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Manny78: multiple psychotropic drugs - which one first?

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Manny78
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8 hours ago, Altostrata said:

What do the doctors say when they look at all your drugs? I just don't know. My primary doctor when  I was put on the psychotropic drugs said that I probably I would need to take them for the rest of my life. When I asked my psychiatrist about the tremors, he said that it could be the risperdal and the biperiden,but I was taking much less compared to the 30mg of abilify and 9 mg of risperdal I used to take. 

 

Why are you taking biperiden? What effect does it have on you? I take the biperiden for the extrapiramidal effects of the antipsychotics drugs but basically it doesn't work because I have the movement disorders.

 

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.

Which drug would you advice me to taper first? Do I continue with the abilify? I am using the 10 mg abilify disintegrating tablets.what I do is to mix one tablet with 10ml of water and I pull out 0,2ml every time I decrease.

 

Edited by ChessieCat
coloured responses and removed unnecessary quote

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Altostrata
14 hours ago, Manny78 said:

When I asked my psychiatrist about the tremors, he said that it could be the risperdal and the biperiden

 

Is this doctor aware of the other 3 drugs you're taking? All of them need to be considered.

 

manny, my feeling is you need to make a big change in your drugs -- you need to go off Abilify or Risperdal altogether, and probably cut Cymbalta in half --  but I'm concerned that if you do that, you would get very sick. This is a change that's best done in the hospital.

 

Can you find another psychiatrist who will help you minimize your drugs?

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Manny78
18 hours ago, Altostrata said:

 

Is this doctor aware of the other 3 drugs you're taking? All of them need to be considered.

 

manny, my feeling is you need to make a big change in your drugs -- you need to go off Abilify or Risperdal altogether, and probably cut Cymbalta in half --  but I'm concerned that if you do that, you would get very sick. This is a change that's best done in the hospital.

 

Can you find another psychiatrist who will help you minimize your drugs?

Hi altostrata.Yes,my doctor knows that I am taking  five medications,but he won't  do anything to change it.When I did blood work,he said my transaminases were high and the meds I take could be a factor.He never said I need to come off.They're playing with my health both my primary doctor and my psychiatrist.They don't give  a damn. I can't go to a detox center or hospital because there is none. It is too expensive and they would get you out too fast.Maybe I can get a second opinion,but knowing all what I know I am afraid of.all doctors are the same. 

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Altostrata

I'm sorry , Manny. You are taking a dangerous and probably unnecessary combination of drugs.

 

High transaminases indicate possible liver damage. Your other symptoms may also be serious side effects of the drugs. A responsible doctor would put you in the hospital and have you at least quickly discontinue Abilify or Risperdal and possibly reduce Cymbalta. Being in the hospital is important in case you have severe withdrawal reactions.

 

While I believe that minimizing your drug burden as soon as possible is important, I cannot tell you to quickly stop taking your drugs on your own. It is dangerous.

 

I'm not sure how the health system works in your country. You might have to appeal to your primary care doctor's and psychiatrist's supervisors and demand to be assigned to someone else as the drug combination is causing liver damage and possibly a movement disorder. You need to find medical help right away. Can you go directly to the hospital and ask to  be admitted?

 

 

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Manny78

Hi,altostrata. If I get admitted in a hospital,it wouldn't be to get off of drugs. They sent you there to take more drugs.basically,they get you off of drugs in three weeks.they play with you. It happened to me when I came from the USA.I was on cold turkey from valium, and they put me to geodon and klonopin. I starting having tremors because I had never been in an antipsychotic. I can try a private psychiatrist to see if he can help me.

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Manny78

Anyone knows how to taper biperiden? I was told to stop taking it and to reduce my abilify or risperidone. Thank you. Manny

 

Please dont delete my post or ban me. I was asked by the administrator,altotrasta, to go to the hospital for help with my psychotropic drugs. I tapered abilify to the point of 10 mgs. I developed  inner tremors.I stopped tapering abilify in may 2019.

 

As today I take the following meds:

Abilify 10mg,risperidone 2mgs,cymbalta 60mgs,klonopin 0,25mg and biperiden 4mg.

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Altostrata
1 hour ago, Manny78 said:

Anyone knows how to taper biperiden?

 

It's the usual 10% per month, Manny.

 

If you're showing signs of liver damage and movement disorder, YOU MUST GET MEDICAL HELP. Why can't you discuss this with a doctor?

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Manny78

This is the advice I was given by other doctor:

´I have to admitt that it seems to me you are on too many drugs and that those tremors could be a neurological side effect of one or more of your medications (achatisia, tardive dyskinesia, parkinsonism or chronic dystonia).

It seems there is not evidence to support the prescription of two antipsychotics (altough this is common practice), and in the case that this were a temporary option, I don`t consider the combination of ariprazole+risperidone the best option. May be if you could stop one of them this would help with the tremors. On the other hand, I tend to use akineton (biperideno) just for acute dystonias, not as a long term treatmente, because the cognitive disfunction it can cause among other anticholinergic side effects.

Another point would be to check accurately any pharmacological interactions with other drugs of common use, like statins for reducing cholesterol or omeprazol for gastric protection. Another very easy option to try to minimize metabolic interactions, would be to shift rivotril (clonazepam) to lorazepam, that does not interfere with the liver metabolism. Finally, I don`t know why you are taking duloxetine, but like any other antidepressant, it should not be prescribed for long periods, and it has an important risk to produce withdrawal symptoms. Another posibility would be to have a pharmacogenetic test done (Amplichip or others ) to know if you have a metabolic deficiency that makes the medication less effetive or gives you serious side effects.
I have checked the metabolic interactions of your treatment and it seems a priory that the metabolic liver path 2D6 is saturated, which means that some drugs are interacting with others and this could affect the efficacy of your treatment.
I am sorry for all this technical talking, but in summary my advice would be: try just one antipsychotic (if still necessary), stop Akineton (biperiden), try to discontinue antidepressants if you are not feeling depressed and shift clonazepam (rivotril) to lorazepam.
Of course this is only a theoretical hypotesis and you have to keep in mind the serious risk of relaps or withdrawal symptoms, so, again, please, get in contact with your psychiatrist to discuss all these issues.¨

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Manny78

Hello everyone. I am asking for advice for my mom. My mom is taking lithium 400 mg(1 and ¼,0,1 and 1, ¼),Anafranil 75mg (0,0,1),Lamotrigine 25mg (1,0,1) and zyprexa 15mg (0,0,1). She just stopped taking her meds for 1 or 2 weeks (early june), and she is having severe back pain now.

Before this my mom (march 6,2019) was taking lithium (1 and ¼ twice a day),anafranil 75 mg (0,0,1),lamotrigine 100 mg (0,0,1) and zyprexa 5mg (0,0,1).

 

She was taking to the hospital on June 19,2019, where she was discharged with the diagnosis of severe depressed disorder with psychotic symptoms and treatment of lamotrigine 25mg (1,0,0),lithium 400 mg (1,0,0 for two days)at the 3rd day (1,0,1 ½), anafranil 75 mg (0,0,1) and zyprexa 5 mg (1,1,1).

 

Later her psychiatrist (june 27th,2019), made these changes, lithium 400 ( 1 and ¼ twice a day),Anafranil 75mg (0,0,1),Lamotrigine 25mg (1,0,1) and zyprexa 15mg (0,0,1).

 

She went to her gp yesterday, and he give her ketoprofen 25 mg which is not supposed to be taken in conjunction with the lithium. She did a cold turkey and she was reinstated not even to the same dose she was before.Any suggestions on what she can do? I am afraid she will have to wait many months to get a little better. She has artrosis on her back too.

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Altostrata
On 9/11/2019 at 4:49 AM, Manny78 said:

This is the advice I was given by other doctor:

´I have to admitt that it seems to me you are on too many drugs and that those tremors could be a neurological side effect of one or more of your medications (achatisia, tardive dyskinesia, parkinsonism or chronic dystonia).

It seems there is not evidence to support the prescription of two antipsychotics (altough this is common practice), and in the case that this were a temporary option, I don`t consider the combination of ariprazole+risperidone the best option. May be if you could stop one of them this would help with the tremors. On the other hand, I tend to use akineton (biperideno) just for acute dystonias, not as a long term treatmente, because the cognitive disfunction it can cause among other anticholinergic side effects.

Another point would be to check accurately any pharmacological interactions with other drugs of common use, like statins for reducing cholesterol or omeprazol for gastric protection. Another very easy option to try to minimize metabolic interactions, would be to shift rivotril (clonazepam) to lorazepam, that does not interfere with the liver metabolism. Finally, I don`t know why you are taking duloxetine, but like any other antidepressant, it should not be prescribed for long periods, and it has an important risk to produce withdrawal symptoms. Another posibility would be to have a pharmacogenetic test done (Amplichip or others ) to know if you have a metabolic deficiency that makes the medication less effetive or gives you serious side effects.
I have checked the metabolic interactions of your treatment and it seems a priory that the metabolic liver path 2D6 is saturated, which means that some drugs are interacting with others and this could affect the efficacy of your treatment.
I am sorry for all this technical talking, but in summary my advice would be: try just one antipsychotic (if still necessary), stop Akineton (biperiden), try to discontinue antidepressants if you are not feeling depressed and shift clonazepam (rivotril) to lorazepam.
Of course this is only a theoretical hypotesis and you have to keep in mind the serious risk of relaps or withdrawal symptoms, so, again, please, get in contact with your psychiatrist to discuss all these issues.¨

 

Did this doctor offer assistance in tapering? If so, you should confer with him. You need to take charge of minimizing your drugs, Manny. We can only give suggestions, we can't do the tapering for you.

 

Please re-read this topic for our prior comments.

 

On 9/17/2019 at 10:58 AM, Manny78 said:

Hello everyone. I am asking for advice for my mom. My mom is taking lithium 400 mg(1 and ¼,0,1 and 1, ¼),Anafranil 75mg (0,0,1),Lamotrigine 25mg (1,0,1) and zyprexa 15mg (0,0,1). She just stopped taking her meds for 1 or 2 weeks (early june), and she is having severe back pain now.

Before this my mom (march 6,2019) was taking lithium (1 and ¼ twice a day),anafranil 75 mg (0,0,1),lamotrigine 100 mg (0,0,1) and zyprexa 5mg (0,0,1).

 

She was taking to the hospital on June 19,2019, where she was discharged with the diagnosis of severe depressed disorder with psychotic symptoms and treatment of lamotrigine 25mg (1,0,0),lithium 400 mg (1,0,0 for two days)at the 3rd day (1,0,1 ½), anafranil 75 mg (0,0,1) and zyprexa 5 mg (1,1,1).

 

Later her psychiatrist (june 27th,2019), made these changes, lithium 400 ( 1 and ¼ twice a day),Anafranil 75mg (0,0,1),Lamotrigine 25mg (1,0,1) and zyprexa 15mg (0,0,1).

 

She went to her gp yesterday, and he give her ketoprofen 25 mg which is not supposed to be taken in conjunction with the lithium. She did a cold turkey and she was reinstated not even to the same dose she was before.Any suggestions on what she can do? I am afraid she will have to wait many months to get a little better. She has artrosis on her back too.

 

Manny, your mother is also on a complicated mix of drugs. It's very difficult for us to counsel people who aren't able to post for themselves, reporting symptom pattern and so forth.

 

I would have your mother see the same doctor you saw who identified the polypharmacy, and ask him for assistance in minimizing your mother's drugs.

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Manny78

Hi,altotrasta. I  spoke with this psychiatrist on a post he made in mad in America: psychiatric drug withdrawal in Spain. The only problem I have is that he is in zamora (Castilla y León). I am in other region,A Coruña (Galicia).He said he would try to find a colleague in Galicia that would help me out with my taper. I will discuss my mother case with him.

 

I will let you know how this turns out.Until now,I have the other psychiatrist who I am trying to change him.

 

 MANNY

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Manny78

Anyone here taking biperiden 4mg? My psychiatrist wants me to start tapering it on alternative days. One day, I take 1 pill,the second day I take half pill and keep doing that for 6 to 8 weeks.what do you guys think? In addition, I take abilify 10mg,risperidone 2mg,cymbalta 60mg and klonopin 0,25mg. I was tapering abilify  but I stopped it, possibly to resume it again. I had very bad inner vibrations and I haven't tapered since may,2019.

Thank you,

Manny

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Gridley
26 minutes ago, Manny78 said:

My psychiatrist wants me to start tapering it on alternative days. One day, I take 1 pill,the second day I take half pill and keep doing that for 6 to 8 weeks.what do you guys think?

 

We don't recommend tapering by alternating doses.  It causes the amount of the medication in your bloodstream to go up and down, battering your nervous system, and makes withdrawal worse.

Your brain likes stability, to be treated gently.  It is ideal if you can accommodate it to lower and lower dosages. Move it slowly down a ramp by gradually decreasing dosage by an amount it may hardly notice. SA recommends tapering by 10% of your current dose with a hold of at least 4 weeks before your next decrease.
 


 

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Manny78

In what order would you taper my medication? 1)Antipsychotics, 2)antidepressant,3)benzo,4)biperiden.

How do I taper biperiden 4 mg extended release? Can I cut the pills in tiny pieces?

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Manny78

A psychiatrist that I know wants me to start reducing risperdal at 0,5mg every 6-8 weeks.I am at 2mg,so it would be,2mg,1,5mg,1mg,0,5mg,and 0mg.Is this too much?Can I get liquid risperdal?

 

Thank you,

 

Manny

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Manny78

I made a cut of risperidone from 2 mg to 1,75mg. Is this a large cut? I use Risperidone 1 mg pills.I cut with a knife 0,25mg.

Thank you, 

 

Manny

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brassmonkey

That would be 13%.  The recommended 10% would be 1.8mg.

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Manny78

Thank you, brassmonkey. 

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Altostrata

Manny, it sounds like you've gotten some help. Please let us know how you're doing.

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Manny78

Hello Altostrata. This doctor wants to help me out,but I don't agree with his tapering plan. He wants me to taper risperdal going from 2Mg to 1,5mg and hold on for 6 to 8 weeks in that dose.  I am tapering at 13% for 2 months. I don't like math.

 

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Manny78

I have trouble focusing. I can't concentrate. This doctor is going to ask a colleague to help me with the taper plan. I don't know him only what I read in the web.

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Altostrata

How are you feeling after your reduction to 1.75mg risperidone?

 

You need to see how this reduction works for you. If 13% is too much, you'll have to reduce by smaller amounts. You can talk about this with the doctor -- but you need to see the effect of this reduction first.

 

Somebody will have to do math to calculate your reductions if you want to do it gradually.

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Manny78

Hello Altostrata, I keep waking up in the evening,legs muscle pain,tiredeness, trouble focusing, legs restleness. 

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Manny78

Does risperdal causes sleeping problems when you are tapering off? I can't sleep. Does the weight gain stop while you tapering or when you are off? I weigh 98 kilos, and I have a big fatty belly.I am starting to eat healthy. 

Thank you, 

 

Manny 

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Manny78

Anyone knows about Aneurol? It contains Valium and vitamins. 

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Manny78

Hello everyone, I am speaking with this psychiatrist about  the extrapiramidal symptoms I have. From what I have spoken with him and the descriptions he gave me, I might have tardive dystonia and akathisia. He suggests increasing the biperiden and clonazepam for the tardive distonia. I won't up me dose of klonopin 0,25mg neither biperiden 4mg because I would have to taper them and  I don't want to cause more damage to my poor brain. He suggest seeing a neurologist to rule out what I have. Possible treatment is baclofeno, vitamin B like pirodoxina 600 to 1200mg/day, or botulinic toxin.

 

Manny 

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Altostrata

Are you now taking 1.75mg risperidone? How are you feeling from the last dosage reduction?

 

Odd that the psychiatrist focused on adding other drugs, most likely the extrapyramidal symptoms come from risperidone. What did he say about reducing risperidone?

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Manny78

Hello Altostrata.Yes,I am at the same dose which is 1,75 mg.I started on October, 18th,and I haven t made any further reduction. At the beginning I didnt feel that bad, just legs pain,mucle pain, but now this week and past week, legs in flames, akathisia, i cant keep my legs without moving them in bed, need to pace,and movement in my torso(tardive dystonia). 

Speaking about risperidone, he said that the offending drug should be reduced if possible. In addition, he mentions to reduce risperidona, abilify and klonopin in an oral solution to reduce very slowly. His advice is for the moment to increase klonopin oral solution for a few weeks (10,10,10). This part of numbers I don't understand. I am at klonopin 0,25mg at night in tablets. I use klonopin 0,5mg and I break it in half. 

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Manny78

I made a mistake in the last post.When  I said oral solution I wanted to say liquid drops.

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Manny78

Hello everyone. I CANNOT find a psychiatrist to help me out with my taper. The one that I found it is too far away from where I live,and he cannot find a psychiatrist close to  me that would help with me. I will have to go to a private psychiatrist not knowing if he will help or not.Most of them,they don t.The problem I have is the label they put on me,that I am schizophrenic and I am not.

I don t have more risperidone 1mg pills. I only have  6,4, and 3 mg pills in that order,and I am taking 1,75 mg of risperidone. My idea is to use the 4mg pills and to cut them in 4 pieces to obtain 1mg trying to get as even as possible.Then, cut the 3 mgs pills in 4 pieces to get 0,75mg.My question is it possible to break the pills and obtain the dose you are on, in my case risperidone 1,75 mg,because the pills also contain  fillers?

RISPERIDONA CINFA 3 mg COMPRIMIDOS EFG  https://cima.aemps.es/cima/dochtml/p/66930/Prospecto_66930.html#6-contenido-del-envase-e-informaci-n-adicional

PROSPECTO RISPERIDONA MYLAN PHARMACEUTICALS 4 MG COMPRIMIDOS RECUBIERTOS CON PELICULA EFG https://cima.aemps.es/cima/dochtml/p/71476/Prospecto_71476.html#6-contenido-del-envase-e-informaci-n-adicional

 

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