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Tips for tapering off Pristiq (desvenlafaxine)

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ChessieCat

Just had a thought about tapering Pristiq under 50 mg.  In Australia we can't get 25 mg, which is a nuisance.  I don't want to change to Effexor completely but I was wonder if I had 30 mg & 10 mg capsules of Pristiq compounded  (and later 20 mgs) would it be a viable option to make up the dose with Effexor.  If it were possible it would make it so much easier and cheaper than getting 2 mg & 1 mg capsules compounded.

 

I welcome anybody's thoughts on this idea.

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Altostrata

The compounded Pristiq capsules will not be extended-release. This may cause problems.

 

You could combine Effexor and Pristiq, but you might as well gradually cross-taper to Effexor XR, it will be easier and less expensive.

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ChessieCat

Hi Alto,

 

     I've just gone back to Post #1 on this topic and found this:

 

"In a phone conversation with Pfizer medical information (1-800-438-1985), I learned that the extended-release characteristic is incorporated into the tablet itself (Thank you, oaklily, for this information about the matrix formulation.)

Rather than a timed-release coating, the coating on the Pristiq tablet is only protective."

 

     and

 

"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.:

 

     Anyway, further down that page I've just found the following tidbit in this post by Lilu

 

"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'm going to check with my compounding pharmacy and see if they can do liquid for me.  I'll let you know.

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Altostrata

Chessie, you have quoted this post by Lilu:
 

....
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. )
[see original post]
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.

 
"In Conclusion" is Lilu's conclusion. Her conclusion that the extended-release mechanism is retained when a Pristiq tablet is crushed to powder is INCORRECT.
 
The extended-release mechanism is part of the tablet MATRIX, or the glue that holds the tablet together. When the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.
 
When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability.

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ChessieCat

Hi Alto,

 

Thank you for clarifying that.  And thanks also for the explanation of Matrix.  The way you have explained it makes sense.

 

Do you know, and are you able to explain, about the slow release additive used in compounded capsules?  Any help with this will be much appreciated.  Thank you in advance.

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Altostrata

No, I don't know what pharmacists might put into compounded capsules. If anyone finds out, please let me know.

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Fresh

I asked my pharmacist what they use , this is the response:

 

"We are PCCA (Professional Compounding Center of America) approved pharmacy and we use PCCA ingredients for our compounds. PCCA has approved us to use Methocel (E4M) as the only ingredient for slow released formulated compounds. 

 
 PCCA approved pharmacies use Methocel (E4M) as their slow-released ingredient, however, we will have no access to other independent pharmacies's medical data on what slow-released ingredients would they use. "
 
Interesting that my Australian pharmacy belong to the American association.
When I did some digging I found this:

"Today, PCCA has become the independent compounding pharmacist’s complete resource for fine chemicals, equipment, devices, flavors, ACPE-accredited training and education, pharmacy software, marketing, business and pharmacy consulting assistance. Our membership includes more than 3,900 independent community pharmacists in the United States, Canada, Australia, and other countries around the world"

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ChessieCat

Just checked the website for my compounder and a PCCA logo is on the top right of their Home Page.  However, it is Professional Compounding Chemists of Australia.  Looking at PCCAust website they have the history of PCCAmerica.

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ChessieCat

Found this today:

 

PRODUCT MONOGRAPH

 
®T.M. Wyeth LLC

Pfizer Canada Inc., Licensee

17,300 Trans-Canada Highway

Kirkland, Quebec

H9J 2M5

Date of Revision:

December 3, 2014

Submission Control No: 170902

©Pfizer Canada Inc. 2014

 

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ChessieCat

Put my Pristiq tablets in to be compounded today and I asked the compounding pharmacist about the slow release and he told me it is in the capsule, not added to the ground up tablet.

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Altostrata

Please let us know how well this works in a compounded capsule. My understanding is the additive only extends the drug effect for a few hours. What did the druggist say about that?

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baroquep

Hi Alto,

 

Thank you for clarifying that.  And thanks also for the explanation of Matrix.  The way you have explained it makes sense.

 

Do you know, and are you able to explain, about the slow release additive used in compounded capsules?  Any help with this will be much appreciated.  Thank you in advance.

 

Hi ChessieCat, decided to switch to Effexor XR 75 mg (from 50 mg Pristiq) as my pharmacist was worried that the slow release additive that she would use to compound the Pritisq might not completely eliminate a potential dose dump of the Pristiq.  First day off of Pristiq to Effexor no symptoms (except maybe a little anxiety but imagine that's in my head and not an effect of switching).  Am going to stay on 75 mg of Effexor for a month until my body is adjusted to the Effexor XR and then reduce the Effexor by 5% each month.  Will take forever to get off of the Effexor but much better than living through another Pristiq withdrawal.

Edited by Altostrata
corrected quote code

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ktp

Hi Alto,

 

Thank you for clarifying that.  And thanks also for the explanation of Matrix.  The way you have explained it makes sense.

 

Do you know, and are you able to explain, about the slow release additive used in compounded capsules?  Any help with this will be much appreciated.  Thank you in advance.

the "matrix" IS the shell.  aka "film".  

as cited by the original poster, "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."

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ktp

 

Found this today:

 

PRODUCT MONOGRAPH

 
®T.M. Wyeth LLC

Pfizer Canada Inc., Licensee

17,300 Trans-Canada Highway

Kirkland, Quebec

H9J 2M5

Date of Revision:

December 3, 2014

Submission Control No: 170902

©Pfizer Canada Inc. 2014

 

 

in which the 'matrix' is called a shell...

 

"PRISTIQ tablets must be swallowed whole with liquids, and must not be chewed, divided or

crushed. The medication is contained within a non-absorbable shell designed to release the drug

at a controlled rate. The tablet shell, along with insoluble core components, is eliminated from

the body; patients should not be concerned if they occasionally notice something that looks like a

tablet in their stool. Due to the controlled-release design, PRISTIQ tablets should only be used

in patients who are able to swallow the tablets whole."

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ChessieCat

Thank you.  I have done a bit more research and have learned something today.  Never too old!

 

I found this and read a fair amount of it: Development of Sustained Release Desvenlafaxine Succinate Hydrophobic Matrix System using Melt Granulation Technique

 

Research Gate dot net: Development_of_Sustained_Release_Desvenlafaxine_Succinate_Hydrophobic_Matrix_System_using_Melt_Granulation_Technique

 

PDF:  Development_of_Sustained_Release_Desvenlafaxine_Succinate_Hydrophobic_Matrix_System_using_Melt_Granulation_Technique

 

This time last year I hadn't even found SA.  Now I'm reading about matrices. :wacko:

 

Edited by ChessieCat
Updated links to article

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ktp

I'm not a bit surprised to hear of brain fog after reading this way-too-long thread.  Instead of compounding pristiq, non-XR effexor, liquids??, etc, you could do it this way:

 

1) since you can't reliably cut up Pristiq, just switch from Pristiq (o-desvenlafaxine) to Effexor (venlafaxine), same drug, the o-isomer is the active version.  be sure to get XR venlafaxine so you don't have to mess around with >1 dose per day.  Double your pristiq mg to get effexor mg.  just switch, it works, you won't even notice.  How?

 

2) get your VenlafaxineXR prescriptions filled at Walgreens, where you'll get TEVA-manufactured capsules, nice because the tiny beads are each approx 1mg of medicine with very little variation, makes counting easy.  the caps come in 37.5mg, 75mg, 150mg, so if you're on 50mg Pristiq you want about 100mg effexor so take a 75mg cap + 25 beads from the next one.   (don't trust me on this, count them yourself, you'll get the same # of beads as the alleged dose in mg).  this makes it very easy to reduce by 10% all the way down to 1mg.  use a few shot glasses for easy counting; with 7 you can set up your whole week.  

 

3) never reduce by > 10% of current dose and don't reduce more often than every 30 days.  DON'T get cocky and think you've got it made when you're down to 10mg, you really do have to do the reductions slowly.  I was well on the way but screwed up very near the end by reducing way too fast and am still paying the price; if you do this right you can do it.

 

4) notes:  might as well get the big dose caps for near the end, you'll be counting beads anyway and 150mg costs the same as 37.5mg, save your $.  

read my diatribe for an example, but don't screw up by going too fast with tapering.  in my sig you can see I did, and I spent the next couple years in pure hell insomnia- and anxiety-wise, developed a parkinson-like tremor I can't get rid of, and am now finally pretty stable on 20mg Prozac and not even thinking of how to get off.   

 

good luck you can do it! 

 

Edited by ChessieCat
Edited first paragraph to read as a suggestion

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ChessieCat
3 hours ago, ktp said:

I'm not a bit surprised to hear of brain fog after reading this way-too-long thread.  Instead of compounding pristiq, non-XR effexor, liquids??, etc, you could do it this way:

 

1) since you can't reliably cut up Pristiq, just switch from Pristiq (o-desvenlafaxine) to Effexor (venlafaxine), same drug, the o-isomer is the active version.  be sure to get XR venlafaxine so you don't have to mess around with >1 dose per day.  Double your pristiq mg to get effexor mg.  just switch, it works, you won't even notice.  How?

 

2) get your VenlafaxineXR prescriptions filled at Walgreens, where you'll get TEVA-manufactured capsules, nice because the tiny beads are each approx 1mg of medicine with very little variation, makes counting easy.  the caps come in 37.5mg, 75mg, 150mg, so if you're on 50mg Pristiq you want about 100mg effexor so take a 75mg cap + 25 beads from the next one.   (don't trust me on this, count them yourself, you'll get the same # of beads as the alleged dose in mg).  this makes it very easy to reduce by 10% all the way down to 1mg.  use a few shot glasses for easy counting; with 7 you can set up your whole week.  

 

3) never reduce by > 10% of current dose and don't reduce more often than every 30 days.  DON'T get cocky and think you've got it made when you're down to 10mg, you really do have to do the reductions slowly.  I was well on the way but screwed up very near the end by reducing way too fast and am still paying the price; if you do this right you can do it.

 

4) notes:  might as well get the big dose caps for near the end, you'll be counting beads anyway and 150mg costs the same as 37.5mg, save your $.  

read my diatribe for an example, but don't screw up by going too fast with tapering.  in my sig you can see I did, and I spent the next couple years in pure hell insomnia- and anxiety-wise, developed a parkinson-like tremor I can't get rid of, and am now finally pretty stable on 20mg Prozac and not even thinking of how to get off.   

 

good luck you can do it! 

 

 

You have provided some good information, however each of us has to make our own decision about how we will taper a drug.

 

I made my decision by doing lots of research and decided to stay with Pristiq for a few reasons.  I didn't want to change from the exact drug that I am on.  I also don't want to change from brand Pristiq to generic desvenlafaxine.  Also, I have found that getting my Pristiq compounded means that I don't have to count tiny beads.  This would drive me nuts for sure.

 

I have been tapering using compounded tablets for 1 yr and 9 mths now and have already had 3 batches of tablets compounded and about to get my 4th batch made up.

 

I am very satisfied with my tapering mether and I'm happy to continue doing it this way.

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Sheri755
2 hours ago, ChessieCat said:

 

You have provided some good information, however each of us has to make our own decision about how we will taper a drug.

 

I made my decision by doing lots of research and decided to stay with Pristiq for a few reasons.  I didn't want to change from the exact drug that I am on.  I also don't want to change from brand Pristiq to generic desvenlafaxine.  Also, I have found that getting my Pristiq compounded means that I don't have to count tiny beads.  This would drive me nuts for sure.

 

I have been tapering using compounded tablets for 1 yr and 9 mths now and have already had 3 batches of tablets compounded and about to get my 4th batch made up.

 

I am very satisfied with my tapering mether and I'm happy to continue doing it this way.

Hi Chessie:

 

My psychiatrist wants to start me on Pristiq.  I've been in withdrawal for over a year now, non functioning with very high anxiety. I'm holding on 5 beads of Effexor since July of last year while tapering Vyvanse that I've become sensitive to. I'm at 5 mg compounded now. 

 

Would you mind sharing exactly how your compounding pharmacy pharmacy is doing this?  I would appreciate it so very much! ❤️

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ChessieCat

The chemist I go to is a member of the Professional Compounding Chemists of Australia, and there is one in America as well.  In Australia we can take the prescription tablets in and I just tell him how many of each dose I want.  He uses slow release, which I'm not sure if it is in the capsule or they add it to the inside mix.  I was advised that they need to be used within 6 months, but I have used previous batches with no problem.

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Sheri755
12 hours ago, ChessieCat said:

The chemist I go to is a member of the Professional Compounding Chemists of Australia, and there is one in America as well.  In Australia we can take the prescription tablets in and I just tell him how many of each dose I want.  He uses slow release, which I'm not sure if it is in the capsule or they add it to the inside mix.  I was advised that they need to be used within 6 months, but I have used previous batches with no problem.

 

I'm assuming that he crushes the whole tablet and removes the outer coating (film)?

 

Then either adding the time release in the powder or using a time released (8-10 hr) capsule. 

 

Ugh!  It's so sad that we have to figure this out on our own. 

 

Thank you again!

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scallywag

Sheri, if you have questions about how a compounding pharmacist/chemist would do this, find one and ask. More than likely, that person will explain the procedure used.

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Jaco2016
On 7/26/2017 at 5:00 PM, ChessieCat said:

 

You have provided some good information, however each of us has to make our own decision about how we will taper a drug.

 

I made my decision by doing lots of research and decided to stay with Pristiq for a few reasons.  I didn't want to change from the exact drug that I am on.  I also don't want to change from brand Pristiq to generic desvenlafaxine.  Also, I have found that getting my Pristiq compounded means that I don't have to count tiny beads.  This would drive me nuts for sure.

 

I have been tapering using compounded tablets for 1 yr and 9 mths now and have already had 3 batches of tablets compounded and about to get my 4th batch made up.

 

I am very satisfied with my tapering mether and I'm happy to continue doing it this way.

Is compounding expensive ?

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Jaco2016

Ok after reading this thread it's not clear if the consensus is that the matrix is in fact the "outer shell" OR if it's what "binds the medication" inside the shell. If I cut this stuff is there any potential for dangerous side effects? I'm taking 25mg ER combined with 3/4 (1/2 + 1/4) cut up 25mg and feeling a little off... maybe this wasn't the best decision 😾

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Jaco2016

And I called a local compounding pharmacy and they charge $200 for 30 tablets ... will try another pharmacy 

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ChessieCat

 

4 hours ago, Jaco2016 said:

Ok after reading this thread it's not clear if the consensus is that the matrix is in fact the "outer shell" OR if it's what "binds the medication" inside the shell.

 

The matrix is inside the tablet, not the shell.

 

On 17/09/2017 at 11:14 AM, ChessieCat said:

It is possible to cut and weigh Pristiq tablets.  Fresh did this before she started getting hers compounded.

 

I have my Pristiq compounded with a slow release formula added.  In Australia we cannot get 25mg tablets so I have been taking all capsules since getting under 50mg.  I am now down to 19mg and have had no difficulties.

 

 

4 hours ago, Jaco2016 said:

I'm taking 25mg ER combined with 3/4 (1/2 + 1/4) cut up 25mg and feeling a little off

 

You have made a dose reduction, reducing from from 50mg to 43.75mg.  This is most probably why you are feeling a little off.  It is withdrawal symptoms.  Changing the way you take your drug can sometimes cause minor issues but these generally settle fairly quickly.

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