Manny78: multiple psychotropic drugs - which one first?

[Manny78]

8 hours ago, Altostrata said:

I would stop tapering, Manny. At what dose did akathisia start?

I remember seeing my new gp in January 17,2020 and complaining about EPS like AKATHISIA.At that time from my signature I was at 1,75ml of risperidone,and I had akathisia. Now in June 4,2020, I am at the dose of 1,30ml of risperidone and I still have akathisia. 

 

Manny

[Altostrata]

Is this symptom better or worse after you take risperdone every day?

[Manny78]

I don't know. 

[Altostrata]

Manny, can you observe what happens after you take risperidone every day?

 

In January, you were taking 1.75mg risperidone. Did the akathisia start after you reduced to 1.70mg, or was it there before you reduced?

[Manny78]

Hi,Altostrata. I had akathisia before. It was  there before I reduced. I was on risperidona 2mg. I made an attempt to decrease to 1,5mg in December,8th, 2019, because I was suggested by a psychiatrist go from 2mg to 1,5mg and hold on there for 8 weeks. I had to up my dose to 1,75mg because I was doing bad.I had akathisia too when I tapered Abilify (INNER AKATHISIA, inner tremors). I want to attach a photo but the system doesn't let me. 

[Manny78]

I had akathisia before going to the doc in January,18th, 2020. It seems to me akathisia is a little very when I take the risperdal when I sleep. I take risperdal 1,30ml at night. Sxs now are  cognitive disfunction,severe back and legs pain to the point it is hard to go out because I have back blocked because of spasms. 

 

Manny

[Altostrata]

I don't know what's going on, Manny. You've been on and off risperidone and Abilify many times, is that right?

[Manny78]

7 hours ago, Altostrata said:

I don't know what's going on, Manny. You've been on and off risperidone and Abilify many times, is that right?

No, I haven't. I have tapered every time. I  never cold turkeyed any drug. I only upped the dose a few times because of bad reaction to withdrawal. I tapered abilify. It took me two years to reduce 10 mgs of it. Was on 20 mg,now I am on 10mg of abilify. 

Manny

[Altostrata]

It may be an adverse effect of the risperidone. You're still taking biperiden, correct? Do you remember this?

 

On 3/8/2019 at 1:54 PM, Altostrata said:

....

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

 

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:

 

 

Have you discussed the adverse effect with your doctor? Are you still taking Cymbalta?

[Manny78]

1 hour ago, Altostrata said:

It may be an adverse effect of the risperidone. You're still taking biperiden, correct? Do you remember this?

 

Hi,Alto.Yes I remember the drug interaction checker. I know that abilify and risperdal compete for the same enzime. 

Have you discussed the adverse effect with your doctor? I have not discussed with my now doc,only to start tapering risperidona which causes akathisia. I also have Priapism. Are you still taking CYMBALTA? 

Yes I am taking Cymbalta 60 mg. Now, I understand why my bilirubin is high,but I cannot taper all drugs at once. 

Current drugs taking now are abilify 10mg,risperdal 1,30ml,cymbalta 60mg klonopin 0,25mg and biperiden 4mg extended release. HOW DO I TAPER BIPERIDEN? 

What should be my big concern now? Risperdal? Cymbalta? Biperiden? I am having muscle spasms and legs and back pain. 

 

[Manny78]

Why can't I find a decent psychiatrist who understands psychiatric drugs withdrawal? Noone knows about the 10 percent rule of tapering.I spoke with one this morning. As far as I know the biperiden needs to be tapered slowly too. I use the extended release one.

[Altostrata]

Very few know anything about tapering. The best you can expect is finding a doctor who will cooperate with writing the proper descriptions.

 

What did this doctor say about your reducing one or more of your drugs?

 

 

[Manny78]

Hi Altro,when I spoke about my mom's back pain,tremors and cognitive disfunction and that her psychiatrist dropped her Zyprexa 15mg to 7,5mg,which is a 50 percent reduction, she said that she would probably taper her (15mg,10mg,5mg). I mentioned her that I need to taper 10% per month or even less(5%)and that I have akathisia,she said that as I my aka would be better as I taper down risperdal.She said she prefers to give abilify,and reduce and hold on for 3 weeks. When I spoke about the biperiden extended release 4mg, she said to hold on and taper risperdal first,stop 4mg pill and start with biperiden 2mg,and take out 1/4mg each time. 

[Manny78]

 Hi, I spoke with my doctor and he prescribed me omeoprazol for gastritis and itchy Throat. Anyone took it? I am afraid to take more medicines. 

[ChessieCat]

I suggest you use a search engine and search for:  site: survivingantidepressants.org omeprazole

 

Note the correct spelling.

omeoprazol  omeprazole

[Manny78]

Thank you ChessieCat. 

[Manny78]

Hello everyone. Is anyone having lots of pain in their legs? I have aka and biceps and butt muscle pain. It hurts a lot. I am at 0,875ml of risperidone. 

Manny

[ChessieCat]

On 8/19/2020 at 12:24 AM, Manny78 said:

 Hi, I spoke with my doctor and he prescribed me omeoprazol for gastritis and itchy Throat. Anyone took it? I am afraid to take more medicines. 

 

 

6 hours ago, Manny78 said:

Is anyone having lots of pain in their legs? I have aka and biceps and butt muscle pain. It hurts a lot.

 

Q:  Did you start taking the Omeprazole?

 

If you did, check out the side effects.

 

From:  https://www.drugs.com/sfx/omeprazole-side-effects.html

Side effects requiring immediate medical attention

Along with its needed effects, omeprazole may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

 

Check with your doctor immediately if any of the following side effects occur while taking omeprazole:

Rare

• Back, leg, or stomach pain
• bleeding or crusting sores on the lips
• blisters
• bloody or cloudy urine
• chills
• continuing ulcers or sores in the mouth
• difficult, burning, or painful urination
• fever
• frequent urge to urinate
• general feeling of discomfort or illness
• itching, skin rash
• joint pain
• loss of appetite
• muscle aches or cramps
• pain
• red or irritated eyes
• redness, tenderness, itching, burning, or peeling of the skin
• sore throat
• sores, ulcers, or white spots on the lips, in the mouth, or on the genitals
• unusual bleeding or bruising
• unusual tiredness or weakness

 

 

[Manny78]

Hi ChessieCat.Thank you for the reply. No I haven't started Omeprazole.In fact, the only thing I have done is to taper risperidone further. I had pain in my legs but not crazy. I think it is that my brain needs more amounts of risperidone to have the therapeutic effect. If I walk, my pain is worse. I tapered from 1ml to 0,875mg roughly. I use the liquid solution and  I measure with a syringe. 

 

[ChessieCat]

16 minutes ago, Manny78 said:

No I haven't started Omeprazole.

 

Well maybe it was a bad reaction by osmosis?!?!  These drugs are strong.  Sorry being facetious, not to you, but big pharma.

 

Just in case you don't understand my joke.  When I used the word osmosis = passive absorption.  Okay, bad joke out of the way. 

_________________________________________________

 

I'll be serious now.  So at least you know that there is no way that it was the Omeprazole.

 

And if the only recent change was the dose reduction.  However you have made a larger than 10% reduction.  A 12.5% decrease.  10% reduction from 1mg is 0.9mg.  It's only been 1 week.  You could try an updose to 0.9mg.

• Are you having difficulties getting smaller doses? 
• What sized syringe are you using? 
• Are you using prescription liquid or making your own?

 

If making your own you can dilute with more water so you measure out more liquid.

 

These are the ingredients for Risperdal liquid.  It contains water so it is okay to dilute the prescription liquid.

 

From:  https://www.drugs.com/uk/risperdal-1mg-ml-liquid-leaflet.html

 

Quote

What Risperdal® Liquid contains
Each millilitre (ml) of liquid contains 1mg of the active ingredient risperidone.
Also contains tartaric acid, benzoic acid, sodium hydroxide and purified
water.

 

[ChessieCat]

risperidone 1ml 7/21/20,Risperidone 0,96ml 8/16/20,Risperidone 0,875ml 8/18/20

 

I've just noticed this in your drug signature.  Is it accurate?

 

You stated:

 

31 minutes ago, Manny78 said:

I tapered from 1ml to 0,875mg roughly

 

[Manny78]

21 hours ago, ChessieCat said:

risperidone 1ml 7/21/20,Risperidone 0,96ml 8/16/20,Risperidone 0,875ml 8/18/20

 

I've just noticed this in your drug signature.  Is it accurate?

 

 

Yes,It is correct.

 

Edited August 27, 2020 by ChessieCat
extracted response from quote box

[Manny78]

21 hours ago, ChessieCat said:

risperidone 1ml 7/21/20,Risperidone 0,96ml 8/16/20,Risperidone 0,875ml 8/18/20

 

I've just noticed this in your drug signature.  Is it accurate?

 

You stated:  (see added quote below for context - quoted quotes don't quote)

 

 

21 hours ago, Manny78 said:

I tapered from 1ml to 0,875mg roughly.

 

Yes I say roughly 0,875ml because I am in the middle of between 1ml and 0,75ml.I am not good in math but the syringe measures go like this 1ml,0,75ml, 0,5ml,0,25ml and 0 ml. THIS IS WITH THE SYRINGE THAT COMES WITH THE PRESCRIPTION RISPERIDONE 1ML LIQUID. 

 

Edited August 27, 2020 by ChessieCat
extracted response from quote box and added unquoted quote for context

[ChessieCat]

I suggest that you start diluting your prescription liquid so that you can measure your dose more accurately.  Doing this will also mean that you can make smaller reductions instead of being limited by the marks on the 1mL (?) syringe that comes with the risperidone.

 

7 hours ago, Manny78 said:

I am not good in math

 

It would be a good idea to buy a graduated cylinder so you can accurately measure the water.  You will need to do everything the same way each time, even the place on the bench or table where you put the cylinder to measure because there can be differences in how level a surface is.  I will have a look and see if I can find an example of what you need.

 

If you add1mL risperidone liquid to 9mL water you will have 10mL of liquid.  Each 1mL of liquid will = 0.1mg risperidone dose.

 

At full strength each 1mL risperidone = 1mg dose

 

1:1     ratio

 

By diluting 1mL risperidone liquid with 9mL water (total liquid is now 10mL = 1mg risperidone dose)

 

1:10    ratio

 

So instead of taking 0.875mL of undiluted risperidone liquid you would multiply that by 10 and take 8.75mL of the diluted 1:10 ratio liquid.

 

If you decide to updose and start taking 0.9mg dose you would measure 9mL of the diluted liquid.

 

OR

 

You could dilute 1mL of risperidone dose with 99mL water (total liquid is now 100mL = 1mg risperidone dose)

 

1:100   ratio

 

So instead of taking 0.875mL of undiluted risperidone liquid you would multiply that by 100 and take 87.5mL of the diluted 1:100 ratio liquid.

 

If you decide to updose and start taking 0.9mg dose you would measure 90mL of the diluted liquid.

Edited August 27, 2020 by ChessieCat

[ChessieCat]

If it was me I'd be trying to get clear plastic (I'd be concerned about me breaking a glass one).  Not the milky plastic like these because these would be harder to see the liquid (unless you added food colouring 🤣 )

 

Milky plastic example:

Plastic-Measuring-Cylinder-Laboratory-Test-Graduated

 

Clear plastic example:

10mL

uxcell-Laboratory-Measurements-Graduated-Measuring

100mL

uxcell-Laboratory-Measurements-Graduated-Measuring

[Manny78]

I am having a rough time tapering risperidone suffering mild akathisia. My question is should I keep tapering if my aka doesn't improve? Too much restlessness,need to be pacing all the time unless I am in bed, inner vibrations, restless legs and back pain,abdominal pain shaky hands and fingers. Walking makes my aka worse. I only have peace when I sleep. I need to taper 0,86ml of risperidone but I feel stuck. I haven't recovered from my last cut 1ml to 0,86ml.

[ChessieCat]

2 minutes ago, Manny78 said:

I need to taper 0,86ml of risperidone but I feel stuck. I haven't recovered from my last cut 1ml to 0,86ml.

 

Please update your drug signature to reflect the changes.  Thank you.

 

I'll ask the other mods for their assistance.

[ChessieCat]

3 minutes ago, Manny78 said:

I am having a rough time tapering risperidone suffering mild akathisia. My question is should I keep tapering if my aka doesn't improve? Too much restlessness,need to be pacing all the time unless I am in bed, inner vibrations, restless legs and back pain,abdominal pain shaky hands and fingers. Walking makes my aka worse. I only have peace when I sleep.

 

Has anything else changed?

 

Have you accidentally missed a dose?

 

Have you had any antibiotics?

 

Have you been drinking any alcohol?

 

Have you eaten any Chinese food or any other savoury foods contains MSG?  MSG is a neurotoxin?

 

Have you experienced any stressors recently?

 

How has covid situation affected you?  Financial, working differently, isolated etc.  We've had members since the beginning of this year posting about unexpected/worse waves which could possibly be related to the unusual circumstances caused by covid.

[ChessieCat]

And another one:

 

Have you been sick?

[Altostrata]

1 hour ago, Manny78 said:

I need to taper 0,86ml of risperidone but I feel stuck. I haven't recovered from my last cut 1ml to 0,86ml.

 

If I were you, I'd go back to 0.875mg and stablize. Do not keep reducing if you have withdrawal symptoms.

[Nocturna]

Hi Manny, sorry to hear you're having such issues Risperidone was really efficient for me, but also extremely hard to taper off, even after having it taken only for a couple of weeks (2 months in the first case) - I needed to switch it to Abilify and suddenly I started experiencing sleep issues. Fortunately those went away in a couple of days (also supported by Zopiclon, a sleep med when it was really bad). Regarding the akathisia, probably what the admins suggest is the safer approach. Good luck and indeed those times are harder for all of us!

[Manny78]

Has anything else changed?

 

No, I keep taking the same dose every day. The only change I did was using a different syringe. I think the syringes are the same. I don´t think I am taking less dose.

 

Have you accidentally missed a dose?

 

No, I haven´t. I take the same dose (0,86 ml of risperidone liquid) at ten o clock at night. Sometimes a little late (30 min late). I am chatting sometimes with my friends until twelve o clock.

 

Have you had any antibiotics?

 

No,I haven´t taken any antibiotics lately.

 

Have you been drinking any alcohol?

 

I drank one non alcoholic beer but I don´t do every day.

 

Have you eaten any Chinese food or any other savoury foods contains MSG? 

 

Sometimes I eat junk food (potato chips,cookies)

 

Have you experienced any stressors recently?

 

No, I have not.Only thing my mother having sleeping issues and taking lormetazepam to sleep.

 

How has covid situation affected you?  Financial, working differently, isolated etc.  We've had members since the beginning of this year posting about unexpected/worse waves which could possibly be related to the unusual circumstances caused by covid.

 

I don´t work because I can´t. I live with my parents but the goverment pays me a pension.I go out to walk to visit friends when I can. In Spain, we had been locked down in our house for a month and a half. That was very difficult for me. My family has a garden where I could go and walk.

 

Edited September 12, 2020 by ChessieCat
extracted response from quote box

[Manny78]

15 hours ago, Altostrata said:

 

If I were you, I'd go back to 0.875mg and stablize. Do not keep reducing if you have withdrawal symptoms.

Hi Altostrata, I can't stabilize. I have reached tolerance. I always have withdrawal sxs. Maybe I made a big cut,12,5 %. If I can't taper 5 or 10 percent per month something is wrong. It will take me another 10 years of my life tapering. I am used to tapering and the side effects but now I need to be in home because of the inner akathisia. 

[Manny78]

17 hours ago, ChessieCat said:

And another one:

 

Have you been sick?

No I have not. 

[Altostrata]

What times of day do you take each of your drugs, with their dosages?

 

Are you still taking Abilify, Cymbalta, Klonopin. Biperiden, omeprazole?

 

You already had akathisia and muscle pain in January 2019, correct?

 

 

 

 

[Manny78]

15 hours ago, Nocturna said:

Hi Manny, sorry to hear you're having such issues Risperidone was really efficient for me, but also extremely hard to taper off, even after having it taken only for a couple of weeks (2 months in the first case) - I needed to switch it to Abilify and suddenly I started experiencing sleep issues. Fortunately those went away in a couple of days (also supported by Zopiclon, a sleep med when it was really bad). Regarding the akathisia, probably what the admins suggest is the safer approach. Good luck and indeed those times are harder for all of us!

Hi Nocturna. I have been taking abilify since 2009. I was on different doses like 30 mgs. I don't remember very well.It is on my story the different doses I was. My last dose was abilify 20mg. I managed to taper it to 10mg.Thats the Dose I am right now. It took me 2 years to come off. How did you taper it? I mean the abilify? I experienced aka while tapering abilify 20mg.i couldnt finish my taper. I just stopped at 10mgs because I was so bad. I had inner vibrations like I do now with the risperidone.