Elexis: tapering fluoxetine / Prozac - did I come off too fast?

[Altostrata]

3 hours ago, Elexis said:

so i dont need to taper promethazine? or i just dont need a break before i start the taper.?

 

If it's working, why do you want to go off promethazine? You can take it while you taper Prozac.

[Elexis]

19 hours ago, Altostrata said:

 

If it's working, why do you want to go off promethazine? You can take it while you taper Prozac.

 yeah the promethazine is helping the insomnia but don't want to stay on it indefinitely as it makes my eyes dry., don't mind in the short term but wouldn't want to keep it up for many months or anything like that.

[Altostrata]

Do you know what your sleep is like without it? You might try reducing promethazine by 25%, see if you can get by with less.

[Elexis]

22 hours ago, Altostrata said:

Do you know what your sleep is like without it? You might try reducing promethazine by 25%, see if you can get by with less.

normally ok but hit & miss since march

 

When I come off 5htp should I leave a break before I reduce promethazine?

[Altostrata]

Yes, do not change more than one drug at a time.

[Elexis]

20 hours ago, Altostrata said:

Yes, do not change more than one drug at a time.

ok, i come off 5htp tomorrow, how long a break would i need?

 

[Altostrata]

How do you feel, having reduced 5-htp?

 

What exactly are you taking now, at what times of day and dosages?

[Elexis]

On 5/19/2020 at 6:55 PM, Altostrata said:

How do you feel, having reduced 5-htp?

 

What exactly are you taking now, at what times of day and dosages?

sleeps been poor past 2 nites, taking 25mg promethazine every nite but no longer seems to help  I don't know if  the insomnia is due to the lack of 5htp as I was on a tiny 2mg dose for a week & slept fine & been a bit stressed past couple of days. I also take 200mG lyrica & 60mg amitripyline but been on them for years. dr has given me zopiclone but worried about taking it. 

[Altostrata]

It's not unusual for an anti-histamine to stop working for sleep. What is your sleep schedule? Do you drink caffeine?

 

On 5/19/2020 at 10:55 AM, Altostrata said:

What exactly are you taking now, at what times of day and dosages?

 

[Elexis]

20 hours ago, Altostrata said:

It's not unusual for an anti-histamine to stop working for sleep. What is your sleep schedule? Do you drink caffeine?

 

 

no caffeine, go to bed late (1am) but always at same time each nite

[Elexis]

these are the 5htp supps i used to take, just ,,noticed they had other stuff in them too, been off a week now but sharing in case relevant:

 

https://www.amazon.co.uk/Vegan-Natural-Melatonin-Sleep-5HTP/dp/B07H73RHN8

[Elexis]

On 5/23/2020 at 7:15 PM, Altostrata said:

It's not unusual for an anti-histamine to stop working for sleep. What is your sleep schedule? Do you drink caffeine?

 

 

Every nite since stopping the supplement mentioned above it's taken 5-7 hrs to get to sleep. last nite took 12 hours & I only slept for 2. I've other severe health issues so this is a nightmare. would taking a zoplicone for just one night be safe? anything else I could take? go back on 5htp? plz help, desperate.

[Altostrata]

On 5/25/2020 at 8:33 AM, Elexis said:

these are the 5htp supps i used to take, just ,,noticed they had other stuff in them too, been off a week now but sharing in case relevant:

 

https://www.amazon.co.uk/Vegan-Natural-Melatonin-Sleep-5HTP/dp/B07H73RHN8

 

I am confused. Did you say you were taking 5-HTP and l-tryptophan? The active ingredient in these capsules is l-tryptophan. (Despite its title, it contains no melatonin.)

 

It sounds like you came off 5-HTP and l-tryptophan too fast. I might reinstate one capsule (50mg l-tryptophan) to stabilize.

 

Have you ever tried melatonin?

[Elexis]

2 minutes ago, Altostrata said:

 

I am confused. Did you say you were taking 5-HTP and l-tryptophan? The active ingredient in these capsules is l-tryptophan. (Despite its title, it contains no melatonin.)

 

It sounds like you came off 5-HTP and l-tryptophan too fast. I might reinstate one capsule (50mg l-tryptophan) to stabilize.

 

Have you ever tried melatonin?

Ingredients: 2 capsules provide: Magnesium (Citrate) 122mg, L Tryptophan (EP Grade) 100mg, Griffonia Simplicifolia Extract (Providing 90.9mg of 5HTP) 91.8mg, Montmorency Cherry (Prunus Cerasus L) 72mg, Chamomile Flower (Matricaria Recutita) 70mg, Grape Seed (Vitis Vinifera) 25mg, L-Taurine 10mg, Biotin 50μg

 

I was taking 1 capsule so 50mg l-tryptophan and 40mg 5htp - should I try reinstating at half that?

 

Is zoplicone risky if taken for just one night?

[Altostrata]

Just now, Elexis said:

I was taking 1 capsule so 50mg l-tryptophan and 40mg 5htp - should I try reinstating at half that?

 

Yes, I would take 1/2 capsule.

 

2 minutes ago, Elexis said:

Is zoplicone risky if taken for just one night?

 

I would not throw more chemicals into the pot. I can't predict what will happen.

[Elexis]

32 minutes ago, Altostrata said:

 

Yes, I would take 1/2 capsule.

 

 

I would not throw more chemicals into the pot. I can't predict what will happen.

Okay, will do. You mentioned melatonin - it's prescription only in the UK but could ask Dr for some tomorrow, I'm guessing it would generally be safer than zoplicone or increasing amitriptyline (probably my only other options). They'll likely only prescribe short term though so if it's the sort of thing that needs a long taper that could be a problem.

[Altostrata]

Melatonin does not need a long taper. As little as 0.25mg per night can be effective to initiate sleep.

[Elexis]

1 minute ago, Altostrata said:

Melatonin does not need a long taper. As little as 0.25mg per night can be effective to initiate sleep.

ok, I'll ask the dr about them tomorrow, I think they prescribe them for about 2 weeks

[Altostrata]

If the melatonin is 1mg tablets, you can quarter them.

[Elexis]

20 hours ago, Altostrata said:

If the melatonin is 1mg tablets, you can quarter them.

took half 5htp last nite, took 7 hrs to get to sleep speaking to dr on friday

[Altostrata]

It may take some time for your system to settle down from your 5-HTP and tryptophan taper.

 

Are you getting regular gentle exercise and going off the computer early in the evening?

[Elexis]

14 hours ago, Altostrata said:

It may take some time for your system to settle down from your 5-HTP and tryptophan taper.

 

Are you getting regular gentle exercise and going off the computer early in the evening?

off pc early, cant exercise as mostly bedridden with chronic illness,

took 12hrs to sleep last nite & only slept for 3, really worried if this continues; health in serious decline

 

would increasing 5htp help? tempted to take zoplicone. can barely function.

[Altostrata]

On 4/22/2020 at 10:30 AM, Elexis said:

The Prozac was an abrupt taper by my Dr which caused PGAD, I reinstated at 1mg thanks to advice on here & it helped a lot.

WD symptoms reducing slowly over the years, these days I'm generally at a 2 or 3 all day, up to a 5 if stressed. However, past two weeks I've been more like 4-5 going up to a 7 if stressed. The PGAD used to wake me up in the night about once every 3-4 months, but it's happened 3 times in the past two weeks. I'm guessing the 5-HTP and Tryptophan are to blame. Since they're causing WD symptoms to flare back up am I safest to stay on them & let things stabilise or try and get off them now before I get dependent? 

 

Thanks for those links, I'll give those threads a good read

 

 

On 5/6/2020 at 10:21 AM, Elexis said:

Been on promethazine 16 days now (25mg for 10 days, 20mg for 4 days) seems to help insomnia. Should I hold at 20mg while I'm tapering the  5-HTP? Or just start reducing the dose?

 

Also whats a good jump off point for the 5htp taper? currently on 5mg 5htp & 4mg l-tryptophan

 

thanks   

 

On 5/11/2020 at 2:22 PM, Altostrata said:

What has been your reduction schedule for 5-htp and tryptophan? Are you feeling any changes as you reduce them?

 

On 5/13/2020 at 9:27 AM, Elexis said:

25% every two days, I've not had any negative effects, the PGAD hasn''t woken me in the nite for 2 weeks now so that's an improvement

 

April 22, you reported PGAD but you didn't mention insomnia. I'm going to assume you were sleeping poorly then because you apparently started taking promethazine at about the same time.

 

When did the sleeplessness start? How has your sleep pattern changed in the last 6 months?

 

It appears the supplement containing 5-HTP and tryptophan did not help you sleep but did exacerbate PGAD. I would not continue to take it. It's very common for antihistamines such as promethazine to work for a while for sleep and then stop working.

 

Are you still taking 1mg Prozac? What times of day do you take your drugs, and their dosages?

[Elexis]

56 minutes ago, Altostrata said:

 

 

 

 

April 22, you reported PGAD but you didn't mention insomnia. I'm going to assume you were sleeping poorly then because you apparently started taking promethazine at about the same time.

 

When did the sleeplessness start? How has your sleep pattern changed in the last 6 months?

 

It appears the supplement containing 5-HTP and tryptophan did not help you sleep but did exacerbate PGAD. I would not continue to take it. It's very common for antihistamines such as promethazine to work for a while for sleep and then stop working.

 

Are you still taking 1mg Prozac? What times of day do you take your drugs, and their dosages?

I'd been having trouble with early morning waking for a month starting in march (would sleep 4 hours, be awake for 4, then sleep another 3), then I had two nights where I took 10 hours just to get to sleep, (that's not my usual pattern, normally would get to sleep fine but just not stay asleep.)  That was april 2nd and 3rd.

 

April 4th started 5htp, since then sleep has been either like my previous pattern or having nights taking 10 hours to go to sleep. Past week that has been almost every night.

 

Still on 1mg prozac. drugs are: (all taken at night except lyrica which is 100mg in morning, 100mg at night)

Amitriptyline - 60mg, since 2011

Lyrica - 200mg since 2014

Prozac - 25mg/day 9 months in 2015. 1mg day since 2016.

Promethazine - 25mg, since 17 April 2020

 

[Altostrata]

Please list times of day you take each of your drugs, and their dosages.

 

The Prozac may be keeping you awake. Suggest you move it an hour earlier each day until you are taking it in the morning.

 

This is a site for going off drugs. Is it your intention to stay on these drugs?

[Elexis]

7 minutes ago, Altostrata said:

Please list times of day you take each of your drugs, and their dosages.

 

The Prozac may be keeping you awake. Suggest you move it an hour earlier each day until you are taking it in the morning.

 

This is a site for going off drugs. Is it your intention to stay on these drugs?

Drugs:

(all taken at 12am except lyrica which is 100mg at 4pm, 100mg at 12am)

Amitriptyline - 60mg

Lyrica - 200mg 

Prozac - 1mg .

Promethazine - 25mg, since 17 April 2020

 

I hope to come off them all eventually but probably not for a long while.

[Altostrata]

Are you still taking promethazine? You may be getting a paradoxical reaction from it. This is what happens with antihistamines taken for sleep.

 

Why are you taking Prozac with amitriptyline?

 

Have you discussed your drug issues with your doctor? It's really your doctor's responsibility to get you comfortable on a drug cocktail, not ours.

[Elexis]

50 minutes ago, Altostrata said:

Are you still taking promethazine? You may be getting a paradoxical reaction from it. This is what happens with antihistamines taken for sleep.

 

Why are you taking Prozac with amitriptyline?

 

Have you discussed your drug issues with your doctor? It's really your doctor's responsibility to get you comfortable on a drug cocktail, not ours.

no since their withdrawal advice gave me PGAD in the first place, I am wary. But if you can't help me here then I'll talk to them.

[Altostrata]

We help people taper off drugs, we don't substitute for doctors when people are having trouble with their cocktails.

[ChessieCat]

2 hours ago, Elexis said:

Amitriptyline - 60mg

Lyrica - 200mg 

Prozac - 1mg .

Promethazine - 25mg, since 17 April 2020

 

I hope to come off them all eventually but probably not for a long while.

 

You might want to reconsider how long you stay on this drug combination.

 

From https://reference.medscape.com/drug-interactionchecker

Serious - Use Alternative

• fluoxetine + amitriptyline

  fluoxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• fluoxetine + amitriptyline

  fluoxetine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.

• fluoxetine + promethazine

  fluoxetine will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

Monitor Closely

• promethazine + amitriptyline

  promethazine and amitriptyline both increase QTc interval. Use Caution/Monitor.

• promethazine + fluoxetine

  promethazine and fluoxetine both increase QTc interval. Use Caution/Monitor.

• amitriptyline + fluoxetine

  amitriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• pregabalin + promethazine

  pregabalin, promethazine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• pregabalin + fluoxetine

  pregabalin, fluoxetine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• pregabalin + amitriptyline

  pregabalin, amitriptyline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• promethazine + amitriptyline

  promethazine and amitriptyline both increase sedation. Use Caution/Monitor.

Minor

• amitriptyline + promethazine

  amitriptyline, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.

• amitriptyline + promethazine

  amitriptyline, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

[Elexis]

16 hours ago, Altostrata said:

We help people taper off drugs, we don't substitute for doctors when people are having trouble with their cocktails.

ok, sounds like my insomnia could be drug cocktail rather than 5htp taper related - thanks for the help anyways tho!

 

15 hours ago, ChessieCat said:

You might want to reconsider how long you stay on this drug combination.

yikes! whats a good taper schedule for promethazine?

[Altostrata]

It's a dumb drug combination.

 

On 5/17/2020 at 10:28 AM, Altostrata said:

Do you know what your sleep is like without it? You might try reducing promethazine by 25%, see if you can get by with less.

 

[Elexis]

19 hours ago, Altostrata said:

It's a dumb drug combination.

 

e

ok, was going to come off 5htp first but will start tapering promethazine instead

[Elexis]

20 hours ago, Altostrata said:

It's a dumb drug combination.

 

 

probably a silly quesiton here but is there ever a need to taper something you've only taken once? took a zoplicone 2 nights ago, not touched it since. I'm thinking if I do take more to avoid taking for more than two days in a row (only took cos had become really unwell from lack of sleep & can't see a doctor for a week  )

[Altostrata]

No need to taper a drug taken once.

[Elexis]

On 5/30/2020 at 6:51 PM, Altostrata said:

No need to taper a drug taken once.

I took zoplicone for 1st time on thur, didnt take any on fri, then took on saturday & sunday 

Last nite (sunday) didnt work very well (tolerance alreaady building?) Do i need to taper or can i just stop now before i get hooked?