it's not uncommon to see terms like “horrific,” “a nightmare,” and “going through hell.” Some of the withdrawal symptoms described include:

 

“Brain zaps”
(electric shock sensations)
Extreme mood swings
(“irritability that quickly turns to rage”)
Suicidal thoughts Paranoia Dizziness Confusion Nausea and Vomiting Limb pain Headache Fatigue Nightmares Insomnia Diarrhea Anxiety Excessive sweating Agitation Involuntary crying or laughing Hypomania Tinnitus Seizures

The Discontinuation Dilemma

When it comes to discontinuing Cymbalta, the prescribing information says, “A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.”

While gradually reducing the dose sounds like a reasonable approach, there is one very big problem. Cymbalta is only available in three dosages: 20 mg., 30 mg. and 60 mg. ....patients are warned, “Cymbalta...should not be chewed or crushed, nor should the capsule be opened and its contents sprinkled on food or mixed with liquids.” So although Cymbalta manufacturer, Eli-Lilly, recommends gradually reducing the dose, there is virtually no way to actually do that.

What Can You Do?

If you're currently taking Cymbalta and want to stop, talk with your doctor about developing a discontinuation plan. ....

If you are contemplating whether or not to take Cymbalta, be aware of what you're getting yourself into. Trying to get off of the drug may leave you feeling far worse than the fibromyalgia symptoms you're trying to relieve. Thoroughly discuss the pros and cons with your doctor before making a decision.

 

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Hello,

 

I wanted to share how I've been making lower dosage Duloxetine capsules from a 60mg capsule. Before I get started I wanted to say all of what I'm about to share I found on this site.

 

First I ordered a microgram scale from Amazon.

 

http://www.amazon.com/American-Weigh-GEMINI-20-Portable-MilliGram/dp/B0012TDNAM/ref=sr_1_1?ie=UTF8&qid=1440389029&sr=8-1&keywords=microgram+scale

 

Then I went to my local health food market and bought the 1000 count bag of empty gelatin capsules. I imagine Amazon would have them as well.

 

Once my scale arrived I set up my station. My station included my Duloxetine capsules, 21 gelatin capsules (I've been doing a 10% for 21 days cycle but you may want to be more conservative), and mini cupcake liners.

 

The first thing I did was to zero the scale. You do this by placing the tray on the actual scale then turn it on. At this point the scale won't weigh the tray and anything placed on it will be an accurate measure. Then I opened a full capsule to get a measure from which I could determine the dose of my first taper.

 

When I weighed the contents of one capsule it weighed 359 milligrams. So I multiplied 359 x .90 to get my first taper dosage. I used .90 because if I'm reducing by 10% (.10) I will need to take 90% (.90) of the original dose. This put my dosage at 323mg.

 

I then carefully poured several capsules into one of the mini cupcake liners. It's easy to manipulate the crimped edges of the liner to make a "spout" for pouring. Then I would gently pour the Duloxetine flakes into the zeroed tray until the number was close to my new dosage. Once I was close (over or under doesn't matter) I used the fine tweezers (it comes with the scale) to add or subtract flakes until I hit the right number. It takes patience and keep in mind puffs of air can affect the number (fan, draft, breath).

 

Once I got the correct number I poured the dosage into an empty mini cupcake liner then into an empty vegetable capsule. I use the liner because although the tray for the scale has a small spout I don't find it to be a very accurate pour.

 

I follow this same procedure to create the remainder of the capsules for the new dosage. When it's time to make a new dosage I took the number from the previous dosage (in this example 323mg) and multiply by .90 to get my new dosage.

 

I created this routine because my doctor had no viable solutions for tapering off of Cymbalta/Duloxetine. I am not a medical professional and this is only my experience. It has worked for me (thankfully) but it may not work for others.

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Brilliant! Thank you for that clear description of your method.

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A note for Canadians:  The Canadian patent on Cymbalta expires on Sept. 10, 2019.  No generic (duloxetine hydrochloride) will be available through Canadian pharmacies for Canadian residents until after then.

 

I can't post the page for Cymbalta directly; the search results expire via a cookie. So here's the link to the register. Clicking on the patent # will bring up the details, when the patent was awarded and when it expires.

 

Health Canada Patent Register link: http://pr-rdb.hc-sc.gc.ca/pr-rdb/index-eng.jsp

 

The patent # is 2344057.  The Drug Information Numbers are:

30 mg capsule: 02301482

60 mg capsule: 02301490

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A blend of Bead-Counting and Compounded Doses 

I had a conversation with a pharmacist at a compounding pharmacy about my taper and my plan for after I use up most of the 30 mg capsules I have on hand. I'm currently at 20mg of Lilly Cymbalta (name-brand, not a generic), about to make a 10% cut to 18 mg. I talked with him about getting compounded doses for 10 mg and under.

 

When I explained to him that I was looking to get multiple doses at 5% cuts (10, 9.5, 9, 8.6, 8.1, 7.7, 7.3) he told me that it would be very expensive for me to do it that way.  There's work and a fee involved in each dosage level. Because I'm currently counting beads and will have some on hand when I get to 10 mg, he suggested making 2.5 mg doses.  The capsules he would make are powder and can't be opened. I'll take his word on that for now. My doctor would prescribe 2.5 mg compounded Cymbalta, 3-4 to be taken daily.

 

To achieve the tapered dose, I'd take 3 capsules and then add enough beads to reach the taper dose. For example: I'd take 3 capsules (3 x 2.5 = 7.5 mg) + beads equal to 1.1 mg to reach an 8.6 mg dose. This allows a great amount of flexibility -- I can do micro tapers, 5% or 10% cuts.

 

When I went off EffexorXR in 2004/5 I did a gradual reductions by bead counting. Had I remembered that in February before getting my last prescription for 30 mg x 90 days filled, I would have asked for a scrip for 5mg compounded caps and about a dozen 30 mg caps for the beads. Live and learn.  I hope some wise person will learn the easy way, from this post.

 

Don't do this to save money: It is "spendy."  When looking at getting 5 months of 2.5 mg caps @ 3-4/day the estimate was very close to what I paid for my last round of 90 days @ 60 mg.  So the same money will get me 25% as much Cymbalta.

Edited by scallywag

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No, absolutely not. You cannot make a powder of Cymbalta, that destroys the action of the active ingredient.

 

If you want to use compounded prescriptions, the pharmacist would put, for example, 2.5mg or 12.38mg of beads, NOT powder, in gelatin capsules.

 

You could get 2.5mg doses compounded of the beads and top up to your dosage with loose beads, as you've planned.

 

People here have had different compounded prescriptions made up for every month of their taper, in 10% decrements. It is expensive, but if the convenience is important to you, it works.

 

You might ask your pharmacist to double-check, Cymbalta is one drug that cannot be crushed under any circumstances.

 

(If you crush Effexor XR beads, you end up with immediate-release Effexor. It's a waste of money to compound Effexor XR into powder, but the active ingredient would survive.)

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Ok got it about crushing Lilly Cymbalta beads. It's entirely possible that I misunderstood. Maybe they get duloxetine HCl powder and use that? That would be similar to what the generic manufacturers do with their beads.  If I go with this option I'll be sure to get a clear explanation and to listen carefully.

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No, there is no duloxetine powder. The coating on the beads is essential to getting the active ingredient into your gut. Please read post #1 in this topic.

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No disagreement from me: Duloxetine hydrochloride (Cymbalta) is destroyed in the highly acidic stomach environment and must be enteric coated for effective absorption.

 

Your statement, "There is no duloxetine powder" may be inaccurate as written. There has to be a duloxetine HCl crystal or powder, it's a salt. How are Lilly's miniscule beads made or the 5g beads of the generic manufacturers? The patent for the manufacturing process of duloxetine HCl identifies the last stage as the conversion of duloxetine oxalate salt into duloxetine HCl salt. This is what I was referring to in post #52. 

 

Might I suggest a more precise statement as a compromise, "There is no duloxetine powder available to patients and consumers."

 

That said, such a product may not be available to a compounding pharmacy. This exchange has identified some useful questions to ask. As I said, if I elect to get compounded doses from this pharmacy, I'll ask the pharmacist for more details about his process -- source of duloxetine HCl, fillers, coatings, final presentation.

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I carefully counted the beads in 3 separate brand name, Lilly, 20mg Cymbalta pills and all 3 pills contained 194 beads.  I hope this is helpfull. 

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Taking a regular dose versus skipping doses - % Cymbalta available every 12 hours

 

 

n4b33nntxmusji26g.jpg

 

Important note: When you look at the daily dose (blue line) this chart shows that the availability increases after 12 hours. In fact, your body continues to metabolize the drug. At 24 hours after a dose its availability is 25%. It's hard to show on a graph (at least it is using my skills)and still keep it simple.

 

Key takeaway: A daily dose keeps the drug availability within a narrower range than skipping days. Consistency is good.

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Great Graph Scallywag!

 

In observing the graph above and considering Cymbalta's 12 hour half life; does anyone know of any benefit to dividing the daily dose and taking Cymbalta twice a day in an attempt to keep the drug availability within an even narrower range and hopefully further decrease wd sx's? 

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Not enough words to thank you for all your tips and advice here. I read this post back in January 2016 as I was trying to figure out how to taper off my Duloxotine (Cymbalta) for 2 years. I found that I gained weight and had hot flashes that were becoming a nuisance and wanted to have the control to taper off. 

 

The doctors and pharmacists all gave me bad advice telling me to take one every other day and so on. There is no half life! so the withdrawls and brain zaps begin immediately..

 

After researching posts, I found yours, dear Administrator. And guess what? It has really helped.  I started by counting the tiny balls, each one, in the capsule and reducing by 10 balls per month. I felt a bit dizzy sometimes and a bit nauseated and fatigued, but nothing i couldn't handle.

 

I am now in month 7 and have reduced 65 balls per capsule (187 balls in each Duloxotine capsule) which equals about 20mg down from 30mg.  I asked my doc to switch me to 20mg to make it easier to continue to taper but the Pharmacy and Doc say that the 20mg does not exist.

 

So I continue to count, every day, 65 balls. It's irritating and me and my partner joke that maybe after a few years I will finally have completely weaned. I do have one question:

 

Question: Now that I have tapered down to minus -65 balls per 187 balls in a capsule, I am starting to feel the familiar depression, tears, and fears that I did before going on the medication. I wondered if I can start supplementing with St. John's Wort now that I'm so low in my dosage.

 

Thoughts?

Edited by scallywag
add extra paragraph breaks

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Shizzy -- Leave the St. John's Wort on the shelf at the online warehouse or local store until you know your baseline without Cymbalta (duloxetine). Many people have had to taper SJW.

 

Tapering St. John's Wort

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Ok - for Cymbalta people - I am also in a Facebook group for Cymbalta withdrawal. According to them, the way to reduce the dosage is not by reducing 10% of the milligrams, but rather 10% of the beads in the capsules.

 

As I read here, it seems like some people reduce by milligrams per dose.

 

Is it not the same thing? Take out the number of beads which would make up the new dose at 10% less?

 

What is the common wisdom here? I'm confused. 

 

Tomorrow, I am supposed to pick up a dose of 81 mg (10% reduction of my current 90 mg dose) from a local compounding pharmacy. Is this going to be a problem? Not sure what to do.

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Counting beads is a very common way of tapering Cymbalta.

 

Please read the first post in this topic.

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Can the healing process occur if one stays at a given dose for a long enough period of time?

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Yes, the nervous system tends to adapt when other conditions are held steady.

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Update on Roy Katz, customRX. He is no longer practicing. I am now working with a new compounding pharmacy in called Pharmacy Solutions. www.pharmacysolutionsonline.com - Important to ask for Michelle Wong. They can fulfill prescriptions in 34 U.S. States. I'm working to get them up to speed on Cymbalta tapering, as well as co-coordinating with the prescribing doctor. There is a learning curve for sure as this drug is like no other for some people.

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Bethsimmons: Alto asked in the compounding pharmacy topic:
 

BethSimmons ... how does Roy Katz compound Cymbalta, other than put the beads into other capsules?


Beth, what have you found out about how the Michelle Wong of pharmacysolutions.com compounds Cymbalta?

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I'm new to this topic, so please forgive me if I'm overlooking something obvious...

 

There appears to be a logical problem underlying all of the tapering strategies in this thread.  I just had a lengthy discussion with my local pharmacist, and she claims that the "micro-beads" contained in Cymbalta are heterogeneous wrt enteric coating.  In other words (to use a made-up example): 25% of the beads might be coated to time-release after 1 hour, 25% to release after 2 hours, 25% after 4 hours, and 25% after 8 hours.  The problem is that when you sub-divide your dosage, you have no way of knowing whether you're getting a balanced cross-section of these different enteric coatings.

 

The pharmacist wasn't sure, but it sounds like the same problem might also apply to the mini-tablets that are found in some generic forms of duloxetine.  See www.wjpps.com/download/article/1438355089.pdf

 

I'm not sure whether to believe the pharmacist, as she seemed to be motivated by a strong agenda of discouraging patients from doing ANY form of DIY dose adjustments, and she may have just been making up this issue of differential enteric coatings.  But if she is right, all of the methods in this thread would be unreliable, and potentially dangerous --  they could have the inadvertent effect of clustering the delivery of the drug into short, time-limited spikes, rather than smoothing out the delivery.

 

This stuff is a bit above my pay-grade.  Is there anybody out there with enough knowledge of pharmacology to confirm whether this is actually an issue?

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I'm new to this topic, so please forgive me if I'm overlooking something obvious...

 

There appears to be a logical problem underlying all of the tapering strategies in this thread.  I just had a lengthy discussion with my local pharmacist, and she claims that the "micro-beads" contained in Cymbalta are heterogeneous wrt enteric coating.  In other words (to use a made-up example): 25% of the beads might be coated to time-release after 1 hour, 25% to release after 2 hours, 25% after 4 hours, and 25% after 8 hours.  The problem is that when you sub-divide your dosage, you have no way of knowing whether you're getting a balanced cross-section of these different enteric coatings.

 

The pharmacist wasn't sure, but it sounds like the same problem might also apply to the mini-tablets that are found in some generic forms of duloxetine.  See www.wjpps.com/download/article/1438355089.pdf

 

I'm not sure whether to believe the pharmacist, as she seemed to be motivated by a strong agenda of discouraging patients from doing ANY form of DIY dose adjustments, and she may have just been making up this issue of differential enteric coatings.  But if she is right, all of the methods in this thread would be unreliable, and potentially dangerous --  they could have the inadvertent effect of clustering the delivery of the drug into short, time-limited spikes, rather than smoothing out the delivery.

 

This stuff is a bit above my pay-grade.  Is there anybody out there with enough knowledge of pharmacology to confirm whether this is actually an issue?

Wow, this is a huge deal!

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I've contacted my compounding pharmacist about this.  I'm hoping he will respond to my email.

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I'm skeptical.  It seems unlikely that the beads are not all coated in the same way with the same amount of enteric coating. First, pharma companies are cheap. Second, if Lilly was doing this, they would brag about it LOUDLY in promotional materials and on their website to discourage people from taking generic duloxetine.

 

A compounding pharmacist I talked to last year told me his process to create compounded doses:  open capsules, crush the beads, weigh the powder, create new tablets with enteric coating in prescribed doses. I didn't ask about the enteric coating on the beads specifically though.

 

It reminds me of the time I called Wyeth about tapering Effexor. When I told the customer service agent that I was opening the capsule and counting the beads, he said, "You can't do that."  I said, "What do you mean can't? I've been doing it for weeks."

 

It will be interesting to see what others dig up.

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I've just joined here, I haven't introduced myself or posted yet. I will soon.

 

I'd like to be kept up to date on this bead issue.  :huh:

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