Brand Change - Side Effects?

[Paradise10]

Hi, been on Ven 150mg for quite a while and doing ok, a couple of weeks ago the pharmacy changed the brand of tablets which I had no problem with but a few days later I started getting brain zaps, then a few days after that I started getting weak arm and leg muscles and now my anxiety has come back.

Could it be from changing the brand of tablets as I haven't missed any?

Thanks :-)

[panic_down_under]

Could it be from changing the brand of tablets as I haven't missed any?

It's rare but it can happen. Can you remember who made the generic you were on and who makes the new one?

[Paradise10]

Hi Ian, I usually have Venilac, venisir or effexor brand but these are dexcel pharma.

They discovered my blood pressure was really high a few months ago so they have me on meds for them that aren't working.

My psych suggested moving ne to prozac if my anxiety flared again.

[Phill2]

I found a definite difference between Lexapro and the generic so much so that I threw the generic away and bought a new packet of the real Lexapro.

[panic_down_under]

Hi Ian, I usually have Venilac, venisir or effexor brand but these are dexcel pharma.

Dexcel Pharma is an Israeli pharmaceutical company with a good reputation so I doubt there is a problem with the med per se, but people can react differently to generics from different companies.

They discovered my blood pressure was really high a few months ago so they have me on meds for them that aren't working.

Has there been a recent change in the meds you're taking to reign in your BP? If so the new meds could be affecting how venlafaxine is metabolized.

My psych suggested moving ne to prozac if my anxiety flared again.

You're still on a low venlafaxine dose. It typically doesn't inhibit noradrenaline, aka norepinephrine, transporters at doses under 225mg, and even then it does so only weakly (although classified as a SNRI it is really only a SSRI). The recommended maximum dose is 375mg/day.

[Paradise10]

Tanks Ian, you are helpful and answer my questions as usual.

I think I am likely just having a blip, started feeling unwell last week and I know that is my trigger for anxiety. I have tried increasing the ven last year and I can't tolerate any higher than what I am on. The Phych took me to 225mg but I had to come back down again. He wrote to my doctor last year and said if I relapsed that they were to try prozac next.

I am trying to manage it myself with what I learned in CBT last year. I do have a docs appointment next Thursday so I will speak to her then if I'm still anxious.

Ava :-)

[panic_down_under]

I think I am likely just having a blip, started feeling unwell last week and I know that is my trigger for anxiety.

It may well be the reason for the heightened anxiety, Ava. The brain changes which manifest anxiety symptoms (also depression) result from a type of auto-immune response and these disorders often worsen when our immune system ramps up to fight an infection.

I have tried increasing the ven last year and I can't tolerate any higher than what I am on. The Phych took me to 225mg but I had to come back down again. He wrote to my doctor last year and said if I relapsed that they were to try prozac next.

If 150mg proves insufficient then switching to another AD is the only option. That said, sometimes people can tolerate a higher dose on the second attempt. I initially couldn't tolerate more than 75mg of my current AD, but after reducing the dose back to 75mg for a couple of months had no problem increasing it to 150mg and I've now been on 225-250mg for over 20 years.

My only concern with switching to Prozac (fluoxetine) is that you'll be going from the SSRI with the shortest half-life to the one with the longest so will have to do a longish cross-taper which requires careful handling. Make sure your GP knows how to manage this. Ime, few do.

[Paradise10]

I doubt they will have a clue, I've seen some people in a venlafaxine Facebook group mention dropping to 112mg for a week then dropping to 75mg for a week then dropping to 37.5mg and adding in 10mg prozac. Then stopping then ven after a week. Do you think that sounds too quick? Also I don't think they will increase it again because my blood pressure is 96/160 and not coming down despite being on 2 blood pressure meds.

[panic_down_under]

I doubt they will have a clue,

Sigh! Then ask your psychiatrist to provide the GP with instructions on how to manage it. Or is he just as clueless?

I've seen some people in a venlafaxine Facebook group mention dropping to 112mg for a week then dropping to 75mg for a week then dropping to 37.5mg and adding in 10mg prozac. Then stopping then ven after a week. Do you think that sounds too quick?

Sounds reasonable. The rule of thumb on this is to reduce (or increase) doses at intervals of not less than 5 times the half-life of the med (this is how long it takes for the med's plasma levels to stabilize after a dose change). The venlafaxine immediate-release half-life is about 5 hours for venlafaxine itself and 10 hours for its active metabolite, so call it 6-8 hours for both. So you could reduce the dose every third day, but as psychology is at least as important as chemistry and biology taking a few extra days to build confidence in the process is often a good move. That said, your GP has the ultimate say.

Also I don't think they will increase it again because my blood pressure is 96/160 and not coming down despite being on 2 blood pressure meds.

Then fluoxetine is likely to be the better med. Are you doing anything to help bring the BP down? Moderate exercise is good both for the heart and anxiety/depression.

[Paradise10]

I saw the psych last year through a health scheme so I wont be able to see him again, not sure how clued up my doc is but I will ask her on Thursday. My whole doctors has merged with a big health centre so it's not always the same person anymore.

I am trying to do more exercise re my blood pressure.