ktp: weaning from 4yrs 50mg Pristiq

[Altostrata]

Sorry for the lack of concrete information about the details of switching to Prozac: That's the best information I could find. This represents the state of medicine. Each doctor more or less makes up his or her own techniques for getting people off drugs (if they think about tapering at all).

 

Sounds like you did okay, how exactly did you switch to Prozac?

[ktp]

thank you for your tons of support Alto.  here we are on the bleeding edge yee hah.

I'm unable to buy into any sudden-switcheroo scheme i've seen described, there's just not enough detail provided, and not a single case history.  i know my doc didn't really think about it when he jumped on this prozac bridge bandwagon; instructions were simply take 10mg 2 weeks then stop the venlafaxine.  no freaking way!

I'm sticking to my gradual shift from effexor to prozac - see my sig for details but simply stated, i started 10mg prozac and have continued reducing Venlafaxine but faster than 10%/month.  last drop was 4mg to 3mg, 25%; that was a month ago and effective tomorrow i'm reducing 3mg to 2mg (33%) venlafaxine along with 10mg prozac.

 

so to answer your question, i'm still at it.  closer but at least a couple months away from purely prozac.  but so far i'm getting away without submilligram venlafaxine reductions.

[baroquep]

Hi KTP, I've just read your story and it looks like you did a very similar switch that I've just started.  I'm only on day five and the anxiety was pretty bad today.  Had a good day yesterday and thought I was out of the woods but it looks like the switch from 50mg Pristiq to 75mg Effexor XR is going to be a bit of a roller coaster.  Have decided to look into bridging with Prozac and just getting off of this Effexor completely as being only on day six of the switch, I can't imagine what another 2-4 years of this kind of wean is going to do to my mind.  The anxiety started around noon today and its been holding steady since.  Have to have my mind clear so I can function at work and not so sure that I can take another day of six straight hours of anxiety.  Days 1-4 were manageable, sick to my stomach, mild anxiety, metallic taste, eyes felt like they were bulging a little but no brain zaps or ping pong head, so that was encouraging but the ramp up of anxiety today has just about knocked me out. In your experience, if you had to do it again, what would you do differently?  Any advise for this newbie?

[ktp]

when you switched from venlafaxine EffexorXR 'E' to desvenlafaxine Pristiq 'P', what were the doses?  was your viral infection cured? 

in my humble opinion you should be able to switch directly from P to E (and back) if you can just find the magic equivalency.  50P v 75E seems about right to me. 
when i switched i did 125mg E first few days and got metal mouth and felt wired.  dropped to 75 and was okay. 
i take my meds in the morning and often have morning anxiety.  when do you take yours?

 

in your position i wouldn't hesitate to switch back to pristiq, if only to see if your anxiety goes away.   if it does i'd look into weaning directly off pristiq,  but over 2 years not 2 weeks.

P is delivered in a pill you can't cut - if you do you're dumping the entire day's dose into your system at once; the time release is accomplished by semi-permeable membrane.  

 

since you're working i'd ask for xanax for those horrible moments; having it handy will let you tolerate quite a bit more anx since you know it's easy to kill.  only takes a touch and don't get strung out on it !

 

doing it over, i'd avoid screwing up like i did in october 2014.  i could be finished with this.  see my sig for that nightmare.

and i think i'd insist on more info before diving into "easier" prozac, but this is hindsight not present tense anxiety begging relief.  

good luck!

[baroquep]

Hi KTP, good question, it's been so long since I did the switch from E to P, that I honestly don't remember (didn't occur to me at the time of the switch back but is a very good question).  The viral infection cleared up completely and though my family doctor thought it might have been caused by Effexor, we didn't investigate further as she switched me.  Might be a good idea to keep an eye on that now that I'm back on Effexor.  

I was on 50P and switched to 75E (XR) .  I take it first thing in the morning and am now more diligent about taking it at the same time every morning.  The anxiety has settled again though when I have it, it is pretty frightening and I get sucked into the fear each time.  

Have made an appointment to see a naturopath who is experienced in helping people off of antidepressants as I think I"m going to need a little support to get through the days when the anxiety is really bad.  So far I've had two really bad days though the rest have been tolerable (head pressure, nausea, rubbery arms, diarrhea, loss of appetite, blurry eyesight, general malaise).  I thought about getting a script for some type of benzo for the days of extreme anxiety but ChessieCat thinks it's best not to add another drug (especially an addictive drug) to the mix.  

The only reason I considered switching to the Prozac is that I can't imagine going through two or three years of withdrawal.  The anxiety and the thoughts that seem to go along with it have been pretty debilitating, so much so that it makes me feel like I"m losing my mind.  Thought with the help of the naturopath, I'd get down to 37.5 of Effexor and then bridge to Prozac and get off of that in a couple of months.  This naturopath has experience doing this and has had success with this approach.  Getting off all medication as quickly and as safely as possible seems so appealing to me.  

End up go back and forth everyday whether to just accept that it will take me a couple of years to get off this garbage or do a quick bridge off with Prozac.  Guess the next few decreases down to 37.5 over the next six months will determine what I'll ultimately end up doing.  If the 10% decreases aren't too bad, maybe I'll just hang in there and take it slow and easy.  Either way, I"m going to see the Naturopath for moral support and see how things progress.  Thanks for your response, helps to know that other people are going through this and not feel so alone

[ChessieCat]

Just a minor correction to your statement about Pristiq:

 

From Tips for Tapering Pristiq:

 

"In a phone conversation with Pfizer medical information (1-800-438-1985), I learned that the extended-release characteristic is incorporated into the tablet itself (Thank you, oaklily, for this information about the matrix formulation.)

Rather than a timed-release coating, the coating on the Pristiq tablet is only protective."

[ktp]

Just a minor correction to your statement about Pristiq:

 

From Tips for Tapering Pristiq:

 

"In a phone conversation with Pfizer medical information (1-800-438-1985), I learned that the extended-release characteristic is incorporated into the tablet itself (Thank you, oaklily, for this information about the matrix formulation.)

 

Rather than a timed-release coating, the coating on the Pristiq tablet is only protective."

 

"incorporated into the tablet itself" includes the coating.  My understanding is the coating is a semi-permeable shell through which the drug slowly leaches.  It follows that crushing a pristiq instead of taking it whole amounts to "dumping".

 

Accurate dosage control is exactly the reason I switched from Pristiq to Effexor (XR of course).  Why else would anyone want to switch from pristiq to effexor?  

 

btw on your own website adwithdrawal.weebly.com you say 

"I have had Pristiq tablets compounded into 2.5 mg, 5 mg and 10 mg capsules with a slow release additive." 

 

Why would you add a slow release additive if the coating is not integral to time-release?

[ChessieCat]

Just to clarify my post, I wasn't disputing about the coating, only wanting to add the additional information about the inside of the tablet:

 

From Alto's explanation here:

 

"The extended-release mechanism is part of the tablet MATRIX, or the glue that holds the tablet together. When the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.
 
When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability."

[ktp]

Hi KTP, good question, it's been so long since I did the switch from E to P, that I honestly don't remember (didn't occur to me at the time of the switch back but is a very good question).  The viral infection cleared up completely and though my family doctor thought it might have been caused by Effexor, we didn't investigate further as she switched me.  Might be a good idea to keep an eye on that now that I'm back on Effexor.  

 

I was on 50P and switched to 75E (XR) .  I take it first thing in the morning and am now more diligent about taking it at the same time every morning.  The anxiety has settled again though when I have it, it is pretty frightening and I get sucked into the fear each time.  

 

Have made an appointment to see a naturopath who is experienced in helping people off of antidepressants as I think I"m going to need a little support to get through the days when the anxiety is really bad.  So far I've had two really bad days though the rest have been tolerable (head pressure, nausea, rubbery arms, diarrhea, loss of appetite, blurry eyesight, general malaise).  I thought about getting a script for some type of benzo for the days of extreme anxiety but ChessieCat thinks it's best not to add another drug (especially an addictive drug) to the mix.  

 

The only reason I considered switching to the Prozac is that I can't imagine going through two or three years of withdrawal.  The anxiety and the thoughts that seem to go along with it have been pretty debilitating, so much so that it makes me feel like I"m losing my mind.  Thought with the help of the naturopath, I'd get down to 37.5 of Effexor and then bridge to Prozac and get off of that in a couple of months.  This naturopath has experience doing this and has had success with this approach.  Getting off all medication as quickly and as safely as possible seems so appealing to me.  

 

End up go back and forth everyday whether to just accept that it will take me a couple of years to get off this garbage or do a quick bridge off with Prozac.  Guess the next few decreases down to 37.5 over the next six months will determine what I'll ultimately end up doing.  If the 10% decreases aren't too bad, maybe I'll just hang in there and take it slow and easy.  Either way, I"m going to see the Naturopath for moral support and see how things progress.  Thanks for your response, helps to know that other people are going through this and not feel so alone

50P to 75E seems a bit light to me (my unfounded theory is that no more than 1/2 of the effexor turns into pristiq); i would guess 100E more likely equivalent.  I did this P-to-E part in Feb 2012, page one of this thread.  metal mouth and wiry seemed to indicate too much effexor.  have fun!

 

Good luck with your naturopath but i must suggest don't blindly follow anybody's advice to make any sudden changes!  

 

While I do accept the long-half-life idea helping Prozac be an easiER wean than effexor (and that's why I'm making the switch), i do not buy into the too-simple too-rosy pictures being painted by "prozac bridge" advocates.  I was down to pretty low mgs of effexor when i bought into the prozac addition; now i've learned a little more about prozac and I think wish i'd stuck with continuing weaning from just effexor.  

[if you were on 50mg Effexor and they told you to add 20mg Prozac for two weeks then abruptly quit the Effexor would you do it?  what if your Effexor does were 100mg, would you do it?  ah, the gory details of "bridging" - are they ever really addressed?  not to my satisfaction.  

 

imho get a tiny rx (say 5 0.25mg tabs) of xanax, but DON'T take it!  just having one in your pocket can help you survive this blast of anxiety.  be really scared of benzos.

 

 

 

while i'm here i'll add that I'm now 10 days into my latest reduction, from 10mgProzac+3mgEffexor to 10mgProzac+2mgEffexor on 9/21.  I was pretty concerned about 33% reduction of the Effexor but actually noticed _reduced_ "base level anxiety" after 3 days or so.  seriously, felt a little closer to the ground, kind of encouraging.  I hope the last 2mg go as well as this one.  

[ktp]

Just to clarify my post, I wasn't disputing about the coating, only wanting to add the additional information about the inside of the tablet:

 

From Alto's explanation here:

 

"The extended-release mechanism is part of the tablet MATRIX, or the glue that holds the tablet together. When the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.

 

When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability."

I agree only with "The particles should be assumed to have NO extended-release capability".  Whether crushed or not: if the coating is violated, the contents are quickly dissolved.   

 

If what you're saying were true, it would not be unreasonable to carefully halve or quarter Pristiq "tablets".  Actually they're more like kernels of corn (and yes you might find the empty shell in your poop!)  

[baroquep]

H KTP, how are you doing?  Looks like you are getting ready to make a reduction soon.  Will have to agree that 75E was a bit too light, the switch was a little rougher than expected and thankfully things have calmed down now.  Have tried to decipher your signature, even went so far as to paste it into a Word document in order to follow it a little easier ... has your anxiety abated as you have reduced the Effexor?  Or are you soldiering through it?  For now, I think I will stick with the E, stabilize a little further and hopefully make a reduction at the end of October.  Hope you are well.

[ktp]

Just to clarify my post, I wasn't disputing about the coating, only wanting to add the additional information about the inside of the tablet:

 

From Alto's explanation here:

 

"The extended-release mechanism is part of the tablet MATRIX, or the glue that holds the tablet together. When the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.

 

When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability."

to be blunt, Wrong.  (and quoting Alto doesn't make it right.)  what you need to understand is that the "matrix" IS the coating.  please go back and read the pfizer docs.  too much very wrong info here. 

[ktp]

H KTP, how are you doing?  Looks like you are getting ready to make a reduction soon.  Will have to agree that 75E was a bit too light, the switch was a little rougher than expected and thankfully things have calmed down now.  Have tried to decipher your signature, even went so far as to paste it into a Word document in order to follow it a little easier ... has your anxiety abated as you have reduced the Effexor?  Or are you soldiering through it?  For now, I think I will stick with the E, stabilize a little further and hopefully make a reduction at the end of October.  Hope you are well.

glad to hear you're making progress and seeing stability.  go slow!

 

sorry for any difficulty reading my sig detail; spreadsheet probably is the easiest way to see how badly i went wrong in October2014 (especially if you're into fancy graphs;-).  i'm flattered that you're actually reading it; i hope it makes sense. if not ask.  i know it's inconsistent in calling drugs by generic and brand names but i don't want to bother changing all those Ps to Fs for fluoxetine despite the Pristiq Prozac conflict.

 

re switching to prozac ("bridging"?), i'm sticking with it now and i do think it will be easier to wean than venlafaxine (v).  but not much:

Think about how you're going to wean from the last 10 mg of V: You can do one last 10% reduction before you have to switch to liquid to continue with 10% reductions.  And going liquid means eliminating the XR feature of the beads, so you're going to be taking a liquid dose twice a day.  prozac liquid at the end just 1/day and its long half life will not hurt.  so i think it boils down to one vs two daily liquid doses at the end.  in which case better to stick with the devil you know.  maybe.   

 

I am skirting the liquid V part of my wean by having added 10mg prozac when i was at 10mg V and dropping about 1mg/month.  I was told at that time this is "the prozac bridge", but the doc's understanding and mine are quite different, he thought it was as simple as "take P for 2 weeks then stop the V" while i fear that would make me inpatient straightjacket material.  so why is this abrupt Switching called Bridging?  My understanding at the time he said that was that yes i'd make that switch but i'd be at the ready with Xanax as the 'bridge' over the very much expected anxiety explosion that would occur a few days after dropping the V.  When it came down to it, I a) didn't want to go full 20mg P dose, and didn't want to be suicidal, and c) don't like taking xanax.  So I chickened out of "prozac bridge" and as such i can't say whether it works.  I'm making the same switch but doing it slowly.  slowly enough?  i'm just about to cut the V from 2mg to 1mg that's 50% and yes i'm apprehensive and yes i will have that x in my pocket.  but i think it's going to be fine.   My last V cut, from 3 to 2mg 33% went okay and i'm ready for this one starts tomorrow see sig.  

 

> has your anxiety abated as you have reduced the Effexor

i don't claim to be anxiety free but it's not over the top gawd-please-give-me-drugs anxiety.  I've been battling anxiety for a long time and am of the opinion(?) that watching for it amounts to increasing it.  You have to sort of forget it's there.  I won't make a reduction if I'm feeling anxious.  When I do make a reduction I want it small enough that I don't feel any increased anxiety; in my experience this rebound anxiety seems to appear 5-10 days after reductions.  

[scallywag]

Just to clarify my post, I wasn't disputing about the coating, only wanting to add the additional information about the inside of the tablet:

 

From Alto's explanation here:

 

"The extended-release mechanism is part of the tablet MATRIX, or the glue that holds the tablet together. When the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.

 

When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability."

to be blunt, Wrong.  (and quoting Alto doesn't make it right.)  what you need to understand is that the "matrix" IS the coating.  please go back and read the pfizer docs.  too much very wrong info here.

What difference does being 100% correct about the definition of the matrix have on the actual effect of destroying the matrix?

[baroquep]

Hi ktp, it looks like you have everything under control and are healthily sceptical about the effects of these drugs.  Wish I had done a little more research on how difficult it was to wean off of Effexor before doing the switch from Pristiq.  Then again, I could have run into even more difficulty if I'd decided to compound Pristiq and losing the time-release matrix which could have brought on a plethora of other issues.  Too late for regrets now though.  Am very interested in following your post as I know that when I get down to the final tapers, I may have to add the Prozac to eventually get off of the Effexor safely.  Hadn't taken into consideration that Effexor might be even harder to wean than Pristiq as I kind of figured they were the same beast, now I'm not so sure.  Am a few years away from that decision, so not going to worry too much or have many regrets.  Hoping your cut goes well and doesn't add any new problems to an already challenging situation.  All the best.    

[ktp]

 

Just to clarify my post, I wasn't disputing about the coating, only wanting to add the additional information about the inside of the tablet:

 

From Alto's explanation here:

 

"The extended-release mechanism is part of the tablet MATRIX, or the glue that holds the tablet together. When the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.

 

When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability."

to be blunt, Wrong.  (and quoting Alto doesn't make it right.)  what you need to understand is that the "matrix" IS the coating.  please go back and read the pfizer docs.  too much very wrong info here.

What difference does being 100% correct about the definition of the matrix have on the actual effect of destroying the matrix?

 

the result of breaking a pristiq "tablet" in half or at all is that the medicine is dumped all at once into your system.  

 

as a staff member, maybe you can fix the original posting which incorrectly interprets the meaning of 'matrix' in the original Pfizer Pristiq docs.  

 

read elsewhere about the similarities of these cousin drugs; the ONLY reason I switched from Pristiq to Effexor is this exact problem of 'dumping': time release is controlled by the outer membrane Pfizer calls the 'matrix'.  Effexor time release is controlled by slow-dissolve jawbreaker-like beads, easy to reduce doses.

[ktp]

Hi ktp, it looks like you have everything under control and are healthily sceptical about the effects of these drugs.  Wish I had done a little more research on how difficult it was to wean off of Effexor before doing the switch from Pristiq.  Then again, I could have run into even more difficulty if I'd decided to compound Pristiq and losing the time-release matrix which could have brought on a plethora of other issues.  Too late for regrets now though.  Am very interested in following your post as I know that when I get down to the final tapers, I may have to add the Prozac to eventually get off of the Effexor safely.  Hadn't taken into consideration that Effexor might be even harder to wean than Pristiq as I kind of figured they were the same beast, now I'm not so sure.  Am a few years away from that decision, so not going to worry too much or have many regrets.  Hoping your cut goes well and doesn't add any new problems to an already challenging situation.  All the best.    

why would you think Effexor more difficult that Pristiq?  I say effexor is easier to wean than pristiq.  same drug, but you can't cut pristiq tablets.  

 

maybe i confused you with the P drugs: started on Pristiq, switched to ~equivalent Effexor for easier wean, later switch(ing) to Prozac for easier weaning (time will tell).

[ChessieCat]

 

Just to clarify my post, I wasn't disputing about the coating, only wanting to add the additional information about the inside of the tablet:

 

From Alto's explanation here:

 

"The extended-release mechanism is part of the tablet MATRIX, or the glue that holds the tablet together. When the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.

 

When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability."

to be blunt, Wrong.  (and quoting Alto doesn't make it right.)  what you need to understand is that the "matrix" IS the coating.  please go back and read the pfizer docs.  too much very wrong info here. 

 

 

Yes, I agree I was incorrect and posted (3 October) in response to your post regarding this in the Pristiq thread:  "Thank you.  I have done a bit more research and have learned something today.  Never too old!"

 

After re-reading what Alto wrote and from what I have read since, I realise that I interpreted "the glue that holds the tablet together" as being the inside of the tablet, instead of it being the outside.

 

Thank you for providing the information about what the matrix is.

[ktp]

 

 

Just to clarify my post, I wasn't disputing about the coating, only wanting to add the additional information about the inside of the tablet:

 

From Alto's explanation here:

 

"The extended-release mechanism is part of the tablet MATRIX, or the glue that holds the tablet together. When the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability.

 

When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability."

to be blunt, Wrong.  (and quoting Alto doesn't make it right.)  what you need to understand is that the "matrix" IS the coating.  please go back and read the pfizer docs.  too much very wrong info here. 

 

 

Yes, I agree I was incorrect and posted (3 October) in response to your post regarding this in the Pristiq thread:  "Thank you.  I have done a bit more research and have learned something today.  Never too old!"

 

After re-reading what Alto wrote and from what I have read since, I realise that I interpreted "the glue that holds the tablet together" as being the inside of the tablet, instead of it being the outside.

 

Thank you for providing the information about what the matrix is

I see what you quoted and each repetition makes another copy of it being wrong.  As staff can you please FIX or REPLACE page one of the the Pristiq thread? http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/ inadavertently very misleading.  thank you.

[baroquep]

Could be that Pristiq isn't prescribed as often as Effexor and the reason I seem to find so many stories about horrible withdrawal from Effexor and few about Pristiq, I don't know.     It is more difficult to cut up the tab for tapering but the last time I tried to discontinue it, it didn't seem to have such an impact ...  mind you I'm a lot older now.  There are too many unknowns and that is the problem with all of these anti-depressants.  In my opinion, family doctors shouldn't be allowed to prescribe them.  They are far too powerful.  Maybe if they had to, by law, be prescribed by a psychiatrist only people with serious problems would have easy access to them.  If I'd known it would take me 3-4 years to get off of them, I would have never taken them to begin with.  What bothers me the most is that they never really worked to begin with!!!

[peggy]

hi ktp - i haven't been to SA much lately, but when i do I usually check in on the effexor taper threads.

 

I am a long time effexor taperer failure  I have done many slow (but not slow enough) tapers and generally crash around 18 - 24mg. The last time this happened was in May this year; i had been on 18mg for 5 weeks with no symptoms of withdrawal and was just getting ready to take another 1mg cut when i was suddenly hit by massive anxiety. - i usually wait it out a few days and then updose significantly to obtain relief. Fortunately i have always been able to stabilise.

 

Recently i was thinking that if i was to try to get off drugs again, i might have to do the Prozac switch - i had thought of tapering back to 37.5 mg and then switching over - i generally don't get physical symptoms like head zaps, vertigo etc - i just get massive anxiety, obsessive thoughts, depression that is so overwhelming i can't breathe.  On the other hand, i don't have many side effects from effexor - I guess i think that one day i will have to pay the piper.

[scallywag]

I asked:

What difference does being 100% correct about the definition of the matrix have on the actual effect of destroying the matrix?

You replied:

the result of breaking a pristiq "tablet" in half or at all is that the medicine is dumped all at once into your system. 

My point: When broken, the matrix is becomes ineffective and the medication becomes immediate release which poses unnecessary and untested risks. It doesn't matter whether the matrix is the coating or the glue.

[ktp]

I asked:

What difference does being 100% correct about the definition of the matrix have on the actual effect of destroying the matrix?

You replied:

the result of breaking a pristiq "tablet" in half or at all is that the medicine is dumped all at once into your system. 

My point: When broken, the matrix is becomes ineffective and the medication becomes immediate release which poses unnecessary and untested risks. It doesn't matter whether the matrix is the coating or the glue.

You are correct, you get it, but the first page of "Tips" is wrong.  as a competent staff member and moderator, perhaps you can go back and repair or replace that "Tips" first post which says it's okay to break up pristiq tablets.  it's not, and that's my point.  

[scallywag]

KTP: Perhaps you missed this part of the first post of the Tapering Pristiq topic:
 

...

Pristiq is difficult to taper "at a more gradual rate." The tablets come in only 3 dosages and, officially, they should not be cut up. See http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2464

...

 

The information has always been there.

[ktp]

KTP: Perhaps you missed this part of the first post of the Tapering Pristiq topic:

 

...

 

Pristiq is difficult to taper "at a more gradual rate." The tablets come in only 3 dosages and, officially, they should not be cut up. See http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2464

 

...

 

The information has always been there

...along with all the misinformation.  please remove any and all hints that it's okay to cut up pristiq; it is not okay.  

[Altostrata]

ktp, I carefully researched the meaning of "matrix formulation." This is a type of tablet formulation that is not particular to Pristiq. See
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648939/
The Role of Oral Controlled Release Matrix Tablets in Drug Delivery Systems

You may note there is more than one type of matrix. I am confident in my interpretation: The matrix is the way the Pristiq tablet itself is constructed. It is a monolithic matrix rather than a reservoir or osmotic pump type.

 

(You may also note that in Tips for tapering off Pristiq (desvenlafaxine), I state that I phoned Pfizer and discussed this detail with them.)

 
True, you might excrete the shell, or fragments of it. This proves nothing other than the coating material is not easily digested. See
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110830/
Curse of the ghost pills: the role of oral controlled-release formulations in the passage of empty intact shells in faeces. Two case reports and a literature review relevant to psychiatry

 

Not that this source is extremely authoritative, but it does state clearly that Pristiq is a monolithic matrix formulation https://quizlet.com/42293537/pharmaceutics-final-drugs-flash-cards/Apparently this is taught in pharmacy schools.

 

While I could not find Pfizer's (or Wyeth's) patent for Pristiq formulation (it might be licensed from someone else), I found lots of research on monolithic matrix formulation of desvenlafaxine from its generic competitors, Ranbaxy, Lupin, etc. They would have to develop their own manufacturing techniques for the generic versions.
 
We have indeed several members who have cut up Pristiq to taper. Some experienced the dumping phenomenon. Others have not.
 
If you are not confident in the information we offer here about tapering, you may want to develop your own techniques for tapering, or you may wish to go elsewhere.

[ktp]

i apologize.  thanks for all your support.

 

I must plead 'off my meds' ha ha.  I'm sorry for my rudeness.  again thanks for all your support.

[ktp]

hi folks, i'm reducing again today so checking in on 'my' thread and i re-read the last few posts and holy toledo do i have anger issues or what?  one more time please try to accept this apology for my way too blunt and just plain rude prose.  i really wish i were not so rude.  specifically chessie cat I was rude to you and didn't apologize.  and i was stating my opinion as fact.  for these and many other instances of just plain rude, i am sorry; i apologize.  thanks for being there, gang.  still need a bit of work on my humanity.  haha wish it were funny.

oh yeah, i'm reducing again today.  last 1 milligram bead of venlafaxine XR was sunday 11/27, i'm still on 10mg prozac.  

 

i am still trying to figure out what drives me from placid to anger at the slightest challenge.  i'm afraid to talk to people because i seem to process and act on emotion before even listening to what's really been said.  like when scallywag was asking what's the diff re how exactly the matrix works and all i saw was big flaming red challenge to my manhood or whatever and boom.  if anybody knows how to fix this i'm all ears, i really hate being an asshat when i'm doing it but wow it's even worse in retrospect.  one more apology, wow.  

[ChessieCat]

Hi ktp,

 

I had already accepted your general apology back in October but I do appreciate your direct apology.  I will mention here that Alto put in a lot of time and effort going back over her previous research and also doing additional research of Pristiq to ensure that the information being provided here is accurate.

 

Here is the link to SA's discussion:  Irritability, Anger, Rage

[Altostrata]

Hi, ktp, thanks for being such a standup citizen.

[baroquep]

Hi ktp, am rooting for you!  Good luck with your final taper off of Effexor, hope all goes well for you 

[baroquep]

Hi KTP, how you are doing since dropping Effexor?  

[ktp]

>how you are doing since dropping Effexor?

a month later.  still on 10mg prozac.  Anxiety is pretty quiet now and i'm not so angry (thanks all!) but I'm just holding steady, not yet thinking about how to reduce prozac.  

 

for your effexor wean I recommend do not accelerate the 10%/month reduction schedule you'll pay big time.  hang in there!

[baroquep]

Hi, glad to hear that your anxiety is quieter, that is a major bonus.  Hope you are planning on doing a nice long hold now that you are off of the Effexor.  Happy to hear that you are off that beast and only dealing with Prozac now.  Congrats, you are getting very close to being free ... yeah!!!

[baroquep]

Hey KTP, wondering how you are doing?  It's been a few months since you've been off of Effexor and am hoping you are well.  Let us know how you are getting on.  BP

[ktp]

20190712: 2+ years later, trying again this time with Fluoxetine which i'll call Prozac because I can spell it.  thanks to long half-life, so far i'm just skipping doses - 2days on, one day off, call it 20 20 0... so 280mg/21days.  that's been the story for about 6 weeks.  (the 21 days is to make the cycle repeat with 3 7-day pill minders;-)  That's approx the same as doing 20 10 10 20 10 10... so next move seems to be switch to 10mg caps and start cutting the 20s to 10s.  all at once would make the change easy 10 10 10 but that's 25% reduction, too much.  okay, how about 20 10 10 10 10 10 20 10 10 10 10 10 20 10 10 10 10 10 20 10 10 10 which is 35mg/21days = 12.5%.  sounds good to me...

 

SHORT VERSION OF ALL THAT is "soon to switch from 280/21days to 245/21days"

 

Edited July 12, 2019 by ChessieCat
coloured font