Mario77: Multiple medication mishaps

[Mario77]

@AltostrataNot much, maybe walk the dog 2x 10 minutes. Thanks.

[Altostrata]

You need to get more exercise, at least 1/2 hour of walking each day, stretch your arms and back, and get your circulation going.

 

Where are you with tapering the afternoon clonazepam?

[Mario77]

@Altostrata0.375mg.

[Altostrata]

When are you supposed to reduce again?

[Mario77]

@AltostrataI cut down from 0.75 to 0.50 on Jan 15th, and to 0.375 on Jan 25th (15 days ago). But I don't feel like I can do it now. I am foggy and anxious. Yesterday I was more active, but this morning I had agitation, starting desperately calling people around, thinking about going back to 0.50...

[Mario77]

@Altostrata My doc is open to a c/o to valium. What do you think? How about TMS? Thanks.

[Mario77]

@Frogie Please see above. Thanks.

[Altostrata]

How about trying more exercise? I think we've been dealing with symptoms (back pain, fogginess, lack of energy, etc.) arising from your inactivity, @Mario77  Your symptom pattern indicates you're still taking too much clonazepam and probably escitalopram as well, not withdrawal symptoms.

 

If you want drug treatment, including a switch to Valium, for symptoms arising from lifestyle , please talk to your doctor. Let us know when you want to taper off your drugs.

[ChessieCat]

After looking at the interactions below, I suggest that you then go back to the start of your topic and read all the posts which Altostrata has made, and then re-read the drug interactions below.  It might help you to understand what Altostrata is telling you.

 

4 Interactions Found

 

Patient Regimen

•   clonazepam
•   escitalopram
•   propranolol
•   amlodipine
•   mirtazapine

Monitor Closely

• propranolol + amlodipine

  propranolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• escitalopram + mirtazapine

  escitalopram and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

• clonazepam + mirtazapine

  clonazepam and mirtazapine both increase sedation. Use Caution/Monitor.

Minor

• escitalopram + propranolol

  escitalopram increases levels of propranolol by decreasing metabolism. Minor/Significance Unknown.

[Mario77]

@AltostrataI thought a switch to Diazepam from Clonazepam is a tapering tool. My bad.

@ChessieCat I did re-read the thread and interactions.  Still not sure what I am supposed to do. Maybe I'm foggiest than I thought...Sorry. Any suggestions are welcome. More exercise, got it. 

[ChessieCat]

3 hours ago, Altostrata said:

Your symptom pattern indicates you're still taking too much clonazepam and probably escitalopram as well, not withdrawal symptoms.

 

This is why I said to read back through Alto's posts because she has been giving you information which you might not have seen or might not have understood.

 

Edited February 9, 2022 by ChessieCat

[Mario77]

Thank you, @ChessieCat.

So, should I continue tapering clonazepam, even after lowering 17% in 3 weeks? 

[ChessieCat]

@Frogie Could you please assist this member?  Thank you.

 

Edited February 9, 2022 by ChessieCat

[Altostrata]

@Mario77, way back when, we discussed how your drugs may be interacting and how that might be causing some of your symptoms. I have explained many, many times how taking too much escitalopram and clonazepam may be contributing to this.

 

All of your drugs cause "brain fog". You've been taking some kind of benzo off and on since 2005. In 2021, it was wall-to-wall benzos. Depression and fatigue are adverse effects of long-term benzo use.

 

Every day, you have some kind of complaint that to you means you need to take more drugs. You decline other methods of self-care. Since you joined in August, you have shown yourself to be far more comfortable increasing dosage or adding drugs than you are with tapering anything.

 

Clearly, you have asked your doctor what he or she thinks about substitution of diazepam for clonazepam. 

 

We don't stand in the way of people and their drugs. If you want to take more or different benzos, please stop bringing that up here for discussion. We're not going to endorse your habit. Talk your doctor.

 

It's not our job to give you a good drug experience. Post here only when you truly want to reduce your drugs.

[Mario77]

@AltostrataWhat would you have me do? Keep tapering the clonazepam?

[Altostrata]

On 8/22/2021 at 6:56 AM, Mario77 said:

I am torn between doing nothing, tapering something (mirt , I guess) and cross-tapering. The cross tapering would be to Zoloft, since my last episode (5 year ago) Effexor stopped working and I was put on Zoloft (which helped, I assume, since I recovered).

 

I honestly do not know what you want to do here, @Mario77 This is a site for going off drugs. Advising people on tapering is what we do here.

 

It appears to me from your symptom pattern that you may be having adverse effects from the drugs you're taking, which are the source of some of your "instability" (and the many occasions of "panic" attacks). Generally, reducing drug dosage reduces adverse effects. This is a little tricky with benzos, which often have to be scheduled at regular intervals to eliminate interdose withdrawal before reducing daily dosage overall.

 

We advise a switch to diazepam only in cases where other techniques have failed, because the switch may not work and then you have worse withdrawal. You've been on and off diazepam, so maybe this has occurred before. 

 

As near as I can tell, rescheduling and reducing clonazepam has caused a reduction in intensity of your symptoms, but you also have symptoms that may be unrelated to tapering, such as your back pain and foggy brain, which might be due to lifestyle issues, such as lack of exercise, as well as other drug adverse effects.

 

Your symptom pattern is made more difficult to interpret because you seem convinced you need more or different drugs to treat these symptoms. While we know a lot about drug adverse effects and how to manage them, switching or adding drugs for "therapeutic" reasons is not something we do here, period. You can do that with the help of your doctor.

 

You seem very wary of tapering and much more inclined to switch drugs or add drugs. Meanwhile, although it appears some of your symptoms are from the drugs, it takes an extraordinary amount of coaching to get you to reduce your drugs, or even to address your symptoms with non-drug means. When people register on this site, they are usually far more interested in tapering.

 

You don't have to continue to taper, but you do need to work on managing your symptoms with self-care instead of complaining about them and musing about adding more drugs for them. If you're interested in tapering, please let us know.

 

Other than that, you might join other communities to discuss your drug cocktail and how you might refine it to address your symptoms, such as patientslikeme.com and depressionforums.org

[Mario77]

2 hours ago, Altostrata said:

you seem convinced you need more or different drugs to treat these symptoms.

That is an assumption, no? And obviously a wrong one.

Yes, I talked to my doc about c/o. That IS a way of tapering. If the risks outweigh the benefits, I'll stick with clonazepam.

2 hours ago, Altostrata said:

musing about adding more drugs for them.

When did I do that?

 

2 hours ago, Altostrata said:

switching or adding drugs for "therapeutic" reasons is not something we do here, period.

I was planning to switch for "tapering" purpose, not "therapeutic" reasons.

 

2 hours ago, Altostrata said:

If you're interested in tapering, please let us know.

How can I let you know? You keep repeating this in every post. All my queries about a tapering plan are met with the dismissive "You don't want to taper anyway".  I am not playing a game, I am looking for advice. And a reason for that advise is that I AM INTERESTED IN TAPERING.

 

2 hours ago, Altostrata said:

you might join other communities to discuss your drug cocktail

Thank you for your invitation, but as I said multiple times, I  want to taper my drugs. However, I won't get any advise from SA without your blessing. As such, I want to reiterate my commitment to tapering. 

I realize this is your website; I am only a guest in need.

[Altostrata]

To understand if you are in a stage to reduce further, we need to see your daily notes. If you want to continue to hold for now, you can, but you need to manage whatever symptoms you have. They are not all withdrawal symptoms.

[Mario77]

@Altostrata @FrogieFeb 9, everything in mg

 

6:30am woke up, lingering in the bed, anxious

7:00am 10-15 min stretching, meditation 5 min

7:30am Propranolol 40

8:00 am taking care of pets

8:15 am bit of brain fog, slight agitation. Clonazepam 0.75

9:00 am escitalopram 12.5, brain fog, mild agitation, uneasiness

10:30 am Amlodipine 5 mg 

11:00am Brain fog, slight back stiffness, agitation

12:00 Sleepy, lunch

1:00 pm not so brain foggy, reading the news, SA

2:00pm chest pain, stiff back, clonazepam 0.375

4:00 pm OK-ish

5-6pm running errands, bit of brain fog

6:00 pm walk with wife and dog in the neighborhood, 20-30 min

7:00 pm dinner

8:00pm OK-ish, reading on laptop

9:15 Clonazepam 0.75

9 to 10:30pm watching movie

10:30 pm liquid mirtazapine 18.75

10:45pm sleep

 

 

 

[Altostrata]

I still see adverse effects from the cluster of drugs (propranolol, clonazepam, Lexapro, amiodopine) you take in the morning. There is no way to tell which drug is causing these symptoms between 7:30 a.m. and 1 p.m.: brain fog, mild agitation, uneasiness, slight back stiffness, agitation. You are taking clonazepam and escitalopram very close together.

 

That these symptoms are lessened in the afternoon indicates something you take earlier is wearing off.

 

Can you take propranolol earlier? Can you take amlodopine at 11 a.m.?

 

I see no evidence at all that you are experiencing withdrawal symptoms from reducing clonazepam. Suggest you and @Frogie discuss your next reduction of the 2 p.m. dose.

[Mario77]

 @Altostrata @FrogieShould I take maybe Clonazepam 6, propranolol 8, escitalopram 10 and amlodipine 12, more spaced, and with 4 hrs between Clonazepam and escitalopram?

Thank you very much.

 

[Mario77]

@Altostrata@Frogie

2/10

6:20 AM woke up anxious

7 AM out of bed, taking care of pets

7:15 breakfast, propranolol 40

8:30 Clonazepam 0.75

9:00 Anxiety, uneasiness, hyperventilation, thirst, brain fog

9:15 Escitalopram 12.5 Agitation, restlessness, stiff muscles, hyperventilation, thirst, brain fog

10:20 Amlodipine 5 Same as above

1100 Lunch sandwich

12 Increased back pain, agitation, thirst, brain fog

2 PM clonazepam 0.375

3  PM Still pacing agitation, anxiety, rumination, bad back pain, brain fog

4 PM resting in bed

5 PM back pain gone, but rumination, depression

7 PM Crying

9 PM clonazepam 0.75, a bit of TV

10:30 liquid mirtazapine 18.75mg

 

[Altostrata]

1 hour ago, Mario77 said:

9:00 Anxiety, uneasiness, hyperventilation, thirst, brain fog

 

Adverse effects from morning clonazepam or perhaps clonazepam-propranolol combination are apparent.

 

1 hour ago, Mario77 said:

12 Increased back pain, agitation, thirst, brain fog

 

These symptoms appear to increase EVERY DAY around noon. This is not accidental. It's because of something you're taking earlier. Since the amlodopine was the last thing you added to the brew, it may be contributing. Did you review adverse effects of amlodopine?

 

3 hours ago, Mario77 said:

 @Altostrata @FrogieShould I take maybe Clonazepam 6, propranolol 8, escitalopram 10 and amlodipine 12, more spaced, and with 4 hrs between Clonazepam and escitalopram?

Thank you very much.

 

 

What do you want to take your drugs on this schedule? It's going to be difficult to schedule 7 drug doses far enough apart over 12 hours in order to identify adverse effects from any one of them.

 

Is your propranolol extended-release or immediate-release? 

 

Mayo Clinic says propranolol extended-release should be taken at night. Is the propranolol absolutely necessary? When was the last time you reviewed your intake of propranolol and amlodopine, combined with the other drugs, with your prescriber? Did you ever mention your adverse effects to your prescriber?

 

Propranolol and amlodopine alone could be responsible for your brain fog and other complaints. I know we discussed this before and you declined to pursue it.

[Mario77]

I am taking propranolol and amlodipine for years without any problems. When I talked to my cardiologist a few months ago (after adding  the 3 psychiatric one) she said there is no problem. Should I push to change my HTN meds to something else? I used to take lisinopril prior to all this.

I thought that spacing the drugs would help pinpoint the culprit, that's why I propose that schedule. My propranolol is regular.

Thank you very much 

[Mario77]

17 hours ago, Altostrata said:

I see no evidence at all that you are experiencing withdrawal symptoms from reducing clonazepam.

@Altostrata How about  the horrendous back pain? Can that be from benzo?

[Altostrata]

18 hours ago, Altostrata said:

Can you take propranolol earlier? Can you take amlodopine at 11 a.m.?

 

Why do you want to take clonazepam first thing in the morning when I'm trying to identify whether propranolol or amlodopine are causing the symptoms you are so vociferously complaining about?

 

This is extremely frustrating to me because although you complain of symptoms that may be caused by these drugs, you shrug and ignore potential effects of propranolol and amlodopine.

 

Every single member on this site has found they need to look more carefully at their drugs than their doctors do. Clearly, even though your cardiologist says there's no problem, there is a problem.

 

TRY GOOGLING AMLODIPINE AND THIRST.

 

23 minutes ago, Mario77 said:

How about  the horrendous back pain? Can that be from benzo?

 

This pain seems to occur after you've taken the bulk of your clonazepam for the day!

 

TRY GOOGLING AMLODIPINE AND MUSCLE PAIN.

 

You see, Mario, it's going on 10 pages of this ceaseless arguing and second-guessing by you that has exhausted my patience. It doesn't matter how much time and care I put into explaining my interpretation of your symptoms. You don't believe it and you keep on questioning it. If you are not concerned about your drug-induced symptoms, why should I be?

 

I should not have to spend my time researching your non-psychiatric drugs, @Mario Again, I cannot understand what you're doing here if you're not committed to reducing your psychotropics. I greatly resent it that you need to be coaxed into making a reduction or change. You are exploiting my time. I'll leave it to the other moderators to assist you if they wish. Please do not tag me again.

[Mario77]

Nobody willing to help?

[Frogie]

@Mario77

 

We have all tried to help you time and time again. Then I set up a set schedule for your meds. And as Altostrata said it is difficult to get all your meds into one day and then you want to change them all around?

 

If I were you I would go to Drug.com Interactions Checker and put in ALL your medications and see how they react to each other. I'm sure you will find quite a few.

 

Your best bet would be to get off the Clonazepam as soon as you can. You are still on a really high dose. But you are almost wanting to "hang on" to all of your medications like a security blanket. Take Tylenol or ibuprofen for your back ache. Maybe ask the dr for some physical therapy to help your back.

 

We can't tell you to take this or that. This is a site to taper off medications. You have to want to help yourself.

 

Let me know what you want to continue to do.

[Mario77]

Thank you for your courage, @Frogie.

[Frogie]

@Mario77

 

I guess I don't understand your comment?

[Mario77]

@FrogieYour courage to keep corresponding with me.

 

[Frogie]

@Mario77

 

You just need to cooperate and we will get along fine

[Mario77]

@Frogie, need your help. Please do not scold me, I am at 15 lexapro, 1.75 clonazepam and the rest stabile. I am cutting 0.02ml of mirtazapine every 2 days, I tried gabapentin 2 times...

I feel very bad in the morning, with chills and shakes along the spine. I know I am in clonazepam tolerance, I tried taking 1 mg around 11AM and 0.75 around 9PM. WHERE TO FROM HERE? I apologize for not listening, I AM DESPERATE

[ChessieCat]

5 hours ago, Mario77 said:

I tried gabapentin 2 times

 

Q:  What do you mean that you tried gabapentin 2 times?

 

Q:  When did you take it, for how long and at what dose?

 

Please provide this information in a reply/post so that the staff will be notified of it.

 

As well as posting the information please also add the dates and doses to your drug signature.  We need to be able to see your drug history at a glance without reading back through your posts.  Thank you.

 

Account Settings – Create or Edit a signature

[ChessieCat]

Also please tell us what happened, ie how you felt, when you took the gabapentin.  If you made you feel worse also tell us how you felt after you stopped taking it.

[ChessieCat]

On 2/12/2022 at 12:35 PM, Altostrata said:

Every single member on this site has found they need to look more carefully at their drugs than their doctors do.

 

5 hours ago, Mario77 said:

I tried gabapentin 2 times...

 

Q:  Did you check for drug interactions before you tried the gabapentin?

 

It is a good idea to do a drug interaction check BEFORE taking anything that is prescribed, and even over the counter supplements, ingredients if a complex (not all of them will be listed in the interaction checker but some might, so it is worth checking).

 

Drug.com Interactions Checker

Medscape Drug Interaction Checker