The Brassmonkey Slide Method of Micro-tapering

[brassmonkey]

It looks like you asked for a reduction of 5% a week, which would give some very large reduction amounts.

 

To go from 16.75 to 16 in four steps would be a reduction of 1.125% a week or 4.5% for the total Slide Cycle. This is would be an asymptotic calculation off of the original dose so it would be an increasing percentage removed from the same number. Divide the target dose by the current dose and subtract from 1 to get the total percentage of reduction.

 

The correct taper schedule for the first Cycle would be;

 

Week 1: 16.75mgai - 1.125% or 16.75mgai X .989 = 16.55mgai

Week 2: 16.75mgai - 2.25% or 16.75mgai X .975 = 16.33mgai

Week 3: 16.75mgai - 3.375 or 16.75mgai X .966 = 16.18mgai

Weeks 4-6 16.75mgai - 4.5% or 16.75mgai X .955 = 16mgai

 

The schedule you suggested would be a linear reduction (16.75, 16.5, 16.25, 16) which would cause a slight increase in symptoms over the course of the reduction. While the asymptotic taper starts with the largest reduction and trails off to a smaller one allowing the bulk of the symptoms the longest time to resolve while still giving the same amount of reduction.

[Ryder]

Brass, that is some complex stuff for my brain brother.

 

5 hours ago, brassmonkey said:

To go from 16.75 to 16 in four steps would be a reduction of 1.125% a week or 4.5% for the total Slide Cycle.

 

The correct taper schedule for the first Cycle would be;

 

Week 1: 16.75mgai - 1.125% or 16.75mgai X .989 = 16.55mgai

Week 2: 16.75mgai - 2.25% or 16.75mgai X .975 = 16.33mgai

Week 3: 16.75mgai - 3.375 or 16.75mgai X .966 = 16.18mgai

Weeks 4-6 16.75mgai - 4.5% or 16.75mgai X .955 = 16mgai

 

First, why does the formula multiply by increased percentages per week (Bold numbers), and how you go those numbers ?

Secondly, the numbers in blue. How did you get those ?

 

Sorry for the questions, i am trying my best to understand and compute it correctly.

6 hours ago, brassmonkey said:

The schedule you suggested would be a linear reduction (16.75, 16.5, 16.25, 16) which would cause a slight increase in symptoms over the course of the reduction. While the asymptotic taper starts with the largest reduction and trails off

 

Will the linear reduction work, it just involves less maths for me to compute and i can pop it straight in.

[brassmonkey]

You are aiming for a total reduction of 4.5% spread over four (4) steps. This gives a change of 1.125% of the original dose for each step.  Each step will reduce the original dose by an additional 1.125%.

 

Reduction 1 will be 1.125% less than the original dose,

Reduction 2 will be 2.25% less that the original dose,

Reduction 3 will be 3.375% less than the original dose

Reduction 4 will be 4.5% less than the original dose.

 

The blue numbers are the standard multiplier for each calculation. It is determined by subtracting the percentage as a decimal from 1. 

 

1 - 0.01125 = 0.989

1 - 0.0225 = 0.975

1 - 0.0375 = 0.966

1 - 0.045 = 0.955

 

Multiplying the original dose by that number will give the dose for that percent reduction. It works for both the strength of the dose and the weight of the dose.

[Ryder]

Ok, So the final part is multiply 0.989 x 16.75 = Week 1. Can i ask why you chose to multiply by 16.75 and not the original 17mg which is my starting dose ?

 

Many Thanks, Ryder.

 

 

[brassmonkey]

Ya, caught me on that one. I read some of the numbers wrong. Let's start again.

 

Reducing from 17mgai to 16mgai will be a 6% total reduction that will be divided into four parts of 1.5% each. This will give different multipliers of:

 

Week 1: 17 X .985 = 16.75

Week 2: 17 X .97 = 16.5

Week 3: 17 X .955 = 16.25

Weeks 4 - 6: 17 X .94 = 16

 

So in actuality you original schedule was correct and I have added a lot of confusion for nothing, for which I apologize.

[Greenriver]

Is it necessary to use this method with Fluoxetine?

 

Could it even be counterproductive?

[brassmonkey]

The Brassmonkey Slide Method is just one of the options available to taper. It has shown to work well with the different drugs we deal with. To the best of my knowledge there have not been any reports of people having problems using it. It can be a bit tedious with all the calculations required, but other than that. We try to present a variety of tapering strategies with their pros and cons so each member can make an informed decision as to which method seems right for them.

[Kristinhopes]

I had this same question in regards to Prozac, since it takes 6 weeks to be fully out of system anyway. And so is making frequent reductions counterintuitive in that sense and also the two weeks hold for that reason? Trying to figure out how frequently I want to decrease the prizac . 

[Yesyes123]

@ChessieCat

 

Thank you so much!

[Greenriver]

On 1/23/2021 at 3:19 PM, Kristinhopes said:

I had this same question in regards to Prozac, since it takes 6 weeks to be fully out of system anyway. And so is making frequent reductions counterintuitive in that sense and also the two weeks hold for that reason? Trying to figure out how frequently I want to decrease the prizac . 

Yea, that’s my thoughts on it. Also, it could be counterproductive spacing the dose reductions out week by week, when Prozac is already self-tapering. I’m not really sure what dosage drop I’m getting my withdrawals from; if it’s from the drop two weeks ago or six weeks ago, if you know what I mean. Tbh my withdrawals so far haven’t been too bad, so I might just carry on with the Brassmonkey method 

[brassmonkey]

Getting the drug "out of the system" is not the object of a taper. Prozac has a reputation for being "self tapering" because of it's long half life, but it is far from the truth. A taper according to the half life would mean reductions of 50% every week for six weeks. This is far too fast for the body to make adjustments.

 

The object of a taper is to reduce the drug in a way that the body can undo the physical changes the drug has caused, in such a manner that the body doesn't realize that it's happening. When the drug is removed too fast the body can't keep up with the healing required, gets confused and manifests the WD symptoms we experience. Because of it's long half life Prozac is the easiest one to taper because the fluctuations in it's blood serum concentration are minimal.  Where as with some of the other medications with short half lives the concentration fluctuates widely on a daily basis, making them harder to taper.

 

That is the main premise behind the Brassmonkey Slide. Make smaller controlled reductions that the body is more likely to handle and the give it a little more time to catch up before doing it all again. Instead of taking a big hit all at once and waiting it out. 

[Kristinhopes]

I am currently doing the brass monkey method with the Prozac although I don’t know if necessary to do it that way or once a month. I think my and green rivers confusion is in the fact we are making a small dose adjustment each week before the one from the week before has only been decreased one half life at the most. Could that further confuse the nervous system to make a dose decrease when the previous weeks dose decreased still has a long way to go? Any hypothesis ? In any case I am three weeks in so far and doing okay and will do a two week hold after the four weeks. I will report back in my thread how it goes from there. As long as it’s not any more harmful to do it this way with the prizac, I do actually like the weekly decreases beCause it helps with the patience part of tapering. You still feel like you are actively working towards decreasing even though it’s not more than if you did it once per month it just feels that way, 

[brassmonkey]

The overlapping half life cycles should only help to make things smoother. Because of the long half life it might be a good idea to add a few weeks of additional hold time every three or four Slide cycles. This would allow any backlog of symptoms to resolve before it grew too big. We haven't seen any problems with this but there is the possibility.

[Iman]

Hello all

 

I'm strictly following the Brassmonkey 10% monthly taper and experiencing good results in my Nortriptyline taper. I still get WD symptoms but they are way too brief and short-lived and tend to get resolved in just a few days (hypnic jerks are the most disturbing WD symptom for me as they result in insomnia on some nights). I'd tasted nervous system crash from rapid tapers before I became familiar with the Brassmonkey slide taper, so I know from experience that the WDs in Brassmonkey taper are far more bearable than the ones you get from a crash. My question now is whether Nortriptyline is comparable in its long half-life to prozac or not. Also, would it be wise to switch from Nortriptyline to Prozac from where I am now at 15 mg Nortriptyline?

 

[Krisseyb]

16 hours ago, Kristinhopes said:

the fact we are making a small dose adjustment each week before the one from the week before has only been decreased one half life at the most. Could that further confuse the nervous system to make a dose decrease when the previous weeks dose decreased still has a long way to go?

 

15 hours ago, brassmonkey said:

Because of the long half life it might be a good idea to add a few weeks of additional hold time every three or four Slide cycles. This would allow any backlog of symptoms to resolve before it grew too big.

@Kristinhopes @brassmonkey

Ya'll are really making me think and use my brain. 🤔 I guess my question...(mostly because I don't understand 1/2 life) is should I be rolling on with my BMS-2 wk hold, or should I be holding every 3-4 cycles also? I'm on a Lexapro (off brand) taper....

 

[brassmonkey]

Do your regular Brassmonkey Slide of four reductions and a hold.

 

Sorry for getting you confused, Kristinhopes and I are getting sidetracked on a discussion of tapering prozac which could be handled a little differently than Lexapro.

 

The body processes/uses up the drug at a fairly set rate. The time it takes to use up half of the drug is called its Half Life. In general terms, if a drug has a Half Life of 24 hours, and I take a dose of 4mg at noon, then at noon tomorrow only half of that dose (2mg) will still be active in my body. At noon the next day half of that (1/4 of the original dose) will still be active. Then at noon on the third day half of that (1/8 of the original dose) will be active, and so on until there is nothing left.

 

When you take a dose every day you add more drug as the previous dose is getting used up. The addition and subtraction balances out over time (usually a week or two depending on the medication) and becomes what we call "Steady State". Meaning the same amount of drug in the body all the time. A long Half Life makes it easier to achieve and maintain this Steady State, where as a short Half Life is a little more difficult.

[Krisseyb]

@brassmonkey Gotcha! Makes sense! Thanks for the explanation. I will continue on as I'm doing.

 

[Yesyes123]

When considering the weight of the pill, should one be worried about the weight of the active ingredient vs the weight of the filler substance?

 

For example, we know that a 15mg Lexapro tablet will weight 0.XXXg. But inside this value, how much is the active ingredient (Escitalopram) and how much is the other filler substance that is used to make up the tablet? 

 

If we reduce the weight very slightly in order to taper, how to know if we aren't taking away only the filler ingredient?

 

I suppose that if we crush the tablet into powder and stir the powder up very well, that's enough to mix the filler ingredient with the active ingredient and then reduce the weight of this mixed-powder, safely reducing the amount of active ingredient in the intended proportion. 

 

I just want to make sure with you guys - I will be starting my 15mg Lexapro taper in a few months, once I'm completely stable.

 

@brassmonkey

[ChessieCat]

Generally the active ingredient would be reasonably well distributed throughout a tablet.  If it wasn't the case then they would not be able to make tablets that are scored and can be broken into two.

[brassmonkey]

Hopefully this will answer a lot of your questions.

 

https://www.survivingantidepressants.org/topic/22065-myths-about-your-drugs/?tab=comments#comment-463989

 

[Yesyes123]

25 minutes ago, brassmonkey said:

Hopefully this will answer a lot of your questions.

 

https://www.survivingantidepressants.org/topic/22065-myths-about-your-drugs/?tab=comments#comment-463989

 

Thanks a ton - extremely useful.

 

From reading that link, it seems to me shaving off the pills with a nail file and weighting them is as safe as crushing the pills to powder then weighting then putting the powder in gelatin capsules.

[Mimosa]

Hi Brassmonkey,

 

I am a new member and have been researching a lot on how to start my taper from Venaflaxine 150XL which I've been on for 12 years but been on psychiatric drugs for over 30  years

 

I have found your post describing The Brassmonkey slide method of Mircro - Tapering very useful.

As you mention, I do feel very nervous about starting my taper but so far I think this method would suit me best.

 

I have a couple of dilemma's that are stopping me from making a decision of which way to go and wondered whether I could hear your views guidance on this?

 

 it is difficult for me in the UK ( have spoken to my pharmacist) to be guaranteed to get Venenaflaxine capsules with enough beads for counting or weighing. ( due to difficulty in ordering since Brexit).

 

 At present I get a generic form of Venaflaxine XL that has 12 mini tablets which are very tiny and difficult to cut. ( Also I've read that the extended release property of them is lost when they're split).

 

Because of the above, I have been thinking that Tapering Strips available from The Netherlands may be a good option.( I am aware they're not provided on th NHS and I'd have to pay.) On their website the customised strips that they make for Veneflaxine tapering are a faster tapering than the Brassmonkey scale and I have called the pharmacist in the Netherlands who says they will make them, to my requirements which is great news.

 

However one of the things I liked about your method and other methods when you measure your own amounts is was you can hold at any point, if you are experiencing too many WD symptoms.

 

The tapering  strips are made for a 28 day period and put in pouches named with day and dose.

So I suppose I'd have to wait towards the end of a month then meet with prescriber for her to agree and sign a new form for a different strip. ( you need a prescriber to agree to the use of the tapering strips and the speed of taper you want). I'm worried that this could take a while ( it takes 2 weeks to get sent tapering strips to the UK) and meanwhile withdrawal symptoms could become too much and become out of control and set me back.

 

Also from what I've read I understand that the tapering can get more challenging as you get to lower doses so the above could be more of a problem then?

 

Also I used the excel sheet provided by @Josef for calculating reductions for the Brassmonkey Scale and it came out that it would take me 7 years to totally come off Venaflaxine. Is this right? ( this was 2.5% reduction a week followed by a two week hold)

 

Any thoughts on any of the above? Much appreciated.

 

Mimosa

 

[brassmonkey]

For doing a Brassmonkey Slide from 150mg seven years sounds about right. It can be a real shock to find out just how long tapering can take. For a rough double check the half life of a Brassmonkey Slide is 9 months. So if you start tomorrow at 150mg in nine months you should be at 75mg and in 18 months be at 37.5mg.

 

The problem I see with the tapering strips is that they are based on a four week cycle while the Brassmonkey Slide is based on six. Four weeks of tapering and two weeks of holding. Possibly they will be willing to work with that schedule and provide a six week package, you'd have to talk to them about it.

 

If the slide is going well then there is usually no need for interim holds. They are only needed if things are starting to backup and the symptom load is growing. If that happens then a talk with your prescriber for a "hold strip" may be in order.

 

Some people do have more trouble at the final lower doses, but it will be a while before you get to that point. The Endgame of a taper is a different creature and will take some different planning and will depend on how things are going at that time. For now I would be more concerned about getting to that point than what you will do when you get there.

[Mimosa]

Thanks for your quick reply, yes you're totally right I'll focus on the first bit first!  

 

I've just spoken to my GP who thank goodness was open to the idea of the Tapering Strips (as i need her signature ) and I'm about to send her links to back up what Im saying (as Id' previously been advised to change doees every week, using doses that were available on prescription)

 

Yes the Tapering strips do come in 28 day strips but you can order as many as you want at one time so I assume if using the Brassmonkey slide the first 28 days strip would include daily doses for micro tapering by 10% and the second strip would be 2 weeks hold and 2 weeks micro tapering,  then the next strip 2 weeks micro tapering  and 2 weeks hold, then the next 4 weeks tapering and so on. 

 

Do you think it would be better to see if I could get the strips made in 6 week cycles?

 

 

[Mimosa]

Sorry one more question, Brassmonkey. The tapering strips will contain pills whereas I've always taken capsules. Do you think that will matter?  I am very sensitive to medication changes and am wondering whether its a good idea to move to the 150mg pills for a while, before I start tapering on the pills.

 

This is because I know capsules and pills dissolve differently in your blood stream. Am I being too particular about this??

[brassmonkey]

If possible getting a 6 week strip would be the best because of the lack of confusion juggling two different 28 day strips. That way you would have all of one reduction cycle in one place. Also if we can talk the strip provider into doing it, it would open the market for others to order that same sort of thing.

 

There shouldn't be any real difference between the capsules and the tablets.  But if you are sensitive then making a cross over to the tablets before starting the taper would be a good idea.

 

[Mimosa]

Thank you. I'll be talking to the strip provider soon and will certainly post on this site what they agree to do, as this way may be good for others too,

[Josef]

Hey jozeff, It's Joseph, what a great spreadsheet you've made (and what a great nickname you have hehe!)

I was wondering if by chance you could teach me how to view calculation that are even more precise (by o.oo1)? Or getting in another column calculation for mgpw?

Big thanks for the excel file.

[Kewlbeanz]

Hi. I am still new to this. I tried tapering 10% of my 20 mg of Lexapro  and that proved too be too much for me. It wasn't the Brass Monkey Slide scale, just a staring cut of 10% and holding for a month. Is it possible to do a 2.5% taper each week for two weeks and then hold for two weeks for a total of 5% taper? I just so scared and I am afraid after an accumulated 10% reduction a month, I would be in a really bad place by the end of the 4 weeks. 

[Rusty1]

3 hours ago, Kewlbeanz said:

Hi. I am still new to this. I tried tapering 10% of my 20 mg of Lexapro  and that proved too be too much for me. It wasn't the Brass Monkey Slide scale, just a staring cut of 10% and holding for a month. Is it possible to do a 2.5% taper each week for two weeks and then hold for two weeks for a total of 5% taper? I just so scared and I am afraid after an accumulated 10% reduction a month, I would be in a really bad place by the end of the 4 weeks. 

Absolutely. The recommendation is to decrease by no more than 10% per month. If you choose to reduce less you are more likely to have reduced symptoms which sounds like what you are looking for.

A smooth taper with as few symptoms would be far preferred over the speed in which you taper.

 

Sounds like you have a good plan.

 

[Kewlbeanz]

My head hurts some today. I'm hoping I can stabilize soon. I went back up to 19 mg yesterday and today. My symptoms are much better though than last week. 

[Mascasa]

I believe I tapered a bit quickly. I am sitting at 12 mg right now. But the waves the last few days are a bit hard. Very low. Should I go back to 13? My 10% would be 12.6. Or back to 14?

[SCHope]

I am new.  Understand the 10% per month taper with 2 week hold, yet confused how to practically perform.  Looking to taper off 1mg Klonopin.  It’s a pill.  How do you obtain such detailed minute doses over time?  How do you measure in terms of weight?  Measure with what?  Do you crush the pill and mix in a certain amount of water.  Very confused how to practically begin a wean.  Any help greatly appreciated.

[Alejandra]

Hello im a little confuse, I did the calculation here http://www.taperoff.co/ and it says 15 years! I filled with the following information: 12,5, to taper at 5% with 4 weeks to hold is that ok? my native language is not English 

[brassmonkey]

@Alejandra-- I just put those numbers on the same calculator. By the end of the fourth year your dose would be sufficiently small that it would be time to think about stopping. That would be a dose of 0.09mg. It still seems like a long time, but it goes quite quickly and your should feel big improvements along the way.

[Alejandra]

@brassmonkey Could you give me a personalized help? hold is ok for 4 weeks or is it a lot? we can talk? I'm very confused