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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by jessers11581 on April 21, 2005, at 22:43:56
I'm sure this has been asked on here before but I can't seem to find it. Anyhow, is there a good way to split Cymbalta capsules? I need to be taking about 45 mg. and the only pills I have are 30 mg. and 60 mg. So what I did tonight was open up a 30 mg. capsule and dump about half the little pellets into a gelcap from the health food store (don't know if it's enteric coated--probably not though). And then I took that along with a another whole 30 mg. pill. Is this okay? My psychiatrist told me that I could split the dose if I wanted, but she didn't tell me how to go about it! Thanks in advance! :)
Posted by D minor on April 21, 2005, at 23:35:53
In reply to splitting Cymbalta pills, posted by jessers11581 on April 21, 2005, at 22:43:56
Hi,
to quote the package insert "Patients and their families should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, ..."
and report them to your pdoc.Also "Duloxetine should be swallowed whole and should not be chewed or crushed, nor should the contents be sprinkled on food or mixed with liquids. All of these might affect the enteric coating."
So, my suggestion might be that maybe you could take 40mg or 50mg by getting a prescription for the 20mg capsules. That way you could avoid the whole problem with the enteric coating. 40mg is considered a theraputic dose.
I'm so interested in how you are doing on this because it totally made me go hypomanic (almost manic). You don't have any history of Bipolar do you? Well, I hope it works out for you. I think it's a really potent drug.
Good luck,
dm
Posted by jrbecker on April 22, 2005, at 10:52:40
In reply to Re: splitting Cymbalta pills, posted by D minor on April 21, 2005, at 23:35:53
I split up my 20mg capsules up without any problem. Splitting capsules is fine - it's the spheroids themselves that are enteric coated, not the capsules. *Just be sure to be consistent and accurate about equally splitting the dosages up. You want to keep make sure you're still getting the same dosage daily (even if it is at such a low dose). This will help guard against possible side effects that might surface should drug levels fluctuate too much.
Posted by Cairo on April 22, 2005, at 16:13:32
In reply to Re: splitting Cymbalta pills, posted by jrbecker on April 22, 2005, at 10:52:40
I tapered Cymbalta down due to severe agitation, akathisia, muscle/jaw tremors and was happy at 5mg which gave me much more energy, less orthostatic dizziness, a bit less anxiety, though no relief from Fibromyalgia pain.
I then discontinued it to try amitriptyline simply to please a new neurologist who insisted that I give it another whirl because I he said I didn't dose it right/take it early enough/or whatever excuse he could come up with despite my protests and I weakly agreed to it because I wanted to try Botox injections in my cervical muscles from him and am tired of fighting doctors and their "good" intentions.
Anyways, after a disastrous trial of amitriptyline (zombie city at low dose for 4 months with no benefits), I stopped that and retried 5mg Cymbalta. I never felt the same energizing effect that I had the first time. Am I doomed to never respond to Cymbalta again? I have to be very careful with SSRI dosing as I get flu-like symptoms and muslce aches anytime I take SSRIs, even at tiny doses. I am on Desyrl 75mg for sleep, and I suspect anything else in combo with that is too much.
Also, my doctor would like some "official" reference to being able to open the Cymbalta capsule. The rep says NO.
Thanks for any help.
> I split up my 20mg capsules up without any problem. Splitting capsules is fine - it's the spheroids themselves that are enteric coated, not the capsules. *Just be sure to be consistent and accurate about equally splitting the dosages up. You want to keep make sure you're still getting the same dosage daily (even if it is at such a low dose). This will help guard against possible side effects that might surface should drug levels fluctuate too much.
Posted by Larry Hoover on April 22, 2005, at 17:04:08
In reply to splitting Cymbalta pills, posted by jessers11581 on April 21, 2005, at 22:43:56
> I'm sure this has been asked on here before but I can't seem to find it. Anyhow, is there a good way to split Cymbalta capsules? I need to be taking about 45 mg. and the only pills I have are 30 mg. and 60 mg. So what I did tonight was open up a 30 mg. capsule and dump about half the little pellets into a gelcap from the health food store (don't know if it's enteric coated--probably not though). And then I took that along with a another whole 30 mg. pill. Is this okay? My psychiatrist told me that I could split the dose if I wanted, but she didn't tell me how to go about it! Thanks in advance! :)
That is exactly the way to go about it. Perfect!
Lar
Posted by Phillipa on April 22, 2005, at 17:23:00
In reply to Re: splitting Cymbalta pills » jessers11581, posted by Larry Hoover on April 22, 2005, at 17:04:08
Yes, that's what I did too. But, everyone talks about how potent this med is and it didn't do anything to me at 60mg. I wonder why? Fondly, Phillipa
Posted by Bill LL on April 25, 2005, at 7:34:37
In reply to Re: splitting Cymbalta pills » jessers11581, posted by Larry Hoover on April 22, 2005, at 17:04:08
The last 2 days I split a 60 mg capsule of Cymbalta into 2 doses of 30. I put half on ice cream and then drank water after swallowing the ice cream. I left the other half in the capsule. It seemed to work ok.
> > I'm sure this has been asked on here before but I can't seem to find it. Anyhow, is there a good way to split Cymbalta capsules? I need to be taking about 45 mg. and the only pills I have are 30 mg. and 60 mg. So what I did tonight was open up a 30 mg. capsule and dump about half the little pellets into a gelcap from the health food store (don't know if it's enteric coated--probably not though). And then I took that along with a another whole 30 mg. pill. Is this okay? My psychiatrist told me that I could split the dose if I wanted, but she didn't tell me how to go about it! Thanks in advance! :)
>
> That is exactly the way to go about it. Perfect!
>
> Lar
>
Posted by jrbecker on April 25, 2005, at 8:55:53
In reply to Re: splitting Cymbalta pills » jrbecker, posted by Cairo on April 22, 2005, at 16:13:32
> I tapered Cymbalta down due to severe agitation, akathisia, muscle/jaw tremors and was happy at 5mg which gave me much more energy, less orthostatic dizziness, a bit less anxiety, though no relief from Fibromyalgia pain.
>
> I then discontinued it to try amitriptyline simply to please a new neurologist who insisted that I give it another whirl because I he said I didn't dose it right/take it early enough/or whatever excuse he could come up with despite my protests and I weakly agreed to it because I wanted to try Botox injections in my cervical muscles from him and am tired of fighting doctors and their "good" intentions.
>
> Anyways, after a disastrous trial of amitriptyline (zombie city at low dose for 4 months with no benefits), I stopped that and retried 5mg Cymbalta. I never felt the same energizing effect that I had the first time. Am I doomed to never respond to Cymbalta again? I have to be very careful with SSRI dosing as I get flu-like symptoms and muslce aches anytime I take SSRIs, even at tiny doses. I am on Desyrl 75mg for sleep, and I suspect anything else in combo with that is too much.
>
> Also, my doctor would like some "official" reference to being able to open the Cymbalta capsule. The rep says NO.
>
> Thanks for any help.I'm guessing if you are pretty med-sensitive, you have atypical features (like myself)?
how long were you on cymbalta...a) altogether, and b) at 5mg? I'm wondering if your early positive response to it at 5mg was going to be short-lived anyway. I always have a very "energizing" response to the ssris/snris upon initial titration, but i soon even out. I have experienced the poop-out effect that you speak of when re-initiating a drug, but I find that this difference is usually pretty small and relates more to this "energizing"/hypomanic period than it does to longterm antidepressant response. I see the cause as both 1) that your system is already sensitized to the drug from the first time around and 2) psychologically/subjectively, your perspective might be skewed by expectations from that first "energizing" response.bottomline, I do believe that you will eventually get a response to it at 5mg IF you were at this dosage for an extended period prior to your withdrawal from it. For me, the full antidepressant effects of the SNRIs never fully peak until more than 4 weeks...just my own experience over the years.
be patient and go slowly. good luck.
JB
Posted by Cairo on April 27, 2005, at 18:06:52
In reply to Re: splitting Cymbalta pills » Cairo, posted by jrbecker on April 25, 2005, at 8:55:53
They started me on 30mg Cymbalta which I stoically stayed on despite full blown panic attacks, akathisia, etc. I was told to stick it out as the side effects would lessen. I tapered myself down slowly over at least 6 weeks until all the horrible side effects stopped at 5mg , so you're probably right that the energizing effect may not have kicked in until then anyway. I was too whacked to notice the difference between "energy" and "atomic" those first weeks.
A new wrinkle is that my doctor said that she's been having several patients with liver problems on Cymbalta and she's been backing off from using it, though she's been having good success with it for pain in Fibromyalgia.
As you're sensitive to meds, can you increase over 5mg Cymbalta at all by ramping up infinitesimally and slowly? Or do your receptors become saturated (or whatever) at your own personal set point?
I've followed your posts as some of your symptoms seem very similar to me. I have atypical features with a hypofunctioning HPA axis that has terrible ramifications on sleep and muscles, especially. My doctor says that I'm in her subset of Fibromyalgia patients that look Addisonian, but my numbers look ok on the surface. What other new meds coming down the pike are you following?
Cairo
> I'm guessing if you are pretty med-sensitive, you have atypical features (like myself)?
>
> how long were you on cymbalta...a) altogether, and b) at 5mg? I'm wondering if your early positive response to it at 5mg was going to be short-lived anyway. I always have a very "energizing" response to the ssris/snris upon initial titration, but i soon even out. I have experienced the poop-out effect that you speak of when re-initiating a drug, but I find that this difference is usually pretty small and relates more to this "energizing"/hypomanic period than it does to longterm antidepressant response. I see the cause as both 1) that your system is already sensitized to the drug from the first time around and 2) psychologically/subjectively, your perspective might be skewed by expectations from that first "energizing" response.
>
> bottomline, I do believe that you will eventually get a response to it at 5mg IF you were at this dosage for an extended period prior to your withdrawal from it. For me, the full antidepressant effects of the SNRIs never fully peak until more than 4 weeks...just my own experience over the years.
>
> be patient and go slowly. good luck.
>
> JB
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