Withdrawal
Index
4.2 Reducing from 1 x 75 mg XL capsule
per day
A separate sheet is attached which could be copied and given to a patient
to give day by day guidance on the following reduction programme starting
with 1 x 75 mg capsule of venlafaxine XL.
The initial reduction from this level is achieved by extending the
period between taking capsules from 24 hours to 36 and then 48 hours.
A varying level of tablet will be used 12 hours before taking the
next capsule to control the rate of reduction in body drug level as
the period between capsules is extended.
4.2.1 Instead of taking a capsule every 24 hours delay it for 12 hours
but take 1 ½ x 37.5 tablets instead at the 24 hour mark. Maintain
for two cycles.
4.2.2 Maintain a cycle of one capsule every 36 hours with tablets
taken 24 hours after each capsule but gradually reduce the level of
tablets being taken by ¼ tablet every two cycles until one
capsule only is being taken over this period.
4.2.3 Extend the period between capsules to 48 hours but take 1 x
37.5 tablet after 36 hours to avoid too rapid a drop in drug levels.
4.2.4 Maintain the capsule cycle of 48 hours but gradually reduce
the level of tablets being taken 36 hours after the capsule by ¼
tablet every two cycles until one capsule only is being taken over
the 48 hour period.
4.2.5 Replace the capsule with 1 x 37.5 mg tablet taken twice per
day. This instinctively feels like an increase in medication but it
does in fact lead to a further reduction in body concentration because
of the half-life effect. Consolidate for at least 5 days to ensure
smooth change over between the types of drugs.
4.2.6 Gradually reduce the level of tablet by ¼ tablet every
3 days down to zero.
4.2.7 To make a smoother transition in these final stages, 12 hours
after making a reduction in tablet level the previous level of medication
can be used once only to make the reduction more gentle.
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