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Where do I go from here? The first week of Nov. I tried to CT .5mg of k. I think I was off 4 days and then reinstated once the withdrawals hit me. I thought I would be able to stabilize so suffered for a month with intense anxiety and nausea with no relief. I thought for sure the V would save me so I crossed over to 10mg the first week of Dec. Unfortunately I was one of the rare, unlucky ones and couldn’t handle it. It caused horrific depression. After giving it 2 weeks I went back on .5mg k. Since then I’ve just been trying to make it day by day. Although the depression lifted a little bit I still cry everyday and the anxiety/nausea has slowly crept back in. I don’t know how or when I’ll be able to start my taper. I’m so scared. Prior to CT off benzo- I gave up my life in Arizona and moved home to live with my parents in Michigan this past Oct. I was on 6 psychiatric medications for depression. I CT the mirtazapine and Abilify I was on and felt amazing until I tried the same thing with the benzo. I also went down to 200mg from 300mg Zoloft and went down from 60mg Adderall to 10mg. I had to increase my dosage of Trazodone from 100 to 200mg. I’m 36 yo, divorced, no friends, no job. I don’t want to live with my parents forever. I don’t know how I am ever going to rebuild a life for myself.

Oct. 2019-

  • CT Mirtazapine 45 mg and Abilify 15mg
  • Zoloft- lowered dose to 200mg from 300mg

Nov. 2019-

  • CT .5mg Klonopin, reinstated within a few days
  • Adderall- lowered dose to 20mg from 60mg
  • Trazodone upped dose from 100mg to 200mg.

Dec. 2019-

  • Crossover from .5mg klonopin to 10mg Valium
  • After 2 weeks switched back to .5mg klonopin

Jan. 2020- Current Meds

  • 200mg Zoloft
  • 10-20mg Adderall
  • .5mg Klonopin
  • 200mg Trazodone

 

I have been suffering since Nov 2019 after failed CT klonopin. Crossover over to Valium in Dec. caused severe depression. Current state- anxiety, nausea, debilitating depression, cry 24/7, cannot function.

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  • Moderator Emeritus

Welcome to SA, Kim.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  Please include all the changes you described in your post, including dates. This drug signature will appear below all your posts and will make it easier for the moderators to help you.

 

Account Settings – Create or Edit a signature.

 

You have made many changes recently, and it is very important that you make no further changes.  Once you have completed your drug signature with dates, we will be in a better position to advise.  Don't worry about tapering at this point.  You need to stabilize after all these changes.

 

Here are some links that will familiarize you with some of our protocols.

 

Why taper by 10% of my dosage?

 

What is withdrawal syndrome.

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

These explain it really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

   On 8/30/2011 at 2:28 PM,  Rhiannon said: 
When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 
 

 

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg to 1.875mg 1986-2020, two CT's and reinstatements

Nov. 2020, 7-week Ativan-Valium crossover to 18.75mg Valium

Feb. 2021, begin 10%/4 week taper of 18.75mg Valium 

End 2021  year 1 of Valium taper at 6mg

End 2022 year 2 of Valium taper at 2.75mg 

End 2023 year 3 of Valium taper at 1mg

Jan. 24, 2024: Hold at 1mg and shift to Imipramine taper.

Taper is 95% complete.

 

Imipramine 75 mg daily since 1986.  Jan.-Sept. 2016 tapered to 14.4mg  

March 22, 2022: Begin 10%/4 week taper

Aug. 5, 2022: hold at 9.5mg and shift to Valium taper

Jan. 24, 2024: Resume Imipramine taper.  Current dose as of Feb. 22: 7.6mg

Taper is 90% complete.  

  

Supplements: multiple, quercetin, omega-3, vitamins C, E and D3, magnesium glycinate, probiotics, zinc, melatonin .3mg, anti-candida, iron, serrapeptase, nattokinase


I am not a medical professional and this is not medical advice but simply information based on my own experience, as well as other members who have survived these drugs.

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Thank you. I've added a signature. I'm sorry but I'm really bad at using these forums. I can add more details if helpful. It's just very hard to function right now.

Oct. 2019-

  • CT Mirtazapine 45 mg and Abilify 15mg
  • Zoloft- lowered dose to 200mg from 300mg

Nov. 2019-

  • CT .5mg Klonopin, reinstated within a few days
  • Adderall- lowered dose to 20mg from 60mg
  • Trazodone upped dose from 100mg to 200mg.

Dec. 2019-

  • Crossover from .5mg klonopin to 10mg Valium
  • After 2 weeks switched back to .5mg klonopin

Jan. 2020- Current Meds

  • 200mg Zoloft
  • 10-20mg Adderall
  • .5mg Klonopin
  • 200mg Trazodone

 

I have been suffering since Nov 2019 after failed CT klonopin. Crossover over to Valium in Dec. caused severe depression. Current state- anxiety, nausea, debilitating depression, cry 24/7, cannot function.

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  • manymoretodays changed the title to Krm: desperate for help
  • Mentor

Hi KRM and welcome

My only advice is to listen to the mods and admins when it comes to tapering and withdrawal symptoms.  Try to give it time and be patient.  Speaking from experience, withdrawal symptoms will vary and some will disappear while others appear.  Support and accurate information is the key to effectively managing your path though withdrawal, and there are no shortcuts.  When I was in withdrawal as a member of PaxilProgress, I leaned very heavily on other members for support, and they got me through some very dark times.  This site will do the same for you.   

Tim C

Started Paxil for GAD in 1999

Unsuccessful taper attempt in 2006

Paxilprogress helped with a successful taper completed in 2009

Using therapy and CBT to manage my anxiety

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  • Moderator Emeritus

@Krm  Thanks for doing your signature.  It is just what we need.  The thing you need to do now is to make no more changes and let your central nervous system stabilize.  I would recommend the omegas and the magnesium (magnesium glycinate is a good form), added in one at a time at a low dose.

 

It's a good idea to stay away from caffeine, alcohol and sugar.  Some members find even fruit to have too much sugar, which is too stimulating to the system.  Try to get a little gentle exercise, like a walk in nature, if you are capable of it. If not, that's fine. Avoid stress as much as possible.  

 

mstimc made some very good suggestions.

 

You will get better.  It will just take some time.

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg to 1.875mg 1986-2020, two CT's and reinstatements

Nov. 2020, 7-week Ativan-Valium crossover to 18.75mg Valium

Feb. 2021, begin 10%/4 week taper of 18.75mg Valium 

End 2021  year 1 of Valium taper at 6mg

End 2022 year 2 of Valium taper at 2.75mg 

End 2023 year 3 of Valium taper at 1mg

Jan. 24, 2024: Hold at 1mg and shift to Imipramine taper.

Taper is 95% complete.

 

Imipramine 75 mg daily since 1986.  Jan.-Sept. 2016 tapered to 14.4mg  

March 22, 2022: Begin 10%/4 week taper

Aug. 5, 2022: hold at 9.5mg and shift to Valium taper

Jan. 24, 2024: Resume Imipramine taper.  Current dose as of Feb. 22: 7.6mg

Taper is 90% complete.  

  

Supplements: multiple, quercetin, omega-3, vitamins C, E and D3, magnesium glycinate, probiotics, zinc, melatonin .3mg, anti-candida, iron, serrapeptase, nattokinase


I am not a medical professional and this is not medical advice but simply information based on my own experience, as well as other members who have survived these drugs.

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  • Administrator

Welcome, krm.

 

What times of day do you take each drug, at what dosage? Do your symptoms follow any daily pattern?

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. You can post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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10:00am: I wake up, crying starts almost immediately, I join my mom for coffee and she makes me breakfast- I don't have big appetite and have nervous stomach

10:30am: I take .5mg klonopin, 200mg zoloft, 10mg adderall

11:00am: Don't feel much different after taking meds, usually still crying, feel like a zombie and can't function

 

  • I can't sleep during the day and try to stay out of my bedroom but may lay down for 15 min here and there. I find that I can't distract myself with my phone, tv or anything else. The crying continues most of the day. I might eat lunch if my mom makes me something otherwise I don't eat until 5:30pm.

 

6:00pm: I try going to bed, take 200mg trazodone and then it takes me an hour or 2 to fall asleep

Oct. 2019-

  • CT Mirtazapine 45 mg and Abilify 15mg
  • Zoloft- lowered dose to 200mg from 300mg

Nov. 2019-

  • CT .5mg Klonopin, reinstated within a few days
  • Adderall- lowered dose to 20mg from 60mg
  • Trazodone upped dose from 100mg to 200mg.

Dec. 2019-

  • Crossover from .5mg klonopin to 10mg Valium
  • After 2 weeks switched back to .5mg klonopin

Jan. 2020- Current Meds

  • 200mg Zoloft
  • 10-20mg Adderall
  • .5mg Klonopin
  • 200mg Trazodone

 

I have been suffering since Nov 2019 after failed CT klonopin. Crossover over to Valium in Dec. caused severe depression. Current state- anxiety, nausea, debilitating depression, cry 24/7, cannot function.

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  • Moderator Emeritus

FYI (from Drugs.com interaction checker)

 

Major

traZODone sertraline

Applies to: trazodone, Zoloft (sertraline)

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, cyclobenzaprine, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and tryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life. For example, some experts suggest a 5-week washout period following use of fluoxetine and 3 weeks following the use of vortioxetine before administering another serotonergic agent. Individual product labeling for washout periods should be consulted for current recommendations. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

References

  1. Paruchuri P, Godkar D, Anandacoomarswamy D, Sheth K, Niranjan S "Rare case of serotonin syndrome with therapeutic doses of paroxetine." Am J Ther 13 (2006): 550-552
  2. Dougherty JA, Young H, Shafi T "Serotonin syndrome induced by amitriptyline, meperidine, and venlafaxine." Ann Pharmacother 36 (2002): 1647-1648
  3. "Product Information. Brintellix (vortioxetine)." Takeda Pharmaceuticals America, Lincolnshire, IL.
View all 99 references

Switch to consumer interaction data

 

Major

amphetamine sertraline

Applies to: Adderall (amphetamine / dextroamphetamine), Zoloft (sertraline)

GENERALLY AVOID: Several case reports suggest that serotonin reuptake inhibitors may potentiate the pharmacologic response to sympathomimetic agents. The exact mechanism of interaction is unclear. In one case report, a patient experienced jitteriness, racing thoughts, stomach cramps, dry eyes, palpitations, tremors, and restlessness following a single dose of phentermine ingested approximately a week after she had discontinued fluoxetine. Because of the long half-life of fluoxetine and its metabolite, an interaction with fluoxetine is possible. Similar toxic reactions have been reported when fluoxetine was used concomitantly with amphetamine or phenylpropanolamine. Additionally, some sympathomimetic agents such as amphetamines may possess serotonergic activity and should generally not be administered with serotonin reuptake inhibitors because of the additive risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. The interaction was suspected in a patient treated with dexamphetamine who developed symptoms consistent with the serotonin syndrome approximately 2 weeks after the addition of venlafaxine. The medications were discontinued and the patient was given cyproheptadine for suspected serotonin syndrome, whereupon symptoms promptly resolved. A second episode occurred when dexamphetamine was subsequently resumed and citalopram added. The patient improved following cessation of citalopram on his own, and residual symptoms were successfully treated with cyproheptadine.

MANAGEMENT: In general, amphetamines and other sympathomimetic appetite suppressants should not be combined with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Close monitoring for enhanced sympathomimetic effects and possible serotonin syndrome is recommended if these agents must be used together. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

References

  1. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  2. Barrett J, Meehan O, Fahy T "SSRI and sympathomimetic interaction." Br J Psychiatry 168 (1996): 253
  3. Bostwick JM, Brown TM "A toxic reaction from combining fluoxetine and phentermine." J Clin Psychopharmacol 16 (1996): 189-90
View all 6 references

Switch to consumer interaction data

 

Major

dextroamphetamine sertraline

Applies to: Adderall (amphetamine / dextroamphetamine), Zoloft (sertraline)

GENERALLY AVOID: Several case reports suggest that serotonin reuptake inhibitors may potentiate the pharmacologic response to sympathomimetic agents. The exact mechanism of interaction is unclear. In one case report, a patient experienced jitteriness, racing thoughts, stomach cramps, dry eyes, palpitations, tremors, and restlessness following a single dose of phentermine ingested approximately a week after she had discontinued fluoxetine. Because of the long half-life of fluoxetine and its metabolite, an interaction with fluoxetine is possible. Similar toxic reactions have been reported when fluoxetine was used concomitantly with amphetamine or phenylpropanolamine. Additionally, some sympathomimetic agents such as amphetamines may possess serotonergic activity and should generally not be administered with serotonin reuptake inhibitors because of the additive risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. The interaction was suspected in a patient treated with dexamphetamine who developed symptoms consistent with the serotonin syndrome approximately 2 weeks after the addition of venlafaxine. The medications were discontinued and the patient was given cyproheptadine for suspected serotonin syndrome, whereupon symptoms promptly resolved. A second episode occurred when dexamphetamine was subsequently resumed and citalopram added. The patient improved following cessation of citalopram on his own, and residual symptoms were successfully treated with cyproheptadine.

MANAGEMENT: In general, amphetamines and other sympathomimetic appetite suppressants should not be combined with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Close monitoring for enhanced sympathomimetic effects and possible serotonin syndrome is recommended if these agents must be used together. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

References

  1. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  2. Barrett J, Meehan O, Fahy T "SSRI and sympathomimetic interaction." Br J Psychiatry 168 (1996): 253
  3. Bostwick JM, Brown TM "A toxic reaction from combining fluoxetine and phentermine." J Clin Psychopharmacol 16 (1996): 189-90
View all 6 references

Switch to consumer interaction data

 

Moderate

clonazePAM traZODone

Applies to: Klonopin (clonazepam), trazodone

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.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
  2. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
  3. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35
View all 36 references

Switch to consumer interaction data

 

Moderate

clonazePAM sertraline

Applies to: Klonopin (clonazepam), Zoloft (sertraline)

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.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
  2. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
  3. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35
View all 36 references

Switch to consumer interaction data

No other interactions were found between your selected drugs. This does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

traZODone food

Applies to: trazodone

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.
  3. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc, Rockville, MD.
View all 4 references

Switch to consumer interaction data

 

Moderate

amphetamine food

Applies to: Adderall (amphetamine / dextroamphetamine)

GENERALLY AVOID: Alcohol may potentiate the cardiovascular effects of amphetamines. The exact mechanism of interaction is unknown. In one study, concurrent administration of methamphetamine (30 mg intravenously) and ethanol (1 gm/kg orally over 30 minutes) increased heart rate by 24 beats/minute compared to methamphetamine alone. This increases cardiac work and myocardial oxygen consumption, which may lead to more adverse cardiovascular effects than either agent alone. Subjective effects of ethanol were diminished in the eight study subjects, but those of methamphetamine were not affected. The pharmacokinetics of methamphetamine were also unaffected except for a decrease in the apparent volume of distribution at steady state. The interaction was suspected in a case report of a 20-year-old male who experienced retrosternal chest pain shortly after drinking alcohol and taking a double dose of his amphetamine/dextroamphetamine medication (Adderall 15 mg X 2) to stay alert. The patient had no family history of cardiovascular diseases, and his past medical history was remarkable only for ADHD. Prior to the episode, the patient had not taken his medication for weeks and had been drinking whiskey the previous three nights before going to bed. The patient was diagnosed with myocardial infarction likely secondary to amphetamine-induced coronary vasospasm.

MANAGEMENT: Concomitant use of amphetamines and alcohol should be avoided if possible, especially in patients with a history of heart disease.

References

  1. Mendelson J, Jones RT, Upton R, Jacob P 3rd "Methamphetamine and ethanol interactions in humans." Clin Pharmacol Ther 57 (1995): 559-68
  2. Jiao X, Velez S, Ringstad J, Eyma V, Miller D, Bleiberg M "Myocardial infarction associated with Adderall XR and alcohol use in a young man." J Am Board Fam Med 22 (2009): 197-201

Switch to consumer interaction data

 

Moderate

dextroamphetamine food

Applies to: Adderall (amphetamine / dextroamphetamine)

GENERALLY AVOID: Alcohol may potentiate the cardiovascular effects of amphetamines. The exact mechanism of interaction is unknown. In one study, concurrent administration of methamphetamine (30 mg intravenously) and ethanol (1 gm/kg orally over 30 minutes) increased heart rate by 24 beats/minute compared to methamphetamine alone. This increases cardiac work and myocardial oxygen consumption, which may lead to more adverse cardiovascular effects than either agent alone. Subjective effects of ethanol were diminished in the eight study subjects, but those of methamphetamine were not affected. The pharmacokinetics of methamphetamine were also unaffected except for a decrease in the apparent volume of distribution at steady state. The interaction was suspected in a case report of a 20-year-old male who experienced retrosternal chest pain shortly after drinking alcohol and taking a double dose of his amphetamine/dextroamphetamine medication (Adderall 15 mg X 2) to stay alert. The patient had no family history of cardiovascular diseases, and his past medical history was remarkable only for ADHD. Prior to the episode, the patient had not taken his medication for weeks and had been drinking whiskey the previous three nights before going to bed. The patient was diagnosed with myocardial infarction likely secondary to amphetamine-induced coronary vasospasm.

MANAGEMENT: Concomitant use of amphetamines and alcohol should be avoided if possible, especially in patients with a history of heart disease.

References

  1. Mendelson J, Jones RT, Upton R, Jacob P 3rd "Methamphetamine and ethanol interactions in humans." Clin Pharmacol Ther 57 (1995): 559-68
  2. Jiao X, Velez S, Ringstad J, Eyma V, Miller D, Bleiberg M "Myocardial infarction associated with Adderall XR and alcohol use in a young man." J Am Board Fam Med 22 (2009): 197-201

Switch to consumer interaction data

 

Moderate

sertraline food

Applies to: Zoloft (sertraline)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of sertraline. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills. In addition, limited clinical data suggest that consumption of grapefruit juice during treatment with sertraline may result in increased plasma concentrations of sertraline. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism by certain compounds present in grapefruit. An in-vitro study demonstrated that grapefruit juice dose-dependently inhibits the conversion of sertraline to its metabolite, desmethylsertraline. In a study with eight Japanese subjects, mean plasma levels of sertraline increased by approximately 100% and maximum plasma concentrations increased by 66% after the ingestion of three 250 mL glasses of grapefruit juice per day for 5 days and administration of a single dose of sertraline 75 mg on the sixth day. In another small study with 5 patients, mean sertraline trough levels increased by 47% after taking sertraline for at least 6 weeks, then taking sertraline with 240 mL grapefruit juice daily for 1 week. The clinical significance is unknown; however, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability. The possibility of significant interaction in some patients should be considered.

MANAGEMENT: Patients receiving sertraline should be advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how sertraline affects them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities. Some authorities recommend that consumption of grapefruit juice should be avoided during sertraline therapy.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Ueda N, Yoshimura R, Umene-Nakano W, et al. "Grapefruit juice alters plasma sertraline levels after single ingestion of sertraline in healthy volunteers." World J Biol Psychiatry 10(4 Pt 3) (2009): 832-5
  3. "Product Information. Zoloft (sertraline)." Roerig Division, New York, NY.
View all 4 references

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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.

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

  • Zoloft (sertraline)
  • trazodone
  • Adderall (amphetamine / dextroamphetamine)
  • Klonopin (clonazepam)

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.

Duplication

Antidepressants

Therapeutic duplication

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

  • Zoloft (sertraline)
  • 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 manymoretodays
spacing, color coding, font size on some

Escitalopram 10mgs from mid 2007 ( can't remember exact date) to 11th Dec 2018

Fentanyl patches ( don't remember dose ) from Nov 2014 to 11 Dec 2018

Quit both cold turkey Dec 2018

Reinstated 3rd March 2019 2.5 mgs.

Updosed  8March to 5mgs and holding

25/11/19 Started taper 4.5mgs and holding

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner

If you are going through Hell, keep going. NCIS series 15, David MaCallum:rolleyes:

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  • Moderator Emeritus

Hi KRM

 

How are you feeling?

 

Sass

Escitalopram 10mgs from mid 2007 ( can't remember exact date) to 11th Dec 2018

Fentanyl patches ( don't remember dose ) from Nov 2014 to 11 Dec 2018

Quit both cold turkey Dec 2018

Reinstated 3rd March 2019 2.5 mgs.

Updosed  8March to 5mgs and holding

25/11/19 Started taper 4.5mgs and holding

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner

If you are going through Hell, keep going. NCIS series 15, David MaCallum:rolleyes:

Link to comment

I went back to 300mg Zoloft and tried updosing one night on klonopin just to see if it would give relief. I feel worse than ever. Am I going to die?

Oct. 2019-

  • CT Mirtazapine 45 mg and Abilify 15mg
  • Zoloft- lowered dose to 200mg from 300mg

Nov. 2019-

  • CT .5mg Klonopin, reinstated within a few days
  • Adderall- lowered dose to 20mg from 60mg
  • Trazodone upped dose from 100mg to 200mg.

Dec. 2019-

  • Crossover from .5mg klonopin to 10mg Valium
  • After 2 weeks switched back to .5mg klonopin

Jan. 2020- Current Meds

  • 200mg Zoloft
  • 10-20mg Adderall
  • .5mg Klonopin
  • 200mg Trazodone

 

I have been suffering since Nov 2019 after failed CT klonopin. Crossover over to Valium in Dec. caused severe depression. Current state- anxiety, nausea, debilitating depression, cry 24/7, cannot function.

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  • Moderator Emeritus
On 1/9/2020 at 12:10 AM, Krm said:

I went back to 300mg Zoloft and tried updosing one night on klonopin just to see if it would give relief. I feel worse than ever. Am I going to die?

No you're not going to die. Currently, you have a very destabilised CNS but it doens not have to be permanent.

 

I'm not an expert, so i can't advise you with your doses. When exactly did you updose to 300mg Zoloft?

 

Stay strong, things can get better ❤️

2006 : 20mg Paxil+Bromazepam. 2008 : cold turkey of both. 2010 : Reinstatement 20mg Paxil + Bromazepam.

2014-June2017 : Switch from Bromazepam to Prazepam, slow taper to 0mg.

2018 to August 2019 : Paxil 20mg taper (3% every 15 days). 22 Aug 2019 updose to 10mg (was at 8.4mg).

25th Sept 2019 To April 2020 : found SA, holding at 10mg Paxil. 

April 2020 : Paxil 10mg to Prozac 7mg bridge. Details topic/21457

 

Current Supplements : magnesium citrate + fish oil

Current medication :

* 7pm Diazepam  : 0.85mg (15 Aug 2022) / 0.95 mg (24 April 2022) / 1mg Diazepam (since 29 Aug 2020)

* 8am Prozac : 6.16mg (25 oct 2022, feel awful, slight updose) / 6.08 mg (9 oct 2022) / 6.24mg (11 July 22) / 6.44mg (22 May 22) / 6.64mg (4 Nov 21) / 6.72mg (8 oct 21) / 6.8 mg (15 Sept 21)6.88mg (14 Aug 21)/ 6.92mg (23 Jun 21)

 

I am not a professional, I don't give medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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I updosed to 300mg over a week ago. I am having a lot of suicidal ideations. Can anyone tell me what to do?

Oct. 2019-

  • CT Mirtazapine 45 mg and Abilify 15mg
  • Zoloft- lowered dose to 200mg from 300mg

Nov. 2019-

  • CT .5mg Klonopin, reinstated within a few days
  • Adderall- lowered dose to 20mg from 60mg
  • Trazodone upped dose from 100mg to 200mg.

Dec. 2019-

  • Crossover from .5mg klonopin to 10mg Valium
  • After 2 weeks switched back to .5mg klonopin

Jan. 2020- Current Meds

  • 200mg Zoloft
  • 10-20mg Adderall
  • .5mg Klonopin
  • 200mg Trazodone

 

I have been suffering since Nov 2019 after failed CT klonopin. Crossover over to Valium in Dec. caused severe depression. Current state- anxiety, nausea, debilitating depression, cry 24/7, cannot function.

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  • 2 weeks later...
  • Moderator Emeritus

How are you doing Krm?

I'm hoping there is some improvement since your last post.

Were you doing any better on the 300 mg of Zoloft before?

And where are you at with your clonazepam right now?  When do you take it and at what dose?

You've had a number of fairly recent drug changes and CT's.  This all does add to the nervous system deregulation and then subsequent WD symptoms.

 

Thoughts are just thoughts.....and can and do pass. 

It does sounds like you've had a really rough go of things and I'm so sorry.  Lot's of changes and losses.  Very tough stuff.

 

I'm also seeing an increase in ?Zoloft to 300 mg around January 5th.  You can update your signature >  Account Settings: signature

 

L, P, H, and G,

mmt

Edited by manymoretodays
additional, 4 days after first inquiry

Late 2023- gone to emeritus status, inactive, don't @ me, I can check who I've posted on, and I'm not really here like I used to be......thanks.

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016.  And.....I quit smoking 11/2021. Lapsed.  Redo of quit smoking 9/28/2022.  Can you say Hallelujah?(took me long enough)💜

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider.  My success story:  Blue skies ahead, clear sailing

 

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