Changing to Ven ER from normal release

Kathi, thanks so much!

Hi did u have any side effects?

Purpledob, thanks SO much for this great reply! I am seeing a GP, and he has recommended that I try to reduce my Ven dosage from 150mg/day to 75mg/day, and hopefully below that down the road. I have come down from 150 to 112.5 over the last several months using standard release tabs with a few bumps, but ok.

Now I want to try 75mg/day, and have seen many times on this forum that the ER caps are more effective. (no?). He has prescribed 37.5mg ER caps so that I will have flexibility to ramp down if I can. My questions for now are: (1) should I take two 37.5mg at the same time, and (2) if so, what is the best time to take them?

Hope this makes sense!

Thanks for listening!!

Hi

ah so you are reducing. Then it is less of a concern. Extended release keeps steadier levels throughout the day which for you, practically, means fewer ups and downs and less tension.

Since you have ER caps at 37.5 you would need to take them at the same time in the morning or latest at noon.

There is a great way of reducing by combining ER with IR release but that may not be necessary at this point since you already did the hard work on IR alone

Take your time when you go on 75 and wait for a couple of months AFTER any adjustment disturbances subside before attempting the next cut to one 37.5 ER.

Good luck

BTW If you were last on 112.5 Immediate Release and taking one 75 IR morning and one in the evening - you are already on 75mg NOT 112.5.

Then by taking 2x 37.5 in the morning you are going through consolidation of 75mg and after 2-3 months dropping to 37.5 should be good. Reduces your chances for a relapse after stopping as well. It is worth it. Basically the longer you take between dose changes the better. I took between 3-9 months between each drop. From 150. No issues, no relapse 4 years - clean.

Wish the same for you.

 

Purpledob, I'm SO appreciative of these highly knowledgable replies, and particularly your encouraging words about being able to achieve a total cessation. I'm really looking forward to this next chapter.

Thanks so much!😀😀😀

Purpledob, Hope I'm not getting to far in the weeds on my dosage details, but here is the profile of my recent past:

15 Aug 16 - 14 July 17  1x150ER cap (significant panic attack early Aug)

15 July 17 - 20 July 17  2x56.25mg IR tab (am/pm) *

21 July 17 - 30 Sept 17 2x37.5mg IR tab (am/pm) * (tried to ramp down)

1 Oct - current               2x56.25mg IR tab (am/pm) *

* used "pill slicer" to get listed dosages!

If I understand what you are saying, my "effective dosages" starting in July have been HALF of what I thought. If so, this is good news, as I have been coping OK,  although not great!

I now need to decide if I'm going to take one or two 37.5 ER caps each morning.

Thanks so much for listening.

Cheers

Yes your dose is considered lower than you thought. Not exactly half but not far from it either due to the rebalancing and recoiling that the brain goes through when treated with IR...especially for anxiety disorder.

Ah...word of warning - You were on therapeutic dose of 150 ER less than one full year. 2 is minimum...4 is much better. (2 for therapy and 2 for maintenance).

You were then switched to immediate release (Only a GP could muck this up like that...) and dropped to 56.25 IR x 2 ...erm...technically close to half initial dose and with a nice spike-dip-spike-dip pattern that  IR offers. Not great. FOR ONLY 5 DAYS before rushing down to 37.5 x 2 IR. Of course you are not feeling great LOL. Two.Take two 37.5 ER and stick on them for at least 3 months and I would suggest longer to help your brain recalibrate and pick a good equilibrium to work from moving forward. Do not make the next cut in case of any major life changes, illness or extra stress. Pick a good time for your next cut. Take 2 not one. You may be shooting yourself in the foot otherwise. You are already compromised by that reckless drop. Feel free to consult a psychiatrist for a second opinion if you are unsure. But not a GP. 

What should have been done, if IR was to be used as a transition, was to take you down to 112.5 ER for a few months and then introduce 75 ER Plus 37.5 IR (taken together or a few hours apart) to train the brain to dip after 6 hours (IR is fast acting). That way you would gradually adjust to the dip before moving to 75 ER which should be kept for a few months. Then the same as above applied by using 1 x 37.5 ER plus 37.5 IR to retrace the dipping procedure for the brain. Then down to 37.5 ER for a few months and finally down to two 37.5 IR if necessary to further slow down. I was fine without that last step. But then I was treated for 4 years PLUS 2 years maintenance and took 2 years to wean off as described.

I went off twice prior to this and each premature and speedier drop landed me back with a vengeance a few months later. So the final lap of therapy was slow and very carefully designed by my amazing neuropsychiatrist. I was treated for massive GAD. The second relapse triggered transient psychotic episodes...So I was in no rush in the final lap. Slow does it.

Let us know how it goes whatever you decide.

All the best

I can't find the words to tell you how very much I appreciate this knowledgeable and comforting advice!

I decided on my own to try the 4 day taper. Pure ignorance on my part. My GP is a good doc, but he basically recommended that I reduce from 150mg/day to 75mg/day without specific guidance on timeframes, etc.

In hindsight, I probably should have requested a referral to a subject matter expert.

I'm very comfortable with your recommendations going forward. I keep very detailed daily records of my anxiety levels and sleep quality, and will be interested to see how the transition to the ER caps goes.

It's amazing to me how comforting it is to have a knowledgeable person looking over my shoulder. I feel like I have a jump start on the next phase😀

If you don't mind, I'll send you a status report down the road.

Cheers

Hi my doc wants me to change from 37.5mg immediate release at night to 75mg extended release at nite is there any side effects

Hi. Would you like to list your history on this drug in some detail?

When did you start?

What symptoms caused you to be prescribed this?

When was the last time you tried to properly come off with doctor's help and how was the taper designed?

How soon after removing just one bead did your condition start to worsen in your opinion?

Were you ever well on this drug?

Were higher doses ever attempted?

Were you ever on any other psychotropic drugs before or after starting venlafaxine?

Any details will help.

See, the problem is, that if you are tapering before actually being well on the drug, you are not likely to fare well however slowly you withdraw. The brain has nothing to draw on or reference to function optimally. Apprehension about impending crash makes you immediately stressed so you end up nowhere.

Have the doctors not suggested a bridge, such as Prozac, to aid in the taper? Have they not advised trying a different dosage? A different drug or combo?

x

I've come down from 150mg daily to 37.5mg per day, after 2 year's use. The effects the past few weeks have been horrendous, suicidal, anger, frustration, depression, anxiety, tearful, dizzy spells. I hate this medication have been trying for several months to get off this nasty drug. Got down to 16mg but the effects were so bad had to go up again, now waiting to see a Psychiatrist for help to get off them for good