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Altostrata

Tips for tapering off Cymbalta (duloxetine)

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Altostrata

Welcome, KD0105. Please read this topic from the beginning. Counting beads is the only way to taper Cymbalta. Some people weigh them to be sure dosing is consistent.

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KD0105

I've contacted my compounding pharmacist about this.  I'm hoping he will respond to my email.

ChessieCat, have you had an answer to this question from your pharmacist yet?

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ChessieCat

No.  He never got back to me and I haven't been in for my new batch yet.

 

The mods have discussed it and think it is highly unlikely that the individual beads would be made to release at different times.

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taperingdown

I'm new to this topic, so please forgive me if I'm overlooking something obvious...

 

There appears to be a logical problem underlying all of the tapering strategies in this thread. I just had a lengthy discussion with my local pharmacist, and she claims that the "micro-beads" contained in Cymbalta are heterogeneous wrt enteric coating. In other words (to use a made-up example): 25% of the beads might be coated to time-release after 1 hour, 25% to release after 2 hours, 25% after 4 hours, and 25% after 8 hours. The problem is that when you sub-divide your dosage, you have no way of knowing whether you're getting a balanced cross-section of these different enteric coatings.

I was told something similar by my doctor, but I'm not sure it is correct. I found the controlled release patent at https://www.google.com/patents/EP1904039A2?cl=en&dq=cymbalta&hl=en&sa=X&ved=0ahUKEwjWgrvz1eLSAhVB8CYKHTUKBmgQ6AEIHDAA

 

I can't find a clear indication that different beads are designed to be dissolved at different times. All that is clear is that the drug is slowly released as the coating dissolves:

 

"Once the dosage form reaches the intestine and pH approaches more than 5.5, the enteric coating starts to dissolve and drug core in polymeric carrier is exposed to the intestinal fluid. The dosage form starts to release the drug in the intestine in a controlled rate by polymeric diffusion, dissolution and erosion mechanisms and the process occurs for prolonged period of time. The dosage form completely erodes and dissolves within the dosing interval (24h), thereby ensuring complete drug release in the intestine."

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Altostrata

I wouldn't worry about this. Counting beads is the only way to taper Cymbalta. There is no other option.

 

Do your best to take what looks like a cross-section of beads.

 

We have many people here who have done this successfully. Go to the Introductions forum and use search for "cymbalta" to find their stories.

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taperingdown

I wouldn't worry about this. Counting beads is the only way to taper Cymbalta. There is no other option.

 

I agree. It just frustrates me that pharmacists and doctors would tell patients that weighing/counting beads will interfere with the timed release when there is no written proof that it would. Oh well.

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gardenlady

My Citron duloxtine (generic Cymbalta) 60 mg capsules won't open.....feels like they are glued together.  I've found 2 that came apart, but the rest won't no matter how hard I pull.  Does anyone have any suggestions?

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ChessieCat

You would have to be very careful.  You could try holding a capsule upright and snipping off the very top with scissors or use a craft knife.  If you can't get the scissors to snip, you could try making a small starter slit with a craft knife so you can then cut with scissors.

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Altostrata

The tiny beads inside a Cymbalta capsule are individually coated to protect them from stomach acid. The gelatin capsule is only a container, it doesn't provide timed release or protection from stomach acid.

 

As far as I know, you cannot buy empty enteric capsules. They are available only to drug manufacturers.

 

If your Cymbalta capsules don't open by grasping at both ends and twisting, you'll just have to break them carefully (or cut them) over a clean container. It may be handy for you to get empty (largish) gelatin capsules so you can package your beads in them for multiple doses; for example, your doses for the week.

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gardenlady

There are so many brands and sizes of gelatin capsules on Amazon that it's confusing.  What kind and size should I buy?  

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ChessieCat

I think I read somewhere 00.  It's better to get the larger size because it is easier to get the beads into them.  You could get the giant 000 ones, but you need to consider whether you would be able to swallow them.

 

I've just found it:  post by Alto

 

She suggests 0 or 00.  But you need to consider your ability to handle the smaller size.  Comparison picture with measurements

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Jewlz

I'm a newbie here and still learning the ropes. 

 

Has anyone ever heard of the periodical/book titled "The Road Back?" I found it a couple of years ago when I was considering a taper off cymbalta which I never started. Anyway, the info in the book seems helpful. They talk about using nutritional supplements that they've personally formulated that cost quite a bit. I'm scared out of my mind about the withdrawal from cymbalta and this book makes it sound like their supplements go a long way in helping to relieve the tapering process.

 

Are there supplements that perhaps someone else has used in their tapering process?

 

Thanks.

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Jewlz

Answered my own question about The Road Back. Something seemed fishy to me, namely the cost. I did email the company that market the supplements and asked questions about ingredients that seemed contradictory to me. I have yet to hear from them, and I'm quite sure I won't. Which I'm fine with.  Moving on to read about self care. Thx

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