Jump to content



Photo

Tapering With Duloxetine


  • Please log in to reply
46 replies to this topic

#1 Wildcarota

Wildcarota

    Newbie

  • Members
  • Pip
  • 6 posts

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

invalidusername

    God-like

  • Site Supporter
  • 3,519 posts
  • LocationKent, UK

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

fishinghat

    God-like

  • Active Members
  • PipPipPipPipPipPipPipPip
  • 10,633 posts
  • LocationMissouri

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

Wildcarota

    Newbie

  • Members
  • Pip
  • 6 posts

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

fishinghat

    God-like

  • Active Members
  • PipPipPipPipPipPipPipPip
  • 10,633 posts
  • LocationMissouri

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

Wildcarota

    Newbie

  • Members
  • Pip
  • 6 posts

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

invalidusername

    God-like

  • Site Supporter
  • 3,519 posts
  • LocationKent, UK

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

fishinghat

    God-like

  • Active Members
  • PipPipPipPipPipPipPipPip
  • 10,633 posts
  • LocationMissouri

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

KathyInFL

    Like a Family Member

  • Site Supporter
  • 530 posts
  • LocationSouth Florida

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

gail

    God-like

  • Site Supporter
  • 5,591 posts
  • LocationSherbrooke, PQ
  • why_joining:
    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

invalidusername

    God-like

  • Site Supporter
  • 3,519 posts
  • LocationKent, UK

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

KathyInFL

    Like a Family Member

  • Site Supporter
  • 530 posts
  • LocationSouth Florida

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 Guest_gardenlady_*

Guest_gardenlady_*
  • Guests

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

fishinghat

    God-like

  • Active Members
  • PipPipPipPipPipPipPipPip
  • 10,633 posts
  • LocationMissouri

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

invalidusername

    God-like

  • Site Supporter
  • 3,519 posts
  • LocationKent, UK

Posted 14 March 2019 - 09:07 AM

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


#16 Wildcarota

Wildcarota

    Newbie

  • Members
  • Pip
  • 6 posts

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

invalidusername

    God-like

  • Site Supporter
  • 3,519 posts
  • LocationKent, UK

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

Wildcarota

    Newbie

  • Members
  • Pip
  • 6 posts

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

invalidusername

    God-like

  • Site Supporter
  • 3,519 posts
  • LocationKent, UK

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

Wildcarota

    Newbie

  • Members
  • Pip
  • 6 posts

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

invalidusername

    God-like

  • Site Supporter
  • 3,519 posts
  • LocationKent, UK

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.


#22 DavidfromTexas

DavidfromTexas

    Member

  • Members
  • PipPip
  • 12 posts

Posted 06 August 2019 - 09:46 PM

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.

 

 

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!

 

Hey Guys. I am brand new to this forum. I joined the Survivingantidepressants.org forum a couple weeks ago when I started going through the first real difficulties after coming off Duloxetine at the beginning of July.

 

I will probably be a frequent poster here as well, but for now I am wondering about something specific. I am located in Los Angeles, CA and I have been getting my prescriptions from Rite Aid lately (before Rite Aid I used CVS, but changed when I moved to a different neighborhood, UNAWARE of the fact that changing manufacturers is apparently not recommended).

 

At this moment, after reading the posts in this thread, I am wondering about the manufacturer that makes the prescription that I have been getting from Rite Aid. It is a 20mg Generic Duloxetine Delayed-Release prescription that I have been opening up, and then counting and dividing beads. I am currently on a reinstatement dose of 1mg (which in this manufacturer's case is 6 beads), but I am about to go up to 8 beads this evening to see if I notice any improvement.

 

The company listed on my prescription bottle is Rising Pharmaceuticals. I am wondering if this manufacturer is "suitable" to use for tapering, as I did not see it in the list provided by either of you.

 

When opening up the 20mg capsules, I came up with an average of 115 beads (from an average of 5 different capsules). I would think that these are the kinds of "micro-beads" that you guys are referring to as being good for tapering, but I would just like to make sure while I am still early in the game. Perhaps I could still find a pharmacy that uses one of the other generic manufacturers y'all listed above.

 

A secondary question...I am not exactly sure how much longer I will be located in California. I may be going back home to Texas sometime in the near-ish future. Will it be a big problem if I cannot find a pharmacy in Texas that uses Rising Pharmaceuticals drugs? If so, perhaps it would be better to jump into my alternate plan of using the PCCA Compounded powder/capsule formula, and I know for sure that there are Compounding Pharmacies in Texas that are PCCA Members so the switching manufacturer/provider issue would not be an issue.

 

 

ONE LAST QUESTION:

 

I am still unclear as to whether or not the capsules themselves are enteric coated, or if it is only the beads inside them that are enteric coated. Does anybody know the answer to this question?

 

This makes a difference because what I have been doing since I've been dividing up the beads into small doses is I have been putting them BACK INTO their original 20mg capsules in order to take them (that way I know I can control the capsule factor). BUT the capsules are difficult to get apart and sometimes they crack which renders them unusable. And this also means that I will not have enough of those capsules to use for the whole month. So I need to know if I need to look specifically for Enteric-Coated empty capsules or if the empty capsules can be just plain old gelatin...

 

 

Thanks in advance for your help!


Edited by DavidfromTexas, 06 August 2019 - 10:07 PM.

#23 invalidusername

invalidusername

    God-like

  • Site Supporter
  • 3,519 posts
  • LocationKent, UK

Posted 07 August 2019 - 10:03 AM

"I am still unclear as to whether or not the capsules themselves are enteric coated, or if it is only the beads inside them that are enteric coated. Does anybody know the answer to this question?"

 

This has gone through many stages of debate and the conclusion is that the capsules certainly need to be enteric coated - do not use the gelatin only capsules. There is a thread on here somewhere with all the details, but appropriate peer-reviewed journal and patient information direct from the manufacturer was taken into account during the decision, so it is for sure the correct way to go...


#24 fishinghat

fishinghat

    God-like

  • Active Members
  • PipPipPipPipPipPipPipPip
  • 10,633 posts
  • LocationMissouri

Posted 07 August 2019 - 10:07 AM

"When opening up the 20mg capsules, I came up with an average of 115 beads (from an average of 5 different capsules). I would think that these are the kinds of "micro-beads" that you guys are referring to as being good for tapering, but I would just like to make sure while I am still early in the game."

That will work. The advantage of a brand with m ire beads is that you can do a smaller mg drop if you desire.

"Will it be a big problem if I cannot find a pharmacy in Texas that uses Rising Pharmaceuticals drugs?"

Probably not a big deal. Just make sure your replacement has a fairly large number of beads in it. You will also have to calculate how many beads to remove from the new capsules to have the same dosage you may be on at that time.

"I am still unclear as to whether or not the capsules themselves are enteric coated, or if it is only the beads inside them that are enteric coated. Does anybody know the answer to this question?"

See...

https://www.cymbalta...ge-2#entry83312


Well, well well...I may have an answer...

All of the data sheets for "Cymbalta" state they are enteric coated capsules.

All "Duloxetine" data sheets say the capsules are hard gelatin except Activas, Teva, Cipla, Heritage, Inventia, Lupin, Solco, Sun Phartmaceutical, Zydes and Ascend which did not state the construction of the capsule. In addition, Camber brand is not enteric coated PELLETS but are only film coated only. Film coated is made of the same material but thinner and does not meet the FDA required digestion time to be considered enteric.

Cymbalta Brands
Eli Lilley
Aphena
Carilion Materials Management
H.J. Harkins Company, Inc.
Lake Erie Medical DBA Quality Care Products LLC
PD-Rx Pharmaceuticals, Inc.
Physicians Total Care, Inc.
Rebel Distributors Corp.
STAT Rx USA LLC

Duloxetine Brands
Aurobindo Pharma Limited
Prasco Laboratories
Rising Health, LLC
Actavis Pharma, Inc.
Teva Pharmaceuticals USA, Inc.
Ajanta Pharma Limited
Ascend Laboratories, LLC
BluePoint Laboratories
Cadila Healthcare Limited
Camber Pharmaceuticals, Inc.
Cipla USA Inc.
Heritage Pharmaceuticals Inc.
Inventia Healthcare Private Limited
Lupin Pharmaceuticals, Inc.
Solco Healthcare US, LLC
Sun Pharmaceutical Industries, Inc.
Zydus Pharmaceuticals (USA) Inc.

#25 invalidusername

invalidusername

    God-like

  • Site Supporter
  • 3,519 posts
  • LocationKent, UK

Posted 07 August 2019 - 10:28 AM

Thank you for finding the thread for me Hat - head is not quite what it should be...


#26 fishinghat

fishinghat

    God-like

  • Active Members
  • PipPipPipPipPipPipPipPip
  • 10,633 posts
  • LocationMissouri

Posted 07 August 2019 - 10:32 AM

No problem but I agree. It should be enteric coated capsules.

#27 DavidfromTexas

DavidfromTexas

    Member

  • Members
  • PipPip
  • 12 posts

Posted 07 August 2019 - 04:56 PM

No problem but I agree. It should be enteric coated capsules.

 

 

"I am still unclear as to whether or not the capsules themselves are enteric coated, or if it is only the beads inside them that are enteric coated. Does anybody know the answer to this question?"

See...

https://www.cymbalta...ge-2#entry83312


Well, well well...I may have an answer...

All of the data sheets for "Cymbalta" state they are enteric coated capsules.

All "Duloxetine" data sheets say the capsules are hard gelatin except Activas, Teva, Cipla, Heritage, Inventia, Lupin, Solco, Sun Phartmaceutical, Zydes and Ascend which did not state the construction of the capsule. In addition, Camber brand is not enteric coated PELLETS but are only film coated only. Film coated is made of the same material but thinner and does not meet the FDA required digestion time to be considered enteric.

Cymbalta Brands
Eli Lilley
Aphena
Carilion Materials Management
H.J. Harkins Company, Inc.
Lake Erie Medical DBA Quality Care Products LLC
PD-Rx Pharmaceuticals, Inc.
Physicians Total Care, Inc.
Rebel Distributors Corp.
STAT Rx USA LLC

Duloxetine Brands
Aurobindo Pharma Limited
Prasco Laboratories
Rising Health, LLC
Actavis Pharma, Inc.
Teva Pharmaceuticals USA, Inc.
Ajanta Pharma Limited
Ascend Laboratories, LLC
BluePoint Laboratories
Cadila Healthcare Limited
Camber Pharmaceuticals, Inc.
Cipla USA Inc.
Heritage Pharmaceuticals Inc.
Inventia Healthcare Private Limited
Lupin Pharmaceuticals, Inc.
Solco Healthcare US, LLC
Sun Pharmaceutical Industries, Inc.
Zydus Pharmaceuticals (USA) Inc.

 

"I am still unclear as to whether or not the capsules themselves are enteric coated, or if it is only the beads inside them that are enteric coated. Does anybody know the answer to this question?"

 

This has gone through many stages of debate and the conclusion is that the capsules certainly need to be enteric coated - do not use the gelatin only capsules. There is a thread on here somewhere with all the details, but appropriate peer-reviewed journal and patient information direct from the manufacturer was taken into account during the decision, so it is for sure the correct way to go...

 

 

Are you guys sure about that? Because for the first couple days of my reinstatement I actually used the regular gelatin capsules I bought from the health store, and nothing happened to my stomach, and I didn't have any other adverse reaction. Granted, I did not feel any immediate effect from it either, but it was only my first 2 days back on it so that would've been unlikely anyway. But I for sure did not have any stomach issues or physical issues from it, so I don't know.

 

What about the risk of the enteric capsules not dissolving like was mentioned in the other thread? If it happens that the prescription Ive been getting from Rising Pharmaceuticals DOES NOT use enteric capsules, wouldn't the non-dissolution of an enteric capsule be a health risk I am facing?

 

Nobody seems to know anything about Rising Pharmaceuticals as opposed to Rising Health LLC. I called them today and the lady I spoke to couldn't even give me a satisfactory answer about the capsule with any confidence. So I have NO IDEA if the usual capsules they use are enteric-coated or not...

 

What would you guys suggest I do?

-continue to take the drugs from this manufacturer? Opening up the capsules and putting them into separately bought enteric capsules?

-check with CVS or another pharmacy to see what manufacturer THEY use? That way maybe it is one on the list you made, and we would know whether the capsules needed to be enteric or not

-OR switch now to a different drug with smaller dosages and more compounding options? I was on Zoloft for years when I was younger, before switching to Cymbalta. Do you guys know if the "Prozac bridging" method works with something like Zoloft too?


#28 fishinghat

fishinghat

    God-like

  • Active Members
  • PipPipPipPipPipPipPipPip
  • 10,633 posts
  • LocationMissouri

Posted 07 August 2019 - 05:12 PM

I am sure that the Cymbalta capsules are NOT enteric coated, only the beads. It can be confirmed when reading the Eli Lilley patent filing.

https://patents.goog...t/US5508276A/en

I also called the Eli Lilley customer service line...

The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979).
Spoke to Michelle S.
May 3rd, 2017 at 8:50 AM



It is also listed on the FDA filings/drug inserts as well.

#29 fishinghat

fishinghat

    God-like

  • Active Members
  • PipPipPipPipPipPipPipPip
  • 10,633 posts
  • LocationMissouri

Posted 07 August 2019 - 05:16 PM

"What about the risk of the enteric capsules not dissolving like was mentioned in the other thread?"

This condition is called pharmacobezoars and is very rare but increasing. Many of the various enteric coatings can contribute to this as well as fillers.


Pharmacobezoars
Pharmacobezoars (or medication bezoars) are mostly tablets or semiliquid masses of drugs which block or partly block the GI tract.
http://www.thefreeli......-a0136387734
http://www.ncbi.nlm..../pubmed/8590522
Aluminum hydroxide gel, enteric-coated aspirin, sucralfate, guar gum, cholestyramine, enteral feeding formulas, psyllium preparations, nifedipine XL, and meprobamate.
Physillium, guar gum and enteric coated aspirin contribute heavily.

http://www.ncbi.nlm....les/PMC3151403/
Caused by venlafaxine (Effexor)

http://informahealth...650.2013.856442
Quetiapine

https://www.ncbi.nlm...pubmed/25083252
Curse of the ghost pills: the role of oral controlled-release formulations in the passage of empty intact shells in faeces. Two case reports and a literature review relevant to psychiatry.

https://www.ncbi.nlm...pubmed/19405260
Dissolution of pharmacobezoar using carbonated beverage.

https://www.ncbi.nlm...pubmed/21370943
Pharmacobezoars described and demystified.

http://onlinelibrary....12679/abstract
Forensic related pharmacobezoars.

http://curriculum.to...ugs In Overdose
Time release coatings causing pharmacobezoars.

http://curriculum.to...ugs In Overdose
Can be caused by any time release slow release medicine.

http://www.ncbi.nlm....0,f1000m,isrctn
Pharmacobezoars consist of medication bezoars, such as cholestyramine, kayexalate resin, carafate and antacids, which adhere when in bulk.
http://www.sciencedi...214750014000146
Extended release potassium salts.

http://www.ncbi.nlm....pubmed/21370943
http://informahealth...650.2011.559472
Review, These include enteric-coated aspirin, activated charcoal, clomipramine, iron, theophylline, and venlafaxine, as well as verapamil-SR and nifedipine-XL preparations. There are 84 references.
See more at: http://www.thepoison...h.vC0lJlHs.dpuf

http://link.springer...?no-access=true

http://www.medscape....warticle/781850
http://www.giendo.th...(06)00015-8/pdf
Enteric coatings and time release coatings.

http://www.ulusalcer...-metin/1168/eng
Heavy doses of multiple medications.

http://www.ijccm.org...1;aulast=Tawfic
Eosopageal pharmacobezoars

http://europepmc.org...cles/PMC3966178

https://www.ncbi.nlm...les/PMC4485820/



Enteric Coatings And Time Release Coatings and other Excipients that contribute to pharmacobezoars.

Methyl acrylate-methacrylic acid copolymers - The methacrylates have numerous uses, most notably in the manufacture of polymers such as Lucite and Plexiglas. The production of Methyl acrylate-methacrylic acid copolymers can involve the use of acetone cyanohydrin (contains cyanide) and formaldehyde.

Hypromellose - (Hydroxypropyl Methylcellulose, Hydroxy propyl methyl cellulose acetate succinate, hypromellose acetate succinate, cellulose acetate succinate) is a synthetic polymer also used in adhesives and eye drops.

Polyvinyl acetate phthalate (PVAP) synthetic polymer. Polyvinyl acetate phthalate - symthetic polymer for enteric coatings/time release. The gastrointestinal tract appears to be the target organ and effects seen (irritation, laxation, colitis with erosions and submucosal fibrosis in the dog and ulcers, polyps, and cecal wall thickening in rats) were dose dependent.
http://www.researchg...imental_animals
Evaluation of the toxicity of polyvinylacetate phthalate in experimental animals.
http://www.preventio...es-pill-coating

Shellac is a resin secreted by the female lac bug. Shellac, edible, is used as a glazing agent on pills and candies. Because of its acidic properties (resisting stomach acids), shellac-coated pills may be used for a timed enteric or colonic release. Shellac is used as a 'wax' coating on citrus fruit to prolong its shelf/storage life. It is also used to replace the natural wax of the apple, which is removed during the cleaning process.
Cellulose acetate trimellitate is soluble in mild aqueous acid and readily dissolve in neutral or aqueous base. A polybenzene compound.
Sodium alginate is an synthetic anionic polysaccharide.

Zein a corn protein

Polyvinyl acetate (Poly(vinyl acetate) (PVA, PVAc, poly(ethenyl ethanoate) is commonly referred to as wood glue, white glue, carpenter's glue, school glue, Elmer's glue and is is an aliphatic rubbery synthetic polymer.
http://www.ncbi.nlm....pubmed/20643750
transaminase elevations

Povidone (Polyvinylpyrrolidone (PVP), also commonly called polyvidone, is a water-soluble synthetic polymer made from the monomer N-vinylpyrrolidone.
Polysorbates are oily liquids derived from PRG(polyethylene Glycol)-ylated sorbitan (a derivative of sorbitol) esterfied with fatty acids.
Polyethylene glycol (macrogol) is a polyether compound. Used in coatings and time release.
Polydextrose is a synthetic polymer of glucose.
Polyvinyl alcohol is a watersoluble synthetic polymer.
Croscarmellose Sodium is an internally cross-linked sodium carboxymethylcellulose.

Medications that contribute to pharmacobezoars
Sucralfate (Carafate) is a sucrose sulfate-aluminum complezx that binds to the mucosa, thus creating a physical barrier that impairs diffusion of hydrochloric acid in the gi tract and prevents degradation of mucus by acid.
Cholestyramine (colestyramine, Questran, Questran Light, Cholybar, Olestyr) a quarternary ammonium group attached to an inert styrene-divinylbenzene copolymer.
Nifedipine XL (Adalat CC and Procardia)
Meprobamate (Miltown, Equanil, Meprospan) is a carbamate derivative.
Venlafaxine (Effexor)
Quetiapine (Seroquel)
Kayexalate resin (Polystyrene sulfonates are polymers derived from polystyrene but containing sulfonic acid or sulfonate functional groups.
Clomipramine (Anafranil and Clofranil)
Theophylline (1,3-dimethylxanthine)
Verapamil-SR
Most of the above drugs contain one or more of the above listed chemicals.
 


#30 DavidfromTexas

DavidfromTexas

    Member

  • Members
  • PipPip
  • 12 posts

Posted 07 August 2019 - 05:18 PM

I am sure that the Cymbalta capsules are NOT enteric coated, only the beads. It can be confirmed when reading the Eli Lilley patent filing.

https://patents.goog...t/US5508276A/en

I also called the Eli Lilley customer service line...

The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979).
Spoke to Michelle S.
May 3rd, 2017 at 8:50 AM



It is also listed on the FDA filings/drug inserts as well.

 

 

So I am confused about what you guys are saying to do. Earlier today you said to go with enteric-coated capsules. But here you're saying that the capsules of the original prescriptions are not enteric-coated...

 

Didn't you find in the other thread that the capsule designs differ from different brand and generic manufacturers, as far as enteric/non-enteric? All this is so stressful, and I am worrying about what the right capsule decision would be, and that's not something I want to be worrying about on top of everything else.


Edited by DavidfromTexas, 07 August 2019 - 05:21 PM.




0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users