Seeker: Newbie seeking advice on Prozac tapering

[Seeker]

I take 20 mg prozac and 0.5mg etizolam daily since July 2020, started on these meds due to anxiety specifically health anxiety.

Now seems to recovered with intermittent bouts of anxiety on some days.

Planning to taper prozac, can I go on faster taper say 10% reduction every 10 days given my short period of drug exposure.

Edited May 27, 2021 by Gridley

[Gridley]

Welcome to SA, Seeker.  Thank you for completing your drug signature.

 

On 5/26/2021 at 8:36 PM, Seeker said:

 

Planning to taper prozac, can I go on faster taper say 10% reduction every 10 days given my short period of drug exposure.

 

We would not advise it.  You've been on Prozac for over ten months, and a person is at risk of withdrawal symptoms after only one month of taking an antidepressant.  We recommend tapering by no more than 10% of current dose every four weeks.  

 

Why taper by 10% of my dosage?

 

We strongly advise against tapering by alternating doses.  Alternating doses makes the amount of your drug in your blood stream go up and down, battering the nervous system and making withdrawal both worse and more likely.  This is true even with an antidepressant with a long half-life such as Prozac.  

NEVER SKIP DOSES TO TAPER - Tapering - Surviving ...

The following link is about withdrawal, which you definitely want to avoid.  

 

What is withdrawal syndrome.

 

I would recommend you take your dose every day and taper with the 10% method described in the first link above. The following link is specifically about tapering Prozac, including how to get the non-standard doses needed for a 10% taper.

 

Tips for tapering off fluoxetine (Prozac)

 

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems. Get supplements that are single ingredient (not mixed with other types of supplements).

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

Edited May 29, 2021 by Gridley

[Seeker]

Hi 

I reduced my prozac dosage by skipping tablets, doing this since April 2021. I have calculated my dose taken per day as a result of skipping to be 14mg. Lately I am experiencing stomach issues, slight increase in anxiety and not being able to continue sleep after 5 hours.

I was not aware of 10% tapering before I found SA. Now should I start taper from 14mg or take my dose back to 20mg per day for 4 weeks and then start the taper from there.

 

 

[Gridley]

11 hours ago, Seeker said:

Now should I start taper from 14mg or take my dose back to 20mg per day for 4 weeks and then start the taper from there.

Over the time that you skipped doses, your system has gotten accustomed to the lower dose, which you calculate now to be 14mg.  So I would not go back up to 20mg, which could cause further destabilization.  I would go to the new dose, taken every day at the same time,  for 3 months to allow your system to stabilize from the month of skipping doses.   Then, if you are feeling stable, you can begin a 10% taper.

 

How are you going to calculate your dosage so that you get 14mg?  This link, which I supplied in my first post, describes several methods to get non-standard doses.

 

Tips for tapering off fluoxetine (Prozac)

 

After reading the link, please let me know the method you plan to use so we can discuss that further.  There are advantages and disadvantages to each method.  Prozac comes in a prescription liquid and is accurate and convenient, but I don't know if it's available in India and transitioning from tablet to liquid requires a crossover period.  Dry cutting tablets and weighing them with a digital scale is another method.  For this, many members use the Gemini-20 digital scale, available on Amazon.  Another method is making you own liquid and another is using a compounding pharmacy.

 

The calculation you made that you're now on 14mg is approximate since it's impossible to tell exactly the effect of skipping doses in terms of your current dosage.  As you begin your new dosage and continue to hold there, monitor your symptoms.  If they worsen, it might be a good idea to updose (increase your dose) very slightly.  If this happens, let us know and we can suggest a dosage.  Do not increase your dosage without letting us know so we can suggest an updose dosage.

 

The symptoms your describe are typical of withdrawal and fortunately do not sound severe.  Here is some information on withdrawal.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Do consider the two supplements I recommended in my previous post, which are calming to the system.

 

 

 

 

 

Edited May 29, 2021 by Gridley

[Seeker]

Thanks for your guidance. You are right that 14mg is an approximate calculation. I have consumed 40 tablets in last 60 days so the average dosage comes to 13.33mg per day, I have rounded it to 14mg. I plan to make a liquid solution from my capsule and start 14mg/day for three months as suggested by you.

In case of worsening of symptoms I will surely let you know and seek further guidance.

Liquid prozac is available here, I will ask for crossover guidance before starting on the prescription oral suspension.

[Seeker]

@GridleyThanks for your guidance. You are right that 14mg is an approximate calculation. I have consumed 40 tablets in last 60 days so the average dosage comes to 13.33mg per day, I have rounded it to 14mg. I plan to make a liquid solution from my capsule and start 14mg/day for three months as suggested by you.

In case of worsening of symptoms I will surely let you know and seek further guidance.

Liquid prozac is available here, I will ask for crossover guidance before starting on the prescription oral suspension.

[Seeker]

On 5/29/2021 at 5:48 PM, Gridley said:

Prozac comes in a prescription liquid and is accurate and convenient, but I don't know if it's available in India and transitioning from tablet to liquid requires a crossover period.

Please elaborate on the crossover method from capsule solution (It is very bitter) to liquid prozac.

[Gridley]

6 hours ago, Seeker said:

On 5/29/2021 at 7:18 AM, Gridley said:

 

Please elaborate on the crossover method from capsule solution (It is very bitter) to liquid prozac.

Here's the crossover we recommend:

 

3/4 dose of old version (in your case capsule solution), 1/4 dose liquid for 3 to 7 days

1/2, 1/2 for 3 to 7 days

1/4 dose capsule solution, 3/4 dose liquid for 3 to 7 days

all liquid thereafter

 

Do not taper during the crossover period.  Hold at your current dose.

[Seeker]

@Gridley Many Thanks for your reply. I have another query specifically related to prozac taper. As prozac has a longer half life compared to other AD and its withdrawal can manifest weeks later and not in few days then the tapering schedule for prozac could be modified by taking a larger percentage cut but a longer hold period say 3 months. This would in my opinion give the taperer a better information on WD. Mark Horowitz has stated the following in his paper:

"Fluoxetine
Substitution of short-acting SSRIs with fluoxetine has
been suggested as a way to avoid intolerable withdrawal
symptoms.3,77 Fluoxetine has been routinely identified to
cause less severe withdrawal effects than other SSRIs,
which has been attributed to its longer half-life.3,29,77
Fluoxetine takes 35–75 days to reach steady state,47 which
is likely to be responsible for observations that its
withdrawal symptoms can arise weeks after cessation.9,56
Therefore, it would be prudent to wait 3 months
(35–75 days plus 4 weeks) to observe for late-arising
withdrawal symptoms. Given this property of fluoxetine,
which is similar to an in-built tapering system, it could
be reasonable to reduce doses by the equivalent of
approximately 30% serotonin transporter occupancy in
each iteration, titrated to patient tolerance.
Nevertheless, we should be wary of the idea that
fluoxetine is self-tapering, and can therefore be abruptly
or rapidly ceased, as guidelines suggest.29,78 Although its
pharmacokinetic profile predicts a gradual decline in
plasma level, a short reduction (eg, 2 weeks)27 could still
represent a rapid withdrawal schedule that exceeds a
10% decrease in biological effect per month. "

 

Eager to know your thoughts whether 10% monthly taper schedule for prozac will be as effective as for other shorter half life ADs and no consideration is necessary on the Pharmacokinetics of the drug being tapered. 

[Gridley]

@Seeker

 

I've brought your question to the attention of the other SA staff.

[Erell]

Hello @Seeker

 

I don't have an absolute answer to your question :

one thing we learn from all the testimonies is that when we talk about tapering/WD there are no universal rule, except being careful.

 

This means that someone might do fine with the strategy you shared, while someone else could suffer from too big drops.

And there's no way to predict how a body will react, we simply know too little about all the factors involved in this process.

 

I understand that you would like to be off the drug as soon as possible, we all can understand that very well.

 

Even if you started it in July 2020, you are now taking a drug that remodel your brain since one year.

Please see :

-how-psychiatric-drugs-remodel-your-brain/

 

As we promote a harm reduction approach, my suggestions would be :

 

- Give time to your body to stabilise on 14mg and to your crossover to liquid.

 

- After some months, if you feel ready to taper : try a first drop, lower than 30%; 5 or 10% or even less.

Then observe how your body react for some weeks, how you react to a low percentage, before thinking about a larger drop.

You don't know yet how you will react to a change in your dosage, so better to learn from your body before thinking about a 30% drop.

 

Fluoxetine has indeed the reputation to be self-tapering but, as usual with psych drugs, nobody can never predict how ones'body will react and every journey is unique.

There are people who can taper from it relatively easily while others need small drops and long holds.

 

 

The key is to listen to our bodies, to see how it reacts, to give time to our CNS to do his repair work. This is the best way we found to taper safely these drugs.

 

Take care 🙏

 

[Altostrata]

From your signature:

Quote

Alternating prozac by one day. 

 

 

Do not skip doses to taper! How long have you been doing this?

 

As Erell said, it's best go cautiously and see what your tolerance is for reductions. Keeping notes is a good idea. 

 

We do not recommend people taking Prozac go any faster than 10% per month, like everyone else. It's not a magic drug.

 

If you're already experiencing withdrawal symptoms from skipping doses, you will definitely have to taper more slowly.

[Seeker]

@Gridley@Erell

Thanks erell for your reply.

I will keep everything in mind.

 

[Seeker]

@Gridley@Erell

Thanks erell for your reply.

I will keep everything in mind.

 

[Seeker]

4 hours ago, Altostrata said:

Do not skip doses to taper! How long have you been doing this?

I skipped doses for 2 months, now I am taking a steady liquid form dose of 14mg made from the capsule powder. I shall continue to keep this dose steady for atleast 2 months while watching any emergent WDs. 

[Erell]

4 hours ago, Seeker said:

I skipped doses for 2 months, now I am taking a steady liquid form dose of 14mg made from the capsule powder. I shall continue to keep this dose steady for atleast 2 months while watching any emergent WDs. 

Please update your signature, it will be easier to understand your situation

 

Have a nice day !

[Seeker]

@Erell signature updated

[Altostrata]

Please let us know how you're doing.