Jshect major issues with Wellbutrin/Deplin and klonopin addiction

[Jshect]

Well, anyway I am feeling better now so I have been putting off contacting these doctors. I will be contacting them shortly.

 

The two options recommended by Dr. Sandson are:

 

1. Dr. Mark Conrad: He has an insanely great resume, unfortunately he is a bit of a celebrity and charges insane prices, but his resume seems to indicate that if you are having serous problems with your medication he may be the one to go to.

http://www.komradmd.com/

 

His prices:

Dr. Komrad's Professional Fees:

 

 

Initial Evaluation,New Patient           2 hrs      $650

    

Individual Session                           1 hr          $275 

Individual Session                           1/2 hr      $140

Individual Session                           85min      $375

 

Family or couples session               1 hr           $300

Family or couples session               85min:      $375 

 

Single One-Time Consultation Evaluation

(for second opinion, or disability evaluation,etc, including written report to referrer)

                                                        2 hrs:         $750  with minimal  past records review

                                                        2hrs:          $850   with extensive past records review

 

I guess I could do a single one time evaluation with him for $750 and get 2 hours with him.

 

2. Douglas W Heinrichs MD

 

 

Douglas W Heinrichs & Associates don't even appear to have a website so I imagine he would probably take insurance like any other specialist, and his fee would be $40 (my copay). Unfortunately, I don't know much about him, but the fact that Sandson recommends him is great! I'll call his office tomorrow!!

 

One of my next steps will also be to find a functional doctor like Dr. Perlmutter. These are the doctors who don't like western medicine and medications, but try to solve your issues by measuring brain inflammation markers, try to reduce brain inflammation, inflammation of your entire body, heal leaky gut and leaky brain, all through diet and nutritional supplements. I've had horrible brain fog nearly my entire life... psychiatrists have not been able to fix it so the next option is diet and exercise.

If anyone knows of any decent functional doctors in VA let me know. I'm sure the celebrities like Dr. Perlmutter and Dr. Hyman cost a fortune to meet with, but maybe there's lesser known functional doctors or even nutritionists in my area. 

 

 

[Altostrata]

Good to hear you're feeling better.

 

Seriously, you need to minimize your drugs before attempting to measure brain inflammation (I'd very much like to know how they do that!!!!) and fixing it.

 

I suggest you get some common vitamin and mineral blood tests via your primary care doctor before trying anything exotic (and expensive).

[Jshect]

 

 

Seriously, you need to minimize your drugs before attempting to measure brain inflammation (I'd very much like to know how they do that!!!!) and fixing it.

 

 

I believe I read an article by Dr. Perlmutter (who is a neurologist  and a nutritionist) where he talked about specific markers they can measure in your blood that can reveal brain inflammation. I'm reading his book grain brain now, so I'll keep you informed. There are so many chemicals in our everyday products and environment we are all probably suffering from chronic inflammation, even the healthiest of us. That's not what he said but that's my opinion.

[Altostrata]

That may be true, but in your case, your drugs are your biggest problem. Please do not get distracted from minimizing your drug burden. I worry about you all the time.

[Meimeiquest]

Oh my, I just brought that up to reassure you that there are probably solutions to your original problems, not to be afraid to move ahead with getting off drugs.

 

Really, there are probably enough of us who have spent money on integrative doctors to mostly coach you. Because it is 90% lifestyle. Save your money for healthy food!

 

If you want a test, multiple doctors recommend a test that insurance will cover and normal doctors understand...c-reactive protein (CRP). You want the cardio-specific or high-specificity version (both the same thing). But you will know by feeling better. It is just an easy, one-number way to track progress.

 

I am using inositol with good success to help cover withdrawal symptoms. I get powder, NOW brand, from Amazon, but there are many options.

 

Just saying....you can do this!

[Meimeiquest]

Clarification...my comment about doctors was about regular integrative doctors. You may need to get a specialized psychiatrist, I don't know. That would be an Alto issue beyond my understanding.

[Jshect]

Damn it, Douglas W Heinrichs MD does not accept insurance and charges $375 for an initial visit. would have to drive 3 hours to meet with him, He doesn't do phone consultations.

[Altostrata]

Can he recommend anyone nearer to you?

[Jshect]

There is a psychiatrist about 30 minutes or so from my house who claims to be a holistic doctor, so I think I'm going to try him. http://www.michaelhoffmanmd.com/About-Us.html

The best psychiatrists near by may be at the prestigious UVA hospital which is an hour from my house.

They have 27 psychiatrists 

 

http://uvahealth.com/doctors/browse-by-specialty/find-doctor?getServiceLine:list=Psychiatry

 

Can you explain scientifically what you think is happening in my body when I either lower the dosage of the uppers (Wellbutrin, Trazodone, and Deplin) or increase the downers (loxapine, Oxcarbazepine)? Why is it having this paradoxical effect of causing PVCs when it almost always is the case that increasing stimulants causes PVCs. I want to be able to explain this to my next psychiatrist better. Most doctors(psychiatrist and a cardiologist) I see don't buy this, but I have experimented with my medications in almost every way possible, and you are definitely correct.

 

I wonder if something more natural and healthy could be substituted for the Wellbutrin. I can't really substitute another antidepressant because no other antidepressant acts on dopamine. The fact that it boosts dopamine, just like the ADHD stimulants, may explain why Wellbutrin has such stimulating effects.

[Meimeiquest]

It looks like Alto is a bit busy today, so I will throw out my random ideas about the PVCs and she can add to it. Usually PVCs are caused by a ventricle that is a bit over-excitable from a relative overload of sympathetic stimulation, like stress, caffeine, etc. This is usually not serious. But they can also be a "rescue" when the heart is not sending an adequate impulse down from the atrium, and this can be more serious (it is also serious if even the over-excitation gets too crazy). So potentially you could be so over sedated when you change your cocktail that this happens.

 

And then there's the beta-blocker issue, plus other side effects and interactions that I don't even know about. Do you think your cardiologist might be up for a 24-hour holter monitor when you make an arrhythmia-inducing change? Then you would have some objective data to work from.

 

I'm thinking working your diet would be a lot safer and more effective than Wellbutrin or stimulants. I am BTDT on all those.

 

Hopefully Alto will have some more informed comments.

[Altostrata]

Very sorry I haven't been around much, I've been having serious computer problems.

 

I understand it more or less as meimei has explained it. The heart tries to regulate its rhythm. You are taking a bunch of drugs, both accelerators and brakes, that affect the rhythm. When the rhythm is thrown off, the heart tries to correct it. Then you get an irregular heartbeat.

 

The drugs you're taking also affect all the hormones in your body. The hormones are chemical messengers that keep various systems, including heartrate, in healthy balance. This is called homeostasis. Our bodies are designed to maintain this balance. There are sensors everywhere (receptors) monitoring balances and relationships. Your drugs affect these sensors, too, probably throwing off the measurements, but your body is still doing its best to maintain balance. Unfortunately, this is a little sloppy because of all the chemical interference.

 

When you keep the drugs consistent, you enable homeostasis, such as it is (although you are still suffering undesirable side effects). When you make a change in the drugs, the entire balance shifts and your body does things to regain balance again.

 

Because you're taking so many drugs with probably untraceable interactions, I don't think anyone can predict what replacing, increasing, decreasing, or quitting any one of them will do. As I see it, the only way out is to move cautiously, but I very strongly believe you need to confer with a doctor about this in case any experiment lands you in the hospital. You also need a champion for the benzo prescription.

 

PS The holter monitor would at least convince MDs that something undesirable is going on, but I doubt any cardiologist will acknowledge that you're having adverse effects from drugs, or if they do, they'll tell you to go to a psychiatrist. Cardiologists don't want to get involved with this stuff either.

 

jshect, have you also canvassed the neurologists near you? It's a long shot, but it could be there's an extraordinary one who'd be willing to help you.

[Jshect]

 

 

jshect, have you also canvassed the neurologists near you? It's a long shot, but it could be there's an extraordinary one who'd be willing to help you.

 

Who, the Holistic psychiatrist or one of the 27 at UVA?

I hate how you never know what you're going to get until you've paid for the more expesive first visit evaluation.

[Meimeiquest]

Sometimes the multi-physician practices have bios on their website that include their areas of interest. And sometimes if you can talk to a nurse in the office, they can direct you. Sometimes even the new appointment scheduler will know. But I agree it is a very expensive game of looking for a needle in a haystack.

[Altostrata]

A neurologist has a different area of practice than a psychiatrist.

 

I would insist on speaking to these people over the phone before paying for an appointment.

 

Still, it is a difficult and frustrating search, I agree. I'm sorry it is the way it is.

[Jshect]

Dr. Kane said a good place to start med reduction is Klonopin. The withdrawal from a Klonopin is absolutely brutal. I've read on other websites that you should switch to Diazapam because it has a longer half-life. Have you guys heard that? I wonder if there are any herbs or meds like buspar I could take to ease the anxiety. This could easily be a year's worth of brutal withdrawal (or longer). I obviously can't go from 150 mg SR to 100 mg SR Wellbutrin. I may have to pay a s*** load and have it professionally turned into a solution. Then I could drop by 1 mg a week or something to reduce heart palpitations. 

[Meimeiquest]

Valium's half-life is extremely long, Klonopin's is long. I can't imagine why you would want to put yourself through another switch. Both Klonopin and Wellbutrin can easily be made into suspensions/solutions at home to deliver any dose you want. You might have to bring them down alternating, doing the Klonopin till it gets hard, rest it, do the Wellbutrin till it gets hard, etc. Everyone is different, it may or may not be difficult.

[Jshect]

Oh, wow, you can easily make Klonopin and Wellbutrin into suspensions yourself (I imagie by crushing them). I guess when you remove the outer cover the Wellbutrin is almost like a powder already. Great, because I know how expensive it is to buy a custom made solution from a pharmacist. This is going to be hell, but I'm really going to do it this time. After Christmas I'm going to reduce my hours at work, and begin this reduction. I'm getting off of Wellbutrin. I don't know how slow to taper it. I'm so sensitive to reductions in Wellbutrin (PVC's) I'm going to taper my 150 mg pills by 1 mg when I figure out the mg/ml ratio for whatever syringe I use, and find a syringe that will work for that small of an increment. 

[Jshect]

Bottom line is I'm getting off of the Wellbutrin. If I start having a ton of PVCs, I'll just have to check myself into a hospital until they can figure out how to decrease them (without medications, my fear is the hospital would not understand my situation & try to, simply and mindlessly, raise the beta blocker.) I'm probably going to have to do a round robin reduction. The Klonopin withdrawal symptoms keep my affective Wellbutrin side effects at bay (anger, irritability, impulsiveness) but don't relieve the pain I'm in from the Wellbutrin. That's why I'm going to have to take turns reducing them. If I reduce the Klonopin from 2 mg to 1.785 (cutting a .5 mg pill by a quarter) I may have to lower the Wellbutrin next. If I get bad PVCs I may have to lower the Loxapine or Oxcarbazepine to reduce the PVCs. Then I'll do the cycle all over again. I hope this works. It will be brutal to be having Klonopin withdrawal and PVCs at the same time. That will cause agonizing anxiety. This is going to suck. But, I'm going to do it. I've got to.

[Altostrata]

Jshect, we have the details about tapering Wellbutrin here Tips for tapering off Wellbutrin, SR, XR, XL (buproprion)
 
Forum for benzo tapering discussions Members-only benzo tapering discussion also see Benzo support -- sites, blogs, Facebook
 
Switching to Valium was proposed in the Ashton Manual for benzo tapering, which many swear by. However, like switching to Prozac to go off an antidepressant, switching to Valium has additional risks. It can go bad. To avoid those risks, people try taking divided doses of Klonopin first, usually in liquid form. Please go to the benzo area or one of the Facebook groups to get details on that.
 
You might also read Stuart Shipko's e-book Xanax Withdrawal It's about Xanax but applies to all benzos.

 

Did Dr. Kane confer with any of the drug-drug interaction experts?

[Jshect]

The two fellows Dr. Sandson recommended were EXTREMELY expensive. I talked to one in Maryland and his receptionist said he doesn't do phone consultations, I'd have to see him in person. I didn't ask him about talking to Dr. Kane. I wish he would just have one phone consultation with me. Dr. Kane is very intelligent, he's a former assistant professor of psychopharmacology at UVA, he's just a little indifferent. The other guy Sandson recommended was sort of a psychiatric celebrity. He had an amazing resume, but the initial visit with him would cost $650. I don't know maybe it's worth it. But I'm not driving over 3 hours for each visit. Maybe I should consult a neurologist and try another cardiologist and possibly a new psychiatrist. Last time when I tried switching to Dr. Alderfer it was a major waste of $ and time. The damn initial visit is what kills me. It's always like an hour and they charge your insurance like $300. I might just start a round robin reduction. i know when I start getting bad PVCs if I lower the Loxapine they greatly decrease and eventually go away. But, when I lower the Loxapine I get Klonopin withdrawal quicker. But lets face it, I'm going to have to get off of all of these eventually and it's going to be painful, all I can do is jump in and get started. It's time to suffer. I reduced the Klonopin by 1/4 .5 mg pill before and I got through it. I could keep lowering that until I get some of the quite "normal" symptoms of Wellbutrin which are irritability and anger. When that happens I can start gradually lowering the wellbutrin. If I start having PVCs I can lower other sedatives. Luckily I have enough family financial support that I could really cut my hours at work. I guess I could try emailing the two fellows with a brief description of my situation and see if they could have some sort of consultation with Dr. Kane. The real issue is the PVCs. I know Klonopin withdrawal is going to be brutal but will disappear evenually. PVCs by themselves are not harmful. The worst part is the brutal anxiety they cause me, but that's because I'm prone to anxiety. SOme people have PVCs are have no anxiety at all. When you reduce Deplin, it takes like 4-6 weeks to really decrease your overall blood concentration. I did that one summer and after 4-6 weeks I started getting a slew of PVCs. I went back on the deplin and the PVCs eventually decreased, but didn't go away. I dropped Loxapine by 10 mg and I may have even lowered oxcarbazepine by 150 mg and they went away. The important thing is I can round robin taper. If the PVCs get to bad I can always just jump back up to 150 mg Wellbutrin because that effect is immediate. 

OH CRAP!!! I just realized I am going to have to buy an SR reduced Wellbutrin solution from a pharmacist. If I turn it into a solution myself it will be like XL and dump it all into my body at once. My heart really dislike XL. Damn. SR solutions will probably cost over $100 a month. The beta blocker is $30/month so it would help financially if I could taper off of that. Since it's mainly the sedatives causing the PVCs then I certainly don't need a beta blocker which is just another sedative. Tricky. My friend saw an idiopathic neurologist she said was pretty good, maybe I should see him. A cardiologist has got to understand this reaction to, as far as sedatives vs stimulants causing heart neurons miscommunicating. THIS SHOULD NOT BE THIS DIFFICULT TO GET HELP FROM ALL OF THESE HIGHLY TRAINED PROFESSIONALS> but it is, why is our medical system so f***ed up?

[Altostrata]

No, you can make the Wellbutrin liquid, you'll just have to take it more than once a day.

 

Dr. Kane should be able to phone the other doctors to consult with them. They do this for each other as a courtesy. Usually there's no charge to you.

 

This is a very inexpensive online drug store https://www.healthwarehouse.com/

 

Walgreen's, Target, Walmart, Safeway, etc. often offer generic drugs for $4 or $5 a prescription. You should look into that.

[Meimeiquest]

It works best to use immediate-release,Wellbutrin for making a liquid, but it would be good to use SR for as much as you can as it's metabolism is longer and smoother.

[Jshect]

No, you can make the Wellbutrin liquid, you'll just have to take it more than once a day.

 

Dr. Kane should be able to phone the other doctors to consult with them. They do this for each other as a courtesy. Usually there's no charge to you.

 

This is a very inexpensive online drug store https://www.healthwarehouse.com/

 

Walgreen's, Target, Walmart, Safeway, etc. often offer generic drugs for $4 or $5 a prescription. You should look into that.

You mean Dr. Kane could call one of these psychiatrists (that are charge $650 for an initial visit) and they'd talk to him for free!? I would think I would have to pay both of them? It seems to me like time is money with these guys. I mean Dr. Kane gets like $100 with copay and insurance just for spending 15 minutes with me. Are you sure both would agree to talk for free? I do probably need start talking to as many people as possible until I find someone who can help me. Sitting here doing nothing has been getting me nowhere, but that's what I've been doing. Time for action. 

[Altostrata]

If they feel like it, they will have a friendly chat with Dr. Kane at no charge to you.

[Jshect]

 

 You also need a champion for the benzo prescription.

Where would I find a champion for the benzo prescription?

It seems like my best bet is with you guys and other online benzo forums. Dr Kane said he thinks I'm at most dependent, but I have a feeling I fit the actual clinical term addicted. I go through 3 stages of withdrawal when I cut a dose. The first is a sort of pleasant cognitive boost ironically as well as a feeling of slight fever & slightly irritable stomach (as my gabba system gets a jolt), 2nd an unbearable anxiety, plus unable to eat much, fever, and last the worst is (as they called on the benzo support group website) dissociation or depersonalization (I think this may be what happens.) this is awful, and this is the toughest to go through at a job. I'm aware of what's going on, but it's like I'm on LSD or something. I can't quite connect with reality very well, the good thing is that I'm aware of what a fool I am making of myself, so I keep communication with coworkers to a minimum. Then this gradually this passes I become adjusted to the new lower dosage.

So, I take 2 mg (4 .5 mg pills). I'll probably make 1/4 cuts to a .5 mg pills, which means it's going to take 16 cuts to get me off this. I guess I would want to go through all three stages and stabilize before I make another cut. I'll have to keep good notes and see how long it takes me to go through all 3 stages. Say it's a month. That's going to be 16 months to get me off Klonopin!!!!!! And that's just Klonopin. The Wellbutrin and trazodone are going to be the trickiest.

The sedatives I honestly could drop pretty quickly, in fact I did that once:

I wasn't on the Deplin, I was on Loxapine, Oxcarbazepine, and Wellbutrin. I felt depressed, energyless, and listless. I dropped the Loxapine and Oxcarbazepine with no major withdrawal symptoms. The Wellbutrin by itself made me incredibly energetic. I really couldn't focus but I had insane amounts of energy (similar to how I felt on the ADHD stimulants. I've played guitar for 20 years (and during the month I was solely on Wellbutrin I played guitar about 8 hours a day after school recording music after school. Eventually I returned back onto the Loxapine and Wellbutrin, and also returned to my old depressed, listless state. It wasn't until I added Deplin that I got kicked into a real overdrive. Work was hectic that summer, so I was kicking ass at work in this overdrive. I started taking the trazodone at night to get to sleep. Finally, I decided to get off the Wellbutrin and that's when the PVCs kicked in. SO I was only on Loxapine, Oxcarbazepine, Wellbutrin, Trazodone, and deplin. When the PVCs caused horrific anxiety I started taking Klonopin daily. Then I went to a cardiologist, I did where a holter monitor, and they said even with the PVCs my heart rhythm looked fine. They said it was not the medication that was causing PVCs and gave me Bystolic, the prick. I was having horrendous anxiety from the PVCs so I could not explain myself well enough.  So in other words, the Loxapine and Oxcarbazepine will not give me much trouble when I reduce them. It will be the uppers giving me PVCs that will be the problem. 

 

PS The holter monitor would at least convince MDs that something undesirable is going on, but I doubt any cardiologist will acknowledge that you're having adverse effects from drugs, or if they do, they'll tell you to go to a psychiatrist. Cardiologists don't want to get involved with this stuff either.

 

jshect, have you also canvassed the neurologists near you? It's a long shot, but it could be there's an extraordinary one who'd be willing to help you.

[Altostrata]

You need an MD who will write the benzo prescription. Dr. Kane is your champion for this.

 

It sounds to me like you are physiologically dependent on the benzos. You do not meet the technical definition of addiction, which requires craving for the drug. So Dr. Kane is correct about that.

 

Still, it can be very difficult for someone who is only physiologically dependent to come off benzos.

 

If you feel more confident reducing the other drugs, you may wish to focus on reducing those.

 

As I've said many times before, I don't know what will happen when you alter your drug mix. You will have to go carefully. If something really bad happens, phone Dr. Kane right away (not that he'll know what to do, but if you go to the hospital, he should know).

[Jshect]

I've kind of come up with a plan to get myself off these drugs. I could start by buying compounded Wellbutrin from a compounding pharmacy. It will be expensive, but if I could reduce the Wellbutrin I wouldn't be in pain, so at least when I start reducing the benzo, I could still exercise and lift weights. Heck, I could even try reducing my 150 mg Wellbutrin SR by 1 mg per week at first. Whenever I get PVCs reducing the sedatives seems to resolve the issue. Luckily, Oxcarbazepine reduction for some reason raises the amount of Klonopin in your system (I think you and Dr. Kane both said that.) So to keep my benzo levels stable, I could alternate lowering Loxapine and Oxcarbazepine while Iower the Wellbutrin. So I could take 149 mg Wellbutrin SR for a week and see how that goes. If it goes OK, and the amount is so small that my body achieves homeostasis quickly, maybe next week I reduce by 2 mg (147 mg Wellbutrin sr.) I'm hoping I could reduce at least by 2 mg a week so this doesn't go on forever. If I start getting PVCs then I lower the dosage of Oxcarbazepine or Loxapine. Also, it does seem like my diet makes a difference with PVCs. When I eat really healthily, it seems like the PVCs go away faster. Even though my Magnesium levels are normal, is there a chance that supplementing that or another nutrient could help. When my bodies heart beat regulatory system is out of whack, maybe it's not utilizing nutrients properly and needs a little help. I'll have to research homeostasis and heart rate.

[Jshect]

Thank you guys, I think I'm finally on the right track and I couldn't have done it without you. I'm feeling confident about getting off of these medications safely and effectively for the 1st time. I think reducing the Wellbutrin by 1 mg or 2 mg per week is a very good idea and I never would have thought of it if it wasn't for your hypothesis on why the PVCs are occurring in the first place. Together WE WILL GET THROUGH THIS!!

[Altostrata]

Yes, absolutely!

 

You don't need to go to the expense of getting Wellbutrin compounded, you can make your own liquid. You can take part of your Wellbutrin dosage in Wellbutrin SR and take part in a liquid made from immediate-release Wellbutrin (Wellbutrin IR).

 

As Wellbutrin SR is dosed twice a day, you can take the liquid part for the second dose.

 

You would subtract the 1mg in the liquid until that was gone. Then you could cut up Wellbutrin SR, make some more liquid from regular Wellbutrin IR, and do the same thing over.

 

For example:

 

You are taking 150mg Wellbutrin. You could get that prescription in 100mg Wellbutrin SR tablets and 100mg Wellbutrin IR (your doctor should write the prescription for twice-daily dosing, one SR tablet in AM and 1/2 IR tablet in PM).

 

Make a liquid from one 100mg Wellbutrin IR tablet. Initially, this will last for 2 days of dosing.

 

To take a daily dose of 149mg, take one 100mg SR tablet in the AM and 49mg of the liquid in the PM.

 

To take a daily dose of 148mg, take one 100mg SR tablet in the AM and 48mg of the liquid in the PM.

 

And so forth for 50 reductions, down to 100mg daily -- that would be just the 100mg SR tablet. Then, cut the 100mg SR tablet in half for a dose of 50mg.

 

To take a daily dose of 99mg, take 1/2 100mg SR tablet (50mg) in the AM and 49mg of the liquid (made from 100mg IR) in the PM.

 

You may be able to get generic buproprion SR and buproprion IR very inexpensively, for about $5 per month, see Getting your prescription filled on a budget

[Jshect]

The thing is I took 100 mg SR before and I believe 35 mg XL and I had horrendous PVCs. THe XL has always given me PVCs. Then again, I believe I took all 135 mg in the morning. I guess I I could try taking 100 mg SR in the morning and 49 IR in the evening. I've just had very bad experiences with XL. I mean like 1 hour after taking it I start getting PVCs. I'll have to compare the half-life of SR and IR.

[Jshect]

Exposure (concentration over time; bupropion exposure = 100%) and half-life   Bupropion R,R-
Hydroxy
bupropion S,S-
Hydroxy
bupropion Threo-
hydro
bupropion Erythro-
hydro
bupropion Exposure 100% 800% 160% 310% 90%

Half-life 10 h (IR)17 h (SR)

 21 h 25 h 26 h 26 h Inhibition potency (potency of DA uptake inhibition by bupropion = 100%) DA uptake 100% No data No data No data No data NE uptake 27% No data No data No data No data 5HT uptake 2% No data No data No data No data α₃β₄ nicotinic 53% 15% 10% No data No data α₄β₂ nicotinic 8% 3% 29% No data No data α₁* nicotinic 12% 13% 13% No data No data DA = dopamine; NE = norepinephrine; 5HT = serotonin.

 

Geez, this chart came out a disaster. It is from wikipedia, go there if you want to see the whole chart. 

 

http://en.wikipedia.org/wiki/Bupropion

 

Maybe this chart could give you guys some clues as to how far apart to take the 100 mg SR and the 49 mg IR solution. My system is very sensitive to the amount of bupropion in it. I guess when it drops below a certain level I start getting PVCs. I already have 100 mg SR tablets and 50 mg XL tablets somewhere from when I tried to quit before. I was taking 3/4 50 mg XL (37.5mg) and 100 mg SR. I don't remember if I was taking them all in the morning. With the half lives differing for all of those metabolites who knows when I should take it or if I can tolerate any amount of XL or IR at all. I have a feeling I won't be able to tolerate it, but I guess since I already have the medications somewhere I could at least try. 

The SR has a half-life of 17 hours. So I could take it and see when I started having PVCs and keep track of the time. Divide that time into 17 hours (and multiply that by 100 mg) and that will tell you at what amount in mg my body requires before I start having PVCs. Whatever time that is I will know to take the 49 mg IR 10 or 20 minutes before that time. I can then again keep track of time when I take the IR in the evening and see how long that lasts before I start having PVCs. Hopefully the total time will go over 24 hours and then I will be able to avoid PVCs but I have a sneaking suspicion it won't. I have never had a pleasant experience with XL. I have a suspicion I will have to fork out the $ for a 149 SR pill.  

[Altostrata]

All types of buproprion have the same metabolites. The metabolites all have the same half-lives.

 

The difference in the types of buproprion is the way the tablet itself is formulated, to release amounts of the drug into the bloodstream at different rates.

 

Probably most people take SR in the morning and then 10 or 12 hours later.

 

Whether you will get PVCs with any plan to change from your present dosing and type of Wellbutrin, no one can predict.

 

I believe we discussed this extensively before and that is why you chose to reduce the other drugs rather than Wellbutrin.

 

Rather than pay a compounding pharmacy to make a 149mg capsule, which would have to be SR or IR crushed into a powder, how about having them make up 125mg capsules and make the rest in a liquid yourself? This might be a way to ease your nervous system onto the combination without less upset.

 

(If you read the Wellbutrin tapering topic, you will see there is some debate as to whether the SR fully retains its sustained-release qualities if it is crushed.)

 

Often, the price per capsule of a compounded drug is less if you order more capsules. If you think it would take 2 months to get down to 125mg (reducing 25mg over 60 days, for example), you could order 60 capsules of 125mg at once.

 

Or any other combination.

[Jshect]

All types of buproprion have the same metabolites. The metabolites all have the same half-lives.

 

The difference in the types of buproprion is the way the tablet itself is formulated, to release amounts of the drug into the bloodstream at different rates.

 

Probably most people take SR in the morning and then 10 or 12 hours later.

 

Whether you will get PVCs with any plan to change from your present dosing and type of Wellbutrin, no one can predict.

 

I believe we discussed this extensively before and that is why you chose to reduce the other drugs rather than Wellbutrin.

 

Rather than pay a compounding pharmacy to make a 149mg capsule, which would have to be SR or IR crushed into a powder, how about having them make up 125mg capsules and make the rest in a liquid yourself? This might be a way to ease your nervous system onto the combination without less upset.

 

(If you read the Wellbutrin tapering topic, you will see there is some debate as to whether the SR fully retains its sustained-release qualities if it is crushed.)

 

Often, the price per capsule of a compounded drug is less if you order more capsules. If you think it would take 2 months to get down to 125mg (reducing 25mg over 60 days, for example), you could order 60 capsules of 125mg at once.

 

Or any other combination.

Yes, I know  and when I lower the Loxapine and the Oxcarbazepine I may start suffering from Klonopin withdrawal and I'm going to figure out how much Loxapine  I can lower and how much Oxcarbazepine I can lower to keep my Klonopin levels even. I know this is going to be a painstaking, painful process. But when the Wellbutrin is in effect I'm irritable, angry etc. and at my current dosage I'm in pain. I want to lower the Wellbutrin to keep the irritability and anger down, and hopefully the pain will go away so I can exercise. A problem will be I will have less energy. But I think the Wellbutrin is the one I want off of the most because I don't want to be in pain or have a rotten personality. I don't know, this is going to be tough any way I do it. If I could get rid of the pain of the Wellbutrin, at least I could work out when I am withdrawing from the Klonopin later. I don't know, there is absolutely no easy answer to this problem. I have support from my parents right now, so if I really need to fork out $100 a month for compounded Wellbutrin I can. Like I said, I have SR and XL now, so when things slow down at work I will try taking 100 SR and 49 IR solution and see what happens. The most important thing is that I start taking action or I will never be off of these meds. 

[Altostrata]

I'm sure you have good reasons to reduce Wellbutrin. I just want you to know that a compounding pharmacy has no choice but to put either powdered SR or IR in a capsule, and what you'll be getting is closer to IR than SR.

 

Cutting up an SR tablet is a little more likely to stay sustained-release, half the tablet stays intact (the SR quality is in the tablet binder).

 

If you don't want to take a liquid made from IR, you could get a digital scale and measure fragments of SR tablets to taper, see Using a digital scale to measure doses

[Jshect]

I'm sure you have good reasons to reduce Wellbutrin. I just want you to know that a compounding pharmacy has no choice but to put either powdered SR or IR in a capsule, and what you'll be getting is closer to IR than SR.

 

Cutting up an SR tablet is a little more likely to stay sustained-release, half the tablet stays intact (the SR quality is in the tablet binder).

 

If you don't want to take a liquid made from IR, you could get a digital scale and measure fragments of SR tablets to taper, see Using a digital scale to measure doses

Wow, the prices on those scales have really come down. I few years ago a good quality .001 gram scale was a couple hundred dollars. Now on Amazon the Gemini was $25!!!! That would probably be my best bet. Take 100 mg SR in the morning, using the formula on your link to create a 49 mg SR tablet in the evening. Even if the scales +/- a few milligrams it should be alright in the long run (I hope).

I talked to a local compounding pharmacy before. You mean they couldn't make a 149 mg SR tablet?? It would be closer to IR?? Is it that difficult for a local pharmacy to make an SR pill? I guess they might need high-tech equipment. 

[Altostrata]

Yes, they can make a 149mg SR capsule. They crush it to a powder. This destroys the binder. Then it's not much different from IR.

 

I would consider this a waste of money myself.