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Altostrata

Tips for tapering off Effexor and Effexor XR (venlafaxine)

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FeralUrban

OK, how to I share my spreadsheet? I couldn't even figure out how to share photos on this site, which I wanted to do on the Is Dirt Good for you? thread I started. You know, proof of my love of dirt and gardening. And fancy pictures of my potatoes and garlic harvests. 

 

The spreadsheet I have is in Apple's program, Numbers. I think I can convert ti to the Office version of spreadsheet, but don't know how much would translate, much less how to share it here.  Perhaps you can message me privately with the info so we won't clog up the thread with technical details. 

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JanCarol

Hey Feral - I use "snip it" which takes a picture of what you highlight, and just make a .jpg.  I then post the .jpg to photobucket, and use the picture link (below the smiley faces above) to post a link to the .jpg in photobucket. 

 

Gosh, that sounds garbled.  But it's what I do.  It's not posting the actual spreadsheet, but you can take a picture of your work, and send that to us.

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Altostrata

If you use a Mac, Command-Shift-4 will take a screenshot.

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primekittycat

FeralUrban, the calculations you provided are exactly what I have done for my Effexor taper in Google Sheets. I weigh every day because I like being as stable as possible in my dosage. It usually ends up with me taking out the same amount of beads, but sometimes can be 1-3 beads different and I am very sensitive. Been doing it for over a year now. Here is a snippit of my spreadsheet:  http://imgur.com/UxBXNrN.  You can't see the formulas but I am multiplying the previous dose by .95 in each column (I do 5% cuts every 2 weeks). I also weigh the 'leftover' beads to make sure the 2 amounts equal my total (the amount I am taking and the amount I am removing). I have had great success with this.

 

Oh, I also highlight the dose I'm taking in green so my eyes don't go crazy with all of the numbers and I measure the right dose. I also have had to either hide columns and also made a new sheet because it got to like 12+ columns and too hard to scroll all the way over using my phone.

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FeralUrban

Continued frustration. I'm appalled really. :o

 

I am, going by the average weight of my first week weighing and reducing weight from there. It seems the only sensible way to do this. So my goal was 0.122g. I appreciate SquirellyGirl for the suggestion!

 

Today I weighed my Effexor beads for the coming week.

Initial weight of all beads in each capsule:

Highest weight: 0.176 -- had to remove 46 beads to arrive at desired doses 0.122

Lowest weight. 0.118 -- had to add 4 beads to arrive at desired doses 0.122

 

Does that mean there was 32.95% difference in content by weight? 

Can someone check my math? 

 

I think the next time I get a bottle, I'm going back to the generic, because at least in that there seemed to be a fairly consistent amount of beads.

 

I do think there is small variance in the scale -- it can go up or down by 0.005g if I shake the measuring tray and redistribute the beads, but no way it is off by that much. 

 

I'm also going to look into getting a more accurate scale -- for now it works, but when I get down into the drops of 0.003g this scale is not going to work.

 

I could of course go to the liquified non-extended release, but from I would have to be taking it like clockwork every 8 hours. This I know from my previous attempt at pill cutting 20mg non-ER and finding that an hour or two late could be hell. And, I'm not super time aware. Think this is my first incarnation with clocks.  ^_^

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btdt

This is one thread that needs to be merged as tons of work has already been done on the various forms of effexor...a lot of old info still holds true and some of it is not easy to find.

peace

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FeralUrban

I've attached a screenshot of my spreadsheet graph, with the informative, gratifying columns that reveal patterns (where I see none in the numbers.) Graphing in this way has helped me understand what is going on, in a way that notes  did not. 

A few words about the spreadsheet.

I use a modified form of the tracking checklist I found somewhere on this site. 

I grouped symptoms that seemed to go together for me. I subtotal each group of symptoms, and then the grand totals.

Each day I rate the symptom on a scale of 1-10.

(There is a difference between being a little dizzy around the corners and having the world spin.)

 

I use a negative rating number for my neuropathy symptoms and positive numbers for my withdrawal symptoms, as in my case these two are separate entities. Neuropathic pain is caused by (imho) by the venlafaxine being in my system. And the withdrawal symptoms are  caused by  taking away venlafaxine. Therefore I have a visual representation of the tightrope I am walking. The rainbow colors are W/D symptoms and the purple is neuropathic pain symptoms. 

 

Below that graph, I have a graph on activity, and below those (not visible) I have a graph of PRN meds, and regular meds. They are all lined up and help me correlate data.

 

I also track medication dosages

Activity levels

I have a section at the bottom for notes about what happened each day, that may remind me of why I was having a good day or bad day.

 

I use a threshold line (Horizontal yellow line) to determine when my W/D symptoms are below an acceptable threshold (in this case under 20 points), and then when I hit 10 -14 days below that threshold I can reduce, in may case by 5%. 

 

I use vertical lines to look at correlations between symptoms and activity and medication changes. 

 

The graphing is a feature you can find in both excel and numbers.

 

post-7563-0-78880100-1471530885_thumb.jpg

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SquirrellyGirl

Feral, I am blown away by, I can't find the right words, your "scientific" approach to evaluating your experience and basing your taper decisions on concrete data.  Truly inspirational! I used to be so detail-oriented, but can't garner the gumption these days.  Kudos to you!

 

SG

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FeralUrban

I HAD to take this approach. My neurologist was in his words "overwhelmed." My psychiatrist was baffled. I was in such severe pain and ANS dysfunction that I thought I would be dying soon. 

 

I learned the technique from my sister, who manages her complicated coronary microvascular disease and vasospasm, so that she can remain objective. Let's admit it a bad day feels like the *worst* and like it's been this way *forever* But when I track I discover some bad days are much worse. or much better than other bad days, and that in fact they come and go.

 

This method, which I started in February helped me identify venlfaxine as a major problem, along with other drugs. The other drugs are gone, V remains at 32.6 mg presently. 

 

I wish I had it together enough to teach others how to do this. Maybe someday.

 

Feral

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SquirrellyGirl

I am glad that you are able to identify the patterns and see that it isn't "all bad all the time."  It is so easy to get caught up in that thinking and many here do and suffer greatly because of it.  You are a strong one and you WILL make it out to the other side of this!

 

SG

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peng

A graph I made for my own Effexor gives 10 beads as about 4%.

 

However, be wary of this, more knowledgeable folks on here report of different numbers of beads in different manufacturer's versions of the drug.

 

If you can manage to count all the beads in a 225mg cap (preferably more than one - I know - what a drag!), you can plot your own graph.

 

Good luck, I am attempting what you are, cutting from 225mg.  I am at 187.5mg today.  If you can get Venlablue XL 37.5mg in Oz, it can help with adjusting doses.  The capsule contains 3 x 12.5mg little white tablets like the old sweeteners for tea and coffee. 

 

The tireless, helpful Mods on here will come on to point you at the most vital introductory sections to read on the website, depending on your particular issue.

 

Stick at it - the fact you are working to solve the problem should help!

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Vitality

Thank you for replies. I've been on 225mg xr Effexor as a maintainence dose for over 2 years though ECT was the only effective treatment to turning a major depressive episode around. My Dr has agreed to consider lowering my Effexor dose from around the beginning of next year but occasionally I get fed up with hearing how ill I was and my terrible relapse rate stats given I've unofficially (ie not been hospitalised) had episodes of depression on other occasions. So I decided to have a go at reducing the dose now but I am very sensitive to any signs that I could return to being so ill as I was in 2014. I felt nauseous and just unsteady psychologically so I quickly put back in the beads I had taken out today and then felt okish. Well as OK as I feel after the recent reminders from my dr of just how grim things were and the impact of my biology.

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Cicci

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.

I'm now on 175 mg of Venlafaxine gelatine capsules - one 150 mg capsule and two 12,5 mg mini-tablets.

Do you recommend me taking the capsule in the morning and the mini-tablets in the afternoon?

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peng

Cicci's latest post promts a hopefully useful note at this point:

 

The Swedish pharma company BLUeFISH make "Venlablue XL 37.5mg prolonged release capsules, hard"

containing 3 hard mini pills of 12.5mg each.

 

These were the form of 37.5mg dose I got as prescribed here in the UK (Scotland).

They have proved most useful in tapering.  A lot better than all that counting beads palaver.

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Cicci

Yes, it's really handy peng! They also come in 75 mg and 150 mg capsules with the same mini-tablets inside (12,5 mg).

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Altostrata
On 10/5/2016 at 9:36 AM, Cicci said:

 

On 5/5/2011 at 8:01 PM, Altostrata said:

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.

I'm now on 175 mg of Venlafaxine gelatine capsules - one 150 mg capsule and two 12,5 mg mini-tablets.

Do you recommend me taking the capsule in the morning and the mini-tablets in the afternoon?

 

 

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.

Edited by Altostrata
corrected error

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alenka9

I successfully went from venlafaxine 150mg to 75mg by eye-balling a 10% taper - worth trying if you're unwilling to count hundreds of beads every day.

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DragonButterfly

Hi everyone,

My husband is on 150mg of venlafaxine (regular tablets not slower release capsules). He split the time for his dose going from 150mg in the morning now to 75mg (AM) and then 75 mg (PM) - about a week ago - with the aim of tapering according to the schedule we found here. Alas, he has already started to experience withdrawal symptoms. I'm wondering if this could be because of the difference between tablets and capsules? We were told making this change should really not change anything as he's still getting the same dose per day (no actual drop) but obviously that's not the case. I should add that he is also currently taking 15mg of mertazapine and 10mg of temazepam as well, right before bed.

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John

Can anyone tell me what the actual weight of a brand name Effexor XR 75mg pill is?

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RachelE

A YouTube video from our friend Mixter showing his method for reducing Effexor XR (the number of beads in his 150mg Wyeth Effexor XR capsule may be different than the number of beads in yours):

 

How to remove 30 mg in pellets off 150 mg Effexor XR Wyeth, to get the desired dose 120 mg the fastest way for my taper! Remember 1 pellet equals 0.2757mg! One 150 mg Effexor Wyeth contains average of 544 pellets! So we get 109 pellets by calculating 30 divided with 0.2757! This is my 5 bunch 5 group method!

 

I'm very thankful my effexor beads are less tiny. 

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peng

DOSE - Effexor 150mg XL  -  

1 X 150mg capsule, or 2 X 75mg (XL).

 

Thanks to you guys, I am down to the magic, round number of 150mg/day.  Not been that low (??!) for 3 years.

 

I have plenty of 75mg.  In your personal opinions, mods, will taking two of them at once in the evening be OK, or is there not much to choose between that and one 150mg at that time, please?

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Altostrata

DOSE - Effexor 150mg XL  -  

1 X 150mg capsule, or 2 X 75mg (XL).

 

Thanks to you guys, I am down to the magic, round number of 150mg/day.  Not been that low (??!) for 3 years.

 

I have plenty of 75mg.  In your personal opinions, mods, will taking two of them at once in the evening be OK, or is there not much to choose between that and one 150mg at that time, please?

 

Yes, you can take two 75mg capsules or tablets rather than one 150mg for your dose.

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peng

Thanks Altostrata!

 

A couple of days ago, now down to 125mg, thanks to ideas offered on your fine site.

 

(75mg capsule + 4 X the extremely useful 12.5mg minitablets in the Swedish "BLUeFISH Venlablue XL prolonged release capsules, hard - Venlafaxine" prescribed by our health centre here.)  

 

Generic versions of Effexor liable to change at any time, here, though, depending on cost to the local county Health Trust.

One of our GPs told me a few years ago that the drugs bill is so immense that they employed a person specially to examine current costs of all medications so that they could opt quickly for the most cost effective brand at any time.

 

Also, personally, I have not been aware of any markedly differing symptoms when changing from one version of Effexor to another as some people report.

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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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