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#1 LS1978

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Posted 13 April 2017 - 04:53 PM

I'm on day 3 of reduced duloxetine (Lupin--30 mg contains 6 pellets, I've reduced to 5).  I was just at the grocery store and felt light-headed for a bit.  I wasn't sure if I was going to pass out or not.  I kept telling myself, "you're okay, you're okay" so that I wouldn't have a panic attack in addition to the light-headedness.  My lips were tingling as well.  I'm feeling a bit like that now as well--with tingling in my lips, fingers and toes--but I'm sitting down at home, so it doesn't seem as bad.

 

I have to wonder if I'm having drops in blood pressure.  My blood pressure was low before I started Cymbalta, then went up after starting it.  

 

Have others experienced this?  Is this something I should be worried about?  Is there anything I can do about it?

 

I should also mention that I have a vestibular imbalance that sometimes causes dizziness.  I'm wondering if that may be a factor as well.


#2 gail

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Posted 14 April 2017 - 08:13 AM

Hi,

The best way to withdraw is to get the brand Cymbalta. Smoother taper, your generic is 5 mg pellets. That is too fast. With the brand you remove 2 or 3 beads a day. Like 3 then 6 then 9 and so on.

Some pellets can be cut but not all generics. Fishinghat will come along to tell you if yours can be cut.

#3 fishinghat

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Posted 14 April 2017 - 08:28 AM

The individual beads on the Lupin are enteric coated and should not be cut. By cutting them you allow them to dissolve too quickly and you get rapid spikes in blood concentrations.

 

I am afraid Gail is right on this one. You may need to go to the brand name.


#4 LS1978

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Posted 14 April 2017 - 12:06 PM

The thing is, I'm unemployed, and there is a time pressure.  My depression has become so bad that I'm barely functioning.  My mother is letting me stay here, but she is losing patience and wants me out.  I would like to taper off slowly, but my psychiatrist isn't going to start me on something new until I'm off the duloxetine.  He wants me to take 30 mg every other day and be done in 10 days.  So I'm trying to do something slower than what he wants me to do, but I can't afford to taper off too slowly, or I will be without much anti-depressant to help me in my system for quite a long time.  I don't want to find myself homeless, severely depressed and unmedicated, but I also don't want to get extremely ill...so I figured I could compromise and try to suffer my way through it the best I can.  I'm just hoping I can get well quickly enough to not be thrown out. 

 

If I become suicidal, I may have to check myself into the hospital, but I'm trying to just push through the unpleasantness so that I can work again soon and not be homeless.

 

Did any of that make sense?  I'm not sure if I was clear.  My head feels pretty fuzzy.


#5 fishinghat

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Posted 14 April 2017 - 02:13 PM

Clear as a bell. That is a tough situation.

 

First of all your dr is an idiot. All I can say is the every other day thing is a terrible idea that the FDA and manufacturer do not recommend. The reason is it jacks up your level on the day you take the capsule and then crashes over the next 2 days. It only has a half life of 12 hours so by the time you take the next pill you only have 6.25% left in your blood stream. You will be suffering the same withdrawal over and over.  Also, there is a standard format for cross tapering from one antidepressant to another. Dozens of people on this site have had their drs do this. It IS a standard practice. There is absolutely no excuse to not do this plus there are several meds he/she can put you on to help during your withdrawal. I believe you said that your med has  7 beads inside. It would be better to remove one more bead every 7 days then the ever other day thing.

 

By the way, the dangers of a fast withdrawal doesn't just include suicidal thoughts but actual suicide , seizures and much more. This must be done slowly to be done safely. If you need any literature on FDA and Eli Lilley warnings or recommended procedures please let me know and I will send them to you.


#6 gail

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Posted 14 April 2017 - 03:39 PM

Hey LS,

Did Cymbalta help with the depression? If so, can't you say to your psychiatrist that you want to continue? This way, you could hold on to the 30mg a while longer. At least till you get a job? Then you decide what you want to do. Just a thought!

#7 LS1978

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Posted 14 April 2017 - 05:46 PM

Clear as a bell. That is a tough situation.

 

First of all your dr is an idiot. All I can say is the every other day thing is a terrible idea that the FDA and manufacturer do not recommend. The reason is it jacks up your level on the day you take the capsule and then crashes over the next 2 days. It only has a half life of 12 hours so by the time you take the next pill you only have 6.25% left in your blood stream. You will be suffering the same withdrawal over and over.  Also, there is a standard format for cross tapering from one antidepressant to another. Dozens of people on this site have had their drs do this. It IS a standard practice. There is absolutely no excuse to not do this plus there are several meds he/she can put you on to help during your withdrawal. I believe you said that your med has  7 beads inside. It would be better to remove one more bead every 7 days then the ever other day thing.

 

By the way, the dangers of a fast withdrawal doesn't just include suicidal thoughts but actual suicide , seizures and much more. This must be done slowly to be done safely. If you need any literature on FDA and Eli Lilley warnings or recommended procedures please let me know and I will send them to you.

 

Thank you.  I do wonder why he isn't cross-tapering meds.  We were talking about Fetzima being my next med.  Could that have something to do with it?  

 

I wouldn't mind the info, as I'd like to give it to my doctor.  I don't think he takes me very seriously.  When I expressed concern about weaning off the Cymbalta, he was dismissive. 

 

I have decided that if I become suicidal I will either have my mother take me to the ER, or I will take a cab.  The thing about possible seizures worries me.  However, I do take clonazepam before bed.  I'm wondering if that will keep me from having seizures.


#8 LS1978

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Posted 14 April 2017 - 05:52 PM

Hey LS,

Did Cymbalta help with the depression? If so, can't you say to your psychiatrist that you want to continue? This way, you could hold on to the 30mg a while longer. At least till you get a job? Then you decide what you want to do. Just a thought!

 

It did for awhile.  I've been on it for over 10 years though, and it just isn't working anymore.  I'm barely functioning.  Just taking a shower seems overwhelming some days.


#9 fishinghat

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Posted 15 April 2017 - 04:44 PM

Well LS I don't know why he didn't cross taper you on to the Fetzima. He seems a little strange.
 
The Clonazepam (a benzo) should help lower the risk of seizures some.

The info from the manufacturer and FDA...

http://www.fda.gov/d...e/UCM172866.pdf

The previous document was issued by the FDA warning of the severity of Cymbalta Discontinuation Syndrome.

Page 1
Cymbalta (Duloxetine) Discontinuation Syndrome
Issues of Scope, Severity, Duration & Management
June 9, 2009

Page 3
The effects of discontinuation can be severe and extend for weeks or even months
Extreme mood swings (anger, irritability)
Debilitating “Brain Zaps”
Physical and neurological problems

Page 4
Claims

Cymbalta discontinuation syndrome is more severe and much more widespread than acknowledged by Eli-Lilly

Lilly sales representatives and marketing materials do not adequately inform physicians about the likelihood and severity of discontinuation syndrome

Lilly Direct to Consumer (DTC) advertizing is misleading related to the probability, severity and complexity of Cymbalta discontinuation

Lilly has not developed and fielded a clinically proven protocol for safely discontinuing Cymbalta

Page 8

2) Lilly sales representatives and marketing materials do not adequately inform physicians about the likelihood and severity of Cymbalta discontinuation syndrome

Unaware physicians unable to discuss Cymbalta benefit-risk profile (including discontinuation) with their patients


Page 9

Lilly Direct to Consumer (DTC) advertizing is misleading related to the probability, severity and complexity of Cymbalta discontinuation

Also states that “opening the capsule is required to taper”

Page 14

Lilly does not offer small dose Cymbalta formulations to facilitate tapering. Patient required to open capsules and count drug beads
Patient may require compounding pharmacy services At his/her expense

Tapering may take weeks or months



https://dailymed.nlm...f2-c185fbad64ba

Cymbalta Drug Insert



2.7 Discontinuing CYMBALTA
Adverse reactions after discontinuation of CYMBALTA, after abrupt or tapered discontinuation, include: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible [see Warnings and Precautions (5.7)].

5.7 Discontinuation of Treatment with CYMBALTA
Discontinuation symptoms have been systematically evaluated in patients taking CYMBALTA. Following abrupt or tapered discontinuation in adult placebo-controlled clinical trials, the following symptoms occurred at 1% or greater and at a significantly higher rate in CYMBALTA-treated patients compared to those discontinuing from placebo: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue.

During marketing of other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. Although these events are generally self-limiting, some have been reported to be severe.

Patients should be monitored for these symptoms when discontinuing treatment with CYMBALTA. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate [see Dosage and Administration (2.7)].

 

https://www.ncbi.nlm...les/PMC3229538/
"Although the risk of seizures with antidepressants is generally very low, the association with overdose is well established [80]. However, the molecular mechanisms by which antidepressants cause seizures have not been clarified. GIRK2 knockout mice exhibit spontaneous seizures and are more susceptible to seizures induced by pentylenetetrazol than wild-type mice [37]. The risk of seizures in overdoses with sertraline, duloxetine, mianserin, and venlafaxine significantly increases [80]–[82], and amoxapine overdose is more likely to cause seizures [83]. "
80. Montgomery SA. Antidepressants and seizures: emphasis on newer agents and clinical implications. Int J Clin Pract. 2005;59:1435–1440. [PubMed]
81. Whyte IM, Dawson AH, Buckley NA. Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants. Q J Med. 2003;96:369–374. [PubMed]
82. Isbister GK, Bowe SJ, Dawson A, Whyte IM. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. J Toxicol Clin Toxicol. 2004;42:277–285. [PubMed]
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http://www.psychforu...topic69139.html
This is a thread about seizures and Cymbalta you might want to check out.
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http://pi.lilly.com/...ta-Medguide.pdf
Under side effects the manufacturer (Eli Lilley) lists seizures as a possibility.
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http://www.ehealthme...mbalta/seizure/
84,701 people reported to have side effects when taking Cymbalta.
Among them, 598 people (0.71%) have Seizure
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#10 LS1978

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Posted 15 April 2017 - 05:49 PM

Thank you, fishinghat!!  I will be printing out this info for my psychiatrist.  I really don't think he knows about Cymbalta withdrawal at all.  When I began seeing him, I was already on Cymbalta.  I wonder if he even prescribes it to patients very much.  Who knows?  Maybe I'm one of the only patients he has who is on it.

 

It also looks like the odds of me having seizures are fairly low.  I think I'm going to try and taper off over a 6-week period, taking a pellet out each week if my body will allow.  I have an appointment with the psychiatrist in May, and I should be down to 2 pellets then (if I'm able to get down to 2 by then)...which I think should be fine if he's going to start me on Fetzima or Pristiq.

 

 

I've been having some dizziness, but haven't felt like passing out since Thursday, so hopefully it won't be a big problem.  I'm still wondering how that's going to go.





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