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Glowy: Tapering Paxil 12,5 mg CR with limited supply


Glowy

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I was placed on Paxil CR 20 months ago due to relentless panic attacks due to a stressful family situation. The stress/panic attacks has cleared up and I wanted to go off Paxil as I feel I don't need it anymore and I constantly felt tired and not myself on it. I also gained a lot of weight and kept having vivid dreams. Then suddenly the medication has become completely unavailable in my country (South Africa).  So I was forced to go off it now as there is no supply in any way.

 

I have read the suggestions about how to taper off Paxil CR in the Tapering section.  I am in a situation where I started tapering 3 weeks ago by moving the hours gradually as I reacted badly to skipping it for an entire day as first suggested by my doctor (I only read later that this also not recommended and almost as bad as cold turkey...).  It went fairly well and symptoms were manageable (not great, but okay). Then at 2,5 weeks I stretched the hours by 5 extra hours to avoid waking up in middle of the night and since then I have been having increasing worse withdrawal (despite trying to taper slowly again). I seem to be super sensitive compared to others. It is as if the wheels are coming off at a fast pace and I don't want to wait to act.  After reading your suggestions about slow and steady tapering, I can see how I have possibly created the ping pong chemical situation I am dealing with now.

 

But now my question what to do with the limited resources I have available now?

 We do not have Paxil liquid in South Africa (as far as I know) so what would you suggest if I only have 40 tablets of Aropax 12,5 mg CR left?  I don't think I will be able to afford a compound pharmacy.  How difficult might it be to switch to the non slow releasing Paxil to be able to cut that in smaller pieces? 

 

I battled to find advice on suggestion for taking Benzos short term to help relieve with the nausea, upset stomach, shaking, headache, heart palpitations, burning skin, dizziness.  Would it be effective when the waves of withdrawal hits? 

 

2 October - started stretching hours by one hour extra per day

25 October - currently stretching it to 48 hours between 12,5 mg CR doses.

 

Please advise what would you do to prevent further worsening of withdrawal symptoms. Thank you so much!!

2020 March  -  Paxil 12,5 mg CR, Purata 10/15 mg twice daily, Dormanoct 1 or 2 mg occasionally as needed.

2020 June - Paxil 12,5 mg CR - no more Benzos as above

2021 - 1 October -  Started tapering Paxil 12,5 mg CR by stretching hours - NOT RECOMMENDED

            20 October - Taking 1mg Dormanoct sleeping tablet per occasion         

 

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  • ChessieCat changed the title to Glowy: Tapering Paxil 12,5 mg CR with limited supply

After further reading here on the forum, I have gotten a few ideas....

 

Please let me know what you think might be an option:

 

1.  Cutting up the Paxil 12,5 mg CR tablet with a decent pill cutter in quarters. Start taking 3/4 of the the 12,5 mg CR tablet each day at the same time, for example 18:00 like I used to before tapering with hour stretching. Then I slowly weekly reduce it as I see comfortable with WD.   Everything I have read says NOT to cut the Paxil CR tablet, so I was surprised to read the recommendation for this here. Is this truly safe to do?  I have only 41 tablets left to try this.

 

2.  Can I do a bridge with Prozac? I can find 20 mg tablets Prozac or 20 mg capsules in my country.  Would starting on say a 5mg dose of Prozac be helpful? I have taken Prozac 20 years ago for 6 months and I didn't have severe side effects just the standard AD side effects. Perhaps a liquid Prozac is available in my country, I would have to find out.

 

I am desperate to be Antidepressant free and feel positive to take on this journey but the WD is difficult to function with.

 

Thank you again!! 

2020 March  -  Paxil 12,5 mg CR, Purata 10/15 mg twice daily, Dormanoct 1 or 2 mg occasionally as needed.

2020 June - Paxil 12,5 mg CR - no more Benzos as above

2021 - 1 October -  Started tapering Paxil 12,5 mg CR by stretching hours - NOT RECOMMENDED

            20 October - Taking 1mg Dormanoct sleeping tablet per occasion         

 

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  • Moderator

Welcome @Glowy

I don't have much knowledge about Paxil, but wanted to welcome you to the forum and ask some questions. Is it just Paxil CR that is now unavailable? Can you get regular Paxil? Maybe find out for sure if liquid is available or not? As you know by now, make sure to take it the same time every single day, no stretching time in between.

 

My understanding is that cutting a CR tablet turns it into a regular release tablet. As Altostrata writes here:

"The CR matrix formulation slows the dissolving of the tablet slightly, releasing the drug into your system a little more gradually. There is no magic in this matrix. If you cut up the tablet, it may dissolve faster like regular paroxetine. The change in release rate probably won’t be apparent to most people and if it is, most likely will go away in a few days. So you can cut up the tablet to reduce the dosage."

https://www.survivingantidepressants.org/topic/405-tips-for-tapering-off-paxil-paroxetine/?tab=comments#comment-4141

 

It is not ideal to rush a taper and Paxil is known to be hard to quit. It might be best to get a hold of regular Paxil and do a proper taper following the rule of 10% of current dose every four weeks. If that is an option?

 

Can you edit your drug history so there is minimal text and follows these guidelines:

  • A list is easier to understand than one or multiple paragraphs
  • Include ALL drugs, doses, and dates (starting and stopping)
  • Any drugs prior to 24 months ago can just be listed with start and stop years
  • Use actual dates or approximate dates (e.g. mid-June 2018) rather than relative time frames (e.g. 3 months ago)
  • Spell out months (e.g. "January" or "Jan" as 9/1/2016 can be interpreted as 9 Jan 2016 or 1 Sept 2016)
  • Please leave out symptoms and diagnoses

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

 

These are my opinions based on my own experience and what I have learned, not medical advice.

 

Drug history

2002-2019 Citalopram/Escitalopram, Lamictal
2019 April Escitalopram, quit at 10mg (withdrawal), Oct Escitalopram 10mg reinstated, quit after a few days (adverse reaction)

2019 Oct Lamictal cut from 200mg to 100mg
2019 Dec Lithium 83x2 mg

2020 Aug-Nov Lamictal tapered to 50 mg

2020 Nov 24 Lithium taper started, 30 Jan off Lithium

2021 15. March-31. May Lamictal tapered to 32.5 mg (holding)

2022 10. Jan started taking 25mg+5mg+2mg+0.5 liquid, 22. Jan went back to taking 25mg+5mg+half 5mg

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  • Moderator

Hi @Glowy,

 

If you cannot find more Paxil, as @Kiasofia suggested, the Paxil to Prozac switch definitely sounds like the next best option. If that is the case, it's best to get some Prozac as quickly as possible so as to maximize the amount of time you can spend cross-tapering from Paxil to Prozac. Although the drugs are similar, you are still likely to experience a bit of withdrawal going from one drug to the other, so it's best to cross-taper as slow as is necessary, to avoid destabilizing your system any further. I think you had mentioned you'd already read about it, but just in case you need the link, here is the main topic on the prozac bridge. Hopefully a slow cross taper and then a slow taper of Prozac with make things a bit easier on your system. Getting off Paxil is never easy and getting off in a hurry can be pretty catastrophic. We'll all be happy if you can avoid doing that : )

 

Another useful link that may give you an idea of how tapering at different speeds can affect your system is this one: why taper by 10%. It's very important to learn all you can about tapering and withdrawal. Generally doctors have very little knowledge on the subject, so some suggestions they make may be inadvertently harmful. Slow, symptom-based tapers are generally recommended, and the linked topic explains why. 

 

On the idea of taking benzos short term to deal with withdrawal: not recommended. Benzodiazepine dependence can happen very quickly - within a couple weeks - and these drugs are famously difficult to taper off. They are also known to be neurotoxic and have a similar mechanism of action to alcohol, so I don't think they would be terribly helpful for your taper and recovery.

 

With regard to stretching the doses, this is not recommended. It is best to take your dose at the same time of day every day. Stability and predictability is what you want to strive for. By stretching the doses you will have blood levels of Paxil go up and down like a roller coaster, which is liable to kindle your nervous system and lead to difficult symptoms. You want to avoid intensifying symptoms any more than is necessary. Ideally tapering should result in as few symptoms as possible, which means you go as slow as you need to. 

Remeron - 2004-2005 (bad withdrawal)

Clonazepam - 2005-2018 (jumped around March)

Olanzapine - 2014- late 2017

Domperidone - 2008-2018

Many drugs in between including Lexapro, other benzos and z-drugs.

Still suffering post-withdrawal from Clonazepam (Klonopin), Olanzapine and Domperidone. 

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Thank you so much for responding. You have given me a few options and valuable guidelines to make this easier.

 

I am hoping that I will be able to speak to a Psychiatrist today where I will discuss all your suggestions.

My psychologist reccomended a Psychiatrist that is not one to prescribe Benzos/medication easily.

 

All that I could track in my country is something called "Adco Paroxetine" which states the active ingredient as "paroxetine 20 mg"  where the Aropax's active ingredient is "paroxetine hydrochloride".

The pharmacist said it was the generic of Aropax, but I am not sure if the pharmacist was that clued up.

 

 

Thank you again for your help!

 

2020 March  -  Paxil 12,5 mg CR, Purata 10/15 mg twice daily, Dormanoct 1 or 2 mg occasionally as needed.

2020 June - Paxil 12,5 mg CR - no more Benzos as above

2021 - 1 October -  Started tapering Paxil 12,5 mg CR by stretching hours - NOT RECOMMENDED

            20 October - Taking 1mg Dormanoct sleeping tablet per occasion         

 

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