TaniaNZ: planning venlafaxine (Enlafax-XR) tapering

[TaniaNZ]

Hi all,

 

I'm Tania and I'm from Christchurch, NZ.

 

After trying several other antidepressants, I was prescribed Venlafaxine. I've been on it for 12+ years now, at doses ranging from 37.5mg - 375mg daily. I'm at 150mg/day now. I'm ready to come off this stuff - it was never intended to be a long-term solution, but the withdrawal side-effects (which of course I was not warned about, and my doctor was insistent were not happening) have prevented me coming off it.

 

For me, at the lower doses (below 75mg) the withdrawal effects are very debilitating. Essentially, I cannot function AT ALL. My physical withdrawal side effects generally include: horrendous vivid nightmares (unbelievably disturbing), sweating, severe headache, blurred vision, vertigo / dizziness (meaning I cannot walk walk straight let alone drive - to others, I look drunk), nausea and vomiting, diarrhea, feeling like I've left my body, and I cannot wake up or stay awake.... I just sleep and sleep and sleep... it takes 100% of my effort and willpower just to get out of bed to go to the bathroom, after which I return to bed and am asleep again within minutes (which is not normal for me). I'll even sleep through alarms right next to my head, and people shaking me to try to wake me (I'm usually quite a light sleeper so this is WEIRD).

I feel like I have the strategies and support to deal with the psychological effects of withdrawal, but the physical effects just ruin me. I cannot afford to take time off work, and I have a house, a family and animals to look after - so I need to get this tapering right so I can function!

 

To make this process more difficult, in NZ we've been changed from Effexor-XR to Enlafax (generic). Effexor-XR is no longer funded and I cannot afford to pay the extra to get it instead of the generic one. Please note, this means there are no beads in the capsule, it's just a single tablet. It appears I'm going to have to crush and weigh the tablet to taper. Since the tablet is not 100% Venlafaxine, and is also made up of various other filler ingredients, is this going to be an accurate way of tapering? I understand I will have to get a super sensitive scale, and also that the slow release will no longer happen if I crush it, so I will have to split my dose in two, taken twelve hours apart. Is that all correct? Any tips would be awesome. 

 

Also, are my calculations correct, that I am looking at 70 months (almost 6 years) to come off this with a 10% taper?! Counting down to August 2024 seems kind of INSANE!!

 

Thanks for reading, and in advance for any advice.

[ChessieCat]

Hi Tania and welcome to SA,

 

It's really great that you have found SA before you got too far along in your tapering.

 

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Q:  Do you have a product leaflet for the Enlafax?  Does it say anywhere that it is XR?  What dosing instruction is on the prescription label?

 

The only information I can find on the internet is for Enlafax XR capsules.  It may be that the tablets are IR / immediate release.  If you don't have the information you will need to contact your pharmacist and ask for the product sheet or ask them about whether they are immediate release.

 

From this topic:  Tips for tapering off Effexor (venlafaxine)

 

On 5/6/2011 at 1:01 PM, Altostrata said:

 

Convert from venlafaxine XL or Effexor XR to regular tablets

Especially in the last leg of your taper, when you might be down to a few beads of Effexor XR, you may wish to switch from an extended-release version to regular Effexor so you can make a liquid from it to make very small reductions.

 

Because of its short half-life, taking regular Effexor as a tablet or liquid necessitates taking the tablets every 12 hours.

 

 

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  If you find that you get withdrawal symptoms you hold for longer and/or reduce by less.

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's Withdrawal Symptoms

 

Yes, it is frustrating that it will take so long to get off a drug, however, it is better to do it with minimal discomfort than to try and go to fast and end up with major issues.  We have some members here that have tried to go faster and ended up having to updose and hold for longer because their symptoms worsen and it ends up taking them longer to get off than if they had followed SA's protocol.  Remember that as you lower the drug dose you are reducing the drug burden on your body.  I've been tapering for 3 y 2 m and have managed to get from 100mg down to 5mg.  I've only experienced mild withdrawal symptoms during this time.

 

It is possible to dissolve a tablet in water.  how-to-make-a-liquid-from-tablets-or-capsules

 

 

50mg tablet in 50mL water

 

each 1mL of liquid will contain 1mg of dose

 

If you decide that you want to weigh your dose here is the topic:  using-a-digital-scale-to-measure-doses 

 

This is your own Introduction topic where you can ask questions about your own situation and journal your progress.

[ChessieCat]

Just now, ChessieCat said:

Does it say anywhere that it is XR?

 

I've just noticed that your topic title says Enlafax XR.  You have also said that they are tablets.  This is what I have found, see the image of the tablets and capsules.  The Enlafax XR in the picture are all capsules.

 

https://www.pharmac.govt.nz/medicines/my-medicine-has-changed/venlafaxine/

 

However, even if they are XR tablets, once they are dissolved they will become IR / immediate release and you will need to take 1/2 your dose 12 hours apart, as quoted in the previous post.

[TaniaNZ]

9 hours ago, ChessieCat said:

 

I've just noticed that your topic title says Enlafax XR.  You have also said that they are tablets.  This is what I have found, see the image of the tablets and capsules.  The Enlafax XR in the picture are all capsules.

 

https://www.pharmac.govt.nz/medicines/my-medicine-has-changed/venlafaxine/

 

However, even if they are XR tablets, once they are dissolved they will become IR / immediate release and you will need to take 1/2 your dose 12 hours apart, as quoted in the previous post.

 

Sorry, to clarify, although they are encased in a capsule, when you open the capsule it's just a tablet inside it, not the beads. They are definitely XR. Is it the capsule that creates the slow release, or a coating on the tablet inside it?

 

Unfortunately, many people here are suffering adverse reactions from the brand change (including myself I believe, though proving a direct link is difficult). Although the active ingredient is the same, the remaining ingredients are not - I'm unsure if this is what is causing / contributing to the adverse reactions, or if perhaps there is a QC issue. When we were swapped we were all told that the product was identical and we would experience no changes at all - we were not even provided with a product leaflet. There have been more than 530 complaints about the brand change causing issues (which is a lot in our tiny country), and reports of suicides and suicide attempts, among other side effects, since the brand change.

 

I'm concerned this is going to exacerbate my tapering efforts. I guess I will just try and see what happens!

 

I am going to do the 10% taper as recommended, and assess how I'm coping with that after several months. Slow and steady wins the race right?

 

[ChessieCat]

Thank you for clarifying the capsule with tablet inside.  From what you said I assume it just 1 single tablet.  Some generics have 3 or more pellets.

 

Is there an immediate release venlafaxine available?  Or can you get generic liquid?

 

I've ask the other mods for their assistance about whether it would be possible to dissolve the inner tablet in water.

 

It's a disgrace that you have been placed in this situation.  I've had a different issue with Pristiq in Australia only being available in 100mg and 50mg when 25mg tablets are available overseas.  This is because the Therapeutic Drugs Authority won't allow Pfizer to provide it.  Thankfully I can get my tablets compounded and have found a reasonably priced compounder, but I am on a pension, get my tablets at the NHS price, but have to pay for the compounding which is working out expensive and is a cost that I shouldn't have to pay in order to get off my drug.  I wish now that I had taken action to try and get something done about it.

[Tom37]

Hi Tania,

 

Another kiwi here and feel your frustration at what your going through!

 

Im on Lexapro and while I’m tapering (currently stopped and holding to stabilise) I too have to use tablets only as they don’t fund liquid under pharmac. For now it’s managable with a Gemini scale and a nail fail but going under 2mg is going to get difficult and making own liquid isn’t ideal.

 

Just whatever you do take it very very slow  and while the time may seem daunting it’s far better than the alternative of going to fast.

 

All the best in your journey!

[ChessieCat]

Just found this in the NZ topic:  new-zealand-members-please-check-in-here

 

On 7/17/2018 at 7:12 PM, KarenB said:

 

A petition to get effexor subsidised again.  https://www.change.org/p/david-clark-mp-david-clark-parliament-govt-nz-bring-back-effexor-enlafax-is-risking-lives-and-mental-health

 

 

 

And this in the Tips for tapering Effexor:

 

[TaniaNZ]

3 hours ago, ChessieCat said:

Thank you for clarifying the capsule with tablet inside.  From what you said I assume it just 1 single tablet.  Some generics have 3 or more pellets.

 

Is there an immediate release venlafaxine available?  Or can you get generic liquid?

 

I've ask the other mods for their assistance about whether it would be possible to dissolve the inner tablet in water.

 

It's a disgrace that you have been placed in this situation.  I've had a different issue with Pristiq in Australia only being available in 100mg and 50mg when 25mg tablets are available overseas.  This is because the Therapeutic Drugs Authority won't allow Pfizer to provide it.  Thankfully I can get my tablets compounded and have found a reasonably priced compounder, but I am on a pension, get my tablets at the NHS price, but have to pay for the compounding which is working out expensive and is a cost that I shouldn't have to pay in order to get off my drug.  I wish now that I had taken action to try and get something done about it.

 

 

Thanks Chessie. I think I'm going to crush my tablet and measure it - I have scales coming! Gosh it's ridiculous in a 'civilized society' that these issues exist isn't it?! Thank goodness for places like this. I remember when I first experienced withdrawal more than a decade ago, it took me a long time to figure it out, and there was little support around (especially from the medical profession, consistently denying the withdrawal was even possible). This forum is such a valuable resource!!

[TaniaNZ]

2 hours ago, Tom37 said:

Hi Tania,

 

Another kiwi here and feel your frustration at what your going through!

 

Im on Lexapro and while I’m tapering (currently stopped and holding to stabilise) I too have to use tablets only as they don’t fund liquid under pharmac. For now it’s managable with a Gemini scale and a nail fail but going under 2mg is going to get difficult and making own liquid isn’t ideal.

 

Just whatever you do take it very very slow  and while the time may seem daunting it’s far better than the alternative of going to fast.

 

All the best in your journey!

 

Thanks for sharing Tom, and or your well-wishes. I have ordered some scales last night.

[ChessieCat]

You might find these topics helpful.  There is a link to AD WD in the DSM-5.

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

[Altostrata]

Welcome, Tania.

 

You cannot split that tablet inside an XR capsule, it's an XR tablet.

 

For alternatives, see Tips for tapering off Effexor (venlafaxine)

[ChessieCat]

44 minutes ago, Altostrata said:

You cannot split that tablet inside an XR capsule, it's an XR tablet.

 

Oh dear, that is bad news.  You will have to investigate these:

 

15 hours ago, ChessieCat said:

Is there an immediate release venlafaxine available?  Or can you get generic liquid?

 

You are going to have to investigate these options.

 

Please check out these topics about how to talk to medical professionals.  It sounds like you are going to need to be very assertive.

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

 

One member made the comment recently that if they had trouble with getting a liquid prescribed (in the UK I think) because the doctor said it was more expensive than the tablets, that s/he was going to say that the medical profession had prescribed the drug in the first place and it was the medical profession's responsibility to help them get off it safely.  I thought that this was excellent.  However I wouldn't say this unless I had tried all other things first.  I think the member who posted this did go to the doctor and ended up being surprised that after discussing withdrawal and tapering with them the doctor prescribed liquid.

 

It might be worth joining the facebook group linked in a previous post to find out what other people are doing, although I imagine that the majority of people would be staying on their drug.

[ChessieCat]

On 12/9/2018 at 8:07 PM, TaniaNZ said:

I'm at 150mg/day now.

 

If you can't get liquid or IR then another option might keep the cost down a bit for you.  But you would need a doctor to get on board with it because of the prescriptions needed.

 

Enlafax is available in 37.5mg, 75mg and 150mg.

 

You could take combo of Enlafax 75mg + Enlafax 37.5mg (+ 112.5mg) + beads from an Effexor capsule to make up the dose for your reduction.

 

At least that way you wouldn't have to pay full price for the Effexor for a full dose, but they should last quite a while.

 

Once you got to lower than 112.5mg you would then take 75mg + beads from Effexor capsule to make up the dose you need.

[TaniaNZ]

32 minutes ago, ChessieCat said:

 

If you can't get liquid or IR then another option might keep the cost down a bit for you.  But you would need a doctor to get on board with it because of the prescriptions needed.

 

Enlafax is available in 37.5mg, 75mg and 150mg.

 

You could take combo of Enlafax 75mg + Enlafax 37.5mg (+ 112.5mg) + beads from an Effexor capsule to make up the dose for your reduction.

 

At least that way you wouldn't have to pay full price for the Effexor for a full dose, but they should last quite a while.

 

Once you got to lower than 112.5mg you would then take 75mg + beads from Effexor capsule to make up the dose you need.

 

Thanks, you're very smart! My current doctor is lovely so I will have a good talk to her about the options, especially around combining the brands to keep costs down. Our government on fund specific brands and type and I'm pretty sure liquid is not funded. I've joined the FB group, but mostly it's about the brand change, not tapering, although I've found a few good tips. Thank you!!!

[TaniaNZ]

15 minutes ago, Altostrata said:

Welcome, Tania.

 

You cannot split that tablet inside an XR capsule, it's an XR tablet.

 

For alternatives, see Tips for tapering off Effexor (venlafaxine)

 

Yeah I know it's an XR tablet inside the capsule, but since they only come in 37.5mg at the smallest I'm going to have to split it to taper. I realise if I crush it up and measure out the doses it will void the modified release so I will have to split my daily dose into two equal doses taken 12 hours apart. Is there any other reason I cannot split them?

[PoetJester]

Hi Tania

 

Please see this post by Altostrata concerning PoetJester's suggestion.

 

@PoetJesterDerek you know that you should not be making drug recommendations.

 

i have the indescribably terrible nightmares, too, and the drunk walking.  you could look into something called Rifaximin.  It's an anti biotic for removing ammonia from the bloodstream.   the all day sleeping, not being able to get out of bed thing almost sound like hepatic encephalopathy (HE) which Rifaximin is used for along with a laxative called Lactulose. 

 

Derek

 

Edited December 11, 2018 by ChessieCat
added notes

[Andie]

On 12/9/2018 at 5:07 PM, TaniaNZ said:

For me, at the lower doses (below 75mg) the withdrawal effects are very debilitating. Essentially, I cannot function AT ALL. My physical withdrawal side effects generally include: horrendous vivid nightmares (unbelievably disturbing), sweating, severe headache, blurred vision, vertigo / dizziness (meaning I cannot walk walk straight let alone drive - to others, I look drunk), nausea and vomiting, diarrhea, feeling like I've left my body, and I cannot wake up or stay awake.... I just sleep and sleep and sleep... it takes 100% of my effort and willpower just to get out of bed to go to the bathroom, after which I return to bed and am asleep again within minutes (which is not normal for me). I'll even sleep through alarms right next to my head, and people shaking me to try to wake me (I'm usually quite a light sleeper so this is WEIRD)

Hi Tania 

 

I have never had anyone describe my own withdrawal  symptoms so perfectly! 

 

I do remember reading the article below from the NZ Herald and it really resonated with me, as I was overseas at the time . Whenever  I travel I always feel like my medications are the most precious possession.  I also carry medical documents approving their use (the UAE are quite strict about psychotoropics from my experience. GPs aren’t allowed to prescribe these in the UAE so they are considered restricted meds)  I Worry  more about where my meds Are than where my passport is ! https://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11782731

 

 

Welcome ! 

 

[Andie]

3 hours ago, ChessieCat said:

 

If you can't get liquid or IR then another option might keep the cost down a bit for you.  But you would need a doctor to get on board with it because of the prescriptions needed.

 

Enlafax is available in 37.5mg, 75mg and 150mg.

 

You could take combo of Enlafax 75mg + Enlafax 37.5mg (+ 112.5mg) + beads from an Effexor capsule to make up the dose for your reduction.

 

At least that way you wouldn't have to pay full price for the Effexor for a full dose, but they should last quite a while.

 

Once you got to lower than 112.5mg you would then take 75mg + beads from Effexor capsule to make up the dose you need.

Hi Chessie and Tania 

 

Just in regards to using the mix of Effexor and EnlafAx. That’s a really clever idea. 

 

When I was very first trying to come off Pristiq my Psychiatrist tried to switch me to Venlafaxine and use the bead counting method. Because I was so very  sensitive, he wanted me to use the TevaPharm Venlafaxine as 1 bead was equal to 1mg. I could then be much more precise in my reductions. 

 

I realise the TevaPharm is going to need to be paid out of pocket too and I’m not sure if it’s even available in NZ  Just  something I remembered and thought I’d share. 

[TaniaNZ]

1 hour ago, Andie said:

Hi Tania 

 

I have never had anyone describe my own withdrawal  symptoms so perfectly! 

 

I do remember reading the article below from the NZ Herald and it really resonated with me, as I was overseas at the time . Whenever  I travel I always feel like my medications are the most precious possession.  I also carry medical documents approving their use (the UAE are quite strict about psychotoropics from my experience. GPs aren’t allowed to prescribe these in the UAE so they are considered restricted meds)  I Worry  more about where my meds Are than where my passport is ! https://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11782731

 

 

Welcome ! 

 

 

It's reassuring (though sad) to hear someone else has similar symptoms to me. Most people I have spoken to have one or two, maybe three symptoms. But for me... it's pretty much total body failure!

[Andie]

Just now, TaniaNZ said:

 

It's reassuring (though sad) to hear someone else has similar symptoms to me. Most people I have spoken to have one or two, maybe three symptoms. But for me... it's pretty much total body failure!

Oh Tania! I have to laugh (not at you). You have a withdrawal sister Over here for sure! I go into what I call total body failure as well. My symptoms are identical and I know hard it is to keep the rest of your life going when you feel like that. Pristiq is basically Effexor’s evil twin. 

 

My story is really similar to yours. I’ve been taking Pristiq for 8 plus years and it was only supposed to be a short term thing. My  GP prescribed it.  The only reason I kept/keep taking it, is to keep the withdrawal at bay so I can function like a normal person. How are your side effects? I was sweating 24/7 and I was having periods of intense tachycardia and high blood pressure. That was when my Doctor  said enough was enough and I had to come off. 

 

A childhood friend of mine came off Effexor and has been free now for many years using a slow taper and then a switch to Another medication.  She’s doing really well. It is possible to come off. Using the 10 percent method described here, I’m down to 12mg of Pristiq from 100mg with only a couple of bumps along the way. 

[ChessieCat]

@PoetJesterDerek you know that you should not be making drug recommendations.

[Altostrata]

@PoetJester especially about powerful antibiotics! You may have illnesses that need antibiotics, most people do NOT, and should not take them.

 

Tania, venlafaxine does not come in a prescription liquid form anywhere. If you want to use a liquid, you have to make a liquid yourself from regular immediate-release venlafaxine tablets (if available) or have a pharmacy make a compounded liquid.

 

I'm sorry it's so complicated. Chessie has made some good suggestions mixing generic and brand-name XR for the beads in the brand-name (or other generic) capsules, which may be more expensive, depending on your insurance coverage.

[TaniaNZ]

@Altostrata Thanks. No health insurance coverage here for most people as we have a public health system in NZ. People generally only have insurance if they wish to skip the public cue or go to private hospitals in stead of public. We have an organisation called Pharmac that decides which medications to fund (they were the one that changed to the generic brand to save money) and health insurers usually won;t pay for anything that Pharmac doesn't fund if there is a generic alternative that is funded (e.g. they won;t pay for Effexor as we can get Enlafax funded). Anyway - there's some info on how it works down here for ya!

 

I think I will pay the extra and get the Effexor to use the beads to top up the standard Enlafax capsules/tablets as suggested - that way it will be faster to measure, I wont have to crush anything up (until I get to very small doses I guess) and I won't void the slow release so won't have to dose twice a day.

 

Thanks everyone for the suggestions - this process would be so much harder without all your help!

[TaniaNZ]

Oh also, I won't be make decisions about any medications such as antibiotics myself - I think I'll leave that to the qualified professionals such a my GP! I also avoid antibiotics unless absolutely necessary anyway.

[ChessieCat]

38 minutes ago, TaniaNZ said:

Oh also, I won't be make decisions about any medications such as antibiotics myself - I think I'll leave that to the qualified professionals such a my GP! I also avoid antibiotics unless absolutely necessary anyway.

 

Excellent!!!

[ChessieCat]

I've added the suggestion to the Tips for Tapering Effexor topic.  I've written that I don't know which dose of Effexor capsules would be best to work with.

 

It would be appreciated if you could post in the tips topic about how you are doing your taper and what Effexor capsule dose you are using so that others will have easy access to the information.  Thank you.

[Altostrata]

If you can get the kind with tiny beads in a capsule, any dosage Effexor XR would work for bead-counting. Getting the largest dosage available will give you more beads to work with and last the longest for the expense.

 

You'll have to calculate how many beads equal 1mg of active drug. You can count the contents of several capsules to get an average number, then divide by the capsule dosage. (You'll have to corral hundreds of tiny beads for the counting.) Some people prefer to weigh the beads with a digital scale.

[ChessieCat]

using-a-digital-scale-to-measure-doses