January: Hopefully very boring Effexor XR taper :)

[January]

I took 300mg Effexor XR and clonazepam for somewhere around 10-15 years, then since 2010 I've successfully tapered/reduced a bunch of it:

 

2010-2011 - Tapered Clonazepam/Klonopin gradually from 200mcg/day to ZERO

2012 March - Dropped Effexor XR from 300mg/day down to 150mg/day

2012 October-2013 February - Tapered Neurontin from 2400mg/day to 800mg/day

2013 March 4 - Tapered Effexor XR to 131.25mg

2013 March 27 - Tapered Effexor XR to 112.5mg

2013 April 16 - Tapered Effexor XR to 93.75mg

2013 April 21 - Tapered Effexor XR to 87.5mg

2013 June 22 - Tapered Effexor XR to 75mg

 

At that point I took a break from tapering for a few years because it's hard work and those doses were easy places to stay steady. My experience with my own body is that taking breaks makes things easier in the long run, so it didn't concern me (I've also previously tapered slowly from high doses of opiates).

 

I do still seem to need the Neurontin for migraines and chronic pain and myoclonic jerks, but the only reason I'm taking the Effexor is that getting off it is such a hassle.

 

Anyway it seems like time to try to do the last little bit of Effexor XR tapering so I'm starting on that as of today and my last progress log was on PaxilProgress so I guess that's disappeared into the ether.

 

My generic Effexor XR is set out like this:

- Each 75mg capsule contains 2 x 37.5mg tablets

- Each 37.5mg capsule contains 3 x 12.5mg tablets

 

That makes it really easy to drop down by 12.5mg and moderately easy to drop down by 6.25mg and a huge pain in the ass to drop down by almost any other increment, sadly. I'll switch to brand name stuff and weigh the tiny little balls out if I have to, but it's expensive and with my other disabilities it's an enormous problem to get it done so if I can safely avoid it I'd rather do that. I'll see how things go.

I've dropped down to 62.5mg today. So far I just have a whole bunch of nausea and gut cramps (why do bodies have neurotransmitter receptors in guts anyway!?) but nothing worse. Fingers crossed!

 

 

 

[January]

Didn't get much sleep last night but it was just from the stomach aches I think, as soon as that subsided I drifted right off.

 

Stomach is way much better today - maybe 80% back to normal most of the time?

 

Nothing else to report. Boring = good!

[scallywag]

January, -- Welcome to Surviving Antidepressants. There are many former members of PP, sometimes called Prior Place, here at SA.
 
I hope you'll find the information in the SA forums enlightening and helpful for your taper.  I'm sorry that you are in the position that you need the information, but am glad that you found us.
 
You did a great job reducing the doses of clonzepam, Effexor XR, and Neurontin previously.  It looks like you removed one mini-bead from your morning dose and from your evening dose. That's 16.7% of your total daily dose and is a bit more than what we suggest, 10% from previous dose to prevent or minimize symptoms. 
 
Why taper by 10% of my dosage?

For your next step in your taper, you might consider removing an extra bead from EITHER the morning capsule OR the evening capsule, then alternate between them or continuing with one dose until you are at 0 mg with it.. This may reduce the nausea and gut cramps. And as you said, at some point you can switch to the brand name capsules and count beads. Another option is to switch to Effexor immediate release tablets (the original version) and create a liquid solution or suspension.

Some relevant reading for you, in case you haven't yet found it:

Tips for tapering off Effexor (venlafaxine)

Tips for tapering off Neurontin (gabapentin)

Counting beads in a capsule versus weighing

Making a liquid from a tablet or capsules

Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-18 months particularly? Any drugs prior to that can just be listed with start and stop years. Please put your withdrawal history in signature
 
When a someone is taking multiple medications, we ask that that you post an interactions report. You can get the report here:Drugs_dot_com Drugs Interactions Checker. Just select the text, copy it and paste it in a post here.
 
Have a look around the forums, especially those linked topics, and post your questions here.

Edited June 23, 2016 by scallywag
Add interactions check

[January]

You did a great job reducing the doses of clonzepam, Effexor XR, and Neurontin previously.  It looks like you removed one mini-bead from your morning dose and from your evening dose. That's 16.7% of your total daily dose and is a bit more than what we suggest, 10% from previous dose to prevent or minimize symptoms. 

Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-18 months particularly? Any drugs prior to that can just be listed with start and stop years. Please put your withdrawal history in signature

 

When a someone is taking multiple medications, we ask that that you post an interactions report. You can get the report here:Drugs_dot_com Drugs Interactions Checker. Just select the text, copy it and paste it in a post here.

 

(Sorry I can't figure out how to break up your quote to reply to each bit)

 

I do realise that reducing by 12.5mg is a bit more than recommended here, but as described I've had very minimal withdrawal symptoms while doing this and reducing by other amounts creates its own problems. Anyway, we all know that everybody's very different with this and that the 10% "rule" is an over-generalisation because there's no actual research in this area. I'm happy with the trade-off of risk and I'll continue to monitor my symptoms - if I start getting more symptoms with the reductions I'll reduce the amount I reduce by.

 

I'm not comfortable with pasting my interactions report into a public forum like this, I take a very specific combination of meds that would probably identify me to anybody who knows me RL. Just trust that I've read and understood it, discussed it with my specialists and with a pharmacist who works with polypharmacy, and got an OK from my primary care doctor. This effort to reduce the meds I take isn't just around the effexor/neurontin, I've been working to reduce *all* the meds I take including the ones which have no brain-related actions.

 

Hmm. What else. Lots of super-vivid dreams! Not bad, just vivid.

 

J

[Dalmo1]

Hey J good luck on your taper! Keep us posted how you go : )

[mammaP]

Hi January, welcome from me too. I've tapered effexor and you are right, it IS a hassle! I was pretty much like you and cut my 75mg dose by half and stayed with that for a few years. I then tapered very carefully  for a whole year from 37.5, and felt better with each drop after the initial day or so of withdrawal.  When I was down to 5 beads (1mg of the brand I was on)  I went away and forgot my effexor, I was fine, no withdrawal and felt amazing, such a difference to the housebound wreck I had become in the 10 years I had been taking it.  After a month off I started to go into withdrawal and had to reinstate that last 1mg, but by then was sensitive to it and that was too much so reduced to 4 beads and it took 7 months before I was stable enough to taper again. I would get some great hyper windows that would lead into devastating waves during that time.  The last 4 beads took nearly 2 years and had to devise my own taper at 3 beads because you can't divide a teeny tiny bead! I took the largest bead every day and that meant they were getting smaller. Threw away the tiniest that were like sugar grains then started with a new capsule and took 3 of the largest beads, in the same way until I got to the smallest of 1 bead.  

 

Effexor is a nightmare, and your body might not react to the drops, mine didn't, and that is quite common. People taper off and feel great then suddenly withdrawal can hit months later.  You are doing great with your tapers, and I'm sure you will be successful but don't be lulled into a false sense of security like I was, I didn't follow the 10% , I wish I had found this site before I started my taper. It is brilliant that you have your doctors on board, it is not often that doctors know anything about tapering, because they are educated by the drug companies. They look at the diagnostic manual, which suggests the drugs to use, and soon a cocktail of drugs is being taken with horrendous side effects and no idea how to taper them, They believe that withdrawal is a return/worsening of the illness and not knowing what to do they add more and more drugs and the cycle goes on. 

 

If your doctors understand and support withdrawal maybe they would agree to being on our list of knowlegeable doctors, they are hard to find! 

[January]

It's not so much doctors that understand or support withdrawal, just ones that said "do whatever you like, I'm happy to write the prescription for that amount" and got out of my way

 

The biggest hassle here, and I'm not sure if it's just an Australia-specific thing, is that doctors aren't allowed to write repeats on the scripts for 37.5mg Effexor XR so you have to go back to the damm doctor every 4 weeks if you want those ones!

[mammaP]

Lol that will do, write the scripts so you can get on with it!  That is a pain, 37.5 is better for counting beads, less of them  

[January]

One week after reduction I realised taht my increased mast cell / histamine related symptoms were probably caused by the drop too. Hadn't realised until now that they were connected, I think.

 

Still have increased fatigue, and increased mast cell symptoms but both are gradually heading back to normal.

 

I saw my myotherapist today and was telling her what had been going on lately and I mentioned that I'd reduced my effexor and she said something about how much was the reduction and I explained about it (expecting her to be surprised at how slow I was going, of course) and the first thing she mentioned was that I needed to be careful because I'd reduced by more than 10%. She actually knows about all this stuff!!! She asked me to send her links to stuff I read too. I was so surprised I nearly fell out of bed! So that's one ally firmly in my corner, which is awesome. She also knows a ton about chronic pain, which is incredibly helpful to me.

 

It was really helpful to talk to her actually because there's such a strong temptation to want to reduce more often and get the damm stuff over with, and intellectually I know it's a dangerous idea but ARGH I want it done with. So discussing with somebody who pointed out that a bunch of the symptoms I reported are probably related to the dose change (I hadn't realised!) and who encouraged me to be slow was very very helpful.

[mammaP]

WOW she is a keeper! Maybe she would like to be recommended here for our Aussie friends when she has looked at the info. 

[Lexy]

She also knows a ton about chronic pain, which is incredibly helpful to me

 

Hi January

I'm also tapering effexor. You mention your therapist helps you with chronic pain. Is this a symptom related to effexor withdrawal?

I also have chronic pain and if you have any info it would be much appreciated.

[January]

Lexy: I have chronic pain from an unrelated disability, so mine isn't caused by withdrawal, but it's certainly exacerbated by withdrawal. I highly recommend the Explain Pain book from NOI and the Neuroplastic Transformation Workbook from Neuroplastix. Both of those explain how chronic pain works and offer lots of concrete things you can do about it.

 

Best of luck!

[January]

WOW she is a keeper! Maybe she would like to be recommended here for our Aussie friends when she has looked at the info. 

 

Where do I find info or recommendation threads? I had a look around with no luck so I'm not sure where to point her?

[Lexy]

Thanks, will look into it.

[scallywag]

January: in the Tapering Forum -- Recommended Doctors, Therapists, or Clinics

[January]

Everything has been going well. My gut has gradually settled down, everything else seems to be back to normal... or as normal as I ever get. 

 

In preparation for the next reduction, I tried cutting the 12.5mg mini-tablets in half and it is SUPER difficult to be accurate because they are so tiny. I cut up five of them with a very sharp craft knife and the pieces range from about 2/3 of a mini-tablet to about 1/3 of a mini-tablet in size. So I arranged the ten pieces in descending size order and that will get me from 62.5mg down to 50mg over 10 days.

 

My contingency plan if that fails to be tolerable is to start making water solutions with a single mini-tablet (12.5mg worth) and use a syringe to draw up more exact amounts. Unfortunately that method takes a ton more energy to implement, so I want to avoid it if it's possible. Using the dry-cutting I can prepare up to 2 weeks worth ahead of time, but if I'm using water solutions I need to do it every day and it's very difficult to find the energy to do that. I have all the supplies needed though, and I know how, so if I need to do it then I will manage somehow.

[scallywag]

January it's good to know that you're taking generic venlafaxine. The generic manufacturers use the mini-beads, which can be helpful in tapering high doses but present challenges at lower ones.

 

There are a number of Effexor/venlafaxine prescribees from Australia here on SA.  I'm wondering what they're doing with the mini-tablets or if they've switched to immediate (IR) release venlafaxine and are using liquids to titrate and taper.

[January]

Just to clarify: These are the mini tablets - there are 3 in each 37.5mg capsule so they're 12.5mg each. The beads (the ones in brand name Effexor) are much smaller and seem to vary in size but are less than 1mg each, I'm not using them.

 

In any case, this is good for now.

[January]

Currently on day 7 of the 10-days of defending-sized part-tablets described above in post #16.

 

Until yesterday I basically had ZERO withdrawal symptoms which was very nice - I had vivid dreams but that's the only thing.

 

Today I'm getting back some of the standard-for-me symptoms - diarrhoea, mast cell stuff, migraines, restless legs, general jumpiness. It's not nearly as bad as when I jumped down 12.5mg all at once though.

 

Unfortunately it's highlighting a drawback of this method - because it's not possible to cut these mini-tablets accurately enough I can't "pause" in the middle of this and stay at the same level for a while. Oops. Luckily these symptoms aren't bad enough that it's a big issue - one 2 more days and I'll be on 50mg which is a stable spot to rest for a few weeks while my body catches up.

(I think next time I'd do the same tablet cutting but with more tablets, perhaps 10 tablets so the process takes 20 days and is half as fast)

 

Anyway, I'm very pleased overall with how easy this is being. Yay boring taper!

[January]

The above very bad day was just one isolated day, luckily. Things settled down after that.

 

I got down to 50mg even a week ago now and I'm going to wait here a few weeks while my body catches up wit the recent changes.

 

Still having vivid dreams, but nothing else I can definitively pin down to withdrawal. I've had probably more migraines lately which may or may not be related (it fluctuates anyway), and more mast cell symptoms (ditto). My mouth tastes super metallic today which is annoying but again, it's something I've had off and on in the past so it may or may not be related.

 

All in all, pretty much as uneventful as I'd hoped for so far! Touch wood and all that ...

[KarenB]

That's good to hear January.  Take your time, just like the tortoise.... You'll win the race .

[January]

Okaaaaay, so now it's October and I'm getting around to the next part. Tapering down to 37.5mg gradually over this week, using the same dry cutting method as before. I'm at the end of day two and doing fine so far, no withdrawal symptoms just now.

[peggy]

It's not so much doctors that understand or support withdrawal, just ones that said "do whatever you like, I'm happy to write the prescription for that amount" and got out of my way

 

The biggest hassle here, and I'm not sure if it's just an Australia-specific thing, is that doctors aren't allowed to write repeats on the scripts for 37.5mg Effexor XR so you have to go back to the damm doctor every 4 weeks if you want those ones!

 

Your doctor can write a 5 repeat script here in Australia for 37.5mg ( I am in Queensland) - he/she just needs to make it a private script, not PBS - the cost is still the same - about $14?  

I found that out by accident when i had to visit a different doctor because mine was on holidays.

 

I am interested in what brand of generic you take?  some generic venlafaxine is the same microbeads as the effexor...  

[January]

Private scripts cost more if you're a pensioner though, so it makes a difference for me.

 

I don't know offhand which brand of generic it is, sorry.

[scallywag]

The prescription bottle usually indicates the generic manufacturer. On Canadian prescriptions the pharmacy/chemist is required to indicate it, usually with some short form, e.g. "TEVA" or "APO"

 

There will be an AUS-R number. If there is no abbreviation for the manufacturer, you can use the AUS-R # to look up the information on the Australian Register of Therapeutic Goods (ARTG).

 

From my quick scan of the register for venlafaxine, three generic manufacturers have registered in Australia: Apotex, Medis & Ranbaxy.

[January]

Nah, it wasn't that - I didn't have the original box around any more because I had used almost all of them. Since I had to order more anyway, I asked my pharmacist and he says it's Apotex.

 

Still doing pretty good - bit of an uptick in migraines and my stomach is grumbly, a super vivid dream last night, but nothing that's at all hard to manage.

[KarenB]

Tapering down to 37.5mg gradually over this week

 

Are you tapering from 50mg to 37.5mg over a week?  I may not have understood correctly.

[January]

 

Are you tapering from 50mg to 37.5mg over a week?  I may not have understood correctly.

 

 

Yup. Please don't give me the speed-of-reduction lecture, I can recite it just as well as anybody else. The method I'm using is working super well for me and I have to balance out many other things that make this hard to do more slowly. That's why I'm putting so much time between each bit of reduction and so far (touch wood!) it's just fine.

[KarenB]

All good then January.  But if anyone wants a lecture from me they'll have to book and pay in advance .  And I ain't cheap . 

[January]

Aaaaaaand I'm done!

 

Spent the last month tapering from 37.5mg down to ZERO.

 

OMG.

 

Started reducing the Effexor in 2012. Can't tell you how bloody relieved I am it's finally done!!

 

I tapered the final month by taking the teeny tiny super annoying beads out of the capsules. After some fiddling I determined that if I removed 4-6 beads per day I was generally fine, so mostly I took 6 out per day.

 

My emotions are slightly wobbly these last few days but it might just be normal variation or it might be my system adjusting. it's not enough to worry me anyway, happy to rest lots and sit it out.

[JanCarol]

How are you going January?

 

You know there is a Delayed Onset of Withdrawal Symptoms

 

You may wish to reinstate a few beads if you run into trouble.

[January]

Thanks for keeping an eye on my JanCarol I'm doing great, thankfully. Back to normal in terms of emotions and no other related symptoms. I will keep an eye out though.

 

I think I had a major advantage to many people here in that I was tapering the Effexor because I just didn't want to be on it - it wasn't causing me any symptoms or problems at all that caused me to have to get off it fast. Also because I did my reading before starting I never tried to jump down in doses super fast or go cold turkey or anything like that. So I was able to take all the time I needed and my nervous system never got into a really messed up state because of going cold turkey or ignoring warning signs or anything. Surely that's got to help.