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Old 05-07-2011, 10:13 PM   #1
ConsensualVic
 
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Pristiq - How does one taper from time-released tab?

My name is Laurie. I am feeling blessed by the Universe to be alive today at this moment in time. I thank the Universe for all things in my life as I try to remember each and every day not to judge anything as good or bad, but simply to accept what is, is. If I may be of help to anyone, please let me know. I ask the same in return.

I am withdrawing from Pristiq and other psychotropics. On 4/25/11, my psychiatrist reduced my dose of Pristiq from 100 mg. to 50 mg. I naturally experienced some unpleasant withdrawals that began on May 3, 2011, peaked on May 4, 2011. Today, May 7, 2011, I have the remnants of some intermittent dizziness and slight visual disturbances, otherwise, I feel stable.

My psychiatrist has no idea how to taper me from a 50 mg. time-release Pristiq tab and neither do I, except that I am aware that I must have a plan of taper not to exceed 10% every 3 to 6 weeks or more until stable, to have support, to take care of myself to the best of my ability, to ask for help from people who support my desire to be drug free when needed, and to reflect on this opportunity to be a "curious observer".

I am looking for suggestions from those who may be able to offer me some options that I can mull over in order to create a realistic, successful withdrawal from this drug which just so happens to be formulated in a time-release tablet and not a time release capsule such as Effexor. (Say hello to Effexor's best-friend, "Pristiq"). Thank you to all who read and big hugs to all. Laurie
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[size="1"]2000-2011 Effexor XR then Pristiq 100 mg
April, 2011- Pristiq reduced to 50 mg
May 20-Added Lexapro 20 mg in order to cross over
June 1, 2011-Pristiq Discontinued - Now on Lexapro 20 mg.
July 15, 2011- Lexapro 15 mg.
July 1-July 18 - Reduced by 2.5 mg until zero
July 18, 2011- Lexapro Free!
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Old 05-07-2011, 11:25 PM   #2
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Re: Pristiq - How does one taper from time-released tab?

I would have to guess of weighing (jeweler's scale) and crushing the tablet and taking that weight and reducing it 10 percent and taking the powder and put into a gel capsule that you can buy online. This is what I am doing with Lexapro. it is not time released. There is a spread sheet I downloaded form this forum to help me.

I hope this helps!

Kay
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Old 05-08-2011, 02:17 AM   #3
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Re: Pristiq - How does one taper from time-released tab?

Quote:
Originally Posted by Kay2020 View Post
I would have to guess of weighing (jeweler's scale) and crushing the tablet and taking that weight and reducing it 10 percent and taking the powder and put into a gel capsule that you can buy online. This is what I am doing with Lexapro. it is not time released. There is a spread sheet I downloaded form this forum to help me.

I hope this helps!

Kay
Hi Kay,

Thanks so much for your quick response. I was thinking that it would be totally worth using a compound pharmacist to make time release 40 mg. capsules. I will check into a compounding pharmacy to see if this can be done. I will let everyone know about getting 40 mg. 30 mg. 20 mg. 10 mg. 5 mg. etc compounded Pristiq capsules. This seems to be about the only logical thing I can come up with. Anyone else have any experience with tapering off with a modest amount of discomfort while on Pristiq? What solution did you find helpful? Thanks for everyone's help! Laurie
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[size="1"]2000-2011 Effexor XR then Pristiq 100 mg
April, 2011- Pristiq reduced to 50 mg
May 20-Added Lexapro 20 mg in order to cross over
June 1, 2011-Pristiq Discontinued - Now on Lexapro 20 mg.
July 15, 2011- Lexapro 15 mg.
July 1-July 18 - Reduced by 2.5 mg until zero
July 18, 2011- Lexapro Free!
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Old 05-08-2011, 01:20 PM   #4
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Re: Pristiq - How does one taper from time-released tab?

Hi Laurie, I've never heard of Kay's suggestion of cutting by 10% and then adding it to a gel capsule. Seems well worth a try. I have known people who put their tablet in water and then reduce the water by 10% each time, but not sure if that would affect the time release action of it. What other drugs are you tapering? All the advice I've ever read says drop one drug at a time. If you do it slow and steady, you will get there, and you will meet some really good people through this site.
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Old 05-08-2011, 02:50 PM   #5
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Re: Pristiq - How does one taper from time-released tab?

Hi effexorsam,

Thank you for your kind and thoughtful response.

I tried cutting a 100 mg. Pristiq tablet in 1/2 last week because I had run out of 50 mg. tablets and I can tell you from personal experience that once I cut into the time-release coating on this tablet and took the 1/2 tablet, I became intolerably ill within 45 minutes of ingesting the tablet. My experience consisted of vomiting, anxiety, hot and cold chills, dizziness and feeling like I wanted to go to the ER. I called my doctor and he callmed me down and said this would pass and that he did not thiink that I had Seratonin Syndrome and that he was "pretty sure" I would not die. It did make me laugh and feel better.

I can only speak of my experience with cutting Prestiq time-release tablets in half and can tell you that I will never repeat this. Sometimes I don't pay attention to some types of instructions, however in this case I found out the hard way that when the package insert (PI) of Prestiq gives the warning, "Do Not Cut, Crush, or Chew this tablet". . . the drug manufacturer was actually giving useful advice that I definitely wish I had paid attention to. Lesson learned! Note to self: Don't cut Prestiq in half or in any manner crush or chew (yuck) this tablet! Laurie
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[size="1"]2000-2011 Effexor XR then Pristiq 100 mg
April, 2011- Pristiq reduced to 50 mg
May 20-Added Lexapro 20 mg in order to cross over
June 1, 2011-Pristiq Discontinued - Now on Lexapro 20 mg.
July 15, 2011- Lexapro 15 mg.
July 1-July 18 - Reduced by 2.5 mg until zero
July 18, 2011- Lexapro Free!
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Old 05-08-2011, 03:14 PM   #6
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Re: Pristiq - How does one taper from time-released tab?

Yeah, you definitely shouldn't cut or crush XR tablets. I think you're right when you said it might be worth it just to have them compounded into time released tabs. I didn't know they could do that, and if they can then that would be optimal for your situation. We usually recommend no more than 10% drops here, but if you were able to take larger drops with not too many problems then you might be able to handle it. If symptoms begin to increase then you can always change your taper amount accordingly.

Welcome to Paxil Progress.
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Old 05-08-2011, 05:16 PM   #7
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Re: Pristiq - How does one taper from time-released tab?

Thank you for the friendly welcome, JessG!

Having a "moment" at the moment and I don't feel as well as I would like to, but this moment will pass like all the others before them. I am taking deep breaths and reclining on my favorite chair. . .

I am laughing with a just a slight hint of embarrassment as I "curiously observe" several hours later, that what I thought might be a possibility (having the Pristiq compounded and placed into time-release capsules"), is not possible. LOL!! I actually thought that somewhere, someplace, (eBay???), somehow, there actually was a empty time-release capsule that could be filled by a "compounding pharmacist". Simply ask my doctor for a prescription for compounded Pristiq in "x" dose and my friendly compounding pharmacist would grind up my Pristiq, measure it accordingly to find out how many milligrams per whatevers, and fill it in these cute, "time-release capsules". Maybe, these special time-release empty gel-caps even come in designer colors!!

OK, I feel the word "DUH" is very appropriate at the moment and I encourage everyone to have a big laugh with me. No, really, I am laughing so hard right now that I think I might have an accident. Then I can ask my "other doctor" if he has any samples of any new drugs for "over-active" bladders.

I am discovering so many new things not only about myself, but in people and the world I live and breathe in and out so many times each day. I encourage everyone to find joy and laughter in ourselves and others as we continue our journeys.

If I should happen to find that special "time-release" empty capsule that can be custom-filled with one's choice of AD's on eBay, how should I bid? Highest I would pay? Wait until the last 2 minutes of the bid and "snipe"?

Hugs to all, Laurie

P.S. I am still ready to "receive" any and all suggestions on how to taper off of Pristiq. Stay tuned for tomorrow's (5/9/11) exciting revelations as to what my doctor will advise as to what the "Plan" is on how to taper off of those last 50 mg. of Pristiq (or more aptly what my doctor happens to pull out of his rectum). The other thing that makes me laugh right now in this moment is that I have a feeling he may be having a "moment" when he sees my name on his list of patients tomorrow.
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[size="1"]2000-2011 Effexor XR then Pristiq 100 mg
April, 2011- Pristiq reduced to 50 mg
May 20-Added Lexapro 20 mg in order to cross over
June 1, 2011-Pristiq Discontinued - Now on Lexapro 20 mg.
July 15, 2011- Lexapro 15 mg.
July 1-July 18 - Reduced by 2.5 mg until zero
July 18, 2011- Lexapro Free!
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Old 05-08-2011, 05:59 PM   #8
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Re: Pristiq - How does one taper from time-released tab?

Have you called any compounding pharmacies in your area to ask them if they can make extended release tabs? I bet they can. If not, maybe you can attempt to go back to Effexor XR and do the pellet counting/weighing method other Effexor users here use.

Regardless, you shouldn't consider touching your dose at all for at least another month. Since your last reduction was rather large at 50%, you want to give your brain ample time to adjust to the dose.
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Paxil since Mar.1998
5% or less drops every 3-6 weeks
2009: 20mg-14mg
2010: 14mg-10.5mg
2011: 10.5-7.6mg
2012: 7.5-6.8mg
2013: 6.7-6.3mg
02/24/14: 6.2mg
04/24/14: 6.1mg
07/15/14: 6.0mg


"For I know the thoughts that I think toward you, says the Lord, thoughts of peace and not of evil, to give you a future and a hope."
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Old 05-08-2011, 06:16 PM   #9
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Re: Pristiq - How does one taper from time-released tab?

Quote:
Originally Posted by JessG View Post
If not, maybe you can attempt to go back to Effexor XR and do the pellet counting/weighing method other Effexor users here use.
Knowing very little about Pristiq, I would be tempted to go to Effexor, which gives you more options for slow weaning. I fear that we are going to start seeing Pristiq users a lot more, and we truly don't have a good weaning option.
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Old 05-08-2011, 09:24 PM   #10
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Re: Pristiq - How does one taper from time-released tab?

Hi to all and thank you for thoughts, ideas, and observations as to how to withdraw from Pristiq. Today, I remain on Pristiq 50 mg. and I have experienced some moments of anxiety, strange ideas that were frightening and physical pain. I prefer to ride each feeling and physical discomfort that I experience as if I am riding a wave to the shore. I remain a "casual observer" and I am taking good care of myself to the best of my ability.

Yes, my decrease from Pristiq 100 mg. to 50 mg. in one shot may sound very drastic, however, so far my experience of this particular attempt at withdrawal is simply different - not bad or good, just what it is. I was in acute crisis and my doctor would prefer that I be able to not only successfully get off of AD's, but to be able to remain off of them. My doctor and I agree on two things: that he and I do not share the same point of view as to the validity of his diagnosis and that we both believe that I should taper off if this can be done safely and with symptoms that can be at the very least, livable.

I will explore compounding pharmacies, however, during my 11 year experience with various withdrawal protocols, I personally prefer having my "drug of choice?" in a time-release capsule formulation in order to "count the beads" during phases of when I am titrating to relatively low doses. Because Effexor XR is Pristiq's "new and improved version" with similar chemical structure and is available in a time-release capsule formulation, my preliminary plan is to cross over to Effexor XR. I would very much appreciate any and all feedback and please look for any holes or flawed logic or flawed pharmacology. I love chemistry, but just not the type that is swallowed.

I really appreciate the sign on the road that was pointed out to me that says, (let me get my glasses on) "Warning-Reduce Speed 30 MPH-Curve Ahead". I will definitely give great consideration to not cross over to Effexor XR or make any further changes until I have had a period of far greater stability, whatever length of time that may be. I am just happy to be where I am, right where I am. Hugs to all, Laurie
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[size="1"]2000-2011 Effexor XR then Pristiq 100 mg
April, 2011- Pristiq reduced to 50 mg
May 20-Added Lexapro 20 mg in order to cross over
June 1, 2011-Pristiq Discontinued - Now on Lexapro 20 mg.
July 15, 2011- Lexapro 15 mg.
July 1-July 18 - Reduced by 2.5 mg until zero
July 18, 2011- Lexapro Free!
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Old 05-09-2011, 09:13 PM   #11
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Re: Pristiq - How does one taper from time-released tab?

Good Evening to all,

I saw my doctor today to discuss my options in order to formulate a plan to taper from Pristiq. As some of you may recall, my doctor abruptly reduced my dose of Pristiq from 100 mg. to 50 mg. on April 25, 2011 and I proceeded to go into withdrawals on May 4, 2011. I am aware that I am becoming increasingly more mood unstable as each day passes and am starting to become very uncomfortable and believe I have just hit the "I am really suffering more than I am not suffering stage". From past experience, this is usually when I decide I have had enough fun and reinstate.

My doctor gave me 3 options as follows:


OPTION 1

1. Begin crossing over to another SSRI that is also available in a liquid preparation. His recommendation was to add Lexapro 10 mg. a day x 3 days and then increase the Lexapro to 20 mg. a day until I am stable. My doctor estimated that it would take somewhere between 2-4 weeks to reach stabilization. (This does not seem realistic at the moment I am writing this).

2. Once stable on the Pristiq + Lexapro combination, discontinue the Pristiq and increase Lexapro to 40 mg. and wait until stable. (I have done this in the past with Effexor + Cymbalta and Cymbalta + Lexapro in order to cross over to the new AD without any problems associated with Serotonin Syndrome and made the transition on two separate occasions without a hint of withdrawal).

3. Switch over to Lexapro liquid when beginning 5-10% taper. Pray a lot.

-or-
OPTION 2

1. Do the "Prozac Thing". (Been there done that - did not work for me.)

-or-
OPTION 3

1. Reinstate Pristiq at 100 mg. daily until stable.

2. Add Lexapro as above, discontinue Pristiq and then cross over to Lexapro 40 mg. daily until stable.

3. Begin 5-10% taper regimen as tolerated.

At this moment, I have decided to give Option 1 a try unless my quality of life continues to trend downward. At any given point, if I feel my symptoms become intolerable, I will abort Option 1 and immediately reinstate and proceed with Option 3.

Any and all ideas, suggestions, tweaks are most welcome. Hugs to all
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[size="1"]2000-2011 Effexor XR then Pristiq 100 mg
April, 2011- Pristiq reduced to 50 mg
May 20-Added Lexapro 20 mg in order to cross over
June 1, 2011-Pristiq Discontinued - Now on Lexapro 20 mg.
July 15, 2011- Lexapro 15 mg.
July 1-July 18 - Reduced by 2.5 mg until zero
July 18, 2011- Lexapro Free!
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Old 05-09-2011, 09:26 PM   #12
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Re: Pristiq - How does one taper from time-released tab?

Quote:
Originally Posted by ConsensualVic View Post


OPTION 1

1. Begin crossing over to another SSRI that is also available in a liquid preparation. His recommendation was to add Lexapro 10 mg. a day x 3 days and then increase the Lexapro to 20 mg. a day until I am stable. My doctor estimated that it would take somewhere between 2-4 weeks to reach stabilization. (This does not seem realistic at the moment I am writing this).
You do what you feel is best, but you are attempting to prevent withdrawal from an SNRI with an SSRI. They are not interchangeable drugs and do not act in the same way. My other concern is that is with this guy ordering twice the normal dose for all of the drugs that he's giving you?

He's going to have you on twice the recommended dose of Pristiq + twice the recommended dose of Lexapro(big serotonin syndrome risk there), then cold turkey you off Pristiq and up the Lexapro to 4 times the recommended dose? What's wrong with this picture?
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Old 05-09-2011, 09:30 PM   #13
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Re: Pristiq - How does one taper from time-released tab?

Quote:
Originally Posted by ConsensualVic View Post

I am looking for suggestions from those who may be able to offer me some options that I can mull over in order to create a realistic, successful withdrawal from this drug which just so happens to be formulated in a time-release tablet and not a time release capsule such as Effexor. (Say hello to Effexor's best-friend, "Pristiq"). Thank you to all who read and big hugs to all. Laurie
I think you just crush the pill, weigh it and take the smaller dose as often as possible to simulate time release, just ignore the fact that it is time release and take the new weight divided up several times per day until the dose is small enough not to make you sick. This is the only way that I can possibly see it working. Hope this helps

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Old 05-09-2011, 09:33 PM   #14
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Re: Pristiq - How does one taper from time-released tab?

Get the immediate release effexor, which is available as a generic, from what I'm seeing on a quick google, and start shaving the pills.

And here's my pubic service announcement for anyone new here...DO NOT TAKE PRISTIQ!
It leaves you with little option for weaning!
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Old 05-09-2011, 09:47 PM   #15
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Re: Pristiq - How does one taper from time-released tab?

I found this on topix...

> Breaking up time release is not a problem. The trick is to take many multiple doses throughout the day, simulating the time release, and each dose has to be very small. A half or a quarter of a tab is just way too much. Try taking tiny chunks. Or, well, I'm not familiar with the tab, but I've done this with other tabs.....crush it into powder and then divide the powder into roughly equal size piles....a lot of low dosage piles. Then take them frequently throughout the day...every hour, every half hour, every two hours, whatever, play with it. To actually consume such tiny amounts, simply put the powder dose on apple sauce or something soft and just swallow without chewing. Some meds can be mixed in juice or water but I don't know if that applies to this one or not.
>
> In any case, get creative in taking much smaller doses more frequently. And then gently reduce as the days and weeks go by. Let your body tell you if you are going too fast or not, listen to your body, and make adjustments accordingly along the way.
>
> I don't know, it might also be possible to take another strategy by switching over to effexor and then weaning off that? I'm not sure, but I think effexor is in capsule form? Inside the capsule are tiny time released beads? If so, it's easy to divide them into little piles and sprinkle on soft food like applesauce or yogurt. Don't chew as that would break the time release coating. I did this trick with Cymbalta and it works great....any size dose you want....no matter how small...is achievable. Heck, my best dose ended up being about 10 beads, which is 1mg.
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Old 05-09-2011, 10:03 PM   #16
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Re: Pristiq - How does one taper from time-released tab?

Sorry Laurie, I just saw that the above was a reply to you from a different forum. I think you are right about your method "IF" you can find a compounding pharmacy that will compound in time release tablets. Good luck Laurie.

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Old 05-10-2011, 11:53 AM   #17
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Re: Pristiq - How does one taper from time-released tab?

Quote:
Originally Posted by scotty View Post
You do what you feel is best, but you are attempting to prevent withdrawal from an SNRI with an SSRI. They are not interchangeable drugs and do not act in the same way. My other concern is that is with this guy ordering twice the normal dose for all of the drugs that he's giving you?

He's going to have you on twice the recommended dose of Pristiq + twice the recommended dose of Lexapro(big serotonin syndrome risk there), then cold turkey you off Pristiq and up the Lexapro to 4 times the recommended dose? What's wrong with this picture?
Hi Scotty,

Thank you very much for your concern. I want to emphasize that I am in no way trying to prevent withdrawals by crossing over to an SNRI to and SSRI. I am not being c/t'd off one AD, because I will have the Lexapro on board given time. If I previously wrote that my doctor was going to increase the Lexapro to 4x the recommended dose, I apologize for the confusion. I will be on 20 mg. of Lexapro at the time I discontinue the Pristiq.

My Number 1 concern at this moment is getting off of Pristiq and onto another SSRI or SNRI that comes in a liquid form or a form that can be crushed (non time-release). In my experience, I get sick when I break the time-release coating on the Pristiq tablets so a direct taper at 10% is impossible.

As I mentioned before, I have been able to successfully use the dual AD method under medical supervision in order to interchange between SSRI's/SNRI's without any problems with Serotonin Syndrome or any signs and symptoms of any uncomfortable withdrawal. This is merely my own personal experience.

My main problem is that I am in rather uncomfortable withdrawal from being reduced from Pristiq 100 mg. to the next available dosage of 50 mg. Had I not been in the hospital (Polypharmacy-induced Rapid Cycling) and thinking clearly, I would never have agreed to a 50% reduction in the Prestiq. My withdrawal symptoms started 3 days after being discharged from the hospital and I have been given the go ahead to reinstate my original dose of 100 mg., but perhaps I am being stubborn because I see this as a setback having 15 days already invested into being on a lower dose. (I know this is silly and that my better senses will kick in).

I have started the Lexapro 10 mg. cross over strategy, having taken 1 Lexapro 10 mg. tablet yesterday and having taken 1 Lexapro 10 mg. tablet this morning in addition to the Pristiq 50 mg. tablet. I have one more day of Lexapro 10 mg. and then I have been advised by my doctor to go up on the Lexapro to 20 mg. and remain on both Prestiq 50 mg. and Lexapro 20 mg. until stable. Once stable, I can commence on a much more realistic dose taper at 5-10% when I am on only on Lexapro which can be crushed for whatever titration method or prescribed in a liquid for easy dose calculation.

Yes, there is a risk of Serotonin Syndrome by being on two AD's at a time. I am not personally concerned by getting a case of Serotonin Syndrome. I know the signs and symptoms of SS and my family and I are well-informed that this is a medical emergency and must be treated as such. However, I have done this dual AD strategy more times than I care to admit under doctors orders and nothing has yet occurred. This does not mean that I endorse this method, only that I have done it several times in the past without harm. This does not mean that I will not experience SS this time either. But given my 11 year experience of doing this back and forth with dual AD's under medical supervision, I am not particularly concerned.

I am trying to stay out of the future as to whether I will be able to continue to tolerate my withdrawal symptoms for the next 2-4 weeks at which time the Lexapro has built up sufficient blood levels and has saturated my serotonin receptors in order to support being pulled off from the Prestiq. Only time will tell.

Again, Pristiq being amongst the newest AD's and coming in rather suspicious 50 mg. and 100 mg. dosing formulations leaves me with little choice but to get onto any other AD (with the exception of Paxil) that can be titrated through a liquid preparation, water titration, the counting of the bead method, etc.

In good conscience, I could not recommend Pristiq to anyone or any other AD for that matter due to the prevalence of people like myself who have ever experienced trying to get off of them.

I shall continue to share my personal experience of using the dual AD method in order to discontinue one AD and get onto another AD purely for purposes of having an AD that is crushable or comes in a liquid form for tapering/titration. Laurie
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[size="1"]2000-2011 Effexor XR then Pristiq 100 mg
April, 2011- Pristiq reduced to 50 mg
May 20-Added Lexapro 20 mg in order to cross over
June 1, 2011-Pristiq Discontinued - Now on Lexapro 20 mg.
July 15, 2011- Lexapro 15 mg.
July 1-July 18 - Reduced by 2.5 mg until zero
July 18, 2011- Lexapro Free!
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