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Manny78: multiple psychotropic drugs - which one first?

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Manny78

Hello everyone, someone here taking lithium,lamotrigine (lamictal). My mom is taking both but she stopped taking the morning dose month ago.I suspect that she is hearing voices or she is having  deliriums.
Should she resume on her latest dose? She is taking 1 and 1/4 mgs of lithium and 1 lamotrigine pill in the morning. She takes plenur,lamictal,anafranil,zyprexa.

Thanks,

Manny

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Manny78

Hello guys. I have a psychiatrist appointment tomorrow? What do you recommend to talk with him? Should I say that I am ok. The more that I talk the worse.I know that we will dismiss all the side effects that I have from the drugs.

 

Thank you,

 

Manny

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Manny78

 I saw my psychiatrist today(05/8/2018). He wanted to reduce my klonopin from 0,5mg to either 0,25mg or to 0 mg.  I said no,that I didn't want to suffer withdrawals. He agreed. He made me psychiatry report based on my medical records that I need to look for a job selling lottery.He said that  I have paranoid schizophrenia.  Before I was ocd and schizophrenic. I am battling to get off these poison drugs. I hate labels because if you are not careful you may start to believe that you have the so called mental disease. I know it is all the damn pills. I need some reassurance.

 

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Manny78
On 5/7/2018 at 6:54 PM, Manny78 said:

Hello guys. I have a psychiatrist appointment tomorrow? What do you recommend to talk with him? Should I say that I am ok. The more that I talk the worse.I know that we will dismiss all the side effects that I have from the drugs.

 

Thank you,

 

Manny

Hello friends. I went to my psychiatrist the other day. Every time I go to see him I come more disappointed and mad. They tell you a  bunch of lies. I don't know how they can live with that.

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Manny78

Hello everyone. I am tapering abilify 10 mg water tritation method. I reduce very litlle. I was on 7,6 mg in april 20th.Yesterday, I decreased 0,2ml (7,4mg). Do you get trouble thinking and lower back pain?

Thank you,

Manny

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RubyJ

Hi, Manny.  Abilify has a long half-life so if you're experiencing symptoms it's probably from the previous reduction (7.8->7.6), not the one you did yesterday, although anything is possible, since we don't understand these drugs that well.  If you're experiencing symptoms, just try holding where you are, I think?

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Manny78

Thank you,RubyJ.

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Manny78
On 5/11/2018 at 9:04 PM, RubyJ said:

Hi, Manny.  Abilify has a long half-life so if you're experiencing symptoms it's probably from the previous reduction (7.8->7.6), not the one you did yesterday, although anything is possible, since we don't understand these drugs that well.  If you're experiencing symptoms, just try holding where you are, I think?

 RubyJ, I decided to keep tapering. I have been on that dose,7,8mg,long enough. 

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Manny78

Do antipsychotics cause actual psychosis?  I am tapering abilify 17,4mgs and I started to hear voices when I want to sleep. I don't remember what I hear. I have a friend that wants me to taper klonopin first because of tolerance.What do you guys think?

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Manny78

Does your legs hurt so bad that you just don't want to do anything? Do you have brain fog that you are listening to someone and you don't remember what they say? Or you are reading and you don't remember what you have read?

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SkyBlue
On 5/13/2018 at 6:11 AM, Manny78 said:

Do antipsychotics cause actual psychosis?  I am tapering abilify 17,4mgs and I started to hear voices when I want to sleep. I don't remember what I hear. I have a friend that wants me to taper klonopin first because of tolerance.What do you guys think?

 

Hi Manny,

 

The muscle pain, brain fog, and memory problems are definitely part of withdrawal. There are a lot of threads on these in this area: http://survivingantidepressants.org/forum/8-symptoms-and-self-care/

 

Coming off "antipsychotics" can cause problems that mimic psychosis, such as you are describing.  You might want to google "Hearing Voices," which is a group that helps people deal with voice-hearing without necessarily using medications.

 

You may also want to read Shep's journey on this site. She came off quite a powerful cocktail of drugs and there may be similarities between you. 

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SkyBlue

Also, if you are already tapering Abilify, it is probably best to keep tapering that. 

 

This thread talks about tapering the antidepressant first: http://survivingantidepressants.org/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/

 

The idea is stability, to make as small and as few changes as possible. 

 

Tapering more than one drug at a time is incredibly complex. 

 

 

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Manny78

Currently water tritating and back to 17mg. I was  at 18mg before.I was reducing at 5 percent, but I speed it up a little bit, I went from 17,2  to 17mg in three days. Now I have inner vibrations. People taking abilify did you get this side effect? I couldn't sleep very weel.

 

Today is the 4th day that I am in 17mg.

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Manny78

Hello everyone. I have been water tritating abilify for almost a year.I was able to go from 20mg to 15mg of abilify. I have tremors on my buttocks.does anyone relate to this?

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Manny78

Hello. Is anybody doing water titration? I am doing it. I am at 15 mg and  I feeling bad. I started 10 months ago at 20mgs. I am having tremors in my legs. I would like to speak with people with the same experience. 

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ChessieCat

From Post #1 of this topic.  tips-for-tapering-off-abilify-aripiprazole

 

On 3/12/2012 at 10:34 AM, Altostrata said:

 

Dissolving tablets in water
I have no information about this. Technically, the ordinary Abilify tablet is insoluble in water (http://www.aapsj.org/abstracts/AM_2009/AAPS2009-003188.PDF ).


For general instructions about making your own liquid http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

About solubility or insolubility, our esteemed member Rhi, a lab technician, has made many, many homemade liquids:

 

On 2/28/2013 at 4:30 AM, Rhi said:

 

.... I just wanted to toss in my usual bit on the subject of making preparations for liquid tapering, which is: I personally don't worry about solubility.

None of the meds I'm tapering are actually soluble in water. But the pills dissolve into small enough particles that I can stir them up and keep them suspended in water while I measure them out, and that seems to work for me. I stir well before I measure, I stir a little while pipetting them up; I dissolve the pills in glass and pipette out of glass so that I can see visually how evenly everything is suspended, and that's good enough for me.

I use water as a medium because I like it that I can easily see for myself how evenly the little particles are suspended or if they seem to be settling out. Also because it's handy and cheap and I don't have to carry it with me if I travel.

Mostly I would just say, I don't think it really matters if the medication is soluble in whatever vehicle you're using, as long as it can be evenly distributed. What really matters is that it be evenly distributed and that your method be repeatable and consistent.

 

 
For a drug that is "insoluble" in water, a pharmaceutical liquid to make suspensions might be the best option, see http://survivingantidepressants.org/index.php?/topic/3068-pharmaceutical-liquids-to-make-suspensions/


You may be able to make a solution with the Abilify DISCMELT® Orally Disintegrating Tablets (available in 10mg and 15mg dosages); I don't know what the stability would be -- how long the liquid would be good.
 
Have a compounding pharmacy make a liquid for tapering
Compounding pharmacies can make a liquid from the tablets. You will need a prescription written for the custom compound. The only drawback is this can be quite expensive.

 

 

 

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ChessieCat

This member used pancake syrup (manmade maple syrup):

 

On 6/25/2018 at 1:01 PM, MadHatter said:

Someone messaged me asking if I had succesfully completed the taper.  In order to help other people, here is my reply to that someone:

 

"I'm about 3 days away from being done.  I was only on 2.5mg Zyprexa for 2 weeks and wanted to get off of it before it started harming me. I did it by doing a liquid taper:

 

I mix 1 tablespoon pancake syrup with 3 tablespoons water.  I use a pill crusher to grind up the 2.5mg Zyprexa.  I pour the powdered pill into the mixture and mix it up.  The syrup helps the powder be evenly distributed so that it doesn't just all fall to the bottom.  

 

Since 4 tablespoons equals 12 teaspoons, each night I take out an additional teaspoon of the mixture.  So by night 6 I'm taking out 6 teaspoons from the mixture and drinking the rest.  Tonight I'll take out 9 teaspoons and drink the remaining 3 teaspoons (which is effectively .6mg Zyprexa).  In effect, it takes me 12 nights to do the complete taper.

 

So far it hasn't been too bad.  My sleep is a little lighter, but I haven't been having the horrific Zyprexa withdrawals that I've read about, which I'm very thankful for.  

 

Hopefully this helps you.  Good luck!"

 

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ChessieCat

From your signature:  klonopin 0,25mg:01/01/2018

 

Q:  How often do you take this?

 

 

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Manny78

Hello chessiecat. I am using the abilify 10mg disintegrating tablets. They dissolve very welI in water. I take 0,25mg klonopin once a day at night time.

 

Edited by ChessieCat
extracted response from quote and deleted quote

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Manny78
16 hours ago, ChessieCat said:

From your signature:  klonopin 0,25mg:01/01/2018

 

Q:  How often do you take this?

 

 

I take klonopin 0,25mg once a day at night time.

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Altostrata
On 5/2/2018 at 2:04 PM, Manny78 said:

Hello everyone, someone here taking lithium,lamotrigine (lamictal). My mom is taking both but she stopped taking the morning dose month ago.I suspect that she is hearing voices or she is having  deliriums.
Should she resume on her latest dose? She is taking 1 and 1/4 mgs of lithium and 1 lamotrigine pill in the morning. She takes plenur,lamictal,anafranil,zyprexa.

Thanks,

Manny

 

Sorry to miss this. Those are a lot of drugs, do you and your mother go to the same doctor? Please ask your mother to join this site or start an Introductions topic for here.

 

On 9/21/2018 at 2:13 AM, Manny78 said:

Hello. Is anybody doing water titration? I am doing it. I am at 15 mg and  I feeling bad. I started 10 months ago at 20mgs. I am having tremors in my legs. I would like to speak with people with the same experience. 

 

 

On 11/25/2017 at 3:33 PM, ChessieCat said:

....

Q:  Have you had a liver function test done?

 

I have used this interactions checker with these results:

Monitor Closely

  • duloxetine + risperidone

    duloxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

  • aripiprazole + risperidone

    aripiprazole and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

  • clonazepam + aripiprazole

    clonazepam and aripiprazole both increase sedation. Use Caution/Monitor.

  • clonazepam + risperidone

    clonazepam and risperidone both increase sedation. Use Caution/Monitor.

  • aripiprazole + risperidone

    aripiprazole and risperidone both increase sedation. Use Caution/Monitor.

Minor

  • duloxetine + aripiprazole

    duloxetine will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

....

 

Manny, did you ever get that liver function test?

 

Do your symptoms follow any daily pattern?  Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

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Manny78
23 hours ago, Altostrata said:

 

Sorry to miss this. Those are a lot of drugs, do you and your mother go to the same doctor? Please ask your mother to join this site or start an Introductions topic for here.

Yes,my mother and I go to the same doctor. She doesnt speak English.

 

 

 

 

Manny, did you ever get that liver function test?

 

Do your symptoms follow any daily pattern?  Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

Hello altotrasta. How are you? No, I haven't done any test to check how my liver is functioning. I don't know a single doctor who will

do it. They all wash their hands. Maybe a holistic doctor. Basically, I don't know what is wrong with me. I feel very tired all the time. I might have adrenal fatigue. I do blood work every 3 to 6 months.  I started reducing on November,27th,2017,the abilify. I had problems with it because the active ingredient(aripriprazol) isn't distributed evenly in the pill, and I was shaving and weighing every pill. So far I was able to reduce 5mgs of abilify out of 20mg. How many mls of water is used to do water titration?  I am doing it with 10mls. I remove 5ml of water and I toss away the other 5ml. I am keeping notes when I reduce. For example, 08/31/18, I drink 5ml,and I toss away 5ml of abilify. 

I take 1 pill of 10mg of abilify by mouth and I take 5mls of water with water titration. My legs hurt all the time. They get better at night. I was getting fasciculations on them now that I reached 15mg of abilify.

 

Right now I take this:

 

Abilify 15mg in the morning

Risperdal 2mg at bedtime

Klonopin 0,25mg at bedtime

Cymbalta 60mg in the morning

Biperiden 4mg in the morning

 

Thank you,

 

Manny

 

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Altostrata

Manny, what do you mean you don't know of any doctors who will order liver and kidney function tests? Are these included in your blood tests?

 

I don't know if you might have an illness along with too many drugs. You need to see a doctor for that.

 

Here is our topic about Tips for tapering off aripiprazole (Abilify)  it explains water titration.

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Manny78

Hi,altotrasta.I don't know if they check that on the blood test. I can show you though the blood test.My primary doctor refuses to give me a copy of the results.I should demand them or get a new primary doc.

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ChessieCat
8 hours ago, Manny78 said:

.I don't know if they check that on the blood test.

 

The easiest way to find out is to ring up the doctor and ask if it was included in the test.

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ChessieCat
On 9/25/2018 at 5:52 AM, Altostrata said:

Do your symptoms follow any daily pattern?  Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Please remember to do this and post them here in your Intro topic.

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Manny78

Hello everyone,is it possible to taper two antipsychotics at the same time,in my case abilify and risperdal? If yes,what percentage? I take 13,8mg of abilify in.the morning and 2mg of risperdal.at night.Thank you,

Manny

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ChessieCat

Tapering two drugs at the same time is generally NOT recommended.  If you start to experience difficulties you will not know what is causing them.  You might then updose both drugs because of this.  Then you would need to hold to stabilise.  It may end up taking longer than if you tapered one drug at a time.  One option is to taper one drug down for a while, do a hold to ensure that you are stable and then taper the other drug down for a while and do a hold.

 

taper-more-than-one-drug-at-a-time

Alto:  "Try this only if you know your withdrawal symptom pattern and know how to control your taper with various tapering techniques."

 

taking-multiple-psych-drugs-which-drug-to-taper-first

Alto:  "If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug)."

 

Edited by ChessieCat

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Manny78

Hello guys. I went to my psychiatrist today because,my primary doctor won t prescribe me without seeing the psychiatrist.I didnt say anything to him. He said that I need to take this crap because I have a so called  chronic disease. It makes me really mad. I am.tapering abilify on my own with the liquid tritation method, but it seems that I cant get any further.I am stuck at 13,8 mg of abilify.,How do you deal with past experiences,emotions etc? I Know my psychiatrist is lying and I will probe him wrong. I will probe it to myself I can do this.He prescribed me pills for 9 months.

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Altostrata

Why are you stuck at 13.8mg Abilify, Manny?

 

Looks like you can get all the Abilify you want, at least.

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Manny78
17 hours ago, Altostrata said:

Why are you stuck at 13.8mg Abilify, Manny?

 

Looks like you can get all the Abilify you want, at least.

Hi,altostrata. I am stuck because i have very bad withdrawal symptoms. I think  I have developed dystonia and akathisia. I started tapering off abilify at 20mg in November,2017  and all what I could remove is 6,4 mg. My hands fingers shake a lot and I have inner vibrations. I think I hit tolerance.

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Altostrata

Are you still taking all of these? When did the dystonia and akathisia start? What are the symptoms like?

 

How is your sleep?

 

On 9/25/2018 at 1:14 PM, Manny78 said:

Abilify 15mg in the morning

Risperdal 2mg at bedtime

Klonopin 0,25mg at bedtime

Cymbalta 60mg in the morning

Biperiden 4mg in the morning

 

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Manny78
18 hours ago, Altostrata said:

Are you still taking all of these? When did the dystonia and akathisia start? What are the symptoms like?

 

How is your sleep?

 

 

Yes,I am taking all of that. It started when  when I started to taper abilify. I have contortion movement in my back. Also,akathisia, I need to pace around.My back back is flame as well my legs. My

sleep is broken. I wake up at 3 am, but I fall sleep again.

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Altostrata

Manny, your doctor is a bad doctor. You are taking too many drugs in a bad combination.

 

You need to find a doctor who will see that you are taking too many drugs. To be honest, I think that drug combination is now causing major problems. It could be causing those symptoms. They could be so serious, you may have to go off some of those drugs rather quickly. You may suffer withdrawal symptoms when you do this.

 

When was the last time you reduced Risperdal? What happened then?

 

What times of day do you take each drug, and their dosages?

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Manny78

When you say quickly,what do you mean? at what percentage? 

I can't find a doctor who takes me out off these drugs. They are all the same sadly.

Can I stop tapering off abilify and start to taper risperidone 2mg or klonopin 0,25mg? Can I jump from 13,6mg of abilify to 10mg?

 

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Altostrata

What do the doctors say when they look at all your drugs?

 

Why are you taking biperiden? What effect does it have on you?

 

The Risperdal and Abilify are the most dangerous. I am worried about your reaction to changing Abilify. If I were you, Klonopin would be the last drug to taper.

 

Here are your drug interactions: https://www.drugs.com/interactions-check.php?drug_list=2019-1305,949-2273,233-109,703-357,384-0&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication&professional=1

 

Quote

 

risperiDONE ARIPiprazole

Applies to: Risperdal (risperidone), Abilify (aripiprazole)

MONITOR: Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation. Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures. Central nervous system-depressant effects may also be additively or synergistically increased when these agents are combined, especially in elderly or debilitated patients. Use of neuroleptics in combination with other neuroleptics or anticholinergic agents may increase the risk of tardive dyskinesia. In addition, some neuroleptics and tricyclic antidepressants may cause prolongation of the QT interval and theoretically, concurrent use of two or more drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death.

 

 

I am concerned that you have developed a movement disorder from risperidone, aripiprazole, or the combination of the two drugs.

 

Biperiden, an anticholinergic, might be adding to this. From WHO Model Formulary 2008:

 

Quote

 

Biperiden

Injection: 5 mg (lactate) in 1-ml ampoule. Tablet: 2 mg (hydrochloride).

Uses: drug-induced extrapyramidal symptoms (but not tardive dyskinesias) and adjunctive treatment of parkinsonism.

 

 

 

 

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