Manny78: multiple psychotropic drugs - which one first?

[Manny78]

On 4/22/2021 at 8:35 AM, gdsequoia said:

I see! In that case, I support you in wanting to get off all meds. But, as other posters have said, it is probably best to taper just 1 med at a time. Not Abilify and Risperidone at the same time. Just 1 of them.

@jdsequoia. Just tapering abilify now. 

[gdsequoia]

15 hours ago, Manny78 said:

Can't take this anymore. My sxs are tremors, pacing, rls legs,back pain.

I find these exercises great:

 

[Manny78]

Hi everyone. I spoke with my psychiatrist and he gave me dulotex 60 mg in pills form? Is it more difficult to taper than Cymbalta 60mg in capsules? 

[Altostrata]

How much of each drug are you taking now, @Manny78? How do you feel after the changes you've  made in risperidone and aripiprazole?

[Manny78]

16 hours ago, Altostrata said:

How much of each drug are you taking now, @Manny78? How do you feel after the changes you've  made in risperidone and aripiprazole?

Hello @Altostrata. I was replying to your question on the phone and I lost the post. Well right now,I am taking abilify 7,2ml,risperidone 8,6ml,cymbalta 60mg,klonopin 0,25mg and biperiden 4mg extended release.

 

I spoke with my psychiatrist yesterday. He doesnt want me to keep tapering abilify below 10 mg, The bad thing at least for me is that I have akathisia, and I mentioned it to him and that I wanted off of at least one antipsychotic.Well, first he said that if I lower the abilify 10 mg,it loses its antipsychotic properties and that 10mg of abilify is the minimal therapeutic dose and that in the past I took 30 mg and 20 mg of abilify because I kept telling him I heard voices.That was my mistake. He just kept increasing my doses. Every time I speak to him,he tells me something different like it is one drug or the other that causes me trouble. Six months ago, when I spoke with him he gave more biperiden to control the akathisia. I take 4 mg of biperiden extended release and I am not going to take biperiden 2mg non extended release for a total of 6 mg of biperiden after he mentioned that causes constipation and dry mouth.

 

He also mentioned that he could lower my risperidone dose. I said to him I was in 1mg,but I refused because I want to keep tapering abilify that it is my offending psy drug that when I take I start to feel really bad with sxs like agitation and severy restless legs that I need to be in bed and also akathisia. Plus he would tell me to taper 0.25ml which it is too much.

 

I have akathisia the whole day (agitation,vibrations,resltess legs,severy back pain,muscle twitches,arm shaking and hand shaking,pacing),more severe when I take the abilify. If I walk or try to do some physical activity it worse.I think I have hit tolerance and I still have 7,2 ml to taper. I am tapering less than 10 percent monthly. I taper 0,4ml per month. At this speed if I complete my taper. I will be tapering for more than 5 years or even more because of the combo of drugs I am in.

 

In addition,he wants me to up my dose of dose of klonopin at night to 0,5 mg. I won t touch my klonopin dose. If I go up I will still have to taper it and shock my CNS more.

 

Also,he gave me cymbalta in tablets. I think there are cymbalta 60 mg in tablets. I don´t know how to taper that. I better tell him to stick with the capsules.

 

Cymbalta trade name is Nodetrip in Spain but it can be changed to xeristar 60mg capsules which it is the one I take (Xeristar 60 mg hard capsules).

 

My prescription list and doses is as it follows:

Klonopin 0,5 mg 0-0-1/2 needs to be corrected to 0-0-1

Abilfify 10 mg 2-0-0 He didn´t change my prescription to 1-0-0. He forgot to do it.

Nodetrip 60 mg changed to xeristar 60 mg hard capsules 1-0-0. He didnt know I had this already.

biperiden 4mg extended release 1-0-0

risperidone 1mg/1ml 100 ml 0-0-2/1/4

abilify 1mg/1ml liquid solution 5ml every 24 hours I cant keep getting it because he doesnt want me to keep tapering.

biperiden 2mg 1-0-0

Dulotex 60 mg tablets – 1-0-0 I think they are tablets not capsules. I don´t know how to taper it.

[Altostrata]

It sounds like you need a new doctor.

 

See Tips for tapering off duloxetine (Cymbalta)
 

[Manny78]

I need help with antibiotics. My mom was prescribed ciprofloxacino 500 mg for urine infection. Is it safe for her to take it? She is on psychiatric drugs.Thanks in advance. Manny

[gdsequoia]

24 minutes ago, Manny78 said:

I need help with antibiotics. My mom was prescribed ciprofloxacino 500 mg for urine infection. Is it safe for her to take it? She is on psychiatric drugs.Thanks in advance. Manny

https://en.wikipedia.org/wiki/Ciprofloxacin#Interactions

Is your mom on olanzapine? On clozapine? Or what are her psychiatric drugs?

[Manny78]

5 minutes ago, gdsequoia said:

https://en.wikipedia.org/wiki/Ciprofloxacin#Interactions

Is your mom on olanzapine? On clozapine? Or what are her psychiatric drugs?

Yes she is on olanzapine,lithium,Anafranil and lamotrigine. 

[LostRunner]

@Manny78From what I've seen online I would say stay firmly away from cipro or any other the antibiotics with 'flox' in them.. they can have terrible, long lasting side effects and people can end up being 'floxed.' There will be a much safer antibiotic that can be prescribed that doesn't do the damage that cipro can do, its just not worth the risk! 

[Manny78]

3 hours ago, LostRunner said:

@Manny78From what I've seen online I would say stay firmly away from cipro or any other the antibiotics with 'flox' in them.. they can have terrible, long lasting side effects and people can end up being 'floxed.' There will be a much safer antibiotic that can be prescribed that doesn't do the damage that cipro can do, its just not worth the risk! 

How do I tell my mom's doctor to give her a different antibiotic?  I have been labeled OCD. 

[LostRunner]

@Manny78I think its perfectly fine to raise concerns about an antibiotic that has a black box warning and has harmed many people. if your mum's dr is a good dr then they would respect that and offer an alternative, otherwise I would go to a different dr!

[Manny78]

40 minutes ago, LostRunner said:

@Manny78I think its perfectly fine to raise concerns about an antibiotic that has a black box warning and has harmed many people. if your mum's dr is a good dr then they would respect that and offer an alternative, otherwise I would go to a different dr!

Thank you  @LostRunner.Can she refuse treatment? It is for my mom. My mom agrees not to take it,but she doesn't want to go there. 

[LostRunner]

Can you see another Dr and ask for a different antibiotic? She isn't obliged to take that medication if she doesn't want it. Ask for a different medication if you can. Better to be safe than sorry!

[Manny78]

13 hours ago, LostRunner said:

Can you see another Dr and ask for a different antibiotic? She isn't obliged to take that medication if she doesn't want it. Ask for a different medication if you can. Better to be safe than sorry!

She gave my mom Septrin Forte 160mg /800 mg. 

[LostRunner]

@Manny78Hope your mum feels better soon! 

[Manny78]

38 minutes ago, LostRunner said:

@Manny78Hope your mum feels better soon! 

Thank you @LostRunner. 

[Manny78]

My dad has been prescribed dogmatil 50 mg for vertigo and dizziness. How do I talk to him to stop taking it? I mean tapering it. I can't believe these doctors given that for vertigo. My dad trust his doctor. Anyone tapering it? I think there are other pills or options for vertigo. 

[Manny78]

I have really bad akathisia from abilify. Please help me out.I am tapering roughly 4 percent monthly(0,2ml every 2 weeks).Right now at 5,6ml of abilify. I am getting bad advise to cross over to a different antipsichotic. Worse symptom is muscular pain in my legs and back, restless legs. I am sleeping though but waking up. I need to update my signature. 

[Manny78]

Guys,please help me out. I am having really bad akathisia. Currently tapering abilify on my own at a 4 percent monthly rate. Polydruged with 5 drugs (abilify 5,6ml,Risperidone 0,86ml,klonopin 0,25mg,cymbalta 60mg and biperiden 4mg extended release).My worse nightmare is the muscle pain in my legs(quadriceps and knees),abdominal pain,equilibrium problems, difficulty to walk because of back pain,inner agitation,pacing, and restless legs.
 

[ChessieCat]

In a post, please list your current drugs, the dose, and the times that you take them.  As well as updating your drug signature. 

 

Thank you.

 

Do you have any daily symptoms notes that you could provide?  If not I suggest that you start keeping them.

 

Is this your only current symptom?

 

When did it/they start to worsen?

 

What other thing/s changed just prior to the symptom/s worsening?  For example:  change in other drugs/supplements, sickness, vaccination, antibiotics, alcohol, additional stress, travel.

 

Providing as much information as you can will help us to help you.  You haven't provided anything since May 2021.

 

I will ask the other mods who are more familiar with your situation to follow up.

[ChessieCat]

Just now, ChessieCat said:

Do you have any daily symptoms notes that you could provide?  If not I suggest that you start keeping them.

 

This post explains what is required and why it is needed:

 

 

[gdsequoia]

8 hours ago, Manny78 said:

My worse nightmare is the muscle pain in my legs(quadriceps and knees),abdominal pain,equilibrium problems, difficulty to walk because of back pain,inner agitation,pacing, and restless legs.

About the muscle pain: I too have extreme muscle pain in my quadriceps, and I am taking 4 things that help extremely:
1. 400mg magnesium lysinate/glycinate chelate (branded Doctor's Best)
2. 500mg magnesium orotate dihydrate (branded Magnerot)
3. low-dose Vitamin B-complex (prolonged release) (branded Doppelherz)
4. a drug called baclofen, which I won't recommend to you because it's a powerful drug.

 

Also try stopping all sugar, even honey and fruits. Any and all sugar worsens my muscle pain and my lower back pain extremely.

 

Are able to do some simple physical exercises for your back pain? If yes, then I can recommend some.

 

For the equilibrium problems, you can try Ginkgo Biloba (a herb), but beware that it "thins the blood", so you should be careful not to combine it with other things that "thin the blood" - otherwise you risk getting some dangerous bleeding.

[Altostrata]

16 hours ago, Manny78 said:

Please help me out.I am tapering roughly 4 percent monthly(0,2ml every 2 weeks).Right now at 5,6ml of abilify.

 

When did this symptom emerge? If after your last Abilify reduction, it may be a withdrawal symptom. You might updose slightly to see if that will help.

 

Have you changed your clonazepam dosing recently?

 

What is your current dosage for each drug, in milligrams? We don't know what dosage in mL means.

 

As you know, Manny, you are taking a combination of drugs that can cause movement disorders. 

 

Your current symptoms may be caused by Abilify, risperidone, Cymbalta, OR biperiden -- OR a combination of them. They may not be a withdrawal symptom but an effect of your drug combination that has overcome your body's ability to manage it. This has been a risk at least since you joined in 2017.

 

Clonazepam may also be playing a part if you 1) changed your clonazepam dosing; 2) increased your daily dose; 3) forgot to take a dose; 4) have become tolerant to your daily clonazepam dose. It is possible clonazepam was keeping this in check but is no longer effective.

 

You have needed a new doctor for a long time.

[Manny78]

On 9/29/2021 at 8:17 PM, Altostrata said:

 

When did this symptom emerge? I have had akathisia all this time (3 years maybe).If I read my posts I know I mentioned it before.My problem is that I switched tapers all this time (klonopin,risperidone and abilify),and never ended one.

 

If after your last Abilify reduction, it may be a withdrawal symptom. You might updose slightly to see if that will help.after your last Abilify reduction, it may be a withdrawal symptom. You might updose slightly to see if that will help.

 

Have you changed your clonazepam dosing recently?No, I haven,t. I have been taking klonopin 0,25 mg at night. My psychiatrist upped my klonopin to 0,5mg at night,but I didn´t follow his advice. I would shock my brain upping doses and I would have to taper klonopin later on and it cost me a lot to get to that lower dose. 

 

What is your current dosage for each drug, in milligrams? We don't know what dosage in mL means.

The doses are the same in milliliters. 1ML is the same as 1 milligram.

I am at 5,6mg of abilify morning dose.

1 capsule of Cymbalta 60 mg in the morning.

1 biperiden 4mg extended realese morning too.

 

Risperidone 0,86mg at night

Klonopinf 0,25mg at night.

On 9/29/2021 at 8:17 PM, Altostrata said:

 

As you know, Manny, you are taking a combination of drugs that can cause movement disorders. 

I am aware Altostrata.I asked my doctor about why I take two antipsychotics that affect the same hepatic enzyme.His reply was that I take minimal doses like 10 mg of abilify and 1mg of risperidone. He thinks I am following his orders.He admitted that the risperidone causes aka,and abilify doesn´t,that at the abilify 10 mg pill I shouldn´t have akathisia. I know that abilify is causing me aka. When I take it,I start to get inner restlessness,pacing,restless legs,and tremors now. Also lots of muscle pain (back,legs pain, and mioclonic jerks),but the worse is inner akathisia and pacing.

In addition,he said that to have full antipsychotic properties the risperidone dose should be 3 mg. He preffers to lower my risperidone dose than to change my abilify. He suggested to go to 0,5mg of risperidone on my own from risperidone 1mg.He is a compulsive liar. He wants me on lower doses of psychotropic drugs,but he doesn´t listen. I once suggested him to taper abilify one milligram each month,and he agreed. He wanted me to go from abilify 20 mg to 15 mgs.Luckily I had tapered already.

On 9/29/2021 at 8:17 PM, Altostrata said:

 

Your current symptoms may be caused by Abilify, risperidone, Cymbalta, OR biperiden -- OR a combination of them. They may not be a withdrawal symptom but an effect of your drug combination that has overcome your body's ability to manage it. This has been a risk at least since you joined in 2017.

Clonazepam may also be playing a part if you 1) changed your clonazepam dosing; 2) increased your daily dose; 3) forgot to take a dose; 4) have become tolerant to your daily clonazepam dose. It is possible clonazepam was keeping this in check but is no longer effective.

I don´t understand this part,never upped my dose of klonopin,but I think I have become tolerant to klonopin. I might need higher doses.

On 9/29/2021 at 8:17 PM, Altostrata said:

 

You have needed a new doctor for a long time.

I can´t find a better doctor.

[Altostrata]

I don't know what to tell you, @Manny

 

How has your symptom pattern changed as you've lowered the Abilify dosage? Is what you're calling akathisia worse at any particular times of day?

 

I do not agree with your doctor, and you have your doubts, too. If I were you, I would not be guided by his opinions. His response about minimal doses doesn't make any sense. Yes, Abilify can cause akathisia.

 

Perhaps after you talk to him, and he agrees you can taper by 1mg per month, you immediately might put that in writing in a letter to him, as a memo and reminder of what you discussed during your visit. His memory may be poor.

 

You may be in a situation where you are tapering on your own, but you need to have a good relationship with him to continue your prescriptions. You can let him believe whatever he wants about what you're putting in your mouth every day.

[Manny78]

On 9/29/2021 at 5:07 AM, ChessieCat said:

In a post, please list your current drugs, the dose, and the times that you take them.  As well as updating your drug signature. 

 

Thank you.

 

Do you have any daily symptoms notes that you could provide?  If not I suggest that you start keeping them.

Hi ChessieCat.This is what I take:

Abilify 5,4mg =morning. I don't take it at the same hour because the moment I take it I start to get very agitated(need to lay down,because I start to get inner restlessness and I start to move my legs(restless legs syndrome)otherwise I start to pace. 

 

Cymbalta 60 mg =when i awake. I tend to wake up at 12 or 1pm.I sleep a lot at least to now. I sleep better in the morning than night. At night I awake a few times (not following to sleep after I wake up).Sometimes I use my mobile phone. I know I shouldn't. Eventually i fall back to sleep. 

 

Biperiden 4mg extended release=morning too when i wake up.

 

THESE TWO, CYMBALTA AND BIPERIDEN ALSO CAUSE ME TO FEEL AGITATED,but less than abilify. 

 

I feel agitated(inner and outter aka) for the rest of the day till 9pm roughly. I walk,visit my girlfriend, take a bus, need to seat down and suddenly need to start walking. 

 

 

 

 

Klonopin 0,25MG AT NIGHT=10pm

Risperidone 0,86mg=10 pm

 

 

 

 

 

 

On 9/29/2021 at 5:07 AM, ChessieCat said:

 

Is this your only current symptom? My current sxs are inner restlessness,muscle pain,pacing and restless legs. I started to get mini tremors. 

 

When did it/they start to worsen?

Now that I made this cut to 5,6mg.

On 9/29/2021 at 5:07 AM, ChessieCat said:

 

What other thing/s changed just prior to the symptom/s worsening?  For example:  change in other drugs/supplements, sickness, vaccination, antibiotics, alcohol, additional stress, travel.

Nothing changed. I don't take supplements.  I got vaccinated 3 months ago (Pzifer vaccine)not major problems with it,no antibiotics,don't drink alcohol, no major stressors. 

 

On 9/29/2021 at 5:07 AM, ChessieCat said:

 

Providing as much information as you can will help us to help you.  You haven't provided anything since May 2021.

 

I will ask the other mods who are more familiar with your situation to follow up.

 

[Manny78]

12 hours ago, Altostrata said:

I don't know what to tell you, @Manny

 

How has your symptom pattern changed as you've lowered the Abilify dosage? Is what you're calling akathisia worse at any particular times of day? I have had problems all this time tapering abilify  even though I do small reductions (maybe 4 to 5 percent monthly).I reduce 0,4ml monthly.Every two weeks I made a 0,2ml cut. 

My worst symptoms are when I take the abilify. I START TO PACE  AND FEEL INNER RESTLESSNESS AND I NEED TO LAY DOWN IN BED WHERE I HAVE RESTLESS LEGS SYNDROME. 

THIS SYMPTOM PERSISTS TO THE REST OF THE DAY. I TRY TO DO NORMAL LIFE, BUT MY MUSCLE PAIN NOW IS SEVERE SO THE INNER AGITATION AND TREMORS. I ALWAYS GO OUT FOR A WALK. I TRY TO DISTRACT MYSELF AS MUCH AS Possible.I visit my girlfriend and i take a bus. 

 

12 hours ago, Altostrata said:

 

 

12 hours ago, Altostrata said:

 

I do not agree with your doctor, and you have your doubts, too. If I were you, I would not be guided by his opinions. His response about minimal doses doesn't make any sense. Yes, Abilify can cause akathisia.

 

Perhaps after you talk to him, and he agrees you can taper by 1mg per month, you immediately might put that in writing in a letter to him, as a memo and reminder of what you discussed during your visit. His memory may be poor.

 

You may be in a situation where you are tapering on your own, but you need to have a good relationship with him to continue your prescriptions. You can let him believe whatever he wants about what you're putting in your mouth every day.

 

[Manny78]

I think the same as you Alto. It doesn't make sense that I take minimal doses. I am on 5 drugs that interact with each other. One psychiatrist commented to me that he doesn't consider the best combination Abilify and Risperdal. You mentioned it before that they act on the same liver enzymes and does have the same effect. They also added Cymbalta. I have sexual dysfunction and when I get to taper I have to count the beads. He wanted to switch me to q different AD. I suspect and SSRI or SNRI. I refused it. 

They put me on biperiden because of the EPS i was having. 

Edited October 2, 2021 by ChessieCat
reformatted - changed some parts in caps

[Altostrata]

If you're still having adverse reactions from Abilify, it makes sense to reduce it to zero. Not sure if there's anything else I can say.

[Manny78]

23 minutes ago, Altostrata said:

If you're still having adverse reactions from Abilify, it makes sense to reduce it to zero. Not sure if there's anything else I can say.

Fast taper or slow taper? 

[Altostrata]

@Manny, we've been talking about this for 4 years. Go off Abilify in the way that doesn't cause withdrawal symptoms. You should know how to do it by now, you've been tapering since 2019.

[ChessieCat]

Manny I'm going to be very honest with you.  You have been a member here for 4 years.  During that time you have been given excellent information by Alto who has been involved with psychiatric drug withdrawal etc for a long time.  The Surviving Antidepressants website was created in 2011.

 

With what you have been advised and the information that you have been directed to on this site, you realise that the doctor/s are not helping you.  You say that you are not able to find a better doctor. 

 

BUT that doesn't mean that you are not able to reduce or get off your drugs.  There are many members here who are in a similar situation who have managed to get off their drugs without a good doctor or the support of a doctor.  All that is needed is to be able to get the prescriptions for your drugs.  The doctor does not need to know what dose you are taking of the drugs, unless you are getting an injection.

 

And I think it is time for you to start doing what is best for you and your health.  You are the one who is taking drugs, not the doctor.  It is you and your body and health that are being affected by what you are taking, not the doctor.

 

It is very easy when we are suffering to forget or not fully comprehend information that we are given.  I suggest that you start back right at the beginning of your Introduction topic and read through all of it.  You could take notes as you go.

 

It is good that you have realised that your doctor is not helping you.  There are some things that we do not have control over and for you, having a bad doctor is not in your control.  However, you do have control over what you do with the drugs you take.

 

[Manny78]

For tapering purposes what is best to taper abilify 10mg dismelt orodispersable pill or just  abilify 10mg regular pill? Or the abilify 1ml liquid solution? 

 

[ChessieCat]

Post #1 of this topic has information about how to get non standard doses:

 

tips-for-tapering-off-abilify-aripiprazole

 

[Manny78]

Anyone tapering Zolafren 7,5mg capsules?