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Tips for tapering off Pristiq (desvenlafaxine)

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#1 Altostrata

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Posted 16 July 2011 - 08:52 AM

To reduce the risk of withdrawal symptoms and post-discontinuation prolonged withdrawal syndrome, as with other psychiatric drugs we recommend reducing Pristiq 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?

However, Pristiq is difficult to taper properly as it comes in only 3 dosages: low, average and excessive.

Do not alternate doses of Pristiq to taper -- this will cause the levels of this medication in your brain to go up and down and is second only to cold-turkey in causing withdrawal symptoms. AND DON'T COLD-TURKEY EITHER!!!!!!!!!


PLEASE READ THIS ENTIRE TOPIC BEFORE GOING OFF PRISTIQ.

Pristiq is a drug made of Effexor's (venlafaxine) active metabolite, O-desvenlafaxine. Pristiq is to Effexor as Lexapro is to Celexa -- a tweaked and more powerful isomer molecule. In effect, Pristiq is concentrated Effexor.

According to Pfizer http://labeling.pfiz...ing.aspx?id=497, Pristiq is available in extended-release tablets of 25mg, 50 mg, and 100 mg; the most common dosage is 50mg.

Unlike Effexor, which is metabolized primarily by liver enzyme P450 CYP2D6, Pristiq is metabolized via conjugation and liver enzyme P450 CYP3A4. It attains peak plasma concentrations in about 7.5 hours.

According to this paper, the extended-release formulation releases desvenlafaxine over 24 hours. The mean half-life of desvenlafaxine, without the extended-release monolithic matrix formulation, is around 11 hours.

The official prescribing information from the FDA contains this:
 

Discontinuation Syndrome
Discontinuation symptoms have been systematically and prospectively evaluated in patients treated with Pristiq during clinical studies in Major Depressive Disorder. Abrupt discontinuation or dose reduction has been associated with the appearance of new symptoms that include dizziness, nausea, headache, irritability, insomnia, diarrhea, anxiety, fatigue, abnormal dreams, and hyperhidrosis. In general, discontinuation events occurred more frequently with longer duration of therapy.
 
During marketing of SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), and SSRIs (Selective Serotonin Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.
 
Patients should be monitored for these symptoms when discontinuing treatment with Pristiq. 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..... [see Dosage and Administration (2.4) and Adverse Reactions (6.1)].
....
Discontinuing Pristiq
Symptoms associated with discontinuation of Pristiq, other SNRIs and SSRIs have been reported [see Warnings and Precautions (5.9)]. Patients should be monitored for these symptoms when discontinuing treatment. 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.
....


Pristiq is difficult to taper "at a more gradual rate." The tablets come in only 3 dosages and, officially, they should not be cut up. See http://www.primaryps...?articleid=2464

In a phone conversation with Pfizer medical information (1-800-438-1985), I learned that the extended-release characteristic is incorporated into the tablet itself (Thank you, oaklily, for this information about the matrix formulation.)

Rather than a timed-release coating, the coating on the Pristiq tablet is only protective. The extended-release mechanism is part of the tablet matrix, or the glue that holds the tablet together. This is called a monolithic matrix tablet. (If the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.
 
When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability.)

According to Pubmed on Desvenlafaxine: "....The extended-release tablet does not dissolve in the stomach after swallowing. It slowly releases the medicine as it passes through your digestive system. You may notice the tablet coating in the stool...."




Can the desvenlafaxine tablet be cut or crushed?
Desvenlafaxine is an ER formulation for once-daily administration that is designed to release desvenlafaxine over the course of the dosing interval.3 Desvenlafaxine tablets contain 76 mg or 152 mg of desvenlafaxine in a matrix formulation that is designed to gradually release the equivalent of 50 mg or 100 mg of desvenlafaxine, respectively.3 To maintain the integrity of the ER formulation and prevent “dose dumping” (ie, rapid release of drug from an ER formulation), desvenlafaxine tablets should not be divided, crushed, chewed, or dissolved.3

3. Pristiq [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals Inc; 2008.

 
There is a description of the similar matrix formulation for quetiapine XR (Seroquel XR) here http://survivinganti...dpost__p__33069

PROTEST THIS DANGEROUS DRUG

  • Phone Pfizer, Pristiq's manufacturer, to make a complaint: (800) 438-1985 in the US

    Pfizer has not provided any specific information on how to taper from a dosage of 25mg Pristiq, the lowest available dosage.

    They may suggest alternating dosages to taper Pristiq. Don't do this -- it's like playing ping-pong with your brain.

    File a complaint about the difficulty of tapering off Pristiq -- the range of dosages is inadequate.
  • Also complain to the FDA 1-800-FDA-1088 Mon–Fri between 8:00 a.m. and 4:30 p.m. EST.

OPTIONS FOR TAPERING PRISTIQ
 
Since medicine knows nothing about tapering Pristiq, the following are all informal suggestions. Try any of them at your own risk. Please let us know how you do by posting in this topic.
 
Cut up Pristiq tablets
Despite the warnings not to cut it up, patients have cut up Pristiq tablets to taper.
 
Now that the 25mg tablet is available, cutting it into quarters gives you the option to taper by 6.25mg per step.
 
If you are taking 100mg Pristiq or 50mg Pristiq, you may wish to request part of your prescription be written for 25mg tablets. (For insurance coverage of multiple dosages, your doctor most likely will have to specify taking Pristiq in "divided doses.")

Rather than a timed-release coating, the coating on the Pristiq tablet is only protective. The extended-release mechanism is part of the tablet matrix, or the glue that holds the tablet together. If the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.
 
If the matrix is sufficiently broken, a Pristiq fragment becomes desvenlafaxine, with an 11-hour half life. If you cut up the tablet, you might take smaller divided doses of Pristiq, more than once a day, like immediate-release Effexor, to mimic an extended-release dose.

From reports on the Web, cutting up tablets does seem to work for some but it makes others ill, possibly because of "dose dumping" (because the matrix is destroyed) when the entire dose is released at once, instead of being gradually released through the matrix formulation.

It seems to sometimes cause stomach upset, which may be reduced by taking it with food.

You may find you need a precise way to measure your tablet fragments. See Using a digital scale to measure doses

As you get down to a low dose, you may wish to switch to Effexor to more precisely control dosage decreases, see below.
 
Crush Pristiq tablets, weigh powder with a digital scale
This is similar to cutting up tablets -- Pristiq is a "do not crush" medication, as it is a time-release drug.

Conceivably, dividing the dose and taking a measured amount of powder more than once a day, like regular Effexor, may make this method feasible.

Crushing the tablet and making sure the shell fragments are evenly distributed in the powder would be a more precise way of tapering than cutting up tablets.
 
As Pristiq's extended-release mechanism is part of the tablet matrix, or the glue that holds the tablet together, when the tablet is crushed, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability.
 
The Pristiq powder becomes desvenlafaxine, with an 11-hour half life. If you pulverize the tablet, you might take smaller divided doses of Pristiq, more than once a day, like immediate-release Effexor, to mimic an extended-release dose.

Peer discussion of this method starts here http://survivinganti...dpost__p__27417
 
Reducing from 100mg Pristiq to 50mg Pristiq
Drug switches incur additional risk. Before trying a switch to Effexor or Prozac (fluoxetine) from 100mg Pristiq, it's probably wise to go down to 50mg Pristiq first, if possible.

  • You might use a 50mg tablet plus a 25mg tablet plus 3/4 of a 25mg tablet (18.75mg) to make the first reduction to 93.75mg
  • 2nd reduction: a 50mg tablet plus a 25mg tablet plus 2/4 of a 25mg tablet (12.5mg) to go to 87.5mg
  • 3rd reduction: a 50mg tablet plus a 25mg tablet plus 1/4 of a 25mg tablet (6.25mg) to go to 81.25mg
  • 4th reduction: a 50mg tablet plus a 25mg tablet to go to 75mg
  • 5th reduction: a 50mg tablet plus 3/4 of a 25mg tablet (18.75mg) to go to 68.75mg
  • 6th reduction: a 50mg tablet plus 2/4 of a 25mg tablet (12.5mg) to go to 62.5mg
  • 7th reduction: a 50mg tablet plus 1/4 of a 25mg tablet (6.25mg) to go to 56.25mg
  • 8th reduction: a 50mg tablet

If withdrawal symptoms occur, some people have found taking an additional fragment of a tablet can smooth the transition from one dosage to another.
 
Once at 50mg, stabilize for a month at least and consider your plan for the next stage of tapering.
 
Use a combination of Pristiq tablets and Effexor liquid
Pristiq cannot be made into a liquid, but its close relative immediate-release Effexor (not Effexor XR) can.
 
You may be able to go off Pristiq by taking part of your dose in lower-dose tablets and part in liquid Effexor, gradually converting to all-liquid Effexor as you get to lower dosages. This may offer a convenient and gradual path off Pristiq.
 
Only regular immediate-release Effexor can be made into a liquid (see Tips for tapering off Effexor (venlafaxine) ). As immediate-release Effexor has a short half-life and is usually dosed twice a day, you may wish to take the liquid portion of your dosage later in the day.
 
For example, if you are taking 100mg Pristiq, you may wish to take your daily dose as one 50mg tablet and the rest in a liquid made from immediate-release Effexor. You can titrate the liquid by 10% of your daily dosage to taper until you get to 50mg. Then you can take a 25mg Pristiq tablet with the rest in a liquid made from immediate-release Effexor. When you get to 25mg Pristiq, you might switch to splitting the tablet and taking the rest in Effexor liquid and so on until you are taking only liquid Effexor.
 
You will have to request a prescription for Effexor tablets as well as Pristiq from your doctor.
 
Have Pristiq made into smaller dosage capsules by a compounding pharmacy
Compounding pharmacies can crush the tablets and put the powder into smaller capsules by weight. Like cutting up tablets or crushing, this destroys the time-release quality, but the compounded method is much more exact.

(According to my compounding pharmacy, they can put in a slow-release additive distributing absorption over 8-10 hours. This is not as long as the Pristiq time-release coating, but at least it's something. Check with your compounding pharmacy about this.)
 
In your body, crushed Pristiq is similar to regular immediate-release Effexor, with an 11-hour half-life.
 
You may wish to have your dose compounded to take twice a day. If you are taking 50mg Pristiq, for example, you would have 60 capsules compounded per month. Each capsule would be 1/2 of 45mg (a 10% reduction of 50mg) or 22.5mg. You would take two capsules per day, once in the morning, and once in the evening.
 
The next month, you would have 60 capsules compounded, each capsule being 1/2 of 40.5mg (a 10% reduction of 45mg) or 20.25mg. And so forth, for each reduction.
 
If this does not work, you may wish to switch to Effexor XR and use the bead-counting method. Regular Effexor probably wouldn't be an advantage over Pristiq compounded to custom dosages.
 
Switch to Effexor or Effexor XR
Note: If you've had an adverse reaction to Effexor before, do NOT switch from Pristiq to Effexor.

"Desvenlafaxine (O-desmethylvenlafaxine) is the major active metabolite of venlafaxine."

Since the relationship is so close, switching to regular Effexor tablets, which you can cut up or make into a liquid, this may be the best way to taper off Pristiq. Because it has a mean half-life of 5 hours, you'd have to take regular Effexor twice a day.

According to FDA Prescribing Information for venlafaxine (Effexor), the usual dose of Effexor is 150mg per day.

Like Pristiq, Effexor XR is released gradually and needs to be taken only once a day.

Since 150mg Effexor and 50mg Pristiq are both "normal" dosages of their respective drugs, they may be roughly equivalent. (See discussion of Effexor and Pristiq dosage equivalency starting http://survivinganti...dpost__p__42249 )

You'd have the difficulty of tapering off Effexor or Effexor XR -- themselves notorious for withdrawal difficulties -- but at least you can do that gradually. See Tips for tapering off Effexor and Effexor XR (venlafaxine).
 
The psychiatrist who writes the 1boringoldman.com blog reports success in switching one patient from Pristiq to Effexor, then tapering Effexor, here (see comments)
 

I had a lady who could not tolerate coming down on the dose for the reason you mentioned. So we moved to Effexor which went fine and then after two weeks, came down successfully.

 
Another psychiatrist said when he tried this, the switch from Pristiq to Effexor was "seamless."
 
Dr. Stuart Shipko posts here:
 

Given the lack of research on the topic, my opinions are necessarily anecdotal, and YMMV.  Despite the Effexor XR supposedly having problems with bead tapering because not all beads contain active ingredients, I have had consistently good results bead tapering Effexor XR.  My approach is to change Pristiq to Effexor XR.  For 50 of Pristiq I make an immediate substitution of 150 of the Efxr and after a few days the Efxr is decreased to 100 mg and kept stable for a week before tapering from the Efxr.

 
Advice from a psychiatric pharmacist
I have been corresponding with a professor at a prominent US university pharmacy department. Here is his best guess at how to taper Pristiq (he does not want his name published):
 

One may want to consider the following options:

  • Always taper to lowest available strength (ie – 50mg) before attempting to discontinue
  • Switch to venlafaxine IR [regular Effexor immediate-release] product (a non-coated tablet which is splittable) and taper further. [See above.] Although there is no absolute dosing equivalence between the two products, a reasonable assumption might be that 50mg of desvenlafaxine is roughly equivalent to 100-150mg of venlafaxine.
  • OR Switch to low-dose fluoxetine (eg – 10mg) [See below.]

 
Then taper off fluoxetine (Prozac). See Tips for Tapering Prozac

Advice from Dr. Stephen Stahl, author of the manual Essential Psychopharmacology
In his widely read psychopharmacology manual, eminent psychopharmacologist Stephen Stahl advises titration by crushing the tablets and mixing in fruit juice, see http://survivinganti...dpost__p__14799

According to our member oaklily, Stahl is wrong. Making a liquid from Pristiq does not work, see http://survivinganti...dpost__p__24822

Dr. Stahl intends to correct his book, according to this correspondence 09/15-9/16/13 with him:

....I am most appreciative of your input.  It is only by thoughtful suggestions like yours, and colleagues who take the time to email me, that I am able to incorporate the best possible information.  Many, many thanks.

In answer to your question about comparing the doses of venlafaxine to desvenlafaxine, there are three articles attached, published in the journal I edit, CNS Spectrums which may be of use to you.  Generally, my thinking is that 50 mg desven may be close to 75 mg venlafaxine, and so on up the titration scale....
....

In the absence of cutting pills or diluting, the best way to come off these agents is to start fluoxetine and then try to taper Pristiq, every other day or every third day, maintaining Prozac which has a very long half life.  Then after a few weeks you can stop fluoxetine.
....

Of course, even taking a drug once a day has fluctuations, but there is less fluctuation if one half life is skipped than if it is stopped.  A masochist could take each pill one hour later, at 25, then 26, then 27 hours until you get to 48 hours but problems doing this at night.  If unable to tolerate every other day fluctuations, have to cross titrate to a long acting substitute such as fluoxetine.

 
"Bridging" with Prozac or another antidepressant
Any drug change incurs additional risk. A switch to Prozac from Pristiq may not work -- they are very different drugs -- or you might have adverse reactions to Prozac.
Prozac is regularly used to "bridge" off Effexor. Given that Pristiq is a cousin of Effexor and Effexor XR, it is possible that one can, similarly, use Prozac to withdraw from Pristiq.

Attributed to Joseph Glenmullen, the "bridging" technique is described by a doctor here http://www.bipolarwo...2005/ph1354.htm

Read this entire topic before attempting a switch to Prozac: The Prozac switch or "bridging" with Prozac

Later, taper off Prozac. At least Prozac comes in a liquid.

To do this, consult a doctor knowledgeable about this technique.


Edited by Altostrata, 22 October 2016 - 03:09 PM.
updated information

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

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#2 Altostrata

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Posted 16 July 2011 - 09:10 AM

Wyeth, the manufacturer of Pristiq (now merged with Pfizer), was well aware of withdrawal issues. Here's a 2008 interview with Dr. Phil Ninan, the Vice President of Wyeth Medical Affairs, Neuroscience:

"....Dr. Grohol: There’s been more talk in recent years about greater concerns about withdrawal syndrome. And so I was wondering what the research has shown what the withdrawal profile on Pristiq looks like compared to other drugs in its class.

Dr. Ninan: First of all, I think, one should distinguish what is a withdrawal syndrome from what we would call discontinuation symptoms. Withdrawal is traditionally associated with medicines that one has got physiologically dependent on. And there is a whole set of not only symptoms, but physiological changes that occur that can be potentially dangerous.

You see that with alcohol, you see that with benzodiapams, the anti-anxiety and sleep medications that can cause physiological dependence. And you see that with pain medications, particularly opiates and that class of medications. So, those can be medically problematic and potentially dangerous in some people.

We should distinguish that from discontinuation symptoms, where those medical risks are not present. And these are not medicines that you become physiologically dependent on, but you can get adaptive changes that have occurred, that then the body and the brain needs to readapt to not having those medications onboard.

And you see this with blood pressure medications where if you suddenly stop certain blood pressure medications you can get a rebound increase in blood pressure that is very transient. And you see that with several other medications. You see that if you take Benadryl on a regular basis and you suddenly stop taking the Benadryl, there are rebound symptoms that could occur.

So, what we have here are discontinuation symptoms that have been reported with antidepressant medications that get out of the system very quickly. And most medicines that get out the quickest are more likely to have discontinuation symptoms, because the brain is not having a chance to adapt to not having that medication occupy the receptors in the brain.

And the longer you’re on the medication, the more the adaptation has taken place, and therefore the more likely you are to have the discontinuation symptoms. So, we know that there were medicines that were the biggest culprits in terms of having discontinuation symptoms. Effexor was one. Paxil is the other.

And Pristiq being an active metabolizer effecter and also having a fairly short half-life, we would expect would have the potential to discontinuation symptoms. And that is exactly what we have found in our clinical trials.

So, these discontinuation symptoms can be anything from just physical kinds of symptoms, which would be things like dizziness, headaches, nausea, those kinds of symptoms that are common side effects of these medications to symptoms that might be unique.

So, patients who are coming off Effexor and Paxil have described various words like "brain shivers" and things like that, which we consider to be under a term called paresthesia, which are physical symptoms that you might be having within your body. And you can also have associated anxiety depressive symptoms.

Now unfortunately, the scales that we use to measure these are not very good. Because what we find is that anywhere from 20 to 30 percent of patients who are on placebo are also demonstrating some of these symptoms. And so there’s the high level of noise in the mechanisms that are standard in the field to try and measure these symptoms.

What we find is that what happened in our studies is when we discontinued these medications rapidly, was that a substantial number of people had these discontinuation symptoms. So, when we started tapering the medication, a number of these patients who were having discontinuation symptoms were reduced. But, they were still present.

And so we would recommend clinically that if a patient is planning to stop the medication, they should do it under medical supervision so that they’re being guided about what are the mechanisms that you can use to reduce the discontinuation symptoms, so that they don’t cause excessive distress, and they can be managed medically. ...."

Edited by Altostrata, 26 March 2013 - 02:38 PM.
added emphasis

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#3 Altostrata

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Posted 16 July 2011 - 09:26 AM

From: Altostrata Subject: Advice on how to taper off Pristiq?

Date: July 16, 2011 10:23:42 AM PDT

To: philip.ninan@emory.edu

 

Dr. Ninan:

 

This is in reference to your 2008 interview with Dr. John Grohol on PsychCentral at http://psychcentral....q 50mg per day.

 

The lowest dosage available for these extended-release tablets is 50mg. As they are extended-release, one assumes they cannot be cut up. Or can they? What is the tapering technique to safely discontinue Pristiq? Exactly how can this be done? Not even an experienced medical specialist can conjure lower dosages appropriate for tapering.

 

Here is a patient who is suffering from Pristiq withdrawal syndrome: http://survivinganti...om that dosage?

 

On the face of it, it’s irresponsible for Wyeth (now Pfizer) to recommend a conventional dosage of 50mg per day but not make available a lower-dosage extended-release tablet to enable tapering. Effexor, as we all know, has a brutal withdrawal syndrome (you may know it as discontinuation syndrome), as it also causes physical dependency, but at least people can cut up the tablets or open the Effexor XR capsules to gradually reduce dosages.

 

Thank you,

 

Altostrata


Edited by Altostrata, 23 January 2014 - 11:10 AM.
fixed text

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#4 compsports

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Posted 16 July 2011 - 10:21 AM

Hi Alto, Someone on Dr. Bob's psychobabble site posted this suggestion which I am not sure is medically feasible or not. http://www.dr-bob.or...sgs/986940.html He has provided a link for purchasing enteric coded capsules that would allegedly allow you to safely break up the Pristiq pill that currently you can't do. And of course, taking the prescription to a compound pharmacist is an option if that works for people financially. But I am glad you write this guy. It will be interesting to see if he responds. CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Diagnosed with sleep apnea 2012 and on pap machine

Dealing with protracted sleep issues


#5 Altostrata

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Posted 16 July 2011 - 12:05 PM

Thanks for searching, cs. Unfortunately, that's a post where one person on a forum site is speculating what another person might do. He hasn't tried it himself.

I've never heard of being able to buy empty enteric-coated capsules. It took a while for that link (on a UK site) to open up, and there were no specifications for the capsules.

It's impossible to even guess what breaking up Pristiq and putting it into a capsule like that would do. It would take analysis by a pharmacist to determine if the enteric coating on the capsule would do the same thing as the enteric coating on the tablet. This is a highly hypothetical solution.

If anyone gets any real info about this, please post it here. Our Cymbalta taperers might appreciate it, too.

Whether you can cut up Pristiq and safely put it into an enteric-coated capsule is a question for a compounding pharmacist. Otherwise, I believe when you cut up Pristiq, you get a turbo-charged Effexor -- and I don't have the faintest idea what that would do.

Edited by Altostrata, 12 March 2014 - 08:43 AM.
fixed text

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

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#6 Altostrata

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Posted 22 July 2011 - 03:05 PM

I talked to a knowledgeable doctor about tapering off Pristiq. He said, "It's like jumping off a cliff. There is no way to taper off." He would switch to Prozac to get people off Pristiq. Don't try this at home, find a doctor who has experience in doing this to help you.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#7 Altostrata

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Posted 30 July 2011 - 07:03 PM

I am getting reports that people are cutting up Pristiq tablets to taper. I do not know how effective this is for gradual weaning.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#8 myself

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Posted 03 August 2011 - 04:28 PM

Hi! Any new news on tapering off of Pristiq? I've been cutting them in half for about two weeks now, at the advice of my psychiatrist (not that I actually trust his knowledge very much) and my pharmacist- it seems to be going relatively ok. I have only really started noticing withdrawal symptoms in the past few days. Depersonalization, headaches, brain fog... I keep scouring the Internet for posts from others on how to taper off of Pristiq, and haven't found much. The only other advice I read was to take a pill every other day. I tried that method first (for one day), and it put me out of commission for about a week. Not good. I suppose I could always try triating? Anywho, wanted to let you know that someone is following this thread! “Depression is not a disease, the end point of a pathological process. It is a sign that our lives are out of balance, that we’re stuck. It’s a wake up call and the start of a journey that can help us become whole and happy, a journey that can change and transform our lives.” James S. Gordon M.D. Unstuck

Have taken psychiatric meds since 2002.
Wellbutrin, Lexapro, Zoloft, Effexor (not sure of the dosages, or how long I took them...); have taken Clonazepam (1mg, as needed) since 2002 as well.
I was prescribed Adderall in late 2009 (after saying I had problems losing weight), stopped taking it cold turkey in Feb. 2011- made me very anxious, obviously.
Currently: Have been on Pristiq 50mg since 2008, I think. Still taking Clonazepam. Began cutting down my Pristiq dosage on July 22, 2011.

Also- it is my last year of grad school! I am looking forward to graduating, being med-free, and starting a new stage in my life!

#9 Baxter

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Posted 03 August 2011 - 04:38 PM

Hi, Myself. SNRIs are all pretty miserable to get off of, so if/when your symptoms get worse (and don't let it go on too long), the switch to prozac may be your best bet. I know that I am just repeating advice offered by others, but it is the best advice on offer. If you want to just continue the Pristique taper, you could try cutting the pills into smaller pieces. 50% is a huge drop, and likely to cause you more anguish than entirely necessary... Hang in there.
ct Serax and Inderol April 2007
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July 2010 - June 2011 on hiatus due to worsening w/d symptoms
June 2011 - 28mg Cymbalta

#10 Altostrata

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Posted 03 August 2011 - 05:11 PM

Welcome, myself. As you have found, alternating dosages is a recipe for withdrawal symptoms. Can you cut a 50mg tablet into quarters? Two weeks is about right for getting hit with withdrawal symptoms. You might want to go up to 37.5mg (a 25% reduction from 50mg) to reduce the abruptness of your 50% reduction. Since you've breached the time-release coating anyway, I would think if desvenlafaxine could be made into a liquid compound, you could try that. Or use an electronic scale to weigh fragments of a tablet. Otherwise, the switch to Prozac could be a solution -- but you'd have to find a doctor who has experience with this.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#11 myself

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Posted 03 August 2011 - 05:17 PM

Hi Baxter, Thanks for the reply. I have read about the switch to Prozac being the most helpful thing- I guess mentally I am just ready to be done with these meds, and kind of don't even want to think about going on another one, you know? Also, I don't think I could rationalize with my psychiatrist that switching to Prozac would be a helpful thing to do. Do you know of a good way to find sympathetic psychiatrists? I have tried asking my friends, therapist, acupuncturist, etc., but they don't know too many like-minded psych's- or the ones they can recommend are aren't taking new patients. I'll see how I feel tomorrow, and then consider finding a new psych. and/or upping my Pristiq dosage by a 1/4 for a while. I'm working on my Thesis, and I need all the brainpower I can get! Thanks again

Have taken psychiatric meds since 2002.
Wellbutrin, Lexapro, Zoloft, Effexor (not sure of the dosages, or how long I took them...); have taken Clonazepam (1mg, as needed) since 2002 as well.
I was prescribed Adderall in late 2009 (after saying I had problems losing weight), stopped taking it cold turkey in Feb. 2011- made me very anxious, obviously.
Currently: Have been on Pristiq 50mg since 2008, I think. Still taking Clonazepam. Began cutting down my Pristiq dosage on July 22, 2011.

Also- it is my last year of grad school! I am looking forward to graduating, being med-free, and starting a new stage in my life!

#12 Altostrata

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Posted 03 August 2011 - 05:25 PM

myself, you are near the nest of mainstream psychiatry -- Harvard and Massachusetts General. Many partners.org (Mass General) psychiatrists did the early research on withdrawal syndrome. You might work your way through the phone list at partners.org for withdrawal advice: http://www.partners....ianResults.aspx I would start with Baldessarini: http://www.partners....jvrgyIKAmmOaQ== He's at McLean in Belmont, Mass. If anyone can refer you to someone who knows how to do the Prozac switch, it's probably him. Or Rosenbaum http://www.partners....m4y/hU/3V0v~A== Or Alpert http://www.partners....jURCVgl9zky/A== You may have to be persistent in asking them if they know of anyone with expertise in either getting people off Pristiq or the Prozac switch. Please let us know what you find out!
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#13 myself

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Posted 03 August 2011 - 05:27 PM

Welcome, myself.

As you have found, alternating dosages is a recipe for withdrawal symptoms.

Can you cut a 50mg tablet into quarters?

Two weeks is about right for getting hit with withdrawal symptoms. You might want to go up to 37.5mg (a 25% reduction from 50mg) to reduce the abruptness of your 50% reduction.

Since you've breached the time-release coating anyway, I would think if desvenlafaxine could be made into a liquid compound, you could try that. Or use an electronic scale to weigh fragments of a tablet.

Otherwise, the switch to Prozac could be a solution -- but you'd have to find a doctor who has experience with this.


Thanks Alto!
You replied while I was replying to Baxter. ;)
It is hard to cut the 50mg tablet into halves as there is no indention line thingy (what's that called?)- so I think 1/4 would be stretching it. But I will see how I feel tomorrow and try that. Also, I'll research making liquid compounds and electronic scales tonight.
And, start working on a letter to Pfizer at some point.... Ughh.

Best, M

Have taken psychiatric meds since 2002.
Wellbutrin, Lexapro, Zoloft, Effexor (not sure of the dosages, or how long I took them...); have taken Clonazepam (1mg, as needed) since 2002 as well.
I was prescribed Adderall in late 2009 (after saying I had problems losing weight), stopped taking it cold turkey in Feb. 2011- made me very anxious, obviously.
Currently: Have been on Pristiq 50mg since 2008, I think. Still taking Clonazepam. Began cutting down my Pristiq dosage on July 22, 2011.

Also- it is my last year of grad school! I am looking forward to graduating, being med-free, and starting a new stage in my life!

#14 Altostrata

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Posted 03 August 2011 - 05:32 PM

A pill cutter will make it easier to cut the darn thing into quarters. They cost about $4 at the drug store.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#15 myself

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Posted 04 August 2011 - 04:23 AM

oh yeah- i figured that out on the second day! :) however, the pill is rounded at the corners and the top and bottom of it are convex. and with no indention- it's a wiley little bugger! and alto- thanks for the advice on psych's to call. i will post whatever info. i get from them. hopefully something good...

Have taken psychiatric meds since 2002.
Wellbutrin, Lexapro, Zoloft, Effexor (not sure of the dosages, or how long I took them...); have taken Clonazepam (1mg, as needed) since 2002 as well.
I was prescribed Adderall in late 2009 (after saying I had problems losing weight), stopped taking it cold turkey in Feb. 2011- made me very anxious, obviously.
Currently: Have been on Pristiq 50mg since 2008, I think. Still taking Clonazepam. Began cutting down my Pristiq dosage on July 22, 2011.

Also- it is my last year of grad school! I am looking forward to graduating, being med-free, and starting a new stage in my life!

#16 Altostrata

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Posted 04 August 2011 - 06:42 AM

Or you could phone Philip Ninan at Emory and ask him what the heck with tapering Pristiq.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#17 myself

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Posted 04 August 2011 - 10:34 AM

ha! or that. :) little med update: before i even opened my eyes this morning i could feel head fog/ brain zaps. soooo...i messily cut up my 50 mg pill and took 3/4 of it instead of the 1/2 i had been taking. feeling better today. still a headache, but not as bad. woo!

Have taken psychiatric meds since 2002.
Wellbutrin, Lexapro, Zoloft, Effexor (not sure of the dosages, or how long I took them...); have taken Clonazepam (1mg, as needed) since 2002 as well.
I was prescribed Adderall in late 2009 (after saying I had problems losing weight), stopped taking it cold turkey in Feb. 2011- made me very anxious, obviously.
Currently: Have been on Pristiq 50mg since 2008, I think. Still taking Clonazepam. Began cutting down my Pristiq dosage on July 22, 2011.

Also- it is my last year of grad school! I am looking forward to graduating, being med-free, and starting a new stage in my life!

#18 annej

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Posted 11 December 2011 - 11:07 AM

I successfully got off of Pristiq by doing the following under "doctor's" supervision: Pristiq 100 mg. ----------> 50 mg. Sick! Lexapro 10 mg. added onto Pristiq 50 mg. Felt much better in about 7 days. Lexapro 10 mg. and Pristiq 50 mg. x 2 weeks Lexapro increased to 20 mg. x 7 days (along with Pristiq) Pristiq discontinued - Lexapro 20 mg. continued A little bumpy for about 5 days but definitely tolerable. Lexapro 20 mg. for about 4 weeks - very well stabilized! Lexapro 20 mg. to 15 mg. - Did just fine. (Go at your own rate) Lexapro 15 to 10 mg. - VERTIGO - back to 15 mg. Lexapro - decreased by 2.5 mg. every 7 days until finished. Jumped after 7 days at 2.5 mg. Did OK. My taper was very complex due to many different meds being discontiued and a simultaneous benzo taper due to an ill-advised pdoc's plan. The Lexapro discontinuation once I got the hang of it was actually very tolerable. Take it slow. That is the best way to taper. :) Annej

My Intro
2000-Effexor and Klonopin
April 2011- C/T Adderall, lithium, Seroquel, Lunesta; Pristiq and Klonopin cut by 1/2 due to med-induced "rapid cycling"
May 2011- Pristiq/Lexapro bridge/taper
June, 2011- K cut to 0.5 mg (doctor)
July 18, 2011 - Lexapro done
October 2011- K taper started
Jan, 2012- Off K, Remeron started -bad idea
March 2012- Horrific Tardive Akathisa/TD (Dx: TA versus withdrawal akathisia secondary to K w/d)
May 2012- Reinstatement of K
Current Psych Meds: Klonopin 2 mg + Propanolol 15 mg and titrating up
As of June 2013: TA gone or suppressed - struggling with tolerance to benzos - beta blocker helping


#19 Altostrata

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Posted 11 December 2011 - 02:33 PM

It's interesting that your doctor crossed you over to Lexapro rather than Prozac. Perhaps he was not aware that Prozac is preferable for this kind of switch because of its very long half-life. In my opinion, that dosage of Lexapro is excessive, roughly equivalent to 200-300mg of Pristiq, but it seems you may be a fast metabolizer and able to handle high doses of a lot of things. And, it's great you found it tolerable to taper off Lexapro over a few months. Some people have problems with tapering Lexapro, but nothing like Effexor/Pristiq, Paxil, or Cymbalta. Also, that alternating dosages you did at the end would trigger terrible withdrawal symptoms in some people. We don't recommend it, but your nervous system seems to be quite hardy!
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#20 annej

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Posted 11 December 2011 - 03:34 PM

It's interesting that your doctor crossed you over to Lexapro rather than Prozac.

Perhaps he was not aware that Prozac is preferable for this kind of switch because of its very long half-life.

In my opinion, that dosage of Lexapro is excessive, roughly equivalent to 200-300mg of Pristiq, but it seems you may be a fast metabolizer and able to handle high doses of a lot of things.

And, it's great you found it tolerable to taper off Lexapro over a few months. Some people have problems with tapering Lexapro, but nothing like Effexor/Pristiq, Paxil, or Cymbalta.

Also, that alternating dosages you did at the end would trigger terrible withdrawal symptoms in some people. We don't recommend it, but your nervous system seems to be quite hardy!


Hi Altostrata,

I agree with many of your points as to my rather inept doctor-ordered taper. My story was not meant as prescriptive, but rather as a narrative of my experiences.

Unfortunately, Prozac did not work for me. I should have mentioned that.

Lexapro 10 mg did not cover my extreme withdrawal symptoms. This is why it was increased to 20 mg. It might be "excessive", but
it was effective and got me out of severe, acute withdrawals and I would have to say that once I started tapering at 2.5 mg. a week, my symptoms were tolerable.

I think most of us would agree that the best overall strategy in getting off of SSRI/SNRI's is do a slow taper.

:) annej

My Intro
2000-Effexor and Klonopin
April 2011- C/T Adderall, lithium, Seroquel, Lunesta; Pristiq and Klonopin cut by 1/2 due to med-induced "rapid cycling"
May 2011- Pristiq/Lexapro bridge/taper
June, 2011- K cut to 0.5 mg (doctor)
July 18, 2011 - Lexapro done
October 2011- K taper started
Jan, 2012- Off K, Remeron started -bad idea
March 2012- Horrific Tardive Akathisa/TD (Dx: TA versus withdrawal akathisia secondary to K w/d)
May 2012- Reinstatement of K
Current Psych Meds: Klonopin 2 mg + Propanolol 15 mg and titrating up
As of June 2013: TA gone or suppressed - struggling with tolerance to benzos - beta blocker helping


#21 Altostrata

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Posted 11 December 2011 - 07:05 PM

Do you have any idea why he chose Lexapro? Or was that just a shot in the dark? I see he had you drop the Pristiq completely after 3 weeks on the two drugs and a week after the boost to 20mg Lexapro.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#22 annej

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Posted 11 December 2011 - 08:14 PM

Do you have any idea why he chose Lexapro? Or was that just a shot in the dark?

I see he had you drop the Pristiq completely after 3 weeks on the two drugs and a week after the boost to 20mg Lexapro.


Hi Altostrata,

My pdoc said I could choose any SSRI with the exception of Paxil that also was manufactured in a liquid form. We both assumed I would need a liquid in which to titrate off. I never used the liquid though.

I honestly believe that I was successful this time because I knew that my medication "cocktail" was no longer sustainable. It was truly a life or death situation. I simply had to dig deep in order to pull this off.

As I mentioned before, if I can do this while suffering from symptoms that made me appear very seriously mentally ill (and I sure felt ill) then I have every faith that any motivated person can be successful! :) annej

My Intro
2000-Effexor and Klonopin
April 2011- C/T Adderall, lithium, Seroquel, Lunesta; Pristiq and Klonopin cut by 1/2 due to med-induced "rapid cycling"
May 2011- Pristiq/Lexapro bridge/taper
June, 2011- K cut to 0.5 mg (doctor)
July 18, 2011 - Lexapro done
October 2011- K taper started
Jan, 2012- Off K, Remeron started -bad idea
March 2012- Horrific Tardive Akathisa/TD (Dx: TA versus withdrawal akathisia secondary to K w/d)
May 2012- Reinstatement of K
Current Psych Meds: Klonopin 2 mg + Propanolol 15 mg and titrating up
As of June 2013: TA gone or suppressed - struggling with tolerance to benzos - beta blocker helping


#23 Altostrata

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Posted 12 December 2011 - 08:08 PM

Well, at least your pdoc had the sense to think about titrating a liquid. I agree with you, your experience is a tribute to how a determined person can overcome unnecessary polydrugging and take responsibility for her own recovery! You've brought intelligence and focus to getting yourself off drugs -- thank you for encouraging everyone reading this.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#24 Altostrata

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Posted 24 December 2011 - 11:09 AM

Many doctors consider Stahl's Essential Psychopharmacology: The Prescriber's Guide: Antidepressants by Stephen M. Stahl to be the Bible of antidepressant prescribing.

If you read this closely, you will see much of the advice is conflicting, which explains why even doctors who are conscientious about looking things up will be terminally confused about how to taper people safely off antidepressants.

Here is Dr. Stahl's advice about discontinuing deslavenlafaxine, from page 61 of the 2011 edition:

(My comments in red.)

  • Do not break or chew tablets, as this will alter controlled-release properties
  • For patients with severe problems discontinuing desvenlafaxine, dosing may need to be tapered over many months (i.e., reduce dose by 1% every three days by crushing tablet and suspending or dissolving in 100 mL of fruit juice, and then disposing of 1 mL while drinking the rest; 3-7 days later, disposing of 2 mL, and so on). This is both a form of very slow biological tapering and a form of behavioral desensitization.
    Wouldn't crushing tablets conflict with the first point? Desvenlafaxine is stronger than venlafaxine, wouldn't destroying the coating release an unaccustomed high dose quickly? Furthermore, it's preferable to mix crushed tablets in water so you can see how well the particles are distributed.
  • For some patients with severe problems discontinuing desvenlafaxine, it may be useful to add an SSRI with a long half-life, especially fluoxetine, prior to taper of desvenlafaxine. While maintaining fluoxetine dosing, first slowly taper desvenlafaxine and then taper fluoxetine
    How would you know a patient has severe problems tapering desvenlafaxine until the patient has tried it? This point implies a previously unsuccessful taper with severe withdrawal symptoms. (Yet, as usual, does not explain what "severe" means.)

    This advice would have the patient taking a double dose of antidepressant, Pristiq with Prozac, for an extended period of time but does not address the possibility of adverse effects, such as serotonin syndrome, from the excessive dosage.

    Dr. Stahl apparently subscribes to the belief, common among psychopharmacologists, that the patient's nervous system is made of an endlessly elastic rubber-like material.
  • Be sure to diffentiate between re-emergence of symptoms requiring re-institution of treatment and withdrawal symptoms
    Easier said than done, Dr. Stahl!

How to Stop

  • Taper to avoid withdrawal effects (dizziness, nausea, diarrhea, sweating, anxiety, irritability)
    True enough. Okay, so how to taper Pristiq, which comes in only two doses, high and higher?
  • Recommended taper schedule is to give a fully daily dose (50mg) less frequently
    In case you were wondering where your doctor got the idea of alternating dosages, here's one source. THIS IS A TERRIBLE IDEA. DON'T DO IT. ALTERNATING DOSAGES IS SECOND ONLY TO COLD-TURKEY IN TRIGGERING SEVERE WITHDRAWAL SYMPTOMS.
  • If withdrawal symptoms emerge during discontinuation, raise dose to stop symptoms and the restart withdrawal much more slowly
    If your doctor followed this advice, you would have been alternating dosages and experienced severe withdrawal syndrome. Doesn't it make more sense to taper gradually from the start?

As near as I can tell, there are no footnotes indicating where Dr. Stahl got his information about tapering desvenlafaxine. He is such a towering authority that doctors accept his advice without question -- although it is well-known that he has gotten a great deal of pharma funding throughout his career, and is currently flogging the new antipsychotic Latuda.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#25 Jemima

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Posted 30 January 2012 - 03:12 PM

I was on Pristiq (50 mg. time-release) for five months and it made me really hyper. Although I don't especially recommend this, my doctor switched me to 10 mg. of Lexapro with no problems. (For all I know, these may be equivalent doses.) Getting off of Lexapro has been a rough ride, mostly due to food sensitivies (which, thank God, are going away), insomnia (ups and downs, here), irritability, and unusual sensitivites to the environment. It may not be the best choice of drugs to switch off to for tapering, but there may be something in the same drug family that wouldn't be as trying as Lexapro, something that comes in a tablet or liquid form so you can reduce the dose very gradually.

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

"Never attribute to malice that which is adequately explained by stupidity." -Hanlon's Razor


Introduction: http://survivinganti...oducing-jemima/

 

Success Story: http://survivinganti...r-dickhead-too/

Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 


#26 Altostrata

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Posted 31 January 2012 - 03:21 PM

There is nothing in the Pristiq-Effexor drug family (SNRI) that comes in liquid form.

Switching to Prozac may be an option, but it is by no means a sure thing.

Please read Important topics in the Tapering forum.

Jemima, it sounds to me like something in your tapering journey must have sensitized you. Was it an unsuccessful taper attempt or the switch to Lexapro?
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#27 Giacomo

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Posted 13 April 2012 - 08:00 PM

Psychiatrist added in the Prozac. She said that was her pattern used successfully with other patients to get them off of Pristiq. She said the Prozac might "stay" or "go" depending on whether or not I can get off the Prozac. She said we can and should try. But, she was willing to consider keeping me on the Prozac if needed. I think it was her "argument" to not frighten me then, when first discussing, by the thought of "no meds." I want "no meds" as my goal, but have to admit some fear at the notion of being all together free from the meds. I have engaged in talk therapy to assist me in dealing with issues, so my approach is not merely one of medication.

#28 NCLady71

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Posted 24 April 2012 - 10:57 AM

I was searching the web for info on Pristiq and came across this board. I am not looking to taper off Pristiq, I just want to be able to take it. This is my story. Started Paxil March 2011, was on it for 11 mos. I took myself off cold turkey because I could not handle the weight gain (40 lbs in the 11 mos on it) plus it really was not helping. My new doctor put me on Celexa, which was just as bad for about 2 mos. I was then put on Pristiq. The first several days were great, although I was still taking 1/2 dose of Celexa to wean off. Well, things took a nose dive big time. I felt like I was in hell, started crying all the time, on edge like I was going to snap and seriouslly thinking of death. Side note here, I have IBS, have had for as long as I can remember. I read on the packaging that you may see an empty shell in your stool when taking Pristiq. Well, I started noticing a whole pill undigested, still all the white powder intact. Nobody ever mentioned taking a time release if you have IBS may cause it to not absorb. So basically, I was not on any antidepressants for a few weeks. Taking a pill everyday, just to have it pass from my body undissolved. If I was getting any of the med, it was not nearly what I needed. So, I took matters in my own hands, started scratching off the coating and taking the pill like that. Within two days, I felt like a different person! No more crying or edginess! I don't know how safe this is, but I had to do something. Go back to doc next week and have to tell her what is happening to get her advice, but I'm having success with the Pristiq in an altered non-time release form! So, maybe you can remove the coating and cut the pill if you want to taper. Just a suggestion.

#29 psychfree88

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Posted 28 April 2012 - 06:30 PM

I called my doctor and he told me to take 25 mg for 6 days and quit...and let him know if anything happens.. Wow...why is it different for every one.. i was thinking of tapering for one month,and based on 10% rule it will be 4.5 months+

#30 LonelyMan

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Posted 10 June 2012 - 07:11 PM

I called my doctor and he told me to take 25 mg for 6 days and quit...and let him know if anything happens..

Wow...why is it different for every one..

i was thinking of tapering for one month,and based on 10% rule it will be 4.5 months+


Due to such a great decrease in tapering. I would strongly not advise doing this. But I dont know much about anything at all!

#31 Altostrata

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Posted 11 June 2012 - 10:37 AM

I called my doctor and he told me to take 25 mg for 6 days and quit...and let him know if anything happens..

Yeah, right, and if you get withdrawal symptoms, what is he going to do about it? If you're lucky, he'll know to reinstate the medication. He may or may not know about how to taper slowly after that.

It's much better for your nervous system not to put it through that kind of injury to begin with. But many doctors think the nervous system is made of rubber.
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#32 Lilu

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Posted 20 June 2012 - 07:05 AM

I am too looking to get off of Pristiq - gently. Years ago I tapered myself off of Effexor xr and all was good until I stopped taking the meds completely. What followed was 2 agonizing months of pure rage - completely alien to my personality. I am one of the most calm and patient people ever.

As for tapering off Pristiq, a couple of options listed here are really not options as I found out.

Compounding: I called a Compounding Pharmacy, and they told me that they cannot compound Pristiq due to the fact that it has a hard outer shell. So compounding is not an option for Pristiq.

Then last night I decided to play chemist, and crushed several Pristiq tablets myself, then sifted the granules through a fine mesh sifter, which left the outer shell behind. So, really compounding is really an option. But as someone mentioned, without the time-release properties, who knows what Pristiq will do.

Using Liquid Pristiq: Chemically this is not an option at all. I mixed finely crushed pristiq powder with a)syrup b)water c)alcohol(vodka) - and this is what happened: Pristiq turns into a gel! It is NOT soluble in any of the substances that I tried.

How can an "Eminent psychopharmacologist Stephen Stahl" advise doing this? Or using a syringe? This will not work. The Pristiq particles clump together and do not distribute evenly. There is no way of knowing what dose you are getting and what the NEW HALF-LIFE of the medication will be.

Conclusion: There is no way to taper Prisiq. You have to switch to a different medication or two. I would think switching back to Effexor xr or effexor tablets and combining it with Prozac would be the only pharmacological solution.

I would prefer to go the natural route, using amino acids L-Tyrosine and 5HTP, but really don't know if it will work. Has anyone tried this successfully?

2005-2008 Effexor xr; 1/2008 Tapered 3 months, then quit.
7/2008-2009 Reinstated Effexor xr due to crying spells.
2009-3/2013 Switched to Pristiq 50 mg then 100 mg
3/2013 Switched to Lexapro 10mg. Cut down to 5 mg. CT for 2 weeks then reinstated for 6 weeks
8/2013-8/2014 Tapering Lexapro
11/2014 -8/2015: Developed severe insomnia, resumed using Ambien & Klonopin
12/2014-6/2015 Tried Ativan, Lunesta, Sonata, Trazadone, Seroquel, Rameron - Adverse Reactions
7/2015 Reinstated Lexapro at 2 mg; Quit Klonopin CT suddenly paradoxical)
Started Gabapentin 100-300 mg for 3 weeks. Developed severe lumbar jerking movements (myoclonus).Quit Gabapentin CT.
8/2015 Continuing Lexapro 2 mg. Baclofen 10mg-AM/20mg-PM - tapered off by 5/2016
1-7/2016 Lexapro 5 mg 
Intro page: http://survivinganti...rsened-by-meds/


#33 annej

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Posted 20 June 2012 - 08:41 AM

Dear Oaklily, I like your analysis and reporting and agree that the eminence of Stahl is to be questioend.

Breaching the time-release tablet of Pristiq by cutting it in one-half was a complete and utter disaster. I got super ill to the point that my doctor was considering a differential diagnosis of Serotonin Syndrome. Fortunately, it passed.

If some people want to try this method, I would say "proceed at your own risk". Broadcasting this approach should come with a warning that people have been made very ill doing so. The warning is on the prescription itself, "Do not cut, crush, or chew". This is a time-release medication and as such dumps a 24 hour dose into the system within a very short period of time.

No one can tell me that cutting up Pristiq is essentially taking regular release Effexor. I was on Effexor for many years and never had this reaction. Both Effexor and Pristiq may be similar in molecular composition, but in no way is cutting up Pristiq "essentially" the same thing as taking regular Effexor. Getting an instantaneous rush of Pristiq is not only miserable, it can be dangerous.

Bottom line: I request that a warning be given on this site about crushing a time release pill and doing so at your own risk. As for you, dear Oaklily, as far as tapering off of Pristiq, I can only share that I got off of Pristiq by adding on Lexapro slowly and then dropping the Pristiq and tapering off the Lexapro. There is a thread somewhere where I discussed my experience of getting off of Pristiq in detail. I'll try to dig it up. The "old" Prozac bridge did not work for me, but was worth a try.

:) Hugs, Annej

Edited by Altostrata, 12 March 2014 - 08:47 AM.
fixed text

My Intro
2000-Effexor and Klonopin
April 2011- C/T Adderall, lithium, Seroquel, Lunesta; Pristiq and Klonopin cut by 1/2 due to med-induced "rapid cycling"
May 2011- Pristiq/Lexapro bridge/taper
June, 2011- K cut to 0.5 mg (doctor)
July 18, 2011 - Lexapro done
October 2011- K taper started
Jan, 2012- Off K, Remeron started -bad idea
March 2012- Horrific Tardive Akathisa/TD (Dx: TA versus withdrawal akathisia secondary to K w/d)
May 2012- Reinstatement of K
Current Psych Meds: Klonopin 2 mg + Propanolol 15 mg and titrating up
As of June 2013: TA gone or suppressed - struggling with tolerance to benzos - beta blocker helping


#34 Altostrata

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Posted 20 June 2012 - 10:00 AM

Thank you for your experimentation, oaklily.

Compounding: I called a Compounding Pharmacy, and they told me that they cannot compound Pristiq due to the fact that it has a hard outer shell. So compounding is not an option for Pristiq.

Yes, compounding into capsules is an option if you are willing to sacrifice the extended-release qualities of Pristiq.

Regular Effexor (not extended-release) is taken twice a day. Effectively, Pristiq is concentrated Effexor. When you remove the extended-release shell from Pristiq, it becomes a concentrated regular Effexor.

Conceivably -- and I'm just guessing here -- one might be able to take a fractional dose of crushed Pristiq twice a day. For example, if you want to take 45mg, take 25mg in the morning and 20mg in the afternoon.

I briefly spoke to my compounding pharmacy and they said they could compound Pristiq into capsules with a slow-release additive that would distribute absorption over 8-10 hours. (Perhaps this is what moses's pharmacy is doing.) They will research a long-acting slow-release additive and get back to me with information next week.

Using Liquid Pristiq: Chemically this is not an option at all. I mixed finely crushed pristiq powder with a)syrup b)water c)alcohol(vodka) - and this is what happened: Pristiq turns into a gel! It is NOT soluble in any of the substances that I tried.

This is exactly what Stahl says http://survivinganti...dpost__p__14799

oaklily, you might write Dr. Stahl with your very interesting findings at smstahl at psychiatrist.com or sstahl at ucsd.edu and see what he has to say. Please share his response here.

There is no doubt he's eminent, the question is if he's accurate.

Conclusion: There is no way to taper Prisiq. You have to switch to a different medication or two. I would think switching back to Effexor xr or effexor tablets and combining it with Prozac would be the only pharmacological solution.

I would prefer to go the natural route, using amino acids L-Tyrosine and 5HTP, but really don't know if it will work. Has anyone tried this successfully?

Unless compounding pharmacies can mix in an effective slow-release additive in capsules, I'm afraid you're right.

Given it can be so difficult to go off Effexor or Effexor XR, it's an unpleasant option. Effexor mixed with Prozac? How about Prozac alone? It's used to get people off Effexor all the time.

I don't believe supplements like L-Tyrosine and 5HTP are going to help much with withdrawal. The pharmaceuticals are so much more powerful.

....Bottom line: I request that a warning be given on this site about crushing a time release pill and doing so at your own risk....

Thanks, annej. I have added that warning.

I've written the FDA, contacted my local compounding pharmacy, and written the UCSF School of Pharmacy.

I'd appreciate your and oaklily's help with the following:
  • Your information about the nature of Pristiq's slow-release coating. It's called Opaglos, manufacturer Colorcon
  • Any information you can get from compounding pharmacies. I've written the head of the UCSF School of Pharmacy with questions about compounding Pristiq.
  • Any information you can get from Pfizer. And don't forget to make a complaint!
  • Philip Ninan, formerly Vice President for Neuroscience, Global Medical Affairs at Wyeth Pharmaceuticals, who knows darn well you have to taper off Pristiq http://survivinganti...-desvenlafaxine now works on Long Island, NY here http://biobehavioral...ndpost__p__7509 and here http://www.winthrop..../f-geri.cfm#aag Perhaps he has some ideas!

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#35 Altostrata

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Posted 27 June 2012 - 05:05 PM

Everyone reading this topic, please phone Pristiq's manufacturer and the FDA to make a complaint that there's no way to taper off Pristiq:

Pfizer (800) 438-1985 in the US

FDA 1-800-FDA-1088 Mon–Fri between 8:00 a.m. and 4:30 p.m. EST.


I haven't gotten any response from the FDA or the phone call I made to Pfizer last week.

I phoned Emory hoping to speak to Philip Ninan, former Wyeth/Pfizer vice president for Pristiq development, but it turned out he's retired (now working part-time on Long Island, NY, see above).

A nice woman from Emory said she would ask another of the psychiatrists there about tapering off Pristiq. She phoned me back this morning. She said the doctor had done some Googling and found an article for me. It turned out to be from a site called SurvivingAntidepressants.org -- this very topic.

Well, I guess it's a good thing doctors are using this as reference, but we still need a way to taper off Pristiq!
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#36 Altostrata

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Posted 29 June 2012 - 08:11 AM

From the FDA:

From: CDER DRUG INFO <DRUGINFO@fda.hhs.gov>
Subject: RE: Pristiq -- tapering advised to discontinue, but impossible
Date: June 29, 2012 5:32:13 AM PDT
To: Altostrata <....>

Dear Alto Strata,

Your email was forwarded to our Division of Drug Information in the FDA's Center for Drug Evaluation and Research for a response.

I am consulting the FDA Review Team for Pristiq regarding your inquiry, and will be in touch shortly. Thank you again for your patience.

Best regards,
Drug Information RL
Division of Drug Information
Center for Drug Evaluation and Research
Food and Drug Administration

For up-to-date drug information, follow the FDA's Division of Drug Information on Twitter at FDA_Drug_Info

This communication is consistent with 21CFR10.85(k) and constitutes an informal communication that represents our best judgment at this time but does not constitute an advisory opinion, does not necessarily represent the formal position of the FDA, and does not bind or otherwise obligate or commit the agency to the views expressed.



----- Original Message -----
From: Altostrata <....>
Sent: Wednesday, June 27, 2012 09:08 PM
To: Woodcock, Janet; Commissioner FDA; Axelrad, Jane A
Cc: pelosi at mail.house.gov
Subject: Re: Pristiq -- tapering advised to discontinue, but impossible

Hello --

I sent you this letter last week; I haven't heard anything back.

My questions were not rhetorical. Patients need FDA attention to how to taper off Pristiq.

Thank you.

On Jun 21, 2012, at 7:45 PM, Altostrata wrote:

Hello --

The FDA advises gradual tapering when discontinuing Pristiq. The product package insert advises the same.

Yet Pristiq comes in only two dosages, 50mg and 100mg, with 50mg being the usual dosage.

The tablets are coated with a slow-release coating and cannot be split.

How is one supposed to taper off Pristiq? Skipping doses is an excellent way to trigger withdrawal symptoms, as you very well know. If a patient is sensitive to dosage drops, how can he or she very gradually reduce dosage?

Did you know many people are finding they cannot tolerate withdrawing from this drug?

Don't tell me to ask my doctor or any doctor, they don't know the answer to this either.

How can the FDA permit Wyeth to sell this drug without an avenue for discontinuation?

Sincerely,

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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