Sweettooth’s methods for withdrawal

[Leslee]

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Sweettooth’s methods for withdrawal
METHOD 1:
 
Now for the how to's:
 
Instead of counting out granules (which really isn't accurate as granule capsule contents vary anywhere from 105 - 124 granules per capsule), use Effexor immediate release tablets (don't worry you won't feel any different than using the capsules.  The only difference is that you will take one half of your tablet dose in the morning and twelve hours later take the second half of your dose. 
 
THE GOOD NEWS:  Effexor comes in tablets:  100mg, 75mg, 50mg, 37.50mg, and 25mg.  You can purchase a "pill splitter" from any pharmacy--the cost about $4.00 (american money) and split your pills in half, quarters, and even eigths--(with a little practice for the 1/8s).  Splitting tablets will enable you to have more control stepping done your medication.  When I got to a dose that is in between one of the tablet sizes listed above, I respectfully requested from my doctor a prescription of two different amounts of tablets (for example 37.50mg tablet and 25mg tablet).  When I step down in doses I do NOT want to make big leaps. 
 
Here is a partial record of my tapering; it starts at the 37.50mg doseage.
 
---I cut a 37.50mg tablet into eights = 4.68mg/per eight and then cut a 25mg tablet in half = 12.50 mg.  I would then take:  one 4.68mg plus one 12.50 mg =  17.18mg (morning dose) and then do the same thing 12 hours later.  17.18mg + 17.18mg = 34.36mg for the day.  (Stayed at this new dose for 1 month.)
 
Next cut:  37.50mg in quarters = 9.37mg and cutting a 25mg into quarters = 6.25mg.  I then took 9.37mg + 6.25mg = 15.62mg in the morning and then same thing 12 hours later.  15.62mg + 15.62mg = 31.24mg for the day.  (Stayed at this dose for 1 month.)
 
Next cut:  1/8 of a 37.50mg tablet = 4.68mg plus 1/4 of a 37.50mg tablet = 9.37mg.  4.68mg + 9.37mg = 14.05mg.  14.05mg + 14.05mg = 28.10 mg for the day.  (Stayed at this dose for 1 month)
 
Next cut:  12.50mg (1/2 of a 25mg tablet) in the morning and 12.50mg twelve hour later = 25mg for the day.   (Stayed at this dose for 7 weeks)
 
Next cut: 12.50mg in the morning and 9.37mg in the evening = 21.87mg for the day.  (Stayed at this dose for 1 month)
 
Next cut: 6.25mg (1/4 of a 25mg tablet) + 4.68mg (1/8 of a 37.50mg tablet) = 10.93mg (morning dose) and 9.37mg (1/4 of a 37.50mg tablet) twelve hours later.
10.93mg + 9.37mg = 20.30mg for the day 
 
Next cut: 9.375mg (1/4 of a 37.50mg tablet) in the morning and 9.375mg in the evening = 18.75 mg for the day (Current dose)
 
You can see this is MUCH EASIER on your system than making big cuts in the doses.
 
 
You can use any combination of the tablet doseages, using the pill splitter,  to get the approx. dose you need.  The above is just an example of where I am at.
 
 
*5%-10% CUTS* --  I think some folks may be taking 5% or 10% of their highest dose and then they keep using that number to subtract for all their cuts--that is not the way to do it.
 
Always use the *CURRENT* doseage amount you are at to multiply by 5% or 10% (not the highest dose you ever took) inorder to see how much you need to come down. 
 
For example: 
If you are at 50mg and are ready to make a cut. 
 
5% Cut: 
50mg x 5% = 2.50
50mg - 2.50mg = 48.50mg--this would be your new dose
 
OR
 
10% Cut:
50mg x 10% = 5mg
50mg - 5mg = 45mg--this would be your new dose
 
Let's say your new dose is now 45mg.  The next time you make a cut you will take 5% or 10% of 45mg to figure out the next doseage amount.
 
 
WHEN CUTTING YOUR PILLS  of differing milligrams, have some empty, clean, prescription bottles that are labeled (for example 4.68mg on one, 9.37mg on another, 6.25 mg on another, etc.) so that you don't get them mixed up.  As you cut smaller amounts it gets harder to distinguish what is what--the labeled bottles will keep you straight. Just be sure to put the correct amounts in the correct bottles!
 
BE SURE once you step down on a doseage that you remain at that amount for at least 3 weeks, preferably 4 weeks.  It will give your brain chemistry time to adjust to the returning natural levels of serotonin. 
 
DON'T BE SUPRISED as you get lower and lower on your dose that you may need more than 3-4 weeks to stablize; remember your brain is going through a HUGE change--give it the chance to even out.  It's not important how long it takes to taper from dose to dose, it matters that you take your time!
 
ALWAYS take Effexor with food in your stomach and drink plenty of water.
 
Do NOT eat or drink anything containing GRAPFRUIT, it can create a serious toxic reaction.
 
NEVER, EVER take St. John's Wort or 5-HTP--they have serotonin in them.  Mixing them with an anti-depressant or taking then after you've been off of an anti-depressant for only a year of less can lead to SEROTONIN SYNDROME - a toxic and deadly condition.   Click on the following link to find out about it:  http://www.antidepressantsfacts.com/ser ... me-ADF.htm

Drugs that may induce serotonin syndrome when taken with antidepress
• ecstasy
• cocaine
• lithium
• St John's wort (Hypericum) - herbal antidepressant
• diethylproprion - an amphetamine
• dextromethorphan - found in many cough suppressants
• Buspar (buspirone) - for anxiety
• Selgene, Eldepryl (selegiline) - for Parkinson's Disease
• anti-epileptics - Tegretol, Carbium, Teril (carbamazepine)
• analgesics - pethidine, Fortral(pentazocine),Tramal(tramadol), fentanyl
• anti-migraine drugs - Naramig (naratriptan), Imigran (sumatriptan), Zomig (zolmitriptan)
• appetite suppressants - This drug is dangerous and fenfluramine
• tryptophan - an amino acid
  
NEVER, EVER take Effexor or any anti-depressant every other day--withdrawal will start and you will never get back on an even keel.  I know, I know your doctor told you to do this, but MOST doctors are truely ignorant of the hell they are about to put you through doing this.  If you are currently on this program get back to taking your dose everyday and after you are stabilized you can start your tapering.
 
PLEASE TAKE THE TIME to visit these webpages; they have critical and very helpful information for tapering:
 
http://www.antidepressantsfacts.com/reaction.htm
 
http://www.antidepressantsfacts.com/taper.htm
 
The best to everyone,
 
Sweettooth 
 
 METHOD 2:
 
I was able to locate a "compounding pharmacy" (customized medication preparation by a pharmacist according to a doctor's specifications to meet a patient needs.)  The compounding pharmacy said they could indeed make a liquid form of Effexor, however it becomes less stable (could affect the potency) and has a very short shelf life (not half life); probably also needs to be refrigerated. 
 
What they will do is crush the tablets and make up capsules in whatever dose amount needed. 
 
Example:  Your at 25mg, you plan on making a 5% cut.
 
25mg x 5% = 1.25
25mg - 1.25 = 23.75mg new dose for the day
 
Capsules are prepared in doses of 11.875mg each.  You would take one in the morning and then one in the evening; 11.875mg + 11.875mg = 23.75mg for the day.
 
Specify that you want the Effexor Brand and not the generic as I've read that generics can have as much as a 20% difference in potency (which is allowed by the FDA).
 
Ask your doctor to write the prescriptions to the compounding pharmacy instead of a regular pharmacy.
 
The beauty of this approach is that you can have as very small or as large a cut as you need because these pharmacies have the sophisticated equipment to accurately do this.
 
Here is a link to learn about compounding pharmacies: 
Hudson's Guide:  Compounding Pharmacies 
http://web.mit.edu/hudson/www/compounding.html
 
 
Here is a locator to find one in your area: 
International Academy of Compounding Pharmacists Referral Service: 
http://ist.intsoftec.com/iacp/referral_ ... index.html
 
 
The only draw back to this approach may be the financial aspect of it.  Most Compounding Pharmacies require paying upfront and not all insurance companies will reimburse for this service.
 
Sweettooth
 
 
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METHOD 3:
 
WATER TAPERING - makes possible tiny reductions in medication.
 
 
 
*CAUTION* This method can ONLY be done with tablets.    XR (extended release) versions of medications CANNOT use this method; it will lead to overdose. 
 
 
 
Here is a better WATER TAPERING method than the previous one I had posted (which I have removed). 
 
Equipment needed:
a tall lab cylinder that holds 250 ml
a small lab cylinder that holds 10 ml
a dropper or syringe
a mortar and pestle
a small battery-operated mixer
a continuing supply of the med. you are using

Process:
Grind the tablet in the mortar and pestle.
 
Fill the tall lab cylinder to a predetermined amount of water.  Use this same amount of water each time you make a reduction.  The amount you start with will determine  just  how small the cut is.  Another words the greater amount of water you use, the fewer medicine particles per ml will be suspended in it.  The less water you use the greater the amount of medicine particles per ml will be suspended in it.
 
How to determine the amount of cut you'll be making:
Divide your dose by the milliliters of water you intend to use to find the amount of drug per 1 ml of water.
 
Examples:
37.50mg Effexor tablet divided by 200ml of water = 0.1875mg per 1 ml of water.
 
37.50mg Effexor tablet divided by 150ml of water = 0.25mg per 1 ml of water.
 
 
Pour a little of the water in the cylinder onto the powdered drug and grind it some more. Then rinse the mortar into the battery-operated mixer, using the water in the cylinder until all of the powder in the mortar and on the pestle has gone into the mixer, as well as the rest of the water in the cylinder. The mortar will become colored from the dye used in the pills, do not be concerned about that.

Hit the spin button on the battery-operated mixer. This puts the drug particles into suspension in the water. There is no need for the pills to dissolve or be water soluble; putting the particles into suspension is sufficient to insure random dispersal for long enough to adjust your dosage.

While the mixer is still ON, take the dropper and remove a small amount of the water. Use the small lab cylinder to measure this amount to 1 ml. Discard this amount and drink the water that remains in the mixer. Then add a little more water from a cup and hit spin again to get all the residue out of the mixer and drink that. The next dose, repeat the process but discard 2mls of water and drink the rest.

The advantage to this method is that as long as you have a sufficient supply of tablets, you can reduce at your own rate and make tiny reductions. The brain doesn't differentiate between very small reductions of dose over a few days, but the cumulative cuts do add up so if you feel withdrawal setting in, STOP and let your body adjust.

Now all you have do is find the equipment.  A Power Mixer can be obtained from www.bodybuilding.com.  It's called the Personal Power Mixer. Or just go to www.Google.com and type in the words "Power Mixer", I'm sure you'll find lots of places that sell them and then you can look for the best price. The same thing goes for graduated cylinders and mortars and pestles.  Here is website so you can at least see what they look like, www.pharmex.com.
 
Sweettooth