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DanaL: Which first


DanaL

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Having successfully weaned from gabapentin, I felt ready to begin tapering from duloxetine. Then I found this site, entered my meds & viewed the interaction between them and I feel rather worried and would like help knowing which to leave off first. The ones I'm concerned about are duloxetine, amitriptyline, and trazodone. I also take tizanidine. tia 

Edited by DanaL
Added my meds
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  • KarenB changed the title to DanaL: Which first
  • Moderator Emeritus

DanaL -- Welcome to Surviving Antidepressants (SA)

 

I'm glad you found us early-ish in your journey off psychiatric prescription medications.  It would help us to give you the most useful information if you provide more detail about your medications.

 

Would you post about taking duloxetine, amitriptyline, trazodone and tizanidine -- what doses do you take and when do you take them? Are those the only drugs you take: prescription, over-the-counter, or "recreational"?

 

Also, it's tremendously helpful to know how you tapered off gabapentin.  A request: Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

  • Any drugs prior to 24 months ago can just be listed with start and stop years.
  • Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
  • Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
  • Please leave out symptoms and diagnoses.
  • A list is easier to understand than one or multiple paragraphs.
  • Link to Account Settings – Create or Edit a signature.
     

 

It's good that you've checked the interactions between your current medications.  Would you copy and post the report here in your introduction topic?

Drugs-dot-com Drugs Interactions Checker.

 

When someone is taking more than one medication, we suggest that they read this topic: Taking multiple drugs? Which to taper first.

 

I suspect we may suggest starting to taper trazodone because its metabolite interacts negatively with very many other medications.

 

Some relevant information:

Tips for tapering off Cymbalta (duloxetine)

Tips for tapering off trazodone (Desyrel)

Tips for tapering off amitriptyline

 

This is YOUR introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.

 

I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

 

Edited by scallywag

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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https://www.drugs.com/mn/

 

Duloxetine HCL DR (60mg 1/morning, 

amitriptyline (50mg 1/bedtime),

trazodone )150mg 1/bedtime)&

tizanidine HCL (4mg 1/bedtime) 

 

i also take:

meloxicam 15mg 1/morning

levothyroxinw 50mcg/1 morning

omeprazole 20mg/1 morning

 

OTC:

magnesium malate 1000mg

magnesium glycinate 400mg

L-theanine 100mg on occasion 

vitD3 10,000 iu 

seniors multi vit

CoQ10 100mg

biotin 5000 mcg

super B-complex 

1 aspirin 325mg

 

i weaned off gabapentin. I was on 500 mg 2X a day. It was my intent to taper 10% every 7-10 days. I'd drop, then stay at that level until my tummy felt better. I began my drop on April 1, 2017 and took my last dose May 28, 2017. So, there were 2 big drops in there: 1 of 350 mg and 1 of 250 mg. 

 

I

 

 

Edited by scallywag
put each medication on its own line for readability
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  • Moderator Emeritus

Dana, the link you posted will only work for someone logged in to that site with your credentials. It's a "My Notes" page.  When you run the report, just highlight the text listing the interactions, copy and paste it here.

 

Usually when someone tapers slowly we suggest that they allow several months for the CNS (central nervous system) to stabilize before starting to taper another medication. Following our cautious approach of 10% decreases once  per month, you would currently be at 81% of starting dose or 405 mg 2X per day. As you might imagine, we consider your taper a very rapid one. 

 

What do you think about delaying the start of the next taper for a few months to make sure you have a steady starting state?

 

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment

I completely understand what you're saying about my gabapentin and yes, I think I'd feel more comfortable waiting & stabilizing. However, I've been reading about trazodone and am extremely concerned about the interactions with my amitriptyline. I'm so angry that a *doctor* would put me on this cocktail and the pharmacy didn't comment on interactions. 

 

I will ill work on the my page stuff tomorrow. I'm not finding it and think I need my phone and my iPad lol

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  • Moderator Emeritus

Ok, I get it ... now. You're accessing the site on a phone.  I'll post the report.

 

Interactions between your selected drugs

Major - amitriptyline trazodone

Using amitriptyline together with traZODone can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. 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 trazodone duloxetine

Using traZODone together with DULoxetine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. 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 amitriptyline duloxetine

Using amitriptyline together with DULoxetine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. 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 amitriptyline tizanidine

Using tiZANidine together with amitriptyline may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol during treatment. In addition, these medications may also have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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 trazodone tizanidine

Using traZODone together with tiZANidine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. 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 meloxicam duloxetine

Using DULoxetine together with meloxicam may increase the risk of bleeding. The interaction may be more likely if you are elderly or have kidney or liver disease. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. 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 tizanidine duloxetine

Using tiZANidine together with DULoxetine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol during treatment. In addition, these medications may also have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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.

 

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Antidepressants - Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes three medicines belonging to the 'antidepressants' category:

  • amitriptyline
  • duloxetine
  • trazodone

Note:
The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.
Edited by scallywag
therapeutic duplication warning added

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment
  • Moderator Emeritus

The interactions effects listed are potential effects to watch out for  -- not guaranteed negative outcomes.  You may find it helpful to track your symptoms.  Many people have found the downloads from the first post of this topic helpful for that task:

Glenmullen’s withdrawal symptom list.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment

Thank you. Yes, I was on my phone. Before I go off to read the withdrawal list, may I ask you about your background? My son is horrified that I'm "getting my information from 'the internet'" and I had trouble explaining about this site. I will see my doctor but am not feeling hopeful for her help. She prescribed this toxic cocktail after all. I didn't realize trazodone was such a serious drug. I understand more now to protect myself. Thank you so much

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  • Moderator Emeritus

My background is the same as yours -- I was prescribed medication and wanted to discontinue it safely. 


Note -- We are not suggesting that you discontinue any medication.  You have indicated that decreasing dose or discontinuing altogether is something you would like to do. What we provide is information about how to do that to minimize withdrawal symptoms.

 

The challenge faced by many if not most people on these medications is that their doctors believe manufacturers' claims that discontinuation symptoms are not that severe and don't last long.  Any discontinuation symptoms are diagnosed as relapse which requires ... guess what ... a new prescription or set of prescriptions.  Great for pharmaceutical company executives and shareholders and at best, not great for the people stuck on the medications.

 

If you want to learn more about how little actual scientific research supports the use of these drugs, I suggest you and your son both read Anatomy of an Epidemic, written by investigative journalist Robert Whitaker, about how the drugs were developed and popularized.

 

The approach we suggest is also suggested by several other peer information and advocacy groups. Reducing by no more than 10% per month is FAR MORE CONSERVATIVE than 99% of doctors will advise. It's like deciding to train for a marathon over two years rather than a running expert's plan to prepare in 6 months. It's your body, your life, and your money. If you want to take longer, what's it to anybody else. When I communicated my plan with a doctor and started to get a little push back about it, I asked "What am I risking by going slow, taking 18-24 months instead of 2-3?" The reply was a sheepish look.

 

About talking with your doctor:

How do you talk to your doctor about tapering and withdrawal.

What to expect from your doctor about withdrawal symptoms.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment

Book ordered. Your comment about tapering more slowly than a doctor would recommend is exactly what I've been thinking & what I'll tell my son. That put it into precise words for me

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  • Moderator Emeritus

Glad I could help.  All my years of sassing back and smart-mouth remarks should benefit someone! :D

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment

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