Yogendra: 24 years on meds - now on Pristiq / desvenflaxine

[Yogendra]

Yogendra from India -- 24 years on various meds. Now on Desvenflaxine 50 mg Exteded Release

 

I am from Delhi, India and was put on such drugs around 24 years back. Now I am 38 years. I have gone through worst experiences in my life. I had a brain stroke around 25 years ago that left my left half of body weakened and paralyzed. I some how recovered mostly from it later on. But have been on psych. drugs for last 24 years ON and OFF. Years back I was on around 10 tabs per day. And many times I stopped medicines cold turkey too but had to come back again when symptoms striked again with full force.

 

I wish to come off from the meds. Currently for the last 6 months I have been on 50 mg desvenlaflaxine EXTENDED RELEASE tablet daily. I heard that extended release tablet should not be cut into pieces. I am in dire need of an advice how to wean off from medicines and live freely and calmly.

 

Edited June 20, 2019 by ChessieCat
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[Carmie]

Hi Yogendra, 

 

Welcome to SA. I’m sorry you’ve been on so many medications, and the pain they’ve caused you. It was good too hear though that you’ve almost recovered from your stroke that you had years ago.

 

Could you first please put your drug history in your signature. Just go to the Read This First section and to the thread entitled “Please Put Your Withdrawal History In Your Signature.” It will tell you what to do there.

 

In the last two years have you been on any other medications? 

 

When did you last cold turkey a medication?

 

Are you on any other medications or supplements, other than the desvenlaflaxine extended release now?

 

What symptoms do you have at the moment? 

 

Please keep us updated, sending hugs🤗

[Yogendra]

Dear Carmie,

 

Thanks a lot for your support. I have put up my signatures. i am sorry for any mistake as I have been on medications for long and it may have downgraded my cognitive and writing skills. 

 

Last cold turkey was April - July 2018.

 

No other medication except desvenlaflaxine ER film-coated 50  mg daily. suppliments I have enlisted in my signatures.

 

Current symptoms --- Impatient, anxious, anger but i guess they are bearable. I need to taper off this desvenlaflaxine ER film-coated 50 mg. But in market there is no lower dosage of it. And as it if film coated, I dont  think crushing or cutting or making liquid is any good idea. Will talk to doctor about switching over. You guys if have any idea. Please help me. I am from India. I could not make myself dependent on pill for ever.

 

 

Edited June 23, 2019 by ChessieCat
removed quote

[ChessieCat]

Hi Yogendra and welcome to SA from me too,

 

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  Why taper by 10% of my dosage?

 

I am also taking Pristiq and I get my tablets compounded.  I have managed to get down to 2.75mg using this method.  When I got to 10mg I started taking my dose twice a day, taking the larger portion in the morning and the smaller amount at night, to try and eliminate/lessen interdose withdrawal.

 

In some countries 25mg tablets are available, but not here in Australia, so I have been using capsules since reducing from 50mg.  When I was taking 50mg+ doses I would take a 50mg tablet and make up the rest with capsules. 

 

I got 40mg/30mg/20mg/10mg capsules made as well as 0.5mg, 1mg, 2mg and 5 mg so that I could make up the doses I need/ed.  I've recently been getting 0.25mg doses and will soon be getting 0.125mg doses.  See this post for my tapering schedule

 

This is SA's topic about Pristiq:  Tips for tapering off Pristiq (desvenlafaxine)

 

Some people change over to Effexor (venlafaxine) to taper.  There is information about this in the above link.

[Yogendra]

1 minute ago, ChessieCat said:

Hi Yogendra and welcome to SA from me too,

 

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  Why taper by 10% of my dosage?

 

I am also taking Pristiq and I get my tablets compounded.  I have managed to get down to 2.75mg using this method.  When I got to 10mg I started taking my dose twice a day, taking the larger portion in the morning and the smaller amount at night, to try and eliminate/lessen interdose withdrawal.

 

In some countries 25mg tablets are available, but not here in Australia, so I have been using capsules since reducing from 50mg.  When I was taking 50mg+ doses I would take a 50mg tablet and make up the rest with capsules. 

 

I got 40mg/30mg/20mg/10mg capsules made as well as 0.5mg, 1mg, 2mg and 5 mg so that I could make up the doses I need/ed.  I've recently been getting 0.25mg doses and will soon be getting 0.125mg doses.  See this post for my tapering schedule

 

This is SA's topic about Pristiq:  Tips for tapering off Pristiq (desvenlafaxine)

 

Some people change over to Effexor (venlafaxine) to taper.  There is information about this in the above link.

Thanks CC for going through my case and recommending the way ahead. I have read many of your posts those were really inspiring. You are doing a very good work. It is only due to the people like you that we newbies come and get in touch with SA.

 

Here problem is that compounding pharmacies are not available. 25 mg ER version is also not available. Now I am in dilemma what to do. Nexvenla OD (desvenlaflaxine ER) here are only in tablet and film coated form.  In India the situation is worse here nobody knows how exactly to taper off. Doctors know what to prescribe but when it come to withdrawal they are least bothered and unaware of. 

 

I take stress of very small things also which happens in daily life. I want to cry. I want to leave everything and roam in nature wander freely but it is not possible as I am married and have one son 6 years and my wife is pregnant too. Don't know what has happened to me. I want to withdraw from this medicine at any cost. Help !!

[ChessieCat]

It's not just in your country that doctors don't know any/much about withdrawal and tapering, which is why this site exists and is so busy.

 

Another member, Fresh, was breaking and weighing her tablets before she started getting hers compounded.

 

Using a digital scale to measure doses
Digital scales can measure less than 1mg by weight

 

 

[ChessieCat]

16 minutes ago, Yogendra said:

How can I taper down gradually especially when my med is extended release and film coated. And compounding pharmacies are not available in India I guess. I can buy pill cutters and weighing balance for milligrams. But my question is Can I cut / Crush these extended release film coated pillls? 

 

You could try using a nail file (a metal one would be better than an emery board/sandpaper type) and file off some of the edge of a tablet and weigh it.  At least then you will keep the tablet "whole" so would still retain most of the extended release character of the tablet.  Please read the following which explains how Pristiq tablets are made:

 

On 7/17/2011 at 2:52 AM, Altostrata said:

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.

 

[Yogendra]

43 minutes ago, ChessieCat said:

 

You could try using a nail file (a metal one would be better than an emery board/sandpaper type) and file off some of the edge of a tablet and weigh it.  At least then you will keep the tablet "whole" so would still retain most of the extended release character of the tablet.  Please read the following which explains how Pristiq tablets are made:

 

 

 

Hi,

 

The salt is same but it may not be a matrix type as mentioned in your quote. Mine is Nexvenla (desvenlaflaxine ER) OD 50 mg. The cover says it is film coated. 

 

[ChessieCat]

Another option would be to crush the tablet into powder and weigh it and take it twice daily.

 

I did a search and found these:

 

http://bellesante.in/compounding-pharmacy/

 

https://www.indiamart.com/proddetail/compounding-pharmacy-15079192133.html

 

On 3/21/2016 at 7:49 PM, Fresh said:

 

I asked my pharmacist what they use , this is the response:

 

"We are PCCA (Professional Compounding Center of America) approved pharmacy and we use PCCA ingredients for our compounds. PCCA has approved us to use Methocel (E4M) as the only ingredient for slow released formulated compounds. 

 

 

 

[Yogendra]

20 minutes ago, ChessieCat said:

Another option would be to crush the tablet into powder and weigh it and take it twice daily.

 

I did a search and found these:

 

http://bellesante.in/compounding-pharmacy/

 

https://www.indiamart.com/proddetail/compounding-pharmacy-15079192133.html

 

 

 

Oh Thanks a lot dear CC ,

 

Yes one Bellsante is in Banglore. I reside in Delhi. Will try to get in touch with them tomorrow and find out whether they provide the services all over India.

 

Thanks again.  Lets see how my tapering journey goes.  

 

[Yogendra]

On 6/23/2019 at 3:54 PM, ChessieCat said:

For people who can't get their Pristiq tablets compounded, or can't afford the additional cost this might work:

 

You could try using a nail file (a metal one would be better than an emery board/sandpaper type) and file off some of the edge of a tablet and weigh it.  At least then you will keep the tablet "whole" so would still retain most of the extended release character of the tablet.  Please read the following which explains how Pristiq tablets are made:

 

 

Hi again,

 

I am on desvenlaflaxine ER 50 mg daily. Now I am thinking of switching to desvenlaflaxine ER 12.5 mg morning and venlaflaxine ER 75 mg at Night. Would it be a right approach ?

 

Then I shall gradually taper to only venlaflaxine ER 75 mg as this comes in capsules and it is easier to count/weigh beads in capsules.

 

Kindly guide. 

[ChessieCat]

I've moved the post you made in the Tips for Tapering Pristiq topic and added it to your Introduction topic.

 

Your Introduction topic is the correct place to ask questions about your own situation.  This keeps your history in one place.

 

7 hours ago, Yogendra said:

I am on desvenlaflaxine ER 50 mg daily. Now I am thinking of switching to desvenlaflaxine ER 12.5 mg morning and venlaflaxine ER 75 mg at Night. Would it be a right approach ?

 

I just want to make clear what you are thinking of doing.

 

You are thinking of taking desvenlafaxine plus venlafaxine to cross over to all venlafaxine?

 

I don't think we have had any members do this because it is difficult to get a 12.5mg dose from a 50mg desvenlafaxine tablet.

 

I will ask the other mods for their assistance.

[Yogendra]

2 hours ago, ChessieCat said:

I've moved the post you made in the Tips for Tapering Pristiq topic and added it to your Introduction topic.

 

Your Introduction topic is the correct place to ask questions about your own situation.  This keeps your history in one place.

 

 

I just want to make clear what you are thinking of doing.

 

You are thinking of taking desvenlafaxine plus venlafaxine to cross over to all venlafaxine?

 

I don't think we have had any members do this because it is difficult to get a 12.5mg dose from a 50mg desvenlafaxine tablet.

 

I will ask the other mods for their assistance.

Hello CC,

 

Yes you are right I wish to finally switch over from desvenlaflaxine ER to venlaflaxine ER as tapering the later one may be easier at it comes in capsules. It's because here in India we have only 1 or 2 compounding pharmacies and those too are not into compounding desvenlaflaxine ER. Hence this step.

 

Here I searched many pharmacies and found that one / two companies make 25 mg ER Desvenlaflaxine too so I bought yesterday 10 taps of 25 mgs. And it was mentioned on them that they are UNCOATED ones. So I guess extended properties of it comes from matrix only. I ordered a pill cutter too yesterday from Amazon so that I cud cut them into half 12.5 mg doses retaining Extended Release properties ( though I am not sure but I will do this and observe for a while).

 

Yesterday I also got my doctor prescribed them i.e. 25 mg ER desvenla. and 75 mg ER venla. But he warned me that the withdrawal from venla may be difficult one owing to short-life but I am ready to take that risk as at least then I cud taper in a more controlled way by bead-counting/weighing method. And when doses will be quite low then I wud switch over to immediate release version of venla. Making liquid form and taking twice / thrice a day if everything goes OK. I am afraid but I have no other option either.

 

I thank SA and people here. Before that I didn't even kNow that such thing as such forum exists or withdrawal from ADs are reality. I suffered a lot for the past around 24 years.

 

Better late than never. I will wait over to the said regime in a day or two. Will post the updates.

 

Thanks CC.

 

One more thing do we have some whatsapp group for us? If yes please tell me, I will share my contact info.

[Altostrata]

Yogendra, if you can't taper directly from Pristiq using compounded capsules or weighing tablet fragments yourself, your plan to gradually switch to Effexor XR makes sense.

 

The tiny beads inside an Effexor XR capsule are extended-release, not immediate-release.

[Yogendra]

1 hour ago, Altostrata said:

Yogendra, if you can't taper directly from Pristiq using compounded capsules or weighing tablet fragments yourself, your plan to gradually switch to Effexor XR makes sense.

 

The tiny beads inside an Effexor XR capsule are extended-release, not immediate-release.

Thanks Alto,

 

Yes Here Desvenla. ER could not be compounded. For few weeks I may be on both Desvenla. ER and Venla. ER. Then gradually I will switch over to only Venla. ER. Will keep posting the updates. Let's see how it works.

 

This site is really helpful for people like us.

[Altostrata]

Desvenlafaxine cannot be compounded anywhere and still be extended-release. If the pharmacy grinds up a tablet, it has to add a filler to extend the release somewhat. 

 

Please read  Tips for tapering off Pristiq (desvenlafaxine) for suggestions about cross-tapering. You probably can accomplish this within a week or two.

 

Please let us know how you're doing.

[Yogendra]

On 6/27/2019 at 11:08 AM, Altostrata said:

Desvenlafaxine cannot be compounded anywhere and still be extended-release. If the pharmacy grinds up a tablet, it has to add a filler to extend the release somewhat. 

 

Please read  Tips for tapering off Pristiq (desvenlafaxine) for suggestions about cross-tapering. You probably can accomplish this within a week or two.

 

Please let us know how you're doing.

Hi Alto,

 

I found enteric coated empty capsules on Amazon. Could we grind up the Pratique in powder form, weigh it according to tapering schedule and put that in the enteric coated capsules. Will it work similar to extended release version ? Any idea? 

 

I have still not yet started switching over from Desvenlalaxine ER  to venlaflaxine ER as I am very afraid and worried of any reaction and withdrawal symptoms. Guide please.

[ChessieCat]

Crushing Pristiq into a powder will make the drug immediate release.  Compounding pharmacists add a slow release formula to the ground uptablets:

 

On 3/23/2016 at 10:50 AM, Fresh said:

 

About the "slow-release additive"  (necessary for pristiq and some other meds.):

 

""We are PCCA (Professional Compounding Center of America) approved pharmacy and we use PCCA ingredients for our compounds. PCCA has approved us to use Methocel (E4M) as the only ingredient for slow released formulated compounds. 

 

 PCCA approved pharmacies use Methocel (E4M) as their slow-released ingredient, however, we will have no access to other independent pharmacies's medical data on what slow-released ingredients would they use. "

 

 

 

Using enteric coated capsules will not make the drug slow release.  It will just change where the capsule starts dissolving in the body.  From https://www.lfatabletpresses.com/articles/benefits-of-enteric-coated-capsules

 

 

Quote

What are they?

Enteric coated capsules are capsules that have an acid resistant coating to prevent them from dissolving when they pass through the stomach. The capsules are activated only when they pass through an alkaline environment -- that is with a pH factor of 5.5 or higher - which is usually when they reach the small intestine.

Benefits

• Enteric-coated capsules do not dissolve in the mouth and therefore are perfect for formulations that need not to be activated by acid exposure. The coating prevents the capsule from dissolving while in the mouth and oesophagus areas.
• Many drugs can cause irritation to the stomach if released there; with enteric-coated capsules, the formulation will pass through the stomach without irritating the stomach lining.
• The enteric-coating also prevents any enzyme present in the capsule from dissolving in the acid environment of the stomach area.
• This enteric coated capsule typically takes an hour or two to dissolve, making it ideal for time- sensitive medications.

 

[Yogendra]

6 hours ago, ChessieCat said:

Crushing Pristiq into a powder will make the drug immediate release.  Compounding pharmacists add a slow release formula to the ground uptablets:

 

 

 

Using enteric coated capsules will not make the drug slow release.  It will just change where the capsule starts dissolving in the body.  From https://www.lfatabletpresses.com/articles/benefits-of-enteric-coated-capsules

 

 

 

Thanks a lot dear for that information. It will benefit me.

 

 

[Yogendra]

I was afraid but somehow took the bold step to switch over from Desvenlaflaxine 50 ER to Venlaflaxine ER 75 (night) and Desvenlaflaxine 25 ER (morning). Let's see how my body responds to it. 

[Yogendra]

On 6/26/2019 at 4:27 AM, Altostrata said:

Yogendra, if you can't taper directly from Pristiq using compounded capsules or weighing tablet fragments yourself, your plan to gradually switch to Effexor XR makes sense.

 

The tiny beads inside an Effexor XR capsule are extended-release, not immediate-release.

Dear Alto,

One question. Can Pratique 50 ER tablets be cut and weighed using a sensitive balance. Can this be done for tapering? I read that if the are crushed in powder they lose their  extended release property. Rite?

[Altostrata]

On 6/26/2019 at 10:38 PM, Altostrata said:

Desvenlafaxine cannot be compounded anywhere and still be extended-release. If the pharmacy grinds up a tablet, it has to add a filler to extend the release somewhat. 

 

Please read  Tips for tapering off Pristiq (desvenlafaxine) for suggestions about cross-tapering. You probably can accomplish this within a week or two.

 

Please let us know how you're doing.

 

How are you feeling on half Effexor ER and 25mg Pristiq? Are you cutting a 50mg Pristiq tablet in half?

 

What is inside your Effexor ER capsule?

[Yogendra]

3 minutes ago, Altostrata said:

 

How are you feeling on half Effexor ER and 25mg Pristiq? Are you cutting a 50mg Pristiq tablet in half?

 

What is inside your Effexor ER capsule?

 

Hi Alto,

 

I switched over to this regime yesterday only. I am Ok Ok till now. Somewhat anxious but this may be due to me being conscious of switching over. Let's see how it goes on further. 

 

No I am not cutting Pristique. The same salt Desvenlaflaxine I found in 25 mg ER version here in India. So bought few strips of that too. 

 

Inside Effect ER, there are very tiny round shaped balls. I haven't counted them yet but will do once I find this switching over fine.

 

Yes you were right this I did just because I couldn't compound pristique here. 

 

 

[Altostrata]

Yes, Pristiq comes in 25mg tablets.

 

It will take 4 days or so for the drug switch to fully register. Or, you may be lucky and feel no difference at all. Tapering Effexor XR by removing the tiny balls will be a lot easier than cutting and weighing Pristiq tablets.

[Yogendra]

7 minutes ago, Altostrata said:

Yes, Pristiq comes in 25mg tablets.

 

It will take 4 days or so for the drug switch to fully register. Or, you may be lucky and feel no difference at all. Tapering Effexor XR by removing the tiny balls will be a lot easier than cutting and weighing Pristiq tablets.

Dear Alto,

 

I wud like to ask that can the pristique tablets be cut and crushed without losing ER property?

 

 

[Altostrata]

Pristiq tablets cannot be crushed and still be extended-release. The fragments become immediate-release desvenlafaxine.

[Yogendra]

On 6/27/2019 at 11:08 AM, Altostrata said:

Desvenlafaxine cannot be compounded anywhere and still be extended-release. If the pharmacy grinds up a tablet, it has to add a filler to extend the release somewhat. 

 

Please read  Tips for tapering off Pristiq (desvenlafaxine) for suggestions about cross-tapering. You probably can accomplish this within a week or two.

 

Please let us know how you're doing.

Helllo,

 

Today is fourth day of the switch over. Feeling ok ok. Sometimes low sometimes fine. Let's wait for some more time before I actually know how my body is adapting to it.

[Altostrata]

That sounds promising. Give it a week for the new baseline pattern to emerge. Please let us know how you're doing.

[Yogendra]

A week has passed peacefully since the switchover. Will hold on till few more days. 

On 7/23/2019 at 12:40 AM, Altostrata said:

That sounds promising. Give it a week for the new baseline pattern to emerge. Please let us know how you're doing.

 

[Altostrata]

Good to hear, Yogendra.

[Yogendra]

2 weeks of switch-over passed safely. Will reduce to 12.5 mg ER Desvenlaflaxine (morning). Will cut into half the tablet. And in night I will keep 75 mg ER Venlaflaxine capsule as it is. 

 

This reduction I will do in a week or two.

 

Thanks all.

[Andie]

Hi There 

 

I am currently on Pristiq and thinking of changing over to Effexor. 

 

How have you been feeling? 

[Yogendra]

1 hour ago, Andie said:

Hi There 

 

I am currently on Pristiq and thinking of changing over to Effexor. 

 

How have you been feeling? 

Hi,

 

Feeling fine ... More than 3 weeks and no issues yet. But mind it that I have not completely switched over as yet. I am still on 25 mg pristique (morning) and 75 mg ER Effexor (night).

 

Though will reduce pristique dose to 12.5 mg in a week or two. 

[Yogendra]

Today reduced my dose of Desvenlaflaxinr ER by half.

 

Now taking ...

 

Desvenlaflaxine ER 12.5 mg (morning)

Venlaflaxine ER 75 mg (night)

[Yogendra]

3 days passed almost peacefully. Last night bit of insomnia set in and heart was pounding at a faster pace. But the things were manageable. Lets see how it gets in the times to come.

 

If everything goes fine, I wud like to hold on (12.5 mg pristique morning + 75 mg effexor night) for atleast 4 weeks.

 

Will update.

[delsol]

I just want to respond to say good luck, and amidst the sea of many posts on here, the fact that yours says "24 years" is what made me click. It's been 27 years for me. I think those of us who have been on these drugs for over 20 years are probably more common than we realize. I sometimes feel shame and then remember that if it was easy to kick these drugs, I would have been able to do it 20 years ago! Wishing you peace and an occasional moment of wellness during this challenging time.