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Tips for tapering off milnacipran (Savella) or levomilnacipran (Fetzima)


Altostrata

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AKA milnacipran, Dalcipran, Ixel, Toledomin

From FDA information at http://www.drugs.com/pro/savella.html#s21
 

Discontinuing Savella
Withdrawal symptoms have been observed in clinical trials following discontinuation of milnacipran, as with other serotonin and norepinephrine re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs). Patients should be monitored for these symptoms when discontinuing treatment. Savella should be tapered and not abruptly discontinued after extended use [see Warnings and Precautions (5.7)].
....
Discontinuation of Treatment with Savella
Withdrawal symptoms have been observed in clinical trials following discontinuation of milnacipran, as with other SNRIs and SSRIs.

During marketing of milnacipran, and other SNRIs and SSRIs, there have been spontaneous reports of adverse events indicative of withdrawal and physical dependence occurring upon discontinuation of these drugs, particularly when discontinuation is abrupt. The adverse events include the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. Although these events are generally self-limiting, some have been reported to be severe.

Patients should be monitored for these symptoms when discontinuing treatment with Savella. Savella should be tapered and not abruptly discontinued after extended use. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate [see Dosage and Administration (2.4)].....

 
Savella has a fairly short half-life (http://www.drugbank.ca/drugs/DB04896) and is usually dosed twice a day, with a maximum daily dosage of 200mg.
 
Savella is available in

Film-coated, immediate-release tablets in four strengths: 12.5 mg, 25 mg, 50 mg, and 100 mg of milnacipran hydrochloride.

 
Reduce by 10% per month to start
The 10% rule holds for Savella, just like other psychiatric drugs: To minimize withdrawal symptoms, 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
You may need a smaller dosage than the 12.5mg tablet to taper gradually. Cut tablets up with a pill cutter, available at any drug store.
 
Precisely weighing tablet pieces or crushed tablets with an electronic digital scale
To precisely measure your dosage in tablet pieces, use 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/
 
Make your own liquid

According to the US National Institutes of Health http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=9970

It is freely soluble in water, methanol, ethanol, chloroform, and methylene chloride and sparingly soluble in diethyl ether.

 

You can make your own liquid out of tablets and water. See How to make a liquid from tablets or capsules
 
Use a combination of tablets and liquid
You may wish to gradually convert your dose to a liquid by taking part as a tablet and part as a liquid. This can be more convenient and, for those who are very sensitive, more tolerable than simply switching to a liquid form.
 
For example, if you are taking 100mg Savella and wish to reduce by 10%, you could get a prescription for 50mg tablets and make the liquid, then take one 50mg tablet and 40mg in liquid form to total a daily dose of 90mg.

Have a compounding pharmacy make up a liquid or capsules of smaller dosages
A compounding pharmacy will accurately make a liquid or weigh small doses and put them into capsules for you. See http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__p__3001#entry3001

Fibromyalgia: Getting off SNRIs with Savella (milnacipran)
Cymbalta and Effexor, SNRIs prescribed for fibromyalgia, are among the most difficult antidepressants to quit. If you have fibromyalgia, a condition of hypersensitivity to nerve pain signals, to begin with, the stress of withdrawal can make this condition worse.

The "Prozac switch" is a method people might use to get off an antidepressant when tapering becomes too difficult. But if you have fibromyalgia, what can you do when withdrawal symptoms become unbearably painful?

I just had a conversation with a knowledgeable doctor who pays attention to the complications of getting people off antidepressants. He said he might switch patients taking Cymbalta or Effexor or another SNRI for fibromyalgia to Savella (milnacipran) and then taper them off the Savella.

He said that Savella is mostly a NRI (norepinephrine uptake inhibitor) and its SRI (serotonin reuptake inhibitor) component is much weaker than Cymbalta or Effexor etc. The NRI component would help dampen the fibromyalgia pain reaction while the SRI part would enable the substitution for a stronger SNRI (Cymbalta or Effexor etc.).

He believes Savella is easier to taper than Cymbalta or Effexor etc. -- but it still requires careful tapering.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 9 years later...
lindamorellato

Hi. I am wondering if it is posible to slowly taper fetzima slowly and can it be dissolved in water. If not what is the best way to withdrawl from this drug. Thank you. 

Lexapro 20 mg.since Aug 2009

Lamotrigine -100 mg. sept. 2009

Seroquel-50 mg.

down from 100 for 6 months.

Been going off and on lexapro since October 2012

off and on Lamotrigine since October 2012.

Incidentally, massive headaches and monthly vomiting has ceased

since October 2012.

So right now no lexapro since Dec. 28th after only taking 15 tables from Nov.12-to Dec.28,2012.

No lamotrigine since mid October 2012.

50 MG. seroquel at bedtime since June 2012.

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  • Moderator Emeritus

I've asked the other mods about this.

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 17 Apr 2021:  Pristiq 0.2665mg  now holding each dose for 3 weeks

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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  • ChessieCat changed the title to Tips for tapering Fetzima / levomilnacipran
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Fetzima is very soluble in both water and ethanol so there are no problems with making a solution to taper with. 

 

You might consider doing the gentler Brass Monkey Slide instead of the regular 10% every 4 weeks taper protocol which will allow you to have more control over your taper.  It will be important to  pay close attention to each reduction and adjust as needed.

 

 

 

 

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 17 Apr 2021:  Pristiq 0.2665mg  now holding each dose for 3 weeks

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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lindamorellato

Thank you, thank you thank you! I thought I read that the extended release wasn't water soluable. Thank you again. 

Lexapro 20 mg.since Aug 2009

Lamotrigine -100 mg. sept. 2009

Seroquel-50 mg.

down from 100 for 6 months.

Been going off and on lexapro since October 2012

off and on Lamotrigine since October 2012.

Incidentally, massive headaches and monthly vomiting has ceased

since October 2012.

So right now no lexapro since Dec. 28th after only taking 15 tables from Nov.12-to Dec.28,2012.

No lamotrigine since mid October 2012.

50 MG. seroquel at bedtime since June 2012.

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lindamorellato
On 12/7/2020 at 10:46 AM, lindamorellato said:

Hi. I am wondering if it is posible to slowly taper fetzima slowly and can it be dissolved in water. If not what is the best way to withdrawl from this drug. Thank you. 

Even if it it tiny, tiny beads inside the capsule? Is that still suitable to dissolve into water for a taper? Thank you. It is an extended release Fetzima.  

Lexapro 20 mg.since Aug 2009

Lamotrigine -100 mg. sept. 2009

Seroquel-50 mg.

down from 100 for 6 months.

Been going off and on lexapro since October 2012

off and on Lamotrigine since October 2012.

Incidentally, massive headaches and monthly vomiting has ceased

since October 2012.

So right now no lexapro since Dec. 28th after only taking 15 tables from Nov.12-to Dec.28,2012.

No lamotrigine since mid October 2012.

50 MG. seroquel at bedtime since June 2012.

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  • Altostrata changed the title to Tips for tapering off milnacipran (Savella) or levomilnacipran (Fetzima)
  • Administrator

Fetzima or levomilnacipran is a close relative of Savella or milnacipran. About Fetzima from FDA information at drugs.com

 

Quote

5.10 Discontinuation Syndrome

There have been reports of adverse events occurring upon discontinuation of serotonergic antidepressants, particularly when discontinuation is abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.

Monitor patients for these symptoms when discontinuing Fetzima. Reduce the dose gradually whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, consider resuming the previously prescribed dose. Subsequently, the dose may be decreased, but at a more gradual rate [see Dosage and Administration (2.4)].

 

 

(This page also contains descriptions of reported adverse effects of Fetzima.)

 

Reduce by 10% per month to start
The 10% rule holds for Savella, just like other psychiatric drugs: To minimize withdrawal symptoms, 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?

 

Taper by counting out beads of the extended-release form

 

Quote

 

Fetzima extended-release capsules are intended for oral administration. Each Fetzima capsule contains extended-release beads with 23.0, 45.9, 91.8, or 137.8 mg of levomilnacipran hydrochloride equivalent to 20, 40, 80, or 120 mg of levomilnacipran, respectively.

 

Inactive ingredients include ethylcellulose, hypromellose, povidone, sugar spheres, talc, titanium dioxide, and triethyl citrate. Inactive ingredients also include black iron oxide, red iron oxide (80 mg and 120 mg capsules only), shellac glaze, and yellow iron oxide (20 mg and 40 mg capsules only).

 

 

If you are taking Fetzima extended-release capsules filled with tiny beads, you may taper it with the bead-counting method usually used to taper Effexor XR or Cymbalta. Also see Counting beads in a capsule versus weighing

 

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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lindamorellato

Thank you. 

Lexapro 20 mg.since Aug 2009

Lamotrigine -100 mg. sept. 2009

Seroquel-50 mg.

down from 100 for 6 months.

Been going off and on lexapro since October 2012

off and on Lamotrigine since October 2012.

Incidentally, massive headaches and monthly vomiting has ceased

since October 2012.

So right now no lexapro since Dec. 28th after only taking 15 tables from Nov.12-to Dec.28,2012.

No lamotrigine since mid October 2012.

50 MG. seroquel at bedtime since June 2012.

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