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Tips for tapering off Cymbalta (duloxetine)

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Cymbalta comes in 20 mg, 30 mg, and 60 mg capsules. Full prescribing information: http://pi.lilly.com/us/cymbalta-pi.pdf

Cymbalta is tricky to taper. It does not come in liquid form and cannot be compounded into a liquid. To protect the drug, each bead inside the gelatin capsule has an enteric coating to protect the drug from stomach acid, which would destroy the drug. (It is absorbed further down in the digestive tract.) The pellets cannot be dissolved in any liquid without destroying the active ingredient.

You cannot crush the pellets (see http://survivingantidepressants.org/index.php?/topic/275-do-not-crush-list/page__view__findpost__p__3021 ) or dissolve them in a solution -- the drug would never get into your system, it would be destroyed in your stomach and you would have immediate cold-turkey withdrawal.

Of course, the range of dosages from the manufacturer is inadequate for very gradual tapering.

 

Like all psychiatric drugs, do not skip doses or alternate doses to taper Cymbalta. Its half-life is very short, about 12 hours. It is metabolized via the liver enzymes P450 1A2 (substrate, inhibitor) and 2D6 (inhibitor).

 

This post has a chart that shows what happens with the Cymbalta dose when skipping days.


See Doctor is shocked at severe Cymbalta withdrawal symptoms and testimony by Dr. Joseph Glenmullen regarding Cymbalta withdrawal syndrome: http://www.baumhedlundlaw.com/pdf/DrGlenmullenDeclarationSupportofCymbaltaClassCert.pdf (PDF)

Reduce by 10% per month to start
As with any neurologically active drug, a conservative taper is the safest way to go off Cymbalta. 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.

A conservative taper for Cymbalta, like other psychiatric drugs is: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

See Why taper by 10% of my dosage?

Cymbalta CANNOT be crushed, compounded into a liquid, or dissolved in a liquid
The pellets in the capsule cannot be dissolved in a liquid; this would destroy the active ingredient.
 
High-dosage Cymbalta: Using different dosages to decrease to 40mg
If you are taking as much as 120mg Cymbalta, see this topic for an example of how to taper to 40mg using existing capsule dosages and a few compounded prescriptions: http://survivingantidepressants.org/index.php?/topic/7060-razzlesf-off-abilify-tapering-cymbalta/?p=129252
 
To taper from a dosage of 40mg, you're going to have to either open up 20mg capsules and count beads, or get custom compounded dosages.
 
The bead-counting method

Like Effexor XR, some people have tapered by opening the Cymbalta capsule and taking out the beads to gradually reduce the dosage. (See http://survivingantidepressants.org/index.php?/topic/272-tapering-off-effexor-venlafaxine/page__view__findpost__p__2985 for the technique.)

 

You can do this if you have brand-name Cymbalta or generic capsules containing hundreds of tiny beads rather than 4-12 "mini-tablets" (see below).

The number of tiny beads in each Cymbalta capsule will vary within a given dosage, across dosages, and from different manufacturers. The capsules are filled by weight. To find an average number of beads per capsule, you will have to carefully count the beads in several capsules. Then you can estimate how many beads amount to  10% of the dosage and manage your taper accordingly by keeping notes on paper showing the number of beads removed and equivalent Cymbalta dosage.

 

Take out 10% of the beads at each step of the taper. Put unused beads into a clean, dry, capped prescription bottle marked with the dosage of the original capsule and expiration date. You might want to use them later. Do NOT mix beads from capsules of different dosages, such as 30mg and 60mg.
 
NOTE When you are taking loose beads, put them in an empty capsule to swallow them. Gelatin capsules and vegetarian capsules are available at health food store. The FDA reports here http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm103473.pdf there have been some instances of the beads causing throat irritation when swallowed without a capsule.

Dividing Cymbalta beads into empty gelatin capsules
To make counting of the beads easier, this technique may work with Cymbalta, see details at
http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__view__findpost__p__3033
 
Opening capsules and weighing beads
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 them instead, see Using a digital scale to measure doses and Counting beads in a capsule versus weighing.

 

Have a compounding pharmacy make up capsules of smaller dosages
For precise dosing, a compounding pharmacy will accurately weigh the doses and put the right number of beads into capsules for you. See http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__view__findpost__p__3001

Dividing Cymbalta beads into apple juice or applesauce
Follow the instructions above for dividing the beads in a capsule and put your reduced dose apple juice or applesauce.

---------
It has been scientifically demonstrated that the Cymbalta pellets survive being put into apple juice or applesauce but NOT chocolate pudding:

http://www.ncbi.nlm.nih.gov/pubmed/18691989

Clin Ther. 2008 Jul;30(7):1300-8.

In vitro stability, potency, and dissolution of duloxetine enteric-coated pellets after exposure to applesauce, apple juice, and chocolate pudding.

CONCLUSIONS:

Results from this study found that the enteric coating of duloxetine pellets mixed with applesauce or apple juice was not negatively affected. The pellets were stable at room temperature for < or = 2 hours and should quantitatively allow delivery of the full capsule dose, provided that the pellet integrity is maintained (ie, not crushed, chewed, or otherwise broken). Therefore, mixing duloxetine pellets with applesauce or apple juice appears to be an acceptable vehicle for administration. However, exposing the pellets to chocolate pudding damaged the pellets' enteric coating, suggesting that pudding may be an unacceptable vehicle for administration.
---------

Tapering generic Cymbalta (duloxetine) capsules containing "mini-tablets"
The generic forms of Cymbalta may contain beads, like brand-name Cymbalta, or 4 to 12 "mini-tablets" rather than beads. From Lupin Pharmaceuticals http://medlibrary.org/lib/rx/meds/duloxetine-3/
 

....
Duloxetine is available as delayed-release capsules:

  • 20 mg: Size ’4′ capsules with green cap and green body imprinted with “LU” on cap and “Q01″ in black ink on body, containing four white to off white mini tablets.
  • 30 mg: Size ’3′ capsules with dark blue cap and white body imprinted with “LU” in white ink on cap and “Q02″ in black ink on body, containing six white to off white mini tablets.
  • 60 mg: Size ’1′ capsules with dark blue cap and green body imprinted with “LU” in white ink on cap and “Q03″ in black ink on body, containing twelve white to off white mini tablets.
....
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....

 

 
The "mini-tablets" cannot be split or dissolved to make a liquid. Suggestions for gradual tapering:

  • If you are taking 20mg, 30mg, or 40mg (two 20mg capsules) per day, switch to brand-name Cymbalta or a generic containing tiny beads rather than mini-tablets. Use the bead-counting method.
  • If you are taking 50mg (20mg plus 30mg) per day, reduce by one mini-tablet from the 30mg capsule (5mg, or 10%) initially for a month, then switch to brand-name Cymbalta or a generic containing beads rather than mini-tablets. Use the bead-counting method.
  • If you are taking one 60mg capsule per day, reduce by one mini-tablet (5mg) per month for 2 months until you are taking 50mg per day, then switch to brand-name Cymbalta or a generic containing beads rather than mini-tablets. Use the bead-counting method.
  • If you are taking one 60mg capsule plus any of the other dosages per day (at least 80mg), reduce by one mini-tablet (5mg) from the 60mg capsule per month until you get to 45mg total daily dosage, then switch to brand-name Cymbalta or a generic containing beads rather than mini-tablets. Use the bead-counting method.
  • You can combine brand-name Cymbalta or generic beads with generic duloxetine mini-tablets to taper. (This would cost less than using brand-name Cymbalta for your entire taper. A prescription for 60mg brand-name Cymbalta capsules will go further.) You could take part of your dosage in brand-name Cymbalta beads and the rest of your daily dosage in generic mini-tablets. For example: If your 30mg generic duloxetine capsules contain 6 mini-tablets, each mini-tablet contains about 5mg duloxetine. Let's say you want to reduce 10% from 30mg to 27mg. You can take 5 mini-tablets (25mg) and add 2mg in beads to it. If a 60mg capsule of brand-name Cymbalta contains 200 beads, each bead contains about 0.3mg duloxetine; you would take 7 beads (2.1mg) to total a daily dose of 27.1mg. (BE SURE TO COUNT THE TOTAL NUMBER OF BEADS IN YOUR CAPSULES  -- THEY CAN VARY FROM THIS EXAMPLE.) When you are down to 5 mini-tablets (25mg) per day, take 4 mini-tablets and the rest in beads to reduce another 10%, and so forth.

Reduce by micro-taper
The very smallest dose of brand-name Cymbalta 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/
 
Do not reduce by one additional bead per day. This is too fast, you may develop withdrawal symptoms before you know what's happening.

 

Here is an example of a micro-taper from cymbaltawithdrawal.com http://www.cymbaltawithdrawal.com/topic/8325-dose-down-bead-counting-chart-anywhere/?p=50499
 
Switch to Prozac
Like its fellow SNRI Effexor, withdrawal from Cymbalta can be very difficult. Recently, I asked a knowledgeable doctor about how he switches patients to Prozac.

He said if the dosage of Cymbalta is "normal" -- 30mg-40mg -- he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Cymbalta.

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 Cymbalta. And, at least Prozac comes in a liquid.

He confirmed that Cymbalta cannot be compounded because the pellets are enteric-coated to get the medication past the stomach acid, which destroys it. Other than the Prozac switch, he said counting pellets is the only way to taper.
 
See more about the Prozac switch http://survivingantidepressants.org/index.php?/topic/1463-the-prozac-switch-or-bridging-with-prozac/

 


 

NOTE Also see

 

2009: FDA hears testimony about Cymbalta discontinuation syndrome

 

Study finds some Cymbalta withdrawal "severe and persistant"
 
Doctor is shocked at severe Cymbalta withdrawal symptoms

 

Cymbalta Withdrawal Lawsuits Progressing in US

Edited by scallywag
updated information, added link to post with chart

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This info looks correct if not exactly great news for those of us on the sh*t. I would have loved to have had Cynmbalta compounded instead of trying to count the little rascals daily while my cats and puppy "assisted" or rattled the door (distracting me and making me lose count) if I shut them out. cymbalta sucks, sucks, sucks.

 

My only advice to anybody who has a long a/d history is to crawl down. The w/d effects take months to subside sometimes. My rule of thumb is to wait until I felt recovered from the w/d symptoms before dropping even before I went on hiatus. Sometimes it took three or four months (even before this past year) until the internal turmoil/jitters/akathesia and insomnia abated. Most people don't believe it, even in poop-out you still need to crawl down. The more of a nerve ball you are the slower you should go.

 

I have been at 30 mg since July 2010. As I adjust to living with a partner instead of a housemate, burying my cats, re-doing my kitchen, I am too - wound up I guess to work on the taper. Even though I feel like Cym. continues to rot my brain. As soon as SO is more settled, the kitchen is fully functional, and the dog is not so - buoyant - I may try again. I wonder sometimes about the Prozac switch. But I don't think it would be helpful while I am still working.

 

I was on tricyclics, then MAOis back in the 1980s - because Prozac made me too anxious when it was the only wonder drug. I am a wicked nerve ball, always have been. In fact, the first year I was on paxil was my first experience with pleasure/peace of mind...ha, the things we learn on our travels.

 

My typical post-taper symptoms include: headache sweats nausea, heartburn increased anxiety increased jitters increased restlessness insomnia racing thoughts decreased attention span decreased short term memory brain fog difficulties with my balance irritability (worsens as my taper progresses)

 

I have been trying to do 20 minutes of mindfulness meditation every morning (achieving 4 times a week), and avoiding processed foods and artificial sweetners. (I confess I am a horrible sugar addict.) I have found that the closer to a protein/vegetable/fruit diet I stay (not terribly successful many times) the better I feel. I haven't been able to be totally pure, but I do eat a lot of fresh, raw or simply prepared vegetables. And I try my best to put my food $$ to organic for the 12 fruits and veggies that are the most soaked with pesticide.

 

After trying all the supplement recommendations that circulate in withdrawal circles - vitamins, Magnesium, Whey protein isolate, fish oils, melatonin and so on, I take NOTHING now, because either the substance made me more anxious (fish oil, multi vits with Bs, melatonin) or did nothing (whey protein, Mag, C, other supplements) I focus on my diet, getting outside every day even just for a few minutes and meditating.

 

The other major health issue for me, insomnia, is somewhat better after 10 months at one level. I invested in room darkening shades, ear plugs, and I try to turn off the computer and the tv before 8 pm. I do get enough sleep often enough in the past 3-4 months. I have a decent life, though I am still on 30mg.

 

My pause in tapering has probably been very helpful in allowing the poor receptors in my brain to repopulate in peace for a while. I would urge anybody who is trying to figure out if they want to taper to approach it from a harm reduction position rather than an absolute, get off of this sh*t as quickly as possible.

Edited by Petu
fixed text

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Has anyone experienced increased inflamation such as carpal tunnel or pinched nerve symptoms after starting to taper down off an antidepressant such as Cymbalta? It seems odd that I suddenly developed carpal tunnel and increased symptoms from a pinched neck nerve right after starting to taper. I've read some evidence that depression can cause inflamation in parts of the body, so I'm wondering about the possible connection.

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With withdrawal, a lot of us seemed to develop aches and tingling pain in hands, arms, back, and shoulders, particularly on mousing side (in my case, my right hand does the mousing).

 

Withdrawal seems to aggravate or stimulate hypersensitivity to pain in some areas, with symptoms that can be mistaken for fibromyalgia. (Others develop chronic fatigue-like patterns; both fibromyalgia and chronic fatigue syndrome have an autonomic component.)

 

I found acupuncture to be helpful to relieve the symptoms I had (painful tingling in hands, arms, shoulder).

 

How is your taper going, Tony? At what rate are you decreasing? Do you have any other symptoms?

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I'm taking 30 mg Cymbalta about a month now, this after alternating days at 60 mg and 30 mg at the advice of my psychiatrist, which made me feel miserable. I still have fatigue and weakness but it's not as bad. My symptoms of numbness and weakness in my hands seem to be from carpal tunnel and a pinched nerve in my neck-- I'm being evaluated now by a neurologist so we'll see. Soon I'll reduce the Cymbalta to about 28 mg.

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Did some surfing and found someone who had counted the pellets in Cymbalta capsules:

 

Cymbalta size and number of pellets

30mg=250 pellets (approx.)

20mg=166 pellets

15mg=125 pellets

10mg=83 pellets

5mg=42 pellets

 

Before you go by this, count the pellets in a couple of your capsules and verify. Please post your results in this topic!

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I'm coming off Cymbalta right now, too.

 

I'm recording my case history and experiene coming off it here in my introductory posting:

 

http://survivingantidepressants.org/index.php?/topic/1120-cymbaltadrone-choosing-a-life-without-drugs/

 

Short story: On Cymbalta 60 mg for 3 yrs. Dropped to 30 mg one month ago. Stopped (almost) altogether 2 weeks ago. Have taken three ~15 mg doses over the last 2 weeks when discontinuation symptoms became intolerable. The most recent of these was 5 days ago.

 

After that last dose of ~15mg 5 days ago, I experienced (as expected) progressively worse discontinuation symptoms (also listed on my intro page) on days 3 and 4. THey got very bad yesterday afternoon but I was out and about with no access to meds so I had to push through it. By the time I got home in the evening the crisi had passed and I've felt better since. I realise that this goes against the tapering recommendations on this site, but since I have arrived where I am rather unintentionally I am going to continue to see what pans out. Perhaps this is the end of it for me - I can always hope!

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You could be lucky, CD -- and I sure hope so -- but I would not recommend your method for everyone.

 

What we know of the nervous system is that it doesn't like sudden changes. Tapering should lead it down the incline gradually, so it can adjust along the way.

 

Jolting back and forth in dosage -- definitely not a gradual incline.

 

However, everyone is different and your nervous system may recover quickly.

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I just opened my Cymbalta 60 mg capsule and counted the contents. I found approximately 190 tiny pellets inside.

 

Ten percent would be 19-20 pellets, so to taper by ten percent drops, remove 19-20 pellets at first drop. Decreases become progressively smaller in number of pellets.

 

or: (190 - 19 = 181) (181 - 18 = 163) (163 - 16 = 147) (147 - 15 = 132) (132 - 13 = 119) etc

 

This would give over 15 steps if you really decreased only 10% each step.

 

Probably most people can taper it faster, don't you think?

 

Even 20% drops gives over 14 levels, although they are small changes near the end.

 

( 190, 152, 122, 98, 78, 62, 50, 40, 32, 26, 21, 17, 14, 11 granules per level is 20% less each level )

 

I see my doc next week and will be interested to see what he recommends. Bet he wants me to keep on the same old dose. We shall see.

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People vary in their tolerance for dosage reduction. Your plan sounds like a good one, try it for a couple of months and see how you do. You may be able to speed up (make reductions every 3 weeks, then every 2 weeks) or you may need to slow down.

 

A taper takes as long as it takes.

 

chronic, please start a topic for yourself in the Intro forum and let us know what your doctor says.

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I found this group a few months ago and have started the taper down method listed on here. I was on 60mg for 8 years, to 40mg for a year, then down to 30 mg for a month, down to 20 for the last month. I am now tapering down to 15 mg for a month. This method is so far working great for me!!!! Very little withdrawl symptoms!!!! I am very thankful to have found this site and to have found suggestions to weaning off the drug from hell as I call it. My Dr. had no clue as to how to help me wean off Cymbalta. Again I am very glad to have found this group!!!!!

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As I wrote in my introduction, my doctor originally told me to taper from a daily 60mg cymbalta dose to taking 30mg for a week and then stopping.  I experienced extreme side effects, so much so that I went back to taking 60mg/day until I could speak to another doctor who has some expertise in SSRIs (I've learned more on this site than my doctor seems to know).  

 

When I was taking 30mg/day, I would feel fine for around half a day, and then all of a sudden my lips would begin to tingle and I would get light headed and I knew the side effects were coming, so I would take another 30mg and after around 1hr I would feel better.  Now that I'm back up to 60mg/day, I'm still experiencing this effect of the onset of symptoms, except that it takes longer, usually around 22hrs after the previous dose.  

 

When I was on my original dose of 60mg/day (prior to attempting a taper), I never felt like I was "on the clock" with the cymbalta.  Now it's come to the point where I'm carrying my pills around with me just in case the symptoms come on earlier than expected, because I cannot function if I let them get to full strength.  It makes sense to me that I would experience this phenomenon when I downgraded to 30mg/day with the half life of the drug, but I don't understand why I'm still experiencing it now that I'm back to 60mg/day.  It makes me feel like there has been some permanent changes made in my brain.  Curious if anyone has experienced anything similar to this.  Thank you.

 

Justin

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It's because your system was destabilized by the drop from 60mg to 30mg. This will cause you to be more sensitive to when the Cymbalta is wearing off.

 

Hopefully, as you continue to consistently take it, your system will adapt to 60mg Cymbalta as a steady state.

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Cathylp,  I am also on a high dose of Cymbalta - 120 mg.  It has been very helpful for depression and anxiety.  However, I am working on tapering down a bit.  Want to see what might be a maintenance dose.

 

The effects I am having:  My med person and I have moved me to 100 mg.  It has been 5 or 6 days.  I have had some of the withdrawal symptoms about which others have written.  Had a few zaps the first day.  Tired in the afternoons most of the days.  Good energy the first two hours of the last two days.  Easy access to tears, but the darkness. Quicker to getting irritable. 

 

What has been helping:  Breathing helps.  I have a light I use in the am's to help me on gloomy days (we are in later fall right now).  Exercise helps.  Compassion for myself helps.   A guided imagery recording helps.  I will talk about it to my counselor today.  My partner and I cuddle.  If I feel tears, I let them come.  No matter there is no reason for them.  It is just the chemistry talking.  I work out in the mornings when I can.  I hug the dog.  Not crazy, not lazy, just adjusting.

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(Tapering from Cymbalta) After reading many of these posts, I contacted my dr. immediately after experiencing major dabilitating side effects, which not only physically brought me to my knees, but mentally as well... i mentioned the Prozac connection I had read here, and we decided to start that right away.. In the meantime, I reach out to others I know who have experienced this, and I try to act opposite, and sometimes think opposite of what I'm doing and thinking.  I started recording  all the things I've accomplished during the day despite my aches/pains/fears, and I've recorded the symptoms I've experienced as well.  My dr conversed with a collegue and decided to jump me right to the 20mg of Prozac, as I am counting beads of Cymbalta at this point and am around 10ish mg of... I've always been med sensitive and am with this taper as well.. My pharmacist is also a friend and great resource and once I explained the plan she was giddy, and happy to see that the chemistry makes sense and the withdrawals should fade... and then, my intention, though probably slower than others, i will begin the taper of Prozac.  What a ride.....I'm calling it a final farewell and letting go to many things....

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Good luck. Given your drug sensitivities, 20mg Prozac may be too much. Please consider 10mg.

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I talked to my pharmacist and she mentioned taking 10mg prozac one day then 20mg prozac the next....?  alternating.....

 

Also, what does "20mg Prozac may be too much" mean...? Will I physically notice like rapid heart beats, high temperature...?

 

Thanks, -Jen

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Yes, rapid heart beat, sweating, and sleep disruption could be signs of too high dosage of Prozac or other antidepressants. In general, you will feel overstimulated or oversedated.

 

As explained carefully above and in many, many other places on this site, we caution against alternating dosages of Prozac or any other psychiatric drug. Consistency of dosing is essential to gradual tapering.

 

Many doctors, pharmacists, nurses, naturopaths, acupuncturists, homeopaths, herbalists, store clerks, postal carriers, tree trimmers, short-order cooks, etc. will suggest skipping doses or alterating dosages. They are mistaken. That is a way to go off psychiatric drugs that increases the risk of withdrawal syndrome.

 

If you wish to skip or alternate doses, it's your decision and your risk.

Edited by Altostrata
fixed text

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I'm starting today to quit Cymbalta from 60 mg.

in my count the full 60 mg capsule have 582 pellet.

(only counted once, so maybe I missed a pellet or two).

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taltal, the number of pellets in a capsule varies among manufacturers and even within dosages. Please be conservative in your estimates.

 

Please start a topic for yourself in the Introductions forum and share your tapering progress there.

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Cymbalta comes in 20 mg, 30 mg, and 60 mg capsules. [...]

 

Do not reduce by one bead a day. This is too fast, you may develop withdrawal symptoms before you know what's happening.

 

Switch to Prozac

Like its fellow SNRI Effexor, withdrawal from Cymbalta can be very difficult. Recently, I asked a knowledgeable doctor about how he switches patients to Prozac.

 

He said if the dosage of Cymbalta is "normal" -- 30mg-40mg -- he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Cymbalta.

 

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 Cymbalta. And, at least Prozac comes in a liquid.

 

He confirmed that Cymbalta cannot be compounded because the pellets are enteric-coated to get the medication past the stomach acid, which destroys it. Other than the Prozac switch, he said counting pellets is the only way to taper.

 

See more about the Prozac switch http://survivingantidepressants.org/index.php?/topic/1463-the-prozac-switch-or-bridging-with-prozac/

 

Great article by the way, thank you...

 

Care should be taken in the consideration of using the "Switch to SSRI only" method withdrawing from Cymbalta.   Evidence is being found that discontinuation of SNRI bassis, (Cymbalta) has a potential compounding side effect of increasing SSRI mediated complications.  For those on high doses of both Prozac and Cymbalta this can have life threatening potentials if they should find they are among the percentage who deal with greater side effects of discontinuation.

 

Most doctors remain seriously undereducated on these potential cumulative effects which can invite emergency room exposures where even worse complications can arrise from misdiagnosis and improper handling.

 

While the quoted article refers to a doctor noting those on "normal doses", readers should be aware to consider what their individual doses are and understand it can take WEEKS for full side efffects to emerge to a critical level of such error.  This delay can further mislead from the true underlying cause withdrawal causes, especially in a complicated medical profile of multiple Rx's.

 

Reference background... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681629/ noting the effect relative to Venlafaxine, a similar SNRI.

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Thank you for that information, Urbansound. You may note that the topic The Prozac switch or "bridging" with Prozac is loaded with caveats.

 

We also suggest attempting a direct taper from Cymbalta (or other antidepressant) is preferable to taking on the risk of a switch to Prozac.

According to the information in The Prozac switch or "bridging" with Prozac, the safest way to accomplish the Prozac switch appears to be a short-term overlap of Cymbalta with a relatively low dose of Prozac, discontinuing the Cymbalta before cumulative effects can occur.

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Yes, tapering off Cymbalta can be tricky and there is a lot of misinformation out there about how to safely taper. Most experts like Dr. Peter Breggin and Ann Blake Tracy will agree that no more than a 10% reduction should be done. In fact, Ann Blake Tracy recommends only removing one or two beads at a time per week. Never skip a day as many doctors recommend every other day tapering. Generic Cymbalta can be compounded contrary to many reports that it cannot. I have recommended Roy at www.customrx.com. He is a pharmacist that will compound the generic Cymbalta with a doctor's script to do so.He can help anyone in the U.S. In my FB group - Cymbalta Hurst Worse - we have a list of functional doctors that will help people taper if their current doctor is not familiar with how to safely taper off. This can be done without the need to switch to another psychotropic.  I hope this helps.

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Thanks for the tip about Roy at www.customrx.com, Beth. How does he get the compounded capsule through the stomach acid?

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Yes, tapering off Cymbalta can be tricky and there is a lot of misinformation out there about how to safely taper. Most experts like Dr. Peter Breggin and Ann Blake Tracy will agree that no more than a 10% reduction should be done. In fact, Ann Blake Tracy recommends only removing one or two beads at a time per week. Never skip a day as many doctors recommend every other day tapering. Generic Cymbalta can be compounded contrary to many reports that it cannot. I have recommended Roy at www.customrx.com. He is a pharmacist that will compound the generic Cymbalta with a doctor's script to do so.He can help anyone in the U.S. In my FB group - Cymbalta Hurst Worse - we have a list of functional doctors that will help people taper if their current doctor is not familiar with how to safely taper off. This can be done without the need to switch to another psychotropic.  I hope this helps.

 

Thanks for the info about tapering Cymbalta, Beth.  Much as I really don't want to take this med, my pain specialist doctor says he has had very good results with it and recommends it to control chronic pain that is giving me serious cognitive difficulty.  We have tried most other meds.  Cymbalta would replace the tricyclic lofepramine  which I am taking for pain, so I guess that mean I would have to first handle a withdrawal from lofepramine and then work out how to minimize my dependency on Cymbalta.

 

To control pain, some antidepressants (like amitriptyline) are used at doses much less than is used for depression.  Unfortunately Cymbalta is different in that it requires as high, if not a higher dose (60 to 120mg a day) to work as an analgesic than is used in depression..  I guess I had better be prepared for it to re-wire my CNS and cause potentially significant withdrawal effects!  

I have just been through a brutal 2 year benzodiazepine taper and know, all too well, what a nasty withdrawal feels like.  I don't want that ever again.

 

Can anyone suggest any good pages on the Net to start reading up on Cymbalta withdrawal problems?  Thank you for any info.

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Altostrata, I would think same way that the generic duoloxitine does, via gelatin capsule. I am not sure how he does it but I am going to make an educated guess and say he crushes the 10 or so irregular chunks per capsule and weighs out the tapered amount. He is really accessabile and easy to talk with. You might give him a call.

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Riffick, everyone is welcome to join us in the Facebook "Cymbalta Hurts Worse"  group- There is also a page on the same subject however the the group is interactive and updated more frequently. As far as withdrawal off of Benzos being bad some people who have done both have said Cymbalta is worse to taper off. No one should ever cold turkey or as some docs recommend, take every other day. Of course, everyone is slightly different and some folks have a metabolism that can handle Cymbalta for so long but after a while the effect wears off and one finds themselves taking more and more. Eventually the body will adapt and try to achieve homeostatis. I can't say enough about the dangers of this drug. Like I said, I lost a family member to it. It always affects the liver, gut,brain, etc. Sorry you have pain but a lot of people have found relief with other non-toxic treatments. Never suddenly stop any of these psychotropics. You probably already knew that but it can't be said often enough. A good book to get a general perspective on this is "Medication Madness" by

Dr. Peter Breggin. Best wishes!

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No one should ever cold turkey

 

You got that right, it was brutal. My post CT headache lasted 3 days and cost me 13K at the ER. They did not even diagnose it for what it was, I found out on my own.

 

 

some folks have a metabolism that can handle Cymbalta for so long but after a while the effect wears off and one finds themselves taking more and more. Eventually the body will adapt and try to achieve homeostatis.

 

Yep. My ending dose was 120mg per day and even then it was not working too well. The doc had to throw in some Lamictal and klonopin to help me.

 

Devil drug, I am glad I am done with it. I may be stuck with tinnitus for life.

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Riffick, everyone is welcome to join us in the Facebook "Cymbalta Hurts Worse"  group- There is also a page on the same subject however the the group is interactive and updated more frequently. As far as withdrawal off of Benzos being bad some people who have done both have said Cymbalta is worse to taper off. No one should ever cold turkey or as some docs recommend, take every other day. Of course, everyone is slightly different and some folks have a metabolism that can handle Cymbalta for so long but after a while the effect wears off and one finds themselves taking more and more. Eventually the body will adapt and try to achieve homeostatis. I can't say enough about the dangers of this drug. Like I said, I lost a family member to it. It always affects the liver, gut,brain, etc. Sorry you have pain but a lot of people have found relief with other non-toxic treatments. Never suddenly stop any of these psychotropics. You probably already knew that but it can't be said often enough. A good book to get a general perspective on this is "Medication Madness" by

Dr. Peter Breggin. Best wishes!

Years ago, because the tinnitus from the Wellbutrin was driving me nuts, psychiatrist offered the option of switching to Cymbalta.   After research the med and its horrific withdrawal symptoms, I made the decision to deal with the tinnitus.   Unfortunately, I still didn't translate that knowledge to the fact that psych meds in general were bad news but you know how that goes.   Anyway, not switching to Cymbalta was one of the better decisions of my life.

 

I am so sorry about your loss.

 

CS

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Altostrata, I would think same way that the generic duoloxitine does, via gelatin capsule. I am not sure how he does it but I am going to make an educated guess and say he crushes the 10 or so irregular chunks per capsule and weighs out the tapered amount. He is really accessabile and easy to talk with. You might give him a call.

 

Thanks, BethS.

 

I am wary about this because you cannot crush the beads in a Cymbalta capsule. The coating on the beads protects the drug from being destroyed by stomach acid. If duloxetine is not protected in this way, it will not be active.

 

Someone who crushes the beads or tries to make a liquid from them to taper will, in effect, not be absorbing a consistently measurable amount of duloxetine.

 

A compounding pharmacy can weigh the beads and redistribute them in capsules of custom dosages. It might be an added expense but would save someone the trouble of counting or weighing beads to taper.

 

Otherwise, I don't know of any other way to compound Cymbalta.

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I have developed a method for myself for tapering off Cymbalta that I have not encountered in this forum or any others so I thought I should share it.

 

For the very reason that the beads inside a Cymbalta capsule are not the same size (two capsules might not contain the same amount of beads) and I do not have a scale to measure such small portions, I have come up with an alternative.

 

What I did is I folded a paper in half from the middle, creating a void where I could pour the beads and they would stay in a straight line next to each other. In that way I created a measurable line of the contents of a capsule.

 

Right now I use a 30 mg capsule which creates a 25,5 cm line (fits on a regular A4 paper), but when I was using a 60 mg capsule I had to devide the beads into portions and measure them all and calculate from there on.

 

Now I am not particularly fond of mathematics, but with a few simple calculations and a lot of concentration (:)) I was able to calculate how many mg of the medicine was in a line of the medicine of a certain lenght. So when 30 mg of Cymbalta is 25,5 cm, that meas for example, that 15 mg of Cymbalta would be 12,75 cm etc. (This is specific to the capsules I use bought from Estonia, yours could be very different so you should always measure your own medication!)

 

I use the same folded paper (with markings on it) every day to pour a certain amount of beads out from the capsule.

So if I am using a 30 mg capsule and I am - let's say - at 20 mg daily dosage I would have to calculate how many (what lenght) beads I would have to extract from the capsule before taking the medicine.

 

So I have established that 30 mg = 25,5 cm.

That means 20 mg = 17 cm.

I know that there is 25,5 cm of beads (30 mg) in the capsule so I have to pour out 10 mg = 8,5 cm. It really makes no difference, if you calculate it in cm or mg after you have established the relation between the two.

So I have a marking on the paper and each day I pour out a 8,5 cm line. And if i reduce the dosage I just make another marking. It is actually very easy to do the reduction just visually, when you have drawn the lines beforehand and calculated what necessary. You also have the history of your reductions right there under your eyes. I always write the date of the reduction next to the specific line every time, so I have a good visual overview of what, when etc.

 

I hope this could be of some help to someone.

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Bethsimmons Hi there! I found a mention about the irregular chunks finally lol. I just talked to this head lady pharmacist and asked her what the heck is up with this and how am I supposed to count these? I showed her an older capsule and then she looked at the Duolexitene and she acted like I was crazy. She said for me to skip one day, take it, then skip 2 days and I said oh no you are so wrong and misinformed. She said that is the way it comes now and I might want to switch pharmacies. Can you direct me to a link about this and why it happened please?

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Alotstrata,

 

When I first start removing beads from my duloxetine capsules, they will be very few (haven't started yet, so haven't figured out exact amts yet). Should I save the few that I remove or just throw them away?

 

Thanks!

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