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Altostrata

Tips for tapering off Effexor and Effexor XR (venlafaxine)

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Quest

If I am trying to reinstate after being off effexor for three months, does one weigh approx. 5 balls and pick a number or close to same number, or just pick five biggest ones?  I am super sensitive to anything right now and do not even know if I chance reinstatement.  Any advice?

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mammaP

You need to count how many beads are in the capsule to work out the mgs, they are all different.  

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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 have myself so confused now. I need some mathematical help. If there are 100 beads in a 37.5mg capsule of Venlafaxine XR then one bead would be .375mg. Now here is where I get confused. Let's says I want to taper 11% how many beads do I take out and how did you figure that. Thanks for help from anyone. This can't be that complicated but math was never my strong suit. 

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brassmonkey

Hi WantoffVen--  The math is pretty easy.  Your signature says you're currently taking 118.5mg of Venlafaxine so I will use that for the calculations.

 

118.5 X 0.89 =105.47  that would be the strength of your new dose in mg. if you do an 11% reduction (please tell us why 11%)

105.7 / .375 = 281  which would be the total number of beads it takes to make that dose.  If one capsule has 100 beads then you need to take two (2) full capsules and one (1) that contains 81 beads (remove  19).

 

Hope that helps.

 

Brassmonkey

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WantoffVen

Thanks for reply. I'm sorry I wasn't clear. I have a 75mg capsule I also take So I strictly need the math for the 37.5mg capsule and I actually started on 112.5 and 11% was just an example to try to understand the math. I am so doggoned confused here. This is my third week wean.

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WantoffVen

Okay I opened a few capsules and am finding there are a different number of beads anywhere from 30 to 121 in the various capsules so I need the mathematical equation I would need to figure how many milligrams in a capsule depending on how many beads and I'll have to open every single capsule and figure the math if I can get a handle on how to figure the math.

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brassmonkey

The strength of each capsule in mg is stated on the bottle and doesn't change even of the number of beads does.

 

The strength of each bead would vary. This would be calculated by dividing the stated strength by the number of beads. So for a 75mg capsule with 30 beads it would look like this:

 

75/30 = 2.5 mg per bead

 

or for a 75mg capsule with 121 beads it would be:

 

75/121 = .62 mg per bead

 

This number is the AIC (Active Ingredient Concentration) for each bead.

 

To determine your new reduced dose in beads;  First determine the strength of the new does in mg. To do this multiply the strength of your previous dose by the quantity  (1 - the percent reduction)  from your example 1 - .11 = .89. From your example 112.5 X .89 = 100.1mg would be the desired strength of you new dose.

 

To Determine the number of beads: Divide the desired strength of the new dose by the AIC of the beads being used to make the dose.  100.1 / 2.5 = 40  or 100.1 / .62 = 161.4

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WantoffVen

Oh thank you thank you thank you. I copied this. Well I know I will never have any reason to be bored as  I can always count beads and do calculations lol.

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WantoffVen

I must be missing something but how can you end up with needing more beads than are in the capsule for a reduction. You said example 75 mg. capsule had 121 beads and is .62 mg per bead and then to reduce from 112.5 to 100.1 you need 161.4 beads. Now how do I mesh that with my 37.5mg capsule. I have a 75mg capsule and a 37.5mg capsule which comes to 112.5 I was taking beads out of the 37.5 to reduce. So my 37.5mg pill which had 121 beads that would be .313mg or half of the 75 so I guess I can times the .313 times 2 to equal one bead from the 75mg. capsule. Crap can you help out with the 37.5mg capsule. Once that's gone then I'll only have the 75mg to deal with. I'm thinking I would obviously take the 75mg capsule and I would need about 80 beads from the 37.5? But then not all the 37.5 have 121 beads - some have like 37 but that's obviously 1 mg. Anymore help would be appreciated or I'll just bumble my way through the danged 37.5mg capsule to get to the 75. If you've had it with me I understand that tool

 

 

Edited by ChessieCat
removed blasphemy

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brassmonkey

Subtract 75mg from your new desired dose, because that will be handled by the 75mg capsule.  That leaves 25.1mg to be made from the 37.5mg capsule. Use 25.1 in the calculation using the AIC. 

 

 Divide the desired strength of the new dose by the AIC of the beads being used to make the dose.  25.1 / 2.5 = 10.4  or 25.1 / .62 = 40.4

 

If the number of beads is different for each capsule then you need to calculate the AIC for each capsule as you use it. AIC = 37.5 / number of beads.

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WantoffVen

Honest I GET IT now. I figured out til 37.5mg capsule will run out figuring 121 beads which seems to be the case in 95% of the capsule BUT I will check each capsule just in case. Boy oh boy 75mg. will seem so easy then. You have been very very kind Thank you from the bottom of my heart.

Edited by ChessieCat
removed blasphemy

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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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ChessieCat

ENLAFAX

 

Suggestion for members taking Enlafax who have to pay full cost for Effexor brand.

 

You would need a doctor to get on board with it because of the prescriptions needed.  Instead of saying you want to get off your drug, tell them you would like to try reducing your drug and that you would like to do it slowly.  You might need to be gently assertive.  See these topics:

 

How do you talk to a doctor about tapering and withdrawal?


What should I expect from my doctor about withdrawal symptoms?

 

 

This suggestion is how to use a combination of funded Enlafax and full cost Effexor and keep the cost as low as possible.  I don't which dose of Effexor capsules would be easiest and/or cheapest to work with.  Please see the quote at the bottom of this post for suggestions about Effexor capsule doses.

 

Example for someone currently taking 150mg:

 

Enlafax is available in 37.5mg, 75mg and 150mg.

 

Take combo of Enlafax 75mg + Enlafax 37.5mg (+ 112.5mg) + beads from an Effexor capsule to make up the dose for your reduction.

 

At least that way you wouldn't have to pay full price for the Effexor for a full dose, but they should last quite a while.

 

Once you got to lower than 112.5mg you would then take 75mg + beads from Effexor capsule to make up the dose you need.

 

Once you got to lower than 75mg you would take 37.5mg + beads from Effexor capsule to make up the dose.

 

 

Once you get to a really low dose you could obtain Effexor IR (immediate release) so you can make liquid.  You would need take it twice a day.  Please see Post #1 of this topic for more information about this.

 

1 hour ago, Altostrata said:

 

If you can get the kind with tiny beads in a capsule, any dosage Effexor XR would work for bead-counting. Getting the largest dosage available will give you more beads to work with and last the longest for the expense.

 

You'll have to calculate how many beads equal 1mg of active drug. You can count the contents of several capsules to get an average number, then divide by the capsule dosage. (You'll have to corral hundreds of tiny beads for the counting.) Some people prefer to weigh the beads with a digital scale. 

 

Edited by ChessieCat
added quote about Effexor capsules

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TortugaHealing

Hello,

I've been on a steady dose of 5o mg Duloxetine minus 30 beads for close to a year.  For a couple weeks now, I've been having a return of w/d symptoms.  Apparently, Rising Pharma bought out Citron Pharma.  So I called Rising Pharma to see if there were any manufacturing changes to the Duloxetine (30 mg).  They said there were absolutely no product changes, not even in the inactive ingredients.  However, I have noticed recently that when I open a capsule, there are little pieces of beads (or maybe they are just tiny, tiny beads?) with the regular sized ones.  I don't know if this is from the change in manufacturer, or if I am accidentally breaking some of the beads when I twist open the capsules.  (For several months now, I have been having difficulty opening the capsules.  I think Citron switched capsules to a cheaper brand at that time.) I've been tearing a lot of the capsules accidentally.  Then I have to throw out the capsules and beads and start over.

 

If anyone has any suggestions as to how to open the capsules easier, I'd be very grateful!  (Of if anyone else is having difficulties with Duloxetine 30 mg pill from Rising Pharma Manufacturer, with tiny tiny beads or little pieces of beads?)  Thanks!

 

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MamaCat

I apologize if this question has already been answered but at what point do you switch from XR capsules to IR tablets? I'm currently at 15.2mg effexor XR (46 mgpw, generic) but eventually I won't be able to taper by going down 1mgpw/week w/ a 2 week hold as that drop will exceed the rate I want to taper at. Ultimately I know I will have to make a liquid anyways, was wondering at what point people make that switch? (realizing that even that transition has to be broken up into multiple stages)

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Altostrata

If your venlafaxine XR capsules contains tiny beads, you'd count out beads to taper. If it contains larger mini-tabs, you'd divide the mini-tabs.

 

You switch to liquid when you can't titrate using the beads or cutting up tablets. (When you cut up tablets or mini-tabs, they become immediate-release anyway.)

 

Please read the first posts in this topic. Please ask for clarification if your questions aren't answered there.

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MamaCat

Alto, thank you for your quick response!

 

I should've been more specific with my question I suppose. I've read through this entire thread and many others here and haven't found info about at what dose people usually switch from the XR to making a liquid of the IR, which is what I was asking about. In general, I haven't found much info or personal stories about people making liquid effexor suspensions and how that has gone for them. If you're aware of any other users doing this, I'd love to read about their experiences (but haven't been able to find them for myself). 

 

I'm on generic XR right now, it has significantly fewer beads than the brand and make my pills by weighing them. I'm currently approaching the point where dropping 1mgpw (the smallest drop possible) will be in excess of what I'm comfortable dropping during my taper. Hence, my thoughts I need to either change the pace of my taper by continuing to drop 1mgpw but for longer periods between drops or simply switching to making a liquid although tbh both prospects make me nervous.

 

I'm genuinely curious what any mods thoughts are, as they have undoubtedly seen more people in this circumstance and would have more insight/suggestions as to how best to proceed. I realize the mods are very busy and I appreciate any consideration on this!

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Nelly

Hello

I reduced to 5 and a half beads from 6 beads, from a capsule of Vensir XL 150mg (12 beads) on 24th September 2019. Should I be concerned about cutting the tablet in half and the possible very slight difference in the half tablet please? I would value your thoughts on this. X

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maxfly

Hi Nelly,

 

What brand of Venlafaxine are you using?  I use Teva.  There are ~450 tiny beads in a 150 mg capsule so it's easier to taper slowly.  Other brands of Venlafaxine are Apo, Ran, PMS, Auro.  I've only used Teva.

 

I discussed tapering with my doctor and proposed bead counting.  He recommended using a compounding pharmacy instead.  The compounding pharmacy essentially does the same thing as bead counting but they use an accurate scale.  More importantly, using a pharmacy stops you from thinking about your taper and getting preoccupied with dosages.  It's one less thing to think about so you can focus on other aspects of your health and daily life.

 

For now I asked the compounding pharmacy to make me 200 10mg capsules so I can control my taper from 150mg.  I'm down to 132.5 mg after about 8 weeks of tapering.  My plan is to drop 10mg every 5 weeks for the time being.

 

If you do find a compounding pharmacy make sure you discuss brand and only use one brand.  I suspect there are slight differences between brands and you want to eliminate as many variables as possible.  For me, compounding was covered under my employers health plan.

 

Hope this helps,

Maxfly

 

 

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Superwoman

Venlafaxine is metabolized to its active metabolite, O-desmethylvenlafaxine (ODV). After administration of extended-release capsules, the peak plasma concentrations of venlafaxine and ODV are attained within 5.5 and 9 hours, respectively.[1] The absorption rate of capsule venlafaxine is slowerthan its rate of elimination. Thus, the elimination half-life of venlafaxine after administration of the extended-release capsule (15 ± 6 hours) is the absorption half-life instead of the true disposition half-life (5 ± 2) hours observed after administration of an immediate-release tablet.

 

I don’t understand the part about the half life. Is the half life of the extended release Effexor (15 + or - 6 hrs.) or is it (5 + or - 2 hrs?). Does anyone know?

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Nelly
On 10/4/2019 at 4:19 PM, maxfly said:

Hi Nelly,

 

What brand of Venlafaxine are you using?  I use Teva.  There are ~450 tiny beads in a 150 mg capsule so it's easier to taper slowly.  Other brands of Venlafaxine are Apo, Ran, PMS, Auro.  I've only used Teva.

 

I discussed tapering with my doctor and proposed bead counting.  He recommended using a compounding pharmacy instead.  The compounding pharmacy essentially does the same thing as bead counting but they use an accurate scale.  More importantly, using a pharmacy stops you from thinking about your taper and getting preoccupied with dosages.  It's one less thing to think about so you can focus on other aspects of your health and daily life.

 

For now I asked the compounding pharmacy to make me 200 10mg capsules so I can control my taper from 150mg.  I'm down to 132.5 mg after about 8 weeks of tapering.  My plan is to drop 10mg every 5 weeks for the time being.

 

If you do find a compounding pharmacy make sure you discuss brand and only use one brand.  I suspect there are slight differences between brands and you want to eliminate as many variables as possible.  For me, compounding was covered under my employers health plan.

 

Hope this helps,

Maxfly

 

 

Hello Maxfly

Thank you for your message and suggestions. 
How is your taper going? I hope it isn’t too painful. 
I am prescribed VENSIR XL 150mg prolonged release capsules

Each capsule has 12 beads. I am currently on 5 and half beads. I am taking the smaller half, when I cut one. I may be able to go to 5 beads now?

12 beads divided by 150mg = 12.5 mg each bead 

But as I am now on 5 and half beads x 12.5 mg = 68.75 mg - current dose. 
So, 10% of 68.75 = 6.87mg = what my next taper should be 

 

I get days were I am so sad, lonely and don’t want to be here, but these feelings pass. I do sleep. I have some aches and pains and ringing in head/ears but bearable, with occasional help of  Ibobrufen pain killers.

I have never heard of a compounding pharmacy, but I can understand why this would help. I need capsules with more beads and smaller doses. 
I am seeing the doctor on 24th October. I could ask then for a lower dose with more beads perhaps? Are you saying it needs to be the same brand; in this case VENSIR. I don’t want to mess up now having got this far. 
I really do appreciate your thoughts xx
 

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Superwoman

Maxfly,

Do you know how many beads are in the 75 mg and the 37.5 capsules?  Are they all the same size?

 

 

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Nelly

Hello

i hope it is ok to come in here. I have googled for information regarding VENSIR XR 75mg capsule. It says that there are 6 beads in the capsule. 
How can I taper slowly on this product? Should I request a different brand? I am currently taking five and a half beads. The half bead varies in size after cutting. I don’t know how else to do this. Many thanks for your advice x

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