Effexor XR vs Effexor

[AmZ]

I just got another months worth of Effexor so have 3 boxes of 28 tablets at 75mg each, so I take 3 in the morning each day.

I asked the pharmacist if the medication comes in a higher dosage per tablet, as I pay for each individual box, so now I'm on 3, it costs quite a bit of money per month. He said that there is also Effexor XR 150mg available. I was wondering if you can split these or how it works (for next month)? Obviously, I couldn't take 2 as that would be 300mg, and need 225mg, so is it possible to take the Effexor XR at 225mg? He said that this is the only other dosage available in the country. So either Effexor 75mg in a box of 28 tablets or Effexor XR 150mg (not sure how many in a box).

Also, the 225mg has been doing bad things for my stomach, as much water and as I drink and fibre and a balanced diet I have, nothing seems to help. I was thinking about maybe not taking all 3 pills at one go in the morning and maybe taking 2 and then one at lunch time or something. I think I remember Dr Baxter saying that it's OK to do this and people do this so as to avoid side effects such as these?

Thanks

 

[defect]

I was on Effexor XR for 8 years and just got off of them, switched to Wellbutrin about 2 months ago.
I'm not sure where you are, but here in BC it is available in 37.5 mg, 75 mg, and 150 mg. The link below has info available about this medication.
EFFEXOR XR® (venlafaxine HCI)*—*Prescribing Information & Medication Guide
If you click on the link that says "prescribing information", you come to this page, Wyeth.com
and if you click "continue" you get a 52 page pdf file that I found quite informative about dosage, pharmacology, etc.

You can't split these pills as they are capsules with beads of medication inside.
If there is any advice I could offer it would be to seriously consider looking into other drugs that have less side effects and withdrawal symptoms. Effexor has a discontinuation syndrome that is unique unto itself. Google "head shivers" and you will get an idea of what I'm talking about.

Also, about the lorazepam, if that is what you are prescribed to help you sleep, I believe that is likely the reason for the numb body and alert mind thing. It was probably prescribed to calm you down so you could try to get some sleep, but it is definitely not a sleep aid. It is helpful for anxiety attacks, but will leave you groggy for sure if taken several minutes before bed, and should not be relied on for any length of time. Now that you are having a less stressful past few days, you might want to check out other remedies to help you sleep, like mindful breathing techniques, yoga, etc. In my extensive experience with drug use (and abuse) prescribed and otherwise, the less drugs you're on, the better chance you have of truly achieving wellness. Hope this helps, good luck.

 

[David Baxter PhD]

You can't split these pills as they are capsules with beads of medication inside.

XR stands for extended release. These are either capsules or coated tablets but either way they should not be split because doing so defeats the purpose of the extended release. For example, with tablets there is a coating which releases the drug slowly into the system. Breaking the tablet means you'd get the dose all at once.

If there is any advice I could offer it would be to seriously consider looking into other drugs that have less side effects and withdrawal symptoms. Effexor has a discontinuation syndrome that is unique unto itself. Google "head shivers" and you will get an idea of what I'm talking about.

1. Please review the Forum Rules: You cannot post statements to other members that countermands the recommendations of their physician.
2. While Effexor is known to produce discontinuation effects in some patients, this does not occur for many others. Additionally, Effexor is not "unique" in this respect: There are other medications that can potentially have similar discontinuation effects.
3. Googling something like "head shivers" only gives you half the story at best and anything you read will be based only anectdotal comments from those who had side-effects or discontinuation effects which they, rightly or wrongly, attribute to the medication. This is not evidence, not science. This is merely opinion. For example, you are prescribed a drug and experience flu-like symptoms. You persist for a few days to a week and the symptoms also persist. You decide to stop the medication and a few days later the symptoms subside. Was this the drug causing side-effdects? Or did you simply have a cold or flu, which over the course of about 10 days will subside on its own?

Also, about the lorazepam, if that is what you are prescribed to help you sleep, I believe that is likely the reason for the numb body and alert mind thing. It was probably prescribed to calm you down so you could try to get some sleep, but it is definitely not a sleep aid. It is helpful for anxiety attacks, but will leave you groggy for sure if taken several minutes before bed, and should not be relied on for any length of time.

Again, you are not qualified to dispense medical advice and you cannot countermand the advice of a health professional who knows far more about the medical history of the patient than you.

 

[defect]

I apologize and did not intend to undermine any prescribed route of therapy. I spoke from a place of personal experience and information. I will restrict my opinion to more suitable threads.

 

[Andy]

Your opinion is fine Defect. It's just that people are prescribed medicine for certain reasons that may be very different to what you may have been prescribed them for. Your welcome to talk about your experiences on medications but telling a person to switch medications or get off of medications, that is definitely not allowed. Leave that up to them and their prescribing doctor.

For example Lorazepam can be used as a sleep aid. In fact it's often one of the medications used in a hospital setting.
This as well. "the less drugs you're on, the better chance you have of truly achieving wellness." . You don't know how anyone would be off medication. If I were off medication, wellness would be the farthest thing from my mind.

I don't want to sound like I am lecturing you, you just REALLY need to be careful with what you say regarding medications and follow the forum rules.

 

[defect]

STP - I did not tell anyone to switch medications or get off of medications. My intention was to suggest to obtain as much information as possible.
I was reprimanded already, and will keep my opinions to myself.
Thank you.

 

[AmZ]

Thanks for the replies everyone.

All good Defect It's OK.

If someone could let me know if it's possible to take the three 75mg a day pills at different times of the day so as to avoid side effects, that would be great. Since going up to the 225mg, my digestive system, shall we say, has been affected and it's like it all the time and very uncomfortable. Maybe it'd be better to take 2 in the morning and one later on in the day or something.

Thx.

---------- Post added at 01:50 PM ---------- Previous post was at 01:20 PM ----------

BTW, especially in the last week or so, but since a couple of weeks ago, I keep getting involuntary muscle twitching in my arms and legs, at least a few times every day. I will bring it up in the next meeting with the psychiatrist but I guess it's nothing that I need to worry about immediately if it's not causing me too much bother?

 

[David Baxter PhD]

These are questions to ask your doctors, AmZ.

Normally, it's not a big deal when you take the medications and whether or not you split them up, unless you're taking an extended release or slow release formulation.

However, with your sleep issues, you might find that Effexor messes up your sleep if taken at night.

Do you take the Effexor with food? If not, that may help. If you already take it with food, you might reconsider what foods you are having with the medication and stay away from things like milk.

 

[AmZ]

However, with your sleep issues, you might find that Effexor messes up your sleep if taken at night.

True.
It's messed up enough as it is!
I'll have to decide what to do about the sleep issue. I tried the new medication again and the same thing, didn't help at all.
I think that if I've been managing to function up until now on half the sleep or less than I normally have, then I'll just get on with it and not try out more medications. Kinda battling with this one, but will see how things go.

Do you take the Effexor with food? If not, that may help. If you already take it with food, you might reconsider what foods you are having with the medication and stay away from things like milk.

Ah, good to know. I always have it with food and a lot of water in the morning, but recently I started having cereal with milk which I didn't do before. I either had it with cereal with soya milk or had bread or something else. Will soya milk be better you reckon?

I know they are questions for my doctors really, but as you know, unfortunately just not the ideal and most accessible etc of doctors. I was just generally asking and hope I didn't over-step the mark. Was just wondering of the general possibilities of when to take the meds and general advice.

Many thanks for the reply.

 

[David Baxter PhD]

Possibly. Cow's milk isn't very easy for humans to digest so I generally advise cutting back or eliminating it if you have an unhappy digestive system until it settles down.

 

[AmZ]

Ah, I was going to say also... I'm going to my family doctor tomorrow (rather than the psychologist) and will ask about the muscle twitching etc. I'm going to ask to check that all is OK with my blood pressure and ask to get blood tests done to also see if all is still OK. Did blood tests last 3 months ago or so and before I was on the medication and in general, think it's good anyway to just get a check up because I'm still not eating much so need to see if my levels of things are OK. (I do take multi-vitamins every day, but still).

Sometimes you just gotta take things in to your own hands! I don't want to overdo things, but don't see the harm in getting a check up. I asked the psychiatrist about this and after how long you need to do blood tests etc when on medication and she just said that I am 25, healthy and not overweight, a smoker, etc etc... so basically, 'don't need to'.

Good idea, no?
I wonder if there is also anything specific I'll need to ask the doctor to check... Nothing has been done through my family doctor really and they don't even have on computer that I am on medication etc or the background of it.

---------- Post added at 05:11 PM ---------- Previous post was at 05:09 PM ----------

Possibly. Cow's milk isn't very easy for humans to digest so I generally advise cutting back or eliminating it if you have an unhappy digestive system until it settles down.

Yeah, good thinking. That's why I stopped having pure milk actually, because I heard and also felt that milk a lot of the time doesn't go down that well! But then was concerned about not getting enough calcium, but I get enough I think anyway from cheese and dairy products.

Will try changing that and see if it makes a difference. If not, then will just switch to toast and water or something which hopefully will be better

 

[David Baxter PhD]

It's not just milk, it's dairy products in general (e.g., ice cream), although personally i don't find cheese to be a problem.

With the medications you're taking, you shouldn't need to worry about frequent blood tests.

 

[AmZ]

It's not just milk, it's dairy products in general (e.g., ice cream), although personally i don't find cheese to be a problem.

Gotcha, yeah. I'm like this too. I was lactose intolerant as a baby and sometimes still get stomach aches etc when I have a lot of dairy like cottage cheese or something... But yellow sliced cheese for example seems OK. Think I'll go back to the soya milk for sure

With the medications you're taking, you shouldn't need to worry about frequent blood tests.

Cool. Good to know. I think that it's even worth it like I say to check that all my vitamin and mineral levels are OK due to the months of not eating much.

 

[AmZ]

Finally, I have 'Feeling Good' by David Burns! After the last one I bought from Amazon went missing in the mail, my therapist advised that I keep trying to get it so found it elsewhere.

I was reading just now about Effexor in the book and it states: "Venlafaxine has a short half-life - meaning that it leaves your body in a matter of hours. Therefore, you must take the medication two or three times a day to maintain an adequate level in your bloodstream".

I think we were talking about splitting the dosage up before and said that only in cases of having side effects, such as taking it at night and it causing sleep problems, that you can adjust when you take it or split it up...
So sorry to bring it up again... But I was wondering if I should do as is being recommended so that I'm not taking all 3 (75mg tablets) in the morning together?
If the psychiatrist decides to move me to 300mg, then I'll simply ask for the Effexor XR which my pharmacist has told me is available in 150mg, so that I can take 2 a day. The regular Effexor is only available in 75mgs.

Thanks.

 

[Retired]

I was wondering if I should do as is being recommended

I've come into this discussion late and having been away for a few weeks may have missed some details in other related discussions.

By "recommended" do you mean the instructions by the prescribing physician? If so, what are those instructions for when you take your Effexor?

Based on what you've written, you currently are taking the original Effexor, and not Effexor XR, correct?

Because this medication has a short biologic half life (about 12 hours) does not mean the medication is completely eliminated from your bloodstream at that time. There is another aspect to the kinetics of the medication called "steady state" whereby the amount eliminated is replaced by the amount ingested and steady state does not mean the levels are at 0 at the end of the 12 hour period.

Extended release offers the advantage of less frequent daily dosing, lessening the chance of forgetting to take the medication.

BTW as a further insight into why cows milk is difficult for humans to digest has to do with the whey cassein ratio of cows milk compared to human milk. Cows milk has a 60/40 whey cassein ratio, whereas human milk is 82/18. It's why babies are not given cows milk at birth because their kidneys are not fully developed and cannot digest the cows milk formulation.

Infant formula companies modify the whey cassein ration, making it resemble that of human milk, so babies can be given formula insteat of breast milk.

This, of course is a totally separate issue from lactose intolerance, which is a person's inability to digest lactose due to the body's inability to produce lactase, the enzyme needed to digest lactose.

 

[AmZ]

I've come into this discussion late and having been away for a few weeks may have missed some details in other related discussions.

Hi Steve,
Yes, I noticed that you haven't been around for a while. Nice to see you back and hope that all is well.

Based on what you've written, you currently are taking the original Effexor, and not Effexor XR, correct?

Yes. Original Effexor.

By "recommended" do you mean the instructions by the prescribing physician? If so, what are those instructions for when you take your Effexor?

I was referring to the quote from the 'Feeling Good' book which says that if you are on regular Effexor, that you should split the dosages up between 2-3 times daily.
The psychiatrist's instructions when I first started the Effexor was that it would probably be best to take it in the morning in case if I took it at night and it would cause sleep problems. However, I was on 75mg to start with for the first month, so was only one 75mg pill a day. Since then, they haven't given me any new or different advice as when to take the pills and have been on 3 x 75mg for 2 months now. They just said that it may cause some 'worse' stomach problems and more of a dry mouth on a higher dosage, wrote me the prescription, and that was it.

Thank you for the extra information concerning the short half-life, but that it doesn't mean it's eliminated totally after 12 hours.

I am going to the psychiatrist on Sunday and will see where we go from now and ask about splitting the dosage. I have asked things in the past and they haven't taken the time to give me a real answer or provide information to me, even though I said that I am new to 'this' so don't know anything about taking this kind of medication. Anyway we'll see how it goes on Sunday. If things are still the same and I feel like I am needing to wean necessary and important information out of them, then I will see about going to another psychiatrist. I have found another in case, but need to check if I can go and if he speaks English also, etc, so watch this space

Extended release offers the advantage of less frequent daily dosing, lessening the chance of forgetting to take the medication.

Sounds definitely more ideal and convenient. The thing was that I am on 225mg and the XR available here only comes in 150mg capsules, so I couldn't split them so am left with the regular Effexor of 3 x 75mg tablets. If they decide to move my dosage up though, I will make sure to ask for the XR instead as I can then take 2 x 150mg a day, 300mg total.

Interesting about the milk !!
I was actually lactose intolerant as a baby so couldn't have breast milk and was only on formula. Now cow's milk is an issue haha, but anyway...
Not sure what to do about this. I have to see about my diet and what I can change around. I often get a stomach ache if I have cows milk, i.e. milk with cereal. So then I switched to soya milk which was a lot better for me and I have a fair amount of other dairy which doesn't cause me the stomach problems, so that covered me calcium wise. Now I've been told today that I need to ideally cut out the soya milk altogether because of something else unrelated. So looks like the cereal is out of the window either way! I've been having porridge with soya milk each morning, 1 minute in the microwave and marvelous, but I guess I will now substitute the soya milk for water instead!

 

[Retired]

Your doctor should have the conversion dosage schedule if it is decided to switch to the Extended release formulation.

BTW Effexor should be available in a 37.5 mg tablet in order to be able to divide a 75 mg daily dose.

 

[AmZ]

Your doctor should have the conversion dosage schedule if it is decided to switch to the Extended release formulation.

Conversion dosage schedule? The XR is not the same dosage equivalent - i.e. 300mg of 4 x 75mg tablets vs 2 x 150mg XR capsules? Or you are referring to something else? The 'schedule'?

BTW Effexor should be available in a 37.5 mg tablet in order to be able to divide a 75 mg daily dose.

The pharmacist said that there isn't. But the 75mg tablets can be split as they have a score line, so perhaps that's what we have here instead.

Thanks for the information Steve.

 

[Retired]

Conversion dosage schedule?

Sorry, my mistake...the dosages of both forms are the same for the original and the extended release and there is no conversion....senior moment here

Thank you for noticing.

Perhaps the dosage forms availability vary from one Country to another, or perhaps the pharmacist doesn't want to stock the lower dosage form; but if the 75 mg tab is scored, then it comes to the same thing.

 

[AmZ]

senior moment here

I'm certainly sure not, Steve

Thanks for the reply.