19 minutes ago, LostinCanada said:

This is why just cutting is not accurate and weighing has to be done. I assume you are weighing to get your dose of 6.8 mg. Instead of cutting, would shaving with a one side razor or filing with a metal nail file work better?

Any switch if not done slowly and carefully can be destabilizing. Does your manufacturer also make regular mirt pills?

If this is the case...I can see how accuracy could be a problem if you are cutting and weighing. I do not know much about this type of pill but it definitely complicates the situation. The pellets/spheres should dissolve because they are made from sugar and starch.

@Chippy did you know the following? To me this means, cutting and weighing could not be accurate due to the matrix.

"In the Remeron SolTab formulation, the tablet structure is essentially a delivery vehicle for these tiny drug-loaded beads. Here is how the drug is distributed:Drug-Loaded Pellets: Each pellet consists of a core (the sugar sphere) that is coated with a layer of the active medicine, mirtazapine.Taste-Masking Coating: A second protective layer—usually a polymer like Eudragit E100—is applied over the drug layer. This coating is crucial because mirtazapine is extremely bitter; the polymer is designed to stay intact in the mouth (at neutral pH) so you don't taste the drug, but it dissolves quickly once it hits the acidic environment of your stomach.The Matrix: The rest of the tablet (the "matrix") is made of fast-dissolving materials like mannitol and crospovidone. When you place the tablet on your tongue, this matrix disintegrates in seconds, releasing the individual pellets so you can swallow them easily with your saliva."

@Emsy Do you take ODT formula? I’m remembering that Emsy dissolved hers in water… I could be remembering this wrong. I hope she’s around and can chime in.

Thanks @Finni

@Emsy does make liquid from her orodispersable mirt.

Emsy: Mirtazapine Withdrawal https://antidepressantrecovery.org/topic/41-emsy-mirtazapine-withdrawal/

That is her thread.

@LostinCanada @Finni @Gilda

To the best of knowledge ODT can’t be cut.

Emsy to the best of my memory is using ODT tablets and she dissolves them to take her 1.2mg (I think) dose. When she tried to switch to a manufactured liquid she found it destabilising and had to switch back, half way through the process. Last I heard she is doing much better and starting to stabilise on ODT.

From what I know it is fine to dissolve ODT tablets in water to taper.

Any bits that don’t dissolve in 20mins or so, I have to assume don’t contain drug and are just filler.

9 hours ago, LostinCanada said:

but it dissolves quickly once it hits the acidic environment of your stomach.

Im sure water must be enough to suspend ODT tablets but if this ⬆️ here is the case perhaps orange juice or something may help the beads disolve better.

@Gilda does your manufacturer also make the normal mirtazapine?

Since you cannot cut the orodispersible, c going to liquid or going to a regular tablet, is still a change. If your manufacturer makes regular pills, that might be a better way to go.

@Chippy thoughts?

24 minutes ago, LostinCanada said:

@Gilda does your manufacturer also make the normal mirtazapine?

Since you cannot cut the orodispersible, c going to liquid or going to a regular tablet, is still a change. If your manufacturer makes regular pills, that might be a better way to go.

@Chippy thoughts?

I think it’s a good thought LIC. Either that or dissolving the tablets. I don’t think cutting is the way to go with the odt tablets. It might be better to just get any kind of Mirtazapine tablet and actually be sure of a stable dose. That’s more destabilising than anything.

48 minutes ago, Chippy said:

It might be better to just get any kind of Mirtazapine tablet and actually be sure of a stable dose. That’s more destabilising than anything.

Agreed. Hope this helps @Gilda

Hi @Gilda sorry to be replying so late, I only check in occasionally at the moment as I find I get very triggered reading others threads and so I’ve just picked up my tags.

I use the oradispersible tablets. I have done since last August. They should not be cut or crushed, if you want to cut or crush tablets to taper you will need to use the ‘normal’ tablets.

I dissolve a 15mg tablet in 15ml warm water (boil the kettle and pour a small amount in a mug and wait until it is hot but I am able to comfortably put my finger in it) then measure my 15ml with a syringe and drop in my tablet. Give a few moments then give it a good stir and the leave it for a minute or two.

I then stir it constantly with a long skewer as I draw up my dose into a syringe.

Ideally I should probably use 7.5ml water and 7.5ml maple syrup to make a suspension as the bits floating around stay suspended longer than just water, but I haven’t wanted to mess with my method as I’ve been holding my dose since the middle of November waiting to stabilise after WD kicked in.

I did try to swap to the commercial liquid at one point but my nervous system freaked out even more so I went back to my current method.

It’s not foolproof but by using the same method day in and day out I’m getting some consistency which is what’s needed.

I am now much more stable than I was.

Hope this helps.

8 hours ago, Emsy said:

Hi @Gilda sorry to be replying so late, I only check in occasionally at the moment as I find I get very triggered reading others threads and so I’ve just picked up my tags.

I use the oradispersible tablets. I have done since last August. They should not be cut or crushed, if you want to cut or crush tablets to taper you will need to use the ‘normal’ tablets.

I dissolve a 15mg tablet in 15ml warm water (boil the kettle and pour a small amount in a mug and wait until it is hot but I am able to comfortably put my finger in it) then measure my 15ml with a syringe and drop in my tablet. Give a few moments then give it a good stir and the leave it for a minute or two.

I then stir it constantly with a long skewer as I draw up my dose into a syringe.

Ideally I should probably use 7.5ml water and 7.5ml maple syrup to make a suspension as the bits floating around stay suspended longer than just water, but I haven’t wanted to mess with my method as I’ve been holding my dose since the middle of November waiting to stabilise after WD kicked in.

I did try to swap to the commercial liquid at one point but my nervous system freaked out even more so I went back to my current method.

It’s not foolproof but by using the same method day in and day out I’m getting some consistency which is what’s needed.

I am now much more stable than I was.

Hope this helps.

Thank you Emsy. That’s really helpful. Xxx

@Gilda I hope you are doing okay. Sending hugs. 🙏❤️

@Emsy @Chippy @LostinCanada Good morning, thank you all for your replies. Unfortunately, after making that cut, I feel terrible. My panic attacks have returned, along with a visceral anguish that I suspect is subjective akathisia, and extremely loud tinnitus. The tinnitus is truly unbearable. I am very scared, and my psychiatrist does not understand the situation at all.

I was at 7.5 mg; then, one day I dropped to 5.5 mg and went back up immediately the next day because I experienced mental confusion. That week, I had pain everywhere and my tinnitus spiked. A week later, I dropped to 6.8 mg. It has been 9 days now, and I am feeling worse every day. I developed the symptoms mentioned above, and this morning nausea started as well.

I don't know what to do now. I imagine my nervous system is very unstable, which is why I am suffering even though I only dropped by 10%. I am lost. Regarding the orodispersible tablets: they do not dissolve in water. I live in It mialy, and there is a suspending vehicle used to prepare a solution from tablets called SyrSpend, but no pharmacy wants to sell it to me. I finally found one pharmacy and asked if they could make the solution for me; I am currently waiting for their answer.

I don't know what to do with the dose now. Should I go back to 7.5 mg? I don't understand why I am not stabilizing. Also, I am not sure if I can switch directly to the suspension. The suspension would be made from regular capsules, not the orodispersible ones. I was suggested to try Lemon Balm (Melissa) mother tincture, but I know it acts on GABA receptors, and I have a history of benzodiazepine use. "I asked the pharmacy if they could prepare the suspension directly using the orodispersible tablets I am currently taking. I want to avoid changing manufacturers or formulations to minimize any further impact on my nervous system

Edited May 4May 4 by Gilda

Hi @Gilda

Sorry are you having a hard still.

15 minutes ago, Gilda said:

I finally found one pharmacy and asked if they could make the solution for me; I am currently waiting for their answer.

I don't know what to do with the dose now. Should I go back to 7.5 mg? I don't understand why I am not stabilizing. Also, I am not sure if I can switch directly to the suspension. The suspension would be made from regular capsules, not the orodispersible ones.

If you are going to go the route of having a liquid made up from a tablet, I would just get the tablets yourself and cut it to the correct dose on your scales. You control the dose, not the Pharmacy then. Mistakes happen and they charge for you this.

Should you go back up to 7.5mg, well I have mentioned this before, on paper I would say yes, although alot of what you are going through is not just due to the drop, the drop may have made things worse.

I understand you don't feel the ODT tablet disolves for you. This may be true, but perhaps not as Emsy can do it, either way if you suspect they are not dissolving, this will lead to anxiety over the accuracy of the dose, and this in itself isn't helpful so....

What you should do next is difficult to say. I think my gut says, based on your situation, get the normal 'hard' tablets, weigh on your scale and updose to 7.5mg. I can't say that the change of type of tablet, won't cause you issues, and I can't say the increase of dose won't make things worse. We don't know. But I suspect increasing back to 7.5mg may help, and the tax you will pay changing type abruptly will be outweighed by the consistent dose you will get from then onwards. Just my thoughts. If you don't updose, the just switch to hard tablets only perhaps.

When calculating your new weight, weigh 10 tablets and divide by 10 to get an average pill weight that you will use going forward. Obviously you will then take that weight and calculate your new dose.

Hope this helps.

Chippy

@Gilda the orodispersible tablets don’t fully dissolve in the true sense of the word. You will still see bits floating around and what you actually have is a ‘suspension’ but as they are designed to break up on the tongue with saliva they are just that bit easier to use to make a suspension than crushing the ‘normal’ tablets for me. That’s why I moved from the hard tablets to the orodispersible once I wanted to go below 7.5mg and I had no issues swapping over (unlike swapping from the orodispersible to the commercially made liquid).

Am I getting a 100% consistent dose? No, but even if I took a whole tablet there is a margin of error factored in by the manufacturers and even what we have eaten and drank on any day will slightly effect absorption rates etc.

It is not an exact science and I have had to learn to be more relaxed about this as originally my need for precision was adding to my anxiety.

I get my feeling of ‘control’ by using the same method, the same syringe, the same time of day for my dose.

After nearly 6 months of staying on the same dose I am still waiting to fully stabilise. I am 60-70% there but still experience tinnitus, occasional nausea, fatigue, headaches and head pressure, disturbed sleep but the terror level anxiety is gone, I am able to eat properly each day and I do get some sleep.

It took just over 4 months for the improvements to come and it got worse before it got better but I left the dose alone and waited for my system to sort itself out.

You’ve had alot of med and dosage changes which rest upsets the nervous system and I believe your system really needs some consistency, so whatever you decide stick with that until you reach stability and your symptoms are barely noticeable.

I will wait until I have been a solid 70-80% myself for at least a couple of months before I restart my taper.

I don’t know if any of this helps.

@Gilda so this is going to sound strange but

what if you spit into a jar, add the pill and lightly stir it...just use a toothpick or something till is dissolved. If this works, you could then add a measured amount of apple juice or some other juice, draw out your dose and discard the rest.

Otherwise, you could try the options from @Emsy or @Chippy as well.

We are here for you. It is a long process and much of it can be trial and error. ❤️🙏

Edited May 4May 4 by LostinCanada

Thank you for your support. @LostinCanada I’m quite desperate. I’ve tried spitting it out, but it doesn’t dissolve. Believe me when I say that my tinnitus is not a ringing sound—it’s a deafening noise in my head. The visceral anxiety has also come back.

I imagine that back in February, with the mess I made with medications, it was those two days when I took mirtazapine that made me feel unwell. I took mirtazapine for two days, and after a week I started feeling bad. I should have waited for the symptoms to pass. The tinnitus had decreased, but I still had visceral anxiety.

Unfortunately, after a month I took this “poison” again, and at first it seemed to work. Now that I’ve tried to reduce it, I feel terrible. I’m afraid I’ll never be able to stop it. I don’t know what to do now—whether I should go back up to 7.5 mg to stabilize and then try a more gradual reduction.

The tinnitus is unbearable for a human being. @Emsy Also, I have these orally disintegrating tablets. When I dissolve them in water, they turn into lots of tiny microspheres that sink and stick to the glass. Is it the same for you? Tiny little pellets?

You said you tried the liquid from the supplier and didn’t like it—was it a pharmacy preparation?In my case there aren’t pieces floating, but microspheres that settle. Tiny little pellets. Maybe what I have here in Italy is different from what you have. If they were pieces floating, I would feel more reassured. In my case they are microspheres—little pellets that settle and stick to the glass when I stir.I use the brand Remeron—what brand do you use?

Edited May 4May 4 by Gilda

21 minutes ago, Gilda said:

should go back up to 7.5 mg to stabilize and then try a more gradual reduction.

If you were able to cut it and feel stable this might be best at this time. It is either that or switching formula to the regular mirtazapine. It is awful that we are put in this position by these drugs.

❤️🙏

26 minutes ago, Gilda said:

Tiny little pellets?

@Gilda have you tried leaving the solution for some time and seeing if these pellets dissolve? Would you consider trying something like a fruit juice to mimic the stomachs acid to help this?

@Chippy @LostinCanada I feel so guilty because I got myself into this mess. I was only in withdrawal from Rivotril and nobody understood it. Then I took all these medications and now I feel terrible and I can’t even get off them. Now I’m too sensitive to any dose reduction. I have unbearable tinnitus. I already had it before but now it is like an airplane in my head. I don’t understand if I can switch to regular mirtazapine and dissolve this. I saw that in water the tablet dissolves better than the orodispersible one. It creates powder that, if I stir it, seems more uniform. I don’t know if going to 7.5 mg would reduce the tinnitus. My psychiatrist insists on staying at this dose. I didn’t imagine I could feel worse than before. I don’t understand why the noises in my ears and head are so loud. I tried adding apple cider vinegar and it dissolves. But I’m afraid it might affect the medication. I’m very scared. The suspension I ordered online is similar to Ora-Plus which is not available in Italy and has pH 4.2. Maybe I should wait for it to arrive and see if the tablet dissolves. I don’t even know how to use it. The video on YouTube is in English and I don’t understand English. I am sending the link.https://youtu.be/-qwWiJvtrCM?is=8n-yFb0FOrn3a0Q9 I didn’t understand if I should use only this product or add water. In other websites they add water. But the particles would still be suspended and I would never know how many I draw with the syringe. Maybe it would be better to dissolve the powder from normal tablets even if the powder does not dissolve. Please think this through with me. I am alone in this decision. I don’t know if it is better to have particles suspended evenly or powder suspended evenly. I started reducing because I was always apathetic and emotionally numb. Now emotions have come back a bit but the price I am paying is very high. It feels like everything I do is wrong. It feels like I have a curse on me. Sorry for the vent.The pharmacy told me they could prepare it from hard mirtazapine capsules using the same product. But I don’t trust it, because maybe they wouldn’t be as careful as I would be, as @Chippy says. My psychiatrist says she does not agree with me preparing it at home. But she is the same one who told me I could cut a piece off my orodispersible tablets.

Edited May 4May 4 by Gilda

@Gilda let’s rule out making a liquid from the odt tablets.

Can you try to dissolve the tablet in a fruit juice and see if that helps? I wouldn’t personally go for apple cider vinegar.

Have you tried the warm water and left it for some time?

35 minutes ago, Gilda said:

suspension I ordered online is similar to Ora-Plus which is not available in Italy and has pH 4.2. Maybe I should wait for it to arrive and see if the tablet dissolves.

A suspension will not dissolve the pill. It simply keeps the pill particles from settling too fast so you have time to draw up the dose in a syringe.

Do not use apple cider vinegar.

This video does not add water. If you add water, you would only do that to a small amount at a time and for OraPlus, not more than 50% water.

Have you tried very warm water and let it sit for 20-30 minutes?

@Gilda the one I have is manufactured by Milpharm.

On the old forum they suggested that you use 50/50 water/suspending liquid, dissolving the tablet in the 50% water first and then adding the 50% suspending liquid whether that is oraplus or maple syrup.

I am in a trap because I started taking Remeron again, not knowing it had caused my tinnitus, and now, removing even a tiny, tiny piece, I feel so bad. This is because my nervous system is hypersensitive right now and... well. Now I also have this cursed, strong nausea and I'm breaking out in pimples, really badly. I feel like I'm in an incredible mess and I'm afraid I won't make it out. Tomorrow I have to go to a psychologist, but what good will it do?

I tried with warm water but the situation is identical. I think I'll have to switch to normal tablets to dissolve in liquid. I can't find any testimonies of people who felt this bad and had such invalidating tinnitus after the first cut of Mirtazapine. Unfortunately, in my opinion, I was still in Rivotril withdrawal since December, plus all the drugs I took. Then I also took two isolated doses of Rivotril in March which hurt me very much because I took them and then stopped immediately. I had tinnitus but not this high. The doctors didn't understand I was in Rivotril withdrawal. Then, unfortunately, the idea to take Mirtazapine was mine because I had akathisia. And now I find myself in this disastrous situation. I have many different sounds in my head and ears. My ears feel clogged and now they are even burning. I feel trapped with a drug that hurts me and that makes things worse if I remove it. I feel stuck and with no way out. I also have a doctor who doesn't want to prescribe me the normal tablets. Now I have a violent headache. My situation is complex. I'm afraid of staying like this. My father keeps saying that I'm depressed. Absurd. With all the pain I have." @Emsy Thank you, when the suspension arrives I will do some experiments. Maple syrup is too sweet for me. Ora-Plus is not sold in Italy

@Chippy @LostinCanada @Emsy Emsy's tablet is made of compressed powder; when she puts it in water, the powder creates a suspension. It is as if she were putting a pulverized hard tablet into water, and what floats is the excipient. My orodispersible tablet, however, uses a different technology—it uses encapsulated microsphere technology. The drug is not a free powder but is protected inside these microspheres. I found the difference online. This is why she is doing well with it. So, I absolutely need to dissolve the normal tablets to get the same effect, but I am afraid of changing brands and the speed of absorption. Furthermore, the microspheres used in my tablet are designed to disintegrate with stomach acidity

8 minutes ago, Gilda said:

afraid of changing brands

I can understand completely. Does your manufacturer make the regular mirtazapine pills?

@Gilda

The Maudsley DePrescribing Guidelines suggests it is possible to dissolve ODT Remeron tablets in water, they state that crushing the tablet with a Pestle and Mortar will help speed up the process, but that the dissolving may take some time. You could also use clear apple juice to assist in this.

If you are not convinced that this is possible for you, I would get 15mg tablets of standard Remeron and cut them to your required dose.

Based on what you have said, I would consider an updose back to 7.5mg.

From here I would hold for several months, focus on coping skills, eating well, getting some fresh air and plenty of fluids and trust your body to stablise.

Im very sorry for what an awful time you are having.

Chippy