jen84: Effexor withdrawal

[scallywag]

You probably know the arithmetic from your previous taper of Effexor.  25 mg of 150 mg is 16.7% which could be a bit much as a dose reduction; on the other hand, I get the convenience of halving a tablet.

 

The half-life of bupropion XL is 21 hours (± 9 hours). Using 25 mg as a cut tablet now an IR would mean that your serum level would peak a bit sooner than it has been and the level in your system would be lower by the time of your next dose.

 

You could try at least a week at 150 mg but cutting one of the tablets and taking both parts. That is likely to get your system switched over to partial IR dosing without effecting a dose reduction at the same time.

[jen84]

Scallywag, I so appreciate your feedback, I'm so confused with this taper. Are you suggesting I switch 100% over to the SR? Or cut the XL into quarters, take 2 of the SR and half of the XL?

[jen84]

Ohhhhh, or do you mean taking two of the 50mg SR and cutting the other 50mg SR in half, just so my body can get used to having the IR? Should I not be worried about the switch from XL to SR?

[scallywag]

Ohhhhh, or do you mean taking two of the 50mg SR and cutting the other 50mg SR in half, just so my body can get used to having the IR?

 

That's what I meant: 3 50 mg XL tablets, 1 cut in halves. Take the 2 intact tablets and all the pieces of the 3rd.

[scallywag]

I want to be clear about your situation. Two questions:

1. Are you taking SR or XL or a combination? 
    
2. What is your most recent prescription from your MD?

[jen84]

1)I'm currently taking 150mg XL, once daily.

 

2)The doc gave me a prescription for 50mg SR, he wants me to take 2 once a day, equaling 100mg

[btdt]

What the heck ... I had to look that up...never heard of intermediate release...

The differences are in how they get bupropion into the body, and have nothing to do with what bupropion does inside the brain. We might callWellbutrin, Zyban adn generic bupropion "immediate release"bupropion, Wellbutrin SR "intermediate release" bupropion andWellbutrin XL "extended release" bupropion.

 

So you can't cut the XL but he could have 

" The extended release of bupropion seen with the XL formulation is achieved by a moisture-barrier coating and a control-releasing coating surrounding a tablet core containing bupropion. The integrity of the delivery matrix is essential to providing an extended-release rate; chewing, cutting, or crushing bupropion XL tablets would disrupt the delivery matrix, resulting in immediate release of bupropion, which could cause significant adverse events."

 

"With once-daily dosing of the XL formulation in the morning, plasma bupropion concentration levels are lower during evening hours compared to the SR formulation (Figure 2) (data on file, GlaxoSmithKline, Research Triangle Park, N.C.). This may result in a lower rate of insomnia, an adverse event that has been reported to be correlated with plasma concentrations."

 

Maybe he said take both in the morning because of the sleep issue it can cause if taken later.... which brings me to something else I read here... about the dose being at one rate no matter how much more you took it would not change... I can't recall the page that is on.... studies I think. 

 

Back to the people who know about this as I did not taper and only know what I have read... I did try. 

Glad your doing well Jen. 

peace

[btdt]

I had to look... could not stop myself must be getting somewhat better

http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

It is about sert occupancy if you want to look up the science article but I do not know if any of these cover wellbutrin... so not sure how much help any of it is. I did just cross my mind that the wd from this lower dose may be ok because of the occupancy deal... but I don't know... other likey do. Something to look at if you want to look 

peace Jen 

[scallywag]

Thanks for straightening me out on what's what, jen.
 

Two more questions (for now):

1. Are you taking the brand name medication from Valeant or a generic?
2. How many 150 mg XL tablets do you have left?

Wellbutrin SR tablets are intended to be taken 2x daily, so your doctor's scrip is probably "50 mg bid" or "one 50 mg tablet twice daily."

 

Cutting or crushing a tablet, whether it is XL or SR, destroys all or some of the extended/sustained release characteristic and the medication becomes immediate release. Immediate release Wellbutrin (bupropion) is usually taken 3x daily.
 
Have you read the first post in the thread on Tips for tapering off Wellbutrin XR, SR, XL (bupropion)? It's not a short read but it's well worth your time. In it Alto posts that she had little difficulty with a 50 mg reduction.

[jen84]

I'm not sure if I'm taking the generic or brand name? It just says "Mylan-bupropion XL 150mg.

 

I still have 29 tablets left.

 

The script I have from the doc is for 50mg SR, it says to take two 50mg pills once a day.

 

I have read the first post on the Wellbutrin page, multiple times, however, I'm still confused...

[scallywag]

Since you have 29 doses of XL left, we've got time to figure out a plan for your first taper step. There are many details in that first post about tapering Wellbutrin. The manufacturers' formulations and lack of support for tapering makes things complicated and confusing.

 

Mylan is a generic manufacturer of bupropion. 

 

Ok, next: your doctor is dealing with outdated information about SR, both the frequency of dosing and in doses available:

 

I've double checked my usual resources -- SR is recommended to be taken twice daily. If you don't want to follow up with your doctor, ask your (or any) pharmacist about the prescription of SR as a single daily dose. It may be that your doctor forgot that SR is twice daily.

 

There's no manufacturer legally marketing 50 mg bupropion in Canada. The Health Canada Drug Product Database lists different manufacturers making these doses:

• XL: 150 mg, 300 mg
• SR: 100 mg, 150 mg
• Immediate release: not available

Check with your doctor or the pharmacist about the SR frequency and the 50 mg tablet availability. Let us know what you find out.

[jen84]

Ok, I finally got the prescription filled. You were right Scallywag, the Drs info was outdated, they do not make SR in 50mg, the lowest it goes is 100mg. I talked to the pharmacist, he said to do the 100mg, but only once a day. I forgot to ask about the frequency, but that's what it says on the bottle. He suggested that when it's time for me to decrease to 50mg, that I switch to a different drug. I have two months worth of the 100mg.

[scallywag]

Glad you got that worked out.

 

If you have problems with symptoms of interdose withdrawal taking 100 mg bupropion once a day, you may want to consider cutting the tablet and taking it twice a day. You could try that for a week or so to see if it helps. Here's the relevant content from the first post of the Wellbutrin tapering topic:

 

 

In the name-brand Wellbutrin SR, the sustained-release quality is in the binder, the glue that holds the tablet together.

 

Generic versions (which would be called bupropion SR, not Wellbutrin SR) may be made differently. Contact the manufacturer to find out exactly how the tablet is formulated, or talk to a pharmacist specializing in psychopharmacology.
 
I personally found you CAN cut Wellbutrin SR (sustained release) tablets up -- the timed-release mechanism is mixed in with the drug. Put the pieces in a water-tight container and use them up within 24 hours because the time-release binder can absorb humidity and degrade.

For a short time, I cut up generic 100mg bupropion SR and took 50mg in the morning, Wellbutrin XL 150mg a couple of hours later, and another SR 50mg in the early evening for a total of 250mg/day. (I never tolerated Wellbutrin very well.)

To taper, convert your dosage to 100mg SR tablets, cut up the 100mg tablets, make reductions by 25mg or less, take 2 times a day.
 
(Note: If you cut an SR tablet in very small fragments or crush it, it won't to continue to be sustained-release -- the binder is extensively damaged. Take as though it was immediate-release.)

[jen84]

Thanks scallywag. So just to be clear, I can drop from 150mg to 100mg?

[scallywag]

Have you found out how the SR characteristic is delivered either by contacting the manufacturer or a pharmacist? A pharmacist specializing in psychopharmacology will be more able to give you an answer quickly than most pharmacists working in a pharmacy.
 
You could try it. Please take notes of the timing of your doses and symptoms. This provides a format for details that are the most help when troubleshooting:
Take notes of doses and symptoms

[jen84]

I'm not really sure what you mean?

 

I started the decrease today, so far so good.

[scallywag]

Yes, you could try the decrease in Wellbutrin from 150 mg to 100 mg. Please take the tablet as close to the same time each day as possible and keep notes on paper about your symptoms.

[jen84]

No major issues thus far... Just some irritability, so I'm giving myself lots of personal space.

[jen84]

Two weeks in, no issues

[jen84]

Still doing well. I've had a few bouts of anxiety, but nothing too crazy. I have about three weeks left at this dose.

[jen84]

The good news... Almost time for another decrease.

 

The bad news... Wellbutrin sr doesn't come in 50mg. The pharmacist and my Dr are trying to figure out what to switch me to. They suggested effexor, I almost had a heart attack. They also suggested I skip days, I told them I didn't like that idea. Will keep you posted on what they decide.

[scallywag]

Good for you for holding your ground against a switch to Effexor and skipping days to taper.

[jen84]

Thanks Scallywag, its not easy telling them what you dont want.

 

My Dr. is awful, the last month or so has been a real eye opener. Him and his office people are lazy and rude. Too bad its so hard to find a family dr around here because I would jump ship in a heart beat.

 

Anyways, my pharmacist and I have been chatting a bit, as we wait for my Dr's instructions. As i said in my last post, the pharmacist has suggested skipping days, or switching to effexor. I am just wondering if anyone here has suggestions on how to come off this? I am on 100mg SR, and thats the lowest dose. I didnt really have any issues coming down from 150mg.. I'm assuming dropping from 100-0 would be too much?

 

I have a Dr. apt on the 25th, so I would like to be prepared for that visit. Any thoughts or suggestions on how to decrease from here?

[KarenB]

Will keep you posted on what they decide.

Or, you can keep us posted on what you decide.  Since you're the boss of you ... and they are just employees somewhere.

[jen84]

You're right Karen, I will keep you all posted on what I decide.

 

I am wondering if I could do my decrease by cutting up the SR tabs that I am currently taking? Im on 100mg SR right now, and I know that if I cut these pills I lose the time release, but what if I cut the 100mg in half, or even quarters, and took 50mg in the morning, and 25mg in the afternoon/evening, for a total of 75mg? Or took 25mg in the morning, and 25mg in the afternoon/evening for a total of 50mg. I seemed to be able to drop from 150 to 100mg no problems, so I dont see why I couldnt drop from 100 to 50 mg.

 

This is just a thought, I am not really sure what my other options would be.. other than switching to a different pill, but Im nervous about what the dr will put me on, or decreasing by skipping days, which i know the dr will suggest I try. Any thoughts on what my other options are?

[scallywag]

jen, start by splitting the tablet and splitting the dose while keeping the total amount per day the same.  Cut your 100 mg SR tablet in two and take one part in the morning and the other in the evening.  After a few weeks you'll have a better sense of how the sustained release is affected by cutting the tablet.

 

Then -- after 2-3 weeks on split dosing -- try taking ¼ tablet instead of ½ at one of the doses.

[jen84]

Thanks Scallywag, I think this approach makes the most sense, I dont really want to switch to another pill, and I dont want to taper by missing days. It makes sense to do 2 or 3 weeks of half and half, I just hope it works. I wonder what my doc will say. 

[jen84]

I will be seeing my Dr tomorrow. Are there any other options I can discuss with him other than cutting the pills?

[jen84]

Update: I did 2 weeks of splitting 100mg in half, took 50mg in the morning and 50mg at night.No issues.

 

3 days ago I dropped from 100mg to 50mg, so I'm taking 25mg in the morning and 25 at night. Haven't noticed any changes.

[scallywag]

That's a big drop, jen.  You might consider taking 50 mg at one "dosing" and 25 mg at the other.

[jen84]

I did drop 50mg on my last drop, and didn't really feel any side effects. Do you think its better to slow down now?

[Altostrata]

It's been 4 days since that decrease, how do you feel?

[jen84]

I'm feeling good actually, I haven't noticed any side effects

[jen84]

It'll be 3 weeks of 50mg soon. I'm feeling ready to make another decrease in a week or so. Should I stop taking the 25mg at night and just take 25mg in the morning? I don't think I can split the 25mg, its pretty small.

[ChessieCat]

Hi Jen,

 

Here is the information about how to make a liquid.

 

From Post #1:  Tips for tapering off Wellbutrin, SR, XR, XL (buproprion)

 

Taper with a liquid

Using a liquid for tapering is very convenient, especially if you wish to taper more cautiously. Using a liquid to taper makes measuring very small decreases much easier and precise.

 

You can only make a liquid from immediate-release buproprion:

• Make a liquid yourself from immediate-release bupropion with water, see How to make a liquid from tablets or capsules
• Get a prescription from your doctor for a liquid from a compounding pharmacy (can be expensive)

[ChessieCat]

Please update your signature so that we can see it at a glance.  Keeping it updated as you taper means we don't have to read back through your posts (and possibly miss something) to find the information.  Thank you.