Silverwattle: Need help understanding tapering

[Silverwattle]

Hi, 

 

I am trying to taper my daughter 15rys off Mirtazaphine.  We have a digital scale.

 

I am more of a visual person and I’m having trouble understanding the tapering guides. 

 

This is what I’m doing atm.

Her pill weighs 156mcg

so the first week I went to 150mcg

this week 140mcg

my plan is to drop by 10m cg ever week

so 15 weeks in total.

 

Obviously if she has symptoms, we will stay at that dose and retaper when appropriate.

 

Am I doing this correctly? 

 

Thanks for for any advice, just trying to give her the best possible withdrawal with limited side effects. 

Edited September 15, 2018 by Silverwattle
Typing error

[ChessieCat]

Hi Silverwattle and welcome to SA,

 

We need some extra information before we can comment about the planned taper.

 

How long has your daughter been taking mirtazapine?

 

What is the reason she is stopping the drug?

 

Is she experiencing any side effects?

 

To help us out, please create a drug signature.  Details we need for the last 2 years are dates, ALL drugs, doses.  For anything older than 2 years ago, just year and drug.  No symptoms or diagnoses, just drug information.  Thank you.  Account Settings – Create or Edit a signature

 

If she has only been taking a psychiatric drug for a short time (several months) she may be able to go faster than SA's recommended taper.  If this is the case, we can give you some suggestions about how to do this.  SA's tapering protocol is to reduce by no more than 10% of the current dose followed by a hold at that dose for about 4 weeks, which allows the brain to adapt to not getting as much of the drug.

 

Why taper by 10% of my dosage?

 

Tips for tapering off Remeron (mirtazapine)

[Silverwattle]

Hi ChessieCat,

 

Since April 2017, she is stopping due to being symptom free since February 2018.  No side effects. 

 

She does have chronic nausea, which is why she was prescribed Mirtazaphine.  We do have 10mg Ondansetron to be taken when needed. 

[ChessieCat]

Thank you for completing the drug signature.

 

Q:  What dose of mirtazapine is she taking?  The signature says 15mg, is that correct?

 

Because she has been on mirtazapine since April 2017 she will need to taper slowly.  Please read the links I provided in my other post.  Psychiatric drugs change the brain and if they are stopped too quickly then you can experience withdrawal symptoms.  Dr Joseph Glenmullen's WD Symptoms Checklist

 

These helped me to understand SA's recommendations:

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

 

 I've asked the other mods for assistance with weighing/measuring the dose.

[Silverwattle]

Thank  you, and yes 15mg Mirtazaphine.  We are happy to go as slow as we need to as we want to hopefully get her off successfully. She did 1.5 years of exposure therapy, and has a supportive team of medical professionals. 

[ChessieCat]

Okay, thanks for confirming the dose.  I got confused with the information given in the first post.

 

To get you prepared for what the other mod/s will talk about these are the terms which will be used.

 

mgai = mg active ingredient = dosage of the drug in the tablet

 

mgpw = mg pill weight

 

This post might help you to start understanding this:  using-a-digital-scale-to-measure-doses and the following post by BrassMonkey explains how to read milligrams using the Gemini-20 scale.

 

[Silverwattle]

Thanks

[Altostrata]

Welcome, Silverwattle.

 

Your reasoning in weighing the tablet and removing x micrograms by weight is correct.

 

However, we recommend a 10% reduction per month. If your daughter's current dose weighs 140mcg, that would be 14mcg reduction over the next 4 weeks. That works out to about 3.5mcg per week. Then, you would recalculate 10% for the next 4 weeks on the resulting 126mcg dosage.

 

At the fastest, you might be able to reduce 10% over 2 weeks, but you must be on the alert for withdrawal symptoms, which can take several weeks to culminate.

 

I would err on the side of caution so as not to trigger nausea, a common withdrawal symptom.

 

See Why taper by 10% of my dosage?

[Silverwattle]

Thank you AltroStrata!

 

That makes things a lot clearer.  Will definitely only do 10% per mo th.