Boomer: Olanzapine + Effexor XR + others

[Boomer]

I called into the Pharmacy today and showed them my 15mg Mirtazapine which is half of the 30mg tab.  They are unable to cut it small enough but have investigated further options and found two tabs a Remeron or Remeron Zispin which can be crushed and made into a soluable solution.  Would this be the way to go please?

[Boomer]

On 9/22/2017 at 5:36 PM, Altostrata said:

Boomer, if I were you, I might start a very gradual decrease of mirtazapine at 10%, calculated on the last dose. You may need to make a liquid to taper it this gradually. I doubt it's doing any good and may be causing some mischief.

 

Here is our topic about tapering mirtazapine: Tips for tapering off Remeron (mirtazapine)

I called into the Pharmacy today and showed them my 15mg Mirtazapine which is half of the 30mg tab.  They are unable to cut it small enough but have investigated further options and found two tabs a Remeron or Remeron Zispin which can be crushed and made into a soluable solution.  Would this be safe way to go please?

[ChessieCat]

Remeron and Zispin are both brand names of the generic drug mirtazapine.  Simply typing in Remeron Zispin into google search found the information very quickly.

 

From https://en.wikipedia.org/wiki/Mirtazapine

 

Mirtazapine is marketed under many brand names worldwide, including Adco-Mirteron, Afloyan, Amirel, Arintapin Smelt, Avanza, Azapin, Beron, Bilanz, Calixta, Ciblex, Combar, Comenter, Depreram, Divaril, Esprital, Maz, Menelat, Mepirzapine, Merdaten, Meronin, Mi Er Ning, Milivin, Minelza, Minivane, Mirastad, Mirazep, Miro, Miron, Mirrador, Mirt, Mirta, Mirtabene, Mirtadepi, Mirtagamma, Mirtagen, Mirtalan, Mirtamor, Mirtamylan, Mirtan, Mirtaneo, Mirtapax, Mirtapil, Mirtapine, Mirtaron, Mirtastad, Mirtax, Mirtaz, Mirtazap, Mirtazapin, Mirtazapina, Mirtazapine, Mirtazapinum, Mirtazelon, Mirtazon, Mirtazonal, Mirtel, Mirtimash, Mirtin, Mirtine, Mirzapine, Mirzaten, Mirzest, Mitaprex, Mitaxind, Mitocent, Mitrazin, Mizapin, Motofen, Mytra, Norset, Noxibel, Pharmataz, Promyrtil, Ramure, Redepra, Reflex, Remergil, Remergon, Remeron, Remirta, Rexer, Saxib, Sinmaron, Smilon, Tazepin, Tazimed, Tetrazic, Tifona, U-Mirtaron, U-zepine, Valdren, Vastat, Velorin, Yarocen, Zania, Zapex, Zestat, Zismirt, Zispin, Zuleptan, and Zulin.^[2]

 

Edited October 5, 2017 by ChessieCat

[Boomer]

On 10/6/2017 at 10:22 AM, ChessieCat said:

Remeron and Zispin are both brand names of the generic drug mirtazapine.  Simply typing in Remeron Zispin into google search found the information very quickly.

 

From https://en.wikipedia.org/wiki/Mirtazapine

 

Mirtazapine is marketed under many brand names worldwide, including Adco-Mirteron, Afloyan, Amirel, Arintapin Smelt, Avanza, Azapin, Beron, Bilanz, Calixta, Ciblex, Combar, Comenter, Depreram, Divaril, Esprital, Maz, Menelat, Mepirzapine, Merdaten, Meronin, Mi Er Ning, Milivin, Minelza, Minivane, Mirastad, Mirazep, Miro, Miron, Mirrador, Mirt, Mirta, Mirtabene, Mirtadepi, Mirtagamma, Mirtagen, Mirtalan, Mirtamor, Mirtamylan, Mirtan, Mirtaneo, Mirtapax, Mirtapil, Mirtapine, Mirtaron, Mirtastad, Mirtax, Mirtaz, Mirtazap, Mirtazapin, Mirtazapina, Mirtazapine, Mirtazapinum, Mirtazelon, Mirtazon, Mirtazonal, Mirtel, Mirtimash, Mirtin, Mirtine, Mirzapine, Mirzaten, Mirzest, Mitaprex, Mitaxind, Mitocent, Mitrazin, Mizapin, Motofen, Mytra, Norset, Noxibel, Pharmataz, Promyrtil, Ramure, Redepra, Reflex, Remergil, Remergon, Remeron, Remirta, Rexer, Saxib, Sinmaron, Smilon, Tazepin, Tazimed, Tetrazic, Tifona, U-Mirtaron, U-zepine, Valdren, Vastat, Velorin, Yarocen, Zania, Zapex, Zestat, Zismirt, Zispin, Zuleptan, and Zulin.^[2]

 

Thank you for information.

[Boomer]

Can anyone shine some light on why my hubby in the morning would maybe not wake up with but after an half an hour to an hour would experience panic attacks.  These panic attacks seems to continue throughout the day.  He is aggitated and restless with frequent panic attacks which more or less paralyse him.  The next day he is a different person although he can be very sleepy and fatigued.  Any suggestions/information please about how to manage this would be appreciated.  Thank you.

[ChessieCat]

I am assuming that this information from the drug signature is correct:

 

Current Medication: 12.5mg Olanzapine, 187.5mg Enlafax XR, 15mg Mirtazpine, Propranolol Slow Release 160mg x 3 pd, Propranolol 320mg to 400mg x 3 or 4 x perday. 40mg Omeprazole x 1, 200mg x 1 Ferrous Fumarate  29/9/17 Propranolol  Slow Release 160mg x 3pd, Propranolol 120mg x 3 pd = 840mg per day.

 

 

 

I used the Drug Interactions Checker  and the following is a MAJOR interaction:

 

Major

venlafaxine mirtazapine

Applies to: venlafaxine, mirtazapine

Using venlafaxine together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome

 

 

 

I have experienced mild serotonin toxicity.  Once my dose got a bit lower I realised that I had been feeling agitated when on the higher dose.  I was also having to have about 2 hours sleep during the day when I was taking the higher dose even though I was sleeping through the night.  I was always tired.  Once my dose got lower I didn't need to sleep during the day.

Q:  Does he take either or both of these (venlafaxine, mirtazapine) upon waking and the agitation occurs afterwards?

 

 

 

From https://en.wikipedia.org/wiki/Serotonin_syndrome:

 

Serotonin syndrome (SS) is a group of symptoms that may occur following use of certain serotonergic medications or drugs. ... Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.

 

Edited October 8, 2017 by ChessieCat

[ChessieCat]

On 02/10/2017 at 7:20 PM, Boomer said:

We were alternating the Propranolol, taking additional amounts on  a  his bad day and hardly anything on his good day.

 

Propranolol is a serotonin antagonist (see below).  The good day may have been the result of him taking the Propranolol the previous day.

 

From https://www.uptodate.com/contents/selective-serotonin-reuptake-inhibitor-poisoning?source=see_link

MANAGEMENT

Key principles — A summary table to facilitate the emergent management of serotonin syndrome is provided (table 1). Five principles are central to the management of serotonin syndrome:

●Administration of serotonin antagonist

 

 

Edited October 8, 2017 by ChessieCat

[Boomer]

7 hours ago, ChessieCat said:

 

Propranolol is a serotonin antagonist (see below).  The good day may have been the result of him taking the Propranolol the previous day.

 

From https://www.uptodate.com/contents/selective-serotonin-reuptake-inhibitor-poisoning?source=see_link

MANAGEMENT

Key principles — A summary table to facilitate the emergent management of serotonin syndrome is provided (table 1). Five principles are central to the management of serotonin syndrome:

●Administration of serotonin antagonist

 

 

Thank you ChessieCat we wondered that and then wondered whether using the Propranolol on alternate days caused spikes.  We now give him the same dose every day and this has not changed his panic/anxiety aggression.  Today we have reduced the Propranolol and I think he is much worse which makes me think that perhaps he does still have serotonin syndrome.

[Boomer]

8 hours ago, ChessieCat said:

I am assuming that this information from the drug signature is correct:

 

Current Medication: 12.5mg Olanzapine, 187.5mg Enlafax XR, 15mg Mirtazpine, Propranolol Slow Release 160mg x 3 pd, Propranolol 320mg to 400mg x 3 or 4 x perday. 40mg Omeprazole x 1, 200mg x 1 Ferrous Fumarate  29/9/17 Propranolol  Slow Release 160mg x 3pd, Propranolol 120mg x 3 pd = 840mg per day.

 

 

 

I used the Drug Interactions Checker  and the following is a MAJOR interaction:

 

Major

venlafaxine mirtazapine

Applies to: venlafaxine, mirtazapine

Using venlafaxine together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome

 

 

 

I have experienced mild serotonin toxicity.  Once my dose got a bit lower I realised that I had been feeling agitated when on the higher dose.  I was also having to have about 2 hours sleep during the day when I was taking the higher dose even though I was sleeping through the night.  I was always tired.  Once my dose got lower I didn't need to sleep during the day.

Q:  Does he take either or both of these (venlafaxine, mirtazapine) upon waking and the agitation occurs afterwards?

 

 

 

From https://en.wikipedia.org/wiki/Serotonin_syndrome:

 

Serotonin syndrome (SS) is a group of symptoms that may occur following use of certain serotonergic medications or drugs. ... Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.

 

He takes the Mirtazapine at bedtime and takes the Venlafaxine  at lunchtime.  He awakes and half an hour or so is panicky and this will continue all day!  If it is serotonin Syndrome I understand that it could do more damage reducing the Mirtazapine too quickly.  Is this correct?     

The other thought was is he having cortisol spikes?  Thoughts please?

[Altostrata]

On 9/25/2017 at 2:38 PM, Boomer said:

Wow that looks so complicated making that liquid.  My gosh.  Is it safe to make this up as the Pharmacy told me it is illegal!  They don't sell liquid Mirtazapine in NZ but Pharmacutical Compounding Company can make it into smaller tabs.  I was just thinking about his symptoms and notice that there is a panic sound in his voice and seems aggitated/anxious.  When he doses up on the Propranolol this relaxes him but of course the Propranolol wears off and he becomes aggitated again!  Any more thoughts appreciated.  Thanks Anne

 

Yes, you can make up the liquid. The pharmacy is probably bound by law to tell you not to do it. 

 

It sounds like perhaps the propranolol might be the most effective drug he is taking.

 

On 10/1/2017 at 6:06 PM, Boomer said:

Can anyone tell me please - Hubby is having a Panic Attack one day - for the whole day and then the next day he is calm.  This is a pattern that has developed.  I am trying to figure out whether there is a psychological component in this?  I also wonder whether he has PTSD through the terrible experiences he has had and this has somehow become all mixed up.  I am finding it hard to believe that the symptoms (Severe Panic one day and calm the next) are so predictable!  Can anyone throw any light on this please?  Thank you.

 

This concerns me. How long has he had symptoms on alternate days, is this a predictable pattern?

 

He's taking so many drugs, one or the other might not be getting metabolized properly, builds up, and causes symptoms. Sounds like it could be the Enlafax, or the mirtazapine-Enlafax interaction.

 

On 10/2/2017 at 1:20 AM, Boomer said:

There was Severe Akathesia, Seratonin Syndrome and now we are left with Panic Attacks that last all day!  We were alternating the Propranolol, taking additional amounts on  a  his bad day and hardly anything on his good day.  We have relooked at the Propranolol and starting on Friday we are now giving 280mg x 3 x per day. It seems so strange that he can be severe panic one day and without fail the next day calm.  

 

Please DO NOT take propranolol inconsistently! this can cause blood pressure spikes. Is that what you mean by panic attacks?

 

11 hours ago, Boomer said:

Can anyone shine some light on why my hubby in the morning would maybe not wake up with but after an half an hour to an hour would experience panic attacks.  These panic attacks seems to continue throughout the day.  He is aggitated and restless with frequent panic attacks which more or less paralyse him.  The next day he is a different person although he can be very sleepy and fatigued.  Any suggestions/information please about how to manage this would be appreciated.  Thank you.

 

Could be the nighttime propranolol wearing off. How long is the Slow Release version supposed to last?

 

2 hours ago, Boomer said:

Thank you ChessieCat we wondered that and then wondered whether using the Propranolol on alternate days caused spikes.  We now give him the same dose every day and this has not changed his panic/anxiety aggression.  Today we have reduced the Propranolol and I think he is much worse which makes me think that perhaps he does still have serotonin syndrome.

 

Please don't reduce the propranolol. Please keep all dosing consistent so we can isolate problems. Change only one thing at a time.

 

Is there a reason you are delaying reducing mirtazapine?

[Boomer]

1 hour ago, Altostrata said:

Yes, you can make up the liquid. The pharmacy is probably bound by law to tell you not to do it. 

 

It sounds like perhaps the propranolol might be the most effective drug he is taking.

So you can make up a liquid using ordinary mirtazapine tabs?  I thought you had to use the soluable form?  I have ordered this Remeron Zispin so a liquid can be made up?  

The Propranolol was effective but we have to keep increasing the dose the get any affect.   We were informed by the Psydoc that we had exceeded the recommended dose and that by taking a high dose one day and nothing the next we could be causing spikes. It was also mentioned that because of the dose he was on this was causing him to drop off to sleep the next day.  This is the reason for reducing the Propranolol.  We will not reduce the Propranolol but will bring it back up tomorrow as he is worse.

[Boomer]

11 hours ago, Altostrata said:

This concerns me. How long has he had symptoms on alternate days, is this a predictable pattern?

 

He's taking so many drugs, one or the other might not be getting metabolized properly, builds up, and causes symptoms. Sounds like it could be the Enlafax, or the mirtazapine-Enlafax interaction.

This pattern concerns me.  He has had this predictable pattern for months, except when there was a reduction in his medication he would have high panic/anxiety every day for around two weeks then a pattern would develop again.  

 

I had wondered about the Enlafax but since the mirtazapine was introduced I felt it has caused lots of problems.  I could be wrong.  I also wonder about the Olanzapine and the effects that is having!

 

11 hours ago, Altostrata said:

 

Please DO NOT take propranolol inconsistently! this can cause blood pressure spikes. Is that what you mean by panic attacks?

We were advised by Psychdoc to use the Slow Release Prop every day and to use the fast release as needed and didn't advise with the fast release what the limit was so we have been increasing it to cope with symptoms and then not using the fast release the following day as he was so sleepy and tired.  We wondered whether it was causing spikes and thus causing panic etc so  have since adjusted his dose to within the recommended dosage (which is lower) and now give it to him every day.  Lowering the dose has increased his anxiety/panic/ and whereas before he would fall asleep straight away in the evening he is now wide awake with fear until 11pm - 12midnight!  He is still having a calm day. I wonder whether the Propranolol was masking some symptoms?

 

12 hours ago, Altostrata said:

 

Could be the nighttime propranolol wearing off. How long is the Slow Release version supposed to last?

Following oral dosing with the sustained release preparation of propranolol the blood profile is flatter than after conventional propranolol but the
half-life is increased to between 10 and 20 hours. The liver removes up to 90% of an oral dose with an elimination half-life of 3 to 6 hours. 

 

12 hours ago, Altostrata said:

Please don't reduce the propranolol. Please keep all dosing consistent so we can isolate problems. Change only one thing at a time.

As mentioned above we have reduced to recommended dose (840mg on the 29/9/17) and anxiety/panic have increased and now we have the wide awake until 11pm. We will continue to hold this level.

 

12 hours ago, Altostrata said:

is there a reason you are delaying reducing mirtazapine?

only reason being didn't know if you could use ordinary Mirtazapine to make into a liquid form. Can you?  I have been trying to source a soluable form and have found one but will take a week to get here.  When we found that the Propranolol dose was too high we thought it best to wait and let this adjustment settle first.  My husband is in a very bad place and I am concerned that he will take his own life because of the terrible side effects.  We have taken precautions and locked garage and I will not leave him alone on his own. Any further help would be appreciated.

[Boomer]

On 10/9/2017 at 9:40 AM, ChessieCat said:

I am assuming that this information from the drug signature is correct:

Drug information is correct and yes we have seen a major conflict with Mirtazapine and Venlafaxine.  I wasn't sure whether you could just use an ordinary Mirtazpine tab,  thought you needed to use a soluable form.  I am still not clear about this?  Talked to pharmacy who said no you had to use a soluable form.  They have managed to locate the Remeron Zispin to make into a liquid form.  

 

23 hours ago, ChessieCat said:

Propranolol is a serotonin antagonist (see below).  The good day may have been the result of him taking the Propranolol the previous day.

We have questions about this ourselves and as mentioned previously, although the propronolol was assisting we were using high doses and it wasn't until I collated all the information on the propranolol and took it to the Psydoc that he said my husband was taking way to higher dose and we needed to reduce it.  The panic and anxiety has been pretty awful since the reduction in propranolol.

[Altostrata]

55 minutes ago, Boomer said:

I wonder whether the Propranolol was masking some symptoms?

 

This is what we want the propranolol to do!

 

Yes, you can make a liquid with a regular mirtazapine tab. Methods for making a liquid are described in Tips for tapering off Remeron (mirtazapine)

[nz11]

1 hour ago, Boomer said:

I have been trying to source a soluable form and have found one but will take a week to get here. 

Boomer are you able to advise your source then i can mention this in the 'NZ members check in here ' thread for others.

Thanks

nz11

[Boomer]

1 hour ago, nz11 said:

Boomer are you able to advise your source then i can mention this in the 'NZ members check in here ' thread for others.

Thanks

nz11

547 Pharmacy in Hamilton  http://www.pharmacy547.co.nz/ can source 30mg Mirtazapine (Remeron Zispin) which is a soluable form.  There is a charge of $66 for 30 caps.  

[Boomer]

1 hour ago, Altostrata said:

2 hours ago, Boomer said:

I wonder whether the Propranolol was masking some symptoms?

 

This is what we want the propranolol to do!

I agree - unfortunately the dosage I was giving was too high and dangerous!  Some other symptoms he displays on his panic days and I wonder about dystonia.  The following symptoms appear on his panic day he walks like his anxiety is so bad that all his muscles are tight, so like a shuffle. First thing in the morning I notice his leg muscles are contracting and I asked him about this and he says he is doing it in anticipation of panic.  He also makes a funny vocal noise and I thought it was his reflux.  His voice can become like a whisper and he finds it difficult to eat his food, he has fast blinking and dry eyes at times.  I thought that these symptoms are because of he is on high alert/panic.   Interesting I noted that his eyes are dilated on his calm day!   I don't know if these symptoms throw any light on our situation?

[Boomer]

On 09/10/2017 at 8:49 PM, Altostrata said:

Is there a reason you are delaying reducing mirtazapine?

The more I read about seratonin syndrome the more I think the mirtz could be the cause. SA recommend tapering 10%at a time holding for a month. Because of his critical condition is there any other quicker way to reduce plz? 

[Boomer]

The soluable Mirtazapine tabs are not in stock so the pharmacy has given me instructions and a 10ml syringe to make the Mirtazapine in liquid form.   She has suggested using liquid honey, glycerol or other thick liquid but not water.  Interestingly she has suggested mixing a finely crushed 15mg tab with 10ml honey and then withdrawing around 9ml and throw out the rest.    Can I check with others please?

 

Also I have found that Omeprazole can cause problems.  My husband is just at the end of his 30 day supply with no repeats given so we were just going to not take that any longer.  I am hoping that, that shouldn't be a problem as we were really wanting to start tapering the Mirtazapine?

[ChessieCat]

1 hour ago, Boomer said:

the pharmacy has given me instructions and a 10ml syringe to make the Mirtazapine in liquid form.   She has suggested using liquid honey, glycerol or other thick liquid but not water.

 

I can't imagine this working.  I'd be sticking (pardon the pun) with Alto's suggested method.  Why make it any harder than necessary?  Other members have been using this method.  See below:

 

On 10/10/2017 at 8:19 AM, Altostrata said:

Yes, you can make a liquid with a regular mirtazapine tab. Methods for making a liquid are described in Tips for tapering off Remeron (mirtazapine)

 

[ChessieCat]

I've asked the other mods for their thoughts about whether it will be okay to start tapering the mirt straight away after going off the Omeprazole.  Also asked them about what % to reduce the mirt by when he does taper.

[Altostrata]

On 10/10/2017 at 11:26 AM, Boomer said:

The more I read about seratonin syndrome the more I think the mirtz could be the cause. SA recommend tapering 10%at a time holding for a month. Because of his critical condition is there any other quicker way to reduce plz? 

 

Please see how your husband does with a very small reduction, such as 10%. 

 

22 hours ago, Boomer said:

The soluable Mirtazapine tabs are not in stock so the pharmacy has given me instructions and a 10ml syringe to make the Mirtazapine in liquid form.   She has suggested using liquid honey, glycerol or other thick liquid but not water.  Interestingly she has suggested mixing a finely crushed 15mg tab with 10ml honey and then withdrawing around 9ml and throw out the rest.    Can I check with others please?

 

Also I have found that Omeprazole can cause problems.  My husband is just at the end of his 30 day supply with no repeats given so we were just going to not take that any longer.  I am hoping that, that shouldn't be a problem as we were really wanting to start tapering the Mirtazapine?

 

He needs to taper the omeprazole! He can go off by a quarter-tablet per week, but he should not simply quit omeprazole. Stomach upset can result.

 

It's lovely the pharmacist has taken an interest in helping you. She should be able to provide glycerol, or you can order the pharmaceutical liquid online, see

How to make a liquid from tablets or capsules

Pharmaceutical liquids to make suspensions

Boomer, if you have difficulty understanding the do-it-yourself instructions, is there a relative or neighbor who can help?

[nz11]

Boomer sorry that you have to make the liquid yourself i had assumed the pharmacy were providing it for you ..i misread your post. 

 

 

[Boomer]

2 hours ago, Altostrata said:

He needs to taper the omeprazole! He can go off by a quarter-tablet per week, but he should not simply quit omeprazole. Stomach upset can result

Oh blast it - these drugs!  The Omeprazole comes in a  40mg capsule - can't cut this one! So I will have to get the capsules in 10mg strength to reduce the dose!  Grrrrrrrrrr

[Boomer]

1 hour ago, nz11 said:

Boomer sorry that you have to make the liquid yourself i had assumed the pharmacy were providing it for you ..i misread your post. 

 

 

NZ11 the Pharmacy will make up the liquid for us using the Remeron Zispin.  But unfortunately the Pharmacy will have to order them in and it may take a week.  We are wanting to taper my hubby as soon as possible so it was interesting that the Pharmacy gave me instructions on how to make up the liquid form using the ordinary Mirtazapine tab while we await the arrival of the Remeron Zispin.  The pharmacy recipe is a little more difficult to understand and hard to work out the small reductions.

[Boomer]

2 hours ago, Altostrata said:

Boomer, if you have difficulty understanding the do-it-yourself instructions, is there a relative or neighbor who can help?

Yes I have today just realised I have a friend who has been supporting us who was involved in lab work and he is not at all afraid of mixing up the liquid.   My brain is on overload so not thinking very straight.  The instructions given by the Pharmacy are alittle different to yours, and my support person said your 1:1 ratio was easier to work with than what the pharmacy gave!

[Altostrata]

That's good, Boomer, you work on reducing the omeprazole right away while your pharmacy friend organizes the mirtazapine liquid.

 

Here in the US, omeprazole tablets are available at the pharmacy without prescription.

 

Since this is a bit of an emergency, you might try reducing the omeprazole every 4 days.

 

Please let us know how your husband is doing while reducing omeprazole.

[Boomer]

On 10/14/2017 at 6:42 AM, Altostrata said:

That's good, Boomer, you work on reducing the omeprazole right away while your pharmacy friend organizes the mirtazapine liquid.

 

Here in the US, omeprazole tablets are available at the pharmacy without prescription.

 

Since this is a bit of an emergency, you might try reducing the omeprazole every 4 days.

 

Please let us know how your husband is doing while reducing omeprazole.

We were unable to obtain the Omeprazole so he has been three days without it. - no stomach cramps.   We have started reducing the Mirtazapine.  I have just checked out the side of effects for Propranolol and I have noted a number that relate to him and I now believe are severe.  I also think the Mirtazapine shouldn't be in the mix but I am very very concerned about the  propranolol side effects listed.  Hubby is on 840mg per day and alot higher before we reduced to this level.  The Psychdoc said 840mg per day was acceptable given his weight etc...  I believe we need to urgently start reducing the Propranolol as   some of the symptoms are:decreased awareness or responsiveness;    difficulty with swallowing;  extreme fatigue;  sweating; skin irritation or rash, including rash that looks like psoriasis; reddening of the skin, especially around the ears; peculiar postures or movements, mannerisms, or grimacing (can hardly walk or talk at times); paranoia; noisy breathing; negativism; unusual drowsiness, dullness, or feeling of sluggishness (drops of to sleep).  It says to contact a medical professional if any of these occur.   I know we shouldn't reduce two things at the same time but I am very concerned as there are alot of symptoms that are listed that relate to my husband.  On Friday he had further blood tests which reveal that his Hemoglobin level is continuing to reduce.  His Iron is up but not Hemoglobin.  I have found a research document that says Propranolol can interfere with the Hemoglobin.  Urgent reply please

[nz11]

Hi Boomer sorry no one has replied to your urgent request

 

Its good news to read that the stomach issues have stopped since quitting the omeprazole.

 

What tapering rate are you using for the mirtz?

It is interesting that there are psoriasis type issues. Since going drug free i have also developed similar, most significant being a big patch of it on the back of my arm just above my elbow.

 

On 10/15/2017 at 9:50 PM, Boomer said:

It says to contact a medical professional if any of these occur.

This statement always frustrates me ..as if these people have a clue... the person is always blamed and not the poison.

Some of those symptoms sound like antipsychotic adverse effects as well.

Its been a week since a mirtz reduction how is your husband doing now.

wishing you improvements.

 

 

 

 

 

 

[nz11]

Any update?

How are things now.

I hope things are more stable for you.

[Boomer]

On 11/5/2017 at 9:17 PM, nz11 said:

Any update?

How are things now.

I hope things are more stable for you.

Hello NZ11

We had to make a decision to withdraw the Mirtazapine as my husbands symptoms became worse after we had reduced the Propranolol.  We believe that he was suffering from Serotonin Syndrome and thanks to the information provided by Altostrata and I think it was ChessieCat, the mirtazapine was causing problems and the Propranolol masked the symptoms.  His symptoms are not as intense as previously and we are hoping that as time goes on he will settle further.  By the way we are now receiving weekly payments from ACC after lodging a claim with them one year ago!

[nz11]

Thats great the symptoms have receded.

Are you saying you have reduced the mirtz ? or stopped it completely?

Thanks for taking the time to update.

Has ACC acknowledged 'medical misadventure' ? ..iatrogenic harm? ...if so good for them.

[Boomer]

5 hours ago, nz11 said:

Thats great the symptoms have receded.

Are you saying you have reduced the mirtz ? or stopped it completely?

Thanks for taking the time to update.

Has ACC acknowledged 'medical misadventure' ? ..iatrogenic harm? ...if so good for them.

NZ11 the intense symptoms have reduced but he is still not stable.  We stopped the Mirtz completely.   We tried to claim for treatment injury this was turned down but we have appealed their decision.  Still waiting on this one.  We also lodged a claim associating this situation to his original TBI (traumatic brain injury) accident.  The NeuroPsych report to ACC stated he should not have been admiinstered (Effexor/Olanzapine) medication because he had had a TBI and this was incorrect medication for him. They have accepted this claim and we are now receiving weekly payments.   We contacted lawyers in Wellington even though we are located in Hamilton and I understand these lawyers know their stuff.  I gave them permission to contact ACC and work on my behalf.  I believe just having them in the picture helped.  They were wonderful people to deal with and they have not charged me for their time.  Once they start charging they will contact you beforehand and advise what the cost may be.  The name of the firm is http://jmlaw.co.nz/    John Miller Law

[nz11]

So glad ACC had a turn around and accepted the claim.

I took them to a review but they declined i knew they were going to however i left them in no doubt regarding my feelings and told them they will need to get more staff because of the flood of future people harmed by psychoactive prescriptions is going to increase exponentially over the coming years.

Im always thrilled to hear of people get off these drugs but a CT may be rough for a while.

Wishing you stability.

Please consider writing to CARM in Dunedin (centre for adverse reactions) and bring this to there attention. They need to hear of this.

I saw an article in the newspaper the other day about the medical profession being told to cut back on prescribing psychoactive drugs. 

Wow what a wonderful lawyer you have found. 

[Boomer]

On 9/19/2017 at 5:08 PM, Altostrata said:

Hi, Boomer -- What does this mean??

 

Did your husband have "panic" attacks while taking Effexor or Enlafax XR?

 

As you probably remember, we need to know about symptom pattern and dosing schedules, and we ask you to keep daily notes. Can you do that?

 

What is your husband's daily symptom pattern and dosing schedule?

Hello Alto - Unfortunately we had to remove the Mirtazapine completely as we felt it was causing seratonin symptoms.  He seemed more settled after the Mirtazapine was withdrawn but we are still continuing to have a good day (a slow day, relaxed and sleepy) and a high alert day (panic, fear, sweating etc).  It is a consistant pattern and I am at a loss to know what is causing this or is it psychological or is it a pattern formed by the brain from all the stress he has been under.  Huge stress.  He had low iron now on iron tabs and his hemoglobin is dropping.  His hemoglobin has continued to drop - should be 130 and is now down to 120 - very concerned  The bloods are showing an infection somewhere.  We are following up on this. We are slowly reducing the propranolol due to side effects and his blood pressure is too low!  I had wondered whether the Effexor was causing problems as his symptoms appear to be worse as the afternoon wears on and he takes his Effexor at lunchtime but this doesn't occur on his calm day!  I am running this past you to see whether you can shine any light on this situation please?   I have attached a copy of his blood results for you to view.  Many thanks.

Hubby Blood Tests.pdf

[Boomer]

On 10/9/2017 at 8:49 PM, Altostrata said:

This concerns me. How long has he had symptoms on alternate days, is this a predictable pattern?

 

He's taking so many drugs, one or the other might not be getting metabolized properly, builds up, and causes symptoms. Sounds like it could be the Enlafax, or the mirtazapine-Enlafax interaction.

Do you think it most likely the Enlafax not metabolizing property and building up and causing symptoms?  I notice in the Drug Interactions the combination of Olanzapine and Effexor brings up a Moderate interaction between these two as per the following:   MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

I am wondering if this is causing him to become panicky, highly aggitated on constant high alert!  We were thinking of lowering the Olanzapine in the future as it would be easier as far as cutting is concerned.

 

By the way what would be the best way to reduce the Enlafax (Effexor XR) now that we no longer have access to the Effexor XR in bead form please?  Thank you.