Kala208: Switching from Venlafaxine ER to Venlafaxine Immediate Release to begin tappering - help needed

[kala208]

I've been on depression and anxiety medication for 20 years. I know I need to get off them. I currently take Effexor XR 150mg and Klonopin 1.5mg daily. I have tried to wean off before with no luck as I started to fear everything in life and started to have panic attacks so I went back to original dose of Effexor two months ago.  I recently told my Dr. I wanted to try again and wean off the Effexor first and she prescribed me 37.5mg tablets that are immediate release. I don't know how to divvy these up throughout the day as I am use to the extended release capsule once a day. I was thinking I would take two tablets (75mg) when I wake up, then take 37.5 tablet 4-6 hours later and then 18.75mg 4-6 after that for my first month of tapering. I am lookin for thoughts and suggestions.

[Erimus]

Hello, and welcome to Surviving Antidepressants. We are a peer support forum to assist in tapering off psychiatric drugs safely, or recovering from psychiatric drug withdrawal.

 

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3 hours ago, kala208 said:

I have tried to wean off before with no luck as I started to fear everything in life and started to have panic attacks so I went back to original dose of Effexor two months ago.

How did you try to taper? I would suggest staying on the XR and reducing by 5% using the bead counting method.

 

Please read Tips for tapering off venlafaxine (Effexor)   in full.

 

Here are some more useful links:

Important topics in the Tapering forum and FAQ

 

Micro tapering

 

Why taper by 10% of my dosage?

 

Taking multiple psych drugs? Which drug to taper first?

 

How to make a liquid from tablets or capsules

 

Using a scale to weigh and measure doses

 

We only recommend two supplements. Omega 3 Fish Oil and Magnesium. Both should be introduced separately and increased slowly.

 

Regards

Erimus

[Alfred1977]

Hi Kala,

I am in a somewhat similar situation (I am no doctor and I am not giving medical advice). I am on Venlafaxine since 2005 and now I am trying to figure out how to get off of it. The last weeks and months I quit too fast and had a bad crash. Therefore I reinstated Venlafaxine about 4weeks ago.

 

It's important to taper in a speed that your body can handle. With respect to that there is no rule or tapering plan that applies to everybody. Therefore it is important that you observe yourself after a reduction and only proceed tapering after a couple of weeks (e.g. 3-6) if the last step went well. If your last step didn't go well and you experience anything worse than slight symptoms for a couple of days (e.g. 3-5) you should immediately go back to the last dose you felt stable on and proceed afterwards more slowly. It is not good to endure withdrawal since withdrawal can lead to a downward spiral of your condition and severe trauma. In this community people usually suggest that you start tapering carefully by reducing 10% of your last dose in each reduction step you do (this means there will be a lot more than 10 reduction steps). When you have gathered more experience about yourself and tapering you can adjust that pace to what suits your well being best - as long as you keep on being careful.

 

It is important to understand that antidepressants have a very strong effect on what seems to be a very low dose. For example 5mg Venlafaxine sounds like little, but in fact it's extremely potent and binds already about 40% of the serotonin reuptake receptors in your brain, whereas 75mg binds about 80% of receptors. This also explains why it's so hard to get off these drugs. The commercially available doses are in this sense massive and it is impossible with them to slowly fade out the receptor occupancy in your brain.

 

Therefore a major challenge when tapering is obtaining the drug in a form that can be dosed granuarly. Personally I will try to solve immediate release tablets in water (the only good thing I so far heard about venlafaxine is that it's (chemically) soluble in water). This sounds a lot easier than counting beads to me. And it probably is also more precise and accurate (affordable scales are not accurate enough to weigh fractions of mg). The downside with this is that you need to tolerate the immediate release version since you cannot solve xr in water (at least the xr effect gets lost) and you cannot prepare your doses time in advance. I will have to try, but I think the advantages outweigh the disadvantages. I already bought graduated cylinders in different sizes, dropping glasses and tinted glass medicine bottles (I will try to keep the solution for 2-3 days).

 

While you are on a higher dose, you might want to combine tablets and a liquid solution. Thus dosing is probably easier on high doses.

 

All the best

[Alfred1977]

P.S.: To the best of my knowledge with immediate release your daily dose is divided up equally into 2 or 3 doses of the same amount. So basically you reduce your daily dose by 5% or 10% and then divide it up into 2 or 3 partial doses, try how that works for about a month and then plan your next step. I probably will try 2 daily doses (morning and evening) since that is less trouble. I also think about taking slightly less in the evening since I don't sleep well and Venlafaxin is known for being activating and causing tension and insomnia.

As far as I read here on SA it is generally a good idea to first taper venla and afterwards the benzo (and not both at the same time).

[kala208]

Thank you both for sharing with me as I really appreciate it. I appreciate this website and am thankful for it and the people as I was losing hope. I am going to try tapering with the bead method as I was not aware of this until now and think it would be best for me as my body is use to the extended release and it will only be once a day. I am going to start tapering by 10% and start in a couple of days as I will need time to prepare the beads. 

[Erimus]

5 hours ago, kala208 said:

Thank you both for sharing with me as I really appreciate it. I appreciate this website and am thankful for it and the people as I was losing hope. I am going to try tapering with the bead method as I was not aware of this until now and think it would be best for me as my body is use to the extended release and it will only be once a day. I am going to start tapering by 10% and start in a couple of days as I will need time to prepare the beads. 

I would suggest starting with a more conservative cut of 5%, given the length of time you have been on the drug, and your past attempts to taper.

Edited May 3 by Erimus

[Alfred1977]

Could you share with us the details about your "beads method" and how it works out for you? I would be very interested since it is always good to have/consider alternative ways.

 

All the best

[Erimus]

On 5/4/2024 at 8:12 AM, Alfred1977 said:

Could you share with us the details about your "beads method" and how it works out for you? I would be very interested since it is always good to have/consider alternative ways.

 

All the best

See:

 

Tips for tapering off venlafaxine (Effexor)

 

Counting beads in a capsule versus weighing

[kala208]

On 5/3/2024 at 6:02 PM, Erimus said:

I would suggest starting with a more conservative cut of 5%, given the length of time you have been on the drug, and your past attempts to taper.

Thank you for your suggestion Erimus. My Doctor wants to me to start my decrease with the Immediate release of Venlafaxine. I am nervous as I've only been on the extended release. I am not sure when to take it as it's recommended to take 2-3 times per day. My Doctor suggested two 37.5mg tablets in the morning and two at night and start the taper with at night. Do you have suggestions as to how I should take the doses throughout the day/night? Thank you in advance for your support!

[Erimus]

4 minutes ago, kala208 said:

Thank you for your suggestion Erimus. My Doctor wants to me to start my decrease with the Immediate release of Venlafaxine. I am nervous as I've only been on the extended release. I am not sure when to take it as it's recommended to take 2-3 times per day. My Doctor suggested two 37.5mg tablets in the morning and two at night and start the taper with at night. Do you have suggestions as to how I should take the doses throughout the day/night? Thank you in advance for your support!

If you have always taken the extended release I do not undertand why you would want to switch to immediate release to taper. It is easier to taper the extended release with the beads in the capsules. If you have not switched yet I would suggest you stay on XR, and tell your doctor that you will be sticking with the extended release indefinitely.

[kala208]

25 minutes ago, Erimus said:

If you have always taken the extended release I do not undertand why you would want to switch to immediate release to taper. It is easier to taper the extended release with the beads in the capsules. If you have not switched yet I would suggest you stay on XR, and tell your doctor that you will be sticking with the extended release indefinitely.

 

25 minutes ago, Erimus said:

If you have always taken the extended release I do not undertand why you would want to switch to immediate release to taper. It is easier to taper the extended release with the beads in the capsules. If you have not switched yet I would suggest you stay on XR, and tell your doctor that you will be sticking with the extended release indefinitely.

I agree with you. My old Doctor left the practice and I see a new Doctor toward the end of July. She thinks I need to taper with the immediate release as she feels it is harder to taper with the extended release. I asked for an appointment as soon as possible but she is booked. I want to call back but I don't know what to say to make the nurse understand who then relays the message to the Doctor. Do you have any suggestions?

[Erimus]

10 minutes ago, kala208 said:

 

I agree with you. My old Doctor left the practice and I see a new Doctor toward the end of July. She thinks I need to taper with the immediate release as she feels it is harder to taper with the extended release. I asked for an appointment as soon as possible but she is booked. I want to call back but I don't know what to say to make the nurse understand who then relays the message to the Doctor. Do you have any suggestions?

 

Tell her you have taken the extended release formulation since 2005, and will be sticking with it until you see fit to change.

 

If she will not compromise and meet your demands you will have to find another doctor who will.

[kala208]

3 minutes ago, Erimus said:

 

Tell her you have taken the extended release formulation since 2005, and will be sticking with it until you see fit to change.

 

If she will not compromise and meet your demands you will have to find another doctor who will.

True enough. In the meantime, I only have one week left of the extended release and then I have a new bottle of immediate release, so I will need to take it as finding another Doctor will take awhile. I will call and try again today but if she does not compromise, can you suggest certain times of the day and amounts that I should take of the immediate release? I am on 150mg now and my immediate release tablets are 37.5mg. I was thinking of taking two in the morning but then I was not sure when and how to take the next two with one being tapered. I appreciate your thoughts. 

[Erimus]

I would take 2*37.5mg in the morning, and 2*37.5mg in the evening. Preferrably 12 hours apart. Some people even split it into three parts, for example you could dose 50mg at 8am, 4pm and 11/12pm (if you're still awake).

 

Read this thread again, it has loads of really useful tips:

Tips for tapering off venlafaxine (Effexor)

Edited June 3 by Erimus

[kala208]

24 minutes ago, Erimus said:

I would take 2*37.5mg in the morning, and 2*37.5mg in the evening. Preferrably 12 hours apart. Some people even split it into three parts, for example you could dose 50mg at 8am, 4pm and 11/12pm (if you're still awake).

 

Read this thread again, it has loads of really useful tips:

Tips for tapering off venlafaxine (Effexor)

Thank you so much for your help and support!