Redman401

[Redman401]

Sorry about the name as "Redman" was a childhood nickname and I have already started with it. I was placed on Seroquel 25mg twice a day, mirtazapine 7.5mg at bedtime, and gabapentin 200mg three times a day a little over two months ago after a psychiatric hospitalization. At first I thought the meds were great as I finally had something that gave me sleep at night. But this effect didn't last and I didn't realize the reason I was feeling  so bad was the medicine and not just my condition, I'm of the opinion, as I look back and at what I was able to do before and since I began them. I didn't realize what these meds were and how that dependency had already set in until doing some research online. After a month of my doctor trying to adjust these meds I realized with fear how difficult getting off Seroquel was going to be given my weakened state and my dread of losing any night's sleep. I would appreciate any advice, tips, pointers, etc. Thanks.

[FireflyFyte]

Hi Redman,

 

Welcome to SA. Can you please put your drug summary in your signature by following the instructions at How to Summarize Your Drug History in Your Signature? You may need to be on a computer to complete this.

Are you still on multiple medications? If so, would encourage you to check out Taking multiple psych drugs? Which drug to taper first? We generally recommend that people taper the most activating drug first but it appears that your current cocktail is all sedating drugs so starting with the Seroquel might make sense. You can read about tapering off of Seroquel at Tips for tapering off Seroquel (quetiapine).

 

Can you put all of your current drugs in the Drug Interaction Checker and share the results here? 

 

Thanks,

 

Firefly

[Redman401]

Drug history: all three of mine began around the first of August 2023: Started gabapentin 200mg three times a day. Now I am taking 100mg morning and afternoon, and 200mg at bedtime without a goal at present. I started with mirtazapine 7.5mg every night at bedtime. Now I have been at mirtazapine 3.75mg for 2 1/2 weeks with goal to stop at around 30 days completely. I started quetiapine at 25mg twice a day. I increased my bedtime dose to 37.5mg while lowering my morning dose to about 12.5mg a few weeks ago. Now I am at 31.25mg at bedtime and have eliminated the morning dose. Goal is to continue taper and end. My doctor has agreed and has directed me to continue 25mg at bedtime and come back in two weeks. Sleeping okay so far with trazadone 25-50mg at bedtime and melatonin 1.5mg. I am getting a burning sensation inside my chest and abdomen that comes and goes and anxiety that usually hits in the afternoons around 3:00-4:00 or there about . Trying different things for anxiety including L-theanine, magnesium supplement, valerian, walking/hiking, getting busy. I would appreciate any helpful advice on what I am doing.  First of August 2023:  gabapentin 200mg three times a day, mirtazapine 7.5mg at bedtime, quetiapine 25mg twice a day.

[Redman401]

On 10/9/2023 at 1:45 AM, FireflyFyte said:

Hi Redman,

 

Welcome to SA. Can you please put your drug summary in your signature by following the instructions at How to Summarize Your Drug History in Your Signature? You may need to be on a computer to complete this.

Are you still on multiple medications? If so, would encourage you to check out Taking multiple psych drugs? Which drug to taper first? We generally recommend that people taper the most activating drug first but it appears that your current cocktail is all sedating drugs so starting with the Seroquel might make sense. You can read about tapering off of Seroquel at Tips for tapering off Seroquel (quetiapine).

 

Can you put all of your current drugs in the Drug Interaction Checker and share the results here? 

 

Thanks,

 

Firefly

 Thanks for your reply. I have read "Taking multiple psych drugs?" and "Which to taper first?" and both were very helpful. I decided to try eliminating Seroquel and mirtazapine simultaneously as I wanted to begin eliminating both. But gabapentin is for my fibromyalgia-like pain, I believe, and I don't know that it has helped me much with pain, and I certainly don't get any high or buzz from taking it. So, I don't know what I should do about it. However my drug sheet did say that it makes your hair come out!

[FireflyFyte]

14 hours ago, Redman401 said:

I decided to try eliminating Seroquel and mirtazapine simultaneously as I wanted to begin eliminating both.

 

We recommend only dropping one medication at a time so you can isolate what is causing issues if they arise.

[Redman401]

Thank you for the reply. So I will concentrate on Seroquel and back up on mirtazapine and continue gabapentin. I was originally on Seroquel 25mg twice a day. I tried increasing my PM dose and simultaneously decreasing my AM dose to start tapering after about a month of being on it so it might not affect my sleep. And, you guessed it, at the end of another month I was still taking the same daily amount. So, I tried reducing the AM dose a bit more and then dropped it entirely a few days ago at a dose of about 12.5mg. I am being rewarded with a bad night's sleep, feeling flushed and hot inside, fatigue, depressed feeling, and anxiety the past couple of days. Maybe I should up my dose a bit, return to twice a day?

[FireflyFyte]

12 hours ago, Redman401 said:

So, I tried reducing the AM dose a bit more and then dropped it entirely a few days ago at a dose of about 12.5mg. I am being rewarded with a bad night's sleep, feeling flushed and hot inside, fatigue, depressed feeling, and anxiety the past couple of days. Maybe I should up my dose a bit, return to twice a day?

 

Yes, I would up your dosage and go back to twice a day dosing. Hold there until you feel stable for at least a few weeks and then you can begin a taper of no more than 10% per month of the previous dose. I would encourage you to reduce your AM dose by 5% and your PM dose by 5%.

[Redman401]

Thank you so much.

[Redman401]

Gabapentin-mirtazapine-quetiapine drug interactions per Drugs.com: Increased dizziness, drowsiness, confusion, difficulty concentrating;  impaired thinking, judgement, coordination; increased risk of irregular heart rhythm. 

[FireflyFyte]

2 hours ago, Redman401 said:

Gabapentin-mirtazapine-quetiapine drug interactions per Drugs.com: Increased dizziness, drowsiness, confusion, difficulty concentrating;  impaired thinking, judgement, coordination; increased risk of irregular heart rhythm. 

 

Can you list the times, and dosage, of your current medications?

[Redman401]

gabapentin: 200mg AM; 100mg around 2:00 PM: 200mg around 9:00 PM. mirtazapine 3.75mg around 9:00PM. quetiapine 31.25mg around 9:00 PM. I had eliminated my 12.5mg AM Seroquel on the recommendation of a pharmacist, and my own hopes, 9-10 days ago to eliminate the AM dose and then go on to the evening taper. But the strain became so much that today I took an AM dose of 6.25mg just to see if it would make the day and the following night's sleep better. After this one-day trial, so far, the jury is still out. I think it reduced my headache some but the anxiety creeped up late afternoon and I still felt awful all day. These doses I have done on my own although I have been sharing with my doctor what I am doing. They did give me Seroquel 25mg pills to make a taper easier. But they don't see the difficulty involved. My question is how the heck do I get down to 5% of a 12.5mg dose or smaller? I'm left comparing the size of this crumb to that crumb and which one is smaller? Please help!

[Redman401]

Sorry, it looks like I'm not even reading your replies here. But I am. And I am taking them to heart. Thank you. As above, getting a 5% reduction on these tiny doses is beyond my ability. I have seen on here "How to make a solution" and some doing micro-dosing. Making a solution sound like figuring out a mg/ml or mg/5ml solution or what not and then taking what part of that ml you need to. But I can't seem to go to the location on here that tells you how to do that.

[FireflyFyte]

Please summarize your drug history in your signature by following the instructions at How to Summarize Your Drug History in Your Signature. You may need to be on a computer to do this. It is difficult for us to advise you without this information especially as you make changes to doses.

 

Regarding changing to doses, I would recommend holding steady for a little while to stabilize before making any additional changes.

[Redman401]

Thanks.

[Redman401]

I'm not very good at this on computer as I see all these clearly readable histories with dates, colors, and arrows and can't seem to do it. It's the best I can do. Sorry.

[FireflyFyte]

3 hours ago, Redman401 said:

I'm not very good at this on computer as I see all these clearly readable histories with dates, colors, and arrows and can't seem to do it. It's the best I can do. Sorry.

 

Are you on the extended or immediate release of quetiapine?

 

Are you currently taking it once a day or twice a day?

[Redman401]

Thank you. I was started on quetiapine 25mg IR twice a day in the hospital, three months ago. Shortly thereafter I was told I could stop it but was reluctant to because it was part of my drug cocktail (gabapentin-mirtazapine-quetiapine)after being in the hospital that helped knock me out at night after going through a nightmarish experience. Soon my reading told me that I did not want to be on quetiapine and I was trying to start a taper after being on it about a month. I was frantic to come off it right away but fearful, too, of quitting suddenly, and withdrawals, mainly insomnia. I asked several of my doctors for approval. Their advice was to do a really quick taper over several days and begin Lexapro right away, which I didn't. Now I am taking quetiapine 31.25mg at night only, trazadone 50mg at bedtime, mirtazapine 3.75mg at bedtime, gabapentin morning, afternoon, and night as 100-100-200mg. I did try Prozac at 5mg every other day which I was ordered and hoped would help my Seroquel taper, which I have quit. I am having some trouble swallowing, aspiration, which involves trying to swallow thin liquids with solids, eating chocolate for example or chewing gum or sucking on a lozenge which varies during the day. I also fear I am having the akathisia which I experience as a feeling of difficulty sitting or lying still  and being/feeing fidgety/restless during the day. I have no nausea, vomiting or diarrhea. I still am able to sleep fairly well but wake early lots of the time. I think I am experiencing withdrawals somewhat hard but am reluctant to back-track. Please help.

[Redman401]

I am relatively new here. Could you be specific about what "withdrawal symptoms" I am trying to prevent while I am tapering and what "stable" looks like exactly? Thanks.

[Redman401]

Bad night last night. Awake around 0300 then no more sleep. I left off the trazodone last night and early awakening may or may not have been the direct result. Still holding Seroquel 31.25mg at bedtime but things don't seem to be improving with my mental/physical state any. My doctor says wait awhile then I can taper off with a quarter of a pill per week until off. I only wish that he was right and it could be that easy!

[Redman401]

I think I am in a precarious position now. I took my usual cocktail, and trazodone, last night and slept pretty good. This morning though, uh-oh,  I'm spaced out, drunk, dopey-headed, dissociated I guess you could say. Not fun and really scary to me. I hope this doesn't last and that I can survive it.

[Redman401]

I decreased my Seroquel to just nightly three weeks ago tomorrow. I did what I was advised not to do here which was to be tapering multiple drugs at the same time. I have been feeling spaced-out for the past several days which is highly unpleasant and scary for me. I see occasionally on SA the title "Should I reinstate?" SA has recommended not to alternate doses so I wonder which is best now: to raise my dose back up again or just continue to hold?

[FireflyFyte]

57 minutes ago, Redman401 said:

I decreased my Seroquel to just nightly three weeks ago tomorrow. I did what I was advised not to do here which was to be tapering multiple drugs at the same time. I have been feeling spaced-out for the past several days which is highly unpleasant and scary for me. I see occasionally on SA the title "Should I reinstate?" SA has recommended not to alternate doses so I wonder which is best now: to raise my dose back up again or just continue to hold?

 

It is difficult to advise when you keep making changes as we cannot pinpoint what is causing what problems for you.

 

If you are taking the IR version of quetiapine, I would recommend returning to taking it twice a day as the dosing should be 2-3 times a day to avoid inter-dose withdrawal. How long have you been taking the 31.25mg at night only?

 

On 10/23/2023 at 3:11 PM, Redman401 said:

I left off the trazodone last night and early awakening may or may not have been the direct result.

 

Please don't skip doses at random as it will cause further disruption for your system.

[Redman401]

According to my calendar I have been taking the 31.25mg only at night only for just over 2 weeks except for a couple of days in the middle of that time when I took 6.25mg on a couple of mornings. Prior to then my PM dose had been 37.5 mg  and my AM dose 12.5mg for just over 6 weeks back to when I began to start a taper. Prior to then 25mg twice a day for 3 weeks back to when I started Seroquel. But I hadn't kept good records, just notes on the calendar.  Sorry to be so frustrating. I've had much to learn. Symptoms, boy have I had the symptoms! I will need to return to twice a day dosing and be stable for a few weeks. Please, any advice, tips, tricks, or help would be greatly appreciated! Thank you. 

[FireflyFyte]

14 hours ago, Redman401 said:

I will need to return to twice a day dosing and be stable for a few weeks. Please, any advice, tips, tricks, or help would be greatly appreciated! Thank you. 

 

Yes, I would return to twice a day dosing and not changing any of your other medication for the time-being. Take some time to stabilize, would recommend at least a month, and then begin a slow taper of one medication at a time of no more than 10% of the previous dose per month.

[Redman401]

Thank you so much! I hope my experience can be helpful to others who are going through similar trials.

[Redman401]

I have obtained one of those little digital Gemini scales and am trying to use it to average weigh my Seroquel IR 25mg and 50mg pills, and weigh halves and quarters and crumbs of pills. I have looked at the spread sheets, Brass Monkey method, micro-tapering, etc. Since I was started on immediate-release Seroquel twice a day and I have been recommended to keep taking my regimen twice a day to prevent inter-dose withdrawal, tapering both doses by 5% monthly, I must ask A: When, if ever, will I be able to take this med as a once-a-day dose and taper from there? and B: Will I be able to use the spreadsheets while still on twice a day dosing or do they only work for one dose per day regimen? This technical stuff is difficult for me. Thank you.

[FireflyFyte]

13 hours ago, Redman401 said:

A: When, if ever, will I be able to take this med as a once-a-day dose and taper from there?

 

You will need to continue taking your doses twice a day through-out your taper to avoid inter-dose withdrawal.

 

13 hours ago, Redman401 said:

B: Will I be able to use the spreadsheets while still on twice a day dosing or do they only work for one dose per day regimen? This technical stuff is difficult for me. Thank you.

 

Which spreadsheet are you using?

[Redman401]

On 10/27/2023 at 9:00 AM, FireflyFyte said:

 

You will need to continue taking your doses twice a day through-out your taper to avoid inter-dose withdrawal.

 

 

Which spreadsheet are you using?

The one that operates on Google or Android I think. I liked what was said about the  BrassMonkey taper but couldn't open it. If I have a higher dose at night and lower in mornings is that wrong?

[Redman401]

At night I  have been taking 1/2 X 50mg and 1/4 X 25mg Seroquel to get my dose. Sometimes I weigh to see what I have too compare what I calculate I should have based on pill weight. In the mornings I have reinstated, as I have been recommended, and  seen Alto say to do in several places, a small  dose in the AM  of 1/4 X 25mg for the past five days. Yesterday, day four, felt almost normal. Today I felt really bad, weak, shaky. What the difference was, I did my meds the same, I do not know. But I think after three months on Seroquel and tolerance build-up, insomnia is almost assured. I guess that is why the doctors I have seen during this 3 months all want me to bump up to 50mg at night when I ask for insomnia relief. Twice I got prescriptions for Seroquel 50mg at bedtime with no morning dose ordered. I have written this to be honest with what I have been doing and may help others.

[Altostrata]

Hello, @Redman401

 

I edited the blank spaces out of your signature.

 

On 10/22/2023 at 1:22 PM, Redman401 said:

Now I am taking quetiapine 31.25mg at night only, trazadone 50mg at bedtime, mirtazapine 3.75mg at bedtime, gabapentin morning, afternoon, and night as 100-100-200mg. I did try Prozac at 5mg every other day which I was ordered and hoped would help my Seroquel taper, which I have quit.

 

Please add the date you started trazodone to your signature. Please list very simply the times o'clock do you take each of your drugs, with their dosages -- put the time o'clock on the left and drug and dosage on the right.

 

On 10/11/2023 at 7:26 AM, Redman401 said:

Gabapentin-mirtazapine-quetiapine drug interactions per Drugs.com: Increased dizziness, drowsiness, confusion, difficulty concentrating;  impaired thinking, judgement, coordination; increased risk of irregular heart rhythm. 

 

Since it appears you're also taking trazodone, please put *all* your current drugs in the Interactions Checker and post the report or a link to it in this topic.

 

It may be that you are experiencing adverse drug effects rather than withdrawal symptoms, or maybe both, and we have to sort that out.

[Redman401]

"Serotonin syndrome- confusion, hallucinations, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, diarrhea; dizziness, drowsiness, confusion, difficulty concentrating, impairment in thinking, judgement, and motor coordination, irregular heart rhythm". The drug interaction checker recommends maximum of three CNS drugs and one antidepressant. If I could I would like to drop mirtazapine after being on 3.75mg for just over a month, would reduce that to three CNS and one antidepressant if I could still preserve my sleep. I don't know if all these potential interactions hold up at the low doses I am on.

[Altostrata]

I edited the tab spaces out of your signature to make it more readable. Please use the Return key to break lines.

 

What is the link for your interactions report?

 

Do you have symptoms of serotonin syndrome? It is unlikely that 50mg trazodone and 3.75mg mirtazapine would produce this. Quetiapine and gabapentin are not serotonergic drugs.

 

Quote

 

9A-2P-9P Gabapentin 100mg-100mg-200mg

9P  mirtazapine 3.75mg

9P trazodone 50mg

9A-9P quetiapine 6.25mg-31.25mg           

 

 

Is this your current drug schedule? Why do you take gabapentin, mirtazapine, trazodone, and quetiapine together at 9 p.m.? How do you feel after you take these 4 drugs at that time?

[Redman401]

Thank you for your comments and editing. My computer skills are limited. I'm trying. I think you are right that serotonin syndrome is unlikely.  I do have some dizziness, excessive sweating, impairment in thinking. It's just that when I came out of the hospital 3 months ago they had put me on gabapentin-mirtazapine-quetiapine, and they helped me sleep. on this schedule, I think. I also have sleep apnea. But I think the drugs made my overall physical-mental condition worse ever since and I couldn't connect the cause and effect at the time. So I took them like clockwork thinking I was helping myself. I have felt weak and frail ever since. When I told the docs that I wanted to come off Seroquel and mirtazapine, and I was afraid I wouldn't be able to sleep,  they gave me trazodone which I started around 9/15, maybe assuming I would be off Seroquel and mirtazapine. I just take my meds around 9P and I just go off to sleep, with variable overall sleep results.. If I could ditch all these drugs and just be able to take something for sleep if I wanted to, today, I would. Thank you for your help.

[Altostrata]

10 hours ago, Redman401 said:

When I told the docs that I wanted to come off Seroquel and mirtazapine, and I was afraid I wouldn't be able to sleep,  they gave me trazodone which I started around 9/15

 

You added trazodone to the other 3 drugs?

 

10 hours ago, Redman401 said:

I do have some dizziness, excessive sweating, impairment in thinking.

 

What times of day is this effect most intense?

[Redman401]

Yes, a psychiatry resident gave me trazodone 50mg on my doctor visit 9/14 when I told him I wanted off Seroquel, I guess as a replacement for it and give me something to take as a sedative/hypnotic. He said he gave me enough to bump it up or down if I needed to! To him, getting off Seroquel was no big deal and not something to be feared since it's not addictive or a problem to come off! Trazodone seems to be something they give out like candy for insomnia since they won't give you a benzo or Ambien,  of which I would be terrified of any way. And I didn't think it was significant until you asked. I can't bear the thoughts of going to bed and lying awake after being miserable all day. So I'll almost do anything to get a good sleep. I know these meds need to be pruned back from what you are saying, though.

 

Your question makes me think and I need to use the symptom diary I have seen here on SA. I think my symptoms come on in an hour or so after I take my AM dose of Seroquel. I feel drunk or doped up, and "woozy-headed", which I don't want or enjoy. Around 4-5PM I get anxiety for which I often take magnesium, L-theanine, valerian or hydroxyzine 25mg for relief. I know,  I'm awful.

[Altostrata]

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

 

 

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and any significant symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can help identify symptoms that are adverse effects from one or more of your drugs.