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Suggest Treatment For Celiac Disease

Posted on Mon, 9 Feb 2015

Question: I was talking Pristiq 50 mg for about 2years and find out it has wheat and I have Celiac Disease, need to get of ASAP trying to go back to Effexor that I use to take years ago
I'm not sure how to do it, my doctor says to keep taking Pristiq for 2 weeks together with 37.5 of Effexor for two weeks and then start with 75 Effexor and stop the Pristiq but don't feel confident doing this combination, for some reason think it would be worst
Someone can help me

Answered by Dr. Dr. Ashok Kumar Choudhary (1 hour later)

Brief Answer:
Cross titration needed

Detailed Answer:
Hello,
Thanks for using healthcaremagic.

I read your query and understand that you are worried about taking two medications at same time. I must assure you that it is completely safe and there is nothing to worry.

When somebody is doing ok with medication and we need to shift to another mediation most commonly we use the method of cross titration in which new drug dose goes up and the existing medication dosage comes down.
Your doctor is right in saying that take first two weeks effexor 37.5 mg and than increase its dose and decrease dose of Pristiq at the end of two weeks.

On similar lines I like to recommend following strategy
In the first week take
Pristiq 50 mg and effexor 37.5 mg

Second week

Pristiq 50 mg and Effexor 75 mg

Third week

Pristiq 25 mg and Effexor 112.5 mg (37.5*3)

Fourth week

Effexor 150 mg

In this way you will avoid withdrawal symptoms of Pristiq as they are slightly troublesome for some patients. The other benefit is that Effexor will be having enough time to start working before Pristiq is removed. The other benefit is side effects as they are less likely to occur when we increase the dose as recommended.

I like to emphasize here that all this should be done under guidance of you treating doctor.

Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
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http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Dr. Ashok Kumar Choudhary (10 hours later)

Dr XXXXXXX thank you for your answer,

I have a doubt I had read that Pristiq can't be cut in half.
So I will be in Pristiq 50 mg and 37.5 of Effexor for two weeks that is what concerns me, that is more than I am taking now
Do you think that I could skip the Pristiq every other day? I Am so concern how to get ride of this medicine I am the CEO of a company and want to have as little as as possible side effects

Thank you again XXXXXXX

Answered by Dr. Dr. Ashok Kumar Choudhary (2 hours later)

Brief Answer:
Taking alternate day is other option

Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.

I seen your attached file and understand your position.

Pristiq comes scored in my country and that can be cut in half but as I can see over the internet in USA it is not scored.
Still it can be breaked as there is no harm in doing that. I am of this opinion as in different countries same molecule is available scored.

Taking alternate day is option but with that it is not possible to overcome all discontinuation symptoms associated with pristiq as half life of pristiq is just 10-12 hours.

So in my view breaking the tablet is better option in compare to taking tablet every other day.

Thanks and regards
Dr Ashok XXXXXXX

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar