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Altostrata

Tips for tapering off Effexor and Effexor XR (venlafaxine)

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KarenB

Trying to work out what to do now that NZ is no longer supplying name-brand Effexor.  Instead we have access to Enlafax, but today I opened the capsule to find two large pills in it!  Less than lady-like words escaped my mouth...

 

So, now looking at Alto's Effexor thread to see what to do:

Quote

 

Check with the manufacturer of your generic extended-release venlafaxine that the capsule is made of gelatin. If it is, the time-release quality is in the mini-tablets.

 

A gelatin capsule has no time-release effects. To make the drug extended-release, the time-release ingredients such as povidone and microcrystalline cellulose are integrated into the core of each mini-tablet (the coatings are not time-release).

 

You can taper by removing these mini-tablets:

  • Ascertain how many mini-tablets are in each of your capsules. Open a few and count the mini-tablets.
  • Divide the dosage of each capsule by the number of mini-tablets in each capsule. That is the dosage of the mini-tablet.

(For example, every dosage of Venlablue contains some number of 12.5mg mini-tablets; 37.5mg contains 3 12.5mg mini-tablets while 150mg contains 12 12.5mg mini-tablets.)

 

Calculate the amount of your decrease, such as 10%, on your current daily dosage. If necessary, you may split a mini-tablet into smaller doses. For more precise dosing when splitting mini-tablets, see Using a digital scale to measure doses

 

The venlafaxine in a mini-tablet fragment may be released more quickly as it can be absorbed easier. If you take your venlafaxine in the morning, you may wish to take the mini-tablet fragment in the afternoon to avoid too much release of the drug at once.

 

 

1.  I have checked to see if the capsules are made of gelatin, and the sheet says gelatin and titanium dioxide (for colour).  So the time-release is not in the outer capsule. 

 

2.  I will have to split/crush the table into smaller doses.  (Above, it says the time-release quality is in the CORE of the mini-tab.  Is it okay to crush and weigh them?)

 

3. I will continue taking two doses daily, to help keep up with the possibly faster releases. 

 

4.  I will do a short bridge between the effexor and the enlafax. 

 

May I have a second opinion to let me know if my plans are on track or not?   

 

Or, would it be a better option to switch to regular effexor, as below:  (Although am wondering if that's no longer available in NZ either.  Crushing as above might be my only option).
 

Quote

 

If you are taking brand-name Effexor XR, use the bead-counting method until you get down to 37.5mg, then convert to regular Effexor and make a liquid from it to finish the taper, taking doses at least twice a day.

 

 

 

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bubble

I will check it with my husband. He found himself in a similar situation with Effexor earlier this year: could not get hold of regular Effexor tablets he had been dissolving to taper thus far. All he could get were XR pills. I have to check but as far as I remember there was a capsule with 3 smaller pills inside. I had no idea where time release could be.

 

Although I was freaking out because that thread you quoted clearly says not to do that he had no choice but to take  those 3 pills out and dissolve them. He started taking that suspension two times a day and luckily he had no symptoms. I still worry as to the efficacy of this and he has been complaining about fatigue a lot lately so I would like to get to the bottom of this too.

 

I think we should best bring it to Alto's attention and mazbe move the discussion to the thread on Effexor so that other members in a similar situation would know what to do... 

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KarenB

Thanks Bubble - I've moved them (clearly;)).  Next to find Alto ... I guess if I'm up now, she'll be asleep.

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bubble

It seems that my brain was a lot mushier in February when I read this because I get what I see now: the way to go is to weigh mini tablets. That would mean that crushing them is ok but would like to hear Alto confirm it.

 

But my husband got so used to his liquid and a syringe that he simply continued doing it: make XR mini tablets into a liquid although it's written in red not to do it.

 

I sort of understand why: it destroys the time release or something like that but would like to know what really happens if you dissolve mini xr tablets. Especially since this is how he has been taking his drug for 5 months now.

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KarenB
On 14/07/2017 at 1:28 PM, KarenB said:

To make the drug extended-release, the time-release ingredients such as povidone and microcrystalline cellulose are integrated into the core of each mini-tablet (the coatings are not time-release).

This interests me.  If the time-release is in the CORE of each mini-tablet, does it need to remain there in order to slowly work, or, can the mini-tab be crushed and mixed round so the time-release ingredients are evenly spread into each dose as it is separated out and weighed.

 

I have been looking, and cannot find any availability of regular effexor (non-XR) in NZ.   

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dj2010

I was on the same vanlafaxine capsules, they were called vensir and had 6 little tablets inside the capsule, they were 75mg, I tapered by cutting the little tablet into bits with a tablet cutter during the end,

 

Not sure if this will work, I have looked online and you can buy empty time release capsules, maybe you could fill them yourself, see here:

 

\\https://www.amazon.com/Empty-Enteric-Coated-Capsules-Joined/dp/B014EPR180

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KarenB

That's very interesting DJ.  It might be very helpful for this turn of events. 

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peng

Our form of Venlafaxine with either 3 or 6 little pills inside for 37.5mg and 75mg, respectively, is called Venlablue XL and is made by BLUeFISH PHARMACEUTICALS  of Stockholm, Sweden.

 

It must come at a favourable price for our NHS Health Trust's GPs, because they employ a person at the surgery whose job is solely, IIRC, to keep up to date with the "best buys" of medication.  

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Altostrata

KarenB, if regular Effexor is available, I'd switch to regular Effexor twice a day, with part tablet and part liquid if possible, to relieve the uncertainty and possibly the inconvenience of crushing and weighing tablets that are supposed to be extended-release.

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KarenB

I've just found out from Pharmac NZ that regular effexor is no longer subsidised here.  So you would say, if I want to be on the safe side, that I shouldn't be crushing and weighing mini-tabs?  I wonder if my next best option would be a prozac bridge.  Yikes. 

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scallywag

Karen: Pardon my question -- it comes from not knowing how NZ healthcare works. Does not subsidised mean it is not available?

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KarenB

It means that it is very expensive, and therefore likely to be unavailable, as pharmacies tend not to buy in things that are not subsidised, I guess as too few people buy them.   

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nz11

I don't know if this is already posted here but I just read an interesting post from Shep regarding the dose related neurotransmitter action of Effexor.

 

4 hours ago, Shep said:

Effexor is different than some antidepressants because how it acts on certain neurotransmitters is very dose-related. Per this Wiki article:

 

At low doses (<150 mg/day), it acts only on serotonergic transmission. At moderate doses (>150 mg/day), it acts on serotonergic and noradrenergic systems, whereas at high doses (>300 mg/day), it also affects dopaminergic neurotransmission

 

I assume then that throughout the course of the day a large Effexor dose would hit all three neurotransmitters.

If it is true that Effexor has a three pronged neurotransmitter influence then that would make it would it not a very addictive drug?

In fact from what I read and understand there is only one other chemical that I know that can act on all three neurotransmitters...and that is cocaine!

[However a cocktail of Wellbutrin and snri or remeron would do it also.]

This then also makes a large dose of Californian rocket fuel even more scary.

Anyone want to comment on this.

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Altostrata

As we can see, Effexor does cause physiological dependency and can be very difficult to quit. Therefore, it's downregulating something very effectively -- that's what causes the withdrawal symptoms.

 

However, the varying targets of Effexor do explain why sometimes Prozac, an SSRI, can be a bridge off it.

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WantoffVen

I am becoming an expert bead counter as I found my Venlafaxine XR 37.5mg capsules had as few as 30 beads and as many as 120 beads. So I am forced to count beads in every capsule and figure out the dose and move on. Well I do a week at a time so it's not that bad. I would recommend counting every capsule or at least dumping them out and making sure they look like the same amount. But that's just me. Still tapering. Having some crying spells but then I have some depressing things going on right now. So I think I'm doing great. Crying spells don't last long.

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KarenB

NZ effexor / enlafax users might like to join this facebook page: https://www.facebook.com/groups/194897591128692/about/

 

Also for anyone interested in news reporting about Pharmac. The creators of the page were interviewed today and were then the lead story on One News!

  

A Radio NZ reporter has contacted me through the page and is going to be calling me in the next few days. He wrote a good article today on RNZ. https://www.radionz.co.nz/news/national/365486/patients-wanting-special-funding-for-antidepressants-turned-down-by-pharmac

 

It's a good time to push - now that we're getting some coverage. 

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H8FXR
On 7/16/2017 at 10:29 PM, Altostrata said:

KarenB, if regular Effexor is available, I'd switch to regular Effexor twice a day, with part tablet and part liquid if possible, to relieve the uncertainty and possibly the inconvenience of crushing and weighing tablets that are supposed to be extended-release.

I am in the same boat at KarenB: mmediate-release venlafaxine is not available in Canada. So I am stuck with generic Venlafaxine Extended Release. The kind I get is called  Sandoz and has 3 75mg mini-tablets in the 150mg capsule; 2 37.5mg minitabs in the 75mg cap; and a 37.5mg tablet in the 37.5mg capsule. Alto, would you be comfortable cutting the tablets in half or qaurters? I've tried blooming a half tablets along with a intact tablet in water. They swell up into a gel from the outside in. There are no fragments or.medication leaching out of the half just because it is cut. Please help!!

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H8FXR
On 10/5/2016 at 3:17 PM, Altostrata said:

 

Cicci, a whole mini-tablet, intact, will not have the extended-release properties. When you cut up a mini-tablet, the extended-release quality may be destroyed.

 

Your mini-tablet can be taken at the same time you take the capsule.

Alto, please pardon me, but do you mean to say a whole mini-tablet, intact, WILL have the extended release properties. Further...when it is cut up, it MAY NOT have the XR qaulity???

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ChessieCat

From Post #1 of this topic:

 

On 5/6/2011 at 1:01 PM, Altostrata said:

 

Check with the manufacturer of your generic extended-release venlafaxine that the capsule is made of gelatin. If it is, the time-release quality is in the mini-tablets.

 

A gelatin capsule has no time-release effects. To make the drug extended-release, the time-release ingredients such as povidone and microcrystalline cellulose are integrated into the core of each mini-tablet (the coatings are not time-release).

 

You can taper by removing these mini-tablets:

  • Ascertain how many mini-tablets are in each of your capsules. Open a few and count the mini-tablets.
  • Divide the dosage of each capsule by the number of mini-tablets in each capsule. That is the dosage of the mini-tablet.

(For example, every dosage of Venlablue contains some number of 12.5mg mini-tablets; 37.5mg contains 3 12.5mg mini-tablets while 150mg contains 12 12.5mg mini-tablets.)

 

Calculate the amount of your decrease, such as 10%, on your current daily dosage. If necessary, you may split a mini-tablet into smaller doses. For more precise dosing when splitting mini-tablets, see Using a digital scale to measure doses

 

The venlafaxine in a mini-tablet fragment may be released more quickly as it can be absorbed easier. If you take your venlafaxine in the morning, you may wish to take the mini-tablet fragment in the afternoon to avoid too much release of the drug at once.

 

 

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Altostrata

Very sorry  @H8FXR, I corrected the error:

 

On 10/5/2016 at 3:17 PM, Altostrata said:

 

Cicci, a whole mini-tablet, intact, WILL have the extended-release properties. When you cut up a mini-tablet, the extended-release quality may be destroyed.

 

Your mini-tablet can be taken at the same time you take the capsule.

 

Yes, if the capsule is gelatin, it's just a container for extended-release mini-tablets. When you cut up the mini-tablet, you may damage the extended-release matrix. You may consider it immediate-release venlafaxine, and take it twice a day to avoid breakthrough withdrawal symptoms.

 

You cannot make a liquid from an extended-release drug that is made in a matrix formulation, which is a kind of glue.

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H8FXR
9 hours ago, Altostrata said:

Very sorry  @H8FXR, I corrected the error:

 

 

Yes, if the capsule is gelatin, it's just a container for extended-release mini-tablets. When you cut up the mini-tablet, you may damage the extended-release matrix. You may consider it immediate-release venlafaxine, and take it twice a day to avoid breakthrough withdrawal symptoms.

 

You cannot make a liquid from an extended-release drug that is made in a matrix formulation, which is a kind of glue.

Perfect, thanks Alto. I feel I am on the right track. I'm starting to see how venlafaxine XR caps can be hacked to yield all sorts of taper dosages using the mini-tablets.

 

The taper would still not be ideal (~10%) but at least I start opening possibilities of at least using halfs and qaurters of sandoz (manufacturer) venlafaxine XR 37.5mg minitabs to make it more gradual that what the doctor would have me take.

 

I am just scared to death he is not going to comply when I suggest this course of action. After all, i need him to prescribe 150mg caps (above my current dose) so I can use the 50mg minitabs in it to make my next step down of 100mg (currently on 112.5mg) and then again for 50mg + 37.5mg after that. Thank you all for being here, your courage inspires me.

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