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Tips for tapering off Effexor and Effexor XR (venlafaxine)

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Trying to work out what to do now that NZ is no longer supplying name-brand Effexor.  Instead we have access to Enlafax, but today I opened the capsule to find two large pills in it!  Less than lady-like words escaped my mouth...

 

So, now looking at Alto's Effexor thread to see what to do:

Quote

 

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.

 

 

1.  I have checked to see if the capsules are made of gelatin, and the sheet says gelatin and titanium dioxide (for colour).  So the time-release is not in the outer capsule. 

 

2.  I will have to split/crush the table into smaller doses.  (Above, it says the time-release quality is in the CORE of the mini-tab.  Is it okay to crush and weigh them?)

 

3. I will continue taking two doses daily, to help keep up with the possibly faster releases. 

 

4.  I will do a short bridge between the effexor and the enlafax. 

 

May I have a second opinion to let me know if my plans are on track or not?   

 

Or, would it be a better option to switch to regular effexor, as below:  (Although am wondering if that's no longer available in NZ either.  Crushing as above might be my only option).
 

Quote

 

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.

 

 

 

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I will check it with my husband. He found himself in a similar situation with Effexor earlier this year: could not get hold of regular Effexor tablets he had been dissolving to taper thus far. All he could get were XR pills. I have to check but as far as I remember there was a capsule with 3 smaller pills inside. I had no idea where time release could be.

 

Although I was freaking out because that thread you quoted clearly says not to do that he had no choice but to take  those 3 pills out and dissolve them. He started taking that suspension two times a day and luckily he had no symptoms. I still worry as to the efficacy of this and he has been complaining about fatigue a lot lately so I would like to get to the bottom of this too.

 

I think we should best bring it to Alto's attention and mazbe move the discussion to the thread on Effexor so that other members in a similar situation would know what to do... 

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Thanks Bubble - I've moved them (clearly;)).  Next to find Alto ... I guess if I'm up now, she'll be asleep.

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It seems that my brain was a lot mushier in February when I read this because I get what I see now: the way to go is to weigh mini tablets. That would mean that crushing them is ok but would like to hear Alto confirm it.

 

But my husband got so used to his liquid and a syringe that he simply continued doing it: make XR mini tablets into a liquid although it's written in red not to do it.

 

I sort of understand why: it destroys the time release or something like that but would like to know what really happens if you dissolve mini xr tablets. Especially since this is how he has been taking his drug for 5 months now.

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On 14/07/2017 at 1:28 PM, KarenB said:

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).

This interests me.  If the time-release is in the CORE of each mini-tablet, does it need to remain there in order to slowly work, or, can the mini-tab be crushed and mixed round so the time-release ingredients are evenly spread into each dose as it is separated out and weighed.

 

I have been looking, and cannot find any availability of regular effexor (non-XR) in NZ.   

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I was on the same vanlafaxine capsules, they were called vensir and had 6 little tablets inside the capsule, they were 75mg, I tapered by cutting the little tablet into bits with a tablet cutter during the end,

 

Not sure if this will work, I have looked online and you can buy empty time release capsules, maybe you could fill them yourself, see here:

 

\\https://www.amazon.com/Empty-Enteric-Coated-Capsules-Joined/dp/B014EPR180

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That's very interesting DJ.  It might be very helpful for this turn of events. 

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Our form of Venlafaxine with either 3 or 6 little pills inside for 37.5mg and 75mg, respectively, is called Venlablue XL and is made by BLUeFISH PHARMACEUTICALS  of Stockholm, Sweden.

 

It must come at a favourable price for our NHS Health Trust's GPs, because they employ a person at the surgery whose job is solely, IIRC, to keep up to date with the "best buys" of medication.  

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KarenB, if regular Effexor is available, I'd switch to regular Effexor twice a day, with part tablet and part liquid if possible, to relieve the uncertainty and possibly the inconvenience of crushing and weighing tablets that are supposed to be extended-release.

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I've just found out from Pharmac NZ that regular effexor is no longer subsidised here.  So you would say, if I want to be on the safe side, that I shouldn't be crushing and weighing mini-tabs?  I wonder if my next best option would be a prozac bridge.  Yikes. 

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Karen: Pardon my question -- it comes from not knowing how NZ healthcare works. Does not subsidised mean it is not available?

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It means that it is very expensive, and therefore likely to be unavailable, as pharmacies tend not to buy in things that are not subsidised, I guess as too few people buy them.   

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