![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by vitalsign0 on August 4, 2005, at 14:11:10
I've been taking 50mgs of Luvox and 1mg of Xanax everyday for 7 years.
I'd really like to get off of Luvox (weight gain and tiredness), but am having trouble.
I split the 50mgs pill into 4 sections and have tried going down to 37.5mgs at night. It's been 3 days now and I feel terrible. I don't have the "zaps", but I feel totally out of it. Hard to think straight.
Is there anything I can do to make this process any easier?
Posted by SLS on August 4, 2005, at 15:53:34
In reply to Luvox withdrawal. Any advice?, posted by vitalsign0 on August 4, 2005, at 14:11:10
Hi.
> I split the 50mgs pill into 4 sections and have tried going down to 37.5mgs at night. It's been 3 days now and I feel terrible. I don't have the "zaps", but I feel totally out of it. Hard to think straight.
The first thing I would do would be to take the medication several times a day rather than once a day.
If that helps, then you can perhaps use a dosing schedule that is more flexible. One strategy is to not take any medication until you feel the withdrawal symptoms begin to emerge. You should find that the interval between dosing will become longer and longer. It would be advantageous to be able to divide your medication into even smaller doses. Once the interval between 12.5mg doses exceeds 10 hours, you might want to try using smaller doses that allows the withdrawal symptoms to emerge between 6-8 hours after each dose, and continue the process from there.
How small a dose can you divide your pills into?
- Scott
Posted by vitalsign0 on August 4, 2005, at 17:35:40
In reply to Re: Luvox withdrawal. Any advice?, posted by SLS on August 4, 2005, at 15:53:34
> Hi.
>
> >
> The first thing I would do would be to take the medication several times a day rather than once a day.
>
> If that helps, then you can perhaps use a dosing schedule that is more flexible. One strategy is to not take any medication until you feel the withdrawal symptoms begin to emerge. You should find that the interval between dosing will become longer and longer. It would be advantageous to be able to divide your medication into even smaller doses. Once the interval between 12.5mg doses exceeds 10 hours, you might want to try using smaller doses that allows the withdrawal symptoms to emerge between 6-8 hours after each dose, and continue the process from there.
>
> How small a dose can you divide your pills into?
>
>
> - Scott
>
>I can split the pill into 2 25mgs halves. Then into 12.5mgs. Anything lower than that and the pills just crumple into dust.
So you are saying try taking 12.5 doses 3x a day and only take a dose when the withdrawal appears?
Posted by SLS on August 5, 2005, at 7:57:51
In reply to Re: Luvox withdrawal. Any advice?, posted by vitalsign0 on August 4, 2005, at 17:35:40
> > The first thing I would do would be to take the medication several times a day rather than once a day.
> >
> > If that helps, then you can perhaps use a dosing schedule that is more flexible. One strategy is to not take any medication until you feel the withdrawal symptoms begin to emerge. You should find that the interval between dosing will become longer and longer. It would be advantageous to be able to divide your medication into even smaller doses. Once the interval between 12.5mg doses exceeds 10 hours, you might want to try using smaller doses that allows the withdrawal symptoms to emerge between 6-8 hours after each dose, and continue the process from there.
> >
> > How small a dose can you divide your pills into?
> I can split the pill into 2 25mgs halves. Then into 12.5mgs. Anything lower than that and the pills just crumple into dust.I use to just nibble off small pieces with my teeth. Precision really isn't necessary when using the flexible-dosing strategy I have found success with. If you can get a small supply of the smaller 25mg tablets, it would make things easier. However, you might end up having an easy enough time not to need them.
> So you are saying try taking 12.5 doses 3x a day and only take a dose when the withdrawal appears?Exactly. You use Luvox as a PRN as needed in a way similar to using aspirin whenever a headache appears. However, don't allow the withdrawal symptoms to persist for more than 30-60 minutes before taking your next dose. It is important to wait until symptoms appear so that the system is "nudged" in the direction of re-regulation. It also guarantees that you are reducing the dosage of the drug at a rate equivalent to that of the body's ability to adjust.
From what I can see, people who go "cold turkey" and discontinue their SRI antidepressants abruptly experience an intense and protracted episode of withdrawal syndrome that can last weeks beyond their taking their last dose of medication. This might be the result of a kindling effect, something that is precipitated by allowing the withdrawal symptoms to persist for too long. In other words, don't be a hero. Trying to withstand the withdrawal syndrome for more than 30-60 minutes hurts rather than helps.
Ideally, you should now find the minimum dosage that will prevent withdrawal symptoms from appearing for approximately 6-8 hours. You should be taking small amounts of Luvox 3-4 times a day. This helps prevent the sharp peaks and valleys in blood concentration that once a day dosing produces. You will then find that it takes less and less medication to produce the 6-8 hour symptomless period. I wasn't quite so precise when discontinuing Effexor and Ativan. I just estimated the doses and erred on the side of undermedication rather than over medication. I knew that I could always take a little more if I needed it. Because Luvox comes in tablets rather than capsules, you have the convenience of breaking off small pieces.
Using the flexible-dosing method, I have been able to withdraw from Effexor 300mg on multiple occasions. I have also used it successfully to discontinue Ativan 4.0mg.
You might want to first try another method of reducing your dosage of Luvox. The most difficult part of the process is the last 25% of the original dosage. It is this last 25% for which I find the flexible-dosing method most appropriate to utilize. Flexibility gives you control over the drug and over your body. You can be creative in how you go about administering a declining dosage of medication, as long as you follow the fundamental plan of waiting for the reappearance of withdrawal symptoms before taking your next small dose.
Sometimes my explanations are not very clear. Please ask questions.
- Scott
Posted by vitalsign0 on August 5, 2005, at 8:29:18
In reply to Re: Luvox withdrawal. Any advice?, posted by SLS on August 5, 2005, at 7:57:51
Sounds interesting and surely worth a shot.
I had to go back to 50mgs yesterday. The withdrawal got too intense. I was crying for about an hour for no real reason, felt like I was on really bad LSD, and barely knew where I was.
After taking to full 50mgs, within an hour I felt better.
So I am at a loss. My doctors (all 3 of them) have been worthless in regards to withdrawal.
So the plan for tomorrow will be having 3 12.5 doses ready. Take one in the morning and then wait for even the slightest symptom to appear and then take another, repeat for the final dose.
Continue this until the withdrawal is minor after many hours of a dose.
Would you say the Xanax compunds the problem of withdrawaling off of Luvox since it's breakdown is hindered in th eliver by Luvox?
Where did this plan come from?
BTW, thanks a lot for your time, it means a lot.
Posted by SLS on August 5, 2005, at 9:40:19
In reply to Re: Luvox withdrawal. Any advice?, posted by vitalsign0 on August 5, 2005, at 8:29:18
Hi again.
> Where did this plan come from?I'm sorry to have to inform you that the plan is my own. The flexible-dosing strategy has been used by others at my suggestion and have been successful discontinuing SRI antidepressants.
> So the plan for tomorrow will be having 3 12.5 doses ready. Take one in the morning and then wait for even the slightest symptom to appear and then take another, repeat for the final dose.
It is good that you be familiar with the signs and symptoms of the withdrawal syndrome so that you can identify it accurately when it does appear without being too anxious and dosing prematurely.
> Continue this until the withdrawal is minor after many hours of a dose.
I think it is better to reduce the size of the dose as you go along and keep approximately the same interval of dosing rather than keep the dose static.
> Would you say the Xanax compunds the problem of withdrawaling off of Luvox since it's breakdown is hindered in th eliver by Luvox?
Wow. That's a great observation. One chart that I was able to find describes the interaction as relatively minor. However, it might still be a consideration. My guess is that the difficulties you have reducing the dosage by only 25% suggests that this drug interaction is probably not playing a role in the appearance of symptoms.
Try to reduce the size of your doses and keep the same dosing schedule rather than allow an increase in the inter-dose period. I believe you will get "stuck" if you try to keep the doses static.
- Scott
Posted by SLS on August 6, 2005, at 6:32:02
In reply to Re: Luvox withdrawal. Any advice?, posted by SLS on August 5, 2005, at 9:40:19
Hi.
> > Where did this plan come from?
> I'm sorry to have to inform you that the plan is my own.
Did I scare you off?
- Scott
Posted by vitalsign0 on August 6, 2005, at 22:15:38
In reply to Re: Luvox withdrawal. Any advice?, posted by SLS on August 6, 2005, at 6:32:02
>
> Did I scare you off?
>
>
> - ScottNot at all. It's been a wacky weekend trying to get back to normal after another failed attempt to get off of Luvox.
I run my own business and it is really busy right now. It may not be the best time to try this.
I made an appointment with a doctor that 'supposedly' is educated on the withdrawal effects of SSRIs.
I will try your method. Hell, it can't be worse than what I've tried. I mean withdrawal from SSRIs is straight up SCARY.
If I were to plan my withdrawal with your method, let me just make sure I am clear.
Take a 50mgs pill at night like always. The next day, take 12.5 4x that day. The NEXT day after that, wait until withdrawal effects show up before taking the first 12.5 dose. Then follow it up with other 12.5 doses. Take no more than 3 for the first day spacing them out as much as possible while not going more than 60 mins after withdrawal has set in.
Am I on the right page?
Thanks again for your time.
Posted by SLS on August 7, 2005, at 10:29:56
In reply to Re: Luvox withdrawal. Any advice? » SLS, posted by vitalsign0 on August 6, 2005, at 22:15:38
Hi.
I think you have the right idea. It is too bad that you don't have a way to split the pills into 6.25mg sections. Perhaps the 25mg tablets would be easier to work with. I haven't seen them, so I wouldn't know. If it were me, I would either nibble off little pieces as needed or break them up into little non-uniform pieces and segregate them into various sizes. Approximations are fine. Precision isn't necessary when the dosing periods remain flexible.
> I run my own business and it is really busy right now. It may not be the best time to try this.
I can certainly understand this. The nice thing about flexibility is that you know that you don't have to suffer the withdrawal syndrome any longer than you want to. The drug reaches peak concentration about an 3 hours after dosing. Once you feel the withdrawal symptoms appear, my guess is that you will feel relief within an hour of dosing. The half-life of Luvox is about 15 hours. This is sort of an intermediate value as antidepressants go. I would still look to dose 2-3 times a day. Ideally, you would want to use 6.25mg (1/4 25mg tablets) as you get closer and closer to total discontinuation. The last 25% of the original dosage can be the most difficult to navigate through. In other words, 12.5mg per day might be your sticking point unless you can find a way to use smaller doses. If you must, you can bite off small pieces of the tablet, or perhaps crush them into powder and add them to a glass of orange juice, drinking fractions of the glass in proportion to the dose you are seeking to use. There have been some pretty creative ways in which people have managed to create micro-doses for themselves. Again, precision of dose amount really isn't necessary. Approximations work well because the body tells you when it's time for the next dose.
I am going to be very interested to see how 12.5mg x 3 works out for you since 37.5mg x 1 allowed unacceptable symptoms to appear. My guess is that you may experience some insomnia for the first few nights. It would not go against the plan to take an extra 6.25mg before bed if by bedtime significant withdrawal symptoms appear. You would probably need to do this for a few days at most should it become necessary. It's not a race, right? You should do fine.
Please post reports as you proceed. I'll say a little prayer for you that this method works for you as well as it has worked for me and others. If it doesn't, there are alternatives. I will be sitting on the edge of my seat to learn what this new doctor offers you as options.
- Scott
Posted by ed_uk on August 7, 2005, at 16:11:33
In reply to Re: Luvox withdrawal. Any advice?, posted by SLS on August 7, 2005, at 10:29:56
Hi Scott!
>.......crush them into powder and add them to a glass of orange juice, drinking fractions of the glass in proportion to the dose you are seeking to use......
I'm not sure whether this would work - I don't know how soluble fluvoxamine is in water. It might work really well, I just don't know. You'd need the fluvoxamine to be dispersed throughout the liquid.
Here is my little idea........
1. Crush a 50mg tablet to form a powder.
2. Separate the powder into little piles eg. 4 or 8 approximately equal piles.
3. Take one pile when required by mixing it with a bit of yogurt .......or some other soft food.
Posted by tizza on September 2, 2005, at 21:14:10
In reply to Re: Luvox withdrawal. Any advice? » SLS, posted by ed_uk on August 7, 2005, at 16:11:33
Old Luvox hey. I was on 300mg a day for about 10 months or so for severe depression. I have tried loads of different anti depression medications over the last 11 years and for me Luvox was by far the worst because for some unknown reason it just stopped working, which is quite common with all medications for depression. My pdoc decided to switch me over to efexor xr which I have taken before, but the big problem was I had to have a 4 day washout period. I have never been so messed up and the withdrawals come on like lightning, almost within 24hrs and knock you around really badly. I can't even put it into words properly, Numb lips, arms, legs and head. Brain zaps, pins and needles all over, crying. Each drug effects every person differently, so keep up the process of weening because I didn't have the chance. Good luck and just remember you are not alone!!!!!!!!!!!!
Posted by vitalsign0 on September 3, 2005, at 16:16:47
In reply to Re: Luvox withdrawal. Any advice?, posted by tizza on September 2, 2005, at 21:14:10
I started seeing a new doctor and I actually increased my Luvox to 100mgs from 50mgs. I am starting to feel better already. My depression, which I really didn't know I had, has gone away.
I am also getting off of Xanax. Cutting it by .25mgs a week with much success.
Posted by 4WD on September 30, 2005, at 22:38:04
In reply to Re: Luvox withdrawal. Any advice?, posted by SLS on August 4, 2005, at 15:53:34
> If that helps, then you can perhaps use a dosing schedule that is more flexible. One strategy is to not take any medication until you feel the withdrawal symptoms begin to emerge. You should find that the interval between dosing will become longer and longer. It would be advantageous to be able to divide your medication into even smaller doses. Once the interval between 12.5mg doses exceeds 10 hours, you might want to try using smaller doses that allows the withdrawal symptoms to emerge between 6-8 hours after each dose, and continue the process from there.
>
> How small a dose can you divide your pills into?
>
>
> - Scott
>
>Scott,
Do you think that the slow taper/withdrawal is necessary or desirable when switching directly from one SSRI to another? (Celexa to Luvox)
I stopped Celexa (10mg) one week ago (after tapering down to 7.5 for about one week) and started Luvox immediately. I started the Luvox at 12.5 for 3 days, then 25mg for the last five days. I have been plunged into deep deep depression. I was okay on Sunday, bad on Monday-Wednesday, good yesterday and horrible today. Should I take some Celexa?
Marsha
Posted by SLS on October 1, 2005, at 11:03:36
In reply to Re: Luvox withdrawal. Any advice? » SLS, posted by 4WD on September 30, 2005, at 22:38:04
> Do you think that the slow taper/withdrawal is necessary or desirable when switching directly from one SSRI to another? (Celexa to Luvox)
No. I think you can just switch over from one to the other.
> I stopped Celexa (10mg) one week ago (after tapering down to 7.5 for about one week) and started Luvox immediately.That sounds good to me.
> I started the Luvox at 12.5 for 3 days, then 25mg for the last five days. I have been plunged into deep deep depression.
Ouch. Sorry. This is very likely a relapse. It is occuring because you have not yet reached a therapeutic dosage of Luvox (100-300mg). It's almost like you are taking nothing. I would report this to your doctor and see if you can accelerate your titration of Luvox. If you do decide to add back some Celexa, know that Luvox will increase the blood levels of Celexa substantially. You could probably simply take half of what you were taking before to recapture an antidepressant effect.
I don't know what to suggest.
Depression is a pain that one will do anything to escape from.
You might add back 5mg of Celexa until you get up to a therapeutic dosage of Luvox and then attempt to remove the Celexa. Just be aware that there is a small risk of developing serotonin syndrome when combining serotonergic drugs. You might want to become familiar with the symptoms associated with this reaction:
http://www.anxiety-and-depression-solutions.com/serotonin-syndrome.htm
What made you decide to switch from Celexa to Luvox?
- Scott
> I was okay on Sunday, bad on Monday-Wednesday, good yesterday and horrible today. Should I take some Celexa?If I were in your shoes, I sure would be tempted to. This is a situation that I think communication with your doctor is important to address your present condition. You don't want to lose your doctor's trust that you can act responsibly with the potent drugs that he prescribes.
- Scott
Posted by 4WD on October 2, 2005, at 0:09:27
In reply to Re: Luvox withdrawal. Any advice? » 4WD, posted by SLS on October 1, 2005, at 11:03:36
> > Do you think that the slow taper/withdrawal is necessary or desirable when switching directly from one SSRI to another? (Celexa to Luvox)
>
> No. I think you can just switch over from one to the other.
>
> > I stopped Celexa (10mg) one week ago (after tapering down to 7.5 for about one week) and started Luvox immediately.
>
> That sounds good to me.
>
> > I started the Luvox at 12.5 for 3 days, then 25mg for the last five days. I have been plunged into deep deep depression.
>
> Ouch. Sorry. This is very likely a relapse. It is occuring because you have not yet reached a therapeutic dosage of Luvox (100-300mg). It's almost like you are taking nothing. I would report this to your doctor and see if you can accelerate your titration of Luvox. If you do decide to add back some Celexa, know that Luvox will increase the blood levels of Celexa substantially. You could probably simply take half of what you were taking before to recapture an antidepressant effect.
>
> I don't know what to suggest.
>
> Depression is a pain that one will do anything to escape from.
>
> You might add back 5mg of Celexa until you get up to a therapeutic dosage of Luvox and then attempt to remove the Celexa. Just be aware that there is a small risk of developing serotonin syndrome when combining serotonergic drugs. You might want to become familiar with the symptoms associated with this reaction:
>
> http://www.anxiety-and-depression-solutions.com/serotonin-syndrome.htm
>
> What made you decide to switch from Celexa to Luvox?
>
>
> - Scott
>
>
> > I was okay on Sunday, bad on Monday-Wednesday, good yesterday and horrible today. Should I take some Celexa?
>
> If I were in your shoes, I sure would be tempted to. This is a situation that I think communication with your doctor is important to address your present condition. You don't want to lose your doctor's trust that you can act responsibly with the potent drugs that he prescribes.
>
>
> - Scott
>
Thanks, Scott. I knew I could count on you.> Depression is a pain that one will do anything to escape from.
You are right. Anything. Even suicide. Though I'm not there yet.
I fear increasing the Luvox because so far I am having a side effect that I also had with Celexa (big part of the reason for the switch). The muscles in my neck and upper back spasm and clench so tightly that it causes chronic burning aching pain. My neck gets so stiff I can't turn it from side to side. This has happened with every SSRI except Paxil. It didn't happen with Effexor but Effexor quit working. (And I'm still not sure that going off Effexor isn't the reason I'm having such awful anxiety in the first place even though it's been 6 months.)
Can you think of any reason this would happen - the neck pain and muscle tightness?
I think I will stick with the 25mg of Luvox until I can talk to my doctor. If it gets totally unbearable I will take a small amount of Zyprexa.
Thank you Scott.
Marsha
Posted by Nic Macca on June 2, 2007, at 8:09:37
In reply to Re: Luvox withdrawal. Any advice?, posted by SLS on August 5, 2005, at 7:57:51
I had a seizure this morning after 6 years of being seizure free and am on a 100mg day dose of luvox. Having read that epilepsy and luvox don't mix plus knowing a cold turkey approach to stopping luvox are both risky strategies - I would appreciate your advice on whether to take a reduced dose this evening or tomorrow morning. Or nothing at all.
Your advice would be much appreciated,
Nicole
This is the end of the thread.
Psycho-Babble Withdrawal | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.