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Tapering With Duloxetine


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#1 Wildcarota

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Posted 13 March 2019 - 11:47 AM

Hi All, I'm new here but have been reading a lot of the forum posts. I really like how supportive and open you all are. I belong to a couple of Facebook groups that are very militant and rigid about tapering, supplementation, bridging, etc so I don't dare post or ask questions there!

 

I've been on 60 mg of cymbalta for 3 years and want to get off. I am also on Lexapro 20 mg (15 years!), but I want to start with the cymbalta and then proceed to the lexapro. I see a GP who will prescribe medications for me but will not help with any changes of medication. In the past I have seen a very uncooperative, authoritarian psychiatrist for these meds. I am on them for anxiety and depression.

 

I'm on the generic duloxetine which, at 60 mg, has 12 beads in it. I am removing 1 bead every 7 days provided withdrawal symptoms are low/manageable. I suspect that when I get to the lower doses I will likely need to hold for longer than 7 days. 

I am supplementing with great results with l-theanine, l-tyrosine, sam-e and cbd oil. I am currently at 7 beads or 35mg.  

 

I suspect many would say removing one bead every 7 days is too fast and that when I get to lower doses it will be harder to safely slow taper, given the large beads. My issue is that my insurance covers very few psychiatrists (and very few in this city are even accepting new patients) so I don't know that I will be able to get a new/diff. prescription. I want to keep tapering with the current script I have and not say anything to my GP nor my (former) psychiatrist.

 

Any suggestions, comments or ideas about tapering on the 12 bead duloxetine given that I'm having very few withdrawal symptoms and I'm on lexapro too?

 

THANKS!


#2 invalidusername

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Posted 13 March 2019 - 12:02 PM

Hi Wilcarota and welcome.

 

It sounds like you have got yourself off to a good start with what you have read and your supplements. I'm a little surprised that you are on Lexapro 20mg as well as 60mg Duloxetine - for a lot of people this wouldn't be tolerated and could easily cause serotonin syndrome. I do not think there is any way to determine which would be best to taper first. I would argue that the large bead duloxetine might indeed get difficult as you go on, but then again, if you have been ok so far, there may be a clearer road ahead of you. I would suggest you continue on your present trajectory whilst listening to your body at all times. If things start to get tough, hang where you are in order to stabalise. Worst case scenario I think you need to get the "regular" beaded duloxetine and go slower - but we'll deal with that as and when.

 

Good job so far! 


#3 fishinghat

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Posted 13 March 2019 - 12:20 PM

You are on the right track but the one bead every 7 days is way way too fast. That is a 33% drop each month. I normally recommend a 4% or less drop per month. I am afraid this will really jump up and bite you hard. That means you will need to weight your 12 beads and save a little off of them to get a small drop. Those who have had this issue ( low number of beads0 in the past have had their pharmacist change them to the brand name Cymbalta by Eli Lilley which has around 300 beads more or less.

#4 Wildcarota

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Posted 13 March 2019 - 12:24 PM

Hi guys and thanks for the thoughtful replies. I have to admit I find the wholly conflicting advice hard to absorb. How does one make a good decision when 2 very knowledgeable people give such conflicting advice?


#5 fishinghat

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Posted 13 March 2019 - 01:48 PM

I think that IUN just saw the 1 bead every 7 days and was thinking this was about right for a normal Cymbalta capsule (300+ beads). I don't think he realized the 12 bead total. He posted earlier he was having a hard time with his own withdrawal so he may not have been thinking clearly. Having said that, I hope I don't have to eat my words later. lol. You are at 35 mg right now so it is about time to consider slowing down anyway when you drop below 30 mg.

He will reply later and clarify.

I just noticed that you are on Sam-e with the Lexapro as well as the Cymbalta. Sam-e can cause serotonin syndrome just by itself let alone with the two antidepressants. There are warnings for taking these products together.

#6 Wildcarota

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Posted 13 March 2019 - 01:53 PM

Thanks for the reply. I also wondered about mixing in the sam-e. I will take your advice and slow my taper down and eliminate the sam-e. :D


#7 invalidusername

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Posted 13 March 2019 - 04:01 PM

Hmmm - we are looking at a 3-month withdrawal doing 7 days per bead. I was going on the assumption that you are half-way through to have reached your 35mg. If this has been plain sailing to this point, then you are certainly fortunate, and whilst I feel this may continue for the next couple of beads (but only in your situation - Hat is right that this usually doesn't pan out) I do think you should prepare to put the brakes on after that. 

 

You could do a preemptive strike on this and reduce now to save any nasty surprises. What you need to consider is the logarithmic reduction of medicine rather than the mg - for example, the 12 mg at 60mg is 20%, but 12mg at 24mg is 50%, so each drop, you are increasing the amount you are dropping by, which is why it generally gets tougher the lower you go. I hope that makes sense.

 

The choice is yours, but if it were me, I would consider one more big bead if you are feeling fine, but then go with the smaller drop after that. The exact rate of this drop would be determined by how you feel when you go from the next bead.

 

Hat is very learned about this stuff and again he is right that I did come off too soon at the end of my taper. If I had the choice I would have reinstated and gone slower towards the end... but alas, I was not given this choice and thus suffered as a result. 


#8 fishinghat

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Posted 13 March 2019 - 04:04 PM

By the way I like your avatar. It looks like Daucus carota. Queen Anne's lace. That is a very common plant around where I live. It is not native to the USA but was introduced. A distant cousin of the carrot.

Of course that explains the name "wildcarota".

#9 KathyInFL

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Posted 13 March 2019 - 06:45 PM

Wildcarota, you will probably have to change generics to get the Cymbalta that has the 300 little beads, the ones that have the 12 bigger beads will make you wean at a higher percentage than recommended. I don't remember which brand has the smaller beads, but I can find out for you. However you might be one of the lucky ones that can wean faster! Good luck!

#10 gail

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

Posted 13 March 2019 - 07:39 PM

Welcome Wildcarota,


I'm with Kathy here concerning the switch to small beads. Much smoother taper that way.

Kathy, can you find out which company that makes it? Thanks! Oh, and I would definitely taper Cymbalta first, Lexapro will be like a cushion for hard times.

#11 invalidusername

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Posted 13 March 2019 - 08:03 PM

Somewhere on the site there is an inventory of how many beads are in which brand - I have tried looking for it, but can't find. But it is here somewhere as I have seen it!


#12 KathyInFL

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Posted 13 March 2019 - 09:28 PM

As soon as I get home tomorrow I'll see if I can find which brands have the micro beads.

#13 gardenlady

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Posted 13 March 2019 - 11:57 PM

Wild, Just saw this thread and thought I'd hop in here with info on generic duloxetine brands that have the microbeads suitable for slow tapering.  They all have different bead counts, even within one manufacturer, so you have to count the number of beads in several capsules in your prescription bottle and then compute the average.  Then, it's necessary to count the beads that you ingest....not that you eliminate...in order to get a consistent dose.  The number of beads can differ in capsules within a given prescription by around 10% or more. 

 

Citron

Sun

Prasco

Breckenridge

Camber

GSMS

Teva -- Getting hard to find as the company is in financial straits and eliminating production sites resulting in temporary unavailability.  It may be safer to avoid for this reason.

 

I wish you all the best in this.  It sounds like you're off to a good start if you're already down to 35 mg from 60 mg and not having much difficulty.  Perhaps you'll be one of the fortunate ones!


#14 fishinghat

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Posted 14 March 2019 - 08:31 AM

This is the info from Summary of Cymbalta Withdrawal.

Bead counting data
Lupin - 7 -12 large beads Yes*
Solco - 146 - 157 beads Yes
Prasco - "Large number of beads" Yes
Teva - Approximately 315 beads Yes
Breckenridge - Unknown Yes
Citron - Small beads, approximately 300+ Yes
Devo - 150 beads Europe
Apotex - various size beads in each capsule as well as various number of beads. Yes
Cymbalta - 250 to 350 beads Yes
Tixal - 60 mg - 88 beads
Andepra AN - 30 mg - 56 beads
Ajanta Pharma - 70 beads
Cymgen - 569 beads

* Yes indicates that this brand is available in the USA.

#15 invalidusername

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Posted 14 March 2019 - 09:07 AM

That's what I was looking for last night... thanks Hat


#16 Wildcarota

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Posted 14 March 2019 - 11:45 AM

HI All, This has been very helpful, thank you! I've decided to put the breaks on early and keep at 35mg for 2 weeks and try to get my next prescription with the smaller bead varieties so I can more slowly and safely continue my taper.

 

This may sound funny, but do I just ask the pharmacy for a different generic by name? Do I need to give a reason? Are they cooperative with this? I thought there were only two options, the name brand and ONE generic/brand and had no idea there were so many available! I have a huge distrust of those in the medical field and try to minimize my interactions with them, including asking them for anything... But I suppose I'll have to get over that.

 

BTW, my profile pic and name are based on Queen Anne's Lace. They were plentiful where I grew up and I really like them :)


#17 invalidusername

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Posted 14 March 2019 - 11:51 AM

Good for you Wildcarota - we're all behind you.

 

You might find that the pharmacy only carry the one brand - this is often the case. They go with whoever has the "best deal" or the biggest incentive at the time of ordering new stock. Therefore they may need to order something in for you, but there is no harm in explaining the situation and I would have thought they would have no harm in complying with your request. In the UK we can go online and choose from any number of pharmacies and send in our prescription to get what we prefer. 

 

When a big pharma like eli lilly loose their hold and go generic, a lot of companies jump on the band wagon and make money. This is a big dent in their kitty when this happens, but only right that they should not have the monopoly for too long.


#18 Wildcarota

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Posted 14 March 2019 - 11:56 AM

I just went online and see that NONE of the other generics are available in my area (maybe they can special order for me). AND the name brand (cymbalta) is NOT covered by my insurance so if I pay for it out of pocket I'm looking at $250 minimum a month. WOW. This may change my plan...


#19 invalidusername

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Posted 14 March 2019 - 12:08 PM

I am sure they will help - but if you absolutely have to stick to the large beads, you will need to invest in a set of microscales and start shaving the beads to get the relevant weight. It will be a bit of a mission, and you might have to take the morning off to get a handful of capsules done, but it is a workaround, and the dividends WILL pay off as everyone here concurs.

 

If you need help with any of this, please just ask as many have done the microscale method and managed just fine. You might feel yourself a bit of a drug junkie surrounded by scales and white powder (!), but bottom line, is it is do-able :)


#20 Wildcarota

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Posted 17 March 2019 - 01:07 PM

Ok, so I went to the pharmacy and explained what I'm looking for. I now understand that it's still Duloxetine that I want, but from a manufacturer that creates capsules with small beads. The pharmacy was not helpful and couldn't seem to understand what I was asking. A manager is supposed to look into ordering the type I want and get back to me, haven't heard anything yet. Will follow up with them tomorrow though. Now that I better understand what I'm asking/looking for, I think I can easily go to another pharmacy until I find one that stocks or can order the kind I'm looking for. 

 

Also did the math more like how you all explained and realized that a 10% reduction at a time is going to take me a LOT longer than I originally anticipated to get off this stuff. Bummer.

 

Thanks for all your help. Not sure that even with all the reading I've done, I would have totally understood these nuances!


#21 invalidusername

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Posted 17 March 2019 - 02:31 PM

Just glad we could help, and that you found us here!

 

I am positive that if you went to another pharmacy that they would have the multi-bead items. The ones with the big beads are not that common by comparison. 

 

Please keep us updated on how you get on.





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