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Tips for tapering off desvenlafaxine (Pristiq)


Altostrata

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  • Moderator Emeritus

Just had a thought about tapering Pristiq under 50 mg.  In Australia we can't get 25 mg, which is a nuisance.  I don't want to change to Effexor completely but I was wonder if I had 30 mg & 10 mg capsules of Pristiq compounded  (and later 20 mgs) would it be a viable option to make up the dose with Effexor.  If it were possible it would make it so much easier and cheaper than getting 2 mg & 1 mg capsules compounded.

 

I welcome anybody's thoughts on this idea.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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The compounded Pristiq capsules will not be extended-release. This may cause problems.

 

You could combine Effexor and Pristiq, but you might as well gradually cross-taper to Effexor XR, it will be easier and less expensive.

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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Hi Alto,

 

     I've just gone back to Post #1 on this topic and found this:

 

"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."

 

     and

 

"In Conclusion, we now know:

1. The coating of the Pristiq tablet is NOT part of the extended release mechanism. In fact it often does not dissolve at all, after it breaks apart in your digestive tract. This means:
a. You can consume the powder w/out the coating, dividing it into smaller doses in order to taper.
b. A compounding pharmacy should be able to compound pristiq powder into smaller doses.(although they would have to sift out the coating, and may not be willing or able to do so.) But they do not need to add an extended release substance into the mix, as it is already in there.:

 

     Anyway, further down that page I've just found the following tidbit in this post by Lilu

 

"Well, this is a relief, I've been wrecking my brain as to how to taper this damn medication! What caused me to call yet another compounding pharmacy was that I crushed a Pristiq tablet myself, including the hard outter shell, with the back of a knife. I had the brilliant idea of taking the crushed pristiq powder and dividing it myself, and putting it into empty capsules! This can be done, but it is very time consuming. When speaking to the compounding pharmacist, he confirmed that they can easily pulverize the tablet coating and create capsules of any strength without any problems. A liquid solution is also an option. Wow! I guess I won't have to buy those pH strips after all! A liquid Pristiq solution seems like the best option if you want to taper very slowly."

 

     I'm going to check with my compounding pharmacy and see if they can do liquid for me.  I'll let you know.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Chessie, you have quoted this post by Lilu:
 

....
Ok, I believe I have found the answers that we have been seeking:

Not only did I find out what the coating is made of, but that the reason my experiment to dissolve the crushed powder from inside the tablet failed - is because the water has to be of a certain pH! Also, the coating is NOT an active ingredient!

http://www.rxlist.com/pristiq-drug.htm

Desvenlafaxine succinate is a white to off-white powder that is soluble in water. The solubility of desvenlafaxine succinate is pH dependent. Its octanol:aqueous system (at pH 7.0) partition coefficient is 0.21. (anybody know what this means?)

Each tablet contains 76 or 152 mg of desvenlafaxine succinate equivalent to 50 or 100 mg of desvenlafaxine, respectively. Inactive ingredients for the 50 mg tablet consist of hypromellose, microcrystalline cellulose, talc, magnesium stearate and film coating, which consists of polyvinyl alcohol, polyethylene glycol, talc, titanium dioxide, and iron oxides.

2. This link describes in more layman's terms that


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. This is normal and does not mean that you did not receive the complete dose of medication.

http://www.nlm.nih.g...her-information
and
http://dailymed.nlm....fo.cfm?id=62532


Patients receiving PRISTIQ may notice an inert matrix tablet passing in the stool or via colostomy. Patients should be informed that the active medication has already been absorbed by the time the patient sees the inert matrix tablet.

In Conclusion, we now know:

1. The coating of the Pristiq tablet is NOT part of the extended release mechanism. In fact it often does not dissolve at all, after it breaks apart in your digestive tract. This means:
a. You can consume the powder w/out the coating, dividing it into smaller doses in order to taper.
b. A compounding pharmacy should be able to compound pristiq powder into smaller doses.(although they would have to sift out the coating, and may not be willing or able to do so.) But they do not need to add an extended release substance into the mix, as it is already in there.

2. You can crush the pristiq tablet, sift out the coating, mix w/water at 7.0 pH (to adjust the pH of water, watch this youtube video, apparently all you need is a pH kit from a garden nursery. But perhaps pharmacies sell them as well. )
[see original post]
I would be very curious to see if it really dissolves and not turns into a gel, like it did in regular water. Then, once in liquid form, you can create your own tapering schedule.

 
"In Conclusion" is Lilu's conclusion. Her conclusion that the extended-release mechanism is retained when a Pristiq tablet is crushed to powder is INCORRECT.
 
The extended-release mechanism is part of the tablet MATRIX, or the glue that holds the tablet together. When 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.

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

All postings © copyrighted.

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Hi Alto,

 

Thank you for clarifying that.  And thanks also for the explanation of Matrix.  The way you have explained it makes sense.

 

Do you know, and are you able to explain, about the slow release additive used in compounded capsules?  Any help with this will be much appreciated.  Thank you in advance.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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No, I don't know what pharmacists might put into compounded capsules. If anyone finds out, please let me know.

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

All postings © copyrighted.

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I asked my pharmacist what they use , this is the response:

 

"We are PCCA (Professional Compounding Center of America) approved pharmacy and we use PCCA ingredients for our compounds. PCCA has approved us to use Methocel (E4M) as the only ingredient for slow released formulated compounds. 

 
 PCCA approved pharmacies use Methocel (E4M) as their slow-released ingredient, however, we will have no access to other independent pharmacies's medical data on what slow-released ingredients would they use. "
 
Interesting that my Australian pharmacy belong to the American association.
When I did some digging I found this:

"Today, PCCA has become the independent compounding pharmacist’s complete resource for fine chemicals, equipment, devices, flavors, ACPE-accredited training and education, pharmacy software, marketing, business and pharmacy consulting assistance. Our membership includes more than 3,900 independent community pharmacists in the United States, Canada, Australia, and other countries around the world"

1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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Just checked the website for my compounder and a PCCA logo is on the top right of their Home Page.  However, it is Professional Compounding Chemists of Australia.  Looking at PCCAust website they have the history of PCCAmerica.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 5 months later...
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Found this today:

 

PRODUCT MONOGRAPH

 
®T.M. Wyeth LLC

Pfizer Canada Inc., Licensee

17,300 Trans-Canada Highway

Kirkland, Quebec

H9J 2M5

Date of Revision:

December 3, 2014

Submission Control No: 170902

©Pfizer Canada Inc. 2014

 

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Put my Pristiq tablets in to be compounded today and I asked the compounding pharmacist about the slow release and he told me it is in the capsule, not added to the ground up tablet.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Please let us know how well this works in a compounded capsule. My understanding is the additive only extends the drug effect for a few hours. What did the druggist say about that?

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

All postings © copyrighted.

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Hi Alto,

 

Thank you for clarifying that.  And thanks also for the explanation of Matrix.  The way you have explained it makes sense.

 

Do you know, and are you able to explain, about the slow release additive used in compounded capsules?  Any help with this will be much appreciated.  Thank you in advance.

 

Hi ChessieCat, decided to switch to Effexor XR 75 mg (from 50 mg Pristiq) as my pharmacist was worried that the slow release additive that she would use to compound the Pritisq might not completely eliminate a potential dose dump of the Pristiq.  First day off of Pristiq to Effexor no symptoms (except maybe a little anxiety but imagine that's in my head and not an effect of switching).  Am going to stay on 75 mg of Effexor for a month until my body is adjusted to the Effexor XR and then reduce the Effexor by 5% each month.  Will take forever to get off of the Effexor but much better than living through another Pristiq withdrawal.

Edited by Altostrata
corrected quote code

Current Prescription Drugs for Hypothyroidism:  Synthroid 100mcg / Cytomel 5mcg (15 years Pristiq/Effexor)

Tapering Schedule
September 15, 2016 - switched from Pristiq 50mg to Effexor XR 75mg; November 10, 2016 - reduced to 67.5 Effexor XR
December 9, 2016 - reduced 60.75
January 5, 2017 - reduced 54.67
January 30, 2017 - reduced to 49.0
February 20, 2017 - reduced to 44.0 
May 20, 2017 - reduced to 40.25 (holding for additional month due to late onset of withdrawal symptoms after this taper)
July 17, 2017 - reduced to 38.24
August 15, 2017 - reduced to 37.5 (50% of my original dose)

October 15, 2017 - reduced to 35.6

November 12, 2017 - reduced to 33.8
December 15, 2017 - up-dose to 35.6
December 28, 2017 - up-dose to 37.5

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  • 3 weeks later...

Hi Alto,

 

Thank you for clarifying that.  And thanks also for the explanation of Matrix.  The way you have explained it makes sense.

 

Do you know, and are you able to explain, about the slow release additive used in compounded capsules?  Any help with this will be much appreciated.  Thank you in advance.

the "matrix" IS the shell.  aka "film".  

as cited by the original poster, "Patients receiving PRISTIQ may notice an inert matrix tablet passing in the stool or via colostomy. Patients should be informed that the active medication has already been absorbed by the time the patient sees the inert matrix tablet."

20090810 Dx GeneralAnxietyDisorder & PanicDisorder.  Rx Pristiq (desvenlafaxine) 50mg.  stable, side effects minor but blurry vision, impotence, others. http://survivingantidepressants.org/index.php?/topic/5418-ktp-weaning-from-4yrs-50mg-pristiq/ for more details.  

20140210 switch Pristiq50mg (can't cut them!) to Effexor (venlafaxine, V) same drug but easier dose reduction (and mfr TEVA's beads are handily ~= 1mg ea).  20140218 125mgV  0309 112mg 0401:100mg, 410:75, 0506:70, 0512:65, 0525:56, 0614:37.5, 0620:30, 0624:27, 0630:26, 0706:24, 0724:22, 0801:20, 0804:19, 0808:18, 0813:17, 0818:16, 0819:15, 0821:13, 0903:12, 0911:11, 0918:10, 0921:9, 0927:8, 1001:6, 1021:5, missed a day?, darn, it was going so well, or so I thought.  SEVERE ANXIETY, INSOMNIA. WAY TOO QUICK REDUCTIONS! hindsight: 0813:5%/5days, 0818:6%/5days, 0819:6%/1day, 0821:13%/2days, 0903: 7%/14days, 0911:8%/8days, 0918:9%/7days; 0921:10%/3days, 0927:11%/6days, 1001:25%/3days (still okay!) 1021:16%20days.  guideline is 10%/30days =  i am a self-diagnosed idiot

20141103 back to 6mgV, xanax next several days. 1111 insomnia bad, 10mgAmbien slept well. 1112 8mgV no Ambien; miserable. 1113 Ambien+xanax, tough night. 1114 Very Tired. 0.125Xanax, 25mgV at 10, better 10min later. 20141115 37.5mg V +Ambien. miserable month, still insomnia & anxiety. 1214 upped to 75mg V, ate .125Xanax. 1215 37.5mg mornings; force sleep for one week and come back". 20150115 lots of appts lots of chat but we never get to MY agenda = meds discussion.  Upping to 47.5mg mornings (no more xanax-, lunesta-forced sleep) but still anxious.  PAYING BIGTIME FOR TOO-FAST WEANING in OCTOBER 2014!  20150220 50mg V. 20150330 still anxy each am let's try reducing: 45mg V 1/day mornings. 20150511:42mg, 0611:40, 0626:39, 0710:38, 0717:37, 0731:33, 0813:32, 0915:29, 0927:28, 1004:27, 1015:26, 1101:25, 1116:22mg/day.  Still anxiety every morning, this sucks.  20151124 found a shrink who seems to get weaning: 20151125 add 10mg/day Prozac aka fluoxetine F, continue taper V to zero, then taper the F, "easier".  20151203:10mg Prozac=P 19mg V, 1213:10mgP17mgV, daily anx quieter but lurking. 1227:10mgP15mgV, 20160108:10mgP14mgV, 0124:10P13V, 0131:P10,V12. 0215 P10,V11.  0223:P10V10.  0314:P10V9. enjoying relatively quiet brain.  0407 P10V8, 0427P10V7, 0517P10V6, 0611P10V5, 0706P10V4, 0818P10V3, 0921P10V2,  1021P10V1, 20161128Prozac10mgVenlafaxine ZERO, 20170115 still anxious upped Prozac to 20mg/day, better anxiety control... 

20190301 finally stable enough to consider weaning again, started skipping one day / week.

20190501 started skipping every 3rd day so 13.3mg/day average.  several days long 1/2life must be why the docs think of prozac as 'self-tapering' i think it just means longer time between upsetting the cart and seeing apples all over the road.  skipping is bad practice, even with longlife prozac: let's do liquid: 20190902 first day of 13mg via 5ml liquid made from 13 20mg caps in 100ml water.  20190921 12mg same way(7.7%/20days).  20191010 11mg (8.3%/20days) 20191031 10mg (9.1%/20days) 20191124 9mg (10.0%/24 days) 20191213 8.5mg (5.6%/20 days) 20191231 8mg (5.9%/20days) 20200120 hit a wall?  going another 20 days at 8mg, just started Lisinopril for hypertension (caused by prozac withdrawal creating less-than-panic-grade anxiety??) and doubled atorvastatin to 40mg.  Minimizing changes in general and had a semi-panic 4am 1/20... BP still wild. 20200208 back to 9mg daily anxiety starting about 1/18.  

20200212 increase to 10mg prozac cap daily.  anxiety still there but clears within hour of drugs.  20200222 still anxy 2 hrs after 10mg, added another 1mg and mucho better.  20200223 11mg early.  anxious enough to be glad i can actually sit.  will wait another 5 days before adding another milligram. 20200229 12mg prozac still anxious.  20200317 13mgProzac still anxious.  20200610 15mgProzac.  bp under control with Losartan50mg (lisinopril cough dictates change)  

20201028 10am met w Dr S.  to switch back to Venlafaxine XR, "take 10mg prozac + 37mg VenlafaxineXR for a monththen quit prozac." i think i'll taper thanx... 
20201116 9am start 10mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.  20201230 5mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.
20210124 4mgP,37V,40S,25L,81A.  20210213 3.5mgP,37V,40S,25L,81A;  20210306 3mgP,37V,40S,25L,81A  20210328 2.5mgP,37V,40S,25L,81A; 20210501 2.0mgP,37V,40S,25L,81A;20210519 1.5mgP,37V,40S,25L,81A; 20210607 1.5mgP,37V,40S,50L,81A. 
20210614 1.0mgP,37V,40S, 50L,81A. 20210702 0.5mgP,37V,40S,50L,81A; 20210728; 0.0mgProzac,37.5Venlafaxine,40Atorvastatin50Losartan,81Aspirin; 20210917 0915am anxiety started about a week after dropping the last 0.5mg of prozac.  just took 0.10mg xanax.  20210929 1:28 PM I'm anxious after so carefully weaning off prozac - the last 0.5mg may need to come back??  instead, trying an extra cap of 37.5mg venlafaxine, let's see if there's sudden relief?  it seems possible.  fingers x'd.  not sure but 5 minutes later i think i feel better gawd i hope.  20210930 7am anxious out of bed, took drugs early and oops chewed them.  no more drugs 2day.  11:41 AM 10/1/2021 very jagged today, avoiding the shower.   took <1/6 of a .5mg xanax and still anxy at noon.  6:59 PM 10/4/2021 2nd or 3rd day of 75mg Venlafaxine  met w/ shrink 2day he says i'm doing  it right so  20210728 75.0mgVenlafaxine,40Atorvastatin,50Losartan,81Aspirin;10mgCarbidopa-Levodopa; 12/18/2021  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 3x 25/100mgSinemet aka Carbidopa/Levodopa.    20220308 new neurologist, raising CL:  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 4x 25/100mgSinemet aka Carbidopa/Levodopa.  possibly need to reduce losartan to avoid fainting.

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Found this today:

 

PRODUCT MONOGRAPH

 
®T.M. Wyeth LLC

Pfizer Canada Inc., Licensee

17,300 Trans-Canada Highway

Kirkland, Quebec

H9J 2M5

Date of Revision:

December 3, 2014

Submission Control No: 170902

©Pfizer Canada Inc. 2014

 

 

in which the 'matrix' is called a shell...

 

"PRISTIQ tablets must be swallowed whole with liquids, and must not be chewed, divided or

crushed. The medication is contained within a non-absorbable shell designed to release the drug

at a controlled rate. The tablet shell, along with insoluble core components, is eliminated from

the body; patients should not be concerned if they occasionally notice something that looks like a

tablet in their stool. Due to the controlled-release design, PRISTIQ tablets should only be used

in patients who are able to swallow the tablets whole."

20090810 Dx GeneralAnxietyDisorder & PanicDisorder.  Rx Pristiq (desvenlafaxine) 50mg.  stable, side effects minor but blurry vision, impotence, others. http://survivingantidepressants.org/index.php?/topic/5418-ktp-weaning-from-4yrs-50mg-pristiq/ for more details.  

20140210 switch Pristiq50mg (can't cut them!) to Effexor (venlafaxine, V) same drug but easier dose reduction (and mfr TEVA's beads are handily ~= 1mg ea).  20140218 125mgV  0309 112mg 0401:100mg, 410:75, 0506:70, 0512:65, 0525:56, 0614:37.5, 0620:30, 0624:27, 0630:26, 0706:24, 0724:22, 0801:20, 0804:19, 0808:18, 0813:17, 0818:16, 0819:15, 0821:13, 0903:12, 0911:11, 0918:10, 0921:9, 0927:8, 1001:6, 1021:5, missed a day?, darn, it was going so well, or so I thought.  SEVERE ANXIETY, INSOMNIA. WAY TOO QUICK REDUCTIONS! hindsight: 0813:5%/5days, 0818:6%/5days, 0819:6%/1day, 0821:13%/2days, 0903: 7%/14days, 0911:8%/8days, 0918:9%/7days; 0921:10%/3days, 0927:11%/6days, 1001:25%/3days (still okay!) 1021:16%20days.  guideline is 10%/30days =  i am a self-diagnosed idiot

20141103 back to 6mgV, xanax next several days. 1111 insomnia bad, 10mgAmbien slept well. 1112 8mgV no Ambien; miserable. 1113 Ambien+xanax, tough night. 1114 Very Tired. 0.125Xanax, 25mgV at 10, better 10min later. 20141115 37.5mg V +Ambien. miserable month, still insomnia & anxiety. 1214 upped to 75mg V, ate .125Xanax. 1215 37.5mg mornings; force sleep for one week and come back". 20150115 lots of appts lots of chat but we never get to MY agenda = meds discussion.  Upping to 47.5mg mornings (no more xanax-, lunesta-forced sleep) but still anxious.  PAYING BIGTIME FOR TOO-FAST WEANING in OCTOBER 2014!  20150220 50mg V. 20150330 still anxy each am let's try reducing: 45mg V 1/day mornings. 20150511:42mg, 0611:40, 0626:39, 0710:38, 0717:37, 0731:33, 0813:32, 0915:29, 0927:28, 1004:27, 1015:26, 1101:25, 1116:22mg/day.  Still anxiety every morning, this sucks.  20151124 found a shrink who seems to get weaning: 20151125 add 10mg/day Prozac aka fluoxetine F, continue taper V to zero, then taper the F, "easier".  20151203:10mg Prozac=P 19mg V, 1213:10mgP17mgV, daily anx quieter but lurking. 1227:10mgP15mgV, 20160108:10mgP14mgV, 0124:10P13V, 0131:P10,V12. 0215 P10,V11.  0223:P10V10.  0314:P10V9. enjoying relatively quiet brain.  0407 P10V8, 0427P10V7, 0517P10V6, 0611P10V5, 0706P10V4, 0818P10V3, 0921P10V2,  1021P10V1, 20161128Prozac10mgVenlafaxine ZERO, 20170115 still anxious upped Prozac to 20mg/day, better anxiety control... 

20190301 finally stable enough to consider weaning again, started skipping one day / week.

20190501 started skipping every 3rd day so 13.3mg/day average.  several days long 1/2life must be why the docs think of prozac as 'self-tapering' i think it just means longer time between upsetting the cart and seeing apples all over the road.  skipping is bad practice, even with longlife prozac: let's do liquid: 20190902 first day of 13mg via 5ml liquid made from 13 20mg caps in 100ml water.  20190921 12mg same way(7.7%/20days).  20191010 11mg (8.3%/20days) 20191031 10mg (9.1%/20days) 20191124 9mg (10.0%/24 days) 20191213 8.5mg (5.6%/20 days) 20191231 8mg (5.9%/20days) 20200120 hit a wall?  going another 20 days at 8mg, just started Lisinopril for hypertension (caused by prozac withdrawal creating less-than-panic-grade anxiety??) and doubled atorvastatin to 40mg.  Minimizing changes in general and had a semi-panic 4am 1/20... BP still wild. 20200208 back to 9mg daily anxiety starting about 1/18.  

20200212 increase to 10mg prozac cap daily.  anxiety still there but clears within hour of drugs.  20200222 still anxy 2 hrs after 10mg, added another 1mg and mucho better.  20200223 11mg early.  anxious enough to be glad i can actually sit.  will wait another 5 days before adding another milligram. 20200229 12mg prozac still anxious.  20200317 13mgProzac still anxious.  20200610 15mgProzac.  bp under control with Losartan50mg (lisinopril cough dictates change)  

20201028 10am met w Dr S.  to switch back to Venlafaxine XR, "take 10mg prozac + 37mg VenlafaxineXR for a monththen quit prozac." i think i'll taper thanx... 
20201116 9am start 10mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.  20201230 5mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.
20210124 4mgP,37V,40S,25L,81A.  20210213 3.5mgP,37V,40S,25L,81A;  20210306 3mgP,37V,40S,25L,81A  20210328 2.5mgP,37V,40S,25L,81A; 20210501 2.0mgP,37V,40S,25L,81A;20210519 1.5mgP,37V,40S,25L,81A; 20210607 1.5mgP,37V,40S,50L,81A. 
20210614 1.0mgP,37V,40S, 50L,81A. 20210702 0.5mgP,37V,40S,50L,81A; 20210728; 0.0mgProzac,37.5Venlafaxine,40Atorvastatin50Losartan,81Aspirin; 20210917 0915am anxiety started about a week after dropping the last 0.5mg of prozac.  just took 0.10mg xanax.  20210929 1:28 PM I'm anxious after so carefully weaning off prozac - the last 0.5mg may need to come back??  instead, trying an extra cap of 37.5mg venlafaxine, let's see if there's sudden relief?  it seems possible.  fingers x'd.  not sure but 5 minutes later i think i feel better gawd i hope.  20210930 7am anxious out of bed, took drugs early and oops chewed them.  no more drugs 2day.  11:41 AM 10/1/2021 very jagged today, avoiding the shower.   took <1/6 of a .5mg xanax and still anxy at noon.  6:59 PM 10/4/2021 2nd or 3rd day of 75mg Venlafaxine  met w/ shrink 2day he says i'm doing  it right so  20210728 75.0mgVenlafaxine,40Atorvastatin,50Losartan,81Aspirin;10mgCarbidopa-Levodopa; 12/18/2021  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 3x 25/100mgSinemet aka Carbidopa/Levodopa.    20220308 new neurologist, raising CL:  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 4x 25/100mgSinemet aka Carbidopa/Levodopa.  possibly need to reduce losartan to avoid fainting.

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Thank you.  I have done a bit more research and have learned something today.  Never too old!

 

I found this and read a fair amount of it: Development of Sustained Release Desvenlafaxine Succinate Hydrophobic Matrix System using Melt Granulation Technique

 

Research Gate dot net: Development_of_Sustained_Release_Desvenlafaxine_Succinate_Hydrophobic_Matrix_System_using_Melt_Granulation_Technique

 

PDF:  Development_of_Sustained_Release_Desvenlafaxine_Succinate_Hydrophobic_Matrix_System_using_Melt_Granulation_Technique

 

This time last year I hadn't even found SA.  Now I'm reading about matrices. :wacko:

 

Edited by ChessieCat
Updated links to article

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 9 months later...

I'm not a bit surprised to hear of brain fog after reading this way-too-long thread.  Instead of compounding pristiq, non-XR effexor, liquids??, etc, you could do it this way:

 

1) since you can't reliably cut up Pristiq, just switch from Pristiq (o-desvenlafaxine) to Effexor (venlafaxine), same drug, the o-isomer is the active version.  be sure to get XR venlafaxine so you don't have to mess around with >1 dose per day.  Double your pristiq mg to get effexor mg.  just switch, it works, you won't even notice.  How?

 

2) get your VenlafaxineXR prescriptions filled at Walgreens, where you'll get TEVA-manufactured capsules, nice because the tiny beads are each approx 1mg of medicine with very little variation, makes counting easy.  the caps come in 37.5mg, 75mg, 150mg, so if you're on 50mg Pristiq you want about 100mg effexor so take a 75mg cap + 25 beads from the next one.   (don't trust me on this, count them yourself, you'll get the same # of beads as the alleged dose in mg).  this makes it very easy to reduce by 10% all the way down to 1mg.  use a few shot glasses for easy counting; with 7 you can set up your whole week.  

 

3) never reduce by > 10% of current dose and don't reduce more often than every 30 days.  DON'T get cocky and think you've got it made when you're down to 10mg, you really do have to do the reductions slowly.  I was well on the way but screwed up very near the end by reducing way too fast and am still paying the price; if you do this right you can do it.

 

4) notes:  might as well get the big dose caps for near the end, you'll be counting beads anyway and 150mg costs the same as 37.5mg, save your $.  

read my diatribe for an example, but don't screw up by going too fast with tapering.  in my sig you can see I did, and I spent the next couple years in pure hell insomnia- and anxiety-wise, developed a parkinson-like tremor I can't get rid of, and am now finally pretty stable on 20mg Prozac and not even thinking of how to get off.   

 

good luck you can do it! 

 

Edited by ChessieCat
Edited first paragraph to read as a suggestion

20090810 Dx GeneralAnxietyDisorder & PanicDisorder.  Rx Pristiq (desvenlafaxine) 50mg.  stable, side effects minor but blurry vision, impotence, others. http://survivingantidepressants.org/index.php?/topic/5418-ktp-weaning-from-4yrs-50mg-pristiq/ for more details.  

20140210 switch Pristiq50mg (can't cut them!) to Effexor (venlafaxine, V) same drug but easier dose reduction (and mfr TEVA's beads are handily ~= 1mg ea).  20140218 125mgV  0309 112mg 0401:100mg, 410:75, 0506:70, 0512:65, 0525:56, 0614:37.5, 0620:30, 0624:27, 0630:26, 0706:24, 0724:22, 0801:20, 0804:19, 0808:18, 0813:17, 0818:16, 0819:15, 0821:13, 0903:12, 0911:11, 0918:10, 0921:9, 0927:8, 1001:6, 1021:5, missed a day?, darn, it was going so well, or so I thought.  SEVERE ANXIETY, INSOMNIA. WAY TOO QUICK REDUCTIONS! hindsight: 0813:5%/5days, 0818:6%/5days, 0819:6%/1day, 0821:13%/2days, 0903: 7%/14days, 0911:8%/8days, 0918:9%/7days; 0921:10%/3days, 0927:11%/6days, 1001:25%/3days (still okay!) 1021:16%20days.  guideline is 10%/30days =  i am a self-diagnosed idiot

20141103 back to 6mgV, xanax next several days. 1111 insomnia bad, 10mgAmbien slept well. 1112 8mgV no Ambien; miserable. 1113 Ambien+xanax, tough night. 1114 Very Tired. 0.125Xanax, 25mgV at 10, better 10min later. 20141115 37.5mg V +Ambien. miserable month, still insomnia & anxiety. 1214 upped to 75mg V, ate .125Xanax. 1215 37.5mg mornings; force sleep for one week and come back". 20150115 lots of appts lots of chat but we never get to MY agenda = meds discussion.  Upping to 47.5mg mornings (no more xanax-, lunesta-forced sleep) but still anxious.  PAYING BIGTIME FOR TOO-FAST WEANING in OCTOBER 2014!  20150220 50mg V. 20150330 still anxy each am let's try reducing: 45mg V 1/day mornings. 20150511:42mg, 0611:40, 0626:39, 0710:38, 0717:37, 0731:33, 0813:32, 0915:29, 0927:28, 1004:27, 1015:26, 1101:25, 1116:22mg/day.  Still anxiety every morning, this sucks.  20151124 found a shrink who seems to get weaning: 20151125 add 10mg/day Prozac aka fluoxetine F, continue taper V to zero, then taper the F, "easier".  20151203:10mg Prozac=P 19mg V, 1213:10mgP17mgV, daily anx quieter but lurking. 1227:10mgP15mgV, 20160108:10mgP14mgV, 0124:10P13V, 0131:P10,V12. 0215 P10,V11.  0223:P10V10.  0314:P10V9. enjoying relatively quiet brain.  0407 P10V8, 0427P10V7, 0517P10V6, 0611P10V5, 0706P10V4, 0818P10V3, 0921P10V2,  1021P10V1, 20161128Prozac10mgVenlafaxine ZERO, 20170115 still anxious upped Prozac to 20mg/day, better anxiety control... 

20190301 finally stable enough to consider weaning again, started skipping one day / week.

20190501 started skipping every 3rd day so 13.3mg/day average.  several days long 1/2life must be why the docs think of prozac as 'self-tapering' i think it just means longer time between upsetting the cart and seeing apples all over the road.  skipping is bad practice, even with longlife prozac: let's do liquid: 20190902 first day of 13mg via 5ml liquid made from 13 20mg caps in 100ml water.  20190921 12mg same way(7.7%/20days).  20191010 11mg (8.3%/20days) 20191031 10mg (9.1%/20days) 20191124 9mg (10.0%/24 days) 20191213 8.5mg (5.6%/20 days) 20191231 8mg (5.9%/20days) 20200120 hit a wall?  going another 20 days at 8mg, just started Lisinopril for hypertension (caused by prozac withdrawal creating less-than-panic-grade anxiety??) and doubled atorvastatin to 40mg.  Minimizing changes in general and had a semi-panic 4am 1/20... BP still wild. 20200208 back to 9mg daily anxiety starting about 1/18.  

20200212 increase to 10mg prozac cap daily.  anxiety still there but clears within hour of drugs.  20200222 still anxy 2 hrs after 10mg, added another 1mg and mucho better.  20200223 11mg early.  anxious enough to be glad i can actually sit.  will wait another 5 days before adding another milligram. 20200229 12mg prozac still anxious.  20200317 13mgProzac still anxious.  20200610 15mgProzac.  bp under control with Losartan50mg (lisinopril cough dictates change)  

20201028 10am met w Dr S.  to switch back to Venlafaxine XR, "take 10mg prozac + 37mg VenlafaxineXR for a monththen quit prozac." i think i'll taper thanx... 
20201116 9am start 10mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.  20201230 5mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.
20210124 4mgP,37V,40S,25L,81A.  20210213 3.5mgP,37V,40S,25L,81A;  20210306 3mgP,37V,40S,25L,81A  20210328 2.5mgP,37V,40S,25L,81A; 20210501 2.0mgP,37V,40S,25L,81A;20210519 1.5mgP,37V,40S,25L,81A; 20210607 1.5mgP,37V,40S,50L,81A. 
20210614 1.0mgP,37V,40S, 50L,81A. 20210702 0.5mgP,37V,40S,50L,81A; 20210728; 0.0mgProzac,37.5Venlafaxine,40Atorvastatin50Losartan,81Aspirin; 20210917 0915am anxiety started about a week after dropping the last 0.5mg of prozac.  just took 0.10mg xanax.  20210929 1:28 PM I'm anxious after so carefully weaning off prozac - the last 0.5mg may need to come back??  instead, trying an extra cap of 37.5mg venlafaxine, let's see if there's sudden relief?  it seems possible.  fingers x'd.  not sure but 5 minutes later i think i feel better gawd i hope.  20210930 7am anxious out of bed, took drugs early and oops chewed them.  no more drugs 2day.  11:41 AM 10/1/2021 very jagged today, avoiding the shower.   took <1/6 of a .5mg xanax and still anxy at noon.  6:59 PM 10/4/2021 2nd or 3rd day of 75mg Venlafaxine  met w/ shrink 2day he says i'm doing  it right so  20210728 75.0mgVenlafaxine,40Atorvastatin,50Losartan,81Aspirin;10mgCarbidopa-Levodopa; 12/18/2021  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 3x 25/100mgSinemet aka Carbidopa/Levodopa.    20220308 new neurologist, raising CL:  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 4x 25/100mgSinemet aka Carbidopa/Levodopa.  possibly need to reduce losartan to avoid fainting.

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3 hours ago, ktp said:

I'm not a bit surprised to hear of brain fog after reading this way-too-long thread.  Instead of compounding pristiq, non-XR effexor, liquids??, etc, you could do it this way:

 

1) since you can't reliably cut up Pristiq, just switch from Pristiq (o-desvenlafaxine) to Effexor (venlafaxine), same drug, the o-isomer is the active version.  be sure to get XR venlafaxine so you don't have to mess around with >1 dose per day.  Double your pristiq mg to get effexor mg.  just switch, it works, you won't even notice.  How?

 

2) get your VenlafaxineXR prescriptions filled at Walgreens, where you'll get TEVA-manufactured capsules, nice because the tiny beads are each approx 1mg of medicine with very little variation, makes counting easy.  the caps come in 37.5mg, 75mg, 150mg, so if you're on 50mg Pristiq you want about 100mg effexor so take a 75mg cap + 25 beads from the next one.   (don't trust me on this, count them yourself, you'll get the same # of beads as the alleged dose in mg).  this makes it very easy to reduce by 10% all the way down to 1mg.  use a few shot glasses for easy counting; with 7 you can set up your whole week.  

 

3) never reduce by > 10% of current dose and don't reduce more often than every 30 days.  DON'T get cocky and think you've got it made when you're down to 10mg, you really do have to do the reductions slowly.  I was well on the way but screwed up very near the end by reducing way too fast and am still paying the price; if you do this right you can do it.

 

4) notes:  might as well get the big dose caps for near the end, you'll be counting beads anyway and 150mg costs the same as 37.5mg, save your $.  

read my diatribe for an example, but don't screw up by going too fast with tapering.  in my sig you can see I did, and I spent the next couple years in pure hell insomnia- and anxiety-wise, developed a parkinson-like tremor I can't get rid of, and am now finally pretty stable on 20mg Prozac and not even thinking of how to get off.   

 

good luck you can do it! 

 

 

You have provided some good information, however each of us has to make our own decision about how we will taper a drug.

 

I made my decision by doing lots of research and decided to stay with Pristiq for a few reasons.  I didn't want to change from the exact drug that I am on.  I also don't want to change from brand Pristiq to generic desvenlafaxine.  Also, I have found that getting my Pristiq compounded means that I don't have to count tiny beads.  This would drive me nuts for sure.

 

I have been tapering using compounded tablets for 1 yr and 9 mths now and have already had 3 batches of tablets compounded and about to get my 4th batch made up.

 

I am very satisfied with my tapering mether and I'm happy to continue doing it this way.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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2 hours ago, ChessieCat said:

 

You have provided some good information, however each of us has to make our own decision about how we will taper a drug.

 

I made my decision by doing lots of research and decided to stay with Pristiq for a few reasons.  I didn't want to change from the exact drug that I am on.  I also don't want to change from brand Pristiq to generic desvenlafaxine.  Also, I have found that getting my Pristiq compounded means that I don't have to count tiny beads.  This would drive me nuts for sure.

 

I have been tapering using compounded tablets for 1 yr and 9 mths now and have already had 3 batches of tablets compounded and about to get my 4th batch made up.

 

I am very satisfied with my tapering mether and I'm happy to continue doing it this way.

Hi Chessie:

 

My psychiatrist wants to start me on Pristiq.  I've been in withdrawal for over a year now, non functioning with very high anxiety. I'm holding on 5 beads of Effexor since July of last year while tapering Vyvanse that I've become sensitive to. I'm at 5 mg compounded now. 

 

Would you mind sharing exactly how your compounding pharmacy pharmacy is doing this?  I would appreciate it so very much! ❤️

Effexor XR 300 (brand) mg & various SSRIs 15 yrs (Effexor XR 300 mg past 10 yrs

Clonazepam, 1.0 mg. am, .5 mg pm. - 15 yrs, 7-17-16- Began .5 three times a day

Vyvanse 60 mg, - 2 yrs, Cut to 50 mg for 6 mths, Cut to 30 mg. on 4-1-16. Tapering.

Approx. 4-1-15 began Effexor XR 300 taper, very slowly for a year. Held at 37.5 for about 3 mths. Cut to 18 mg for 2 wks to 0. WD began 2 wks later. Depression, anxiety, paranoia, low appetite, nausea.

7-14-16-Reinstated 5 beads Effx after 4 mths misery.Pooped out 10 days.

9-12-16-to present- Wide eyed terror, bedridden fear, no appetite/feeling of being full.

10-30-16- Began 15% liquid tapering of 30 mg Vyvanse. (25 mg)

11-13-16- Liquid Vyvanse 22 mg,11-27-16- Liquid 15 mg, 12-12-16- Vyvanse 12.5 for 5 days. 12-16 - 12-29, 15 mg.

11-20-16- Switched back to 1.0 clonazepam am & .5 bedtime

12-30-16- Moved to 15 mg COMPOUNDED Vyvanse.Current 4/11-4/25 7.5 mg.(10% ev 2 wks) Off Vyvanse

Current meds:Effexor XR- 3 Beads, Clonazepam-1.0 mg am, .5 mg bedtime,Vyvanse-(tapering) Estradiol- 2

mg,Progesterone 200 mg,Testosterone 30 mg/ml,Nature Throid- 48.75 mg.(12-21-16-65 mg.) (4-18-17-81.25 mg) Current supplements: Fish Oil-1360 mg, Curamin- 2706 mg.

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The chemist I go to is a member of the Professional Compounding Chemists of Australia, and there is one in America as well.  In Australia we can take the prescription tablets in and I just tell him how many of each dose I want.  He uses slow release, which I'm not sure if it is in the capsule or they add it to the inside mix.  I was advised that they need to be used within 6 months, but I have used previous batches with no problem.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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12 hours ago, ChessieCat said:

The chemist I go to is a member of the Professional Compounding Chemists of Australia, and there is one in America as well.  In Australia we can take the prescription tablets in and I just tell him how many of each dose I want.  He uses slow release, which I'm not sure if it is in the capsule or they add it to the inside mix.  I was advised that they need to be used within 6 months, but I have used previous batches with no problem.

 

I'm assuming that he crushes the whole tablet and removes the outer coating (film)?

 

Then either adding the time release in the powder or using a time released (8-10 hr) capsule. 

 

Ugh!  It's so sad that we have to figure this out on our own. 

 

Thank you again!

Effexor XR 300 (brand) mg & various SSRIs 15 yrs (Effexor XR 300 mg past 10 yrs

Clonazepam, 1.0 mg. am, .5 mg pm. - 15 yrs, 7-17-16- Began .5 three times a day

Vyvanse 60 mg, - 2 yrs, Cut to 50 mg for 6 mths, Cut to 30 mg. on 4-1-16. Tapering.

Approx. 4-1-15 began Effexor XR 300 taper, very slowly for a year. Held at 37.5 for about 3 mths. Cut to 18 mg for 2 wks to 0. WD began 2 wks later. Depression, anxiety, paranoia, low appetite, nausea.

7-14-16-Reinstated 5 beads Effx after 4 mths misery.Pooped out 10 days.

9-12-16-to present- Wide eyed terror, bedridden fear, no appetite/feeling of being full.

10-30-16- Began 15% liquid tapering of 30 mg Vyvanse. (25 mg)

11-13-16- Liquid Vyvanse 22 mg,11-27-16- Liquid 15 mg, 12-12-16- Vyvanse 12.5 for 5 days. 12-16 - 12-29, 15 mg.

11-20-16- Switched back to 1.0 clonazepam am & .5 bedtime

12-30-16- Moved to 15 mg COMPOUNDED Vyvanse.Current 4/11-4/25 7.5 mg.(10% ev 2 wks) Off Vyvanse

Current meds:Effexor XR- 3 Beads, Clonazepam-1.0 mg am, .5 mg bedtime,Vyvanse-(tapering) Estradiol- 2

mg,Progesterone 200 mg,Testosterone 30 mg/ml,Nature Throid- 48.75 mg.(12-21-16-65 mg.) (4-18-17-81.25 mg) Current supplements: Fish Oil-1360 mg, Curamin- 2706 mg.

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Sheri, if you have questions about how a compounding pharmacist/chemist would do this, find one and ask. More than likely, that person will explain the procedure used.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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  • 1 month later...
On 7/26/2017 at 5:00 PM, ChessieCat said:

 

You have provided some good information, however each of us has to make our own decision about how we will taper a drug.

 

I made my decision by doing lots of research and decided to stay with Pristiq for a few reasons.  I didn't want to change from the exact drug that I am on.  I also don't want to change from brand Pristiq to generic desvenlafaxine.  Also, I have found that getting my Pristiq compounded means that I don't have to count tiny beads.  This would drive me nuts for sure.

 

I have been tapering using compounded tablets for 1 yr and 9 mths now and have already had 3 batches of tablets compounded and about to get my 4th batch made up.

 

I am very satisfied with my tapering mether and I'm happy to continue doing it this way.

Is compounding expensive ?

June-Current Started Pristiq 50mg 

March-June Discontinued Wellbutrin. 

February 15-March 1 2017: Taper Wellbutrin. 

December 24, 2016- Feb. 15 2017: Switched to Wellbutrin 150mg 2x/day after Genesight testing; 

August 4-December 23, 2016: Reinstate celexa

March 18-August 3, 2016: Switched to Prozac 

Feb-March 2016   Reinstate celexa

Jan-Feb 2016  Tapered 5mg/every week to 0mg

August 2015-Jan. 2016: Celexa 30mg

2008-2016: Celexa 30-40mg/day for anxiety

2006-2007: Strattera ?80mg/day + xanax

 

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I am in Australia.  Post #1 in this topic has some information about compounding in America:  Compounding pharmacies

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Ok after reading this thread it's not clear if the consensus is that the matrix is in fact the "outer shell" OR if it's what "binds the medication" inside the shell. If I cut this stuff is there any potential for dangerous side effects? I'm taking 25mg ER combined with 3/4 (1/2 + 1/4) cut up 25mg and feeling a little off... maybe this wasn't the best decision 😾

June-Current Started Pristiq 50mg 

March-June Discontinued Wellbutrin. 

February 15-March 1 2017: Taper Wellbutrin. 

December 24, 2016- Feb. 15 2017: Switched to Wellbutrin 150mg 2x/day after Genesight testing; 

August 4-December 23, 2016: Reinstate celexa

March 18-August 3, 2016: Switched to Prozac 

Feb-March 2016   Reinstate celexa

Jan-Feb 2016  Tapered 5mg/every week to 0mg

August 2015-Jan. 2016: Celexa 30mg

2008-2016: Celexa 30-40mg/day for anxiety

2006-2007: Strattera ?80mg/day + xanax

 

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And I called a local compounding pharmacy and they charge $200 for 30 tablets ... will try another pharmacy 

June-Current Started Pristiq 50mg 

March-June Discontinued Wellbutrin. 

February 15-March 1 2017: Taper Wellbutrin. 

December 24, 2016- Feb. 15 2017: Switched to Wellbutrin 150mg 2x/day after Genesight testing; 

August 4-December 23, 2016: Reinstate celexa

March 18-August 3, 2016: Switched to Prozac 

Feb-March 2016   Reinstate celexa

Jan-Feb 2016  Tapered 5mg/every week to 0mg

August 2015-Jan. 2016: Celexa 30mg

2008-2016: Celexa 30-40mg/day for anxiety

2006-2007: Strattera ?80mg/day + xanax

 

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4 hours ago, Jaco2016 said:

Ok after reading this thread it's not clear if the consensus is that the matrix is in fact the "outer shell" OR if it's what "binds the medication" inside the shell.

 

The matrix is inside the tablet, not the shell.

 

On 17/09/2017 at 11:14 AM, ChessieCat said:

It is possible to cut and weigh Pristiq tablets.  Fresh did this before she started getting hers compounded.

 

I have my Pristiq compounded with a slow release formula added.  In Australia we cannot get 25mg tablets so I have been taking all capsules since getting under 50mg.  I am now down to 19mg and have had no difficulties.

 

 

4 hours ago, Jaco2016 said:

I'm taking 25mg ER combined with 3/4 (1/2 + 1/4) cut up 25mg and feeling a little off

 

You have made a dose reduction, reducing from from 50mg to 43.75mg.  This is most probably why you are feeling a little off.  It is withdrawal symptoms.  Changing the way you take your drug can sometimes cause minor issues but these generally settle fairly quickly.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 4 months later...

Hi, I'm about to start tapering Pristiq 50mg. I just read the whole topic slowly, and the way I decided on which option to choose on how to taper pristiq was in checking which option has the majority of people that agree with it, including all the people that talked about it in this whole topic. And the option is to switch to Effexor XR 150mg and then gradual taper by bead-counting. But I only have one question for which I please need every person that switched to effexor xr to answer: Do I need to take the "Effexor XR" brand/patent from Pfizer or does the generic version works equally fine as the Pfizer effexor patent? If I can take the generic version it's ok because I can safe some money but if I really need to take the "effexor" brand/patent, it's also ok, I can afford it. I prefer spending more money taking the one that works fine or the one that works best because in the past I've been in many psychiatric drugs and I lived hell with adverse effects and withdrawal. I saw that before posting this post I was able to select the option of being notified when anybody replies so I tried to erase and edit this post in order to get that but it's not possible, how can I get notified if anybody replies this post? Thank you so much

In 2008 I was 16 years old. 2008 - 2010 paxil, clonazepam & semisodium valproate. 2013 - 2017 many psych meds with cold switches and CT's prescribed by psychiatrists.

Nov/30/17 started quetiapine IR tablets 100mg 0-0-1. Dec/1/17 started pristiq 50mg tablets 1-0-0. Jan/14/18 started 1.5mg melatonin 0-0-1

Tramadol: 2 year well done (slow and gradual) taper: from Mar/12/18 to Feb/11/20 

Pristiq taper: Jun/15/20 Converted from pristiq 50mg to efexor xr 75mg for 57 days (felt good).  Aug/11/20 weaned to efexor 37.5mg and stayed there for 2 months with 26 days (felt good). Nov/6/20  CT 0mg of efexor xr (felt good). Total time in tapering pristiq 50mg by converting to efexor xr 75mg: 4 months with 22 days: Jun/15/20 to Nov/6/20. (felt good)

Efexor 0mg and quetiapine 100mg (Nov/6/20 to Dic/11/20) (felt good being without effexor and taking 100mg quetiapine)

Dic/11/20 quetiapine 75mg, so 75mg from Dic/11/20 to Jan/4/21  25 days. Jan/5/21 quetiapine 50mg (1 day in 50mg).

Jan/6/21 1st CT of quetiapine. Mar/1/21 CT melatonin. Felt terrible so Mar/25/21 reinstated 100mg quetiapine. 

100mg quetiapine 19 days (Mar/25/21 - Apr/13/21) Felt good while in quetiapine 100mg. 75mg quetiapine 55 days (Apr/14/21 - Jun/8/21) the 55th day (Jun/8/21)  felt hellish so CT'd quetiapine for a 2nd time on Jun/9/21. 

Jun/9/21 - Nov/16/21 1st days insomnia, anxiety, took cbd and felt very good many days (healed insomnia & anxiety), CT'd ginkgo which made me felt terrible so reinstated ginkgo. Started intolerable back pain (spasm) so tried other herbs along with cbd, then started derealization, panic, indecisiveness, nostalgia & others. Stopped taking cbd & herbs, reinstated quetiapine 75mg Nov/17/21, immediately after taking it, had severe heart palpitations, so Nov/18/21 back to cbd (no quetiapine). Nov/20/21 reinstated 75mg quetiapine (stopped cbd & herbs), severely couldn't breathe for 5 seconds after taking quetiapine 75mg so reduced to 50 mg on Nov/28/21 had new and worse and very severe adverse effects, got indecisive if CT or keep taking quetiapine because I was terrified of CT, but since the new severe adverse effects were very severe I CT, and because of indecisiveness and panic to CT, I reinstated again, then CT'd and reinstated many times, last time I was taking quetiapine it was 25mg and had severe TD, hellish anhedonia, suicidal, intrusive thoughts of imagining myself running into a wall and crashing into it and I was feeling the pain as if I was doing it in real life, involuntary thoughts of punching my face or head and shashing it against the wall and some times I did punch my face, and when I didn't, I also felt the pain just by imagining it, so definitive CT on Jul/15/22. 

Free from quetiapine and psych meds since Jul/15/22.

MY BEST ADVICE: FOLLOW SA'S GUIDELINES, DON'T CT BECAUSE IT IS HORRIFIC AND BE PATIENT TO WAIT A LONG TIME TO DO VERY SLOW AND GRADUAL TAPERS IN ORDER TO GET OFF OF YOUR MEDICATIONS, IT IS WORTH IT. THE ONLY MOMENTS WHERE IS RIGHT TO CT IS AFTER YOUR 1ST CT THAT YOU DID BECAUSE OF IGNORANCE OR IMPATIENCE, IF YOU REINSTATE AND FEEL SEVERE ADVERSE EFFECTS LIKE TD, ANHEDONIA, FEEL LIKE YOU ARE DROWNING, OR THE ONE'S I HAD, IT IS BEST TO CT IN MY EXPERIENCE, BECAUSE WHEN I REINSTATED I GOT MUCH WORSE THAN WHEN I WAS IN THE PREVIOUS CT. I'm not a doctor.

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Member baroquep switched from Pristiq to venlafaxine and we (her and I) believe that she should have used a 1:2 ratio when she switched.  So 50mg Pristiq = 100mg venlafaxine.

 

When deciding on whether to take Effexor brand or a generic you will need to consider a couple of things.  If you read Post #1 of tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine you will see that there is mention about the contents of the capsules, beads and pellets.  Other posts discuss the size of the beads.  If you decide on a generic you will need to find out  what the capsules contain, and also take into consideration whether you will be able to continue obtaining the same generic form of the drug.

 

Members have posted in the tips topic discussing their issues etc and you can also find some members who are tapering venlafaxine and can visit their topic.  You can also use the site's search (top right) and type in effexor or venlafaxine.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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yes, switch to extended release venlafaxine, essentially the same drug as Pristiq after a bit of metabolism.  

My best guess is you need 2x the milligrams of pristiq to get effexor potency.  so 100mg venlafaxine would be a better switch.  When I went to 125mg V from 50mg P, I got OD symptoms, felt a bit jacked up.  Better at 100mg.  

Generic is just fine, same drug = same drug.

If you manage to find TEVA manufactured capsules (Walgreens, for one!), you're lucky, as each bead in the cap represents darn close to 1mg of medicine, making it very easy to count beads to achieve particular dosages.

When you taper, cut no more than 10%, and wait at least 3-4 weeks between reductions.

 

Finally, don't think you're out of the woods just because you're down to 3 or 4 mg dose, it's just as critically important you get that med.  I screwed up my wean when i was already down to about 5mg/day, went fing crazy for months, and now i've mostly given up on ever getting off ADs.  I switiched to Pristiq because it's allegedly easier to wean from but that's it - so far I'm best just sticking with my 20mg Prozac, not currently considering getting off.

 

finally, save a ton of $$ by getting the support of your doctor, and when you're on tiny doses, remember there are twice as many doses in a 150mg cap as ther are in a 75mg cap.

20090810 Dx GeneralAnxietyDisorder & PanicDisorder.  Rx Pristiq (desvenlafaxine) 50mg.  stable, side effects minor but blurry vision, impotence, others. http://survivingantidepressants.org/index.php?/topic/5418-ktp-weaning-from-4yrs-50mg-pristiq/ for more details.  

20140210 switch Pristiq50mg (can't cut them!) to Effexor (venlafaxine, V) same drug but easier dose reduction (and mfr TEVA's beads are handily ~= 1mg ea).  20140218 125mgV  0309 112mg 0401:100mg, 410:75, 0506:70, 0512:65, 0525:56, 0614:37.5, 0620:30, 0624:27, 0630:26, 0706:24, 0724:22, 0801:20, 0804:19, 0808:18, 0813:17, 0818:16, 0819:15, 0821:13, 0903:12, 0911:11, 0918:10, 0921:9, 0927:8, 1001:6, 1021:5, missed a day?, darn, it was going so well, or so I thought.  SEVERE ANXIETY, INSOMNIA. WAY TOO QUICK REDUCTIONS! hindsight: 0813:5%/5days, 0818:6%/5days, 0819:6%/1day, 0821:13%/2days, 0903: 7%/14days, 0911:8%/8days, 0918:9%/7days; 0921:10%/3days, 0927:11%/6days, 1001:25%/3days (still okay!) 1021:16%20days.  guideline is 10%/30days =  i am a self-diagnosed idiot

20141103 back to 6mgV, xanax next several days. 1111 insomnia bad, 10mgAmbien slept well. 1112 8mgV no Ambien; miserable. 1113 Ambien+xanax, tough night. 1114 Very Tired. 0.125Xanax, 25mgV at 10, better 10min later. 20141115 37.5mg V +Ambien. miserable month, still insomnia & anxiety. 1214 upped to 75mg V, ate .125Xanax. 1215 37.5mg mornings; force sleep for one week and come back". 20150115 lots of appts lots of chat but we never get to MY agenda = meds discussion.  Upping to 47.5mg mornings (no more xanax-, lunesta-forced sleep) but still anxious.  PAYING BIGTIME FOR TOO-FAST WEANING in OCTOBER 2014!  20150220 50mg V. 20150330 still anxy each am let's try reducing: 45mg V 1/day mornings. 20150511:42mg, 0611:40, 0626:39, 0710:38, 0717:37, 0731:33, 0813:32, 0915:29, 0927:28, 1004:27, 1015:26, 1101:25, 1116:22mg/day.  Still anxiety every morning, this sucks.  20151124 found a shrink who seems to get weaning: 20151125 add 10mg/day Prozac aka fluoxetine F, continue taper V to zero, then taper the F, "easier".  20151203:10mg Prozac=P 19mg V, 1213:10mgP17mgV, daily anx quieter but lurking. 1227:10mgP15mgV, 20160108:10mgP14mgV, 0124:10P13V, 0131:P10,V12. 0215 P10,V11.  0223:P10V10.  0314:P10V9. enjoying relatively quiet brain.  0407 P10V8, 0427P10V7, 0517P10V6, 0611P10V5, 0706P10V4, 0818P10V3, 0921P10V2,  1021P10V1, 20161128Prozac10mgVenlafaxine ZERO, 20170115 still anxious upped Prozac to 20mg/day, better anxiety control... 

20190301 finally stable enough to consider weaning again, started skipping one day / week.

20190501 started skipping every 3rd day so 13.3mg/day average.  several days long 1/2life must be why the docs think of prozac as 'self-tapering' i think it just means longer time between upsetting the cart and seeing apples all over the road.  skipping is bad practice, even with longlife prozac: let's do liquid: 20190902 first day of 13mg via 5ml liquid made from 13 20mg caps in 100ml water.  20190921 12mg same way(7.7%/20days).  20191010 11mg (8.3%/20days) 20191031 10mg (9.1%/20days) 20191124 9mg (10.0%/24 days) 20191213 8.5mg (5.6%/20 days) 20191231 8mg (5.9%/20days) 20200120 hit a wall?  going another 20 days at 8mg, just started Lisinopril for hypertension (caused by prozac withdrawal creating less-than-panic-grade anxiety??) and doubled atorvastatin to 40mg.  Minimizing changes in general and had a semi-panic 4am 1/20... BP still wild. 20200208 back to 9mg daily anxiety starting about 1/18.  

20200212 increase to 10mg prozac cap daily.  anxiety still there but clears within hour of drugs.  20200222 still anxy 2 hrs after 10mg, added another 1mg and mucho better.  20200223 11mg early.  anxious enough to be glad i can actually sit.  will wait another 5 days before adding another milligram. 20200229 12mg prozac still anxious.  20200317 13mgProzac still anxious.  20200610 15mgProzac.  bp under control with Losartan50mg (lisinopril cough dictates change)  

20201028 10am met w Dr S.  to switch back to Venlafaxine XR, "take 10mg prozac + 37mg VenlafaxineXR for a monththen quit prozac." i think i'll taper thanx... 
20201116 9am start 10mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.  20201230 5mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.
20210124 4mgP,37V,40S,25L,81A.  20210213 3.5mgP,37V,40S,25L,81A;  20210306 3mgP,37V,40S,25L,81A  20210328 2.5mgP,37V,40S,25L,81A; 20210501 2.0mgP,37V,40S,25L,81A;20210519 1.5mgP,37V,40S,25L,81A; 20210607 1.5mgP,37V,40S,50L,81A. 
20210614 1.0mgP,37V,40S, 50L,81A. 20210702 0.5mgP,37V,40S,50L,81A; 20210728; 0.0mgProzac,37.5Venlafaxine,40Atorvastatin50Losartan,81Aspirin; 20210917 0915am anxiety started about a week after dropping the last 0.5mg of prozac.  just took 0.10mg xanax.  20210929 1:28 PM I'm anxious after so carefully weaning off prozac - the last 0.5mg may need to come back??  instead, trying an extra cap of 37.5mg venlafaxine, let's see if there's sudden relief?  it seems possible.  fingers x'd.  not sure but 5 minutes later i think i feel better gawd i hope.  20210930 7am anxious out of bed, took drugs early and oops chewed them.  no more drugs 2day.  11:41 AM 10/1/2021 very jagged today, avoiding the shower.   took <1/6 of a .5mg xanax and still anxy at noon.  6:59 PM 10/4/2021 2nd or 3rd day of 75mg Venlafaxine  met w/ shrink 2day he says i'm doing  it right so  20210728 75.0mgVenlafaxine,40Atorvastatin,50Losartan,81Aspirin;10mgCarbidopa-Levodopa; 12/18/2021  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 3x 25/100mgSinemet aka Carbidopa/Levodopa.    20220308 new neurologist, raising CL:  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 4x 25/100mgSinemet aka Carbidopa/Levodopa.  possibly need to reduce losartan to avoid fainting.

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It's also best to only make 1 change at a time.  So you would make the switch from Pristiq to venlafaxine AT THE EQUIVALENT DOSE, hold for a period of time to allow for things to stabilise before make a dose reduction.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Thank you very much @ChessieCat and @ktp for replying. I want to be very sure about the pristiq 50mg and effexor xr 100mg equivalency. As I said, I read the entire topic, each and every post. I got to the pristiq 50mg = effexor xr 150mg equivalency for the majority of what people said. 50=150 had 7 persons that said was the right equivalency, and 50=100 had 5 persons that said was the right equivalency. And then, after my post, with what you guys (ChessieCat and ktp) said, now 50=100 has 8 persons that say it is the right equivalency, and 50=150 still has 7. Still, I would like for more people in this thread to tell me which equivalency they think is the right one: 50=150 or 50=100. 

Here are all the comments (of the entire topic) about the equivalency:

  • Lilu: "my conclusion earlier that 50 mg of Pristiq is equivalent 150 mg of Effexor is wrong. Because the 50 mg tablet, even though it might actually have 76 mg, it is still releasing 50 mg of Pristiq continuously into your system." 
  • someone: "Maybe 37.5 mg of Pristiq = 75 mg of Effexor"
  • someone: "Maybe Pristiq 50mg tablet = Effexor 100mg"
  • someone: "Pristiq 50mg= 100 mg Effexor"
  • someone: "Effexor 150mg and Pristiq 50mg are both "normal" dosages of their respective drugs, they may be roughly equivalent"
  • someone: "perhaps equivalent doses are 150 mg and 50 mg, respectively, because venlafaxine ER's NRI potential becomes noticeable at 150 mg/d, likely comparable to desvenlafaxine's 50 mg starting dose."
  • someone: "Therefore, in some efficient metabolizing patients, 75 mg of parent venlafaxine ER drug may convert to a 300 mg equivalent of desvenlafaxine. As a result, the jury is out, in that 50 mg of desvenlafaxine metabolite antidepressant might equal 75 mg, 150 mg, or 18.75 mg of the parent drug." 
  •  someone: "Using this extrapolative method, perhaps equivalent doses are 150 mg and 50 mg, respectively, because venlafaxine ER's NRI potential becomes noticeable at 150 mg/d, likely comparable to desvenlafaxine's 50 mg starting dose. "
  • someone: "Desvenlafaxine is about 3 times stronger, mg wise, than venlafaxine." 
  • Shipko: "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."
  • someone: "I didn't have ANY side effects switching from Effexor to Pristiq, or going from 50mg to 100mg"
  • someone: "50 mg of Pristiq is about the same as 150 mg of Effexor - it seems reasonable. I think that making the transition is always going to be a trial and error, and that it is best to err on the side of too much Effexor."
  • A Dr: "My thoughts are that a person can change safely from 50 Pristiq to 150 Effexor"
  • baroquep: "from pristiq 50mg he/she went to effexor xr 75mg"
  • ktp: “so if you're on 50mg Pristiq you want about 100mg effexor so take a 75mg cap + 25 beads from the next one.“ 
  • ChessieCat: "Member baroquep switched from Pristiq to venlafaxine and we (her and I) believe that she should have used a 1:2 ratio when she switched.  So 50mg Pristiq = 100mg venlafaxine."
  • ktp: "My best guess is you need 2x the milligrams of pristiq to get effexor potency.  so 100mg venlafaxine would be a better switch.  When I went to 125mg V from 50mg P, I got OD symptoms, felt a bit jacked up.  Better at 100mg."  

In 2008 I was 16 years old. 2008 - 2010 paxil, clonazepam & semisodium valproate. 2013 - 2017 many psych meds with cold switches and CT's prescribed by psychiatrists.

Nov/30/17 started quetiapine IR tablets 100mg 0-0-1. Dec/1/17 started pristiq 50mg tablets 1-0-0. Jan/14/18 started 1.5mg melatonin 0-0-1

Tramadol: 2 year well done (slow and gradual) taper: from Mar/12/18 to Feb/11/20 

Pristiq taper: Jun/15/20 Converted from pristiq 50mg to efexor xr 75mg for 57 days (felt good).  Aug/11/20 weaned to efexor 37.5mg and stayed there for 2 months with 26 days (felt good). Nov/6/20  CT 0mg of efexor xr (felt good). Total time in tapering pristiq 50mg by converting to efexor xr 75mg: 4 months with 22 days: Jun/15/20 to Nov/6/20. (felt good)

Efexor 0mg and quetiapine 100mg (Nov/6/20 to Dic/11/20) (felt good being without effexor and taking 100mg quetiapine)

Dic/11/20 quetiapine 75mg, so 75mg from Dic/11/20 to Jan/4/21  25 days. Jan/5/21 quetiapine 50mg (1 day in 50mg).

Jan/6/21 1st CT of quetiapine. Mar/1/21 CT melatonin. Felt terrible so Mar/25/21 reinstated 100mg quetiapine. 

100mg quetiapine 19 days (Mar/25/21 - Apr/13/21) Felt good while in quetiapine 100mg. 75mg quetiapine 55 days (Apr/14/21 - Jun/8/21) the 55th day (Jun/8/21)  felt hellish so CT'd quetiapine for a 2nd time on Jun/9/21. 

Jun/9/21 - Nov/16/21 1st days insomnia, anxiety, took cbd and felt very good many days (healed insomnia & anxiety), CT'd ginkgo which made me felt terrible so reinstated ginkgo. Started intolerable back pain (spasm) so tried other herbs along with cbd, then started derealization, panic, indecisiveness, nostalgia & others. Stopped taking cbd & herbs, reinstated quetiapine 75mg Nov/17/21, immediately after taking it, had severe heart palpitations, so Nov/18/21 back to cbd (no quetiapine). Nov/20/21 reinstated 75mg quetiapine (stopped cbd & herbs), severely couldn't breathe for 5 seconds after taking quetiapine 75mg so reduced to 50 mg on Nov/28/21 had new and worse and very severe adverse effects, got indecisive if CT or keep taking quetiapine because I was terrified of CT, but since the new severe adverse effects were very severe I CT, and because of indecisiveness and panic to CT, I reinstated again, then CT'd and reinstated many times, last time I was taking quetiapine it was 25mg and had severe TD, hellish anhedonia, suicidal, intrusive thoughts of imagining myself running into a wall and crashing into it and I was feeling the pain as if I was doing it in real life, involuntary thoughts of punching my face or head and shashing it against the wall and some times I did punch my face, and when I didn't, I also felt the pain just by imagining it, so definitive CT on Jul/15/22. 

Free from quetiapine and psych meds since Jul/15/22.

MY BEST ADVICE: FOLLOW SA'S GUIDELINES, DON'T CT BECAUSE IT IS HORRIFIC AND BE PATIENT TO WAIT A LONG TIME TO DO VERY SLOW AND GRADUAL TAPERS IN ORDER TO GET OFF OF YOUR MEDICATIONS, IT IS WORTH IT. THE ONLY MOMENTS WHERE IS RIGHT TO CT IS AFTER YOUR 1ST CT THAT YOU DID BECAUSE OF IGNORANCE OR IMPATIENCE, IF YOU REINSTATE AND FEEL SEVERE ADVERSE EFFECTS LIKE TD, ANHEDONIA, FEEL LIKE YOU ARE DROWNING, OR THE ONE'S I HAD, IT IS BEST TO CT IN MY EXPERIENCE, BECAUSE WHEN I REINSTATED I GOT MUCH WORSE THAN WHEN I WAS IN THE PREVIOUS CT. I'm not a doctor.

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10 minutes ago, papaloapan said:

50 mg of Pristiq is about the same as 150 mg of Effexor - it seems reasonable. I think that making the transition is always going to be a trial and error, and that it is best to err on the side of too much Effexor.

 

My personal opinion is that it would be better to err on the side of too LITTLE Effexor.  When reinstating it is better to start with a low dose and updose if needed than to start too high.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Thank you very much ChessieCat, most likely I will convert from Pristiq 50 to Effexor XR 100. I found another comment about equivalency: 

  On 2/1/2018 at 7:22 PM, Shep said:

"Effexor is different than some antidepressants because how it acts on certain neurotransmitters is very dose-related. Per this Wiki article:

At low doses (<150 mg/day), it acts only on serotonergic transmission. At moderate doses (>150 mg/day), it acts on serotonergic and noradrenergic systems, whereas at high doses (>300 mg/day), it also affects dopaminergic neurotransmission"

 

First, it's not clear if "moderate doses" is not only greater than but also EQUAL than 150mg/day. Same with "low doses" if < means only less or less AND EQUAL than 150mg/day.

Pristiq is an SNRI (it acts on both serotonin and noradrenaline), and according to the comment above, if I convert from Pristiq 50mg to Effexor XR 100mg it would only act on serotonin and not in noradrenaline. And I've been on Pristiq since 12/1/17 along with quetiapine 100mg IR and before that I've been in many other psych drugs since 2013. My brain obviously got used to be activated by Pristiq on serotonin and noradrenaline, and if I turn to 100mg of Effexor XR is going to be new for my brain to only be activated in serotonin. 

 

@Altostrata  I would appreciate a lot if you and any other members and moderators tell me what they think. I know there is not an absolute equivalency, but since I'm about to convert from Pristiq 50mg to Effexor XR I would appreciate your thoughts. Thanks a lot.

In 2008 I was 16 years old. 2008 - 2010 paxil, clonazepam & semisodium valproate. 2013 - 2017 many psych meds with cold switches and CT's prescribed by psychiatrists.

Nov/30/17 started quetiapine IR tablets 100mg 0-0-1. Dec/1/17 started pristiq 50mg tablets 1-0-0. Jan/14/18 started 1.5mg melatonin 0-0-1

Tramadol: 2 year well done (slow and gradual) taper: from Mar/12/18 to Feb/11/20 

Pristiq taper: Jun/15/20 Converted from pristiq 50mg to efexor xr 75mg for 57 days (felt good).  Aug/11/20 weaned to efexor 37.5mg and stayed there for 2 months with 26 days (felt good). Nov/6/20  CT 0mg of efexor xr (felt good). Total time in tapering pristiq 50mg by converting to efexor xr 75mg: 4 months with 22 days: Jun/15/20 to Nov/6/20. (felt good)

Efexor 0mg and quetiapine 100mg (Nov/6/20 to Dic/11/20) (felt good being without effexor and taking 100mg quetiapine)

Dic/11/20 quetiapine 75mg, so 75mg from Dic/11/20 to Jan/4/21  25 days. Jan/5/21 quetiapine 50mg (1 day in 50mg).

Jan/6/21 1st CT of quetiapine. Mar/1/21 CT melatonin. Felt terrible so Mar/25/21 reinstated 100mg quetiapine. 

100mg quetiapine 19 days (Mar/25/21 - Apr/13/21) Felt good while in quetiapine 100mg. 75mg quetiapine 55 days (Apr/14/21 - Jun/8/21) the 55th day (Jun/8/21)  felt hellish so CT'd quetiapine for a 2nd time on Jun/9/21. 

Jun/9/21 - Nov/16/21 1st days insomnia, anxiety, took cbd and felt very good many days (healed insomnia & anxiety), CT'd ginkgo which made me felt terrible so reinstated ginkgo. Started intolerable back pain (spasm) so tried other herbs along with cbd, then started derealization, panic, indecisiveness, nostalgia & others. Stopped taking cbd & herbs, reinstated quetiapine 75mg Nov/17/21, immediately after taking it, had severe heart palpitations, so Nov/18/21 back to cbd (no quetiapine). Nov/20/21 reinstated 75mg quetiapine (stopped cbd & herbs), severely couldn't breathe for 5 seconds after taking quetiapine 75mg so reduced to 50 mg on Nov/28/21 had new and worse and very severe adverse effects, got indecisive if CT or keep taking quetiapine because I was terrified of CT, but since the new severe adverse effects were very severe I CT, and because of indecisiveness and panic to CT, I reinstated again, then CT'd and reinstated many times, last time I was taking quetiapine it was 25mg and had severe TD, hellish anhedonia, suicidal, intrusive thoughts of imagining myself running into a wall and crashing into it and I was feeling the pain as if I was doing it in real life, involuntary thoughts of punching my face or head and shashing it against the wall and some times I did punch my face, and when I didn't, I also felt the pain just by imagining it, so definitive CT on Jul/15/22. 

Free from quetiapine and psych meds since Jul/15/22.

MY BEST ADVICE: FOLLOW SA'S GUIDELINES, DON'T CT BECAUSE IT IS HORRIFIC AND BE PATIENT TO WAIT A LONG TIME TO DO VERY SLOW AND GRADUAL TAPERS IN ORDER TO GET OFF OF YOUR MEDICATIONS, IT IS WORTH IT. THE ONLY MOMENTS WHERE IS RIGHT TO CT IS AFTER YOUR 1ST CT THAT YOU DID BECAUSE OF IGNORANCE OR IMPATIENCE, IF YOU REINSTATE AND FEEL SEVERE ADVERSE EFFECTS LIKE TD, ANHEDONIA, FEEL LIKE YOU ARE DROWNING, OR THE ONE'S I HAD, IT IS BEST TO CT IN MY EXPERIENCE, BECAUSE WHEN I REINSTATED I GOT MUCH WORSE THAN WHEN I WAS IN THE PREVIOUS CT. I'm not a doctor.

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1 hour ago, papaloapan said:

if I convert from Pristiq 50mg to Effexor XR 100mg it would only act on serotonin and not in noradrenaline.

 

If this is correct than you may want to consider doing a long cross over from Pristiq to Effexor.  I generally suggest 3 days 3/4 +1/4, 3 days 1/2 + 1/2 and 3 days at 1/4 + 3/4 when changing from brand to generic and tablet to liquid.  You could hold on each of these combinations for a minimum of 2 weeks, however I think 1 month for each would be a more cautious approach.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 2 weeks later...
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A gradual conversion is a good idea. Nobody knows exactly what the equivalent dosage is. If you get withdrawal symptoms, you know you're taking too little Effexor.

 

Pristiq and Effexor are siblings. Both are SNRIs.

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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  • 7 months later...
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I hadn't thought about asking my compounding pharmacist whether Pristiq could be made into a solution.  I will be doing that before I get my next compounding done because I will be needing 0.25mg doses.

 

So I decided to research on the net about whether Pristiq can be made into a liquid and found this comment by Callie on the bottom of this web page

 

The way to get around the insolubility is to crush the pills with a mortar and pestle and then use a small amount of 'wetting agent'. An emulsifier is the ideal (you can purchase these anywhere you find baking items like cakes). Depending on how many pills you crush, it would be ideal to use anywhere from a teaspoon to a tablespoon. 

Then, you can use a small amount (two to three drops) of a flavored extract and finally make it a measurable volume by adding a water based syrup. If you don't have a syrup, water plus a little Stevia extract liquid will work as well. If you do this with water, just know it is only good for 14 days.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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