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Tips for tapering off Effexor and Effexor XR (venlafaxine)

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Altostrata   
Altostrata

Aka Efexor, Elafax, Trevilor, Venlafaxina, Venlor, Ventab, Alenthus

As with many psychiatric drugs, patients have had to write the book on Effexor withdrawal.

Effexor comes in immediate-release form (tablets) and extended-release form in capsules (Effexor XR).

As with other psychiatric drugs: Start with a reduction of 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.) See Why taper by 10% of my dosage?

Some people find they can go faster and some people find they have to go slower -- they can only tolerate decreases of a fraction of a milligram at a time.

As with other psychiatric drugs, do not taper Effexor by taking a dose every other day! This is like playing ping-pong with your brain.

Withdrawal from Effexor is thought to be brutal because it has a very short half-life (at most, about 15 hours for regular Effexor). From http://www.medscape.com/viewarticle/506427
 

[Regular] Venlafaxine's half-life is only 4 hours. Its primary metabolite, O-desmethylvenlafaxine [the active ingredient in Pristiq], has a half-life of 10 hours.

 
According to FDA information at http://www.drugs.com/pro/venlafaxine.html

venlafaxine is metabolized into its active metabolite O-desmethylvenlafaxine via liver enzyme P450 2D6.

O-desmethylvenlafaxine (the active ingredient in Pristiq) is in turn metabolized by conjugation and liver enzyme P450 CYP3A4.
 
The half-life of extended-released venlafaxine (Effexor XR) is longer; it generates O-desmethylvenlafaxine as well:
http://www.medscape.com/viewarticle/724703

Venlafaxine is metabolized to its active metabolite, O-desmethylvenlafaxine (ODV). After administration of extended-release capsules, the peak plasma concentrations of venlafaxine and ODV are attained within 5.5 and 9 hours, respectively.[1] The absorption rate of capsule venlafaxine is slower than its rate of elimination. Thus, the elimination half-life of venlafaxine after administration of the extended-release capsule (15 ± 6 hours) is the absorption half-life instead of the true disposition half-life (5 ± 2) hours observed after administration of an immediate-release tablet.

FDA information for

  • Regular Effexor http://www.drugs.com/pro/venlafaxine.html
  • Venlafaxine ER capsules http://www.drugs.com/pro/venlafaxine-er-capsules.html
  • Venlafaxine ER tablets http://www.drugs.com/pro/venlafaxine-er.html
  • From FDA advice about discontinuation

    Discontinuation of Treatment With Venlafaxine Hydrochloride Tablets

    Discontinuation symptoms have been systematically evaluated in patients taking Venlafaxine, to include prospective analyses of clinical trials in Generalized Anxiety Disorder and retrospective surveys of trials in major depressive disorder. Abrupt discontinuation or dose reduction of Venlafaxine at various doses has been found to be associated with the appearance of new symptoms, the frequency of which increased with increased dose level and with longer duration of treatment. Reported symptoms include agitation, anorexia, anxiety, confusion, impaired coordination and balance, diarrhea, dizziness, dry mouth, dysphoric mood, fasciculation, fatigue, flu-like symptoms, headaches, hypomania, insomnia, nausea, nervousness, nightmares, sensory disturbances (including shock-like electrical sensations), somnolence, sweating, tremor, vertigo, and vomiting.

    During marketing of Venlafaxine, other SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), and SSRIs (Selective Serotonin Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.

    Patients should be monitored for these symptoms when discontinuing treatment with Venlafaxine. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate....

Extended-release (Effexor XR) capsules: Open and count out beads
Effexor XR is available in 37.5mg, 75mg, and 150mg capsules. Prescription information, including package insert, available from Pfizer at http://www.pfizerpro.com/hcp/effexorxr/indications-dosing-safety
 
The capsules are filled with tiny beads. It is the coating on the beads that extends release of the drug. From Pfizer http://labeling.pfizer.com/showlabeling.aspx?id=100


Drug release is controlled by diffusion through the coating membrane on the spheroids and is not pH dependent.

Opening the Effexor XR capsule and taking out the beads to gradually reduce the dosage is an established tapering method: You take out a certain number of beads every day for 4 weeks, then increase the number of beads subtracted for another 4 weeks.

(Generally, it's a good idea to save the beads you take out in a clean capped pill bottle, to use later in the taper. Mark it with the drug manufacturer, dosage, and expiration date. Do not mix beads coming from different dosages or manufacturers.)

If you are very sensitive to dosage variations, you may wish to weigh the beads with a digital scale to get precise dosages, see below.
 
Or you may wish to micro-taper, see below. (Some people microtaper by reducing by one or two beads at a time. Be sure to keep notes about your count!)

Also, at the very end of your taper, you may wish to switch to regular Effexor and make a liquid from it so you may reduce by fractions of a milligram.


Capsules are filled by weight. There is variation in the size and number of beads, between brands and dosages and maybe even lots within a brand and dosage.

You have to count the beads in the capsules of the type you have, and go by your own average. Someone else's bead count might be of a different brand or dosage.

  • The size of beads in a capsule varies slightly from bead to bead.
  • The number of beads in a capsule of a specific dosage varies among manufacturers, e.g., not all 150mg venlafaxine XL capsules from different manufacturers contain the same number of beads. If your prescription gets filled with venlafaxine ER capsules from a different manufacturer, counting out the same number of beads may give you a different dosage.
  • Even from the same manufacturer, the number of beads in a capsule of a specific dosage varies, e.g. not all 150mg Effexor XR capsules from Pfizer contain the same number of beads.
  • The number of beads in a capsule varies from dosage to dosage, e.g. the number of beads in 75mg Effexor XR capsules from Pfizer is NOT half the number of beads in 150mg Effexor XR capsules from Pfizer.

The number of beads in capsules may vary because the manufacturer, particularly generic manufacturers, have sloppy quality control and the capsules vary in weight (this may be illegal and worthy of a complaint to the government drug regulatory agency).

 

Use the same dosage and same manufacturer of Effexor XR throughout your taper.

 

Extended-release venlafaxine capsules: Open and count out mini-tablets

Some generic types of Effexor XR are gelatin capsules containing smaller tablets. Depending on the manufacturer and dosage, there may be 3-12 tablets in a capsule, for example Vanlalupen XL https://imedi.co.uk/vanlalupen-xl-75mg-prolonged-release-capsulesor  http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1438318470327.pdf (PDF) or Venlablue http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con062651.pdf(PDF).

 

There are many such generic versions from many manufacturers in Europe, Asia, other parts of the world. Check with the manufacturer of your generic extended-release venlafaxine that the capsule is made of gelatin. If it is, the time-release quality is in the mini-tablets.

 

A gelatin capsule has no time-release effects. To make the drug extended-release, the time-release ingredients such as povidone and microcrystalline cellulose are integrated into the core of each mini-tablet (the coatings are not time-release).

 

You can taper by removing these mini-tablets:

  • Ascertain how many mini-tablets are in each of your capsules. Open a few and count the mini-tablets.
  • Divide the dosage of each capsule by the number of mini-tablets in each capsule. That is the dosage of the mini-tablet.

(For example, every dosage of Venlablue contains some number of 12.5mg mini-tablets; 37.5mg contains 3 12.5mg mini-tablets while 150mg contains 12 12.5mg mini-tablets.)

 

Calculate the amount of your decrease, such as 10%, on your current daily dosage. If necessary, you may split a mini-tablet into smaller doses. For more precise dosing when splitting mini-tablets, see Using a digital scale to measure doses

 

The venlafaxine in a mini-tablet fragment may be released more quickly as it can be absorbed easier. If you take your venlafaxine in the morning, you may wish to take the mini-tablet fragment in the afternoon to avoid too much release of the drug at once.

 

Opening capsules and weighing beads
Tapering by removing beads from Effexor XR can be tricky. Eventually, as you remove more and more beads, it may become too confusing and time-consuming to count out them.

 

You may wish to weigh the beads instead, see Using a digital scale to measure doses and Counting beads in a capsule versus weighing.

Reduce by micro-taper
The very smallest dose of Effexor XR is one bead. Some people find they can better tolerate a reduction of one bead at a time rather than a 10% decrease. You may be able to make reductions of one bead more frequently; try reducing by one bead a week for a while to see what your tolerance is. See http://survivingantidepressants.org/index.php?/topic/2878-micro-taper-instead-of-10-or-5-decreases/

 

But -- when people get down to a small number of beads, they sometimes find one bead is too great a reduction. In that situation, longer holds are necessary, or switching to regular Effexor in liquid form for more gradual titration.

 

Use an electronic digital jeweler's scale to weigh small amounts
If you are sensitive to dosage changes, you may wish to be more precise in your measurements so you can taper at a measured rate. A digital scale, which can be bought for about $30, is useful. See http://survivingantidepressants.org/index.php?/topic/1596-using-a-digital-scale-to-measure-doses/

(Converting to regular Effexor and making a liquid from it may be more convenient than weighing tiny amounts, see above.)
 
Convert from venlafaxine XL or Effexor XR to regular tablets
Especially in the last leg of your taper, when you might be down to a few beads of Effexor XR, you may wish to switch from an extended-release version to regular Effexor so you can make a liquid from it to make very small reductions.

 

Because of its short half-life, taking regular Effexor as a tablet or liquid necessitates taking the tablets every 12 hours.

 

If you are taking brand-name Effexor XR, use the bead-counting method until you get down to 37.5mg, then convert to regular Effexor and make a liquid from it to finish the taper, taking doses at least twice a day.

 

For example, in the UK, generic venlafaxine XL (similar to extended-release or ER) comes in 75mg, 150mg, and 225mg tablets, per this pdf http://www.oxfordshirepct.nhs.uk/professional-resources/prescribing/prescribing-points/documents/PrescribingPointsVol18-15.pdf
This is a "do not split" tablet. To taper gradually, regular venlafaxine tablets may be substituted as below.
 

Dosed properly, the immediate-release form is equivalent to the extended-release form. From the FDA  http://www.fda.gov/ohrms/dockets/ac/04/briefing/2004-4050B1_20_Venlafaxine-IR-Label-peds.pdf:
 

When equal daily doses of venlafaxine were administered as either an immediate release tablet or the extended-release capsule, the exposure to both venlafaxine and ODV was similar for the two treatments, and the fluctuation in plasma concentrations was slightly lower with the Effexor XR capsule. Effexor XR, therefore, provides a slower rate of absorption, but the same extent of absorption compared with the immediate release tablet.

 

and http://www.drugs.com/dosage/effexor-xr.html

Depressed patients who are currently being treated at a therapeutic dose with Effexor (immediate release) may be switched to Effexor XR at the nearest equivalent dose (mg/day), eg, 37.5 mg venlafaxine two-times-a-day to 75 mg Effexor XR once daily. However, individual dosage adjustments may be necessary.

People who are very sensitive may have some difficulty with a switch from an extended-release form to regular Effexor. One technique to make the switch gradually would be to convert only part of the extended-release dosage to immediate-release tablets.

 

You would then be able to cut up the immediate-release tablet or make a liquid from it to reduce by 10%.
 

Taper by cutting up regular venlafaxine tablets
Regular Effexor tablets come in 25mg, 37.5mg, 50mg, 75mg, and 100mg doses. Because it's half-life is so short, it is taken 2 or 3 times a day.

People taking regular Effexor taper by cutting up the tablets with a pill splitter. It's a good idea to keep the pieces you don't use in a clean pill bottle labeled with the dosage for future use.
 
Use a liquid solution of regular Effexor (NOT Effexor XR)
(Effexor XR cannot be made into a liquid.)
Titrating using a liquid is very good for very small measured decreases in dosage, allowing more precise measurements.

Have a compounding pharmacy make capsules with custom dosages, or a liquid
Compounding pharmacies can weigh Effexor or Effexor XR and make up capsules for you of specific dosages. They can make a liquid of regular Effexor.
 
The only drawback is this can be quite expensive.

 

Using a combination of tablets or capsules and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in tablets, gradually converting to all-liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

You can use low-dose Effexor XR tablets or capsules for part of your dosage and make a liquid from regular immediate-release Effexor for the rest. You may wish to take the liquid part later in the day as it will not last as long as the Effexor XR.

 

"Bridging" with Prozac
Attributed to Joseph Glenmullen, the "bridging" technique is described by a doctor here http://www.bipolarworld.net/Phelps/ph_2005/ph1354.htm
 
Another doctor explained his technique to me:

For a "normal" dose of Effexor (150mg per day or more), he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Effexor. Lower doses of Effexor require lower doses of Prozac as a "bridge."

Later, taper off Prozac. He acknowledged Prozac can have its withdrawal problems, but given Prozac's long half-life, gradual tapering should be much easier than tapering off Effexor. And, at least Prozac comes in a liquid.
 
For more information, see http://survivingantidepressants.org/index.php?/topic/1463-the-prozac-switch-or-bridging-with-prozac/

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

 

About "California rocket fuel"
This is a combination of mirtazapine and venlafaxine (Effexor) that has some popularity among psychiatrists, but also can have dangerous side effects.
 
If you are taking this combination, you probably will want to taper the Effexor first with the hope that the remaining mirtazapine will maintain sleep.

 

See About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

Edited by Altostrata
updated

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Altostrata   
Altostrata

A YouTube video from our friend Mixter showing his method for reducing Effexor XR (the number of beads in his 150mg Wyeth Effexor XR capsule may be different than the number of beads in yours):

 

How to remove 30 mg in pellets off 150 mg Effexor XR Wyeth, to get the desired dose 120 mg the fastest way for my taper! Remember 1 pellet equals 0.2757mg! One 150 mg Effexor Wyeth contains average of 544 pellets! So we get 109 pellets by calculating 30 divided with 0.2757! This is my 5 bunch 5 group method!

Edited by Altostrata
moved video

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hannah531   
hannah531

Hey guys,

 

I am taking the tablet form of Venlafaxine. It says not to cut them? How do i go about tapering?

 

Thanks

Hannah :)

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Altostrata   
Altostrata

If it's the regular form of venlafaxine, and not extended-release, you can cut the tablets up to make smaller doses.

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Rhiannon   
Rhiannon

Alto, I just have to say, once again, thank you SO MUCH for assembling this information for people--such good and complete information presented so well. You're a huge gift to the world.

 

Just sayin.

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John   
John

Does anyone know what the weight of a 75mg Effexor pill is in mg or g? Not the XR version just the regular one.

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jeremy   
jeremy

I have a question: my next taper will be by 11mg (10% of current 112.5mg) but I was wondering if instead of going down 10% all at one time, which is still a lot, if instead when it's time to taper again I taper by 1mg every other day for 22 days? My brand of venlafaxine seems to come at just about 1mg per ball (I opened a 37.5 capsule and it had 37 balls, and a 75mg capsule had 75 balls) so it would be pretty easy for me to, every other day, simply remove one more ball from the capsule than last time. Of course I would keep meticulous records since I can't remember anything anymore.

 

Thoughts?

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Altostrata   
Altostrata

You cannot assume each pellet weighs the same or contains the same amount of Effexor, but this is the best way to taper Effexor XR because you can't get it in a liquid.

You can taper at the rate your nervous system tolerates. However, withdrawal symptoms can take some time to coalesce. If you make a change in dose every couple of days, after 2 or 3 weeks withdrawal might catch up with you. Then you are up the creek.

It's best to be cautious until you can find the rate that's right for you. Start with a reduction of 10% per month. The reason you wait a month is to see if your nervous system can handle that amount of a reduction. If no problems, you have a better idea of what you can handle.

Once you're very familiar with your withdrawal pattern, you might be able to reduce by one pellet every X days. If I were you, I'd wait at least 4 days between drops. Due to half-life, it takes that long for your nervous system to fully register a change has been made.

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Mixter   
Mixter

You CAN do the slow daily tapers, but rest for 3 weeks minimum after each 3 weeks of daily megaslow tapers.

 

It is slow and does work. Less hard on your CNS than direct taper approaches.

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Altostrata   
Altostrata

I agree, Mixter, if you know what your tolerance is.

 

jeremy, why not try a reduction of 1 pellet over 4 days and see how it works for you?

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jeremy   
jeremy

Cool, thanks for the advice. I might give that a try. I still need to get over my current horrendous withdrawals first, and it's actually hard to imagine being in a place where I would feel confident tapering again but I guess I need to believe it will happen. Luckily I haven't had any more brain zaps since that first one so hopefully that continues.

 

Had a dream last night where I was screaming into an electronic device made for communicating with God and telling him how much I hate him and that Jesus was a fake. God would then electrocute me which just made me scream louder and more violently.

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Rhiannon   
Rhiannon

You have to weigh it yourself because different manufacturers will have slightly different compositions.

 

When I was dry cutting, I weighed six to eight pills and averaged the weights to get the average weight that I used for figuring out how much to cut et cetera.

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Rhiannon   
Rhiannon

You CAN do the slow daily tapers, but rest for 3 weeks minimum after each 3 weeks of daily megaslow tapers.

 

It is slow and does work. Less hard on your CNS than direct taper approaches.

 

This is what works for me--small incremental reductions every few days, followed by holds of a few days, with intermittent longer holds any time my symptoms seem to be beginning to ramp up.

 

You definitely need to be aware of the "lag time" effect. Also, some withdrawal symptoms don't kick in right away. That's why I like to take the intermittent longer holds, to let the healing and adjustments catch up.

 

This kind of approach seems to be acquiring the name "microtaper." Smaller daily cuts instead of big cuts all at once. But the breaks are important.

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John   
John

Every 4th week I drop my dose 10%. I noticed that after 2 weeks of dropping, I get some kind of withdrawal effect, whether it's zaps, or anxiety. Is it possible that it can take 2 weeks to catch up?

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Rhiannon   
Rhiannon

Yes, not just possible but normal. In fact sometimes a person needs to take the occasional even longer hold because even more delayed effects can kick in and accumulate.

 

The thing is, these drugs aren't like aspirin. They don't just work while they're in you and then go away. Our brains respond to the way the drugs change their chemistry, and try to rebalance themselves. So the drug causes our brains to become different in ways that are not quickly reversible when we remove the drug.

 

When you remove the drug you're growing new cells, turning genes on and off, et cetera, basically growing a new brain. This isn't an overnight process of adaptation. It's not something that really follows a predictable, straightforward calendar schedule.

 

In my opinion and experience, it's best to attune to your own healing patterns and cycles and schedule your cuts by the messages your body is giving you.

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Altostrata   
Altostrata

John, that seems like a reliable indicator that you either need to hold longer or make smaller cuts every 4th week. Slow your taper, in other words. Don't stress your nervous system if you don't have to.

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caro123   
caro123

If there are so many of us that have difficulties with reducing from Effexor - xr could we start a petition to get the company to make smaller increments thereby making it easier for us to withdraw??? I know this is a long shot but honestly if they made 20mg, 10mg and 5mg tablets life would be easier wouldn't it?

I have just started doing the taper and counting beads is not easy (for me at least). I am reducing from 75mg.

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GiaK   
GiaK

it's not easy...especially if you don't feel well. My husband did it when I came off Effexor...many moons ago now.

 

that said, having come off other drugs that only have solid tablets that become impossible to cut, Effexor is actually one of the easier drugs to deal with...the beads make tiny incremental cuts very doable.

 

you can buy empty capsules and divide the contents of a large capsule into multiple capsules...

 

or my husband made tiny paper envelopes and put the contents in there for me to swallow daily.

 

it's tedious and meticulous work, but it is precise which is really a very good thing.

 

good luck.

 

I'm not sure the pharmaceutical company would care about making small doses, especially if it's only for people who need to withdraw..that is a loss of a customer...sad but true.

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Altostrata   
Altostrata

GiaK has a good point. The manufacturer can never make Effexor XR in enough of a range of doses to make very gradual tapering possible for those who need it. What about when you get down to 10.8mg?

 

But patients need more than the 3 dosages available. caro, you might phone the manufacturer and ask them why they don't do this. I'd like to hear what they say.

 

Here's a place to start a petition: http://www.ipetitions.com

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Altostrata   
Altostrata

Compounding pharmacies will repackage Effexor XR granules in smaller capsules -- for a price. That would be the limousine service.

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caro123   
caro123

Thanks everyone it was a bit of a rant as I was struggling with those little beads. Plus you are so right they couldn't make the doses small enough, plus they don't recognise the need to taper as do they really want us to wean. No. One day at a time. Even my chemist who is a friend (he not a compounding chemist) doesn't understand the need to gradual taper. He advised using capsules 37.5 am and pm and then gradually drop one capsule etc, which is too fast. A compounding chemist will make smaller doses but said it would be too expensive.!

 

Am very grateful for every comment. Thanks. Have already stuffed up with counting as somehow found beads on the counter after I counted out the 10 so I have to be more careful!!!

 

Cheers!

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Altostrata   
Altostrata

Pour them on a creased black paper or cloth, it will help you keep track of them. Have empty gelatin capsules handy to save the extras in.

 

If you just started, you can take out a few beads at a time, you don't have to pour them all out.

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jr1985   
jr1985

I found it was easier to weigh the beads rather than count them. You need a jeweller scale that an measure small quantities.

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caro123   
caro123

I decided to wrote to Peter Breggin's email to see if there is any information he an pass on; when/if he does I will let you know. Tried to email Pftzier on the contact page and had to enter in details; they did not recognize my australian post code (zip code) so wouldn't accept. I might also try Dr Stuart Shipko as well. I might just be barking up the wrong tree and maybe I should just concentrate on my tapper but thats me.

 

 

To: "empathictherapy@hotmail.com" <empathictherapy@hotmail.com>

Sent: Sunday, 3 June 2012 12:36 PM

Subject: from Australia query tapering

 

Hello,

 

My query relates to withdrawal from SSRI Effexor-xr. Effexor -xr only has 150mg ; 75mg and 37.5 mg.

 

Once deciding to taper the recommended proceedure is to step down the doses by gradually missing a capsule every second day etc.

 

This recommendation is too "harsh" for the majority of those trying to reduce doses or trying to wean off.

 

After researching and finding the excellent site Surviving Antidepresents and reading more information on nurmerous other sites, I don't understand why this drug (and others) don't have further smaller doses available?

 

Do you have any knowledge if there has been any discussions with Pharma to make this possible/available ie manufacturing smaller doses?

 

Any information would be appreciated even if it relates to who else to query this with? p.s tried to contact direct with Effexor site but they wouldn't accept my australian zip code.

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peggy   
peggy

i find that emptying the capsules in a long line on a black velvety cloth makes it easier to count. I also use a knife to group the beads into lots of 5.

 

I worked out my reduction schedule and how many beads will be required (in the regular effexor XR - ie not generic) there is 0.3mg effexor per bead, so i divide the dose by 0.3 and then count out the 3 weeks of doses and keep them in a bottle.

 

For example: if your dose is 42mg then you divide 42 by 0.3 to get 140 beads. It does take a little time to do but this method has worked really well for me.

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Altostrata   
Altostrata

Great tip, Peggy.

 

What dosage Effexor XR are you taking? Is it the brand-name (Wyeth/Pfizer) Effexor XR?

 

The number (and maybe size) of the pellets varies according to the dosage and probably manufacturer.

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peggy   
peggy

i am on the brand name effexor - i was too much of a chicken to go generic!!!

currently i am on 18mg :)

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Altostrata   
Altostrata

i find that emptying the capsules in a long line on a black velvety cloth makes it easier to count. I also use a knife to group the beads into lots of 5.

 

I worked out my reduction schedule and how many beads will be required (in the regular effexor XR - ie not generic) there is 0.3mg effexor per bead, so i divide the dose by 0.3 and then count out the 3 weeks of doses and keep them in a bottle.

 

For example: if your dose is 42mg then you divide 42 by 0.3 to get 140 beads. It does take a little time to do but this method has worked really well for me.

 

What dosage are your Effexor XR capsules, Peggy?

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peggy   
peggy

75mg - there are 250 beads in each capsule. i went dizzy counting them!!!!!

I count out 60 beads and scoop them into the new capsule - so each 75mg capsule makes about 4 new doses. I make up the three weeks and put them in a little bottle, mark my diary with the dosage and the number of beads used. And then repeat when next required - it does take about 1/2 and hour to do but time well spent.

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caro123   
caro123

I started reducing down from 75mg Effexor-xr - removing 10 beads to 65 in June and now 20 beads for this month. Just went to the GP to renew script.

 

We had discussed tappering and I was going to the compounding chemist to find out my options. Which you will know that for Effexor-xr (slow release) there are no options other than removing beads and its too expensive for them "to make up smaller doses".

 

Anyways he wants me to take 75mg day one and 37.5 day 2 etc reducing down this way. I told him that the "drop" was too much and this way was more even. I ended up agreeing that this is what I would do. I don't think I will because this way to me seems better. Why don't they understand? Why wasn't I able to speak up?

 

I found that now that I am used to counting the beads its ok. My withdrawal seems to be ok. I do feel the "drop". I am experiencing waking up in the middle of the night. Definately feel tired most of the time. Some teeth clenching, but really nothing too bad. I am lucky.

 

I regularlly read posts here which helps keep me on track!! Thank goodness for this site. Just wanted to share.

 

Caro.

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Brandy   
Brandy

This idea of alternating doses (or sometimes alternating days) seems to be becoming increasingly popular advice for doctors to give.

 

I've seen countless posts about people trying to do this, and IMO one of the few things you can count on in withdrawal is that alternating doses is without exception DISASTROUS.

 

DON'T DO IT! It throws the brain into chaos! Drop slowly and take the same dose every day, at about the same time or times, until it's time for your next small drop. It will save you a lot of grief!

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Skyler   
Skyler

 

Anyways he wants me to take 75mg day one and 37.5 day 2 etc reducing down this way. I told him that the "drop" was too much and this way was more even. I ended up agreeing that this is what I would do. I don't think I will because this way to me seems better. Why don't they understand? Why wasn't I able to speak up?

 

I found that now that I am used to counting the beads its ok. My withdrawal seems to be ok. I do feel the "drop". I am experiencing waking up in the middle of the night. Definately feel tired most of the time. Some teeth clenching, but really nothing too bad. I am lucky.

 

I regularlly read posts here which helps keep me on track!! Thank goodness for this site. Just wanted to share.

 

Caro.

 

Caro, I alternated doses and ran into a proverbial brick wall after a long and successful taper. Went by the 10 % book with the first med, the second I alternated doses, and it was a disaster. Don't take that route. ~S

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Altostrata   
Altostrata

Why don't they understand?

The eternal question.

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