BfromNJ: mirtazapine taper

[Maca44]

Posting about my ups and downs helps me even if no one replies, also I get alot out of reading other posts of the same, like this one.

 

 

[Shep]

50 minutes ago, BfromNJ said:

I dont think I was making  "random complaints ".  I thought my thread was a place where I could post about my ups and downs, observations, etc..    And talking about having a window was not a complaint.  It was an observation that I do have days that are relatively symptom free.    

 

I think Alto was referring to your previous post:

 

12 hours ago, BfromNJ said:

the only thing throwing me off is that I do have days where I can go whole day and lay down at night and feel good.  So that is throwing me off.  If it is too much gaba, wouldn't I feel crappy every day?  Of course I'm grateful for these days.  These windows.  

 

It's unclear if you wish to taper or if you have follow up questions before you feel comfortable in proceeding. It sounds like you do have a question, but you may have answered it yourself (by mentioning "windows"), but it's not clear. That's what I interpret as "random".  It's a pattern that happens periodically in your thread. 

 

Your observations are fine. It's the way you word it in the form of a question that's confusing to the staff. 

 

Are you comfortable in proceeding with tapering the gabapentin?  Alto's main point was about needing a drug and symptoms journal if you need more information. That way we can offer you targeted advice based on your symptoms within the context of when you take your drugs. 

[BfromNJ]

26 minutes ago, Maca44 said:

Posting about my ups and downs helps me even if no one replies, also I get alot out of reading other posts of the same, like this one.

 

 

Thank you I agree.   

[BfromNJ]

18 minutes ago, Shep said:

 

I think Alto was referring to your previous post:

 

 

It's unclear if you wish to taper or if you have follow up questions before you feel comfortable in proceeding. It sounds like you do have a question, but you may have answered it yourself (by mentioning "windows"), but it's not clear. That's what I interpret as "random".  It's a pattern that happens periodically in your thread. 

 

Your observations are fine. It's the way you word it in the form of a question that's confusing to the staff. 

 

Are you comfortable in proceeding with tapering the gabapentin?  Alto's main point was about needing a drug and symptoms journal if you need more information. That way we can offer you targeted advice based on your symptoms within the context of when you take your drugs. 

I understand Shep.  I guess my question is - if a drug is causing adverse reactions how is it possible to have days when there are no such reactions?  Can this happen? That was all.  

 

And yes I do wish to taper.  My intention will be after i return from a memorial day trip.   And it will be probably 5% to start.   Baby steps this time.  Do you think its wise to wait till after I get back from travelling? 

[Shep]

6 minutes ago, BfromNJ said:

I guess my question is - if a drug is causing adverse reactions how is it possible to have days when there are no such reactions?  Can this happen?

 

It really depends on how bad the adverse reaction is in proportion to how good the window is.

 

You could have a minor headache during a window day and still have a good day. But if you're already exhausted and run down during a wave, that minor headache could be the straw that breaks the camels back, so to speak, during the wave. 

 

So it's really hard to know for sure. The windows and waves pattern makes tapering part science and part art. You could try a small gabapentin reduction and if you feel better, that would speak to an adverse reaction. 

 

8 minutes ago, BfromNJ said:

And yes I do wish to taper.  My intention will be after i return from a memorial day trip.   And it will be probably 5% to start.   Baby steps this time.  Do you think its wise to wait till after I get back from travelling? 

 

I would wait until after you're home. Many people go off their restrictive diets and consume more sugar and carbs during holiday trips. Sleep may also get interrupted if you're in an unfamiliar environment such as a hotel. Also, even good stress can still be taxing on your nervous system. 

 

Please remember to avoid alcohol and caffeine, as they can be major temptations over holiday trips. 

 

Hold where you're at and hopefully you'll have a window to enjoy for your trip. 

[BfromNJ]

32 minutes ago, Shep said:

 

It really depends on how bad the adverse reaction is in proportion to how good the window is.

 

You could have a minor headache during a window day and still have a good day. But if you're already exhausted and run down during a wave, that minor headache could be the straw that breaks the camels back, so to speak, during the wave. 

 

So it's really hard to know for sure. The windows and waves pattern makes tapering part science and part art. You could try a small gabapentin reduction and if you feel better, that would speak to an adverse reaction. 

 

 

I would wait until after you're home. Many people go off their restrictive diets and consume more sugar and carbs during holiday trips. Sleep may also get interrupted if you're in an unfamiliar environment such as a hotel. Also, even good stress can still be taxing on your nervous system. 

 

Please remember to avoid alcohol and caffeine, as they can be major temptations over holiday trips. 

 

Hold where you're at and hopefully you'll have a window to enjoy for your trip. 

That is my plan.  And no booze for me I'm sober 9 years.  And no caffeine either.  

[BfromNJ]

@Shep

 

So one question on the gabapentin taper. If I start at 5% the first time, then all goes well with that, could I jump to 10% the next one?  Is it bad to increase the percent of the cut?  should it remain consistant?  Im just wondering if the destablilizes a person.  I know I can always slow down, but I wasn't sure about going up higher is an okay thing to do or is a consistant percentage is better.  I would like to be able to up it if the 5% ends up being a no brainer (pardon the pun, lol).  

 

Also, im reading on liquid tapering and im so confused on how to do it.  I was thinking of doing this with gabapentin because I take 6 capsules a day, and cutting some out of each is a loooong process.  is there a link or information that explains this is a child like sense?  lol.    

[Altostrata]

11 hours ago, BfromNJ said:

I guess my question is - if a drug is causing adverse reactions how is it possible to have days when there are no such reactions?  Can this happen? That was all.  

 

I can't answer you question unless I see daily symptom notes. Same with your initial reduction of gabapentin.

 

Yes, you can post your ups and downs in your Intro topic.

 

Let's make this a rule: If you want an answer to a question about your taper, you need to post daily notes. Otherwise, no answers from the staff, we'll assume you don't expect an answer.

[BfromNJ]

38 minutes ago, Altostrata said:

 

I can't answer you question unless I see daily symptom notes. Same with your initial reduction of gabapentin.

 

Yes, you can post your ups and downs in your Intro topic.

 

Let's make this a rule: If you want an answer to a question about your taper, you need to post daily notes. Otherwise, no answers from the staff, we'll assume you don't expect an answer.

I just posted a question about my taper that I haven't started yet is that allowed?  Daily notes would not apply in this case.  Symptoms would not be relevant.   I didnt think I was doing anything wrong.  

[BfromNJ]

Daily symptoms/schedule

5/14

Slept good

5:45- up .  No symptoms.  Normal for morning.

- 200 mg gaba and probiotic

7:00- noticed during meditation that left foot pulsing/,trembling 

- clear headed and feeling good all morning.   Some waves of ringing/buzzing and some zaps.  Nothing terrible.

12:00- lunch

12:30- 200 mg gaba and 18.75 mg luvox

Still notice some waves of ringing.  Mood still good and feeling okay.

-tired in afternoon, foot and up leg trembling/pulsing.  Very odd sensation.  

4:00- gym .  

6:00- dinner

8:00- ringing increases in intensity.  Like a hum.  Very annoying.  Made worse by TV, etc

Turned off TV.   It felt better some.  

8:30- 200 mg gabapentin. 

9:00- 25 mg seroquel 

 

Main symptom is still the ringing/ buzzing, but having much better days with it.  It is aggravated by noise.  I do have hyperacusous.   

 

[Shep]

11 hours ago, BfromNJ said:

5/14

Slept good

5:45- up .  No symptoms.  Normal for morning.

- 200 mg gaba and probiotic

7:00- noticed during meditation that left foot pulsing/,trembling 

 

Thanks for the drug and symptoms notes. This verifies what you and Alto were discussing about the gabapentin building up in your system. Looks like the only time you are symptom free is prior to taking the gabapentin. 

 

23 hours ago, BfromNJ said:

That is my plan.  And no booze for me I'm sober 9 years.  And no caffeine either.  

 

Sounds like an excellent plan. 

 

[BfromNJ]

12 minutes ago, Shep said:

 

Thanks for the drug and symptoms notes. This verifies what you and Alto were discussing about the gabapentin building up in your system. Looks like the only time you are symptom free is prior to taking the gabapentin. 

 

 

Sounds like an excellent plan. 

 

Although shep this morning I woke up with symptoms.  Prior to taking my morning meds.  This does happen sometimes.  I'm buzzing/ringing like crazy. And anxiety was up.   I woke up earlier than alarm and felt it coming on.  Maybe this is a wave due to luvox drop.  I'm confused.  

[Shep]

7 minutes ago, BfromNJ said:

Although shep this morning I woke up with symptoms.  Prior to taking my morning meds.  This does happen sometimes.  I'm buzzing/ringing like crazy. And anxiety was up.   I woke up earlier than alarm and felt it coming on.  Maybe this is a wave due to luvox drop.  I'm confused.  

 

It could be a wave from the Luvox or just your nervous system trying to adjust and acclimate from prior changes in drugs from months ago. 

 

Do you feel you're at Withdrawal Normal? 

 

WDNormal

 

This is where you ideally want to be before making another reduction. 

 

How much earlier did you wake up prior to the alarm? Did you sleep well other than an early awakening? 

 

 

[BfromNJ]

49 minutes ago, Shep said:

 

It could be a wave from the Luvox or just your nervous system trying to adjust and acclimate from prior changes in drugs from months ago. 

 

Do you feel you're at Withdrawal Normal? 

 

WDNormal

 

This is where you ideally want to be before making another reduction. 

 

How much earlier did you wake up prior to the alarm? Did you sleep well other than an early awakening? 

 

 

So do I want to be at wd normal even if I wil be reducing a different med now?  And yes i slept well.  It was like 45 minutes before. 

[Altostrata]

15 hours ago, BfromNJ said:

I do have hyperacusous. 

 

Did you always have this?

 

Does the ringing and buzzing get worse after your morning gabapentin?

 

15 hours ago, BfromNJ said:

Some waves of ringing/buzzing and some zaps.  Nothing terrible.

 

What are these zaps, when did they start?

[BfromNJ]

1 hour ago, Altostrata said:

 

Did you always have this?

 

Does the ringing and buzzing get worse after your morning gabapentin?

 

 

What are these zaps, when did they start?

 

I didn't always have the hyperacousus.  this started around late  January.   it almost seems like my ringing competes to be heard over other noises. 

 

the zaps - Its this weird tingling sensation I get in the back of my throat, or like a zinging in my head. I always thought maybe it was brain zaps?   I think I have had this since February.  

 

 I am having a hard time determining if it gets worse after the morning gabapentin if I already wake up with i.   but I can say that today, I woke up with it, but mild, where I normally do not wake up with it. It will usually come on later.   I took my meds.   it seemed tolerable through out the morning, but it was there.  it has grown in intensity as today has worn on.   I took my afternoon meds at 12:30, which is 200 mg gabapentin and 18.75 mg luvox.    

 

Normally when I wake up okay, by the evening when I go to bed, its really bad.  it seems like it builds, but it is also quieter when I go to sleep so I am going to notice it more. 

 

I am having more days that I do not have this problem at all or very little, so I am hopeful that I am headed in the right direction.   

 

One thing is for sure, regardless of how long or what first, I want these meds to go. 

 

 

 

 

[BfromNJ]

 

Just some thought I wanted to get out .  

 

I rack my brain trying to figure out why I can have two good days in a row, then a crappy day.  I always feel like, this is it! im turning around.  But maybe I am because there are good days.   Then the overthinking comes in.  Did I go to hard at the gym the day before?  did I eat something I shouldn't have?  do I have a life stressor at play?   am I missing something?  one really can go crazy trying to figure it out.  there can be so many variables at play.  I think I need to remove the variables one at a time.  Maybe not eat that one item and see.  Then maybe not do that work out I did next time.   but in the end, I guess it just is what it is.  I really hate that saying and here I am using it.  lol.  

 

Its really something. 

 

[BfromNJ]

For the mods.

 

Daily symptom and med entry:

 

5/15
- 5:15 up.  woke up earlier, like 4:30 and layed in bed.  bit of anxiety over an incident day before.  meditated to alleviate.  
- have symptoms-  ringing/buzzing in head bad this morning.  normally dont have in morning. 
- 200 mg gaba and probiotic. 
6:00 - breakfast- waffle and milk
12:30 - lunch - salad works salad
- 200 mg gaba and 18.75 mg luvoxg
6:30- dinner.  sushi.
8:00- 200 mg gaba
9:00- 25 mg seroquel

the ringing and buzzing persisted all day . 
terrible by bed time.

[BfromNJ]

Ive been having few good days of windows.  yay.  Holding on taper right now till after return from weekend trip.  

[Maca44]

Enjoy the Window 

[BfromNJ]

Hello.  I am shortly going to start my gabapentin taper.  I have capsules.  I am not comfortable with and do not understand the whole liquid method, so I will just be taking out what I need to from my capsules.  So I assume if I want to do a 5% reduction to start (im being conservative), I was going to weigh the contents of say 5 capsules to get an average of a capsule.  Then divide this by 5 to get my capsule weight.  then times that capsule weight by 95% to get my new capsule amount.  Do I need to do that first step of getting an average?  Do I need to be concerned with the capsules varying in weight or should they all be the same?  this is the first time I am doing capsules. previous luvox taper was tablets that I crushed. 

 

Thanks for the input. 

[BfromNJ]

@Shep

 

So I have a concern/question.  If I feel like I may be having interdosing withdrawal from my gabapentin, what happens when I start to taper?  I am not sure if this is the case, but I will be watching closely the next few days to see if I am seeing a pattern emerging or if its just a fluke. I think it may be a fluke, but I am concerned. 

 

but how does it generally go if you are tapering off a medication that you are also having interdosing withdrawal from?  its it just that much more unpleasant or as the drug load decreases does it actually help?  I can only see one way, which is through it if one wants off, as increasing to avoid the interdosing withdraw is out of the question.  do I hold off on reducing now and focus on my other med if I do find this is the case?

[brassmonkey]

Hi B-- you're very close on your calculations. It looks like you have thrown in an extra step though. "Then divide this by 5 to get my capsule weight."  This would actually be part of finding the average weight of a capsule.  

 

Weigh the contents of five capsules separately. They will be a little different from each other which is why we work with the average. It gives us a consistent starting point.

Add those weights together

Divide that total by 5 to get the average weight of the contents on 1 capsule

 

Multiply that weight by .95 to get the weight of a dose that is 5% smaller.

 

Weigh out that amount on your scales

Put the "powder" back into a capsule and save the left overs in a small bottle. When you get enough left overs you get a "free dose".

 

Next time you want to reduce your dose, start with the number you calculated above and multiply by .95 to get your new dose weight.

 

If you have more questions just ask.

[BfromNJ]

19 minutes ago, brassmonkey said:

Hi B-- you're very close on your calculations. It looks like you have thrown in an extra step though. "Then divide this by 5 to get my capsule weight."  This would actually be part of finding the average weight of a capsule.  

 

Weigh the contents of five capsules separately. They will be a little different from each other which is why we work with the average. It gives us a consistent starting point.

Add those weights together

Divide that total by 5 to get the average weight of the contents on 1 capsule

 

Multiply that weight by .95 to get the weight of a dose that is 5% smaller.

 

Weigh out that amount on your scales

Put the "powder" back into a capsule and save the left overs in a small bottle. When you get enough left overs you get a "free dose".

 

Next time you want to reduce your dose, start with the number you calculated above and multiply by .95 to get your new dose weight.

 

If you have more questions just ask.

So brassmonkey is that the norm to get an average?  And I need to only do this once right?  Then I can just make up as many capsules I need for the month?  I guess I am a bit confused.  Trying to make it easy because i take 600 mg a day.  I take two 100 mg capsules three times a day.  Is there an easier way?  Because what I will be doing is condensing those two capsules into one when a refill.  If there is a better way let me know.  Because its alot of capsules!  Lol.  🙄

[brassmonkey]

Yes, that is the way to figure an average, The larger the sample size the more accurate it is.  Most of us use 10 capsules for the calculation.

 

You only have to do it once, provided that you stay on the same capsules.  If you change manufacturers or generics or strength then things need to be calculated.  But that's for another time.

 

Doing 6 capsules a day is going to be a pain.  I would suggest making reduced weights for three and each time you take your dose you would use one full strength and one reduced strength. For a 5% reduction you would be aiming for a daily total of 570mg or 3 X 190mg. So if you took 1 capsule at 100mg and 1 capsule at 90mg each time you'd be fine.

 

To figure the weight of the 90mg capsules you would multiply the average weight by .90.

 

It's would be fine to make up a months worth at a time. Keep them in different containers and clearly mark then as full strength and reduced strength. 

 

When you have all the numbers post them here and we will double check your calculations.  Several of the mods are really good at it.

 

Are you thinking of combining the full strength and the reduced strength into one capsule?  I think it would be better to keep them separate, easier to swallow, easier to manage and easier to make changes if necessary.

[BfromNJ]

9 hours ago, brassmonkey said:

Yes, that is the way to figure an average, The larger the sample size the more accurate it is.  Most of us use 10 capsules for the calculation.

 

You only have to do it once, provided that you stay on the same capsules.  If you change manufacturers or generics or strength then things need to be calculated.  But that's for another time.

 

Doing 6 capsules a day is going to be a pain.  I would suggest making reduced weights for three and each time you take your dose you would use one full strength and one reduced strength. For a 5% reduction you would be aiming for a daily total of 570mg or 3 X 190mg. So if you took 1 capsule at 100mg and 1 capsule at 90mg each time you'd be fine.

 

To figure the weight of the 90mg capsules you would multiply the average weight by .90.

 

It's would be fine to make up a months worth at a time. Keep them in different containers and clearly mark then as full strength and reduced strength. 

 

When you have all the numbers post them here and we will double check your calculations.  Several of the mods are really good at it.

 

Are you thinking of combining the full strength and the reduced strength into one capsule?  I think it would be better to keep them separate, easier to swallow, easier to manage and easier to make changes if necessary.

Okay this all makes sense.  I see what you mean by keeping them separate.   That way it is easier to make changes. I would also make the reduced ones I different capsule color, then no mistaking that they are different.  

[Shep]

The best way to handle interdose withdrawal is to split the drug into multiple doses taken throughout the day. 

 

You're taking gabapentin 3 times a day. When are you feeling interdose withdrawal? Does it go away when you take the next gabapentin dose? 

[BfromNJ]

7 hours ago, Shep said:

The best way to handle interdose withdrawal is to split the drug into multiple doses taken throughout the day. 

 

You're taking gabapentin 3 times a day. When are you feeling interdose withdrawal? Does it go away when you take the next gabapentin dose? 

Hi shep.  I'm not even 100 percent on whether it is or not, but I'm already taking it three times a day.  So I cant change that. It may just be coincidental.   I'm trying to keep an eye on it.  I'm going to be starting to taper this one shortly 

[BfromNJ]

On 5/29/2019 at 6:59 AM, BfromNJ said:

 

@brassmonkeyOkay so i did my math for the taper.   

 

I weighed the powder of 10 capsules.  the average is .125 per capsule.   so i figure i take 2 capsules 3x a day.  so that is .125 x 2 = .25 each dose.   im doing a 5% to start, so .25 x 95% is .2375.   this is what i will take each dose three times a day.  Which is a daily total of .713.   What I plan to do is put the .2375 in one larger capsule, this way i only have to weigh out three capsules for each day instead of 6.  I know previously you said to maybe only change the dosage in one of the two capsules i take each time, which would be easier to make changes, but i dont plan on making up too much at a time.  That way if i have to make changes, in dont have too many that i have wasted my time on.  

 

does my math make sense?  thanks !  

[brassmonkey]

That checks out fine.  Best of luck with it and keep us informed.

[BfromNJ]

23 minutes ago, brassmonkey said:

That checks out fine.  Best of luck with it and keep us informed.

Thanks will do!

[BfromNJ]

13 hours ago, brassmonkey said:

That checks out fine.  Best of luck with it and keep us informed.

so after i went ahead and filled all my capsules, i wanted to double check my math. so i went and opened up a few of my original capsules, just to make sure i was okay with my original average capsule weight.    and it looks like my average capsule weight was off, not sure how, but i may not have gotten it all out of the capsule?  i have long nails so it could be some got stuck still in there. not sure what happened there.  i come up with .128-.130 actually.  which would i believe put me more in the 10% taper range.  im upset since i weighed all these for a whole week.  so im wondering if i go ahead and go with what i have?  or should i just start over and reweigh again.  waste of time but id rather be safe than sorry.  I think i may start over.  I really wanted to stay at 5% to start.  but I will make sure to be very careful with my measuring of my capsules to get my average.   darn.  on the bright side, i have a crap load of powder to work with now!  

[brassmonkey]

Using 0.130 as the average this would give about a 9% reduction.  This is well within our guidelines but as you said you wanted to stick to 5%.  It would be a good idea to take the time and redo the capsules and get things the way you want them.  Luckily the powder should be pretty easy to work with and you've had some practice.

 

So you will be aiming for 247mgpw (pill weight) for each of the capsules you are going to remake. Then you would take one capsule three times a day.

 

For your records this will give a dose of 190mgai (active ingredient)

 

mgpw: milligrams pill weight, the actual weight measured on the scales.  Your unmodified capsules contain 130mgpw of powder.

mgai: milligrams active ingredient, the strength of that dose. Your unmodified capsules contain 100mgai of medication.

[BfromNJ]

23 minutes ago, brassmonkey said:

Using 0.130 as the average this would give about a 9% reduction.  This is well within our guidelines but as you said you wanted to stick to 5%.  It would be a good idea to take the time and redo the capsules and get things the way you want them.  Luckily the powder should be pretty easy to work with and you've had some practice.

 

So you will be aiming for 247mgpw (pill weight) for each of the capsules you are going to remake. Then you would take one capsule three times a day.

 

For your records this will give a dose of 190mgai (active ingredient)

 

mgpw: milligrams pill weight, the actual weight measured on the scales.  Your unmodified capsules contain 130mgpw of powder.

mgai: milligrams active ingredient, the strength of that dose. Your unmodified capsules contain 100mgai of medication.

Oh I dont understand all that at all.  Lol.  But I did reweigh more capsules and came up with what I did before.  Is it really possible that they can vary that much?  They ranged from .121- .130.  Can that be?  I guess that is why we do an average?  So maybe then the .125 I previously had is okay? 

 

 

[brassmonkey]

When it comes down to it, the actual starting numbers aren't all that important, as long as the reduction isn't too large (greater than 10%).  The key thing is to reduce at a consistent rate from a known starting point.  This is where the average comes in, it gives a known starting point.  From then on you would be weighing out a specific amount of powder so the differences in the weight of each capsule would be canceled out. 

 

Don't worry about all the calculation above and stick with your original plan. 

 

It means that for the first reduction you may be bigger than you'd like, but with all the subsequent ones you will be in much better control. The first reduction of a taper sometimes can be larger because there still is a lot of medication to "cover" the reduction.  There probably will be some symptoms no matter what the size of the reduction is, but they will settle out.

[BfromNJ]

On ‎6‎/‎1‎/‎2019 at 4:20 PM, brassmonkey said:

When it comes down to it, the actual starting numbers aren't all that important, as long as the reduction isn't too large (greater than 10%).  The key thing is to reduce at a consistent rate from a known starting point.  This is where the average comes in, it gives a known starting point.  From then on you would be weighing out a specific amount of powder so the differences in the weight of each capsule would be canceled out. 

 

Don't worry about all the calculation above and stick with your original plan. 

 

It means that for the first reduction you may be bigger than you'd like, but with all the subsequent ones you will be in much better control. The first reduction of a taper sometimes can be larger because there still is a lot of medication to "cover" the reduction.  There probably will be some symptoms no matter what the size of the reduction is, but they will settle out.

That makes sense .  Thanks brassmonkey.  You have been helpful.  so I will be starting shortly.  I am not sure where I would post this, but I think I may be having some interdosage withdrawal with the gabapentin.  I have seen a bit of an uptick in anxiety and when I get close to my time to take my afternoon dose, I get nausea and some tremor.  it could be a coincidence and be something else, but I am concerned that I will be tapering while also having interdosing withdrawal.  But really there is no way around it right?  obviously taking more is out of the question or I wouldn't be here (lol).  and I really cant shorten the time between doses.  I seem to be okay overnight, which makes me wonder if it is something else.  Maybe I am just nervous about the taper in general.