jmncrr: tapering risperidone

[jmncrr]

Hello,

This is my first post here at SA.

I start tapering risperidone a few months ago, and have had relative ease tapering from 3 to 2 mg at 5% a week off the reduced dose. Is it not recommended to reduce by any more than that, or is it safe to gradually increase the weekly drop by a larger %? Has anybody decreased by a larger than 5% weekly or 10% every two weeks, and had success? Should i do this or not?

Thank you

[Altostrata]

Hello, jmncrr.

 

I've moved your post to the Introductions forum. You can track your progress in your Intro topic.

 

5% a week is about 20% a month. As this rate seems to be working for you so far, I would not increase it.

 

If you get any withdrawal symptoms, you're going too fast. In that case you might want to reduce 5% every 2 weeks, amounting to about 10% per month.

 

Please let us know how you are doing.

[ChessieCat]

Hi jmncrr,

 

Welcome to SA.  It sounds like you are doing well with your taper.  You've got this far, please don't try and go too quickly.  It's just not worth it.

 

It will be helpful if you would Please put your Withdrawal History in Signature.  Please include details for the last 12-18 months of  all drugs, dates, doses and discontinuations & reinstatements.  If you can't remember dates, please write it as "early March" or "mid-August".  Please provide a summary of any drugs prior to that which can just be listed with start and stop years.  Please remember to update when you make a change so it remains current and can be seen at a glance.

 

Why taper by 10% of my dosage?

 

Tips for tapering off Risperdal (risperidone)

 

Brain Remodelling (Rhi's Description of Brain Healing)

Video:  Healing From Antidepressants - Patterns of Recovery

 

I've given you some links to check out.  You can ask questions here in your Intro/Update topic and journal your progress.  Click "Follow" top right and you will be notified when someone responds.

[jmncrr]

Thanks for replying to my post. I will stick with the 5% a week, until i run into some withdrawal. I will then make 5% cuts every two weeks like you said. Thanks again for the feedback, and i will keep you up to date on my progress.

[scallywag]

If the two week frequency in dose decreases works for you -- great!  If not, please don't let that schedule dictate the next decrease. Your symptoms are a better indicator than a calendar.

[jmncrr]

What about Dr Bregins 10% off the original dose every 7 to 10 days i have seen on this website. Is that just something to ignore and reduce by 10% of new dosage? Which method is advised? I have only been on Risperidone for 20 months. Could i apply this method to my taper, or would it be not advised? I am afraid of being on this risperidone for another year or more. I am thinking my body would just become accustomed to having the drug in my system longer than need be, and potentially make withdrawals harder because i was on it longer. Feedback would be appreciated. Thank you

[scallywag]

We strongly urge you to be more conservative than Breggin's taper routine.  Going slower and calculating decreases from current dose is intended to minimize the risk of withdrawal symptoms. 

[jmncrr]

I am currently on risperidone 2 mg paxil 20 mg and wellbutrin 300 mg. My goal is to get off all of it eventually, which will take many years. Risperidone is my priority though. I want off it yesterday, but i know a slow taper is best, which i am doing.

Is there any chance my other medications will help with any of the risperidone withdrawals when i do get them? When is the right time to switch over to the oral liquid risperidone? 1 mg possibly?

Should i slow it down ahead of time anticipating withdrawals, or just wait till i get them, and then slow it down? Do i need to go back up a dose to relieve withdrawals, stabalize for a few days, and then go slower, or should i just hold until they go away, and then taper slower than before? Thanks for any feedback.

[jmncrr]

I saw my Doctor today, and he wanted me to get off the risperidone in 1 month. He wanted me to go from 2mg to 1.5 for one week, then from 1.5 to 1mg the next week, then from 1mg to .5 the next week, and then stop. I was shocked. I told him that i would get withdrawals, and he said i would not. I ended up telling him i am not comfortable going that fast, and he gave support for what ever i wanted to do. Will my body just become use to having risperidone in my system the longer i am on it? Wont it just become more of a habit by prolonging the taper? Any feedback and answers to my questions would be appreciated.

[scallywag]

Please add  Paxil 20 mg  and Wellbutrin 300 mg to your signature. 
 
When a someone is taking multiple medications, we ask that that you post an interactions report.  Please include all medications you are taking -- prescription, over-the-counter, and street drugs if any. Follow the link below to get your report. Just select the text of the entire report, copy it and paste it in a post here.
Drugs-dot-com Drugs Interactions Checker.

Because you are taking 3 different medications, it would be a good idea for you to read this topic:
Taking multiple drugs? Which to taper first.

It's best to go slowly enough that symptoms don't occur, or that they arise shortly after a dose reduction and then resolve. You are in one of the best possible situations -- you are asking information about tapering before having started to decrease dosage or experiencing withdrawal symptoms.

 

You asked:

Will my body just become use to having risperidone in my system the longer i am on it? Wont it just become more of a habit by prolonging the taper?

 

Medications like Risperdal, Paxil and Wellbutrin do not build a dependency in the same way as alcohol and opiates.  Shortly after you started taking the medications, your CNS (central nervous system) started to make changes to itself, adjusting neurotransmitter cells and processes in the presence of the drug. It takes time for the CNS to undo all these changes. We want to sneak away from the drug without destabilizing the CNS. Have a look at these two items for another description of the process:
How your brain responds to psychiatric drugs - aka "Brain remodeling"
Youtube video, 4 minutes: Healing from antidepressants
 

[jmncrr]

Major
bupropion ↔ risperidone
Applies to:bupropion and risperidone
Talk to your doctor before using buPROPion together with risperiDONE. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of risperiDONE, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Major
bupropion ↔ paroxetine
Applies to:bupropion and paroxetine
Talk to your doctor before using buPROPion together with PARoxetine. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of PARoxetine, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
 
Moderate
paroxetine ↔ risperidone
Applies to:paroxetine and Risperdal (risperidone)
Before taking PARoxetine, tell your doctor if you also use risperiDONE. This combination may increase the effects of risperiDONE. This can cause development of extrapyramidal symptoms resulting in tremor, shuffling of your feet, drooling, a mask-like face, tongue stiffness, muscle spasms or rigidity, and involuntary movements. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment if you take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
 

Edited October 24, 2016 by scallywag
add classification of interactions

[jmncrr]

I am not taking the risperidone to counter an adverse effect of an antidepressant. I feel the taper of the risperidone must come first, because it is so toxic to the body. I may have sleep problems the lower i get with the taper of risperidone, because i am taking two antidepressants. At that time i can take something like Vistaril for sleep. A prescription antihistamine with no dependency. I would rather hold off and wait on the antidepressant tapers, just in case i have any depression problems from the risperidone taper. Any feedback is appreciated... Thank you.

[jmncrr]

Any opinions on how my doctor wanted to taper me off risperidone in just 1 month? He said i would not get withdrawals.

[scallywag]

I saw my Doctor today, and he wanted me to get off the risperidone in 1 month. He wanted me to go from 2mg to 1.5 for one week, then from 1.5 to 1mg the next week, then from 1mg to .5 the next week, and then stop. I was shocked. I told him that i would get withdrawals, and he said i would not. I ended up telling him i am not comfortable going that fast, and he gave support for what ever i wanted to do.

 

 

Your doctor is probably basing his opinion and recommendation on the fact that 2.0 mg is well below the "therapeutic dose" of 15 mg.  There are some studies that have investigated the relationship between neurotransmitter transporter cell occupancy and dose. The neurotransmitter transporter cell occupancy is what seems to make the drug "treat" psychiatric conditions; there is a strong relationship between this occupancy and what manufacturers establish as therapeutic dose.

 

All that said, these studies seem to indicate that once one gets below therapeutic dose, occupancy drops off quickly. What that means for tapering is that small decreases at low doses have a much larger effect on occupancy, and probably therefore on symptoms.  The implication is that the later in the taper when the dose is low reductions should be smaller than previously not larger. The study investigated the effect of 5 SSRIs; our observations of people tapering suggest that the same phenomenon applies to other psychiatric medications, such as Risperdal. Here's our discussion topic on those papers and download links:

Why taper paper: dose-occupancy curves

 

His plan is faster than our experience suggests is wise. You've managed your dose reductions carefully so far with no withdrawal symptoms.   Reducing from 2.0 mg to 0 in 3 weeks risks triggering withdrawal symptoms.

[jmncrr]

Thanks for the link

So basically my Dr is ill informed about the process, and the lower doses need to be tapered with smaller reductions to avoid withdrawal. I will eventually hit an uhoh point, and need to slow down. Is this usually below 1 mg? Is it wise to reinstate a previous dose once that uhoh point is reached for relief to stabalize, and at that point continue taper at slower pace? Using half the taper % than before possibly. Thank you for your responses and feedback, for it is much appreciated.

[scallywag]

It's best to prevent creating an uh-oh point. You've done well reducing 5% every week. You could continue that from 2.0 mg, but calculating the 5% from your current dose.
 
Next few doses would be: 1.9 mg, 1.81 mg, 1.72 mg, 1.63 mg.
 
Many people find creating a solution of the medication an effective way to taper these non-standard dosages.
Making a liquid from a tablet or capsules

[jmncrr]

What is the best time to switch over to the liquid solution? 1 mg? Will withdrawals just all of a sudden hit me like a ton bricks, sometime below 1 mg? Should i slow it down ahead of time anticipating withdrawals or just wait till they come? Last question: Should i go back up a dose, when i do hit withdrawals for relief? Thanks for all the feedback.

[scallywag]

jm - I understand that you are looking for certainty. Unfortunately nobody can give that to you. If somebody tells you that they know what will happen and/or how long it will last, they are MAKING IT UP out of whole cloth, well may imaginary cloth. Slower is almost always better. Giving your CNS (central nervous system) time to adjust after a recent change, whether formulation or dose, is almost always a good idea.

 

If you have a negative reaction to a dose change, you'd be well advised to see what happens over a few more days. Often these dissipate within a week or so after your CNS adapts to the new level.

[ChessieCat]

These topics might be helpful:

 

Keep it Simple, Slow and Stable

 

Windows and Waves Pattern of Stabilization

[Rockingchaircat]

Thanks for the link

So basically my Dr is ill informed about the process, and the lower doses need to be tapered with smaller reductions to avoid withdrawal. I will eventually hit an uhoh point, and need to slow down. Is this usually below 1 mg? Is it wise to reinstate a previous dose once that uhoh point is reached for relief to stabalize, and at that point continue taper at slower pace? Using half the taper % than before possibly. Thank you for your responses and feedback, for it is much appreciated.

Unfortunately most Doctors are ill informed- by the Pharma companies.  

I too was polydrugged. With a benzo and an antidepressant. I chose to get off of the benzo first.  Even though I was on an antidepressant, it didn't spare me from the horrors of the benzo withdrawal.

I can understand the desire to want to get off of these pills in the here and now.  But when I first started going too fast on my benzo withdrawal- I got real close to DT's. (Delirium Tremens). And as it turned out- I went too rapidly on my anti-d taper. I've paid for that too.

 

I wish you the best in your taper and recovery.

[jmncrr]

Thank you all for your responses, and the links to information.

The way i understand it from reading all this valuable information is to reinstate a previous dose if you run into trouble, and make next reduction smaller. You can also wait it out for a week to see if they go away i read also.

I have not experienced any withdrawals so far, and i am having a little anxiety anticipating the first sign of them. As long as the reductions get smaller, this improves your chances of avoiding withdrawals. Hope i am right about that, and I hope i am not moving too fast. I plan to switch to the liquid form of risperidone at the 1 mg mark. That seems about right to me. Thanks again for all the feedback.

[ChessieCat]

Hi jmncrr,

 

"reinstate a previous dose if you run into trouble"

 

Depending on the size of the dose drop and how long it has been since the drop, you may only need to updose a small amount now back the previous dose.  And this will depend on whether the symptom lasts for a while and if it is unbearable.  It is not a good idea to updose at the first sign of symptom.  Keep it Simple, Slow and Stable.  And keep daily notes of symptoms, what improves, what worsens.

 

It's also a good idea to find non-drug ways to cope with symptoms:

 

1. Yoga for calming (very simple poses can help greatly)
2. Non-drug techniques to cope with emotional symptoms
3. Acceptance
4. Acceptance and Mindfulness
5. Claire Weekes' Method of Recovering from a Sensitized Nervous System
6. "Change the channel" -- dealing with cognitive symptoms
7. Change cognitive framing - Redirect - Another Way
8. Cognitive Behavior Therapy (CBT) for anxiety, depression
9. Cognitive Behavior Therapy lessons

[jmncrr]

Should i be reducing 10% every two weeks, or stick with 5% a week like i have been doing? Since my dose decreases are so small just 5%, i assume i should just go back to the last dose fully. If i run into trouble at 1.81mg, and my last dose was 1.9mg, go back to 1.9 if feeling uncomfortable, and at that point make cuts of 5% every two weeks, or whatever my body dictates to avoid withdrawals. Thats the way i understand it. Thanks again for all the support.

[scallywag]

If what you've been doing has been working, stay with that.

 

When you have symptoms after a decrease, it's up to you whether you're going to ride it out until things settle or updose.  We suggest riding it out if you can function and if you can tolerate the symptoms because the fewest number of changes easier on your CNS (central nervous system). If you updose to the previous dose, be sure to hold there for a good long while before making your next decrease and that decrease should be less than 5%.

 

How are you calculating 5% -- are you using your starting dose or your current dose as the base?

[jmncrr]

I am calculating using the current dose, not the starting dose every 7 days. If i ever up dose, should i just wait two weeks instead of one to make the next 5% decrease, instead of a smaller decrease every week, like 2.5%? Is two weeks long enough after an up dose? How long does it take to feel well again after an up dose?

[jmncrr]

If i have to up dose, is two weeks long enough to then resume taper?

 

Do you normally feel better the next day after an up dose?

 

When there is 10 to 20% of taper left, is that when i should feel most of my withdrawals, and have to slow it down to 5% a month basically to avoid withdrawals?

[scallywag]

You're thinking very carefully about the last phase of your taper. That's a good thing. The "what ifs" can be a trap, leading you down the proverbial rabbit hole. It's best to let your symptoms guide you through your taper. A timeline about anything related to withdrawal (other than hard facts such as half-life) is largely a work of creativity and would be a disservice to anyone tapering.
 
Are you keeping track of your symptoms, if any?
Glenmullen’s withdrawal symptom list
Take notes of doses and symptoms

[jmncrr]

I am keeping track of my doses so far.

 

The way i understand it, your taper should be slow enough so withdrawal symptoms are almost non-existent. Slowing down at the end can help you avoid this i think, which i plan to do. I just don't understand why i am not getting withdrawals now.  Does individual physiology play a factor in withdrawal? Is the fact that i am still taking other medications masking withdrawal? Thanks for answering my questions.

[scallywag]

There are many factors that affect an individual's experience during withdrawal. This question and your other one would best answered by scientific research. Unfortunately because most research is funded by pharmaceutical manufacturers, very little time and money are going into studies on withdrawal from their products.

[jmncrr]

Have you heard of anybody else having no problems with a taper? Is it rare to not have some withdrawal, or is my situation not unusual, for some people have an easier time with it?

[jmncrr]

Have you heard of anybody else having no problems with a taper? Is it rare to not have some withdrawal, or is my situation not unusual, for some people have an easier time with it?

[jmncrr]

Have you heard of anybody else having no problems with a taper? Is it rare to not have some withdrawal, or is my situation not unusual, for some people have an easier time with it?

[jmncrr]

Ive been tapering fairly aggressively at 5% a week off current dose a week so far with success, but i know i will have to slow it down to bi weekly reductions eventually.

 

When should i slow it down? Is 1 mg a good time slow it to 5% cuts every two weeks to avoid withdrawals, or should i wait to get withdrawals, and then slow it down? I dont want to get hit hard with withdrawals all of a sudden, and possibly have to backtrack, and slow my taper down because of a up dose.

 

Do most people have to slow it down even more with 10% of starting dose left, possibly to 5% a month, or can one get away with 10% a month still?

 

I am thinking it would be wise to slow it down ahead of time anticipating withdrawals. Any advice would be appreciated, and i am sure glad i found this website.

[nz11]

Have you heard of anybody else having no problems with a taper? Is it rare to not have some withdrawal, or is my situation not unusual, for some people have an easier time with it?

Well if they were having no problems they wouldnt be on this site thats for sure.

I think we all know of people who have 'appeared' to not have a problem with tapering.

 

Just consider yourself very lucky at this stage. However your drug sig reveals that you are taking 20mg paroxetine and another 30mg equiv dose of paroxetine in the wellbutrin ...thats a total of 50 mg paroxetine. Thats quite a high dose imo and  may be  very numbing to the cns.

 

Why not just follow the sa resperidone advice

'To minimize the risk of withdrawal symptoms, we recommend a conservative taper of 10% from the previous dosage every few weeks.'

If you want to be more conservative at 5% then i think thats a doubley good harm reduction approach.

 

What dose are you on now....1.6 mg?

[jmncrr]

 

What dose are you on now....1.6 mg?

 I am down to 1.68 mg. I have been reducing by 5-6% a week.I have read that other psychitatric drugs can mask the withdrawal from another drug.

So you think the two AD's i am taking are numbing the withdrawal from risperidone?

 

I think i will stay at the pace i am at for now, and maybe at 1 mg i will slow it down a bit, just to be safe.

[scallywag]

You might want to hold at a dose for several weeks. It can take time for w/d symptoms to appear. Another member posted noticing that w/d symptoms appeared 10 days or more after reducing dose of a neuroleptic medication ("anti-psychotic").
 

What I've learnt from my personal experience of withdrawing an antipsychotic is that the effects of the wd really come with a lag. 10-16 days from the cut is not exceptional. So I too urge you to be very cautious, for there is a chance your cuts will pile on.

That said, I do know that you are good at listening your body and probably know its boundaries well. Just that it is an antipsychotic now, not the AD you are used to tapering - be careful, ok?