Wrong amount of Venlafaxine prescribed - help!

[Shattered04]

I've started a new thread as this is quite urgent!

Yesterday I picked up my prescription for Venlafaxine 37.5mg immediate release. As I mentioned in my other thread, the GP had told me 37.5mg once a day for four weeks, yet the prescription was for 2x37.5mg daily.

I took the first tablet last night, and then it occurred to me - this drug has such a short half life, that is why immediate release is always prescribed twice or more a day. In fact that's probably why she selected that dose from the drop down menu - she wasn't paying proper attention and didn't see there wasn't a one-a-day dose for immediate release. Even the instructions say twice daily, as do the NICE guidelines and everything else online that I've seen. The only one that is once daily is the extended release version which she didn't prescribe.

The last thing I want is to have withdrawal every day!

Needless to say first thing I rang the doctor's surgery, but they're closed for the weekend. I'm due to take another tablet now if I was going to.. obviously I have enough for a fortnight but a) it's going against doctor's orders and b) she wasn't expecting me to start taking it yet.. (again, bad advice from her!)

What should I do? Doesn't help I can't think that clearly..!

Don’t panic! Is this your first ever experience with Venlafaxine?

Can you get to a pharmacy? Pharmacists tend to be more knowledgeable about dosages than Doctors. You could go in and ask one.

Just spotted I can break the pills in half - might do that twice a day, and then ring them on Monday.

It is! I've stopped Citalopram as of day before yesterday and went straight onto it.

That's not a bad idea about seeing a pharmacist actually. Although neither of the ones I've seen about my prescription said anything about the dose even when I queried it.

You are right that immediate release Venlafaxine is often prescribed for twice a day. But I have also known people on relatively high doses with immediate release tablets on one dose per day.

I guess I'm worried that as it's a low dose, it'll be mostly gone long before I'm due another one. And I won't know if what I'm feeling is withdrawal or the opposite.

They dont like prescribing the slow release as they cost a lot more my GP was v cross with me when I demanded the slow release .

Snapping in half is a good idea, so that the daily dose is spread out.

You’re on a low dose and withdrawal shouldn’t happen as long as you remember to take your meds on time each day.

Yeah, I'd heard the XR ones cost a lot more. She's already prescribed me Qlaira though (more expensive contraceptive pill, for my hormonal issues as it's more "natural" and mimics a normal cycle) so she might be amenable.

I will take half one now, find a pharmacist and have a chat and see what they say. I'm pretty good at remembering to take meds at the same time, never had a problem there (fortunately!)

Thank you all

It isn’t so much that you would get withdrawal from the quick release tablets. It’s that they cause more side effects in high doses. But on a lower dose, it won’t be such an issue. If your dosage ever increases, ask for slow release.

She's probably prescribed it for once a day because the side effects for the first two weeks are unpleasant. You won't get withdrawals. Then after two weeks when the side effects have gone, you can up the dose to twice a day.
For me, it seemed best to take the single dose with evening meal, that way the drowsiness etc happened during the night.

Did the GP put 2x daily on the prescription? If that is what she prescribed and that is what the instructions say, that is what I would take.

If she said take once daily, but prescribed twice daily I'd go with what she prescribed. Perhaps she said that before checking? GPs are not experts in medicines.

You could double check with a pharmacist, but 75mg daily split into two doses is the usual initial dose for venlaflaxine. The maximum daily dose is 375mg so it will not cause you harm to take 2 tablets.

The IR tablets are a good way to build up your levels of venlafaxine slowly considering you have only just stopped citalopram (needs to be cleared from your system still). It is normal to take it once daily initially to prevent any adverse effects from the combination of the two drugs. You must have a review appointment/phone call soon?

I was on 10mg Citalopram which is obviously a really low dose. I had been on 20mg but it was knocking me out too much, but the 10mg was not really having much of an effect, plus the migraines I had were getting a lot more frequent. My already crappy concentration and focus also took a massive nosedive. I started on it back in September.

I realised the only thing she could prescribe me which may help with all that was an SNRI, and this was all she would offer. I guess she said 37.5 as it's kind of equivalent to the 10mg Citalopram, but as mentioned that wasn't really enough. So I wouldn't be adverse to 75mg. My only issue is that I only have enough for two weeks if I do that, and she's expecting me back in four weeks.

I'll split the dosages anyway until Monday - if nothing else and they do agree to up it to 75mg (and give me another prescription) then at least it'll be a little taper. I've heard to give it 4-7 days before upping anyway if you taper like this.

Nimueh - she told me verbally one a day for four weeks, but the prescription (including what the pharmacist has printed) clearly states twice daily. There are 28 pills. Either way, she's made a mistake! And I agree, from everything I've seen including the instructions that come with it, 75mg IS the usual initial dose. Sigh!

Lentilbaby - she only prescribed it on Wednesday, and it wasn't until today when I managed to pick it up (had trouble finding stock locally) and I'd taken one that it dawned on me that it might be an unusual prescription. I haven't managed to find much about taking it in the way she said - most people are 2 or 3 times a day, or on the extended release.

Call up a pharmacist and speak to them they will advise you on what’s best to do. You could also go to your local walk in center which will be open today and they can fix your prescription.

i was on low dose of venlafaxine like this when i was first on it and also coming off it later, and neither time did i have a noticeable comedown when i was taking it, apart from when i actually stoped

I would just take the one pill for the next couple of days until the surgery opens on Monday; you could ask the surgery then.
I have been on Citalopram and was able to stop ‘cold-turkey’ with no problem. The Venlafaxine, however, is another issue. 37.5 is low. I ‘m on 225mg which has side effects.

venlafaxine did save my life, but ultimately i couldnt deal with the side effects

OP it really is common to start off on a once daily dose like this, many people do, please don’t worry.

I would continue taking it as one daily, let the venlafaxine levels build up over the next few days, establish if you are suffering any side effects with it and after a couple of weeks there should start to be some effect from it.

Taking it in this way helps to prevent side effects which if you go in at a high dose, may occur and may prevent you taking a drug that could have been very beneficial for you.

If within the next week or two, your mental health is suffering beyond a point you can manage, then obviously get in touch with your GP ASAP.

Shattered04 the initial dose is different when changing from Citalopram http://www.gpnotebook.co.uk/simplepage.cfm?ID=16511795922*

Hopefully this link will work and you can scroll down to the correct part of the table.

As a PP has said, best to stick to one daily for now and contact GP early next week, bearing in mind the following week is Christmas.
If it is causing you significant anxiety which it is, it’s probably best to have that conversation with your GP sooner rather than later.

@MynewnameisKy Absolutely. The drugs have to be cross tapered otherwise there is a chance of adverse effects.
The reference you have linked is used by GPs and Pharmacists.

Just do as you’re told and phone on Monday, no need to get in such a flap. Also don’t go on with the attitude that she’s wrong, it sounds like there are many reasons for what she’s done.
You will not be at a therapeutic dose by Monday anyway so calm down and stop googling.

I should add that no matter how professional the sources on the internet you should still seek professional advice from a GP or Pharmacist. No reference sources will allow for your individual medical history.