UncleLeroy: Lexapro, Zyprexa, Trazodone

[UncleLeroy]

I tried posting my technique, but after I hit submit, it cleared and didn't post. Will try again soon.

[FireflyFyte]

29 minutes ago, UncleLeroy said:

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. 

 

I tend to feel withdrawal symptoms around 5/6 days after a drop but everyone is different and, as Alto mentioned, Olanzapine has a long half-life so some might not experience withdrawal symptoms for weeks afterwards. I would stick with the every 4 week schedule. 

[UncleLeroy]

On 4/10/2023 at 10:35 AM, FireflyFyte said:

 

I tend to feel withdrawal symptoms around 5/6 days after a drop but everyone is different

FfF, how long do your symptoms usually last, and how long do you hold after they subside?

 

I know everyone will be different, just trying to get an idea of how long to hold after stabilizing if that occurs with us. 

[UncleLeroy]

2 minutes ago, UncleLeroy said:

I tend to feel withdrawal symptoms around 5/6 days

Also, if half-life is an average of 30 hours (for olanzapine) and I read somewhere to multiply that fives times, to find clearance of dose reduction.

 

Are clearance and washout defined the same? 

 

Astro said it can take up to 4 weeks for washout so I'm not sure where I'm getting the idea to multiply half-life by 5, and for what it is I'm finding...I just read here somewhere. But I've read so many things lately.  

 

If that is the way to do the math for clearance, it would make sense with when you begin to feel symptoms. (30*5)/24=6.25 days. 

 

I realize that isn't all that's involved with WD symptoms, and it can be latent, etc. just trying to understand concepts.

[UncleLeroy]

Typo above ...I meant to type Alto. Silly autocorrect.

[FireflyFyte]

1 hour ago, UncleLeroy said:

FfF, how long do your symptoms usually last, and how long do you hold after they subside?

 

I do 5% drops every two weeks and my symptoms have subsided by the time I am ready to drop. If it happens that they persist, I might consider holding longer and stabilizing better before dropping again.

[Altostrata]

Washout is the same as clearance. I allow 6 weeks for full washout. 6 half-lives also determine when one reaches the steady state of drug plasma level, in either increasing or reducing (tapering) dosage.

[UncleLeroy]

 

Update (for personal reference): 

 

Nearing the end of the 3rd week of initial Zyprexa taper of 10% (4.5 mgai from 5 mgai). 

 

No noticable WD symptoms to date since beginning taper. 

 

4th week of initial taper begins Tuesday.

 

Will begin 2nd reduction (4.05 mgai) the following Tuesday if no WD symptoms arise during last week of initial taper, otherwise will intend to hold if symptoms arise until stabilized. 

 

 

[UncleLeroy]

On Tuesday, we should begin the next 10% of Zyprexa/olanzapine to 4.05%.

 

I previously stated that my husband has not had any WD symptoms of note for the 4 weeks since beginning the  Zyprexa taper. 

 

He has had dull kidney pain in the past couple of years as frequent as once or twice over the course of several months at a time.

 

The kidney pain has become more frequent, as in once or twice a week to every few days increasingly the last couple of months, which coincides with starting the psychotropics. 

 

Between Zyprexa and Trazodone, both being horrible drugs, is there one over the other that is possibly more damaging to kidneys?

 

Any suggestions or knowledge in this area is much appreciated.

[UncleLeroy]

8 minutes ago, UncleLeroy said:

On Tuesday, we should begin the next 10% of Zyprexa/olanzapine to 4.05%.

Edit: to 4.05 mg...not %

[Altostrata]

17 hours ago, UncleLeroy said:

Between Zyprexa and Trazodone, both being horrible drugs, is there one over the other that is possibly more damaging to kidneys?

 

Please review metabolism of both these drugs, one or both may be metabolized through the kidneys. If there's a prior kidney issue, this could exacerbate it.

[UncleLeroy]

2 hours ago, Altostrata said:

Please review metabolism of both these drugs, one or both may be metabolized through the kidneys. If there's a prior kidney issue, this could exacerbate it.

Thank you. I have reviewed, and am continuing to research. I don't want to burden anyone by asking questions that have already been answered here, or where the information can be found independently.  I have used the search function on this site as well as other internet searches.  I was just wondering if anyone else had knowledge or any info, links that could lead more into understanding that I may not have found yet.  

 

What I've found so far on various medical sites, drugs.com, etc is that 

 

Both are extensively metabolized via the liver, 

 

There is no data available concerning the pharmacokinetic disposition of trazodone or its metabolites in patients with renal and/or liver disease. Should be administered cautiously in patients with significantly impaired renal or liver function. 

 

Trazodone being 1% of the drug found in its  unchanged from in urine, 74% excreted in urine, 21% excreted in feces.

 

Olanzapine being 7% of the drug found in it's unchanged form in urine. 53% excreted in urine, 30% in feces. 

 

Found a study stating acute kidney injury at 1% of 97,000 elderly participants 65 years of age and older taking olanzapine, average age 81. Leroy is 53, but his kidneys may be much older (sigh).

 

We are just going to continue trodding along with the taper, while monitoring symptoms and making sure he keeping electrolytes balanced. Hopefully reducing drug burden will eventually alleviate symptoms.

[UncleLeroy]

Altostrata, I do so appreciate you attending my concerns. I am sure you have so many to attend. I just wanted to thank you. (And Gridley) for helping us navigate this unfortunate detour over unknown terrain.  I am doing my best to research and understand, and regardless if I do or don't get it all, I do feel that following the advice from you all is the best course of action. You all seem to be the only experts worldwide that anyone can seek safe advice on such matters.  Again, I thank you. 

[Altostrata]

You're welcome. 

[UncleLeroy]

April 25, 2023

 

No WD symptoms arose during first 4 weeks of 4.5 mg Zyprexa/olanzapine (10% of 5mg). 

 

Positives this last month:

-Some improvement of sexual dysfunction, maybe coincidental. Maybe not. 

-Still alcohol free

-Moderately lowered carb and sugar intake

-Still sleeping about 8 hours per night. 

-Weight increase has slowed down.

 

Began 2nd reduction to 4.05 mg today.

[UncleLeroy]

At the end of 1st week of 2nd reduction, 2nd month of Zyprexa taper.

 

Still going without noticeable WD symptoms, except joints/muscles are aching a little more.

 

This has been a side effect since starting these drug. 

 

Planning tomorrow to add magnesium (chelated/glycinate) as a supplement starting at a low dose. 

[UncleLeroy]

During 2nd month of taper achy joints and muscles grew in intensity beginning on 4th day after reduction (but not debilitating, could still work and perform daily activities), then subsided 7-8 days later. Only noticable WD symptom so far, which is also a side effect. 

 

Began magnesium May 2, increased dose May 6. Doing fine with magnesium. 

 

Adding omega-3 this week. 

 

Planning 3rd reduction of Zyprexa/olanzapine May 23 to 3.65 mg.

[Altostrata]

23 hours ago, UncleLeroy said:

achy joints and muscles grew in intensity beginning on 4th day after reduction (but not debilitating, could still work and perform daily activities), then subsided 7-8 days later.

 

If this pattern shows up after a reduction, it's most likely a withdrawal symptom. I'm a little concerned that it lasts 7-8 days. If after the next reduction, there's more aching and it lasts longer, that's a sign that reductions should be a bit smaller.

 

Good to hear of the improvements!

[UncleLeroy]

14 hours ago, Altostrata said:

If this pattern shows up after a reduction, it's most likely a withdrawal symptom. I'm a little concerned that it lasts 7-8 days. If after the next reduction, there's more aching and it lasts longer, that's a sign that reductions should be a bit small

I do think it's a withdrawal symptom...but also just stating this was also a side effect when initially starting these drugs. 

 

The intensity didn't last for the full 7-8 days, it was more like a fade in, intense for a few days, then faded out (to what has been the normal amount of achiness since starting these drugs).

 

The way it began was in elbows, thumbs and top of feet and moving into neck, lower back. But also mildly achy all over (like when getting the flu). I suppose we can call it myalgia? It was most intense in those specific areas mentioned. Then it faded out in the same order the aches came in. 

 

I will definitely be paying close attention to the next taper and adjust accordingly thereafter.  

 

We hadn't added magnesium before this, so I am hoping it may mitigate some of the intensity with the next reduction. It seems to be helping already.  Using hydromassage at the gym (gently) and stretching are also helping. 

[Altostrata]

10 hours ago, UncleLeroy said:

The intensity didn't last for the full 7-8 days, it was more like a fade in, intense for a few days, then faded out (to what has been the normal amount of achiness since starting these drugs).

 

This is how withdrawal symptoms would show up and resolve.

 

Magnesium is a muscle relaxant, so that might help.

[UncleLeroy]

11 hours ago, Altostrata said:

This is how withdrawal symptoms would show up and resolve.

Hopefully with this next reduction we will be better able to gauge whether or not to decrease the % of cuts. Even at the most intense achy days he was still able to function, just mildly irritated with it.  If we can avoid this by adjusting the reduction, we certainly will.

 

11 hours ago, Altostrata said:

Magnesium is a muscle relaxant, so that might help.

Hope so as well. We added Omega 3 fish oil today also. 

[UncleLeroy]

Thought I'd leave this info here for documentation.

 

Leroy had his scheduled appointment with psychiatrist today. (Voluntary, but also the prescriber, which is really the only reason he is keeping the appointments).

 

Dr. asked him if he is experiencing any side effects from the medicine. One of the things Leroy said was that he feels more tired than he feels he should. Dr. said that it's probably the Zyprexa and if he wanted, he could just break the pill in half and only take half and that should help with fatigue.  That's it. No taper down to half or anything. 

 

I suppose at least that's better than him deciding to prescribe a lower dose since we need the 5mg for our taper.

 

Since we have already become aware of the importance of slowly decreasing, obviously that is how we plan to get to the halfway mark.

 

Luckily he doesn't have another appointment for almost 5 months and will continue to receive his prescription in the meantime.

[Altostrata]

Good to hear you're still able to manage the taper.

[UncleLeroy]

Today's the day we've reduced Zyprexa to 3.65 mg.

[FireflyFyte]

2 hours ago, UncleLeroy said:

Today's the day we've reduced Zyprexa to 3.65 mg.

 

Hope it's an easy drop for your husband.

[UncleLeroy]

Reduced Zyprexa yesterday to 3.65 mg.

 

Experienced nausea and chills today mid morning before Zyprexa dose. (No sweating/no vomiting).

 

Ate usual brunch. Had a cup of ginger tea.  Both helped.

[UncleLeroy]

Nausea subsided within a few hours

[UncleLeroy]

Last weeks reduction (3rd month in) has gone smoothly so far. 

 

So for the 3 reductions this far:

 

1st month - no symptoms

 

2nd month -by 4th day muscle/joint pain fairly intense and grew to full body flu-like aches especially for a few days, but not debilitating. Symptoms lasted a week once they began.

 

---added in magnesium and fish oil

 

3rd month - nausea next day, subsided quickly. By 4th day muscle/joint pain very mild but still noticable, no full body aches, lasted 3 days.

 

Sleep has remained solid (8.5 hours) and mood stable throughout taper thus far.

[Altostrata]

If Uncle Leroy can tolerate those symptoms, sounds like the taper is going well. If the withdrawal symptoms become more severe, you may wish to make slightly smaller reductions.

[UncleLeroy]

5 hours ago, Altostrata said:

If the withdrawal symptoms become more severe, you may wish to make slightly smaller reductions.

Thank you, this is exactly what we would do.  So far, they are tolerable. 

[UncleLeroy]

On second thought, although taper is going well so far...I think why not just split the 10% reduction in 2 week intervals per month at 5% each so the step downs are smaller but still at a 10% reduction by the end of each month. If this lessens even the mild WD symptoms, then the little extra math per month is worth it.  

 

Also, now that WD symptoms have abated, and before the next months reduction, we are going to begin moving Zyprexa dose closer towards evening to see if it helps with daytime fatigue.  That part is a bit tricky to keep it at least 2 hours away from Trazodone, but also so that it doesn't effect him too much while still working.

 

We plan to reduce Zyprexa to at least the halfway mark in attempt to lessen it's side effects before holding and then beginning to taper trazodone. 

 

[UncleLeroy]

For a little over a week, we slowly moved taking Zyprexa from 12:30 pm to 8:00 pm.

 

Lexapro 9:00 am, Zyprexa 8:00 pm, Trazodone 11:00 pm.

 

Leroy is now sleeping through the most of the side effects of Zyprexa and his days are much improved of general fatigue, grogginess, and bloating. (Thank you for the suggestion Altostrata, to move this towards the evening). 

 

All of this was so new and uncharted for us in the beginning and the side effects seemed much stronger than now that we were too nervous to move it.  We worried of how it would effect his work. I am relieved we were able to without any issues.

 

 

 

[Altostrata]

You're welcome!

[UncleLeroy]

We made another reduction yesterday (June 20) on Zyprexa.  We decided for this month to begin splitting the 10% reduction into 2 weeks at 5% reductions each.  Although, Leroy has mild and manageable symptoms of muscle and joint aches after each reduction, we are going to see if reducing in half increments lowers them even more. 

[Altostrata]

Good to see it's going well.

[UncleLeroy]

Since the last reduction (of the first half of 10%), Leroy did not present with any new WD symptoms.

He still has a constant achy foot and thumb. Sleep is still fine, (many times a week I'm waking him up to make sure he takes his trazodone at 11 pm as he's already dozed off). 

 

We've also come to a conclusion that what we initially believed was kidney pain is actually lower back side pain.

 

So, other than those 3 areas of muscle and joint pain, he is not experiencing any new or worsening symptoms. 

 

The way we are making reductions is 10% of current dose every 4 weeks, then 5% linear reduction each 2 weeks from each 10% exponential reduction.

 

This is working very well so far