Reducing dosage from 30mg to 15mg

[dreambeliever]

Hello, so I've been on mirtazapine for almost 3 years for anxiety. I started out at 15mg in June 2013 and stayed on the 15mg until March 2015. In March 2015 I upped my dosage to 30mg with my Doctor's permission, and I've been on 30mg steady for a year now. I've talked with my Doctor, and I want to go back down to the 15mg before eventually coming off, but I'm terrified of withdrawal symptoms. This is the first medication I've ever been on and I really don't know what to expect.

I'm from Canada, and the lowest dosage pill my pharmacy makes is in the 15mg form. My Doctor has suggested to start taking 23.5mg to reduce for 4-5 weeks before going down to 15mg. This would be 1, 15mg + 1, 7.5mg pill (15mg broken in half) - I have a prescription for 15mg pills. Is this going to be too much of a reduction? It's a 22% reduction from the 30mg.

Has anyone ever reduced their dosage with mirtazapine, or have experience reducing/coming off with any other medications?

My body is very sensitive and I don't want to shock it with too much of a reduction.

TIA.

[MyNameIsTerry]

I think you've got a good doctor if pill splitting and gradual reduction is even mentioned, over here GP's have no backing from the NHS on pill splitting so they just tell us to reduce based on what dosages the manufacturers make.

You could always quarter the pills to slow it down.

Have a look at sandie's thread on this board because she did a gradual reduction with pill splitting that was well researched and sensible. Her thread was a support one, so it may be long, so perhaps trace it back from the end of the thread?

[Cherryade]

I went from 45mgs to 15 mgs following this method. For a 30mgs to 15mgs reduction, do the 30mgs to 22.5mgs first, then the 22.5mgs to 15mgs. For each stage, replace one of the 30mg pills with one 22.5mgs pills every 2 weeks until you are taking all 22.5mg pills, then do the same for 22.5mgs to 15 mgs. Each stage will take 12 weeks.
Week 1 & 2: 6 x 30mgs, 1 x 22.5mgs.
Week 3 & 4: 5 x 30mgs, 2 x 22.5 mgs
Week 5 & 6: 4 x 30mgs, 3 x 22.5mgs etc.
until week 11 & 12: 1 x 30mgs. 6 x 22.5mgs
week 13: 7 x 22.5mgs
This is a very gradual decrease. It does mean that it will take 6 months to get to 15 mgs. If you feel you can do it quicker then just use one week before dropping the dose. You can then do it over 3 months. Try and space the smaller dose tablets as evenly as possible throughout the week.

[dreambeliever]

MyNameIsTerry, thank you for the recommendation. I had a look through the thread and found it helpful! Yeah, I'm happy that he was able to write me a prescription for taking 1-1/2mg of the 15mg pills.

Cherryade, thank you as well! This looks like a really smart way to do it! Did you notice any negative symptoms when coming from the 45mg to the 15mg?

I've managed to find a "pill cutter" that works really well to split my already halved 7.5mg pills into 3.75mg. It also works to split the 3.75mg to 1.875mg. I'm going to see if I can come up with a schedule for tapering that doesn't allow more than a 20% decrease from each lowered dosage. If I can come up with a good schedule, with the math done properly I'll post it in case others are searching the thread. Cherryade, your schedule also looks like a good way to do it!

[MyNameIsTerry]

Psychiatrists tend to advise 10% drops for long term users. This can be tricky with pills but what you can try to aim for is as close as possible. If you do it like this though it takes you into little pieces of pills which can mean they differ.

So, if you want to be more sure, use a jewellery scale. They cost about the same as the pill cutters, which is very cheap over here. Then you just have to weigh a whole pill first so you know the true weight since these meds are packed with fillers, binders and other things. You can then calculate the weight at 10% but it will mean you the active drug in 10% of gross weight of a pill will be less (does that make sense?). Then perhaps you can play around with the cutting to more than quarters?

[Cherryade]

If you do the tapering using my schedule you don't have to worry about cutting pills. The pills will break easily along the indent.
I had a few wibbly wobbly days but on the whole it was fine. I am now at 15 mgs and am going to sit on that for 6 months then go down to zero in 15mgs to 7.5mgs and then 7.5mgs to zero. If you do feel off kilter at any time then just stay on that weeks dose for another week or two until it all settles down. (I have been on mirtazapine for 8 years).