DISCLAIMER: THIS IS NOT MEDICAL ADVICE! We do not employ doctors or licensed medical professionals, so we do not provide medical advice. Nothing presented here is a substitute for the advice of a DOCTOR or other licensed health care provider. Never stop, start or add medications or supplements to your health or mental health care regime without first checking for interactions or other problems, and thoroughly researching the substance. Before you employ any information here, consult your health care professional. No information here is the result of valid clinical trials.

Tapering Slowly, Steadily and Consistently
off Cymbalta/Duloxetine.

You will find several warnings here about staying safe.

Tapering Guide

 

BACKGROUND

  1. Introduction
  2. Guidelines for Time to Taper
  3. On the Drug for only a Short Time
  4. Tapering After Reinstating
  5. Alternating Days
  6. Tapering When Taking Other Drugs

THE PRESCRIPTION

  1. Switching to the Correct Prescription for Tapering
  2. Micro-Beads
  3. Large Beads
  4. Chunks
  5. Powder
  6. Name Brand Cymbalta or the Correct Brand of Generic

THE TAPER

  1. Preparing for your Taper
  2. Buying Capsules
  3. More Things You Should Know
  4. The 3 Possible Tapering Methods
  5. Counting
  6. Weighing
  7. Compounding Pharmacy
  8. Asking for Support
  9. Warnings and Reminders

BACKGROUND

1. Introduction

Disclaimer - this is not medical advice

  • We are not doctors. We are not medically trained. We do not provide medical advice.
  • Sadly, there are very few professionals who understand the need for slow tapering, so we are here to support you.
  • We encourage you to do your own research and thinking. We ask you to make your own decisions, based on the discussions in the group and the many files available to you.
  • Please: never stop, start or add medications or supplements to your health or mental health care regime without first checking for interactions or other problems, and thoroughly researching the substance.

Our recommendations

  • CHW recommends a slow, steady taper while working on natural lifestyle changes to address the reasons the drug was prescribed.
  • Only very dangerous situations call for a sudden stop: serotonin syndrome, organ failure or an allergic response. Cold Turkey is extremely dangerous, both short- and long-term.
  • You need to work on diet, supplements and other natural remedies to help fortify the body and manage withdrawal symptoms. Use the Lifestyle Changes pages to find information.
  • Tapering is ideally done with a knowledgeable doctor, but they are rare. Be careful not to alienate your doctor as you will still need to get your prescription filled.
  • If you want to see how your doctor feels about it, be careful how you mention slow tapering.  (They may make patients go cold turkey, do a rapid taper or bridge them to other drugs.)
  • You may wish to not mention your taper until it is finished so you can continue your prescription.

Doctors will tell you a number of things which simply
are not true.

  • Just a quick look at the Discussion page will show you how dangerous Cymbalta is.
  • Trust your own judgement - you are the one who will suffer, not the doctor.

Here is the truth:

  • Cymbalta does cause dependency and brings with it a host of side effects.
  • Skipping days, dropping 20 or 30mgs in one go, or going cold turkey is extremely dangerous.
  • Slow tapering avoids the misery suffered if you do not follow our recommendations.
  • Withdrawal symptoms can kick in at any point and may last for months or years.
  • Bridging to another drug will not stop withdrawals but will complicate your taper.

Withdrawal can look and feel like other major health and mental health disorders:

  • A bad Fibromyalgia flare
  • Multiple Sclerosis
  • Bipolar
  • Schizophrenia
  • GAD
  • MDD
  • Depression
  • Anxiety
  • and all the rest …

2. Guidelines for Time to Taper

General

  • There are no absolutes or guarantees when tapering off a psychotropic drug. They are unpredictable, so these are merely guidelines, based on experience.
  • The maximum taper we suggest is 5% or less of the previous dose, holding a minimum of 2 weeks.  The 1st hold should be 3 weeks.
  • If you have had a previous bad taper or even CT, a taper rate of even 2 or 3% may be too fast.
  • Important to note: a 10% taper is ONLY suitable for people who have been on Cymbalta for a month or less, who are pregnant or have life-threatening situations - providing they are able to taper and don't have to go cold turkey.
  • Everyone wants to taper as fast as possible, but slower is much safer than faster. Your brain needs time to adjust.
  • Most people find they need to slow the taper at the mid-way point and towards the end. From 50 beads on, many people only reduce by 1 bead at a time. From 30 beads this is essential.

You must taper down to the very last bead.

  • Even after finishing, you may still have a difficult time. It depends on your brain and body, your taper, your previous experiences and prescribed drugs.

3. On the Drug for Only a Short Time

It takes only 2 to 3 weeks for the brain to become dependent on Cymbalta/Duloxetine.

  • Many people on the drug for a short time find they need to taper much longer to avoid harsh and/or protracted withdrawal.

The following suggestions are all up for discussion and you, the member, must make the decision, based on the information available to you through CHW.

  • The closer you are to 2 weeks on the drug, the more likely you will need to slow taper. The taper needs to be steady but not too long. Moderators can discuss this, based on their experience with other members.
  • When on the drug 2-3 weeks it becomes much more difficult to decide. Withdrawal may resolve quickly, or it could produce a more protracted withdrawal.
  • So, from 2 weeks to 4 weeks you can consider a 10% taper. But anyone on the drug less than a year should proceed with caution. The general rule is to taper at least as long as on the drug, but again, many find they need to taper much longer than they were on the drug.

4. Tapering After Reinstating

  • After reinstating, stabilize and then hold at least 2-3 weeks or longer before beginning your taper.
  • Take that time to read through the tapering document and other files, and prepare for your taper.
  • Reinstatement without stabilizing. Some people think stable means without symptoms.  But for many of us, stable is as good as it gets, and not perfection.
  • Stabilizing is difficult to define exactly but most people who are tapering have had enough adverse effects to know what it’s like to miss a dose.  We understand it as being the baseline or where you were before the event causing the reinstatement.
  • Occasionally, someone will reinstate and even after a very long time - months to a year – they find they just can’t stabilize.  In that case, we recommend 2.5% decreases every 14 days or more.

5. Alternating Days

  • Cymbalta has a short half-life of 12 hours, meaning around 24 hours from the last dose, the body will start to go into withdrawal.
  • Alternating days throws the body into withdrawal every other day.

Ideally, you should be on a daily dose for tapering.

  • The FDA and the manufacturers warn that abrupt changes in dose are dangerous and the drug should be decreased slowly over a longer period.
  • The most dangerous times with serotonin-affecting drugs are when stopping, starting, changing doses up or down, or adding and taking away other drugs.
  • After alternating days for more than 2-3 weeks, it is risky going back to a daily dose. You may consider finding a mid-point between the two doses and trying to stabilize there.(Example: alternating 60mg and 30mgs…try to stabilize at 45mgs daily for at least 2-3 weeks before beginning a slow taper.)

6. Tapering When Taking Other Drugs

There can be no clear-cut recommendations for tapering when taking other drugs.

  • Cymbalta is such a difficult, dangerous drug on its own. In combination with other drugs the situation is much more complicated.
  • It has to be a personal decision which you make with the guidance and experience of our moderators.

THE PRESCRIPTION

7. Switching to the Correct Prescription for Tapering

Any switching may cause side-effects, adverse reaction or withdrawal symptoms.

  • After changing to a new brand, hold for 2-3 weeks to see how the body will react before beginning a taper. It is the enteric coating which may affect you.
  • When switching brands mid-taper, some adjustment may need to be made so you can stabilize.

Capsule Contents

What type of beads do you have? (4 possibilities)

  • Not all brands will work for bead counting or weighing, or other tapering methods. You need to switch to a brand suitable for tapering BEFORE beginning the taper. Switching after the taper has begun may cause problems.
  • How you arrange this with your doctor / pharmacist may need some thought.

8. Micro-Beads - round, similar sizes

  • Use the weighing or bead counting method.

9. Large Beads (5mgs each)

  • DO NOT USE FOR TAPERING. Switch to microbeads.

10. Chunks - Irregular Shapes

  • Cannot be used for bead counting. Use the weighing method.

11. Powder

  • Uncommon - takes a highly sophisticated scale. Switch to microbeads or use a compounding pharmacy.

12. Name Brand Cymbalta or the Correct Brand of Generic

If you have the name brand Cymbalta or the generic, with several hundred, similar-sized beads, then you can do the bead method. This is counting the beads.

These capsules have microbeads suitable for tapering

  • Actavis
  • Ajanta
  • Breckenridge
  • Camber
  • Citron
  • Cymbalta (Name brand)
  • Cymgem
  • Duloxetin krka (Denmark)
  • Golden State Medical Supply (GSMS)
  • Orion
  • Rising Health
  • Sandoz
  • Solco
  • Sun
  • Torrent Pharmacy

PROBLEM BRANDS

  • Apotex- may have supply issues. AND - These should ONLY be weighed!
  • Duciltia made by Pharmatha - does NOT have microbeads
  • Teva - supply problems
  • Prasco - no longer being manufactured.
  • Accord - no longer being manufactured
  • Blu - no longer being manufactured
  • Dr. Reddy - no longer being manufactured
  • Mylan - no longer being manufactured
  • Lupin – does NOT have microbeads

THE TAPER

13. Preparing For Your Taper

Print or bookmark this page and use it
to keep you focused.

The first few weeks may be stressful. Being fully prepared can help to ensure a successful taper.

Do think carefully through all these points. Some will not apply outside the U.S.

  • Read and understand the tapering documents. Read the FAQ file.
  • Know that talking to an uninformed doctor about a SLOW TAPER plan can result, worst case, in their implementing their OWN fast taper plan that can be devastating. It may be better to not tell your doctor and keep getting your regular script.
  • Have a back-up doctor who can write a prescription in case your original prescriber is not available.
  • BEFORE beginning your taper, speak to your pharmacist about always getting the correct brand for tapering.
  • BEFORE paying for your prescription refill, make sure you have been given the correct brand. (Sometimes pharmacies change brands without warning!)
  • Start a tapering journal (dates, doses, decreases, symptoms) and then keep it going.
  • Use the Excel spreadsheet to prepare your tapering doses and schedule.
  • Get together all the things you need for your tapering method.
  • Buy supplements to support your healing - good quality ones.
  • Make a crisis and safety plan with close, trusted family and friends. (Look in files section.)
  • Stabilize for at least 2-3 weeks before you start.

Plan how you will manage the taper and any withdrawals:

  • See files for list of natural ways to address withdrawal symptoms.
  • Start building an anti-inflammatory diet into your daily routine.
  • Avoid refined foods, GMOs, sugars, sweeteners, simple carbs, dairy, alcohol & caffeine.
  • Take good probiotics and eat plenty of cultured and fermented foods to repair gut health.
  • Stay well hydrated - lots of water and lots of electrolytes.
  • Add gentle exercise, meditation and breathing exercises to your routine.
  • Stock freezer with healthy meals for bad days.
  • Get plenty of fresh air and sunshine.
  • Make a post to CHW so you know everyone is there to support you. Ask for comments on your plans if you want.

14. Buying Capsules

Plain gel capsules can be bought online (Amazon and many others) or in a pharmacy or health store. Size 0 or 00 are preferred by many for ease of filling. 00 is the larger of the two. For comparison: Cymbalta usually comes in size 4. You can buy vegetarian ones if you want.

Enteric capsules should not be used. The beads already have an enteric coating.

15. More Things You Should Know

  • Each decrease is a decrease from the PREVIOUS DOSE and NOT from the ORIGINAL DOSE.
  • If you take a morning dose and an evening dose, you will need to make capsules with the correct number of beads for each dose.
    - Your morning dose and your evening dose should both be equal. Keep your percentages the same.
    - You will need to empty both capsules and reload them with the correct number of beads.
  • DO NOT take the beads without a capsule. Empty capsules can be bought.
  • Set aside a time each week to make up your doses.
  • Keep pets and small children out of the room.
  • Store capsules and beads safely - away from children and animals.
    - In the refrigerator will help prevent static and keep the beads under control when counting.
  • Count beads on a dark cloth to prevent them from rolling around.
  • Keep your left-over beads. Store the extra beads in an airtight glass container. Keep them in the refrigerator or other safe place for later use.
    - You can also just use them in the next capsules you make up, if you are using new capsules.
  • Listen to your body. If you observe any unusual side effects, then you should probably decrease your percentage and/or hold longer between decreases.
    - If withdrawal symptoms persist then hold your taper until things resolve.
  • You may need to reduce the percentage as you go lower, and most likely hold longer between decreases.
    - Usually at 30-15 beads you will need to start decreasing by only one bead at a time.
  • Youtube video member Chuck Dobovsky's bead tapering suggestions: https://www.youtube.com/watch?v=a4Gd_GBO-Ec.
  • Follow the guidelines. Do not go "off roading". Keep decreases at the recommended % and hold at least 2 weeks between decreases.
  • Do not rush the taper.
  • Do not alternate or skip days.
  • Always ask for support when you need it.  Please give us basic information at the start of the post.

16. The Three Basic Tapering Methods

17. Counting

We are excited to introduce our online bead calculator!

You will not need to download or use excel and we are hoping this will be more convenient and easier for everyone. Find it here

 

The Excel Spreadsheet for Bead Counting provides the exact dosages and counts for a successful taper:

  • Prepare for your taper and start your journal. (See list above.) Keep the journal up-to-date.
  • Count the beads in 3 separate capsules to find the average number. This will be the number you use to put in the Excel spreadsheet to make your tapering calculations. Each capsule contains a different number of beads so using an average helps to ensure consistency.
    EXAMPLE: Capsule 1 contains 300 beads, Capsule 2 contains 320 beads and Capsule 3 contains 290 beads. Add 300 + 320 + 290 = 610. Divide 610 by 3 = 303 beads average.
  • Enter the number into the Excel taper spreadsheet found in the Files tab. The spreadsheet is the safest way to do it. You will need to have the Excel program set up on your computer or electronic device. Go to the library or a print shop that has computers if you need to.
    You can also make calculations by hand or with a calculator.
  • Decide what rate you want to taper (*10%, 7.5%, 5%, 2.5% or less) and decide how long you want to hold between each decrease.
    We recommend you start at 5% and hold the first decrease for 3-4 weeks. After the first decrease, the hold time may be shortened to at least 14-21 days or longer between decreases.
    *10% is far too aggressive for most people. It is only recommended in a few special cases.
  • You want to have the exact bead count each time.
    So: empty all the beads from the capsule, then count the correct number of beads (indicated on the Excel spreadsheet) back into the capsule.
  • Remember, the first decrease should be held at least 21-28 days to see how the body tolerates it.
    Put all the details in your tapering journal and resist the urge to speed up. Stay with your schedule.

COUNTING - EXAMPLE

Here is an example to show you what to do. Try and work through it. Take your time.

First decrease of 5% - average bead count 303.

303 x 5% = 15 beads. 303 - 15 = 288 beads.

Count out 288 beads and put them into the old capsule or a new gel capsule.

Take a capsule with 288 beads every day for 3 - 4 weeks, at the same time every day.

Second decrease of 5% - this time it is 5% of 288 (5% of the previous dose).

288 x 5% = 14 beads. 288 - 14 = 274 beads (take for 2-3 weeks)

Third decrease of 5% again - this time 5% of the last dose is 5% of 274 beads.

274 x 5% = 13 or 14 beads. 274 - 14 = 260 beads (take each day for 14 days)

Fourth decrease - 5% decrease again - 5% of 260 = 13

260 x 5% = 13 beads. 260 - 13 = 247 beads each day for 14 days. And so on.

There are videos available to show you different ways of doing this. You can "Search this group" with the words "counting beads".

You are going to have to make up capsules for at least a few days. This is hard but does get easier.

If that really does not make sense, ask for support.

18. Weighing

See our complete instructions for weighing here: http://www.healingamericanow.com/chw-the-scale-method/

Or you can visit the web site Duloxetine.info for detailed instructions on how to weigh. This site provides a step-by-step tutorial on exactly how to SLOW TAPER using an inexpensive scale. It also details all the materials needed and all the steps for a successful slow taper.

19. Compounding Pharmacy (Not Used Very Often)

  • This is not always easily available, if at all.
  • Cymbalta cannot be used in a liquid form.
  • You must have a good working relationship with both your pharmacy and your doctor.
  • (You need them to respond quickly to your needs and change the taper instructions when required.)
  • Your doctor will need to write a taper prescription to give to the compounding pharmacy.
  • Not all doctors and compounding pharmacies know how to do a proper % taper, so it is vitally important that you fully understand the process. You must work with them very closely to ensure they are doing it correctly.
  • Tell the pharmacy as soon as you experience any withdrawal symptoms. Work with them on slowing the taper or reducing the percentage.
  • Make sure you have the correct microbeads for tapering.
  • Tell the pharmacy / doctor you always want to use that brand.
  • You will probably need to switch to bead counting as you near the end of your taper.
  • Between 30-15 beads, you will need to begin decreasing by only 1 bead each time.
  • Taper down to the last bead.
  • Your doctor and pharmacist must agree with your plans to follow our guidelines for a 5% or less taper every 2 weeks or longer.

They must be willing to adjust your taper as necessary: for example, if you need to hold longer and/or reduce your percentage rate.

Using a compounding pharmacy can be very expensive, and you have to make sure that they use beads, NOT a liquid or powder form of Cymbalta.  Only the beads are delay-released.

Useful links

  • For U.S. residents: Pharmacy Solutions www.pharmacysolutionsonline.com
  • They bead count by hand and they will be charge $25.00 for 7 capsules. That's $100.00 for a four week supply. They also accept insurance, so if you don't enjoy counting beads, have insurance or can otherwise afford it, this might be a good option for you. They will need a doctor's prescription.
  • For the Seattle area: http://www.thefallspharmacy.com/
  • There is a document in the CHW FB files called compounding-pharmacies-us-australia-uk-and-canada which may help.

20. Asking For Support

Please make a new post, don't try and discuss your own problems on someone else's post.

Make it easier for moderators and more helpful for you too. At the start of your post give this information:

  1. Are you tapering?
  2. If so, what is your tapering history: (percentage, date started, holding time).
  3. Is this your first drop? What symptoms are you experiencing?

And only then say what problem you have.

21. Warnings and Reminders

DO NOT RUSH THE TAPER!

  • How you taper directly affects the outcome. Rushing has a direct negative impact on success.
  • We recommend you to start at a taper rate of 5% or lower to avoid withdrawals.  You should hold the first taper for 3 weeks to allow your body to adjust.
  • A low taper rate will be needed after going cold turkey, reinstating or having previous bad tapers or cold turkey withdrawals.
  • The holding time between decreases depends on the individual. It is usually 2 - 4 weeks before dropping again. The longer on the drug, higher dose amounts and more other psychotropic drugs involved will make it more complicated, and a longer, slower process.
  • Please remember the positives: even after previous unsuccessful tapering attempts, most people have been successful when tapering slowly, steadily and consistently.

FINAL REMINDERS

  • When people cold turkey or fast taper, withdrawal effects may show up later, generally between 2-6 months later - but sometimes even later.
  • It can take 2 or 3 weeks or even longer for a negative reaction to reducing the dosage.
  • Keep a note of any symptoms in your journal.
  • If you experience severe withdrawal symptoms such as brain zaps, irrational thoughts, rages, suicidal ideation, etc., hold until stabilized.
  • You may also need to lower the percentage taper rate. Some people are so sensitive they can only reduce by 1% or even just one bead.
  • Hold the first decrease at least 3-4 weeks to see how you are going to do with your initial taper percent.
  • Listen to your body.

"OFF-ROADING" PITFALLS TO AVOID - FOLLOW THE RULES!

Be consistent. All of the pitfalls below can lead to problems and may risk the success of the taper.

  • Starting the taper without fully understanding the process
  • Making large decreases, alternating days, bridging to other drugs
  • Tapering with the large beads
  • Unrealistic percentage decreases of previous dose
  • Yo-yoing the dose up and down
  • Rushing the process
  • Shortening hold times
  • Dumping beads, guesstimating and "eye-balling" the beads
  • Removing beads instead of loading the capsules with the correct number
  • Jumping off at the end instead of going to the final bead

If you have any questions, do not hesitate to contact the group for support and advice. We are here to help, and want to see you have as safe and comfortable a taper as possible.

 

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