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Withdrawals And Whether I Should Use Bead Count To Help With Symptoms


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#1 rwa12141977

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Posted 30 May 2016 - 06:18 PM

I, without knowledge of how it should be done, stopped taking Duloxetine 30mg cold turkey about 12 days ago. I am continuing to get brain zaps, occasional emotional symptoms and also the vivid dreams. While the symptoms are not extremely bad, they are still frequent. Would it be wise to use the bead counting method from my remaining duloxetine to help with the symptoms?


#2 gail

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Posted 31 May 2016 - 05:32 AM

Hello rwa and welcome,

This is up to you, depends if your symptoms are manageable.

You could do fine, we don't know, no one has the same reactions.

At two weeks in, it's not too late to go back on the 30mg and bead count.

I am sorry but I have no definite answer for you. How long were you on this? For what condition?
Being young makes it more manageable, so they say. Anxiety? Pain?

Come anytime to the forum for whatever questions you may have.

It could be an easy ride for you....or not!

#3 fishinghat

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Posted 31 May 2016 - 08:20 AM

Welcome RWA

 

I have to agree with Gail. It is hard to tell how difficult it will be for you. In the event you wanted to go back to 30 mg and bean count do you have a prescription for more so that you will have enough to work with?


#4 rwa12141977

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Posted 31 May 2016 - 03:35 PM

After today, which was horrendous, I have gotten back on my 30 mg of cymbalta. This morning, being about the 2 week mark of having quit 30 mg cold turkey, I almost broke down at work and had to come home. On top of that, I called my CVS pharmacist and they since I have been taking 30mg for about 6 months (originally prescribed for depression) the withdrawal symptoms could last a couple of months. That was the straw that broke the came's back. I came home and took another 30mg tablet. I plan to see my doctor soon and I guess I will drop to 20 mg and then to bead count. I hope this helps. This medicine is a fucking nightmare!


#5 fishinghat

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Posted 31 May 2016 - 04:42 PM

RWA

 

Good move. A nightmare it is.


#6 gail

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Posted 31 May 2016 - 06:42 PM

Rwa,

Yes,good move as FH mentioned, you will be stable real soon.

After that breathing period,when ready, bead count your way down.

Always here for you my dear.

#7 zivcha

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Posted 03 June 2016 - 03:01 AM

be strong rwa.

i also thing that you have a good plan now.

 

god bless.


#8 Inge

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Posted 28 June 2016 - 12:41 AM

My son (53) is going through a horrific experience regarding discontinuation of Cymbalta.

Diagnosis: Major Clinical Depression.

His doc has recently doubled the initial 60 mg dose (which is supposed to be the maximum therapeutic dose) to 120mg. Side effects unbearable.

When my son reported the side effects to the doctor (impaired cognitive function, memory problems, etc.), he prescribed yet another pill: Aricept, which is usually given to people to slow down Alzheimer symptoms! This finally broke the camel's back!

Next, we have been looking for a different psychiatrist who is less pill-happy.  Meanwhile, we took matters into our own hands (ass it turns out -- big mistake!) and started the reduction -- while still looking for a different doc at the same time. 

He started with a 10% reduction for 1 week; then another 10%, now being down to 90 mg.

What we did not know is that dividing a capsule into smaller segments ("beads") is dead-wrong! 

He finally checked with his pharmacist who told him that if one opens a Cymbalta capsule, then the formulation is destroyed and the medication releases in different parts of the body incorrectly. This can be dangerous and can cause mood swings, which is exactly what he has been experiencing. (Wish he had checked this out sooner.)

It is only in the last few days that we finally found a holistic clinic whose approach is quite different. They will, among other things, manage the gradual discontinuation of all 3 drugs (Cymbalta, Wellbutrin, Lithium).

I felt that I wanted to put this situation into this forum so others won't make the same mistake.

Thank you.

 

 


#9 fishinghat

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Posted 28 June 2016 - 08:35 AM

I sincerely appreciate your post and wish your son the best. I have done extensive searching in the medical journals considering the effects of opening the capsules. I can find no research on the issue therefore I can not take a position on your pharmacists claim. I can add one bit of subjective information on this subject. If one reviews the personal histories of withdrawal on this site they will find that the mood swings and other symptoms for withdrawal is relatively the same whether cold turkey or with bead counting. Just while bead counting one has more control on their severity. Just an opinion. I would be most interested in the source of the pharmacists opinion. But in any case, I do truly wish your son the very best and easy recovery. If his experience is a good one we would be most interested in the approach. Post like yours today and any further info you can supply in the future is how we learn and we do want to give the very best option to those suffering from the withdrawal.


#10 fishinghat

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Posted 28 June 2016 - 09:24 AM

This information was really hard to find but did bring up some interesting questions.

https://www.ncbi.nlm...pubmed/25325120

Prescrire Int. 2014 Sep;23(152):209-11, 213-4.
Crushing tablets or opening capsules: many uncertainties, some established dangers.
Abstract
For patients who have difficulty swallowing, a common solution is to crush tablets or open capsules. What are the consequences of this practice? We reviewed the main evidence available using the standard Prescrire methodology. The clinical consequences for the patient of crushing tablets or opening capsules can be serious: alteration of the drug's absorption can result in sometimes fatal overdose, or conversely underdosing, rendering the treatment ineffective. When it disrupts a drug's sustained-release properties, the active ingredient is no longer released and absorbed gradually, resulting in overdose. When a gastro-resistant layer is destroyed by crushing, underdosing is likely. The active ingredient released may degrade on contact with light, moisture or the food with which it is mixed for administration. The person who crushes the tablets or opens the capsules is exposed to drug particles, which may be carcinogenic, teratogenic or fetotoxic. They are sometimes allergenic. In practice, there are many drugs that should never be crushed or opened. Before crushing a tablet or opening a capsule, it is better to consider and research the impact it will have on the drug's effects. It is sometimes preferable to use a different dosage form, or a different active ingredient

"The active ingredient released may degrade on contact with light, moisture or the food with which it is mixed for administration. The person who crushes the tablets or opens the capsules is exposed to drug particles, which may be carcinogenic, teratogenic or fetotoxic. They are sometimes allergenic."
Comment -These statements seems invalid as any carcinogenic, tetragenic, fetotoxic or allergenic components would be consumed whether the tablet where opened or not. Now I will admit it is logical that when opening a capsule or crushing one, the added surface area will increase the rate of absorbtion and go into the blood stream faster. However, the exposure of medicine to the acidic environment in the stomach could alter the composition of the medicine and its absorbtion, especially if the medicine is water soluble.

https://www.ncbi.nlm.../pubmed/2595104
Respiration. 1989;55(4):210-3.
Theophylline serum levels in children with bronchial asthma after administration of slow release theophylline as open or closed capsules.
Naspitz CK1, Solé D.
⦁ Abstract
Theophylline serum levels were studied after oral administration of slow release theophylline (Talofilina) in children with bronchial asthma. The children received the drug as closed capsules or as granules, obtained by opening the capsules, for 1 week in each form. The mean dose used was 8.6 mg/kg every 12 h. The theophylline blood levels at 4, 8 and 12 h after drug ingestion were significantly lower when granules from open capsules were used. Our recommended dose of Talofilina for Brazilian children is 16 mg/kg/day, if administered as closed capsules, every 12 h. On open capsule administration every 12 h, the total daily recommended dose is 20 mg/kg/day.
Comment - Interesting. The use of an open capsule with beads resulted in slower drug absorbtion.

http://www.nature.co...jg2000744a.html
The American Journal of Gastroenterology 95, 2448 (September 2000) | doi:10.1111/j.1572-0241.2000.02487.x
Esomeprazole open capsule mixed with applesauce is bioequivalent to the intact capsule when administered to healthy volunteers
Tommy Andersson, David J Magner, Jay B Patel, Paul Rogers and Jeffrey G Levine
Abstract
Purpose: To determine whether an open capsule of esomeprazole (NEXIUM™) 40 mg (OC) in applesauce is bioequivalent to an intact capsule (IC).Methods: In a randomized, single-center, open-label crossover, pharmacokinetic study consisting of 2 study days separated by a minimum 7-day washout period, 45 healthy volunteers (21 males) aged 18 to 45 years received a single dose of OC or IC in a randomized sequence.

Comment - No noticable effect on efficacy of medicine by opening capsule. This medicine is designed to be released in the stomach.

http://www.ismp.org/.../DoNotCrush.pdf
Oral Dosage Forms That Should Not Be Crushed
"Cymbalta (DULoxetine), Capsule Slow‐release, (a) (Note: may add contents of capsule
to apple juice or applesauce but NOT chocolate)"

Comment - This would suggest opening the capsules is acceptable. Cymbalta is fat soluble and vertually insoluble in water so exposure to the medicine in the acidic contents of the stomach is less likely to have an impact.


#11 fishinghat

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Posted 28 June 2016 - 09:32 AM

http://www.fda.gov/d...s/ucm103473.pdf

WOW

 

It is most important to note that we do NOT recommend opening the capsule, removing a few beads and then take the rest of the beads orally. The remaining beads should be put BACK in the capsule and then taken so its original design criteria is met.


#12 fishinghat

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Posted 28 June 2016 - 09:36 AM

From the Cymbalta manufacturer's insert.

"Swallow CYMBALTA whole. Do not chew or crush. Do not open the capsule and sprinkle its contents on food or mix with liquids. All of these might affect the enteric coating. CYMBALTA can be given without regard to meals."

 

This would indicate to me that the medicine may be absorbed faster but not altered in any way. It could also be absorbed in the stomach where it is more likely to cause stomach irritation.


#13 Inge

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Posted 28 June 2016 - 01:02 PM

Thank you, God-like, for the extensive research you have done regarding my earlier post today. It is very much appreciated, although I do not have the wherewithal at the moment to read all of the links.

What the pharmacist had told my son yesterday was actually confirmed by a physician today. That is good enough for me.

I am sorry to say out loud that the Cymbalta manufacturer's insert can go to hell, as I have ceased to trust in the pharmaceutical industry altogether --  no matter what they say.

However and again, many thanks for your meticulous research. It has been my experience in reading a  multitude of books on antidepressants over the years, that one gets almost as many different opinions as there are doctors. In the end, our personal experience is what counts. There definitely is a place for ADs but for some of us (and I am one of them) they simply do not work. They call us "treatment-resistant"........

I shall report back in due time as the new course of treatment (a more holistic one) is  not a quick fix.


#14 lady2882Nancy

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Posted 28 June 2016 - 02:49 PM

Is this not why we have told people to reseal the capsule and if they want to save the beads then they should get the empty capsules from a pharmacy or online to store the beads in?

This is the way we did the bead counting when I was bead counting my way off and many that tried it did so successfully.


#15 Carleeta

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Posted 29 June 2016 - 06:00 PM

Inge.

 

Hoping you find the best way for your son to come off of this nasty drug.  Please do keep us posted on your son's progress.  Would most definitely like you to share your son's (you too mom) progress with us as we too would like to learn of other methods which might be suitable for new members here.  Best of luck to you and your son


#16 emoothart

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Posted 18 July 2016 - 02:10 AM

Seems like as long as we close the capsule after removing some beads, nothing will really have changed.





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