Jump to content
Altostrata

Tips for tapering off Cymbalta (duloxetine)

Recommended Posts

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.

Share this post


Link to post
Share on other sites
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?

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites
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."

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites
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?

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites
gardenlady

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

Share this post


Link to post
Share on other sites
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

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites
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

Share this post


Link to post
Share on other sites
gardenlady

I'm interested in knowing if there is a way to do a daily micro taper of Cymbalta vs percentage cuts every few weeks.  I'm finishing up a valium taper and switched to a daily liquid micro taper when I got to 2.5 mg.  It's made all the difference and is so much better.  Of course, there isn't a liquid version of Cymbalta, but I'm wondering if anyone has figured out how to do it using a scale or other way.  

 

Once I'm stable enough after the benzo taper, I have 48 mg of Cymbalta to taper so would like to have a plan in place.  I'm kindled and very, very sensitive to even small cuts.  I'm taking the Teva generic brand of duloxetine and a 60 mg capsule has an average of 315 beads.  Right now, I'm using a Gemini 20 scale from Amazon to weigh the beads and tapered in May from 60 mg to 48 mg.  However, an attempt to taper 2.5% in October was a disaster after only one day.  I was already in benzo withdrawal from the valium taper and so shouldn't have touched the Cymbalta.  But, that experience showed me how sensitive my CNS is and that I have to be very careful resuming the Cymbalta taper when I've completed and stabilized from the valium withdrawal.

 

Thanks in advance to anyone who can offer guidance on this.  

Share this post


Link to post
Share on other sites
Altostrata

Unfortunately, the smallest dose of Cymbalta is one bead. You cannot make a liquid of Cymbalta, or grind it up.

 

At 48mg Cymbalta, which is still a large dose, a reduction of one or two beads at a time (less than 1% of the 315 beads in your capsules) might be the best you can do for a micro taper.

Share this post


Link to post
Share on other sites
gardenlady

Thanks, Altostrata.  Just for clarification, I wrote: 

 

Of course, there isn't a liquid version of Cymbalta, but I'm wondering if anyone has figured out how to do it using a scale or other way.

  

 As you wrote, it would come down to eliminating a bead or so each day at a dose of 48 mg or so. I'd be curious to know of anyone's results using this method with a scale.  

 

So, is 48 mg considered a high dose?  

Share this post


Link to post
Share on other sites
CymbaltaDrone

I tapered down over a number of months. I managed to escape it. Read my details in my history. I don’t recall exact detils of what I posted but i do recall opening capsules and spacing them out more and more. After I was off altogether I felt like I had cognitive impairment for quite some time. In fact I still do but I’m not sure if it’s from all the ADs or from three kids....

Share this post


Link to post
Share on other sites
gardenlady

CymDrone, I read some of your posts and it sounds like you were on a very low dose of Cymbalta by the time you got to this forum.   I'm so awfully sorry that you still have cognitive impairment after being off the drugs for so long.  How severe is it?  From what I understand, Seroquel is one of the more dangerous drugs, so I'm glad you're off it of.  Do you have any suggestions as I prep for tackling my taper from 48 mg of Cymbalta?  It'll be on the heels of a benzo taper, so my CNS is very fragile.  I'll have to wait a few months to stabilize from the valium before starting the Cymbalta taper.  

Share this post


Link to post
Share on other sites
CymbaltaDrone

Yes by the time I registered myself I was pretty low but I’d been viewing the forum through a friend who was sharing resources like this with me so a lot of the advice I followed was straight from here or from Dr. Peter Breggin’s work. My strongest caution would be not to taper too fast, to not see it as a failure of some sort when the discontinuation symptoms force you to taper more slowly and to exercise a LOT to help your brain stabilize itself. Exercise triggers all kinds of hormone and neurotransmitter production whicn felt like it had a dampening effect on the discontinuation swings and kickstarted my own brain into balancing itself again. Running everyday for at least 20 mins would be my min recommendation for exercise. And if you’re felling doubtful that exercise could be so effective, the most approachable resource I’ve seen in the research is called Spark: the revolutionary new science of exercise and the brain. 

 

When I say i still suspect cognitive impairment, it’s maybe helpful to understand my context. I’m a high performance knowledge / head worker, an engineer working in the project planning and investment part of our business and I deal with huge amounts of data and people that I have to say on top of. My company hires top 1-5% of performers to begin with. I can perform my job and have improved my performance ranking consistently since getting off the drugs. But I am by no means a top performer at my company, I’m average. But if I was working almost anywhere else I may not notice a difference. And Mum brain is a thing too - not well understood but looks

like mild dementia from the symptoms side of things. I’ve had three kids in 5 years so am definitely a Mum brain candidate. Every time I go back to work after a year of maternity leave I feel the mountain my brain has to climb to get “back in the game”. My youngest is almost three now though and I’ve not worked this long a stretch since starting ADs. I’m hoping I’ll comtinue to see sustained improvement in brain (and work!) performance going forward. 

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

×

Important Information

By using this site, you agree to our Terms of Use.