Katerina: How to continue with Olanzapine after several weeks on it?

[Katerina]

Hello everybody,

I am new on this forum. Hopefully I filled all pieces of information into my signature so you can read it.

I would like to ask you for help, what to do in my situation.

I had to reinstate 50mg Amitriptyline (I tapered too fast to 19mg within 3 months - February - May2018). I had to be hospitalized (June 2018) because I lost a lot of weight and was really weak. They added another medication, so I have been using today:

- 50mg of Amitriptyline

- 50mg of Valdoxan for 8weeks

- 10mg Olanzapine since 21st June, lowered to 7,5mg since July14th

 

My question is, what would you do next with Olanzapine? I feel

- a lot of inner vibrations

- restlessness

- fatique during first part of the day, till 2-3pm

- constipation (and gut pains)

 

Olanzapine helped with my anxiety, but unfortunatelly only during first 3 weeks, today I have anxiety back, every morning a lot of cortisol and adrenaline

So I would like to quit Olanzapine, as I read horrible storries about withdrawing this drug after months or years of use. But I don´t know what to do?

Quit it as soon as possible? Or do a slow taper within next weeks eventhough I was on it only for couple of weeks (in total 5weeks today)?

What would be your recommendation?

I apologize for my English, I am not a native speaker.

 

Thank you

[Altostrata]

Welcome, Katerina.

 

How do you feel after reducing olanzapine on July 14? Did your symptoms get worse or better? Did you get any new symptoms?

 

What times of day do you take your drugs, and their dosages? Do your symptoms follow any daily pattern?

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results in this topic. Also, on drugs.com, read up on the side effects of each of your drugs.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature

[Katerina]

Alto, thank you for your reply. I added signature, so you can view my history.

I will try to take Olanzapine only once a day in bed time, because my brain fog durin first half of the day can be caused due to morning Olanzapine. I have been trying this just for today and it seems to be better. I will take the whole 7,5mg dose in the evening,  and wait what happens.

Thank you for your help. It is very good source of information here on AS.

Katerina

[Altostrata]

Good to hear. Some of your symptoms may be due to drug interactions.

 

On 7/27/2018 at 12:42 PM, Altostrata said:

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results in this topic. Also, on drugs.com, read up on the side effects of each of your drugs.

 

[Katerina]

Hello everybody,

it has been 3months today I am on Olanzapine and I want so much to get rid off this horrible drug. I am on 10mg (5 morning, 5 bedtime). I tried to decrease the dose to 7,5mg, but I failed and after 14 days I had to reinstate on 10mg. I decided to taper slow, not more than 10% of previous dose. Do you think it could be done faster than 10% within a month? As I only was on this med for 3months? What would you recommend?

I will start with the morning dose,, from 5mg to 4 mg (in total from 10mg to 9mg a day). I want to use water titration because the pills I use are soluble in water. I will keep the evening dose on 5mg (the whole pill) and the morning dose mix with water and taper.

Will this be ok?

Thank you all for your help.

[Katerina]

I have one more question to ask about tapering Olanzapin. I have been taking 5mg in morning and 5mg at bedtime and I would like to taper. Would you recommend to taper the morning dose first to zero and then the night dose? Or shall I do it simultaneously - decrease by 10% and then split the dose half by half (the same amount taken in morning and bedtime?) I will really apreciate your help, your suggestion?

Thanks a lot

[manymoretodays]

Hi Katerina,

I'm wondering if you are having trouble with this........the copy and paste request?  Let me know if so.

On 7/27/2018 at 1:42 PM, Altostrata said:

Welcome, Katerina.

 

How do you feel after reducing olanzapine on July 14? Did your symptoms get worse or better? Did you get any new symptoms?

 

What times of day do you take your drugs, and their dosages? Do your symptoms follow any daily pattern?

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results in this topic. Also, on drugs.com, read up on the side effects of each of your drugs.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature

 

I was unable to plug the Valdoxan/agomelatine in there, possibly because it is not used in the U.S.  Once you plug in your other medications though, and copy and paste the results here.........  you can go back to the same site and plug the Valdoxan in at the search box at the tip.  That way you can read more about that medication.  Same with your other medications.

 

And then can you do a drug and symptom journal on paper and then post it here on your introduction page?  Keep it simple with the time on the left, then drug name, dosage, and any symptoms on the right.  That will help us a lot.  You can also include your sleep patterns and any supplements taken in this.  This may help:  Daily drug and symptom notes

 

Right now.....I'm thinking that if it were me,  I'd probably taper the morning dose first.......as when I took olanzapine, I could barely function taking it every 12 hours.  I was effectively a barely walking zombie of sorts. 

Here is what we have on Tips for tapering off Zyprexa

And Why taper by 10% of my dosage*

 

When did you do the taper down to 7.5 mg of Zyprexa?  And then when did you go back up to 10 mg total daily dosage?

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug. When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

Also with the changes in medications, up and down.......often havoc results on an already sensitized nervous system.

 

All for now.

Love, peace, healing, and growth,

mmt

Edited September 29, 2018 by manymoretodays
added daily notes request and link

[Katerina]

Thank you Manymoretodays.

 

I dont have proper notes about my withdrawal so far, so I will start to keep them daily. Now I can only react what I do remember about Olanzapine changes in dosage. I made within last two months.

I tried to lower the dose on July 14th (10mg top 7,5mg), then I increased the dose again somewhere around beginning of August to 10mg in one dose in the evening. Then another attempt of reducing  the dose in the beginning of September (10mg to 7,5 mg in one evening dose), after 2weeks I hade to reinstate. I decided to reinstate in the pattern 5mg morning, 5mg evening because this worked the best in the beginning of my Olanzapine experience for my anxiety.

 

I take Olanzapine at 7-8am (5mg) and 9.30 pm (5mg).

 

My typical symptoms are inner vibrations, nausea almost the whole day, tremors in hands, absolutely no appetite (which is strange as almost all users of Olanzapine have increased appetite), running thoughts in the morning, upset stomach.

My sleeping pattern is folowing. Going to bed at 9.30pm, falling asleep without problems, but then wake up after 1-1,5 hours of sleep. But sometimes it is not happening, sometimes I sleep till 4-5am. When I wake up after 1-1,5 hours of sleep I take Melatonin (1mg) and continue without problems sleeping till 4-5am, when I wake up and no more sleep. Usualy my body is full of Cortisol and Adrenalin, I wake up with running thoughts and upset stomach.

 

I already made check of my medicine interactions and some of the symptoms as dry mouth and dizziness are due to combination of drugs I use. But what is reason of what hard to say because I am polydrugged.

 

I didn´t understand your mote about copy and paste?! Shall I paste here the results from the web sites where are infos about the interactions between the drugs? Please, let me know.

 

I decided to start my taper tomorow morning, from 5mg to 4mg and hold for several days. I am on the drug only 3months so I strongly believe I can go faster than 10% within a month. If I had to follow this recommendation I would withdraw several months after only 3months of use. But never knows how my body reacts.

 

Thank for your help.

 

[manymoretodays]

Yes...copy and paste the interactions report.                   Then, with the drug and symptom notes,  when you share your notes here.....be sure and include the time, name of drug, and dosage for all of your medications. ...as well as the rest I mentioned above......in regards to daily notes.  Thank you Katerina.

Edited September 29, 2018 by manymoretodays
Clarity

[Katerina]

So here are the interactions (Valdoxan is not in the list)

 

Oxazepam and Amitriptyline interactions

Using oxazepam together with amitriptyline may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Applies to: oxazepam, olanzapine

OLANZapine should not be used with oxazepam without first talking to your doctor. This combination may cause low blood pressure or slow heart rate. Low blood pressure can cause dizziness or feeling like you might pass out, especially when getting up from a sitting or lying position. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Applies to: amitriptyline, olanzapine

Using amitriptyline together with OLANZapine may increase side effects such as drowsiness, blurred vision, dry mouth, heat intolerance, flushing, decreased sweating, difficulty urinating, abdominal cramping, constipation, irregular heartbeat, confusion, and memory problems. Side effects may be more likely to occur in the elderly or those with a debilitating condition. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

 

[Altostrata]

Hi, Katerina. What times of day do you take amitriptyline and oxazepam?

 

How often do you take oxazepam? It's very important to note this in your daily drug and symptom record.

 

Did you feel better after you put the olanzapine back to 7-8am (5mg) and 9.30 pm (5mg)?

[Katerina]

Alto,

my daily schedule of medicine is following:

 

8am - Olanzapine (since yesterday 4 mg)

9.30pm - Amitriptyline (75mg), Olanzapine (5mg), Valdoxan (25mg)

 

Sometimes when my morning is really bad and I am full of cortisol and adrenaline and feel very anxious I take Oxazepam (5-10mg). I know that it is benzo and should be used only temporarily, I have experience with Clonazepam unfortunatelly (I used Clonazepam for 3months and then 6months slowly withdrawing).

 

During night when I wake up and it is impossible to fall asleep again I try Melatonin (1-5mg) or Oxazepam (5mg) - usually it is around 11pm.

 

Yes, I felt a little bit better when I put Olanzapine back from 7,5mg to 10mg. But during those days I had problems with my work and so maybe I felt bad (on 7,5mg Olanzapine) because it was in the same time whe I had to solve some severe troubles.

 

Thank you for your help. Katerina

[manymoretodays]

On 9/29/2018 at 9:53 AM, Katerina said:

I decided to start my taper tomorow morning, from 5mg to 4mg and hold for several days. I am on the drug only 3months so I strongly believe I can go faster than 10% within a month. If I had to follow this recommendation I would withdraw several months after only 3months of use. But never knows how my body reacts.

 

On 9/27/2018 at 8:28 AM, Katerina said:

I will start with the morning dose,, from 5mg to 4 mg (in total from 10mg to 9mg a day). I want to use water titration because the pills I use are soluble in water. I will keep the evening dose on 5mg (the whole pill) and the morning dose mix with water and taper.

 

Hi Katerina,

If I were you, until you know how the taper will go.........I would suggest just tapering 10% off your morning dose of 5 mg. 

So you would just be going down to taking 4.5 mg of Zyprexa(olanzapine) in the morning.

 

Tips for tapering off Zyprexa(olanzapine)

How to make a liquid from tablets or capsules

Using an oral syringe and other tapering techniques

 

Do proceed a bit slowly and cautiously, as any changes made in your Zyprexa dosing now, may take a while until felt.  It has a fairly long half life which equates to it not reaching a new steady state, for several days or longer after a change in dosage.   It's a whole lot easier to try to avoid W/D symptoms, from a too fast taper now, than to deal with them after they have occurred.     HOLD for at least 4 weeks after this initial change.  If all goes well, then, you may be able to go more quickly.  You have also changed the form of 1/2 of your daily dose of Zyprexa.   The liquid formulation change, causes changes in absorption of your drug, even though you are using the same tablet in the water.  This may effect your nervous system too.  We want to try and sneak in changes very gradually, as to not disrupt your nervous system, any more than necessary.

 

Keep notes on paper too.   Not only will that help with your organization of medications, it will also be useful to share here when you have questions.

Keep it simple.  Time on the left, drugs, dosages, symptoms on the right.  Here's a sample and more on that:  Drug and Symptom notes

 

And yes, please be very cautious with the usage of Oxazepam.   How long have you been using this benzo?  Did you cross right over from Clonazepam to Oxazepam?

You may want to start an introduction over on our benzo forum as well.  That might help to get some guidance with your Oxazepam usage now.

 

If you can use any non-drug coping that would be great!  And might help avoid another long, tough withdrawal at a later date.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.

 

Love, peace, healing, and growth,

mmt

 

Thanks for the copy and paste of drug interactions.  Again, you can use that site, to find more information on the Valdoxan(agomelatine) as well.  Just use the search box at the top.

 

 

[Katerina]

Thank you a lot for your answer. I have been tapering from 5mg to 4mg my morning dose, today is day 4. I will hold for several days, weeks. Hopefully I am patient enough to hold for proper time and not to make cuts too fast. I stopped using Clonazepam in January 2018, since then I was benzo free until middle August, 2018,  when 10mg Oxazepam was added. I have been using it most of days since then so I know there will be a slow taper necessary too. I try to avoid Oxazepam bud I feel I need it to calm my inner restlesness that is maybe caused by Olanzapine, as I remeber it started shortly after starting Olanzapine.

I use Magnesium, Calcium and Zinc. Your recommendation is to stop using supplements? I have been using them for a long time.

And one more question - shall I first finish my Olanzapine taper and then start Oxazepam taper? You know I see that Olanzapine taper is long process and the sooner I am off of this poison the sooner the next taper of Oxazepam dan start. I would like to make both tapers safe but fast enough to stay on these drugs for only the shortest necesaary time. Does it make sence?

Thank you once more for your reply.

Katerina

[Altostrata]

On 10/1/2018 at 8:35 AM, Katerina said:

8am - Olanzapine (since yesterday 4 mg)

9.30pm - Amitriptyline (75mg), Olanzapine (5mg), Valdoxan (25mg)

 

Katerina, why are you taking these 3 drugs at the same time? Why was Valdoxan added?

 

Valdoxan interactions https://www.drugbank.ca/drugs/DB06594#interactions
 

Quote

 

The risk or severity of adverse effects can be increased when Olanzapine is combined with Agomelatine.

The risk or severity of adverse effects can be increased when Oxazepam is combined with Agomelatine.

The risk or severity of adverse effects can be increased when Amitriptyline is combined with Agomelatine.

 

 

Quote

 

CYP450 2C9 substrate	Non-substrate	0.7647
CYP450 2D6 substrate	Substrate	0.7219
CYP450 3A4 substrate	Substrate	0.7276
CYP450 1A2 substrate	Inhibitor	0.8543
CYP450 2C9 inhibitor	Non-inhibitor	0.7758
CYP450 2D6 inhibitor	Non-inhibitor	0.5445
CYP450 2C19 inhibitor	Non-inhibitor	0.7478
CYP450 3A4 inhibitor	Non-inhibitor	0.7746
CYP450 inhibitory promiscuity	High CYP Inhibitory Promiscuity

 

Valdoxan patient information and adverse reactions https://www.medicines.org.uk/emc/product/6564/pil

 

When was the last time you had a liver function blood test?

[Katerina]

Alto, I do not understand the quotes?! What do the numbers mean?

Valdoxan was added to Amitriptyline to help with sleep. And to increasae the antidepressive functioning of Amitriptyline. The liver tests were made three times till today, the las one 1month ago and there was everything perfect. 

You ask about reason of taking all three drugs together. I don´t know, it was prescribed by my doctors this way. Amitriptyline is usually taken in one dose in the evening, I tried to split the dose (25mg morning and 50 mg evening) but I was so tired during the morning, that I returned it to only one dose in bed time. Valdoxan is taken in the evening too and with Olanzapine we made several trials and it seemed to work the best when it is split to orning dose and evening dose.

What would you recommend?

I have started with Olanzapine taper as I feel this drug is the worst to withdraw. 

Yes, I need Oxazepam too, usually taken in the morning to ease the cortisol morning. It seems to work pretty well, I know it is benzo and shouldn´t be taken regularly and longterm, but I need to live a bit and it helps me to start the day a little bit better.

Thanks for your kind help, I really apreciate it,

Katerina

[Altostrata]

Did Valdoxan improve your sleep? What is your sleep pattern?

 

I am worried that your "cortisol morning" is rebound from all the drugs you're taking at night. In that case, you're taking oxazepam for a drug reaction. If we can unravel the drug reaction, you may not feel you have to take oxazepam.

 

Exactly how often have you taken oxazepam in the last week, and at what dosages?

 

I am thinking that perhaps moving 10mg amitriptyline to the morning might allow you to skip taking oxazepam, without the side effects of amitryptyline, but we have to find out how dependent you are on oxazepam first.

 

The numbers in the quote for Valdoxan indicate which liver enzymes might be involved in a drug-drug conflict (I put them in bold). Valdoxan interferes with the metabolism of lots of drugs, it is "promiscuous."

[Katerina]

Alto,

my Oxazepam use within las week is following:

27.9.2018: 6 am 5mg Oxazepam; 8.15 am 10mg Oxazepam

28.9.2018: 7am 10mg Oxazepam

29.9.2018: 6am 10mg Oxazepam, 10.30pm 5mg Oxazepam

30.9.2018: 7am 10mg Oxazepam, 10.30pm 5mg Oxazepam

1.10.2018: 6.45am 10mg Oxazepam

2.10.2018: 7am 5mg Oxazepam, 9.pm 5mg Oxazepam

3.10.2018: 7am 10mg Oxazepam, 7pm 5mg Oxazepam

4.10.2018: 7.15 am 10mg Oxazepam, 9.30pm 10mg Oxazepam

 

My doctor suggested to try Amitriptylin 25mg in the morning and 50mg in the evening. I tried for two days but my morning fatigue was very high. Unfortunately there are only 25mg tablets available in my country,no 10mg. So it is impossible to take 10mg as you sugested. And I don´t want to start water titration with Amitriptyline now when i started water titration of Olanzapine.

 

To be honest I don´t know whether Valdoxan does someting with my sleep. It was added in the time I used 50mg Amitriptyline and it was added as second antidepressant to prolong my sleep. The dose of Valdoxan was 25mg, after 3weeks updosed to 50mg. Then Amitriptyline was updossed from 50mg to 75mg and after one week Valdoxan was decreased to 25mg. I really don´t know whicch drug helps more, all are taken in the bedtime.

 

About my sleep - I go to bed 9.30 pm, I read a little bit and then fall asleep,, usually withou probems. In the days I can´t fall asleep or wake up after 45 minutes of sleep I take Oxazepam. I tried to take Oxazepam earlier, 7-9pm as well to see what it does, whether I am calm and it seems to be better than to wait unless I woke up or not. You know I am not happy that I use benzo again, but unfortunatelly it seems to me I have no other option. I do relaxation, have sleeping mask, don´t use electric equipment before sleeping... and still there are bad nights. I wake up 2-3times  a night (that is ok) and then I wake up betweek 5 and 6.30 am, try to fall asleep but impossible.

 

Would you recomend to try again Amitriptyline in the morning? Lets say 1/2 of the 25mg tablet, so it would be 12,5mg? And the rest in the evening? Shall Amitriptyline work against anxiety? Cortisol mornings are so exhausting!

 

And how it is possible that I lost apetite? During the whole day I have no hunger, no appetite, no need to eat?! Do you think it is because I have been using so many drugs, or becuase withdrawing Olanzapine? People usually discribe highe appetite on Olanzapine, it is not my case. I only felt increased appetite in the very beginnig during first several days and then it diminished. Do you think it has anything to do with serotonin that is produced in the gut? I would really appreciate your explanation, if there is any.

 

Thank you very much.