Firing My Primary Care Physician Today

Thank you all! It is amazing how so many different variances and opinions about withdrawing from Cymbalta. I believe 49er over my doctor who I have had for 10 years. I did read all the links that everyone so kindly sent me, not to mention that all of this will mess with my sleep, and that is why we are all on here.

My doctor so "kindly" will prescribe more 30's for me and I think what I will do is open up one of my generic 30's and see what is going on with beads. I will see how many are in there today. If there are hundreds or many beads, I don't trust myself into counting and recounting so many of them. I have a friend here who is willing to go on a "bead counting date" with me in my kitchen but he loses track of everything, so not sure I trust him to count beads accurately or myself for that matter. Someone wrote on some website that the generics have less beads in them, so I will see once I open them later tonight.

Also, I don't quite understand why some people are saying if you open them, take out a few for instance and put it into an empty gelatin capsule, why this is seriously dangerous, including the FDA?
I know the beads are enteric coated but does removing some and putting them into an empty clean gelatin capsule ruin their entericness? Is it the actually capsule itself that provides the coating?
If anyone knows would love to know this. I see a "freight train" coming head on at me and I appreciate everyone's comments especially 49er and everyone. I wouldn't wish any kind of harm on anyone either and would be there to help too! Thank you and please let me know if you think removing beads and recapping in a capsule will cause harm? Mr. Dick MD, won't even give me 20 mg!

Thanks all. Luthie from Chicago

Hi Luthie,

You might want to call a few pharmacists and ask them if removing beads and putting them in another empty gelatin capsule is harmful. Personally, I wouldn't be worrying about it but you're the one who has to be comfortable with this so calling them to get an opinion might be helpful. And they could hopefully address all your concerns.

I would also call the compound pharmacy and ask their advice since they are used to making unusual drug dosages.

Hang in there.

49er

Luthie2006 wrote:Thank you all! It is amazing how so many different variances and opinions about withdrawing from Cymbalta. I believe 49er over my doctor who I have had for 10 years. I did read all the links that everyone so kindly sent me, not to mention that all of this will mess with my sleep, and that is why we are all on here.

My doctor so "kindly" will prescribe more 30's for me and I think what I will do is open up one of my generic 30's and see what is going on with beads. I will see how many are in there today. If there are hundreds or many beads, I don't trust myself into counting and recounting so many of them. I have a friend here who is willing to go on a "bead counting date" with me in my kitchen but he loses track of everything, so not sure I trust him to count beads accurately or myself for that matter. Someone wrote on some website that the generics have less beads in them, so I will see once I open them later tonight.

Also, I don't quite understand why some people are saying if you open them, take out a few for instance and put it into an empty gelatin capsule, why this is seriously dangerous, including the FDA?
I know the beads are enteric coated but does removing some and putting them into an empty clean gelatin capsule ruin their entericness? Is it the actually capsule itself that provides the coating?
If anyone knows would love to know this. I see a "freight train" coming head on at me and I appreciate everyone's comments especially 49er and everyone. I wouldn't wish any kind of harm on anyone either and would be there to help too! Thank you and please let me know if you think removing beads and recapping in a capsule will cause harm? Mr. Dick MD, won't even give me 20 mg!

Thanks all. Luthie from Chicago

Thanks everyone, 49er for your advice regarding calling a compound pharmacy, pharmacist, etc. Pharmacists are trained to read the Eli Lilly labels and other labels that do specifically state not to open or crush capsules. But I will try the compound pharmacy. Thank you all!! I will keep you posted.

Luthie2006 wrote:Thanks everyone, 49er for your advice regarding calling a compound pharmacy, pharmacist, etc. Pharmacists are trained to read the Eli Lilly labels and other labels that do specifically state not to open or crush capsules. But I will try the compound pharmacy. Thank you all!! I will keep you posted.

If you find that the pharmacist is unsure of something, and the question is appropriate to ordering a product, you might ask the pharmacy tech. Awhile back, one of my medications changed suppliers and went from a smaller pill to one that is too large for me to swallow. I have narrow plumbing as well as a high gag reflex, so I can only get larger pills down by cutting them. The pharmacist was not sure if this one was safe to cut. She even got out the information, and we guessed it might be okay as we could not find a warning on it. But she wasn't sure. I asked the other pharmacist the next day. Not sure either. I happen to work at the grocery store where I pick up my prescriptions, so I looked online, found the photo of the old pill and printed the info. I asked the pharmacy tech, and two days later, my prescription was in. She just had to order it in from a different supplier, and she just told me to let her a know a few days before I wanted to pick them up. Since the techs do the ordering, they know how to get different versions of the same medication.

She has also given my tips on what to ask the doctor for. My insurance wouldn't cover one version of something, but would cover something else. My insurance will give me prilosec for free if it is the capsul form, but not the tablet form (no idea why), so I had my doctor specify capsul on the prescription.

My final Answer: I did call the Compound Pharmacy and spoke with a super pharmacist. He stated that with all drugs, even Tylenol capsules, there is a filler (like a cake that smooshes beads together) This allows the beads to enter the GI tract in a certain time-released manner. Without a filler, he would not recommend it. It is not dangerous to open Cymbalta (or any capsule) but the fillers have a formula for the timing of the time-releasing of the capsule or a new gelatin capsule. He has a formula of fillers that they have to use for each medication.

So I guess counting beads will not work and this is on the advice of a very friendly informative pharmacist. He didn't know the formula of filler to use for Cymbalta off the top of his head but he said the fillers get released with the beads in a certain manner, so this will not work for me. Sound like sound advice?

Luthie2006 wrote:My final Answer: I did call the Compound Pharmacy and spoke with a super pharmacist. He stated that with all drugs, even Tylenol capsules, there is a filler (like a cake that smooshes beads together) This allows the beads to enter the GI tract in a certain time-released manner. Without a filler, he would not recommend it. It is not dangerous to open Cymbalta (or any capsule) but the fillers have a formula for the timing of the time-releasing of the capsule or a new gelatin capsule. He has a formula of fillers that they have to use for each medication.

So I guess counting beads will not work and this is on the advice of a very friendly informative pharmacist. He didn't know the formula of filler to use for Cymbalta off the top of his head but he said the fillers get released with the beads in a certain manner, so this will not work for me. Sound like sound advice?

Luthie,

I don't know, it seems people have been tapering Cymbalta by counting beads for quite awhile without problems but of course, that doesn't prove anything.

The only other option I can think of is to get a prescription from Dr. Pundy for Prozac and transition to the med from Cymbalta because it is allegedly easier to taper off of. But that is definitely not risk free either.

49er

Luthie2006 wrote: I think what I will do is open up one of my generic 30's and see what is going on with beads. I will see how many are in there today. If there are hundreds or many beads, I don't trust myself into counting and recounting so many of them. I have a friend here who is willing to go on a "bead counting date" with me in my kitchen but he loses track of everything, so not sure I trust him to count beads accurately or myself for that matter. Someone wrote on some website that the generics have less beads in them, so I will see once I open them later tonight.

if you've got a kitchen scale, you might be able to get close enough by *weighing* the beads.

or, do like you see in movies where they are doing coke, and put 'em on a nice flat surface and divide 'em up into multiple piles...

I'd think you could get pretty close to 50/50 just by eyeballing the piles...

might be worth a try.

Luthie2006 wrote: So I guess counting beads will not work and this is on the advice of a very friendly informative pharmacist. He didn't know the formula of filler to use for Cymbalta off the top of his head but he said the fillers get released with the beads in a certain manner, so this will not work for me. Sound like sound advice?

open one up and see if there's any filler in there with the beads.

if not, sounds like the guy was guessing.

palerider wrote:

Luthie2006 wrote: So I guess counting beads will not work and this is on the advice of a very friendly informative pharmacist. He didn't know the formula of filler to use for Cymbalta off the top of his head but he said the fillers get released with the beads in a certain manner, so this will not work for me. Sound like sound advice?

open one up and see if there's any filler in there with the beads.

if not, sounds like the guy was guessing.

That is a great idea PR. I am surprised my cynical brain didn't think of that.

49er

Assuming it is safe to open the capsules and divide the contents, I don't think you need to be overly fanatical about exact ratios.

The doctor is recommending going from 1 a day to 1 every two days. That's a 50% change. If you're trying to get 90% and end up getting 80% instead, you're still ahead of the "standard" scenario.

If you're more concerned, you could pour it out on a flat surface. Then divide it in half by eye. Then divide that in half by eye, giving 25%. Then divide that in half, giving 12.5%. Throw away 12.5% and you have 87.5% plus or minus the margin of error.

Makes me think of the stereotypical Hollywood image of dividing up cocaine.

However, maybe counting beads isn't that hard. Looks like there are roughly 250 beads per capsule.

Google also has lots of hits about "cymbalta bead counting."

Once again, read the warning links posted above.

palerider wrote:harvard says your doctor is wrong: http://www.health.harvard.edu/newslette ... depressant

I opened up the above link and I can see how doctor's can easily get confused when it comes to tapering off meds. In many cases, they rely on the pharma's rep to provide them instructions.

Just looking at the above link, to dumb me, it appears in the sample chart that you taper off over 5 doses and then you're done. However, the article says you may have to taper off over a period of 6 or more weeks. The chart is very confusing to say the least. To me, one dose is taking your meds one time, second dose is the next time, and so on. I can see how a GP might be dismissive of this especially if you're questioning his/her judgment.