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BfromNJ

BfromNJ: mirtazapine taper

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Altostrata
8 hours ago, BfromNJ said:

@Altostrata

HI Alto.  You previously asked whether I have tried eliminating the probiotic.  I was reading up on it in the forums, but not clear to me on whether they can be detrimental to your taper or withdrawal.  Should I drop it and see if it helps?   does it interact with the medication? 

 

I would stop the probiotic and see what happens. You might be allergic to it.

 

Please continue to post your daily notes, include the shaking feeling.

 

Does this always happen after you take Seroquel

11 hours ago, BfromNJ said:

10:00- 25 mg seroquel
- legs feeling activated 

 

What is the sensation you get in your legs?

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BfromNJ
25 minutes ago, Altostrata said:

 

I would stop the probiotic and see what happens. You might be allergic to it.

 

Please continue to post your daily notes, include the shaking feeling.

 

Does this always happen after you take Seroquel

 

What is the sensation you get in your legs?

The shaking tremor feeling is all day, thru my body.   It's like an internal vibration.   More noticable in legs.  It's been worse last week or so.  But I've had it a while 

 

The activated , restless feeling in my legs was in my log from yesterday. It started up yesterday in the afternoon.  It is awful today.  I need to stand for relief .  And yes I will have my notes for today later.  I had some months back but it went away.  It has persisted all day today.  

  

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BfromNJ
2 hours ago, Altostrata said:

 

I would stop the probiotic and see what happens. You might be allergic to it.

 

Please continue to post your daily notes, include the shaking feeling.

 

Does this always happen after you take Seroquel

 

What is the sensation you get in your legs?

And sorry also no it doesnt happen after the seroquel.   I just mentioned it there because it started to bother me again around that time.

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BfromNJ

7/5 drug/symptoms 

 

5 00- up.  slept ok.   very exhausted and nauseous.  
5:20- 190 mg gabapentin
6:00- breakfast
legs feel activated and restless, really bad when sitting.  head feels fuzzy and thick, ears ringing 
nausea subsided
6:15- probiotic
7:00- burning in chest, back
7:30- ringing is bad and continues thru morning
9:00- legs act up again ,  feeling overall down, anxiety , dr/dp,  hopeless, hard to put into words
10:00- when outside to sit and noticed bad floaters in vision.
11:30- feeling very depressed  . cried some.  
12:00- lunch
- problem with legs is severe now (some relief when I stand )
12:15 - 190 mg gabapentin and 18.75 mg luvox
2:30- legs still activated and restless. this is such a disturbing feeling.  anxiety.  feel like crying again.  hopeless.  
4:30.  - very bad episode of depression and crying.  
6:30- meditated.  - it felt good
8;00- burning chest and mouth. 
,- legs still restless and activated , mood is ok
8:30- gabapentin 190 mg
9:00- legs calmed down for about an hour.
,internal tremor, shaking very prominent, especial in feet, legs
10 - 25 mg seroquel 
11- bed

Fell asleep ok .   Usually do knock out. Despite the internal tremor/shaking
 

If this is too wordy or is wrong somehow please let me know.  

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Altostrata

You're still taking the probiotic?

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BfromNJ
1 hour ago, Altostrata said:

You're still taking the probiotic?

I did not take it today Alto and will continue not to.   i have been taking this same one for quite some time now.  pearls complete .   

 

I will post my daily notes later for today, but just wanted to let you know that my restless, activated legs is continuing today.  I get some breaks from it, but its pretty consistant .  It at times is hard to deal with.  and waves of anxiety, bouts of deep depression.   I hope this is not akithisia.  when I was inpatient i was given cogentin for muscle twitches.  could lowering the gabapentin have set off akithisia as a seroquel side effect?   

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KMart95

A lot of your symptoms correlate with menopause. You said you're in peri right? Tinnitus is a pretty common menopause symptom due to the changes happening with your hormones.

 

Also, some people in withdrawal develop histamine intolerance. Certain strains of probiotics are high in histamine and this may be what is causing the burning sensations.

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BfromNJ
47 minutes ago, KMart95 said:

A lot of your symptoms correlate with menopause. You said you're in peri right? Tinnitus is a pretty common menopause symptom due to the changes happening with your hormones.

 

Also, some people in withdrawal develop histamine intolerance. Certain strains of probiotics are high in histamine and this may be what is causing the burning sensations.

Oh wow that's a very interesting.  Thank you so much..  I am eliminating  the probiotic.  

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BfromNJ

Daily log

 

7/6

slept fine.  
5:40- 190 mg gabapentin
- back in bed .  muscle twitches, internal tremor, waves of anxietslepty
7:45- up
-legs feel activated/restless. tremor continues, very noticable in feet, like a tingling uncomfortable to sit, very difficult to drive- this persists all morning. 
8:30-burning in ear, chest , mouth
9:30- breakfast - bagel
9-12:00- waves of anxiety , tightness in chest, feelings of hopelessness, scared and deep depression
12:30- gaba 190 mg and luvox 18.75 mg
- banana and glass of milk
1:00- feel a little calmer
1:15- meditated
2:00- burning sensation through chest, torso and ear , creepy crawly/tingling feeling in feet and lower legs (left worse)
- 6:30- dinner 
- calmer mood .  
- 7:00 -legs  feeling  better but still tremor and tingly, but not as restless
,8:00- severe burning in chest , mouth , stomache
8:30- legs very bad.  agonizing. - very activated .  painful.  various tingling/internal tremor throughout body.  ear burns.  
- 190 mg (.238 pill weight) gabapentin
10:15- 25 mg seroquel
10:45- bed- activated, restless legs , internal tremor/shaking.  fell asleep ok .  

 

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Altostrata

Do your symptoms get worse after you take gabapentin?

 

It looks like the Luvox has a beneficial effect.

 

We have been around and around adverse effects from gabapentin before.

 

On 5/13/2019 at 9:57 AM, Altostrata said:

B, my best guess is you're having adverse effects from gabapentin and you should reduce that next.

 

I'm sorry we haven't answered some of your posts. You seem to ask a lot of questions but not absorb the answers.

 

 

Here are our Tips for tapering off Neurontin (gabapentin)

 

If you have 100mg capsules, you can take part of each dose as a capsule and the rest in liquid.

....

 

and drug interactions

 

On 4/5/2019 at 11:19 AM, BfromNJ said:

Yes I did this.  They all interact with each other.  althought what can I do about interactions until im off of them?    here it is:

 

Interactions between your drugs

Moderate

gabapentin fluvoxaMINE

Applies to: gabapentin, Luvox (fluvoxamine)

Using gabapentin together with fluvoxaMINE 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.

Switch to professional interaction data

Moderate

gabapentin QUEtiapine

Applies to: gabapentin, Seroquel (quetiapine)

Using gabapentin together with QUEtiapine 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.

Switch to professional interaction data

 

Moderate

fluvoxaMINE QUEtiapine

Applies to: Luvox (fluvoxamine), Seroquel (quetiapine)

FluvoxaMINE may increase the blood levels of QUEtiapine. You may be more likely to experience side effects such as dizziness; drowsiness; dry mouth; constipation; increased appetite; weight gain; increased blood sugar and cholesterol or triglyceride levels; cognitive and motor impairment; involuntary muscle movements involving the face, tongue, or other parts of the body; difficulty swallowing; low blood pressure (especially at the start of treatment or after a dose increase); blood pressure increases (reported in children and teenagers); irregular heart rhythm; and seizures. Let your doctor know if your condition changes or you experience increased side effects. 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.

 

 

but as I recall, you don't want to make any drug changes. So what is it you want to do here?

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BfromNJ
47 minutes ago, Altostrata said:

Do your symptoms get worse after you take gabapentin?

 

It looks like the Luvox has a beneficial effect.

 

We have been around and around adverse effects from gabapentin before.

 

 

and drug interactions

 

 

but as I recall, you don't want to make any drug changes. So what is it you want to do here?

I did make a change.  I started reducing the gabapentin on 6/5.  5% to start.  The issues with my legs started three weeks after that first reduction.  I will look at my log to see if they kick up after my gabapentiln doses.  I'm having a hard time determining that.   I held after my luvox drop in april because it was 25%.  Then gaba I started 6/5. That was what was suggested by you and shep so I started the gaba.   I'm going on vacation 7/21 so thought it wise to wait until after to do another.  If the luvox is beneficial maybe I should take it earlier in the am? 

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BfromNJ

7/7

 

slept fine.  
5:40- 190 mg gabapentin
- back in bed .  muscle twitches, internal tremor, waves of anxiety
7:45- up
-legs feel activated/restless. tremor continues, very noticable in feet, like a tingling uncomfortable to sit, very difficult to drive- this persists all morning. 
8:30-burning in ear, chest , mouth
9:30- breakfast - bagel
9-12:00- waves of anxiety , tightness in chest, feelings of hopelessness, scared and deep depression
12:30- gaba 190 mg and luvox 18.75 mg
- banana and glass of milk
1:00- feel a little calmer
1:15- meditated
2:00- burning sensation through chest, torso and ear , creepy crawly/tingling feeling in feet and lower legs (left worse)
- 6:30- dinner 
- calmer mood .  
- 7:00 -legs  feeling  better but still tremor and tingly, but not as restless
,8:00- severe burning in chest , mouth , stomache
8:30- legs very bad.  agonizing. - very activated .  painful.  various tingling/internal tremor throughout body.  ear burns.  
- 190 mg (.238 pill weight) gabapentin
10:15- 25 mg seroquel
10:45- bed- activated, restless legs , internal tremor/shaking.  fell asleep ok .  

 

My concern is the issue with my legs.  Today I will try to be cognizant as to whether the doses of gaba are making symptoms worse.  I was wondering if my reduction could have brought it on.  

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BfromNJ

I have started my taper of gabapentin .  I see here that water titration seems to be recommended.  But I am doing mine by just removing the needed amount from my capsules.  it seems to work for me.  Any downsides to this way?  I just wasn't comfortable with the whole water method.  

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BfromNJ
On ‎7‎/‎5‎/‎2019 at 4:39 PM, Altostrata said:

I would stop the probiotic and see what happens. You might be allergic to it.

So Alto, two days without the probiotic and the burning sensation I had throughout my chest, torso, ears etc is at a minimal for two days.   maybe you are correct. Could this also be histamine intolerance?   I will moniter but I am hoping this is one positive!  on to the rest. 

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Altostrata

Yes, you could have histamine intolerance. Please use search to read our discussions about this.

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Altostrata

How do you measure your custom gabapentin dosage?

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BfromNJ

I got an average of ten capsules.  Which was .125.  X 2 which is .250.  This is my dose I take three times a day 

 

.250 x 95% = .238 pill weight. I re capsule this into one larger capsule. This is what I take 3 x per day.  Brass monkey said I was good.   I seem to need to wait a bit longer in between drops.  I may do brassmonkey slide next.  

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BfromNJ

7/9 daily log

 

4:30- woke up sudden with anxiety (cortisol?)
not able to fall back asleep, but may have dosed off.  rumination/racing thoughts. 
6:30- up. 
-190 mg (.238 pill weight) gabapentin. 
8:00 -some heartburn
9:00- some dizzyness , out of sorts , dp/dr? ( but had bloodwork and no breakfast yet).  persisted through the morning.  head is buzzing . 
11:30- legs acting up a bit/activated, starting to hurt
12:30- 190 mg (.238) gaba and 18.75 mg (.096) luvox
3:00- fatigue.    legs feel jittery/nervous.
-ringing/fullness in ears
5:00- legs and feet very achy . 
8:00- walked dog.
-after walk feet and legs tingling and painful
8:30- 190 mg gabapentin
-ringing in ears bad
9:30- 25 mg seroquel
10:00- bad pain in fear and legs restless when laying down to sleep
- fell asleep ok

 

internal tremor/vibration  is present all day as usual and very bad today.  tinnitus a bit up as well. 

 

My legs are right now the worst symptom, as well as the increase in anxiety and deep bouts of depression.   

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BfromNJ
On ‎7‎/‎6‎/‎2019 at 5:15 PM, KMart95 said:

A lot of your symptoms correlate with menopause. You said you're in peri right? Tinnitus is a pretty common menopause symptom due to the changes happening with your hormones.

 

Also, some people in withdrawal develop histamine intolerance. Certain strains of probiotics are high in histamine and this may be what is causing the burning sensations.

I did like alto said and eliminated the probiotic.  for a few days now the burning has subsided.   What do you think about maybe even the leg pain, tremors etc relating to menopause? boy these hormones really mess with us. between that and the meds, etc, this is a terrible time in my life.  If I could just go back in time I would really do things differently if I knew what I know now about meds. 

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KMart95
41 minutes ago, BfromNJ said:

I did like alto said and eliminated the probiotic.  for a few days now the burning has subsided.   What do you think about maybe even the leg pain, tremors etc relating to menopause? boy these hormones really mess with us. between that and the meds, etc, this is a terrible time in my life.  If I could just go back in time I would really do things differently if I knew what I know now about meds. 

I'm not sure about leg pain, but tremors yes. I'm only 24 but i've done a lot of research about the symptoms of menopause because I came off the pill a few months ago and my hormones are out of whack - I have all the symptoms of menopause. I definitely recommend reading up on menopause ! The symptoms are actually VERY similar to withdrawal so it may give you some peace of mind to know what is happening to your body at this time. 

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BfromNJ
26 minutes ago, KMart95 said:

I'm not sure about leg pain, but tremors yes. I'm only 24 but i've done a lot of research about the symptoms of menopause because I came off the pill a few months ago and my hormones are out of whack - I have all the symptoms of menopause. I definitely recommend reading up on menopause ! The symptoms are actually VERY similar to withdrawal so it may give you some peace of mind to know what is happening to your body at this time. 

Its so frustrating these hormones reek havoc.  And I know I'm peri because I'm going months without periods.

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Altostrata
11 hours ago, BfromNJ said:

internal tremor/vibration  is present all day as usual and very bad today.  tinnitus a bit up as well. 

 

My legs are right now the worst symptom, as well as the increase in anxiety and deep bouts of depression. 

 

What day did you reduce gabapentin, from what to what in milligrams? Are your symptoms on 7/9 significantly worse than your prior symptoms?

 

You're taking a lot of drugs. Your symptoms, including anxiety and depression, may be side effects of them.

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BfromNJ
1 hour ago, Altostrata said:

 

What day did you reduce gabapentin, from what to what in milligrams? Are your symptoms on 7/9 significantly worse than your prior symptoms?

 

You're taking a lot of drugs. Your symptoms, including anxiety and depression, may be side effects of them.

by prior Alto, do you mean prior to the gabapentin drop?  If that is what you mean then yes.   This issue with my legs which is the worst started on 7/4. the internal tremor/shaking has been with me  a while but has gotten worse and consistant.  and the anxiety and depression has gotten worse.  before the drop, it was feeling more settled.  thats why i proceeded.  

 

I reduced the gabapentin starting on 6/5.  I went from .250 (average weight of two capsules) to .238 pill weight.  5%.  or 200 mg per dose to 190 mg per dose.  this is where i am at. 

 

 

Yes I understand I am taking alot.  Do you think it could be akithisia?  and if so, could it settle down?   

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Altostrata

Did you see your drug interaction report? What do you think "cognitive and motor impairment; involuntary muscle movements involving the face, tongue, or other parts of the body; difficulty swallowing; low blood pressure (especially at the start of treatment or after a dose increase); blood pressure increases (reported in children and teenagers); irregular heart rhythm" and so forth means?

 

My guess is you're having bad drug-drug reactions, which I believe I've explained a half-dozen times already. My guess is the drug-drug reaction has been getting progressively worse since you started Luvox with Seroquel, which obviously is a terrible combination, and you are feeling adverse effects from Seroquel, which you mistake for gabapentin withdrawal. You are also having other adverse reactions from gabapentin, such as tinnitus.

 

Most likely, you'll feel a lot better when you minimize your drug burden. This is not going to happen unless you REDUCE THE DRUGS, which you seem very reluctant to do.

 

If you can't find a doctor to help you minimize your drugs, you'll have to figure it out yourself. We're trying to help but it seems you are having a lot of trouble understanding.

 

We cannot promise you this process will be painless. If you want that kind of promise, you'll have to talk to a psychiatrist.

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BfromNJ
1 hour ago, Altostrata said:

Did you see your drug interaction report? What do you think "cognitive and motor impairment; involuntary muscle movements involving the face, tongue, or other parts of the body; difficulty swallowing; low blood pressure (especially at the start of treatment or after a dose increase); blood pressure increases (reported in children and teenagers); irregular heart rhythm" and so forth means?

 

My guess is you're having bad drug-drug reactions, which I believe I've explained a half-dozen times already. My guess is the drug-drug reaction has been getting progressively worse since you started Luvox with Seroquel, which obviously is a terrible combination, and you are feeling adverse effects from Seroquel, which you mistake for gabapentin withdrawal. You are also having other adverse reactions from gabapentin, such as tinnitus.

 

Most likely, you'll feel a lot better when you minimize your drug burden. This is not going to happen unless you REDUCE THE DRUGS, which you seem very reluctant to do.

 

If you can't find a doctor to help you minimize your drugs, you'll have to figure it out yourself. We're trying to help but it seems you are having a lot of trouble understanding.

 

We cannot promise you this process will be painless. If you want that kind of promise, you'll have to talk to a psychiatrist.

I am reducing.  I did luvox at 25% in April.  Then it was suggested I hold off on that because it looked like i was having adverse reactions from gaba.   I followed advice.  So i did as suggested and started to reduce the gabapentin.  If it appears not to be gaba now what is my next step?  I have listened and I understand.    The only thing different I did was wait a bit longer after my first reduction.  It was a big one.   Do i reduce the luvox again and hold gaba where it is?  If so, 10%?  I see no benefit of seeing a doctor or psychiatrist.   I do fine with my scale.  

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BfromNJ

7/10

5:00- up before alarm - racing thoughts/rummination
5:30- up
- 190 mg (.238) gabapentin
- mild anxiety.  feeling very hopeless,  depressed.  numb.- improved
6:00- legs feel activated/restless - settled down
7:30- tingling bad in feet, worse in left.  this is consistent all morning. 
10:30-  legs are aching, tingling.  internal tremor/shaking bad in body and head.   stood up and felt like floor was moving. 
12:00- severe wave of anxiety.   legs are very restless and painful. feel dizzy and out of sorts (dp/dr?)
12:30-  190 mg gabapentin and 18.75 mg luvox
-zaps and increase in ringing - passes
1:15- leg pain and restlessness calmed.  still have internal trembling and tingling .
1:45 - slight burning in chest and throat.- passes.
  mood and legs much better.  gets even better thru afternoon.  still some restlessness and pain in them though
5:00- work out.  30 min. elliptical very light.
-legs activated/restless again with surges of anxiety -persists thru evening. 
6:30-dinner
internal tremor/shakes more bothersome
7:00- leg pain
8:30- 190 mg gabapentin
10:00- 25 mg seroquel
fell asleep ok but woke up at 2:30 am with bad internal tremors/ shaking.  noticable in head.  and had trouble falling back.  eventually did

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Altostrata
22 hours ago, Altostrata said:

Did you see your drug interaction report? What do you think "cognitive and motor impairment; involuntary muscle movements involving the face, tongue, or other parts of the body; difficulty swallowing; low blood pressure (especially at the start of treatment or after a dose increase); blood pressure increases (reported in children and teenagers); irregular heart rhythm" and so forth means?

 

Those symptoms are from the drug-drug interaction with Seroquel. You might try reducing Seroquel next. See Tips for tapering off Seroquel (quetiapine)

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BfromNJ
38 minutes ago, Altostrata said:

 

Those symptoms are from the drug-drug interaction with Seroquel. You might try reducing Seroquel next. See Tips for tapering off Seroquel (quetiapine)

When they say " involuntary movements" , is this internal tremors as well?   If I go lower , you think it will still help me sleep?  And do I keep the gabapentin where it is right?  Just hold? It will be time consuming for sure because I'm weighing and recapsuling two meds already.   I feel like a mad scientist.  🤣🙄 thank u I will check the thread.  Good night to you. 

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Altostrata

You're taking 3 drugs. Nobody would be able to figure out exactly what drug is causing what. They're all interacting.

 

I stated above that I think you are also having an adverse reaction to gabapentin.

 

Whatever doctor put you on these 3 drugs at once time was not following good medical practice. I can't tell you exactly what you need to do to make this drug cocktail more tolerable. There are too many moving parts. All you can do is change one drug at a time and see what happens.

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BfromNJ
5 minutes ago, Altostrata said:

You're taking 3 drugs. Nobody would be able to figure out exactly what drug is causing what. They're all interacting.

 

I stated above that I think you are also having an adverse reaction to gabapentin.

 

Whatever doctor put you on these 3 drugs at once time was not following good medical practice. I can't tell you exactly what you need to do to make this drug cocktail more tolerable. There are too many moving parts. All you can do is change one drug at a time and see what happens.

Okay.  So it's okay to drop a bit from one, then hold that and do another without finishing one? 

I am going on a cruise on 7/21.  Would it be best if I do the seroquel when I get back? 

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BfromNJ
10 hours ago, Altostrata said:

You're taking 3 drugs. Nobody would be able to figure out exactly what drug is causing what. They're all interacting.

 

I stated above that I think you are also having an adverse reaction to gabapentin.

 

Whatever doctor put you on these 3 drugs at once time was not following good medical practice. I can't tell you exactly what you need to do to make this drug cocktail more tolerable. There are too many moving parts. All you can do is change one drug at a time and see what happens.

Okay.  So it's okay to drop a bit from one, then hold that and do another without finishing one? 

I am going on a cruise on 7/21.  Would it be best if I do the seroquel when I get back? 

  7/10 daily log

 


 

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BfromNJ

5:00- up and layed in bed a bit
5:45- 190 mg gabapentin (.238)
- the usual internal tremor/shaking/pulsing 
8:30-  legs start to feel a bit activated/restless.  
-some zaps, mild ringing. -gets better
10:00- various areas of pulsing feet, vaginal area, head.- passes
12:00- anxiety surges along with very bad restless/activated legs, cant sit
12:30- 190 mg gabapentin and 18.75 mg luvox.
 2:30- feel better anxiety wise.  
- still have internal tremor/shaking .  very bad
- burning sensation on upper back.  
3:00- heartburn.
4:30- legs activated/restless- painfully so, cant sit. seems to radiate to back .
   anxiety in store. out of sorts
6:00- restlessness/activation seems to radiate to back. 
8:00- legs much better, almost not noticible
8:30-  intense burning in stomach, sore throat,  nausea 
8:45- 190 mg gabapentin (.238 pill weight)
9:45- 25 mg seroquel

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BfromNJ
On ‎7‎/‎8‎/‎2019 at 10:38 AM, BfromNJ said:

I have started my taper of gabapentin .  I see here that water titration seems to be recommended.  But I am doing mine by just removing the needed amount from my capsules.  it seems to work for me.  Any downsides to this way?  I just wasn't comfortable with the whole water method.  

Im not sure why this posted here on this date.  please disregard, my gaba taper was started on 6/5. 

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BfromNJ

@Altostrata  when I start the Seroquel reduction, should I go for the 10%?   or a more conservative 5%? I do know I need to reduce my burden, but I also want to try and hold onto what sleep I can.  Hopefully the gabapentin will help with that. 

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BfromNJ
1 hour ago, BfromNJ said:

@Altostrata  when I start the Seroquel reduction, should I go for the 10%?   or a more conservative 5%? I do know I need to reduce my burden, but I also want to try and hold onto what sleep I can.  Hopefully the gabapentin will help with that. 

In reading more about this med, I can honestly say that this is indeed the right one to tackle now.  I wish I'd started with it.   but I needed my sleep.  and now ironically I think the side effects of this horrid drug (restless legs, internal tremors, etc) will probably be what keeps me awake.

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Altostrata

If you feel safer decreasing by 5%, try that first.

 

It's up to you whether you want to taper during your cruise. You'll still have to keep daily notes during any drug changes.

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