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Altostrata

Tips for tapering off Luvox (fluvoxamine)

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Altostrata

aka

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From official FDA prescribing information http://www.drugs.com/pro/fluvoxamine.html

Fluvoxamine (immediate release) comes in 25, 50, and 100mg tablets. It is available as a generic. Its half-life is about 15.6 hours.
 
Luvox CR or generic fluvoxamine ER comes in 100mg or 150mg extended-release capsules. Per http://www.drugs.com/pro/luvox-cr.html
 

Pharmacological information here http://www.drugbank.ca/drugs/DB00176

 

Luvox's half-life is the shortest of all SSRIs and it is well known to incur withdrawal symptoms.
 

Reduce by 10% per month to start
The 10% rule holds for Luvox, just like other psychiatric drugs: 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?

Cutting up immediate-release tablets
Get your prescription refilled with a combination of dosages that includes 25mg tablets. Cut up the tablets so you can reduce by a quarter of a tablet (6.25mg) at a time.

Tablets can be cut up with a pill splitter like other medications in tablet form. Keep the pieces you don't use in a clean pill bottle labeled with the dosage for future use.

Do-it-yourself liquid

 

Mod Note:  See this post for DIY instructions.

 

You may be able to make a liquid with immediate-release tablets and water. A liquid makes it easier to titrate by small, controlled amounts.

It is "sparingly soluble" in water, see http://www.drugbank.ca/drugs/DB00176 -- stability (shelf-life of dilution) is unknown. As traces are found in municipal water supplies http://cfpub.epa.gov/ncer_abstracts/index.cfm/fuseaction/display.abstractDetail/abstract/1755/report/F
it is somewhat stable, but degraded by light.

See How to make a liquid from tablets or capsules
 
Have a compounding pharmacy make a liquid for tapering
Compounding pharmacies can make a liquid of immediate-release fluvoxamine (NOT extended-release fluvoxamine). You will need a prescription written for the custom compound. The only drawback is this can be quite expensive.
 
Extended-release capsules: Open and count out beads
Opening the 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.)

Some people microtaper by reducing by one or two beads at a time. (Be sure to keep notes about your count!)

Tapering by removing beads from a capsule can be tricky. See:

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 fluvoxamine CR capsules from different manufacturers contain the same number of beads. If your prescription gets filled with fluvoxamine CR 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 Luvox CR capsules 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 100mg fluvoxamine CR capsules is NOT 2/3 the number of beads in 150mg fluvoxamine CR capsules from the same manufacturer.
  • 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).

If you are very sensitive to dosage variations, you may wish to weight the beads with a digital scale to get precise dosages. Or you may wish to micro-taper, see below.

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

 
Have a compounding pharmacy make capsules with custom dosages
Compounding pharmacies can weigh fluvoxamine or fluvoxamine and make up capsules for you of specific dosages. You will need a prescription written for the custom compound. The only drawback is this can be quite expensive.

Convert from fluvoxamine CR or Luvox to regular tablets
You may wish to switch from the extended-release version to regular fluvoxamine so you can use the tablet-cutting method or make a liquid from it.

Because of its short half-life, taking regular fluvoxamine may necessitate taking a dose twice a day.

You would then be able to cut up the immediate-release tablet or make a liquid from it to reduce by 10%.
 
Reduce by micro-taper
The very smallest dose of Luvox CR 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/

Switching to 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.

Edited by ChessieCat
added link to DIY instructions

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Buffy

Thankyou!

 

I hope you and those running this forum know how valued you are.

 

onwards to the healing!

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ChessieCat

DIY Liquid Luvox:

 

On 19/01/2018 at 1:04 PM, brassmonkey said:

Making your own liquid is a bit confusing the first time out but it is really pretty easy once you get the hang of it.  There is a little trick to use when making a liquid from Luvox.  From my research I have learned that Luvox does not dissolve all that well in plain water, but it does dissolve quite well in isotonic saline, which is basically salt water.

 

To make it you would use 9 grams of table salt mixed into 100 grams of water. Add to this one crushed tablet and let it sit over night. If you crush the tablet carefully you won't lose enough powder to cause any problems.  Almost all of the active ingredient will be dissolved into the water and all of the fillers will settle to the bottom where you don't have to worry about them. If you keep it refrigerated the liquid should be good for a week or so.

 

NOTE:  You do not have to shake before measuring

 

On 20/01/2018 at 5:07 PM, brassmonkey said:

I prefer to use the two spoons method to crush tablets. Put the tablet between the bowls of two spoons and grind it into a powder.  Work over a piece of waxed paper and you won't lose anything.  Only crush one tablet at a time and put it directly into the water you're mixing up for that batch.  So you will mix 50ml of water (1ml of water weighs 1 gram) with 4.5 grams of table salt and 1 crushed 50mgai tablet.  Shaking it up will help things to dissolve and then let it sit overnight.  This will give you a solution with a concentration of 1mgai per 1ml of liquid. You don't have to shake it up because the active ingredient is all dissolved in the water and the stuff on the bottom is basically just mud. (For other people reading this who are using different medications this does not apply to you, this is for Luvox users only, other medications need to be shaken before use.)

 

mgai (active ingredient) is the strength designation on the bottle

 

The other designation is mgpw which is the weight of the actual material from the pill.

 

Example:  BrassMonkey used 40mg paxil tablets.  They were 40mgai, but they weighed 500mgpw each.

 

On 21/01/2018 at 1:19 PM, brassmonkey said:

Distilled water would work fine, but any bottled water would be fine.  You could use tap water depending on it's quality where you live.  Bottled is probably the best. A tinted container is usually best for storing medications.

 

The process from switching from inaccurately cut tablets to a very accurate dose of liquid is probably going to have some affects on you.  Be prepared for an upswing in symptoms for the next few weeks.  It's not anything going wrong it's just your body adjusting to the new form of the drug and a more consistent dose.  If there is an increase in symptoms it should start to stabilize and calm down in a few weeks.  Also the liquid might taste pretty terrible, you could try mixing it with some fruit juice or flavoring of some sort (don't use Grapefruit juice).

 

On 01/02/2018 at 1:33 PM, brassmonkey said:

Yea, sea salt would work fine.

 

32 minutes ago, brassmonkey said:

Draw in a bit extra, point the syringe up and tap it to get all the bubbles at the tip.  then squirt out just a bit to get to the right dosage.

 

Edited by ChessieCat

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mustangwoman

Thanks Tom and AliG.  A little history with Luvox that might help others on it.  Luvox is metabolized in a large part by CYP1A2.  I first found that out during a trip to the ER the first year on the med after having a caffeine drink, I almost had caffeine intoxication.  Anyone interested can look at research, for example https://www.ncbi.nlm.nih.gov/pubmed/8807660

Since then I have found many other items that either inhibit or induce cyp1a2 affecting my Luvox dose up or down.  The lower the dose the more I feel the effect.  A partial list, almost anything with antioxidants or carcinogenic.    Blueberries, blackberries, smoked meat, meat cooked at high temps, cabbage, cauliflower, smoke, cement ( breathing the powder form or touching wet cement, bacon, squash, etc.  Even supplements, I already had a previous experience with k2, turmeric, vitamins, iron, etc.  I have to be very careful introducing anything new.   I had already eaten a lot of hamburger patties though, for months without any issues, so I didn't think about k2 in grass feed beef.   I can eat a cup of blueberries and feel sedated as it increases my dose.

 

Those big drops were from those situations, dropping my dose after taking say finishing an antibiotic interacting with my med (as the antibiotic caused a drop to start with).  Tom you may be correct, the big drops over a year finally caught up.  I initially thought it was side effects from going up (following the drop) because I felt very 'bright'  right after taking a dose (after stopping the meet).  Maybe it was just withdrawal catching up to me from the drop.

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