Tips for tapering off escitalopram (Lexapro)

[catmama]

4 hours ago, Frogie said:

That is way to fast for the end of a Lexapro taper.

 

Then what do you recommend? I'm having a hard time finding any info.

[ChessieCat]

34 minutes ago, catmama said:

 

Then what do you recommend? I'm having a hard time finding any info.

 

Q:  Have you read Post #1 of this topic?  It explains how to get non standard doses.

 

This link will go straight to Post #1:  tips-for-tapering-off-escitalopram-lexapro

 

It includes the following:

 

On 5/27/2011 at 12:16 PM, Altostrata said:

Do-it-yourself liquid
People report that they can make their own liquid from Lexapro tablets and water.

It is sparingly soluble in water, see http://www.drugbank.ca/drugs/DB01175 -- stability (shelf-life of dilution) is unknown.

 

 Escitalopram oxalate occurs as a fine, white to slightly-yellow powder and is freely soluble in methanol and dimethyl sulfoxide (DMSO), soluble in isotonic saline solution, sparingly soluble in water and ethanol, slightly soluble in ethyl acetate, and insoluble in heptane. According to RxList,com.

 

Your best bet would be to use a homemade isotonic(normal saline) saline solution (9% salt in water) which is made by dissolving 9 grams(1.8 tsp) of table salt in 1000mL of water.  Preparing a Saline Solution  The NS(normal saline) should be good for up to a month to draw from.

Draw out or extract the amount of NS(normal saline) for your desired dilution, add to a separate, mixing vessel, preferably amber colored, and with a lid, then add in your escitalopram tablet or powdered tablet until it's dissolved.  Keep protected from light in the refrigerator, and best to remix a batch of your Lexapro(dissolved) at least every week.

 

 

Edited March 29, 2022 by ChessieCat

[Altostrata]

Please post questions about your particular taper in your Introductions topic.

[ChessieCat]

19 minutes ago, catmama said:

My question is in regards to finally getting to 0. I understand that the end game forum section is under construction. But who knows when it will be completed. Until then I was looking for any info on when to make the jump to 0. Mathematically, I can't keep dropping by a percentage, I know there has to be a "jumping off" point. I recall that the end game suggestion used to be to get to 1 mg then make bigger cuts with longer hold times. But now I'm being told that's no longer recommended. 

 

The hyperbolic taper never gets to 0.

 

Lexapro is a very strong drug, as explained in Post #1 of the Tips for Tapering Lexapro topic below:

  

On 5/27/2011 at 12:16 PM, Altostrata said:

If you are taking 5mg of Lexapro, it's not tiny, it's equivalent to 10-20mg Paxil or Celexa.

 

So this means that 0.05mg Lexapro equals about 0.1-0.2mg Paxil or Celexa.

 

This is very important to keep in mind when you compare the jump off dose for your drug as to other members' jump off dose.

 

When to end the taper and jump to zero?

 

28 minutes ago, catmama said:

I can't keep dropping by a percentage

 

When you are using liquid you can continue reducing by 10% until you get to a low enough dose to stop.  Obviously the jump from the last dose to 0 is going to be 100%.

[Altostrata]

When you go off depends on your history of withdrawal effects. @catmama, please continue this discussion in your own Introductions topic.

[ChessieCat]

Just found this by on the other mods:

  

On 3/22/2022 at 3:27 AM, getofflex said:

 

I'll probably go to 0.005 mg, just because Lexapro is such a strong SSRI.

 

 

[DazzlingCold]

On 5/26/2011 at 9:16 PM, Altostrata said:

aka Cipralex, Seroplex, Lexamil, Lexam

As with all psychiatric drugs, Lexapro must be tapered for safe discontinuation.
 
In the US, Lexapro comes in 5, 10, and 20mg tablets and as a liquid solution.  Apparently the  pharmacy made suspension is becoming less available(mmt, 2021 August).

 

It is available as a generic. Its half-life is 27–32 hours http://www.ncbi.nlm.nih.gov/pubmed/17375980

 

In Canada, Lundbeck's Cipralex comes in 5, 10, 15, 20 mg tablets.

In both the UK and US escitalopram comes in a concentrated solution.

UK version Cipralex oral drops solution 20 mg escitalopram in each 1 mL(millilter of solution) and then 1 mg per gtt(drop) EU-pil, 4306.pdf

(this one comes with the dropper attached to the bottle, each gtt(drop) then equivalent to 0.05 mL(millileter))

*^ highly concentrated, keep out of reach of children, or infirm

US Escitalopram Oral Solution- FDA prescribing information

This one comes in a concentration of 5 mg in each 5 mL(millileter of solution, or 1 mg in each 1 mL.

 

Official US information:

• Description at PubMed https://pubmed.ncbi.nlm.nih.gov/17375980/
• FDA documentation, including history of warnings, https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021323s052,021365s037lbl.pdf
• Prescribing information: FDA prescribing information: https://www.drugs.com/pro/lexapro.html

From http://www.drugs.com/pro/escitalopram-tablets.html
The liver enzymes represented by P450 CYP3A4 and CYP2C19 are the primary avenues of metabolization.

 
From the FDA-mandated US package insert (PDF):
 

 
 

Special considerations
A significant characteristic of Lexapro is that milligram for milligram, it is much stronger than other SSRIs. Chemically, Lexapro is a variation of Celexa; the molecule was re-engineered to be patentable as Celexa's patent was about to expire. The streamlined molecule is a more potent SSRI, 2 to 4 times stronger than others. (Wikipedia has a good explanation of this at https://secure.wikimedia.org/wikipedia/en/wiki/Escitalopram.)

However, many doctors are unaware that escitalopram is stronger than other SSRIs and dose it as though it were the same strength. Although the so-called usual starting dose of escitalopram, 10mg, is equivalent to 20mg-30mg or more of, for example, paroxetine (Paxil), your doctor may have moved you to an even higher dose. If you are taking 20mg of escitalopram, you are taking a hefty dose of an SSRI.

If you are taking 5mg of Lexapro, it's not tiny, it's equivalent to 10-20mg Paxil or Celexa.

Consequently, when you taper off escitalopram, you should be careful to decrease by small amounts, as each drop is magnified by escitalopram's extra potency. If you find withdrawal symptoms from a 10% decrease to be too difficult, after 3-4 weeks decrease by a smaller amount.

Cold-turkeying off Lexapro is not a good idea. It's like throwing your brain off a cliff.

Reduce by 10% per month to start
The 10% rule holds for Lexapro, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

See Why taper by 10% of my dosage?

Cutting up tablets
Although 5mg tablets are available, if you are taking 20mg Lexapro, a drop to 15mg would be a 25% decrease. This is a larger decrease than the 10% recommended.

If you wish to try cutting up tablets, they can be cut up with a pill splitter like other medications in tablet form. Keep the pieces you don't use in a clean pill bottle labeled with the dosage for future use.

Reducing with a combination of tablets and liquid
If you are taking, for example, 15mg, and want to decrease by 10% (1.5mg), you can take one 10mg tablet and 3.5mg in the liquid form for a total of 13.5mg.

Titrating using liquid formulation
Using the liquid form is the best way to control the amount of each decrease. The US formulation provides 5 mg per 5 mL (amounting to 1mg of the medication in a milliliter of the liquid, or 1mg:1mL).

From http://www.hipaaspace.com/Medical_Billing/Coding/National.Drug.Codes/0456-2101-08

 

The NDC code 0456-2101-08 is the US order code for the liquid.

 

You can measure out dosages under 10mg by using a 5mL or 10mL oral syringe, see http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__view__findpost__p__2607

The 10mL oral syringe has markings that enable measuring out amounts as small as .20mL.

If you are at 5mg, for example, use a 10 milliliter oral syringe to measure a 10% decrease, i.e. .5mg. Subtracting .5mg from 5mg would give you a reduced dose of 4.5mg.

If you need to measure an even smaller fraction of a milligram, use a 1 milliliter oral syringe, see http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__view__findpost__p__2284

NOTE: In the UK, the liquid form is available at a 10mg:1mL or 20mg:1mL concentration -- very inconvenient for tapering. One version of the liquid form is Cipralex from Lundbeck.

To take 1mg of the 10:1 liquid, use the small slim 1mL oral syringe to take 0.1mL (one-tenth milliliter). The 1mL oral syringe has 10 ticks within .1mL, enabling taking .01mL (one-hundreth milliliter) or, given the 10:1 concentration, .1mg (one-tenth milligram) escitalopram.

 

From:  https://www.lundbeck.com/au/products/our-products/lexapro/lexapro-oral:

 

 

This information from Lundbeck, a manufacturer of escitalopram drops in Europe, http://www.medicines.org.uk/EMC/medicine/21976/SPC/Cipralex+5,+10+and+20+mg+film-coated+tablets+and+20+mg+ml+oral+drops,+solution/ suggests the liquid form can be diluted with water:

 

 
Since water is part of the original formulation, it is unlikely additional water will cause the dilution to degrade. However, being exposed to light, etc. may do this, so it is unclear how long a diluted solution will last in potency.

Do-it-yourself liquid
People report that they can make their own liquid from Lexapro tablets and water.

It is sparingly soluble in water, see http://www.drugbank.ca/drugs/DB01175 -- stability (shelf-life of dilution) is unknown.

 

 Escitalopram oxalate occurs as a fine, white to slightly-yellow powder and is freely soluble in methanol and dimethyl sulfoxide (DMSO), soluble in isotonic saline solution, sparingly soluble in water and ethanol, slightly soluble in ethyl acetate, and insoluble in heptane. According to RxList,com.

 

Your best bet would be to use a homemade isotonic(normal saline) saline solution (9% salt in water) which is made by dissolving 9 grams(1.8 tsp) of table salt in 1000mL of water.  Preparing a Saline Solution  The NS(normal saline) should be good for up to a month to draw from.

Draw out or extract the amount of NS(normal saline) for your desired dilution, add to a separate, mixing vessel, preferably amber colored, and with a lid, then add in your escitalopram tablet or powdered tablet until it's dissolved.  Keep protected from light in the refrigerator, and best to remix a batch of your Lexapro(dissolved) at least every week.

 

See How to make a liquid from tablets or capsules

 

Using a combination of tablets or capsules and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

Switching to Prozac
The risks of this method may not be worth switching from Lexapro to Prozac. This is usually used for medications with shorter half-lives than Lexapro. If you want to try this, make sure you consult a doctor who has done it many times and knows what he or she is doing.

 

Anyone with experience tapering off Lexapro can tell me if they found it more helpful to take at a particular time of day?

Also, anyone doing their solution with only tablets and water? I do it that way and wondering how making the liquid by first making a saline solution is helpful. 

[ChessieCat]

4 hours ago, DazzlingCold said:

wondering how making the liquid by first making a saline solution is helpful. 

 

From Post #1 of this current topic:

 

  

On 5/27/2011 at 12:16 PM, Altostrata said:

It is sparingly soluble in water, see http://www.drugbank.ca/drugs/DB01175 -- stability (shelf-life of dilution) is unknown.

 

 Escitalopram oxalate occurs as a fine, white to slightly-yellow powder and is freely soluble in methanol and dimethyl sulfoxide (DMSO), soluble in isotonic saline solution, sparingly soluble in water and ethanol, slightly soluble in ethyl acetate, and insoluble in heptane. According to RxList,com.

 

Edited May 15, 2022 by ChessieCat

[Altostrata]

We have dozens of people tapering with a homemade liquid.

[ChessieCat]

On 5/15/2022 at 6:31 AM, DazzlingCold said:

Anyone with experience tapering off Lexapro can tell me if they found it more helpful to take at a particular time of day?

 

Generally antidepressants are activating and it is better to take them in the morning.  However there are some people who find their drug has a sedating effect and they may choose take it at night.

[Escitalopram21]

Currently tapering Lexapro after a 9 month hold. The only liquid available here is 20mg/ml so it is very inconvenient when tapering and my pharmacys smallest syringe is 1 ml.
Doing a Cut is very hard with that strong solution and that big syringe.

So i found syrings with needles that are 0,5 ml meant for diabetics. Could this be a good solution until i get my brain on board to start making my own liquid? Or does anyone know if the syringes for diabectics are somewhst different?

[conkaia]

On 6/23/2022 at 9:31 PM, Escitalopram21 said:

Currently tapering Lexapro after a 9 month hold. The only liquid available here is 20mg/ml so it is very inconvenient when tapering and my pharmacys smallest syringe is 1 ml.
Doing a Cut is very hard with that strong solution and that big syringe.

So i found syrings with needles that are 0,5 ml meant for diabetics. Could this be a good solution until i get my brain on board to start making my own liquid? Or does anyone know if the syringes for diabectics are somewhst different?

I don’t see any reason why you couldn’t use a 0.5ml diabetic syringe. Are you diluting the drops? 

[Escitalopram21]

On 6/25/2022 at 3:11 AM, conkaia said:

Are you diluting the drops? 

At this point 2,85 mg i am not diluting my solution. I Will have to when i get to lower doses. 
The insulin syringes seems to be in units not in ml so i need to figure out what that means in ml. 

[brassmonkey]

I would strongly suggest seeing a pharmacist and getting a mL syringe, it will greatly reduce the chance of making a mistake and they are usually free, or very inexpensive.

 

Here is some good information on converting from Units to mL.

 

Converting Units Of Insulin To Milligrams And Milliliters (walrus.com)

[Escitalopram21]

Thanks for your reply.
Now i have a 1mL syringe but would make it easier with 0,5 mL with the 20mg/ml solution. Now when making a drop the lines dont help much and i have to eyeball it. Very inconvenient and i believe this might have been the reason to why it have taken me such a long time to stabilize. @brassmonkey

[brassmonkey]

I don't remember if I sent you this link or not, but it has a very good section on working with dilutions of liquid medications.

 

Brassmonkey's Tips and Tricks for Tapering - Tapering - Surviving Antidepressants

 

[conkaia]

4 hours ago, Escitalopram21 said:

At this point 2,85 mg i am not diluting my solution. I Will have to when i get to lower doses. 
The insulin syringes seems to be in units not in ml so i need to figure out what that means in ml. 

So how are you getting 2.85mg, are you just estimating with the 1ml syringe? That might well be why you’re taking so long to stabilise. This is such a minefield. I’m still trying to stabilise after inadvertently withdrawing from 2mg due to taking out of date drops. Having read @brassmonkey advice I hope it’s safe to dilute the drops in water when I decide to taper again. 

[Escitalopram21]

Yes unfortunately eyeballing it.
and still I have such big resistance agaisnt doing anything differently because my mind keeps finding obstacles. For example a few drops always leaves in the syringe and i have to take a few shots with water to make sure i flushed all the solution out. How to think about that if diluting it? 
@conkaia

[conkaia]

Hmm I see what you mean. Maybe you could dilute extra and only draw up what you need in syringe? My worry about diluting is that the active ingredient isn’t dispersed evenly. @Escitalopram21

[Escitalopram21]

@conkaia

Yes thats my plan when its already diluted. But when diluting it should i just press out what comes out from the syringe, flush it and then measure water for the solution or? Like what about the medication staying in the syringe. Thats quite much. 
Maybe @brassmonkeycan give an answer to this?

[conkaia]

I was planning on making a 1mg/1ml solution by putting the drops straight from the bottle into the water each day.  Then mixing it and drawing up what I need. @Escitalopram21

[Escitalopram21]

@conkaia👍🏻 Sounds like a good way to do it. 
How are you planning on measuring the amount of water?

[conkaia]

I was thinking measure water with syringe @Escitalopram21

[brassmonkey]

The syringe is designed to have a small amount stay in it, so you don't have to work to get the extra out.

[Escitalopram21]

40 minutes ago, brassmonkey said:

 

The syringe is designed to have a small amount stay in it, so you don't have to work to get the extra out.

 

So i have actually been taking more than what i have been thinking when flushing it with water into my mouth every time?

if changing methods and not flush it anymore, how much i actually staying in the syringe? Do i need to measure extra to get the right amount after doing what i have done. 

Thank you for the reply. And sorry for so many questions, this is one of my first attempts to taper after going CT with prevoius meds.

[ChessieCat]

My suggestion would be to continue doing it the same way until your next reduction and then just do a reduction and not flush the syringe.

 

I don't think the dose difference would only be minuscule and not worth worrying about.

 

If you next reduction is from 2.85mg to 2.8mg then it is only a 1.75% decrease.

[brassmonkey]

As Chessie said, just treat it as part of your next reduction and not worry about it.

[Escitalopram21]

Thank you. And could you confirm that by adding 1,5 ml of water to 1,5 ml of my 20mg/mL liquid gives me a Ratio of 1:1?

[conkaia]

41 minutes ago, Escitalopram21 said:

Thank you. And could you confirm that by adding 1,5 ml of water to 1,5 ml of my 20mg/mL liquid gives me a Ratio of 1:1?

It will. But personally I’d add 2 drops to 2ml water then draw up 1.5ml with a syringe. To save me trying to measure out 1.5mg. 

[indario55]

When making homemade escitalopram liquid with water mixed with salt, how does it taste?

[ChessieCat]

57 minutes ago, indario55 said:

When making homemade escitalopram liquid with water mixed with salt, how does it taste?

 

It is less than 2 teaspoons of salt in 1 litre of water.

[Mutfael]

On 6/26/2022 at 9:24 PM, brassmonkey said:

I would strongly suggest seeing a pharmacist and getting a mL syringe, it will greatly reduce the chance of making a mistake and they are usually free, or very inexpensive.

 

Here is some good information on converting from Units to mL.

 

Converting Units Of Insulin To Milligrams And Milliliters (walrus.com)

How many days does the liquid last in the refrigerator?

[brassmonkey]

I wouldn't keep it more than four days.

 

[indario55]

Anyone using just water instead of making a saline solution?

 

I've tried both and it looks almost the same, after shaking it a little, tablet dissolves nicely no matter if using only water or saline solution.

 

So I guess, water only is ok? 

[ChessieCat]

4 hours ago, indario55 said:

Anyone using just water instead of making a saline solution?

 

I've tried both and it looks almost the same, after shaking it a little, tablet dissolves nicely no matter if using only water or saline solution.

 

So I guess, water only is ok? 

 

It is better to use a saline solution and it is not difficult nor expensive.  This is the information provided in Post #1 of this topic together with the "recipe" for the saline solution:

  

On 5/27/2011 at 12:16 PM, Altostrata said:

Do-it-yourself liquid
People report that they can make their own liquid from Lexapro tablets and water.

It is sparingly soluble in water, see http://www.drugbank.ca/drugs/DB01175 -- stability (shelf-life of dilution) is unknown.

 

 Escitalopram oxalate occurs as a fine, white to slightly-yellow powder and is freely soluble in methanol and dimethyl sulfoxide (DMSO), soluble in isotonic saline solution, sparingly soluble in water and ethanol, slightly soluble in ethyl acetate, and insoluble in heptane. According to RxList,com.

 

Your best bet would be to use a homemade isotonic(normal saline) saline solution (9% salt in water) which is made by dissolving 9 grams(1.8 tsp) of table salt in 1000mL of water.  Preparing a Saline Solution  The NS(normal saline) should be good for up to a month to draw from.

Draw out or extract the amount of NS(normal saline) for your desired dilution, add to a separate, mixing vessel, preferably amber colored, and with a lid, then add in your escitalopram tablet or powdered tablet until it's dissolved.  Keep protected from light in the refrigerator, and best to remix a batch of your Lexapro(dissolved) at least every week.

 

See How to make a liquid from tablets or capsules

 

[indario55]

Yes I've read that. I've tried saline too.

 

But if it dissolves in water just fine, then I guess no need to go for extra steps making a saline solution. Maybe I'm wrong, I don't know.