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#1 kitchenhag

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Posted 02 January 2019 - 12:01 PM

I have only recently started cymbalta and Dr. started me on 60 mg at the get go.

The side effects are worse than the nerve pain, for which I am taking it for. So I call and they tell me I have to wean off it! I am now on 30 mg for 2 weeks then 30 mg every other day for 2 weeks. What can I expect as far as withdrawal?

 

 


#2 fishinghat

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Posted 02 January 2019 - 02:00 PM

Welcome kitchenhag

First of all your dr is an idiot. There is an FDA warning against doing the every other day thing. Cymbalta has a 12 hour half-life which means that after 12 hours there is still half left in your system. So you take a 30 mg capsule at 8 am ON A Monday morning (example) and by 8pm you have 15 mg still in your system. At 8 AM on Tuesday ,morning you have 7.5 mg left in your system and 9PM Tuesday 3.7 mg. Then on the morning of Wed., your second day, you take another capsule and boot your blood levels back up again only to repeat the withdrawal all over again.

by going to the link below...
https://www.cymbalta...-your-symtpoms/

you can get an idea of the symptoms that people experience. In general it starts with digestive issues and cold/flu like symptoms, and dizziness. As those fade they are replaced by severe emotional issues, primarily anxiety. Then that goes to swings back and forth from anxiety to depression which slowly fades over several months.

We (and the FDA) recommend the bead counting method. a capsule and count the number of little beads inside. Lets say 300 beads. Remove 1% every day. So the first day you remove open the capsule and remove 3 beads and trake the capsule, the next day remove 6 beads, the next day 9 beads, etc. This provides for a nice even drop in the medication.

In your case, with you having been on it a couple weeks, I would suggest you go a little faster. Maybe a 5% drop each day (for the example of 300 beads that would be 15 beads. IF AT ANYTIME YOU FEEL THE SYMPTOMS START DO NOT TRY AND PUSH THROUGH IT. Don't underestimate the withdrawal. When the symptoms start just maintain your dose at its current level until the symptoms are gone. Then you can start reducing a little faster. If at any point the symptoms get to bad you can always go back up afew beads and then stabilize.

We are always around so feel free to come back with any questions you might have. Always glad to help.


#3 invalidusername

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Posted 02 January 2019 - 07:12 PM

Welcome kitchenhag!

 

Hat went straight to the mark - yes, your Doctor needs talking to.

 

If not for anything else, one does not jump direct to that dose without first trying a lower dose to make sure you first get on with it, which in your case would have been well worthwhile.

 

You say you have started it "recently" - so just how long ago are we talking? That way we can give you a better idea of weaning off the stuff. It can also be an indication of the symptoms you have already had.

 

And absolutely do not take it every other day as Hat says. No way. You will get a mini-withdrawal for each day you don't take it.

 

You are in safe hands here - keep in touch if you need anything.


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Posted 02 January 2019 - 08:59 PM

 There is an FDA warning against doing the every other day thing.....We (and the FDA) recommend the bead counting method. 

fishinghat, Where is this warning against taking it every other day specified?  I can't find it.  Also, where does the FDA recommend bead-counting as the way to discontinue?  I'd like to show this to my doctor, but I don't see it in any Cymbalta literature.  Thanks!


#5 kitchenhag

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Posted 02 January 2019 - 09:57 PM

I started cymbalta about 1 month ago. It seemed okay at the beginning and does help with nerve pain.
The down side is insomnia, RLS..stomach pain and so on. I have been on the 30 mg since Sunday,so 4 days.

#6 fishinghat

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Posted 03 January 2019 - 08:44 AM

fishinghat, Where is this warning against taking it every other day specified?  I can't find it.  Also, where does the FDA recommend bead-counting as the way to discontinue?  I'd like to show this to my doctor, but I don't see it in any Cymbalta literature.  Thanks!


I noticed this document has been removed from the server or maybe it is because of the government shutdown. Anyway the items below were taken directly from the document.

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

The following 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

Physicians can not make an accurate comparative assessment of Cymbalta vs. alternatives

Patients can not make an fully informed choice to take the drug

Practical effects (common in anecdotal reports):Patient becomes totally distrustful of the physician who did not advise/warn them in the first place

Doctor /patient relationship is wrecked

Patient in distress refuses to ingest Cymbalta under any pretext

Tapering is taken off the table

Patient fires the doctor or the doctor disengages from the patient

Syndrome mood swings militate anger directed at the physician

Physician may deny syndrome even exists

Physician may jettison a newly “difficult” patient

Physician seeks to avoid malpractice implications

Patient becomes deeply suspicious of any psychotropic medication

Underlying problem may go untreated


This is a process flaw – there is no excuse for it


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 taperingPatient required to open capsules and count drug beads
Patient may require compounding pharmacy servicesAt his/her expense

Tapering may take weeks or months
 


#7 fishinghat

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Posted 03 January 2019 - 08:59 AM

I also found this quote. I will try to find a full copy of the document referred to above as well.

Norther - In Joseph Glenmullen's book, 'The Antidepressant Solution' (devoted to withdrawal), he states the situation very clearly, on p.97:
"Q. Can antidepressants be taken every other day as part of tapering off them?
A. None of the short acting antidepressants should be taken every other day as a method of tapering them. Because of their short half-lives, the every other day schedule can result in roller coaster levels of the drugs and roller coaster levels of withdrawal symptoms."
However, patients seem to be told, time after time, to withdraw by alternating doses or missing out days - a surefire recipe for destabilising drug levels, and putting the patient through needless physiological chaos and withdrawal nightmares

#8 fishinghat

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Posted 03 January 2019 - 09:11 AM

OK, I finally found the entire document. I better save this off before I loose it.

https://wayback.arch...e/UCM172866.pdf

Nothing in there on the every other day usage. I will continue to look. If I remember right the document above recommends the bead counting method 'as the only option' but does not mention the every other day method.

I will continue looking.

#9 fishinghat

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Posted 03 January 2019 - 09:22 AM

I couldn't find anything else on the FDA position on the every other day method.

#10 kitchenhag

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Posted 03 January 2019 - 10:08 AM

Has anyone used benadryl with cymbalta? For the itches?

#11 fishinghat

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Posted 03 January 2019 - 10:20 AM

Yes many have and with good success. I might also suggest you go to the Medical Support section and find the thread called Summary of Cymbalta Withdrawal. It is a summary of what everyone has tried and their successes and failures. Just do a search for the word itch or itching and you will probably find several suggestions.


#12 kitchenhag

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Posted 03 January 2019 - 11:22 AM

Thank You!
So, the bead counting? How do I start?

#13 invalidusername

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Posted 03 January 2019 - 11:41 AM

Get yourself a clean container like a medical sample tube or similar where you can keep the spare beads, then it you can bear it, empty all your beads into this container and count out your beads for the capsules from there.

 

Why can't I just take beads out as it would be quicker you might ask. 

 

Not all capsules contain the same amount of beads, so in order to be consistent and aid the withdrawal process, it is better to count up. Alternatively you can get some micro scales and weigh the beads.


#14 kitchenhag

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Posted 03 January 2019 - 01:22 PM

How many do I take each day. Is there a chart? I am not thinking clearly and can't figure this out.

#15 fishinghat

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Posted 03 January 2019 - 01:57 PM

First of all go ahead and count the number of beads in your capsules. What brand are you using?


#16 invalidusername

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Posted 03 January 2019 - 04:01 PM

Yes - as painful as that first count is, you will soon get used to it!

 

We can then help you from there with the "medicine maths". We have done this more time that had hot dinners, so feel free to ask - it is natural to be a little uneasy about the experience, which is why people are angry for Eli Lilly (the manufacturer) to not have supplied people like us lower does to withdrawal on.


#17 kitchenhag

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Posted 03 January 2019 - 05:59 PM

The brand is duloxetine Hcl Dr 30 mg cap
There are 104 beads in one capsule.

#18 invalidusername

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Posted 03 January 2019 - 06:13 PM

OK - that is useful - so give or take, we can call it 1% = 1 bead.

 

Therefore, 10% would be 27mg and would be 90 beads. That would be a safe starting point as you have only been on it a month. I would recommend you give that at least a week and see how the symptoms go. This will then dictate how you can then proceed to ween off the rest.

 

Following this, it would be a case of a similar pattern until you get down to 10mg, then the brakes need to go on regardless of how well the previous 20mg have gone. Trust me. The last 10mg nearly always catches people out.

 

If you change pills supplies, we need to re-evaluate by counting beads again. No 2 capsules from different pharm's have the same number of beads.

 

What are your thoughts 'Hat?


#19 fishinghat

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Posted 03 January 2019 - 06:26 PM

I agree with everything but the 10%. Some are very sensitive at this level so I would start with a drop of 1% a day and see how it goes. I always say the slower the better.


#20 kitchenhag

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Posted 03 January 2019 - 06:27 PM

Okay I understand better now. Are the beads the same strength no matter the mg of the pill?

#21 invalidusername

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Posted 03 January 2019 - 06:48 PM

No - you can have a 30mg capsule with 100 beads, or you can have a 30mg capsule with 200 beads. Therefore the first pill would have beads twice the strength of the second, which is why I say, when you refill your prescription, it would be wise to count the beads again - even if it is the same brand as batches will often vary from one to the other. Odd you might say, but we have seen it here!!

 

OK - so if Hat is recommending 1%, this would be 1 bead, but you wouldn't do this per week otherwise it will take you 2 years (although this is reality for some!)

 

So if we go 1 bead/day it might be a little easier on the symptoms rather than a weekly drop, even though you might be perfectly alright - but I will side with our cautious leader here! He is absolutely right to be cautious however... as should we all.


#22 kitchenhag

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Posted 03 January 2019 - 08:00 PM

Okay so day 1- I remove 1 bead, day 2-
2 beads and so on. Until I get down to 10 beads Then I do what?

#23 invalidusername

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Posted 03 January 2019 - 08:13 PM

Correct.

 

But until you reach 10mg, not 10 beads. This will be when you get to around 34 beads.

 

It will be a case of seeing how the taper has gone at that point. If you have had minimal issues, then you will be alright to continue doing 1 bead/day, but it is wise to proceed with caution at this point, so perhaps a bead every other day. Everyone is different, but a slow taper will always guarantee a better result.

 

When I reached 10mg, my doctor took the last of my beads away and told me to stop saying I would be fine. What I then went thru can only be described as hell. I was begging them to give me them back knowing it would help my symptoms, but they did not. I would not wish this on anyone... and I was only taking 60mg for 10 weeks.


#24 gail

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    5 months on cymbalta, scary side effects, to get help and to return the favor if I can.

Posted 04 January 2019 - 10:34 AM

Kitchenbag,

Welcome. I find the one bead a bit slow, and I wouldn't like to see you having to take Cymbalta any longer that you need.

I would start with 2-4-6 and so on. If all goes real good, you might want to try 3-6-9

Stay with us, any questions, we're here for you.

#25 invalidusername

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Posted 04 January 2019 - 01:08 PM

Difficult to say as always. We never know how sensitive people can be. But i'd go 2 to begin with...

#26 DepressedGramma

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Posted 07 January 2019 - 06:56 PM

I am befuddled by the whole bead thing!!
So after removing appropriate amount of beads, you throw the remaing capsule out? Or do you swallow what's left?

#27 DepressedGramma

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Posted 07 January 2019 - 07:02 PM

Fishing hat, I clicked on the link containg the document a few posts back. It is dated 2009. Is there a more recent one? Thank you!!

#28 fishinghat

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Posted 07 January 2019 - 07:03 PM

Open a capsule and remove 2 beads and leave the rest in the capsule. Take the capsule. The next day remove 4 beads and take the rest in the capsule. Save the beads you remove you can use them later if you start running low on Cymbalta.


#29 fishinghat

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Posted 07 January 2019 - 07:06 PM

That is thee last statement on Cymbalta withdrawal from the FDA that I know of.


#30 DepressedGramma

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Posted 07 January 2019 - 07:13 PM

Fishing hat, I clicked on the link containg the document a few posts back. It is dated 2009. Is there a more recent one? Thank you!!



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