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LilBit

LilBit: polypharmacy nightmare

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LilBit

I have also been rethinking the Depakote taper and I am extremely certain that my aches and pains, weakness, weight loss, diarrhea, nausea, lack of appetite and liver issues are because of it. If possible and you think it is advisable, I would like to try 375mg.  I think the sooner I get off of it the better, from what I researched it can cause liver damage even when discontinued in more severe cases.  I know I am asking lots of questions and I apologize, I am just very concerned and want to make sure I am doing the tight thing.  Thanks 

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Altostrata
18 hours ago, LilBit said:

....

I told her that I felt this was too much of a drop for me given my history and I would like to take 250mg Depakote ER with one and a half of the Depakote Sprinkles as you suggested for a total of 437.5mg, and she responded with saying that she could not endorse that because she doesn’t agree with only taking a partial dose of a sprinkles capsule and that I should be fine on 375mg.

 

At that point I just told her to send the prescription for Depakote Sprinkles to my pharmacy.  I didn’t want to argue with het on the phone but now I am not sure how to proceed.  I am going to probably have to find another psychiatrist in the middle of my disability case (again) which really stresses me out.  What are your thoughts on this?

....

 

The Sprinkles capsules are designed to be opened. There is no reason why you cannot take a partial dose. It sounds like your psychiatrist is not familiar with Depakote Sprinkles.

 

Next time you talk to her, you might not go over every single little detail of your taper. At that point, you might be down to 250mg Depakote anyway and no need to discuss opening a Sprinkles capsule.

 

If I were you, I would definitely take one 250mg Depakote ER (is that what your tablets are??) as part of your dose. This will make the change of part to Sprinkles easier.

 

From her strategies, I can see your psychiatrist is not familiar with any tapering methods.

 

17 hours ago, Songbird said:

It's good that you were able to get the Sprinkles.  You might only need the half capsule for a couple of weeks as a step down between 500mg and 375mg.

 

It looks like you've been taking the whole 500mg dose a.m.  Why does she want you to split the dose between a.m. and p.m.?

 

Yes, why a split dose? You really need to ask her reasoning when she comes up with this stuff.

 

It's up to you if you want to do this, Kev. It means you might have an adverse reaction to Depakote in the evening, too.

 

If you choose to divide the dose, I'd take the 250mg Depakote ER (??) tablet at the usual time in the morning, and the Sprinkles part of the dose in the evening. I have no idea what this will do.

 

4 hours ago, LilBit said:

Also one more question Alto... in your opinion am I still safe taking the Xifaxan?

 

I don't know, Kev. Xifaxan is a very expensive, powerful antibiotic that is used for some kinds of gut infections. Why does the gastroenterologist think this is best for you? Did he take a stool sample or get results from any other kind of test?

 

Did you discuss other types of treatment with the gastroenterologist? Did he explain why Xifaxan was the best choice? You need to get full information from your doctors, Kev. Sometimes it takes asking a lot of questions. You need to actively participate in your care.

 

Like all antibiotics, Xifaxan can be rough on your system. You should read up on Xifaxan side effects.

 

3 hours ago, LilBit said:

I have also been rethinking the Depakote taper and I am extremely certain that my aches and pains, weakness, weight loss, diarrhea, nausea, lack of appetite and liver issues are because of it. If possible and you think it is advisable, I would like to try 375mg.  I think the sooner I get off of it the better, from what I researched it can cause liver damage even when discontinued in more severe cases.  I know I am asking lots of questions and I apologize, I am just very concerned and want to make sure I am doing the tight thing.  Thanks 

 

Kev, I don't know what will happen if you decrease from 500mg Depakote ER (is that what you're taking??) to 375mg Depakote (250mg ER?? plus 125mg Sprinkles). This is a pretty big jump. You might get withdrawal symptoms.

 

How about splitting the difference? Reduce to 437.5mg Depakote by combining your 250mg tablet with Sprinkles for 5 days, then go down to 375mg.

 

Whether you want to split the dose into morning and evening is up to you.

 

If I were you, I might put off starting Xifaxan until you get down to 375mg Depakote, at least, or maybe until you are off Depakote altogether. If the nausea, etc. get better, there may be no reason for taking a chance on Xifaxan -- unless your gastroenterologist has a definite diagnosis instead of a guess.

 

You need to decide 1) what you want your first decrease to be; 2) if you want to take a morning and evening dose.

 

Please pick up your Depakote Sprinkles prescription right away.

 

Please confirm that your Depakote tablets are Depakote ER.

 

Please continue to keep notes as you change your dosing.

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ChessieCat

The psychiatrist might be confusing the different forms of depakote.

 

Fromrxlist.com/depakote-sprinkle-capsules-drug

 

If you cannot swallow a sprinkle capsule whole, open it and sprinkle the medicine into a spoonful of pudding or applesauce. Swallow the mixture right away. Do not save it for later use.

 

Do not crush, chew, break, or open a delayed-release or extended-release tablet or capsule. Swallow it whole.

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LilBit

 Sorry folks, I think I may have miscommunicated a bit, she is aware that Depakote sprinkles capsules are meant to be opened, what she was telling me is that she would advise against taking a partial dose of that with the ER.  Alto, you were right in that I should not be sharing every detail of my taper with her, as this just confuses things even more when doctors clearly don’t understand the proper way to taper. 

 

My gastroenterologist is just guessing at this point, based on a physical exam and symptoms and my previous labs.  It amazes me that he is not taking the Depakote into consideration.  You are right that I need to ask more questions, I get very foggy brained sometimes and forget to ask the really important ones.  I already took a Xifaxan this AM, can I stop now and wait until after I taper Depakote some more or is it too late?

 

Just to confirm (you may have missed it in my previous posts with all of my rambling 😊) yes I am taking Depakote ER.

 

I will be picking up the sprinkles this afternoon and be starting the taper tomorrow.  I will take all of the med in the AM and NOT dividing the dose.  I will start with 437.5mg.

 

Thank you for taking the time to help me.  I will do a better job of asking doctors questions so that I can clarify why they make the choices they do.  Getting here in the first place should have taught me this.

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LilBit

I just contacted the gastroenterologist’s office and let them know that I would like to try tapering the Depakote first and see if my symptoms improve before trying Xifaxan, unless he is wanting to do an actual test to rule out any infection before starting it.  The labs he did show my ALT SGPT went from 63 to 61.  That is what I should have done in the first place but I guess I was scared because of how quickly my GI symptoms are progressing.  Right now it is constant nausea, diarrhea, lethargy, and weight loss.  On Friday I have the ultrasound to check the kidney and liver further. 

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Songbird
1 hour ago, LilBit said:

 I will be picking up the sprinkles this afternoon and be starting the taper tomorrow.  I will take all of the med in the AM and NOT dividing the dose.  I will start with 437.5mg.

 

This sounds like a good plan.  I'm assuming you're going to combine one 250mg ER tablet and half a 125mg capsule of sprinkles.

 

44 minutes ago, LilBit said:

I just contacted the gastroenterologist’s office and let them know that I would like to try tapering the Depakote first and see if my symptoms improve before trying Xifaxan, unless he is wanting to do an actual test to rule out any infection before starting it.  

 

Sounds good.  Just throwing an antibiotic at a problem without confirming there is an actual infection doesn't seem a good idea to me.  It's good to see you taking charge of your health more.

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LilBit

Thanks Songbird!  Yes I am combining the ER with the Sprinkles.   I am feeling pretty good so far this morning... I enjoy windows like these where I get out and walk the dogs, enjoy the beautiful outdoors and appreciate the small things.  I especially love it when that dreaded brain fog is not around!  🧠 

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Songbird

Glad to hear you are having a window.  I don't have a dog, but going outdoors and walking dogs sounds great.  There are scientific studies showing that pets are good for our health.

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Altostrata

How many days have you been taking 437.5mg Depakote?

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LilBit

Nov 12

 

135.4 lbs.  1720 cal

 

6:20am  cramps/diarrhea 

7:20am  diarrhea

9:00am  nausea

9:30am  bowl of oatmeal (200 cal)

10:25am  500mg Depakote

1:30pm  baked potato soup with carrots (600 cal)

5:00pm  half of a medium turkey original from Schlotzsky’s (400 cal)

7:30pm  other half of sandwich (400 cal)

8:00pm  greek yogurt (120 cal)

10:40pm  bedtime

12:00am, 1:20am, 2:30am, 3:30am, 4:30am woke up, had hard time because I was wearing the holter monitor which was uncomfortable 

5:45am woke up for the day, got about 3 to 3 1/2 hours of sleep 

 

 

Nov 13

 

134.4 lbs   1690 cal

 

6:50am  loose bm/diarrhea 

9:00am  bowl of oatmeal and banana (420 cal)

9:30am  500mg Depakote

10:00am brain fog / cog fog

11:30am  nausea

2:00pm  nervousness / crying spells

2:40pm  chicken breast, white rice with carrots (400 cal)

2:50pm  noticed clicking in jaw when I chew

4:20pm small serving of bread pudding 

4:50pm abdominal pain right side 

5:15pm  smoked turkey sandwich (500 cal)

7:40pm  bowl of cereal (370 cal)

9:00pm  nausea

9:30pm  22.5mg Quetiapine, 2mg diazepam 

11:00pm  bedtime

1:00am, 2:00am woke up

4:10am  severe abdominal pain/diarrhea

5:00am woke up

5:40am woke up, got about 3 1/2 hrs of sleep

 

 

Nov 14

 

135 lbs  1895 cal

 

4:10am  severe pain/diarrhea

7:15am severe diarrhea

9:00am  bowl of oatmeal and banana (305 cal)

10:00am  550mg Xifaxan, 500mg Depakote

10:30am  diarrhea

11:00am nausea

11:30am  2 cups applesauce (180 cal)

12:00pm  gas

12:00pm  palpitations

1:00pm  gas

1:20pm  diarrhea

1:30pm  blueberry muffin (120 cal)

2:45pm  chicken, rice and carrots (400 cal)

3:20pm  strawberry greek yogurt (120 cal)

5:30pm  small smoked turkey breast sandwich (350 cal)

5:45pm  brain fog

7:30pm  grilled chicken sandwich (420 cal)

9:30pm  22.5mg Quetiapine, 2mg diazepam 

10:40pm bedtime

12:20am, 4:10am, 5:00am woke up

5:45 am woke for day, got about 4 hours of sleep

 

 

Nov 15

 

135 lbs  1890 cal

 

7:50am  cup of oatmeal and strawberry yogurt (320 cal)

10:30am  437.5mg Depakote 

11:45am  Chick fil A grilled chicken sandwich and fries (600 cal)

12:30pm  brain fog / derealization

2:30pm  fish sandwich (430 cal)

4:40pm  back pain

5:00pm  brain fog

6:00pm  back of neck itching

6:30pm  nausea

7:15pm  peach greek yogurt (120 cal)

8:10pm  6 oz of shoulder steak with 1/2 cup white rice (420 cal)

9:30pm  22.5mg Quetiapine, 2mg diazepam 

11:30pm bedtime

12:40am, 1:40am, 4:10am woke up

5:45am woke for day, got about 3 1/2 hours sleep

 

 

Nov 16

 

135 lbs, soft bm urine ok,  1960 cal

 

9:20am  437.5mg Depakote

11:00am  bowl of cereal and banana (400 cal)

12:45pm  nausea

2:00pm  grilled chicken sandwich (310 cal)

2:20pm  nausea, palpitations 

3:00pm  weakness

5:00pm  hungr buster jr from Dairy Queen (400 cal)

7:30pm  chicken breast with peas, rice and apple juice (850 cal)

9:30pm  22.5mg Quetiapine, 2mg diazepam 

11:30pm  bedtime

12:50am, 2:00am woke and had a hard time falling back asleep due to body pain on side I was lying on

5:20am woke up

6:20am woke up, got about 4 hours of sleep 

 

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LilBit
2 hours ago, Altostrata said:

How many days have you been taking 437.5mg Depakote?

 

It’s been 3 days so far, I reduced it on the 15th... I need to update my signature. 

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wantrelief

How wonderful you had a window, LilBit!  I hope more come your way soon. 

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Altostrata

The reduction to 437.5mg is taking effect.

 

In 2 days, I'd reduce to 400mg Depakote. Please continue to take notes.

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LilBit

I’m so glad the site is back online, was starting to worry!  🙂

 

Well just when I felt things were going well, I have nausea and had a bout of diarrhea a little while ago.  😔  I also did not get any sleep last night because my CPAP machine came in and it was the first night I tried using it, I know it is going to be an adjustment.  I have felt totally out of it today, and something occurred to me that I never thought of.  What if the prolonged sleep deprivation is causing some sort of hypercatabolic or hypermetabolic effect?  I continue to lose weight and body mass even though I am eating, and I’m sure my insomnia and stress are not helping.  My arms, hands and legs are even thinner and this concerns me.  I feel like no doctors are taking me seriously on this and I want to catch it early if it’s the case.

 

I do like the idea of continuing the Depakote taper.  The sooner I can get off

of this poison the better!  I’ll continue to provide updates as I go.  Thanks for the feedback.

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Altostrata

My guess is your digestive problems and weight loss are because Depakote makes your liver unhappy.

 

Your liver will heal but there may be some ups and downs.

 

Lack of sleep tends to make people feel poorly but doesn't cause liver or kidney lesions. I don't believe your theory is valid.

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