Albert: preparing to get off Paxil / paroxetine for good

[ChessieCat]

I've had a discussion with the other staff and from what you say it seems that you might be stable enough to start tapering when you feel the time is right.

 

Compounding can work out very expensive so you will need to take that into consideration.  Tapering is going to take about 5 years.

 

Brassmonkey did his whole taper using the Gemini-20 scale and put the powder into gel caps.  The weighing topic has more information.  It might also possible to make a like from paroxetine tablets.  Check out Post #1 of the Tips for tapering off paroxetine (Paxil, Seroxat) topic.

 

Are you planning on the the-brassmonkey-slide-method-of-micro-tapering?

 

This method of tapering is gentler on your system and gives you more control over your taper.  Just like the 10%/4 week taper rate, noting your symptoms and holding for longer at any time (ie at any time during the 6 week reduction stage) is suggested.

 

There should be no issue with keeping the split dosing.  If you are doing the BM Slice, then reduce 10% off the evening dose for the first 6 weeks and then reduce 10% off the morning dose for the next and continue alternating the reduction pattern. 

[Altostrata]

Paroxetine comes in a prescription liquid, as explained here before:

On 8/16/2019 at 3:23 PM, Gridley said:

This link is specifically about tapering Paroxetine/Paxil:

 

Tips for tapering off Paxil (paroxetine)

 

On 8/18/2019 at 7:15 AM, Albert said:

1.  I am not a daily drinker, but usually will have 3 or 4 beers on the weekend.  Will this cause a problem while I am tapering? 

 

YES. Have you been having a beer now and then all along?

[Albert]

I checked in with a local compounding pharmacy and the cost for two tablets daily is $75 per month.  Some of which may be covered by insurance but likely not all of it.  That seems fairly reasonable, considering all things.  They would use pure Paroxetine powder.   I was going to try the BM slide but when cutting or smashing my Paroxetine tablets I have discovered that they have a coating on them that kind of prevents the entire pill from turning into a powder.  I am not opposed to a liquid, but I thought that the compounding pill may be more convenient since I am trying to work and keep my job.  If I decide to go with the compounding pharmacy, would a reduction of 10 percent every 6 or 8 weeks be recommended or start. Would 5 percent be recommended?  Will I have a major adjustment to the powder? Should I switch over to the compounding  powder without a reduction for 6-8 weeks? 

[Albert]

Well, going to hold off on taper just for a wee bit.  This past weekend a wave started and it is back full force.  Bowel dysfunction, muscle tension, twitching, fear, insomnia, brain fog, burning muscles, all of that stuff.  It is very intense, but I have noticed that it is coming a going a little quicker that it did in the past.  Just trying to keep positive.  Just not sure what I am doing wrong.  

[Sebas]

Keep good analyses of what you eat and drink. From my experience several ingredients can cause conflicts with serotonine absorption. Especially those ingredients who are well known for causing changes in serotonine levels or intestinal flora such as pumpkin, grapefruit, certain supplements, probiotics, certain herbs, caffein, alcohol, chocolate etc. Did you take anything new before weekend? Stop drinking beer during withdrawal, switch to 0%.

[Sebas]

On 3/6/2022 at 4:44 PM, Albert said:

 I am not opposed to a liquid, but I thought that the compounding pill may be more convenient since I am trying to work and keep my job

Using the liquid is not less convenient, on the contrary. How in your opinion does this influence working or keeping your job? 

[Albert]

I was thinking that the compounding pill may be easier since I am taking the medication twice per day.  That way I could carry one in my car or pocket.  However, I could be incorrect around that as I have never tried the liquid or making my own liquid.  I have tried cutting the pill and I am pretty good at weighing, but I went to fast when I tried that and it came back to bite me for sure.   I have cut out alcohol and also shaved down my diet.  Only supplements I am taking are fish oil and magnesium.  I was a little better yesterday but I am still experiencing a revolver full of symptoms that come and go from minute to minute.   Super blurry vision, cognitive impairment one minute, cold feet one minute, tight muscles, twitching, balance, nausea, head pressure, severe weakness, blunt emotions, and insomnia that includes waking at 5:00 AM.  Thank you very much for replying.  I really appreciate it.  I can use all of the help I can get right now.  Hopefully I am just in another wave and will come back out of it soon. 

[Sebas]

8 hours ago, Albert said:

I was thinking that the compounding pill may be easier since I am taking the medication twice per day. 

Dont know much about compounding. You can use paxil liquid twice a day, for example before work and after work.

 

I've had to learn ingredients of everything i consume to analyse what ingredients cause waves. Its quite a list. Certain e-numbers, certain oils, and i'm still unpleasantly surprised every know and then. Some are well hidden and sometimes you have to consult Google for more information. And then you realise 'oh now i understand why'. If you know the cause than you become less anxious about the wave, there's acceptance, cause there's a "logical explanation".

If you doubt anything feel free to ask.

[Albert]

Well, I could probably tighten up my eating for sure.  I have been holding for about 5 months trying to get better.  Just no real significant improvements to really speak of.  I am functioning but I have pretty significant cognitive impairment though.  Just when I start to feel like I can start to taper, I get another wave and feel like I should hold.   I wonder if I will even be able to balance out.  

[Albert]

On 3/17/2022 at 6:27 PM, Sebas said:

Dont know much about compounding. You can use paxil liquid twice a day, for example before work and after work.

 

I've had to learn ingredients of everything i consume to analyse what ingredients cause waves. Its quite a list. Certain e-numbers, certain oils, and i'm still unpleasantly surprised every know and then. Some are well hidden and sometimes you have to consult Google for more information. And then you realise 'oh now i understand why'. If you know the cause than you become less anxious about the wave, there's acceptance, cause there's a "logical explanation".

If you doubt anything feel free to ask.

Have you been able to balance out where you can comfortably taper?  Can you exercise? 

[Albert]

Did have improved day today and a little less brain fog

[Sebas]

In time you will balance. You know you've fully stabilised when you feel a sudden calm and more energy. Its a certain feeling that you will recognize after a few times. Then take some weeks with no changes before tapering again. Don't rush things, some taper periods can take months or even years depending on all kinds of circumstances. Exercise on a lower level, for example walking, swimming, no high intensity workouts. For example: perform some basic gym exercises at home instead of heavy lifting. This will increase mental mindset. Take it slow, just keep physical condition on a basic level. During waves take more rest. When you've improved, then you can intensify workout. Eat, drink healthy and also very basic, basic is key.

[Albert]

Thank you for the reply.  I do feel as I am starting to balance back out again.  I have these severe urges to over eat carbs and that is complicating things.  It is causing prickling as well as highs and lows.  Not to mention weigh gain.  Any advice on how to combat that?  

[Albert]

On 3/22/2022 at 5:38 PM, Sebas said:

In time you will balance. You know you've fully stabilised when you feel a sudden calm and more energy. Its a certain feeling that you will recognize after a few times. Then take some weeks with no changes before tapering again. Don't rush things, some taper periods can take months or even years depending on all kinds of circumstances. Exercise on a lower level, for example walking, swimming, no high intensity workouts. For example: perform some basic gym exercises at home instead of heavy lifting. This will increase mental mindset. Take it slow, just keep physical condition on a basic level. During waves take more rest. When you've improved, then you can intensify workout. Eat, drink healthy and also very basic, basic is key.

Yes, my work can get stressful and sometimes that does not help me either.  I can handle it at times and then at times I really struggle with it.  I am also trying to stick to a clean diet but I have massive urge to over eat carbs and sugar and then I really pay for it with symptoms.  Have u heard of that?  How do people deal with that?  

[ChessieCat]

1 hour ago, Albert said:

Yes, my work can get stressful and sometimes that does not help me either.  I can handle it at times and then at times I really struggle with it.  I am also trying to stick to a clean diet but I have massive urge to over eat carbs and sugar and then I really pay for it with symptoms.  Have u heard of that?  How do people deal with that?  

 

Stress causes the body to produce cortisol which in turn uses glucose in the blood which causes the carb cravings.  The body turns carbs in food, eg bread, pasta, potatoes and some other high carb vegetables, into glucose.

 

I started a low carb diet last October when I was diagnosed as diabetic.  After only about 1 week my cravings for carbs went and I stopped getting "hangry", hungry and having to eat immediately.

 

And after only 3 months eating a low carb diet I reversed my diabetes - a1c from 7.0 to 5.2.

[Albert]

On 3/31/2022 at 12:16 AM, ChessieCat said:

 

Stress causes the body to produce cortisol which in turn uses glucose in the blood which causes the carb cravings.  The body turns carbs in food, eg bread, pasta, potatoes and some other high carb vegetables, into glucose.

 

I started a low carb diet last October when I was diagnosed as diabetic.  After only about 1 week my cravings for carbs went and I stopped getting "hangry", hungry and having to eat immediately.

 

And after only 3 months eating a low carb diet I reversed my diabetes - a1c from 7.0 to 5.2.

So basically, changing over to a diet high in protein and good fats, and staying away from carbs and sugars will really help?   As well as trying to reduce stress or handle stress differently?  

[ChessieCat]

1 hour ago, Albert said:

So basically, changing over to a diet high in protein and good fats, and staying away from carbs and sugars will really help?   As well as trying to reduce stress or handle stress differently?  

 

It probably would not hurt to try it.  But as with most things it is generally better to do it gradually.  I started by cutting out obvious things, candy/lollies/sweets, added sugar, biscuits/cookies and cakes, and heavily processed food.  Then after a few weeks (when I learned more about lower carb foods) I cut out potatoes, pasta, rice, flour, bread.

 

I have added links to some good videos in diabetes

 

Since mid October last year I have lost 10kg (started 80kg) without really trying (ie only light exercise to strengthen my back).  My a1c went from 7.0 to 5.2, my blood pressure went down (I have had to reduce by BP medication) and my cholesterol has improved.  Yesterday I tried on a pair of trousers that I have not fitted into (around the waist) for a long time and they are fit perfectly.

[Sebas]

15 hours ago, ChessieCat said:

I started by cutting out obvious things, candy/lollies/sweets, added sugar, biscuits/cookies and cakes, and heavily processed food. 

This goes for me too. Most candies are also full of additives, like flavors and colorings, some of which (for me) don't combine well with paxil such as curcuma, pumpkin, safflower, herbal extracts etc. 

I'm taking thea biscuit when i feel a little candy-ish. I must say that candy need has dropped since my new diet. Before i was eating chocolate, icecream en lots, lots of liquorice. And indeed i've become really trained.

 

If you search google by 'paxil sugar cravings' you'll find more information. 

 

 

[Albert]

Thanks to both of you for the help.   This is really good information, I am going to drink lots of water today and start with the high sugar stuff and breads.  Maybe I can curb these extreme cravings to dive into sugar and sweets.   I am also going to try to control my stress this week a little better.  Focus on taking one thing at a time.   Thanks again.  

[Albert]

OK, I have settled down from the last big wave and I would say I am 75- 80  percent stable.   I am ready to start tapering as per the Brass Monkey Slide.   However, I am more worried about how to taper than actually tapering itself.   What I would really like to do is crush / compound my existing tablet as I am very comfortable with weighing and compounding and my system is very used to seeing this tablet. This is how I completed my Hydro taper and was able to make it off.   However, the Paroxetine tablet that I am currently taking ( have been for about 12 years ) has a coating on it that looks like it may make it very difficult to compound myself.  The coating brakes into large chunks and makes a mess of the powder solution.  The tablet it scored to indicate that it could be cut in 1/2.   I don't know how to find out if the medicine w/in the tablet is consistent enough to successfully achieve accurate doses by just shaving and weighing the tablet.  Is there any information around this ?   I worry that it would big adjustment trying to change over to the liquid and I am finally to the point where I am starting to think straight and can function semi-comfortably.  I could go to the local compounding pharmacy as they compound using the pure powder and it is not crazy expensive $75 per mo.  Or I could see if I could get my PSYC to get me a different tablet.   Any thoughts around this would be much appreciated. Thanks in advance.  

[Sebas]

I would wait until you are 95-100% stable, then wait another couple of weeks. But that is up to you. Tapering too soon might disrupt CNS when it has not completely reset. Better safe than sorry.

[ChessieCat]

On 4/23/2022 at 3:11 AM, Albert said:

However, the Paroxetine tablet that I am currently taking

 

Q:  Which company manufactures this tablet?

[ChessieCat]

Q:  Also, what type of tablets are they?  For example:  XR (extended release), CR (controlled release), (IR immediate release)

[Albert]

On 4/24/2022 at 6:16 PM, ChessieCat said:

 

Q:  Which company manufactures this tablet?

Sorry for the late reply Chessie Cat, The tablets are distributed by Solco and they are 10mg Paroxetine.  The label also says that it is manufactured by Zhejiang Huahai Pharmaceutical

Each film coated tablet contains Paroxetine hydrochloride USP

They are a beige oblong scored tablet

I get them from CVS Caremark and they are the standard release.  

[Albert]

On 4/24/2022 at 6:16 PM, ChessieCat said:

 

Q:  Which company manufactures this tablet?

 

On 4/24/2022 at 8:45 PM, ChessieCat said:

Q:  Also, what type of tablets are they?  For example:  XR (extended release), CR (controlled release), (IR immediate release)

I have been on the IR / same tablet for about 15 years now.  My Dr tried to switch me to the CR and I tired it for like a year or so before that and I did not do well with that so he switched me back.  I currently take a 10mg IR tablet every 12 hrs ( twice daily ) and I am good weighing if these can be weighed and the medicine w/in the tablet is consistent.  Thanks again 

[Albert]

On 4/24/2022 at 8:27 AM, Sebas said:

I would wait until you are 95-100% stable, then wait another couple of weeks. But that is up to you. Tapering too soon might disrupt CNS when it has not completely reset. Better safe than sorry.

Well, I am getting closer to back to normal, but I am still symptomatic.   I am still getting some twitching and I also still waking up every morning at 5:30 and not being able to sleep.  Unable to nap during the day as well.  I can tell my CSN is still on edge, but man I am 1000 times better than I was when my attempted bridge to cymbalta failed miserably !!!!   I am still living in fear of that.   Good news is that I am starting to settle in on 20mg vs the original dose of 30 that I was on.  I may wait just a little longer to see if I can get my CNS to relax a little more.  I am starting to feel some emotions again as well.  I have noticed that.  

[ChessieCat]

On 4/23/2022 at 3:11 AM, Albert said:

However, the Paroxetine tablet that I am currently taking ( have been for about 12 years ) has a coating on it that looks like it may make it very difficult to compound myself. 

 

This will depend on what the coating is made from.  You could try grinding one tablet up between 2 spoons or crushing it with something in a bowl, replicating a mortar and pestle to see how fine you can get the coating.  You might be able to grind the coating up enough and mix it well.  If this looks like it would work then you could buy a pill crusher/grinder so it would be easier to do a batch of tablets at a time. 

 

Frogie posted the link to one that she uses:

 

tania-45mg-mirtazapine-tapering

[Albert]

On 4/27/2022 at 9:13 PM, ChessieCat said:

 

This will depend on what the coating is made from.  You could try grinding one tablet up between 2 spoons or crushing it with something in a bowl, replicating a mortar and pestle to see how fine you can get the coating.  You might be able to grind the coating up enough and mix it well.  If this looks like it would work then you could buy a pill crusher/grinder so it would be easier to do a batch of tablets at a time. 

 

Frogie posted the link to one that she uses:

 

tania-45mg-mirtazapine-tapering

Well, the tablet will crush up, the coating kind of lays around in the powder and you have to try to pick it out in larger pieces.  The coating does not seem to want to crush up into powder like the rest of the pill.  I actually have a stainless mortar and pestle and that is how I was able to taper my last medication but it ground up into powder really easily and I was able to weight out the exact amount into capsule and it worked like a charm.  However, this coating might be a problem.  Do you think I would be better off trying to get the pharmacy to get me a different pill that will crush into powder ( w/out the coating ), or just cut and shave this tablet.  Is switching from one pill manufacture to another as problematic as switching to liquid or is that usually a little smoother?  Thanks

[ChessieCat]

2 hours ago, Albert said:

Do you think I would be better off trying to get the pharmacy to get me a different pill that will crush into powder

 

I would definitely be trying to find a different tablet that you can crush because this is the simplest solution to getting a consistent dose.  If you do change it would be better to do a cross over:

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

The other option is to change to liquid.  If you can get/afford Paxil brand tablets they can be made into a liquid.  The other option is to get a prescription for Paxil brand liquid.  See below for the discard information for Seroxat liquid and Paxil liquid.  It would make sense to get the Paxil liquid which will lasts longer and in the long run might possibly end up costing less.

  

On 5/27/2011 at 10:52 AM, Altostrata said:

Use Paxil liquid to taper

(NOTE:  Paxil Oral Suspension is stable until expiry date when stored correctly - see this post; Seroxat contents to be discarded 1 month after opening - see this post)

 

 

[Albert]

On 4/29/2022 at 5:45 PM, ChessieCat said:

 

I would definitely be trying to find a different tablet that you can crush because this is the simplest solution to getting a consistent dose.  If you do change it would be better to do a cross over:

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

The other option is to change to liquid.  If you can get/afford Paxil brand tablets they can be made into a liquid.  The other option is to get a prescription for Paxil brand liquid.  See below for the discard information for Seroxat liquid and Paxil liquid.  It would make sense to get the Paxil liquid which will lasts longer and in the long run might possibly end up costing less.

  

 

 

Thanks Chessie Cat, I think the local Walmart Pharmacy carries the Paroxetine tablets w/out the coating.  It is just the round white tablet that I can crush up and either compound into a capsule or make into a liquid.  Would that work the same as the Paxil tablet that is non coated?   

[ChessieCat]

9 hours ago, Albert said:

Would that work the same as the Paxil tablet that is non coated? 

 

You stated above that the tablet you take is IR.  It could just be that the inside of the tablet is crumbly so it holds it together to get it into the stomach. 

 

Generally the generics are very similar to the brand drug, it is usually only some of the non-drug ingredients that are different which might cause a slightly different delivery timing to the body which is why the cross over is suggested.

[Albert]

Sorry, I am not on the “controlled release “ version of Paroxetine, I am just on the standard immediate release version.  I am just trying to find the best way for me to taper.  My current tablet has a coating, so when I use the mortar and pastel ,the coating will not smash up and it just creates a mess.  I just confirmed with the local Walmart that they offer the Paroxetine tablets that are from a manufacturer that has no coating and can be smashed.  I could have my Dr change me over to Walmart but that would require a manufacturer change.  Or I could try that pill grinder that Froggie mentioned on Amazon and it may grind my tablet into a powder despite the coating.  If that works, could I make a liquid out of the tablet that has a film coating if I can get it to grind into a powder?  Which do you recommend, making the manufacturer change, or getting the grinder that will grind my current pill into a powder?  Thanks AJ

[ChessieCat]

If it was me I would stay with what you have been taking.  That's what I did.  During my taper generic Pristiq became available but I decided to stay with the brand because I didn't know if changing would cause an issue.

 

I think making a liquid from your current tablet would be the better option instead of weighing.

 

Making a liquid from the finely ground up tablet would give a more consistent dose.

 

Q:  Are you currently taking a whole tablet?

 

If yes, then the cross over process will be much easier.

 

[ChessieCat]

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

[Albert]

On 5/4/2022 at 9:33 PM, ChessieCat said:

If it was me I would stay with what you have been taking.  That's what I did.  During my taper generic Pristiq became available but I decided to stay with the brand because I didn't know if changing would cause an issue.

 

I think making a liquid from your current tablet would be the better option instead of weighing.

 

Making a liquid from the finely ground up tablet would give a more consistent dose.

 

Q:  Are you currently taking a whole tablet?

 

If yes, then the cross over process will be much easier.

 

Yes, I am taking the entire tablet.   

[Albert]

I will see how this grinder works when it gets here and if it will grind up this tablet I will see if it will make a liquid.