Kevman2112: Cross taper Pristiq to Viibryd. Here for some help

[Kevman2112]

Hello all,  

I have joined this forum because I am currently cross tapering between Viibryd and Pristiq and I am looking for advice.  

[Kevman2112]

Hello All,

 

Looking for a bit of advice as I am in the midst of a cross taper and I am having some confusing symptoms.

 

For some background, I have struggled with anxiety since I was 13 (now 33).  I have taken Pristiq 100mg for the past 10 years where it worked well for the first 7.  
 

I am currently cross tapering Pristiq and Viibryd with the goal of getting off of the Pristiq and staying on the Viibryd.  Here’s how it’s been going:

 

Week 1&2: reduced Pristiq from 100mg to 75 and started on Viibryd 10mg.  I felt almost immediately better during this time. My daily morning anxiety / panic attacks were gone, I slept better and was more productive at work. 
 

Week 3-current (just over 2 weeks): reduced the Pristiq to 50mg and upped the Viibryd to 20mg.  Started out not quite as good as the first two weeks but now have increasing anxiety and panic attacks, difficulty sleeping and trouble concentrating.  
 

I know now that I decreased the Pristiq too quickly (above the 10% recommended) but not sure where to go from here.  My doctor recommended either:

1. Keep things as is at current levels and reassess in a week

2. up the Pristiq to 75mg and keep the Viibryd at 20

3. Up the Viibryd to 30 and keep the Pristiq at 50.

 

I am currently proceeding with option 1 but today has been the worst day yet.  
The reason I am hesitant to do #2 or #3 is I have a suspicion that my recent issues prior to the cross taper may have been due to some level of serotonin toxicity when the Pristiq was at 100mg.  90% of my anxiety occurs in the morning 1-2 hours after taking the Pristiq and subsides about 6 hours after taking the dose.  Obviously if this theory were to be correct, upping either medication while maintaining the other would likely worsen the symptoms, no?

 

Any advice on how to proceed would be greatly appreciated.  
thanks in advance  

[Altostrata]

Welcome, @Kevman2112

 

Yes, it sounds like you had adverse effects from an absurdly high dosage of Pristiq. It could have been serotonin toxicity.

 

This is a site for going off drugs. You are in the midst of a doctor-supervised switch so you may continue taking Viibryd. I understand you feel your doctor's grasp of the technique is shaky, but it's beyond our mission to assist drug switches for this purpose, for which your doctor is paid.

 

I suggest you have a candid talk with your doctor, who seems to have made some serious errors. You may need another doctor.

 

If you would like assistance going off Pristiq, please let us know.

[ChessieCat]

I experienced mild serotonin toxicity when taking 100mg Pristiq (only drug).  I'm now at 0.405mg after following SA's tapering method.  The link to my topic is under my avatar on the left.

 

This is SA's topic which explains how to get non standard doses of Pristiq.  I get mine compounded.  You cannot make a liquid from the tablets but you can make a liquid using the contents of a compounded capsule.

 

tips-for-tapering-off-pristiq-desvenlafaxine

 

[Kevman2112]

Thank you for the replies and for the clarification on the intent of SA.  If you can believe it, I was temporarily on 125mg of Pristiq with a previous doctor when things started heading south after about 7 years at 100mg.  I suspect as I aged from my early 20s to my early 30s that my metabolism slowed which may explain the changes I experienced.

 

Again, I appreciate your responses and suggestions and will return for some assistance should my circumstances change.

 

best regards 

[ChessieCat]

  

I have responded to this in ddd's Introduction topic as well as here.

 

9 hours ago, Kevman2112 said:

I had undigested/intact Pristiq come out the other end and looked just like this yesterday.  I am currently taking 37.5 mg (1x whole 25 and 1/2 25mg all in the morning).  My doctor had never heard of this nor had my pharmacist.  Everyone initially assumes it’s just the shell and say that it’s normal.  However, it’s the entire tablet and it’s contents.

 

According to Page 30 of the official Pristiq monograph: 

 

from:  https://www.pfizer.ca/sites/default/files/202002/Pristiq_PM_225933_05Feb2020_E.pdf

 

Quote

 

The medication is contained within a non-absorbable shell designed to release the drug at a controlled rate. The tablet shell, along with insoluble core components, is eliminated from the body; patients should not be concerned if they occasionally notice something that looks like a tablet in their stool.

 

 

 

 

[RusTW]

How are u doing?

[Kevman2112]

25 minutes ago, RusTW said:

How are u doing?

Thank you for asking.  I am doing ok.  I feel a bit better today after splitting my doses yesterday (2 halves of 25mg at 730am and 1/2 25mg at 1030pm.  This morning I was irritable and felt jacked up like an adrenaline rush that persisted.  Likely the dose dump from the split tablets.  I’m planning on eating a high fat meal before my morning dose tomorrow to see if it slows down the split tablet absorption.  

[RusTW]

22 hours ago, Kevman2112 said:

Thank you for asking.  I am doing ok.  I feel a bit better today after splitting my doses yesterday (2 halves of 25mg at 730am and 1/2 25mg at 1030pm.  This morning I was irritable and felt jacked up like an adrenaline rush that persisted.  Likely the dose dump from the split tablets.  I’m planning on eating a high fat meal before my morning dose tomorrow to see if it slows down the split tablet absorption.  

Try to get used to not depending so much on the medication and more dealing with the symptoms and accepting them. They will always fluctuate regardless of the medication and dosages

[RusTW]

The mornings are always hard because of the high cortisol. What I used to do was get up and just get busy and not think about it. They eventually dissipate

[Kevman2112]

Thanks for the replies, advice and encouragement.  I have to remember that healing is not linear.  I tend to have a good day followed by a bad day and the bad day feels worse because I had a good day.  Almost feels discouraging.

 I am going to make a change and stop taking the 12.5mg right before bed.  I have been waking up in complete fear and disorientation since making that change.  I think I am going to go with @mogfish approach and take the 12.5mg (half of a 25mg) around 4pm after taking the 2 25mg halves at around 7am.  

[Kevman2112]

Wanted to provide an update as things have stabilized a bit.  As mentioned, I have taken the approach of splitting the Pristiq as opposed to compounding.  The unregulated nature of compounding made me try splitting instead of getting it compounded.  My plan was that if I physically could handle the split tablets, I would proceed with that approach and if I couldn’t, I would get it compounded.  I ordered a digital scale with a 1mg tolerance and will start to weigh the split tablets to get as close the the 10% reduction as possible.
 

I am still at 37.5mg (25mg in the morning and 12.5mg in the mid-afternoon).  I am a data analyst by day so I have started tracking how I am feeling using a composite score of the severity of the symptoms and how long they last during the day.  I have a benchmark for when I am ready for a drop based on the trend.  In some cases it may end up being slower than 10% per month and in some cases faster, driven by how I have been feeling.  
 

If this approach works, I will share the data here and perhaps even provide a template in Excel if others would find it helpful.

[Kevman2112]

I wanted to see if anyone has an opinion on an updated approach I am taking.  As I mentioned, I purchased a scale to measure the split Pristiq tablets.  I have just dropped to approximately 31 from 37.5 with one caveat.

 

I have found that it is nearly impossible when splitting the tablets to not end up with a big half or big quarter and a small half or small quarter.  Even then, they vary by .25mg - .5mg.  What I have decided to do is that in the first 2 weeks of the drop I will start with the big quarters or halves and take them each day in descending order, then switch to the small half or quarter and go in descending order until I take the smallest one I have and then drop again. 
 

Any feedback on this approach, good or bad?

 

[ChessieCat]

If it was me I would be cutting them as closely as possible, place the smaller portion on the scale and then adding from a "stash" of tiny bits.  For pieces that are larger than your dose you could file off a small amount over a piece of paper so you keep the powder.  If you use non stick baking paper then the powder will not stick to the paper.

 

The other option is to crush several tablets completely and weigh the powder.

[Kevman2112]

Wanted to provide an update and share a few things I have learned during my journey.

 

First, I have found that the symptoms I have experienced differ significantly during different time periods.  That is, they are not consistent in terms of the type or severity at different times during my taper.  For example, when I first started experiencing withdrawal symptoms it was mainly anxiety and intrusive thoughts (from 50 to 43.5).  Subsequently the anxiety has subsided and the symptoms are mainly brain fog, confusion and some intrusive thoughts.  
 

Second, I have found that my symptoms follow a pattern.  Immediately after a drop, I feel significantly better.  The severity of the symptoms are nearly halved.  About 10-14 days into a drop things begin to worsen and stay that way for about a week to a week and a half.  They then begin to drop again. 
 

Hopefully this helps someone experiencing the same.

[Kevman2112]

Brief update, I got the covid vaccine yesterday (JNJ).  I am about 105 days into my taper and have only had a handful of brain zaps to date.  However, today, after getting the vaccine I am having constant brain zaps, about 1 every 30 seconds to 1.5 minutes.  I am able to tolerate it and have upped my dosage of fish oil to compensate.  By no means do I think anyone should avoid the vaccine because of my experience.  If the alternative is getting covid, who knows how much worse it could be.  It may be a coincidence but I think it may be unlikely.  

[ChessieCat]

Please post your covid vaccine experience in this topic:

 

coronavirus-covid19-and-psychiatric-drug-tapering-withdrawal-covid19-vaccine

 

Thank you.

 

[Kevman2112]

I just dropped from 25mg to roughly 21.5 (measuring on a digital scale and trying to get as close to 10% as possible).  I am using a pill cutter to take a corner off of a 25mg tablet and then weighing.  
 

My question is, should I be splitting up the dosage? For example, should I cut the tablet in half and take them at different times and if so when?  I tend to have my worst symptoms at mid morning and in the late evening when taking it at 730am.  In the past when at a higher dosage, I took a 25mg in the morning and half a 25 in the evening.  That caused some issues with my sleep where I was waking up in a panic, gasping for air and really vivid and bothersome dreams.  It seems like my symptoms could be intradose withdrawal but I suffered issues when trying to split it up and solve for that in the past.

 

Any suggestions?

 

thanks in advance!

[ChessieCat]

I didn't start splitting my dose until I got under 10mg.  In Australia Pristiq is only available in 50mg and 100mg so once I got below 50mg I was taking all capsules.  Even though I didn't notice any interdose withdrawal, if I had realised earlier I would have split my dose.  I'm assuming that my interdose withdrawal was happening overnight because I took my once daily dose in the morning.  However, it would have taken several hours for the new morning dose to kick in so taking it twice a day might have improved my mornings.  I think the reason I didn't ever pick up on any interdose withdrawal I was experiencing was because I had felt so bad when taking a high dose (mild serotonin syndrome) and then experienced extreme withdrawal symptoms when I reduced my dose from 100mg to 50mg I actually felt better than I had.  But perhaps I might have felt even more better if I had split my doses.

 

The easiest way to work out if you are experiencing interdose withdrawal is to keep daily symptoms notes for yourself.  There will be a daily pattern of worsening and improving at certain times of the day, corresponding to 'x' number of hours before and after you take the dose.

 

Here is some information which might help:

 

 If you were able to get and take the ingredient of pure desvenlafaxine then the half life is about 11 hours.  To make a Pristiq tablet, the desvenlafaxine is mixed with other ingredients to make a paste / glue (called matrix) which slows down the access to the drug in the tablet. 

 

If you cut a whole Pristiq tablet in half and take the two halves, the half life will be shorter than the ~24 hours.  If you cut the tablet into quarters and take the 4 quarters the half life will be even shorter.  When you crush the tablet finely then you still have the ingredient desvenlafaxine mixed with other ingredients but when you take the powder the other ingredients do not delay the release of the drug so the half life is ~11 hours, the same as if you took pure desvenlafaxine.

[ChessieCat]

And when I split my dose I just take the larger amount in the morning.  Up until recently I've been working with 0.125mg capsules as my minimum dose so have had to adjust my taper according to that.

[Kevman2112]

Thanks @ChessieCat.  I think I am going to split my .75 of a 25mg in half and take half at 730am and the second half mid day and see how that goes.  This morning, I had heart palpitations after taking the full dose in the morning, I think it’s just too much all at once without the full extended release in play.  My goal, obviously, is to get a stable amount in my system while not impacting my sleep like when I took a dose in the morning and in the evening.  

[Kevman2112]

Any tips on slowing the absorption of Pristiq?  I am currently on 18.75mg, a half of a 25mg in the morning and a quarter in the early afternoon.  The part of my taper that has gone the best was when I was on a whole 25mg per day, likely because the levels in my system were stable.

 

It seems like whenever I am on less than a full, unsplit pill, things are much more difficult.  If I take the second dose too late in the day, after 12pm, I get more symptoms at night so I haven’t found a way to split the doses during the day in a good way. 
 

Now that I am below 25mg, the remainder of my taper will include split pills and it’s making things much more difficult.  I assume I would experience the same if I were to get the dose compounded.  
 

I can’t think of a solution so maybe i am just in for a rough rest of my taper.

Thanks in advance

[Kevman2112]

I thought I’d share something I have learned from my taper that may help others.

 

Having suffered from anxiety and panic for most of my life, I found it difficult to distinguish between withdrawal and anxiety and panic that I have experienced prior to my taper.  This has made it challenging to gauge how I am doing with my taper, i.e. am I going to fast, could I go faster or am I experiencing no withdrawal and it’s all just my normal self.

 

With my last drop, I started having more significant symptoms that differ from my anxiety and panic.  Vivid dreams, confusion, severe indigestion, and muscle tension are all distinct from my past symptoms prior to my taper.  I have experienced severe panic and anxiety as well, but again, sometimes it can be difficult to say whether that is my anxiety or the taper.  I have found it helpful to track those distinct symptoms as a barometer for my withdrawal and somewhat ignore the anxiety and panic piece because it can be misleading. 
 

I am now using those distinct symptoms to track taper timing and intradose withdrawal.  Hopefully this is helpful to others.

[Kevman2112]

Is there a way to change the title of this topic? Viibryd is no longer in the picture so I don’t want readers to get confused.  I am going to update my signature to reflect it as well.

[Kevman2112]

Hello All, hope everyone is doing well.

 

I am looking for some advice.  Today I had something similar to a panic attack but very different.  I felt like I couldn’t breath and was extremely dizzy.  I was driving home from vacation and had to pull over and have my wife drive.  It lasted for about an hour to an hour an a half and I considered going to the ER several times.  The only thing that helped was closing my eyes and slowing down my breathing.  Every time I opened my eyes, I would immediately start hyperventilating again and feel tingling in my extremities.  Eventually it passed. 
 

There are 3 potential explanations for this.  First, the calibration weights on my scale got jumbled and I determined I was taking about 3.25mg of Pristiq rather than 6.5 for the 2 weeks I have been at the current level.  I decided to stick with the 3.25 after discovering the issue rather than go up in dose.

Second, due to a sinus infection, I was put on Augmentin, an antibiotic about 4 days ago.  
Third, it might be just standard withdrawal symptoms I haven’t experienced before. 
Any advice on moving forward would be appreciated. 

[Kevman2112]

I’ll also mention that the issue I experienced was most similar to two experiences I had when withdrawaling from gabapentin, never with Pristiq.

[Kevman2112]

Hopefully someone can provide an opinion on updosing.  As mentioned, I accidentally went down to 4.29 as opposed to 6.5.  My taper had been going well.  I looked at my symptom log back to before I found SA and looked at another drop that was too fast.  The worst of the symptoms lasted about 7-10 days from the onset of symptoms (not the decrease in dose).  I am on day 6 today and things are really difficult.  
If things don’t improve by day 14 of symptom onset, I am thinking of going up in dose.  
Any recommendations? Should I go back to where I was before, 12.5mg? Or to where I thought I would have been, 6.5mg?

 

I haven’t been getting a lot of replies so I’ll acknowledge that my entire taper has been faster than SA recommends.  Perhaps that is why users are reluctant to help.  I have kept a symptom log and rating and based on that let the rating system determine when to drop.  So far, other than dropping more than intended, it’s worked well. Right or wrong, I have the belief that although I am having withdrawal I also believe Pristiq is causing many of my issues so there is a desire to be off entirely.  If I didn’t believe that, I would go as slow as possible, years.  Again, I might be entirely wrong in my theory, but wanted to share why I have gone faster intentionally as opposed to throwing caution to the wind and just trying to go fast to go fast. 

[Kevman2112]

I felt tremendously better after upping my dose to 6mg, the best I have felt during my taper which started kn December 2020.  Not sure if it’s a window and I will experience a wave soon or if it’s just improved so much because of a slower taper.  I started taking 2mg 3x per day which also seems to have leveled things out.  I am so hopeful and feel like there is a light at the end of the tunnel.  

[Kevman2112]

Hi All, I have been at 5mg for 32 days now and it continues to be a roller coaster.  I have been sick with a severe cold for about a week now which may be making things worse but my symptoms are at their highest so far.  
 

I am wondering if I should up my dose to 5.5 mg.  I am still having panic attacks, intrusive thoughts, some depression (which is new during the taper).  My one hold out is that I am sick which could be impacting how I feel.  I don’t want to make the wrong decision here.  Please any advice is appreciated!!!!

 

also want to mention I have been taking cold medicine during this time too but not one with pseudoephedrine.  

Edited August 8, 2021 by Kevman2112
Updated cold medicine

[Kevman2112]

All- hoping I can get some good opinions.  I have been at 5mg for 35 days, much longer than I’ve typically held at a given dose.  I typically held for 3 weeks and went down in dose when symptoms subsided.  I can say I’ve finally seen the SA light and intend to do 10% every 6 weeks as part of my endgame taper.

 

My symptoms have intensified in the last week to 10 days to nearly the worst I’ve had during this drop and perhaps as bad as the worst during my entire taper.  I am having symptoms I’ve never encountered before - depression, intense intrusive thoughts, general confusion and consistent fear and panic. 
 

To complicate matters, I’ve also had a severe cold during this time.  I took Flonase and cold medicine with phenylephrine in it.  Phenylephrine I later found out works on the norepinephrine receptors (ughh!). I stopped the Flonase and cold medicine about 4 days ago but nothing has improved and perhaps gotten worse.

 

I have read a lot about reinstatement after cold turkey but not a lot about deciding to updose.  I feel like I have two options, updose or wait it out.  
 

Any advice would be greatly appreciated, I’m really struggling!

[Kevman2112]

I updosed to 6mg.  Hopefully that was the right choice.  Not feeling better yet but last time I updosed it took a few days to feel better.  
 

Any reason I’m not getting any replies?  Am I doing something wrong? 

[wantrelief]

Hi Kevman - I am sorry you are having a rough time.  It can take quite awhile to feel the effects of an updose.  Although I am not a moderator, in my experience, the more times I updosed (and unfortunately I did it quite a bit over the years), the longer it took to stabilize.  My recommendation is to stay at the same dose....eventually you will stabilize.  Also if I am understanding your signature correctly, it appears you are going fairly quickly with your taper....you might want to slow down and do a maximum cut of 10% (of your current dose) per month with a two week hold (as suggested by this website).  Hang in there.....I know how miserable this can be but it will get better.  

 

[Kevman2112]

Thanks, @wantrelief.  I need to update my signature.  I kept getting an error message of too many lines.  Essentially I started taper from 100mg in December 2020 and did go too fast but with minimal issues at the time.  I definitely crashed yesterday, day 35 at 5mg from 6 mg. I’m hoping the updose helps me as it did in the past.  I’m planning on sticking with 6mg for 2 months before I start going down again and then go down by 10% every six weeks.  Long road ahead for me but I think my desire to be off has caused unnecessary suffering.  Thanks again for your reply.

[Kevman2112]

I broke down and called my doctor to let him know how I had crashed after more than a month at 5mg of Pristiq and uprising yesterday to 6mg.  I say broke down because his inclination after an updose would be to prescribe something new which I am afraid of.

 

In any event, he prescribed hydroxyzine to help through the really difficult days, 10mg. I’m very reluctant to complicate things and add a drug to this withdrawal but the pst few days I have been extremely restless, anxious and confused and unable to work. 
 

Any opinions on whether to use it or not?

[Rusty1]

You crashed to to discontinuation symptoms from your current medication. Your taper schedule listed in your signature appears faster than recommended.

 

The solution is to find a dose you feel more stable on and hold for a longer period of time before tapering again.

 

Adding another medication doesnt solve the withdrawal from this one. It only complicates your symptoms and may force your CNS to have to slowly withdraw from that one as well.

 

The go to for doctors is to always add. It only complicates things. Make your own decision, but the purpose of this board is to stabilize on the medications you are on and safely get off them.

[Altostrata]

Please use search in the Symptoms and Self-Care forum to find discussion of hydroxyzine.

 

What time of day (o'clock) are you taking Pristiq? How are you measuring it? Have you had odd symptoms as you've reduced it?

 

Did you ever take Effexor? You may wish to gradually switch over to Effexor XR beads, they are easier to taper at low doses. Venlafaxine is closely related to desvenlafaxine. See Tips for tapering off desvenlafaxine (Pristiq)