Cutting pristiq tablets during taper

[MisterKitty]

I know that pristiq has time released coating, but is it okay to cut the tablet in half for a patient weaning off the medication?

Ideally patient would take a lower prescribed dose but they do not want to pay for more medication.

Anyone have experience with this issue?

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[sighchiatry]

I know that pristiq has time released coating, but is it okay to cut the tablet in half for a patient weaning off the medication?

Ideally patient would take a lower prescribed dose but they do not want to pay for more medication.

Anyone have experience with this issue?

Not ok.

Two weeks of 25 mg costs around $20 on goodrx.

 

[MisterKitty]

Thanks

 

[Jules A]

If extremely sensitive to reductions of that and Cymbalta I have changed over to Effexor with decent results when tapering.

 

[tr]

Agree can't cut a time release capsule. I do qod dosing for difficult tapers after hitting lowest dose.

Sidebar: @Jules A you switch to *Effexor* for tapers? Does that work well? Effexor has been about the worst offender for nasty withdrawal in my experience. Similar or worse than Cymbalta usually from what I've seen.

 

[TexasPhysician]

If extremely sensitive to reductions of that and Cymbalta I have changed over to Effexor with decent results when tapering.

Makes no sense to me. I’d do the reverse. Effexor has a shorter half-life.

 

[hamstergang]

Makes no sense to me. I’d do the reverse. Effexor has a shorter half-life.

But Effexor has immediate release tablets which can be cut. Not that I've actually done this but I'd think this is the reasoning.

 

[Jules A]

But Effexor has immediate release tablets which can be cut. Not that I've actually done this but I'd think this is the reasoning.

Yes, not ideal and rarely needed but has been helpful or positive placebo. IDK
And wasn't it Stahl who talked about dissolving in juice?

 

[tr]

Yeah I think the use of very short acting agents in tapers creates more problems than it solves. I find that people at the end of a Cymbalta or Effexor taper usually start noticing the w/d sx about 2 days post last dose, so the every other day dosing works pretty well to keep it at bay. Like 20 mg qod for two weeks, then if they are still having difficulty can go to 20 mg every third day, but I've rarely had to do this.

 

[Mass Effect]

I also had a patient who also didn't want to pay for the 25 mg. She chose to taper off 50 mg and was able to do it without any problem.

Curious -- if you're cross-tapering to an SSRI, how long after last dose do you start it if they do the 50 mg taper rather than 25 mg?

 

[calvnandhobbs68]

I also had a patient who also didn't want to pay for the 25 mg. She chose to taper off 50 mg and was able to do it without any problem.

Curious -- if you're cross-tapering to an SSRI, how long after last dose do you start it if they do the 50 mg taper rather than 25 mg?

You mean not starting the SSRI until they're completely off Pristiq or what time of day you give the SSRI while giving them both at the same time?

It's not really a cross-taper if you don't taper up on one medication while they're tapering down on the other.

 

[Liquid8]

Agree that you can't cut an extended release capsule. When taking patients SNRIs will usually go down to alternate day dosing at the lowest available dose, but adding a bit of mirtazapine in the short term can help with bad withdrawals.

I also had a patient who also didn't want to pay for the 25 mg. She chose to taper off 50 mg and was able to do it without any problem.

Curious -- if you're cross-tapering to an SSRI, how long after last dose do you start it if they do the 50 mg taper rather than 25 mg?

If the patient is very worried about side effects of a new treatment or the severity of their depression isn't so bad that they can be off medication completely, I'll suggest a 2 week washout period before starting something new.

 

[Attending1985]

What is the problem with splitting the extended release? Now it’s not extended release who cares. The dose is small and you’re getting off of it.

 

[Mass Effect]

You mean not starting the SSRI until they're completely off Pristiq or what time of day you give the SSRI while giving them both at the same time?

It's not really a cross-taper if you don't taper up on one medication while they're tapering down on the other.

Sorry, meant if you don't do a cross-taper,with 50 mg of Pristiq being last dose, when would you start the SSRI?

 

[Alemo]

Is there any evidence that desvenlafaxine is more efficacious than regular velafaxine for MDD?

 

[Sushirolls]

The answer to breaking a capsule is within the pharmacy literature. You need to know what technology the drug manufacturer used for this capsule and extended release. Some drugs you can break a capsule with some loss, others have marked loss. But when you are doing a taper a partial loss is just fine, because, well, you are tapering off anyways. Consult the pharmacy literature. That is where you find your answer. Most retail pharmacists don't know. Its rare to find a pharmacist who is truly knowledgeable on the specifics of each extend release mechanism of delivery and what breaking the capsules will do.

Clinically, I've not yet had a single patient who couldn't tolerate the cessation of 50mg of pristiq and needed a step down.

 

[Sushirolls]

Is there any evidence that desvenlafaxine is more efficacious than regular velafaxine for MDD?

Clinically for me, no. I've yet to see a patient respond to pristiq. I've seen countless respond to effexor though.

 

[calvnandhobbs68]

Agree that you can't cut an extended release capsule. When taking patients SNRIs will usually go down to alternate day dosing at the lowest available dose, but adding a bit of mirtazapine in the short term can help with bad withdrawals.



If the patient is very worried about side effects of a new treatment or the severity of their depression isn't so bad that they can be off medication completely, I'll suggest a 2 week washout period before starting something new.

Sorry, meant if you don't do a cross-taper,with 50 mg of Pristiq being last dose, when would you start the SSRI?

I agree with the above, the only reason (which is what I'm guessing you're getting at) that I would totally wash out one med before restarting another one (especially with SNRIs/SSRIs because they just take so long to get theraputic) is if a patient is extremely worried about side effects or they don't have terrible depression in the first place. Otherwise, why not just start a low dose SSRI (ex. 5mg Lexapro, 10mg Prozac, etc) the last week or two of the taper?

 

[tr]

Can we revoke forum access for anyone using variations of the phrase, "balance chemicals within our brain"?

 

[birchswing]

Can we revoke forum access for anyone using variations of the phrase, "balance chemicals within our brain"?

I can name names of practicing psychiatrists who have used this exact description of medication. I can name pharmaceutical advertisements that stated "may be caused by a chemical imbalance in the brain." I can name psychiatrists who are deeply enmeshed in that industry. Please don't pretend this came from anywhere other than the field of psychiatry/pharmaceuticals.

Here are just a few of the marketing tag lines verbatim:

Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature

www.ncbi.nlm.nih.gov

You know psychiatrists repeated these. You know the psychiatrists let drug reps put the brochures in the offices to get their fried chicken lunches ("How else would we get lunch? We see patients all day!"). You know the psychiatrists got paid to repeat this stuff as thought leaders (Open Payments Data - CMS | CMS Open Payments Data). You know people have been told it's "just like a diabetic needs insulin."

Can we get doctors off the pole is a better question.


I'm sure every doctor here has attended some function funded by the propagators of these myths at some time.

 

[tr]

I can name names of practicing psychiatrists who have used this exact description of medication. I can name pharmaceutical advertisements that stated "may be caused by a chemical imbalance in the brain." I can name psychiatrists who are deeply enmeshed in that industry. Please don't pretend this came from anywhere other than the field of psychiatry/pharmaceuticals.

Here are just a few of the marketing tag lines verbatim:

Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature

www.ncbi.nlm.nih.gov

You know psychiatrists repeated these. You know the psychiatrists let drug reps put the brochures in the offices to get their fried chicken lunches ("How else would we get lunch? We see patients all day!"). You know the psychiatrists got paid to repeat this stuff as thought leaders (Open Payments Data - CMS | CMS Open Payments Data). You know people have been told it's "just like a diabetic needs insulin."

Can we get doctors off the pole is a better question.


I'm sure every doctor here has attended some function funded by the propagators of these myths at some time.

I agree, the world is full of idiots, gulls, frauds, parasites, hypocrites, and ignorami. Let us not be among them.

 

[PsyDr]

I know of a psychiatrist that uses the microtaper technique. Has high functioning patients open the capsule, count the beads, reduce the number of beads progressively.