Tips for tapering off Paxil (paroxetine)

[Erell]

Hello

 

Quick note To tell that oral solution is out of stock in France too. 

All I can advise for dear survivors is To try To call all drugstores in their area : it worked for me this morning as I found my med for another month.

 

About January 2020 : In France we don't have a timeframe, I Will let you know when this out of stock Will end.

 

Best wishes

[goggins]

Hi guys.

 

I'm going through a journey of tapering off paroxetine. My initial dose was 20mg that I've been on for years.

 

Now at 11mg and just went through some tough times trying to get down to 10mg. Couldn't bear the symptoms so I'm resuming to 11mg for a while.

 

I'm doing liquid paroxetine.

Because it was so hard to taper off 1mg, I think it's time to start tapering off by smaller amounts.

 

The problem is that the dispenser of the little bottles does only 1mg/droplet, so I need another way to dose. The concentration is 33mg/mL, which means 1mg/30.3uL.

Doing the math, my current dose of 11mg means I'm at 333.33uL.

 

My plan is to buy some 100uL precision syringe. With a 1uL scale, I'll be able to taper off as low as 33ug at a time. That will be a much slower pace which I'm sure my nervous system will tolerate much better.

 

I was also thinking about doing my own solid tablets or capsules, mainly for convenience. That will allow me to do the dosing for a whole week or month in one sitting, and I won't have to be home every day by the time I need to take the pill. I can just carry the pill around with me and take it wherever I'm at.

 

So that leads me to my actual questions:

• what's the best filler that I can use for the solid tablet or capsule? I mean, I want to dispense the liquid paroxetine dose into the tablet or capsule, but I'm not sure which solid substance or powder to use. It definitely needs to be something neutral that will not react with the paroxetine. I read about some herbal fillers such as Cayenne, Ginger or Turmeric. I'd love to hear thoughts on those, as well as any other suggestions.
• what are some good suppliers that I could get 100uL precision syringes? I'll have them shipped to Germany.
• any thoughts about my approach? am I doing something wrong?

 

[brassmonkey]

@goggins  Very interesting questions.  I have some ideas and comments but need some more information first. What is the total volume of liquid you wish to use per dose?

[Altostrata]

You can increase the dilution by adding water. This will enable you to accurately measure small amounts. What size is your oral syringe, what is the smallest amount between ticks? (You usually can get 1mL or 0.5mL oral syringes from a pharmacist or veterinarian.)

 

@brassmonkey will explain.

[goggins]

hey @brassmonkey and @Altostrata, thanks for replying

 

I also considered diluting in water, this can be an easy way to achieve similar results without going for a high grade precision syringe

 

the problem with this approach is that the liquid volume could become restrictive to do the tablets or capsules, which is my main goal

 

I've been looking into some syringes with 100uL volume. They have a scale of 1uL, which allows for great precision.

 

For example this one: https://www.hamiltoncompany.com/laboratory-products/syringes/80630

 

@brassmonkey my current dose is 333uL.

 

What I'm really curious about is which material to use for filling the capsules. I mean, I need the solid part, I can't just inject the liquid into empty gelatine capsules. And it needs to be something I'll know for sure won't interact with the paroxetine chemically.

[Altostrata]

1 hour ago, goggins said:

the problem with this approach is that the liquid volume could become restrictive to do the tablets or capsules, which is my main goal

 

Please explain. Are you putting liquid in capsules? Why?

[goggins]

I don't want to do the dosing every day.

I can become cumbersome and error-prone.

 

I want to do a whole batch in one sitting, meant to last for at least a week or more.

 

That's why I'm speculating around capsules and trying to find out what to use for the solid part.

 

But it just occurred to me to use blotting paper, in the same fashion LSD is dispensed. Not that I'm advocating LSD or anything (much on the contrary). I just mean it as a reference of how small liquid doses are dispensed on large batches.

[Altostrata]

Sorry, we're fans of Keep It Simple. Please let us know what you find out.

[Adili13]

Has anyone experimented with tapering down to 12.5 paroxetine ER and using that pill and it’s extended property to stabilize better than being on a liquid dose or paroxetine standard release. 

[maree]

HI all, Today is monday here in New Zealand and I'm getting confused about conflicting information. The medical industry  doctors, chemist etc are saying everything is going ot be ok and yet the media last week in the articles I posted said otherwise. Apparently my meds that were being supplied by Apotex has been supplied since last Dec by a drug company out of USA called 'Mylan' according to doctors office and chemist.  So I'm calmer but still wondering. Maree and thanks again to everyone

[ChessieCat]

  

  Rachelina posted this elsewhere:

 

Diluting concentrated Paxil liquid:

 

7 hours ago, Rachelina said:

I just realized it's been about a year since I started diluting my liquid Paxil, so I thought I'd give a quick update. It's going great. The solution that I make is ten times less concentrated than the original liquid, which means my measurement is ten times more accurate. That is huge. Liquid Paxil is so concentrated that any tiny variation in the amount taken, which is impossible to avoid with syringes, makes a big difference in the dose you are getting. This makes consistent daily dosing almost impossible, and I think that was a factor in how badly I was doing last year before starting to dilute. The other advantage of diluting is that I get to make drops as small as I want them, whereas before the smallest drop I could make was .02 mg.

 

I knew for years that I was not getting accurate doses due to the high concentration of the liquid, but postponed diluting because I was afraid to change anything, afraid I wouldn't be able to figure out how to actually do it, afraid I would get the math wrong. Someone in this thread kindly got me started, and actually, it's totally easy. It's hardly any more work than before.  So I just wanted to recommend dilution to anyone tapering a highly concentrated liquid medication. It will be vastly more accurate, which becomes more and more important the lower you get in dose.

 

 

[olderinoregon]

I searched and could not easily find my answer so I will ask.  How does liquid Paxil taste?   Flavor?   Is it unpleasant taste?

Since nausea is part of my withdrawal symptoms I thought I'd ask.   I will ask my doctor to switch my prescription to liquid so i can titrate down with precision.  

 

Thanks.

[brassmonkey]

It is made with an orange flavoring.

[Colonial]

It's just like, sugary icing watered down.

Not bad really.

[DeterminedAnna]

Hi all – message for people in the UK who use branded Seroxat oral solution...

 

It appears there is a shortage of this product. I had to call 15 pharmacies today to get my monthly prescription filled.

 

Can't say if that means there's a shortage of paroxetine tablets as well, because at the time of posting this, I can't find any info online, and my usual pharmacy was clueless.

 

This previously happened towards the end of 2019/early 2020 – here is the archived notice about it. The PSNC alerts pharmacies to drug shortages and is free to the public to view, unlike paywalled healthcare professional sites that also have these alerts.

 

If you're lucky, your pharmacy will tell you an item is out of stock as soon as they receive the prescription. Unfortunately, mine didn't, despite requesting it two weeks ago. So it was only today at the eleventh hour that I found it was out of stock – with only one day left for my current bottle.

 

If you're using Seroxat oral solution, my advice would be to ask for an extra prescription ASAP, even if you've only just opened a new bottle (you have to throw it away after 30 days). That might bide you some time if the shortage continues.

 

Another option is to ask for a 'special order' (or 'special') prescription – I got this in early 2020 – an instruction to a pharmacy to make up a suspension from crushed pills. Back then, my GP wouldn't issue the special because it was deemed too expensive, so I sidestepped her and went to the local mental health team. As the psychiatrist was so clueless, I had to explain to her how a special works, and dictate the prescription to her, including with 20mg/10ml ratio of branded Seroxat. Be prepared to do this if you go down this route – have it written down in advance.

 

Thankfully, using the special for two months did not cause me any issues. But I wasn't tapering at the time, and was stable. If you are tapering and have to switch to a special, it might be worth pausing your taper, as we all know the effect of too many changes at once. 

 

Other options and helpful guidance (e.g. crushing pills) is on this site. @Altostrata, I hope the tips here are ok – and hope that I've added this post to the right place... Although might be better in the UK section? Don't want to duplicate posts...

[DeterminedAnna]

 

PS. This was the official guidance concerning the previous shortage. Also attached is the prescription I was issued in 2020 to get a special.

Edited February 11 by ChessieCat
removed quote

[MrMiyagi]

Liquid Paxil Reduction Help

 

Hello everyone,

 

  Can someone help explain an easy method to figure out a 10% reduction schedule for 20mg Paxil? I am soon switching to liquid solution and I am not sure how I can make 10% cuts out of milliliters. 

 

Thank You,

 

Edited March 16 by ChessieCat
added topic title before merging with existing topic

[Heath]

@MrMiyagiHello !

will you be using liquid that is equivalent to mg -  5 mg equals 5 ml? 
 

you can use this taper calculator it’s easiest one I know of. It works for ml or mg. 
http://www.taperoff.co/

 

And get you a 10 or 20 ml syringe for the ml and a 1 ml syringe for the tenths of a ml. 
 

Don’t forget to gradually transfer to liquid over a months time and then hold at least another month. 

 

[MrMiyagi]

I will have to wait to see if they will be using liquid that is equivalent to mg and then the calculator will work great I will keep you posted thank you so much.

[MrMiyagi]

4 hours ago, Heath said:

@MrMiyagiHello !

will you be using liquid that is equivalent to mg -  5 mg equals 5 ml? 
 

you can use this taper calculator it’s easiest one I know of. It works for ml or mg. 
http://www.taperoff.co/

 

And get you a 10 or 20 ml syringe for the ml and a 1 ml syringe for the tenths of a ml. 
 

Don’t forget to gradually transfer to liquid over a months time and then hold at least another month. 

 

PAROXETINE HCL 10 MG/5 ML SUSP SUSPENSION

[Heath]

@MrMiyagi  make sure you are going to be taking correct dosage. See attached 

 

And always double check with dr and pharmacy that you are taking/getting correct dosage . Mistakes can be made sometimes. Take care of yourself.

[MrMiyagi]

Hello Heath,

   Thank you for your advise I am still a bit confused in calculating my reductions because my oral solution is not the same ML. for MG.

PAROXETINE HCL 10 MG/5 ML SUSP SUSPENSION

 

So I will use 10ML of solution to obtain my current 20mg dose. To reduce 10ML by 2.5% weekly would be my goal. So my dosages would look like this ?

 

9.75 ml

9.50 ml

9.26 ml

9.02 ml

HOLD one to two weeks 

🤧🤯

[Heath]

@MrMiyagiYes your numbers are correct. and yes hold a couple of weeks- brass monkey slide👍

And even though you are doing 10/5 ratio when you calculate the 2.5% it will equal out the same. 
so at 20 mg x 2.5% is 19.5 mg

at 10 ml x 2.5% is 9.75 ml

so 19.5 to 9.75 is same as 10/5 ratio

 

so basically you will calculate your cuts by the dose you are taking regardless of mg or ml. 
 

I know it’s confusing they gotta make it so complicated!

 

next time you see dr ask him for 1 to 1 ratio . Even ask the pharmacist if 1 to 1 ratio is available. 

[Sunflower414]

Has anyone had a difficult time switching from tablets of Paxil to the liquid? If you get very sick and have extreme WD, what do you do? I would like to get on the liquid to make smaller cuts

 

[Obstacle1]

Seems to be another shortage of the liquid in the UK. Has anyone else encountered this? I found you can look up drugs shortages here, but the return data is supposedly 'early June'.
https://www.mims.co.uk/drug-shortages-live-tracker/article/1581516

 

I'm trying to see if my pharmacist can find me an unlicensed version of the liquid otherwise it looks like I'll need to start crushing pills

[souim]

Same problem of shortage in France, and it's been going on for months🙄. Even when it's back in store, it lasts only a few days. 

 

I found two bottles recently thanks to a friend of my parents who is a pharmacist, but I don't know how long I can manage if the situation isn't solved quickly. I found a french website with indications about which pharmacy still has some in store, but it's not always reliable.

I have even called the french lab, they told me they had zero info about when it will be available again...

I'm thinking of crushing pills as well, but I have to admit I find much more reassuring to take a "proper" medication rather than a homemade fix. Anyway, it sucks.

 

[Obstacle1]

19 hours ago, souim said:

Same problem of shortage in France, and it's been going on for months🙄. Even when it's back in store, it lasts only a few days. 

 

I found two bottles recently thanks to a friend of my parents who is a pharmacist, but I don't know how long I can manage if the situation isn't solved quickly. I found a french website with indications about which pharmacy still has some in store, but it's not always reliable.

I have even called the french lab, they told me they had zero info about when it will be available again...

I'm thinking of crushing pills as well, but I have to admit I find much more reassuring to take a "proper" medication rather than a homemade fix. Anyway, it sucks.

 

 

That's interesting, what is the website? I don't think they have the equivalent of that in the UK. Now I'm wondering about if I can make a trip to France to get a prescription...which is completely crazy. My other option is to start phoning every pharmacist nearby to see if anyone happens to have a bottle in store

 

I also spoke to my pharmacist and apparently when there is a shortage, labs here are allowed to make a 'special' of the same medication. But they are not licensed to do it unless there is a genuine shortage. So I'm waiting for GlaxoSmithKline to respond to the lab to give them permission. I think I'd feel better taking this than crushing up the pills as well although I've seen lots of helpful info about crushing up pills on this site

 

 

 

[ChessieCat]

9 hours ago, Obstacle1 said:

I've seen lots of helpful info about crushing up pills on this site

 

Brassmonkey, one of the senior mods, was also on the now defunct website PaxilProgress.  He successfully got of Paxil by crushing and weighing his doses for his whole taper.

 

I recently asked him about making liquid from Paxil tablets, because there in information in post #1 of this current topic which says that you can make a liquid and I was wondering why he did not do that.

 

He told me that because of his occupation he felt very comfortable working with with crushing and weighing.

 

But he did tell me that yes, you can make a liquid from Paxil tablets.

 

I made a liquid from the contents of my compounded Pristiq tablets (the tablets don't dissolve but go gluggy) and found it very easy to do.

[souim]

10 hours ago, Obstacle1 said:

That's interesting, what is the website? I don't think they have the equivalent of that in the UK. Now I'm wondering about if I can make a trip to France to get a prescription...which is completely crazy. My other option is to start phoning every pharmacist nearby to see if anyone happens to have a bottle in store

The website is called Vigirupture. It is not targeted toward the main public, but toward health professionnal, especially pharmacists.  However, it's pretty easy to create an account pretending to be a doctor, and they don't check afterwards.

I wouldn't advise to go to France, because it's really hard to find the product here as well. It's been on shortage for more that three months, and even with the website, I'm struggling more and more. I might follow chessiecat advice and just go for the homemade liquid.

[Sebas]

Liquid out of stock in the Netherlands for the 2nd time this year. Current date november 22. I'm.currently switching back to pills with help from compounding pharmacy. I also discovered, this could be relevant for those who are facing allergic issues such as food intolerance and (pseudo) allergy issues; 

 

Edited August 10 by ChessieCat
removed translation text box

[Sebas]

Local compounding pharmacy is able to make 0.5mg pills (60 pieces per box).  

 

in fact they are not pills but small capsules

 

Edited August 10 by ChessieCat
removed translation text box

[Ariel]

IMPORTANT:  SEROXAT ORAL SUSPENSION DISCONTINUED

 

NOTE:  Paroxetine tablets can be made into a liquid.  Please see Post #1.  Please see below for information on doing a cross over.

 

Please note that GSK is discontinuing "manufacturing, supply and marketing of paroxetine hydrochloride oral suspension products."

 

MIA write-up here: https://www.madinamerica.com/2022/08/discontinuation-antidepressant-affect-tapering-patients-say-experts/

 

The news was published in The Pharmaceutical Journal on 27 July 2022: 

https://pharmaceutical-journal.com/article/news/discontinuation-of-antidepressant-could-affect-tapering-patients-say-experts

 

Excerpt from article: 

 

Discontinuation of antidepressant could affect tapering patients, say experts

Exclusive: Paroxetine 20mg/10mL oral suspension is being discontinued, but experts have highlighted how these liquid formulations of antidepressants are "essential" for successfully tapering patients.

 

The liquid selective serotonin reuptake inhibitor (SSRI) paroxetine (Seroxat; GSK) 20mg/10mL oral suspension is to be discontinued, raising concerns for patients in the process of tapering off the drug.

 

On 14 July 2022, the Pharmaceutical Services Negotiating Committee (PSNC) announced via a medicine supply notification that paroxetine (Seroxat) 20mg/10mL oral suspension would be discontinued in July 2022 and that there were “limited” supplies remaining.

 

The notification said that paroxetine tablets and unlicensed specials of paroxetine 10mg/5mL oral suspension remained available and could “support an uplift in demand”.

 

PLEASE NOTE:  When changing form of a drug SA recommends doing a cross over, which is gentler on your nervous system.  For more information on how to do this please see SA topic:

 

Cross Over: Changing form (eg tablet to liquid) of drug OR changing brand of same drug

 

 

Edited August 11 by ChessieCat

[souim]

@Ariel thanks so much for the info. The discontinuation is not announced in France yet so I kept checking the official website of the National Health Agency to see if there was a date announced.

I guess I will crossover when I've finished my bottles. I have three unopened ones which I found in three different drugstores, in three different cities...

My goal is to get to 50% of my original dosage, which will allow me to work with half a pill and smoothen the transition. It seems doable, if my withdrawal symptoms don't worsen.. We'll see. Anyway, thank you.

The cynicism of this industry baffles me. Pretty unsurprising though I guess.

[Erell]

Hello @souim
If you feel comfortable calling the lab, don't hesitate to do so: when I found myself without liquid paroxetine in 2020, I realised that the information from the health authorities was sometimes a bit late, so I called the lab directly as a patient to get information on their forecasts and they answered me.
Once I was told that they only give information to professionals: if that happens, you can ask a pharmacist or a doctor to call them with you.

[souim]

Thanks so much for the info Erell. I will try to call them tomorrow.

[Sebas]

On 8/14/2022 at 4:21 PM, souim said:

@Ariel thanks so much for the info. The discontinuation is not announced in France yet so I kept checking the official website of the National Health Agency to see if there was a date announced.

I guess I will crossover when I've finished my bottles. I have three unopened ones which I found in three different drugstores, in three different cities...

My goal is to get to 50% of my original dosage, which will allow me to work with half a pill and smoothen the transition. It seems doable, if my withdrawal symptoms don't worsen.. We'll see. Anyway, thank you.

The cynicism of this industry baffles me. Pretty unsurprising though I guess.

@souim If you do a crossover this is a recommended switch to minimalise WD.

1st week 75% liquid-25% tablet

2nd week 50-50

3rd week 25-75

4th week 100% tablet

Bonne chance,

Sebas