change from venlafaxine capsules to tablets

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Having suffered from depression on and off most of my adult life I finally found venlafaxine prolonged-release capsules and life has been soo much better. None of the emotional numbness that came with seroxat: just a feeling of beeing almsot normal. Normal highs and lows - not too dramatic and the ability to go to work, cope with stress, divorce, kids - bliss. Last year however, the pharmacist gave me the tablet form, not the capsules and I went very dramatically and rapidly down, to the point of nearly being hospitalised for bad behaviour/anger. Coincidentally I came to the end of the batch and my new prescription put me back on the capsules and lo, within hours I was feeling more myself again. After a couple of weeks dim-witted me put 1 + 1 together and mentioned to my GP that I thought the tablet form didn't suit me and could I please have the capsules from now on. No problem she said. However, a few weeks later the head of the surgery rang to ask me what was my problem with the tablets. There is no difference, she said and because the tablets are cheaper, that is what you'll get from now on. I got a new prescription 5 weeks ago and am now screaming up the walls. Saw my GP this morning. She re-itterated that there is absolutely no difference between tablet and capsule but that I would have to wait at least 6 weeks before the drugs started to take effect. Why - if there is no difference, should I have to wait 6 weeks? I begged her to put me back on the capsules and she said no. I let the surgery sobbing my heart out and retching with distress. No-one came to ask if I was OK - they just let me leave. How do I persuade my GP that I NEED the capsules and that there must be a difference. I know nothing about chemicals. I can't explain it in technical terms. I only know how I feel; that I am sure it is not a coincidence and I need some help. Anyone had similar experience and can anyone tell me how to get my GP to listen to me and help me??

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  • Posted

    Hi

    “The GP/pharmacists are correct in saying that the capsules and tablets are considered to be bio-equivalent (that is, to have the same effect).

    There are however a couple of things to be aware of. Venlafaxine capsules are all modified release but there are two formulations of tablets – a modified release form and a standard formulation. You may like to check with your GP that you are taking the modified release tablets.

    The other difference between venlafaxine capsules and tablets could be the excipients. As there are so many brands/generics of venlafaxine it is difficult to point to anything in particular in this case, but if you have, eg an intolerance to say lactose, this could be something else to discuss with your GP.”

    Patient UK Admin Team

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  • Posted

    Have only just seen your post. I hope you are surviving this. I have almost exactly same experience with the change over imposed by PCT.

    I have been assured that there's no difference between capsules and tablets but my experience shows there is and I am much worse re depression. Verging on suicidal and very desperate.

    I've read information leaflets with both capsules and tablets and it states tablets are not suitable for people with digestive/instestinal disorders...because unlike the capsule type, the tablets are absorbed by the gut and so the release /absorbtion process is not the same.

    When I read this, I was shocked because I have long standing intestine problem, which must be recorded in my medical notes somewhere. I suspect no one has bothered to check. Also, I suspect that when we have been told medication the same, they are confused by the fact the chemical ingredients are the same but not understood the release process is different .

    I am talking to my GP tomorrow, in the hope of getting a change back to the capsules. I have no idea how it will be received but feel the more evidence I have, the better chance I've got of succeeding.

    I really hope this helps you and wish you good luck.

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  • Posted

    An added comment from my previous reply of last night:

    The irony in all this is that the original capsules I was taking, a generic version of Venlafaxine (called AlventaXL prolonged release) costs 7 times LESS than the tablets the PCT pharmacist changed me to.*

    Yet the letter from the pharmacist told me the change had been done because tablets \"considerably cheaper\"!!!

    *My Alventa XL capsules 150mg + 75 mg cost (£1.65 x £1.65)= £3.30 for 28 days supply. He called this \"premium priced\" and transfered me to Venlalic XL. new total cost cost for 28 days is £ 11.65 +£11.65 =£22.50. This information of costs is from the local pharmacist who prescribes my medication.

    So if your GP's still being difficult and obsessed about apparent savings, ask to be transferred to the gereric version, such as Alventa XL because that is a lot cheaper.

    My thoughts on this is if the PCT pharmacist was bright enough to get qualified as a pharmacist and clearly get promotion into a position of being able to change patients' medication without seeing them, why is he so dim as to make this sort of mistake?

    Who is making these decisions? How far up does it go?

    It is very worrying to think these sorts of shadowy people have total control over our lives and at the tick of a box, can make us go through such agony. WE necer meet them and can never appeal to them. It is not what I thought the NHS and the UK was about.

    It is so hard when we are desperately ill, but we have to fight this. Something is clearly wrong.

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  • Posted

    hi i think its disgusting the way price is involved.

    also i was doing really well on alventa xl and then got changed to venlalic, pharmacists told me there was no difference but unless someone has taken them themselves and had the experience we have i dont think they can comment.

    wish i was young enough and well enough to train to become a psychiatrist then i would really listen to patients opinions!

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  • Posted

    Hi. I also had a dreadful experience changing to the tablets from Effexor capsules. The change came about by me foolishly going to a different chemist. Within a week I had become a recluse and almost catatonic. It was that bad. Saw the GP today and explained to him and he gave me a repeat prescription and I took it to the chemist I usually go to and got the capsules again.

    I guess a point to note is that the prescription was for Venlafaxine and not for any particular brand. The prescription I got today said exactly the same thing so the only difference was the dispensing chemist I went to. If that happens again I'll just request the prescription back and go around the chemists until I get what I want.

    To answer the earlier question, if it was me and my GP was prescribing the brand I was to get then I think I would be offering to pay the difference. In the worst case I would go to a private GP and hope throwing more money at the problem would fix it.

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  • Posted

    I'm so glad that I finally went and 'googled' this problem!  I can't remember how long ago it was that I was forced to switch from the effexor capsules to the generic tablets (because of cost) but have have noticed a difference.  Nothing dramatic, but first I rapidly gained several kilograms.  And then I noticed that I would be getting the 'brain zap' withdrawal symptoms only 6 hours or so after taking my 75mg tablet, and also been really drowsy.  Recently, my moods have been a bit less stable and I have felt a bit depressed.  I have been having digestive issues for the last few months -- almost continuous bloating and gas, straight after eating and it doesn't seem to matter what it is that I eat.  Bowel movements are followed by mucous.  I don't believe that the digestive problems are caused by the tablets, but on one occasion recently I passed and entire, intact tablet, which wouls suggest that I didn't absorb any of it at all!!  From reading the other comments I suspect that my absorption of the tablets is poor compared to the capsules and that my symptoms (weight gain, drowsiness, brain zaps) is due to a reduced dose due to malabsorption.  It makes me angry to hear that the medical profession ignore these issues when they are reported and but cost above patient well-being. I will be going back to my GP here in New Zealand and asking that I be put back on the capsules.  I hope that he will listen to me and that the government regulatory agency (Pharmac) don't insist that I have the cheap tablets.
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    • Posted

      You say that you excreted a whole tablet. Pharmacist explained to me that what passes through is the inert framework after the drug has been gradually absorbed out. It's like a mini dosing ball. I didn't notice any difference when I changed from capsules to prolonged release tablet, but it sounds like some other people have.
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    • Posted

      I have exactly the same ive gone from years of going regular as clock work in the morning to now once twice a week and when i do go ther are like 5 intact whole tablets in my stool they are blaming my oramorph but i was on that for 2 years before ans never had a problem def going to tell my doctor now thankd
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  • Posted

    I found the tablet form was passing out in my stools! Quite easy to see if this is happening! Like. You I believe I went cold turkey. Now back on the capsules. What dose are you on?
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    • Posted

      Im on a 150 and 225 supposed to take in morm8ng found strange so moved to night then would go at 4

      30 to toilet every day then split tablets up thought give time for them to digest and take 150 in mirning and 225 at nighr go at least 5 days without going to the toilet have loads of winf bloated and fed up and depressed i want my routine back going every mornibg

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  • Posted

    Ive been on ven tabs for about 18months,  I automatically thought I was on the time release drug.  But I don think I am , always been tablets and I got up to 150mg abt 12 months ago.  I noticed that if I missed a dose ( 150 on an evening) following day I really felt down and out.

    I think the pharmisist is the best to ask, Ive found with my other medications (diabetes and gabapentin) that the pharmasist often gets his drugs from a cheaper place)

     

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    • Posted

      I love my gabapentin they help wiyh pain and sleep mind you im on the max dose 3 times a day if you dont mind me asking what are you on that for
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  • Posted

    When I switched from Mitazapine 45 mg over a week ago ( which made me suicidal ) I was put on normal release venflaxine (Venpax) tablets, that's to say you get a hot pretty much straight away, I am now on the slow release capsule (Effofor XR )which are hugely better and much more tolerable. 

    There in this sense is a huge difference. Check on the BNF I dont thing Effofor XR come in tablet form.

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  • Posted

    I have an issue with the tablets as well ever since i went in them i bwen better than my previoua but had some periods with anger issues. The worst thing is ive gone constipated but them blame it on the oramorph but been on that for 2 years and still continued to go rehular as clock work every morning. But since going onto the tablet ive gone constipated. Wont go for days then when i do go i have like 4 or 5 whole tablets in my stools i keep saying to them but they referred me to collerectal unit with colonic irregation kit instead. But having read one of the replies to your message it may make sense as im wheat yeasy gluten dairy poss lactose intolerant

    Im seeing my doctor next friday and didnt know they did capsulea so going to ask for them. Wht dont you say they are making you constipated and that they comubg out in your stools like me and makibg you bloated

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    • Posted

      Venlafaxine comes in sustained release tablets, mine are called Venlalic. Pharmacist explained that what comes out in your stool is just the empty framework of the pill, from which all the active drug has been dissolved and absorbed. I noticed no difference when I changed from Effexor XL capsules to Venlalic XL tablets. Hope that helps.
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