Manny78: multiple psychotropic drugs - which one first?

[Manny78]

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

 

I take abilify 10mg,cymbalta 60mg,and biperiden 4mg extended release form in the morning.

 

I take risperidone 0,86ml,and klonopin 0,25mg at night usually at 22:00 hours. 

 

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

 

Yes I am

 

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

 

Yes I had. 

 

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

[Nocturna]

7 hours ago, Manny78 said:

How did you taper it? I mean the abilify?

First, I should point out that I was on 15 mg for very small amount of time. Most of the time I was on doses between 2 and 5 mg, which my pdoc considers "a baby dose". I can assure you though that it's still absolutely efficient, as it prevented me from getting a psychotic relapse (when I attempted twice to completely stop it, I got relapses).

So I'm currently tapering down the 5 mg and I reached 3 mg just this week. I'm using the liquid solution, reducing by 10% of the initial dose each month. Sometimes I get more unrest, I have vivid dreams and some mild anxiety, then I keep the dose for 1-2 weeks more, until those go away. I can definitely feel the dose going down, and I like the extra energy, but I have to be careful.

 

Also, I was lucky to not get any physical symptoms besides mild tremors here and there. But I'm trying to be consistent with practicing yoga at home (the famous "pyjama yoga"  ), swimming and even doing short jogs. That's extremely important I think. Do you do any physical activity besides walks?

[Manny78]

On 9/13/2020 at 6:50 AM, Nocturna said:

First, I should point out that I was on 15 mg for very small amount of time. Most of the time I was on doses between 2 and 5 mg, which my pdoc considers "a baby dose". I can assure you though that it's still absolutely efficient, as it prevented me from getting a psychotic relapse (when I attempted twice to completely stop it, I got relapses).

So I'm currently tapering down the 5 mg and I reached 3 mg just this week. I'm using the liquid solution, reducing by 10% of the initial dose each month. Sometimes I get more unrest, I have vivid dreams and some mild anxiety, then I keep the dose for 1-2 weeks more, until those go away. I can definitely feel the dose going down, and I like the extra energy, but I have to be careful.

 

Also, I was lucky to not get any physical symptoms besides mild tremors here and there. But I'm trying to be consistent with practicing yoga at home (the famous "pyjama yoga"  ), swimming and even doing short jogs. That's extremely important I think. Do you do any physical activity besides walks?

Hi Nocturna. Thanks for the reply. No, I don't do other kind of activity besides walking. In the summer I went to the beach and swam a little bit. I am not familiar with yoga. I have not tried it. What do you mean with psychotic relapse? Do you hear voices? I don't want to take psychiatric drugs. In Dr. Breggin's book it speaks about tardive psychosis caused by APs. Never heard voices until they gave me antipsychotics. I had more OCD. ABILIFY 15MG is a high dose. Doctors believe it is so easy to taper these and it is not. Most people get akathisia since the moment they start taking psy drugs. They had to give me biperiden because I was shaking so much. Can you tell me what abilify liquid solution you take? I take risperidona cinfa 1mg/1ml solucion oral EFG,but I find it very hard to stabilize.I used to take 6mg of risperidone but I was able to lower it down to 1,5mg, but the lower I get the more difficult it is for me. 

[Nocturna]

4 hours ago, Manny78 said:

What do you mean with psychotic relapse? Do you hear voices?

For me personally it was false beliefs, e.g. if someone wants to lie to me or send me to a hospital against my will (those were not motivated by any real experience). I had those before I started taking APs and I had them twice when I attempted to stop the meds.

The Abilify liquid solution is also 1 mg/ml. That makes precise dosing easier than cutting the pills.

6 mg Risperidone is also a high dose, I remember taking 1-2 mg for a couple of days was enough to get me out of the psychosis.

I know it can be very difficult, especially when you've been taking the meds for so long. I'm sure though there's a way out of being continuosly medicated, we have to be persistent.

[Manny78]

Does the akathisia get worse as I lower down the dose of my ANTIPSYCHOTICS? 

 

Should I increase the intake of my biperiden to help me to with akathisia? Can I reduce them at the same time? 

[Nocturna]

Re: akathisia - for me it gets better I think with the lower AP doses. Regarding biperiden (just learned that's the same as Akineton), I'd suggest you ask your doctor about the exact dose. At least for me with the lower AP doses I didn't need it at all. But I also had very mild akathisia, and I didn't enjoy its own side effects (like memory impairment).

[Manny78]

Thank you,Nocturna. 

[Manny78]

Can the biperiden 4mg extended release broken in half? 

[brassmonkey]

It is not a good idea to break the tablets. Even though they have a score line they are not designed to be broken. Breaking them changes then from extended release to instant release which is very different for this medication.

[Manny78]

Hola buenas noches. Alguien que tome risperidona y akineton retard 4mg.Estoy en reducción de la risperidona 0,86ml pero tengo acatisia.Debería subir el akineton retard o continuar reduciendo la risperidona? Siento que no puedo seguir reduciendo por tolerancia. Llevo un mes en la misma dosis 0,86ml de risperidona y no me estabilizó. 

Gracias

Manuel

 

Google translation:

 

Hello Goodnight. Someone taking risperidone and akineton retard 4mg. I am reducing risperidone 0.86ml but I have akathisia. Should I increase the akineton retard or continue to reduce risperidone? I feel like I can't keep reducing for tolerance. I have been on the same 0.86ml dose of risperidone for a month and it has not stabilized me.

Thank you

Manuel

 

Edited September 20, 2020 by ChessieCat
added Google translation

[Manny78]

3 hours ago, brassmonkey said:

It is not a good idea to break the tablets. Even though they have a score line they are not designed to be broken. Breaking them changes then from extended release to instant release which is very different for this medication.

How do I taper them biperiden? Do I take 2 pills of biperiden 2mg non extended release? 

[brassmonkey]

The other mods and myself need to talk about this.  This is a totally different medication than we are use to working with, so we need to come up with a new plan.

[Altostrata]

Manny, you had akathisia in January, before you started tapering the drugs, is that correct? How has the akathisia changed?

 

I believe we discussed this many times, any of the drugs you're taking can cause akathisia. You are taking too many drugs together, the combination of any 2 or 3 or 4 of your drugs can be causing your symptoms. If the akathisia is already there, we can't tell what drug to taper to reduce it.

 

On 9/12/2020 at 2:12 PM, Manny78 said:

I take abilify 10mg,cymbalta 60mg,and biperiden 4mg extended release form in the morning.

 

I take risperidone 0,86ml,and klonopin 0,25mg at night usually at 22:00 hours. 

 

Is the akathisia worse in the morning or at night? Is it worse before you take the combination of Abilify, Cymbalta, and biperiden in the morning, or after you take them?

 

Is it worse before you take the combination of risperidone and Klonopin at night, or afterwards?

[Manny78]

17 hours ago, Altostrata said:

Manny, you had akathisia in January, before you started tapering the drugs, is that correct? I had akathisia acatisia when I tapered abilify too. How has the akathisia changed?My akathisia gets worse as I taper risperidona,when I get to lower doses.People tell me this is impossible because I am reducing the intake of risperidone.

 

I believe we discussed this many times, any of the drugs you're taking can cause akathisia. You are taking too many drugs together, the combination of any 2 or 3 or 4 of your drugs can be causing your symptoms. If the akathisia is already there, we can't tell what drug to taper to reduce it.

 

 

Is the akathisia worse in the morning or at night? Akathisia es worse during the day. Is it worse before you take the combination of Abilify, Cymbalta, and biperiden in the morning, or after you take them? It is worse after I take them (abilify,cymbalta and biperiden).When I wake up my sxs start going crazy,restless legs,back pain, need to pace,shoulders,arms, neck pain,inner vibrations,ribs pain,abdominal pain and muscle jerks. 

 

Is it worse before you take the combination of risperidone and Klonopin at night, or afterwards? When I take the risperidone and klonopin and I get to sleep I don´t have pain.

 

[Altostrata]

Please answer my questions.

[Manny78]

  On 9/12/2020 at 11:12 PM, Manny78 said:

I take abilify 10mg,cymbalta 60mg,and biperiden 4mg extended release form in the morning.

 

I take risperidone 0,86ml,and klonopin 0,25mg at night usually at 22:00 hours.

  18 hours ago, Altostrata said:

Manny, you had akathisia in January, before you started tapering the drugs, is that correct? Yes I had. How has the akathisia changed?My akathisia gets worse as I keep tapering,but I managed to taper from 1,75mg to what I am right now,0,86ml,but I had to go up and down because I didnt have risperidone liquid solution and I didnt feel well so I updosed.

 

I believe we discussed this many times, any of the drugs you're taking can cause akathisia. You are taking too many drugs together, the combination of any 2 or 3 or 4 of your drugs can be causing your symptoms. If the akathisia is already there, we can't tell what drug to taper to reduce it.

 

When you say if the aka is already there, you mean that I won´t be able to keep tapering? I have to keep tapering my risperidone.Maybe 2 percent or 5 percent.

 

Is the akathisia worse in the morning or at night? Akathisia is worse in the afternoon and whole day if I do exercise like walking. Is it worse before you take the combination of Abilify, Cymbalta, and biperiden in the morning, or after you take them? After I take (abilify,cymbalta and biperiden).

 

 

Is it worse before you take the combination of risperidone and Klonopin at night, or afterwards? Before I take the risperidone and klonopin.

Edited September 21, 2020 by Altostrata
removed code

[Altostrata]

13 minutes ago, Manny78 said:

When you say if the aka is already there, you mean that I won´t be able to keep tapering? I have to keep tapering my risperidone.Maybe 2 percent or 5 percent.

 

No, if the akathisia was there before you started tapering the drugs, it's a drug or drugs causing the akathisia. We don't know which drug. The akathisia probably won't go away until you lower all the drugs substantially. The akathisia is not a withdrawal symptom, it's an adverse effect of one or more of your drugs.

 

15 minutes ago, Manny78 said:

Is it worse before you take the combination of Abilify, Cymbalta, and biperiden in the morning, or after you take them? After I take (abilify,cymbalta and biperiden).

 

Is it worse before you take the combination of risperidone and Klonopin at night, or afterwards? Before I take the risperidone and klonopin.

 

If the akathisia is worse AFTER you take Abilify, Cymbalta, and biperiden, one or more of those drugs is most likely causing it.

 

If the akathisia is less after you take risperidone and Klonopin, one or both of them is helping it (most likely Klonopin).

 

Have you tried tapering Abilify? When did you start taking Abilify, Cymbalta, Klonopin, biperiden, and risperidone? Please add those dates (month and year) to your signature.

[Manny78]

24 minutes ago, Altostrata said:

 

No, if the akathisia was there before you started tapering the drugs, it's a drug or drugs causing the akathisia. We don't know which drug. The akathisia probably won't go away until you lower all the drugs substantially. The akathisia is not a withdrawal symptom, it's an adverse effect of one or more of your drugs.

 

 

If the akathisia is worse AFTER you take Abilify, Cymbalta, and biperiden, one or more of those drugs is most likely causing it.

 

If the akathisia is less after you take risperidone and Klonopin, one or both of them is helping it (most likely Klonopin).

 

Have you tried tapering Abilify? When did you start taking Abilify, Cymbalta, Klonopin, biperiden, and risperidone? Please add those dates (month and year) to your signature.

 Thank you Altostrata. I don't have to many lines left to add to my signature. How can I create a nice long list of the drugs I tapered? As far as I know the signature can contain only 12 lines. 

 

Manny 

[ChessieCat]

16 minutes ago, Manny78 said:

How can I create a nice long list of the drugs I tapered? As far as I know the signature can contain only 12 lines. 

 

You post them in a regular post in your Intro topic and them after you have submitted it, copy the link (the share icon top right of the post) and add that to your signature so that it can be clicked on and your list can be easily accessed.

 

Replace this:

 

Risperdal 1,5mg ---12/06/19

Risperdal 1,75mg - - - 12/08/19

Risperdal 1,5mg - - - - 12/20/19

Risperdal 1,75mg(0,018g) 12/26/19

Risperidone 1,75ml 1/8/20;Risperidone 1,70ml 1/18/20;Risperidone 1,62ml  1/30/20, risperidone 1,54ml 2/29/20,Risperidone 1,44ml 5/6/20,Risperidone 1,42ml 5/7/20,Risperidone 1,40ml 5/18/20, Risperidone 1,30ml 6/1/20,Risperidone 1,25ml 6/11/20,Risperidone 1,12ml 7/5/20,risperidone 1ml 7/21/20,Risperidone 0,96ml 8/16/20,Risperidone 0,875ml 8/18/20, risperidone 0,86ml  8/28/20 

 

 

With this:

 

Risperdal 1,5mg 12/06/19; 1,75mg 12/08/19; 1,5mg 12/20/19; 1,75mg (0,018g) 12/26/19

Risperidone 1,75ml 1/8/20; 1,70ml 1/18/20; 1,62ml 1/30/20; 1,54ml 2/29/20; 1,44ml 5/6/20; 1,42ml 5/7/20; 1,40ml 5/18/20; 1,30ml 6/1/20; 1,25ml 6/11/20; 1,12ml 7/5/20; 1ml 7/21/20; 0,96ml 8/16/20; 0,875ml 8/18/20; 0,86ml 8/28/20;

 

 

Edited September 21, 2020 by ChessieCat

[Altostrata]

The history of the tapering is not as valuable as the history of when you started the drugs you're currently taking and the dosages you're taking now.

 

Details of your risperidone taper prior to March is not very useful to use, though you might want to save it for your own reference.

[Nocturna]

7 hours ago, Altostrata said:

No, if the akathisia was there before you started tapering the drugs, it's a drug or drugs causing the akathisia.

Hey, hope I can give my 2 cents here. I agree with Altostrata. I know this is personal, but at least for me the akathisia came because of the drugs and goes away (bear in mind - slowly!) as I taper off of them. And I've only ever taken AP, not an AD, so that leads me to...

 

7 hours ago, Altostrata said:

If the akathisia is worse AFTER you take Abilify,...

It's a really wild guess, but Abilify is a partial agonist of dopamine (unlike other APs, which are solely antagonists) and it's widely known to cause restlessness. I've tried taking it before bed time while experiencing insomnia and that made it awful, I was so unrest in bed I could barely fit in my skin. OTOH I've taken Risperidone (never the two simultaneously) and it always made me sleepy, super calm and unwilling to move in general. Again, I know this is personal, but if I were you, my main suspect would be the Abilify. Try monitoring your symptoms during the day and you'll definitely find the reason! Good luck 🤞

[Manny78]

16 hours ago, Manny78 said:

Have you tried tapering Abilify?Yes, I have tried tapering abilify.  When did you start taking Abilify, Cymbalta, Klonopin, biperiden, and risperidone? I started taking them in February 6,2009.I started taking risperidone 3mg,abilify 15 mg,cymbalta 120mg. As the years passed by I was taking more and more mgs.  Please add those dates (month and year) to your signature.

Abilify from 20 mg to 10 mg-Nov.29,2017 to March.24,2019; Abilify 10 mg March.24,2019 to present

Cymbalta 120 mg Jun.28,2011; 90mg Feb.19,2013 to Jun 5,2014;60 mg Jun.5,2014 to present

Klonopin 1,25 mg Jan.3,2016; 0,25mg Nov.28,2017 to present

biperiden extended release 4mg April.25,2008 to Feb.6,2009;Jun 24.2011 to present

Risperidone 2mg May.4,2017 to Dec 6.2019

Risperdal 1,5mg 12/06/19; 1,75mg 12/08/19; 1,5mg 12/20/19; 1,75mg (0,018g) 12/26/19

Risperidone 1,75ml 1/8/20; 1,70ml 1/18/20; 1,62ml 1/30/20; 1,54ml 2/29/20; 1,44ml 5/6/20; 1,42ml 5/7/20; 1,40ml 5/18/20; 1,30ml 6/1/20; 1,25ml 6/11/20; 1,12ml 7/5/20; 1ml 7/21/20; 0,96ml 8/16/20; 0,875ml 8/18/20; 0,86ml 8/28/20;

 

[Manny78]

16 hours ago, ChessieCat said:

You post them in a regular post in your Intro topic and them after you have submitted it, copy the link (the share icon top right of the post) and add that to your signature so that it can be clicked on and your list can be easily accessed.

Thank you ChessieCat. I don´t know if I understood but you helped me a lot with the signature.

[Manny78]

10 hours ago, Nocturna said:

Hey, hope I can give my 2 cents here. I agree with Altostrata. I know this is personal, but at least for me the akathisia came because of the drugs and goes away (bear in mind - slowly!) as I taper off of them. And I've only ever taken AP, not an AD, so that leads me to...

 

It's a really wild guess, but Abilify is a partial agonist of dopamine (unlike other APs, which are solely antagonists) and it's widely known to cause restlessness. I've tried taking it before bed time while experiencing insomnia and that made it awful, I was so unrest in bed I could barely fit in my skin. OTOH I've taken Risperidone (never the two simultaneously) and it always made me sleepy, super calm and unwilling to move in general. Again, I know this is personal, but if I were you, my main suspect would be the Abilify. Try monitoring your symptoms during the day and you'll definitely find the reason! Good luck 🤞

Thank you for your input Nocturna. 

[Altostrata]

Thanks, Nocturna. Abilify has always been a prime suspect.

 

Manny, gradually tapering off Abilify makes the most sense. It may very well be causing your akathisia, it's duplicated by the risperidone, and it may be conflicting with other drugs.

[Manny78]

37 minutes ago, Altostrata said:

Thanks, Nocturna. Abilify has always been a prime suspect.

 

Manny, gradually tapering off Abilify makes the most sense. It may very well be causing your akathisia, it's duplicated by the risperidone, and it may be conflicting with other drugs.

Thank you Altostrata. I have an appointment with my psychiatrist this Thursday. I tried to taper abilify before and I managed to taper 10 mg. If I get the liquid solution 1mg/1ml,would it be easier to taper? 

[Altostrata]

Tips for tapering off aripiprazole (Abilify)

 

If you have questions about tapering any of your other drugs, read the appropriate topic here

 

 

It's been 3 years of the same question over and over, Manny.

[Manny78]

1 hour ago, Altostrata said:

Tips for tapering off aripiprazole (Abilify)

 

If you have questions about tapering any of your other drugs, read the appropriate topic here

 

 

It's been 3 years of the same question over and over, Manny.

Sorry Altostrata. I have read the tips to taper off abilify before. My question is how about combining pills with abilify liquid. Will it be suitable to take abilify 5mg with abilify 5ml?

[Manny78]

The abilify 1mg/1ml oral solution jar contains 50ml,150ml or 480ml.

[ChessieCat]

This information is in Post #1 of the Tips for Tapering Abilify topic:

 

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

 

Using a combination of tablets or capsules and liquid
Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.
 
If your doctor prescribes liquid and tablets or capsules at the same time, most likely he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

 

 

[Altostrata]

Please confer with your pharmacist about how to measure the liquid.

[Manny78]

Hi,I spoke with my pharmacist.She told me they only have abilify 1mg/mg oral solution in 150 ml. To measure liquid there is a small plastic vase that measures 2,5ml and makes decrements of 0,5ml. What do I do? My psychiatrist thinks I am taking abilify 20mg when I am taking abilify 10mg.

Thank you, 

Manny 

[ChessieCat]

using-an-oral-syringe-and-other-tapering-techniques

 

Very small syringes are available.

 

[Manny78]

I am reducing 2%of abilify 10 Mg.  My psychiatrist thinks that I was taking 20 mgs. He dropped 5mg of those 20mgs,so they are 15mg. I don't know what to tell him. That I take 19,8mg (Abilify 20mg),or 14,8mg (abilify 15mg) when in reality I am taking 9,8ml,but these I cannot tell him. I want to make sure he gets that I cannot taper more than 2 percent. my options are telling him I was on abilify 15 mg but I felt bad dropping from abilify 20mg to 15mg and I had to go back to 19,8mg.Second choice, I could handle a 5mg reduction from 20mg to 15mg and I want to taper the  abilify 15mg(abilify 10mg  plus 5ml oral solution) to 14,8ml.
I won't tell him I am in 9,8ml,No way. My taper would be like this 9,8ml,9,6ml,9,4ml,9,2 ml, 9ml each month. My last taper of abilify took me two years to get rid off of abilify 10mg. 

[Manny78]

How do I talk to my psychiatrist about tapering? He just don't get it. He wants me to taper the abilify making reductions of 1mg each time (15mg,14mg, 13mg,and so on). I am reducing 2 percent and I have problems managing my Akathisia. 

[ChessieCat]

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

Are you familiar with The Icarus Project?

 

https://www.willhall.net/files/GuiaReducciondelDanoDiscontinuaciondeDrogasPsiquiatricas1EdOnline.pdf

 

http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide2Edonline.pdf

 

Coming Off Psychiatric Drugs: A Harm Reduction Approach to Medication Withdrawal | Will Hall

 

https://www.antipsychoticwithdrawalsurvey.com/