Tips for tapering off desvenlafaxine (Pristiq)

[Lilu]

interestingly though, quite a few years ago i tried to swap over to pristiq from effexor (before i knew what i know now) as someone suggested it might have less weight gain and other side effects. I was on 75mg effexor at the time - i swapped to 50mg pristiq and i found it WAY too stimulating - i had surges of anxiety that just came out of nowhere. I swapped back to effexor and they went away. Never had them before or since.

 

 

Peggy,

The reason you had a reaction to Pristiq was not because Effexor and Pristiq are different meds, but because on about 50% of Effexor is metabolized into it's active ingredient, which is Pristiq. Thus, 75 mg of Effexor is about 37.5 mg of Pristiq. But of course your body might be very sensitive to slight increases or decreases of this medication. I'm not sure exactly why, but I didn't have ANY side effects switching from Effexor to Pristiq, or going from 50mg to 100mg. It's always the lowering of the dose that tends to give me flu-like symptoms.

[Altostrata]

Pristiq is stronger than Effexor.

 

A psychiatrist reported to me he's found the switch from Pristiq to Effexor to be seamless.

[Lilu]

Obviously it's not "seamless" for everyone. It sure would be nice if they could predict how someone might react to any one particular medication.

[Altostrata]

It's not at all clear what the equivalency is between Effexor and Pristiq.

 

We know that, milligram for milligram, Pristiq is somewhat stronger.

 

See http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__7507

 

According to FDA Prescribing Information for venlafaxine (Effexor), the usual dose of Effexor is 150mg per day.

 

Since 150mg Effexor and 50mg Pristiq are both "normal" dosages of their respective drugs, they may be roughly equivalent

See http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__31850

 

oaklily, can you contact your pharmacology resources and find out what they think the equivalency might be? I'll do the same.

 

May I also point out that a lot of people can step down somewhat in dosage, it's when they get past the half-way point that it seems all heck breaks loose. Also, if someone is already off Pristiq, reinstatement of the full dosage or equivalent in Effexor may not be necessary as it seems often there is some adjustment in the nervous system and it will accept a lower dose.

Some naturalists also recommend supplementing with Amino Acids during your taper. 1000 mg of L-Tyrosine in the morning and

100 mg of 5HTP or 500 mg of L-Tryptophan at night.

Do this cautiously -- many people withdrawing react poorly to large amounts of amino acids. Adding 5-HTP to an antidepressant runs the risk of serotonin syndrome, a dangerous condition of excessive serotonin in the brain, or otherwise excessive activation.

[Altostrata]

I've sent out a bunch of e-mails to psychiatrists requesting their estimates of Pristiq-Effexor equivalency.

 

- One, a psychopharmacologist, says he's never prescribed either drug (kudos to him) but "as an isomer the dose of Pristiq should in principle be something between 1/2 and 3/4s of the Effexor dose, so 50mg Pristiq = either 75 or 100 mg Effexor."

 

- A clinical psychiatrist says "I've only used 150mg of Effexor [75mg bid no matter the Pristiq dose] and that instead of replacing Pristiq with Effexor, I kept the patient on Pristiq 50mg for the first several days of Effexor. My logic was to get the Effexor on board first. It's a logic I made up, later I read it on your site [Glenmullen] , but it went smoothly so maybe it helped. Since we last talked about this, I had a patient who wanted to change to another SSRI rather than simply stop Pristiq. She changed from Pristiq to Celexa 20mg with no problems at all, having had withdrawal hell just trying to stop abruptly before. She also had some "overlap days."

 

- From Dr. Stuart Shipko: "I do not have any special information on Effexor/Pristiq equivalence, so your guess is as good as mine. Your website suggests that 50 mg of Pristiq is about the same as 150 mg of Effexor - it seems reasonable. I think that making the transition is always going to be a trial and error, and that it is best to err on the side of too much Effexor. You are correct that I have had a pretty easy time tapering Effexor by counting the beads and cutting out 5 or 10% at a time - I wish that more pills came in beads as it is easy to get a small reduction. Pristiq is the active metabolite of Effexor, so the switch should be easy. To date I have not had anyone ask for assistance tapering Pristiq, but based on what I know, transition to Effexor seems to be the best approach. My thoughts are that a person can change safely from 50 Pristiq to 150 Effexor, but if this seems insufficient, a person can always increase the Effexor dosage upwards until a comfortable equivalence is achieved. BTW - Nice thread on your site."

[mogfish]

Hello Altostrata and thank you for such a wonderful site. I came across this site a few days ago and just wanted to make a possible suggestion for weaning off pristiq. I have been on pristiq for a few years now and feel that I am in a place where I no longer need the drug...however I am well aware that it is not an easy drug to get off.

 

I tried to wean off pristiq a few months ago by cutting the 50mg tabs into halves. I experienced head shocks and postural dizziness after the first day and after the first week I was teary, easily agitated and had no tolerance for anybody. This time I am taking things a little slower. My doctor suggested taking half each day or one every second day but I don't agree with either of those suggestions. I am a registered nurse so I do tend to do things my own way

 

I am 5 days in now to weaning off 50mg tabs and I am cutting the meds into halves and quarters. I take 25mg in the morning and 12.5mg around 3pm in the afternoon. So far I have had very good success with this with little to no "head shocks" and no altered mood. Infact last night I had the best drug free sleep I have had in a very long time!!! ( I occasionally take temazepam 10mg( realtively short acting and mild prescription sedative) or restavit (doxylamine succinate 12.5mg which is over the counter in pharmacies here in Australia)

 

My rationale for doing the wean this way is that a 50% reduction is too much but to take 75mg in the morning when I have breached the coating would probably result in a stronger dose dumping effect. Having the smaller dose in the afternoons seems to keep me going till the next morning without keeping me awake or giving me any unwanted side effects. Its too early to say if this will be totally effective for me but so far so good! I have continued working without any issues and I am coping well with my teenage daughter who I raise on my own.

[Altostrata]

Thank you, mogfish. A 12.5mg dosage reduction (25%) from 50mg Pristiq is a reasonable way to taper since you found a 50% reduction is too much for your nervous system.

 

Your method of apportioning the morning and evening doses is also reasonable.

 

If they have no other options, cutting up Pristiq into quarters may be the only way some people can go off it.

 

However, as you go down by quarters, your taper becomes more precipitous.

 

For example, your first decrease was 12.5mg, 25% of 50mg. Your nervous system has accommodated to 37.5mg. For your next decrease, if you drop the second quarter-tablet, you'll be decreasing by 33.3% (12.5mg is 33.3% of 37.5mg).

 

Your nervous system accommodates to 25mg. Your next decrease is 50% (12.5mg is 50% of 25mg). The slope of the taper has become much steeper.

 

Since there is a wide range of reactions to dosage reductions, this may work for some people and may work for you. (Please be prepared to let your nervous system rest a month or more between decreases.) If you start to get withdrawal symptoms, you may wish to taper more gradually.

 

What we've seen is, for gradual tapering that minimizes withdrawal symptoms in people sensitive to dosage reductions, that the absolute amount of the reduction should get progressively less, in proportion to the last dosage. We recommend a 10% rate of taper as gradual enough for most people.

 

Now that you're at 37.5mg, to maintain a rate of 25%, you would have to figure out how to decrease 37.5mg by 25%, which puts you in the same quandary of controlling the dosage that we've attempting to address in this topic.

 

If you get withdrawal symptoms and need to taper more slowly, you might consider a switch to regular Effexor as we've discussed above. If you're at 37.5mg Pristiq, you'd estimate an equivalent dosage of Effexor (maybe 75mg).

 

Please also start a topic for yourself in the Intro forum to track your progress -- this could help a lot of people.

[Lilu]

I've sent out a bunch of e-mails to psychiatrists requesting their estimates of Pristiq-Effexor equivalency.

I found an article that addresses the very question of dose equivalency between Venlafaxine & Desvenlafaxine

Metabolites: novel therapeutics or “me-too” drugs? Using desvenlafaxine as an example

byThomas L. Schwartz

Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA

"That brings us back to dose equivalencies in venlafaxine/desvenlafaxine dyad. The minimum therapeutic dose of venlafaxine ER is 75 mg/d, whereas that of desvenlafaxine is 50 mg/d. Of note, all therapeutic doses ever studied of the latter (50–400 mg/d) have been statistically efficacious. There has not been a minimum therapeutic dose discovered for desvenlafaxine. The first interpretation should clinically state that 75 mg must equal 50 mg based upon regulatory trials and FDA benchmarks. A pharmacodynamic interpretation would differ in that 75 mg of venlafaxine ER is likely a pure serotonin reuptake inhibitor (SRI) with little norepinephrine reuptake inhibitor (NRI) properties.¹³ Both antidepressants have different neurochemistry ratios at their starting doses and cannot be seen as equivalent. Using this extrapolative method, perhaps equivalent doses are 150 mg and 50 mg, respectively, because venlafaxine ER's NRI potential becomes noticeable at 150 mg/d, likely comparable to desvenlafaxine's 50 mg starting dose.

 

Pharmacokinetically, we should again cite the work of Nichols etal.,^4,8 and observe the ratios of desvenlafaxine to venlafaxine after metabolism (DES/VEN ratio). Efficient metabolizers taking 75 mg of venlafaxine developed a DES/VEN ratio of 6.2, where poor metabolizers were approximately 50% less with a 3.3 ratio. Therefore, in some efficient metabolizing patients, 75 mg of parent venlafaxine ER drug may convert to a 300 mg equivalent of desvenlafaxine. As a result, the jury is out, in that 50 mg of desvenlafaxine metabolite antidepressant might equal 75 mg, 150 mg, or 18.75 mg of the parent drug."

 

source:

http://journals.camb...8e851f47f408cbf

 

[Altostrata]

Both antidepressants have different neurochemistry ratios at their starting doses and cannot be seen as equivalent. Using this extrapolative method, perhaps equivalent doses are 150 mg and 50 mg, respectively, because venlafaxine ER's NRI potential becomes noticeable at 150 mg/d, likely comparable to desvenlafaxine's 50 mg starting dose.

 

....

As a result, the jury is out, in that 50 mg of desvenlafaxine metabolite antidepressant might equal 75 mg, 150 mg, or 18.75 mg of the parent drug.

The action of desvenlafaxine is STRONGER (isomer effect) milligram per milligram than venlafaxine. This confounds even this very informed attempt to establish an absolute equivalency between Pristiq and Effexor dosages.

 

Thanks for this effort, oaklily.

[mogfish]

hello Oaklily!

I have been weaning off pristiq for 10 days now and so far so good. I have been taking 25mg in the morning and 12.5 mg in the afternoon....just cutting the tabs with pill cutter. changing to effexor is not an option for me as I was put on effexor 75mg several years ago and had quite a strong reaction to it with shakes, vomiting and sweats ++. I found it quite unusual that I was able to tolerate the pristiq as they are so similar. I am very keen not to switch to any other antidepressant so fingers crossed I will successfully taper. I have been taking natural supplements of Krill oil and flaxseed oil which are high in Omega 3's and I do feel that this has helped me keep some of the horrible side effects at bay as Omega 3's especially EPA are really good for the brain and nervous system

[Altostrata]

mogfish, I started an Intro topic for you here http://survivingantidepressants.org/index.php?/topic/3783-mogfish-weaning-off-pristiq/

 

Please keep us updated on your progress there. I hope your tapering method does not prove to be too fast for you.

[Lilu]

Pristiq is stronger than Effexor.

 

A psychiatrist reported to me he's found the switch from Pristiq to Effexor to be seamless.

 

I recently asked my psychiatrist at UMDNJ what he thinks of using Effexor to wean off Pristiq, and he said that he doesn't think it's a good idea, since Effexor's side effects and withdrawal side effects are worse than Pristiq. I must say from personal experience I agree with him. It is probably better to just cut Pristiq tablets with a pill cutter as best you can without messing with Effexor.

[Gardner]

 

 

Pristiq is stronger than Effexor.

 

A psychiatrist reported to me he's found the switch from Pristiq to Effexor to be seamless.

 

I recently asked my psychiatrist at UMDNJ what he thinks of using Effexor to wean off Pristiq, and he said that he doesn't think it's a good idea, since Effexor's side effects and withdrawal side effects are worse than Pristiq. I must say from personal experience I agree with him. It is probably better to just cut Pristiq tablets with a pill cutter as best you can without messing with Effexor.

 

I have not been on in weeks.

I have to agree as the depression and emotional detachment has been a nightmare w/d from effexor

Just want to sit and stare.

down from 25- 12.5- 6

Been on 6 for maybe 4 weeks.

Thanks for the note Oaklily

[Altostrata]

That would be a great idea if it were doable, oaklily.

 

Could you post detailed instructions on how to wean off Pristiq gradually by cutting tablets in this topic?

[Lilu]

That would be a great idea if it were doable, oaklily.

 

Could you post detailed instructions on how to wean off Pristiq gradually by cutting tablets in this topic?

 

Well, I have been able to split a Pristiq tablet into halves and quarters. Even with a brand new pill-splitter and a quick split, it's still hard to get the two halves to be even. However after you have split enough tablets, you'll have a pile of larger halves and smaller halves. Once the tablet is split in two, it's easier to split it into even quarters. To do a very gradual taper, just shave off a little bit with a knife. Obviously, the doses will not be precise, but this way you are not limited to halves and quarters. Also it seems that people do better by taking a larger dose in the morning and a smaller dose at night.

And taking supplements while withdrawing seems to help a lot of people too.

[mogfish]

Oaklily!

I have had great success weaning off pristiq with the method you are using.

I started taking 1/2 in AM and a quarter in PM.

I then reduced the AM dose by shaving a little off the edge and continued to take a 1/4 in the afternoon. After a few weeks I went back to taking a full 1/2 in the mornings and completely dropped the afternoon dose.

I have had no side effects at all weaning this way.

I am going to stabilise on half a tablet for a while as have had a bit of a crappy few weeks with some personal issues so will hold for a while until things settle down.

 

I agree that you don't always get an even half and I have kept the smaller halves aside as I will use these for my next dose reduction.

[Lilu]

I have not been on in weeks.

I have to agree as the depression and emotional detachment has been a nightmare w/d from effexor

Just want to sit and stare.

down from 25- 12.5- 6

Been on 6 for maybe 4 weeks.

Thanks for the note Oaklily

 

Well, if it makes you feel any better, that's how I became on Pristiq - just wanna sit and stare. Feel so lethargic and slow. Like my bones are made of lead. But I've recently added Lexapro to the Pristiq and started feeling a little bit better. Still waiting to feel even better before weaning off the Pristiq. Of course the Psychiatrist's instructions were as ridiculous as ever. "After 5 days on Lexapro, take Pristiq every other day for 3 days and then stop." When I protested and tried to convey to him that this is the worst thing you could do, based on people's experience, boy did he get angry! It seems that it's best to just nod, say yes, and then just do what you feel is right for your body. I cut the Pristiq dose in half, since I had already started Lexapro, but "down I went" both in mood and energy. So I went back up to my 50 mg of Pristiq and 10 mg of Lexapro and within 2 days, I was back to feeling more or less stable.

[Gardner]

Wow thanks for you in put. I just want off the meds and not add more. Interesting I was more emotionally alert and active on pristiq. Amazes me how different we call react to the same meds.

 

Mogfish.. Hi

Haven't been up to writing and getting on the computer

I'm so glad to see that you're doing well with your reduction even with a little emotional interruption.

I posted to note on my intro thread

[Altostrata]

Thanks for that information, oaklily.

 

Your method provides for decreases of approximately 12.5mg (one-quarter of a 50mg tablet). If someone finds this amount of decrease causes withdrawal symptoms, what should that person do?

 

What should a person do after he or she is down to the last 12.5mg?

 

By the way, Effexor has adverse effects and Pristiq has adverse effects.

 

See adverse effects:

 

Pristiq http://www.drugs.com/pro/pristiq.html

 

Effexor http://www.drugs.com/pro/effexor.html

 

Your psychiatrist at UMDNJ thinks Pristiq is easier to go off than Effexor? That person must be the world's foremost expert about withdrawal. Perhaps we can add him or her to our list of doctors?

 

Or maybe he or she is just pulling this opinion out of the usual orifice?

[Lilu]

Your method provides for decreases of approximately 12.5mg (one-quarter of a 50mg tablet). If someone finds this amount of decrease causes withdrawal symptoms, what should that person do?

 

What should a person do after he or she is down to the last 12.5mg?

As I and Mogfish mentioned, you can start "shaving" off a little bit off the quarter of a tablet everyday.

 

By the way, Effexor has adverse effects and Pristiq has adverse effects.

Your psychiatrist at UMDNJ thinks Pristiq is easier to go off than Effexor? That person must be the world's foremost expert about withdrawal. Perhaps we can add him or her to our list of doctors? Or maybe he or she is just pulling this opinion out of the usual orifice?

Well, as much as I disagree about his tapering advice, he does have the opportunity to see a lot of patients since he works at a Psychiatric hospital and counsels both inpatient and outpatient clients.

His opinion is also in agreement with what I've read on the Web, both from people's opinions and clinical articles. Unfortunately there is no official data.

 

How do discontinuation symptoms for desvenlafaxine compare with venlafaxine ER?

Direct head-to-head comparative studies of desvenlafaxine and venlafaxine ER to evaluate discontinuation symptoms have not been conducted. In the absence of data from prospectively conducted studies, the relative rates of discontinuation symptoms are not known. However, it may be possible to speculate that a lower rate of discontinuation symptoms could occur with desvenlafaxine, because it has fewer metabolites that do not have antidepressant pharmacological activity (but that may have pharmacological activity potentially associated with AEs), compared with venlafaxine ER, which has additional metabolites (eg, N-desmethylvenlafaxine) that may contribute to AEs, including discontinuation symptoms. Data from the venlafaxine ER and desvenlafaxine clinical trial programs indicate that abrupt discontinuation of both drugs was associated with dizziness, nausea, headache, insomnia, diarrhea, anxiety, fatigue, abnormal dreams/nightmares, and sweating. In addition, following abrupt discontinuation of venlafaxine ER, agitation, anorexia, confusion, impaired coordination and balance, dry mouth, dysphoric mood, fasciculation, flu-like symptoms, hypomania, nervousness, sensory disturbances (including shock-like electrical sensations), somnolence, tremor, vertigo, and vomiting were noted.^3,13http://www.primaryps...?articleid=2464

 

Personally I can say that Effexor gave me 10 times the side effects that Pristiq did. Now I don't know if that was the case because my body had already been used to both drugs, since Effexor turns into Pristiq. When I first went on Effexor, the side effects were just aweful lasting 3 months. With other ones developing later. However, the second time I went on Effexor ( after taking it for 3 years and then being off all drugs for 6 months), the side effects were fewer and milder. The body definitely adapts.

[Altostrata]

That article in Primary Psychiatry was published in 2009, as a follow-up to Pristiq marketing, which started in 2008. How do I know this?

Acknowledgments: This question-and-answer session was sponsored by Wyeth which was acquired by Pfizer Inc in October 2009. Medical writing and editing support for this manuscript was provided by Diane M. Sloan, PharmD, and Lorraine Sweeney, BA, of Advogent and was funded by Wyeth.

This means the article was written by contractors hired by Wyeth, the pharmaceutical manufacturer of Pristiq. It is pharma propaganda, to be taken with more than a grain of salt.

 

Some months back, I wrote to Dr. Lawrence J. Cohen, the expert source for the Primary Psychiatry article, to find out more about his knowledge of Pristiq withdrawal, but unfortunately have had no response, maybe because the money from Wyeth ran out:

Disclosure: Dr. Cohen is a consultant to Janssen and Wyeth; is on the speakers bureau of AstraZeneca, Eli Lilly, and Forest; and serves on the advisory board of AstraZeneca and Eli Lilly.

Pharma-planted speculation in journals about a new antidepressant having fewer side effects and withdrawal symptoms is typical. The latest and greatest is always the best. Your psychiatrist's belief that Pristiq has a favorable side effect and withdrawal profile compared to Effexor sounds like something a drug rep told him when Effexor went off patent and Pristiq went on the market.

 

Here is a 2008 interview with Dr. Philip Ninan, then the Vice President of Wyeth Medical Affairs, Neuroscience, who shepherded Pristiq through the FDA review process, about Pristiq's potential withdrawal syndrome, quoted here http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__7509

 

With absolute certainty, I can say nobody knows what withdrawal is worse, whether from Pristiq, Effexor, Paxil, Lexapro, SSRIs, or benzodiazepines, and anyone who claims to know such a thing is full of manure.

 

One of the great errors in logic, to which all humans are prone, is extrapolating from one's own experience and expecting everyone else to have the same results. We know that some people can quit cold turkey from high doses of antidepressants taken for years and report not feeling any adverse effects. This absolutely does not mean anyone should risk cold turkey.

 

I am glad the method you and mogfish used worked well for you. If it hadn't, you'd be posting in quite a different tune.

 

I have reports from two concerned, informed, intelligent psychiatrists whom I trust that they found switching from Pristiq to Effexor worked well to get patients off Pristiq.

 

In the first post in this topic, I've tried to give viewers (46,000 of them to date) all the reasonable options for tapering Pristiq. Since no one knows the "right" way to taper it, I want to give people the information to make the choice they think is best for them.

 

oaklily, I do not disagree that your method may work fine for some people. Cutting up tablets is given as one option in post #1. I would appreciate it if you stopped campaigning for what you believe is the "right" way to taper Pristiq. All you're doing is making work for me in deconstructing your sources and composing responses.

[Lilu]

oaklily, I do not disagree that your method may work fine for some people. Cutting up tablets is given as one option in post #1. I would appreciate it if you stopped campaigning for what you believe is the "right" way to taper Pristiq. All you're doing is making work for me in deconstructing your sources and composing responses.

 

I thought this was a forum where people could freely share their experiences, knowledge, and information. I'm not campaigning for anything. Just sharing what I find out as it comes in. Frankly your control-freak methods and attitude are really off-putting. You seem to think that you are the only one who is right about anything! I thought a forum was a free exchange of ideas, opinions, and experiences. But your Big Brother approach in managing this website is really disturbing. As well as your self-righteous attitude. Why is it only YOUR sources who are reliable? Why is it only YOUR opinion that matters and whenever I post mine, it is undermined, discredited, and devalued. Seriously!!!

[Altostrata]

oaklily, I appreciate your interest in discovering safe ways to taper Pristiq.

 

But the evidence you're putting forth does not meet my standards, as explained above and in many, many posts. It could be misleading for other people reading this topic.

 

"Free speech" on the Web is a myth. There are forums whose standards are looser, you might want to post your theories there, or start your own Web site.

[Rhiannon]

oaklily, I appreciate your interest in discovering safe ways to taper Pristiq.

 

But the evidence you're putting forth does not meet my standards, as explained above and in many, many posts. It could be misleading for other people reading this topic.

 

"Free speech" on the Web is a myth. There are forums whose standards are looser, you might want to post your theories there, or start your own Web site.

 

Actually speech is just as free on the Web as it is anywhere. I see this a lot, people posting in moderated comments or on moderated forums, and then complaining when their posts are, well, moderated. You can't just write something for the New York Times and then yell at them for denying you free speech if they don't want to publish what you wrote. It's the same on the Internet.

 

BUT you can start your own magazine, or website, and say pretty much whatever you want. At least as things stand today.

 

Alto, the other night someone I met referred to someone as a "national treasure." I would call you that, except that your work is international. And "international treasure" doesn't have quite the same meaning, does it? Anyway, I'm not sure everyone is aware of just how fortunate we are to have this forum and your huge storehouse of experience and knowledge and your very high standards. You won't be here forever, although the need for what you do is likely to be here long into the future. We're very lucky that our time of need has overlapped with your time of being here.

 

And I am not someone given to handing out unearned praise, FYI.

[Altostrata]

Awwww, Rhi, thanks. I needed that.

[Jemima]

Everything Rhi said!!!

[Barbarannamated]

Everything Rhi said!!!

 

Me, too!

[Zephyr]

Hello all, 

I have been using the info here to assist with discontinuation of several pharmaceuticals. My friend found this link that you may find interesting. 

 

http://www.theglobalmail.org/feature/party-like-your-drugs-going-generic/624/

 

I am currently suffering withdrawal from Pristiq .. and empathise with others doing the same. Keep safe and keep strong.

Zephyr

[Altostrata]

Thanks, Zephyr. Crooks everywhere. Nobody should be prescribing Pristiq for any reason.

[Lilu]

Hello all, 

I have been using the info here to assist with discontinuation of several pharmaceuticals. My friend found this link that you may find interesting. 

 

http://www.theglobalmail.org/feature/party-like-your-drugs-going-generic/624/

 

I am currently suffering withdrawal from Pristiq .. and empathise with others doing the same. Keep safe and keep strong.

Zephyr

 

I tried to taper Pristiq, by cutting the 50 mg tablet, but it was just too much of a rollercoaster. I would take 25 mg in the morning and then 12.5 mg in the evening, but it was impossible to maintain the same effect that the extended release tablet gives.  In the morning it would take a couple of hours for Pristiq to take affect and "wake me up". I'd feel sort of normal for maybe 4 hours, then I would crash, as if someone just flipped the switch off. Then I would take the quarter tablet, and again it would take a few hours for me to "come to my senses".  By morning I'd be in deep brain-fog again.

 

I really think it's better to just switch to another medication that you can actually taper!

[Altostrata]

Excellent point about how difficult it is to quit Pristiq by cutting up the tablets. Nobody should be prescribing this drug.

[Barbarannamated]

Alto,

 

I haven't seen if this new version of desvenlafaxine has been discussed on the forum, so providing link to manufacturer website. I don't know what the difference is from Pristiq; info says it is not a generic.

 

http://pr.parpharm.com/phoenix.zhtml?c=81806&p=irol-newsArticle&ID=1856984&highlight=

[Altostrata]

I guess Khedezla differs enough chemically that it has its own patent. I'm sure it will also be a bear to discontinue -- it comes in only 50mg and 100mg dosages.

 

http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0224e77b-7f6f-4191-ad3b-06847d5930e2

 

Horrible name.

[ewallac6]

After reading this thread all the way through and multiple articles on the subject, I spoke with my physician and started tapering off my Pristiq in March 2013.  It was not fun and I had to keep reminding myself that there's a light at the end of the tunnel.  

 

My doctor told me to split the pills in half for two weeks and I should be fine.  That was not at all accurate.  I ended up splitting the pills to quarters (not easy) so taper even moreso than the doctor suggested.  I have a feeling that this doctor has never been through this before.  I added a weekly therapy session that I'm still attending, which helped me learn to flex that part of my brain that regulated emotion.

 

I never understood "brain zaps" before now. Basically, for those who haven't felt them yet and are afraid, they are very short moments are vertigo that can come and go in rapid fire succession.  They can be mild to a point of being able to ignore them or severe, which are the ones that made me need to stay home.  They lasted for months, coming and going in fequency and severity.  The last severe episode I had happened moments after I prayed to God for relief.  There were a couple of months of very mild "echoes" of brain zaps - I call them my reminders never to take Pristiq again - and I can't remember when the last one happened.

 

Add to that dry mouth and some insomnia.  I also did a detox to help flush it out, which may have helped.

 

All the while, I kept telling myself that there is an end to it.  And I did I make it to the other side.  

 

I feel amazing.  You CAN get off this terrible drug with patience and knowledge!  It's a temporary thing that will be over.  

[starriol]

Hey guys!!!

 

I'm pasting a bit of a post I made at another thread, hopefully you can help me out... I've read this twice already, ALL OF IT, but I'm still not convinced about what to do...

 

So, here we go. My history is at my signature, but basically, I went down from 100 mgs to 50 mgs Pristiq 4 days ago, and while it's TOLERABLE, I'd like to mellow it out a bit...

 

If I cut it, it will lose it's time reléase properties. I also can't possibly cut the pill perfectly enough to dose, say, 40 mgs of a 50 mgs pill, to go down to 90 first, distribuited all day long. It's a very hard pill... I tried...

So, I'm basically stuck with 3 options, all of which suck for different reasons:

 

1) Bite the bullet and jump from 100 to 50 mgs. So far, so good. I'm feeling generally weird, would be the best way to describe it.... easy to anger, get sad, but also more alive. TOO sensitive. But, HEY, still alive, able to function, more or less... so, if this is the worse I can expect, it's not THAT bad

2) Cut a 50 mgs pill in 5 and shave 10 mgs off every 10 days or so. The problem with this is that it's IMPOSSIBLE to cut it decently, the pill it's very hard and breaks randomly

3) Go down to 50 mgs and add regular venlafaxine in a certain dose. Desvenlafaxine is about 3 times stronger, mg wise, than venlafaxine. I know they shouldn't be any weird interaction if I follow the dosage, but my psy said I should first, lower from 100 to 50 mgs desvenlafaxine. Wait a week or two... then, go to ZERO (gasp!), wait ANOTHER WEEK and then reinstate regular venlafaxine. Yeah, sure, if I could do that without going bat crazy I wouldn't need to do it, would I??? GRRRR!!!!

 

So... that's why I thought it would be a good alternative to add a bit clonazepam (went from 1 mg to 0, finished 4 months ago). Maybe add 0.25 mgs at the evening, to take the edge off? And then, after I'm stable with 50, withdraw the 0.25 clonazepam. THEN, I'll think how in hell I'm going off the last 50 mgs of Pristiq...

If someone can convince (due to having had experience) me to add venlafaxine or maybe crush a bit of a 50 pill and, don't know, take about half of it evenly distributed and know that it's not so terrible to take, say, 20 mgs more one day, 30 the other, since it's hard to properly divide, I could do that!

[Altostrata]

I'm sorry the paths to going off Pristiq are so unclear, but that's the best information I can find People do cut up the tablets and most appear to tolerate the loss of the extended-release qualities. Starriol, the idea of adding some Effexor to 50mg Pristiq to compensate for a 50mg decrease is a logical solution. I have not done this myself and I don't know anyone who has.

 

Your psychiatrist's idea of jumping off Pristiq at 50mg is not a good one, even with added venlafaxine. What you might consider is a cross-taper -- adding venlafaxine as you go down in Pristiq dosage.

 

Cutting up 50mg tablets into quarters gives you a little more leeway with a gradual reduction. Taking clonazepam regularly tends to lead to dependence on clonazepam. Tapering off clonazepam can be very difficult. Tapering gradually without the assistance of clonazepam is preferable. kjasdk -- To our knowledge, taking tryptophan, SAM-e, or any other supplement to boost serotonin does NOT reliably compensate for withdrawal symptoms, although everyone is different. See the relevant topics in the Symptoms and Self-care forum.(Withdrawal symptoms are not due to a lack of serotonin, but to the inability of receptors to recognize the serotonin you are producing, and the consequent autonomic dysregulation.)

Edited November 5, 2013 by Altostrata
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