Akriti: about tapering paroxetine and clonazepam

[Akriti]

I need some help and information about the tapering schedule as I am from India and pursuing Mba, I tried as many psychiatrist and doctors but nobody could help me to taper and the withdrawal symptoms are horrendous, I can't even stand when tapering even smaller amounts.I am taking 25 mg of paroxetine and 0.25 mg of clonazepam since three years for severe depression and anxiety,  I am just too sleepy all the day almost lack motivation to do daily tasks ,these drugs make you stable but have number of side effects getting tired researching daily about tapering and the stories are horrifying, I want to become whole and free from these poisoning drugs 😢 I think there is a lack of knowledge regarding tapering procedure among doctors in India. 

I found this site and maybe it will answer some questions of mine. Guys please help me tapering these drugs efficiently so that no withdrawal symptoms will bother me.I am taking two psychiatric drugs 25 mg paroxetine and 0.25 mg clonazepam since three years. Please help me. 

[Gridley]

Welcome to SA, Akriti.  We'll be happy help you with your taper.  

 

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.  This is basically the information you provided in your post, and it will appear at the bottom of all your posts.

 

Account Settings – Create or Edit a signature.

 

We recommend tapering no more than 10% of your current dose every four weeks.  Some people have to go slower, such as 5% every four weeks.

 

Why taper by 10% of my dosage?

 

Another method we recommend is the Brassmonkey Slide, which is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month.

 

The Brassmonkey Slide Method of Micro-tapering

 

A micro-taper is the gentlest way to come off these drugs. 

 

Micro-taper instead of 10% or 5% decreases

 

We recommend tapering only one drug at a time.  Otherwise, if problems arise you won't know the cause.  We recommend tapering the more activating drug first (known as accelerators), while keeping the mode sedating drug to taper later to act as a buffer and to help preserve sleep.  SSRIs such as Paroxetine are accelerators, and benzos such as clonazepam are brakes. 

 

Taking multiple psych drugs? Which drug to taper first?

 

Unless the Clonazepam is causing serious side effects, we would recommend you taper the Paroxetine first (again, preserving sleep is very important in tapering).  This link is specifically about tapering Paroxetine, including how to get the non-standard doses you'll need for your taper.  

 

Tips for tapering off paroxetine (Paxil, Seroxat)

 

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.

 

 

 

 

[Akriti]

 Thank you for your reply ...Can I ask you questions? Because I take 25 mg paroxetine ,so when I reduced 12.5 mg paroxetine,  I had withdrawal symptoms and the 0.25 mg clonazepam was dropping my blood pressure and I was feeling very dizzy so is my concern that how could I taper the antidepressants first because I have tried and failed and just to clear this I came up to this site. Thank you. 

[Gridley]

1 hour ago, Akriti said:

 Thank you for your reply ...Can I ask you questions? Because I take 25 mg paroxetine ,so when I reduced 12.5 mg paroxetine,  I had withdrawal symptoms and the 0.25 mg clonazepam was dropping my blood pressure and I was feeling very dizzy so is my concern that how could I taper the antidepressants first because I have tried and failed and just to clear this I came up to this site. Thank you. 

When you tapered the Paroxetine, you reduced by 50%, which is 5 times the 10% we recommend.  That is why you failed.  If you tapered by 10%, your first taper would be to reduce 2.5mg, so your next dose would be 22.5mg and your withdrawal symptoms should not be severe.  You could also taper by less than 10%, perhaps 5% of current dose every four weeks, as I wrote in my previous post.

 

Dizziness and lowered blood pressure are known side effects of Clonazepam.  If they are causing you concern, you may want to decide to taper the Clonazepam first.  The same taper rate of 10% of current dose every four weeks would apply to a Clonazepam taper.

 

There are three basic methods to taper.  First is to taper using a liquid.  Clonazepam does come in a liquid but I don't know if it's available in India.

CLONAZEPAM ROSEMONT 2MG/5ML ORAL SOLUTION | 

With some drugs you can make your own liquid, but Clonazepam doesn't appear easily soluble.  @Shep Do we have information on this?

 

The other option is to use a digital scale to weigh your dose.  Many members use the Gemini-20 scale; again, I don't know if it's available in India. If not, perhaps there is another brand of scale available.  A third option is to have your doses made at a compounding pharmacy.

 

Please let us know what you decide to do.

 

 

 

 

 

[Akriti]

Yes ...and I want to ask the replacement supplements I was recommended by a doctor that was amino acids tablets natural for 0.25 clonazepam, should I go for this? Or again if tapering antidepressants first how would I make it to 22 mg because the extended release of paroxetine does not come in that 22 mg tablet. And talking about clonazepam 0.25 mg tablet I had tried cutting it but it does not work. 

What should I do? 

[Akriti]

(Mod Note:  post moved from BrassMonkey Slide topic)

 

Brass monkey please help me tapering 25 mg paroxetine and 0.25 mg clonazepam have been taking for 3 years. ...for severe depression and anxiety, I am a 25 year old female. 

Just tell me which drug to taper first because I am very concerned about it. 

how should I make tapering dose of paroxetine tablets? 

 

Edited September 1, 2020 by ChessieCat
added mod note and removed irrelevant quotes

[brassmonkey]

(Mod Note:  post moved from BrassMonkey Slide topic)

Hi Akriti-- Welcome to SA I'm so glad you have found us before you've started to make changes to your medications. You are asking some very general questions about your persona taper so it would be best if I answered them on your introduction thread. That is the best place to ask questions because all your material is there in one place. So I will talk to you over there.

 

 

Edited September 1, 2020 by ChessieCat
added mod note

[brassmonkey]

Hi Akriti-- Welcome to SA. This is your introduction thread and is your personal journal for keeping records, asking questions, making comments and talking with other members.

 

Gridley has already given you several very informative links about tapering the two medications you are taking. Please read through them because they will answer a lot of your questions.

 

Of the two medications you are taking the paroxetine will be the hardest to taper off of. We have plenty of members tat have done so, myself included it just needs more attention that some of the others. It would be best if you tapered that one first because the clonazepam will help cover up the withdrawal symptoms. Once you are off of the paroxetine we can help taper the clonazepam.

 

We really need the information in your drug signature so we can see what we are dealing with. Account Settings – Create or Edit a signature.

 

There are a number of ways to taper paroxetine: the dry cutting method of crushing and measuring smaller and smaller amounts of the tablets, making a liquid preparation from the tablets, or switching to another medication all together. As we get more information about your situation we can help you decide which method will be best for you.

 

Bihar looks like a lovely district to live in. I was in Nagpur and Delhi in March. Spent most of the time out in the bush and really loved it. Had to leave the country quickly because of the COVID situation, but will be coming back as soon as possible.

 

Brassmonkey

[Akriti]

Thankyou so much brass monkey for your concern. Actually I had removed 12.5 mg paroxetine in September2019 and was taking clonazepam 0.25 mg ,it lowered my blood pressure, as told by my neurologist .I was very dizzy and again when I removed 0.25 mg clonazepam from my daily dose of 25 mg paroxetine, I was having sleepless nights and withdrawal. 

So please tell me how should I prepare 10 % taper of paroxetine cr ,because liquid version is not available here. 

[ChessieCat]

Just letting you know that I have moved the posts from the BrassMonkey Slide topic to your Introduction topic.

[brassmonkey]

Gridley has already given you this link https://www.survivingantidepressants.org/topic/405-tips-for-tapering-off-paxil-paroxetine/ but I will give it to you again.  Please read through it because it has a lot of good information and will answer many of your questions.

 

The easiest way to reduce your dose is to remove 10% of the tablet. There are several ways to do this. Do you have or can you get a scale that measures to 0.001g?

 

[ChessieCat]

19 minutes ago, brassmonkey said:

Do you have or can you get a scale that measures to 0.001g?

 

using-a-digital-scale-to-measure-doses

 

[Akriti]

You know that in India I cannot get these things and specially in lockdown 😣

[ChessieCat]

Are you able to buy them online and get them mailed to you?

[Akriti]

No .....I cannot buy these in India 😕please help me tapering paroxetine as I have searched online but unable to find the liquid form of paxil ....which I should make reduced dosage. ...of paxil as take the extended release version. 

[ChessieCat]

 

You can make your own liquid Paxil from tablets.  It is best to use a graduated cylinder and you will need a small syringe.  Chemists should have syringes.

 

On 5/27/2011 at 10:52 AM, Altostrata said:

 

Some people are sensitive to changes in the form of the drug. If you are taking tablets, you may wish to take part of your daily dosage in tablet form and part in liquid for a few days to ease the transition from tablets to liquid.

Use oral syringes to taper with the liquid, see http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/

Make your own liquid
You can make your own liquid with water. See How to make a liquid from tablets or capsules

 

 

[brassmonkey]

Hi Akriti-- making your own liquid using the tablets you have should not be a problem. What is needed is a very accurate way to measure the amount of water used to make the bulk liquid and the small amounts needed for the dose you will take. At first the dose will be fairly large and you will take small amounts out of it to make the reductions, but later on the dose will become smaller and smaller so you will only be using a part of the bulk amount.

 

How big is the city you live in?  What resources do you have, such as a local chemist, and does the lock down prevent you from getting to their shop? Are you taking your MBa online or is there a local university?

 

You are going to need a small glass bottle that will hold 10mLs of water (about 2 teaspoons). You will also need some way to measure the volume of water as accurately as possible. The best way would be a syringe you'd get from the chemist. A 1mL syringe would be best but if there are only bigger ones we can make that work.

 

Getting things set up to start a taper can be a frustrating part of the journey, but it is necessary to make the trip as smooth as possible.  We have to ask a lot of questions so we can get things right.

 

[Akriti]

Thank brassmonkey. ....are you Indian? ??okay yes there is a medicine store which I used to take medicine. ..and I am pursuing MBA international business from government university which is in patna. ..not in my town and I was there but the college closed during covid 19 ...and college took classes and exams on routine basis. 

I am in my home town right now. ...dehri on sone ...since March 2020 

How do I make 22 mg dosage if the paxil tablet are only in 12.5 composition. It is a small town where I live in and it has a number of medical stores where I take my medicines. 

But I cannot find the liquid version here...

Edited September 2, 2020 by Akriti

[Akriti]

On 9/1/2020 at 1:25 AM, Gridley said:

When you tapered the Paroxetine, you reduced by 50%, which is 5 times the 10% we recommend.  That is why you failed.  If you tapered by 10%, your first taper would be to reduce 2.5mg, so your next dose would be 22.5mg and your withdrawal symptoms should not be severe.  You could also taper by less than 10%, perhaps 5% of current dose every four weeks, as I wrote in my previous post.

 

Dizziness and lowered blood pressure are known side effects of Clonazepam.  If they are causing you concern, you may want to decide to taper the Clonazepam first.  The same taper rate of 10% of current dose every four weeks would apply to a Clonazepam taper.

 

There are three basic methods to taper.  First is to taper using a liquid.  Clonazepam does come in a liquid but I don't know if it's available in India.

CLONAZEPAM ROSEMONT 2MG/5ML ORAL SOLUTION | 

With some drugs you can make your own liquid, but Clonazepam doesn't appear easily soluble.  @Shep Do we have information on this?

 

The other option is to use a digital scale to weigh your dose.  Many members use the Gemini-20 scale; again, I don't know if it's available in India. If not, perhaps there is another brand of scale available.  A third option is to have your doses made at a compounding pharmacy.

 

Please let us know what you decide to do.

 

 

 

 

 

Hi gridley. ..please tell me if I take paxil cr version and the liquid version is not available here how would I reduce it to 22 mg if I take 25 mg ...

[Gridley]

Just now, Akriti said:

the liquid version is not available

Brassmonkey can help you with making the liquid.

[Akriti]

Just now, Gridley said:

Brassmonkey can help you with making the liquid.

Okay so I take the extended release version if it can be a problem making the liquid? ??or it will after in liquid form ...work different? ?

[Gridley]

14 minutes ago, Akriti said:

16 minutes ago, Gridley said:

 

Okay so I take the extended release version if it can be a problem making the liquid? ??or it will after in liquid form ...work different? ?

Brassmonkey is more knowledgable than I on making liquids.  Please direct this question to him.

[Akriti]

😊

[Akriti]

11 hours ago, ChessieCat said:

 

You can make your own liquid Paxil from tablets.  It is best to use a graduated cylinder and you will need a small syringe.  Chemists should have syringes.

 

 

Classie cat thankyou so much for your concern. ...did you take any sleep pills? ?

And tell me how's your sleep now ??

[ChessieCat]

49 minutes ago, Akriti said:

Classie cat thankyou so much for your concern. ...did you take any sleep pills? ?

 

No, I have not taken sleeping pills for tapering/withdrawal. 

 

Earlier in my taper I did experience sleep issues but I used non drug coping techniques to help with this.

 

Recently I hurt my back I did take some painkillers for a very short time (which contained an antihistamine to help me sleep) but because I'm am taking a very low dose of my drug now it didn't affect me too much.  I also had a cortisone/steroid injection.  The stress I experienced from having difficulty sleeping for about 3 nights and the pain from my injury did cause my withdrawal symptoms to increase and I decided to hold for longer on the same dose until things improve.

 

Please note that my situation is very different from yours.  You are taking a different antidepressant and also a benzo (clonazepam).  I'm only taking Pristiq, no benzo.

[ChessieCat]

Because we don't know what measuring equipment you have or are able to get where you are living at the moment, please tell us what you have or think you can get and we can work something out.

[Akriti]

I could try taking the syringe and try to buy it. ..but paxil cr cannot be made into liquid. ...😩 I really don't know who to trust on this. ..

[Akriti]

4 hours ago, brassmonkey said:

Hi Akriti-- making your own liquid using the tablets you have should not be a problem. What is needed is a very accurate way to measure the amount of water used to make the bulk liquid and the small amounts needed for the dose you will take. At first the dose will be fairly large and you will take small amounts out of it to make the reductions, but later on the dose will become smaller and smaller so you will only be using a part of the bulk amount.

 

How big is the city you live in?  What resources do you have, such as a local chemist, and does the lock down prevent you from getting to their shop? Are you taking your MBa online or is there a local university?

 

You are going to need a small glass bottle that will hold 10mLs of water (about 2 teaspoons). You will also need some way to measure the volume of water as accurately as possible. The best way would be a syringe you'd get from the chemist. A 1mL syringe would be best but if there are only bigger ones we can make that work.

 

Getting things set up to start a taper can be a frustrating part of the journey, but it is necessary to make the trip as smooth as possible.  We have to ask a lot of questions so we can get things right.

 

Brass monkey. I take paxil extended release so I cannot make it in a liquid form because the extended release version cannot be made into liquid suspension also I cannot find the liquid version of paxil which is 10 mg /5ML here in medical stores 😣

[ChessieCat]

15 minutes ago, Akriti said:

I take paxil extended release so I cannot make it in a liquid form because the extended release version cannot be made into liquid suspension

 

The mods are discussing whether you can use the extended release tablets to make your own liquid.

[ChessieCat]

21 minutes ago, Akriti said:

I really don't know who to trust on this. ..

 

We understand you being concerned.  Many of us felt the same way when we first joined SA.  We have been led to believe that doctors know a lot.  Unfortunately there are not many medical professionals who understand psychiatric drug withdrawal, adverse reactions and how to help their patients get off their drug.  That is the reason why SA exists.

 

Doctors get their information about drugs from the pharmaceutical companies.  And pharmaceutical companies are businesses making profit for themselves and their shareholders.  I suggest you watch these videos.  Gwen Olsen was a pharmaceutical representative for 15 years.

 

 

Video:  Ex-Big Pharma Rep:  Manipulating Doctors to Sell More Drugs (10 minute video)

 

Video:  Ex-Big Pharma Rep:  We’re Trained To Misinform (6 minute video)
 

Interview:  Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)

 

Surviving Antidepressants was started in 2011.  Altostrata, this site's owner, was taking Paxil.  Brassmonkey took Paxil.  Both Altostrata and Brassmonkey were members on a different tapering website called Paxil Progress (now closed down) a few years before Surviving Antidepressants were started.

 

I'm taking Pristiq which in Australia is only available in 50mg and 100mg doses (other countries can get 25mg).  The slow release is in the "glue" of the tablet so they are not meant to be cut up or made into powder or liquid.  However, I have been tapering successfully by getting my tablets compounded (and when I get under 0.125mg I will get liquid made).  They become immediate release and I have a slow release formula added and because of the short half life I have to take my dose 2 times a days.  I have been taking only capsules once I got below 50mg.  I am now down to 0.75mg.  We have members who are taking a drug which comes in capsules with lots of tiny beads (and they aren't all the same size so they have to try to work out how to take the same dose each time by selecting their beads).  They taper by opening the capsule and removing beads.

 

This is the link to Alto's story.  In Post #1 there are links to a video about her, as well as to a recent (last month) panel discussion which Alto was a member of.

 

about-altostrata-withdrawal-syndrome-since-2004

[Akriti]

ChessieCat. ...you are very knowledgeable. ...thank you so much for your detailed information about these drugs ... .😊❤ ...at least you got compounded pharmacies but I have not one here so that I could taper them. ..

[ChessieCat]

1 hour ago, Akriti said:

ChessieCat. ...you are very knowledgeable

 

It's only what I have learned from information on SA and the other moderators.  There are some areas that I don't have much knowledge about but other moderators do.

 

The mods have been discussing your tablets and we don't think there will be any problem with you making a liquid from them.

 

Your English is very good but the moderators are wondering do you speak an Indian language that we could translate using Google translator if there is information that you have difficulty understanding in English.

 

Go to this website https://translate.google.com/ and click on one of the down arrows above the word Translation.  You will then see all the languages that can be translated using Google translate.  Please tell us if there are any languages that we might be able to translate the English into.  Thank you.

 

 

[Akriti]

No I speak hindi which you guys cannot understand and I can speak English too.

If you guys have any problems regarding my English just let me know, I can understand and even improve my English as well 😊. 

I think my English is good. if you have any problems understanding it just let me know. Maybe it could be some grammar error or the punctuation marks. 

No not at all the English information is well understood by me and I don't have any problems. I do watch English YouTube channel only for information about antidepressants. 

[ChessieCat]

I mean this.

Yes your English is very good, but it can be difficult for moderators to explain some things in English. It is good to know that you speak Hindi and if necessary we can write in English and translate it into Hindi.

 

Did you understand?

 

Google translation:

 

मेरा मतलब यह है।

हां आपकी अंग्रेजी बहुत अच्छी है, लेकिन मॉडरेटर्स के लिए अंग्रेजी में कुछ चीजों को समझाना मुश्किल हो सकता है। यह जानना अच्छा है कि आप हिंदी बोलते हैं और यदि आवश्यक हो तो हम अंग्रेजी में लिख सकते हैं और इसे हिंदी में अनुवाद कर सकते हैं।

क्या तुम्हे समझ आया

 

mera matalab yah hai. haan aapakee angrejee bahut achchhee hai, lekin modaretars ke lie angrejee mein kuchh cheejon ko samajhaana mushkil ho sakata hai. yah jaanana achchha hai ki aap hindee bolate hain aur yadi aavashyak ho to ham angrejee mein likh sakate hain aur ise hindee mein anuvaad kar sakate hain.

kya tumhe samajh aaya

[ChessieCat]

We will write in English.  If you don't understand it, please tell us and we can then try to explain it differently in English and use the translator as well.

 

It is good that we know we can communicate. 😊

[Akriti]

Yes of course we can communicate in English only, hindi is not suitable for use right now, it is quite a mess to translate English to hindi, so let us talk about the tapering methods. I am getting anxious even talking about those tapering methods. I need to do it as soon as possible. I don't want to be on these meds 😑