Zatara Zyprexa Taper (need advice)

[Zatara]

Hi, I've decided to start tapering Zyprexa, and need advice on how to do it.

My reasons: I was diagnosed previously with psychosis and "simple schizophrenia", but I don't want a label to define my life. I can't think or speak fluently on this medication and suffer chronic fatigue with constant tiredness, and as a writer I really need fluency in speech and energy.

I have been cutting pills, and every two months I've tapered from 5 mg to 2.5 mg pill and a half (3.75 mg), then to a 2.5 mg pill and a quarter of it (so, 3.125 total). But I feel this taper is too fast. Now I have this tension on the back of my head and can't fall asleep without using 0.5 mg Xanax (which I don't want to use, since it's dangerously addictive). 

Reading through Hayduke's thread, I know I can dissolve a pill and make a liquid suspension to do a gradual 10 % taper of the current dose every month (or even slower). But I have a few questions:

• Does any of the dose get "lost" when I make the suspension? I'm told repeatedly by my family that part of it will get stuck to the surface of the glass or recipient I'm using to taper.
• Should I go back to 3.75 mg or 5 mg? Which dose is easier to taper? I figure 5 mg might be easier, considering it's one pill rather than one and half, and I'll part from a more stable point.
• Is Zyprexa Velotab easier to dissolve for a liquid suspension? I read some of its official information online, and it said it was perfectly fine to dissolve it in a liquid to drink it (since it's orodispersable?).
• I am also taking 4.5 mg Cariprazine for "cognitive improvement". Should I taper this dose before or after Zyprexa? 

 

Also, two important points for reference.

• I once tapered 6 mg Invega by reducing 25 % every month and finished my last dose by alternating 3 mg every two days. While feeling initially rather lucid, the result was rebound insomnia and a struggle to urinate during 6 months that resulted in a psychosis. 
• I have a bunch of physical symptoms like photophobia, tinnitus and aversion to loud noises/voices that grow worse when I've tapered quickly. They make me feel physically ill and make it impossible to have a functional or social life. The symptoms weren't there to begin with, or at least not so strongly, when I first started Risperdal in 2017, and have only grown worse whenever I've dropped or tapered quickly medications. I feel like the medication probably exacerbated or made worse how I felt previously. 
  
  Anyway, thanks for reading me out

[hayduke]

Hello and welcome @Zatara

 

Sorry to hear you're having a bumpy ride on these drugs.  Thank you for filling in your drug history in your signature. 

 

It definitely sounds like you've been tapering too fast on balance.  Among other things, apparent psychosis can actually be a symptom of withdrawal, rather than a re-emergence of the original condition which most doctors tend to assume.

 

Tips on tapering off olanzapine

 

Why is it important to taper at 10%/mo of previous dosage

 

How to make a liquid from tablets or capsules

 

The last of those links covers most of what you need to know about liquid titration.  I'd say any loss of dosage doing this is negligible, from experience.  Some people have trouble crossing over to a liquid from the tablets, though I never noticed it as any more difficult than a regular cut myself.  I would hold for some time once switching to a liquid.  I never felt a real need to cross over to orodispersible tablets, the regular ones worked well enough.

 

I would consider going back up to 3.75 or 3.5 from where you are if you aren't sleeping.  It sounds like a good long hold is in order either way.  It took me a while to get down from 5 to 2.5mg, and I did a 6 month hold at 2.5.

 

It's good to feel around a bit and get used to listening to your body to work out what amount of the drug it needs to cope well enough and withdraw safely.

 

It's also worthwhile to look into trauma therapy, as whatever was the trouble before you were on these drugs is likely to emerge in some form as you come off them.  I think both aspects are important to withdraw safely.

 

Cheers

[Zatara]

Hi, thanks for answering

I've returned to 3.75 mg and can sleep again without problems. I'm going to hold for 3-4 months before switching to liquid, then should there be no problems in the first month or so, start the gradual reduction. 

Regarding the loss of dosage, it's the main argument both my mother and psychiatrist put forward when I propose this form of tapering. Neither of them is familiar with it, and regard it as dangerous or experimental. I'd be ideal to convince them it can work, but I already struggle explaining things as it is. Doing something so difficult would be better with support. It is very vexing to be offered pills every time I feel the slightest under the weather x;

As for trauma therapy, I've spent so long with meds and deep inside my head, that it feels extremely hard to get started.
I have a clinical psychologist specialized in laconian psychoanalysis. He's intelligent and very good at listening, and helps me elaborate on my line of thoughts. Since I started with him, I became fluent enough to talk with others (I was extremely asocial and silent previously). 
But so far, we haven't established a "direction" of sorts to put me on a better path or attend to the "root issues". As in, he's not the kind of psychologist that gives guidelines, unless I directly ask for them. Though honestly, a normal psychologist would mostly likely offer practical advice... that I can't follow through due to how tired I feel all the time.
I guess I am comfortable with my psychologist. He listens unconditionally and without judgements, but I'm not sure on how to push forward to fix my traumas.

Honestly, the last time I dropped my meds, I had such energy that I felt able to exercise and walk often. Even if it was under extreme agitation, I felt able to calm my anxiety with exercise, writing and recording thoughts, or singing or whatnot. And feel again, most of all (which is vital for me as a wannabe writer).
It was like riding a constant wave of activity to push away my anxiety, with barely any sleep. But I have so little energy with medication, and I felt so lucid then, that my medless state now seems more addictive than the drugs themselves. 

I am both eager and scared to withdraw my meds, to be honest. I've felt empty for so long, that I don't know what will come up when I try to be myself once more

[hayduke]

Lacan is an interesting one, personally I never was able to make much sense of him.  But the main thing is that the rapport and support are good for you.

 

On 8/7/2023 at 8:24 PM, Zatara said:

Regarding the loss of dosage, it's the main argument both my mother and psychiatrist put forward when I propose this form of tapering. Neither of them is familiar with it, and regard it as dangerous or experimental.

Well, looking at it from first principles, how could going slower be less safe than an abrupt withdrawal?

[Zatara]

1 hour ago, hayduke said:

Well, looking at it from first principles, how could going slower be less safe than an abrupt withdrawal? ↳

 

 

They're not familiar with the use of a liquid titration whatsoever. And they're both stickers for rules and following protocol. So anything that deviates from the norm, they can't much process. Never mind, they believe I have psychosis and shouldn't be off my meds at all (even if I've never experienced hallucinations or voices).

For further reference, my mother works at a public hospital and is a strong advocate of public healthcare. She strongly believes professionals know better. Which is fine for herself, of course. Except whenever I've complained of my light/noise sensitivity symptoms, I've been attended with as much hurry as possible, with my problems dismissed immediately as mental illness. Something that is very frustrating, to be honest.

I'm plagued with symptoms that feel extremely physical and discomforting, medication or not. And in her mind, there's no professional that can attend to me except a psychiatrist and my psychologist. Of course, I've only worsened since taking medication and at best I can only feel "stable". To say I feel trapped and gaslighted is an understatement x;.

[hayduke]

Sounds like a good plan to hold for a while until you're stable.  Glad sleep has returned.

Please keep your drug signature updated with your latest changes and let us know how you get on.

[Zatara]

So I can sleep again. But I admit I can feel a little on edge. I'm finding it difficult to relax and write these last weeks, even listening to music all the time. And it's often that I wake up feeling tired (and continue tired all day).

Higher doses or not, I have some symptoms that don't go away.

• I have this tension at the left back of my head, ever since I started feeling physically ill some years back. When I last lowered my dose of Zyprexa last month, it was almost like having a light bulb on. A feeling of wakefulness, despite knowing I am tired.
• There's also this pressure on the left of my lower abdomen. It makes me want to vomit or urinate constantly, more usually right after drinking liquids. When I tapered completely Invega, I became unable to urinate whatsoever.
• Then there's my general aversion to sounds with tinnitus. I'm sensitive enough to noise, that I can't talk with others while there are other voices or noises in the background. It's almost as if they cut completely my line of thought, or reverberated with my head tension. The tinnitus is also strong enough that it correlates too with the tension and makes it worse when in silence, and I need constant music so it doesn't worsen.
• Lights are also a prime offender. I can't go out at night either with all the artificial street lights. They make said tension worse, and later at night I have trouble sleeping.

I didn't feel as physically ill before taking Risperidone. Both my psychologist and psychiatrist (which work together) regard these symptoms as a derivative of my psychosis. But I wish I found some specialist that regarded them beyond being just mental illness.
 

[Zatara]

Another day waking up tired (despite sleeping eight hours). My body feels like it weighs heavily, and I avoided going to training today. I don't think I can write today either. This is one of those days when I feel completely blocked.

Lately I'm doing less of my hobbies than I'd like. While I find talking becomes easier on lower doses of Zyprexa, it's becoming harder to relax or focus. Sleeping also becomes a little harder. Whereas before I fell asleep right after taking the pill, now it takes a while before sleep takes me.

[Zatara]

A thought popped up. What if I increase the dose back to 5 mg? 
I can sleep 8 hours now, but I don't think I feel at my best (relatively speaking). So maybe if I do an even slower taper, I might return to my current dose (3.75 mg) without feeling as tired.
Otherwise, I might just as well grit my teeth (deal with it, so to speak) and try some supplementation. For four, six months or so.

Also, another question. I am currently cutting 2.5 mg pills in half, so I take 3.75 mg by taking one pill and a half. 
Were I to do a water titration, is it recommended dissolving halves? The cut halves aren't always the same in my experience.

[Altostrata]

16 hours ago, Zatara said:

I can sleep 8 hours now, but I don't think I feel at my best (relatively speaking). So maybe if I do an even slower taper, I might return to my current dose (3.75 mg) without feeling as tired.

 

 

When was your last drug change? What was it? How has your sleep pattern changed?

 

You've been taking Zyprexa for more than a year. You haven't felt tired from it before?

 

What times o'clock do you take your drugs, with their dosages? 

 

On 8/7/2023 at 2:47 AM, hayduke said:

Tips on tapering off olanzapine

 

 

Please read this topic about titrating Zyprexa.

[Zatara]

Quote

When was your last drug change? What was it? How has your sleep pattern changed?

 

 

 

I reduced from 5 mg Zyprexa to 3.75 mg in May by cutting the pills, then to 3.125 mg in July. With the last dose, I became unable to sleep with this acute tension at the back of my head. So I returned to 3.75, a dose at which I can usually sleep without interruption around 8 hours, but I don't fall asleep immediately like at 5 mg. 

 

Quote

You've been taking Zyprexa for more than a year. You haven't felt tired from it before?

 

 

 

 

 

Tiredness with Zyprexa and other antipsychotics is a constant for me. But this last month or so I've felt drowsy during the entire day, with more lethargy than usual. I wake up tired, continue tired, and go to bed tired. I can't relax with music and write like I did with 5 mg and previous doses, either. 

 

17 hours ago, Altostrata said:

What times o'clock do you take your drugs, with their dosages? 

 

 

Around 9 am, I take 4.5 mg Cariprazine. My psychiatrist tells me it should have a positive effect on my cognitive problems and energy, but that doesn't seem to be the case.
Then at 10 pm, I take 3.75 mg Zyprexa (or rather, one 2.5 mg pill and a cut half). I find I really need it to take it now. Otherwise I struggle to sleep in the same night.

 

17 hours ago, Altostrata said:

Please read this topic about titrating Zyprexa.

 

I have. To be honest, I cut the pills hoping to shortcut to 2.5 mg, stabilize for some months, then start the titration. Now I sit at 3.75 mg where I can sleep, but face some issues. I'm thinking I can stabilize, or go back to 5 mg and start the titration there without less issues.
I'm just unsure whether I can use Zyprexa Velotab without problems. The product page suggests "it can be taken with a liquid", so it should be fine?

[Altostrata]

5 hours ago, Zatara said:

Now I sit at 3.75 mg where I can sleep, but face some issues.

 

You only went back to 3.75mg recently? Since you got withdrawal symptoms (sleep disruption), we'd suggest you stay on 3.75mg and let your symptom pattern settle down.

 

We also recommend you taper much more slowly to avoid withdrawal symptoms such as sleep disruption.

 

How did you intend to use Velotabs? We have many people making liquids from orodispersable tablets. 

[Zatara]

Staying on 3.75 mg seems a good call. I will sit on this dose between 4 and 6 months, then reevaluate. The only issue right now is the drowsiness  during the mornings that prevents me from working (as well as tension at the back of my head). But I'm hoping that might go away with stabilization.

It's possible the drowsiness could also be a side effect of Cariprazine, which I increased from 3 to 4.5 mg in May. 
 

10 hours ago, Altostrata said:

How did you intend to use Velotabs? We have many people making liquids from orodispersable tablets. 

 

Velotabs dissolve easier than the usual solid tablets, I think. I'd drop a Velotab into a measured glass of water, shake it a bit, take the excess content I don't need with a measuring syringe, then drink the solution. 

P.S: I'm just told by my psychiatrist and my family that Velotab is meant to put under the tongue and dissolve in the mouth, and won't work otherwise if dissolved in water. So I wanted to confirm first Velotab can be used without problem. 



 

[Altostrata]

You may wish to gradually move your Zyprexa dose by an hour later each day until you're taking it in the evening. This is how most people take it.

[Zatara]

So I'm taking two antipsychotics, Zyprexa and Cariprazine (aka Vraylar). Which one should I taper first?

[Altostrata]

In August, you said you wanted to taper Zyprexa. Have you changed your mind?

 

On 8/19/2023 at 4:29 AM, Zatara said:

So I wanted to confirm first Velotab can be used without problem. 

 

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1755-5949.2008.00053.x

"The orally disintegrating tablets may be placed in the mouth or dispersed in water or other suitable beverage for administration (data on file: Eli Lilly and Company). Stability of the orally dispersible tablet formulation was tested in water, apple juice, orange juice, coffee, milk, and cola beverages, and it was found that a stable suspension formed with each of these beverages except cola. The suspension with apple juice, orange juice, coffee, and water is stable at room temperature for 6 h. All of these suspensions are also stable under refrigeration for 24 and 48 h. Coffee was not tested under refrigeration at any time period. The suspension in milk is stable for 6, 24, and 48 h under refrigeration. A precipitate forms when the orally disintegrating tablet is mixed with cola; therefore it is not recommended that orally disintegrating olanzapine tablets be mixed with cola beverages. At the time of this report, evaluation of the efficacy and safety of extemporaneous preparation administration has not been conducted."

[Zatara]

Thanks for the information on Velotab.

 

10 hours ago, Altostrata said:

In August, you said you wanted to taper Zyprexa. Have you changed your mind?

 

 

 

 

My aim was, and still is, to start tapering Zyprexa in January. But I was concerned on Cariprazine's effects. Some people report insomnia from the drug, and I wondered whether I should taper it before Zyprexa. So I considered tapering Cariprazine first and (too) quick.

In my overconfidence, I tapered from 4.5 to 3 mg Cariprazine, then to 1.5 mg in about 3 months. I can sleep well but feel somewhat unable to function as a result, so I'm returning to 3 mg. Provided I am stable, I will start the Zyprexa taper in around 2 months. 

I also increased Zyprexa to 5 mg Velotab. Partly because I believed it'd help offset the reduction of Cariprazine, and partly because I find it easier to administrate and taper. 

[Altostrata]

8 hours ago, Zatara said:

I also increased Zyprexa to 5 mg Velotab. Partly because I believed it'd help offset the reduction of Cariprazine, and partly because I find it easier to administrate and taper. 

 

It seems you have recently changed both your cariprazine and Zyprexa dosages. We recommend changing only one drug at a time, or you won't know where withdrawal effects are coming from.

 

We cannot offer peer counseling for inconsistent dosing. I believe you understand the principles of tapering, which also apply to cariprazine. Good luck with your dosage reductions.

[Zatara]

I understand, but do you have any information on cariprazine?

I've read it's activating, and I'm not sure if it could trouble my sleep when I taper off Zyprexa. It'd be helpful to know which drug to taper first.

[Altostrata]

It appears you have been switching drugs and changing dosages since 2019. You'll have to be more systematic to taper anything.

 

We do not have any specific information about tapering cariprazine. Do you find it activating?

 

Do you find your combination of 2 antipsychotics sedating? It may not make a difference which one you taper first.
 

https://www.frontiersin.org/articles/10.3389/fpsyt.2022.827744/full

 

 

Quote

 

Sleep Disturbances

Next to akathisia, insomnia was the second most frequently occurring side-effect of cariprazine with a dose-response effect observed in the pooled safety studies (84). Since cariprazine is rather an activating substance, it is not surprising that it improved sedation in three of the reviewed cases.

 

 

[Zatara]

I find it very difficult to speak and think fluently since they medicated me with the combination following my first episode. It's as if I physically struggle to find my words. The sedation is significant, and anything that involves focus or problem-solving proves a problem. Even thinking about doing something tires me, and whenever I actually do something, it feels as if my energy is too spent. I always feel tense, and need to use music in the background to do basic chores like making my bed or dressing myself. Can't pay attention or read books, either, feels like all information goes over my head. I feel useless, to be honest. 

I take cariprazine in the morning, but I don't feel any activation. My psychiatrist recommended me it to help with my cognitive issues. I don't feel it helps cognitively. If anything, I have worsened since my Invega days. 

Do you know if I can use a liquid to taper cariprazine too? I am not sure what is the best method for a cariprazine taper at the moment.

[Altostrata]

You are taking 2 antipsychotics and experiencing the typical effects of antipsychotics. Your increase of olanzapine may have increased these effects.

 

You may find using a liquid is the most accurate way to taper either of the drugs. Please ask your pharmacist if cariprazine can be compounding into a liquid. Often, people find it most comfortable to take part of the dose in tablet form and part in liquid, while they taper from the liquid part.

 

Strongly advise you to stop changing your dosages for a good while before tapering anything.

[Zatara]

I'll sit on the current dose and update after some time.

Thanks for your help.

[Bucksfan8]

On 8/1/2023 at 6:14 AM, Zatara said:

Hi, I've decided to start tapering Zyprexa, and need advice on how to do it.

My reasons: I was diagnosed previously with psychosis and "simple schizophrenia", but I don't want a label to define my life. I can't think or speak fluently on this medication and suffer chronic fatigue with constant tiredness, and as a writer I really need fluency in speech and energy.

I have been cutting pills, and every two months I've tapered from 5 mg to 2.5 mg pill and a half (3.75 mg), then to a 2.5 mg pill and a quarter of it (so, 3.125 total). But I feel this taper is too fast. Now I have this tension on the back of my head and can't fall asleep without using 0.5 mg Xanax (which I don't want to use, since it's dangerously addictive). 

Reading through Hayduke's thread, I know I can dissolve a pill and make a liquid suspension to do a gradual 10 % taper of the current dose every month (or even slower). But I have a few questions:

• Does any of the dose get "lost" when I make the suspension? I'm told repeatedly by my family that part of it will get stuck to the surface of the glass or recipient I'm using to taper.
• Should I go back to 3.75 mg or 5 mg? Which dose is easier to taper? I figure 5 mg might be easier, considering it's one pill rather than one and half, and I'll part from a more stable point.
• Is Zyprexa Velotab easier to dissolve for a liquid suspension? I read some of its official information online, and it said it was perfectly fine to dissolve it in a liquid to drink it (since it's orodispersable?).
• I am also taking 4.5 mg Cariprazine for "cognitive improvement". Should I taper this dose before or after Zyprexa? 

 

Also, two important points for reference.

• I once tapered 6 mg Invega by reducing 25 % every month and finished my last dose by alternating 3 mg every two days. While feeling initially rather lucid, the result was rebound insomnia and a struggle to urinate during 6 months that resulted in a psychosis. 
• I have a bunch of physical symptoms like photophobia, tinnitus and aversion to loud noises/voices that grow worse when I've tapered quickly. They make me feel physically ill and make it impossible to have a functional or social life. The symptoms weren't there to begin with, or at least not so strongly, when I first started Risperdal in 2017, and have only grown worse whenever I've dropped or tapered quickly medications. I feel like the medication probably exacerbated or made worse how I felt previously. 
  
  Anyway, thanks for reading me out

I’m also trying to taper off Zyprexa 5mg. How did you taper to 3.75mg? Did you use a digital scale that measures in mg?

[Zatara]

On 12/31/2023 at 8:22 PM, Bucksfan8 said:

I’m also trying to taper off Zyprexa 5mg. How did you taper to 3.75mg? Did you use a digital scale that measures in mg?

 

 

I cut pills with a knife. Not a recommendable method, it's not very precise. I'd suggest doing a water titration instead. This post (Tips for tapering Zyprexa) was my major source of information. 

This explanation from Hayduke in the attached image also helped me understand how 

[Zatara]

Starting from January 10th, I've begun tapering off Zyprexa. I am considering, however, doing a faster taper: a reduction of 10% of the current dose every two weeks. I find myself too cognitively impaired to function and talk fluently right now, and I am desperate to be even a fraction of myself again as soon as possible. 

It bears without saying, but if I find withdrawal symptoms or insomnia too impairing, I will hold for a time, then go slower.  

[Zatara]

Hi, good day to you all

I began tapering Zyprexa this January, and have experiencing massive drowsiness since I began. More so than before my taper. I feel tired and lethargic since I wake up, and it gets worse as the day progresses. It's a pain to get anything done.

And now, as my dosage gets lower, sleep comes much harder to me. There's a constant tension at the back of my head that becomes worse during the night. I feel sort of wired like there's a "lightswitch on", and there's no way I can fall asleep. I do reading with calming music for sleep, and avoid screens at least 1 hour before sleep. It has helped so far. but when I've tapered down further than 3 mg, this "lightswitch" prevents me from falling asleep.

Questions!

• Is the drowsiness a WD symptom? I thought tapering would give me more energy, not make me more tired.
• I am currently tapering down 10 % of the current dose every 4 weeks. If I am experiencing "windows and waves", should I not be able to stabilize after a reduction? Or should I hold at 3 mg for a longer time?

 

Thanks for reading me out, at any rate.

P.S.: I drink my Zyprexa liquid before sleep, while also taking the antipsychotic Cariprazine in the mornings.
 

[Emonda]

Hi Zatara,

I've moved your new post back here, to your own thread. Your own Introduction topic is the best place to ask questions and the place to journal your progress.  This keeps your history in one place and means you do not have to repeat your story. 

3 hours ago, Zatara said:

Is the drowsiness a WD symptom? I thought tapering would give me more energy, not make me more tired.

 

This is a great resource to keep handy. It lists many potential WD symptoms: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

3 hours ago, Zatara said:

I am currently tapering down 10 % of the current dose every 4 weeks. If I am experiencing "windows and waves", should I not be able to stabilize after a reduction? Or should I hold at 3 mg for a longer time?

 

We all experience WD symptoms when tapering. The goal is WD normal = you can still go about your normal day. If you cant do this, hold the dose until stability returns.

 

I hope this helps.

[Zatara]

@Emonda To be honest, I could barely go about my normal day when I started tapering or even with a stable dose. Cognitively speaking, I feel very tired and depressed and stressed all the time. I struggle reading, and talking/thinking fluently, and everything that involves concentration is a massive struggle. Even shaving, showering or dressing myself has been difficult these last few weeks.

It's my hope that with tapering things might get better, but they have not thus far. Holding is very difficult for me in these conditions, because time doesn't seem to improve my other symptoms (most of all my poor cognition). It's very difficult to stay the course where doesn't seem to be a light in sight.

I am tempted to give up and just take whatever sleep drug. But I am aware of how much worse they can be. I just wish I could be my functional self again.

 

On 6/5/2024 at 1:42 AM, Emonda said:

This is a great resource to keep handy. It lists many potential WD symptoms: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

This lists Antidepressant WD symptoms, not those of antipsychotics. I haven't found mention of drowsiness or tiredness anywhere for antipsychotics. If anything, things like anxiety and insomnia are usually reported.