DMV64: reinstate Saphris?

[Rosetta]

Thinking of you.  I'm struggling today, too.  You are not alone.

[DMV64]

Sending you big hugs!

[Carmie]

4 hours ago, DMV64 said:

Yes. Trying to remember.  Today not as good but not terrible. Just dread about being able to function. Teach. Etc. And keep feeling like I want to go to the hospital. Not sure why. Guess desperation. Must remember windows

 

Hi DMV,

 

Going to the hospital will probably cause more problems. They will up doses, change doses, give you different meds etc etc and you may be worse off than you are now. 

 

You sound in fairly good spirits though. You said today is not as good, but not terrible. That’s a positive. And yes, we have to keep remembering the windows, they come and go but they eventually come again. Keep remembering windows. I know it’s hsrd but they do eventually come again. 

 

I remember being in long waves and I just had to keep reminding myself, windows do come, windows do come. They do open and let fresh air in occasionally 💚

[DMV64]

1 hour ago, Carmie said:

windows

Yes!! Yes!! Thank you for this reminder. 

[Rosetta]

7 hours ago, DMV64 said:

Sending you big hugs!

 

Thanks.  I hoping you are getting a reprieve.

[DMV64]

@JanCarol @Shep I am thinking of looking for a more sensitive scale than the Gemini-20. Seems next step up is lab grade and expensive. Thinking of trying ebay. Any recommendations for brand?

[DMV64]

I found this on our site! Dr Mussy Was Here posted! I see Saphris (asenapine) dose I am on is equivalent to 80 mg of geoden (ziprasidone) . I am having a hard time getting correct 10% doses as I get lower (1.5) on Saphris with the Gemini-20 scale (Saphris is a sublingual wafer). So....should I consider using Geoden to get completely off saphris? If so, how?  @JanCarol @Shep @DoctorMussyWasHere @brassmonkey Any help or mathy guidance much appreciated. I do have a math disability.

 

Amisulpride	100	400	800	1200
Aripiprazole	2	5	10	15	20	30
Asenapine	0.4	0.8	1.6	3.2	4.8	10	20
Clozapinec	100	300	600
Haloperidol	4	4.5	6	8	10	12	15	15±5	16	20
Iloperidone	4	4–8	8	10–16	12	12–16	20–24	24
Lurasidone	20	40	80	120	160
Olanzapine	1	5±2.5	10	10±2.5	15	15±2.55
Paliperidone	1.5	3	6	9	12	15
Quetiapine	75	150	<250	250	300	400	450	600	750	800
Risperidone	2	4	6	8	10	12	16
Sertindole	8	12	16	20	24
Ziprasidone	10	40	80	120	160	200
Zotepine	75	150	300

[DMV64]

So for example: could I take my usual Geoden dose, take out the Saphris completely and substitute 80mg of Geoden? And then taper from there? Would I not have withdrawal because they are the same class of med? I could just switch it out? It sure would make tapering MUCH easier with these small Saphris numbers.

[brassmonkey]

Hi DMV-- don't go down that road, it will just cause you more trouble.  Psych drugs are placed in the same class because they have a similar chemical structure and target similar things inn the way they act.  It does  not make them interchangeable.  Making a switch like this will leave you with ct symptoms from the first drug and start up and a whole new set of symptoms from the second.  It will also sensitize your body, making any changes, including slow tapering, a lot harder to do.

 

There is also the time factor to consider. When making the switch it is more than likely to take six months or more to restabilize on the new medication before you can start to taper.  Your signature says you're doing 10% tapers.  At that rate it will take you about two and a half to three years to taper the Sephris.  If you try to taper the Geoden at the same rate, and you may have to go even slower starting from 300mgai you're looking at a minimum of eight years to taper off.  That's if nothing goes wrong and not counting the time needed to switch over and restabilize.  For right now you need to be practicing your AAF.  Do a site search on AAF or Acknowledge, Accept, Float to find information.

 

The Gemini-20 style of scale is not the most accurate especially at the lower doses. But the alternatives are pretty much out of the question.  There are three ranges of scales available; the ones we tend to use at a price of around 35USD. The next step up which sell for around 450USD and are the exact same scales in different packages. Then come the laboratory grade scales.  These are very accurate but you need very controlled conditions to use them, they are very hard to keep calibrated and very touch to use.  Also their starting price is 2500USD for the cheap ones.

 

Brassmonkey

[DMV64]

2 minutes ago, brassmonkey said:

interchangeable

Thanks for all this info. I am sad though. I thought maybe I had found a solution to the end of Saphris taper. I guess I am just going to have to deal with the extreme drops because of the small dosage and scale limitations. 

[DMV64]

@brassmonkey I have no way of measuring 10% drops once I get to around 1.1 from what I understand. I can only measure 010, 009, 008 etc which will be larger than 10 from what I understand. 

[DMV64]

Just checking in...have two births upcoming and feeling nervous about them as it gets closer. Having to manage my symptoms and also my titrate for the unknown length of a labor is hard. Feel a little scared.

[Rosetta]

Are you a midwife?  I'm sorry you are feeling scared.  I'm sure that when you are in the situation you will manage just fine.  Maybe you are feeling anticipatory anxiety.  I have strong anticipatory anxiety, but when I get into the situation I seem to handle it just fine.  Do you have that experience?  Maybe it's just me.  

[wantrelief]

It is amazing how much you do to support others as both a yoga teacher and doula (I think you are a doula?), especially going through withdrawal.  It seems only natural that you would feel nervous about the upcoming births.  I am not doing anything close to what you are doing at the moment but find when I am nervous about accomplishing something and then actually am in the moment of that thing, it ends up being ok.  You are doing great, DMV, in pushing through and doing what you need to even when you are having symptoms.

[DMV64]

Thank you both for cheering me on. Usually once I’m teaching and once I’m in the situation of Doula work I am OK but I do have a lot of anticipatory anxiety you are right. Today started out OK but it went downhill and so I guess I’m feeling it a bit more.

[Altostrata]

DMV, are you still taking this drug combination?

If you've added or changed drugs, please generate a new report and copy and paste it here.

[DMV64]

Yes. I am taking this. But clarinex only as needed

[DMV64]

my therapist just recommended this site:

http://www.eusophi.com/

[Altostrata]

Do you have ANY of the symptoms mentioned among the interactions?

 

[DMV64]

I have difficulty concentrating and also with memory. Maybe a bit of confusion. I have a pre-existing bladder condition (beforemeds). 

[Carmie]

On 6/15/2018 at 6:30 AM, DMV64 said:

Just checking in...have two births upcoming and feeling nervous about them as it gets closer. Having to manage my symptoms and also my titrate for the unknown length of a labor is hard. Feel a little scared.

 

Hi DMV, 

 

Just wanted to say it’s normal to feel scared and have anticipatory anxiety before doing important things. In withdrawals all our senses are really heightened and things can be quite overwhelming. Like you said, once you start doing things the anxiety lessens a bit. Must be hard though to be helping mothers when you don’t know how you’ll be from day to day. 

 

All I could think of when you were talking about births was the show Call The Midwife. I love that show. The stories are all real, off course they would have embellished them a lot for tv. I don’t think I’ve ever seen so many births in a tv show.😀

 

Hope you cope okay, sending hugs your way 🤗

[JanCarol]

On 6/14/2018 at 10:09 PM, DMV64 said:

I see Saphris (asenapine) dose I am on is equivalent to 80 mg of geoden (ziprasidone) .

 

I'll do this graphically.

 

Here is asenapine (Saphris).  The spikes on the ball are all the different types of receptors that asenapine binds to.

 

 

Now, here's ziprasidone (Geodon):

 

 

Look how many receptor bindings that drop off when you come off the asenapine.  This is why it is so challenging to come off of - even tapering is a challenge, because at different levels, different receptor bindings "fall away."

Your plan (as Brass indicated) is a sure path to withdrawal symptoms.  As he said - they are in the same class, but they do different things.

 

When Alto asks:

7 hours ago, Altostrata said:

Do you have ANY of the symptoms mentioned among the interactions?

 

She is most concerned about this:
 

Quote

Using ziprasidone together with asenapine is not recommended. Combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with either of these medications. 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

 

Please reassure us about your symptoms, and let us know if you are having any of these.

 

This is why it is important to keep these two drugs apart - not take them at the same time (this is what Dr. Breggin recommends when you have a major conflict).  So far that's what you've been doing, and it may be moderating the interaction between these two drugs somewhat.  We certainly hope so!  (if you look at the pictures, you will see that all of the spikes on the ziprasidone are also on the asenapine - these are the overlaps which cause an interaction - a double hit on the same receptors) - plus there may be a metabolism conflict, too  (checking.....both are metabolised in the liver, but with different enzymes - so they are hard on the liver, but not in direct metabolic conflict).

 

For others to check my work:  Ziprasidone is metabolised on CYP P450 and 3A4, asenapine is CYP1A2.  from http://www.drugbank.ca/ 

 

What you are calling anxiety could be a drug interaction amplifying your natural cortisol cycles and spikes for stress.  While I'm sure you had anxiety before taking these drugs - they tend to amplify things as they bind to receptors, and your system upregulates and downregulates  to compensate for the changes in neurotransmission.

 

On the whole, you are doing really well - you are more active and engaged with your community than most of us - if you were in serious trouble, you wouldn't be able to do all of that!  Keep that in mind when you start to second guess yourself (fear of the fear - see:  Dealing with Emotional Spirals ) - you are not bedridden, you can stand, sit, walk, talk and do sun salutations!  You sleep at night (mostly), and function during the day.  That's more than a lot of people here can say.

 

Count your blessings, and they will help you get through the rough times.

 

I hope you see the sun today!

Edited June 16, 2018 by JanCarol

[DMV64]

2 hours ago, JanCarol said:

drugs

 Thank you so much! This is a lot of really good information. I really like the visuals. 

I do believe that what feels like anxiety to me is drug interaction. I certainly never had this level of anxiety before I was on this class of medication. Not even close.

 It is good to be reminded that I am doing OK, it is easy to park at. I will keep on top of the possible interactions but for now I’m only having the ones I posted. 

Thankfully. 

[DMV64]

4 hours ago, Carmie said:

overwhelming

It is true that once I am there I am usually fine, riding the wave of the birth. It’s hard to be on call though and manage the routine of my paper and sleeping. Plus when you go to a birth you never know how long you’re going to be there. I need to take my  different drugs with food at certain times and it can be a little tricky.

[DoctorMussyWasHere]

On 6/14/2018 at 8:41 PM, brassmonkey said:

don't go down that road

Yes, I should make a note there. The chart is more for referencing in relation to past prescribing, not future direction.

[Carmie]

13 hours ago, DMV64 said:

It is true that once I am there I am usually fine, riding the wave of the birth. It’s hard to be on call though and manage the routine of my paper and sleeping. Plus when you go to a birth you never know how long you’re going to be there. I need to take my  different drugs with food at certain times and it can be a little tricky.

 

Hi DMV, 

 

Yes, I can imagine how hard it would be to be on call when you don’t know how you will be feeling from one minute to the next and juggling your meds with food. 

 

I hope you cope okay, it must be a very rewarding job seeing life come into the world. 

 

Take care💚

[DMV64]

Hey just checking in here. Had some restless legs stuff last night. I have not had to deal with this so far. Did not sleep well. Trying to just have my day anyway, move ahead, not worry about tomorrow or how tonight will go. We are going to the beach today, so that is good.

[JanCarol]

Hey D - 

 

Just got some info from Brassmonkey, who researched oral vs. sublingual uptake of Saphris for the purpose of liquid tapering.

If you swallow Saphris, you only get 2% of the dose absorbed (via the stomach) but if you dissolve it under your tongue you get the full dose.

 

So - to liquid taper Saphris, you use only a small amount of liquid, and hold the liquid in your mouth for 10-15 minutes.

 

Then you can do tiny increments with a liquid taper.  (we'll do the maths later)

 

You can still dry cut the next taper (maybe two) but then switch to making liquid when it gets too small for your scale.

 

How does that sound? 

 

I hope you see the sun today,

JanCarol

[DMV64]

It sounds really great except I don’t really understand it. Maybe we can talk a little more about it

[DMV64]

Also how do you feel about me starting to split the geoden dose more evenly now, I feel ready and I really do think the uneven dose it’s not helping me

[DMV64]

3 hours ago, JanCarol said:

sound

@JanCarol @brassmonkey It sounds great but I just don’t understand how I get the dry dose small enough even if I am holding water in my mouth.

[JanCarol]

I'm not super smart, but you will dissolve the whole tablet in a small amount of water - like 10 ml.

 

The tablet is 2.5 mg?

 

You will shake, and use a small, accurate syringe to extract a "the right number of mils" to take*.  You will hold this in your mouth for 10 minutes.  

 

*that's the maths part, like I said, we'll get to that later.  Example, if your tablet is 2.5 mg/10 ml of water, then your current dose of 1.5 mg would be 6 ml of water+tablet.  You would discard the other 4 ml.  In a few months, you will be able to get more than one dose out of a tablet.

I'm trying to imagine 10 minutes without speaking....but 6 ml is very small, and maybe won't be that intrusive.  (a teaspoon is 5 ml)

[DMV64]

Ok this helps!

[JanCarol]

So - if you are doing your first taper early July (make sure you are clear of births, travel & major events - maybe plan for a weekend or a time when you have lighter duties), continue to dry cut.

 

However, you need to get a couple of 15 ml vials,

 

(Golly that looks big - I say 15 ml, and you will use your cylinder to measure the 10 ml.  You might want to make a mark on the jar.  The extra 5 ml just gives you a little "splash" space.)

 

a  10 ml graduated cylinder (for this, the accuracy of glassware would be good)

 

 

and 5 and 10 ml syringe (the 5 ml syringe will come in handy later)

 

 

again, sorry about the size of the picture

 

 

Collect these items during July, and you can start practising with them.  They are available on Amazon.com - some of them are even available at Walmart.  They are not expensive.  The syringes are often "disposables" and some members pick them up for free at the pharmacy counter.

 

To practice (I'm getting ahead) - you put DISTILLED WATER in the graduated cylinder.  Use the syringe to make it EXACTLY 10 ml.  Pour that into the vial.  Shake, and extract 6 ml of water (there is no drug in this, you are just practicing) and put it in your mouth to hold. 

Once you've practiced a few times, you will be ready to try your next taper that way.  We'll help you with the maths.

 

I'm getting ahead of myself, because I don't know when I'll be back, and this gives you a new thing to focus on and learn.

 

 

I hope you see the Sun today!

[DMV64]

I have some of these items already although my cylinder is made of plastic. I think I have 5 mL syringe is as well. I will check it out and see what I need to buy

[DMV64]

Also what about the Geodon split