Jshect major issues with Wellbutrin/Deplin and klonopin addiction

[Rhiannon]

Looks like Virginia doesn't have its own exchange so it's the federal one. Unfortunately the open enrollment period expired yesterday, I'm not sure what that means for you. You might not be able to change plans. But you might still qualify for a subsidy, I think over half of people do.

[Jshect]

It sounds like the pain started when you added the Wellbutrin. This indicates trazodone and mCPP are the culprits. All of the drugs blocking or using cyp2D6 are contributing to this. Loxapine is one of them.

 

Is the pain worst in the daytime or night?

 

Actually, i believe Wellbutrin is the main culprit. It says on drug.com Wellbutrin can cause calf aches and musculaskeletal chest pain. That's exactly what I have. I only get the pain when I've used the muscles (like walking for an hour) or doing upper body exercises, so I am very cautious about what I do. I can't play basketball anymore, but I can go on 40 minute hikes (and not everyday). I can do very light weightlifting workouts. When I decreased the Wellbutrin from 150 mg to 100 the pain immediately left. However, the Trazodone could also be contributing to this. I honestly never suspected anything sinister out of Trazodone, so I don't know that much about it. I will read up on it and educate myself.

 

Read this about trazodone and mCPP http://survivingantidepressants.org/index.php?/topic/2883-tips-for-tapering-off-trazodone-desyrel/

 

Wow, I always assumed Trazodone was a harmless, sleep aide. That was devious of them to put in chemicals that make you sleepy, while at the same time adding mCPP  which makes you anxious and causes other problems. This is all such a mess. I can't wait to be off these meds completely, if it ever happens.

 

Yes, this is the doctor who put me on a lot of my current meds. However, he does not deserve the entire blame. I've seen around 4 or 5 different psychiatrists over the last 14 years or so. They each take away and add medications. This is kind of a culmination of 4 or 5 different Pdocs experimenting with me. When I got to Dr. K***, I was already on an antidepressant, mood stabilizer, and antipsychotic.  

 

I'm going to have make a decision about Klonopin. Increase my dosage, or face withdrawal symptoms while tapering off my other meds.

 

[Jshect]

It couuld very likely be that reducing the loxapine by 10%, sped up the metabolism of clonazepam, which caused adverse withdrawal symptoms. It looks like they share CYP3A4. And of course there could be some other kind of domino effect going on with all of the other medications too, given that they all share at least one liver enzyme with one another, so they are all either directly or indirectly related to each other in this complex relationship... I guess.

[Jshect]

Enzymes shared:

CYP2D6: Loxapine, Trazodone, Bupropion.

CYP3A4: Loxapine, Oxcarbazepine, Trazodone, Bupropion, Clonazepam

CYP1A2: Loxapine, Clonazepam, Bystolic

CYP2C19: Oxcarbazepine, Buproprion, Clonazepam

 

So, I guess reducing Loxapine by 10% could directly effect the metabolism of Trazodone and Bupropion, which could then in turn speed up the metabolism Oxcarbazepine, Bystolic, and ultimately Clonazepam. Or I guess since Loxapine shares 3 enzymes with the other medications it actually directly speeds up the metabolism and elimination of every single other medication. 

 

Is this correct Alto?

 

Of course this is also only one aspect of it. How these medications are interacting in the brain is a whole other topic that maybe my psychiatrist could help with. Getting rid of the Loxapine and Oxcarbazepine may speed up the metabolism and elimination of Wellbutrin and Trazodone, but in the brain the lack of neurotransmitter brain "brakes," would leave the brain "accelerators" to make greater use of their, albiet, shorter half-lives, and I would be in a manic state. It would be interesting to see what happens to my pain and irritation if i were only on Wellbutrin and not on Trazodone. Oh, so many factors. I guess a lot of this tapering process is going to come down to educated trial and error.

[Altostrata]

Correct, they're all interdependent and affect each other's metabolism and blood levels. Neil Sandson, the drug conflict expert, may or may not have some insight into which pickup stick to pull out first. Or not!! Whatever is suggested, get a full rationale. Take notes.

[Jshect]

Well, unfortunately, I raised my Klonopin from .625 to .75 and, fortunately, I felt better. This is going to suck if I have to raise my Klonopin dosage every time I taper a med by 10%. I'm going to end up on a huge dosage of Klonopin. In reality, I am actually already on the equivalent of a much higher dosage of Klonopin, because all of the meds I'm on are battling for the same liver enzymes to metabolize them, which is increasing the half-life of my Klonopin dramatically. If I keep going at this rate, I could be on 5 mg of Klonopin when I'm finally off all of my other meds.

 

Does anyone have any advice on how to taper off of my other meds and not have to increase my Klonopin or suffer withdrawal symptoms?

Certainly others on this site have gone through this predicament with Klonopin as well. I've heard grapefruit juice can increase the half-life of Klonopin, fact or fiction? I'll have to go to some of the Klonopin threads on this forum. 

 

I'll call Neil Sandson tomorrow, and see if I can consult with him.

[Meimeiquest]

Coming off multiple drugs is, IMO, like dismantling a house of cards. I have no idea how to avoid WD symptoms. But I had major issues at the end of the two drugs I have come off separately so now I am doing a round robin with the ones I am still on. Are you over the PVCs? Once you are done with that, maybe you could do like 2% of one drug, recover, do 2% of another, etc? Leave the Klonopin alone? It seems like the multi-drug taperers who are rocking it are doing something like this..I think they find what they can handle.

[Jshect]

Coming off multiple drugs is, IMO, like dismantling a house of cards. I have no idea how to avoid WD symptoms. But I had major issues at the end of the two drugs I have come off separately so now I am doing a round robin with the ones I am still on. Are you over the PVCs? Once you are done with that, maybe you could do like 2% of one drug, recover, do 2% of another, etc? Leave the Klonopin alone? It seems like the multi-drug taperers who are rocking it are doing something like this..I think they find what they can handle.

Yes, maybe it would be smart to taper 2% at a time, rather than 10%, in a round robin manner.

Alto thinks it's the breaks that triggered the PVCs. When I decreased the breaks (loxapine) by 10%, my PVCs disappeared. So I plan on tapering the breaks quicker than the accelerators. The only problem is, if you look at the liver enzyme chart in my signature, reducing ANY of my medications, be it breaks or accelerators, is going to speed up the metabolism of Klonopin, which may cause withdrawal symptoms (it already is). The Klonopin withdrawal symptoms can be vicious and brutal, so I think I have to occasionally increase the Klonopin to not get them. One of the withdrawal symptoms of Klonopin is extreme fatigue and disorientation. I can't be that way at work. I don't know what I'm going to do when I have to try and taper off of the Klonopin for good. I almost feel like getting myself off of all of my other drugs, and raise the Klonopin as it gets metabolized faster and faster, and then checking myself into a drug rehabilitation center, and try to get myself off of Klonopin. I can't be at work and be completely disoriented and incapacitated. This f***ing sucks!

My psychiatrist is probably making $200,000 a year, the maker of Klonopin probably makes billions a year, I wish I could make them pay for me go to rehab and get off it. The worst part is knowing I'm addicted to these meds and want off of them, yet having to pay the billion dollar drug companies around $200 a month because I'm stuck on their meds. meanwhile, I make $8 an hour. These drug companies offer no help or comprehensive plan to help get you off of THEIR drugs, lie with false promises, and make mucho dinero when your hooked on their damn meds.

 

Can anyone provide me a link to a thread of someone who tapered off multiple meds and Klonopin at the same time, and faced a similar challenge I face, where reducing a med increases Klonopin withdrawal symptoms? Hopefully, a thread of someone who did this successfully.

 

It may even be better for me to taper off of Klonopin first, so I don't have to keep raising it!?!??!?

Honestly, I think if it were possible to work it out mathematically, 1 1/4 pills of Klonopin while on 5 other meds clogging up my liver, is probably similar to being on something like 5 pills of Klonopin alone, when my liver can fully devote itself to metabolizing the Klonopin. I guess.

[Altostrata]

This is a tough one, jshect.

 

Rhi is tapering off multiple drugs, but your particular cocktail is unique. I don't think anyone can predict what will happen if you reduce any of these drugs.

 

I guess you might taper Klonopin first, but I don't know how difficult that might be for you, since you already experience withdrawal from small variations. I don't know if it's any consolation, but a recommended maximum dose is around 4 mg/day http://www.drugs.com/dosage/klonopin.html

 

If Sandson will talk to you, he might have some suggestions. But I have to warn you: Often a specialist will talk only to another specialist. He may require that you make an office visit before he advises you personally on anything. Perhaps you can phone him and ask if he can recommend anyone closer to you. Have a list of your drugs and dosages handy when you talk to him.

 

Here's a 2003 interview with Sandson

http://pro.psychcentral.com/2013/this-months-expert-neil-b-sandson-m-d-on-drug-interactions/001588.html#

[Altostrata]

meimei has a good idea. Perhaps if you tapered the loxapine by 2% every 4 days or so, you could sneak off it while very gradually lowering the blood level of clonazepam.

[Altostrata]

Here's another idea:

 

You have an established relationship with the local psychiatrist who knows of your situation. You can phone him and ask him to phone Sandson ASAP to get Sandson's opinion about which drug is causing the most problems. Make sure he understands the withdrawal issues -- PVCs and clonazepam withdrawal.

 

Have your list of drugs and dosages on hand to refresh your psychiatrist's memory. Who knows what shape his notes are in. Also give him Sandson's phone number. Ask him to let you know when he's spoken to Sandson.

 

Do not expect either of these doctors to have a tapering strategy.

[Jshect]

It sounds like the pain started when you added the Wellbutrin. This indicates trazodone and mCPP are the culprits. All of the drugs blocking or using cyp2D6 are contributing to this. Loxapine is one of them.

 

Is the pain worst in the daytime or night?

 

Read this about trazodone and mCPP http://survivingantidepressants.org/index.php?/topic/2883-tips-for-tapering-off-trazodone-desyrel/

 

Uh oh, this is the psychiatrist who prescribed 5 random drugs for you? This guy doesn't know anything. Scary, but a good psychiatrist is very, very hard to find.

 

Neil Sandson, the drug conflicts expert, might have some ideas which drug to taper first but isn't likely to know anything about tapering.

I just reread this post. You may be right. I have had a reduction in pain! I have been having acupuncture done and I attributed it to that. But, I have reduced the Loxapine by 1.2 mg, and my pain has definitely decreased. It could be both. Why are drugs using up cyp2DR the culprit? What is it about that enzyme and not the other enzymes (like CYP3A4) that would cause pain? If Loxapine and Trazodone are major culprits, than I'm ready to lower  Loxapine some more and start lowering the Trazodone! I'm only on 50 mg of Trazodone. If I cut by 5 mg, and the brakes start causing PVCs, I could immediately cut more Loxapine until the PVCs go away. After all, the first 10% cut of Loxapine dramatically reduced the PVCs! And if Trazodone is a major culprit in my agitation, as well as pain, than I'm definitely ready to start cutting it. 

 

Addition: I just reread your thread on mCPP. I guess CYP2DR eliminates mCPP from the body. Wow, mCPP is so bad it's banned from other countries! If it serves no therapeutic value, why is it regularly prescribed?

 

So it seems to me the worst drugs here are Loxapine, Trazodone, and Clonazepam. Are the Oxcarbazepine and Bupropion not as bad in this case? If that's the case it may be better to round robin taper the Loxapine and Trazodone.

[Altostrata]

How are the PVCs now?

 

Did you reduce an additional 1.2mg loxapine?

 

It's not the drugs that are using or blocking cyp 2D6 per se causing the pain. It's the buildup of mCPP (a hypothesis), which is metabolized through cyp 2D6.

 

Reducing loxapine might make more cyp 2D6 available to metabolize mCPP.

 

Why were loxapine and oxcarbazepine http://www.drugs.com/pro/oxcarbazepine.html

added to your cocktail?

[Jshect]

How are the PVCs now?

 

Did you reduce an additional 1.2mg loxapine?

 

It's not the drugs that are using or blocking cyp 2D6 per se causing the pain. It's the buildup of mCPP (a hypothesis), which is metabolized through cyp 2D6.

 

Reducing loxapine might make more cyp 2D6 available to metabolize mCPP.

 

Why were loxapine and oxcarbazepine http://www.drugs.com/pro/oxcarbazepine.html

added to your cocktail?

I had some PVCs when I upped the Clonazepam. Now they're better. No, I've only reduced Loxapine by 1.2 mg total. I'm at 8.8 mg. LIke I've said, I've been on some combination of antipsychotic and mood stabilizer ever since I had an antidepressant-induced manic event many years ago. Loxapine and Oxcarbazepine are just the most recent. My psychiatrist recommended Loxapine because it doesn't cause weight gain. I see him on Tuesday and will show him your threads and ask him if he could contact the psychiatrist you recommended. Do you know how much this expert charges for consultations? Does he accept insurance?

 

In the meantime, maybe a good plan would be to cut a little Loxapine, then a little Trazodone etc. If I could get off of those two, then I would just have Wellbutrin, Deplin, Oxcarbazepine, Klonopin, and Bystolic to deal with. If I have trouble sleeping, maybe the eastern practitioner could recommend something natural. The Chinese medicine practitioner is really good. I can really feel a noticeable difference after I go to him. 

...or I could try round robinning some combination of all of them. I would be interested in seeing what happens when I reduce the Trazodone.

 

Alto I wish I could just work with you! I wish you could prescribe medications! Is there a quick online medical degree you could get lol?

[Jshect]

another interesting thing, is the stages of withdrawal I go through with (I think) Klonopin. 

-Stage 1

  is usually, anixety, slight disorientation and confusion, feeling uncomfortable, upset stomach, fever

-Stage  2 

  is usually a sharper mind as well as a boost and mood, memory, and sense of humor, along with a sort of uncomfortable feeling. 

  slight upset stomach

-Stage 3 when I've been at a lower dose for a while I start getting Stage 1 again, but worse, disorientation, confusion, and feeling really uncomfortable,

  upset stomach, fever

until finally I've stabilized at a lower dosage. 

 

Really strange combination and differing stages of withdrawal symptoms

[Jshect]

Well, the med I was on before Loxapine was also metabolized by CYP2D6 (Risperdal), so I guess many antipsychotics are metabolized by that enzyme. When I came to my Psych I was already on Risperdal and a mood stabilizer so I can't completely blame him for the CYP2D6 screw up. I may have already been taking Trazodone as well. 

[Altostrata]

Can you tell us more about the antidepressant-induced manic event?

 

I am envisioning your going off loxapine entirely first, then the oxcarbazepine, which I think may be causing that feeling of weakness. Also, I would like to see you get completely out of the PVC woods.

 

Let's see if trazodone-mCPP or excitation symptoms emerge, and deal with that if they do. Also, when you get the benzo withdrawal symptoms, perhaps you can increase by a much smaller amount?

 

Did you get benzo withdrawal symptoms from reducing .2mg loxapine? When did you do that?

 

I don't believe we can even out the symptoms with a plan of a little off this and a little off that, the interrelationships are too complicated.

[Jshect]

I saw my old psychiatrist and it went well. Unfortunately, I had forgotten to take my morning meds, so I was feeling crappy so I couldn't explain myself as well as I would have liked, but he was cooperative. He suggested that I keep lowering the loxapine since that seemed to be having a positive effect (just as you had.) I can't believe I forgot to take my morning meds! I had a lot of questions for him. He is a smart fellow. He was an associate professor of psychopharmacology at UVA, so if he's willing to work with us, he could provide valuable insight.

[Altostrata]

That's good. Did you talk about drug-drug conflicts with him? Is he going to phone Neil Sandson?

 

When did you last reduce the loxapine? Did you have any withdrawal symptoms?

 

Please be very regular in taking your drugs. Irregularity could cause symptoms.

 

What about that antidepressant-induced manic event? What antidepressant? How much? What was the event like?

[Jshect]

Sorry, I haven't been on this forum in a while.

to review:

I am on what you metaphorically called brakes (Loxapin, bystolic, Oxcarbazepine, Klonopin) and accelerators (wellbutrin, deplin, caffeine).

When accelerators are lowered brakes cause PVCs. But the Accelerators cause agitation, irritation, at times a crazy mania, and pain.

 

 

That's good. Did you talk about drug-drug conflicts with him? Is he going to phone Neil Sandson?

 

When did you last reduce the loxapine? Did you have any withdrawal symptoms?

 

Please be very regular in taking your drugs. Irregularity could cause symptoms.

 

What about that antidepressant-induced manic event? What antidepressant? How much? What was the event like?

I see my Psychiatrist again in about 5 days. I went into the drug-drug conflicts a little last time. Of course he was slightly defensive, and he said most patients he sees don't have any issues on combinations like Trazodone and Wellbutrin. He may be right. He said in the past that there were only a handful of patients (including myself) who have had such dramatic effects to the medications. He's probably been a psychiatrist for 20 years. 

However, I told him that doesn't mean I'm not having a reaction. I am overly sensitive to these medication combinations. So he was defensive, but he is willing to work with us. I didn't ask him to phone Neil Sandson. I'll have to check and see how much Sandson will cost, do you know if he takes insurance?

 

The antidepressant-induced manic event happened like 12 years ago. When I get a fever I sometimes get minor mania. I had recently started taking antidepressants, I had a fever of 102 degrees, and mania progressed over the night. I wasn't hallucinating, but by 6 am I was definitely out of it. After that I had not had any type of crazy manias, until this current combination 10 years later. 

 

I went from 10 mg to 8.2 mg Loxapine. I started to get mania, and bad irritability, so I lowered the caffeine. By the way other things like caffeine are also a part of this. Caffeine boosts the accelerators. Too much and the accelerators become problematic. Too little, and the brakes cause fatigue and PVCs.

It's paradoxical that too little caffeine would cause PVCs. 

So I think this is beyond medication now, although I think the medication is the number one factor in whether or not I get PVCs. When I was having PVCs in the past I went on a gluten free, milk free diet, high in meats and vegetables, and my PVCs decreased. However, medications are still the main factor.

 

I think I'm ready to lower the Trazodone or Wellbutrin now. The Trazodone might be best because I'd rather have energy and get less sleep, than be tired and sleep all of the time. If you think the Trazodone is a big culprit with irritability, and agitation, than I would definitely like to cut it. If I can't sleep, I could always try adding a more natural sleep aide like meletonin. 

[Altostrata]

Thank you for checking back in with us.

 

Specialists may consult with each other as a professional courtesy. Your psychiatrist should be able to phone Sandson and ask some questions without an additional charge to you. On the other hand, if Sandson thinks your case is too complex for a consult, he may want to speak to you directly.

 

You may wish to print this out for your psychiatrist http://pro.psychcentral.com/2013/this-months-expert-neil-b-sandson-m-d-on-drug-interactions
 

 

I went from 10 mg to 8.2 mg Loxapine. I started to get mania, and bad irritability, so I lowered the caffeine.

 

 

What happened then? What is your PVC pattern now? Did you get any benzo withdrawal symptoms?

 

I guess you could start lowering the trazodone, though I doubt on its own it's responsible for you feeling tired during the day. Rather, trazodone's metabolite mCPP would be a stimulant. Personally, I'd rather see you go off the loxapine completely first.

[Jshect]

Thank you for checking back in with us.

 

Specialists may consult with each other as a professional courtesy. Your psychiatrist should be able to phone Sandson and ask some questions without an additional charge to you. On the other hand, if Sandson thinks your case is too complex for a consult, he may want to speak to you directly.

 

You may wish to print this out for your psychiatrist http://pro.psychcentral.com/2013/this-months-expert-neil-b-sandson-m-d-on-drug-interactions

 

 

I went from 10 mg to 8.2 mg Loxapine. I started to get mania, and bad irritability, so I lowered the caffeine.

 

 

What happened then? What is your PVC pattern now? Did you get any benzo withdrawal symptoms?

 

I guess you could start lowering the trazodone, though I doubt on its own it's responsible for you feeling tired during the day. Rather, trazodone's metabolite mCPP would be a stimulant. Personally, I'd rather see you go off the loxapine completely first.

Well, I'm down from 10 mg Loxapine to 8 mg Loxapine and I am definitely starting to feel the benzo withdrawal. I thought I was sick today, but I wasn't totally sure if it wasn't the benzo withdrawal, so I ended up taking .25 mg klonopin today, and I felt better. I was hoping I wouldn't have to, but I may have to start raising the benzo. My PVCs haven't been bad. I guess because I'm lowering the "Brakes".

I have been seeing an Eastern Practitioner for acupuncture and he recommended Peace Pearls http://www.classicalpearls.org/products/peace-pearls/ and although I was weary about adding anything to the mix, these are really calming and have major antidepressant features. I do not like the idea of adding herbs into the mix, but I also have to function at a job and in life, and these reduce irritability.

 

I guess the only option I'm left with now is to raise the Benzo, unfortunately. I will show my psychiatrist that article.

Thanks, Alto

[Jshect]

Also, I am trying to add very low doses of Methyl B12 supplementation and then gradually increase. My nutritionist was saying if you haven't been receiving adequate b12, a lot of processes in your body are malfunctioning, so when it starts getting too much, a kind of rapid detox can occur, so I'm going to build up slowly. I'll let you know how that goes.

[Altostrata]

Please be careful about changed or adding too many things at once.

 

Good to hear the PVCs have not increased. Have they decreased at all?

[Jshect]

Yes, they have decreased because we've lowered the brakes. However, I still get them from time to time. I realize a lot of factors or at work. My meds, my diet, caffeine, now even these herbs. I encourage you to look into the peace pearls and other herbs made by that company. Those peace pearls are the best antidepressant I've taken and with no intetactions according to my eastern practitioner.

[Altostrata]

That's good.

 

I am wondering if you lowered the oxcarbazepine, which is a cyp3A4 inducer, it might cause metabolism of clonazepam to slow and perhaps enable you to reduce the Klonopin a bit.

 

I don't take mixed herbs or other mixed supplements because I'm so hypersensitive. Unless you analyze each of those herbs, you don't know what's in the Chinese remedy. They might be adding more complication to the metabolism of your drug cocktail.

 

Good to hear you like it, though.

[Jshect]

That's good.

 

I am wondering if you lowered the oxcarbazepine, which is a cyp3A4 inducer, it might cause metabolism of clonazepam to slow and perhaps enable you to reduce the Klonopin a bit.

 

 

How much should I reduce the Oxcarbazepine by? 10%?

[Altostrata]

Yes, a cautious 10%.

[Jshect]

I'll have to look up how to reduce Oxcarbazepine by 10%. Crush the pill and weigh it? Maybe, I should go to a compounding pharmacy. I've been taking a 1000 mg B12 pill, and for the first 2 or 3 days, I've been cutting it into approximately 1/8, today I cut it to about 1/6. It has made a huge difference. I haven't even been taking the peace pearl herb combination. 

[Altostrata]

That might be the best thing to do. The liquid is quite expensive http://www.healthwarehouse.com/solr/result/?q=trileptal , lasts only 7 weeks at most, and I'm not sure about the stability of a DIY liquid.

 

See http://www.drugs.com/monograph/trileptal.html

[Jshect]

Hi guys, I haven't posted in 2 months. Just thought I'd check in. I'm about the same level on my meds. I'm at 8 mg Loxapine. I noticed as I cut down the Loxapine, as you stated, the Klonopin was metabolized faster and I got withdrawal symptoms. Strangely enough, when I am slightly withdrawing from the Klonopin I feel absolutely great. I guess the withdrawal gives my brain a jolt, and my memory, mood, conversation skills are better. Does anyone know why that is? Unfortunately, withdrawing slightly eventually turns into withdrawing majorly. So I've been taking more Klonopin to stop the withdrawal. On a positive note, I forgot to refill my bystolic so I couldn't take it one night. I took a half a pill the next day and besides fatigue I felt fine. Since I really don't need a beta-blocker since we know the real reason I am having PVCs is because of the downers, and it costs over $30 a month, I may just slowly taper off of it.

Any advice or answers to my question on why slightly withdrawing from Klonopin makes me feel better and makes my memory better and my mind sharper?

[Altostrata]

Good to hear from you again, jshect.

 

Often people do feel better initially when reducing, as the adverse effects of the drug are relieved. Then withdrawal symptoms ramp up, as you've experienced.

 

Good to hear you've found a route off Bystolic. How are the PVCs now?

[Jshect]

Ever since we reduced the loxapine by 2 mg the PVCs haven't been that big of an issue. I don't know what bystolic withdrawal symptoms are so I'll guess I'll look that up. When I started severely withdrawing from the klonopin, I upped the amount I take and that caused some PVCs to return. Now that the withdrawal symptoms are leaving I'm lowering the dosage so the PVCs have left again. I may have to check myself into a rehab facility when I finally decide to quit Klonopin. The withdrawal symptoms are debilitating. I swear I could punch my psychiatrist in the face for starting me on them.

[Altostrata]

Well, now you know the PVCs are iatrogenic.

 

You have had bad luck with doctors, for sure.

[Jshect]

Good grief, I can't find any good sources for what to expect with Bystallic withdrawal. Why doesn't drug.com or webmd. list withdrawal symptoms?

[Altostrata]

Yes, medicine doesn't know enough about coming off drugs. The guides always say ask your doctor, but it's likely your doctor doesn't know anything.

 

Beta blocker withdrawal:

 

http://www.everydayhealth.com/health-questions/beta-blockers/what-is-the-safest-way-to-withdraw-from-a-beta-blocker-medication-i

 

http://www.ncbi.nlm.nih.gov/pubmed/7949498

 

This seems to be the key paper, "Withdrawal syndromes with antihypertensive therapy" by Norman M. Kaplan, but I don't have access to it http://www.uptodate.com/contents/withdrawal-syndromes-with-antihypertensive-therapy

 

 

The half-life of Bystolic is only about 10 hours http://en.wikipedia.org/wiki/Nebivolol

 

My guess is since you skipped a dose with no appreciable adverse effects, you are fairly tolerant to dosage reductions, and a 25% decrease a week (based on the last dose, the decreases keep getting smaller) might be okay. But, be careful and back up if you get any symptoms!