Pioneer: Fetzima / levomilnacipran tapering advice

[Pioneer]

Hello! I found this forum after doing much googling about my situation. I've been on Fetzima for 4 years due to anxiety but I've maxed out the dose and noticed that it was becoming less effective. Joyfully, I've also gotten married and my partner and I are looking to start a family. Since Fetzima is a newer drug, with very little studies about its effects and pregnancy, my Dr and I discussed switching from Fetzima to another, more well-studied drug (TBD).

 

She started tapering me, from 120mg to 80 mg and I've been at 80 mg for about 2 weeks and experiencing some of the classic discontinuation symptoms. Basically I feel like I've pulled an all-nighter most days this week--that kind of all around, "I'm tired and something hurts" kind of head aches. 

 

Right now I'm stuck with what to do-- my Dr wanted me to go down again to 40mg but I refused. I have some hours in the day I feel normal, and some where I have the headaches or waves of depression. I could go back up in does and try tapering more slowly, or hold out where I am. I'm also unsure if I'll switch to another med, or if I should try to continue to taper down and see if I can make it. Would appreciate the support of the community as I get it figured out!! 

[Sassenach]

Hello  Pioneer  and welcome to SA.

 

This site is run entirely by volunteer Administrators and Moderators, all have been through or going through withdrawal.

There are no commercial interests or influences  involved .

 

I am sorry you are having such a rough time but you are now in the right place.

First, well done for standing up to your doctor.

The medical profession knows nothing of withdrawal from A/Ds ( antidepressants )

The taper you have already done is 30%, the max taper advised on here is 10%.

What you are already experiencing are withdrawal symptoms.

When withdrawal hits we have to take it one day at a time.

I hear your remarks regarding starting a family and the drug safety, but we can investigate that later.

For the moment you need to stabilise on the Fetzima to get you back on course.

There are two ways to do this.

1. Hold on your current dose and wait for your CNS ( central nervous system )  to settle on this dose.

2. Make small updoses and try to meet your CNS on the way down.

As we are all different there is no way of knowing how long each will take.

Please see the links below which will explain how withdrawal happens and what you can do to help yourself.

about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

the-windows-and-waves-pattern-of-stabilization/

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

dr-joseph-glenmullens-withdrawal-symptom-checklist/

are-we-there-yet-how-long-is-withdrawal-going-to-take/

 

In the meantime DO NOT MAKE ANY CHANGE TO YOUR CURRENT MEDS please.

Please feel free to browse the site, it is a wealth of info.

Other members threads will give you an insight and the opportunity to share experiences.

 

Again welcome.

 

Sassenach

 

[Pioneer]

 Thank you Sassenach for your kind words. 

 

I have decided to stay at 80mg. I'm tolerating it fairly well currently, although there's no way to tell if it'll get worse. I'm discussing with my partner the following options:

1) Stay at 80mg and maintain until and through pregnancy (fetzima has not been well studied, this is risky)

2) Fast taper 10mg/month and hold until pregnancy (or if getting unbearable, switch to more well studied SNRI/SSRI)

3) Do what my dr wants and do a very fast taper (next step down would be 40mg) and immediately switch to a new SSRI/SNRI that is more well studied

 

Unfortunately, I don't have 5 years to do a 10% taper....

 

 

Edited September 2, 2019 by ChessieCat
removed quote

[Sassenach]

Hello Pioneer

 

It is good that you have support and someone by your side through this.

I would like to make the following points

6 hours ago, Pioneer said:

1) Stay at 80mg and maintain until and through pregnancy (fetzima has not been well studied, this is risky

I can't comment on this but I assume you have researched the risks?

6 hours ago, Pioneer said:

2) Fast taper 10mg/month and hold until pregnancy (or if getting unbearable, switch to more well studied SNRI/SSRI)

By the time it becomes unbearable you will be in full withdrawal and a switch of drugs will make it worse.

6 hours ago, Pioneer said:

3) Do what my dr wants and do a very fast taper (next step down would be 40mg) and immediately switch to a new SSRI/SNRI that is more well studied

The first drop you did ie 120mgs to 80mgs was a 30% reduction.

The next one will be 50% ie 80mgs to 40mgs.

Doctors talk about switching these as if they are discussing Paracetomol vs. Codeine.

There is no straightforward switch and many go wrong because doctors do not understand the power of these meds.

Any change of med or dose can initiate withdrawal.

This is a very difficult post to write because it is not what you want to hear, and I understand why.

 

why-taper-by-10-of-my-dosage/

 

The decision has to be yours but if you require any further information please contact us.

antidepressants-withdrawal-during-pregnancy/?do=findComment&comment=53537

 

Whatever your decision I wish you well.

 

Sassenach

 

[Pioneer]

3 hours ago, Sassenach said:

Hello Pioneer

 

It is good that you have support and someone by your side through this.

I would like to make the following points

I can't comment on this but I assume you have researched the risks?

 

Fetzima is a newer drug (approved 2013) so there just isn't enough research on the effects of it during pregnancy--it would be a gamble. There is a similar drug that was approved in 2009, milnacipran (Savella), but the results were not very promising. Fetal defects in the development of his or her heart, lungs, low birth weight, etc, could all occur. 

 

 

Quote

By the time it becomes unbearable you will be in full withdrawal and a switch of drugs will make it worse.

The first drop you did ie 120mgs to 80mgs was a 30% reduction.

The next one will be 50% ie 80mgs to 40mgs.

Doctors talk about switching these as if they are discussing Paracetomol vs. Codeine.

There is no straightforward switch and many go wrong because doctors do not understand the power of these meds.

 

 

Yes, good points. I spoke with my partner today. Option 4) would be to do a 10% taper, and by Oct 2020, if my math is right (80mg-->20mg), I would be at 20.3mg of Fetzima, dropping to 18mg in November 2020. That would be technically "below the therapeutic dose" (BS but whatever). If I conceived and still tapered, it would be down to about 7mg by the time the baby was born, or if I held, again, it would be at the "non therapeutic dose." I will have to do research on if the level/dose of SNRI has an effect on the fetus, but 20mg sounds much better to me than 120 mg, or even 80mg.  

 

If I were to do this, how long should I hold at 80mg since it was such a huge jump down?

[Pioneer]

An update for anyone later searching about tapering from Fetzima and/or using a compounding pharmacy for Fetzima. My partner has amazing health insurance, so he called and spoke with a compounding pharmacy in the area. The pharmacist did some research and called him back, saying that it would be impossible to make Fetzima into a liquid due to the long release qualities in each of the Fetzima beads within the pill. It just wouldn't be possible for them to suspend the medication in liquid and have it act the same. He also said that because Fetzima has beads, there would be no way for them to create custom dosages in pill form. He said there would be no way to achieve consistency with the number of beads per capsule. The compounding pharmacist's recommendation was to taper down via the 20mg pills that are provided by the company, and then add in another, more generic and compatible SSRI/SNRI like Zoloft. He said if you bridged to another drug, they could then create a liquid or a custom dose of another drug and do the final taper that way. 

 

On a personal level, I'm doing very well at 80mg. After the first two weeks, I've been steadily improving and have few symptoms.

[ChessieCat]

The compounding pharmacist you contacted may have the correct information however I think it might be worth contacting www.pccarx.com direct.

 

Send an email to:  customerserviceexternal AT SYMBOL pccarx DOT com

 

With this subject:  Subject:   ATTN:  Clinical Compounding Pharmacist