Andie: tapering off Pristiq

[Andie]

Hi Chessie

 

I have been really unwell these last few months so the switch had to put on hold. 

 

I’ve developed allergies and sensitivities to a lot of things so it’s been a struggle. 

 

I think I will eventually switch to Effexor as the compounding is continuing to be problematic. Yes I am using the enteric but After switching over and giving it a few months I haven’t noticed a huge difference. 

 

The Pharmacists I have spoken to can’t agree on whether the capsule should be enteric or regular gelatin. 

 

 

[ChessieCat]

Sorry to hear that.  If you do decide to switch to Effexor please be careful.  Yogendra is/was doing a cross over instead of a straight swap.  I will admit that I have considered it but I seem to be doing okay with my capsules and the compounding pharmacist has told me he can make very small doses.

 

I've been fortunate the last couple of months.  Last reduction period I know I missed one night time dose (0.75mg, total 2.75mg), and this reduction period I've missed a morning (2mg) and a night time dose (0.5mg) (don't know if consecutive doses) and I've no idea when I've missed them.  Thankfully the result wasn't really obvious.  I do count out my capsules very carefully at the start and do a double check that I have the correct number to begin with so I know it wasn't an error.  I've now printed off a small list for the reduction period which is taped to the mirror and I now cross off each dose as I take it.

 

I had a thought after I picked up my last batch of capsules.  I was thinking that the compounding pharmacist might just be using a non drug powder in the capsules and I haven't been taking any Pristiq.  But of course it was just a really stupid thought but I did think it funny.

[Andie]

I will cross taper, I need to get myself organised and have the correct dosages of Pristiq and Effexor compounded. 

 

The big thing that is holding me back is not knowing the equivalency between Pristiq and Effexor. I know there is debate out there but my Dr suggests 50mg of Pristiq is 100mg of Effexor. It scares me not knowing for certain. I would be happy just for a successful switch and an indefinite hold. 

[ChessieCat]

Note about this post.  I've ended up musing, but I hope something might be helpful. 😉

 

On 9/23/2016 at 8:13 PM, baroquep said:

 

Hi ChessieCat, Have to agree with you, the switch to 75mg Effexor XR from 50mg Pristiq probably resulted in a 25% reduction ... if I had to do it over again, I would have started on 100mg Effexor rather than 75mg.  Am thinking that 50mg Pristiq is likely closer to 100mg Effexor despite what my pharmacist recommended.  After all is said and done, during the switch I only had one really awful day, so I guess I'll have to say, for me anyway, it was successful.  Now to get off of the f'ing Effexor!!!  

 

To start with this member thought her switch to Effexor 75mg from Pristiq 50mg had gone okay but then started having issues.  I think we suggested updosing by a small amount but it looks like she didn't.  I also suggested that she do a nice long hold but again it looks like she didn't.   Unfortunately even though she logged in back in January 2019 she hasn't posted since December 2017.

 

From baroquep's drug signature:  September 15, 2016 - switched from Pristiq 50mg to Effexor XR 75mg; November 10, 2016 - reduced to 67.5 Effexor XR
December 9, 2016 - reduced 60.75

 

29 minutes ago, Andie said:

my Dr suggests 50mg of Pristiq is 100mg of Effexor.

 

I think I would go with the 50mg Pristiq = 100mg Effexor.  From what I've found it seems that 50mg is equal to between 100mg-150mg.  I think it would be better to start lower and increase by small amounts if needed than to go too high.

 

When doing a cross over we suggest not making a reduction at the same time.  If it happened that 50mg is equal to >100mg it would mean that you were making a reduction.  One way of overcoming this would be to stay on each cross over combination for 1 month.

 

The below is interesting regarding SSRI/SNRI.  That may be why baroque had issues.  But does the same thing happen with lower doses of Pristiq? 

 

That might be why you have started having issues at the lower doses.  Looking back on my taper doses, during 2018 I went from 14mg down to 5mg.  It was a really tough year but I had put it down to having dental issues for a couple of months (May? started root canal on one tooth and then had to have 2 extractions on the same side).  At the beginning of November 2019 I had a major melt down at work.  I'm now wondering if it was related to going through a tough dose (6mg).  

 

From https://psychopharmacologyinstitute.com/publication/venlafaxine-and-desvenlafaxine-differences-and-similarities-2178

 

Quote

There is evidence from experimental and clinical data suggesting that there is a dose-response relationship in terms of clinical efficacy and pharmacological affinities. At its lower therapeutic dose (75 mg/day), venlafaxine blocks the reuptake only of serotonin. So it can be said that at 75 mg venlafaxine works as an SSRI. As the dose increases, so does its noradrenergic effect. It is believed that at a range of 150-225 mg a day, venlafaxine shows its dual activity as both serotonin and norepinephrine reuptake blocker. There is one caveat though, this hypothesis cannot be fully tested until a radioactive ligand is developed, so that in vivo clinical studies can be performed. An unrelated example of this type of studies are PET studies that measure D2 receptor occupancy and correlate it with antipsychotic activity.

 

[Andie]

2 hours ago, ChessieCat said:

But does the same thing happen with lower doses of Pristiq? 

 

Yes I wondered that too. At what dose does desvenlaxine become an ssri? We don't know. It's not certain for Effexor either as it's just a hypothesis until science comes up with a radioactive ligand for NET.  We just don't know enough about these drugs. 

 

For me the major trouble has come at the lower doses and it's somehow tied in with having allergies and sensitives. It was like some switch was flicked over.  I've got terrible allergies and dermatitis, but I need to avoid antihistamines like the plague as they now make me very agitated, teary and anxious. 

 

Ive definitely got classic withdrawal but it only hit at a lower dose 

 

I just need the guts to make the next step. 

 

[ChessieCat]

Is there a reason you are taking such a high dose of D3?

 

I took 4000iu for about 5-6 years but a couple of years ago reducec to 1000iu.

[Andie]

I have to take high D3 as I have really low vitamin d but require iron infusions. Its to prevent hypophosphataemia after having the infusion. 

 

1000 vitamin D can't raise my level high enough so it's safe to have an infusion. 

 

 

[Andie]

I've been to see a Psychopharmacologist. He recommends coming off the compounded Pristiq ASAP. The time release is too critical as I am sensitive to fluctuations (as I've always suspected) He says compounded Pristiq should always be taken in divided doses and that Compounding Pharmacies are allowed a certain room for error each side of the prescribed dose. This isn't going by to work for me. 

 

Speaking to the Chief Pharmacist working for the same Hospital, he believes that Pristiq is the hardest  medication to safely taper from because of the time release and lack of dosage options in Australia. 

 

I won't be posting here for a while. I need to digest that I've developed withdrawal syndrome after a slow and careful taper. I am taking some time to work out the next step. 

 

 

 

[Altostrata]

Andie, how are you doing?

 

You can take compounded Pristiq in divided doses, or you can substitute Effexor (if you've never had an adverse reaction to it).

[Andie]

Hi @Altostrata

 

Still struggling along. I can’t seem to find a sweet spot with the divided doses.  My new Doctor really wants me to try the Prozac bridge rather than the Effexor. I’m too scared so I haven’t made the move. 

[Altostrata]

Substitution of Effexor XR, the kind that comes in capsules with tiny beads inside, may be a lot easier than a switch to Prozac, with less risk, since venlafaxine is a sibling of deslavenfaxine.

 

The beads individually are extended-release. You can taper by counting out the beads.

[Andie]

So after many months deliberating what path to take going forward, I am in the middle of completing the Prozac bridge. I couldn't tolerate Effexor and had become very ill on the compounded Pristiq. The impact withdrawal has had on my quality of life has been too profound not to take action. 

 

I have added 10mg to my dose of pristiq, slowing increasing from 2.5mg up to 10mg over 3 weeks. I will start dropping the Pristiq later this week. My Doctor very specifically wanted to allow the Prozac to build up before dropping the offending Pristiq. 

i will then stabilise on Prozac and wean off using a liquid suspension. 

 

I am feeling much improved with the addition of the Prozac and its definity buffered the symptoms of withdrawal. My nausea and vertigo have disappeared and I feel much more like myself. My sleep has been slowly improving as has the panic on waking. In terms of negative effects, I have had An increase in muscle spasm and restless legs. . I had some agitation that seems to be subsiding. 

[Andie]

Sleep much improved and I am finding it easier to wake in the morning.  There is still some anxiety and vivid dreaming. 

 

overall anxiety has been reduced by 90 percent. No more nausea vomiting or dizzinesss. 

 

Feeling a bit flat and musicles in legs are sore.. Getting ready to drop the Pristiq

 

[Andie]

I am waking without panic. The first time in 15 months. I know I am having vivid dreams but I cannot remember the content. 

 

Successfully dropped 6mg of Pristiq as a test dose. I have a slight headache. 

 

Feeling really lethargic and dull from the 10mg of Prozac which was definitely an overshoot, but will use this to my advantage to pull out the rest of the Pristiq. 

 

I have liquid Prozac ready to use. Dr is monitoring and supportive. 

 

 

 

 

 

 

 

 

 

 

[Andie]

Felt very tired yesterday morning, but perked up later in the day. Had a nap but experienced sleep paralysis. 

 

Feeling better on half dose Pristiq and 10 mg Prozac. Will try to drop another to make Pristiq dose 5mg. Tempted to drop the whole amount but I could be playing with fire. 

 

I think 10mg Prozac is too high as I am feeling fatigued and have to take it at night right before bed. Will give it another week  and then will consider reducing Prozac dose. 

 

Muscle spasm has decreased and not as sore in legs. Feeling a bit spaced out and tired this morning but this feels more like the addition of Prozac not the reduction of Pristiq. 

 

[FindRest]

I am glad you have a supportive dr, Andie. Glad you are getting a bit of relief from all the side effects. Hope that trend continues!

[Andie]

I’ve realised that the meds have a massive impact on my sleep. I always suspected but now I know for sure. I’ve aleays found it hard to wake up from sleep and now I know why. 

 

 

[Andie]

Still feeling fatigued and spaced out. 

 

No feelings of withdrawal and only slight morning anxiety. 

 

Definitley overshot the Prozac and dose needs to come down. 

 

 

[FindRest]

1 hour ago, Andie said:

Definitley overshot the Prozac and dose needs to come down. 

 

 

As I’ve been contemplating whether or not to do the Prozac bridge, I’ve thought about using the liquid form, therefore, changing dosages would be easier (in my mind, anyway).  Are you on a liquid or tablet/capsule? 

[Andie]

Hi FR

 

I am using liquid made up by a compounding Pharmacy. I think I could probably make my own for a fraction of the cost. 

[Andie]

Forgot to mention I couldn't drop the Pristiq at 2.5, 5 and 7.5mg- I had withdrawal symptoms with vomiting.

[Andie]

Woke with a pang of uncomfortable anxiety but didn’t spiral out of control. Anxiety felt more contained. 

 

So far no symptoms of withdrawal- I think I can only feel side effects of Prozac. Not knowing what is a side effect of starting up Prozac and reducing Pristiq is difficult 

[Andie]

How I feel currently:

 

• slight anxiety 
• some slight increase in muscle spasm
• feel a bit spaced out 
• sweaty

got to speak to Dr today about reducing dose of Prozac. 

[Andie]

Felt a huge improvement around lunch time today. The awful brain fog and lethargy lifted. I don’t know why, I just hope it stays this way. 

 

Sleeping pattern has radically changed. I’m getting at least 5 hours straight. Have gone from falling asleep quickly to waking at 2am and struggling to get back to sleep only to have a morning panic attack. I am now having some trouble getting to sleep ( I take Prozac In the evening as can’t tolerate a morning dose) but once I have drifted off, I don’t wake until the morning. 

 

Still having intensely vivid dreams, but instead of dreaming about all sorts of violent and upsetting things, I now dream intensely about food. It is just bizarre...

[Andie]

I feel an improvement every time I reduce Pristiq. Today will be my final dose. 

 

Sleep is so much better. 

 

Still think dose of Prozac is too high but I will reassess once Pristiq is out of my system. 

 

Feeling hopeful for a full recovery. 

[FindRest]

Andie, I am thrilled for you!! I know it’s still not easy, but this is very good news!!! ❤️

[Andie]

Thanks! 

 

I’m keeping everything crossed that this last drop will be as easy as the rest. 

 

It Is so hot where I am I will be hiding in doors all day and watching Netflix. I think I could easily fry an egg on the pavement. 

[Andie]

Went out to shops today and felt very scared and panicked. I wanted to burst into tears and run home. Felt all my energy drain out of me. 

 

The irony is is that being unwell for the last 15 months has brought about a complete destabilisation in my original problem of anxiety. I feel anxious because I am out of control, and I have felt ncreasingly out of control due to withdrawal and the numerous losses that  have come with it. I then feel anxious about having anxiety.

 

Having improved so much in the last few weeks, I Can definitley say that there is a lot of grief and emotional injury attached to life upheaval that is withdrawal. 

[Andie]

Pristiq free !! 

 

 No feelings of withdrawal other than lots of anxiety yesterday afternoon and again this morning. 

 

Now for long stabilisation on Prozac. My system really needs it. 

 

 

[FindRest]

Congratulations!!!! 

[Andie]

While I have no physical symptoms at the moment, I think the anxiety I am feeling is a bit of withdrawal. 

 

I have 1.0mg and 0.5mg of Pristiq to smooth things out.. 

[Andie]

Woke with anxiety this morning but much more contained. Having some parathaesia in my legs which for me is a hallmark of withdrawal/ uproar of my nervous system. It seems as though the Prozac has been acting as a safety net and buffer. 

 

Reminding myself that on the whole I am feeling better and that I must expect some degree of discomfort, as my system has had a jolt and I've been ping ponging my brain with mofified Pristiq for many years. 

 

As as much as I like my 2 Psychiatrists and they actually use the words ' withdrawal syndrome'- they seem to still consider my condition as an anomaly. We here we know this is not the truth. Looking forward to transferring all of my care back to my GP who has been a pillar of support, and does not Prescribe Pristiq as she said she has seen more and more of her patients ' falling off the wagon'. 

 

 

[FindRest]

I see you’ve added “Pristiq chips”. Do you notice a reduction in symptoms after taking the crumb?

 

It sounds like you are getting some good medical support, especially from your GP. She’s a keeper!

[Andie]

Yes the small doses have made the transition much  more bearable. I’ve had tingles in my arms and legs and its less pronounced now. 

 

 

[Andie]

Ive seen seeing my primary Psychiatrist for 4 years and his colleague for 6 months. They are still Psychiatrists at the end of the day and I don’t trust them at their word, but the are open to my suggestions (badgering) about info from research I have found as well as this website. That’s pretty much all I need from them. 

 

My GP very honestly told me that she didn’t know what she was dealing with and didn’t want to make me any worse,  so she referred me on. 

 

I’ve been very blessed in that regard, but I still think the industry needs to get its act together. 

[FindRest]

Do you limit yourself to 1 “chip” a day or take a chip as needed?