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jeshyrFair warning: It's a antidepressant dose reduction week, so I may be a pain in the backside. Previous experience suggests that the next 2-3 weeks will include an excessive amount of: migraines, grumpiness, no concentration, mood swings, crying, and generally needing to hide from the world. It will pass - it always passes!
What follows is WAY more than you probably ever wanted to know about my meds...
The reduction in dose seems crazy tiny, from 112.5mg to 93.75mg. The weird amounts are because Effexor only comes in capsules containing 150mg, 75mg, and 37.5mg ... go figure. I went from taking 75 + 37.5 to taking 75 + half of a 37.5. Luckily the halves can be "made" at home because the extended-release is in the little beads inside the capsule, so opening the capsule doesn't mess up the dose timing. Unfortunately that means I have to mess around with teeny tiny little balls to split the capsules, and it's not an exact process. What I have been doing is going down to the half-a-capsule amount and then a week or 10 days later doing a second drop so I'm back to a whole number of capsules.
Taking a half-a-capsule requires organisation - I can't halve them at 6am while half asleep or mistakes would be WAY too common! And it requires some amount of energy and pre-planning etc., plus of course it's not very exact because I have to do it by eye as I don't have a gram scale or anything like that. Plus the pharmacy totally understandably isn't allowed to pack home-made capsules into my dosette/webster pack, so I have to remember to take the extra half as well as my standard pre-packed meds which pretty much doubles the chance I'll screw up my meds. So basically it's not actually a good solution, it's just less bad on my system than reducing my 37.5mg all at once.
Future plan is that once I'm down to 75mg I'll stay at that level for a few months until I'm totally adjusted and actually I'm not really sure what I'll do after that. The way the PBS (pharmacy insurance med rebate system here) works it's pretty hard to be on 37.5mg capsules for more than a month or so because the doctors aren't allowed to prescribe repeats - you're only supposed to need that dose for a week or two while you're increasing/decreasing the dose. The system doesn't allow for bodies that work like mine, it seems... the best idea I have at the moment is that I'll save up and get the pharmacy to compound me a few hundred capsules at a really low dose, 10mg or 15mg and combine them and the 37.5mg caps to manage a bunch of jumps each about 4 weeks apart until I'm down to zero.
On the other hand, I might just stay at 75mg for a few more years and worry about other things - the tiny bit of energy I have is probably better spent. I felt quite unhappy being stuck on 300mg of Effexor, which is about the maximum dose, but being on a quarter of that dose feels much less worrying to me. I'm not actually getting any awful side-effects and I don't need to be off it so that I can take something else or anything, it's just reductions in my general cause of "be on less drugs".
Wins so far in the "be on less drugs" crusade:
Clonazepam/Klonopin - down to zero, last dose was 3/3/2011!
Neurontin/Gabapentin - reduced from 600mg four times a day to 200mg four times a day, as of 4th Feb 2013
Effexor - reduced from 300mg/day to 93.75mg/day, as of today and down to 75mg next week
Because there are so many damm drugs in my dosette it's a LOT easier to "sit" on doses that can be made from a smaller number of capsules, which is not always related to how much drug is being taken, eg Neurontin comes in 100mg and 300mg capsules, so reducing from 300mg four times a day to 200mg to four times a day actually doubled the number of things I have to swallow, and which the pharmacy has to fit in my dosette box. That's why 75mg is a good 'rest point' for Effexor reductions and similarly 100mg is good for Neurontin reductions. Reducing the Neurontin from 200mg x 4 to 100mg x 4 is my next goal after getting the Effexor down to 75mg ... It'll take several months I know, but at least it makes me feel like I'm doing something positive for myself!!!
My life is so weird ....
r
What follows is WAY more than you probably ever wanted to know about my meds...
The reduction in dose seems crazy tiny, from 112.5mg to 93.75mg. The weird amounts are because Effexor only comes in capsules containing 150mg, 75mg, and 37.5mg ... go figure. I went from taking 75 + 37.5 to taking 75 + half of a 37.5. Luckily the halves can be "made" at home because the extended-release is in the little beads inside the capsule, so opening the capsule doesn't mess up the dose timing. Unfortunately that means I have to mess around with teeny tiny little balls to split the capsules, and it's not an exact process. What I have been doing is going down to the half-a-capsule amount and then a week or 10 days later doing a second drop so I'm back to a whole number of capsules.
Taking a half-a-capsule requires organisation - I can't halve them at 6am while half asleep or mistakes would be WAY too common! And it requires some amount of energy and pre-planning etc., plus of course it's not very exact because I have to do it by eye as I don't have a gram scale or anything like that. Plus the pharmacy totally understandably isn't allowed to pack home-made capsules into my dosette/webster pack, so I have to remember to take the extra half as well as my standard pre-packed meds which pretty much doubles the chance I'll screw up my meds. So basically it's not actually a good solution, it's just less bad on my system than reducing my 37.5mg all at once.
Future plan is that once I'm down to 75mg I'll stay at that level for a few months until I'm totally adjusted and actually I'm not really sure what I'll do after that. The way the PBS (pharmacy insurance med rebate system here) works it's pretty hard to be on 37.5mg capsules for more than a month or so because the doctors aren't allowed to prescribe repeats - you're only supposed to need that dose for a week or two while you're increasing/decreasing the dose. The system doesn't allow for bodies that work like mine, it seems... the best idea I have at the moment is that I'll save up and get the pharmacy to compound me a few hundred capsules at a really low dose, 10mg or 15mg and combine them and the 37.5mg caps to manage a bunch of jumps each about 4 weeks apart until I'm down to zero.
On the other hand, I might just stay at 75mg for a few more years and worry about other things - the tiny bit of energy I have is probably better spent. I felt quite unhappy being stuck on 300mg of Effexor, which is about the maximum dose, but being on a quarter of that dose feels much less worrying to me. I'm not actually getting any awful side-effects and I don't need to be off it so that I can take something else or anything, it's just reductions in my general cause of "be on less drugs".
Wins so far in the "be on less drugs" crusade:
Clonazepam/Klonopin - down to zero, last dose was 3/3/2011!
Neurontin/Gabapentin - reduced from 600mg four times a day to 200mg four times a day, as of 4th Feb 2013
Effexor - reduced from 300mg/day to 93.75mg/day, as of today and down to 75mg next week
Because there are so many damm drugs in my dosette it's a LOT easier to "sit" on doses that can be made from a smaller number of capsules, which is not always related to how much drug is being taken, eg Neurontin comes in 100mg and 300mg capsules, so reducing from 300mg four times a day to 200mg to four times a day actually doubled the number of things I have to swallow, and which the pharmacy has to fit in my dosette box. That's why 75mg is a good 'rest point' for Effexor reductions and similarly 100mg is good for Neurontin reductions. Reducing the Neurontin from 200mg x 4 to 100mg x 4 is my next goal after getting the Effexor down to 75mg ... It'll take several months I know, but at least it makes me feel like I'm doing something positive for myself!!!
My life is so weird ....
r
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Date: 2013-04-16 03:46 am (UTC)no subject
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Date: 2013-04-16 10:58 am (UTC)no subject
Date: 2013-04-16 11:26 am (UTC)no subject
Date: 2013-04-16 10:02 pm (UTC)(I had a halfway dose like yours and got around it by alternating 100mg and 50mg every other day, but your med probably clears too quickly for that trick. I love my pharmacists.)
My Lamictal (lamotrigine) comes in 25mg tablets for the express purpose of ramping up in the first week. But I'm such a special snowflake that if I take 100mg tablets once/day I have horrible headaches. If I take 2x25 mg twice a day no headaches. And of course they don't make 50s and the 100s are film so no split. At one pharmacy the 25mg cost US$1000/month, while the 100mg cost US$42.00. Yes, this makes no sense at all. ...oh no, that's "the great Amurrican free market at work."
My sympathies.
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Date: 2013-04-17 10:56 am (UTC)Good news on the dose-splitting front: I took apart one of the tiny capsules today to discover that since my pharmacy changed brands instead of a zillion teeny tiny beads inside it has 3 "mini-tablets" inside. Checked with pharmacy and yes as long as I don't split those I'm golden - so I have a no-mess-no-fuss-no-measuring way of getting 12.5mg doses! \o/
Also, thank the GODS for Australian PBS - the pharmacy med price control stuff. My faith in the "free market" is about .... well, zero. Markets do what we set them up to do: make as much money as they can. Yeah.
*hugs*
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Date: 2013-04-17 04:08 am (UTC)no subject
Date: 2013-04-17 10:56 am (UTC)no subject
Date: 2013-04-17 10:37 am (UTC)Sadly, there is a remote possibility that Effexor may be related to my recent mystery blood pressure rise and I may have to go through this process (again). Considering I've spent the last few months having trouble finding a shrink just to renew the damn existing scrip, I am really really hoping I can dodge that bullet. And while it is remotely possible that one of the newer SNRI or N-type drugs might work better on my fibro or not mess with my blood pressure (SSRIs don't touch my depression) I really don't see the need to mess with what's not really broken. I like sanity too much and I have too many other health problems to want to mess with it.
I'd be a little concerned in your case because Effexor's effects are super dose dependent. On the 75-and-less it only affects serotonin, not norepinephrine or dopamine. After about 200 it's all dopamine. The line is different for everyone, but I don't get the good effects until I'm at 150 and get no real benefit from adding more. I've added a hair of tricyclic in an effort to treat fibro pain, but more than a hair and I lose the good antidepressant effects (and got not appreciable pain change). So Effexor especially is one I wouldn't mess about with if it's working, what with its nasty withdrawal symptoms and tendency to do completely different things at different levels.
That said, the withdrawal/missed dose side effects are super shitty, and I've had to do that "take apart the pill" thing, so my sympathies. Hope it all works out for you!
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Date: 2013-04-17 10:57 am (UTC)I am aware of the dose dependence but thanks for making sure - it's a very odd thing for a drug to do! More post coming on this too :)
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Date: 2013-04-17 02:49 pm (UTC)I've really been so happy with it.