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Tips for tapering off amitriptyline

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Altostrata

Aka Vanatrip, Elavil, Endep, Saroten Retard

 

Official FDA information at http://www.drugs.com/pro/amitriptyline.html

 

Amitriptyline is a tricyclic antidepressants (TCA). Its half-life is highly variable, estimated at 10-26 hours, but it breaks down to an active metabolite, nortriptyline, with a half-life of 18-44 hours (see https://online.epocrates.com/u/10a136/amitriptyline

 

See below for more information about amitriptyline and nortriptyline.

 

From http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20A)/AMITRIPTYLINE.html

Quote

Pharmacokinetics: Amitriptyline is well absorbed from the gastrointestinal tract with peak plasma concentrations occurring between 2 and 12 hours after administration. Bioavailability of the drug is between 30 and 60% due to extensive first pass metabolism of the drug in the liver. Amitriptyline is demethylated in the liver to its primary active metabolite, nortriptyline.

....

Its elimination half-life varies from 10 to 50 hours, with an average of 15 hours. Within 24 hours, approximately 25 to 50% of a dose of amitriptyline is excreted in the urine as inactive metabolites; small amounts are excreted in the bile.

....

Drug Interactions [see the page for full list]

....

Selective Serotonin Reuptake Inhibitors (SSRIs): Amitriptyline toxicity may occur if used concurrently with fluoxetine, because of inhibition of the hepatic mirosomal enzyme responsible for the metabolism of amitriptyline. Reduction of amitriptyline dose by as much as 75% may be necessary. The potential for this interaction occurring with other SSRIs must be considered. Because of the extremely long elimination half-life of fluoxetine, the potential for interacting with other drugs remains for several weeks after its discontinuation. Thyroid Medications: Concomitant use of amitriptyline and levothyroxine may potentiate the cardiovascular effects (e.g., arrhythmias) of both drugs. ....

 

Harm reduction: Taper by 10% As with other psychiatric drugs, a conservative taper of 10% per month, calculated on the last dosage (the amount of the decreases keeps getting smaller), is recommended to minimize withdrawal symptoms. See http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

Tablet dosages

In the US, amitriptyline comes in 10mg, 25mg, 50mg, 75mg, 100mg, 150mg tablets. See FDA information at http://www.drugs.com/pro/amitriptyline.html Sometimes the tablets are taken in 3 to 4 divided doses per day or all at bedtime per http://www.drugs.com/dosage/amitriptyline.html

 

Sustained-release capsule dosages

In Europe, amitriptyline is available from Lundbeck as Saroten Retard (amitriptyline hydrochloride in a sustained release formulation) in 25mg and 50 mg capsules.

 

Here is the package insert from Lundbeck for Saroten Retard: http://home.intekom.com/pharm/lundbeck/saroten.html

Quote

Amitriptyline as such is rapidly absorbed but owing to the sustained release from SAROTEN RETARD capsules amitriptyline only becomes available for absorption slowly. This results in a rather flat serum concentration curve.

 

Probably, as in many extended-release formulations, the coating on the pellets inside the capsules is what delays the release of the entire dose at once.

 

Cutting up tablets

If you are taking the tablets, you can cut them up. For precise dosing, weigh the pieces with a digital scale.

 

Using amitryptyline liquid to taper

Amitryptyline is available as a liquid in the UK http://www.patient.co.uk/medicine/Amitriptyline.htm

The liquid needs refrigeration.

 

Order a liquid from a compounding pharmacy

Compounding pharmacies can make a liquid from medications that do not have special extended-release coatings or Cymbalta. Your doctor will have to write a prescription specifying how the drug is to be compounded.

 

Making a Liquid Solution of Amitriptyline

 

In the past it was believed that a liquid preparation of Amitriptyline could be made simply by dissolving the tablets in a specific volume of water. It has since been discovered that Amitriptyline is only sparingly soluble in water. This will lead to the possibility of the dose of water-based liquid being much smaller than is required. However, if you are having success using this method there is no need to change, but for people just starting a liquid taper of Amitriptyline there is a better way.

 

It turns out that Amitriptyline is very soluble (25mgai/1mL) in ethanol, or as most people know it vodka. Once the Amitriptyline is dissolved in the vodka it can then be added to water to make up a workable volume. However, according to the manufacturer, this new liquid will only be usable for the day it is made.

 

To create 10mL of the new liquid: measure out 1mL of vodka into a container and add one entire crushed tablet up to 25mgai in strength. For larger tablets double the amounts for each 25mgai that is used. So a 50mgai tablet uses 2mL and a 100mgai tablet uses 4mL. In the next step increase the water in the same manner. Mix this up and let it stand for an hour, shaking occasionally. Do not worry about any sediment, that is just filler and does not count. Then add 9mL (18mL, 36mL) of water to the vodka to make the final liquid solution. This will yield 10mL (20mL, 40mL) of solution that will have the strength of the original tablet so you can calculate the volume of your dose from there

 

Dissolving amitriptyline in water to make a liquid

Please note that this method has been superseded with the one listed above.  If you are having success with this method there is no need to change, but if you are just planning to use a homemade liquid we recommend that you use the alternative method.

 

About basic amitriptyline in tablets: Manzo 2006 Biowaiver Monographs for Immediate Release Solid Oral Dosage Forms: Amitriptyline Hydrochloride http://www.fip.org/files/fip/BPS/BCS/Monographs/Manzo%202006.pdf

Quote

Amitriptyline hydrochloride is soluble 1:1 in water.11 The USP and the Ph. Eur. report this API to be ‘‘freely soluble in water’’.

 

How stable is this solution of amitriptyline in water? See Buckles 2008 The stability of amitriptyline hydrochloride in aqueous solution http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2710.1976.tb00052.x/abstract

Quote

The present work, using thin layer chromatography and polarography, reports that solutions of amitriptyline hydrochloride in purified water at room temperature are stable for at least 8 weeks if protected from light.

 

Theoretically, you should be able to make a solution of amitriptyline in water, and use an oral syringe for precise dosing. See How to make a liquid from tablets or capsules

 

I haven't personally done this and I don't know of anyone who has, so if you do it, please post your experience in this topic.

 

Counting out pellets (sustained-release amitriptyline capsules)

As with Effexor XR, opening the capsule and counting out pellets is the only way to taper sustained-release amitriptyline by very small amounts. If you dissolve your sustained-release amitriptyline hydrochloride in water, my guess is you would get basic fast-release amitriptyline. We don't know how your nervous system would respond to this. I don't know anyone who's done it. If you try it, please post your experience in this topic.

 

Converting from sustained-release capsules to regular tablets

As with Effexor XR, to use the tablet cutting method, one might taper by converting from sustained-release amitriptyline capsules to regular amitriptyline in the same daily dosage amount. Keep in mind the sustained-release capsules gradually release the dosage over some number of hours, and amitriptyline's unpredictable half-life. Depending on how your nervous system interacts with the drug, converting to tablets may require taking the tablets in in 3 to 4 divided doses per day. You can then cut up the tablets to reduce the daily dosage. I don't know anyone who's done this. If you do it, please post your experience in this topic.

 

Use a combination of tablets or capsules and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

If your doctor prescribes liquid and tablets or capsules at the same time, most likely he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

 

Notes about amitriptyline and nortriptyline

Amitriptyline's metabolite, nortriptyline, is an even stronger drug. Nortriptyline has its own active metabolite, 10-hydroxynortriptyline, half-life of 8-10 hours (https://www.springerlink.com/index/P65310133707531P.pdf

 

(Nortriptyline, marketed on its own as another tricyclic antidepressant (ex. Pamelor), is metabolised by liver enzyme CYP2D6. See Official FDA Information for Nortriptyline http://www.drugs.com/pro/nortriptyline.html ), with potential for drug-drug conflicts, such as with trazodone's active metabolite mCPP.

 

From Wikipedia:

 

Quote

 

Nortriptyline is an active metabolite of amitriptyline by demethylation in the liver. Its pharmacologic profile is as the table to the right shows (inhibition or antagonism of all sites).[17][29]

Chemically, it is a secondary amine dibenzocycloheptene and pharmacologically it is classed as a first-generation antidepressant.[30]

These effects account for some therapeutic actions as well as for most side effects such as sedation, hypotension, anticholinergic effects, etc.[clarification needed] Nortriptyline may also have a sleep-improving effect due to antagonism of the H1 and 5-HT2A receptors.[31] In the short term, however, nortriptyline may disturb sleep due to its activating effect.

 

 

The overlapping metabolism of amitriptyline and the 2 active metabolites nortriptyline and 10-hydroxynortriptyline is probably why it's so difficult to estimate the half-life of this medication: amitriptyline (10-26 hrs) ---> nortriptyline (18-44 hrs) ---> 10-hydroxynortriptyline (8-10 hrs)

 

This means that after you take one dose of amitriptyline, in a little while, it starts making nortriptyline. The two drugs overlap until the dose of amitriptyline is fully metabolized, which takes about 6 x 20-25 hours or 5-6.25 days, then the nortriptyline effects take over.

 

Nortriptyline washes out in 6 x 18–44 hours or 4.5-11 days.

 

With nortriptyline, an active metabolite, a dose of amitriptyline has an effect over 20-44 hours. When you taper amitriptyline, you reduce both these drugs -- but the amount of amitriptyline in your bloodstream will lower at a faster rate than the nortriptyline, amitriptyline continually producing nortriptyline all the while.

 

If you get an adverse effect 5-7 days after you reduce amitriptyline, it may be the effect of the nortriptyline, not a withdrawal symptom. A 2.5% taper every week may be more comfortable in these situations -- by continually reducing both amitriptyline and nortriptyline, you might stay ahead of any adverse nortriptyline effect.

Edited by brassmonkey
Added Vodka Method of Making Liquid

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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MrsGreen

Alto, I am amazed about all this information, thank you!

I think I will get another prescription and continue to take out the little balls.

I feel the ones I have left might have suffered in the light and I just can't risk worse nights right now!

 

I will keep returning to this post for reference.


June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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Altostrata

I suggest you save the little balls in a clean, airtight medicine container, you can use them later.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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MrsGreen

Good idea, you mean the sunlight hash't damaged them yet?

 

Take care,

Mrs. Green


June 2009 - September 2010 25mg Amitriptyline

Tapered 0,2mg every few days.

Speeded up (too fast) until I was left with 4mg mid December 2010.

Severe Insomnia set in.

Always had trouble sleeping but not like this.

Kept reducing by 0.2mg every so often.

26 March 2011: 0mg.

Insomnia slowly getting better, still in need of help on 2 out of 7 days.

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Altostrata

Discard the ones that have been exposed to light, heat, or moisture.

 

Keep any new ones you take out of the capsule. You can always discard them later if you don't use them.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Danack

Hia,

 

Been put onto this funny old stuff for nerve pain. Now I missed a dose the Friday night and then on Saturday night I had a nightmare. (Whereas on  I normally just have really boring dreams on the stuff).

So, I know I've got to be a bit careful with this stuff and what I read here confirms that.

 

I'm taking 20mg per night at the moment and I want to taper it right down to the bare minimum to control the pain because I don't think it's doing my mental health any good. I'm not sleeping the same as I was.

 

. So if I look at doing the following:

- 20mg this week

- 15 mg next week

- 10 mg the week after that

 

Would this work or do I need to even more careful...?

 

Thanks,

Danack.

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Danack

I should mention that it's the tablets that I've been given, the little blue ones, so there's no little balls or anything like that, I will need to get a pill cutter.

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Altostrata

If you've been on this drug for more than a month, we recommend a much slower taper, see http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

Read post #1 above, you might wish to taper using a liquid preparation.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Rhiannon

Hia,

 

Been put onto this funny old stuff for nerve pain. Now I missed a dose the Friday night and then on Saturday night I had a nightmare. (Whereas on  I normally just have really boring dreams on the stuff).

So, I know I've got to be a bit careful with this stuff and what I read here confirms that.

 

I'm taking 20mg per night at the moment and I want to taper it right down to the bare minimum to control the pain because I don't think it's doing my mental health any good. I'm not sleeping the same as I was.

 

. So if I look at doing the following:

- 20mg this week

- 15 mg next week

- 10 mg the week after that

 

Would this work or do I need to even more careful...?

 

Thanks,

Danack.

 

As Alto says, if you've been taking it more than a month, this is MUCH too fast.


Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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ang

This site is so wonderfu!   My dear friend,  is on endep          Wants me to research it, and damn more information, instantly on this thread!  This person had  idea it is an SRNI.

 

I thought it was an old tricyclic,   this thread has put me straight.    

 

This person wanted was a sleeping tablet,   this doctor has written on the box  ""take one at night, as required""...................    with an SRNI!!!!!!!!!!!!!!!!

 

Advice, very welcome.    Please help me here, with my friend,  had to have 2 weeks off work, and not travelling well.               Hopefully, my friend, has only taken a few taqblets,  odd nights,   if so, my advice will be   STOP TAKING THEM!!!

 

Otherwise, I will be back here for advice...................................                   Alto, you are a lifesaver!              Seems gps put people on this stuff, with a damn take one tablet at night, as required?          OMG.


1992 Dothiepin 375mg 8 weeks, exhaustion/depression.  Serotonin syndrome, oh yes!  seizures . Fell pregnant, 3rd baby, Nitrous Oxide, 3 weeks mental hospital pp psychosis. zoloft tegretol.

Feb 1996 ct tegretol, tapered Zoloft 8 weeks. as (unexpectedly)  pregnant. Steven died after 3 days.(Zolft HLHS baby).  98 had run in with Paxil, 2 tablets, 3 weeks taper, survived.
2005..menopause? exhausted again. Zyprexa, mad in three days, fallout....  Seroquel, Effexor, tegretol,   and 8 years of self destruction. Failed taper.
Damn 1/4 valium... nuts again! .fallout, zoloft 100mg  seroquol 400mg mirtazapine 45 mg  tegretol 400mg.  Mid 14 3 month taper. Nov 14 CRASH.
Mid 15 ....   75mg  seroquel,  3 x 1800mg SJW  2 week window end of December followed by 6 week wave
5/2 68mg seroquel, 2.5 x 1800mg SJW::::20/2 61mg seroquel, 2.5 x  SJW::: 26/2 54mg seroquel, 2 x SJW::::21/3 43mg seroquel, 1 x 2700SJW :::: 23/4 36mg seroquel 1 x 1800 SJW
15/5 33mg seroquel, 1 x SJW::::   28/5 30mg seroquel, 1 x SJW::::;  18/6 25mg seroquel 1/2 SJW::::, 11/7 21mg seroquel 1/2 SJW::, 26/7 18mg seroquel 1/2 SJW:::, 9/8 12mg seroquel :::, 16/8 6mg seroquel ;;;;, 12/9 0 jump.

23/9  3mg.....,  27/9 0mg.  Reinstated, 6mg, then 12mg.............  LIGHTBULB MOMENT,  I have  MTHFR 2x mutations.  CFS and issues with MOULD in my home. So I left home, and working 150km away during week, loving it.

Oh was hard, panic attacks first week, gone now, along with the mould issues.

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Beary

Same story. I was told to take one tablet per night to help me sleep. I took 10 mg tablets, once a day for three nights then stopped. One month later I still have tingling and muscle jumps. My doc wants me to take a course of steroids and I am not sure how this will effect my symptoms. He has diagnosed me with whiplash.


Oct 2016 Took 10mg of amitriptyline, one per day for three days on Oct 6,7,8. Then stopped taking the medication when my legs jerked. Experiencing tingling body wide, burning in the top of my head and jerking movements at night ever since. No history of psychiatric drugs before or since.

 

Dec 2016 Jerking has lessened.  Burning in head has lessened.  Took anti inflamitories for a couple of weeks Nov 2016.  Now I have increased tingling all over my body, increased burning to my head, ear ringing and vision focusing issues.

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peng

Just been prescribed for my wife's, now-troubling, osteoarthritis.

 

First thing I read on two websites is that the drug is a tricyclic antidepressant and not SNRI as we see here on this thread.  ????

I am wary on my wife's behalf due to my own 15 years of trouble with Effexor.


Born 1945. 

1999 - First Effexor/Venlafaxine

2016 Withdrawal research. Effexor.  13Jul - 212.5mg;  6Aug - 200.0mg;  24Aug - 187.5mg;  13Sep - 175.0mg;  3Oct - 162.5mg;  26Oct - 150mg 

2017  9Jan - 150.00mg;  23Mar - 137.50mg;  24Apr - 125.00mg;  31May - 112.50mg holding;  3Sep - 100.00mg;  20Sep - 93.75mg;  20Oct - 87.5mg;  12Nov - 81.25mg;  13 Dec - 75.00mg

2018  18Jan - 69.1mg; 16Feb - 62.5mg; 16March - 57.5mg (-8%); 22Apr - 56.3mg(-2%); CRASHED - Updose 29May - 62.5mg; Updose - 1Jul - 75.0mg. Updose - 2Aug - 87.5mg. Updose - 27Aug - 100.0mg. Updose - 11Oct 112.5mg. Updose - 6Nov 125.00mg

2019 Updoses 19 Jan - 150.0mg. 1April - 162.5mg. 24 April - Feeling better - doing tasks, getting outside.  7 May - usual depression questionnaire gives "probably no depression" result.

Supps/Vits  Omega 3;  Chelated Magnesium;  Prebiotics/Probiotics, Vit D3. 

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scallywag

Peng, prescription drug regulations allow prescribing amitriptyline to "treat" symptoms of "depression." Other uses are off-label. You may wish to check what the equivalent prescribing rules are in the U.K.:

 

MHRA - amitriptyline


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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peng

Thanks for that s'wag!

Yes, probably offlabel for some pain problems.

Confirms it is a tricyclic ad.


Born 1945. 

1999 - First Effexor/Venlafaxine

2016 Withdrawal research. Effexor.  13Jul - 212.5mg;  6Aug - 200.0mg;  24Aug - 187.5mg;  13Sep - 175.0mg;  3Oct - 162.5mg;  26Oct - 150mg 

2017  9Jan - 150.00mg;  23Mar - 137.50mg;  24Apr - 125.00mg;  31May - 112.50mg holding;  3Sep - 100.00mg;  20Sep - 93.75mg;  20Oct - 87.5mg;  12Nov - 81.25mg;  13 Dec - 75.00mg

2018  18Jan - 69.1mg; 16Feb - 62.5mg; 16March - 57.5mg (-8%); 22Apr - 56.3mg(-2%); CRASHED - Updose 29May - 62.5mg; Updose - 1Jul - 75.0mg. Updose - 2Aug - 87.5mg. Updose - 27Aug - 100.0mg. Updose - 11Oct 112.5mg. Updose - 6Nov 125.00mg

2019 Updoses 19 Jan - 150.0mg. 1April - 162.5mg. 24 April - Feeling better - doing tasks, getting outside.  7 May - usual depression questionnaire gives "probably no depression" result.

Supps/Vits  Omega 3;  Chelated Magnesium;  Prebiotics/Probiotics, Vit D3. 

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Altostrata

Yes, it's a tricyclic. Sorry for the error in #1, corrected.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Melissa5000

I have some tablets of amitriptyline that have a coating. This might be a gastric juice resistant coating.  

 

Can I cut up those tablets or make a liquid from it in despite of the coating? 


2019 2.1 mg amitriptyline ,15th july 2.1 mg, 22-7 2.09 mg, 29-7 2.08 mg, 5-8 2.09 mg , 7-8 2.1 mg . 2020 Holding at 2.1 mg

2019 125 mg lyrica, 15th july 124,5 mg, 22-7 124 mg, 29-7 123,5 mg, 4-8 124 mg 2020 holding at 124 mg

2015 january building up my medication to 450 mg lyrica and 50 mg amitriptyline for face ache after a rootcanal treatment at the dentist. 2016 february start tapering lyrica from 450 mg to 200 mg 2016 october tapered 25 mg amitriptyline to 25 mg 2017 tapered lyrica from 200 mg to 100 mg 2017 september tapered my last tablet of 25 mg amitriptyline to zero  (horrible muscle pain started) 2018 february tapered lyrica from 100 mg to 75 mg (my muscle pain got worse and I have a lot of nervepain in my arms and legs, sometimes all over musclepain and nerve pain and burning pain) 2018 may reinstated 25 mg lyrica. My current dose is 100 mg lyrica. My pain is still very bad but a little less intense, my mood improved. 2018 since 22th may updose amitriptyline.  9 beads. 2018 june updosing lyrica. 2018 16 th june 125 mg lyrica and 9 beads amitriptyline ( 2mg) Now I'm doing a long hold. I can't taper anymore. Too much pain. I hope to stabilize and improve while holding. I'm trying graded activity to get rid of my pain. 2019 1 jan. Lyrica 125 mg (holding) 2019 1 jan. Amitriptyline tapering from 9 beads to 8 beads (1 jan. 2019),  8,5 beads (5 jan 19), 9 beads (16 jan 19) tapper attempt failed

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Altostrata

Look on the package and check with the manufacturer. Most likely, the coating doesn't do anything but protect the tablet, it has no timed-release properties, and the tablet can be split.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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