Tips on minimising withdrawal symptoms from Effexor (aka Venlafaxine)

Posted by richyrich @richyrich, Nov 2, 2016

I have been taking Effexor/Venlafaxine for years and tried to get off it a few times but each time I try to give up the chemical withdrawal symptoms are a horror story and I give up giving up. Anyone got any tips or tried and tested strategies? Thank you

@youngsally

I'm wondering where you found the information on the "change the extended nature" of the XR when the capsule is opened. In capsule forms the extended release is usually built into the bead coating — the capsule disintegrates quickly. In tablets, where the extended release is built as a combination of coating and/or structures to the tablet (laser drilled holes or a gel matrix) – then one definitely changes the absorption rate if the tablet is broken in half or crushed. It's one of the reasons why there has been such a push to make opioids "tamper proof" – can't crush em and smoke/snort or inject them.

It's a minor point – and I agree that a bridge is an option for people…and bead counting is tedious – and difficult to do correctly every time.

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@youngsally
Whether the extended nature of the drug is in the gelatin capsule, or in the beads within–
Saw this at drugs.com re how to take Effexor XR capsules–"Swallow whole. Do not chew, break, or crush. You may sprinkle contents of long-acting product on spoonful of applesauce. Do not chew. Swallow the mixture right away. Do not store for use at a later time." This sounds to me as though the capsule is not important; what is important is that you let the beads dissolve in your digestive system.

Re bead-counting and why it is not a reliable tapering method and difficult to do–
From a Reddit post by u/tacomaprime and 37.5mg capsules–"I emptied the beads out of 7 capsules, 1 at a time and counted them. They were between 93 and 106 beads in each capsule." And this on survivingantidepressants.org by FeralUrban–"Effexor capsules do not contain the same amount of medication by weight in each capsule. The beads are all different sizes, as noted by others on this site and therefore inherently impossible to accurately reduce by 10% since you could be removing a bead that weighs three times as much as another bead, etc. [The] Pfizer Medication Help line [told him,] 'The capsules are filled by weight, not by volume. Ranges are validated with in an allowable variance.' The actual weight variability of each 37.5mg dosage of brand name Effexor is at least 3.5%, meaning if you take out 10% you could actually be taking out 13.5% or 6.5% and be bouncing your dose all over the place."

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On the web site survivingantidepressants.org, there's a post about using an expensive jeweler's scale to get a precise weight for bead measurements for tapering (it has to be an expensive scale because the cheaper ones aren't precise enough). I considered buying one because I was so concerned about being precise, but I decided that eyeballing the beads would be close enough since I could easily see which ones were teeny-tiny, which ones were stuck together, etc. I didn't find much variation at all in the size BTW. I decided if there was variation between the capsules I put together, it would even out over the days I took that particular number. (I read many, many blogs and posts before I started tapering and after I began because I wanted to take as good care of myself during the process as I could. I've experienced the zaps and certainly didn't want them again if I could avoid it! I also don't know how far I'd trust a drug company's help line because the companies want us to keep taking their drugs — their goal is profit, not healthy patients. The current screaming-out-loud example is today's announcement that Richard Sackler of Purdue Pharma, the company that produced and marketed OxyContin, knowing full well the addictive nature of the drug, has been granted a patent for a new drug to help wean people off Oxy. All along, Purdue knew it could add something to Oxy to keep the addiction from kicking it, but it didn't do it. Now Sackler will make additional millions — no exaggeration — from the people that his company addicted in the first place. To back up my statements about Sackler and Purdue, I refer you to the current edition of “Pain Killer'' by Barry Meier. But I digress . . . ) I know the tapering method isn't 100% accurate in dosage, but neither is the method where you get tablets of various sizes, cut them in half or in fourths, etc. I just wanted to get off the damn drug and I'm doing it the best way I know how. (My GP knows what I'm doing and he's fine with it. His only comment about counting the beads was that he knew he could trust me to be conscientious about doing it, but he wasn't sure that every patient would be.)

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@texasduchess

@susanarm
The most important strategy is to taper off slowly. I also hope you are enlisting a doctor's help (although some are not familiar with the difficulties of getting off Effexor and some suggest some pretty fast tapers); be your own best advocate–if you feel like cr*p with the reduction program, it's too much reduction too fast.

Please read all the posts on here for tips; I started with Page One and reread some posters often. If you click on my name beside this reply, you can read my posts in particular. I have mentioned some ways to reduce/taper.

You don't say if you tried to taper off your 75mg, if you tried skipping days, or if you tried cold turkey (that's not a successful strategy for most people).

You don't say if you are on Effexor tablets, or capsules, or your medication is extended-release (XR). Regular-release tablets can be obtained in 25mg doses. I was on that for 18 years. You can use a pill cutter to slice these in halves and quarters and then mix and match to get tapered doses that you can tolerate without experiencing withdrawal symptoms. You can ask your doctor to change your prescription. Capsules are trickier. Some folks open them and delete a set of beads, stay at that level for a while, then start taking out a larger number of beads, stay at that level for a period, etc. I mention in one of my posts how some folks dissolve their daily dose of medication in juice and throw out a small set amount and maintain that reduced dosage for while and then taper down again when ready. Compounding pharmacies can make tapered doses for you (if you can find one in your area and afford the cost).

Dram*mine, or Bon*ne (motion-, or sea-sickness OTC drugs) will help tremendously with the dizziness, light-headedness and nausea. If you are tapering, sounds like you're trying to reduce too fast.

I'll warn you–Effexor messes with your brain neurotransmitters; it will take time for your body/brain to reestablish how to balance these chemicals on its own again. I was on Effexor for 18 years for hot flashes at 25mg; I tapered off over 2.5 months and felt fine until six weeks AFTER the last dose. I am only feeling well now because I take a whole host of supplements four times a day and every now and then some Valium (prescribed by my doctor for the akathisia symptoms that started at that six weeks later time).

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Thank you! I take 75mg capsules, ER. I try to skip a day, but if I skip 2 I feel so sick! It actually takes a full day to recover from that. I’m struggling because I’m getting ready to start a new job, ugh! I’m going to ask my doctor to send me to a specialist.

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@catamite

Wow. You are really going fast young sally. I wish you all the best. I will be off soon too. Monday I will be down to 12mg for a week, then down to 0. I got very sick with nausea and insominia when I tried to go from 37.5 to 0. I am still waking up with an occasional headache lasting no longer than an hour. It will be so nice to get this monkey off my back.

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We'll see what happens. Although I did learn one benefit of Effexor — apparently it tamps down menopause symptoms…I hit menopause 3 years ago – no symptoms whatsoever….when I spoke to my therapist about how crappy I felt on Wednesday and how I slept with ice packs for a couple of nights — she said that I was probably experiencing hot flashes….mine were more like heat waves.

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@danalee5

@youngsally
When I was ready to go down from 37.5 my PC doctor told me to divide the capsules in half but the psychiatrist she referred me to for the withdrawal process (his main field is psychopharmacology) disagreed and said that not all the beads were the same and that it was not a good idea to do that. So he prescribed some 25 mg tablets so that I could split them as needed.

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Interesting — I haven't broken open a capsule — but there may be different coatings on different beads and they may be the same color.

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@grandmar

@youngsally
Good Morning!
I was on XR for years but after having weight loss surgery 2 years ago, I had to change to immediate release. After weight loss surgery, the body does not adsorb the way it used to. At that point, my psychiatrist did not know how I would adjust to the change. No problem.
Yes, I take 150 mg, twice a day.
Thank you for sharing your plan. I am worried that would be a little too quick for me. I actually take 2-75mg in the am/pm. I was thinking about cutting the evening 75mg in half for a week (or 2 depending on how I feel), thendoing the same with the am dose next.
I know I cannot do this without the guidance of a psychiatrist.
I don't know if you read, but my psychiatrist left so I have to find a new one, which I am working on. I actually think I found one, will call today.
Anyway, thanks again for all your sharing.
Have a great weekend!
Ronnie

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I recall you mentioning that you were looking for a new psychiatrist. I was concerned that you might be racing to get this done before you found someone. It won't hurt if you stay on a certain lowered dose for awhile. I have been at 37.5mg for 2 weeks – originally it was only supposed to be a week — but my joyful (and hopefully brief) excursion into what menopause might have been like had I had any symptoms – was enough to get me to hit the pause button for a week. And if the titration down to zero is too weird – I might do every other day for a couple of weeks.

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@mrhappy

I did read this somewhere and felt that it was unusual also. I read that the physical container for all the little capsules had the time release properties not the individual capsules themself. If someone on this forum would provide accurate information that would be great!

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There is a comment somewhere on this thread where a patient says they were told that all the beads are not the same — I haven't looked it up yet — but it would throw the whole bead counting thing as an accurate titration method – out the window — unless there are so many different types of beads that it doesn't really matter. But then I have to pull out a statistics book to figure that.

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@terri672

I suppose it would have to be both the capsule and the beads. The capsule has to dissolve before the beads can. If you are tapering off, you can always buy the gel capsules empty and put the beads in them if you can't change the mg..

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The capsules dissolve almost immediately. They are simply gelatin….they will even begin to dissolve it they get a little too wet. The technology is likely entirely in the beads.

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@susanarm

Thank you! I take 75mg capsules, ER. I try to skip a day, but if I skip 2 I feel so sick! It actually takes a full day to recover from that. I’m struggling because I’m getting ready to start a new job, ugh! I’m going to ask my doctor to send me to a specialist.

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You can always slow or delay the taper…new jobs are stressful enough — titrating and being sick is no way to start.

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@susanarm

I am a 55 year old female who started taking Effexor for my hot flashes about two years ago. I take 75mg daily. I’ve tried to quit but my symptoms are so severe, I can’t get off. My ears feel really full making me dizzy, light-headed and nauseous, and I am physically ill. Any suggestions?

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See if you can get a scrip for 37.5mg (assuming you are taking the XR capsules not the immediate release)…titrate down to 37.5 first. I didn't get any symptoms until last week when I had two days of what you are feeling – plus my first experience with hot flashes — 3 years after hitting menopause without symptoms….all because my dosage masked the symptoms.

If you are taking immediate release I think the options are different. Just speak with the doctor to say that titrating off is difficult. Also know that some of your hot flashes might come back while you are titrating down – or afterwards….but hopefully they will be less severe/frequent.

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@youngsally

We'll see what happens. Although I did learn one benefit of Effexor — apparently it tamps down menopause symptoms…I hit menopause 3 years ago – no symptoms whatsoever….when I spoke to my therapist about how crappy I felt on Wednesday and how I slept with ice packs for a couple of nights — she said that I was probably experiencing hot flashes….mine were more like heat waves.

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Today has been the worst day yet with withdrawal symptoms. Headache, sweats and throwing up. I've been sick all week but today it was just sever throwing up. My throat is killing me, headache probably from the vomiting and the sweating!! My poor fiance is freezing and I'm laying under air vent with a big fan blowing on me. Even taking cool showers. I bet it's your withdrawal and not hot flashes.

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@grandmar

@youngsally
Good Morning,
Thank you very much for the information, I had no idea.
Guess I need to research more before I shoot off my mouth.
Thanks again,
Ronnie

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Ronnie — I've covered the healthcare industry for 20+ years (including pharmaceuticals)…it gives me an historical context/perspective that I wouldn't expect most people to have….

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