Why come off slowly
Stopping desvenlafaxine is usually harder than starting it. The relationship between the dose you take and its effect on the brain isn't a straight line — at lower doses, even a small reduction in milligrams can be a large change in effect. This is why prescribers increasingly recommend hyperbolic tapering: smaller and smaller reductions as the dose gets lower, rather than fixed steps.
In practice that means the standard strengths — designed for the treatment range, not for coming off — often can't give you the small doses the end of a taper needs. That's where a method like the one below, so you can measure a precise fraction, comes in.
Combining capsule strengths, step by step
- Check which capsule strengths your pharmacy can dispense or compound.
- Use the calculator below to find a combination of whole capsules that reaches your target dose.
- Take the combination together as a single daily dose.
- Re-check the combination with your prescriber at each reduction step.
Your step-by-step taper schedule
This is the Desvenlafaxine schedule from the RELEASE Toolkit, reproduced with permission. It's a starting point to discuss with your prescriber — you can pause, slow down or speed up depending on how you feel. Aim to reduce roughly every 2–4 weeks.
| Step | Daily dose | Daily tablets / capsules |
|---|---|---|
| 1 | 200mg | 4 × 50mg tablets |
| 2 | 150mg | 3 × 50mg tablets |
| 3 | 100mg | 2 × 50mg tablets |
| 4 | 80mg | 1 × 50mg tablet & 3 × 10mg capsules |
| 5 | 60mg | 1 × 50mg tablet & 1 × 10mg capsule |
| 6 | 50mg | 1 × 50mg tablet |
| 7 | 40mg | 4 × 10mg capsules |
| 8 | 30mg | 3 × 10mg capsules |
| 9 | 25mg | 2 × 10mg & 1 × 5mg capsules |
| 10 | 20mg | 2 × 10mg capsules |
| 11 | 17mg | 1 × 10mg, 1 × 5mg & 1 × 2mg capsules |
| 12 | 15mg | 1 × 10mg & 1 × 5mg capsules |
| 13 | 12mg | 1 × 10mg & 1 × 2mg capsules |
| 14 | 9mg | 1 × 5mg & 2 × 2mg capsules |
| 15 | 7mg | 1 × 5mg & 1 × 2mg capsules |
| 16 | 5mg | 1 × 5mg capsule |
| 17 | 4mg | 2 × 2mg capsules |
| 18 | 3mg | 1 × 2mg & 1 × 1mg capsules |
| 19 | 2mg | 1 × 2mg capsule |
| 20 | 1mg | 1 × 1mg capsule |
| 21 | Stop | You've completed the taper 🎉 |
Highlighted steps are the most important — do not skip them.
| Step | Daily dose | Daily tablets / capsules |
|---|---|---|
| 1 | 200mg | 2 × 100mg tablets |
| 2 | 150mg | 3 × 50mg tablets |
| 3 | 100mg | 2 × 50mg tablets |
| 4 | 90mg | 1 × 50mg tablet & 4 × 10mg capsules |
| 5 | 80mg | 1 × 50mg tablet & 3 × 10mg capsules |
| 6 | 70mg | 1 × 50mg tablet & 2 × 10mg capsules |
| 7 | 60mg | 1 × 50mg tablet & 1 × 10mg capsule |
| 8 | 55mg | 1 × 50mg tablet & 1 × 5mg capsule |
| 9 | 50mg | 1 × 50mg tablet |
| 10 | 45mg | 2 × 20mg & 1 × 5mg |
| 11 | 40mg | 2 × 20mg |
| 12 | 35mg | 3 × 10mg & 1 × 5mg |
| 13 | 30mg | 3 × 10mg |
| 14 | 27mg | 1 × 20mg & 1 × 5mg & 1 × 2mg |
| 15 | 25mg | 1 × 20mg & 1 × 5mg |
| 16 | 22mg | 1 × 20mg & 1 × 2mg |
| 17 | 20mg | 1 × 20mg |
| 18 | 19mg | 3 × 5mg & 2 × 2mg |
| 19 | 17mg | 3 × 5mg & 1 × 2mg |
| 20 | 16mg | 3 × 5mg & 1 × 1mg |
| 21 | 15mg | 1 × 10mg & 1 × 5mg |
| 22 | 13mg | 1 × 10mg & 3 × 1mg |
| 23 | 12mg | 1 × 10mg & 1 × 2mg |
| 24 | 10mg | 1 × 10mg |
| 25 | 9mg | 1 × 5mg & 2 × 2mg |
| 26 | 8mg | 1 × 5mg & 3 × 1mg |
| 27 | 7mg | 1 × 5mg & 1 × 2mg |
| 28 | 6mg | 1 × 5mg & 1 × 1mg |
| 29 | 5mg | 1 × 5mg |
| 30 | 4.5mg | 2 × 2mg & 1 × 0.5mg |
| 31 | 4mg | 2 × 2mg |
| 32 | 3.5mg | 1 × 2mg & 3 × 0.5mg |
| 33 | 3mg | 1 × 2mg & 1 × 1mg |
| 34 | 2.5mg | 1 × 2mg & 1 × 0.5mg |
| 35 | 2mg | 1 × 2mg |
| 36 | 1.5mg | 1 × 1mg & 1 × 0.5mg |
| 37 | 1mg | 1 × 1mg |
| 38 | 0.5mg | 1 × 0.5mg |
| 39 | Stop | You've completed the taper 🎉 |
Highlighted steps are the most important — do not skip them.
- Do not skip the final small-dose steps — they're the most important for preventing withdrawal.
- Don't skip days, alternate days, or suddenly stop.
- If withdrawal symptoms appear, you can return to your previous dose; when ready, reduce more slowly.
Schedule © The University of Queensland (RELEASE Toolkit), reproduced with permission. Dosing guidance: Dr Mark Horowitz.
Measuring smaller doses accurately
Use the right tool for your method — an oral syringe for liquids (your pharmacist can supply 1 mL, 5 mL and 10 mL sizes), or a milligram scale for weighing. Choose the smallest measuring tool that fits your dose: it's far more accurate for tiny amounts.
- Measure slowly and double-check before you take your dose.
- Read at eye level, against the syringe plunger's flat edge.
- Keep the concentration or method the same each day so doses stay consistent.
What withdrawal can feel like
Withdrawal effects vary a lot between people. They often come in waves — harder days followed by windows of feeling more like yourself. Common, usually-manageable effects include dizziness, "brain zaps", nausea, vivid dreams, irritability and low mood. They tend to ease if you hold at your current dose for a while before reducing again.
Questions for your appointment
- How quickly is it safe for me to reduce, and by how much each step?
- How long should I hold at each dose before the next reduction?
- What should I do on a bad day — hold, slow down, or pause?
- Which symptoms mean I should contact you sooner?
- Would a compounded oral liquid be more accurate for my lowest doses?