Shown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Laurie1041 on May 8, 2011, at 0:34:09
On Effexor XR 10 years, Pristiq 2 years + multiple other psychotropics that made for a potentially lethal combo. Have 3 meds remaining: Pristiq 50 mg.
(decreased from 100 mg. 2 weeks ago), Klonopin 1.25 mg. (decreased from 2 mg.), and Lunesta 3 mg.My pdoc says I can cut the Pristiq 50 mg. time-release tab (does not come in a smaller dosage) in quarters and start my taper by taking 3/4's of a tablet (or 3 pieces) every day until I am stable. My pdoc further advised me to not taper more rapidly than every 3 weeks.
I am afraid to cut the tablets because they are time-release and have personal experience of doing this 1 time last week whereby I cut a 100 mg. tablet in half because I could not find a pharmacy within a 20 mile radius of where I live that had 50 mg. tabs in stock. I got violently ill within 45 minutes of taking the 1/2 tablet.
Anyone have any ideas on tapering off of Pristiq?
Thanks so much for reading.
Posted by bleauberry on May 8, 2011, at 4:19:39
In reply to Pristiq Taper: Any ideas???, posted by Laurie1041 on May 8, 2011, at 0:34:09
Breaking up time release is not a problem. The trick is to take many multiple doses throughout the day, simulating the time release, and each dose has to be very small. A half or a quarter of a tab is just way too much. Try taking tiny chunks. Or, well, I'm not familiar with the tab, but I've done this with other tabs.....crush it into powder and then divide the powder into roughly equal size piles....a lot of low dosage piles. Then take them frequently throughout the day...every hour, every half hour, every two hours, whatever, play with it. To actually consume such tiny amounts, simply put the powder dose on apple sauce or something soft and just swallow without chewing. Some meds can be mixed in juice or water but I don't know if that applies to this one or not.
In any case, get creative in taking much smaller doses more frequently. And then gently reduce as the days and weeks go by. Let your body tell you if you are going too fast or not, listen to your body, and make adjustments accordingly along the way.
I don't know, it might also be possible to take another strategy by switching over to effexor and then weaning off that? I'm not sure, but I think effexor is in capsule form? Inside the capsule are tiny time released beads? If so, it's easy to divide them into little piles and sprinkle on soft food like applesauce or yogurt. Don't chew as that would break the time release coating. I did this trick with Cymbalta and it works great....any size dose you want....no matter how small...is achievable. Heck, my best dose ended up being about 10 beads, which is 1mg.
Posted by Laurie1041 on May 8, 2011, at 8:47:25
In reply to Re: Pristiq Taper: Any ideas???, posted by bleauberry on May 8, 2011, at 4:19:39
> Breaking up time release is not a problem. The trick is to take many multiple doses throughout the day, simulating the time release, and each dose has to be very small. A half or a quarter of a tab is just way too much. Try taking tiny chunks. Or, well, I'm not familiar with the tab, but I've done this with other tabs.....crush it into powder and then divide the powder into roughly equal size piles....a lot of low dosage piles. Then take them frequently throughout the day...every hour, every half hour, every two hours, whatever, play with it. To actually consume such tiny amounts, simply put the powder dose on apple sauce or something soft and just swallow without chewing. Some meds can be mixed in juice or water but I don't know if that applies to this one or not.
>
> In any case, get creative in taking much smaller doses more frequently. And then gently reduce as the days and weeks go by. Let your body tell you if you are going too fast or not, listen to your body, and make adjustments accordingly along the way.
>
> I don't know, it might also be possible to take another strategy by switching over to effexor and then weaning off that? I'm not sure, but I think effexor is in capsule form? Inside the capsule are tiny time released beads? If so, it's easy to divide them into little piles and sprinkle on soft food like applesauce or yogurt. Don't chew as that would break the time release coating. I did this trick with Cymbalta and it works great....any size dose you want....no matter how small...is achievable. Heck, my best dose ended up being about 10 beads, which is 1mg.Hi,
Thank you so much for your very instructive and helpful answer. You gave me much to think about. I am concerned that the crushing of the tablet and taking small amounts of it throughout the day to control withdrawals would cause me to possibly become overly concerned with the actual process and always have to have a small amount available wherever I go. In addition, I would never know how much ground up medication weighed and would therefore not know how many miligrams of medication I was taking daily in order to know how many "piles" of ground up medication controlled my symptoms and how I was doing overall with respect to getting off of 50 mg. In other words, my reports might sound like, "I have just begun my Pristiq taper and I had to take x "piles" of medication throughout the day to keep my withdrawal symptoms within "tolerable" limits".I think what I shall do is to use a compounding pharmacy to compound Pristiq by making 40 mg. 30 mg. 20 mg. etc. doses into time-release capsules to avoid having to buy a scale, mortar and pestle, time-release capsules, and fill them myself. A chemist, I am not.
I want to avoid crossing over to Effexor XR as that is Pristiq's "best new friend" and is very closely molecularly structured - they are essentially the same medications with a little molecular tweaking. After all, I was on Effexor XR for 10 years and had several unsuccessful withdrawal attempts.
I also want to avoid crossing over to a different SSRI/SNRI just because it is available as a non
time-release SSRI/SNRI for the purposes of being able to begin a 10% taper regimen over the course of time. I have read of many persons experiences who have done this and have been unsuccessful and find themselves back on Effexor or Pristiq due to "intolerable" withdrawal symptoms.IMO, the best, and probably most expensive option (unfortunately) is to have small dose increments of Pristiq compounded (ground, weighed, and put into time-release capsules) into perhaps 30 tablets of daily capsules of decreasing strengths, for example 40 mg. capsules, 30 mg. capsules and so on.
My next search is to find a qualified compounding pharmacy within 20 miles or so of my home that is qualified to do this. I have done some reading and researching about "compounding pharmacists" and there are no qualifications necessary other than to be a licensed pharmacist in order to "compound" prescription medication. Compounding is simply part of the scope and practice and included in the educational preparement of a registered pharmacist.
I'll keep you posted on my plan and what I learn from "compounding" pharmacists and what the costs will be. Again, thank you so much for your response. It really got me thinking! :) Laurie
Posted by Phillipa on May 8, 2011, at 11:15:40
In reply to Re: Pristiq Taper: Any ideas??? » bleauberry, posted by Laurie1041 on May 8, 2011, at 8:47:25
Compounding what a great Idea. I'm betting if like here if you do a google search for your area of compounding RX one will show up. Hope so. Phillipa
Posted by bleauberry on May 11, 2011, at 5:13:28
In reply to Pristiq Taper: Any ideas???, posted by Laurie1041 on May 8, 2011, at 0:34:09
The compounding pharmacy approach is a great idea. I would make the steps in 5mg steps rather than 10mg steps. That's just me though. 10mg is a pretty big step.
The crushing and measuring is not as complicated as you made it sound. So assume you have 4 equal size piles of powder and you scraped away maybe the tip of one of those piles. Well, we don't know the dosage you are taking. Does it matter? No. It's around 45mg, plus or minus, and doesn't matter. You could say, wow I'm down to 2 1/2 piles a day now versus 4 piles a month ago, I'm doing good with this.
All you need is a bowl, a spoon or knife to crush, a flat plate, and a single edged razor blade. A compounding pharmacy is ideal however because it makes it all so easy. The accuracy thing is not a big deal when you're talking a few milligrams.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.