LamictalBlues: Introduction and Savella Tapering

[LamictalBlues]

Just wanted to introduce myself as someone in the process of tapering Savella (milnacipran).  I've been able to taper from my original 100 mg dose to 18.75 mg over the past 4+ months.  It's been a rocky ride though.  Recently, I tried the step down from 18.75 mg to 12.5 mg and that's were I'm stuck.  It's just not going to happen.  My prescribing rheumatologist has been surprised (and skeptical and unhelpful) of my difficulty although my GP and psych nurse are quite understanding.

 

I'm considering making a Savella suspension with ora-plus or something similar to more easily facilitate small dose changes.  While I've had to be fairly creative tapering in the past, I've not seen any information on whether a Savella suspension is a reasonable approach.  We'll see!

[Petunia]

Welcome LamictalBlues,

I'm sorry you've had a difficult time trying to come off Savella, although I'm not surprised, I think you may have been tapering too fast.

 

We don't have a topic specific for Savella (milnacipran hydrochloride) but its a selective serotonin and norepinephrine reuptake inhibitor (SNRI), similar to cymbalta. http://www.drugs.com/pro/savella.html  It needs to be tapered slowly, especially as the dose gets lower. We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage?

 

What symptoms are you experiencing at the moment?

 

Could you give us a few more details of how you have been tapering, how often you have been making cuts and what percentage.

 

Are you taking any other medications?  Please would you put your drug and withdrawal history in your signature. Putting a short version of this in your signature helps people understand your context, it appears below each of your posts. Here are instructions for how to do it:

 

http://survivinganti...your-signature/

 

I suggest you hold for now, don't make any more cuts and get back to us with some more information, then we will be able to offer some suggestions. Its good that your GP and PN are being supportive, many are not.

 

You can use this thread as your ongoing journal to track progress, write about symptoms, ask questions and communicate with the community, add to it whenever you want, you will find a lot of friendly help and support here.

 

Petunia.

[LamictalBlues]

Yes, I've definitely been tapering too fast.  In the past, I had to taper very slowly with venlafaxine and it's not going to be much different with milnacipran.  

What symptoms are you experiencing at the moment?

At the moment, I'm fine.  I've been stable on 18.75 mg and thought I'd try going down to 12.5 mg by dropping my second of three doses (33% cut).  In mere hours it was too much.  With the experiences I've had withdrawing ADs in the past, I knew it was time to reevaluate.  I took my second dose to get me back up to 18.75 mg for the day and felt fine within about 1 hour.  I'm not in a rush and am in a good state of mind so I can stay at this dose until I come up with a more reasonable plan.

Could you give us a few more details of how you have been tapering, how often you have been making cuts and what percentage.

I've used some fairly large cuts and my rheumatologist originally suggested a very aggressive schedule of 10 days between cuts.  Some of these cuts were in the 25% to 33% range.  They were far too much, and I knew this at the time, but have not had luck in getting the 12.5 mg tables in order to make smaller cuts nor was I really interested in making up a water suspension of milnacipran.  I've had problems which range from just feeling horrible, insomnia, mild depression, and almost went manic in February.  My rheumatologist suggested changing from twice daily split dosing to a single daily dose which caused rapid cycling and some very dangerous moods for about 2 weeks in March.  I switched back to twice daily split dosing and the mood swings resolved literally within an hour.  I was very surprised by the hypomania and rapid mood swings.  Perhaps the relatively short half life just makes milnacipran unsuitable for once daily dosing.  It hasn't been as difficult as venlafaxine for me, but it's been tricky.

Are you taking any other medications?  Please would you put your drug and withdrawal history in your signature. Putting a short version of this in your signature helps people understand your context, it appears below each of your posts. Here are instructions for how to do it:

I take lamotragine 150 mg for bipolar II which is a very helpful medication.  I also take 0.5 mg clonazepam to control nocturnal limb movements.  This is down from 2 mg as the limb movements have largely resolved.  Tapering the last .5 mg is my next project after the milnacipran.  I take 50 mg of tramadol for fibromyalgia pain.  Very rarely oxycodone/APAP 7.5mg/325.  I also occasionally use 1-2 mg of eszopiclone to help with sleep.  Mostly this is an aid to help during milnacipran step downs.

I suggest you hold for now, don't make any more cuts and get back to us with some more information, then we will be able to offer some suggestions. Its good that your GP and PN are being supportive, many are not.

 

Yes, I'm in a pretty good place to hold.  I've just been confronted with the fact that I definitely need to come up with a method other than imprecise pill cutting and do something closer to 1 mg steps and long holds -- eventually .5 mg or smaller steps.  I'm considering a milnacipran ora-plus suspension.  Everything I need is at hand except the actual ora-plus and I have a spreadsheet worked up.  Having never done this, and not seeing anyone else having done this with milnacipran, I'm a bit hesitant.  I'm also wondering whether or not to involve my rheumatoligist in this.  He's confused that it could be this difficult to stop this medication.  My GP and psych nurse practitioner understand, however.  I suspect I'll let my rheumatologist know that I will move forward with a slow suspension taper.  If he decides to fire me as a patient, I'm pretty sure my psych nurse would be quite supportive so I have a backup plan.  She's pretty on the ball with things.

 

[Altostrata]

Welcome, LamictalBlues.

 

Yes, you are tapering too fast. This can help figure out how to make a liquid from Savella How to make a liquid from tablets or capsules

 

Also see Tips for tapering off Savella (milnacipran)

[LamictalBlues]

This is good info.  I checked with my doctor and he is actually OK with me doing a liquid suspension and tapering however slowly I need to.  My pharmacist has bottles with oral dispensing caps and Ora-Plus, which I'm going to try instead of water.  

 

I'm glad my doctor more or less came around.  Otherwise, I'd feel like I was self-detoxing from some illicit drug.