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carefulprayerful: switch to drug with longer half-life before tapering?

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carefulprayerful
0.1 mg scale vs. liquid mixture?

 

I am trying to decide which tapering method to use.  I read on the Inner Compass Initiative website that it is best to choose one method at the beginning and stick to it. 

 

In the thread on making a liquid mixture on this site (SA), I read a couple posts by people who had difficulty transitioning to liquid.  My nervous system is very sensitive to changes in dose of this drug, and I am exploring the option of using a more precise digital scale to taper instead of making a liquid mixture. 

 

I purchased a $20 1 mg digital scale on Amazon, but I am open to spending the money to get a 0.1 mg scale, which would be about $400+.   

 

Background on Risperidone tablets

 

The smallest pill of the drug I am tapering, Risperidone, is 0.25 mg.  The pill (manufactured by Solco Healthcare) weighs 112.5 mg on a 1 mg scale.  (I got the weight of the pill by weighing ten pills on the scale and dividing the reading by 10.)

 

About a 0.1 mg scale 

 

The minimum weight the 0.1 mg scale can weigh is 10 mg.  (You can't put a 10 mg weight on the scale and then add the powder to it, according to the Inner Compass Initiative website.)  Given the limitations of the 0.1 mg digital scale, the smallest dose I could measure would be 0.02 mg, and the tiniest decrement would be 0.002 mg (although I think there might be significant variation in measurements that small).  

 

I read that the jump-off point for most people is 2% of the original dose.  I could measure that amount on a 0.1 mg scale, but not less.  Two percent of my original dose (1.0 mg) would be 0.02 mg. 

 

Today I spoke to a compounding pharmacist who said he could make 0.01 mg pills or any amount I needed. 

 

I would love tips on how to select a 0.1 mg digital scale or how to use it properly.

 

About a liquid mixture

 

With a liquid mixture, diluting a 0.25 mg pill in a large amount of water (say 400 mL), I could measure even tinier amounts than with a 0.1 mg scale.  From the numbers I ran, it seems that the liquid mixture method would provide the most control in measuring tiny amounts. 

 

Risperidone is not soluble in water, so it has to be suspended.  I tried this.  It broke down in the water in 20 minutes, and then I shook it up.  I read here that if I stirred the mixture while using the syringe, the drug would remain more or less evenly distributed.  Of course I realize that there might be variation, especially at tiny doses.  

 

Your tips are always welcome!

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carefulprayerful
1 hour ago, carefulprayerful said:

the tiniest decrement would be 0.002 mg

This was based on the fact that with a 0.1 mg scale, the lowest reliable measurement would be 1.0 mg. 

 

I just remembered that at a certain point, people make bigger drops, i.e., from 5% to 2% to 1% of the original dose (or something like that).  So I guess the 0.1 mg digital scale would allow me enough flexibility.  

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brassmonkey

I think you're getting your units of measure mixed up.  A 0.1mg scale would not have a minimum  weight of 10mg, however a 0.1g scale would.  Please check the designation on the scales it is very important to get it correct.  Many of our members, myself included, use the Gemini-20.  It's available on Amazon for about 20USD.  It is designed to measure down to 1mg or 0.001g.  For the money it is quite accurate. 

 

When the dose weight gets below 4mgpw (milligrams pill weight, the physical weight of the dose) it does have some problems. But with many of these drugs that is giving you a dose strength of just 0.32mgai (milligrams active ingredient, the strength of the dose).  When this point is reached it becomes necessary to visually divide the pile of powder into smaller portions making it relatively easy to obtain a dose in the 0.08mgai range, which is very tiny.  It does, however, cause the percentage of each reduction to increase dramatically depending on how many parts the pile is divided into.  Being at the end of a long slow taper this usually doesn't cause a problem.

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carefulprayerful

Thank you for your reply! 

 

The 0.1 mg scales I looked at on Amazon said this: "Capacity: 10 mg - 120g." The Inner Compass Initiative website says: "Caution: Some people have anecdotally reported increasing the base weight they’re measuring by adding a coin or other known weight to the scale alongside the drug – but while this may make the scale’s display readings appear more consistent, in fact this typically does not actually improve the ability of a scale to accurately measure these relatively tiny weights or weight changes in the amount of drug itself" (copied from: https://withdrawal.theinnercompass.org/taper/understanding-limits-digital-scales-accuracy).

 

I read your post on the brassmonkey scale about microtapering, and it was really helpful!

 

 

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carefulprayerful
1 hour ago, brassmonkey said:

 It does, however, cause the percentage of each reduction to increase dramatically depending on how many parts the pile is divided into.  Being at the end of a long slow taper this usually doesn't cause a problem.

Thank you!  That is what I was wondering about.

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carefulprayerful

I am still trying to settle on a tapering method and stick through it all through my taper.  I bought an analytical balance (a 0.1 mg scale), but I would not mind returning it.  It might not be easy to measure with it below 0.02 mgai.  I might want to go lower than that since I started at 1.00 mgai Risperidone. 

 

The minimum weight of the scale would be 10 mgpw, which would be 0.02 mgai.  According to https://withdrawal.theinnercompass.org/taper/understanding-limits-digital-scales-accuracy, I could "Consider if the significance of the scale’s errors could be lessened by working with multiple tablets or capsules at once, thereby increasing the overall base weight on the scale."  I'm not sure if that means I could place a whole pill in my measuring dish on the scale and then measure powder along side it to measure a quantity of power less than 10 mgpw.  (I would discard the whole pill and then just consume the powder.)

 

I'm concerned about making a DIY liquid mixture because Risperidone is not soluble in water, and I'm not sure, for example, if I suspended 0.25 mgai (the smallest pill size) in 10 mL of water and followed Rhi's suggestions for stirring whether I would be able to reliably measure how many mgai were in 0.1 mL. (That would be 1/400 of my original dose.)  I am thinking that because Risperidone is not soluble in water and I am dealing with smaller doses than most other drugs come in, even if I measured the same way every time, I might not be able to be consistent with liquid mixtures.

 

I got a prescription for 0.0025 mgai from my psychiatrist and brought it to a compounding pharmacy who said they could fill a month's supply for $65, which I think would be manageable.  That would be 1/400 of my original dose. I assume I could cut/crush the pill to get even smaller quantities. 

 

I am asking these questions because I noticed that on both this site and withdrawal.theinnercompass.org, DIY liquid mixtures seem to be the preferred method.  I also don't know how painstaking it is to measure out specks of dust on a 0.1 mL scale, in the end. 

 

Any insight is welcome!

 

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carefulprayerful

Do you think the 0.25 mgai would be well-distributed in a 100 mL suspension?

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Glosmom

Hi Carefulprayerful,

I was reading through your thread and did not see any mention of switching to liquid risperidone.  I am helping my daughter taper off risperidone and we switched to the liquid form and have been able to adjust our doses much better.  Have you talked with your prescribing doctor about that?  Much more accurate than you making a liquid.  I apologize if you mentioned or already addressed this somewhere in your posts.  Also wanted to let you know that the worst of my daughter's symptoms clear up after the third week from a reduction in dose.    Best wishes to you! glos mom

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carefulprayerful

I asked my doctor, who said yes, but the manufacturer’s oral solution only comes in 1.00 mgai per 1 mL.  The compounding pharmacist said it might not be possible to dilute it further in water.  Are you diluting it in water?  I would like to make tiny reductions.  

 

Thanks for the reply! 

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Glosmom

No we don't dilute it further in water.  It is a one to one ratio so your current dose of .75 mg = .75 ml of fluid.

 

  The 3mL syringe that comes with the bottle has a line for .75 mg and has lines for every .05mg. so you could decrease to .70 ml, .65 ml etc. You can actually decrease by less that that but you are just in 'white space' on the syringe if you decrease by less that .05mg.   If you use a 1mL syringe you could draw up the liquid to .74mg or .76 mg (each line on the syringe is .02mg)  Or if you went in between the .74 and .76 line, you could 'call that' .75mg.  I think you could easily control your taper much better if you used the liquid form of risperdal and used either the 3 ml syringe or the 1 ml syringe.  

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carefulprayerful

I am so glad to hear Glo is having success.  It is encouraging to hear, too.  

 

Thank you for the information about the syringes.  I forgot they could measure so small.  

 

The compounding pharmacist also also told me he could compound 1.00 mgai in 10 mL of solution.  

 

It’s good to know there are options!  

 

I guess I’ll test out the scale a little to see how tricky it is to use before I decide to return it.  I’m considering the different liquid options.

 

I’m feeling really good and am ready to tapering again. 

 

 

 

 

 

 

 

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carefulprayerful

After waiting a couple months until all symptoms subsided, I changed from the pill to the prescription liquid in stages, and it went smoothly.  I am so grateful.  I know that from one generic manufacturer to another, though, the amount of the drug contained in each dose can actually vary.  I have no symptoms right now.  I think I may be getting more of the drug in each dose now.  Any tips for adjusting the dose?  I have microtapered down to 0.7425 mg. 

 

Thank you for this excellent site!

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Glosmom

Glad to hear that your switch to liquid went smoothly!  That is a great success and you will be able to control your taper better since you can make much smaller and more accurate decreases then you can with pills.  It is always tough to decide where to decrease next.  Not sure if you are using extra water and are on the 10 mL syringe but If you are on the 3 mL syringe and you went to .70 mg  that would be about a 5.7% decrease from where you are now.  We like staying 'on the lines' :)  of the syringes.  You know your body best and good luck with whatever you decide! glosmom

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carefulprayerful

Thank you for the encouragement!  Knowing that we are all in this together gives me so much hope

 

I'm not sure if switching from pill to liquid resulted in an increase or decrease of the drug, so I am going to continue a slow microtaper.  I am trying to get to know my body ☺️

 

(I am actually diluting the Risperidone in water for a total volume of 60 mL, using both a graduated cylinder and an oral syringe.)

 

💜 carefulprayerful

 

 

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sunnylou

Hi there. I am in the same boat as you. I am tapering 1 mg of Risperidone. I too have another medication I tried to taper but have decided to do the Risperidone first. My 1mg tablets weigh 095mg and I am down to 0.73mg. That's 2 10% reductions so far and have been completely fine. I did say on my thread that I was dropping to 0.66mgpw a few days ago but came down with a cold so temporarily delayed the drop.I just hope this drop is as straight forward as I've waited months to drop and have had zero withdrawals. My biggest worry is TD as well.

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carefulprayerful

I cut my dose of Risperidone by 5% over 30 days (by the daily microtaper method).  It went smoothly with mild symptoms.  Common symptoms were brain fog, restlessness, anxiety/tension, and headaches.  I also experienced a host of symptoms that were very faint and lasted a few seconds: sharper pains in my head, elevated mood, fear, sensitivity to light, etc. (usually just before bed).  A nice portion of the time, I was able to forget about WD and focus on other things.  On a scale from 0 to 10, I was usually at a 1 and sometimes at a 0 or 2.

 

I feel grateful.  I am planning to increase my taper rate to 6% over the course of the month.

 

I am following Rhi's advice to "Start slow and listen to your body."  I am also remembering a quote I saw in JanCarol's signature: "Easy, easy--just go easy, and you'll finish."

 

I am also doing the clean gut diet, and I believe it is helping.

 

Tonight I vented to my mom about everything I have read in Robert Whitaker's book, Mad in America.  She is a very patient listener.  

 

I also find that cuddling does a lot for me.  Norman Doidge says in his book The Brain that Changes that cuddling boosts neuroplasticity!  If I did not have my boyfriend, I would get a cat.

 

Also my symptoms of TD have mostly gone away.  Maybe it was "withdrawal-emergent dyskinesia" as described in the DSM-5.  Hope it doesn't come back!

 

I am not taking on any stressful projects and have put some of my life plans (like going back to school) on hold for however long is necessary.  Just trying not to get too angry about this.  "Emotional binges" tend to aggravate my WD symptoms.  Plus I have a tremendous amount to be grateful for, such as SA.

 

I am hoping at the end of all this to have back my fine sense of humor and knack for poetry!  I noticed that when I was not on drugs, I could be really funny, and I liked to write poems when inspiration hit.

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carefulprayerful

Also, my kidney function went as low as 36% as a result of Lithium.  Now it is at 43% after 10 months off the drug.  My nephrologist said that after Lithium discontinuation, the kidneys may continue to worsen, may stabilize, or may improve to a degree.  😃

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carefulprayerful

Overall progress in 2018 toward coming off Lithium, Risperidone, and Lamotrigine

 

                          Lithium       Risperidone       Lamotrigine        Synthroid               Vienva

                                                                                                  (for thyroid)    (oral contraceptive)

January 2018:      900 mg           1.0 mg              250 mg           125 mcg            standard dose

January 2019:       0 mg             0.625 mg           175 mg             75 mcg            standard dose

 

In the past year, I attempted coming off psychiatric drugs following the fast-taper method.  I hit a wall, re-stabilized, and have since made progress by microtapering. 

 

Now seems like a good time for a look-back.   I hope that my story will be of benefit to someone, maybe even to medical professionals, or maybe just to me looking back on it in future years. 

 

As of a year ago, I had been on a cocktail of Lithium, Risperidone, and Lamotrigine for 5-6 years (my drug history goes back further, though).  I got off Lithium cold turkey in January 2018 and then began to reduce Risperidone and Lamotrigine until I hit a wall in the spring.  Then I took a long hold over the summer until all symptoms subsided.  Now I am tapering one drug at a time, Risperidone first.  I tapered Risperidone 5% in October, 6% in November, and 7.5% in December, using a daily microtaper method.  (See signature for further details.)

 

Success so far microtapering Risperidone October-December 2018

 

By microtapering Risperidone over the past three months, so far I have avoided the severe symptoms which I experienced in past attempts to withdraw from Risperidone: brain zaps, withdrawal-induced 'psychosis,' insomnia, a flash of anger, etc.  I originally experienced nothing like this before being prescribed medication.  Indeed, the cure has been worse than the 'disease.'

 

While microtapering Risperidone in October and November, I felt no symptoms for large portions of the day.  As of December, I now pretty much always feel something.  Symptoms are still mild, though.  Currently I would rate them as a 1-2 on a scale from 1-10. 

 

I'm using a very helpful rating scale from The Antidepressant Solution by Glenmullen p. 137.  Basically it says:

1-3: mild, symptoms do not affect ability to function

4-7: moderate, uncomfortable, affect ability to function even a small amount

8-10: severe, scary symptoms that prevent functioning, requiring updosing and very slow tapering

 

My symptoms while microtapering Risperidone have included anxiety, fear, restlessness, agitation, tension, headache, brain fog, zoning out, slowness finishing sentences, tiredness, sensitivity to light, glassy eyes, abdominal pain, nausea, blurred vision, ringing in my ears, thirst, chest pain, loss of appetite, achy muscles, dizziness, a burning feeling once in my right shoulder, changes in bowel movements, and facial tics.  Some last only seconds.  Some have lasted a couple days.  They are worse for 2-3 days when I get my period.  I also recently got a rash, diagnosed as a fungal infection called tinea corporis.  The doctor said a suppressed immune system may have prevented me from fighting it off. 

 

I have been functioning fully in my work and personal life since beginning to microtaper Risperidone, though I am taking more time for rest, particularly the past couple of weeks since I have been on a stay-cation.  I am concerned I may not have much stamina when I go back to work tomorrow since I have been getting a ton of rest on this stay-cation and I am still tuckered out. 

 

Tardive dyskinesia (TD)

 

As I have mentioned in previous posts, after cutting my dose of Risperidone from 1.0 mg to 0.75 mg last spring, unable to reduce it further, I held my dose at 0.75 mg over the summer, when I developed mild facial tics.  Symptoms include lip puckering, jaw clenching, a twitch in my left eyelid, lip licking, tongue wiggling, and my tongue sitting forward in my mouth, pressing against the back of my lower front teeth.  Of course, I am hoping the tics will die down when I am off Risperidone, and I pray that I don't develop tongue protrusion.  The tics distract me but mostly do not seem to attract attention from other people.    

 

It seems to me that after making a big cut of Risperidone in the spring, the tics that showed up in the summer were a little more intense than they are now.  While I was holding the dose, they almost went away entirely by the early fall, when I ended my long hold and began microtapering Risperidone.  Since microtapering they have come back but a little less strong.

 

Relationship with a prescribing doctor

 

I do not think she has formally diagnosed me with TD, but my doctor is concerned and does not want me on Risperidone.  She is supportive of me microtapering, though.  I don't express indignation at my appointments with her.  In my relationship with my doctor, I followed guidance from Psychiatric Drug Withdrawal by Peter Breggin and withdrawal.theinnercompass.org.  It seemed worth it to me to try to find a doctor with whom I could have a collaborative relationship.  Managing this relationship sometimes occupies my head space of course.  

 

Lasting long-term effects of Lithium (which I stopped taking in January 2018)

 

As a result of long-term Lithium use, my kidney function went down to 36%.  My most recent kidney function results were at or above 40%.    

 

I was also put on thyroid medication while on Lithium.  I am currently reducing my thyroid medication (Synthroid) with the help of my primary care doctor.  I have gone down from 125 mcg to 100 mcg to 75 mg.  Blood work is in the healthy range.

 

Mental well-being

 

My psychiatrist has observed no symptoms of relapse.  All things considered, I feel I am doing better than when I was on more medication: better ability to follow a train of thought, feel emotions, etc. 

 

Over the years I have found the following to be helpful for mental well-being: an eating disorders outpatient program; talk therapy; EMDR (trauma therapy); CBT; a 12-step group; spirituality; meditation; exercise such as yoga; nutrition; life-coaching; and self-help books, including some on the topic of positive psychology.

 

Reading

 

I have been reading the books people recommend on this site among others, including:

·         Anatomy of an Epidemic by Robert Whitaker

·         Mad in America by Robert Whitaker

·         Psychiatric Drug Withdrawal by Peter Breggin, MD

·         Your Drug May Be Your Problem by Peter Breggin, MD

·         The Antidepressant Solution by Joseph Glenmullen, MD

·         Pharmageddon by David Healy, MD

·         Models of Madness edited by John Read, PhD and Jacqui Dillon (the first edition was edited by Loren Mosher, MD, and others)

·         Hope and Help for Your Nerves by Claire Weekes

·         The Brain That Changes by Norman Doidge, MD (currently reading)

·         Primer in Positive Psychology by Christopher Peterson, PhD (currently reading)

 

Thank you, SA!  Have a happy, healthy new year!

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Altostrata

Thanks for that progress report, careful. You've come a long way, reducing your drug burden. Hope you have continued healing in the new year.

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carefulprayerful

Thank you, Alto.  I appreciate this site immensely.  Hope you have continued healing, too.

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Glosmom

Thank you for this very informative post, careful!  It is so helpful to hear how others are progressing and feeling as it gives me clues into my daughter's journey since she can not articulate it herself.  I wish you great success as you continue on in your tapering journey!!

 

I do have one question when/if you have time. Do you feel that your CT off of lithium in January of 2018 (not sure what dose you jumped from) could have compounded your withdrawal symptoms in the spring with your risperidone taper?  Obviously, it is impossible to know for sure but didn't know if going to zero with one AP med and then tapering the other a few months later increased symptoms? 

 

Again so very happy that things are going well for you!   You give me hope for my daughter!  peace, glosmom

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carefulprayerful
Posted (edited)

Glosmom, 

 

Sorry for my delayed reply.  I wanted to think about your question.  

 

I CT’d Lithium from the full dose in January (it is actually a mood stabilizer, not an AP).  I think those symptoms passed after about a month, but I imagine my brain was still inflamed.  This probably made tapering the other drugs harder to some degree.

 

I can’t be completely sure about the symptoms in the spring because I was reducing Lamotrigine at around the same time as Risperidone.  Lamotrigine is known to have a protective effect on the brain from what I have read on SA (it is a seizure medication as well as a psych drug).  In the spring, I first reduced Risperidone, then Lamotrigine, then tried reducing Risperidone again a couple more times but was unable to. (Some of the symptoms when I hit that wall, while while not doing a slow taper, included feeling like the ground fell out from under me, brain zaps, and a flash of anger that I did not express but which was scary to go through.)  I really think that reducing the Lamotrigine made the Risperidone symptoms more pronounced because my brain was less stable and because I lost some of the protective effect of Lamotrigine.  I feel like I know which symptoms come from reducing Risperidone, though, because they show up right away, but who knows?  I have read that medical science doesn’t know how these drugs interact.

 

The symptoms I attribute to Lamotrigine (back and neck ache, low tolerance for exercise, and intolerance for light, heat, and sound) did not show up until the summer.  (Other people tapering Lamotrigine on here have had similar symptoms.)

 

I think Risperidone has been the toughest drug to taper. 

 

I mentioned withdrawal-induced ‘psychosis’ and insomnia from Risperidone withdrawal in previous posts.  I experienced these symptoms after FT’ing Risperidone in 2014 after being on it for one year, and then I went back on it.  However, I also reduced Lithium at that time.  All in all, the only time I have reduced Risperidone alone without also changing the dose of another psych drug has been the last three months microtapering (although I am reducing my thyroid medication).  

 

You and your daughter give me a lot of hope, too.  From what I have read here, Glo has a definite advantage from being on the drug a shorter time than many and from being young.  I hope she has continued success! 

 

Best, 

Careful

 

Edited by ChessieCat
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Glosmom

HI Careful,

Thanks again for your very thoughtful reply.   Your assessment is probably more accurate than any doctor or health care professional could ever attempt to know.  I am very happy you are able to experience clarity about what has and is happening to you.  Some (or most) of the symptoms you described during your risperdal taper (then and now) appear to match many of what Glo has (and is) gone/going through.  Even just being on one drug, it never ceases to amaze me how powerful this one drug is. It has her brain held hostage, most definitely.  I am happy to report that she has slept the last seven days in a row. This past week was week 4 of her last taper from .2mg to .1mg liquid. Yesterday, i saw some really good things from her that I haven't seen in a very long time (reading a few words, counting, describing what was in the room and outside) which shows me her brain is trying to heal. Today however, even though she slept all night, has not been nearly as good.  Waves and windows as they say, eh? :)

 

Again, thank you so much for taking the time to write out in such detail your story and tapering progress.  Even though it is 'your thread' it is so very helpful and comforting to read and refer to as I continue to help Glo make it through her journey.

 

Wishing you all the best as 2019 moves along, glosmom

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carefulprayerful
Posted (edited)

Alto et al, 

 

I take 100 mg Lamotrigine in the morning (6:30 am) and 75 mg at night (8:30 pm) for a total of 175 mg/day.  I am not currently tapering Lamotrigine. 

 

I take Risperidone at 8:30 pm, and I have tapered down to 0.53 mg.  

 

Yesterday I forgot to take the 100 mg Lamotrigine in the morning, so I took it at night.  (at night I took 175 mg.) 

 

This morning I took the 100 mg as usual.  

 

I would like to normalize my blood levels.  What would you do?  Can I take 75 mg instead of 100 mg tomorrow morning ?  If I reduce my dose tonight (for example take 50 mg instead of the usual 75 mg), I am concerned it might affect my sleep. 

 

Both Lamotrigine and Risperidone have a sedative effect (much stronger for Risperidone).  

 

Lamotrigine has an interaction with Risperidone—it increases the blood level of Risperidone (in my interactions in a previous post, it says it increases Risperidone blood levels by about 25%).  

 

If I reduce the Lamotrigine tonight, I would be getting less Risperidone in my blood, and I think I might not sleep as well. 

 

Btw do you have any tricks or tips for remembering my morning dose? 

 

Thank you!! 

 

Edited by ChessieCat
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Altostrata

I would go back to your usual drug schedule for lamotrigine. with 100mg in the morning and 75mg in the evening. Keep all other dosing steady.

 

As lamotrigine has a short half-life, you may feel bumpy for a few days.

 

I don't have any memory tricks. Put the bottle where you can see it at 6:30 a.m.

 

Please let us know how you're doing.

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carefulprayerful

Alto, ChessieCat, 

 

Thank you for the tips!

 

An update on my progress microtapering Risperidone:

 

Preceding my mistake with the Lamotrigine on Wednesday, I actually had the easiest two weeks in a long time. My symptoms were mostly un-noticeable over the course of the day.  My symptoms had got down to: fidgeting, facial tics, headache, brain fog, difficulty concentrating, zoning out (particularly in the evening), momentary abdominal pain, slight fatigue certain days (but less and less often), and lighter sleep.  I discovered that the following factors are key (no surprise): not missing any doses of any other drug I am taking, going to sleep at 9 pm every night, getting exercise (can mean the difference between two hours of sleep!), and essential oils (for sleep).

 

Good news:

  • My kidney function has risen to 48%!  It was down to 36% when I stopped Lithium abruptly a year ago following the kidney damage, which it caused.
  • I am better able to feel emotions (including anger toward the pharmaceutical industry). 
  • As I feel emotions, I am finding healing from experiences many years ago.    
  • I have been tapering Synthroid and am down to 75 mg from 125 mg.  I am tapering this drug slowing (25 mg every 3 months) even though it is not a psych drug.  My numbers are perfectly in the middle of the normal range!  My doctor has written me a prescription for 50 mg, which I will start taking as soon as I am done with this hold.  
  • Life is good.  My partner and I are buying a house with a white picket fence (literally)!
  • I am still working full-time.  Although I have made some careless errors in the past year, I got a really good review for 2018. 
  • The facial tics have continued to reduce gradually over time.  They rarely attract attention from other people (this has happened a handful of times over the last 6 months.)   

 

Since my mistake with the Lamotrigine on Wednesday:

 

I have been feeling mild symptoms: feeling like my brain got blasted, lighter mood, energetic, better ability to concentrate, sounder sleep, a feeling of unease (momentary), headache, ringing in my ears (momentary), nausea (momentary, comes and goes), and slight anxiety (momentary, comes and goes).  

 

I am holding everything the same for five more days (a week total) and seeing how it goes.    

 

Of course, I am disinclined to do a hold because I am impatient to make progress, but I like this quote from Tony Robbins on billionaire investing: "Find where there is the least amount of risk with the most upside--do that again and again, and you're going to eventually win."  I am learning how not to make rash decisions.  

 

On remembering to take medication:

 

I have alarms to help me remember when to take my doses, but they actually serve multiple purposes.  For example, the 6:30 alarm signals to me: get up from meditation chair, eat breakfast, and take dose.  Now I have decided to think of alarms as signaling one thing (take a dose) regardless of what else I am doing, i.e., I am training myself to hear the alarm and think only "take dose."  Also I am now carrying extra Lamotrigine in my purse and setting a cell phone reminder!  These drugs (in both active use and withdrawal) have made me a space cadet!

 

Positive Affirmations:

 

By the way a friend gave me these positive affirmations, which put me in a good mindset and (who knows?) may be easing this process:

  • I am healthier.  I am healthier every day. 
  • The drugs are leaving my body very easily, without effort, and at my body's pace. 
  • I am willing to release the pattern than is causing this condition. 

I put them on bookmarks.  

 

I don't know where I would be without this website!  Wishing everyone healing!

 

careful

 

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carefulprayerful

What seems to happen when I miss a dose of Lamotrigine:  I will share this because it is not all roses.  When I miss a dose of Lamotrigine, I experience more significant withdrawal symptoms from Risperidone (one can assume this is for reasons stated earlier in my topic--Lamotrigine has a "protective effect" and also increases the levels of Risperidone in the blood according to a case study).  I missed Lamotrigine a few times in December and February while microtapering Risperidone, so I have observed what happens when I miss a dose of Lamotrigine while microtapering Risperidone--my thinking is temporarily slightly off.  Since I experienced unusual thoughts and behavior and browned out from FT off Lithium and Risperidone in 2013 and 2015, I am very wary of this.  I have experienced this nonsense uniquely after exposure to these drugs.  When I missed my morning dose of Lamotrigine on Wednesday and decided to take it on top of my evening dose that evening, it was because I wanted to avoid this experience.  I knew it was not recommended to double up.  The truth is what I experienced was slight and passed quickly in December and February when I missed my morning dose of Lamotrigine, but it was more noticeable in February than in December.

 

I think I am over-concerned about this.  (The FT off Lithium and Risperidone a few years ago and the ensuing withdrawal had consequences for me both personally and professionally.  I had to go back on the drugs and thought something was wrong with me as I knew nothing about WD at the time.  As you can imagine, the memory is lasting.)  

 

In December I just got a little fuzzy feeling.  In February, I momentarily had what the DSM calls ideas of reference.  I thought when I overheard a conversation, the speakers were intending me to overhear them or to interpret some message, even though they were not talking about me.  It was fleeting and I did not pay it much head.  It was at work in the early afternoon.  I did not act unusually.  I know a normal person can think something like this, but there's just a chemical feeling to it that reminds me of the severe WD I had in the past.  (Another example of ideas of reference would be hearing a song on the radio and thinking it was a message sent to you specifically.  I am not an expert or a therapist, but the therapist I saw had me read about this in the DSM.)  

 

Question to the moderators:  I usually take 100 mg Lamotrigine in the morning and 75 mg Lamotrigine at night.  If I were to miss the 100 mg Lamotrigine in the morning, would it be okay to take 100 mg Lamotrigine at night for one night?  Just a question.  I can save my questions for when the situation arises.  

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carefulprayerful
1 hour ago, carefulprayerful said:

I have experienced this degree of nonsense uniquely after exposure to these drugs. 

 

I may have to accept that I cannot avoid every unusual or odd thought. 

 

I do know I need to keep it stable (just not miss a dose of Lamotrigine in the first place!).  Thanks!  

 

 

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carefulprayerful
On 3/7/2019 at 10:52 AM, carefulprayerful said:

 

Lamotrigine has an interaction with Risperidone—it increases the blood level of Risperidone (in my interactions in a previous post, it says it increases Risperidone blood levels by about 25%).  

I misquoted.  It does not say 25%.  It does not give the percentage.

 

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carefulprayerful

I am still sleeping more heavily and having a touch of headache and anxiety and a barely perceptible elevation in mood around noon.  It has been a week, and I don't feel totally back to WD normal.  

 

I just discovered this information saying that Lamotrigine can take up to 2 weeks to clear this system.  I suppose that may be an indication of how long the excess I took will leave my body:

 

"After multiple dosing (in volunteers who took no other medicines) of lamotrigine the elimination half life is noted to be between 11.6 to 61.6 hours.

The elimination half half varies with other parameters. Please see link below.

https://www.drugs.com/pro/lamotrigine.html

For lamotrigine to be totally out of your system it would take 5.5 half life's (5.5 x 61.6 hours (max)) i.e. 338.8 hours (approximately 14 days). This is using the maximum time and could vary with change in other parameters."

(Copied from https://www.drugs.com/answers/if-you-are-taking-lamotrigine-how-long-does-it-88886.html.)

I'm planning to wait until the weekend and re-evaluate.  

 

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carefulprayerful

It has been 10 days since the dose mistake with Lamotrigine.  Symptoms have all subsided except my brain feels a little blunted/drowsy in the morning when I wake up.  I am not aware of being on any medications that lengthen the half life of Lamotrigine, but I read that it is longer in patients with renal failure ("The elimination half-life of lamotrigine was approximately 25 h in subjects with normal renal function and 50 h in uraemic patients. These are very large variations in uraemic patients and the results were not statistically significant. Renal clearance of lamotrigine is significantly reduced" https://www.ncbi.nlm.nih.gov/pubmed/8223137).  I have reduced kidney function, so I guess I might be affected by that.  I might start microtapering again tonight, but I might give it another couple days.  I am really feeling great. 😉

 

 

 

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carefulprayerful

Started at 1.0 mg Risperidone a year ago and just got below 0.5 mg yesterday.  As of now it seems to be getting easier going down.  The most noticeable symptom is that I'm a lighter sleeper now, but I generally don't feel under-rested.  I exercise 5+ days a week for 15-40 min because I get much better sleep if I do.  I also use essential oils to help me fall asleep 1-2 nights a week.  Since I have not been missing any doses of the Lamotrigine (which I am not tapering right now), the Risperidone tapering has been going smoothly.  The facial tics have greatly diminished.  Feeling grateful!

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Glosmom

This is great news, Careful! So happy the risperidone tapering is going well for you.  Best wishes always, glosmom

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carefulprayerful

Hello all,

 

I posted on here that by coming off these drugs, I was hoping to get back my creativity and sense of humor which have been dampened by them.  Well, the spirit moved me to write a poem recently for the first time in over 7 years ago!  

 

I am also grateful to report that tapering  Risperidone has gotten easier.  I think this has happened because: 

 

1. Still going at 7-8%/month by microtaper method.  

2. I have stopped missing doses of Lamotrigine (the other psych drug I am taking).  Since then all the WD thought patterns have gone away. 

3. I discovered fermented foods (sauerkraut).  It has to be probiotic lacto-fermented.  It makes a really significant difference.  Most of my WD symptoms have subsided since I started eating it. (I had already stopped eating sugar, flour, gluten, and dairy.). (“Clean gut” diet) 

4. Exercising most days.

 

Symptoms that have decreased : 

insomnia (now getting 6+ hours usually)

facial tics (have overall gotten milder, I rarely think about them) 

brain fog (more mental clarity most of the time)

 

Most common symptoms: 

 

headache 

stomach ache (This is all the time.  I need to get this checked out just in case it is not WD.) 

 

I heard a tip to spend a year whittling down the last 5%.  At my current pace, it will take me 3+ more years to get off Risperidone. 

 

Then I will taper Lamotrigine.  

 

Kidney function seems to to be stable in the 40th percentile range.   

 

I have spent a lot of time stewing in anger but gradually finding peace.  A smooth taper thus far makes it easier to find acceptance.   Thank you, SA.

 

I get a little concerned I am going to get dementia one day even if I taper off everything.  

 

Overall honestly feeling wonderful.   Working full time at a low-stress job.

 

Hopeful this will continue.    

 

Wishing everyone a day of healing!  Let’s be patient and I know we’ll make it.  ❤️

 

Thank you 🙏 

 

careful 

 

 

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carefulprayerful

At the risk of giving TMI, I also wanted to record on my page that as a result of Lithium use and the kidney damage that resulted, I ended up with frequent urination.  After being off Lithium for over a year, it has finally gone away.  🌈

 

Another daily symptom I get is dehydration.  

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