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Tips for tapering off Effexor and Effexor XR (venlafaxine)

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LovingSupport

Thanks for your reply, Peggy.

 

To clarify, are you recommending staying at 3 week reduction intervals?

 

Or that one should do three complete intervals before reducing to a shorter interval time (i.e., my partner should consider doing 3 rounds of two week reduction intervals before dropping down to one-week reduction intervals)?

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mammaP

Peggy is right Poppy, we do not recommend reducing the time between cuts. I did just fine with my tapering of effexor but it caught up with me because I went too fast. I also had bad withdrawal and it took a long time to stabilise properly again.  No more than 10% cuts of the current dose with at LEAST 3 weeks between cuts. Any withdrawal symptoms that pop up are a sign that he is going too fast and needs to slow down. 

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Altostrata

Generally, we advise reductions at intervals of a month. This is very conservative and accommodates most people except those at the extreme edge of the curve representing sensitivity to dosage reductions.

 

On the other hand, by listening to their bodies, many people might be able to taper faster. LovingSupport's partner is following a reasonable schedule adapted to a higher tolerance for dosage reductions.

 

However, even if you're highly tolerant of dosage cuts, I would not reduce any faster than every 2 weeks, to give your nervous system and the rest of your body a chance to adapt to the new drug levels.

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LovingSupport

Thank you, Altostrata, MammaP, and Peggy for your thoughtful consideration. We are going to stick with the current 2-week reduction schedule (10% of current dose, each time), based on your input.

 

If someone is going to have withdrawal issues while following the protocol, is s/he more likely to experience it down at the lower end of the titration process? (ie, when down to 25% of original dose rather than at 75%). If yes, as my partner gets down to lower dosages, we may consider going back up to 3 week intervals (he's at about 70mg of Effexor XR, down from 150mg).

 

Thank in advance for your help on this!

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Altostrata

Yes, it seems the last leg of the taper can be more difficult.

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LovingSupport

We just did the math looking at the Dose Weights calculation chart from the SA site. At a two-week interval reduction schedule, it will be longer than a year to get down to 1.5mg of Effexor XR from today's 64.6 mg  downward. My partner has already be reducing for the last four months, so this whole schedule might take a full year and a half.

 

The emotional disappointment is strong realizing this.  We talked about working down slowly to 10 day intervals, so that the "jump off" point is not soooo far away (assuming all goes smoothly). Another full year feels like a very long time, considering he was on the AD for 13 1/2 months before starting titration--less time than the titration will potentially take.  

 

Any and all advice, wisdom, experience is greatly appreciated.

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peggy

well, from my past experience one and a half years is not long!  I used to think the same thing and would speed up (as i was feeling fine with no apparent withdrawal symptoms) until i went too far and got slammed with anxiety and depression.  Then i would have to updose and stabilise for a few months and then begin the process again - so i am now 3 years since i found this site and still almost back where i started - if i had stuck with a 10% plan i could be off now.  

 

As your partner reduces the side effects of the medication will also reduce; if you can go slow and avoid any potential problems a year and a half out of your life is nothing!

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Altostrata

People vary in their tolerance for tapering. Some need to go slower and others can go faster.

 

Here's the thing: You cannot tell which you'll be, and once you develop withdrawal symptoms, it can be too late for an easy correction.

 

That is why we recommend these slow tapers, to stay out of trouble. Speeding up a taper is entirely at your own risk.

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Lexy

I know how you are feeling....I was only on effexor for 7-9 weeks egrb I cut my dose in half. I've been decreasing since jan 2013. You can risk getting wds. If he is tolerating the tapering at the rate this forum suggests, then he has a better chance of getting half as bad as some of us here are. May I suggest setting mini goals?

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Lexy

Oops sorry typing from my phone and my vision is not as good as before effexor.

I meant if he following this forum's tapering advice then he will not be half as bad as some of us here are.

Good luck!

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LovingSupport

Advice heeded. "Slow and steady wins the race", so to speak. Love the idea of "mini goals"; good reminder for us all to celebrate the micro-gains.

 

Thanks, everybody.

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LovingSupport

My partner is on the "slow titration train" off of Effexor XR. He started at 150 mg, is now down to 27.8mg. At what mg amount might you recommend him migrating to either non-XR to make liquid form for more precise measuring? Or would you suggest staying as long a possible on the XR scale measuring? We weighed out what 1.5 mg would be, and it seems to be about 4 beads of the Effexor XR brand he is taking. (We have been ordering the same brand at an independent pharmacy from near the beginning of the titration, to stay consistent.)

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LovingSupport

Good to hear, LovingSupport.

 

Is your husband tapering by 1.5mg at a time?

 

At 27.8mg, a 10% reduction would be 2.78mg (you calculate the 10% based on the last dosage, not the initial dosage). A reduction of 1.5mg would be even more gradual -- that's fine.

 

Hi Altostrata, thanks for responding.

 

No, he is tapering at the 10% of last dosage each time, as SA recommends. The 1.5 mg is the lowest amount listed on the Excel spreadsheet y'all graciously provided on this site, called "Dose_weights_SA.xls".

 

(Side note to those who have not found/used this spreadsheet yet--it's amazing and will save you a big headache trying to calculate each reduction on your own).

 

I'm trying to assess whether he should simply stay on the scale method all the way down to the last 1.5mg dosage weight listed, or make the transitional switch to liquid at a higher weight to stay more exact. He's free of withdrawal symptoms at this rate, and I want to keep it that way as the reductions continue when possible.

 

I know that as the dosages get lower, the accuracy range of the scale's range of variance will get proportionally less accurate. (for example, a .001g or .skipping around a 003g variance in weight is more significant when one is measuring a total weight of .007g).

 

 

Thanks in advance for your input.

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brassmonkey

Hi LovingSupport--  Just because 1.5mg is the lowest dose on the spreadsheet doesn't make it the best place to jump off, it is still quite high.  If you haven't read this thread I would recommend that you do;

 

Tapering to zero -- when do you just drop off? 

 

It is very disheartening to have done a great taper and have it all go wrong at the very end.

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Altostrata

To taper further from 1.5mg, one might switch to making Effexor liquid from immediate-release Effexor and take a dose as beads plus liquid, such as 3 beads plus the remainder in liquid.

 

I would taper as long as feasible.

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primekittycat

Has anyone had any withdrawal symptoms occur when your Effexor XR generic manufacturer is changed, even though you're taking the same dose? My pharmacy keeps going back and forth between Teva and Wyeth, and I'm finding myself having some (manageable) symptoms 2.5 weeks after a 5% cut for which I hardly had any symptoms days after.

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brassmonkey

Some people do have trouble switching between generics, but it usually shows up in a day or two.  If you aren't getting symptoms for two and a half weeks after a drop it is more than likely just regular old WD and not the change in brand.  Are you keeping records as to what brand you are using for which dose reduction and when the symptoms hit?

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NotANutter

Does anybody know if Im likely to experience withdrawal effects after only being on 75mg for 11 days? I absolutely hate feeling so drugged and want to stop asap but wondering whether I will still need to taper off? Has anyone else stopped suddenly after this time period and any effects?

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brassmonkey

Hi NotANutter-- welcome to the group.  You'll get a lot more responses if you start a thread in the Introduction forum.  That is the best place for asking questions and keeping a journal. 

 

If there are no other factors involved, like other drugs, then just stop.  With only being on it for 11 days you shouldn't have too much trouble.  Effexor is a very powerful drug and because you are already feeling some side effects you will probably feel some when you stop.  They shouldn't last very long and should be pretty mild, nothing like you may read about on some of the other threads.  Don't let them panic you, they will pass.

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Kris108

Hello all!

 

Does anyone know if it is possible to turn XR (extended release) capsules of Venlafaxine into an instant release version of the drug. By dissolving it in warm water, for example? Where I live, the only available version is XR, and it would be much easier to manage if I could begin to reduce my evening dosage, which would among other things improve my sleep.

 

Thanks

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Fresh

Hi Kris , please start a thread for yourself in the Introductions forum.

 

Thanks , Fresh

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peggy

Hello all!

 

Does anyone know if it is possible to turn XR (extended release) capsules of Venlafaxine into an instant release version of the drug. By dissolving it in warm water, for example? Where I live, the only available version is XR, and it would be much easier to manage if I could begin to reduce my evening dosage, which would among other things improve my sleep.

 

Thanks

 

I was unable to do it - maybe a compounding pharmacy might be able to crush them and mix with a solubiliser - we only have the XR version available here too

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Altostrata

Kris, please read post #1 in this topic carefully.

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mammaP

Note for member  'Crossover' I moved your post to the introductions forum where you will get more replies and more people will see it. You can add to it there and ask questions about your taper. This forum is about general info on effexor tapering. Here is a link to your new thread. 

 

http://survivingantidepressants.org/index.php?/topic/11964-crossover-tapering-effexor/

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FeralUrban

Oh dear. Effexor capsules do not contain the same amount of medication by weight in each capsule. 

 

I was counting beads as a means of removing 10% from my 37.5 mg brand name Effexor  The beads are all different sizes, as noted by others on this site and therefore inherently impossible to accurately reduce by 10% since you could be removing a bead that weighs three times as much as another bead, etc.

 

AND I HATE COUNTING, I suck at it. My brain can't do it easily. I have to have tricks and methods, making piles of 10, counting the piles over and over. 

 

So I got a scale. AWS ZEO-50 Jeweler's scale 50g x 0.001g with a wind shield and level, and rubber feet for minimization of vibration. I had gotten their less expensive scale but it had problems. This one does indeed work better, but I have to be very careful. Don't touch the table the scale is on, put the wind shield down. Put the weighing dish in the same place each time. Try to distribute the beads evenly in the tray. If you do all that it is very accurate. Care of course must be taken regarding bouncing beads, static cling beads, etc. 

 

BUT -- here is what this weeks Effexor capsules weighed:
0.156g     removed 0.016     10% reduced dose by weight: 0.140

0.121g     removed 0.012     10% reduced dose by weight: 0.109

0.137g     removed 0.014     10% reduced dose by weight: 0.123

0.127g     removed 0.013     10% reduced dose by weight: 0.114

0.138g     removed 0.014     10% reduced dose by weight: 0.124

0.155g     removed 0.015     10% reduced dose by weight: 0.140

0.129g     removed 0.013     10% reduced dose by weight: 0.116

0.118g     removed 0.012     10% reduced dose by weight: 0.106

 

Difference between highest weight and lowest weight  0.038g, significant enough when doing a taper

% difference in weight of doses taken: 3.4%. So um, being sensitive this is not good. I'll see how it feels this week, see if it feels like I"m bouncing on Day 2 or 7.

 

I do not know if the difference in weight is due to the different in the active ingredients or the time release and binder ingredients. But I would say that prior to tapering I occasionally experienced taking the pill and experiencing WD, which seemed to me to indicate what was in one capsule was not equal to another. Therefore I'm guessing that the active ingredient is not accurately measured in the capsule. 

 

Does anyone know if the active ingredient in each capsule of Effexor is the same -- or not? 

 

The unequal weights of each capsule means that when I do my next taper (which will be 5%) that I will have to do the calculation as follows. Forgive me if I have written the formula's incorrectly. I haven't used much algebra for past 40 years. 

Step 1: Capsule A weight

Step 2: A*0.9 = New 10% reduced dose

Step 3: 0.95*(A*0.9) = New dose, 5% reduction from previous dose

Step 4: 0.95*(0.95*(A*0.9))

Step 5: 0.95*(0.95*(0.95*(A*0.9)))

Step 6: 0.95*(0.95*(0.95*(0.95*(A*0.9))))

 

And so on, for each damn capsule. I will try to make a spreadsheet so I can make the machine make the calculations for me.

 

Given that I will have to do this for each bead, and each time I reduce dose I will have to add another line to the formula, makes my blood boil and my brain freeze. 

 

I pray that a 5% taper works for me, as I can't imagine doing this with a 1% taper. 

 

I'm going to the garden now and deal with plants and dirt. So much easier than capsules. 

 

 

 

 

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FeralUrban

I just spoke to Pfizer Medication Help line.

"The capsules are filled by weight, not by volume. Ranges are validated with in an allowable variance."

"We have no recommendations, other than the standard withdrawal which is to reduce the dosage by 75 mg per week until the patient is off."

 

ARGH!

 

Therefore, since I am weighing the beads and re-inserting them into the capsule, I will come up with a standard dosage by weight and reduce that standard weight by percentage. 

 

AVG WGHT: 0.135g

Less 10% previous dose: 0.122g

Less 5% previous dose: 0.115g

 

ETC.

 

BE warned-- if you are super sensitive you must consider that the actual weight variability is of each 37.5 mg dosage of brand name Effexor is at least 3.5%, meaning if you take out 10% you could actually be taking out 13.5% or 6.5% and be bouncing your dose all over the place. 

 

This may explain some of the problems I read about on the site. I'll let you know how my new plan goes.

 

Now to re-weight those remaining 7 capsules to standard 0.122g dosage. 

 

I feel like I should change my screen name to P****d!

Edited by ChessieCat
language bleeped

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peng

Maybe you are being too fussy about differences that may not be significant, FeralUrban? Just my view.

I have done a lot of counting beads over the last few years and have not had any crashes due to the reductions.  (I have had 'em due to external factors in my life though!!)

I think I got 270 beads in the 75mg EffexorXL, by the way.

 

I am on 200mg at the moment, so some flippin' way to go again.

 

"We have no recommendations, other than the standard withdrawal which is to reduce the dosage by 75 mg per week until the patient is off."

Sheesh!  Talk about not grasping the magnitude of the problem.  That is a classic, and shows what we are up against.

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FeralUrban

Maybe you are being too fussy about differences that may not be significant, FeralUrban? Just my view.

I have done a lot of counting beads over the last few years and have not had any crashes due to the reductions.  (I have had 'em due to external factors in my life though!!)

I think I got 270 beads in the 75mg EffexorXL, by the way.

 

 

Well, I have had extreme variability day to day with my WD symptoms with bead counting. 3 weeks since a 10% reduction from 37.5mg and every day is a complete crap shoot. I had days where I was in "normal WD" and days where I couldn't control my body well enough to walk without a cane or staff. I had days of normal emotional tone and days of impending doom and periods of intense anger for no reason really. 

 

During my full blown WD after a 3 month taper and completely off the venlafaxine I looked and moved like someone with a severe movement disorder. I couldn't stand without holding onto something, my whole body was undulating uncontrollably. And then on day 10 I flew into a series of rage tornados, broke stuff, physical hurt myself, and scared the **** out of my husband. I can tolerate a lot, but that was too much. 

 

I'm afraid I'm one of the super-sensitive folks, and it's complicated by other issues, neuropathic pain, and the need for asthma meds (asthma brought on by the WD) and the asthma meds aggravate the WD. 

 

I did some calculations and at the current rate of 5% every three weeks it will take me to January 2021 to get off this ****. So I've revised to a schedule I will attempt: 2.5% reduction every 4-7 days. Towards the end if I continue using the scale the drops will be a larger percentage, due to the limits of the scale and I can get off in about a year. OF course time will tell. 

 

 

"We have no recommendations, other than the standard withdrawal which is to reduce the dosage by 75 mg per week until the patient is off."

Sheesh!  Talk about not grasping the magnitude of the problem.  That is a classic, and shows what we are up against.

 

Oh yes, the first person I talked to was obviously trained to say exactly the company line. She was a pharmacist. Those quotes were from her.

The second person, the Quality Control Report taker was more human, and I suggested to her that someone in the company ought to become a whistle blower. I'm sure it's not the first time she's heard the tales of woe of those stuck in WD hell. She did pause before continuing. I imagine her conscience was pricked. 

 

I know it's probably pointless, but I'm going to contact a lawyer sometime soon. I'm 59 and I'm as weak as if I were 79. I can't imagine ever regaining a semblance of health and strength. I'm simply old before I'm old. On good days I leave the house. And I usually pay in pain and and WD symptoms.  I've tracked everything with a spreadsheet since June. And I have nearly daily notes since February. I may have a case, because  the whole thing was kicked off by irresponsible and damaging poly-pharmacy. 

 

I'm in an angry phase, that doesn't seem to go away, unless I stop thinking about this altogether. Or go into deep meditative prayer. At least now I only have to weigh my meds once every 4-7 days. 

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peggy

i found that there was a significant variability in the weight of the capsules to cause me problems when i reached around 18.5mg  I have increased back up to 75mg again - i couldn't stabilise on 37.5 this time - i don't like mucking around with withdrawal symptoms - i am too afraid that i would end up in protracted withdrawal and so i updose until i settle.

 

I am thinking this time that i will come back to 37.5mg and then cross over to Prozac. I have tried too many times to come off the bead counting/weighing method

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SquirrellyGirl

My brain went into overload when I read your post about the variation in weights, FeralUrban.  Here's what I do, and it seems to be working well for me:

 

Take the average weight of several capsules - let's say 5 to be thorough.  The average of your first five capsules is 135.8 mg.  I would then use that number to weigh out all future dosages.  If I was reducing 10% from there, I'd weigh out 135.8-13.5=122.3 mg.  Every day you take that amount.  That way, the variation isn't carried over from your original capsule variations.

 

I take two additional steps to make things as constant as possible.  One is to weigh out two weeks' worth at a time.  The other is to select the largest bead size to make up the bulk of the dosage, using the smaller beads to get to the final weight if one more large bead puts me over the mark.

 

I hope that helps.

 

SG

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peng

IMO, withdrawal symptoms, day to day, will be very volatile (Mods?), hence one cannot assume a different kind of day to yesterday is due to dose weight, especially when you are feeling on the extreme edge.

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scallywag

Feral, I am bead-counting to taper. Over the weekend I opened a new package of Cymbalta and noticed that there are more beads per capsule.  I did exactly what SquirrellyGirl said -- take 3-5 capsules and determine the average # of beads. I'll use that new number as my basis for bead counting: It was 9 beads/mg, now it's closer to 10 beads/mg.

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Altostrata

IMO, withdrawal symptoms, day to day, will be very volatile (Mods?), hence one cannot assume a different kind of day to yesterday is due to dose weight, especially when you are feeling on the extreme edge.

 

This is true. Also, if you've been taking an antidepressant consistently for more than a week, due the half-life, you'll have an average "steady state" level of it in your bloodstream.

 

Very sensitive people may feel even small variations in this average "steady state." If you are very sensitive and do not take the drug at the same time each day, you may feel variations simply from that.

 

One data point doesn't make a trend. As peng observed, one day of symptoms may be due to factors other than the recent decrease in dosage. This is why we ask people to keep daily notes on paper about symptoms, the time you took your drugs, and the dosages. You need to look for patterns over time.

 

It's frustrating to count beads or weigh beads when going off Effexor XR (or Cymbalta), but it's the best method we have to manage a direct taper off the drug.

 

Even give the known inconsistency in Effexor beads, many people have tapered counting beads or weighing them. If you frequently have withdrawal symptoms after a decrease, you might make your decreases a little smaller -- 7.5% instead of 10%, for example. This will cause less of a variation in your "steady state."

 

We also have people here who are so sensitive they can tolerate decreases of only 5% and even less.

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peggy

personally, i think the variation is less of an issue at a higher dose because of the receptor occupancy curve - when you get down around 15mg a smaller difference is greater. We cannot get immediate release effexor in this country - if we could i would change over to it and have a liquid made up - i think that would be more accurate.

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FeralUrban

 

Very sensitive people may feel even small variations in this average "steady state." If you are very sensitive and do not take the drug at the same time each day, you may feel variations simply from that.

 

One data point doesn't make a trend. As peng observed, one day of symptoms may be due to factors other than the recent decrease in dosage. This is why we ask people to keep daily notes on paper about symptoms, the time you took your drugs, and the dosages. You need to look for patterns over time.

 

It's frustrating to count beads or weigh beads when going off Effexor XR (or Cymbalta), but it's the best method we have to manage a direct taper off the drug.

 

We also have people here who are so sensitive they can tolerate decreases of only 5% and even less.

 

 

When I was taking Effexor at my full dose, 225 mg, if I was late by a few hours I had brain zaps. And some days, even with taking it at the same exact time I'd get them anyway. I'm assuming now, that this could have been in part due to the inconsistency of the dose as dispensed in the capsules. Or possibly it could be a problem with my metabolism, which was for completely chaotic, I presume as a side-effect of the venlafaxine.

 

If, when, I get to my next decrease it will be a 5% decrease. I think the 10% drop was too much for me, and i'm still waiting for things to level off. 

 

I do find weighing with a scale to be so much easier than counting beads. Using the scale requires some fussy attention to detail but at least I don't get lost in the counting. I think I have some mild form of dyscalculia (like dyslexia but with numbers) and I've had a hard time counting all my life. 

 

I have been tracking daily data with a  spreadsheet since June, and before that with notes in a little notebook. The notebook tipped me off -- gave me clues about what was happening that made me aware that Effexor in combination with other meds was toxic for me. That prompted me to start tracking on a spreadsheet, something I learned from my sister's management of a complex cardiac issue. Data over time is revealing. 

 

I use the graphing capacity of my spreadsheet, since I'm a visual processor. I like it when I see the graph bars getting shorter! I also place graphs below that line up that show medication dosages and activities, so I can correlate symptoms with dosages and activities. This process makes it much easier for me to know what's going on. It's true that subjectively, a bad day seems like it's always been this way and always will be. A good day does the same, at least for me. So having the spreadsheet and graphs really helps me a lot to be a bit more objective in the process.

 

I still think it's outrageous that a 3.5% variation in dose is considered within acceptable parameters for 37.5 mg dosage.  The variation may be even greater than that. I only weighed the contents of 7 capsules. I'll let you know if the variance is greater than that as I continue to weigh capsules. 

I realized early in counting the beads that subtracting beads (taking out ten beads) wouldn't work because there could be 150 beads, or 110 beads in any given capsule, so I always counted the beads I would retain in the capsule. Never mind the bead size differential.

 

I truly appreciate the information and help I'm getting here. I can't imagine trying to figure all this out on my own. Thank-you all.

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Altostrata

Thank you, FeralUrban! Perhaps you could share a sample of your spreadsheet, it sounds like you are doing a great job of tracking your symptoms.

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