Albert: preparing to get off Paxil / paroxetine for good

[Albert]

On 5/4/2022 at 9:33 PM, ChessieCat said:

If it was me I would stay with what you have been taking.  That's what I did.  During my taper generic Pristiq became available but I decided to stay with the brand because I didn't know if changing would cause an issue.

 

I think making a liquid from your current tablet would be the better option instead of weighing.

 

Making a liquid from the finely ground up tablet would give a more consistent dose.

 

Q:  Are you currently taking a whole tablet?

 

If yes, then the cross over process will be much easier.

 

Yes, I am taking a full tablet currently 

[ChessieCat]

9 hours ago, Albert said:

Yes, I am taking a full tablet currently 

 

The reason I said that the cross over will be easier if you are taking a full tablet is because you do not have to be so precise with your cutting because you will be getting your full dose regardless of whether it is tablet or liquid.  Obviously it is still better to try and get it as close as possible but there is more room for "error" when doing this.

[Albert]

So I started to measure out some tablets this even and quickly discovered that my Gemini is weighing the Paroxetine tablets differently.  I am noticing that these coated tablets can vary some in weight.  Is this case, is weighing each tablet and then shaving it down to 97.5% necessary?  I was hoping to weigh one tablet and then do my calculation to 97.5 percent and then cut and weigh then all to that weight but I notice that they can vary in weight.   How would I get them all exact in this case? 

[ChessieCat]

I suggest that you ask your question here:

 

using-a-scale-to-weigh-and-measure-doses

 

[Albert]

19 hours ago, ChessieCat said:

I suggest that you ask your question here:

 

using-a-scale-to-weigh-and-measure-doses

 

I just watched the micro tapering video where the guy uses tablets and grinds them into a powder and the re-distributes the tablets into capsules using the Gemini scale.  This is the method that I want to use, but it is going to require changing from my current Paroxetine pill that I get from CVS over to the pills from Wal-mart that are non coated and will crush into powder.  My Dr is on board with changing my script over to Wal-Mart . It is either that or I can shave my current tablet but sooner or later I will get to a point where I get to a low enough dose that I would have to make the change over, so I might as well go ahead and try to make the change now.   I am still traumatized by the failed cross taper over to cymbals and that entire event that I am scared of going back to that place.  That wouldn’t happen just changing manufactures would it?  Thanks 

[ChessieCat]

16 minutes ago, Albert said:

That wouldn’t happen just changing manufactures would it?

 

Unfortunately some members do have issues changing brands.  SA suggests doing a "cross over" which might be gentler on your system.  It might also allow you to "see" if you are having a reaction to the new brand.  You will need to try and stay calm so that you don't add anxiety into the mix which can make it difficult to know if it is your anxiety about the change or an adverse effect from the new brand:

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

[Albert]

Just returned from our family vacation to the Dominican Republic.  I had a good time on vacation and I was probably 80 percent symptom free.

 Main symptom I still deal with is some brain fog, but it is better than it was a year ago.  Unfortunately, upon returning I did acquire Covid but I am working through that now.  I plan on going ahead and starting my taper here in a couple of weeks.  I have decided that I will either start by cutting my current tablet ( tablet with coating). Or cross over to the other generic form that has no coating and can be turned into liquid or compounded.  I have read all the information around cross over and wanted to get a recommendation around which one would be more recommended.  Just cutting my current tablet or going ahead and doing the crossover?  

[ChessieCat]

3 hours ago, Albert said:

Unfortunately, upon returning I did acquire Covid but I am working through that now.  I plan on going ahead and starting my taper here in a couple of weeks.

 

I think you should wait for at least 2 months before making a change/reduction.    And when you do make a reduction you might consider only making a small test reduction first to see how you react.  If that goes all right, then you could make a larger reduction for the next one.

 

3 hours ago, Albert said:

Just cutting my current tablet or going ahead and doing the crossover?  

 

You need to decide which one you feel more confident making your dose with.  We cannot decide that for you.  The aim is to get consistent and accurate dosing.

[Albert]

13 hours ago, ChessieCat said:

 

I think you should wait for at least 2 months before making a change/reduction.    And when you do make a reduction you might consider only making a small test reduction first to see how you react.  If that goes all right, then you could make a larger reduction for the next one.

 

 

You need to decide which one you feel more confident making your dose with.  We cannot decide that for you.  The aim is to get consistent and accurate dosing.

Well, I am pretty confident in compounding myself and I am also pretty confident in weighing a cut tablet.  If I feel confident in both, can cutting and weighing the tablet be just as accurate as compounding?    So you think I should wait 2 months because of the Covid-19? Or if I do the crossover?  Thanks again

[ChessieCat]

10 hours ago, Albert said:

If I feel confident in both, can cutting and weighing the tablet be just as accurate as compounding?

 

Compounding isn't perfect.  I've seen videos on YouTube (search:  making compound capsules) about what they do and how they fill the capsules.  They crush tablet/s and add filler to it and then mix and fill.  There is no guarantee that the drug is mixed thoroughly and evenly.

 

Brassmonkey did his whole taper crushing Paxil tablets and weighing them.  There is no way I would have had the patience to do this, but I was comfortable making liquids of various dilutions.

 

10 hours ago, Albert said:

So you think I should wait 2 months because of the Covid-19? Or if I do the crossover?  

 

I think you should wait at least 2 months before you make a reduction.  And yes, because of Covid.  You don't want to be confusing reduction issues and health issues.  I extended the end of my taper and went to a very low dose because I changed my diet to low carb due to a diabetes diagnosis and I wanted to be more confident about being able to distinguish any issues if they happened.

 

Unless you are doing the crossover to get a more accurate dose, I think it would be a good idea to wait 1 month before doing the crossover.  The reason is you want to be able to distinguish crossover issues from other health issues if they arise.  If an issue arises then you hold on that combination for longer.

 

Edited June 22, 2022 by ChessieCat

[Albert]

4 hours ago, ChessieCat said:

 

Compounding isn't perfect.  I've seen videos on YouTube (search:  making compound capsules) about what they do and how they fill the capsules.  They crush tablet/s and add filler to it and then mix and fill.  There is no guarantee that the drug is mixed thoroughly and evenly.

 

Brassmonkey did his whole taper crushing Paxil tablets and weighing them.  There is no way I would have had the patience to do this, but I was comfortable making liquids of various dilutions.

 

 

I think you should wait at least 2 months before you make a reduction.  And yes, because of Covid.  You don't want to be confusing reduction issues and health issues.  I extended the end of my taper and went to a very low dose because I changed my diet to low carb due to a diabetes diagnosis and I wanted to be more confident about being able to distinguish any issues if they happened.

 

Unless you are doing the crossover to get a more accurate dose, I think it would be a good idea to wait 1 month before doing the crossover.  The reason is you want to be able to distinguish crossover issues from other health issues if they arise.  If an issue arises then you hold on that combination for longer.

 

Thank you very much Chessie Cat, I will give it a good month and check back in when I go to start. 

[Albert]

On 6/22/2022 at 10:45 PM, Albert said:

Thank you very much Chessie Cat, I will give it a good month and check back in when I go to start. 

So for you, the most accurate way was to make your own liquid?  Did you buy a solution from a pharmacy or just use water?  Did you make it from your own capsule 

[ChessieCat]

It is possible to make a liquid from paroxetine tablets.  See Post #1 of this topic:

 

Tips for tapering off paroxetine (Paxil, Seroxat)

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

I was using compounded Pristiq for the majority of my taper.  But the lowest dose capsule that the compound pharmacist could make at a reasonable price was 0.125mg (but I was taking 2x a day so lowest daily dose was 0.25mg) and I wanted to go lower than than.  After seeing another member write that they were able to make a liquid from their compounded tablets I decided to see if I could make a liquid from mine and it worked.

 

I found using the tablets compounded into capsules was very convenient.  I think I changed to liquid when I got to 0.6075mg

 

The benefit of using liquid, especially for the very low doses (lots of places after the decimal point/mark), is that you can dilute with more water and get tiny doses.  My lowest daily dose was 0.0025mg but I was taking it twice a day so was making a liquid that I could measure 0.00125mg.  There was one dilution that I made where I used 2 litres of water but after making the liquid I kept a smaller amount and threw out the rest.

 

[Albert]

On 6/24/2022 at 6:21 PM, ChessieCat said:

It is possible to make a liquid from paroxetine tablets.  See Post #1 of this topic:

 

Tips for tapering off paroxetine (Paxil, Seroxat)

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

I was using compounded Pristiq for the majority of my taper.  But the lowest dose capsule that the compound pharmacist could make at a reasonable price was 0.125mg (but I was taking 2x a day so lowest daily dose was 0.25mg) and I wanted to go lower than than.  After seeing another member write that they were able to make a liquid from their compounded tablets I decided to see if I could make a liquid from mine and it worked.

 

I found using the tablets compounded into capsules was very convenient.  I think I changed to liquid when I got to 0.6075mg

 

The benefit of using liquid, especially for the very low doses (lots of places after the decimal point/mark), is that you can dilute with more water and get tiny doses.  My lowest daily dose was 0.0025mg but I was taking it twice a day so was making a liquid that I could measure 0.00125mg.  There was one dilution that I made where I used 2 litres of water but after making the liquid I kept a smaller amount and threw out the rest.

 

Well it is good to know that I can go ahead and use compounding capsule and when I get down to .5mg or less, I can change over to liquid. 

[Albert]

I think I am finally getting over Covid!!! I feel as if I am pretty much Covid symptom free at this time.  Probably going to give it another week or two before I start to taper.  I reached out to a local compounding pharmacy and confirmed that they will compound Paroxetine.  I also confirmed that the brand they carry that they compound with is “Solco” and that is the same brand tablet / manufacturer that I am on.  Does that mean that the transition from my current tablet, over to the compounded tablet should be smoother?  It is only $85 per month for the compounding fee.  What are your thoughts?  When having the compounding done professionally, is that usually more accurate?  Thanks 

[ChessieCat]

5 hours ago, Albert said:

When having the compounding done professionally, is that usually more accurate?

 

It depends.  I think generally we can trust that they are doing a good job with the compounding but there are no guarantees.

[ChessieCat]

5 hours ago, Albert said:

 I also confirmed that the brand they carry that they compound with is “Solco” and that is the same brand tablet / manufacturer that I am on.  Does that mean that the transition from my current tablet, over to the compounded tablet should be smoother?

 

This is good.  However, you still might notice a difference simply because the compounded drug may get into your system faster than the tablet form.

 

If you can do it, I think it would be better to do a cross over because it is gentler on your system.

[Albert]

14 hours ago, ChessieCat said:

 

This is good.  However, you still might notice a difference simply because the compounded drug may get into your system faster than the tablet form.

 

If you can do it, I think it would be better to do a cross over because it is gentler on your system.

Yes, I can get the compounding form and then take 1 regular tablet in the morning and one compounding tablet in the evening and do that for a week or two and then convert over to the compounded tablet.  Do you think that is a good plan?  

[ChessieCat]

 

7 hours ago, Albert said:

1 regular tablet in the morning and one compounding tablet in the evening

 

It think it would be better to take 1/2 of each type at the same time.  I understand that this is probably harder/more costly to do.  BUT doing the above might be a better option than changing straight over to all capsule and might work out okay.

 

Please be observant and stay on that combination until you feel stable.  If you do notice a difference please try not to panic, which only adds more symptoms, which can be similar to WD.

[Albert]

Thanks again, I will review this with my Dr and see if I can get him to prescribe it so that I can take 1/2 compounding medication and then I can brake one tablet in 1/2.   That way I am getting 1/2 of each type and I will try that for about 1 month and see how that works out.   Do you think that you made a full recovery?  

[ChessieCat]

20 minutes ago, Albert said:

Do you think that you made a full recovery?  

 

See:

 

Post 0 updates start here

[Albert]

Thanks again, I will review this with my Dr and see if I can get him to prescribe it so that I can take 1/2 compounding medication and then I can brake one tablet in 1/2.   That way I am getting 1/2 of each type and I will try that for about 1 month and see how that works out.   Do you think that you made a full recovery?  

 

That fact that you feel like you have made a full recovery, gives me so much hope.  Thanks again I will keep in touch and let you know how it goes as soon as I can get everything put together around the compounding. 

[Albert]

Here I am back again still trying to make a final decision around how to start tapering.  I spoke with my Dr again as he will be writing the script and he is supportive either way.  I am back to trying to decide around using liquid, compounding into capsule, or cut and shave the tablet.  I had all but decided to have the local compounding pharmacy do the compounding into a capsule but when I went to the pharmacy and filled out my the paperwork to get a profile started in the computer, I was able to talk with the pharmacist there at the compounding pharmacy and while it was nice to get to review this further with him, it has be back to what do I do?   I need to just make a decision and try to go with it at some point but I do want to make sure that I choose right so that I can set the ground work for a smooth taper.   After getting this updated information, I just wanted to get some final input.  

 

1.  Good:  - They offer the same exact tablet / manufacture that I am currently on ( Solco ).  

2.  They are willing to compound into a tablet form or liquid. 

3.  Considering that this tablet has a coating, they would have to run it through the machine and then sift out the coating and then place the powder into a capsule.  The Pharmacist is game doing this, but did mention that there is the possibility that having to sift the coating out of the powder and then mix in the other fillers, he was not certain how consistent the active ingredient would be in each tablet but felt it would be close.  

4.  They can make a liquid suspension out of the same Solco tablet and they thought that would be a little more accurate.  The active ingredient would be the same as the current tabler that I am on, it would just be my system adapting from the tablet to the liquid form.  

5.  Another thing that he brought up is that this tablet is scored.  He mentioned that since the tablet scored, that means that the active ingredient should be should be spread pretty evenly throughout the tablet.  He advised I should be able to cut this tabler in 1/2 or 1/4's and taper that way.    If I were to do go ahead and just try to cut / shave 2.5% off every 4- 6 weeks, is it recommended that I weigh each tablet since they all weigh slightly different and then shave off that percentage of each tablet?  

 

This is the most reputable compounding lab in this area and it sounds like they know what they are doing when it comes to compounding, but after talking with them, I am not so sure that they are used to working with AD's and the micro taper process.  

 

Questions:  

1.  Is the Pharmacist correct in stating that since the tablet is a scored tablet, the active ingredient should be spread out evenly throughout the table?  If that is the case, should I just consider cutting and shaving this table?  If I do that, should I weigh each pill and then cut / shave my percentage off accordingly, or am I ok to just average the weight of 7 pills and cut them all according to that?  

 

2.  Since the liquid suspension would be compounded from my existing tablet, should my transition from tablet to liquid be more successful if I were to go ahead and just make the change over to the liquid suspension.  

 

3.  If I were to try and make my own liquid / suspension at home, should I buy a suspension to do this or just use water?  

 

Thanks again, I am getting ready to make a final decision and just go with it.  Thanks again

[ChessieCat]

8 minutes ago, Albert said:

3.  Considering that this tablet has a coating, they would have to run it through the machine and then sift out the coating and then place the powder into a capsule.  The Pharmacist is game doing this, but did mention that there is the possibility that having to sift the coating out of the powder and then mix in the other fillers, he was not certain how consistent the active ingredient would be in each tablet but felt it would be close. 

 

I am fairly certain that my compounding pharmacist just ground the tablet very finely and did not sift out the "shell" of the Pristiq tablet.  When I opened capsules to create a liquid I could see very small bits in the mix.

[ChessieCat]

11 minutes ago, Albert said:

1.  Is the Pharmacist correct in stating that since the tablet is a scored tablet, the active ingredient should be spread out evenly throughout the table? 

 

Yes.

 

11 minutes ago, Albert said:

3.  If I were to try and make my own liquid / suspension at home, should I buy a suspension to do this or just use water?  

 

You can make a liquid using water for paroxetine.

 

[Albert]

I am going to gather the supplies and learn to make a suspension / liquid from my current Paroxetine tablets.   Is there a list of supplies that I will need and maybe a video on this is done by chance?  Would you recommend the water solution or buying the a fluid from the Pharmacy.  Is it possible to make up a bottle that I can draw from for several weeks at a time?  Thanks AJ 

[ChessieCat]

On 6/25/2022 at 9:21 AM, ChessieCat said:

It is possible to make a liquid from paroxetine tablets.  See Post #1 of this topic:

 

Tips for tapering off paroxetine (Paxil, Seroxat)

 

[ChessieCat]

5 hours ago, Albert said:

 Is there a list of supplies that I will need

 

how-to-make-a-liquid-from-tablets-or-capsules

 

Syringes, graduated cylinder, container for storing in fridge.  You can do a search for those terms in the above topic to find posts about them.

 

5 hours ago, Albert said:

Would you recommend the water solution or buying the a fluid from the Pharmacy. 

 

For paroxetine you only need water.

 

5 hours ago, Albert said:

Is it possible to make up a bottle that I can draw from for several weeks at a time?

 

It is better to only store it, refrigerated for 3-4 days.

[Albert]

Do you think it would be beneficial if I were to work my way back to taking it only once per day vs splitting dose like I currently am?  

 

[ChessieCat]

9 hours ago, Albert said:

Do you think it would be beneficial if I were to work my way back to taking it only once per day vs splitting dose like I currently am?  

 

 

Generally paroxetine is only taken once a day because the half life is approximated to be around 21 to 24 hours; if a person is a fast metaboliser they might notice some interdose withdrawal which would appear leading up to when the next dose is due, if they only take it once a day.  However, there is no issue with splitting the dose and taking it more than once a day UNLESS it interferes with your sleep, because ADS are usually activating.  If a person observed interdose withdrawal and it interferes with sleep, the split doses could be taken early morning and lunch time.

 

HOWEVER if you find that you get some reaction soon after taking the whole LIQUID dose (eg activated or nauseous etc) at one time then splitting the dose might help with this.

 

This is something that you need to observe and decide on the best method for you.

[Albert]

According to my Gene test.  The only two considerations for Paroxetine are Serum level may be to high and patient may do better on lower doses, and Gene type may impact drug merchanisim and result in reduced efficiency.   When it comes to Paroxetine it says I am CYP2D6 and I am an intermediate Metabolizer.   And I have reduced enzyme activity with this drug.  

[Albert]

Started Taper !!!!   Drop:  = 5% off of the evening dose = This will result in 10mg in the AM and 9.5 in the PM.  - 2.5% drop overall.  Will plan on holding for 30 days and see how I feel.  

 

[Albert]

Today is day #4 of my 2.5% drop .  I have only noticed a few minor things - some minor twitching, some brain fog that resolves, and some leg stinging that left.  I ways, I have actually felt better.  However, sometimes for me, the WD has been delayed so I may not feel it for a week or two. 

 

[Albert]

Yesterday started to experience some symptoms.  Mild head pressure, some mild brain fog, some prickling in the evening and then mild insomnia.  Been a little over a week since my dosage reduction.  I know I am going to have to experience some symptoms in order to get through and heal.  Symptoms were manageable so will try to push through. 

[Albert]

Some advice please.  As the day went on yesterday and on through the day today, I have started to experience an increase in symptoms as well as some symptoms that I have not had in well over 6 months.  Nausea, prickling, tingling and numbness in feet and legs, blurry vision and other symptoms.   Now, they are not as intense as they have been when I was recovering from my chronic episode, but they are disturbing.  I have still been able to work and they have been coming and going.  In attempt to avoid getting to a bad place where it takes me months to recover again, at what point to I draw the line between pushing through the symptoms and up-dosing?  I know that I am going to have heightened symptoms when I make a dosage adjustment and I am going to have to work through some things until system settles down, but to what level should I consider this to be normal withdrawal, or headed toward hurting myself again? 

[Sebas]

The taper strategy seems to be just fine at current dose. An increase of light symptoms after a couple of days is also normal. It may last a couple of days to weeks.

 

Several external factors can influence WD. Take notes of what you eat and drink (and weather there was a response), supplements etc.

 

Avoid herbs, caffein, chocolate, products rich in sugar, alcohol.

 

1 hour ago, Albert said:

Nausea, prickling, tingling and numbness in feet and legs, blurry vision and other symptoms

Those are all known paxil wd symptoms. Nothing to be worried about even though they're annoying especially under working circumstances.

 

Take it easy at work (work from home), be gentle to yourself, go outside for a walk, take a nap during afternoon. Give CNS time to recover.

 

Bye Sebas