@samrichardson, thank you so much for sharing what you learned from your pharmacist and the approach you are taking to taper. You've also received first-hand knowledge and guidance from fellow members @jakedduck1 @rosa66 @kbmayo @sears @texasduchess and others have said. Tapering off venlafaxine is different for everyone. It's not easy.

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The Mayo pharmacist did some more digging and contacted the manufacturer as well. Here's what she writes:

"Recommendations from the manufacturer and compendia suggest discontinuation after tapering to the venlafaxine er 37.5 mg for a period of time in the same manner that someone would be initiated on that dose (and not ramped up by counting beads to start). I reached out to the manufacturer Viatris to see if they had information about opening Effexor XR capsules and dosing based on bead counting. The manufacturer stated they did not have any data on opening the capsules and could not provide recommendations about that. They defer to the discretion of a prescriber.

Generally, venlafaxine can be tapered by 37.5 mg intervals over several weeks. Some patients may have more trouble with tapering and require a longer taper or change to another medication, such as fluoxetine, for a period of time before tapering off that. It could be that patient specific factors lead the prescriber to conclude that counting pills was the best option, even if information regarding this approach is lacking.

The danger is that if the beads are not standardized the dosing by bead counting would be variable. The manufacturer offers no indication that there is any particular amount of drug per bead, and release from the beads themselves could vary from the drug delivery from the bead and capsule since they are not designed to be taken that way. In practice across several states over 15 years I have not encountered prescriptions describing this method of administration for tapering.

You can read more about antidepressant withdrawal here:
- Antidepressant withdrawal: Is there such a thing? https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressant-withdrawal/faq-20058133
It’s important that you are reaching out for advice to help manage symptoms. It can also be important to involve your care provider to ensure there is a plan in case depressive symptoms worsen on tapering. "

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Sam, I agree with you and others who have stated that the manufacturers and "monography alone never provide the reason why they advice not to split/crush/break their original form." How is your tapering going? Is the guidance from your pharmacist helping you?

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