HopefulRecovery: help with tapering off 12.5 mg Amitriptyline (Elavil)

[HopefulRecovery]

I've successfully tapered off other medications in the past, but am really struggling with this one. I was on 25 mg Amitriptyline since 2015. Last year, I tried tapering off and ended up back on, but gratefully, only at 12.5. I was originally put on this to help with IBS-C pain and found it helped my migraines as well.

 

I'm 64 and am seeing cognitive issues and complete constipation, both of which are well-documented as side effects and why seniors should not be on this drug. So I really want to see how I do off it.

 

Last week, I went down to 10 mg (I have those pills as well). But I'm really feeling withdrawal effects.

 

The problem is that I'm not sure Amitriptyline HCL is stable in water. Here's what I read: http://www.pharminfotech.co.nz/manual/Formulation/mixtures/amitriptyline.html

Indeed, as the article states, the liquid was really bitter and had a weird localized effect when I tried to taper this way last year.

 

And I can't cut the pills down to make small enough doses because the pill is already tiny. The best I can do is cut the 10 mg into four (2.5 mg), but from what I'm reading, that is too big of a jump.

 

My doctor is useless about these things. He says the drug can't cause these problems because of the low dose and that I can just stop taking it at this point because the dose is so low I won't have withdrawal.

 

I'd appreciate any suggestions on what I can do to taper under these circumstances.

 

Thanks,

Susan

 

 

 

 

 

Edited March 30, 2019 by Shep
added username to title

[HopefulRecovery]

I just ordered the Gemini-20 AWS scale from Amazon. In the meantime, I'm going to go back to my normal 12.5 mg dose (I cut 25 in half). I had gone down to 10 mg (I have those pills), but am really feeling the withdrawal. It was too big a drop.

 

I'm having so much brain fog that I can't understand the generic instructions and am overwhelmed with all the material regarding timing, etc. So could someone please let me know how to do this with my dosage?

 

Should I reduce by 10% of the current amount or by .5 mg? I've read both.

 

How long is a recommended amount of time to stay on a dose?

 

A 10% reduction of 12.5 is 1.25. I could crush the 12.5 and take 11.25. So I could remove 1.25 from the measurement, right? Can I then just put it in water and drink it or should I put it in a capsule?

 

Would it be better to take a 10 mg and crush a 10 and just take 1.25 of that in powder form?

 

***

I could use help with the calculation if I need to convert anything.

 

Thanks for your help,

Susan

 

 

 

 

 

[SkyBlue]

5 hours ago, HopefulRecovery said:

I've successfully tapered off other medications in the past, but am really struggling with this one. I was on 25 mg Amitriptyline since 2015. Last year, I tried tapering off and ended up back on, but gratefully, only at 12.5. I was originally put on this to help with IBS-C pain and found it helped my migraines as well.

 

I'm 64 and am seeing cognitive issues and complete constipation, both of which are well-documented as side effects and why seniors should not be on this drug. So I really want to see how I do off it.

 

Last week, I went down to 10 mg (I have those pills as well). But I'm really feeling withdrawal effects.

 

 

Hi Susan and welcome to SA.

 

To help us understand your recent drug history, please fill out a drug signature using these instructions: https://www.survivingantidepressants.org/topic/18343-please-put-your-withdrawal-history-in-your-signature/

 

 

Brief is best. : ) Most important will be a) most recent changes to the drug you're taking now;

and b) any other meds, drug changes/tapers in the past two years especially. 

 

Here is a topic on tapering that specific drug: https://www.survivingantidepressants.org/topic/1099-tips-for-tapering-off-amitriptyline/

It sounds like some versions can dissolve in water--please read for more info. 

 

 

What is your daily symptom pattern? 

[HopefulRecovery]

I want to taper off 12.5 mg Amitriptyline (Elavil). I got the Gemini scale.

 

I take 1/2 of a 25 mg coated pill. A 10% reduction is 11.25 mg.

 

Here is where I'm very confused:

 

I crushed the pill and weighed it on the Gemini scale - averaged .053.

 

10% of that is .0053. Subtracting it off means I take .0477 (.048 since the scale only has three decimal places for grams).

 

But the scale swings from .476 to .479 and lands on .478 sometimes.

 

Is this correct?

 

Thanks so much for your help. I really want to get started on my taper.

 

Susan

 

 

 

 

 

 

 

 

 

[Shep]

@HopefulRecovery I've merged your other posts into your main intro thread. Please continue to use this thread to ask questions about your taper instead of starting new threads.

 

On 3/28/2019 at 11:14 AM, HopefulRecovery said:

I just ordered the Gemini-20 AWS scale from Amazon. In the meantime, I'm going to go back to my normal 12.5 mg dose (I cut 25 in half). I had gone down to 10 mg (I have those pills), but am really feeling the withdrawal. It was too big a drop.

 

How are you feeling at 12.5 mg? 

 

Did your symptoms improve? 

 

1 hour ago, HopefulRecovery said:

10% of that is .0053. Subtracting it off means I take .0477 (.048 since the scale only has three decimal places for grams).

 

But the scale swings from .476 to .479 and lands on .478 sometimes.

 

Is this correct?

 

Yes, there can be some variations, but make sure you are taking all precautions to make your scale as stable as possible (away from windows, vents, and fans and on a level table or desk). 

 

Using a digital scale

 

This post in that thread may be helpful - More tips on using the Gemini Scale

 

This video shows you now to recalibrate the scale, starting at around 3:30 minutes into the video: 

 

          Smart Weigh GEM20 Digital Jewelry Scale Review

 

 

On 3/28/2019 at 3:55 PM, SkyBlue said:

What is your daily symptom pattern? 

 

We really need this information before giving you specific tapering advice.

 

Are you taking any other drugs or is Amitriptyline the only drug you are taking? Are you taking any supplements?

 

[HopefulRecovery]

I hope this is the thread I'm supposed to continue.

 

WITHDRAWAL SYMPTOMS ON 12.5 MG ELAVIL

 

I've been on 12.5 mg Elavil since April 2018. That is when I first tried tapering from 25. I have no withdrawal symptoms on 12.5 mg.

 

But I want to get off the drug completely.

 

OTHER MEDICATIONS

 

I'm taking no other medications on a regular basis. However, I do get migraines. And I take Rizatriptan or Tylenol/Caffeine pills when needed. Sometimes, I can go weeks without a migraine. And sometimes they come weekly. I am highly sensitive to caffeine, so that can also impact my withdrawal symptoms.

 

I take no supplements other than putting trace minerals in water.

 

RECENT TAPER ATTEMPT AND SYMPTOMS

 

About two weeks ago, before joining this group, I tried tapering by going from 12.5 mg to 10 mg (dr. prescribed 10 mg last year when I said I wanted to taper). Withdrawal symptoms were severe:

• Increased dizzy/spinning in my head (I have had chronic dizziness for 10 years - well before I began this medication)
• Increased brain blanks and brain fog
• Increased anxiety
• Increased irritability
• Increased migraines
• Difficulty with words
• Gut was not significantly worse

First taper dose?

 

So am I correct that I take 10% of the weighed amount of the pill?

 

Can I just put it in some water and drink it?

 

Or should I get capsules, since it is bitter and has a slight numbing effect on the tongue?

 

Again, I really appreciate your help.

 

Thank you,

Susan

[Shep]

19 hours ago, HopefulRecovery said:

I hope this is the thread I'm supposed to continue.

 

Yes, please continue posting here in this thread.

 

20 hours ago, HopefulRecovery said:

I've been on 12.5 mg Elavil since April 2018. That is when I first tried tapering from 25. I have no withdrawal symptoms on 12.5 mg.

 

But I want to get off the drug completely.

 

20 hours ago, HopefulRecovery said:

About two weeks ago, before joining this group, I tried tapering by going from 12.5 mg to 10 mg (dr. prescribed 10 mg last year when I said I wanted to taper). Withdrawal symptoms were severe:

 

I would go back up to 12.5 mg and stabilize before making any more changes. Going from 12.5 mg to 10 mg was a 20% reduction, which is way too steep a reduction. We recommend 10% or less per month. Also, as you go on the lower doses, you may find it a bit more difficult to taper than when you were on a higher dose.

 

For more, please see:

 

Why taper by 10% of my dosage?

 

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

20 hours ago, HopefulRecovery said:

First taper dose?

 

So am I correct that I take 10% of the weighed amount of the pill?

 

Can I just put it in some water and drink it?

 

Or should I get capsules, since it is bitter and has a slight numbing effect on the tongue?

 

 

Please see:

 

Tips for tapering off amitriptyline - Vanatrip, Elavil, Endep, Saroten Retard

 

You can do either a water or a dry taper, whichever you prefer. The link above gives information about using a water titration and I posted information on using a scale in my earlier post. 

 

You could also get your drug compounded. 

 

Getting custom dosages at compounding pharmacies (US, UK, and elsewhere)

 

A 10% reduction is done by removing 10% of your last dose (not 10% of the original dose). Yes, if you are using a scale, it would be 10% of the weight of the pill (including the filler).

 

You may want to consider the Brassmonkey Slide or a regular micro-taper, which is gentlest to the nervous system. Please see:

 

Micro-taper instead of 10% or 5% decreases

 

 

The Brassmonkey Slide Method of Micro-tapering

 

After you decide which method you wish to use, please post any questions you have and we can walk you through it step by step, including help with math if you need it. 

 

[HopefulRecovery]

Hi Shep,

 

Thank you so much for your response. Yes, I did go back on the 12.5 a few days ago and am holding there.

 

Thank you for all the links. The easiest and best spreadsheet for me to understand is the one by Jozeff. So I will use that.

 

I am waiting for my capsules. Since I'm not sure how stable Amitriptyline is in water, I guess I will crush and weigh the powder.

 

I'm not sure if the 2.5% Brass Monkey or 10% standard reduction method would be best for me. But thanks to your suggested links, now I better understand how to calculate the amounts.

 

QUESTIONS

 

1. NOTE: I did calibrate my Gemini scale so that is accurate. Should I stop worrying about the slight fluctuations on the Gemini scale? For instance, if I want to take .036 of the powder and the scale weight moves back and forth from .034 to .038 sometimes settling on .036, is that acceptable for the dose?

 

2. The Brass monkey method is in such small increments that I'm not sure it will work with this scale since it does fluctuate so much as stated above. Any suggestions on how to do this method with the Gemini scake since it does fluctuate so much? Please note that I did read all the links about the scale.

 

Thanks, again, for your help,

Susan

 

 

[BfromNJ]

On ‎3‎/‎31‎/‎2019 at 11:52 AM, HopefulRecovery said:

Hi Shep,

 

Thank you so much for your response. Yes, I did go back on the 12.5 a few days ago and am holding there.

 

Thank you for all the links. The easiest and best spreadsheet for me to understand is the one by Jozeff. So I will use that.

 

I am waiting for my capsules. Since I'm not sure how stable Amitriptyline is in water, I guess I will crush and weigh the powder.

 

I'm not sure if the 2.5% Brass Monkey or 10% standard reduction method would be best for me. But thanks to your suggested links, now I better understand how to calculate the amounts.

 

QUESTIONS

 

1. NOTE: I did calibrate my Gemini scale so that is accurate. Should I stop worrying about the slight fluctuations on the Gemini scale? For instance, if I want to take .036 of the powder and the scale weight moves back and forth from .034 to .038 sometimes settling on .036, is that acceptable for the dose?

 

2. The Brass monkey method is in such small increments that I'm not sure it will work with this scale since it does fluctuate so much as stated above. Any suggestions on how to do this method with the Gemini scake since it does fluctuate so much? Please note that I did read all the links about the scale.

 

Thanks, again, for your help,

Susan

 

 

where is the spreadsheet by Jozeff?

[HopefulRecovery]

BfromNJ here is the thread with the attached spreadsheet. You can change any of the variables really easily.

 

In fact, I think I'm going to try the liquid since I am really struggling with that Gemini scale fluctuating so severely. It's making a challenging situation even more difficult! I'll pretty much just make enough liquid for two days and refrigerate it. So it should be ok, I hope other than that tongue numbing thing I've experienced and has been documented.

 

BfromNJ, if you need any help with the spreadsheet, let me know. But I found it simple to use.  Susan

[Shep]

20 hours ago, HopefulRecovery said:

In fact, I think I'm going to try the liquid since I am really struggling with that Gemini scale fluctuating so severely. It's making a challenging situation even more difficult! I'll pretty much just make enough liquid for two days and refrigerate it. So it should be ok, I hope other than that tongue numbing thing I've experienced and has been documented.

 

Please make the switch from tablet to liquid gradually. This gives your nervous system time to adjust.

 

We recommend switching over by 25% increments. So 75% tablet / 25% liquid for a few days, then 50/50 even for a few days, then 25% tablet / 75% liquid for a few days and then you're finally at 100% liquid.

 

[HopefulRecovery]

Hi Shep,

 

Thanks so much for your continued help.

 

But I'm confused. Why would there be any need for adjustment if I simply crush the pill and put it in water in a 1 to 1 ratio?

 

The reason I decided to do the water taper instead of crushed powder weighed is that the scale is just impossible to work with for me. It moves up and down way too much, even after calibration. So I can't get the crushed pill weighed accurately at any percentage. (And I would definitely prefer the powder to the liquid.)

 

Is there something I'm missing? Or any other suggestions?

 

Thanks so much for your support.

 

Susan

[Shep]

53 minutes ago, HopefulRecovery said:

But I'm confused. Why would there be any need for adjustment if I simply crush the pill and put it in water in a 1 to 1 ratio?

 

Some people find that they get upticks in symptoms when they switch methods. You may or may not, but since it's unknown, we recommend a gradual switch over just to be safe. Some people's nervous systems are so destabilized that they are hyper-reacting to many things. 

 

Please let us know how you do. 

[HopefulRecovery]

Yes, that's me for sure - hyper-reactive.

 

I wish I could just use the scale. Any tips or suggestions for accuracy with tiny doses? Thanks

[Shep]

See the below post from the thread Using a digital scale:

 

As mentioned below, you may want to use the ten gram weights that come with the Gemini scale. 

 

On 11/13/2011 at 6:58 PM, Altostrata said:

More tips on using the inexpensive electronic digital scale JoLe mentioned above, the Gemini-20 Portable Milligram Scale -- these from the comments on Amazon:

 

1) Let the scale stabilize on a hard, flat and level surface.

2) Make sure the sample tray is properly seated inside the circular indent of the scale's metal measuring platform. Take care that the sample tray (as provided) does not touch the body of the scale, grossly throwing off the measurement.

3) Tap the table that the scale is on to help everything settle.

4) Calibrate as described in the manual.

5) Place and remove materials to be weighed consistently and carefully - don't drop them. Even the slightest impact can throw off the measurement.

6) Wait for ten seconds or so for the sample to settle.

7) For minuscule samples, use the ten gram weight in addition to the sample to put the scale in the middle of its operating range. With a little care, one will get closer to the performance of a lab-grade milligram scale than anything else for this price.

 

 

NOTE: If you a looking for a digital scale that measures milligrams, it must measure to at least .001g. A milligram is 1/1000 of a gram. A scale that measures to only 0.1g will not measure milligrams accurately.

 

Another reasonably priced digital scale that measures milligrams is the Grobet Precision Pocket Scale 10g x .001g Model 50.303, for about $55 here. I don't know how accurate or easy to use it might be. It's for weighing precious stones.

 

 

 

[HopefulRecovery]

Thank you so much, Shep. There's so much information, I missed that. I'll try it and see if it helps. I really appreciate it. Susan

[HopefulRecovery]

I couldn't figure out how to do the taper back when I wrote here months ago.

 

But now, I've been getting the 25 mg Amitriptyline from a compounding pharmacy with just Microcrystalline Cellulose as filler (pretty sure that's the one they used as we discussed as minimal as possible).

 

Just want to clarify that I can keep it simple and just use 25 ml water for a 1 to 1 ratio (not perfect due to the weight of the filler, but hopefully good enough?).

 

Then, I combine the powder and the water and swish it around and quickly remove the part I don't want to take, right? (I really hope it can be this simple 🙏.)

 

(And I'll figure out which taper timing and amount works best for me.)

 

Thanks so much for your help,

Susan

 

 

[Emonda]

Welcome back,

I've moved your new post back here. It's best to keep everything relating to you in one spot.

 

I have no personal experience with your AD, so I read the link below to find out about mixing with water (I do that with my WD).

 

 

A relevant quote from the above is:

 

Making your own liquid suspension of amitriptyline

A liquid preparation of Amitriptyline could be made simply by dissolving the tablets in a specific volume of water. (It is also soluble in ethanol, see below.) If you make your own liquid, you will want to use an oral syringe for precise dosing. See How to make a liquid from tablets or capsules

 

I'm currently using a combination of 3ml and 0.5ml syringes to taper. Keep a bunch of identical spares on hand, and put some clear tape over the numbers on the syringe so they don't wear off.

 

I hope this helps.

 

Emonda

 

[SurreyGuy]

Hello @HopefulRecovery, 

A 1:1 ratio of active ingredient (25mg of amitriptyline) and solvent (in your case 25mL of water I assume) is a good idea. With a 1:1 ratio, things are easy: any mL of the solution you drink correspond to the same number of mg of the drug you ingest. You can use a 1mL syringe to take out (from the bottle where you dissolve the pill) what you do not need and drink the rest.

Personally, I am now down to using 10mg amitriptyline pills diluted in 10mL of water and it seems to work ok (I used to be on 25mg pills and asked to switch to 10mg pills after I went below 10mg in the course of my taper). Of course, I still have withdrawal symptoms, with some days/nights more challenging than others, but, overall, I remain functional-ish, i.e. I can make a living...

 

[HopefulRecovery]

@SurreyGuy - thank you so much. That was just what I needed to hear. ❤️ So glad you can work. That's so encouraging to be reminded that I can get off this medication again. It just takes time.

 

@Emonda thank you for your suggestions, the link, and for that tip to cover the numbers so they don't wear off.

 

  

 

 

[HopefulRecovery]

Hi @SurreyGuy, I'm about ready to begin my taper off amitriptyline. Did you use one of the spreadsheets for timing and percentage?

 

Thanks for all your help. I hope you're still doing well.

 

[SurreyGuy]

Hello @HopefulRecovery. In answer to your query, no I did not use any of the spreadsheets for timing and percentage. Because of my initial (ill fated) attempt at cold-turkey-ing multiple drugs (as directed by my clueless yet well intentioned GP), my nervous system got sensitised and I could not tolerate a 10% taper, so I used a 5% taper instead. The timing between successive tapers has varied throughout the past 4 years.

A few things have helped me: keeping a symptom diary (with a colour code) to visualise where I am after each decrease. It helps me decide when to do the next taper. Another important thing is the agreement I have with my pharmacist: I always get the same brand of amitriptyline as I noted I could get quite a few more symptoms when I switch to a different brand.

I am presently on 2.3mg and will hold for a while while I deal with another issue.

Good luck and let me know if you have any other questions. 

[HopefulRecovery]

Thank you, @SurreyGuy. I understand what you're doing now. I've been looking at some of the spreadsheets in the meantime.

 

I'm still a bit confused on how to make this work. This is what I think is right:

 

I will always dilute the 25 mg pill with 25 ml water, but will increase the amount I remove

 

First taper

1. So if I did the 5% taper, I would figure out 5% of 25 = 1.3 (rounding up as I can't find syringes with 2 decimal points)

2. Then, I would remove 1.3 ml from the mixture
3. Drink 23.8

 

For next taper:

1. Still diluting a 25 ml pill

2. I would remove 1.3 + 5% of 23.8 (rounding up), which is 1.2

3. So I would remove 2.5 from the mix and drink 22.5

 

And continue this way. Is this right?

 

Thanks for your help clarifying.

 

[SurreyGuy]

Yes, that's right. That how I understand it anyway.