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Cross Over: Changing form (eg tablet to liquid) of drug OR changing brand of same drug


ChessieCat
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I use the term "cross over" for changing FORM of drug.

 

The term "cross taper" is used when changing to a different drug which is also know as "bridging" or "switch".  

 

PLEASE NOTE: 

 

The method being described in this topic is for changing FORM of drug. 

 

It is NOT about how to do a cross taper or bridge to a different drug. 

 

______________________________________________________________________________________________________

 

Sometimes it is necessary or desirable to change form of drug OR change brand/generic of drug.

 

When this happens it is a good idea to do a cross over, eg to change from tablet to liquid, brand to a generic, one generic to a different generic.  This is more gentle on your nervous system.

 

Note:  It is a good idea not to leave getting your prescription filled until the last minute just in case there is a change in the brand/generic you can get.  This way you will still have a few of the old drug to at least do some form of cross over.

 

IMPORTANT NOTE:

 

Only make one change at a time.  That is, if you are splitting your dose DO NOT make a dose reduction/increase, add/stop supplement, change brand or form of drug etc at the same time you are splitting your dose.

 

Try to measure your dose as accurately and consistently as possible.

 

To do a cross over you would take the following combinations for 3 to 7 days or longer if needed:

 

3/4 old form of drug (eg tablet) + 1/4 new form of drug (eg liquid)

 

1/2 + 1/2

 

1/4 + 3/4

 

Sometimes it is difficult to get the doses you need to do the cross over but you might be able to do:

 

2/3 old form + 1/3 new form

 

1/2 + 1/2

 

1/3 + 2/3

 

Please note that there are no hard and fast rules about how to do this.  Observe your symptoms and if needed stay on a combination for longer.

 

NOTE:  If you notice a worsening of your symptoms that you think is related to the new form of the drug it would be better to go back to the old form of the drug if possible.

 

Edited by ChessieCat
added extra info

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.  Please DO NOT TAG me - thank you.

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  • ChessieCat changed the title to Cross Over: Changing form (eg tablet to liquid) of drug OR changing brand of same drug
  • Moderator Emeritus

I hope that this topic is helpful for SA members.

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.  Please DO NOT TAG me - thank you.

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  • 4 weeks later...

Yes @ChessieCat, it is helpful. Thanks. Just heard my pharmacy is having trouble getting my usual brand. Fortunately I keep 12 weeks in hand for such times. Hopefully within that time they will get the usual brand, if not, in 8 weeks I’ll do a switch @25% a week. 

Mirtazepine 15mg Nov 2018 -April 2019

April - Sept 2019 Mirtazepine 7.5

October 2019 - about 4 Nov 6mg Mirtazepine 

4-13 Nov anxiety & sleep problems caused by change of brand & jumping around with doses

13 Nov 2019 to 7 Dec 2019 10mg Mirtazepine 

8-10 Dec 2019 15mg Mirtazepine 

11 Dec 2019 to 14 Dec 12.5mg Mirtazepine 

15 December 2019 to 13 June 2021 15mg Mirtazepine 

14 June 2021 started brass monkey Slide.  
2021: 23 August 12.3mg, 28 October 11.1mg, 6 Dec 10mg

2022: 12 Feb 8.5, 27 Feb 8.1, 22 March 7.7, 5 May 6.9, 25 July 5.7 (hooray!)

 

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  • 3 months later...

Thanks for this topic @ChessieCat! Do I need to be concerned when switching pharmacies? What should I be on top of?

1- October 2011- Wellbutrin. Few months later-Zyprexa. Quite some months later-DepakoteClonapen throughout. November 2014- med free successfully! (Quick doc taper)

 2- November 2015- zyprexa (almost sure) May 2015- Lithium 900 mg throughout, carried over to pregnancy and next baby. Currently still on same lithium.     

3- June 20, 2017- zyprexa refused. June 21, 2017- forced hospitalization. June 2017- risperdal, lithium raised to 1200.

no memory when-zoloft. Got off risperdal with dr- no clue how fast or when.  June 2018- got off zoloft extremely fast resulting in complete dissociation (total disconnect of body), depression & severe fatigue

Around august 2019- lithium 1050. Lithium 975. Lithium 900. January 11, 2021Lithium 825.

February 5, 2021- Found SA 🌞! February 23, 2021- Compounding natural pharmacy 🙂. May 9, 2021- Lithium 750. August 30, 2021- Lithium 675

(will add in more dates when I figure them out)

June 23, 2022- Started brassmonkey slide 💟 June 23, 2022- Lithium 658

>ALL meds were coerced ILLEGALLY< 

CURRENT MEDS- LITHIUM  MG CURRENT SUPPLEMENTS- magnesium 350 MG

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  • Moderator Emeritus
8 hours ago, HardWork said:

Do I need to be concerned when switching pharmacies? What should I be on top of?

 

Do NOT run out of your current prescription before getting the new ones so that if you are not able to get the same brand/generic you will at least be able to do a cross over.

 

BEFORE you give them the prescription to fill ask the pharmacist what brand/generic they will be issuing.  During my taper the Pristiq patent ran out (I was not aware of this) and when I went to pick up my tablets she had a generic pack on the counter and said do you want the generic (I was very glad she asked, because some would not have and it would have been very annoying having to return them, especially if I had run out) and I said no, I want the brand.

 

If you want to stick to the same brand/generic and you have access to different pharmacies do the rounds and find out what they issue.

 

You also might find it helpful to find a pharmacy that you can continue using who will hold the same type that you use for when your prescription is due to be reissued.

 

Generics might be cheaper than the brand version of a drug.  If you can afford to then it might be worth always getting the brand of the drug because it is more likely to be available for the duration of your taper.

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.  Please DO NOT TAG me - thank you.

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Thank you @ChessieCat for your detailedresponse!! Unfortunately I did run out of meds before transferring pharmacy. That's because I had asked original pharmacy to transfer over drug formulation to new pharmacy and they were very delayed at doing it. Luckily I received the meds the day I ran out of it...

If the pharmacy gave over the info and the new one says its same can I just trust?

Also- originally I took Lithium ER, former compounding gave me SR, current pharmacy tells me it's ER but nothings on the bottle, & they told my Dr its immediate release cuz that's what I've been taking all along. My assumption- ER is prohibited to crush so they're keeping it quiet. Should I just trust and swallow? (Well that's what I did the past 10 years) Can I have your input on this?

Thanks for suggestion on using brand vs generic. Should I switch to brand if I used generic until now, or should I fear side effects?.. 

1- October 2011- Wellbutrin. Few months later-Zyprexa. Quite some months later-DepakoteClonapen throughout. November 2014- med free successfully! (Quick doc taper)

 2- November 2015- zyprexa (almost sure) May 2015- Lithium 900 mg throughout, carried over to pregnancy and next baby. Currently still on same lithium.     

3- June 20, 2017- zyprexa refused. June 21, 2017- forced hospitalization. June 2017- risperdal, lithium raised to 1200.

no memory when-zoloft. Got off risperdal with dr- no clue how fast or when.  June 2018- got off zoloft extremely fast resulting in complete dissociation (total disconnect of body), depression & severe fatigue

Around august 2019- lithium 1050. Lithium 975. Lithium 900. January 11, 2021Lithium 825.

February 5, 2021- Found SA 🌞! February 23, 2021- Compounding natural pharmacy 🙂. May 9, 2021- Lithium 750. August 30, 2021- Lithium 675

(will add in more dates when I figure them out)

June 23, 2022- Started brassmonkey slide 💟 June 23, 2022- Lithium 658

>ALL meds were coerced ILLEGALLY< 

CURRENT MEDS- LITHIUM  MG CURRENT SUPPLEMENTS- magnesium 350 MG

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Share on other sites

Thank you @ChessieCat for your detailedresponse!! Unfortunately I did run out of meds before transferring pharmacy. That's because I had asked original pharmacy to transfer over drug formulation to new pharmacy and they were very delayed at doing it. Luckily I received the meds the day I ran out of it...

If the pharmacy gave over the info and the new one says its same can I just trust?

Also- originally I took Lithium ER, former compounding gave me SR, current pharmacy tells me it's ER but nothings on the bottle, & they told my Dr its immediate release cuz that's what I've been taking all along. My assumption- ER is prohibited to crush so they're keeping it quiet. Should I just trust and swallow? (Well that's what I did the past 10 years) Can I have your input on this?

Thanks for suggestion on using brand vs generic. Should I switch to brand if I used generic until now, or should I fear side effects?.. 

1- October 2011- Wellbutrin. Few months later-Zyprexa. Quite some months later-DepakoteClonapen throughout. November 2014- med free successfully! (Quick doc taper)

 2- November 2015- zyprexa (almost sure) May 2015- Lithium 900 mg throughout, carried over to pregnancy and next baby. Currently still on same lithium.     

3- June 20, 2017- zyprexa refused. June 21, 2017- forced hospitalization. June 2017- risperdal, lithium raised to 1200.

no memory when-zoloft. Got off risperdal with dr- no clue how fast or when.  June 2018- got off zoloft extremely fast resulting in complete dissociation (total disconnect of body), depression & severe fatigue

Around august 2019- lithium 1050. Lithium 975. Lithium 900. January 11, 2021Lithium 825.

February 5, 2021- Found SA 🌞! February 23, 2021- Compounding natural pharmacy 🙂. May 9, 2021- Lithium 750. August 30, 2021- Lithium 675

(will add in more dates when I figure them out)

June 23, 2022- Started brassmonkey slide 💟 June 23, 2022- Lithium 658

>ALL meds were coerced ILLEGALLY< 

CURRENT MEDS- LITHIUM  MG CURRENT SUPPLEMENTS- magnesium 350 MG

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  • 1 month later...

Hey @ChessieCat

Would going from shaving pills to crushing pills be considered a change of form? Same pill and still in gel capsules, the method of getting the pill down to the correct weight has changed. 
 

Thank you!

Ryan

2005- 2008: Lorazepam (max dose- 1 MG daily)

2008- 2016: Lexapro (max dose-10 MG daily)

January 2017- March 2017- Pristiq (max dose- 100 MG daily)

April 2017- June 2017: Trintellix (max dose- 10 MG)

July 2017- October 2017:  Lexapro (max dose-10 MG daily)

November 2017- April 2018- Luvox (max dose- 100 MG)

May 2018- Zoloft (max dose- 18.75)

5/28/18- 3 MG Lexapro, 6/3/18- 3 MG Lexapro, 6/7/18- 3.5 MG Lexapro, 6/13/18- 4 MG Lexapro, 6/21/18- 4.5 MG Lexapro, 6/28/18- 3/29/21- 4 MG Lexapro, 3/30/21- Present- 3.8 MG Lexapro

**Bad Wave Caused by Trileptal 150 MG (one pill) in December '20 and Low Dose Naltrexone .12 MG (one pill) in April '21**

 

"The Journey is The Reward"

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  • Moderator Emeritus
33 minutes ago, ryan1982 said:

Would going from shaving pills to crushing pills be considered a change of form?

 

Yes I think it would simply because there would be a difference in the size, ie chunk/s compared to powder.  Think of it like this, if you have a candy/lolly/sweet and you put it in your mouth as a whole and the next time you crush one up and put that in your mouth, the crushed one will dissolve a lot quicker than the whole one. 

 

However, if nothing else has changed then it might be okay to go straight from one to the other.  And I don't know what sized chunk/s of tablet you have been using.  You will have to use your discretion.  If you do go straight from chunks to powder you might notice a change/increase in symptoms, but I think that things would settle fairly quickly and of course you would know what caused it so you wouldn't be too anxious about it.

 

If you did want to do a transition, eg if you know are sensitive to changes or just for peace of mind, you could partly crush your weighed tablet which you have shaved down and each time crush it a bit finer.

 

If it was me, I think I would take the cautious route and try to do a transition, simply because if it is possible to do it then I would, because better safe than sorry.  You wouldn't have to do it for very long.  I think you could do it over 3-4 days and I think it would be worth the little bit of extra effort, just knowing that you did it the best way you could.  It's similar to the conundrum of what dose to go down to before you stop completely.

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.  Please DO NOT TAG me - thank you.

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