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Benzhelp: Advice appreciated please

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Benzhelp

Hi all,

 

I am posting on behalf of an elderly relative who is 88 years old. I do think that some medications are not suitable for her to be on, especially Alprazolam. What the general physician gave her after a bp spike recently is in the signature. Bp was then 180/100 4 days ago now is stable at 140/83. Waking pulse after 2 days was 60 after Alprazolam. I think the drugs are too sedating and bp could go lower if all doses are not adjusted. She is frail and I am concerned this might be too much for her system. 

 

Previously was only on current hyperglycaemia meds and Prazosin 10mg x3, Verapamil x3. We were going through a lot of stress at the time from a bad flu. Now after antibiotics it has cleared up, though she still recovering. Bp is checked 3 x times a day since high bp. 

 

I am not sure if the prescribing gp knows what they are doing, they are not qualified in Cardiology or seem to care much about the medications given. Since the worst symptom is bp I asked other relatives to get a second opinion sooner, but they are not convinced.  I think the doses should be be lowered paying attention to side effects since there a few new ones prescribed. 

 

She has gone to the doc for a long while, I think it is better to switch to a qualified caring doctor who does not give too many meds and is available to communicate with other caregivers since current one does not do these things  It is only now that we have begun to check side effects and some meds don’t seem to even treat her conditions at all only giving side effects.

 

She has had high bp for years and probably should be on some but prescribed are not the safest ones, dosages too high, too many drug changes etc. according to research online. It might be tolerated in someone stronger, younger perhaps. People blame solely advanced age for her declining health, but before all these meds I have noticed she was healthier and physically active than she is now. I am concerned that the newest meds might make her feel even worse than she is at the moment if taken in this way. She has not had the care she deserves IMHO.

  

Lesser symptoms are insomnia, dizziness which I’m guessing could have been side effects from Prazosin. All are prescribed for a month till next doc visit. Medicating side effects with more meds don’t make sense. 

We were going to do the 10% taper before this crises.  We were also going to discontinue the said physician and find a better qualified doctor to treat her bp and was overprescribing innapropriately, but in the stress of flu they were not thinking clearly I guess, and rushed too soon forgetting what we agreed upon earlier. They could get better help, yet are not convinced from what online research I show them. Maybe later they will understand and she will get the support she needs. 

 

I researched the Beers list and resources for older adults and they do not recommend most of these drugs to be given including antihistamines, dizziness meds when symptom is improved, too many bp meds like Nifedipine which has more side effects than Verapamil which she seems to tolerate better.  

 

Is there anyway some of the unnecessary meds can be lowered starting with the benzodiazepine? I am concerned about anticholinergic symptoms and the consequences to her health by the overall drug burden at her age.

 

I would be grateful for your advice. Thank you for reading. Take care.

Edited by ChessieCat
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scallywag

Benzhelp -- Welcome to Surviving Antidepressants (SA)
 
Thank you for posting an introduction and a signature for your relative's situation.
 
When a someone is taking multiple medications, we ask that that you post an interactions report.  Follow the link below to get your report. Just select the text, copy it and paste it in a post here.
Drugs-dot-com Drugs Interactions Checker.

Often people get "poly-drugged" over time as doctors prescribe to deal with issues, or multiple doctors prescribe medications. Some geographic locations have teams that review medications for people in your relative's situation. My family health team offers the services of a clinical pharmacist for these reviews. It might be worth checking if similar expertise is available near you.

 

Is your relative living at home (her own or someone else's) or is she living in a care facility? 

 

Have you looked at the information in our members-only benzo forum? There is helpful information there about tapering benzo medication.

Link to Members-only benzo forum
 

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Benzhelp

Hi scallywag,

 

Thanks for your reply and questions. I am so glad this forum exists and so many people willing to help even when they are suffering. 

 

She lives in her own home. We don’t have those kind of facilities available to help with polydrugging sadly, that is why I am asking for help.

 

I will check out the benzo forum thanks. 

Here is the drugs.com interaction report: 

 

Cinnerizine isn’t included here because it wasn’t in the list.

 

Drug Interaction Report

Drug interactions for the following 6 drug(s):

Unsaved Drug List Email | Print | Save | New list alprazolam diltiazem metformin nifedipine prazosin sitagliptin

Interactions between your selected drugs

 

 

Moderate diltiazem nifedipine

Applies to: diltiazem, nifedipine

 

Before taking diltiazem, tell your doctor if you also use NIFEdipine. You may need dose adjustments or special tests in order to safely take both medications together . The levels of diltiazem or NIFEdipine may be increased. You should notify your doctor if you have symptoms of low blood pressure such as headaches, faint, or slow heartbeats. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor first.

Switch to professional interaction data

 

 

Moderate nifedipine prazosin

Applies to: nifedipine, prazosin

 

Before taking prazosin, tell your doctor if you also use NIFEdipine. You may need dose adjustments or special tests in order to safely take both medications together. This combination may have additive effects on lowering your blood pressure. You should take prazosin at bedtime and notify your doctor if you feel dizzy or faint. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor first.

Switch to professional interaction data

 

 

Moderate diltiazem alprazolam

Applies to: diltiazem, alprazolam

 

Diltiazem may increase the blood levels and effects of ALPRAZolam. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience increased side effects or your condition changes. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

 

Moderate prazosin alprazolam

Applies to: prazosin, alprazolam

 

Prazosin and ALPRAZolam may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

 

Moderate nifedipine metformin

Applies to: nifedipine, metformin

 

Using NIFEdipine together with metFORMIN may increase the effects of metFORMIN, which may lead to a life-threatening condition called lactic acidosis This can cause weakness, increasing sleepiness, slow heart rate, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting. Talk with your doctor before using NIFEdipine while you are using metFORMIN. You may need a dose adjustment and you may need to check your blood sugar more often. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

No other interactions were found between your selected drugs.

Note: this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist.

 

Other drugs and diseases that your selected drugs interact with

Interactions between your selected drugs and food

 

 

Moderate diltiazem food

Applies to: diltiazem

 

Alcohol can lower your blood pressure and add to the effects of diltiazem. You may experience dizziness, lightheadedness, fainting, or a rapid heartbeat if you drink alcohol with diltiazem, especially when you first start taking the medication or just after a dose increase. Grapefruit juice may also increase the effects of diltiazem in some people by increasing its levels in the blood. You may want to limit alcohol intake and avoid excessive consumption of grapefruit and grapefruit juice during treatment with diltiazem. However, if you have been regularly consuming grapefruit or grapefruit juice with diltiazem, do not alter the amounts of these products in your diet without first talking to your doctor or other healthcare professional. Contact your doctor if your condition changes or you experience increased side effects of diltiazem such as headache, irregular heartbeat, swelling, unexplained weight gain, or chest pain. Orange juice is not expected to interact.

Switch to professional interaction data

 

 

Moderate nifedipine food

Applies to: nifedipine

 

Talk to your doctor or pharmacist before consuming grapefruit or grapefruit juice if you are receiving treatment with NIFEdipine. Grapefruit juice may significantly increase the blood levels and effects of medications like NIFEdipine. You may be more likely to experience side effects such as headache, low blood pressure, irregular heartbeat, swelling, and fluid retention. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

 

Moderate alprazolam food

Applies to: alprazolam

 

Grapefruit and grapefruit juice may interact with ALPRAZolam and lead to potentially dangerous side effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor. Do not drink alcohol while taking ALPRAZolam. This medication can increase the effects of alcohol. You may feel more drowsy, dizzy, or tired if you take ALPRAZolam with alcohol. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

 

 

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

 

Duplication Calcium channel blockers

Therapeutic duplication

 

The recommended maximum number of medicines in the 'calcium channel blockers' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'calcium channel blockers' category:

  • diltiazem
  • nifedipine
Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

 

Duplication Antihypertensives

Therapeutic duplication

 

The recommended maximum number of medicines in the 'antihypertensives' category to be taken concurrently is usually two. Your list includes three medicines belonging to the 'antihypertensives' category:

  • diltiazem
  • nifedipine
  • prazosin
Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

 

 

 

I checked out the benzo forum and I am not sure, can we stop since it is only 6 days now on it? not sure about this. It was prescribed for sleep and it would be worse if she got addicted and had to deal with withdrawal. Slow pulse is probably a side effect of it too.

 

Thank you so much for the support.

Edited by scallywag
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Shep

Hi, Benzhelp.

 

Welcome to the forum from me, too.

 

 

I checked out the benzo forum and I am not sure, can we stop since it is only 6 days now on it? not sure about this. It was prescribed for sleep and it would be worse if she got addicted and had to deal with withdrawal. Slow pulse is probably a side effect of it too.

 

 

Yes, you can either stop or do a very, very rapid taper off. Dependency can develop in as little as 2 weeks for benzos, so it's best if she can get off as quickly as possible.

 

Here is some information that may be helpful from the Benzo Forum:

 

 

Ashton and Beyond in Benzo Tapering

 

Please let us know how she's doing. 

Edited by ChessieCat
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Benzhelp

Hi Shep,

 

Thank you so much for the reply. I am so thankful that this forum exists and grateful to it’s caring members.

 

So they apparently stopped the benzo 4 days ago, after I alerted them to the addictive quality of it, which is a relief. 

The betahistine was also stopped 2 days ago. She seems less sedated and alert. She seems to be doing okay now. A little stressed after all that she’s been through but that is to be expected, I suppose.  

 

I would like to mention another somewhat complicated situation, that I have wanted to ask advice about on here before: How to taper prazosin

 

Previously this year, after showing them the information and explaining, she and the other relatives all agreed to taper off it 10% like this site suggested. We didn’t stop abruptly, as she was already on it 4 years before I found out, and was concerned the withdrawal might be uncomfortable. But we only succeeded in dropping 2 mg in 5 months, very cautiously according to her stress levels and stabilization. 

 

That was from 12mg to 10 mg, taken 3x a day as 3mg morn, 4 mg noon, 3mg night. The meds were spaced out during the day, now after this episode, she is taking 5mg at night may be a bit strong I think to take at once. Especially since the drug side effects that it causes, severe incontinence, that worsens at night. She has been on prazosin for 5 years now, so probably halving the dose abruptly last week didn’t help, and I am guessing, is now going through withdrawal for it. 

 

Noone seems to see that the incontinence is caused by it since it was only after being on it that it occurred, not even the diabetes made her this frequent urinating. It is affecting her sleep, and now is having to wear diapers this year.  She has already suffered from falls because of the dizziness and orthostatic hypotension. For the dizziness she is on cinnerizine, which I am not sure if she should be taking everyday or only when the dizziness is apparent. 

This is why it the first drug I was concerned about before the new drugs were prescribed last week. It seems they are giving more drugs for the prazosin side effects. 

 

Is it too late to reinstate the previous way she took it at 10mg, to prevent withdrawal, 7 days ago when it was halved or leave it be at 5mg because of the side effects and space it out daily? 

 

Any advice how to taper off the prazosin, what to do given the strong side effects vs withdrawal situation, would be much appreciated, as I am not an expert. 

 

This was and still is the first drug I am concerned about before the new prescription. 

 

Thank you for reading.

Edited by ChessieCat
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Shep

Hi, Benzhelp.

 

Like you mentioned, the 10% reduction for Prazosin is recommended. If you haven't already seen this thread, it may be helpful:

 

 

Tapering Beta Blockers or Alpha Blockers

 

Like you wrote, incontinence can be a side effect of prazosin.  I'm sorry that your relative's doctors are treating her prazosin side effects with more drugs, but glad that you're researching this so it can be avoided in the future. 

 

 

 

That was from 12mg to 10 mg, taken 3x a day as 3mg morn, 4 mg noon, 3mg night. The meds were spaced out during the day, now after this episode, she is taking 5mg at night may be a bit strong I think to take at once. Especially since the drug side effects that it causes, severe incontinence, that worsens at night. She has been on prazosin for 5 years now, so probably halving the dose abruptly last week didn’t help, and I am guessing, is now going through withdrawal for it.

 

 

 

 

Since it's only been a week, you could go back to to the 10 mg and definitely space it out so that she's taking less in the evening.

 

You may even want to consider a micro taper, due to her age and the severity of her symptoms along with her other medical conditions.

 

Micro-taper instead of 10% or 5% decreases

 

 

I'm glad the benzo was stopped. She's very lucky you're doing research for her. 

 

Please keep us updated. 

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Benzhelp

Hi Shep,

 

Thank you for your reply and thoughtful comments. 

 

Definitely will check out the links again, as I have read them before, thank you. 

 

Researching is nothing compared to what she is going through now, knowing firsthand how severe side effects can be. So I think it is better to be careful by learning all there is about these drugs online as a patient possibly can.

 

I am lucky to have your support, Shep, I am very grateful. Take care.

 

Update: We have decided not to give the cinnerizine unless there is severe dizziness. So that is another drug reduced. 

It also affects neurotransmitters according to this link: www.dizziness-and-balance.com/treatment/drug/cinnarizine.html

 

We have also decided to space the prasozin 2.5 mg x2 daily, noon and night so the side effects are reduced. This must be very hard to deal with for her, hopefully in time she will stabilize and recover.

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Shep

Thanks for the update, benzhelp.

 

I'm glad you were able to research cinnerizine and are keeping her drug burden as minimal as possible. 

 

Are you familiar with the PubMed database?  Lots of scientific research there, although you should be careful of research funded by the pharmaceutical industry. Some articles do disclose this. 

 

Also, there's the Propublica Dollars for Docs database.  which lists doctors who have received funding from big pharma and may be more likely to prescribe for financial reasons. It's sad our medical system as devolved into this state, but it's good we have ways of researching and finding this out. 

 

She is very lucky indeed to have you helping with her drugs and this research. 

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Benzhelp

Update:

 

My relative is in critical condition with heart trouble. She is hospitalized and is in and out the ICU for weeks now. I am praying for her.

 

I would be grateful if you could please keep her in your prayers and send healing vibes out to her in this troubled time.

 

Thank you.

 

God bless you all.

Edited by Benzhelp

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Shep

I'm sorry to hear this, Benzhelp.

 

Take care of yourself, as well, as being a care giver can be very stressful. 

 

Yes, we will definitely send some positive, healing vibes to you and your relative. 

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Benzhelp

Hi,

 

I've been put on Ambilify 10mg 5 days ago. Wondering If I could stop it? Really scared of the side effects.

Edited by ChessieCat
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Benzhelp

Sorry about the abilify post. I was really confused when I posted it. I still don't know what to do about it. I have been on theses meds before and suffering withdrawal also. Trying to get a doc to taper me off at the moment. 

 

As for my relative, I really am going through a really tough time right now. I wanted to post an update but find I cannot. I am sorry about this. I am a mess sadly.

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scallywag

Would you add Abilify dose and start date to your signature?  Why was it prescribed? What symptoms are you having?

 

If you decide to discontinue abilify:

After a week or so of taking Abilify, it would be better to fast taper off it than to stop it suddenly.  Halve the dose to 5 mg and take that for 4-5 days; if you have no strong reaction to the decrease, halve it again for 4-5 days, then discontinue entirely.

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Benzhelp

Would you add Abilify dose and start date to your signature?  Why was it prescribed? What symptoms are you having?

 

If you decide to discontinue abilify:

After a week or so of taking Abilify, it would be better to fast taper off it than to stop it suddenly.  Halve the dose to 5 mg and take that for 4-5 days; if you have no strong reaction to the decrease, halve it again for 4-5 days, then discontinue entirely.

 

 

Hi Scallywag,

 

Thank you so much for the reply. I feel kinda lost. I will update my signature.

I was on abillify 10mg for 7 days and cut tablet to 2.5mg for 2 days now, since terrible side effects like mild TD and akathisia. So total 9 days. I have no idea why I was put on it.

Thinking of halving that soon, around the next 10 days, too. Still have drowsiness and mild akathisia like wanting to walk for a few hours on this dose instead of all day on 10mg. Can sleep better too but have asthma like breathing difficulties and can only sleep with mouth open my jaw is so stiff. It’s like the back of my head and lungs are asleep and hard to function. I have a Taper friendly naturopathic doc, but who is not as good in tapering as in this forum, I think. He just expressed the wish to get me off eventually. I have an appointment with him soon. 

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TikkiTikki

Hi Benzhelp – just realised you are posting for two! How are things going?

 

You haven't updated your thread in so long.

 

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Benzhelp

Hi TikkiTikki, 

 

Thanks for replying.

Sorry I haven't updated in awhile. I am doing fine and everything is well with my relative and family. I Tapered my last med and doing well, though with protracted withdrawal. Just wanted to help out folks who have the same issues and give back. Thanks everyone on this site Alto, moderators especially Shep and Scallywag for helping me out at a very difficult time. Thank you all members and supporters. Wishing everyone Healing and recovery.

Hope everyone is doing well. Take care all <3

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TikkiTikki

So glad everything is going well. 

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Carmie

Hi Benzhelp, 

 

So glad to read you’re doing well despite protracted withdrawal. It does help others going through the same to realise it does slowly get better. Withdrawals are definitely up n down and all over the place but we will all eventually heal.

 

Wishing you all the best💚

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Rose9975

Hi Benzhelp,

 

How are you feeling at the moment?

 

Love & light xx

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