Ansh: Tapering desvenaflaxine mirtazapine lamotrigine

[Ansh]

Iam on following meds for 10 years 

Lamotrigine 25 day 50 night 

Devenaflaxine 25 day 50 night

Mirtazapine 15 mg

How should i begin tapering 

Which drug first 

And can all three be reduced simultaneously 

Edited June 17, 2021 by Gridley

[Gridley]

Welcome to SA, Ansh.  

 

To start:

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  You can use the information in your post but please include the dates (approximate its fine) you started each.

 

Account Settings – Create or Edit a signature.

 

We recommend tapering only one drug at a time.  Otherwise, if problems arise you won't know the cause.  We recommend tapering the most activating (stimulating) drug first, leaving the more sedating drugs in place to preserve sleep and be tapered later.  Mirtazapine and and Lamotrigine generally are sedating drugs.  SNRI's like desvenlafaxine are more stimulating.  Thus, unless one of the drugs is causing you problems, you should taper the Desvenlafaxine first.

 

Taking multiple psych drugs? Which drug to taper first?

 

The following link is specifically about tapering Desvenlafaxine.

 

Tips for tapering off desvenlafaxine (Pristiq)

 

We recommend tapering by no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The link above about tapering Desvenlafaxine contains specific information about how to get the non-standard doses needed for a 10% taper.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems. Get supplements that are single ingredient (not mixed with other types of supplements).

 

This is your Introduction topic, where you can complete your drug signature, ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

[Ansh]

Iam taking 25 mg .devenaflaxine twice a day can i cut the 25 into 2 

 

Can anyon3 suggest a  reliablecompounding pharmacy which can compound dosagea of devenaflaxine especially in India

 

 

 

[ChessieCat]

PM question from Ansh:

 

Quote

can u name your compounding pharmacy which compounded the doses and iam not ae to find one in india

 

I am in Australia.  I did a search for compounding pharmacies in India and was not able to find any.  You could try doing that search yourself.  If you cannot find it by searching online you could ask your local pharmacy if they know of any compounding pharmacists.

 

If you are not able to find a chemist to compound the tablets for you, then you might need to find another way to get your dose.

 

You can crush the tablets very finely, between two spoons or buy a tablet grinder (Amazon) and then weigh them.  For both compounded tablets and crushed/weighed tablets you need to take your dose 2 times a day because they become immediate release and only last about 11 hours.  Taking a split dose will help to stop interdose withdrawal.

 

Here is the topic which gives information about weighing doses:

 

using-a-scale-to-weigh-and-measure-doses

 

Many SA members use the Gemini-20 scale which can be bought online from Amazon.  I do not know what you are able to access to buy online.

[Ansh]

Thanks a

But instead of crushing tablet can split 25mg into 2 pieces by pill cutter 

If i do so how much pieces i have to consume at a time i take 25 mg one in morning one in night so how to do that

[ChessieCat]

Pristiq tablets are very difficult to cut in half evenly.  So even if you cut them, which is okay to do, you would still have to weigh them to make sure that you are getting a consistent dose.  Taking different doses each day is not good.

[Ansh]

Chessie 

 

The compounded doses u rook of pristiq was in liquid form or solid

 

How did u convince ur phyciatrist to get compounding prescription 

Whats the name of the compounding 

Can u do me A FAVOR 

can u get the doses compounded from your pharmacy and PERSONALLY me to INDIA  i will bear all the courier charges and other plz 

 

This is best option plz help 

[ChessieCat]

I am in Australia and cannot help you get compounded Pristiq.

 

I do not know what you are able to buy online or how much money you can afford to spend so I will list some options.

 

If you can buy a scale than you could crush your tablets and weigh some of the powder and take the powder or you could mixs the powder in water to measure with a syringe.

 

That is the best suggestion that I can give you.

 

You can buy a scale from the Indian Amazon.  I do not know how much the postage would cost. 

 

The Gemini-20 scale weighs 0.001g

 

https://www.amazon.in/Smart-Weigh-Precision-Milligram-Weighing

 

If this type of scale is too expensive for you to buy, then you could buy a scale that weighs 0.01g like the following which are much cheaper:

 

https://www.amazon.in/Pocket-Scale-Digital-Jewellery-Weighing

 

https://www.amazon.in/Jewellery-Weighing-Calibration-Capacity-Operational

 

https://www.amazon.in/Accuracy-Digital-Pocket-Weighing-Scale

[Ansh]

Can u do one think can you demonstrate how to crush tablet then weight through syringe whole process via video on skype or something just for once to me or my sisster plzz 

 

Plz do atleast this 

[ChessieCat]

If you have a pill cutter you could cut a whole tablet into pieces with the pill cutter and crush all of the the pieces of one tablet between 2 spoons over a piece of paper.

 

If you cannot find the information to help you in the topics linked below search on YouTube.  Search with this term:  liquid taper instructions

 

You will need to divide your dose into two and take it 2 times a day otherwise you might experience interdose withdrawal.

 

There are some videos in this topic:

 

using-a-scale-to-weigh-and-measure-doses

 

how-to-make-a-liquid-from-tablets-or-capsules

 

using-an-oral-syringe-and-other-tapering-techniques

[Ansh]

Iam taking 25 mg devenaflaxine one in night and one in morning 

And mirtazapine 7.5 in night 

I reduced to 3.75 but facing issues

So i want to taper devenaflaxine as suggested but which dose of devenaflaxine should i taper first and how if cut.night dose how take dosages plz tell 

[ChessieCat]

Q:  Did you reduce your mirtazapine from 7.5mg to 3.75mg in one go, meaning that you did not take for example 5mg?

 

Please create your drug signature as requested in June last year.  We need to be able to see your drug history at a glance.  Thank you.

 

On 6/18/2021 at 5:00 AM, Gridley said:

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  You can use the information in your post but please include the dates (approximate its fine) you started each.

 

Account Settings – Create or Edit a signature.

 

[Ansh]

Done the signature 

 

Yes in one go

 

Shall i taper devenaflaxine first if yes then which dose 25 in morning or night

 

If night then if i split it how many doses of devenaaxine plz tell @Altostrataand @ChessieCat

[ChessieCat]

1 hour ago, Ansh said:

And mirtazapine 7.5 in night 

I reduced to 3.75 but facing issues

 

You have made a 50% reduction this month.  SA recommends tapering by no more than 10% of the current dose with a hold of at least 4 weeks to allow the brain to adapt to not getting as much of the drug.  Gridley gave you the link for that information in June last year.  See below:

 

On 6/18/2021 at 5:00 AM, Gridley said:

We recommend tapering by no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

 

 

 

5 minutes ago, Ansh said:

Shall i taper devenaflaxine first if yes then which dose 25 in morning or night

 

1 hour ago, Ansh said:

And mirtazapine 7.5 in night 

I reduced to 3.75 but facing issues

 

As stated above you have only just recently reduced the mirtazapine by 50% and you also state that you are having issues.  These issues are withdrawal symptoms from reducing the mirtazapine too quickly.  You are not ready to start tapering the desvenlafaxine yet.  If your current symptoms are bad then you might consider increasing your mirtazapine dose to 5mg.  Even if you do not increase the mirtazapine it would be better to wait until you are stable before making another decrease of any drug.

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

See:

 

Stability

 

WDnormal

 

And Brassmonkey talks more about it here:

 

tao-of-the-brassmonkey

 

SA provided you with the information of how to get off your drugs carefully when you joined the site 8 months ago but you have decided to taper quickly.  It is your decision about how quickly you go off your drugs.  We cannot make you follow SA's suggestions, but if you decide to go faster than what SA suggests then we are not going to be able to help you.  The staff of SA is small and are unpaid peers who give freely of their time to help members to get of their drugs carefully.  We do not have the time to spend trying to help members who choose not to follow SA's suggestions.  There are many other members who choose to follow the suggestions of SA and the staff prefer to spend their valuable time helping those members.

 

Please read this topic:

 

Why taper by 10% of my dosage?

 

[Ansh]

Issues facing is only taking time to fall asleep shall i 

do one thing reinstate mirtazapine to 7.5 mg snd then start devenaflaxine tapering if u start after few days devenaflaxine tapering which dose if devenaflaxine 25 mg morning or evening and if i cut tablet 25 then how many doses without cuttind devenaflaxine 25 mg its hf life js how much

[Ansh]

I reduced 50 % bcz how i cant get mirtazapine compounded  so  very sorry 

[ChessieCat]

2 minutes ago, Ansh said:

I reduced 50 % bcz how i cant get mirtazapine compounded  so  very sorry 

 

You didn't ask.  See Post #1 of this topic:

 

Tips for tapering off mirtazapine (Remeron)

 

This topic has links to various important topics on SA:

 

 

[Ansh]

Okay just tell me as perguidline shall i start taoering devenaflaxine kerping mirinite 7.5 

Snd if yes then which doses of devenaaxine25  should i taper first  morning or night if i cut the pill how many total doses plz tell ism really sorry and need guidance 

 

 

 

 

 

[Ansh]

Kindly guide @Altostrataand @ChessieCat

[Ansh]

Can u plz guide @ChessieCat  i will follow exact suggestions by you iam not able to find guidance 

[Blossom71]

5 hours ago, ChessieCat said:

As stated above you have only just recently reduced the mirtazapine by 50% and you also state that you are having issues.  These issues are withdrawal symptoms from reducing the mirtazapine too quickly.  You are not ready to start tapering the desvenlafaxine yet.  If your current symptoms are bad then you might consider increasing your mirtazapine dose to 5mg.  Even if you do not increase the mirtazapine it would be better to wait until you are stable before making another decrease of any drug.

 

Hi @Ansh

 

Did you see what ChessieCat wrote a few posts ago?

 

[Ansh]

Okay  thanks 

 

[Altostrata]

@Ansh do you know of a compounding pharmacy who can make custom doses for you? Most likely, they would make capsules.

[Ansh]

Hi thanks @Altostrata for replying i looked everywhere in INIDA there is no such compounding pharmacy 

 

Can u get the doses conpounde in your country and send it to INDIA i will pay all charges thats best way i could taper

 

Iam currently on 25 mg devenaflaxine both in morning and night

 And mirtazapine 5 mg in night and stable

 

Now which drug should i first taper iam thinking of tapering devenaflaxine 25 mg night 

 

In case i do that i will have to cut 25 mg into 2 piece then how many doses of devenaaxine should i take can u plz help with this taper schedule

 

And help to send compounded doses

 

 

 

[Altostrata]

Did you read Tips for tapering off desvenlafaxine (Pristiq)?

 

Another option is to substitute venlafaxine, a close sibling drug, and taper that.

 

I cannot help you find a compounding pharmacy in the US. This may be a compounding pharmacy in India.

 

 

[Ansh]

I contacted them they dont do it

 

I read the tips

Can u suggest how to further taper like 25 mg devenaflaxine i take in morning as well as night and mirtazapine 5 u  night so

 

How should i go tapering first mirtazapine or devenaflaxine  and which which dose of devenaflaxine first night one or morning one if cut the night dose in 2 how many doses in a day can u suugest proper taper schedule

 

 

[Ansh]

Iam thinking cutting the night dose of devenaflaxine 25 mg 

Into 2 peace along with 5 mg mirtazapine 

 

And continue 25 mg in morning is it right or how to do 

[Altostrata]

@Ansh, you need to read the links the staff gives you.

[Ansh]

I have read it but still if you could  suggest a schedule  and guidewould be more helpful since iam.taking 2 doses of devenaflaxine and its quite hard to taper 

[Altostrata]

That is correct, desvenlafaxine is hard to taper. That is why we explain the different ways you can do it so carefully.

 

On 2/21/2022 at 10:50 PM, Altostrata said:

Another option is to substitute venlafaxine, a close sibling drug, and taper that.

 

Venlafaxine is very, very commonly prescribed and easy to get.

[Ansh]

Okay but shall i cut devenaflaxine 25 mg night in 2 piece and take is it good idea or what u suggest since i take 25 mg two times in.morning and night can u suggets a schedule 

[Ansh]

@Altostrata @ChessieCat as per your instructions he reinstated 3.5 to 7 mg mirtazapine all was fine till 2 months  one find day i started experiencing extremely anxiety and palpitation so saw doctor he added two more drig a benzo cloba and petril  beta what this made  situation more worse should i take additional drug its making more miserable is doctor right are these withdrawl systems then how to combat withdrawl issues without adding new drugsplz

[Shep]

@AnshI would not add in more drugs. 

 

For ways of coping without drugs, please see:

 

Non-drug techniques to cope with emotional symptoms

 

Tips to help sleep: so many of us have that awful withdrawal insomnia

 

Are you taking any supplements? We don't recommend a lot of supplements, as many members report their nervous systems are simply too fragile to handle them. However, magnesium and fish oil tend to be calming to the nervous system and many people report they do help. Please only add in one supplement at a time and at a small dose to see if your nervous system can tolerate it. For more, please see:

 

 King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

 

What time(s) of the day are you taking your drugs? Please list the time(s), the drug names, and the doses.

[Ansh]

@Altostrata @ChessieCat at least dont leave me in middle like this 

 

I came.to.forum with faith kindly read my chat on april 22 help me sail out it

 

Reading it kindly tell its withdrawl or relapse or doctors call relapase qnd recommend increasing dose of all medications lamtec pristiq mirtazapine they  already increased mirtazapine dose to 15 and add two more  medications one benzo cloba plz iam getting misguided plz help in name of god what should i do in such case 🙏 

 

 

 

 

 

 

 

[Ansh]

@Altostrata  @ChessieCat kindly guide me plz for god sake 

[Shep]

@AnshPlease see my earlier post and answer the question - What time(s) of the day are you taking your drugs? Please list the time(s), the drug names, and the doses.