Counting beads in a capsule versus weighing

[CharlieBrown]

On 9/3/2019 at 10:17 AM, drugged said:

When I begin to taper that remaining 75mg I plan to start by removing a certain number of beads for each step of the taper but this doesn't give me an exact dosage to report.  So what would be the way to report that?  

 

Hi, Just popping in. I tapered by removing various size beads from 100mg Sertraline XR. Pouring them all onto a piece of paper. Then removing more each day until they were gone.

 

I have taken Venlafaxine. Is it possible to talk to your Dr., and get a prescription for 37.5mg capsules? That would make the separation of beads easier. Along with the counting and tapering accuracy.

 

As for how to report the dose you are taking. Since you are removing beads that are not exactly the same, there is no way to accurately pinpoint the exact MG you are taking. You could do some math. Count the beads per capsule and divide by the Milligram count. That would give you an average of how many Mg are in each bead. Once you have that number you multiply it by how many beads you are taking. This is still an approximation.

Edited September 4, 2019 by CharlieBrown
How to report

[drugged]

On 9/2/2019 at 2:15 AM, Altostrata said:

drugged, I am sorry you are so uncomfortable.

 

 

 

 

 

 

One thing that strikes me is that you are clearly at risk for all kinds of drug-drug interactions as well as adverse reactions to any individual drug, you feel worse after you take batches of drugs, and yet you seem to think you have medical illnesses that need treatment with these drugs.

 

FYI, trazodone releases an active metabolite that can cause muscle tightness and pain. If you take trazodone at night, this metabolite, m-CPP peaks during the day -- and it can interact with other drugs you take then. It can make you feel quite ill.

 

As I understand it, over the last few months you've been taking 10mg diazepam per day, yet you decided to stabilize on 15mg per day -- a dosage escalation. Is that correct?

 

You also seem used to adjusting or remixing your drugs and dosages when you feel it's necessary, is that so?

 

15 hours ago, CharlieBrown said:

 

Hi, Just popping in. I tapered by removing various size beads from 100mg Sertraline XR. Pouring them all onto a piece of paper. Then removing more each day until they were gone.

 

I have taken Venlafaxine. Is it possible to talk to your Dr., and get a prescription for 37.5mg capsules? That would make the separation of beads easier. Along with the counting and tapering accuracy.

 

As for how to report the dose you are taking. Since you are removing beads that are not exactly the same, there is no way to accurately pinpoint the exact MG you are taking. You could do some math. Count the beads per capsule and divide by the Milligram count. That would give you an average of how many Mg are in each bead. Once you have that number you multiply it by how many beads you are taking. This is still an approximation.

I've got about a six month supply of the 75mg capsules.  I don't want to toss them, they were quite expensive.

[drugged]

The reason that the beads inside a capsule of venlafaxine are different sizes is because each head has more or less slow release coating on it.  If you take beads out of the capsule and weigh out, say 10mg worth of beads that isn't  giving you 10 mg of active ingredient!  Weighing beads gives you the weight of the inert coating + active ingredient.  

 

Again, the beads are different sizes due to the amount of delayed release coating around an equal amount of active drug.  

 

If you sort out beads by size and take only the smallest beads you are essentially selecting the immediate release beads.  If you only take the largest beads you are selectively taking beads that will release the drug some time later.  

 

This probably doesn't matter a whole lot with the drugs that have a longer half-life but it can make a big difference with a drug like venlafaxine.  One thing my psychiatrist did see fit to warn me about was to avoid the immediate release tablets.  

[ChessieCat]

10 hours ago, drugged said:

One thing my psychiatrist did see fit to warn me about was to avoid the immediate release tablets.

 

Depending on the drug's half life, immediate release tablets would generally need to be taken at least 2 times a day, or possibly 3.

[drugged]

12 hours ago, ChessieCat said:

 

Depending on the drug's half life, immediate release tablets would generally need to be taken at least 2 times a day, or possibly 3.

Yes, and with venlafaxine having a half-life of ~5 hours, when you get down to extremely small doses that's difficult to do.  I have read case histories of people who've counted beads all the way down to one bead per day then dropped to zero.  

[CharlieBrown]

On 9/5/2019 at 8:51 AM, drugged said:

 

I've got about a six month supply of the 75mg capsules.  I don't want to toss them, they were quite expensive.

 

Understandable. No need to waste money and pills.

 

Due to the shorter half-life of Venlafaxine, and the various thickness in XR coating on the beads. Try to keep a log/journal of the number and size of beads you have removed each day.

 

When I was removing the Sertraline beads, there were different sizes. I did something similar. Taking one "Large and two small," each time I reduced beads.

Sometimes I would wait a few days to stabilize, before continuing to take more beads away. (I.E. spend 4-7 days taking out the same number of Large beads and small before continuing my reduction.)

 

I counted my beads all the way down to zero.

[drugged]

Thanks Charlie Brown.  

[CharlieBrown]

19 hours ago, drugged said:

Thanks Charlie Brown.  

You're welcome. I think I may have gone a little fast. I can remember taking out more every morning. Until I felt side-effects later in the day from withdrawal, then I would wait those 4-7 days.

 

Because of the shorter half-life, and the length of time you have taken Venlafaxine. If it were me, I would only reduce once I felt that I was "stable" on the slightly lower dose. And then continue to step down, as my blood levels of Venlafaxine "level off" after each reduction... But then again I can't give medical advice! Talking to a Dr. is always good.

 

Also I should mention, as you know. There are more than just "Large and Small" spansule beads. So you might want to categorize the beads into 3 or 4 sizes. I think 3 is fine. S,M,L.

 

The time release difference of a small VS a very small bead, might not be worth counting. I counted mine on a sheet of paper. After separating and discarding beads, I then folded it into a tight V shape funnel, to fit back into the capsule. Pouring back my dose into the capsule, over a bowl to catch any droppings. Any that dropped, after I finished pouring, I would lay down the paper and pour them from the bowl to the paper and then into the capsule again. That way, I was always holding the larger capsule half with my left hand, over the bowl while pouring. (I'm right handed)

 

Then again if you start feeling ill, it would take more time to do the counting... but wouldn't hurt to change to 4 sizes of beads. The beads are usually pretty consistent. As in, they seemed to have set sizes. Like a gravity coin sorter. During production each bead falls through holes to determine their size and how much XR coating is on each bead.

 

Well at least every generic, spansule bead capsule medication I have ever seen in Canada.

(Fluoxetine, Venlafaxine, Sertraline, Dexedrine and Adderall, I'm probably forgetting a couple. Almost generics entirely in fact. Nova, Apotex, Teva and [PMS, Pharma Science Canada] Mostly APO and PMS)

I would assume the medications in the United States have the same or nearly the exact same, standards as Canadian meds. I wouldn't doubt they have the same industrial medical machinery for production.

 

Good luck!

Edited September 13, 2019 by CharlieBrown
Spansule counting on paper method

[Superwoman]

Also, does anyone know why the drug companies claim that the capsules should not be opened and the beads should not be divided?  Is there a valid reason for this?

[ChessieCat]

Probably for legal reasons.

[CharlieBrown]

12 hours ago, Superwoman said:

Also, does anyone know why the drug companies claim that the capsules should not be opened and the beads should not be divided?  Is there a valid reason for this?

 

8 hours ago, ChessieCat said:

Probably for legal reasons.

 

Yes, "Tampering" with medication is what it is considered.

[ktp]

who exactly are "the drug companies" saying don't mess about with capsule contents?  please be aware there are multiple mfrs and more than one way to achieve "extended release".  one is making all the 'drug' beads the same size, and then add one or two or three 'buffer' coatings to delay drug release.   a variation on this adds 3 coatings, one or two or three of them dissolving at faster & slower rates, so you get all the same size beads but you can't tell which are fast and slow.   another is jawbreaker style, in which drug and inert ingredients are mixed then made into 3 different size beads, achieving about the same result.  another, my favorite with venlafaxine is caps from TEVA, which are apparently slow jawbreaker style but all the same size, meaning consistent beads.  (and those TEVA beads happen to come 75 beads in a 75mg capsule, making counting the easy way to go.)  i suggest being very careful to avoid being fooled into believing you have one style when you actually have another.  yes it boils down to legal reasons but not evilly so.
 

[Altostrata]

Interesting, ktp. Yes, the generic drug makers have to make tweaks in the formulation. Please post that detail in the Tips for Tapering Effexor topic.

[Superwoman]

How can we be sure that we have a consistent release of drug if the some beads are slow release and some are fast release and you don’t know which is which?  Or if the beads have different amounts of extended release coatings?  Does Effexor from the manufacturer Teva provide a consistent release of Effexor because the beads are all the same size?  KTP can you please clarify what “slow jawbreaker” is?  I am a little confused.  Thanks

[ktp]

> KTP can you please clarify what “slow jawbreaker” is?

By jawbreaker I mean a homogenous solid rock which dissolves continuously and by slow I mean slowly enough to last 24 hours, so you get drug at a pretty continuous rate.
As opposed to tootsie-pop  - a drug 'core' coated with one or more layers of buffer.  like a tootsie pop.

 

[despite my utter failure at weaning from venlafaxine  (see my tedious sig - I got excited at the end and weaned way too quickly), I do believe TEVA's venlafaxine beads are slow jawbreaker style.  the additional fact that they consistently contain as many beads as there are alleged milligrams of drug, TEVA caps make it easy to count your doses down to 9mg, at which point you need to switch to liquid to enable <=10% reductions.]

 

[Superwoman]

Ktp,

Are the Effexor beads still currently the same size?  I see that the company was bought out a few years ago. I didn’t know if they changed anything.  

[ktp]

 

3 hours ago, Superwoman said:

Ktp,

Are the Effexor beads still currently the same size?  I see that the company was bought out a few years ago. I didn’t know if they changed anything.  

Effexor is Pfizer's registered trademark for Venlafaxine; I believe they own the drug's patent.  I've never seen it, so I don't know.

TEVA is (was?) a popular manufacturer of the generic drug Venlafaxine, and TEVA's caps contain(ed?) the same number of beads as milligrams of drug.  I haven't seen that since I quit taking V and switched to Fluoxetine (Prozac).

  

I suggest seeking out TEVA and find out if they still make venlafaxine and if yes then the next question is are the beads still homogenous and all the same size.  and are they available to you.  if all are yes, I would recommend them for easy dose reductions down to 9mg.  Beware that my opinion is only that of a slightly experienced layman.  

 

[my current battle is vs Fluoxetine (Prozac), having switched due to trusting a shrink who claimed to understand weaning.  Oops! well he was aware of the need, but nowhere near as aware as users who've tried quitting.  He was simply paying lip service to "prozac bridging" and "longer half-life means easier to wean"; both are poppycock imho.  Knowing what I know now, I wish i'd stuck with the venlafaxine, which had less side effects than fluoxetine.]

[Superwoman]

What kind of empty capsules should we get?  I see gelatin capsules and veggie capsules on Amazon.  Some are colored and some are clear.  Would the colored ones be better so that the light does not effect the bead properties?

[Superwoman]

https://capsuleconnection.com/capsule-sizing-info/

 

Above is a useful reference that I found that lists the measurements of the various sizes of capsules 

[drugged]

On 7/20/2018 at 11:51 PM, WantoffVen said:

I am very confused by this bead thing. Hypothetically let's say I want to take ten beads. Can I just swallow those ten beads or do they have to be in a capsule? If they must go into a capsule, where do I get empty capsules? Thanks for help.

 

I just count out the number of beads I need and swallow them with water.  I don't know whether that's the right way or the wrong way but my former psychiatrist told me that a capsule wasn't necessary and that I could just take the beads.  I double checked with a pharmacist and was told the same thing.  fwiw

[Gridley]

20 minutes ago, drugged said:

I could just take the beads.

 

Correct.

[Superwoman]

On 9/27/2019 at 10:23 PM, Superwoman said:

Also, does anyone know why the drug companies claim that the capsules should not be opened and the beads should not be divided?  Is there a valid reason for this?

I emailed the drug company Aurobindo and asked them this question.  See below...

 

Me:

“I have had an extremely difficult time tapering Effexor xr.  Why does the drug pamphlet say that the capsules should not be opened up and the beads divided?  I think that opening up the capsules and dividing the beads would make it easier to taper Effexor xr, with less withdrawal.“

Aurobindo’s response:

 

Hello,

 

As per our manufacturing unit, Venlafaxine ER capsules are Extended release and should be taken whole.  Venlafaxine hydrochloride extended-release capsule contains spheroids, which release the drug slowly into the digestive tract. Opening the capsules can disrupt the release of the medication. Hope this information helps.

[sunnysideup69]

12 minutes ago, Superwoman said:

. Opening the capsules can disrupt the release of the medication. Hope this information helps.

 

Oh my god, that is SUCH A STUPID ANSWER!!!  😂 HOW, exactly, does opening a capsule disrupt the release....it makes absolutely no sense. Aurobindo are idiots.

[brassmonkey]

For some drugs the capsule itself is part of the time release mechanism. The capsule can be formulated to dissolve at a specific rate so the medication is delivered to the correct part of the digestive tract.  Some medications can not be exposed to stomach acid and have to be delivered to the intestine before they can be absorbed correctly.  Otherwise they react badly with the acid and don't function properly. So removing them from the capsule can greatly change their effectiveness.  Also it is the type of response that is expected from a drug company.  It's a matter of CYA.  People messing about with their medications opens them up to a lot of legal problems which they don't want.

[Superwoman]

@brassmonkey

 

I thought that the extended release mechanism of Effexor xr is in the coating of the beads not the capsule itself?

[brassmonkey]

That's part of the system too.  It is more common to have it as part of the bead themselves, which is why you shouldn't cut or crush the beads. It all depends on the medication as to how the delivery system is devised.

[drugged]

13 hours ago, Superwoman said:

@brassmonkey

 

I thought that the extended release mechanism of Effexor xr is in the coating of the beads not the capsule itself?

I can't speak to the specific brand mentioned but, before starting my first Effexor XR taper, I asked my pharmacist this very question and was told that the capsule was just a conveyance and it wouldn't make a bit of difference if I took the beads out and threw the capsule away.  I was taking capsules made by Pfizer at the time.

[Superwoman]

Is weighing beads more accurate and precise than counting beads?  Do people have less withdrawal with the weighing method?

[Superwoman]

On 1/13/2020 at 12:35 PM, Superwoman said:

I emailed the drug company Aurobindo and asked them this question.  See below...

 

Me:

“I have had an extremely difficult time tapering Effexor xr.  Why does the drug pamphlet say that the capsules should not be opened up and the beads divided?  I think that opening up the capsules and dividing the beads would make it easier to taper Effexor xr, with less withdrawal.“

Aurobindo’s response:

 

Hello,

 

As per our manufacturing unit, Venlafaxine ER capsules are Extended release and should be taken whole.  Venlafaxine hydrochloride extended-release capsule contains spheroids, which release the drug slowly into the digestive tract. Opening the capsules can disrupt the release of the medication. Hope this information helps.

Follow up emails....

Me....

I don’t understand.  According to the drug label below, the capsules can be opened and the contents sprinkled on applesauce.  You said that opening the capsule can disrupt the release of the medication.  Why would the drug label say that the capsule can be opened, if doing so can disrupt the release of the medication?  Is the extended release properties in the capsule itself or only the beads?

 

 

2 DOSAGE AND ADMINISTRATION

 

Venlafaxine hydrochloride extended-release capsules should be administered in a single dose with food, either in the morning or in the evening at approximately the same time each day [see CLINICAL PHARMACOLOGY (12.3)]. Each capsule should be swallowed whole with fluid and not divided, crushed, chewed, or placed in water or it may be administered by carefully opening the capsule and sprinkling the entire contents on a spoonful of applesauce. This drug/food mixture should be swallowed immediately without chewing and followed with a glass of water to ensure complete swallowing of the pellets (spheroids

 

Hello,

 

My apologies in the typo error. Dividing the contents of capsule will not provide the correct dosage and is not recommended. What dosage are you currently taking or tapering to? Once you provide your response I can forward to the manufacturing unit and they can clarify further.

 

Thanks & kind regards,

 

Jasleen Gupta, Pharm. D

Manager, Pharmacovigilance                     

 

279 Princeton-Hightstown Rd

East Windsor, NJ 08520-1401

JGupta@AurobindoUSA.com
732.839.9400- option 2

Fax -732.289.6189
 

Me....

Is the capsule itself extended release or are only the beads themself extended release?  Calculating the correct dosage is not an Issue.  It is simple math.  I am currently taking 101.25mg if Effexor xr.  I tapered from 112mg Effexor xr. by removing 10% of the beads.  

 

Me 1/25/20

 

Is there a pharmacologist if a chemist who I can talk with?

 

No response

[Altostrata]

You can taper by counting beads or by weighing beads. Weighing beads is probably more accurate at low doses.

 

Do not expect any information about tapering from the drug manufacturer.

[gardenlady]

On 2/3/2020 at 1:51 PM, Altostrata said:

You can taper by counting beads or by weighing beads. Weighing beads is probably more accurate at low doses.

My experience was that the opposite is true.  Weighing beads worked at high doses.  Once I got down to a lower dose, I had to count beads as the weight was too low to register accurately on the scale. 

[Superwoman]

I found a novel way to count beads.  Below are the tools that I used....
 

This is a tray that I found in my kitchen cabinet.  The textured indented design on it works great for dividing out beads.  I got this at a local grocery store a long time ago.  I don’t remember which one.  I think it was from the bakery section and had cake or cookies or something on it.  I looked at the baking section at Meijers and I did not see this plate there.  Maybe try Krogers.  I know this tray is still made b/c I saw someone had brought in this plate to work with fudge squares on it.   I think that a school lunch tray would also work.

Sorry the picture is upside down.  I don’t know how to fix that.  My husband made me the pill rack.  He said it was very easy.  If you are not handy like my husband (he is a skilled tradesman), they do sell pill racks.  My husband also made me the tiny funnel.  You can also buy tiny funnels online.  The device to the side of the pill rack is a pimple popper tool.  You can buy this at any drug store in the cosmetic section.  The pimple popper tool works wonderfully for dividing and moving the beads.  
 

Below is a baby snot sucker 🤣.  It works well to suck up those tiny AD beads.  I was having difficulty picking up those pesky little beads so I started looking for something that could suck up the beads.  Pretty resourceful, huh.  The device plays you lullaby’s 😂.  The lullaby’s are actually rather soothing for my anxiety lol 🤣.  I got it for $20 or $30 at Walmart. 
 

[Superwoman]

This is a chart that I created to log your taper data.  It has columns for Reduction Cycle, Percent Reduced, Start date, end date, start dose MGAI, End dose MGAI, Beads removed, remaining beads and notes/symptoms.  Please free to use.  
Antidepressant Reduction Chart.docx

 

• It may not open correctly on your phone.  You need to open it on Microsoft word to view it in a chart format. 

[Superwoman]

@Altostrata, 

 

I came up with a unique method for tapering by counting and dividing beads.  I tried to post the video, but it said it was too big.  How can I post the video?   I think that the video would be very helpful to others.  The video is around 4 minutes long.  I was able to post some pictures of the tools that I used, but not the video.  

[Altostrata]

Put the video in your Google Drive and then post a link to it here, allowing read-only access to anyone who clicks on the link. If you don't know how to do this, please ask a teenager.

[Superwoman]

https://drive.google.com/file/d/15b4bNWYHDyx_iAnKX5k1j0121zcz-W34/view?usp=drivesdk