kayjaydee: clomipramine

[kayjaydee]

I have a long history of anxiety, was on chlorpromazine and diazepam as a teenager; I'm now 67. Developed OCD in 1970s. Drug-free till 1990s. Developed CFS in 1986, OCD worsened and developed depression over the next 5 years. Prozac from 1991 till 1994, helped to some extent, then OCD worsened again. Switched to dosulepin in 1994, then to clomipramine on the advice of a clinical psychologist in July 1994. Helped a little with the OCD, but to everyone's surprise helped a lot with the CFS. Have been on clomipramine since then, doses from 25 to 125 mg - mostly between 50 and 100mg. The OCD resolved in 1997 after various non-drug therapies, but have continued with the clomipramine because it helped the CFS - usually a dose increase would help after a setback. Since about 2005 the doses my GP allowed did not help the CFS.....tried citalopram in 2007, no better and had a nasty reaction 4 weeks after stopping the clomipramine/starting citalopram - extreme anxiety and uncontrollable shaking. At the time, scared it might be serotonin syndrome - the citalopram had just started to "kick in" - but maybe it was clomipramine withdrawal. Tried dosulepin again in mid 2007 - that made me anxious and did not help the CFS, so switched back to clomipramine. I would like to reduce it.....currently having supply problems in the UK as some manufacturers have stopped producing it, and the constipation is really getting me down. I'm currently on 50mg/day, but my GP and I are talking about reducing it....not sure it's helping any more (the CFS is greatly improved these days, irrespective of clomipramine dose), and would like to find out if I can cope without it.

[Gridley]

Welcome to SA, kayjaydee.  We can help you taper the Clomipramine.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, the last 12-24 months particularly.  Please let us know how you take the Clomipramine.  Is is a capsule with powder inside?  

 

Account Settings – Create or Edit a signature.

 

At SA we take a harm reduction approach to tapering.  This means we recommend tapering no more than 10% of current dose every four weeks.  Some members have to taper more slowly.

 

So your first taper would be a 10% reduction of your current 50mg, which would be 45mg.  You would hold for four weeks, then reduce by 10% of 45mg, etc.  You should know that doctors generally know little or nothing about tapering or antidepressant withdrawal and so very often advise a too-fast taper that can result in some very unpleasant withdrawal symptoms.

 

Why taper by 10% of my dosage?

 

What is withdrawal syndrome.

 

These links explain what is happening in your brain as you taper and heal.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

To get the nonstandard doses you will need for your taper, there are basically three different methods--making your own liquid from the tablet or powder (I believe Clomipramine is water soluble), getting the drug in liquid form (if available), or weighing the tablet or powder using a scale such as the Gemini-20, available on Amazon.  Another approach is to have your dose made by a compounding pharmacy.  

 

How to make a liquid from tablets or capsules
General instructions on making a homemade liquid suspension
 

Using a digital scale to measure doses
Digital scales can measure less than 1mg by weight

Compounding pharmacies (US, UK, and elsewhere)
These pharmacies can make up custom dosages and liquid medications

 

This is your Introduction page, where you can update on your progress and ask questions.

 

 

 

 

 

 

 

Edited December 9, 2018 by Gridley

[kayjaydee]

Will do the signature soon. Clomipramine may be water soluble, but I've tasted it (when a capsule split in  my mouth) - no way! If I have to reduce that slowly, I'll get the scales and measure it.

[kayjaydee]

I've just started tapering, currently on 44 mg clomipramine. Having problems with the capsule sizes available - at present in this area of the UK you can't get the 25mg capsule, so it's a choice between 50 and 10mg. At the moment I'm alternating doses, 3 days on 50mg and 1 on 25mg (using up a few I had left) - I know you don't advise alternating doses, but I've done it successfully in the past with clomipramine, I think the long half-life means it evens out from day to day pretty well. Hopefully I shall get 10mg capsules in my next prescription, which will make it easier.

[ChessieCat]

You can make your own liquid.  From Post #1 of tips-for-tapering-off-clomipramine-anafranil

 

Your brain likes stability.  You can take a tablet + liquid to make the dose you need.

 

Make a clomipramine liquid yourself from tablets or capsules

Clomipramine is soluble in water. See How to make a liquid from tablets or capsules

 

Use an oral syringe to precisely measure out doses as small as .01mg.

[kayjaydee]

The liquid may be the way to go when I get to smaller reductions - tho I have to say, clomipramine tastes absolutely disgusting, I'd need to squirt it down the back of my tongue. For now, I can cope on the capsules. Thanks for the info.

[kayjaydee]

Have been fine on the 44mg, just reduced to 40 this week.

[ChessieCat]

Please update your drug signature with the drug, date and dose.    Account Settings – Create or Edit a signature

[kayjaydee]

OK, have done.

[kayjaydee]

I'm getting quite a bit of muscle pain - not sure if it relates to tapering, maybe I picked up a bug. Holding the dose at 40mg for now. Currently it's difficult to get clomipramine in the UK, having to shop around different pharmacies. I hope it won't become unavailable; could be a fast taper if so.

[kayjaydee]

I've been tapering for just over 2 months; started at 50mg clomipramine, had 4 weeks at 44mg and so far 5 weeks at 40mg. About a week ago I began to get muscle pain and headaches, which have persisted. What puzzles me is that I've reduced from 50mg to 37.5 (alternating doses of 50 and 25mg) several times in the past, without getting muscle pain as a reaction....so why is it happening this time?

[kayjaydee]

I suspect worry about the availability of clomipramine locally isn't helping - scared I might not be able to get it, and have to fast taper/CT.

[Gridley]

6 hours ago, kayjaydee said:

I've been tapering for just over 2 months; started at 50mg clomipramine, had 4 weeks at 44mg and so far 5 weeks at 40mg. About a week ago I began to get muscle pain and headaches, which have persisted. What puzzles me is that I've reduced from 50mg to 37.5 (alternating doses of 50 and 25mg) several times in the past, without getting muscle pain as a reaction....so why is it happening this time?

 

The central nervous system can become  over-sensitized after several bouts of going up and down on a drug.  This is known as kindling.  Because of this sensitization, what worked once or twice might not work the next time.  You might want to continue holding at 40mg until these symptoms resolve.

 

We strongly advise again alternating doses.  Your system craves stability.

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

[kayjaydee]

I plan to hold it at 40mg for a while. I've been alternating 50 and 30mg, trying to conserve more of my 10mg capsules (I have spare 50mg ones)….this is down to the fear of running out. It's annoying to have to ring round the pharmacies to see who has clomipramine and in what doses - my prescription is currently for 10mg capsules, so if the pharmacy only had 25s or 50s I'd have to go back to the surgery (again!) to get a new prescription. I don't know what the manufacturers are playing at in the UK - in November I first had problems when I went to collect my prescription as usual and the pharmacy said "sorry, we don't have any and can't get any, and nor can the other pharmacies in town. You'll have to go back to the doctor and ask for an alternative" - as though one can just switch antidepressant at a moment's notice! I've been able to source them in nearby towns, so far, but there's always the fear that I won't be able to get them. I'll look up what you mention about kindling....I can only try not to worry about running out - it may never happen, and if it does I can't stop it, so I'd just have to face it if and when.

[Gridley]

25 minutes ago, kayjaydee said:

 trying to conserve more of my 10mg capsules 

 

I sympathize.  I live in Ecuador, where one of my drugs is not dependably available and another not at all.  I stock up when I can and hope for the best.

 

Have you considered splitting your Clomipramine to get smaller doses? That might help conserve your inventory.   That's what I did when I was tapering Imipramine, another tricyclic.   I use the AWS Gemini-20 scale, available on Amazon in the U.K., to weigh my doses.  You put the weighed dose in a gelatin capsule, also avalailable on Amazon.  The size 00 is best.

 

 Using a digital scale to measure doses  

[kayjaydee]

I have thought about splitting doses, or making capsules into liquid. I may well investigate the scales (much as I dislike Amazon for not paying their taxes!) and I already have some empty capsules I got online….for right now, I'm sticking on 40mg (4 x 10mg) and, as you say, hoping for the best, and refusing to worry about what "might" happen - no point worrying about it in advance.

 

[kayjaydee]

Things have settled down, so I've reduced the dose to 35mg. Still problems with the supply - last time I could only get 10mg capsules, now I can only get 25mg - causes a lot of bother getting prescriptions redone!

[Gridley]

15 minutes ago, kayjaydee said:

, so I've reduced the dose to 35mg.

 

You'll need to hold there for at least 4 weeks.

 

Why taper by 10% of my dosage?

 

Your next reduction at that time should be no more than 3.5mg, which would be 31.5mg.  Don't be tempted to go too fast for convenience sake.  Those who go too fast often end up taking longer because they have to updose or hold to stabilize.

[kayjaydee]

Yes, I plan to hold it for 4 weeks. I've ordered some milligram scales, so when they turn up I'll have the ability to adjust doses more precisely.

[kayjaydee]

Just tried weighing the contents of a capsule - several problems; 1. it's hard to get all the powder out of the capsule. 2. it takes so long to get the powder out, the scales switch off in the meanwhile. I think I can get round this by weighing the container separately, adding the powder and weighing again and subtracting, rather than using the convenient tare function on the scales. 3. when I pour the powder from either the scale pan or a sheet of folded paper into a fresh capsule, some powder stays stuck to the surface, so how do I know how much I've actually transferred? Is the amount left behind significant? It would be so much easier if the contents were beads rather than powder! Not sure whether to continue to try this, or maybe try dissolving contents of capsules - I have at least a couple of weeks before the next reduction. I don't want to waste capsules trying to get the measuring right, when I'm still unsure of my supply - I was hoping to use up some of the 50mg ones (which otherwise won't get used), to get a dose of 31.5mg.

[Gridley]

5 hours ago, kayjaydee said:

when I pour the powder from either the scale pan or a sheet of folded paper into a fresh capsule, some powder stays stuck to the surface, so how do I know how much I've actually transferred? Is the amount left behind significant? I

 

Get LabExact Grade WW Non-absorbent weighing paper, available on Amazon, box of 500 sheets.  I place a sheet on the scale, pour the powder onto the sheet, remove the excess powder with tweezers to get the weight you want, then bend the sheet and pour powder  into the capsule.  It does not stick to the weighing paper.  Takes a little practice but it works.

[kayjaydee]

Sounds like a good idea....Amazon say it's out of stock, but I'll see if I can come up with an alternative.

[kayjaydee]

I wonder if greaseproof paper would be smooth enough? It leaves only a faint residue when tested with flour (which I'm assuming has a similar consistency).

[Gridley]

5 minutes ago, kayjaydee said:

I wonder if greaseproof paper would be smooth enough? It leaves only a faint residue when tested with flour (which I'm assuming has a similar consistency).

 

Sounds like a good idea.  Definitely worth a try.  Aluminum foil?

[kayjaydee]

Not sure aluminium foil would be any better than the metal scale pan. I've been looking online, and all the suppliers of actual "weighing paper" are sending it from China or similar with an expected delivery of up to a month. I could experiment with the greaseproof, test how much of the flour is lost in the transfer, shouldn't be too hard to do.

[Gridley]

Sounds good.  It's interesting the lengths we have to go to, but all worth it.  Using the metal scale pan was very clumsy.  Good luck.  It looks like your taper is going well--congratulations.

[kayjaydee]

I've been practising the weighing using flour....I think I've about got the hang of it....next thing is to try with the actual medication!

[Carmie]

20 hours ago, kayjaydee said:

I've been practising the weighing using flour....I think I've about got the hang of it....next thing is to try with the actual medication!

 

That’s a really innovative idea kayjaydee,

 

All the best when you start tapering again 💚

[kayjaydee]

Just weighed out some 10mg capsules, from my pharmacist-issued 25mg ones (because I'm running out of ready-made 10mg ones, which don't appear to be available at all in the UK at the moment). Hoping my measurements and arithmetic were accurate enough, and that I shall trust them enough to start taking them - I'm currently on 35mg, made up of a 25 and a 10.

[kayjaydee]

Delayed withdrawal symptoms?

 

I'd been doing OK on the 35mg which I've now been on almost 8 weeks....but over the past week I've noticed a sort of light-headed and "spaced-out" feeling, plus a bit of anxiety......not anxious all the time, but more easily triggered than usual. Plus I seem less constipated, and have just also wondered if I'm sweating more than usual (either that, or my usual deodorant has ceased to work!). So I'm wondering if it relates to reducing the dose....I guess it could, it seems almost any symptom can be attributed to that. It's possible a general nervousness about a trip abroad that starts this weekend is contributing as well, tho I don't see as that's likely to affect my guts and sweating.

 

Edited May 9, 2019 by ChessieCat
added topic title

[kayjaydee]

Feeling OK again....just about to try a cut to 32.5mg.

[eymen23]

Kayjaydee,

 

Well done on holding for so long and diligently paying attention to both your symptoms and signs of stability. 

 

Lightheadedness, dizziness, anxiety, GI issues and increased sweating can all be attributed to withdrawal. I have experienced all of those symptoms during waves. Very often it can feel like your entire body is ‘off’ or in some way ‘shutting down’. 

 

Good luck with the next cut and hopefully you will feel more confident going through difficult days if more of same symptoms appear again. 

[kayjaydee]

I cut to 32.5 mg on Saturday...but have felt lousy since, anxious and "overwhelmed" by everything. Not sure what's caused it...on past experience it feels too soon to be that last cut down. Had a stressful time a few weeks back which might be contributing, maybe it's still reaction from the cut to 35mg in March, maybe I've just got excessively worried about stuff (not helped by the lower level of clomipramine in my system making me more susceptible to stress and anxiety)….I dunno, but it doesn't seem a good time to be making a new cut, so I'm going back to 35mg.

[kayjaydee]

Planning a reduction to 32.5mg tomorrow. Feeling pretty much OK, though I think I am a bit more prone to anxiety than I was on higher doses.

[ChessieCat]

Have you considered the Brass Monkey Slide?

[kayjaydee]

I've read about it....it would be more complicated in terms of measuring out doses, and I think I'm OK at the minute with the 10% at a time. I've been stalled on the 35mg for a while, largely because of trips away and not wanting to do a reduction just before. Can't say as I've had much in the way of withdrawal symptoms - I'd expect them to kick in when I get to lower doses, if at all.....the graph for clomipramine occupancy of receptors suggests below 10mg might well be hairy, but that's quite a way in the future.