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Tips for tapering off Pristiq (desvenlafaxine)

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Just a note, plain distilled water should be pH 7.0 already. That's the standard, pH 7.0 is neutral pH. You may want to check it the first time however depending on the source of your water. But any plain water you get, really, should be very close to pH 7.0. I wouldn't worry much about the pH unless something has been added to the water.

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i hope people who are having trouble with pristiq consider this - effexor is certainly no 'walk in the park', but at least with the beads you can go down really slowly. It is much easier to change to a much closer (chemically) drug, than changing over to prozac and risking it not working

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Thinking about the withdrawal I experienced when I missed just one dose of Effexor (zaps, dizziness, classic acute w/d) in contrast to complete lack of acute w/d symptoms when tapering Pristiq, I am curious as to WHY..? I was on the same cocktail (Klonopin and trazodone qhs). The only difference was being on stimulant during Pristiq taper. Did that somehow cushion the Pristiq taper?

 

I'm tossing this in only as anecdotal info. In no way suggesting it be used or initiated! The drop from it has been terrible. Linear and *understandable*, but brutal.

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Just a note, plain distilled water should be pH 7.0 already. That's the standard, pH 7.0 is neutral pH. You may want to check it the first time however depending on the source of your water. But any plain water you get, really, should be very close to pH 7.0. I wouldn't worry much about the pH unless something has been added to the water.

 

Yes, I read that distilled water is supposed to be at 7.0 pH but that it rarely is. And I wouldn't think that my water is at 7.0 pH because the drug would not disolve even a little bit in it.

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I found a Compounding Pharmacy in my area that pretty much does anything with any medication, including Pristiq. Their only requirement was that by law, they can only alter the medication with a doctor's prescription and tapering schedule. They cannot take medication that you already have, since federal law does not allow this. Although this pharmacy is in New Jersey, any prescription and instructions can be called in, faxed in, or sent electronically. Most insurance should cover the cost of compounding. Otherwise, it is about $150 for either capsules or liquid.

http://www.thewellne...60/Default.aspx

 

Well, this is a relief, I've been wrecking my brain as to how to taper this damn medication! What caused me to call yet another compounding pharmacy was that I crushed a Pristiq tablet myself, including the hard outter shell, with the back of a knife. I had the brilliant idea of taking the crushed pristiq powder and dividing it myself, and putting it into empty capsules! This can be done, but it is very time consuming. When speaking to the compounding pharmacist, he confirmed that they can easily pulverize the tablet coating and create capsules of any strength without any problems. A liquid solution is also an option. Wow! I guess I won't have to buy those pH strips after all! A liquid Pristiq solution seems like the best option if you want to taper very slowly.

 

I had no idea that compounding pharmacies even exist or that they can:

  • Create tasty flavors for children
  • Combine several medications into a single dose to increase compliance
  • Turn prescription medications into capsules, liquid suspensions, suppositories, lozenges, creams, ointments, lotions, gels, lollipops, popsicles, gummy gels, lip balms, nasal sprays or fizzy drinks.
  • Even prepare formulations for your pet!
Now all I have to do is get my doctor on board! It's unbelievable that not a single doctor has mentioned this to me. And the pharmacist said that they have never done this with Pristiq, but he assured me that it would be no problem to create a solution or lollipops or ice cream for that matter!

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Probably the configuration of your nervous system had changed, Barb, from all the other drug experiences.

 

What do you mean by "acute" withdrawal symptoms from Effexor?

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Brilliant, oaklily!

 

Can the matrix formulation withstand crushing?

 

See http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2464

 

Can the desvenlafaxine tablet be cut or crushed?

 

Desvenlafaxine is an ER formulation for once-daily administration that is designed to release desvenlafaxine over the course of the dosing interval.3 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.3 To maintain the integrity of the ER formulation and prevent “dose dumping” (ie, rapid release of drug from an ER formulation), desvenlafaxine tablets should not be divided, crushed, chewed, or dissolved.3

 

3. Pristiq [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals Inc; 2008.

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Brilliant, oaklily!

 

Can the matrix formulation withstand crushing?

 

See http://www.primaryps...?articleid=2464

 

Can the desvenlafaxine tablet be cut or crushed?

 

Desvenlafaxine is an ER formulation for once-daily administration that is designed to release desvenlafaxine over the course of the dosing interval.3 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.3 To maintain the integrity of the ER formulation and prevent “dose dumping” (ie, rapid release of drug from an ER formulation), desvenlafaxine tablets should not be divided, crushed, chewed, or dissolved.3

 

3. Pristiq [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals Inc; 2008.

There is nothing in this paragraph that indicates that the matrix is interwoven with the coating. As I posted before, various sources indicate that the tablet coating is not an active ingredient. Granted I do not fully understand how the matrix works, but I don't believe all the information from the manufacturer is correct. Especially since they advise to alternate days as a way of tapering! Personally, I do not experience any side effects when I ingest a cut pristiq tablet.

 

I believe this is all a design to keep people hooked on the drug. No responsible pharmaceutical company, would not manufacture lower doses of a drug to give people a way to taper their medication safely! Wyeth originally did this with Effexor by providing tablets of 25 mg in incremental doses up to 100 mg. But it is pretty obvious that when Effexor's patent was due to expire, they came up with Pristiq!

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What do you mean by "acute" withdrawal symptoms from Effexor?

 

By "acute", I was referring t the brain zaps, dizziness, lightheadedness that I had within 24 hours of missing a dose of Effexor. I experienced none of that when tapering Pristiq, even when dropping from 100 to 50 to 25 to 0. I know I completely missed doses on some days, too. I had the anxiety, morning cortisol awakenings/panic, some insomnia, but it was manageable. It was months after the sloppy taper that protracted withdrawal hit. HARD.

 

I was *on alert* for the zaps and when I never experience that, I let my guard down, thinking I had escaped withdrawal. I took my last dose around May 2011 and then found you through Gianna's Beyond Meds in July 201. That was the AHA moment when I finally had any idea what had been going on.

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Right, people don't always get symptoms immediately, and earlier experiences of quitting are no predictor of future experiences.

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Right, oaklily, extended-release is baked into the matrix formulation.

 

BUT, as I read it, it seems the matrix itself might be damaged by crushing, causing "dosage dumping."

 

The matrix might not be at the molecular level.

 

Or, this could be because the coating protects the medication from stomach acid, for gradual absorption, via the matrix disintegrating more slowly, further down in the digestive track. If it gets released in the stomach, the matrix disintegrates faster, causing dumping.

 

If the matrix survives crushing, perhaps an enteric encapsulation at the compounding pharmacy can help.

 

(I found Wellbutrin SR, another matrix formulation is also subject to "dosage dumping" http://www.uspharmacist.com/content/d/pharmacy%20law/c/22033/

 

Wellbutrin SR, a sustained-release (SR) formulation that utilized a matrix release mechanism allowing the drug to be metabolized in the upper gastrointestinal (GI) tract. With the SR formulation, peak blood concentrations were reached 3 hours after oral ingestion. However, it was disclosed in the labeling that the drug was subject to the “dose dumping” phenomenon of being absorbed faster when it was taken with food. This was not considered to be a clinically significant event. The normal dose of the SR formulation was two 150-mg doses daily.

 

Personally, I cut up Wellbutrin SR tablets and suffered no ill effects that I could tell, but the dosage I was taking was lower and Wellbutrin is weaker than Pristiq.)

 

I wrote Lawrence J. Cohen, PharmD, BCPP, FASHP, FCCP at Washington State University College of Pharmacy (see http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2464 ) yesterday about this. He may or may not respond. You might give him a call at 509-358-7739.

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Just a note, plain distilled water should be pH 7.0 already. That's the standard, pH 7.0 is neutral pH. You may want to check it the first time however depending on the source of your water. But any plain water you get, really, should be very close to pH 7.0. I wouldn't worry much about the pH unless something has been added to the water.

 

Yes, I read that distilled water is supposed to be at 7.0 pH but that it rarely is. And I wouldn't think that my water is at 7.0 pH because the drug would not disolve even a little bit in it.

 

Probably what would not dissolve was the actual binders and fillers of the pill itself. If a drug is readily water soluble they have to put it in a carrier that's very water resistant.

 

Most of what you see when you look at a pill isn't the drug at all. Usually the drug itself is in way too small an amount to see easily. Depends on the med, but even a gram is a pretty small amount, and a milligram is one thousandth of a gram, a pretty small dot.

 

Distilled water, or any plain water, is never going to be very far off from pH 7.0. You have too put something in it to change the pH.

 

I don't know how relevant any of this is but I'm a chemistry nerd, what can I say...

 

Except the part about, when cutting or crushing or dissolving any pills or tablets: What you're cutting, crushing and dissolving is the carrier, the matrix, the fillers/binders et cetera. And what you can see with your eyeballs is usually small particles of those things.

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In further communication with the compounding pharmacist about tapering Pristiq, I mentioned to him that Pristiq is an extended release drug, and asked if that would interfere with the total doses if he were to turn Pristiq into a liquid suspension. He said that it would depend on the TYPE of extended release matrix. Also I mentioned that the drug literature says that a 50 mg tablet of Pristiq actually has 76 mgs. He said that would be very expensive to test and that he cannot go by that figure, but by what the tablet is designated as, which is 50 mg.

 

This made me realize that my conclusion earlier that 50 mg of Pristiq is equivalent 150 mg of Effexor is wrong. Because the 50 mg tablet, even though it might actually have 76 mg, it is still releasing 50 mg of Pristiq continuously into your system. So really a 50 mg Pristiq tablet is equivalent to 100 mg of Effexor.

 

The Pharmacist (who has worked in various Pharmaceutical companies here in New Jersey - the pharmaceutical capital of the world, lol), has assured me that the best and simplest and cheapest way to get off of Pristiq, is to switch to Effexor tablets.

He said, "your body does not know the difference between Venlafaxine (Effexor) and Desvenlafaxine (Pristiq). "

Personally having switched from Effexor to Pristiq, 3 years ago, I must agree, the transition was seamless.

 

So, instead of paying $200 dollars to turn Pristiq into a liquid, or taking Prozac with Pristiq and waiting for it to kick in, or trying to cut Pristiq tablets, (which never cut evenly), I decided that switching to Effexor tablets is the best way to taper Pristiq. I asked my doctor to prescribe Effexor tablets in 25 mg doses, so that I wont have to cut a 100 mg tablet, and make tapering much easier. She wrote me a prescription for 25 mg tablets of Venlafaxine, to be taken 4 times per day. And I plan on reducing it by 12.5 mg every week. Of course you can create an even slower reduction plan for yourself. Having the 25 mg tablets should be so much easier to work with, since it is scored and you can even cut it into quarters.

 

I'll let you guys know how this works out for me. Also before the process, I plan on "fortifying" my system with Amino Acids, L-Tyrosine and 5HTP. Based on the work of Psychiatrist Marty Hinz, it is important to take both of these at the same time in order for either one to work. His research explains why antidepressants always reach a plateau and actually CAUSE as well as perpetuate depression in the long run. According to him, it is important to supply your body with the raw materials (the Amino Acids), since antidepressants deplete your body of these nutrients at an accelerated rate AND deactivate your existing neuro-receptors. Hence, the plateau!

That is what I learned from his report on depression available here: http://www.neuroassi...ith%20cover.pdf

 

Good luck everyone! Stay informed, and don't ever let a doctor dictate to you against your better judgement!!! Unfortunately, most psychiatrists and main-stream medical professionals that I have come across, DO NOT keep up with the latest research, and will vehemently deny any facts you present to them from the Internet. They will try to save face and protect their Ego at your expense. Just like a psychiatrist I recently saw, who told me that there is no way to taper Pristiq, and that I should just quit cold-turkey! Apparently all her patients were just fine. When I mentioned the Prozac Bridging technique, she said "I never heard of such a thing! Prozac is a completely different drug, and takes 6 weeks to kick in! That is ridiculous!"

This is a psychiatrist at a prestigious University and Medical school - UMDNJ, named Dr.Gutterman. Well Dr.Gutterman, I say, "Shame on you! Shame on you for being so ignorant AND close minded." Since she baulked at the idea of using Pristiq to help me taper, I mentioned using Effexor, but she didn't even want to hear about it. She actually turned her back to me and started doing something on her computer! I could feel how furious she was with me! Dr. GOD's Ego was bruised. Boo hoo. Even my primary care doctor knew of Prozac Bridging. When I told my primary care doctor, (who is the one who has been prescribing my antidepressants), that a psychiarist told me to quit Pristiq cold-turkey, she was shocked. "NO, no, no!" she said, "you have to taper very slowly!"

So, there you go.

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Excellent plan, oaklily. And thanks for your very helpful contributions to this thorny topic!

 

I believe in our discussion we've come further than anyone else in figuring out how to get off Pristiq.

 

Please do continue to let us know how you're doing. If you have a chance, please open an Intro and updates topic here http://survivingantidepressants.org/index.php?/forum/3-introductions-and-updates/

 

By the way, if necessary you can make a DIY liquid from regular Effexor, if you find you need to make smaller, more carefully measured cuts.

 

Why are you planning to take Effexor 4 times a day?

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Excellent plan, oaklily. And thanks for your very helpful contributions to this thorny topic!

 

I believe in our discussion we've come further than anyone else in figuring out how to get off Pristiq.

 

Please do continue to let us know how you're doing. If you have a chance, please open an Intro and updates topic here http://survivinganti...ns-and-updates/

 

By the way, if necessary you can make a DIY liquid from regular Effexor, if you find you need to make smaller, more carefully measured cuts.

 

Why are you planning to take Effexor 4 times a day?

 

Actually the 4x/day prescription was necessary in order to get 100 mg but in 25 mg tablets. I don't have to take it 4 times a day, but only 2 times 50mg in the morning and 50mg at night, since Effexor tablets do not have extended release properties. The 25 mg tablets will make it easier to taper and require less cutting. My physician didn't even know that Effexor tabs came in 25 mgs. But they do.

 

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I too have found it difficult to taper off of pristiq. For 20 years I've managed getting on and off wellbutrin and prozac with little to no problems. I've been on pristiq for several years now and I began noticing vertigo and the brain zaps when I would forget to take it. This website was instrumental in confirming my withdrawal problems and providing me with the necessary info to taper off. I am currently weaning from Pristiq by bridging prozac 20 mg (2 days now). And I have successfully been taking 25mg (cutting them in half) for 5 days now!! Yeh... TIP to cut the pristiq (which I know is not advised): Use a serrated knife, drill through the coating (make your own score mark) then hit the top of the blade to splice the tablet. I've found that it is much more even and I've had no side effects thus far taking this dosage . (I did contact a compound pharmacist who will alter the tabs into 25mg capsules if I get my doctor to prescribe a compounded 25 mg. capsule of pristiq.) However, I was suprised that due to the legalities, the pharmacist can not even cut my current tablets in half with his pill cutter!! So, in leiu of wasting a new bottle of pristiq ($130), I'm cutting them myself. Good luck to everyone on getting off of these. I'll check back in a few days/week to update on my progress of weaning. Oh, and upon telling my family doctor I wanted to get off off pristiq, she replied, "with pristiq, you can just quit taking them"!!! Wrong!! Luckily, I had researched the info before I went to her so I knew better. It's too bad Wyeth wasn't diligent in thinking through this antidepressant and the weaning process.

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I have read this entire thread and feel so educated now. Thank you everyone for all of your time in calling, writing and researching!

I have been taking 1/2 of a 50mg pristiq daily for nearly 2 years. I want to wean off. After reading everything my question is, should I ask for Effexor to bridge or should I taper the pristiq myself? I am figuring I already take the cut tablets so prob not much harm in beginning to take the smaller portions of the pills-since they never cut regularly-and then shaving those a bit smaller and smaller each week. What advice can you offer being that I didn't find anyone who took the cut tablet long term as I have?

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Good question, nonethewiser.

 

We can assume your stomach and system have accommodated to the unbuffered Pristiq.

 

The problem is measuring your dosage, particularly since you're starting with a half a tablet. Using a nailfile to take off shavings is very inaccurate, but I guess you could start with that. Make sure you keep track of how many swipes you make each day.

 

Go slow, don't rush, figure on reducing week by week.

 

If you get withdrawal symptoms, I would stop reducing. We'll have to figure out a different way to reduce it more precisely, maybe switching to Effexor and making a liquid.

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Hi all ,This is my first post but I have been following this topic to get more info on breaking Pristiq for tapering. From what I gather the coating of the tab is an enteric coating to stop the drug being absorbed in the stomach, allowing it to pass into the intestines for absorption. The time release mechanism is "baked" into the contents of the tab. So.... perhaps break the pill into quarters , coat with confectioners glaze (alcohol and shellac used as an enteric coating on medicines) take 1/4 3x daily, then 1/4 twice daily , then 1/4 daily then stop or perhaps 1/4 every 2 days for a while.wait until stable between reductions.

Multiple small doses over 24hrs(1/4 of tab)should help keep blood levels fairly steady given the short half life of pristiq. Use a benzo as required (sparingly) to control anxiety related to withdrawal.

 

 

I'll be trying this method after Christmas and post my progress, any thoughts would be appreciated.

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Hello, mr2e.

 

As I understand it, the matrix formulation is damaged when the tablet is cut up, so you can't count on it continuing to gradually release.

 

Desvenlafaxine is the active metabolite of Effexor (venlafaxine), which comes in an immediate-release form to be taken twice a day. The desvenlafaxine from regular Effexor is responsible for most of Effexor's so-called antidepressant effect.

 

The venlafaxine goes into your stomach, where it is absorbed and passed along to be metabolized by the liver, etc., which produces the desvenlafaxine.

 

When you take a divided Pristiq tablet, you're imitating the effect of immediate-release Effexor desvenlafaxine, with the same short half-life, requiring it to be taken twice a day.

 

If you can tolerate this, it's not necessary to put an enteric coating on a Pristiq fragment. Just take half a dose at a time, twice a day.

 

I have a report from a doctor that conversion from Pristiq to regular Effexor for tapering works very well. Additional advantages are regular Effexor comes in cheap generic forms and can be made into a liquid.

 

oaklily found you cannot make Pristiq into a liquid, it clumps up from the matrix additives.

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why switch to effexor, break the pristiq into 1/4 and take "immediate release" desvenlafaxine in divided doses. If your stomach doesn't like it simply coat it with shellac so that it absorbs in the intestine. Switching to effexor is not always seamless and effexor has more of a reputation for side effects (known as sideffexor to some users) as well as having more active metabolites other than Desvenlafaxine. The Phsyc I see say's he has had many patients break Pristiq and successfully stop although he does agree that it is the worst antidepressant to stop and the makers should manufacture smaller doses. Where would be the profit in that !!!

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Coat it with shellac??? I don't think so -- not the furniture finish shellac.

 

Some people will be able to tolerate breaking up the Pristiq tablets, and some may require a more precise and gradual method of tapering. You don't know until you get hit by severe withdrawal symptoms, which are not trivial and may not go away upon reinstatement of the full dose. It's a lot safer to go very gradually at first and see what your tolerance is.

 

If you are one of the lucky people who can taper faster, you can speed up. But if you are one of the unlucky people who need slow tapering, you will be protecting your nervous system by starting slow.

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Furniture polish ???

Food grade Shellac is used on many medications as an enteric coating to prevent the drug dissolving in the acidic stomach, allowing it to pass through and be absorbed in the intestine. It is dissolved in alocohol and called confectioners glaze where it is used to make all your lollies nice and shiny.

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Thank you for the tip, mr2e.

 

About the pharmaceutical type of shellac, pharmaceutical glaze aka confectioner's glaze, also called resinous glaze, pure food glaze, and natural glaze http://en.wikipedia.org/wiki/Pharmaceutical_glaze

 

(To my surprise, it has the same source as furniture shellac -- insects.)

A competitive non-animal-based product is zein, a corn protein.

Confectioner's glaze can be purchased from baking supply firms, Amazon, Ebay, etc. for about $8 US for 8oz.

 

I don't see any sources for zein.

 

mr2e, have you had any success coating fragments of a drug with pharmaceutical glaze?

 

Please allow me to point out that, even if you do this, it's going to be hard to control a very gradual taper. You'll have to cut up tablets, weigh them, adjust the weight, and then coat the fragment with the glaze.

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Hi everyone! I actually wanted to post here because I went through an intensely terrible time when I first tried tapering off pristiq, and I found a solution that worked for me and has taken care of ALL withdrawal symptoms, and the best part is I won't have to taper off the medicine that helps me, and I experience no side effects with it. Maybe it will help someone else.

 

Heres my story: My job is answering a phone all day, so when my Dr. told me to taper my pristiq, I was concerned, and rightfully so. He had me cut my dose (50 mg) by 1/4.

 

By day two I was basically non functioning. Slurring, stumbling, tremors, severe brain zaps, nightmares...you name it, I experienced it. Mind you, this was the first time I had seen this psychiatrist, and my pristiq was prescribed by my general doctor, and I had never been to a psychiatrist before. I've since found a new doctor, because I personally think the psychiatrist was one who just likes to throw pills at you, but I won't get into that.

 

After basically having a meltdown, the doctor called me and said to resume my full dose for three days, and then cut it by even less, and that he would probably give me Prozac.

 

Well, I am a little paranoid about taking medicine now, because the pristiq was so rough, so I did my own research. After countless forums and Wikipedia articles, I decided to try something.

 

I have severe RLS, and taking Motrin for it isn't a good option for me because I had gastric bypass a few years ago. My general dr had been prescribing me 50 mg of tramadol as needed for the pain, but I hadn't taken it in a long time because I didn't want to combine it with pristiq.

 

However, I had viewed an article mentioning tramadol as something used to help the withdrawals, and I figured I'd give it a shot. I personally had never had a problem stopping tramadol, and never had a side effect, which was my worry with prozac.

 

I stopped the pristiq completely, and started taking 50mg of tramadol when I woke up, and 50mg around three or four pm, when the withdrawal symptoms, mainly brain zaps, came back. That was enough to get me through to nighttime, when I would just take melatonin to sleep.

 

As long as I take tramadol, I have NO withdrawal symptoms. Not a single one. I explained this to my dr, who despite his hesitation to prescribe a pain medicine, said that he could see how it would work medically (because of how tramadol affects serotonin levels), and he prescribed me more of it.

 

I can go longer now between the doses of tramadol, and it's still holding strong after almost two weeks. By the time I'm over it completely, and can stop taking tramadol, I'll be seeing my new doctor, who is much more familiar with this kind of thing.

 

So all in all, I can't say how this would work for everyone, but it was a god send for me, and I feel great knowing I didn't have to go on Prozac, which I'd have to wean off of as well. I feel normal with the tramadol. I sincerely hope this helps someone out there; talk to your doctor. I unfortunately had to do all the research myself for my doctor, because he didn't care, but maybe this way someone won't have to.

Edited by Altostrata
added paragraph breaks for readibility

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Welcome, Cb. I made your post into its own topic.

 

I am glad your switch to tramadol is working for you. It is in fact an SNRI, like Pristiq, as well as a painkiller. See this journal article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714818/

 

You have, in effect, substituted an SNRI for Pristiq. If you had substituted Effexor, you probably would have had the same results.

 

You are, in effect, tapering off tramadol by extending the intervals between doses. I hope your exit off tramadol is as trouble-free for you as it has been in the past.

 

(What we've seen is that prior ease in withdrawal is no guarantee of the same in the future.)

 

Tramadol has its own risks, including lots of side effects, drug-drug interactions, and withdrawal symptoms. One prominent danger of tramadol is that if it is taken with an antidepressant, it may cause serotonin syndrome.

 

It can also be addictive; see offical FDA prescribing information at http://www.drugs.com/pro/tramadol-tablets.html

 

Withdrawal

 

Withdrawal symptoms may occur if tramadol is discontinued abruptly (see also DRUG ABUSE AND DEPENDENCE). Reported symptoms have included anxiety, sweating, insomnia, rigors, pain, nausea, tremors, diarrhea, upper respiratory symptoms, piloerection, and rarely hallucinations. Other symptoms that have been reported less frequently with tramadol discontinuation include panic attacks, severe anxiety, and paresthesias. Clinical experience suggests that withdrawal symptoms may be avoided by tapering tramadol at the time of discontinuation.

 

....

Drug Abuse and Dependence

Abuse

 

Tramadol has mu-opioid agonist activity. Tramadol can be abused and may be subject to criminal diversion.

 

....

Abuse and addiction are separate and distinct from physical dependence and tolerance. Physicians should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. In addition, abuse of tramadol can occur in the absence of true addiction and is characterized by misuse for non-medical purposes, often in combination with other psychoactive substances.

 

Concerns about abuse and addiction should not prevent the proper management of pain. However all patients treated with opioids require careful monitoring for signs of abuse and addiction, because use of opioid analgesic products carries the risk of addiction even under appropriate medical use.

 

Proper assessment of the patient and periodic re-evaluation of therapy are appropriate measures that help to limit the potential abuse of this product.

 

Tramadol is intended for oral use only.

 

Dependence

 

Tolerance is the need for increasing doses of drugs to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Physical dependence is manifested by withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist (see also WARNINGS, Withdrawal).

 

The opioid abstinence or withdrawal syndrome is characterized by some or all of the following: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. Other symptoms also may develop, including irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate.

 

Generally, tolerance and/or withdrawal are more likely to occur the longer a patient is on continuous therapy with tramadol.

....

 

So this method may not be for everyone. Thank you for adding your experience.

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Having been on 50 mg. Pristiq at one point myself, I'd expect that anything strong enough to prevent withdrawal symptoms from it would be equally as strong and just as dangerous in terms of withdrawal hazards. In my case, I was switched to 10 mg. Lexapro and went through hell getting through withdrawal for the past 13 months. I still have a few lingering symptoms.

 

I'm glad this has worked for you so far, and may you be one of those who can get off an antiderpessant quickly with no problems. If not, we're here.

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I have a benzo withdrawal friend who took tramadol for a while after her withdrawal for some pain issues...when it came time to come off of it her withdrawal syndrome was renewed with vigor...

 

it's worth coming off very very slowly...just like any other psychiatric drug. She wasn't prepared or expecting issues...so if you proceed with great caution it's likely you won't have to face something like she did.

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I first heard of Ultram (tramadol) at a talk by the medical director of an inpatient rehab. He made the point that rehabs are often a sort of testing ground for whether new drugs are 'habit-forming' or not. He said, every five years or so the drug companies would introduce some new drug to replace some old class which had abuse potential. He said the best test about abuse was whether or not he started to get admits hooked on the new 'non-addictive' medication.

 

Anyway, Ultram was the big example he used. His punchline was, "Remember when they said Ultram had no abuse risk?" This brought a lot of laughs from the audience many of whom I suppose were Ultram abusers. I don't have personal experience with Ultram, but I've seen enough of the phenomenon when I was around AA. Later saw it with Lyrica.

 

I'd be very cautious with this approach.

 

Good luck to you,

Alex

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I withdrew from Tramadol..It was terrible..My PC told me it would be okay to stop taking it but when I saw a psych. doc he told me alot different,he said alot of Pharmacists were abusing tramadol ??? and how difficult it was to come off of. I don't have a clue where he got that info. I saw Tramadol addiction treated with Methadone at the Psych. hospital. What's up with that? The one thing I did like about Tramadol was I had NO anxiety. I stopped because my breasts became very sore and swollen ,I couldn't sleep. Celexa is worse to WD from.. For me anyhow.

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hi again

Sorry, I wasn't able to go and put my information where you wanted. I can't get my thoughts together to concentrate.

today it's been 1 week I've gone every other day with 50 milligrams of pristiq.

 

I know you told me not to do it this way but seemed somewhat toletrable till today on no pill-now jitters, quivery, leg weakness brain fog.

 

dr just called and is going to put me on 25 milligrams of effexor. He said to take it twice a day but I could try taking it just once in the morning. I'm the 1 that had to bring up the

Effexor not him. because of the site I knew questions to ask like the time released effexor 37.5 but he didn't want not to us that'.

Can you please give me you opinion on this. Do you see any problem with this.

Thanks in advance. Going to get perscription now

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Taking some Effexor twice a day is preferable to Pristiq withdrawal syndrome. I would do that if I were you. Please let us know how it works for you.

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Hi Alostrata,

You know maybe you should just shorten this whole topic of tapering Pristiq to a small paragraph. State that Pristiq is DesVenlafaxine which is a metabolite derivative of Venlafaxine which is Effexor. Doctors will not suggest this because there is nothing in medical literature about Pristiq that tells them that this is how they need to taper patients. In Pristiq professional literature it says that you should alternate. We already know this is not the way to do it. It's like teasing your body. Would you give a heroin addict heroin on Monday then skip Tuesday then give him some again on Wednesday? It's obvious that the drug companies want patients to stay on Pristiq. Not wanting to deal with the process of withdrawal is a big reason why I am still taking my 50 mg of Pristiq everyday. If I miss my morning dose, by nightime I already start experiencing withdrawal symptoms. The manufacturer refuses to even call it that. They call it "discontinuation syndrome". Right. Try telling that to a substance abuse professional. "Doc, i don't have withdrawal, i have discontinuation syndrome"! So gimme some more drugs please. Please. Indeed.

 

Anyway, I can tell you from personal experience that I have mentioned using Effexor as a way to taper off Pristiq to at least FOUR mental health professionals. They were clueless about it. And what's worse, is that they insist that Pristiq is a different drug. I have looked at the molecular diagrams and compared Venlafaxine (effexor) and DesVenlafaxine (pristiq) and it clearly shows that desvenlafaxine is the ONLY active metabolite of venlafaxine. In other words, the active ingredient inside Effexor is Pristiq! Why did Wyeth create Pristiq? Because drug patents expire after 17 years! Effexor's patent was expiring, and so conveniently Pristiq showed up on the market, with no generic equivalent for another 17 years! You see how this game works?

 

So people, please save yourselves the headache of trying to cut Pristiq tablets, whose shape has insured that they can never be cut uniformly. Forget switching to Prozac, because that is a totally different medication. And you know what, despite it's extended half-life, I still had side-effects when I got off of it. All these drugs must be tapered!!!

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oaklily, I think you're right, the best way to get off Pristiq might be to switch to regular Effexor, from which you can make a liquid. I'll edit the first point accordingly.

 

Since so little is known, it took us a while of discussion to come to that consensus. However, I'd rather visitors read this entire topic, and all the ifs, ands, and buts, to come to their own conclusions about how they want to come off Pristiq. We can't guarantee that any particular method will be trouble-free.

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interestingly though, quite a few years ago i tried to swap over to pristiq from effexor (before i knew what i know now) as someone suggested it might have less weight gain and other side effects. I was on 75mg effexor at the time - i swapped to 50mg pristiq and i found it WAY too stimulating - i had surges of anxiety that just came out of nowhere. I swapped back to effexor and they went away. Never had them before or since.

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