Mattie: tapering off Pristiq

[Mattie]

@ChessieCat, I took it twice but my stomach was hurting days before taking it , I took 100 mg , it starts hurting after my morning meds and starts going away around 4. Thankfully I can eat my evening meal without too much discomfort 

[Altostrata]

@Mattie, we've talked about this stomach pain before, but you said it was a startup effect. It doesn't appear to be a startup effect. Suggest you take Pristiq with food to avoid upsetting your stomach.

[Mattie]

@Altostrata, I do eat before taking it. Today it wasn’t nearly as bad as the last few days so hopefully it will start subsiding 

[Mattie]

It’s 17 days total since split dose, day 10 (12hrs apart) not seeing much improvement, still very depressed, getting my nightly windows again but days are no better, is it still early in this adjustment? Also I will call my pharmacy to see if they put different fillers in this batch because my stomach is still upset, some days worse than others, I think I will switch to another compounding pharmacy (I spoke to their pharmacist and she seemed very informative and was kind and patient with me (I actually called 3 times in a row because I kept forgetting things I wanted answered) and she was very patient with me) she also said she could compound to any amount which eased my mind. They also a member of PCCA. My current pharmacy purchase from them but is not a member. Does this sound like a good idea? I’m so desperate 😞thanks for y’all continued support 

[ChessieCat]

8 hours ago, Mattie said:

getting my nightly windows again

 

This is a good sign.

 

8 hours ago, Mattie said:

They also a member of PCCA. My current pharmacy purchase from them but is not a member.

 

I think it would be better to use the PCCA member pharmacy.

[Mattie]

Thanks for your response, I’ll call as soon as I get to the end of this bottle unless they can refill sooner, not sure if you have to be closer to the end of bottle or not, I have close to 2 weeks of meds left 

[Mattie]

Had a better day today, still ruff but definitely better than usual, when I woke up I felt horrible but when my morning meds kicked in I started getting relief and earlier windows, my depression was more tolerable and was able to practice mindfulness more. Hopefully I’ll continue to improve, night 11 split dose 12 hrs apart 

[Mattie]

Day before yesterday was hopeful,yesterday was horrible, no windows, depression so intense, is this normal? Will I ever stabilize? Ever since I titrated from 10 mg Prozac slowly to 4.28, in 2020, all hell broke loose and I haven’t stabilized since, nothing consistent, will this night mare ever end? On a good note, no more upset stomach and I’m very grateful, if I could just get passed this depression, sorry so negative, this is so hard to go through at 61 years old 

[Mattie]

So I called the PCCA associated pharmacy thinking I’d be in better hands and they told me they couldn’t compound pristiq. I told them I was under the impression they could but they told me that they said they would look into it and they can’t crush the tablet because it causes a different chemical reaction and I told them my other pharmacy was doing it with a er compound and they said they can’t. All I know is I feel horrible. It’s been around 4 months on 18 and now day 12 on split dose 9 and 9 . My question is it like starting over since splitting my dose and have to give it more time for my body to adjust to split dose so disregard the 4 months I’ve already been on 18mg?

[Altostrata]

You're already having Pristiq compounded, correct? Why are you contacting other compounding pharmacies>

 

5 hours ago, Mattie said:

My question is it like starting over since splitting my dose and have to give it more time for my body to adjust to split dose so disregard the 4 months I’ve already been on 18mg?

 

As explained before, you've been taking immediate-release Pristiq only once a day, which probably caused many bad symptoms.

 

You've had some good days, which means getting stable on Pristiq twice a day is proceeding.

[Mattie]

I really just need reassurance that I will stabilize on this dose, I question that lately if it’s the withdrawals or am I truly severely depressed and it’s hard not to think the compounding meds are making me feel worse, I’m sorry, I’m just desperate for healing 😞

[littlebird]

1 hour ago, Mattie said:

I really just need reassurance that I will stabilize on this dose, I question that lately if it’s the withdrawals or am I truly severely depressed and it’s hard not to think the compounding meds are making me feel worse, I’m sorry, I’m just desperate for healing 😞

Hello! 

 

We haven’t talked before, but I wanted to check in and hopefully offer a little reassurance. Our bodies, brains included, are so incredibly resilient and capable of healing. While it’s rocky to make these changes, please know your systems are working hard to stabilize and balance things out and you won’t always feel the way you do now. All storms run out of rain, you know?

 

Most of all, please be gentle with yourself. This isn’t easy. Not the changing of meds and side effects of that process, and not the emotions/traumas that come up during the process. You’re brave, and tough, and you’re getting better every minute of every day. Sometimes progress is so slow it doesn’t feel like progress, but it’s happening. 

 

Take care of yourself! Rest as much as you need to (unless it turns into avoiding life through sleeping), and choose activities/entertainment that bring you joy. Prioritize your joy. It’s what you’re working towards, so it’s something worth scheduling in. Whatever that looks like for you! This is an opportunity to learn more about yourself, and what makes you glow, and then choosing to give yourself more of what makes you light up.

[Mattie]

@littlebird, thank you for the kind words and encouragement,hopefully tomorrow will be a brighter day, good luck in your healing journey also ❤️

[Mattie]

Update

 

Yesterday

 

On a positive note, I started with a decent window around 230, I was so sick and depressed today and the last few days that I didn’t think I would climb out but I did! I feel beat up but my depression lifted somewhat and my energy level improved, hopefully it will continue

 

Today

 

It’s been another rough day, 6:30 pm and I’m getting a window

 

Edited October 23, 2022 by ChessieCat
CC helped mattie provide the update

[Altostrata]

Good to hear that taking immediate-release Pristiq in a rational way twice a day is helping you stabilize.

[Mattie]

Altostrata, honestly I don’t feel any different yet then I did on single dose, my depression is so bad all day (have suicidal thoughts) would never act apon , zero motivation, crying spells and the windows comes no earlier, the average window starts at 4-5 o’clock and that’s when I start to get a little relief to where I can convince myself to keep going. Occasionally I will get a window starting around 2-3 . I wish there was something natural I could take for the depression and hopelessness I feel all day long 

[ChessieCat]

This information might be included somewhere earlier in your topic but I don't have time to read through your posts.

 

Q:  Have you stopped the Prozac?

 

If yes, please add that information to your drug signature.  That way we can see your drug history at a glance. Thank you.

 

If no, Q: what dose of Prozac are you taking?

[Mattie]

1 hour ago, ChessieCat said:

This information might be included somewhere earlier in your topic but I don't have time to read through your posts.

 

Q:  Have you stopped the Prozac?

 

If yes, please add that information to your drug signature.  That way we can see your drug history at a glance. Thank you.

 

If no, Q: what dose of Prozac are you taking?

Cheesiecat, I don’t know how to do it, but I’m only on pristiq. I directly switched from Prozac to pristiq 

[Mattie]

Just now, Mattie said:

Cheesiecat, I don’t know how to do it, but I’m only on pristiq. I directly switched from Prozac to pristiq 

Dec 31, 2021 last dose Prozac, started pristiq 25 mg Jan 1 2022

 

 

 

[Mattie]

2 hours ago, Mattie said:

Dec 31, 2021 last dose Prozac, started pristiq 25 mg Jan 1 2022

 

 

 

Cheesiecat done! I figured it out 

[Mattie]

So I sent emails to the pcca to get a list of compounding pharmacies in my area and they replied with a few including the compounding pharmacy im already using. I spoke to another pharmacist at a different compound pharmacy on my list and she had concerns about compounding for me because she would not be able to get the doses exactly ex: one capsule could be 8.9 mg and another 8.7 mg etc. because they have to crush tablets . It got me thinking maybe that’s why I’m having a hard time? The inconsistency however small could be affecting me cause I’m so sensitive ? Also she said it would be too hard for her to do 10% cuts so I’m so discouraged. 

[ChessieCat]

Brassmonkey has posted about this somewhere and explained that even if we take the exact same dose every day there will still be some variation due to our metabolism varying from day to day, and things like what you have beeneating and how much etc.

 

No method of getting a dose is going to be 100% accurate.  Making a liquid is the most accurate method but the tablet needs to completely crushed to do this.  And you cannot keep the liquid for more than a few days so you would need to weigh your powder or get capsules made to use the contents.

 

Do you think that you would be able to weigh your dose and get your dose as accurate as a compounding pharmacist can make the capsules?  They don't weigh the doses, they do a calculation of the tablet/s add slow release formula and calculate how much filling they need to fill "x" number of capsules.  It is all put into a lidded canister and shaken on a machine.  The mix is then put into capsules by scraping across the top.  You can find videos on Youtube showing how it is done.

 

Brassmonkey crushed his Paxil tablets and weighed his doses down to a very tiny amount.  I know I would not have the patience to do that, but because of his work he was familiar with this.

 

All we can do the best with whatever method/s we have available.

 

And even if the doses are slightly inconsistent, it is much better to do the gradual taper recommended by SA than how the medical professional would tell us to do it.

 

Edited October 26, 2022 by ChessieCat

[Mattie]

Cheesiecat, thanks for your response, so I guess I will stay with this pharmacy and wait it out and hopefully soon I’ll start getting relief during the day from this depression and lack of willpower to do anything, I’m at 3 weeks of double dosing 12 hrs apart 

[Mattie]

I spoke to my pharmacist and he said he would only be able to split my dose by even numbers, I’m on 9 &9 so it would be 8&8 ext, 2 mg drops are way too much for me. I contacted all the pharmacist on the list the pcca emailed me and no one can do it . One pharmacist told me to take it every other day and third day that people do fine that way 🤦‍♀️Oh boy , my anxiety is through the roof 

[ChessieCat]

If it was me I would continue investigating and contacting other compounding pharmacies.  My pharmacist was able to go as low as 0.125mg doses.  And that was using 50mg tablets because 25mg are not available in Australia.

 

If you check out my topic and the Pristiq topic I have posted about what sized capsules I was getting made up and how I would combine them to get my doses.  I wasn't tapering by reducing 10% but using the combinations to get as close to 10% as possible.  My tapering program  

 

If you cannot get what you need from a pharmacy then you could use the contents and make a liquid for the additional portion of the dose; so take capsule plus home made liquid.

[Mattie]

Cheesiecat, how do you make liquid and could you give example of what dose capsules I would need next time I taper from 9&9 to somewhere around 10%, I’m so confused sorry 

[ChessieCat]

When the contents of a Pristiq compounded capsule is added to water it can go gluggy because of the filler/s.  When I make my liquid I would add the water to the container and then open the capsule over the water and tip it in.  I would then close the container (it needs to seal well) and give it a really good shake.  It will go frothy but once it is left the bubbles with subside so you need to make the dose early enough for this to happen.  Before measuring my dose I would just tip the container upside down once or twice gently so as not to make any bubbles but enough to mix the liquid.  Be aware that you might see some tablet shell in the water depending on how the compounder makes the capsules.  I just ignored this.

 

Here is what I posted to another member.  Hopefully you can work out how to use your own numbers.  Always double check your calculations.  It is a good idea to calculate and then go away and come back to double check things :

 

I will give you some examples using a 10mg tablet as well as explain what I did to get the results.  That way you can use the examples with your own tablet dose to work it out.  To start with you could try practising the calculations with 5mg tablet (use the same amount of water as the examples - the dividing number will not change but the 1mL contains ?mg will) because then the results will be 1/2 or double (depending on what part of the process you are working out/looking at) what have been provided below.

 

Please double check - I am human after all.

 

If you put a 10mg tablet in 10mL of water each 1mL of liquid will contain 1mg dose.  Divide both sides by 10.

 

If you use more water the liquid is weaker so you need to take more, but it is sometimes easier to measure and you can be more accurate and get doses with more numbers after the decimal point.

 

10mg tablet in 20mL - each 1mL will contain 0.5mg dose  Divide both sides by 20.  This is so you can find out mg per 1mL.

10mg in 50mL - each 1mL will be 0.2mg dose.  Divide both sides by 50.

10mg in 100mL - each 1mL will be 0.1mg dose.  Divide both sides by 100.

10mg in 200mL - 1mL will be 0.05mg dose.  Divide both sides by 200.

You can use the above to make your own calculations.

 

Basically:

 

tablet mg : water mL

 

Divide both sides by the mL amount to find out what dose 1mL of liquid will contain.

 

Getting the dose:

 

If you want to take 7mg dose choose which dilution you want to use.  In this example I will use 10mg in 50mL / 1mL = 0.2mg

Divide 7mg by the dose amount per for 1mL of liquid; in this case 0.2mg.  So 7mg divided by 0.2mg = 35.  So because each mL of liquid contains 0.2mg dose to get a 7mg dose you would take 35mL of liquid (ie 0.2mg x 35).

[Mattie]

Cheesiecat, what do you mean by divide both sides. And you refer to tablets, do you mean capsules? You are way smarter than I, and my brain is so mushy but I really want to understand this , would I have to get extra capsules prescribed besides my regular double dose?

 

 

 

 

[Mattie]

Cheesiecat, I understand now what you mean by dividing both sides but still confused on what to get from pharmacy, or is it possible to make liquid from the 25mg tablets and take 2 or 3 times a day?

[ChessieCat]

The information I gave was just an example of the calculations.  What I wrote was to another member who was taking tablets.

 

In your case you will be using the contents from a capsule.  I have already provided the information about how to make the liquid.

 

So instead of using the 10mg tablet in 10mL water, you can, for example, use 2mg capsule contents in 2mL of water. 

 

BUT obviously that will not be enough water to be easy to work with.  So you can increase the water.  For example, 2mg capsule contents in 20mL water, and then you divide both sides by 20 to find out how much dose will be in 1mL of liquid.

 

Or you could put 2mg capsule contents in 50mL of water and divide both sides by 50.

 

I suggest you sit down with a pen and paper and a calculator and write out the example and do the calculations so that you can work out how to do it.

 

Then you "plug in" your own mg dose of a capsule.  I have used 2mg as an example but you might be using 5mg.  So then start with 5mg in 5mL of water and work from there.

 

It will be much easier doing it than trying to figure it out in your head.

 

 

 

[Mattie]

So I’m confused about when I do my next taper, how would I do it with 9mg twice a day capsules, lets say I wanted to go down to 17.5 mgs, would I take one 9 mg capsule and 8.5 mg liquid daily? My pharmacy can only do 9&9, 8&8, etc I think I understand how to make the liquid but not how to get the capsules to where the psychiatrist doesn’t know I’m doing this 

 

 

 

 

, 

[ChessieCat]

You need to find a compounding pharmacist who will make the doses that you need to taper the right way.

 

It is hard enough tapering and getting the dose you need without having to work with something which makes it so much more difficult than it needs to be.

 

Q:  Do you already have capsules?  If yes, what dose and how many of them?

 

Q:  What dose are you currently taking and what sized reduction are you wanting to make?

 

If you can provide this information I can try to work out a way for you to get your doses.

 

If you don't already have the capsules then please do yourself a huge favour and find a different compounder who will do it the way you want.  I realise that it takes a lot of effort but in the long run it will make things so much easier for you.

 

 

 

 

[Mattie]

Cheesiest, I’m currently on 18mg daily (9mg twice a day) so I get prescribed 60 9mg capsules monthly. I would like to start tapering 5% next drop or no more than 1/2 mg because my last drop was 2mg and that was too drastic and I can’t seem to stabilize, I apologize for making this so difficult. My brain is truly sick right now, and it’s hard for me to grasp things like I use to. I was a lot sharper than I am now and I can’t thank you and the others enough for y’all support, thanks for being patient with me 

 

[ChessieCat]

So you already have 60 x 9mg capsules?  That will see you through for the next month.

 

The next reduction of 5% would be 17.1mg (calculation:  18mg x 0.95)

 

Round it to 17mg (this is okay because it will only be a little bit more than 5% reduction).

 

Divide by 2 for split dosing = 8.5mg

 

So you will need 60 x 8mg capsules PLUS liquid.

 

If you can get a pharmacy to make 1mg capsules then you could add the contents to water and then take half the liquid twice a day to get 8.5mg each dose.  For this reduction you would need 30 capsules of 1mg.  This will be different if you have to get a larger capsule dose.  (You really do need to find out what you can get because it will save a lot of time and mentally energy, both for you and the staff.)

 

If they will only make a larger dose, find out what is the smallest dose they will make and you might be able to work with that.  Obviously I am trying to be cost efficient.  The home made liquid can be kept refrigerated for 3-4 days.  The left overs are disposed of.

 

I don't know how things work in the USA when getting compounding done and it being covered by insurance.  It will be up to you to work out whether you are willing to use larger capsule doses and dispose of the excess or if it won't cost any more because of the way the prescribing/insurance works.

 

The next reduction would be 16.15mg (17 x 0.95).  Round down to 16mg so 8mg capsules x 30 needed.

 

The following reduction would be 15.2mg (16 x 0.95).  Round down to 15mg, so 7mg tablets PLUS 0.5mg liquid needs to be added to each dose.

 

The next one would be 14.25mg.  Here we are getting a larger round down but because you are only making a 5% reduction then it might be okay.  If you find that you are having issues making the previous reductions then you might need to round up to 14.5mg.  Whichever, you would take 7mg x 2 capsules PLUS the liquid to make up the dose.

 

Note that the calculation for the following reduction is done on the dose you took, not the calculation before rounding.

 

So the reductions which are more than a 5% reduction:

 

18mg

17mg

16mg

15mg

14mg OR 14.5mg

 

Now for you to find out what is the lowest dose capsule you can get.

[Mattie]

Cheesiecat, thank you so much for info, I’ll contact my pharmacist and see what he says and I’ll continue to look for other compounding pharmacies. I don’t know if I’ll ever stabilize enough to taper again, I’m not getting any windows till at least 7pm, I’m so horribly depressed and drained and lightheaded, it’s so hard to feel like this everyday, before I made this switch from 20mg to 18 mg I was having lots of windows, good and bad days but since going to 18 mg I can’t stabilize. It’s 3 weeks at split dose but 5 months on 18mg

 

 

 

 

, 

[ChessieCat]

Have you noticed a gradually improvement in any symptoms during the last 3 weeks?

 

Sometimes when we still have annoying symptoms we can miss noticing the improvements.