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Altostrata

Tips for tapering off Cymbalta (duloxetine)

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Altostrata

Welcome, KD0105. Please read this topic from the beginning. Counting beads is the only way to taper Cymbalta. Some people weigh them to be sure dosing is consistent.

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KD0105

I've contacted my compounding pharmacist about this.  I'm hoping he will respond to my email.

ChessieCat, have you had an answer to this question from your pharmacist yet?

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ChessieCat

No.  He never got back to me and I haven't been in for my new batch yet.

 

The mods have discussed it and think it is highly unlikely that the individual beads would be made to release at different times.

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taperingdown

I'm new to this topic, so please forgive me if I'm overlooking something obvious...

 

There appears to be a logical problem underlying all of the tapering strategies in this thread. I just had a lengthy discussion with my local pharmacist, and she claims that the "micro-beads" contained in Cymbalta are heterogeneous wrt enteric coating. In other words (to use a made-up example): 25% of the beads might be coated to time-release after 1 hour, 25% to release after 2 hours, 25% after 4 hours, and 25% after 8 hours. The problem is that when you sub-divide your dosage, you have no way of knowing whether you're getting a balanced cross-section of these different enteric coatings.

I was told something similar by my doctor, but I'm not sure it is correct. I found the controlled release patent at https://www.google.com/patents/EP1904039A2?cl=en&dq=cymbalta&hl=en&sa=X&ved=0ahUKEwjWgrvz1eLSAhVB8CYKHTUKBmgQ6AEIHDAA

 

I can't find a clear indication that different beads are designed to be dissolved at different times. All that is clear is that the drug is slowly released as the coating dissolves:

 

"Once the dosage form reaches the intestine and pH approaches more than 5.5, the enteric coating starts to dissolve and drug core in polymeric carrier is exposed to the intestinal fluid. The dosage form starts to release the drug in the intestine in a controlled rate by polymeric diffusion, dissolution and erosion mechanisms and the process occurs for prolonged period of time. The dosage form completely erodes and dissolves within the dosing interval (24h), thereby ensuring complete drug release in the intestine."

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Altostrata

I wouldn't worry about this. Counting beads is the only way to taper Cymbalta. There is no other option.

 

Do your best to take what looks like a cross-section of beads.

 

We have many people here who have done this successfully. Go to the Introductions forum and use search for "cymbalta" to find their stories.

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taperingdown

I wouldn't worry about this. Counting beads is the only way to taper Cymbalta. There is no other option.

 

I agree. It just frustrates me that pharmacists and doctors would tell patients that weighing/counting beads will interfere with the timed release when there is no written proof that it would. Oh well.

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scallywag

If you really want to play it safe, you can get empty enteric coated capsules to protect the beads from stomach acid. They cost considerably more than a gelatin or vegan capsule: 

 

An amazon search for empty enteric coated capsules.

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gardenlady

My Citron duloxtine (generic Cymbalta) 60 mg capsules won't open.....feels like they are glued together.  I've found 2 that came apart, but the rest won't no matter how hard I pull.  Does anyone have any suggestions?

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ChessieCat

You would have to be very careful.  You could try holding a capsule upright and snipping off the very top with scissors or use a craft knife.  If you can't get the scissors to snip, you could try making a small starter slit with a craft knife so you can then cut with scissors.

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Altostrata

The tiny beads inside a Cymbalta capsule are individually coated to protect them from stomach acid. The gelatin capsule is only a container, it doesn't provide timed release or protection from stomach acid.

 

As far as I know, you cannot buy empty enteric capsules. They are available only to drug manufacturers.

 

If your Cymbalta capsules don't open by grasping at both ends and twisting, you'll just have to break them carefully (or cut them) over a clean container. It may be handy for you to get empty (largish) gelatin capsules so you can package your beads in them for multiple doses; for example, your doses for the week.

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gardenlady

There are so many brands and sizes of gelatin capsules on Amazon that it's confusing.  What kind and size should I buy?  

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ChessieCat

I think I read somewhere 00.  It's better to get the larger size because it is easier to get the beads into them.  You could get the giant 000 ones, but you need to consider whether you would be able to swallow them.

 

I've just found it:  post by Alto

 

She suggests 0 or 00.  But you need to consider your ability to handle the smaller size.  Comparison picture with measurements

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gardenlady

I'm interested in knowing if there is a way to do a daily micro taper of Cymbalta vs percentage cuts every few weeks.  I'm finishing up a valium taper and switched to a daily liquid micro taper when I got to 2.5 mg.  It's made all the difference and is so much better.  Of course, there isn't a liquid version of Cymbalta, but I'm wondering if anyone has figured out how to do it using a scale or other way.  

 

Once I'm stable enough after the benzo taper, I have 48 mg of Cymbalta to taper so would like to have a plan in place.  I'm kindled and very, very sensitive to even small cuts.  I'm taking the Teva generic brand of duloxetine and a 60 mg capsule has an average of 315 beads.  Right now, I'm using a Gemini 20 scale from Amazon to weigh the beads and tapered in May from 60 mg to 48 mg.  However, an attempt to taper 2.5% in October was a disaster after only one day.  I was already in benzo withdrawal from the valium taper and so shouldn't have touched the Cymbalta.  But, that experience showed me how sensitive my CNS is and that I have to be very careful resuming the Cymbalta taper when I've completed and stabilized from the valium withdrawal.

 

Thanks in advance to anyone who can offer guidance on this.  

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Altostrata

Unfortunately, the smallest dose of Cymbalta is one bead. You cannot make a liquid of Cymbalta, or grind it up.

 

At 48mg Cymbalta, which is still a large dose, a reduction of one or two beads at a time (less than 1% of the 315 beads in your capsules) might be the best you can do for a micro taper.

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gardenlady

Thanks, Altostrata.  Just for clarification, I wrote: 

 

Of course, there isn't a liquid version of Cymbalta, but I'm wondering if anyone has figured out how to do it using a scale or other way.

  

 As you wrote, it would come down to eliminating a bead or so each day at a dose of 48 mg or so. I'd be curious to know of anyone's results using this method with a scale.  

 

So, is 48 mg considered a high dose?  

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CymbaltaDrone

I tapered down over a number of months. I managed to escape it. Read my details in my history. I don’t recall exact detils of what I posted but i do recall opening capsules and spacing them out more and more. After I was off altogether I felt like I had cognitive impairment for quite some time. In fact I still do but I’m not sure if it’s from all the ADs or from three kids....

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gardenlady

CymDrone, I read some of your posts and it sounds like you were on a very low dose of Cymbalta by the time you got to this forum.   I'm so awfully sorry that you still have cognitive impairment after being off the drugs for so long.  How severe is it?  From what I understand, Seroquel is one of the more dangerous drugs, so I'm glad you're off it of.  Do you have any suggestions as I prep for tackling my taper from 48 mg of Cymbalta?  It'll be on the heels of a benzo taper, so my CNS is very fragile.  I'll have to wait a few months to stabilize from the valium before starting the Cymbalta taper.  

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CymbaltaDrone

Yes by the time I registered myself I was pretty low but I’d been viewing the forum through a friend who was sharing resources like this with me so a lot of the advice I followed was straight from here or from Dr. Peter Breggin’s work. My strongest caution would be not to taper too fast, to not see it as a failure of some sort when the discontinuation symptoms force you to taper more slowly and to exercise a LOT to help your brain stabilize itself. Exercise triggers all kinds of hormone and neurotransmitter production whicn felt like it had a dampening effect on the discontinuation swings and kickstarted my own brain into balancing itself again. Running everyday for at least 20 mins would be my min recommendation for exercise. And if you’re felling doubtful that exercise could be so effective, the most approachable resource I’ve seen in the research is called Spark: the revolutionary new science of exercise and the brain. 

 

When I say i still suspect cognitive impairment, it’s maybe helpful to understand my context. I’m a high performance knowledge / head worker, an engineer working in the project planning and investment part of our business and I deal with huge amounts of data and people that I have to say on top of. My company hires top 1-5% of performers to begin with. I can perform my job and have improved my performance ranking consistently since getting off the drugs. But I am by no means a top performer at my company, I’m average. But if I was working almost anywhere else I may not notice a difference. And Mum brain is a thing too - not well understood but looks

like mild dementia from the symptoms side of things. I’ve had three kids in 5 years so am definitely a Mum brain candidate. Every time I go back to work after a year of maternity leave I feel the mountain my brain has to climb to get “back in the game”. My youngest is almost three now though and I’ve not worked this long a stretch since starting ADs. I’m hoping I’ll comtinue to see sustained improvement in brain (and work!) performance going forward. 

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Altostrata

48mg Cymbalta is a fairly high dose.

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CymbaltaDrone

And it was doubled before that too. When I first proposed reducing it due to ineffectiveness my dr asked me to try increasing it first. I felt I had to accept and be cooperative to maintain his cooperation in getting off them in the end, so I agreed. (That may not have been the case - he ended up being moderately supportive all along including contacting the drug companies directly seeking guidance on how to stop each med, but at the same time I took control of my tapering based on info here and Dr Peter Breghin and visited my dr infrequently enough that i could achieve a fair bit in between and demonstrate success to ensure his continued support). Most of the next month I was overseas visiting family and it was awful trying to restrain the increased aggression and sensitivity to sound / stressful people around me due to the increased dose. As unpleasant as it was, it clearly demonstrated to both my dr and to me that increasing meds was not the answer. 

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tom1967

Where to get Cymbalta with beads in US? tried generic 20mg, 30mg & 60mg; everything has mini-tabs (5mg)(I want 2.5mg) . I can try non-generic that is expensive(not covered by insurance), not sure that has beads or not. can anyone point how to get beads? online shop is also ok. I live in US NE coast.

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Altostrata

Brand-name Cymbalta contains the beads. Generics usually contain the mini-tabs.

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gardenlady

I am in the U.S.and have used two generic brands of duloxetine that contain beads.  One was Citron, made in India. A Citron 60 mg capsule contained about 356 beads, if I remember correctly.  Now, I'm using Teva made in Israel.  The 60 mg Teva capsule contains an average of 315 beads.  I like Teva better as the beads are bigger and easier to weigh and count. 

 

Lupin generic makes the 60 mg capsule with 12 mini tabs.   

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Altostrata

Thanks for that info, gardenlady.

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tom1967

Thanks gardenlady for the information. I will try to get TEVA or CITRON generic from the pharmacy.

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tom1967

I got 20mg CITRON generic from Safeway pharmacy today. Each tablet contains 120 beads. Thanks.

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DavidfromTexas

I have begun counting and removing the beads in my Cymbalta capsules as part of measuring a minuscule dose that I am attempting to reinstate with. 

 

HOWEVER, when it comes to tapering from an extremely low dose such as 1 or 2 mg...how does one do this?

In the lowest manufacturer-provided capsule of 20mg I counted an average of 115 beads. A 2 mg dose rounded up to 12 beads, a 1mg dose rounded up to 6.

BUT if we are supposed to be reducing amounts by 10% during tapering, the closest we can get to this on Cymbalta beads would be to just reduce by 1 bead every reduction. It will be far from exact, but there is no other option, is there??

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ChessieCat

When we reduce we don't have to taper by exactly 10%.  The idea is to reduce by no more than 10%.  I'm tapering Pristiq using compounded capsules and have had to adapt my taper to the monetary denominations of the capsule doses.  So there are some weeks that I hold for 3 weeks but when I get closer to the 10% reduction mark I hold for the full 4 weeks.

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DavidfromTexas
Posted (edited)
On 1/3/2017 at 3:19 PM, cymbaln00b said:

 

There appears to be a logical problem underlying all of the tapering strategies in this thread.  I just had a lengthy discussion with my local pharmacist, and she claims that the "micro-beads" contained in Cymbalta are heterogeneous wrt enteric coating.  In other words (to use a made-up example): 25% of the beads might be coated to time-release after 1 hour, 25% to release after 2 hours, 25% after 4 hours, and 25% after 8 hours.  The problem is that when you sub-divide your dosage, you have no way of knowing whether you're getting a balanced cross-section of these different enteric coatings.

 

 

Okay. Soooo I just saw this...this is definitely a little worrying. Would the best bet then be to use a compounding pharmacy for all your tiny doses? And can you trust compounding pharmacies to get it EXACTLY right and precise?

Edited by DavidfromTexas

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DoctorMussyWasHere
8 minutes ago, DavidfromTexas said:

 

Okay. Soooo I just saw this...this is definitely a little worrying. Would the best bet then be to use a compounding pharmacy for all your tiny doses? And can you trust compounding pharmacies to get it EXACTLY right and precise?

 

A compounding pharmacy I tried initially refused to compound beads. Not for this reason, though (I think).

 

I said:

Quote

 

Surely it's just a matter of weighing the beads with a digital scale? ie. the same process used to weigh powder.

 

 

They replied:

Quote

We will have to add a filler and not sure what effect this will have on the dissolution of the beads. We also not sure if the distribution of the beads will be equal when adding the filler. If you are happy to continue with the  compounding it without having answers to these questions we will go ahead.

 

I'm wondering if https://www.taperingstrip.org/ takes cymbaln00b's concerns into account?

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DavidfromTexas
Posted (edited)

Whaaa???

 

So basically there’s no REAL good way to do it?

 

If it’s an unsteady dose, does it make reinstating less of an obvious preference compared to riding the withdrawal? OR does it make a better case for trying a transition to Prozac? (I think that was an option)

 

What would the effect be if these supposedly differently-timed beads all dissolved and were absorbed at the same time? I though Delayed Release only meant that it doesn’t dissolve in your stomach but is “delayed” until out of the stomach...

 

I have only just taken my 2nd dose of Cymbalta reinstatement so I’d like to know if there’s a different solution or not. This makes me think since I am currently not experiencing any PHYSICALS withdrawal symptoms that maybe I should just try to ride out the emotional withdrawal period. Could this discrepancy with the beads actually make reinstating a worse idea than the withdrawal, causing even more bad effects later?

 

Have others been successful reinstating on personally divided tiny doses, and been able to stabilize and then subsequently taper?

It would seem that the very fact that you’re getting a mix of differently designed beads can’t be good for you...

 

Does the “steady state” negate this issue after a certain point??

Edited by DavidfromTexas

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DavidfromTexas
On 8/22/2011 at 9:48 AM, Altostrata said:

Did some surfing and found someone who had counted the pellets in Cymbalta capsules:

 

Cymbalta size and number of pellets

30mg=250 pellets (approx.)

20mg=166 pellets

15mg=125 pellets

10mg=83 pellets

5mg=42 pellets

 

Before you go by this, count the pellets in a couple of your capsules and verify. Please post your results in this topic!

 

I found an average of 115 beads in the 20mg capsules...

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DavidfromTexas
Posted (edited)

 @Altostrata

 

GUYS. I spoke with a pharmacist at Rancho Park Compounding Pharmacy here in Los Angeles, and she said a manufacturer out of Texas called PCCA DOES MAKE POWDER/CAPSULE AND LIQUID DULOXETINE!

 

I called PCCA to confirm and they verified it, and they said there’s a lot of compounding pharmacies that do business with them as “members”. 

You can search them by going here:

 

https://pccarx.com/Resources/FindACompounder

 

She suggested going with the powder/capsule over the liquid because compounding the liquid requires more ingredients that would need to be provided, I assume making it more expensive. 

 

Also, I don’t believe a prescription is required for this particular pharmacy I found here. 

Edited by DavidfromTexas

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ChessieCat

Please be aware that once your dose is compounded it may be immediate release which will probably require you to dose twice daily.

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DavidfromTexas
1 hour ago, DavidfromTexas said:

 @Altostrata

 

GUYS. I spoke with a pharmacist at Rancho Park Compounding Pharmacy here in Los Angeles, and she said a manufacturer out of Texas called PCCA DOES MAKE POWDER/CAPSULE AND LIQUID DULOXETINE!

 

I called PCCA to confirm and they verified it, and they said there’s a lot of compounding pharmacies that do business with them as “members”. 

You can search them by going here:

 

https://pccarx.com/Resources/FindACompounder

 

She suggested going with the powder/capsule over the liquid because compounding the liquid requires more ingredients that would need to be provided, I assume making it more expensive. 

 

Also, I don’t believe a prescription is required for this particular pharmacy I found here. 

 

My apologies, OF COURSE a prescription is required lol

 

I got a little excited

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DavidfromTexas
Posted (edited)
29 minutes ago, ChessieCat said:

Please be aware that once your dose is compounded it may be immediate release which will probably require you to dose twice daily.

 

I asked the pharmacist that I talked to already and she said they use a capsule that is designed to break down I the intestines. So the action of the timed release should be the same as the pellets, no? The capsule begins to dissolve in the intestines and the powder begins to leak through. Should that not have the same effect as the pellets?

 

Either way, would powder/capsule form be a recommended way OVER the pellet/capsule form, since there is some discrepancy with the actual pellets themselves?

 

Is this something y’all dont recommend?

Edited by DavidfromTexas

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