Posted by SLS on February 24, 2005, at 7:16:17
In reply to Do NOT skip days when tapering medications!, posted by SLS on February 23, 2005, at 16:07:39
Hi.
> With the exception of Prozac (fluoxetine), it seems that skipping days in between doses of medication is counterproductive.
I would say that my statement is an overgeneralization with regard to which medications it applies.
For now, I think a daily taper guideline applies best to SRI antidepressants (Zoloft, Paxil, Luvox, Celexa, Lexapro, Effexor, Cymbalta) along with many benzodiazepines. I don't know to what degree it would apply to Remeron and Wellbutrin, for instance. I would like to see more data concerning tricyclics and MAOIs, but my own experience with these drugs persuades me to use a daily taper schedule. It does seem most critical for the serotonergic drugs, though, particularly Paxil and Effexor, which have short half-lives.
Paxil is a drug for which the half-life varies greatly between individuals. The range seems to be between 5-21 hours. This might offer one reason for why some people have more trouble skipping days than others. Although the drug company doesn't give much of an idea as to which values are most common, my guess is that most people experience a half-life of 11 hours or less. Still, I think a daily dosing guideline is a more conservative approach that should make the discontinuation of the SRIs less eventful.
For those people for whom no taper strategy seem to be effective for Paxil, Effexor, and Cymbalta, I think Jay's suggestion makes a lot of sense. He substitutes the offending drug with a combination Prozac + nortriptyline. These drugs are much easier to discontinue, and complement the chemistry of the original drugs.
Of course, many people have no trouble discontinuing serotonergic drugs regardless of how they go about it. However, I believe there is an increasing risk of inducing a withdrawal syndrome with subsequent drug discontinuations. For this reason, I would still argue in favor of a taper schedule that involves daily dosing.
- Scott
poster:SLS
thread:462343
URL: http://www.dr-bob.org/babble/wdrawl/20050214/msgs/462581.html