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Reducing Cymbalta

This Cymbalta reduction information is based on a study run by Eli Lilly, the maker of Cymbalta. “In Vitro Stability, Potency, and Dissolution of Duloxetine Enteric-Coated Pellets After Exposure to Applesauce, Apple Juice, and Chocolate Pudding” Kevin A. Wells, BS; and William G. Losin, PharmD. Eli Lilly

With Cymbalta being a time release medication, only available in specific dosages, the dosages available from Eli Lilly require large reduction of Cymbalta, and the large reductions create withdrawal side effects.

In 1999, I was the first to publish how to gradually reduce psychoactive medication and that procedure has been adopted by most every drug company as the safest method of tapering off these medications. Cymbalta, being a time release drug does not allow that procedure to be followed.

To recap how to safely reduce these medications: Reduce the drug slowly and gradually. If withdrawal side effects become too severe, go back up to the last dosage you were doing fine at, and remain at that dosage until you are stable once again. The next time you reduce the medication, reduce the drug at a more gradual and slower reduction.

As you see, the slow and gradual will not work with time release drugs.

The Internet is full of advice on how to reduce Cymbalta. Chat forums give plenty of advice and recommends but most are not based on concrete evidence backed by a clinical study.

Inside the capsule of all time release medication you will find pellets. These pellets are often called; balls or beads but for the sake of calling them what Eli Lilly calls them, I will be referring to them as pellets.

Over the years, The Road Back has received countless e-mails from people stating how they opened up the time release capsule and removed the pellets and how great this was working for them. Most often, when they reached the lowest capsule dosage of the drug and removed the pellets as they did earlier, all hell broke loose. Withdrawal started and it reached the point where they had to go back up to the last full dosage they were at and many were too afraid to ever attempt reducing the drug again.

About Cymbalta Pellets

The pellets found inside the Cymbalta capsule are enteric coated. The coating on the pellets stops the Cymbalta from breaking down in the stomach and allows the intestinal fluid to bread down the enteric coating for an intestinal absorption. This gives the highest absorption rate of the drug, a consistent dosage, a consistent peak of the drug as well as a consistent clearance of the Cymbalta.

The Lilly Study

The reason for the study was to figure out how to deliver Cymbalta to the elderly who had a difficult time swallowing the capsule. This study by Lilly was not conducted to help anyone taper off Cymbalta.

Method Used

The capsules were opened and the pellets were mixed with applesauce or apple juice.

Why Applesauce and Apple Juice Was Successful

The pH of applesauce is roughly 3.5. Lilly tried chocolate pudding but the pH of the chocolate pudding has a pH of 5.5 to 6.0 and it affected the enteric coating of the Cymbalta.

Once the pellets are mixed in the applesauce, the pellets are stable at room temperature for roughly 2 hours. This gives you a little time and you do not need to rush the process.

The Cymbalta study used Mott’s applesauce and Mott’s apple juice. I urge you to also use Mott’s.

What to Avoid

Do not crush, chew or do anything that will break the enteric coating of the Cymbalta.

Reducing the Pellets

The number of pellets found inside a capsule of Cymbalta is subject to change by Eli Lilly.

Week # 1

Open the Cymbalta capsule and gently stir the pellets in 1 tablespoon or less of applesauce. Swallow the applesauce and pellets without chewing or crushing the pellets. If using apple juice, pour an ounce of apple juice into a cup, add the Cymbalta pellets and drink. Again, avoid crushing or chewing the pellets.

The enteric coated Cymbalta is now in your stomach and they are not surrounded by the capsule. It is important to keep the pH right in your stomach at this time. Avoid all dairy for 1 hour before and after taking the Cymbalta pellets. Ideally, you will only consume the applesauce or apple juice for 1 hour. If you drink pH altered water to be on the safe side refrain from drinking a pH altered water for 1 hour before and 1 hour after taking the Cymbalta pellets.

Take the Cymbalta at the same time each day that you have been taking the Cymbalta. This is very important. You want to spend the first week making sure you can take the Cymbalta in this manner and to make sure this approach is not going to cause you to have withdrawal side effects.

During week 1, go ahead and count how many pellets are in the capsule of Cymbalta.

Use your pharmacist along the way. You want to make sure each refill of the prescription is exactly the same as the previous, as far as the number of pellets found in each like dosage of the Cymbalta.

Week 2

If everything went well for you during week 1, you can proceed to week 2. If you felt withdrawal starting but it remained very mild, go ahead with week 2. If you felt a full blown withdrawal I do not recommend you use this method of Cymbalta reduction.

First reduction: The first reduction of Cymbalta should be as close to 5% as possible.  This 5% reduction will not be possible if you only have 10 pellets in the capsule. You would need to remove 1 pellet, if this was the case, and you would have a 10% reduction.

Follow this same procedure each day for 14-days.

This is very important. You will likely be able to reduce the Cymbalta by 10% with each reduction but start with a 5% taper if at all possible. If you can’t do a 5% reduction there is no way you will be able to do a 10% reduction of the Cymbalta. Slow and steady will win this race.

Second Reduction

Reduce the Cymbalta by 10% this time. Only reduce by 10% if the 5% reduction went well.

The 10% reduction is based upon the starting dosage of the taper.

Let’s say the Cymbalta had 20 pellets in each capsule. You would have removed 1 pellet from the capsule for a 5% reduction the first week. This second reduction you will remove 3 pellets from the capsule. One of the 3 pellets is the original 5% reduction and the other 2 pellets being removed will give you the additional 10% reduction. You are now taking 15% less of the Cymbalta.

Only reduce again after 14-days have passed and you are doing very well with the reductions.

Third Reduction – Up to Having 2 Reductions Left

Just continue with the 10% reductions of the Cymbalta and only continue to reduce the Cymbalta when the last reduction went well.

Second to Last Reduction and Last Reduction of Cymbalta

It is best to slow down the reduction amount during the second to last reduction as well as the last taper of the Cymbalta.

The concept is much like the landing of a large passenger jet. You have been doing your descent and now it is time to prepare for the landing and you want the landing to be as smooth as possible for the passenger, which is you. Stop for a second and remember a time you landed on a plane and the landing was so smooth you hardly, if at all, felt the wheels even touch the runway. This is what you want.

Going back to a 5% reduction for these last few reductions of the Cymbalta would be the ideal approach. This gives your body more time to adjust. The Cymbalta, as well as all psychoactive drugs will disrupt other parts of the body, well beyond the drugs intended target, and this will give those other areas of the body some time to balance out again as well.

If you are already taking the lowest dosage available of the Cymbalta it can be difficult to slow the process down further.

As an example; if you were taking a 60mg dosage of Cymbalta at the start of your taper, you should now get a prescription for the 20mg Cymbalta so you can have a more gradual reduction of the Cymbalta during these last few reductions. This is where your pharmacist and prescribing physician will be very useful.

Just take it slower and very gradual for these last reductions.

If You Start to Get Withdrawal Side Effects While Reducing in This Manner

If withdrawal side effects start while reducing the Cymbalta with this tapering method, you can try using the supplements suggested with The Road Back Program. You will likely need to take far less of each supplement for fast relief.

The most common side effect during the Cymbalta will be head symptoms. This might be the electrical brain zaps or more of a dizzy sensation. The Omega 3 Supreme  should resolve that quickly.

If you were prescribed Cymbalta for depression, I would start taking the Optimum Solace as I start the taper.

Jim Harper
www.theroadback.org