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Altostrata

Tips for tapering off Pristiq (desvenlafaxine)

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Altostrata

If you are having difficulty tapering off Pristiq, I suggest you write Nurse Wei Lu at the FDA directly, since she doesn't seem to know there are 744 reports in the FDA database of Pristiq withdrawal difficulties (see https://www.rxisk.org/Research/DrugInformation.aspx?DrugID=7113&ProductDrugID=132507&ProductName=Pristiq#7_10013754_0_1_0 and report your adverse reaction there.)

 

 

From: Lu, Wei <Wei.Lu at fda.hhs.gov>

Subject: RE: Pristiq -- tapering advised to discontinue, but impossible

Date: July 6, 2012 8:55:53 AM PDT

To: Altostrata <altostrata at comcast.net>

Cc: pelosi at mail.house.gov

 

Dear Alto Strata,

 

Thank you for writing to the Food and Drug Administration (FDA or the Agency) requesting information on how best to discontinue from treatment with Pristiq. Your email has been forwarded to the Division of Psychiatric Products for review.

 

The Agency appreciates your concern regarding optimal approaches to discontinuing treatment with Pristiq in order to minimize withdrawal symptoms, and remains committed to providing updated information on how to use the drug safely. We continue to evaluate new information on this issue, including reports from patients and physicians, literature reports, and study results from the drug manufacturer. We will continue to work with the drug manufacturer to explore better approaches to minimizing this problem, including the possibility of developing a lower dosage than the currently available 50 mg dose.

 

We encourage you to work closely with your physician when you need to discontinue Pristiq or switch to another medication for your treatment. FDA is interested in learning of any adverse experiences that patients encounter, and has implemented the MedWatch program to facilitate reporting. It is a voluntary system of reporting to FDA adverse effects and product problems. We would encourage you or your physician to complete this form to report the problems with the drug. Reports can be submitted electronically by accessing FDA's MedWatch homepage at: www.fda.gov/medwatch, click on "How to Report," then "Reporting by Health Professionals" or "Reporting by Consumers."

.

Thank you again for your patience.

 

Sincerely,

__________________________________________

Wei Lu, RN, MS

U.S. Food and Drug Administration

CDER/OEP/DEO

10903 New Hampshire Avenue

Silver Spring, MD 20993

Bldg 51, Room 6174

Office: 301-796-3448

Fax: 301-847-8753

Email: Wei.Lu at fda.hhs.gov

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Barbarannamated

Major research center referred you to yourself!! CLASSIC!!

 

BUMP!!!

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Brandy

She said the doctor had done some Googling and found an article for me. It turned out to be from a site called SurvivingAntidepressants.org -- this very topic.

 

o... m... g...

 

I don't know whether to laugh or cry.

 

Guess I'll do both...

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Barbarannamated

There seem to be quite a few recent people trying to CT Pristiq or skip days. Wondering if this is stemming from any particular (bad) news source. ?

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Rhiannon

"Dr. Stahl apparently subscribes to the belief, common among psychopharmacologists, that the patient's nervous system is made of an endlessly elastic rubber-like material." snort! that or they think it's just a machine, like a computer. Dead matter that just sits there waiting for us to manipulate it. Although I think they're more careful with their hard drives than they are with our nervous systems. Actually the problem seems to be that there is VERY LITTLE ACTUAL THINKING GOING ON AT ALL in the field of psychopharmacology. Sigh.

 

About the Pristiq: Just a crazy notion from someone with absolutely NO experience, but, as you say, if you crush it, you remove the hard coating that provides timed-release protection, so you get the whole intense dose at once if you take it all at once. But could you just take small amounts of the powder at regular intervals over the course of 24 hours?

 

Like say maybe crush, measure on your scale on a piece of Saran wrap and remove your current increment for tapering, carefully wrap up the rest and take about one-fourth of what's left every eight hours or so? Or one-eighth every four hours?

 

What brings this to mind is that this is how I have to taper Xanax since it's so short-acting the only way to keep blood levels even is to dose frequently. I dose every three hours. I've started spreading out my Lamictal the same way lately and when I tapered Neurontin I did it the same way too.

 

This is how I advise tapering short-acting benzos and lots of people have tapered them that way--even sized doses spread out at even intervals. Just sort of homemade timed release. I don't really think crushing is an ideal way to taper, and what I've described doesn't sound very precise, but it would probably be better than nothing.

 

And please, please don't stop the activism and holding Wyeth responsible for making a drug that has to be tapered off but can't be tapered off.

Edited by Altostrata
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jr1985

My god, this thread just illustrates how incompetent the so called "professionals" really are. First they redesign the worst AD ever and make it so it can't be tapered. Then no one has a clue what you're supposed to do about it, and refer you to yourself, basically admitting they have no idea! Idiots! I will never trust another psychiatrist again.

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Brandy

"Dr. Stahl apparently subscribes to the belief, common among psychopharmacologists, that the patient's nervous system is made of an endlessly elastic rubber-like material."

 

snort!

 

that or they think it's just a machine, like a computer. Dead matter that just sits there waiting for us to manipulate it. Although I think they're more careful with their hard drives than they are with our nervous systems.

 

Great post! Brilliant!

 

I not only think - I'm SURE - they're more careful with their hard drives.

 

Otherwise they'd have devised "restore points" and backup software for our nervous systems.

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Altostrata

....

About the Pristiq: Just a crazy notion from someone with absolutely NO experience, but, as you say, if you crush it, you remove the hard coating that provides timed-release protection, so you get the whole intense dose at once if you take it all at once.

 

But could you just take small amounts of the powder at regular intervals over the course of 24 hours?

 

Like say maybe crush, measure on your scale on a piece of Saran wrap and remove your current increment for tapering, carefully wrap up the rest and take about one-fourth of what's left every eight hours or so? Or one-eighth every four hours?

 

What brings this to mind is that this is how I have to taper Xanax since it's so short-acting the only way to keep blood levels even is to dose frequently. I dose every three hours. I've started spreading out my Lamictal the same way lately and when I tapered Neurontin I did it the same way too. This is how I advise tapering short-acting benzos and lots of people have tapered them that way--even sized doses spread out at even intervals. Just sort of homemade timed release.

 

I don't really think crushing is an ideal way to taper, and what I've described doesn't sound very precise, but it would probably be better than nothing.

 

And please, please don't stop the activism and holding Wyeth responsible for making a drug that has to be tapered off but can't be tapered off.

 

Yes, dosing 2 or 3 times a day, like regular Effexor, does seem like a way you might be able to do it.

 

You'd have to crush the tablet so the coating is distributed evenly throughout, and weigh the powder on your digital scale so you can control the dose.

 

oaklily found the powder can't be mixed in water -- the coating causes it to clump up, see http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__24822

 

(okb78 cold-turkeyed Pristiq, got severe withdrawal, and found a quarter-tablet gave her some relief, see http://survivingantidepressants.org/index.php?/topic/2614-okb78-pristiq-cold-turkey-for-14-days . It seems the tablet fragment hit her stomach pretty hard. If you cut or crush a tablet, strongly suggest taking the dose with food to lessen nausea.)

 

Yes, everybody, let the FDA and Wyeth know we have a problem with Pristiq!

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Rhiannon

If anyone decides to try the crushing and then taking multiple doses of the powder method, here's a couple of thoughts:

 

When you crush the powder and manipulate it in various ways, you are going to lose some of it in the process, no matter how careful you are. So merely crushing it is going to be a cut of some indefinite amount. So if you're going to try this, don't actually remove any of the powder at first; just start by crushing, saving the powder, and then taking even amounts of it every eight hours or so. (Eight hours is just a guess. You may find you need to dose more or less often than this.) Anyway, the point here is, merely crushing and manipulating the powder is going to be a cut, so don't remove any of it at first.

 

Since we don't have a large group of people who've done this and accumulated a large body of experience, anyone who tries this method is totally a pioneer blazing a trail. If you try it, please be very careful. Keep a daily journal of what time you took your doses and how you felt afterwards and throughout the day. Pay close attention to your symptoms. Stop immediately if you experience any extreme reaction. If you have a supportive and sympathetic and psych-drug-wise doctor, keep him or her in the loop. If you don't have one, work on finding one (although goddess knows they can be hard to find--not the supportive part, but the having a clue about psych drugs part).

 

You'll be on your own as far as figuring out all the details, too. Another reason not to start with trying to cut--start with just figuring out how to crush and save and divide while losing the least amount of the drug possible, and with seeing how the multiple doses affect you.

 

Okay, just some thoughts. Please keep in mind that I have never done this nor worked with anyone who has, so these are just ideas, hypothetical, and you'll need to be very careful if you try it. If you do, please let us know.

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Kepgirl

Thank you so much for having this forum topic! I have been on 50mg of Pristiq for about 4 years now and I really want to be done with meds (been on one anti-depressant or another since I was 13...am 26 now). I have started cutting my Pristiq in half and so far it's been a bit rough (only started the half doses about 3 days ago). Insomnia, vivid dreams, a general unwell feeling (light headed, slight nausea, fatigue). I am currently in between doctors as I am about to move from DC to NYC for grad school (any recommendations for NYC doctors with experience in Pristiq would be greatly appreciated), so "being under a doctor's supervision" isn't applicable for me right now. I REALLY want to get off of meds for good, as I've been completely stable and happy for the past several years, but I'm nervous about tapering off (if a solution can be found for Pristiq) while starting grad school.

 

I guess I'm just posting for any advice or words of support people might have. I've read the whole forum thread, and logically it sounds like grinding up the Pristiq and taking small amounts of the powder during the day would cause the least amount of w/d symptoms. I'm nervous because I've been on Pristiq for so many years. I can't see any way of not getting horrible sick.

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Barbarannamated

Kepgirl,

 

Welcome to the group. You have alot going on with a relocation and starting grad school. Congrats on a great accomplishment!

 

I tapered off of Pristiq when I was feeling pretty good. I wasnt prepared for the havoc it created and didnt have proper support system in place. I thought I tapered carefully over approximately 8 months, but went into a tailspin. I didnt have any major responsibilities or stressors and cant imagine how I would have handled those.

 

Others will offer input, but my first thought was that you might want to consider waiting until after you're settled in NYC and grad school before adding this tremendous stress to yourself. You are young and will likely do fine with a good, slow taper, but it can be incredibly difficult. Several people have had to defer from grad school and take medical leaves from jwork while going through this process. I understand and fully support your desire to be off of meds. Encourage you to wait a little while so that you dont disrupt your career.

 

PS. I'm jealous - LOVE NYC! I almost did grad work at NYU.

 

B

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Rhiannon

I have to agree that 50% is probably going to be rough.

 

In my experience there are a number of things that are risk factors for having more trouble getting off these drugs, and you have two of them: a long history of many years on the meds, and being on them when you were young during the years when your brain was still developing.

 

Your brain is going to need to basically remodel itself as you slowly come off the drugs. It can definitely do this, but it's not a quick and easy process.

 

I like to use the analogy of a plant on a trellis. The chemistry caused by the drug is the trellis. Your brain has grown and formed itself around this trellis. If you yank out the trellis, it's going to be hard for your brain to adapt, and you may cause some damage that will have to be fixed.

 

If you just take it out a little bit at a time, though, your brain can gradually grow its own new supports around its own natural chemistry. Eventually your chemistry will normalize.

 

This appears to be a slightly more challenging process for brains that never actually achieved their normal adult chemistry to begin with. (Actually at 23 your brain is still not completely finished maturing.)

 

So please consider doing a slow, careful taper. It can take a long time, but in the long run it will be SO worth it. You have the rest of your life ahead; it's worth investing some time now to give yourself a chance at a wonderful future.

 

It will be a great journey as you discover who you actually are, free of these mind-and-emotion-warping drugs. So consider taking a nice slow healing time and allowing yourself to grow your new, natural brain.

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peggy

I thought i would start a new topic rather than put it the pristiq tapering thread.

 

What do people think about this? Maybe it's swapping th w**** for the b**** ...but here are my reasons:

1. pristiq is a metabolite of effexor..

2. pristiq is hard to crush up and reduce down, where as with effexor you can count out the beads.

 

I tried pristiq a few years ago but i found it really stimulating and gave me too much anxiety, i am really glad i didn't stick with it - whilst i am having trouble getting off effexor, i do think it is more manageable

What do other people think?

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Sparrow

If your goal is to get off Effexor, I can see no benefit to switching to Pristiq. As Alto said in the main Pristiq thread, it's simply jumping from one frying pan into another.

 

Are you taking regular or extended-release Effexor?

 

Sparrow

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peggy

sorry, sparrow, you misunderstood... I am not wanting to switch to pristiq, i was just wondering what others thought about switching to effexor to get off pristiq.

 

I have been reading the posts about people having trouble getting off pristiq and i wanted to offer what i thought might be a viable solution..

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Altostrata

The Tips for Tapering Pristiq thread mentions switching to Effexor as a theoretical possibility, but I haven't heard of anyone's experience doing this.

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alexjuice

I thought i would start a new topic rather than put it the pristiq tapering thread.

 

What do people think about this? Maybe it's swapping th w**** for the b**** ...but here are my reasons:

1. pristiq is a metabolite of effexor..

2. pristiq is hard to crush up and reduce down, where as with effexor you can count out the beads.

 

I tried pristiq a few years ago but i found it really stimulating and gave me too much anxiety, i am really glad i didn't stick with it - whilst i am having trouble getting off effexor, i do think it is more manageable

What do other people think?

 

I went the other way. Switched from Effexor to Pristiq because my doc thought it'd be easier to taper.

 

The cross was aborted after I entered a doublequote manic doubleunquote state and flipped out at work. Also, had the worst hypersensitivity of my entire ordeal. One sip of coffee = migrainelike headache.

 

Maybe a gradual cross wouldve lessened the A->B discomfort. Returning B->A after abort, just brought some relief.

 

Thats backwards of your ask, but still I share.

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Brandy

I went the other way. Switched from Effexor to Pristiq because my doc thought it'd be easier to taper.

 

If ever there was proof one shouldn't follow a doctor's advice about tapering psychotropic meds, this is it in one sentence.

 

(I would love to hear your doctor try to give his reasoning for that one.)

 

*big sigh*

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alexjuice

As a matter of fact I recall his reasoning, "Effexor can be tough to get off. This is essentially Effexor, reformulated to address the discontinuation problem."

 

Yep, this is my expert...

 

Maybe Pfizer send him a really vibrant brochure, delivered by a really blonde rep?? I dunno. But he was gung ho on Pristiq for a month back in late 2009.

 

EDIT: in fairness to the facts, this doctor didn't put me on Effexor, not sure if he prescribes it even. He tried me on every AD but never Effexor. I started on Effexor in an inpatient clinic. Now, facts disclosed, my ex-doc is/was intellectually arrogant despite being monstrously wrong-headed, continually.

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Altostrata

God, what an idiot.

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Barbarannamated

As a matter of fact I recall his reasoning, "Effexor can be tough to get off. This is essentially Effexor, reformulated to address the discontinuation problem."

 

Yep, this is my expert...

 

OMG. I'm trying to think of any reason someone might think this is plausible...? Because P has the time-release coating and longer halflife so is Pfizer version of Prozac ...? Crazy.

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snuffy

Thinking about trying the crush and method, then slowly reduce method.

Any new success stories?

Finding a Doctor that really knows about this issue seems to be a big problem as mine also suggested the alternate days which is clearly the wrong approach. I'm checking with them again today to see if they have any new guidance as well.

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Altostrata

Hi, snuffy.

 

I've tried to summarize all the possibilities. Plus, I've corresponded with the FDA and with academic pharmacist PhDs. There's nothing new to add.

 

Yes, we have people who cut up Pristiq to taper. Be aware, though, that having it hit your system all at once might feel very strange (and hard on your stomach) and consider taking divided doses of the powder -- half in the morning and half in the evening.

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Altostrata

I just got off the phone raking some hapless person at the FDA over the coals for a lack of dosage range in Pristiq that enables tapering. Although Pristiq was approved by the FDA in 2008, the FDA is still in “discussion” with Pfizer about providing other dosages. The situation has to be “studied.”

 

The complaints about Pristiq withdrawal in the FDA's Adverse Events Reporting System have to reach some level of critical mass before the FDA takes action. Here are the current statistics, derived from FDA AERS Reports from 01/01/2004 to 03/31/2012 at AdverseEvents.com:

 

Effexor: 580 reports of withdrawal syndrome http://adverseevents.com/drugdetail.php?AEDrugID=2322&BrandName=EFFEXOR

Effexor XR: 1,437 reports of withdrawal syndrome http://adverseevents.com/drugdetail.php?AEDrugID=5487&BrandName=EFFEXOR+XR

Pristiq: 665 reports of withdrawal syndrome http://adverseevents.com/drugdetail.php?AEDrugID=10&BrandName=PRISTIQ

 

(Pristiq was released in only 2008; the rate of AERs is roughly equivalent to that of Effexor XR.)

 

Given the utter ineffectuality of the FDA AERS system, we can assume these reports are by no means the entirety of incidence. Larry at the FDA is going to send my inquiry to some other department or departments handling the Pfizer negotiations. He and I agreed to talk again in a week or so.

Edited by Altostrata
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Rhiannon

Thinking about trying the crush and method, then slowly reduce method.

Any new success stories?

Finding a Doctor that really knows about this issue seems to be a big problem as mine also suggested the alternate days which is clearly the wrong approach. I'm checking with them again today to see if they have any new guidance as well.

 

If you do try the crush and take multiple doses method, please post here and let me know how that works for you. Pay close attention to your symptoms and keep a written journal of how much you took and when, and rank your symptoms daily on a numerical scale. And journal what you feel, symptoms, etc. That will help you keep yourself on track and pace your withdrawal. (I speak from much experience, most of it screwing up and then picking myself up off the floor. You can't rely on your subjective judgment in withdrawal. A daily written record is much better.)

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Altostrata

Dr. Mickey, who writes the 1boringoldman.com blog, reports success (in the comments) with switching from Pristiq to Effexor and tapering from there.

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Lilu

Regular Effexor (not extended-release) is taken twice a day. Effectively, Pristiq is concentrated Effexor. When you remove the extended-release shell from Pristiq, it becomes a concentrated regular Effexor.

 

Conceivably -- and I'm just guessing here -- one might be able to take a fractional dose of crushed Pristiq twice a day. For example, if you want to take 45mg, take 25mg in the morning and 20mg in the afternoon.

 

I briefly spoke to my compounding pharmacy and they said they could compound Pristiq into capsules with a slow-release additive that would distribute absorption over 8-10 hours. (Perhaps this is what moses's pharmacy is doing.) They will research a long-acting slow-release additive and get back to me with information next week.

Hi everyone,

I didn't realize there were replies to my original post, as I didn't subscribe to receive them! Either way I'm back to report on my latest research. I want to comment on your statement about Pristiq being concentrated Effexor. According to this article: http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2464

, about 55% of Effexor metabolizes into Pristiq and it's metabolites.

 

 

So I suppose that you would think that about 100mg of straight Effexor would equal 50mg of Pristiq, right?

 

Except that Desvenlafaxine tablets contain 76 mg or 152 mg of desvenlafaxine in a matrix formulation that is designed to gradually release the equivalent of 50 mg or 100 mg of desvenlafaxine, respectively.

 

So a 50 mg tablet of Pristiq is really equivalent to 150 mg of Effexor. About 55% of Effexor will be converted into Pristiq, but the other 45% will be converted to other metabolites that could potentially cause other side effects.

 

Having tapered Effexor in the past, I can say from personal experience that the worst discontinuation side effects came AFTER I was done tapering. I had the same side effect when I went off of Prozac, although I did not taper it.

Edited by Altostrata
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Altostrata

Thanks, oaklily!

 

According FDA Prescribing Information for venlafaxine (Effexor), the usual dose of Effexor is 150mg per day.

 

That confirms the equivalency you found, since the usual dose of Pristiq is 50mg per day.

 

Dr. Mickey of 1boringoldman.com reports converting his one patient from Pristiq to Effexor went fine (see comments).

 

What does "matrix" mean? Is this bound with the coating on the Pristiq tablet?

 

Yes, withdrawal symptoms occur not only while you're tapering but after, if you taper too fast and your nervous system didn't have time to catch up.

Edited by Altostrata
updated

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Lilu

Thanks, oaklily!

 

According FDA Prescribing Information for venlafaxine (Effexor), the usual dose of Effexor is 150mg per day.

 

That confirms the equivalency you found, since the usual dose of Pristiq is 50mg per day.

 

Dr. Mickey of 1boringoldman.com reports converting his one patient from Pristiq to Effexor was "seamless" (see comments).

 

What does "matrix" mean? Is this bound with the coating on the Pristiq tablet?

 

Yes, withdrawal symptoms occur not only while you're tapering but after, if you taper too fast and your nervous system didn't have time to catch up.

 

From Dictionary.com, one of the definitions of MATRIX is a ground substance or material, as cement, in which lumps of coarser material, as of an aggregate, are embedded.

The quote I posted was from the link that was included. But having read the defintion of matrix, I would think that the coating is not part of this matrix that has the time release properties. The coating or outer shell of pristiq (desvenlafaxine) is probably designed to withstand the acidity of the stomach, and to dissolve in the small intestine or by the time it reaches the small intestine where it starts releasing the drug as it travels through the intestines. This is how it is described in the pharmacological literature or at least how I understood it.

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Barbarannamated

When I was on Effexor XR and ran out (Work Comp insurance runaround with authorization), my doc advised to fill in with regular Effexor tablets that I had remaining. I went into withdrawal within 1 day - zaps, dizziness, etc.

 

I've never understood the pharmacology - why immediate release Effexor did not cover for Effexor XR - but thought I'd put my experience here just just for the record. It was my introduction to withdrawal many years ago.

 

Oddly, when I tapered off of Pristiq, I had none of the same withdrawal symptoms so thought I had escaped and proceeded with a very sloppy taper over ~8 months. I did have anxiety, early morning awakenings, and perceptual symptoms that I attributed to real life.

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Altostrata

There's a new addition to the Tips for tapering off Pristiq (desvenlafaxine) topic -- I have a report from a doctor who's done this, and he said it worked very well.

 

Note: If you go from Pristiq (time-released) to regular Effexor (not time-released), you probably will have to take the Effexor twice a day.

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Altostrata

That makes sense to me, and explains why when you tried to dilute Pristiq, it became gluey, but it suggests people can cut up the tablets, since the time-release additive would be distributed throughout each piece of the tablet. (This is true of Wellbutrin SR sustained release tablets.)

 

Is there any way to confirm this is, in fact, the way Pristiq is produced? Do I have any volunteers who would contact the manufacturer and keep on them until you get an answer?

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Lilu

That makes sense to me, and explains why when you tried to dilute Pristiq, it became gluey, but it suggests people can cut up the tablets, since the time-release additive would be distributed throughout each piece of the tablet. (This is true of Wellbutrin SR sustained release tablets.)

 

Is there any way to confirm this is, in fact, the way Pristiq is produced? Do I have any volunteers who would contact the manufacturer and keep on them until you get an answer?

 

You don't need to contact the manufacturer, which is now Pfizer to get this information, it is readily available. I will find the text where I read this information about how Pristiq is broken down in the body.

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Lilu

That makes sense to me, and explains why when you tried to dilute Pristiq, it became gluey, but it suggests people can cut up the tablets, since the time-release additive would be distributed throughout each piece of the tablet. (This is true of Wellbutrin SR sustained release tablets.)

 

Is there any way to confirm this is, in fact, the way Pristiq is produced? Do I have any volunteers who would contact the manufacturer and keep on them until you get an answer?

 

Actually, I've tried cutting the Pristiq tablets and even with a pill-cutter, they do not cut evenly, no matter how many times I tried or how carefully.

 

Ok, I believe I have found the answers that we have been seeking:

 

Not only did I find out what the coating is made of, but that the reason my experiment to dissolve the crushed powder from inside the tablet failed - is because the water has to be of a certain pH! Also, the coating is NOT an active ingredient!

 

http://www.rxlist.com/pristiq-drug.htm

 

Desvenlafaxine succinate is a white to off-white powder that is soluble in water. The solubility of desvenlafaxine succinate is pH dependent. Its octanol:aqueous system (at pH 7.0) partition coefficient is 0.21. (anybody know what this means?)

 

Each tablet contains 76 or 152 mg of desvenlafaxine succinate equivalent to 50 or 100 mg of desvenlafaxine, respectively. Inactive ingredients for the 50 mg tablet consist of hypromellose, microcrystalline cellulose, talc, magnesium stearate and film coating, which consists of polyvinyl alcohol, polyethylene glycol, talc, titanium dioxide, and iron oxides.

 

2. This link describes in more layman's terms that

 

The extended-release tablet does not dissolve in the stomach after swallowing. It slowly releases the medicine as it passes through your digestive system. You may notice the tablet coating in the stool. This is normal and does not mean that you did not receive the complete dose of medication.

 

http://www.nlm.nih.g...her-information

and

http://dailymed.nlm....fo.cfm?id=62532

 

Patients receiving PRISTIQ may notice an inert matrix tablet passing in the stool or via colostomy. Patients should be informed that the active medication has already been absorbed by the time the patient sees the inert matrix tablet.

 

In Conclusion, we now know:

 

1. The coating of the Pristiq tablet is NOT part of the extended release mechanism. In fact it often does not dissolve at all, after it breaks apart in your digestive tract. This means:

a. You can consume the powder w/out the coating, dividing it into smaller doses in order to taper.

b. A compounding pharmacy should be able to compound pristiq powder into smaller doses.(although they would have to sift out the coating, and may not be willing or able to do so.) But they do not need to add an extended release substance into the mix, as it is already in there.

 

2. You can crush the pristiq tablet, sift out the coating, mix w/water at 7.0 pH (to adjust the pH of water, watch this youtube video, apparently all you need is a pH kit from a garden nursery. But perhaps pharmacies sell them as well. )

I would be very curious to see if it really dissolves and not turns into a gel, like it did in regular water. Then, once in liquid form, you can create your own tapering schedule.

 

 

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