member21: tapering venlafaxine

[member21]

Advise on switching the form of AD- tablet to capsule

 

My doctor has been tapering my venlafaxine for more than one and a half year now.

 

I was taking half+1/8 (of 37.5mg) tablet. So the division used to be inaccurate. Thus on my request and my doctor's approval, two days ago I switched to  using granules from the capsule form.

 

Some days I would be able to use the original capsule-cover, and for other times I would use empty capsule available in the market (seen as red and white large capsule in the image below).

On the second day itself (when I took the medicine in the empty capsule available from the market) I experienced anxiety and restlessness.

 

Could it be due to different release characteristics of the capsule that I bought from the market.

I tried my best to properly count the total no of granules in each capsule and count for the same dose as before.

 

Any suggestions please. would it be wise to try this capsule form for some time, or should I switch back to the tablet form.

 

If I can adjust to the capsule granules, it would be easier for me to gently and accurately taper my dosage. 

 

Edited August 7, 2022 by ChessieCat
added spacing

[ChessieCat]

Hello and welcome to SA,

 

22 minutes ago, member21 said:

Could it be due to different release characteristics of the capsule that I bought from the market.

 

Yes, it could be that the dose is delivered to you body faster/slower.

 

24 minutes ago, member21 said:

would it be wise to try this capsule form for some time

 

You could try it for a few days and see if the symptoms improve.  If the same thing keeps happening than it might be better to change back to tablet.

 

If the symptoms do improve I think it would be better if you made all the capsules the same.  That is, throw out the original capsules and use all bought ones.

 

It is possible to make a liquid from tablets, but you need to split the dose and take it twice a day.

 

Tips for tapering off venlafaxine (Effexor)

 

  

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

immediate-release tablet and make a liquid from it to finish the taper, taking doses at least twice a day.

 

 

 

 

[Altostrata]

Hello, @member21

 

You also need to verify that the drug in the capsule is genuine by talking to a pharmacist. 

 

It's unlikely that an empty gelatin capsule or vegetarian gelatin capsule would cause a reaction.

[member21]

On 10/23/2022 at 12:44 PM, Altostrata said:

If I were you, I would not stay up late, go to bed at the same time each night. 

 

Are you getting gentle regular daily exercise? Sleep and exercise are healing. The waves should very gradually diminish.

 

Do you get any symptoms every day at the same time?

 

 

My job demands rotational shift duty. 2 morning- 2 afternoons, 2 nights, 2 offs.

so if I have to accept that duty...would that make my withdrawal miserable.

[Altostrata]

If withdrawal symptoms from tapering disrupt your sleep, your irregular schedule may become very difficult.

[member21]

My venlafaxine withdrawal was going ok till about 10 days ago. But now anxiety and restlessness were getting intolerable so I visited my doctor today. 
I told him that the capsules I was preparing by counting the beads may be causing the fluctuations...since my symptoms have been around since I switched from tablet to capsules. My doubt was on the quality of empty capsules...but my doctor said that such repackaging is not reliable so cannot be continued.

Therefore to facilitate tapering he switched from venlafaxine to fluoxetine suspension.

Now I am apprehensive about this change...

[member21]

Any guidance please 

[FindRest]

I would not switch to fluoxetine until a moderator here has gotten back with you.

 

One reason your switch from a divided/cut tablet to a capsule (beads) may have been giving you trouble could be the fact that cutting a tablet makes it instant release.  This requires you to take half your dose twice a day in order to get 24/hr coverage due to venlafaxine’s short half life.  Did your doctor have you take your cut tablet twice a day or just once?
 

If you were taking the cut tablet just once a day, switching to the capsules (extended release), was a big change that your body wasn’t used to.

 

I think your dr’s comment about counting beads/repackaging just reflects how little they know about tapering. 
 

What does the packaging of your extra capsules (red/white) say on it?  What type are they (ie. gelatin)? Unless they are some extended release type of capsule (which I doubt), seems to me it wouldn’t make much difference. I’ve used various different ones and haven’t had a problem.

Edited October 28, 2022 by FindRest

[member21]

I also feel that I have read on surv. ADs against switching medicine.

I was taking the cut tablet only once a day.

I thought switching from Cut tablet to XR should have been easier on the body, instead of being tough.

I also believe that the doctor's comments are inappropriate. Though he is highly qualified and a very good person but in addition to the training he has, is also low on experience. In the past also he has recommended me faster taper etc.

The red/white capsules that I was using must be gelatin ones. I buy them loose from a local chemist. But was thinking of buying similar looking one from amazon...which are advertised at Gelatin capsules.

The capsules that I pack sometimes appear to be not so water-tight as the ones that come in original drug packing (generally due to bends etc).

So according to my doctor they would be spoiled by the acidity of the stomach. According to him the original ones are somehow sealed, which cannot be done manually.

Today I was thinking...is it the medicine that gets spoiled in the stomach acidity, or the XR mechanism. If it is the XR, I can take them twice a day.

Due to the doubt over the local capsule quality, I was still using both the original capsule casings(3 days) and local ones(2 days).

[ChessieCat]

See Post #1 of this topic:

 

the-prozac-switch-or-bridging-with-fluoxetine

 

Q:  Do you have brand name Effexor with the tiny beads?  Many members here at SA are or have managed to taper using those.

 

See Post #1 of this topic which provides information about how to get non standard doses:

 

Tips for tapering off venlafaxine (Effexor)

[member21]

Due to the sick feeling, I have increased my venlafax. from 0.6 of 37.5mg tab to 0.625 (22.5mg to 23.5mg approx). I have taken 2 increased doses. What dosage is recommended so that I can get out of this. Do I increase it to 0.7 (26.5mg) / 0.75 (28.125mg) / or higher/other. Or should wait for a few days. Though I have been feeling slightly better since yesterday evening (could just be psychology, or the wavy state)...still the internal feeling that things may get out of control are there.

When I switched from tab to capsule on Aug 05, I kept experiencing some anxiety...waking up early morning etc. Then as about 20 days had passed, and for the ease of division I decreased the dose from 23.5 to 22.5mg (now the capsule beads could be conveniently divided into 60%-40%). Thought that it is a very small change, so should not be a problem. Upto about 15 days ago, I used to feel mild anxiety, restlessness for 2/3/4 then better for a few days. Even had good mood days in between. In my taper from jan 22 onwards also, I many times felt that the situation is going out of control, but would recover in 4-5 days max. But this time it has continued longer, and 23, 26, 27 oct felt a lot more bad (almost as anxious-restless as when things go out of hand...and you cannot go to work, or even pass time)

I want to be safer than faster...and keep functional at work. 

[member21]

The brand name on my capsule is Venlor XR 37.5

 

[Altostrata]

On 10/28/2022 at 2:41 AM, member21 said:

When I switched from tab to capsule on Aug 05, I kept experiencing some anxiety...waking up early morning etc. Then as about 20 days had passed, and for the ease of division I decreased the dose from 23.5 to 22.5mg (now the capsule beads could be conveniently divided into 60%-40%). Thought that it is a very small change, so should not be a problem. Upto about 15 days ago, I used to feel mild anxiety, restlessness for 2/3/4 then better for a few days. Even had good mood days in between. In my taper from jan 22 onwards also, I many times felt that the situation is going out of control, but would recover in 4-5 days max. But this time it has continued longer, and 23, 26, 27 oct felt a lot more bad (almost as anxious-restless as when things go out of hand...and you cannot go to work, or even pass time)

 

We advise people not to taper until they have been stable for a while. You became unstable when you made the switch from tablet to capsule. Then you made a dosage reduction from 23.5 to 22.5mg that probably was premature, and you became unstable again.

 

It took you several days to recover from reductions up to the reduction you made most recently. What was your last reduction?

[member21]

For four days I took 23.5mg (inc from 22.5) venlafaxine. Though my anxiety/restlessness felt better than earlier, still on the 4th day I felt as if I may slip into crisis. So today I further increased my dose to 25.3mg (5th day onwards).

It has further controlled my symptoms but felt mild nausea, sleepiness.

Have I updosed too much. But I am too afraid of the low feelings...they may force me to be bed ridden.

 

[Altostrata]

It may take you a few days to get used to the updose.

[member21]

I was doubting...do these side effects indicate that a lower up-dose was sufficient. Also once I felt so in first 1-2 days, would it have been wise to roll back slightly.

However yesterday after 2 days at 25.3mg (venlor) I could go to sleep a little late...and in the morning wanted to keep lying for an hour or more. Since then today I am again experiencing some anxiety, fear of future, low on hope, courage etc. 

[Altostrata]

You may feel some bumps for a while. Read The Windows and Waves Pattern of Stabilization

 

In my opinion, it's too early to decide to increase the dose, you changed it less than a week ago.

 

[member21]

Now I have taken 15 doses of 25.3mg venlor. Started feeling better...but its fluctuating. Feel mild anxiety, restlessness, overwhelm...its settling-off.

 

Although I was desperate to get back my functionality and was full of fear that the symptoms may not go away after the up dose, still wondered - could I have contained the increase to 24.5 mg only. This was because I experienced side effects like nausea, heaviness in the head, dry mouth, some dizziness.

Now the side effects have subsided, and the symptoms are also managable.

 

I had read Peter Breggin's book - "Psychiatric Drug Withdrawl". From reading that book I felt that tapering slowly should only bring up some discomfort for a few days and the process would be much easier.

 

I have small children. So I need to maintain my job all through. Also I think at my place, and in my industry, it is very difficult to get another job if you are laid off in your 40s. 

Thus my goal is to taper only as much and at a rate that my basic functionality is intact. The possibility of up-dose/reinstatement not working gives me immense fear. During the past 3 weeks I kept worrying about it.

 

Request guidance.

[member21]

I have taken 25.3mg Venlafax for more than 3 weeks now.

Last Friday I felt very elated and there were no symptoms. I thought may be now I am out of WD and this state would prevail most of the time.

Saturday  was fine till afternoon...then felt some anxiety, restlessness, not feeling like doing anything...and even flu like symptoms. 

Sunday again quite bad most of the time...then calm later in the day.

Monday- felt fine except mild symptoms a couple of hours in the day. In the evening had some triggers (quarrel with the neighbours, children health prob)

Tues (yesterday)-was having off-on anxiety in the day and I thought that these days I am having 1-4 intensity symptoms which should fade off, or could be managed. But in the evening realised that the intensity also going to 6, or even sometimes 8.

Again today feel that the symptoms tend to cross the intensity level 4.

So is this the time to up the dose now...or may be in a week - on having completed a month. Else how long can I test the current dose.

[member21]

Recently I have not been able to get guidance. Now it is getting unmanageable.

Since yesterday Evening the symptoms are getting intolerable. I cannot say what it is...feels like restlessness mainly, vomitting feeling, some weeping tendency, overwhelm etc. Feels as if heading towards a crash. Felt similar in oct end...when I had increased venlafax by 1mg + 2mg.

So I feel it would be right to up dose from my next dose (tomorrow morning).

Now the question is...how much increase is necessary...1mg..2mg or more. Also should it be a repeated inc over weeks...upto what value.

last 2mg inc felt like a bit too much-bringing up side effects. Those side effects had eased over 10 days. And for once it felt that I would not need to increase the dose further.

Request prompt guidance.

[FindRest]

Quote

 

Last Friday I felt very elated and there were no symptoms. I thought may be now I am out of WD and this state would prevail most of the time.

Saturday  was fine till afternoon...then felt some anxiety, restlessness, not feeling like doing anything...and even flu like symptoms. 

Sunday again quite bad most of the time...then calm later in the day.

Monday- felt fine except mild symptoms a couple of hours in the day.

 

 

It’s a good sign that you’ve had some good days mixed in there.

 

Quote

Since yesterday Evening the symptoms are getting intolerable. I cannot say what it is...feels like restlessness mainly, vomitting feeling, some weeping tendency, overwhelm etc. Feels as if heading towards a crash.

 

Did you, by chance, drink alcohol or consume any other substance? Might also think about what you ate, whether you exercised too much, were under more stress, or any of those type of things. They can all increase WD symptoms.

Much of what you describe is consistent with the windows and waves pattern of WD symptoms. 
https://www.survivingantidepressants.org/topic/82-the-windows-and-waves-pattern-of-stabilization/

 

Are all of the medications and supplements you are taking listed in your signature? Are you taking everything at the same time every day?

 

How are you arriving at your Venlafaxine dose (counting beads consumed vs removing a certain number of beads from the capsule vs weighing)?

Edited November 25, 2022 by FindRest

[member21]

Dear FindRest thank you very much for your reply. Yes I was under more stress - a. quarrel with the neighbours b. children's emotional health.

I do not take alcohol etc. But...each time I posted in the forum in the last few day - I forgot to mention that I had recently started taking ayurvedic medicine for Hernia. while I started this medicine, I totally forgot the suggestion to refrain from adding anything...atleast when the state is not so good. Otherwise I could have waited a few weeks for the mood to get more stable.

I took the ayurv. med twice a day for two days(started on last Wednesday only), then it came to my mind that it could be making a difference. So against prescription, I reduced it to once a day (although I was feeling very good on that day - last Friday).

 

To me it didn't feel like the windows and withdrawal pattern. The situation which was improving since my up-dose 3-4 weeks ago, started getting worse all of a sudden.

 

I count the total no. of beads in the capsule and take a fixed percentage out of it. try to evenly divide the bigger and smaller beads.

 

I am now adding the supplements in my signatures.

Yes I take the medicines at the same time each day. Only on Sundays/holidays time of morning dose (Venlafaxine) gets about 3hrs late.

I was taking the ayurvedic medicine about 90min after the venlafaxine. Today I thought I would take it after lunch so that it is six hours from each of my psychomed. Since my hernia symptoms were increasing so I am reluctant to totally stop the ayur med right away. But request suggestions.

[FindRest]

12 hours ago, member21 said:

Yes I was under more stress

One thing I and others have found is that stress affects our WD’s very easily. Seems like we now are much more susceptible to the side-effects of stress, including physical and emotional stress.

 

12 hours ago, member21 said:

I forgot to mention that I had recently started taking ayurvedic medicine for Hernia.

What ingredients are in this medicine? 
 

12 hours ago, member21 said:

The situation which was improving since my up-dose 3-4 weeks ago, started getting worse all of a sudden.

When symptoms worsen suddenly after a period of steady improvement, it’s often a sign that some change (diet, stress, new/diff medication, supplement, etc.) precipitated it.

 

12 hours ago, member21 said:

I count the total no. of beads in the capsule and take a fixed percentage out of it. try to evenly divide the bigger and smaller beads.

I and others find it much easier to take an average of the number of beads in 3-5 capsules, and use that as a basis for computing our dose. In other words, let’s say I add up the number of beads in 4 separate capsule, divide them by 4, and the result is 130 beads. I then use 130 to calculate the number of beads in my dose for all of my doses for the next month, rather than counting the beads in each capsule separately. This saves a lot of time and I believe it is also more accurate. Pharmaceutical companies are allowed to vary the dose in each capsule by a pre-set margin. I believe that by making sure every capsule I take has the exact same number of beads in it, I’m actually consuming a more-consistent dose than if I took what the company sold us. I can explain this better if you need me to.
 

Good idea on taking some of each size. Many people have no problems with taking random sizes, but Ive personally found that with a super sensitive cns, I feel better now that I sort my beads by size. I divide mine in 4 sizes and try to take a certain amount of each. My original capsules (Effexor name-brand), have only a few large beads in each with many medium and small, so I try to replicate that ratio and take a few large + more mediums and smalls.

 

12 hours ago, member21 said:

Yes I take the medicines at the same time each day. Only on Sundays/holidays time of morning dose (Venlafaxine) gets about 3hrs late.

Ouch! 3 hours late would definitely increase my symptoms which then worsen for a few days more. I set my alarm and take mine at the same time every day, regardless of holiday or work schedule. This has really helped with stabilizing my symptoms.

 

I hope some of these suggestions help you. Please let us know the ingredients in your ayur medicine. I’m thinking it could very well be causing problems. 

Edited November 25, 2022 by FindRest

[Altostrata]

@member21 Please take your drugs at a consistent time every day. Going off-schedule causes variation in your symptom pattern.

 

It appears the updose is working. We cannot tell what an ideal dosage for you might be. There may not be an ideal dosage. Generally, we advise people to leave well enough alone and let their nervous systems make the repairs. 

 

Fluctuations in symptom pattern may continue for a while, see The Windows and Waves Pattern of Stabilization

 

[member21]

Dear FR

 

I am taking 2 ayurvedic pills:

1. Kanchanar guggulu - may have potential antibacterial, antiviral, and anti-inflammatory properties which may make it an effective remedy for lymph node swellings.

2. Govradig/Godradig -(what I could read from the prescribers writing) cannot find it on google. so do not know what it is.

 

Your suggestion to take average of the no. of beads in 4-5 capsules would be more accurate...but I feel that it would be a lot more work. So for the time I want to continue counting the beads of one capsule and dividing. also I have observed that capsules from the same strip of 10 have approx the same no. beads.

 

I would now on take the medicine at the same time even on holidays/sundays. Thanks for pointing out...should be very helpful.

 

Regards

 

 

[Altostrata]

How are you doing now, @member21

[member21]

Dear Alto I am very thankful for your concern and time.

After the last up-dose on Nov 25 I was doing pretty fine, and was hoping that the symptoms will now be gone and would be able to start further taper in a few months. But yesterday my father broke his bone and was operated upon. That incident has again changed my condition. Today am again experiencing anxiety, and maybe some Akathisia also.

This is very difficult as like this there is no limit to how much we have to go on up-dosing, and seems to be an endless process.

I shall write more later. Thanks

[Altostrata]

@member21 sudden illness of a family member might cause anyone to have surges of anxiety. This is normal. I encourage you to stop thinking of controlling normal emotions with psychiatric drugs.

[member21]

Hello

I last up dosed on 25th Nov 22. Since then about 4 weeks have passed. I was doing ok. Some days feeling fine, and other days felt unsure - whether it would improve, or get worse. In general it varied between mild and very mild anxiety, restlessness and overwhelm (having to do anything appears too difficult, and want to lie down). I thought as the days are passing I am moving into safer zone.

But today I felt much more anxious...and I think there hasn't been any trigger. Only thing that comes to my mind is that for the last 3-4 days I had increased my ayurvedic medicine (for hernia) from once a day to twice a day. I have again reduced it to once a day. From the experience that I have had so far, I feel that the situation is soon going to get worse...beyond what I can manage (with job and family responsibilities, and also my ability to bear/negotiate).

 

I was thinking that in the last few months I have experienced the same cycle - things getting unmanageable in about 4 weeks after the last up dose. So is this because the up doses have been too small? Had I incorporated a higher up dose the last time, would it have arrested this downward curve?

So if I have to further increase my dose...what increment would be suggested....2mg (venlafaxine) or more? Please guide.

[Altostrata]

We cannot answer to the possible effects of the increase of other medication.

[member21]

Sorry, I do not seek answer to side effect of other medication.

 

I paste my earlier question again:

"I was thinking that in the last few months I have experienced the same cycle - things getting unmanageable in about 4 weeks after the last up dose. So is this because the up doses have been too small? Had I incorporated a higher up dose the last time, would it have arrested this downward curve?

So if I have to further increase my dose...what increment would be suggested....2mg (venlafaxine) or more? Please guide."

 

If I can get guidance on the above. Or any universal thread which talks about the above.

[Altostrata]

If you are adjusting the dosage of a psychiatric drug and changing doses of other drugs at the same time, we cannot tell you the cause of symptom variations.

[member21]

On 11/26/2022 at 2:29 AM, FindRest said:

I and others find it much easier to take an average of the number of beads in 3-5 capsules, and use that as a basis for computing our dose. In other words, let’s say I add up the number of beads in 4 separate capsule, divide them by 4, and the result is 130 beads. I then use 130 to calculate the number of beads in my dose for all of my doses for the next month, rather than counting the beads in each capsule separately. This saves a lot of time and I believe it is also more accurate. Pharmaceutical companies are allowed to vary the dose in each capsule by a pre-set margin. I believe that by making sure every capsule I take has the exact same number of beads in it, I’m actually consuming a more-consistent dose than if I took what the company sold us. I can explain this better if you need me to.

 

I am not sure that keeping the total no. of beads fixed would give a more constant doze. As the bead sizes are variable...in my opinion this will cause more fluctuation.

I think taking a constant weight of the beads may give better result.

Can someone please suggest what would be the average weight of the beads from a venlafaxine 37.5mg capsule.

The weighing balances available to me claim to be accurate upto 0.006 gm. I was wondering how accurate they would actually be. Would such a balance be useful for accurately weighing small doses.

[Altostrata]

You need to count and weigh the beads yourself. Please read this Tips for tapering off venlafaxine (Effexor)

[FindRest]

23 hours ago, member21 said:

 

I am not sure that keeping the total no. of beads fixed would give a more constant doze. As the bead sizes are variable...in my opinion this will cause more fluctuation.

I think taking a constant weight of the beads may give better result.

 

Note that in the next paragraph I state the following:

 

On 11/25/2022 at 2:59 PM, FindRest said:

Many people have no problems with taking random sizes, but Ive personally found that with a super sensitive cns, I feel better now that I sort my beads by size. I divide mine in 4 sizes and try to take a certain amount of each. My original capsules (Effexor name-brand), have only a few large beads in each with many medium and small, so I try to replicate that ratio and take a few large + more mediums and smalls

I not only count the beads, but I sort them and take a certain ratio of the 4 different sizes in each capsule. I then weigh them. Most people don’t have to go through all of these steps, however. I do it out of caution and because my symptoms after my CT were so intense. My body took a long time to stabilize after the CT. After doing a lot of research, I was convinced that the size of bead determines its time-release. I wanted to make sure that I was covered all 24 hours of the day. With my dose being so low, it seemed like I had less room for error. If I was on a higher dose, I’m not sure I would be going through all of these steps. Most people tapering Effexor do ok tapering either by counting beads or weighing, or even a combination of both methods.
 

23 hours ago, member21 said:

Can someone please suggest what would be the average weight of the beads from a venlafaxine 37.5mg capsule

Only you can determine the average weight of your beads. It’s too variable to compare to someone else’s. 
 

There are a couple of links in the link Alto posted above that will help you determine if your scale is appropriate (looks like it is to me) and how to use it. One of them is: 

 

https://www.survivingantidepressants.org/topic/1596-using-a-scale-to-weigh-and-measure-doses/

 

There are no perfect ways to taper Effexor/Venlafaxine. We can only do our best with what we have to work with. What works best for one person may not work as well for another. Eventually, you’ll figure out what works best for you.

Edited January 12, 2023 by FindRest

[member21]

Dear Findrest

Thank you very much for your detailed reply.

I would need some time to go through the articles in detail. I understand that I have to weigh and count the beads for myself...I just wanted an idea - what would be the ORDER of weight of 1mg, 2mg, 5mg of active ingredient. (would it be 1/100 of gm, 5/1000 etc.)...just to have an idea how comfortable/reliable it would be to use the weighing scales that are available with an accuracy of 0.006gm.