[sweettooth]

The information posted to this list is for support purposes only and is not intended to replace the examination, diagnosis and treatment of a licensed physician and no such claims are inferred. You should always consult with your doctor before tapering off or stopping any medication--either of these decisions are between you and your doctor.


--- You may have taken only a small dose of an anti-depressant or benzo, or you may have not been on them for a long time, or you may not have had any trouble getting on them, *but* getting off of these medications is a whole different story.

--- You *cannot* just stop taking these types of medications (also known as going "cold turkey".) Abrupt discontinuation will cause withdrawal to set in within hours. Click here for a list of withdrawal symptons that are possible to experience: http://www.websitetoolbox.com/tool/p...post?id=627185 Several withdrawal can be life threatning.

--- As badly as you want to get off of any anti-depressant or benzo it is *so* important that you make small cuts in your dose amounts and stay at the new amount until you feel completely stable.

--- Taking these medications every other day, every two days, etc. is a HUGE no, no!

--- Going back up on a dose after tapering too fast or going cold turkey is *not* a bad thing; allowing your body and mind to be exposed to excessive and prolonged withdrawal is. You may "get over it" (the horrible withdrawals), but withdrawal symptons can occur or resurface months *after* you've finished taking these medications and there can be long lasting and permanent damage because of going cold turkey or tapering too fast. These meds. do not only effect your blood chemistry in the area of your moods, they effect all your systems.

--- If you are taking more than one medication, then taper only one at a time.

12/05/05

My story: Given Effexor for panic attacks; my highest dose was 150mg XR/once a day (extended release capsules) for 1 1/2 years. My doctor decided it was time to come off the medication. He dropped my dose from 150mg to 75mg--I felt dizzy, impatient, had a hard time concentrating, and had diarrehea--I thought it was just me. About 5 days later I felt better. Stayed at 75mg for 6 months, then the doctor cut my dose to 37.50mg. Had all the previous problems only much more severe; I never got stablized at 37.50mg. Then after a month he cut my dose to 37.50mg every other day--what a mess I was. Then after about 5 days I couldn't take it anymore and just stopped the medication--all hell broke loose! I thought it was just me, that I couldn't handle life and of course my doctor said it was just my original problem returning---NOT! He put me back up to 75mg and I stayed there for several months before I could even think of tapering again. My doctor said that Effexor didn't come in tablet form, but I knew this was wrong. I went to a different doctor and I have been tapering ever since at my own rate. I am now at 21.87mg/for the day (using tablets). I have had minimal withdrawal to this point and I attribute that to the very slow tapering and cutting doseage's at a rate between 5-10% each time.


METHOD 1:

Instead of counting out granules (which really isn't accurate as granule capsule contents vary anywhere from 105 - 124 granules per capsule), use Effexor immediate release tablets (don't worry you won't feel any different than using the capsules. The only difference is that you will take one half of your tablet dose in the morning and twelve hours later take the second half of your dose.


THE GOOD NEWS: Effexor comes in tablets: 100mg, 75mg, 50mg, 37.50mg, and 25mg. You can purchase a "pill splitter" from any pharmacy--the cost about $4.00 (american money) and split your pills in half, quarters, and even eigths--(with a little practice for the 1/8s). Splitting tablets will enable you to have more control stepping done your medication. When I got to a dose that is in between one of the tablet sizes listed above, I respectfully requested from my doctor a prescription of two different amounts of tablets (for example 37.50mg tablet and 25mg tablet). When I step down in doses I do NOT want to make big leaps.

Here is a partial record of my tapering; it starts at the 37.50mg doseage.

---I cut a 37.50mg tablet into eights = 4.68mg/per eight and then cut a 25mg tablet in half = 12.50 mg. I would then take: one 4.68mg plus one 12.50 mg = 17.18mg (morning dose) and then do the same thing 12 hours later. 17.18mg + 17.18mg = 34.36mg for the day. (Stayed at this new dose for 1 month.)

Next cut: 37.50mg in quarters = 9.37mg and cutting a 25mg into quarters = 6.25mg. I then took 9.37mg + 6.25mg = 15.62mg in the morning and then same thing 12 hours later. 15.62mg + 15.62mg = 31.24mg for the day. (Stayed at this dose for 1 month.)

Next cut: 1/8 of a 37.50mg tablet = 4.68mg plus 1/4 of a 37.50mg tablet = 9.37mg. 4.68mg + 9.37mg = 14.05mg. 14.05mg + 14.05mg = 28.10 mg for the day. (Stayed at this dose for 1 month)

Next cut: 12.50mg (1/2 of a 25mg tablet) in the morning and 12.50mg twelve hour later = 25mg for the day. (Stayed at this dose for 7 weeks)

Next cut: 12.50mg in the morning and 9.37mg in the evening = 21.87mg for the day. (Stayed at this dose for 1 month)

Next cut: 6.25mg (1/4 of a 25mg tablet) + 4.68mg (1/8 of a 37.50mg tablet) = 10.93mg (morning dose) and 9.37mg (1/4 of a 37.50mg tablet) twelve hours later.

10.93mg + 9.37mg = 20.30mg for the day [Current Dose]

You can see this is MUCH EASIER on your system than making big cuts in the doses.

You can use any combination of the tablet doseages, using the pill splitter, to get the approx. dose you need. The above is just an example of where I am at.


*5%-10% CUTS* -- I think some folks may be taking 5% or 10% of their highest dose and then they keep using that number to subtract for all their cuts--that is not the way to do it.

Always use the *CURRENT* doseage amount you are at to multiply by 5% or 10% (not the highest dose you ever took) inorder to see how much you need to come down.


For example:

If you are at 50mg and are ready to make a cut.
5% Cut:
50mg x 5% = 2.50
50mg - 2.50mg = 48.50mg--this would be your new dose

OR

10% Cut:
50mg x 10% = 5mg
50mg - 5mg = 45mg--this would be your new dose

Let's say your new dose is now 45mg. The next time you make a cut you will take 5% or 10% of 45mg to figure out the next doseage amount.


WHEN CUTTING YOUR PILLS of differing milligrams, have some empty, clean, prescription bottles that are labeled (for example 4.68mg on one, 9.37mg on another, 6.25 mg on another, etc.) so that you don't get them mixed up. As you cut smaller amounts it gets harder to distinguish what is what--the labeled bottles will keep you straight. Just be sure to put the correct amounts in the correct bottles!

BE SURE once you step down on a doseage that you remain at that amount for at least 3 weeks, preferably 4 weeks. It will give your brain chemistry time to adjust to the returning natural levels of serotonin.

DON'T BE SUPRISED as you get lower and lower on your dose that you may need more than 3-4 weeks to stablize; remember your brain is going through a HUGE change--give it the chance to even out. It's not important how long it takes to taper from dose to dose, it matters that you take your time!

ALWAYS take Effexor with food in your stomach and drink plenty of water.

Do NOT eat or drink anything containing GRAPFRUIT, it can create a serious toxic reaction.

NEVER, EVER take St. John's Wort or 5-HTP--they have serotonin in them. Mixing them with an anti-depressant or taking then after you've been off of an anti-depressant for only a year of less can lead to SEROTONIN SYNDROME - a toxic and deadly condition. Click on the following link to find out about it: http://www.antidepressantsfacts.com/...ndrome-ADF.htm


Drugs that may induce serotonin syndrome when taken with antidepressants (not a complete list)
ecstasy
cocaine
lithium
St John's wort (Hypericum) - herbal antidepressant
diethylproprion - an amphetamine
dextromethorphan - found in many cough suppressants
Buspar (buspirone) - for anxiety
Selgene, Eldepryl (selegiline) - for Parkinson's Disease
anti-epileptics - Tegretol, Carbium, Teril (carbamazepine)
analgesics - pethidine, Fortral (pentazocine), Tramal (tramadol), fentanyl
anti-migraine drugs - Naramig (naratriptan), Imigran (sumatriptan), Zomig (zolmitriptan)
appetite suppressants - phentermine and fenfluramine
tryptophan - an amino acid


NEVER, EVER take Effexor or any anti-depressant every other day--withdrawal will start and you will never get back on an even keel. I know, I know your doctor told you to do this, but MOST doctors are truely ignorant of the hell they are about to put you through doing this. If you are currently on this program get back to taking your dose everyday and after you are stabilized you can start your tapering.


PLEASE TAKE THE TIME to visit these webpages; they have critical and very helpful information for tapering:

http://www.antidepressantsfacts.com/reaction.htm

http://www.antidepressantsfacts.com/taper.htm

***********************************************

METHOD 2:

I was able to locate a "compounding pharmacy" (customized medication preparation by a pharmacist according to a doctor's specifications to meet a patient needs.) The compounding pharmacy said they could indeed make a liquid form of Effexor, however it becomes less stable (could affect the potency) and has a very short shelf life (not half life); probably also needs to be refrigerated.

What they will do is crush the tablets and make up capsules in whatever dose amount needed.

Example: Your at 25mg, you plan on making a 5% cut.
25mg x 5% = 1.25
25mg - 1.25 = 23.75mg new dose for the day

Capsules are prepared in doses of 11.875mg each. You would take one in the morning and then one in the evening; 11.875mg + 11.875mg = 23.75mg for the day.

Specify that you want the Effexor Brand and not the generic as I've read that generics can have as much as a 20% difference in potency (which is allowed by the FDA).

Ask your doctor to write the prescriptions to the compounding pharmacy instead of a regular pharmacy.

The beauty of this approach is that you can have as very small or as large a cut as you need because these pharmacies have the sophisticated equipment to accurately do this.

Here is a link to learn about compounding pharmacies:
Hudson's Guide: Compounding Pharmacies
http://web.mit.edu/hudson/www/compounding.html


Here is a locator to find one in your area:
International Academy of Compounding Pharmacists Referral Service:
http://ist.intsoftec.com/iacp/referr...ice/index.html

The only draw back to this approach may be the financial aspect of it. Most Compounding Pharmacies require paying upfront and not all insurance companies will reimburse for this service.

Sweettooth