UncleLeroy: Lexapro, Zyprexa, Trazodone

[UncleLeroy]

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

 

Yes, that's what meant. Calculate the reduction, then round up to the nearest 1000th place before measuring.

 

Thank you, that helps a lot in understanding and deciding which route to choose. Trying to keep it simple, steady, and stable as much as possible from beginning to end. 

 

[Gridley]

3 minutes ago, UncleLeroy said:

 So you'd have to round up to .041.

If you want to quote something so you can refer to it in your post, highlight the quote.  A little rectangle with "quote" in it will appear.  Click on it and the quote will appear in your post wherever your cursor is.

 

15 minutes ago, UncleLeroy said:

Trying to keep it simple, steady, and stable as much as possible from beginning to end. 

That's the ticket.

[UncleLeroy]

Thanks @Gridley. I thought I had figured out the quote thing before, but missed a step. Will do how you described for next time.

[UncleLeroy]

I have ordered the GEM20 digital scale, some empty capsules, and a pill crusher to get ready for the initial taper off 5mg Zyprexa. I am reading through posts about dry cutting, and listening to Mad in America podcasts while waiting for our supplies to arrive. Although it is tempting to want to reduce the Zyprexa more quickly in the beginning and do a slower taper around the halfway mark, I'm sure it's probably wise just to start and stay with the 10% reductions throughout the taper. I somewhat understand the hyperbolic taper, serotonin occupancy science jargon, but feel like there is more involved than just that. While staying on the drug itself worries me, I would rather my husband stay stable throughout the taper as much as we can control so we don't "muddy the waters". I will look into tapering with liquid titration further down the line. I'm sure we have plenty of time (begrudgingly) before we get to the point of needing such small doses. Thanks to this site, I feel like we have a good handle on our situation before even getting started, and for that I am grateful!

[UncleLeroy]

One question:

If and when we decide to make a switch to liquid titration (diy), is there any consensus on when a good time would be, say the halfway mark? Sooner, or at the end? I know it would make sense at the end to get more accurate measurements of minute doses. What are pros and cons of any of these choices?

[Gridley]

12 minutes ago, UncleLeroy said:

If and when we decide to make a switch to liquid titration (diy), is there any consensus on when a good time would be

If you're going to switch, I'd do it at the beginning before you started tapering, for several reasons:

 

First, you'd be doing your switch from a more stable place than once you start tapering (since even slow tapering generally causes some withdrawal symptoms).  Second, doing the switch before you taper psychologically lets you get all your ducks in a row before starting your taper.  Third, you wouldn't have to interrupt your taper to do a switch (the old one change at a time rule--plus keeping things simple).  Fourth, if the liquid method doesn't work physiologically for your husband (it works for most but for some it doesn't), you won't have to try to discern whether the problem is the liquid method or withdrawal from an ongoing taper.  Fifth, if the liquid method doesn't work for you technically (you find it too difficult), you'll have that knowledge before beginning the taper.  

 

 

[UncleLeroy]

 Welp, I have ordered all the supplies and we'll just go with it to the end. Thanks again @Gridley

[Altostrata]

In a switch to liquid, it's a good idea to take part of your daily dose in liquid and part in tablet form, taper from the liquid. This allows you to get used to the liquid.

[UncleLeroy]

Thank you. I think our due to our best route is to stick with dry measurement weights, but I would do a partial switch over before full liquid. This information/site is such a blessing.

[UncleLeroy]

I am recapping my husband's situation (mainly as a reference point for me).

Beginning February 13 he was put on

 

Lexapro 10 mg and Zyprexa 5mg both taken in the morning.

Trazodone 100 mg taken in the evening.

 

He has taken all consistently beside 2 days of not having his prescription available on 3/8 & 3/9. WD symptoms were mild, mostly nausea and GI upset for a couple of days.

 

With more research about these drugs  and advice from this site, we decided to taper Zyprexa first at a 10% taper. 

 

From 3/14 to 3/17 we gradually moved from taking Zyprexa in the morning to midday at 12:30 PM

 

His schedule is Lexapro at 9 AM, Zyprexa at 12:30 PM, Trazodone at 11 PM.

 

We ordered supplies to begin the taper using a scale. We received scale on 3/25, and will receive empty capsules and pill crusher shortly. 

 

On February 8, 3 days after his last drink of alcohol he experienced acute mental and physical withdrawals symptoms and went to the ER. He was placed on an involuntary hold and became stable while in hospital awaiting a placement for detox. He went to a detox/rehab facility on February 13 weighing 155 lbs. He now weighs 180 lbs. He has a greater appetite and also has been working out at the gym. He is also trying to control his food cravings (especially sweet carb-laden treats) with healthier protein based foods. He has always been thin-frame and muscular, but also need to gain this amount (albeit a lot of it has seemed to go to his gut, probably due to the carb cravings).  

 

We plan to begin the first 10% reduction of Zyprexa this week when all supplies are in and I am comfortable using and reading our scale.

 

The plan is to weigh 7 pills, take the average weight, take a 10% reduction off the average weight, crush and weigh the 7 pills, put them in the empty capsules and store them in a pill box for the week, save any leftover powder in a dry, clean, dark bottle). We will do this same 10% reduction for the first 4 weeks, preparing one weeks worth at the beginning of each week.  Base on any WD symptoms, if things go smoothly, we will make another 10% reduction (off the current dose) following this same process for the next 4 weeks. If WD symptoms are mild and he remains stable, we will do this same process but for 3 weeks instead of 4. 

  

Okay, just typing this all out helps me process our way forward. Thank you for allowing the space! 

[Altostrata]

Sounds good. Please let us know how your husband (and you) are doing.

[UncleLeroy]

Thank you Alto, we are doing well so far. He's accustomed to me keeping him on schedule and or asking how he's feeling (looking for new or stronger symptoms). I am just beginning to process that for the short time he has been on these drugs, it will effectively take about one year each to taper off them safely.  3 years for 1 month (now 2). I know it's the safest, least risky way to go, but I am seething at the consequences of accepting them in the first place. I know I am not alone in this feeling, but if I had gone with my intuition the same week he came home from detox, he would have cold turkey-ed at my suggestion quite possibly with no ill or long term effects. But who knows... and we can't go backwards now, so we'll just move forward with the cards we're dealt. 

[Altostrata]

Tapering off can take a long time, but adverse drug effects tend to diminish as the dosage is lowered.

 

Sorry your husband was caught in this trap.

[UncleLeroy]

We received our digital scale yesterday and should receive the capsule and pill crusher today. I spent time playing with the scale and weighing supplement tablets, crushing with a spoon and practicing weighing. (mine, as my husband doesn't take any).

 

I went ahead and weighed what he has left of his Zyprexa 5mg before his next prescription is filled. He has 13 tablets. I weighed them individually and took the average weight. 

 

If someone can check my math...

 

The average weight of these tablets is .189 grams 

 

10% of 5 mg is 4.5 mg.

 

So I take 10% off the weight of .189 g to get .1701 grams and round to .170 grams before weighing as the scale only read to the thousandths place. 

 

Also if anyone has the time, I calculated what 2% of his dose would be for end taper ideas and got .00378 grams, rounding to .004 grams. If this is correct, and this scale only starts weighing at .004, I could theoretically use it to the end to calculate the very last dose if all goes well enough and we choose to jump off at 2% of original dose? 

 

Thanks to all!

[Gridley]

56 minutes ago, UncleLeroy said:

I calculated what 2% of his dose would be for end taper ideas and got .00378 grams, rounding to .004 grams.

There isn't a hard and fast rule about when to jump to zero.  I've seen the 2% of original dose standard mentioned.  However, .004g is 4mg, which is much higher than I would recommend.  The jump-off point I've seen used most often recently is well into the point 00's.  For example, I jumped off Lexapro at .025mg and I've seen lower.

 

It's really going to depend on how your husband is doing when he gets to the low doses. I don't know that you can predict it at this point.  

[UncleLeroy]

Thank you Gridley, I meant 2% of the weight would be .004 grams which would be  (if my math is right) .14 mg of the original 5mg dose. 

But I understand that we can't predict. And making further divisions visually after we get to the lowest readable weight may be necessary. I hope I'm not confusing...I feel I have it figured out one moment, then fairly confused again. Sorry, and thank you. 

[Gridley]

4 minutes ago, UncleLeroy said:

I feel I have it figured out one moment, then fairly confused again.

Not a problem, UncleLeroy.  It's a whole new world and you're doing great at understanding it.  

[UncleLeroy]

We began the 10% taper of Zyprexa yesterday (March 28, 2023). 

Needless to say, but I am on high alert for any type of changes.

 

He's never been on any of these drugs in the past, but he knows withdrawal from other "things" in general (from his younger years, and recently alcohol). 

 

I have informed him of things to look for (without trying to cause undue stress) if experiencing withdrawal symptoms and to be as forthcoming as possible of any physical or emotional symptoms.  And also that because we are doing small reductions and at long intervals we should expect maybe some symptoms, but they should be short lived and temporary...they will pass and we will get through it.  He's never been a very big "complainer" so I have asked for him to let me know if things start to go sideways and am trusting that he will. He's had an even, calm temper as long as I have known him (except during the acute phase of alcohol withdrawal), so I feel like (hope!!!) I can pick up on any changes also. He's actually less anxious/fearful about all of this than me...for now. 

[FireflyFyte]

I am down from 2.5mg of Zyprexa to 1.93mg and have yet to experience any significant withdrawals with dropping 5% every two weeks so hopefully your husband will be similar with a slow, and steady, taper.

[UncleLeroy]

6 hours ago, FireflyFyte said:

I am down from 2.5mg of Zyprexa to 1.93mg and have yet to experience any significant withdrawals with dropping 5% every two weeks so hopefully your husband will be similar with a slow, and steady, taper.

 

Thank you for the encouragement and glad to hear your taper is going well.

 

I realize this site has so many coming in for assistance in safely tapering after being terribly advised to taper quickly and are already in withdrawals from previous attempts. I wonder if there are any people here that have begun this 10% taper from the beginning before withdrawals, switches, etc and if that makes a difference at all in terms of symptoms.  I realize everyone will have their own journey regardless, but I couldn't help but wonder. I haven't read of any intros yet where this seems to be the case, but I also haven't read them all.  I am though, little by little. It is hopeful to hear that even with all that others have been through before beginning again THIS way, that it still works, and you do recover. I am thankful all of you have found this resource, (Alto! and all of her moderators, donators, mentors et al!) and am also saddened, though not surprised, that the ones who should be doing this for their patients have no idea how (willful negligence, uninformed, paid off, or whatever it is), such a shame.

[Altostrata]

7 minutes ago, UncleLeroy said:

I wonder if there are any people here that have begun this 10% taper from the beginning before withdrawals, switches, etc and if that makes a difference at all in terms of symptoms.

 

We sure hope that tapering more gradually from the start is much easier! Indications are that it is. However, UncleLeroy has a history of going on and off psychotropics (alcohol), so better err on the safe side.

[UncleLeroy]

11 minutes ago, Altostrata said:

We sure hope that tapering more gradually from the start is much easier! Indications are that it is. However, UncleLeroy has a history of going on and off psychotropics (alcohol), so better err on the safe side.

You're not wrong! And that withdrawal was pretty recent. The pattern he used to taper off the alcohol probably should have been better guided. And it did happen that he could/did reduce greater amounts quickly at the start and held with minimal consistent amounts for many months (maybe 6). Then he went from only 3 beers a night for a few months, then 2 for a few, then off.  He had already quit drinking any liquor the year before, and that wasn't really his thing anyway. Mostly beer. I had no idea withdrawal from such a small amount in the end could do such a thing, or cause such a thing as psychosis, especially since we thought were going about it the safe way. I felt so naive and guilty for not reaching out for more information...it seemed to be going well...until it didn't. Lesson learned. So also, in my mind, it stresses the important of slow and steady and quite possibly microtapers towards the end. After the experience we had from that, I am definitely erring on the safe side, and am pretty happy he's agreeing to it. 

[UncleLeroy]

Today is day 5 of 10% taper of 5mg Zyprexa to 4.5 mg. No WD symptoms have presented themselves to date.

 

I do not like my cheapo pill crusher as the coating of the tablet is quite tough.  I am going to try my marble mortar and pestle for the next weeks batch. Hoping to cut my time in half with the process.  If that still doesn't work, I am going to look into an electric pill grinder.  We'll see.

 

I pick Sundays to weigh all 7 tablets we'll be using for the following week.  I have cleaned out a desk drawer to store the scale, empty capsules, saved powder, post-its, etc. I now have a "station" and feel more organized and confident. I find this helps me get on with the rest of the week and keep this in the background as much as possible, so all the hubs has to do is continue to take his daily regime... morning, noon, and night.  Simple, steady, stable.  

 

I have been thoroughly immersed in this site, however.  Much to our benefit (as long as I set a timer to tell me to go to sleep). 

 

I just have to say, I am quite impressed with the dedication and patience of you all in your service to others.  It is something else, I tell you. I am amazed.

[Altostrata]

Thank you. Very impressed with your own dedication and attention to detail! 

[UncleLeroy]

I have a few things that have been weighing on me.

 

First, I understand based on each drug my husband is taking, Zyprexa is deemed to be the most dangerous, and we are definitely going to continue tapering this one first.

 

But I can't seem to let go the information about major interactions listed between Lexapro and Trazodone. 

 

I know it is not generally promoted to alternate between tapers and I understand the reason, but I have read that it "may" be a choice.  I suppose I am wondering if there are reasons that may justify this (at our own risk, of course) for our situation.

 

I would like to them all down a bit and not wait to be off one completely before beginning another.  

 

I am concerned, due to his alcohol abuse, how much his liver and kidneys can tolerate the current doses and if these drugs interactions could possibly play a bigger role due to this. 

 

I had already been thinking through this, and then read Rhiannon threads about alternating her tapers and it sparked further curiosity.  I see how it can be complicated, but also see how it is manageable, if one is organized and disciplined with record-keeping, etc.

 

When thinking through how this could be applied to our situation, I think about getting the Zyprexa down to half the original dose and hold on that, then begin working on Lexapro, then pause Lexapro at the halfway point, then move on to Trazodone.  Once they are all at the halfway doses, go back to Zyprexa and completely taper off one before moving to the next. If seems that lower doses, below half are more of a struggle for many and this would potentially reduce complicating/confusing WD symptoms if only tapering one at a time from this point.  I struggle with accepting the current doses of all of them and continuing those doses for the entire length of time it takes to get completely off one. I suppose psychologically, I would feel better knowing they are all reduced some in the beginning.  

 

I know part of me considers this because I'm like the rest that just want it all over and done, but I also wonder if being able to get each one to a lower dose by alternating could be valid for us specifically. 

 

Is this only usually supported if problems with interactions are blatantly severe? Or is the thought of severity enough and desiring prevention enough to justify?

 

I think it is in my own mind, but I'm pretty sure I'm biased.

 

Tapering them all down (alternating of course, with holds) would help mitigate potential interactions in the future (or ones that could be happening without us being aware until it is very apparent).  I accept that is will take just as long or longer to be completely off all three, and I am not trying to short-cut length of time at all, just the amount of time he is on original doses for all.

 

I am going through pros and cons, reading through threads.   We still have a quite a number of months before reaching the halfway mark on dosage with Zyprexa before making any decisions.

 

My brain is "ping-ponging" already, but I hope I am making sense and this is not irrational or unreasonable to consider. 

[Gridley]

 

33 minutes ago, UncleLeroy said:

suppose I am wondering if there are reasons that may justify this (at our own risk, of course) for our situation.

 

I don't have the link, but here is Rhiannon's reasoning for doing a partial reduction rather than going to zero on one drug.  

 

QUOTE:

 

"PS: Although I will personally continue with my multi-micro-taper, I'm beginning to think that a more viable option for many people-- which would confer most of the benefits of the multi-drug taper--is to focus on reducing doses of one drug at a time. 

 

In other words, taper one med down to 3/4 or 2/3 or half the original dose; then taper another one; then another one; then go back to the first one and reduce it more; et cetera. 

 

This way you're still only tapering one at a time, but you're also reducing the full load together as a mixture, rather than forcing your brain to adapt to a complete transition off one drug entirely. I really think it's easier for the system to adapt this way."  

 

END OF QUOTE

 

I'm reducing my Valium and Imipramine in alternating chunks because of my limited supply of both drugs.  This likely isn't a factor for you.  I've alternated twice so far with no ill effects that I can feel.  It can take a bit longer, since you'd probably want to hold for a time at the end of one "chunk" before beginning the next. 

 

44 minutes ago, UncleLeroy said:

 

When thinking through how this could be applied to our situation,

Your reasoning in this paragraph seems sound to me.  

 

 

 

[UncleLeroy]

1 hour ago, Gridley said:

I'm reducing my Valium and Imipramine in alternating chunks because of my limited supply of both drugs.  This likely isn't a factor for you.  I've alternated twice so far with no ill effects that I can feel.  It can take a bit longer, since you'd probably want to hold for a time at the end of one "chunk" before beginning the next. 

That's good to hear of no ill effects so far. My husband is always concerned with supply chains and the possiblity of well... anything not being available when needed, not just these prescriptions. Considering we already were delayed once for 2 days getting his filled, the idea of having more than we need already on hand if doing an alternating, multi-drug taper sounds less stressful in the long run.

[FireflyFyte]

15 minutes ago, UncleLeroy said:

That's good to hear of no ill effects so far. My husband is always concerned with supply chains and the possiblity of well... anything not being available when needed, not just these prescriptions. Considering we already were delayed once for 2 days getting his filled, the idea of having more than we need already on hand if doing an alternating, multi-drug taper sounds less stressful in the long run.

 

First, I would recommend having a backup doctor who can prescribe medication if ever needed. My current prescriptions are being filled by my psychiatrist but my PCP has agreed to fill them if needed. Takes some of the stress out of worrying about getting them filled.

 

Second, while I haven't started yet, I do plan to taper down on my Gabapentin once I get to around 1mg of the Olanzapine/Zyprexa. I am feeling very flat, overall, and not sure which (if not both) are to blame so am hoping that by lowering one, and then lowering the other, I can bring more of my emotions to the surface. I think it is a decent strategy for those of us unfortunately poly-drugged.

[Altostrata]

Suggest you taper Zyprexa part way, then trazodone. Trazodone is the major offender among the drug-drug interactions.

 

Zyprexa taken at bedtime should replace the trazodone for sleeping.

[UncleLeroy]

16 hours ago, Altostrata said:

Suggest you taper Zyprexa part way, then trazodone. Trazodone is the major offender among the drug-drug interactions.

 

Zyprexa taken at bedtime should replace the trazodone for sleeping.

Okay, we will. Thank you. 

 

Question:

Once we get Zyprexa down part way and start tapering Trazodone, also meaning to come off that completely before doing anymore alternating of Lexapro or Zyprexa?  I understand it that way, just want to be sure.

 

 

On a side note, just thought I would share that

the zombification of the Zyprexa doesn't noticeably present itself any longer.

 

Initially in the first month, he said he could feel it within 30 minutes or so of taking (pointing to his pineal gland) or maybe he was pointing to his whole brain...who knows. And I could tell by his behavior he was stupified, but no longer can tell.   If it stays that way during further reductions, fingers crossed it won't be an issue if he has to take it at work a few times to move it to the bedtime hour.

[Altostrata]

Yes, I would go off trazodone completely, it interacts badly with both Zyprexa and Lexapro. 100mg trazodone is quite a high dose for sleeping.

[UncleLeroy]

5 hours ago, Altostrata said:

Yes, I would go off trazodone completely,

Okay, thank you 

[UncleLeroy]

Update: April 7, 2023 

 

About halfway through week 2 on initial Zyprexa reduction of 10% (4.5mg). 

 

No noticeable WD symptoms as of yet.

 

Will continue to the end of the 4th week.

 

Will continue to ruminate on how far to taper Zyprexa down before holding that and beginning the Trazodone taper.  

 

Definitely want to taper Zyprexa far enough to make it less dangerous, but also hold at an easy number to work with, and where stability is more likely.     

 

Not sure if half the original dose (which is 2.5mg) or somewhere close will/should be that number yet, or if we should start on reducing Trazodone sooner.  Either way, it seems we don't want to get below that before working on Trazodone completely. We also want the Zyprexa dose in a safer dose zone, if there is such a thing.  Seems below halfway becomes more troublesome to many.  If someone has that magic trick to share, I'm all ears. 

 

I hate them ALL, (did I mention that yet?)

 

Had some good conversations and "education" classes with hubs about serotonin syndrome (including reducing strenuous exercise, excess sun, massage, etc.)  Also discussed traffic jams in the liver with Lexapro and Trazodone, WD symptoms, and harm reduction. It all seemed to click pretty well after sharing a post/explanation by Rhiannon on How psych drugs remodel your brain.

 

I stayed focused on the positives of it all while stressing the seriousness of the situation and importance of keeping a regular dosing schedule and being aware and forthcoming of symptoms when/if the arise and how to proceed.

 

You all are so busy, and I truly appreciate your assistance and combined knowledge and expertise in these matters.  

 

I will leave you all to help those that may require more attention than us presently, unless something urgent comes up, although I will continue to post updates (even if it is just for me to refer back to). 

 

Hubs is 62 days alcohol free.  Thankful for that and thankful for you all.

[UncleLeroy]

I meant to mention that the marble mortar and pestle I already owned is fantastic for pulverizing tablets to literal powder, even the coating. It is way less time consuming for me and not frustrating at all compared to the disappointing store bought pill crusher.

[Altostrata]

Please add your technique to 

 

 

On 4/7/2023 at 10:38 AM, UncleLeroy said:

About halfway through week 2 on initial Zyprexa reduction of 10% (4.5mg). 

 

This is good. Zyprexa can have a long half-life, with almost a month to wash out, so we're not going to be able to taper faster than each month. The 3rd and 4th weeks after a decrease will be crucial.

[UncleLeroy]

14 hours ago, Altostrata said:

This is good. Zyprexa can have a long half-life, with almost a month to wash out, so we're not going to be able to taper faster than each month. The 3rd and 4th weeks after a decrease will be crucial.

Ugh. Okay. I was wondering if no WD symptoms yet was a good sign to possibly faster taper than every 4 weeks but alas...we aren't even to the washout. It is what it is.