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Hallo. I have been on Paxil for 20 years, 20 mg I went down to 10mg, then I switched to Prozac After 15 months tapering, I am down to 1 mg In my country there is no liquid for Prozac, but I can resolve them in water, just don’t know how to measure. I would appreciate a help with that. Thank you

PLEASE READ THIS ENTIRE TOPIC BEFORE GOING OFF PRISTIQ. Pristiq comes in insufficient dosages to taper. Do not alternate doses of Pristiq to taper -- this will cause the levels of this medication in your brain to go up and down and is second only to cold-turkey in causing withdrawal symptoms. AND DON'T COLD-TURKEY EITHER!!!!!!!!! To reduce the risk of withdrawal symptoms and post-discontinuation prolonged withdrawal syndrome, as with other psychiatric drugs we recommend reducing Pristiq by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.) See Why taper by 10% of my dosage? The official prescribing information from the FDA contains this: However, Pristiq is difficult to taper "at a more gradual rate" as it comes in only 3 dosages: low, average and excessive -- and officially, the tablets cannot be split. PROTEST THIS DANGEROUS DRUG Phone Pfizer, Pristiq's manufacturer, to make a complaint: (800) 438-1985 in the US Pfizer has not provided any specific information on how to taper from a dosage of 25mg Pristiq, the lowest available dosage. They may suggest alternating dosages to taper Pristiq. Don't do this -- it's like playing ping-pong with your brain. File a complaint about the difficulty of tapering off Pristiq -- the range of dosages is inadequate. Also complain to the FDA 1-800-FDA-1088 Mon–Fri between 8:00 a.m. and 4:30 p.m. EST. Pristiq is Effexor's fancier sibling Pristiq is a drug made of Effexor's (venlafaxine) active metabolite, O-desvenlafaxine. Pristiq is to Effexor as Lexapro is to Celexa -- a tweaked and more powerful isomer molecule. In effect, Pristiq is concentrated Effexor. See http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2464 According to Pfizer http://labeling.pfizer.com/showlabeling.aspx?id=497, Pristiq is available in extended-release tablets of 25mg, 50 mg, and 100 mg; the most common dosage is 50mg. Unlike Effexor, which is metabolized primarily by liver enzyme P450 CYP2D6, Pristiq is metabolized via conjugation and liver enzyme P450 CYP3A4. It attains peak plasma concentrations in about 7.5 hours. As a chemical, before it's put into an extended-release tablet, desvenlafaxine has a half-life of around 11 hours. Pristiq's extended-release formulation According to this paper, the extended-release formulation releases desvenlafaxine over 24 hours. The mean half-life of desvenlafaxine, without the extended-release formulation, is around 11 hours. The extended-release formulation is a monolithic matrix -- it's in the glue that holds the tablet together, not in the coating. I confirmed this in a phone conversation with Pfizer medical information (1-800-438-1985). (Thank you, oaklily, for this information about the matrix formulation.) Rather than a timed-release coating, the coating on the Pristiq tablet is only protective. The extended-release mechanism is part of the tablet matrix, or the glue that holds the tablet together. This is called a monolithic matrix tablet. If the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability. When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability. A Pristiq fragment becomes desvenlafaxine, with an 11-hour half life. (Here is a description of the similar matrix formulation for quetiapine XR (Seroquel XR) .) OPTIONS FOR TAPERING PRISTIQ Since medicine knows nothing about tapering Pristiq, the following are all informal suggestions. Try any of them at your own risk. Please let us know how you do by posting in this topic. Cut up Pristiq tablets Despite the warnings not to cut it up, from reports on the Web, cutting up Pristiq tablets does seem to work for some but it makes others ill, possibly because of "dose dumping." According to Pubmed on Desvenlafaxine: "....The extended-release tablet does not dissolve in the stomach after swallowing. It slowly releases the medicine as it passes through your digestive system. You may notice the tablet coating in the stool...." The extended-release mechanism is part of the tablet matrix, or the glue that holds the tablet together. If the matrix is destroyed, the entire dose is released at once or "dumped," instead of being gradually released through the matrix formulation. Without the extended-release matrix, a Pristiq fragment becomes desvenlafaxine, with an 11-hour half life. To avoid "dose dumping" of the entire dose, you might take smaller divided doses of Pristiq, more than once a day, like immediate-release Effexor, to mimic an extended-release dose. Cut-up Pristiq seems to sometimes cause stomach upset, which may be reduced by taking it with food. Now that the 25mg tablet is available, cutting it into quarters gives you the option to taper by 6.25mg per step. If you are taking 100mg Pristiq or 50mg Pristiq, you may wish to request part of your prescription be written for 25mg tablets. (For insurance coverage of multiple dosages, your doctor most likely will have to specify taking Pristiq in "divided doses.") You may find you need a precise way to measure your tablet fragments. See Using a digital scale to measure doses As you get down to a low dose, you may wish to switch to Effexor to more precisely control dosage decreases, see below. Reducing from 100mg Pristiq to 50mg Pristiq Drug switches incur additional risk. Before trying a switch to Effexor or Prozac (fluoxetine) from 100mg Pristiq, it's probably wise to go down to 50mg Pristiq first, or 25mg if possible. Combining whole tablets, with their extended-release qualities, with tablet fragments probably makes "dose dumping" less likely or noticeable. You might use a 50mg tablet plus a 25mg tablet plus 3/4 of a 25mg tablet (18.75mg) to make the first reduction to 93.75mg 2nd reduction: a 50mg tablet plus a 25mg tablet plus 2/4 of a 25mg tablet (12.5mg) to go to 87.5mg 3rd reduction: a 50mg tablet plus a 25mg tablet plus 1/4 of a 25mg tablet (6.25mg) to go to 81.25mg 4th reduction: a 50mg tablet plus a 25mg tablet to go to 75mg 5th reduction: a 50mg tablet plus 3/4 of a 25mg tablet (18.75mg) to go to 68.75mg 6th reduction: a 50mg tablet plus 2/4 of a 25mg tablet (12.5mg) to go to 62.5mg 7th reduction: a 50mg tablet plus 1/4 of a 25mg tablet (6.25mg) to go to 56.25mg 8th reduction: a 50mg tablet If withdrawal symptoms occur, some people have found taking an additional fragment of a tablet can smooth the transition from one dosage to another. Another way to get from 100mg to 50mg or 25mg is to combine Pristiq tablets with a liquid made from immediate-release Effexor (see below). Once at 50mg or 25mg, stabilize for a month at least and consider your plan for the next stage of tapering. Have Pristiq made into smaller dosage capsules or a liquid by a compounding pharmacy Compounding pharmacies can crush the tablets and put the powder into smaller capsules by weight. Like cutting up tablets or crushing, this destroys the time-release quality, but the compounded method is much more exact. In your body, crushed Pristiq is similar to regular immediate-release Effexor, with an 11-hour half-life. You may wish to have your dose compounded to take twice a day. If you are taking 50mg Pristiq, for example, you would have 60 capsules compounded per month. Each capsule would be 1/2 of 45mg (a 10% reduction of 50mg) or 22.5mg. You would take two capsules per day, once in the morning, and once in the evening. The next month, you would have 60 capsules compounded, each capsule being 1/2 of 40.5mg (a 10% reduction of 45mg) or 20.25mg. And so forth, for each reduction. (According to my compounding pharmacy, they can put in a slow-release additive distributing absorption over 8-10 hours. This is not as long as the Pristiq time-release coating, but at least it's something. Check with your compounding pharmacy about this. See getting-custom-dosages-at-compounding-pharmacies-us-uk-and-elsewhere ) If this does not work, you may wish to switch to Effexor XR and use the bead-counting method. Regular Effexor probably wouldn't be an advantage over Pristiq compounded to custom dosages. One of our members had a desvenlafaxine liquid made by a compounding pharmacy. Most likely, this compounder used pure desvenlafaxine succinate powder to make this liquid, as desvenlafaxine tablets contain a glue that might resist being made into a liquid. But he may have a way to grind tablets up to make a suspension. A liquid would have to be immediate-release, with a half-life of around 11 hours. Generally, you'd take a drug with that short a half-life twice a day. Crush Pristiq tablets, weigh powder with a digital scale This is similar to cutting up tablets -- Pristiq is a "do not crush" medication, as it is a time-release drug. The Pristiq powder becomes desvenlafaxine, with an 11-hour half life. If you pulverize the tablet, you might take smaller divided doses of Pristiq, more than once a day, like immediate-release Effexor, to mimic an extended-release dose. In principle, this would be a more precise way of tapering than cutting up tablets: Crush the tablet Make sure the shell fragments are evenly distributed in the powder Weigh the powder for a dose with a digital scale Put the powder into an empty gelatin capsule to make it easier to ingest Peer discussion of this method starts here http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__27417 Switch to Effexor or Effexor XR Note: If you've had an adverse reaction to Effexor before, do NOT switch from Pristiq to Effexor. "Desvenlafaxine (O-desmethylvenlafaxine) is the major active metabolite of venlafaxine." Since the relationship is so close, switching to regular immediate-release Effexor tablets, which you can cut up or make into a liquid, this may be the best way to taper off Pristiq. Because it has a mean half-life of 5 hours, you'd have to take regular Effexor twice a day. Alternatively, you might substitute Effexor XR, which is released gradually like Pristiq and needs to be taken only once a day. You'd have the difficulty of tapering off Effexor or Effexor XR -- themselves notorious for withdrawal difficulties -- but at least you can do that gradually. See Tips for tapering off Effexor and Effexor XR (venlafaxine). 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. (If you've just quit Pristiq and are experiencing withdrawal symptoms, you may wish to reinstate a LOWER dose of Effexor XR, such as 37.5mg, to start. This may be enough to stop withdrawal symptoms and avoid a kindling reaction.) The psychiatrist who writes the 1boringoldman.com blog reports success in switching one patient from Pristiq to Effexor, then tapering Effexor, here (see comments) Another psychiatrist said when he tried this, the switch from Pristiq to Effexor was "seamless." Dr. Stuart Shipko posts here: Advice from a psychiatric pharmacist I have been corresponding with a professor at a prominent US university pharmacy department. Here is his best guess at how to taper Pristiq (he does not want his name published): Then taper off fluoxetine (Prozac). See Tips for Tapering Prozac Advice from Dr. Stephen Stahl, author of the manual Essential Psychopharmacology In his widely read psychopharmacology manual, eminent psychopharmacologist Stephen Stahl advises titration by crushing the tablets and mixing in fruit juice, see http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__14799 According to our member oaklily, Stahl is wrong. Making a liquid from Pristiq does not work, see http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__24822 Dr. Stahl intends to correct his book, according to this correspondence 09/15-9/16/13 with him: Use a combination of Pristiq tablets and Effexor liquid Pristiq cannot be made into a liquid, but its close relative immediate-release Effexor (not Effexor XR) can. You may be able to go off Pristiq by taking part of your dose in lower-dose tablets and part in liquid Effexor, gradually converting to all-liquid Effexor as you get to lower dosages. This may offer a convenient and gradual path off Pristiq. Only regular immediate-release Effexor can be made into a liquid (see Tips for tapering off Effexor (venlafaxine) ). As immediate-release Effexor has a short half-life and is usually dosed twice a day, you may wish to take the liquid portion of your dosage later in the day. For example, if you are taking 100mg Pristiq, you may wish to take your daily dose as one 50mg tablet and the rest later in the evening as a liquid made from immediate-release Effexor. You can titrate the liquid by 10% of your daily dosage to taper until you get to 50mg. Then you can take a 25mg Pristiq tablet with the rest in a liquid made from immediate-release Effexor. When you get to 25mg Pristiq, you might switch to splitting the tablet and taking the rest in Effexor liquid and so on until you are taking only liquid Effexor. To do this, you will have to request a prescription for Effexor tablets as well as Pristiq from your doctor. "Bridging" with Prozac or another antidepressant Any drug change incurs additional risk. A switch to Prozac from Pristiq may not work -- they are very different drugs -- or you might have adverse reactions to Prozac. Prozac is regularly used to "bridge" off Effexor. Given that Pristiq is a sibling of Effexor and Effexor XR, it is possible that one can, similarly, use Prozac to withdraw from Pristiq. Attributed to Joseph Glenmullen, the "bridging" technique is described by a doctor here http://www.bipolarworld.net/Phelps/ph_2005/ph1354.htm Read this entire topic before attempting a switch to Prozac: The Prozac switch or "bridging" with Prozac Later, taper off Prozac. At least Prozac comes in a liquid. To do this, consult a doctor knowledgeable about this technique.

Hi all. Found this site by accident but glad I did. I’m struggling a lot after recently stopping AD’s and so trying to educate myself, encourage a semblance of kindness towards myself 🙄and get a bit of support and a more objective perspective on this bloody difficult journey. Been on Prozac for 25 years and then replaced with Duloxetine/Cymbalta in 2014 (after failed attempts to come off Prozac). During the majority of this time I have had no psych service input other than putting me on and leaving me on AD’s. At present - Was on 60mg Duloxetine which I tapered over the last 2 months 🤔 with vague advice from an NHS psychiatrist. This advice now feels very vague and a little dismissive given withdrawal effects and current situation. Anyway, I have been completely off Ad’s for approx 2 weeks. The main symptom during taper- brain zaps, dizziness and irritability. Then the symptoms seemed to disappear. However the last 2 weeks with no drugs has been like nothing I imagined. It has completely pulled the carpet from under me. Brain zaps that make me so dizzy I feel I could fall, spontaneous and uncontrollable crying, severe insomnia, feeling super anxious and panicked at times and generally odd, a bit removed and frightened of it all. On the plus side I feel less numbed, verbal fluency is returning and I feel a little more hope 🤞 (that this is the right thing and all will be well), relief (that these symptoms that when stopping the drugs had me straight back onto them as ‘I was ill’ were/are actually withdrawal) and an immense sadness that I am only at this point 30 years later and this is sprinkled with a rage (at the psychiatric/pharmaceutical world). Sorry...blaahhh. I guess I’m looking for someone else to say it will be ok, it gets better, well done. Some kindness. More hope and success stories. I really can’t believe how hard this is. I see that it appears my ‘taper’ was very quick but I do not want to go back on anything and am riding it out. I feel so isolated as I really don’t feel people who haven’t had this journey really understand. Thanks in advance for any replies. This is so, so damn hard. Kind thoughts to you all 🙏🏻 S, Scottish Lass Prozac 60mg ( 1996-2014) Duloxetine/Cymbalta (2014-March 2021)

Hello all, first thank you for this really helpful forum. I started taking Venlafaxine 150 back in 2016. Later in 2018 i started tapering it off with 5-10% rule. In 2020 I arrived finally at 50mg. At this point however I got strong withdrawal symptoms even with 5%. I learned then about the Prozac bridge method and i thought I give it a try. So i am now off the Venlafaxine for about 2 months and now i only take Fluoxetine 13mg. However I still have some withdrawal problems from the venlafaxine 2 months later. It is not that bad, but mostly my brain is hurting headache and strange feelings and tingeling at my brain. I think I will now stay on the Prozac 13mg until the problems go away and then see how fast i can taper the prozac. Or would you say it would be better to go back to the Venlafaxine after 2 months now already because of the symptoms, I am now afraid that those will last years as I have read on some other cold turkey cases. Thanks NightWarrior

Hello Im 2 weeks off of Pristiq. My idiot NP decided to switch me from 50 of pristiq to 20 of prozac. Now getting off prozac. Symptoms started about 4 or 5 days in. Intolerable restlessness, irritability, hopelessness, and tremors in face, hands, arms, neck, trunk. Big problem is they r still getting worse at this point. When I was on the 50 I felt at least ok, but I wanted to get off because I thought it was causing the tremors, which have now gotten much worse in withdrawl. Effexor use and withdrawl also cause tremors. Should I get back on the pristiq and let myself stablize hoping the tremors and depressive symptoms go away, and then work down slow?

I am withdrawing from Effexor it was a brutal withdrawal. My dr put me on Prozac 5 mgs for a few weeks and I stopped the effexor I was down to 25 a day. I’m hoping I can stop the Prozac too but feel awful. Can’t sleep kind of queezy physically not myself. Better tho than the withdrawal from Effexor where I had cold, sore throat, dizziness nausea. I was on the Effexor for over 5 years so I guess tapering off is hard.

Moderator note: added link to Gato123's Introduction topic: Gato123: withdrawal from Cymbalta and Prozac; Introduction topic Gosh, I don't even know where to start. The short of it is, you WILL get better if you do not give up. I entered into withdrawal 14 months ago and was absolutely debilitated. Fast forward 14 months and most of my physical symptoms I was presenting are much less intense and the paralyzing anxiety and black depression I sank into are much more manageable. When I was in the middle of withdrawal "hell" I truly didn't know if I believed recovery was possible and it.was.terrifying. No medical professional knew what to do to help (Note: This was if they even recognized the "discontinuation syndrome" (which the very terminology makes me so angry because it's SO misleading but that's for another post) other than recommended I reinstate the drug. I refused. All I kept thinking during this time was, "What is going to happen to me?" "When will this end?" "Will it end?" "What has chronic, long-term exposure done to my body? My brain? My Central Nervous System?" These were constant questions running through my mind for a long time. But I am here today to share my experience with you. No matter how bad you feel in the middle of it, your body IS capable of healing and WILL! I will share my experience in more detail below if you are interested to know more. I am a female in my 30s. I was prescribed Wellbutrin over 17 years ago to help with the side effects of the birth control pill I was taking. In the last 17 years I've been on most of the "common" SSRI/SNRIs/benzodiazepines/sleeping pills including but not limited to: Wellbutrin, Effexor, Lexapro, Paxil, Cymbalta, Prozac, Lorazepam, Alprazolam (Xanax), Ambien, and more. Each one brought new side effects, and in general, made me sick. I felt like I was on a roller coaster and never quite at peace. I am 14 months out and much better than where I was day 1. It is has been the hardest, most trying, exhausting experience of my life but I have survived. And YOU will too!