thisisbort: how do I do a sliding scale taper of tapentadol?

[thisisbort]

Hi all, 

 

First time on here, and came across the sliding scale taper. 
I was wondering how you can reduce your dosages by such small percentages?!

 

Am currently on;

Tapentadol (Palexia) 50mg SR twice a day

Lyrica (Pregabalin) 75mg twice a day

Cymbalta (Duloxetine) 60mg morning, 30mg night. 
 

I’m currently trying to taper the Tapentadol (gone from 100mg SR twice a day) and am wondering if the sliding scale taper is relevant here, as they’re tablets, not capsules??

 

Thank you for any help or answers you can provide. 
 

Ben

 

Edited November 24, 2022 by ChessieCat
Resized font/removed comment about name

[Shep]

Hi, @thisisbort

 

Welcome to Surviving Antidepressants.

 

On 11/22/2022 at 6:28 PM, thisisbort said:

Am currently on;

Tapentadol (Palexia) 50mg SR twice a day

Lyrica (Pregabalin) 75mg twice a day

Cymbalta (Duloxetine) 60mg morning, 30mg night. 

 

I placed these drugs in a drug interaction checker and there are two MAJOR drug interactions and MODERATE interaction. Please see:

 

Drug Interaction Checker - tapentadol, lyrica, cymbalta

 

Please list the times of day you are taking each of your drugs. The reason I'm asking is because you'll likely want to separate them out by at least two hours to help with any potential adverse reactions - as you can see in that report, it's potentially quite serious. 

 

Also, please set up a signature. Here is how:

 

How to Summarize Your Drug History in Your Signature

 

Please note I'm not ignoring your question about tapering. But first, let's focus on spacing out your drugs and getting your signature set up so we know your history. Then we can get into the details of how to taper. 

 

[thisisbort]

Hi @Shep

 

Thank you for taking the time to reply in detail. I really appreciate it. 
 

I will do up my signature after I type this all out 🙂

 

I’ve been on Lyrica and Tapentadol together for the last 6 years, and Cymbalta on top of those 2 for the past 5 years, and the benefits seem to outweigh the risks for me. 
 

I took all 3 at the same time in the morning (10am ish) and the Lyrica & Tapentadol together again at (9pm ish)

 

This was up until about 3 weeks ago when I split the Cymbalta into a morning and night. So the same as above, just taking a smaller dosage of Cymbalta in the morning, but actually taking some at night now too. 
All together, just like above. 
 

Don’t hesitate to ask any questions you need, and thank you again! 

[Shep]

10 hours ago, thisisbort said:

 

I’ve been on Lyrica and Tapentadol together for the last 6 years, and Cymbalta on top of those 2 for the past 5 years, and the benefits seem to outweigh the risks for me. 

 

Please write more about this statement. Usually people come to the forum to get off these drugs because the drugs are making them sick or at best, the drugs are no longer effective. Are you having any symptoms?

 

Here is a thread about symptoms common to people dealing with withdrawal:

 

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

10 hours ago, thisisbort said:

This was up until about 3 weeks ago when I split the Cymbalta into a morning and night. So the same as above, just taking a smaller dosage of Cymbalta in the morning, but actually taking some at night now too. 

 

What made you move the Cymbalta to twice a day dosing? Was it the short half-life? 

 

I'm not sure if it's best to continue tapering the Tapentadol or if you may be better served by tapering Cymbalto or Lyrica first. It will help to know how these drugs affect you. For context, please read the first post in this thread:

 

Taking multiple psych drugs? Which drug to taper first?

 

Note the concept of "brakes and accelerators" and let us know if you find any of your drugs more sedating than the others. It may be hard to tell when you're taking them at the same times of the day, but do the best you can. 

 

Here are some links specific to your drugs and information on tapering speed:

 

Tips for tapering off duloxetine (Cymbalta)

 

Tips for tapering off pregabalin (Lyrica)

 

Why taper by 10% of my dosage?

 

We don't have a thread dedicated to tapering Tapentadol, but here is the Wikipedia page with general information:

 

Tapentadol - Wiki

 

We would recommend also tapering this drug no faster than 10% a month based on the prior month's dose (not the original prescribed dose).

 

Please let us know about any symptoms you're having, as that will help us give you the best tapering advice and ways of reducing these symptoms. 

 

[thisisbort]

I’m plan on coming off them all (doing Tapentadol first) because my chronic pain (over 8 years) has subsided to the point where I don’t need them (or at least not as high a dosage anymore. 

 

Before starting to reduce Tapentadol 6 months ago, my mental health was quite good. 
 

I’ve had a plethora of symptoms reducing Tapentadol. 
Some of which include; 

 

Depression, Anxiety & Stress all severely elevated. 
Sleep issues (waking early and unable to get back to sleep)

Very lethargic

Constantly feeling sick

Constant headaches

No/Low energy

Constant overwhelm & overthinking

Low sex drive

Imposter Syndrome 

 

At its worst, symptoms have also included;

 

Difficulty breathing

Panic attacks

Feeling paralysed

Hit & cold spells (feverish)

All of which is at its worst upon waking. (This is the reason why I did the below)

 

Yes, you are correct. I changed to 60mg in the morning and 30mg because of the short half-life. 
Along with the symptoms above this caused brain zaps and memory loss.  
This has taken about 3 weeks to adjust to, but I think it’s settled now. 

 

The Lyrica is a ‘brake’ for me and the Cymbalta is quite Neutral I’d say. 
My psychologist has recommended reducing the Cymbalta last based on the fact it’s the most important of these two in reducing the withdrawal symptoms from Tapentadol. 
 

50mg is actually the smallest dosage of Tapentadol available, and as it’s a tablet, it’s virtually impossible to reduce it by 10% at a time. 
Unless anyone has any experience or ideas for doing this. 
So unfortunate this is the case. 
They really should make much smaller dosages for tapering. 

[Shep]

13 hours ago, thisisbort said:

50mg is actually the smallest dosage of Tapentadol available, and as it’s a tablet, it’s virtually impossible to reduce it by 10% at a time. 
Unless anyone has any experience or ideas for doing this. 
So unfortunate this is the case. 
They really should make much smaller dosages for tapering. 

 

Yes, I agree - they definitely should make much smaller dosages for tapering. 

 

Tapentadol is not a common drug here, so we don't have a dedicated thread about it. I did read that it comes in prescription oral solution (the various formulas are listed here - Drugs.com Tapentadol)

 

If you're not able to get the prescription liquid, you may want to use a scale or make your own liquid. Here is more on these methods:

 

Using a scale to weigh and measure doses

 

The Gemini-20 scale works great for tapering. There are video how-to's in the first post in that link.

How to make a liquid from tablets or capsules

 

13 hours ago, thisisbort said:

Before starting to reduce Tapentadol 6 months ago, my mental health was quite good. 
 

I’ve had a plethora of symptoms reducing Tapentadol. 

 

You may even want to taper slower than 10%, since you know you're sensitive to reductions. Many people like to use the Brassmonkey Slide, which is a very gentle way to taper by decreasing smaller amounts weekly instead of a larger amount monthly. 

 

The Brassmonkey Slide Method of Micro-tapering

 

After you have a chance to read through these threads, please let us know if you have any questions. 

[thisisbort]

Thank you for the ‘making liquid’ link. 
 

Has anyone you know of on here used buprenorphine to help manage the symptoms of their taper??

 

To do a successful brass monkey slide of a tablet I think it’d have to be made into a liquid hey?

Or maybe a crush and weigh? Haha

 

I think that’s all the questions I have for now…

[brassmonkey]

Crushing and weighing the tablet is a very acceptable way to do the Brassmonkey Slide. I developed the Slide crushing my paxil tablets. 

 

Tapentadol  has a good solubility rate of just over 1.1mg per mL of room temperature water, so making a liquid would be easy. Either method would work well.