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Altostrata

Tips for tapering off Zoloft (sertraline)

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Altostrata

Aka Lustral, Serlift, Sertawin, Zosert, etc.

Sertraline is an SSRI with a half-life of about 26 hours. It is metabolized mainly by the liver enzyme P450 CYP2B6, plus CYP 2D6 (substrate, inhibitor), CYP 3A4 (substrate, inhibitor), and CYP 2C9 (substrate). It has an active metabolite, norsertraline, with a half-life of 62 to 104 hours, which may extend its effects.

 

Dosage forms and strengths, from Pfizer:

  • 25 mg tablets
  • 50 mg tablets
  • 100 mg tablets
  • Oral solution (new name, same product as oral concentrate): a clear, colorless solution with a menthol scent containing sertraline hydrochloride equivalent to 20 mg of sertraline per mL and 12% alcohol. It is supplied as a 60 mL bottle with an accompanying calibrated dropper that has 25 mg and 50 mg graduation marks.


The best method for a very gradual, precise taper would be using Zoloft liquid.

Reduce by 10% per month to start
The 10% rule holds for Zoloft, just like other psychiatric drugs: Reduce 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?

Cutting up tablets
According to FDA information at http://www.drugs.com/pro/zoloft.html, Zoloft comes in scored tablets of 25, 50 and 100 mg dosages.

The scoring on the tablets indicates they can be split. Cut them up with a pill cutter, available at any drug store.
 
Precisely weighing tablet pieces or crushed tablets with an electronic digital scale
You may wish to precisely measure your dosage with an electronic scale that measures milligrams. These are available for under $30 US. See http://survivingantidepressants.org/index.php?/topic/1596-using-a-digital-scale-to-measure-doses/
 
Use Zoloft liquid concentrate to taper
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=52077:

Quote

Zoloft oral concentrate is available in a multidose 60 mL bottle. Each mL of solution contains sertraline hydrochloride equivalent to 20 mg of sertraline. The solution contains the following inactive ingredients: glycerin, alcohol (12%), menthol, butylated hydroxytoluene (BHT).

 

From http://www.nlm.nih.gov/medlineplus/druginfo/meds/a697048.html
 

 

Quote

Sertraline concentrate must be diluted before use. Immediately before taking it, use the provided dropper to remove the amount of concentrate your doctor has told you to take. Mix the concentrate with 4 ounces (1/2 cup [120 milliliters]) of water, ginger ale, lemon or lime soda, lemonade, or orange juice. Do not mix the concentrate with any liquids other than the ones listed. Drink immediately.

 
US order code for Zoloft 20mg/ml Concentrate Solution NDC 000494940

 

Unlike other oral liquid antidepressant preparations, Zoloft liquid should be mixed with water because if it is taken directly from the bottle, it is likely to cause a burning sensation in the mouth.

As it is in a 20mg per mL concentration, this means using an oral syringe to measure out the proper amount. If you wish to take 50mg, you would take 2.5mL from the bottle, drop it in a small glass of water, etc., and drink it all.
 
If you are taking 50mg and wish to reduce by 10% (5mg), you would take 2.25mL (45mg) from the bottle, drop it in a small glass of water, etc., and drink it all.

Personally, I would use water rather than fruit juice or soda so I can see what's left in the glass. I might even drink the mixture, fill the glass again, swirl it a bit, and drink that to make sure to get all the Zoloft out of the glass.

Make your own liquid
Many people make their own Zoloft liquid out of tablets and water. See How to make a liquid from tablets or capsules

 

Use a combination of tablets and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in tablets, gradually converting to all-liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

For example, if you are taking 100mg Zoloft and wish to reduce by 10%, you could get a prescription for 50mg tablets and the liquid, then take one 50mg tablet and 40mg Zoloft in liquid form to total a daily dose of 90mg. Most likely, the doctor who writes the prescriptions will have to indicate "divided doses" to get the drugs covered by insurance.

Have a compounding pharmacy make up capsules of smaller dosages, or a liquid
A compounding pharmacy will accurately weigh small doses and put them into capsules for you. If you cannot find Zoloft liquid or do not want to make your own, a compounding pharmacy can also make a sertraline liquid (probably from crushing tablets).

 

See http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__p__3001#entry3001

Edited by Altostrata
updated

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Becca

"Precisely weighing tablet pieces or crushed tablets with an electronic digital scale

You may wish to precisely measure your dosage with an electronic scale that measures milligrams. These are available for under $30 US."

Can you tell me where to get a digital scale that measures milligrams? I'm thinking on line-- the local scales I've seen don't measure milligrams.

Okay-- I found the link for the gemini 20.

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lotusflower

Can someone help me figure out what I need to do? I am currently taking 5 mg. zoloft and will make liquid from my tablet. I plan to dissolve the 5 mg. in water. i want to taper to 4.8 mg. I have three syringes. One is one ml., one is 5 ml, one is 10 ml. How much water do I use to dissolve the 5 mg. in? How much do I drinK?

Is this the proper way to do this? Or should I use a larger pill and subtract in a different way?

I'm nut sure even what question to ask? My brain fog and general difficulty with this type math is making this very difficult for me to figure out on my own. Just need a bit of guidance and it is much appreciated.

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Altostrata

There are a number of ways you can do this.

 

You may notice 10mL is a very little amount of water and may not dissolve the tablet. Try 50mL.

 

  • Crush the 5mg Zoloft on a piece of wax paper. Carefully pour it into a small container with a lid.

  • Using the 10mL syringe, put 50mL lukewarm water in the container. (Draw the water from a glass.)

  • Put the lid on the container. Shake gently.

     

    You now have 5mg mixed in 50mL water, or 1mg in 10mL, or .1mg in 1mL.

  • To take 4.8mg, use the 5mL syringe to remove 2mL (containing .2mg). Throw it away. (You will use the 1mL syringe when you need to make smaller decrements.)

  • 48mL (4.8mg) is left in the container. Drink this, add a little water to the empty container, swish it around and drink again to make sure you get all the particles.

This is a 1:10 dilution. You may find it convenient to make other dilution ratios. You'll have to adjust the math accordingly.

 

Zoloft also comes in a liquid form with prescription from the pharmacy.

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lotusflower

Alto,

 

This is exactly what I need. Can't thank you enough, God bless. xx

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Dale

Has anybody done a DIY liquid Zoloft here? I need some advice and guidance from somebody that has the experience of what Im fixin to do.

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Altostrata

Dale, have you seen these tips?

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Dale

Yes, I've read it but I wanted to chat directly with someone that's doing the Zoloft taper. You know, kinda like support. ;)

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Dale

Whats funny is I've read all these tips and there awesome. Knowing that Zoloft comes in liquid, I feel like I'm bothering my doctor if I ask for a prescription for it. I see a doctor at whats called a mental clinic and I've just got my 100mgs filled so He might make me wait but I dont know.

Im feeling confident the more I read on how to make my liquid. Thanks to this site. :)

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Altostrata

You're welcome, Dale. You're not bothering your doctor to get a prescription for the liquid. Writing prescriptions is his or her job.

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SunshininDay

Can you please give me advice for tapering off 200mg of Zoloft?  If I follow the 10% regimen, calculating at each new dose, it would be 3 years before I even got down to 5mg.

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Altostrata

That would be correct at 10% decreases every month.

 

You may be able to go a little faster with 10% decreases every 3 weeks or 2 weeks until you get about half-way down, then most people need to go slower.

 

Get ready for a long project. This is why a lot of people here have a lot of anger towards psychiatry.

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LoveandLight

Brain fog and scared that I'm doing it wrong not a good mix. So I mix 25 ml water to 25mg of tablet. Take out 25ml and add juice. But I just realised that haven't been very accurate with the juice..so as long as I measure the same amount of juice this is ok? Juice needed as it really burns the mouth just with water.

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Altostrata

You don't need to measure the juice, just make sure you drink it all after you add 25mL Zoloft liquid.

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LoveandLight

Thanks.

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ang

Just a tip, if you put the zoloft tablet into water, and wait, it breaks up itself, no need to crush it.

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LoveandLight

I now have liquid sertraline but wondered if it can be diluted to get the dilution that I need. I asked the pharmacy and they cannot recommend it 'for legal reasons'. Laughable if it weren't so tragic that the existing advice is so damaging.

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Altostrata

Find the ingredients for the liquid sertraline (could be in an insert). If it contains water, you can dilute it with water.

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LoveandLight

Ok thanks

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irishlondon

Hi everyone,

 

I was on 50mg of sertraline for 7 months. Over the course of a month I decided to taper down to come off the AD. 3 weeks after my last dose I have now been hit by the most awful anxiety. So in the past fews days I have restarted the sertraline at 25mg...

 

Is this the right thing to do? Or am I messing my brain chemistry up by doing this? 

 

I feel very worried by all this right now

 

Thanks

Ryan

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LoveandLight

No ingredients list on the liquid sert.

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LoveandLight

A different brand of sertraline has been delivered..I cannot get hold of the kind I know is ok for me..where do I go from here then if I react to this now..

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Altostrata

Phone the manufacturer for the ingredients. Dilute with water if water is one of the ingredients.

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Fresh

Is there any benefit in taking sertraline in divided doses ?

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Altostrata

Some people find it more comfortable to divide doses.

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Oceanrat

I have liquid now and 25mg tablets. Can I mix the tablets and liquid? Or stick to one or the other? Or switch to liquid safely only? Hope this makes sense. My brains not working that well. Thx again!

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Oceanrat

Thx alto!

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PanickedPathfinder

Hi there. I've been trying to find the right place to post this, so I hope someone can redirect me to the proper thread. I'm beginning tapering from 18mg of Sertraline, have looked at this site's many links to precise scales, but I'm still not sure how or what kind of file to buy to shorten the pills? If someone could please redirect me to a video or list of files I'd be much obliged. Thanks!

 

PanickedPat

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LoveandLight

I don't know pat I'm afraid but I know that I absolutely love the quote by Amelia eckhart!

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Altostrata

PanickedPathfinder, we do not recommend the filing method, it's too imprecise, see Did I go wrong with my nailfile?

 

Please read the first post in this topic for other, more controllable ways to taper.

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PanickedPathfinder

Thanks for the response, Altostrata. Unfortunately, my doctor is playing ignorant about any liquid sertraline options, and I honestly don't feel comfortable with liquid solutions I'd make myself. Your community here has had tremendous results with making their own liquid solutions, but I really don't feel it's for me. I'd feel most in control (though I know the margin for exact doses is large) through filing. Are you certain you can't recommend some method for shaving/filing scored pills? If I could at least start with this method and see how I feel, I'd love to go that route. (I just ordered a precise gram scale for the exercise!)

 

Any further comments would be appreciated. Thanks!

 

PanickedPat

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Altostrata

Weighing will make the nailfile method more precise.

 

For your doctor's information: US order code for Zoloft 20mg/ml Concentrate Solution is NDC 000494940
 

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Haap

I´m doing some research for my husband who fears he has to taper his Zoloft. He wonders if anybody has found anything that masks the dreadful tast he knows will be a problem with liquid solutions. I understand the tablets taste horrible. He can´t use anything with sugar.

 

He fears that Zoloft mixture from the pharmasy will be too different from the tablets and hopes that making solutions of the tablets will give a smoother  taper. Has anybody tried tapering on mixture after using tablets? How was the transition?

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Altostrata

Please read this topic from the beginning. You could make a solution with water and then take your dose in apple juice.

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