UncleLeroy: Lexapro, Zyprexa, Trazodone

[UncleLeroy]

Am I in the right place to ask about advice to taper medication as an advocate for my husband?

Edited March 11, 2023 by Gridley

[Gridley]

Welcome to SA, UncleLeroy.  I'm sorry you and your husband are going through this.

 

We're a site for helping taper of psychiatric medications, so you're in the right place.  We prefer to deal directly with the member.  If that is not possible, we can work with you.  Please let us know.

[UncleLeroy]

Thank you Gridley, for your response and agreeing to work with me. Yes, I agree it would be better to work with him directly, and hoping that may be possible when he is not so overwhelmed. 

I've reviewed this site and posts prior to becoming a member and am interested in any advice on which medication to begin tapering first. My thoughts were starting with the Zyprexa first. Would you (or anyone else that would like to share thoughts) advise that this is a good idea?

[Gridley]

@UncleLeroy

 

A prefatory note: a person is at risk of withdrawal symptoms from antidepressants (and likely antipsychotics) after approximately one month of usage.  Since your husband has been on his three drugs slightly less than one month, there is the outside chance that he could just quit without tapering.  However, there's no way to know, and the risk of severe withdrawal for some people is so great that a very conservative approach to tapering is called for.  If a taper goes wrong, it can take  very long time to recover.  The fact that your husband's nervous system has been destabilized by alcohol use and alcohol cessation would also argue for a conservative approach.  But I did want to make you aware of this aspect of your husband's situation.

 

That said, let me talk about some principles we'd apply regarding your husband's taper.  When choosing which drug to taper first, in the absence of other factors, we generally recommend tapering activating/stimulating drugs (known as accelerators) first, leaving sedating drugs (known as brakes) in place to help with sleep and cushion the effects of the activating drug taper.  The brakes would be tapered later.  SSRI's like Lexapro are accelerators, and antipsychotics like Zyprexa are brakes.  Trazodone is a complicated drug but would be classified as a brake.

 

Taking multiple psych drugs? Which drug to taper first

 

So normally we'd say taper the accelerator Lexapro first.  But there are other important factors to consider.  One is that antipsychotics like Zyprexa can do long-term damage.  Another is that there is a major drug interaction between Lexapro and Trazodone, that being serotonin syndrome (check that out for yourself if you wish on a drug interaction checker like drugs.com).  So the choice of which drug to taper first is complicated.  It's a devil vs. the deep blue sea situation.  I'm afraid you're about to become an expert in something you'd just as soon not have known anything about, but read through the following SA links on tapering your husband's three drugs to get an idea of factors to consider. 

Tips for tapering off escitalopram (Lexapro)
Aka Cipralex, Seroplex, Lexamil, Lexam

Tips for tapering off olanzapine (Zyprexa)

Tips for tapering off trazodone (Desyrel)

 

You mentioned tapering the Zyprexa first, and there are certainly arguments for that.  Did you have a reason for choosing Zyprexa?

 

On whole, I'd recommend tapering the Trazodone first, because of the serotonin syndrome factor and because (as described in the link above) it's such a nasty drug.  That would leave the Zyprexa in place for sleep. 

 

Regarding rate of taper, we recommend tapering by no more than 10% of your current dose every four weeks.  That would mean that your husband would be tapering for quite a bit longer than he was on the drugs.  That's another of the many perverse aspects of these infernal drugs.  When you read the link, you'll see that there is the possibility of speeding up the taper rate (though not the percentage rate) if your husband can tolerate it, but it's very important to start out at the 4 week rate.  I've tried to go faster than 4 weeks but found I can't.  It's all individual.

 

Why taper by 10% of my dosage?

 

The links above on the individual drugs describe how to get the nonstandard doses needed for a 10% taper.

 

Whew.  Lots of information, I know.  Please take your time and try not to be overwhelmed.  Feel free to ask any questions.

 

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 (glyciinate is a good form) 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 -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.  I hope you’ll find the information in the SA forums helpful for your situation.  I'm sorry that you are in the position that you need the information, but I am glad that you found us.

 

 

 

 

 

Edited March 11, 2023 by Gridley

[Altostrata]

Hello, @UncleLeroy

 

Quote

 

3/8 -3/9 No meds taken (prescription was delayed)

 

 

How did this affect your partner?

 

Did he have any new symptoms after being released from detox in February?

[UncleLeroy]

@Gridley

Thank you and yes, lots of information. I was thinking the Zyprexa, as the possible list of side effects seemed more severe (if I am remembering correctly). He seems to already have side effects (that I may be wrongly attributing to the Zyprexa.) Weight gain, food cravings (especially sweets), frequent urination, sexual dysfunction, aching joints, heartburn, and a "zombie" like state for hours a day that makes it harder to function. I was thinking of choosing one "brake" to taper first. Then the Lexapro, then Trazadone. The trazadone was prescribed as a sleep aid, so I was concerned with removing that one first in case the Lexapro would cause sleep problems. And if we chose to taper the Lexapro first, I was concerned that still taking the other 2 "brakes" would make it harder for him to function, (work, family, etc.) 

 

I would love to think that he could just stop taking these with no ill effects, especially given the short time frame he's been in them.  The neurological changes he suffered from use/withdrawal makes me fearful it won't be that simple. I would really regret suggesting cold turkey and have him/us suffer the consequences of that decision. Of course it sounds the easiest, without the time and measuring involved, but the "easy way out" seems like it would be the harder way out, intuitively speaking. I suppose I am extra cautious and would rather choose the most correct and reasonable way with the least likely withdrawal symptoms. He would be willing to do whichever I think is best after researching and receiving sound advice. He was actually considering going cold turkey after he passed his 90 day mark of sobriety. His psychiatrist told him that would be telling if he could get through 90 days without relapsing. So his train of thought was that these meds would help him get there, as he is intent on staying sober. I had already known of the possible withdrawals, and how much harder it would be going cold turkey, or otherwise, the longer you're on these drugs. I began more in depth research which led me here.

 

@Altostrata The two days he wasn't on medication,  he had GI upset, some nausea, achy joints, but still slept fine. He was able to work, do daily activities (one being adding fencing to our chicken coop) with no problem. He claimed, other than the few symptoms I mentioned, that he felt fine. We even went to gym and did a light workout on one of those days. 

 

I am not clear about your question asking about new symptoms after his release. I will try to answer what I think you are asking. He had one episode during withdrawal from what I believe was alcohol withdrawal induced psychosis. He basically recovered while on involuntary hold in the hospital for 5 days without any drugs being administered before even being placed in detox/rehab.  Once he got admitted to rehab he was diagnosed with Major depressive disorder and substance use disorder and was given this cocktail (coaxed into believing it would help him get released sooner). So he was symptom free, except for insomnia before any medication. Given the circumstances and bedding, this would have been normal for anyone. He doesn't have a history of depression whatsoever, substance use disorder yes, but highly functional.

 

Thank you both for your time. He has spent 20+ years battling one addiction, and the thought of spending another 20+ trading in that one for these new dependencies, well...no thanks.

[Gridley]

2 hours ago, UncleLeroy said:

I was thinking of choosing one "brake" to taper first. Then the Lexapro, then Trazadone.

That seems to me to be an excellent plan. You have a good handle on the situation.

 

2 hours ago, UncleLeroy said:

I would love to think that he could just stop taking these with no ill effects, especially given the short time frame he's been in them.  The neurological changes he suffered from use/withdrawal makes me fearful it won't be that simple. I would really regret suggesting cold turkey and have him/us suffer the consequences of that decision.

That is the conundrum.  We don't want him to go through an unnecessarily long taper period, but we don't want him to suffer the possible withdrawal consequences of a cold turkey.  For that reason I asked Altostrata, the owner of this site, to take a look at the situation.  She is extremely knowledgeable about these drugs and going off them.  Let's see what she has to say.

 

2 hours ago, UncleLeroy said:

He was actually considering going cold turkey after he passed his 90 day mark of sobriety.

That would be the worst course of action.  At the 90-day point, he will definitely be at risk of withdrawal from each of these drugs.  Let's see what Altostrata says. 

[Altostrata]

What times o'clock does your partner take each of his drugs, with their dosages?

 

Please put ALL the drugs in this Interactions Checker and post the report or a link to it in this topic.

 

12 hours ago, UncleLeroy said:

Weight gain, food cravings (especially sweets), frequent urination, sexual dysfunction, aching joints, heartburn, and a "zombie" like state for hours a day that makes it harder to function.

 

Weight gain, food cravings, and zombification are typical of Zyprexa. Sexual dysfunction could be from any or all of that assortment. The other symptoms may indicate an allergy to one of the drugs. We will go into this further.

[UncleLeroy]

@Altostrata 

Around 8 AM: Lexapro 10 mg, Zyprexa 5 mg

Around 10-11 PM: Trazodone 100 mg 

His job is in the early afternoon and this gives time for him to come out of zombieland before beginning.

 

The Trazodone interaction with Lexapro is concerning.

 

[Altostrata]

Why is he taking Lexapro and Zyprexa together in the morning?

 

Need to see this:

1 hour ago, Altostrata said:

Please put ALL the drugs in this Interactions Checker and post the report or a link to it in this topic.

 

[UncleLeroy]

https://www.drugs.com/interactions-check.php?drug_list=1013-565,2228-0,1744-1113

 

@Altostrata other than that is the way it was originally administered in rehab/detox, we don't know. The rehab pharmacy was only open twice a day. Am and pm. I presumed it was to not have to "deal" with patients, as zombies are easier to deal with?  

[UncleLeroy]

Seeing that Lexapro and Trazodone have major drug interactions, and Trazodone being particularly nasty, I am rethinking the strategy. Tapering or just quitting CT the trazodone (if applicable, as he is still just barely under a month of being on them), and switching taking the Zyprexa at night? 

Sorry, trying to process and feeling pressure to make some decisions as tomorrow will 29 days.

Thank you again, truly.

[UncleLeroy]

@Gridley

@Altostrata

 

Thank you for your time and efforts with my situation and all that you do for all those you advise here.

 

I am still contemplating a strategy. Although tossing around the idea, we have decided against CT for any and will do the safer 10% taper. 

 

Deciding the one to begin tapering first is where we are. I feel like I am back to square one with this. Although I felt like choosing a brake was right, my husband feels that he would like to wait to taper trazadone because he says the Zyprexa doesn't make him feel sleepy, just zombie like. He is concerned it won't do the same job as trazadone as a replacement for sleep aid. Also, given the major interactions between Lexapro and Trazodone, and the suggested tapering of accelerators before brakes, we are now leaning towards starting with the lexapro and leaving the others in place. I know after making the decision, there will be no going back so as not to complicate matters or confuse symptoms of withdrawals. 

 

I also realize how much time it takes for all of you gracious moderators to sift through changes to give sound advice. 

 

Do you agree that tapering the Lexapro is the strategy to go with?

 

[Gridley]

29 minutes ago, UncleLeroy said:

Do you agree that tapering the Lexapro is the strategy to go with?

I can't say absolutely that the Lexapro is the strategy to go with, but it's viable and there are certainly good arguments to be made for it, which you've made in your post (taper activating drugs first, get rid of one prong if the Lexapro/Trazodone interaction).  And sleep is very important.  

 

If you do decide on the Lexapro, prescription liquid is the best way to taper Lexapro.  If your husband is currently taking the tablet, do a gradual crossover before starting the taper to avoid jarring the system:

 

3/4 dose tablet for 3 days

1/2, 1/2 for 3 days

1/4 tablet, 3/4 liquid for 3 days

all liquid thereafter

 

Wait a few days to make sure the liquid is setting well.  Most do fine with the liquid, but some few don't.  If all is well, you can then begin your taper.

 

We're happy to help.  

 

 

 

 

[UncleLeroy]

@Gridley

Thank you. If we are unable to get the liquid prescription Lexapro, is it possible to taper using the tablets/scale? We are not discussing the taper with the prescriber, as we don't feel it will be well received/supported. We want to be sure we continue receiving the prescription until tapering is complete. 

[Gridley]

13 minutes ago, UncleLeroy said:

If we are unable to get the liquid prescription Lexapro, is it possible to taper using the tablets/scale?

Definitely.  That's how I did it.  Or you can make your own liquid from the tablets.  Both methods are described in this link:

Tips for tapering off escitalopram (Lexapro)
 

Many members, myself included, have used the Smart Weigh Gem20 scale available on Amazon.

 

Smart Weigh GEM20-20g x 0.001 grams, High …

 

 

 

 

 

[UncleLeroy]

@Gridley

Perfect. Many many thanks.

[Altostrata]

1) I would definitely not take Lexapro and Zyprexa at the same time, this increases risk of drug interaction. I would keep Lexapro in the morning but gradually move Zyprexa to later in the day. This will move zombification to the evening.

2) We have many people here taking antipsychotics such as Zyprexa for sleep. Misguided, but it's very commonly used for this purpose.

3) Trazodone also interacts with Lexapro, which the drug checker didn't catch.

4) Zyprexa is the most dangerous drug he's taking.

[UncleLeroy]

@Altostrata

Thank you and @Gridley for taking the time to respond. It is invaluable to me as I am sure it is to all those seeking assistance here. 

 

The drugged checker did list a major interaction between trazodone and lexapro which had me thinking we might taper Lexapro first. 

 

If the Zyprexa is the most dangerous, that is the one we will taper first. 

 

Should we start by gradually moving the Zyprexa to the end of the day and get it to where we need it before beginning the taper?

 

His work day ends in the evening around 10 pm, so taking zyprexa and trazodone both at bedtime would be okay? 

 

Many thanks!

[UncleLeroy]

On 3/13/2023 at 7:11 PM, Altostrata said:

1) I would definitely not take Lexapro and Zyprexa at the same time, this increases risk of drug interaction. I would keep Lexapro in the morning but gradually move Zyprexa to later in the day. This will move zombification to the evening.

We have begun the move of taking Zyprexa by an hour a day to evening.

 

Based on reading others posts, once we have the time of day adjusted, we should hold on tapering for at least (4) days to let things settle?

 

Thank you

[FireflyFyte]

50 minutes ago, UncleLeroy said:

We have begun the move of taking Zyprexa by an hour a day to evening.

 

Based on reading others posts, once we have the time of day adjusted, we should hold on tapering for at least (4) days to let things settle?

 

Thank you

 

After any change, it's recommended to hold for some time to ensure one is stable before making a drop. When I changed from taking my Zyprexa in a pill form to dissolved in water, I took a week to make the transition and then held for a little over a week before making my first drop. Without holds, it can be difficult to know what might be causing symptoms if they arise. 

[UncleLeroy]

Thanks @FireflyFyte, we'll hold for at least a week after the transition before beginning a taper. 

[Altostrata]

On 3/13/2023 at 5:33 PM, UncleLeroy said:

so taking zyprexa and trazodone both at bedtime would be okay? 

 

Taking any 2 drugs at the same time is not a good idea, increasing risk of drug-drug interactions and other unintended consequences.

 

[UncleLeroy]

@AltostrataI am not sure how to get around this. He works afternoon shifts and and can't be stupefied at work. The strongest effects of Zyprexa usually wear off within an hour or two after taking so we may just need to leave it at taking it in the middle of the day. That would leave Lexapro in the am, Zyprexa at noonish, and Trazodone in the evening. Thank you.

 

[FireflyFyte]

You only need to space the medication at least two hours apart so he could take the Zyprexa in the evening and the Trazadone right before bed, for example.

[UncleLeroy]

4 hours ago, FireflyFyte said:

You only need to space the medication at least two hours apart so he could take the Zyprexa in the evening and the Trazadone right before bed, for example.

Thanks, I think middle of the day for Zyprexa may work better with his work schedule. He usually gets off work too close to the bedtime trazodone hour as it is. He would still be at work if he tried taking the Zyprexa 2 hours earlier than the Trazodone. 

[Altostrata]

Your partner may have to cope with a transitional phase of being overdrugged at inconvenient times. Once his dosing gets on a stable schedule, he can start to reduce Zyprexa.

[UncleLeroy]

We have been holding the Zyprexa at 12:30 daily for 3 days and so far (although this is probably too early to tell truly) he hasn't had any new negative effects. He still experiences the initial zombification within 30 minutes to an hour, but subsides in less than 2 hours.

 

 Unless there is another reason not to take it at this time that I'm not clear about, we will keep it here as he is doing fine at work with this schedule so far.  

 

Either way, we will likely hold for more than a week at this time while we get our supplies together for tapering. 

[Altostrata]

On 3/18/2023 at 1:19 PM, UncleLeroy said:

Unless there is another reason not to take it at this time that I'm not clear about, we will keep it here as he is doing fine at work with this schedule so far.  

 

Either way, we will likely hold for more than a week at this time while we get our supplies together for tapering. 

 

Sounds like a good plan.

[UncleLeroy]

We are still holding to begin tapering Zyprexa.

 

I need some suggestions about whether to crush the tablets and use the digital scale 

...or the water titration method.

 

With the digital scale, I realize that I would be using the actual weight of the tablet and making a 10% reduction on that, but for examples sake let's say the weight is the same as the dose. At a 10% reduction of 5mg, I need to be able to read 4.5 mg. The digital scale GEM20 only reads to the 1000th of a gram. So 5mg would read as .005.

 

4.5 mg should read as .00045. This scale wouldn't read to the next place value so how would I measure? 

 

I'm still reading through posts about the water titration method and am trying to level up my math game, which is a bit weak.

 

When I figure out which way to go with this I can order the right supplies. 

[FireflyFyte]

10 hours ago, UncleLeroy said:

...or the water titration method.

 

I am doing the water titration method and am finding it to be fairly straight forward. I take my 2.5mg pill and put it in 25ml of water so 10ml = 1mg so with a 5mg pill you could use 50ml of water for the same conversion. At the moment, I use a 1ml syringe to remove my titration amount. For example, I am currently on 2.025mg so I take 4.75ml of liquid and drink the rest.

 

As I type this out, it sounds complicated but swear in practice that it's not that bad 😂

[UncleLeroy]

Thanks @FireflyFyte I'm sure it's not as complicated as my brain thinks it is, but I will be asking for any competant member willing to check my work before each reduction. 

 

Currently we are holding at the initial dose of 5mg after gradually changing the time of day. 

 

Moving forward, we will begin the gradual switch over from tablet to liquid while keeping the same initial dose. We'll do this by dissolving a 1/4 of the tablet in water and taking the rest in tablet form. Then 1/2 liquid, then 3/4 liquid, then all liquid.

 

When switching over from tablet to liquid, is the hold still 4-7 days on each adjustment?

 

[Gridley]

13 hours ago, UncleLeroy said:

let's say the weight is the same as the dose.

Because of the fillers, the weight is always much more than the dose.  For example, the weight of my brand of Lexapro was 10X the dose.  

 

If you want to use the titration method, that's fine.  I know Altostrata prefers it.  I could never get my head around it, but that's me.

 

29 minutes ago, UncleLeroy said:

When switching over from tablet to liquid, is the hold still 4-7 days on each adjustment?

 

Yes.

1/4 liquid, 3/4 tablet for 4 to 7 days.

1/2, 1/2 for 4 to 7 days.

3/4 liquid, 1/4 tablet for 4 to 7 days.

All liquid thereafter.

 

Give it few days let things settle and to be sure the liquid agrees with your husband before starting to taper.

Edited March 21, 2023 by Gridley

[FireflyFyte]

27 minutes ago, UncleLeroy said:

When switching over from tablet to liquid, is the hold still 4-7 days on each adjustment?

 

I did two days at each stage and than held for a little over a week at full liquid before making my first drop but probably safer to hold 4-7 days instead.

[UncleLeroy]

@Gridley so theoretically if his 5mg tablet weighs 10 times more than his dose, I would be taking 10% off 50 mg, so I would only need the digital scale to be able to weigh 45 mg, which would read as .045? And the next 10% reduction would need to read at .0405? And would I round up to .041?

 

Thanks to all for your input.

[Gridley]

10 minutes ago, UncleLeroy said:

so I would only need the digital scale to be able to weigh 45 mg, which would read as .045?

Yes.

10 minutes ago, UncleLeroy said:

And the next 10% reduction would need to read at .0405? And would I round up to .041?

 

The scale doesn't have enough places to read .0405.  So you'd have to round up to .041.