Drug absorption and stability in the body - A question to people who understand it we

[Nivsch]

and can make withdrawal of pharmacological drugs easier for me and for others.

I am tapering down an antidepressant drug called cymbalta to get off the drug in the future. In order to make my body adjust better to the reductions of the dose, I try to keep it as stable as possible during the month I hold the dose after every reduction.

One of the things that I do is to make the maximum distance between the drug and food, because I have read that food can decrease absorption by couple of %, and I know that even 2% of day to day change in absorption is still really significant in withdrawal. but I still have some concerns about the stability issue ,so my questions are:

1. What do you think about that?

2. How much time it takes until the drug bypasses the stomach and reaches the small intestine? cymbalta has gastro resistant capsules with hundrents of enteric-coated micro beads (my current dose) to delay absorption that has to be in the small intestine.

3. Is there a concern that if I take it when the metabolism is very slow - before sleep/too early in the morning or when I keep lying in bed after I take it - that the capsule will partially dissolve in the stomach? 

4. Can we say that maybe it is important to eat something even a little bit to make the stomach move and ensure the drug will pass the stomach in one piece? Or that all these parameters are negligible?

5. Does my drinking habit during the day affects the absorption phase and I should keep it the same as possible every day? or this is negligible?

6. anything else from your knowledge/experience that can help the dose be more stable?

Edited July 17, 2022 by Nivsch

[undeather]

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1. What do you think about that?

Its difficult to deliberately influence the passing mechanism because thats a very complex process with dozens of factors that come into play. The respective bioavailablity of duloxetin also varies a lot and usually lies between 32% and 80% of your dose. Peak plasma concentrations are reached approximately 6 hours after ingestion of the gastro-resistant capsules.

My advice: Just dont change your lifestyle-habits during the cessation-period. Keep up with your usual oral application protocol. Meaning, if you always took the pill in the morning with your breakfest, then keep doing that. Your body has already adapted to this regime, so its smart to keep it going, even if you lower the dose. Eat your usual meals and dont add other drugs or supplements to the mix. Th

Smoking is a strong influencer of duloxetin metabolism - thats one to keep in mind. 

Also, you should be under your physicians observance. He knows best how and when to get lower.
Generally, duloxetine tapers last around two weeks - but you might need an individual protocol.
Cymbalta is one of the more difficult SSRI's to get off - you might experience withdrawal symtpoms.

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2. How much time it takes until the drug bypasses the stomach and reaches the small intestine? cymbalta has gastro resistant capsules with hundrents of enteric-coated micro beads (my current dose) to delay absorption that has to be in the small intestine.

It depends on multiple factors - can be 30 minutes or 3 hours. 
 

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3. Is there a concern that if I take it when the metabolism is very slow - before sleep/too early in the morning or when I keep lying in bed after I take it - that the capsule will partially dissolve in the stomach? 

Not really.
Your gastrointestinal metabolism actually works most efficiently when you are at rest.

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Can we say that maybe it is important to eat something even a little bit to make the stomach move and ensure the drug will pass the stomach in one piece? Or that all these parameters are negligible?

Negligible. However, it's best tolerated when taken after a meal.
Its much more important to keep the time of intake constant.
 

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5. Does my drinking habit during the day affects the absorption phase and I should keep it the same as possible every day? or this is negligible?

Negligible. Swallow the capsule with a drink of water.




 

Edited July 18, 2022 by undeather

[Nivsch]

@undeather Wow thank you very much for the in depth answer!

Sorry for the late in my answer.

About the withdrawal, unfortunately this is only true if you have been on the med for couple of weeks/1-2 months. But after years on medications one must taper slowely in a time frame of many months or years. Sadly most doctors dont have a clue about withdrawal.

Edited August 6, 2022 by Nivsch