kayjaydee: clomipramine

[kayjaydee]

Reducing to 30mg tomorrow. Seem more or less OK on the 32.5, tho I do seem a bit lightheaded/unsteady, and possibly clumsier than usual. I guess that might relate to tapering....who knows, all kinds of things can cause those sort of feelings.

[kayjaydee]

Down to 25mg 2 days ago....fine so far.

[kayjaydee]

I've been holding at 25 mg for quite a while. My partner was recently diagnosed with advanced prostate cancer, and we've had lots of medical appointments and stress; I basically feel I can do without the extra hassle of having to weigh out doses at present, so I'll continue tapering when things are more settled.

[kayjaydee]

Just about to start tapering again - my partner is stable at present on his treatment and is feeling fine, so things feel more settled (despite Covid19 - we're both retired, so no major stress from it, just going out as little as possible). I'm going to cut to 22.5mg from tonight.

[kayjaydee]

I'm finding it quite tricky weighing out powder from capsules - not sure of the accuracy as I get to smaller reductions. Wondering about dissolving the drug in water and using a syringe - is it OK to switch straight from, say a 25mg capsule to taking 90% of that dissolved in water? Do I recall something about the solution affecting you differently to a capsule?

[brassmonkey]

Clomipramine dissolves very nicely in water, so making the solution shouldn't be a problem. I would suggest making the switch to liquid while staying on the same dose.  This would throw one less variable into the mix.  Some people do have problems with using a homemade liquid and it is easier to tell if there isn't a reduction thrown at the same time.

 

The way the body absorbs the drug is different for the capsules and a liquid, this can sometimes cause problems for people trying to make the switch. The liquid will absorb faster and can give the body a "jolt" of drugs which can set off some symptoms. We also recommend a cross taper, taking part of the dose as capsule and part as liquid. Slowly decreasing the capsule while increasing the liquid over several weeks.  This tends to make the change over much smoother.

 

I have just learned of a syringe technique that would work very well for this medication and for making the cross taper.  If you are interested let me know and I'll write something up.

[kayjaydee]

Can itching be related to withdrawal? I've had an itchy back for about 18 months now.....I know there are lots of possible causes, and I've been working on the idea that it's a reaction to non-steroidal anti-inflammatory drugs, but I've not taken any or used the gel form for over 2 weeks, and the itching is driving me mad at the moment - I think exacerbated by the current heatwave in UK. Just wondering if anybody has experienced long-term itching in the course of tapering.

[ChessieCat]

Are you getting lumps/welts/hives or just itchy skin?

 

Have you changed any of the soaps you use, either for your body or for your clothes?

 

You could also keep a food diary to see if there is something in your diet which might be causing it or making it worse.  I've had very bad itching and think I've linked it to egg tomatoes.  Ordinary tomatoes seem to be okay.

 

skin-issues-hives-acne-dryness-itching-etc

 

[kayjaydee]

No lumps or welts, just itching. I've already tried changing soaps, washing powder etc....my conclusion, from when it started (and reactions since) was that it was ibuprofen, and also diclofenac gel - it started after I began using ibuprofen for my dodgy shoulder. But that was also around the time I started tapering, so who knows?

[ChessieCat]

Itching or rash can be a side effect of both ibuprofen and diclofenac:

 

https://www.rxlist.com/ibuprofen-side-effects-drug-center.htm

 

https://www.rxlist.com/consumer_diclofenac_cataflam/drugs-condition.htm

[kayjaydee]

I know....I was only wondering if that was the cause, when I've not used the gel for nearly 3 weeks now and if anything the itching has got worse.

[kayjaydee]

Anti-inflammatory effects of antidepressants

 

I've been on clomipramine for over 20 years; I've been tapering for about 18 months - currently down to 18.4mg per day. I've been noticing various painful symptoms, which I assumed were entirely separate from this  - rotator cuff problems, and pain in my left knee - which seem to be getting worse. I've only just found out that clomipramine has an anti-inflammatory effect - so is reducing the dose causing me to have more inflammation? Does anyone know anything about this, or have any suggestions about other ways to reduce inflammation? I've tried NSAIDs, by the way, and they cause me to be itchy so I don't take them.

 

Edited September 4, 2020 by ChessieCat
added topic title

[Altostrata]

That is increased pain sensitivity from reducing the drug that you've been taking so long. It's a type of withdrawal effect.

 

Clomipramine is also anti-cholinergic and antihistaminic.

 

Antidepressants that are not anti-cholinergic and antihistaminic, such as most SSRIs and SNRIs, are also claimed to have anti-inflammatory effects. Muscle and joint pain are seen in withdrawal from them, too, as well as benzodiazepines -- known muscle relaxants -- and GABA-ergics.

 

In my opinion, the importance of this purported anti-inflammatory effect is vastly over-hyped.

 

Magnesium supplements or Epsom salts baths might help, magnesium helps muscles to relax.

[kayjaydee]

Interesting. Presumably something is causing the inflammation (eg wear and tear on the rotator cuff), and it hurts more now because I'm not getting as much reduction of it as I was at higher doses.

[Altostrata]

It could be muscle tension from withdrawal.

 

Chiropractic, osteopathic manual therapy, or acupuncture may help.

[kayjaydee]

Could be; but I suspect it's problems with the rotator cuff etc, maybe being more painful as I've reduced the dose. I'm speaking to the GP on Thursday about the shoulder pain, see what he can come up with. I plan to hold the clomipramine for a bit longer at 18.4mg and see how things go.

[kayjaydee]

Beginning to think it is withdrawal after all - it's nearly 5 weeks since my last taper, so I assumed things were OK but over the past week or so I've become aware of problems getting to sleep as well as more pain than usual, and at the moment a lot of anxiety and feeling of mental over-excitement. I guess withdrawal symptoms can be delayed this long? I'm wondering if a slight increase in dose (say to 19.4) would help, or if I've left it too long after the dosage reduction and will just have to grit my teeth and get through it. And indeed taper more slowly (and quite possibly with longer holds) from here on. Any advice would be welcome. I'd guess it's because I'm getting to lower doses; so far coming down from 50mg I've had minimal withdrawal symptoms, but bearing in mind the occupancy curve I'm only now starting to actually drop the % occupancy.

[ChessieCat]

I've merged the new topic you created "Anti-inflammatory effects of antidepressants" with your Introduction topic.  This keeps your history in one place.

[kayjaydee]

I've been trying cocodamol for the shoulder pain, and finding that causes itching as well! Could withdrawal make me more prone to reacting to other drugs, or more prone to itching in general? Don't think I've reacted to codeine in the past.

[kayjaydee]

This morning I had what seemed to be a visual migraine - just aura, only very slight headache - which I' ve never had before. I read that migraine is sometimes prevented with tricyclics.....so could reducing the dose cause migraine to occur? I' m wondering whether to updose slightly, or if that would cause more disruption.

[ChessieCat]

On 9/10/2020 at 4:10 AM, kayjaydee said:

I've been trying cocodamol

 

9 hours ago, kayjaydee said:

This morning I had what seemed to be a visual migraine - just aura, only very slight headache - which I' ve never had before.

 

You say that this is the first time it's happened. It could be from the codeine in the cocodamol.  Especially if that is the only thing that is different.

 

Check out the list of side effects:  https://www.drugs.com/sfx/codeine-side-effects.html

 

 

[kayjaydee]

I guess it might be from the codeine; I've not taken any for 2 days, since the itching started. I searched for migraine on here, and several people reported it while tapering, as one of their WD symptoms. I'm doing my best not to worry about it and just stick with the current dose if I can, while getting a fair bit of anxiety at present - it will pass, I hope!

[Hanna72]

Hi @kayjaydee

39 minutes ago, kayjaydee said:

I'm doing my best not to worry about it and just stick with the current dose if I can, while getting a fair bit of anxiety at present - it will pass, I hope!

That’s a great strategy. Worrying about the symptoms only makes things harder. Know that it will pass. 

Believe you can

and you are half way there.

My best wishes to you.

[kayjaydee]

And of course, if you believe you can't, you've got no chance! Think that was how I got stuck in a rut with my CFS - believing I hadn't the energy to do this or that made me not have the energy.

[kayjaydee]

I'm having a really rough time at the moment - incredibly anxious, muscle spasms in ankles and feet at night. This is largely situational, I think - my partner has advanced prostate cancer, and his symptoms have increased over the past month or so. I am planning a slight updose, in the hopes that it will help with the anxiety - in the past I have updosed when under stress, eg from 25 to 50mg clomipramine. At present I'm on 18.4mg, and would look to up it to 19.1 initially. Does this sound reasonable? My last taper was from 20.5 to 18.4, 2 months ago.

[kayjaydee]

Updosed to 19.1 mg....feeling a lot calmer now - my partner was admitted to hospital just after my last post, has had surgery to relieve pressure on his spinal cord, and is beginning the process of recovery. But at least he's under professional care, and it's no longer my call as to what constitutes an emergency, which has taken a lot of pressure off me. I'm wondering whether to continue an "upward taper" towards 25mg, as it would be less hassle to not have to weigh out the medication at the moment. Any views on this? I've had no bad reaction to the updose to 19.1. Alternatively, I could gradually transfer towards taking the current dose dissolved in water - and then would be able to do the same with a 25mg capsule, and take the proportionate amount of the liquid. Not sure which method would be best - or whether to just put up with the extra work of weighing out the relevant amount of powder.

[kayjaydee]

Adjusting the dose

 

I'd been feeling very stressed and anxious, not helped by my partner being admitted to hospital for surgery as a consequence of prostate cancer. I updosed to from 18.4 to19.1 mg, with no ill-effects. I'm feeling a lot calmer now - my partner has had the surgery to relieve pressure on his spinal cord, and is beginning the process of recovery. Now he's under professional care, and it's no longer my call as to what constitutes an emergency, it has taken a lot of pressure off me. I'm wondering whether to continue an "upward taper" towards 25mg, as it would be less hassle to not have to weigh out the medication at the moment. Any views on this?  Alternatively, I could gradually transfer towards taking the current dose dissolved in water - and then would be able to do the same with a 25mg capsule, and take the proportionate amount of the liquid. Not sure which method would be best - or whether to just put up with the extra work of weighing out the relevant amount of powder.

 

Edited October 21, 2020 by ChessieCat
added topic title

[ChessieCat]

Each member has only 1 Introduction topic.  This keeps your history in one place and means that you don't have to repeat yourself.  Mods regularly check new posts made by members in the Introduction forum.  If you post questions about your situation elsewhere they may be overlooked.

[ChessieCat]

It seems silly, to me at least, to increase your dose more than you need to, and there is a possibility that it could make things worse.  I can understand that it would be more convenient for you.

 

You've only just made a dose increase.  It takes about for 4 days for a dose to get to full level in the blood and a bit longer for it to register in the brain.

 

Depending on the drug it might be possible to take your dose in part tablet/capsule and part liquid.  This works well if smaller standard doses are available or you are able to reasonably accurately cut or split the dose.  Or you could switch to taking all liquid.  If doing this we suggest a cross over, taking the following combinations for 3-7 days and holding longer if needed.  It is gentler on your system to do it this way:  3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4.

 

Please see this post for ways to get your dose:  tips-for-tapering-off-clomipramine-anafranil

 

[ChessieCat]

Oh yes, and that's good news about your husband.  And him being under care would certainly make a huge difference to your stress.

[kayjaydee]

Hi Chessie. I didn't realise we had just the one topic - I'd wondered if it might be more visible if I posted something separately.

 

I agree about not increasing the dose if I don't have to - it is just the inconvenience of not having a ready-made capsule. I may try dissolving it in water - if it's not too horribly bitter; I have tasted the stuff when a capsule split in my mouth, and it's pretty vile. Though whether the hassle of having to buy syringes and measure out precise amounts of water would be worse than weighing out the powder is probably a moot point! For now I'm sticking where I am.

 

Thanks for your good wishes about my partner.

[ChessieCat]

8 hours ago, kayjaydee said:

I may try dissolving it in water - if it's not too horribly bitter; I have tasted the stuff when a capsule split in my mouth, and it's pretty vile.

 

I've just started making a liquid from my compounded Pristiq.  Because there is water added, and you can always dilute it with more water, either in the initial creation or adding your measured out dose to water to take, then it shouldn't be as bitter because it won't be as strong.  Also, I found that because it is chilled in the fridge the taste isn't as strong.

[kayjaydee]

I've decided to compromise....I can get 10mg capsules, so I'll go up that fraction to 20mg just for the convenience of it. When things are more settled, I can start tapering again.

[kayjaydee]

I've been stable on 25mg since November 2020; my partner died in October 2021. Lately I'd been feeling quite anxious, so decided (with my GP's approval) to go back to 50mg. I've taken it in stages, a week at roughly 33 mg and then up to 41mg for the past 6 days (1 1/3 of a 25mg and then 1 2/3) - if anything I feel worse, very anxious, twitchy, tense muscles, lightheaded....I suspect I've increased too quickly, or possibly become more sensitive to the drug, and would like to decrease it again. Would going back to 33mg be sensible as a start, or have I increased it for too long to drop back that much?

[kayjaydee]

Adjusting dosage of clomipramine

 

I've been on clomipramine for many years, and was reducing the dose successfully - I'd got down under 25 mg per day by October 2019. After that my partner was diagnosed with incurable prostate cancer; I increased the dose a little and stabilised at 25 mg by October 2020. My partner died in October 2021, and I've had varying degrees of anxiety since then. A few weeks back I decided maybe increasing the dose would help with the anxiety, my GP was OK with that. I increased to 33 mg for a week, and then to 41 mg, but during the second week I started to feel odd - nauseous, lightheaded and sleepy. Is it normal to get side effects from an increase in dose of that size? I'd not had problems before with increasing or reducing doses - but I'd not been on as low a dose as 25mg for a long period previously. I reduced the dose back to 33 mg after 6 days.....the anxiety and nausea etc come and go - I don't know if it's "just" my anxiety, and getting spooked by any unfamiiliar feeling, or if it relates to chopping and changing the dose.

 

Edited November 13, 2022 by ChessieCat
added topic title before merging with intro topic

[Altostrata]

Hello, @kayjaydee I am sorry you are running into problems adjusting your clomipramine dose. We do not provide peer support for adjusting doses for therapeutic reasons.

 

I'm not a doctor and this is not medical advice, but it is possible to take too high a dose for your individual tolerance, even if your doctor approves it.

 

Please let us know when you want to reduce your drugs.