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FeralUrban

Effexor capsules vary in bead count and weight

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FeralUrban

Oh dear. Effexor capsules do not contain the same amount of medication by weight in each capsule. 

 

I was counting beads as a means of removing 10% from my 37.5 mg brand name Effexor  The beads are all different sizes, as noted by others on this site and therefore inherently impossible to accurately reduce by 10% since you could be removing a bead that weighs three times as much as another bead, etc.

 

AND I HATE COUNTING, I suck at it. My brain can't do it easily. I have to have tricks and methods, making piles of 10, counting the piles over and over. 

 

So I got a scale. AWS ZEO-50 Jeweler's scale 50g x 0.001g with a wind shield and level, and rubber feet for minimization of vibration. I had gotten their less expensive scale but it had problems. This one does indeed work better, but I have to be very careful. Don't touch the table the scale is on, put the wind shield down. Put the weighing dish in the same place each time. Try to distribute the beads evenly in the tray. If you do all that it is very accurate. Care of course must be taken regarding bouncing beads, static cling beads, etc. 

 

BUT -- here is what this weeks Effexor capsules weighed:
0.156g     removed 0.016     10% reduced dose by weight: 0.140

0.121g     removed 0.012     10% reduced dose by weight: 0.109

0.137g     removed 0.014     10% reduced dose by weight: 0.123

0.127g     removed 0.013     10% reduced dose by weight: 0.114

0.138g     removed 0.014     10% reduced dose by weight: 0.124

0.155g     removed 0.015     10% reduced dose by weight: 0.140

0.129g     removed 0.013     10% reduced dose by weight: 0.116

0.118g     removed 0.012     10% reduced dose by weight: 0.106

 

Difference between highest weight and lowest weight  0.038g, significant enough when doing a taper

% difference in weight of doses taken: 3.4%. So um, being sensitive this is not good. I'll see how it feels this week, see if it feels like I"m bouncing on Day 2 or 7.

 

I do not know if the difference in weight is due to the different in the active ingredients or the time release and binder ingredients. But I would say that prior to tapering I occasionally experienced taking the pill and experiencing WD, which seemed to me to indicate what was in one capsule was not equal to another. Therefore I'm guessing that the active ingredient is not accurately measured in the capsule. 

 

Does anyone know if the active ingredient in each capsule of Effexor is the same -- or not? 

 

The unequal weights of each capsule means that when I do my next taper (which will be 5%) that I will have to do the calculation as follows. Forgive me if I have written the formula's incorrectly. I haven't used much algebra for past 40 years. 

Step 1: Capsule A weight

Step 2: A*0.9 = New 10% reduced dose

Step 3: 0.95*(A*0.9) = New dose, 5% reduction from previous dose

Step 4: 0.95*(0.95*(A*0.9))

Step 5: 0.95*(0.95*(0.95*(A*0.9)))

Step 6: 0.95*(0.95*(0.95*(0.95*(A*0.9))))

 

And so on, for each damn capsule. I will try to make a spreadsheet so I can make the machine make the calculations for me.

 

Given that I will have to do this for each bead, and each time I reduce dose I will have to add another line to the formula, makes my blood boil and my brain freeze. 

 

I pray that a 5% taper works for me, as I can't imagine doing this with a 1% taper. 

 

I'm going to the garden now and deal with plants and dirt. So much easier than capsules. 

 

 

 

 

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FeralUrban

I just spoke to Pfizer Medication Help line.

"The capsules are filled by weight, not by volume. Ranges are validated with in an allowable variance."

"We have no recommendations, other than the standard withdrawal which is to reduce the dosage by 75 mg per week until the patient is off."

 

ARGH!

 

Therefore, since I am weighing the beads and re-inserting them into the capsule, I will come up with a standard dosage by weight and reduce that standard weight by percentage. 

 

AVG WGHT: 0.135g

Less 10% previous dose: 0.122g

Less 5% previous dose: 0.115g

 

ETC.

 

BE warned-- if you are super sensitive you must consider that the actual weight variability is of each 37.5 mg dosage of brand name Effexor is at least 3.5%, meaning if you take out 10% you could actually be taking out 13.5% or 6.5% and be bouncing your dose all over the place. 

 

This may explain some of the problems I read about on the site. I'll let you know how my new plan goes.

 

Now to re-weight those remaining 7 capsules to standard 0.122g dosage. 

 

I feel like I should change my screen name to P****d!

Edited by ChessieCat
language bleeped

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peng

Maybe you are being too fussy about differences that may not be significant, FeralUrban? Just my view.

I have done a lot of counting beads over the last few years and have not had any crashes due to the reductions.  (I have had 'em due to external factors in my life though!!)

I think I got 270 beads in the 75mg EffexorXL, by the way.

 

I am on 200mg at the moment, so some flippin' way to go again.

 

"We have no recommendations, other than the standard withdrawal which is to reduce the dosage by 75 mg per week until the patient is off."

Sheesh!  Talk about not grasping the magnitude of the problem.  That is a classic, and shows what we are up against.

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FeralUrban

Maybe you are being too fussy about differences that may not be significant, FeralUrban? Just my view.

I have done a lot of counting beads over the last few years and have not had any crashes due to the reductions.  (I have had 'em due to external factors in my life though!!)

I think I got 270 beads in the 75mg EffexorXL, by the way.

 

 

Well, I have had extreme variability day to day with my WD symptoms with bead counting. 3 weeks since a 10% reduction from 37.5mg and every day is a complete crap shoot. I had days where I was in "normal WD" and days where I couldn't control my body well enough to walk without a cane or staff. I had days of normal emotional tone and days of impending doom and periods of intense anger for no reason really. 

 

During my full blown WD after a 3 month taper and completely off the venlafaxine I looked and moved like someone with a severe movement disorder. I couldn't stand without holding onto something, my whole body was undulating uncontrollably. And then on day 10 I flew into a series of rage tornados, broke stuff, physical hurt myself, and scared the **** out of my husband. I can tolerate a lot, but that was too much. 

 

I'm afraid I'm one of the super-sensitive folks, and it's complicated by other issues, neuropathic pain, and the need for asthma meds (asthma brought on by the WD) and the asthma meds aggravate the WD. 

 

I did some calculations and at the current rate of 5% every three weeks it will take me to January 2021 to get off this ****. So I've revised to a schedule I will attempt: 2.5% reduction every 4-7 days. Towards the end if I continue using the scale the drops will be a larger percentage, due to the limits of the scale and I can get off in about a year. OF course time will tell. 

 

 

"We have no recommendations, other than the standard withdrawal which is to reduce the dosage by 75 mg per week until the patient is off."

Sheesh!  Talk about not grasping the magnitude of the problem.  That is a classic, and shows what we are up against.

 

Oh yes, the first person I talked to was obviously trained to say exactly the company line. She was a pharmacist. Those quotes were from her.

The second person, the Quality Control Report taker was more human, and I suggested to her that someone in the company ought to become a whistle blower. I'm sure it's not the first time she's heard the tales of woe of those stuck in WD hell. She did pause before continuing. I imagine her conscience was pricked. 

 

I know it's probably pointless, but I'm going to contact a lawyer sometime soon. I'm 59 and I'm as weak as if I were 79. I can't imagine ever regaining a semblance of health and strength. I'm simply old before I'm old. On good days I leave the house. And I usually pay in pain and and WD symptoms.  I've tracked everything with a spreadsheet since June. And I have nearly daily notes since February. I may have a case, because  the whole thing was kicked off by irresponsible and damaging poly-pharmacy. 

 

I'm in an angry phase, that doesn't seem to go away, unless I stop thinking about this altogether. Or go into deep meditative prayer. At least now I only have to weigh my meds once every 4-7 days. 

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peggy

i found that there was a significant variability in the weight of the capsules to cause me problems when i reached around 18.5mg  I have increased back up to 75mg again - i couldn't stabilise on 37.5 this time - i don't like mucking around with withdrawal symptoms - i am too afraid that i would end up in protracted withdrawal and so i updose until i settle.

 

I am thinking this time that i will come back to 37.5mg and then cross over to Prozac. I have tried too many times to come off the bead counting/weighing method

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SquirrellyGirl

My brain went into overload when I read your post about the variation in weights, FeralUrban.  Here's what I do, and it seems to be working well for me:

 

Take the average weight of several capsules - let's say 5 to be thorough.  The average of your first five capsules is 135.8 mg.  I would then use that number to weigh out all future dosages.  If I was reducing 10% from there, I'd weigh out 135.8-13.5=122.3 mg.  Every day you take that amount.  That way, the variation isn't carried over from your original capsule variations.

 

I take two additional steps to make things as constant as possible.  One is to weigh out two weeks' worth at a time.  The other is to select the largest bead size to make up the bulk of the dosage, using the smaller beads to get to the final weight if one more large bead puts me over the mark.

 

I hope that helps.

 

SG

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peng

IMO, withdrawal symptoms, day to day, will be very volatile (Mods?), hence one cannot assume a different kind of day to yesterday is due to dose weight, especially when you are feeling on the extreme edge.

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scallywag

Feral, I am bead-counting to taper. Over the weekend I opened a new package of Cymbalta and noticed that there are more beads per capsule.  I did exactly what SquirrellyGirl said -- take 3-5 capsules and determine the average # of beads. I'll use that new number as my basis for bead counting: It was 9 beads/mg, now it's closer to 10 beads/mg.

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Altostrata

IMO, withdrawal symptoms, day to day, will be very volatile (Mods?), hence one cannot assume a different kind of day to yesterday is due to dose weight, especially when you are feeling on the extreme edge.

 

This is true. Also, if you've been taking an antidepressant consistently for more than a week, due the half-life, you'll have an average "steady state" level of it in your bloodstream.

 

Very sensitive people may feel even small variations in this average "steady state." If you are very sensitive and do not take the drug at the same time each day, you may feel variations simply from that.

 

One data point doesn't make a trend. As peng observed, one day of symptoms may be due to factors other than the recent decrease in dosage. This is why we ask people to keep daily notes on paper about symptoms, the time you took your drugs, and the dosages. You need to look for patterns over time.

 

It's frustrating to count beads or weigh beads when going off Effexor XR (or Cymbalta), but it's the best method we have to manage a direct taper off the drug.

 

Even give the known inconsistency in Effexor beads, many people have tapered counting beads or weighing them. If you frequently have withdrawal symptoms after a decrease, you might make your decreases a little smaller -- 7.5% instead of 10%, for example. This will cause less of a variation in your "steady state."

 

We also have people here who are so sensitive they can tolerate decreases of only 5% and even less.

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peggy

personally, i think the variation is less of an issue at a higher dose because of the receptor occupancy curve - when you get down around 15mg a smaller difference is greater. We cannot get immediate release effexor in this country - if we could i would change over to it and have a liquid made up - i think that would be more accurate.

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FeralUrban

 

Very sensitive people may feel even small variations in this average "steady state." If you are very sensitive and do not take the drug at the same time each day, you may feel variations simply from that.

 

One data point doesn't make a trend. As peng observed, one day of symptoms may be due to factors other than the recent decrease in dosage. This is why we ask people to keep daily notes on paper about symptoms, the time you took your drugs, and the dosages. You need to look for patterns over time.

 

It's frustrating to count beads or weigh beads when going off Effexor XR (or Cymbalta), but it's the best method we have to manage a direct taper off the drug.

 

We also have people here who are so sensitive they can tolerate decreases of only 5% and even less.

 

 

When I was taking Effexor at my full dose, 225 mg, if I was late by a few hours I had brain zaps. And some days, even with taking it at the same exact time I'd get them anyway. I'm assuming now, that this could have been in part due to the inconsistency of the dose as dispensed in the capsules. Or possibly it could be a problem with my metabolism, which was for completely chaotic, I presume as a side-effect of the venlafaxine.

 

If, when, I get to my next decrease it will be a 5% decrease. I think the 10% drop was too much for me, and i'm still waiting for things to level off. 

 

I do find weighing with a scale to be so much easier than counting beads. Using the scale requires some fussy attention to detail but at least I don't get lost in the counting. I think I have some mild form of dyscalculia (like dyslexia but with numbers) and I've had a hard time counting all my life. 

 

I have been tracking daily data with a  spreadsheet since June, and before that with notes in a little notebook. The notebook tipped me off -- gave me clues about what was happening that made me aware that Effexor in combination with other meds was toxic for me. That prompted me to start tracking on a spreadsheet, something I learned from my sister's management of a complex cardiac issue. Data over time is revealing. 

 

I use the graphing capacity of my spreadsheet, since I'm a visual processor. I like it when I see the graph bars getting shorter! I also place graphs below that line up that show medication dosages and activities, so I can correlate symptoms with dosages and activities. This process makes it much easier for me to know what's going on. It's true that subjectively, a bad day seems like it's always been this way and always will be. A good day does the same, at least for me. So having the spreadsheet and graphs really helps me a lot to be a bit more objective in the process.

 

I still think it's outrageous that a 3.5% variation in dose is considered within acceptable parameters for 37.5 mg dosage.  The variation may be even greater than that. I only weighed the contents of 7 capsules. I'll let you know if the variance is greater than that as I continue to weigh capsules. 

I realized early in counting the beads that subtracting beads (taking out ten beads) wouldn't work because there could be 150 beads, or 110 beads in any given capsule, so I always counted the beads I would retain in the capsule. Never mind the bead size differential.

 

I truly appreciate the information and help I'm getting here. I can't imagine trying to figure all this out on my own. Thank-you all.

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Altostrata

Thank you, FeralUrban! Perhaps you could share a sample of your spreadsheet, it sounds like you are doing a great job of tracking your symptoms.

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FeralUrban

OK, how to I share my spreadsheet? I couldn't even figure out how to share photos on this site, which I wanted to do on the Is Dirt Good for you? thread I started. You know, proof of my love of dirt and gardening. And fancy pictures of my potatoes and garlic harvests. 

 

The spreadsheet I have is in Apple's program, Numbers. I think I can convert ti to the Office version of spreadsheet, but don't know how much would translate, much less how to share it here.  Perhaps you can message me privately with the info so we won't clog up the thread with technical details. 

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JanCarol

Hey Feral - I use "snip it" which takes a picture of what you highlight, and just make a .jpg.  I then post the .jpg to photobucket, and use the picture link (below the smiley faces above) to post a link to the .jpg in photobucket. 

 

Gosh, that sounds garbled.  But it's what I do.  It's not posting the actual spreadsheet, but you can take a picture of your work, and send that to us.

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Altostrata

If you use a Mac, Command-Shift-4 will take a screenshot.

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primekittycat

FeralUrban, the calculations you provided are exactly what I have done for my Effexor taper in Google Sheets. I weigh every day because I like being as stable as possible in my dosage. It usually ends up with me taking out the same amount of beads, but sometimes can be 1-3 beads different and I am very sensitive. Been doing it for over a year now. Here is a snippit of my spreadsheet:  http://imgur.com/UxBXNrN.  You can't see the formulas but I am multiplying the previous dose by .95 in each column (I do 5% cuts every 2 weeks). I also weigh the 'leftover' beads to make sure the 2 amounts equal my total (the amount I am taking and the amount I am removing). I have had great success with this.

 

Oh, I also highlight the dose I'm taking in green so my eyes don't go crazy with all of the numbers and I measure the right dose. I also have had to either hide columns and also made a new sheet because it got to like 12+ columns and too hard to scroll all the way over using my phone.

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FeralUrban

Continued frustration. I'm appalled really. :o

 

I am, going by the average weight of my first week weighing and reducing weight from there. It seems the only sensible way to do this. So my goal was 0.122g. I appreciate SquirellyGirl for the suggestion!

 

Today I weighed my Effexor beads for the coming week.

Initial weight of all beads in each capsule:

Highest weight: 0.176 -- had to remove 46 beads to arrive at desired doses 0.122

Lowest weight. 0.118 -- had to add 4 beads to arrive at desired doses 0.122

 

Does that mean there was 32.95% difference in content by weight? 

Can someone check my math? 

 

I think the next time I get a bottle, I'm going back to the generic, because at least in that there seemed to be a fairly consistent amount of beads.

 

I do think there is small variance in the scale -- it can go up or down by 0.005g if I shake the measuring tray and redistribute the beads, but no way it is off by that much. 

 

I'm also going to look into getting a more accurate scale -- for now it works, but when I get down into the drops of 0.003g this scale is not going to work.

 

I could of course go to the liquified non-extended release, but from I would have to be taking it like clockwork every 8 hours. This I know from my previous attempt at pill cutting 20mg non-ER and finding that an hour or two late could be hell. And, I'm not super time aware. Think this is my first incarnation with clocks.  ^_^

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btdt

This is one thread that needs to be merged as tons of work has already been done on the various forms of effexor...a lot of old info still holds true and some of it is not easy to find.

peace

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FeralUrban

I've attached a screenshot of my spreadsheet graph, with the informative, gratifying columns that reveal patterns (where I see none in the numbers.) Graphing in this way has helped me understand what is going on, in a way that notes  did not. 

A few words about the spreadsheet.

I use a modified form of the tracking checklist I found somewhere on this site. 

I grouped symptoms that seemed to go together for me. I subtotal each group of symptoms, and then the grand totals.

Each day I rate the symptom on a scale of 1-10.

(There is a difference between being a little dizzy around the corners and having the world spin.)

 

I use a negative rating number for my neuropathy symptoms and positive numbers for my withdrawal symptoms, as in my case these two are separate entities. Neuropathic pain is caused by (imho) by the venlafaxine being in my system. And the withdrawal symptoms are  caused by  taking away venlafaxine. Therefore I have a visual representation of the tightrope I am walking. The rainbow colors are W/D symptoms and the purple is neuropathic pain symptoms. 

 

Below that graph, I have a graph on activity, and below those (not visible) I have a graph of PRN meds, and regular meds. They are all lined up and help me correlate data.

 

I also track medication dosages

Activity levels

I have a section at the bottom for notes about what happened each day, that may remind me of why I was having a good day or bad day.

 

I use a threshold line (Horizontal yellow line) to determine when my W/D symptoms are below an acceptable threshold (in this case under 20 points), and then when I hit 10 -14 days below that threshold I can reduce, in may case by 5%. 

 

I use vertical lines to look at correlations between symptoms and activity and medication changes. 

 

The graphing is a feature you can find in both excel and numbers.

 

post-7563-0-78880100-1471530885_thumb.jpg

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SquirrellyGirl

Feral, I am blown away by, I can't find the right words, your "scientific" approach to evaluating your experience and basing your taper decisions on concrete data.  Truly inspirational! I used to be so detail-oriented, but can't garner the gumption these days.  Kudos to you!

 

SG

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FeralUrban

I HAD to take this approach. My neurologist was in his words "overwhelmed." My psychiatrist was baffled. I was in such severe pain and ANS dysfunction that I thought I would be dying soon. 

 

I learned the technique from my sister, who manages her complicated coronary microvascular disease and vasospasm, so that she can remain objective. Let's admit it a bad day feels like the *worst* and like it's been this way *forever* But when I track I discover some bad days are much worse. or much better than other bad days, and that in fact they come and go.

 

This method, which I started in February helped me identify venlfaxine as a major problem, along with other drugs. The other drugs are gone, V remains at 32.6 mg presently. 

 

I wish I had it together enough to teach others how to do this. Maybe someday.

 

Feral

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SquirrellyGirl

I am glad that you are able to identify the patterns and see that it isn't "all bad all the time."  It is so easy to get caught up in that thinking and many here do and suffer greatly because of it.  You are a strong one and you WILL make it out to the other side of this!

 

SG

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peng

A graph I made for my own Effexor gives 10 beads as about 4%.

 

However, be wary of this, more knowledgeable folks on here report of different numbers of beads in different manufacturer's versions of the drug.

 

If you can manage to count all the beads in a 225mg cap (preferably more than one - I know - what a drag!), you can plot your own graph.

 

Good luck, I am attempting what you are, cutting from 225mg.  I am at 187.5mg today.  If you can get Venlablue XL 37.5mg in Oz, it can help with adjusting doses.  The capsule contains 3 x 12.5mg little white tablets like the old sweeteners for tea and coffee. 

 

The tireless, helpful Mods on here will come on to point you at the most vital introductory sections to read on the website, depending on your particular issue.

 

Stick at it - the fact you are working to solve the problem should help!

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Vitality

Thank you for replies. I've been on 225mg xr Effexor as a maintainence dose for over 2 years though ECT was the only effective treatment to turning a major depressive episode around. My Dr has agreed to consider lowering my Effexor dose from around the beginning of next year but occasionally I get fed up with hearing how ill I was and my terrible relapse rate stats given I've unofficially (ie not been hospitalised) had episodes of depression on other occasions. So I decided to have a go at reducing the dose now but I am very sensitive to any signs that I could return to being so ill as I was in 2014. I felt nauseous and just unsteady psychologically so I quickly put back in the beads I had taken out today and then felt okish. Well as OK as I feel after the recent reminders from my dr of just how grim things were and the impact of my biology.

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Quest

If I am trying to reinstate after being off effexor for three months, does one weigh approx. 5 balls and pick a number or close to same number, or just pick five biggest ones?  I am super sensitive to anything right now and do not even know if I chance reinstatement.  Any advice?

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mammaP

You need to count how many beads are in the capsule to work out the mgs, they are all different.  

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