How to wean of Cymbalta?
I am going to take a devil's advocate position here and suggest maybe we have been going about this the wrong way with bead counting. A very slow consistent taper is quite logical but my current feeling is that we can not provide a "consistant" dose reduction.
Things that make our bead drops less consistant are...
Things that effect serum Cymbalta levels
Using the capsules the Cymbalta come in compared to enteric or gelatin capsules bought from the internet.
Large differences in bead size within the same capsule.
Variation in bead count/size from one capsule to the next, same manufacturer, same batch.
Variation in bead count/size from one capsule to the next, same manufacturer, different batch.
Variation in bead count/size from one capsule to the next, same manufacturer, different batch made at different facility.
Limited Cymbalta destruction by the liver due to use of magnesium, calcium, PPIs and H2 inhibotors and other medications (numerous) that use the same liver CYP enzymes as Cymbalta. .
Limited absorption use of pepto and kao pectate.
Changes in absorption due to changes in acidity by heartburn medication.
Changes in absorption due to other antidepressants, ssri/snri, Dextromethorphan(cough syrup), Saint John's Wort, etc.
Loss of weight releases stored Cymbalta into the system.
Gaining weight causes serum Cymbalta levels to drop as more is stored in fat tissue.
Liver and kidney diseases allow Cymbalta to build in the body except for non-alcoholic fatty liver and/or pancreas disease which causes serotonin levels to initially drop in the blood stream.
FDA allows a 10% variation in drug doses within a batch.
Things that effect serum serotonin levels
Such as SAMe, 5htp, Meperidine (Demerol), Pentazocine (Talwin), Tramadol (Ultram), calamus, California poppy, catnip, hops, Jamaican dogwood, kava, St. John's wort, skullcap, valerian, yerba mansa, Hawaiian baby woodrose, L-tryptophan...
Moderate to large doses of melatonin can have an effect on serotonin levels depending on environmental conditions.
Amount of sun exposure effects serotonin levels.
Things that effect serum adrenaline/noradrenaline levels
Stimulants (Make anxiety worse)
Over-the-counter cold preparations contain phenylpropylamine and pseudoephedrine*
* - Only some people have this reaction.
Toxic Degradation products of duloxetine
All these things effect withdrawal while reducing the Cymbalta dose. Do we actually thing we can provide a stable and even weaning process. Would it be better to wean off Cymbalta over a 3 month period and just do the best we can in handling the symptoms rather than having our blood Cymbalta levels jump up and down like crazy during an extended withdrawal?