Pako: which drug to taper first?

[Pako]

Hello everyone. I want to quite meds, but I am not sure which drug I should taper first. Here’s the short history of my meds.

 

I was put on drugs (ADs and neuroleptics) in March of 2017 during detox from alcohol. I had the acute withdrawal symptoms: tremors, agitation, suicidal thoughts etc. I was hospitalized and doctor prescribed me Tofisopam (Emandaxin, Grandaxin, Sériel), Carbamazepine and Phenibut. After 2 weeks I got worse and another doctor put me on Amitriptyline (1 tab - 25 mg – 3 times a day). My reaction was bad and after some time they changed it with Emoxypine and Sulpiridum (Sulpirid). After 7 days prescription was changed again. I was suggested to take Prozak (20 mg once a day). The reaction on Prozak was terrible (suicidal behavior, tremor etc.) and the doctor changed Prozak with Trittico (Trazadone) – 150 mg. Then Quetiapine was added. Lately – ¼ of Akineton (Biperiden) twice a day for controlling the side effects of neuroleptic (it helped a bit with tremor).

 

Well, this is the story. I’d like to add that I had no idea about SSRI’s, neuroleptics and other psychotropic drugs, so I was taking them very carelessly. Tofisopam, Carbamazepine, Emoxypine, Sulpiridum, Prozak  - all these drugs I stopped without tapering.

 

Now I am taking:

 

Trittico (Trazadone) – 150 mg

Quetiapine – 25 mg (last week I decreased it from 50 mg)

Akineton (Biperiden) - 1 mg

 

I am suffering from severe agitation and tremors (it is a bit better after adding Akineton). Sometimes I am also feeling exhausted, dizzy.

 

I was planning first to quit neuroleptic (Quetiapine), because of the risk profile. But it seems that Trazadone is the cause of agitation, which is disturbing me very much. What should I do now? Please, help me.

[scallywag]

Pako -- Welcome to Surviving Antidepressants (SA)

 

Thank you for posting a clear account of your history with these medicines and putting those details into a signature. It's rotten that a good decision -- stopping alcohol consumption -- has led to prescribing psychiatric medications and the uncomfortable symptoms.  Please keep your doses exactly the same for now and do your best to take each medication at the same time you took it the day before.

 

Please be kind to yourself about having taken these medications. Your withdrawal symptoms from quitting drinking were severe. Anyone would have looked for relief and followed a doctor's advice. That painful and upsetting experience may have forced you to discover that you are more sensitive than most people to medications (alcohol and prescription drugs) that act on your CNS (central nervous system). That is useful information for you for the rest of your life.

 

What changes in your symptoms have you noticed since you decreased your quetiapine dosage?

 

It helps us to understand your situation and to suggest a next step when we understand more about your symptoms. Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

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.

 

Almost always we suggest that people taper very slowly, decreasing dose by no more than 10% once per month. When people are taking more than one medication, we strongly urge them to taper only one drug at a time. Please read these topics:

Before you begin tapering -- what you need to know.

Why taper by 10% of my dosage?.

Taking multiple drugs? Which to taper first.

 

You'll find others discussing the symptoms you mention in these topics:

Akathisia vs. restlessness and agitation

Tremors, shaking, body vibration, internal trembling

 

This is YOUR introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.

 

I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

[Pako]

Hello, Scallywag.

 

Thank you very much for useful links and advice.

 

I am going to keep my doses exactly the same for now.

 

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do your best to take each medication at the same time you took it the day before.

 

What should I do if I have to delay taking one of the medicines? For example, yesterday night I had to drive a car and decided to delay taking Quetiapine till the morning (because I would feel sleepy, dizzy and confused). Can it cause any symptom?

 

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What changes in your symptoms have you noticed since you decreased your quetiapine dosage?

 

My tremor, weakness and agitation are increased. I’ve got a vision symptom as well – something like a blurred vision.

 

I have read a topic about taking multiple psych drugs and now I am in doubt if my decision about tapering Quetiapine first is right.

 

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However, if you're taking an antipsychotic to counter an adverse effect of an antidepressant, such as sleeplessness or agitation, you may want to discontinue the antidepressant first.

 

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Conceivably, one might systematically lower the antidepressant part way, then lower the antipsychotic. If sleep doesn't break up, continue to get off the antipsychotic. If it breaks up, stop lowering the antipsychotic, stabilize, and lower the antidepressant, managing the tapers in a way that preserves sleep.

 

 

Agitation is the main adverse effect of Trazadone. I guess Quetiapine is a bit helping with it… So, which medicine should I decrease next? If my sleep doesn't break up, should I continue to decrease the dose of Quetiapine in accordance with schedule?

 

[scallywag]

About taking medication at the same time: Do your best. If it's not practical to take it at the same time as you usually do, take it as close as possible to the usual time. The point in my original comment was to suggest a way to keep things as stable as possible, not to lay down a "rule" or a "commandment."  Doing your best is good enough.

 

Stabilize on your current dose of quetiapine -- wait until your symptoms have subsided and settled in to a regular pattern with no wild swings day-to-day. Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

After your symptoms have settled, it might make sense to start tapering trazodone. Making changes now, soon after other recent changes, is very unlikely to help your situation and risks making your symptoms worse. 

[Pako]

Thank you very much, Scallywag!