Tips for tapering off Prozac (fluoxetine)

[Shmalan]

One general question in Fluoxetine capsule using my dosing as an example:

I take 7mg Fluoxetine per day. Using a digital scale I have determined the average weight of each 10mg capsule and the average weight of the powder. I get to the correct dosage by removing contents of the capsule and weighing.
 

The question is there any reason to suspect that the active ingredient fluoxetine is not evenly distributed throughout the inactive ingredients I.e could the fluoxetine be concentrated at one end of the capsule or the other)

[vincent]

When I was using capsules I would empty out 10 of them, weigh the total and divide by 10. 

I could then work out the amount needed for each capsule; you could of course mix the bulk first

[Shmalan]

Good idea. Thanks Vincent.

[ChessieCat]

3 hours ago, vincent said:

When I was using capsules I would empty out 10 of them, weigh the total and divide by 10. 

I could then work out the amount needed for each capsule; you could of course mix the bulk first

 

@Shmalan

 

This is what Brassmonkey did.  He had a "stockpile" of powder.  It is discussed in this topic:

 

using-a-scale-to-weigh-and-measure-doses

 

A search for "stock" in the above topic brought up these posts:

 

https://www.survivingantidepressants.org/search/?q=stock&quick=1&type=forums_topic&item=1596

 

Edited January 30, 2022 by ChessieCat

[Shmalan]

@ChessieCat

 

Thanks for the link. This is what I am going to do. 

[Leland]

So, I've been pouring my 1 MG/1 ML solution into a different plastic container, and storing in a drawer in the bathroom. Not refrigerated. Is this acceptable or should it be in a cooler place?

[ChessieCat]

Q:  Is this a homemade liquid?  SA's recommendation is to store it in a covered container in the refrigerator.

 

Q:  If it is prescription liquid why are you putting it into a different container?

 

For storage of prescription liquid check the patient instructions or ask the pharmacist.

[Leland]

It is not a homemade liquid, it's made from a compounding pharmacy. The attendant there told me this afternoon to keep the medicine at room temperature, so I'll continue to do that.

 

The medicine comes in a blue container with a very small opening. They also send me a syringe that fits only to a certain level. The other container I've been using has a wider mouth and allows for easier syringe pulls. 

 

Thank you!

[Mezzer]

@Altostrata. @ChessieCat hi, can you help me with a question? I’ve been crushing and weighing my Prozac tablets since sept 25th. I know the math to create the powder and weight each capsule. The question I have is how do I know there’s an equal distribution of filler and active med going into each capsule. There’s such a small amount of active med in each tablet based on the overall weight there’s no way to tell what’s what in the powder. Is it much better to make liquid or am I splitting hairs. I’m at 8-8.1 mgs and it’s a struggle finding stability. Been here for seven weeks now. Anxiety is strong. I’m holding for a long while until this levels off. Any wisdom you guys have is appreciated 

[Altostrata]

Don't worry about the filler. Using a liquid is easier and less prone to error than crushing and weighing tablets.

[Mezzer]

My doc won’t give me liquid. Is making a liquid out of tablets ok? 

[ChessieCat]

@Mezzer People have been making liquid with Prozac tablets and capsules for decades.  Please see Post #1 of this topic which has information about how to get non standard doses.

[Babar123]

Does time frame of prozac matter if you want to taper it off? 

 

Or is it the same for someone who’s taken it for 10 years vs someone who’s been on it for 2.5 years?

[ChessieCat]

Having been on the drug for 2.5 years will necessitate SA's taper rate of no more than 10% reduction of current dose, not starting dose, with a hold of at least 4 weeks definitely and generally applies to anyone who has taken the drug for 6 months or longer.  Even a person who has only taken the drug for 4 months might need to follow the SA tapering protocol.  For people who have taken it for less than 6 months and have taken no other previous psychiatric drug might be able to do a fast taper but regardless of the amount of time a person has taken a drug it is important to listen to your body/symptoms and make the reduction amount so as to keep withdrawal symptoms to a minimum and not taper until the withdrawal symptoms have eased.

 

Because of Prozac's long half life you might need to hold for longer than 4 weeks before making the next reduction.

 

The aim is to get off your drug with minimal withdrawal symptoms and be able to live your life as normally as possible during that time.

[KingPrawn]

I've just reinstated fluoxetine after originally following my GPs tapering instructions ie 40 to 20mg for a month then stop. Due to the long half life I felt OK until 6 weeks then bang and I've lived with the worst 6 weeks of my life ever since.

 

The reason I'm replying here is that I'm useless about even the simplest mathematical type problems so something even I could handle was this.

 

I unfortunately have 40mg capsules. I measure 40ml of tap water dissolve a 40mg capsule in that and then draw up 2mg for a taper starting at 2mg.

 

As I have more than enough fluoxetine owing to having paid a prescription scheme before I decided to come off the drug for the next year on the NHS I then just thrown the rest of the solution away and make up some more the next day. It only takes a couple of minutes to make it each time. I use a ceramic pestle to make the solution and stir it with a tea spoon to fully dissolve it. I have no problem with floating particles and it is purely solution within a few minutes. It tastes pretty horrible but a swill of the mouth with water soon sorts that out.

 

 

 

[manymoretodays]

Hi again KingPrawn,

I think you are doing fine with your method.

If you have a covered container to mix it in..........You could after stirring or gently shaking, get another couple of doses out of your mixture.

 

Keep it refrigerated and protected from light.

 

Up to you.  I know you are not at home right now......and so daily mixing sounds fine.

 

L, P, H, and G,

mmt

 

 

Edited December 27, 2022 by manymoretodays
spelling

[normalhuman]

I hope this is ok I post this here. I’ve talked to enough people over the last couple years and had the experience myself as well, that Prozac potentially needs a slower taper than just 1 month initial suggestion to know what the reduction is doing. Most other meds have a shorter half life and by 1 month you may know for other meds but at 1 month of Prozac reduction it’s barely registering the reduction in the brain and getting a chance to respond. There is also commonly an initial response at a week or so and another 1.5-3 months out. Other people on this site have had the same thing it would be nice if you talk about how the long half life with multiple metabolites means potentially needing a longer hold between reductions compared to other antidepressant guides. Also the fact that many people don’t experience withdrawal until 2-3 months out. This all indicates reductions need to be slower too. Reviews on drugs.com also talk about not getting withdrawal months out, so tapering to see what the result is should be generally slower than the rest of these guides imo. At least pls consider putting a note on first post this is a possible issue. It seems like Prozac is treated the same and it really needs a specific warning 1 month reductions can pile up not giving your body a chance to recover and risking a withdrawal crash. 

[vincent]

Hi @normalhuman

 

I concur with  "There is also commonly an initial response at a week or so and another 1.5-3 months out". This has been my experience.

 

I paused on 16mg in June and it is only the last week I feel really well. That's 6 months after a slow reduction of 6 months (4mg in total). I should point out that I have been on Prozac for 20 years.

[mpalas123]

Hi i have a question. If i dissolve a 10mg prozac pill to 10 ml water, then taking 5 ml of this solution equals to 5mg of prozac.... This is what i understand.... Am i right so?

[methuselah]

On 1/6/2023 at 8:54 AM, mpalas123 said:

Hi i have a question. If i dissolve a 10mg prozac pill to 10 ml water, then taking 5 ml of this solution equals to 5mg of prozac.... This is what i understand.... Am i right so?

that is correct.  You’re at 1mg/1ml.  Make sure to use distilled water, apparently that can make a difference.

[mpalas123]

I have never user distilled water so far, tap water only! Whats the difference on drugs?

[methuselah]

Distilled water is what was recommended here somewhere.  Does it make a difference, i have no idea.  My assumption is that chlorine and other water treatments in tap water may impact the drug molecule in some way.  

[Doctorsrcrap]

Can I ask a quick question. My sister wants to start tapering her fluoxetine and she takes them in gelatine capsules. Can she just pour the powder out of the capsule into water to dissolve? Does the capsule have to go into the water too? 

[NardilTime]

Aren’t those things time release? 

[Doctorsrcrap]

I dont know 

[WeLiveInHope]

On 1/17/2013 at 9:09 PM, Altostrata said:

Measuring Prozac-brand liquid

The concentration of the Prozac liquid from the pharmacy can make measurements confusing.

 

Usually, it contains 20mg Prozac in 5mL of liquid. (Check the label on your bottle.) If 20mg = 5mL, then there are 4mg in 1mL.

 

If you are taking 1mL, you are taking 4mg Prozac. To make a 10% reduction, you would decrease by .1mL (.4mg Prozac). A 5% reduction would be .05mL (.2mg Prozac).

 

Measuring Prozac-brand liquid dosage tables

At 20 mg/5ml (4mg Prozac in 1mL solution), if you wish to take

 

• 20mg Prozac, take 5mL liquid
• 10mg Prozac, take 2.5mL liquid
• 5mg Prozac, take 1.25mL liquid
• 2.5mg Prozac, take .625mL liquid
• 1mg Prozac, take .25mL liquid
• .08mg Prozac, take .02mL liquid
• .04mg Prozac, take .01mL liquid

Using a syringe to measure Prozac-brand liquid dosage

If you are using a 10mL oral syringe (photo here), and there are 5 ticks between 1mL and 2mL, each division is .2mL (2/10 mL).

 

At 20 mg/5ml (4mg Prozac in 1mL solution):

 

• .2mL (1 tiny division on 10mL syringe) = .8mg Prozac
• .4mL (2 tiny divisions on 10mL syringe) = 1.6mg Prozac
• .6mL (3 tiny divisions on 10mL syringe) = 2.4mg Prozac
• .8mL (4 tiny divisions on 10mL syringe) = 3.2mg Prozac
• 1.0mL (5 tiny divisions on 10mL syringe) = 4.0mg Prozac

If you are using a 1mL oral syringe (photo here), and there are 5 ticks between .10mL and .20mL, each division is .02mL (2/100 mL).

 

At 20 mg/5ml (4mg Prozac in 1mL solution):

 

• .01 ml (1 tiny divisions on 1mL syringe) = .04 mg Prozac
• .02 ml (2 tiny divisions on 1mL syringe) = .08 mg Prozac
• .03 ml (3 tiny divisions on 1mL syringe) = .12 mg Prozac
• .04 ml (4 tiny divisions on 1mL syringe) = .16 mg Prozac
• .05 ml (5 tiny divisions on 1mL syringe) = .20 mg Prozac

Increase dilution to make measuring easier

Increasing the dilution might make measuring easier. For example, you may wish to make it 1mg = 1mL. To do this, add 10mL (40mg) of the 20:5 solution to 30mL of water. Now you have 40mL of liquid containing 40mg Prozac, or 1mg in 1mL.

 

If you wish to take 4mg Prozac, take 4mL of the diluted liquid. A 5% reduction would be .2mL, for a dose of 3.8mL (3.8mg Prozac).

I have a question about this please. Is 1ml that same as 1mL? numbers/measurements is not a strong point.

[Altostrata]

1 hour ago, WeLiveInHope said:

1ml that same as 1mL

 

yes

[WeLiveInHope]

 

11 hours ago, Altostrata said:

 

yes

Thank you! P.S. today I am mindful and grateful over how amazing and life saving SA can be for me personally as I did not realise that fluoxetine oral solution could be mixed with water to make the measuring of doses easier. This is something that has filled me with so much joy and hope to when I do get to taper from my fluoxetine as I fear may be sooner than originally planned due medicine shortages in the UK! 
 

Thanks again!

[vincent]

3 hours ago, WeLiveInHope said:

 

Thank you! P.S. today I am mindful and grateful over how amazing and life saving SA can be for me personally as I did not realise that fluoxetine oral solution could be mixed with water to make the measuring of doses easier. This is something that has filled me with so much joy and hope to when I do get to taper from my fluoxetine as I fear may be sooner than originally planned due medicine shortages in the UK! 
 

Thanks again!

I am from the UK.

 

My doctor is now unable to supply me with liquid Prozac and has prescribed 20mg tablets.

 

I am back to using mini scales.

[WeLiveInHope]

8 hours ago, vincent said:

I am from the UK.

 

My doctor is now unable to supply me with liquid Prozac and has prescribed 20mg tablets.

 

I am back to using mini scales.

I have not been able to get liquid Prozac for 2 years. But, I could get another brand for liquid fluoxetine. Unfortunately, there seems to be so much ongoing issues with all types of formulas of fluoxetine in the UK. I must admit, it makes me ever so nervous. I wasn’t able to get any liquid for 3 months in a row and luckily, I had some stock built up but fear soon I’ll have to switch formula or something. 

It’s confusing to me why it can’t be special ordered in some way.

Scary times. I hope it works out for you. Good luck and best of care. 

[WeLiveInHope]

12 hours ago, WeLiveInHope said:

I have not been able to get liquid Prozac for 2 years. But, I could get another brand for liquid fluoxetine. Unfortunately, there seems to be so much ongoing issues with all types of formulas of fluoxetine in the UK. I must admit, it makes me ever so nervous. I wasn’t able to get any liquid for 3 months in a row and luckily, I had some stock built up but fear soon I’ll have to switch formula or something. 

It’s confusing to me why it can’t be special ordered in some way.

Scary times. I hope it works out for you. Good luck and best of care. 

@vincent Hi again Vincent,

 

I just want to share that that there is a way to still get fluoxetine oral solution see here https://psnc.org.uk/our-news/medicine-supply-notification-fluoxetine-20mg-5ml-oral-solution-and-fluoxetine-olena-20mg-dispersible-tablets/ 

 

It may be that your prescriber is unaware of the options available to have it special prepared. Or, something else. 
 

I hope that helps and please do let me know how you get on should you pursue the option of getting the oral solution specially prepared.

 

WeLiveInHope