Stacy: transitioning from 10 mg amitriptyline pill to liquid

[Stacy]

Hi, Wanted to come off of my 10mg of amitriptyline because I didn't feel like it was helping that much and I was having side effects. One of my doctors told me to skip every other night. I skipped one night and things got very bad for me, physically and mentally. Five days later I was in the E.R. I saw my gp today and he prescribed me liquid. I read that there can possibly be some trouble when transitioning. How should I handle switching over? I'm afraid I won't be able to cut the pills precisely in order to take part by pill and part by liquid. Would I be safer just switching to the liquid all at once? Has anyone switched all at once and if so how did it go? Thanks. 

[Carmie]

Hi Stacy, 

 

Welcome to SA. It’s definitely not a good idea to skip days. Our brains can’t handle that.  Please take your medication every day at the same time. 

 

How long have you been on 10mg of amitriptyline? 

 

Have you been on any other medication?

 

Are you on any other medications now?

 

The only way to get the tablet part of it really accurate would be to use a scale. A popular one is the Gemini 20. 

 

I once changed formulas without a crossover ( changing from water titrating a tablet to water titrating a compounded capsule), and I went through three months of waves, so I definitely wouldn’t recommend changing from tablet to liquid without a crossover.

 

I didn’t know anything about crossovers at the time, but when I decided to go back to my tablet I did a crossover and it went really smoothly. Phew!

 

The crossover formula is: 

 

3/4 old formula.                              1/4 liquid. 

 

1/2 old formula.                               1/2 liquid. 

 

1/4 old formula.                                3/4 liquid. 

 

Then all liquid. 

 

You do each phase for about 3 to 7 days, or longer if you wish. 

 

Take care, sending hugs 🤗

[Stacy]

Hi, Carmie. Thank you for responding.

 

Yes, skipping a day was definitely a bad idea. 

 

I've been on 10 mg Amitriptyline for about 3 months for chronic headaches. 

 

When you say you switched to a compounded capsule are you referring to a time release capsule with the beads in it? 

 

I took 225 mg of Effexor XR for about 19 years. Several years into taking it I found out I was pregnant with my third child and the Psychiatrist told me to stop taking it cold turkey.  Threw up for 3 days and then my husband at the time took me to E.R. Had several days stay in the hospital. Went home with pills for extreme nausea that I had no choice but to take during my pregnancy because I was so deathly sick the whole pregnancy. After I had my son my anxiety was sky high so while I was in the hospital still I reluctantly went back on them. Mine son is 15 now. About a year or may 1 1/2 years ago I decided to wean myself off of the Effexor XR. I didn't tell the doctors because they would have weaned me too fast and I knew I had plenty of pills to take my time. I had gotten the bright idea to count down the beads very slowly and go by how I felt. It worked. I didn't keep up with how many months it took, but it took a while. Things were recently looking up for my son and I (he's my only one left at home). About 3 months ago I went to the doctor about my headaches I struggle with cervical dystonia and chronic cluster headaches. That's when they put me on ami. I had no idea it would be like this or what the drug was capable of or I would have never taken it. It's 10,000 times worse than Effexor. So now here I am, stuck again in a bad place. 

 

The problem with trying to crossover is I have no time. I'm running out of pills, only a few left. I have read about their possibly being some turbulence and I am beyond terrified after what I experienced over the last 2 weeks. I still don't feel like my body has quite gotten back normal since the withdrawals started on the 3rd from that one dose. Still have somewhat of a racing heart and breathing feels a little heavy. Not to mention I've been a basket of nerves. I don't even have a scale. It would have to take time to order one,  time to figure out how it works and then to measure out the liquid. I'm so scared and confused. It's already been several days since I got my liquid prescription and it only lasts a month. The doctor doesn't get it and is wanting to pull me off way too fast and can't understand why I'm having so much trouble from it all. He said Ami doesn't affect the Serotonin, lol. I thought he was wrong and looked it up and it absolutely does. That is terrifying that he doesn't know that. He gave me 2 refills on the liquid but I'm scared he won't give me more so I can taper off much slower. I have tried getting in with some psychiatrists to get a second opinion and help me figure out what to do and as back up for future refills, but It takes 2-3 months to get in as a new patient. I haven't seen my old psychiatrist in 5 years or so and they said I would have to be seen as a new patient. 

 

I'm a little loopy right now from some Hydroxyzine the E.R. gave me for the anxiety and racing heart so I'm not going to proofread what I wrote. I hope it all makes sense. 

[Stacy]

Sorry to bother you again, but would this be the correct scale? 

 

American Weigh Scales GEMINI-20 Portable MilliGram Scale, 20 by 0.001 G

[Carmie]

Hi Stacy, 

 

Yes, that’s the scale. Many people use it to get down to the tiny doses. 

 

You asked me about what compounded capsules I changed to, they were still immediate release. I’m on Seroquel. I was crushing a 25mg tablet in water and when I got down to 7.5mg I got a compounding pharmacist to make me 7.5mg compounded capsules and I started water titrating that. Brassmonkey brought to my attention at the time that compounding capsules aren’t always that accurate, so I went back to water titrating my original tablet. Someone on this site actually took four compounded capsules to get analysed and they were also different. I can’t remember the difference in percentages, but they were quite big. 

 

As I mentioned before, when I didn’t do a crossover to the capsules I went through months of waves before I stabilised again. When I did a crossover back to my original tablet, it went really well.

 

I’m sorry you’re running out of pills. Is there any way you can get some more? Any doctor can prescribe them, they don’t need to be a psychiatrist. 

 

If you’re not stable yet and you still have bad symptoms from missing that dose it’s best not to make any other changes, otherwise it might take even longer to stabilise.

 

Please let us know how you’re doing💚

[Stacy]

Do you tell your doctors you are tapering or do you let them think you are still taking your original dose so they don't cut you off and make you taper too soon? 

 

Do you think it would be ok to take electrolytes while I'm tapering? I read somewhere that amitriptyline shouldn't be given to people with low potassium which I have had for years. 

I know some people are also taking omga 3 and magnesium. Is it a good idea to do that in the beginning of tapering? 

 

Thank you for all your help. 

[ChessieCat]

Hi Stacy and welcome to SA from me too,

 

It's important to only make one change at a time.  It is also a good idea to start with a small amount first so you can see how you respond.

 

Keep it Simple, Slow and Stable

 

Magnesium

 

Omega-3 Fish Oil

 

I take Gastrolyte/Hydralyte Electrolyte replacement or something similar if I have sweated a lot.  I live in Australia and we had several very hot periods over summer time.

 

You will need to do whatever you need to in order to continue getting your drug.

 

It is highly unlikely that you will find a doctor who understands tapering.  Not many medical professionals understand psychiatric drug tapering and withdrawal which is why this site exists.

 

As long as you have a doctor (any doctor can write a prescription) who will prescribe the drug for you, then you don't even need to tell him that you are tapering. 

 

If you do need to get something specific from your doctor for your tapering then before you see your doctor, I suggest you check out these topics.  You might find it helpful to write a script and rehearse what you are going to say so that you can get what you need to taper.  Be calm, gentle but assertive.  You are the customer, it is your body.  Use words like I'd like to try this, or I'd prefer to do it this way.  If a suggestion is made that you don't want to follow, say I'd like to think about it before making a decision.

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

[Stacy]

Hi ChessiCat.

 

After ending up in the ER I had an appt. with my gp two days later that was already scheduled. I was confused about what to tell him especially since I was still feeling bad from missing that one dose and had been to the ER. I decided to tell him the truth worrying that it would be a mistake. He prescribed me liquid amitriptyline, but is still wanting me to taper way too fast. I am still having symptoms from missing that one dose almost two weeks ago. My heart and breathing stills feels funny which is my main concern,  I'm still somewhat anxious, and feel like I can't regulate my body temperature. It's been a week since I got the liquid prescription filled and I have been afraid to try to transition over. The liquid only lasts 30 days according to the pharmacy. I have 2 refills. So my anxiety is being worsened because I am terrified I won't get any refills. Is it normal for  your heart to race like this during the whole time you are trying to decrease your dosage? I am so terrified! I thought I went through hell the first time I came off of Effexor but that was non stop vomiting, several days in the hospital, and then very sick at home for the next few months with nausea meds.  The amitriptyline that I'm dealing with now is so much more than that; heart, mind, etc., etc.  I've never experienced anything like this before. 

 

As far as dissolving a tablet goes, do you put your whole dose in the water and then over time just decrease the amount you suction up from that same dose with your syringe? Not sure if I'm explaining myself well. I tried awhile back to see what would happen if I tried to dissolve a tablet in water after crushing it. It does not seem that it completely dissolves. I saw some medicine that settled on the bottom. Is that the way it supposed be? I know it needs to be stirred but if it doesn't completely dissolve how do you know you're getting the right amount when you suction some out with the syringe? 

 

 

[intothewoods]

7 hours ago, Stacy said:

As far as dissolving a tablet goes, do you put your whole dose in the water and then over time just decrease the amount you suction up from that same dose with your syringe? Not sure if I'm explaining myself well. I tried awhile back to see what would happen if I tried to dissolve a tablet in water after crushing it. It does not seem that it completely dissolves. I saw some medicine that settled on the bottom. Is that the way it supposed be? I know it needs to be stirred but if it doesn't completely dissolve how do you know you're getting the right amount when you suction some out with the syringe? 

 

Hi @Stacy,

 

In December I converted my Amitriptyline coated tablets to a water solution. My pharmacist helped me get started but mainly used this topic from SA 

 

 

We keep it simple and it's worked great for me. I do a 1:1 ratio of tablet to water. One 25 mg tablet goes into 25 ml of water. You would do 10 to 10. I do not crush the pills, just let them melt into the water. 

 

As I have been taking 25 mg per night for years, I dropped to 23.5 ml of the water liquid equalling 23.5 mg of Amitriptyline. A 6 percent drop. I use a 20 ml oral syringe and a 3 ml syringe for the dosing.

(The 1/2 ml lines on the 3 ml syringe are precise enough) 

 

I didn't know about crosstapering at the time so I did a straight conversion. It was a bit rocky for a couple of days but honestly - - I am thrilled my body adapted quick. We're all different. It would be hard to crosstaper with 10 mg tablet because you can't get a clean half-cut. 

 

The coating on the tablets takes longer to disperse - - maybe 15 minutes - - but it's clear sailing from there. The water will be cloudy. Just make sure you stir well before drawing the solution out with each syringe. It doesn't have to dissolve, just be evenly distributed. 

 

I now make a batch to last two weeks and am happy to share more if you decide to go this route. Amitriptyline, as is noted in the topic above, has a long shelf life. I keep mine refrigerated in a clear mason jar with plastic screw-on lid. 

 

Hope this helps 😊

 

[intothewoods]

Stacy, here's an SA quote from Rhiannon about the solubility aspect..... 

 

 On 2/27/2013 at 12:30 PM,  Rhiannon said:

Mostly I would just say, I don't think it really matters if the medication is soluble in whatever vehicle you're using, as long as it can be evenly distributed. What really matters is that it be evenly distributed and that your method be repeatable and consistent

[intothewoods]

P. S. - - I just noticed you're in Dothan. I have family in Dothan and Opp, and live in Apalachicola. Small world 😊

[intothewoods]

One more thought.. If you decide you need a new primary doc, mine is all on board with my multiple water tapers and has a clinic in Quincy, FL. About 80 minutes from Dothan. Pm me if interested and I'll check in 2 weeks when I see her. Think she's taking new patients still. 

[Stacy]

@intothewoods

 

Thank you for all the information. This helps a lot.

 

Yes, it is a small world. I would definitely be interested in getting in touch with your doctor. I have been feeling pretty nervous to even drive around town right now though since missing that one dose almost 2 weeks ago and ending up in ER. I still feel somewhat shook up but it's getting better. How do I send you a private message on here? 

 

[composter]

Hey @Stacy, my story also involves 10 mg Amitriptyline taken for 3 months for headaches. What a shame that this "treatment" can put us in much more misery than we were prior to starting. Who knew such a tiny pill could make such profound changes.

 

During my withdrawal I went through many of the same issues: difficulty with temperature regulating (sweating and feeling cold in my head constantly) and lots of despair, anxiety and emotional upheaval.

 

Thankfully I've now fully stabilized after I reinstated and held at 11 mg for 8 months. I am starting my taper this week. As for methods I'm using compounded pills because I have a trusted family member who is an MD who can write the prescriptions. Making your own liquid may be a good idea, or if you are able to seek out more understanding/supportive doctors you can look into compounding.

 

Either way I want to tell you that you have come to the right place and you will be able to taper properly and successfully as long as you follow the recommended schedule (10% per month or slower). 

 

Are you planning to stabilize on 10 mg for a few weeks before beginning your taper?

[intothewoods]

@Stacy, you might have already seen this but just in case, as I had mentioned windows and waves to you. 

 

The Windows and Waves Pattern of Stabilization

[Stacy]

Hi @composter. Thanks for your reply. You're exactly right about it causing so many more problems than what we were dealing with to begin with. I hate this medicine was ever given to me or anyone else, and just to think, they give this to kids! You're lucky in the sense that you have a dr. In the family. As far as waiting to stabilize, the doctors haven't given me a choice. Common sense tells me that's what i need to do, but they are now trying to take away the meds that they put me on without letting me go slowly and it was my idea to come off of them in the first place. I'm still trying to get a game plan together and have been under a lot of stress worrying about this this last couple of weeks since i ended up in the ER after following the doctors advice. I hope your taper goes well. I will let you know about my plan soon hopefully.

 

@intothewoods thank you. I will take a look at the video.

[intothewoods]

@Stacy, this link should take you to where you can create your drug signature. 

 

 

Account Settings – Create or Edit a signature.

[intothewoods]

@Stacy, I'm so glad you made contact with my doctor's office as she just helped me convert two meds to water solutions in Dec-January. She's keeps up to date on SA and the major media articles (NY Times, New Yorker ...see the Media section of SA) and also on psychiatric and psychology journals that are beginning to not be able to deny this.

 

As @composter said, staying at the 10 mg is your main goal at the moment. You'll get there!  

[composter]

@Stacy I'm sorry to hear that you've been having trouble finding doctors who will support a plan to stabilize and taper slowly. If you have the means to do so, perhaps see if you can get a second opinion and establish a new neurologist or primary doc who is more understanding. I don't think it's wise to just take what you're given and hope for the best. I've had some luck with the Mad in America provider directory to find doctors in my general area who are aware of withdrawal and advocate slow tapers.

[composter]

Good to hear that you have such a supportive doctor on board, and Stacy's been connected -- @intothewoods! Perhaps with your doctor's permission you can add her information to the thread on "Suggested doctors, clinicians..." or the Mad in America directory so others can get connected with her.

[intothewoods]

22 minutes ago, composter said:

Perhaps with your doctor's permission you can add her information to the thread on "Suggested doctors, clinicians..." or the Mad in America directory so others can get connected with her.

 

I will ask her again, @composter Technically she and her cardiologist husband aren't taking new patients -- they have three clinics spread over 100 miles and see mostly Medicaid and Medicare patients. They have quite a few with cancer, diabetes -- very broad based. It's just whether or not someone has left at that very moment that a new person can get in. My neighbors can't even get in. So I don't want to overwhelm her and do want to respect her wishes.

 

Thanks for being on top of this too with the Amitriptyline. You and Stacy and I have amazing timing! She lives not too far from me. 

 

I'm in severe, I mean, electrocution-style akathesia and burning, the past few days so I'm going to take a computer break. I see you're from California and would love to get to know you more!!  

 

 

[composter]

Oh gotcha, @intothewoods I can see how that might be difficult seeing how she's very booked out. 

 

Indeed! We will get through this together! I was reading elsewhere that you are a journalist and are working on pieces about withdrawal. I very much support that and think that more writing and reporting about this issue is what we need to break the floodgates of reductionist medical thinking that portrays ADs as benign and even helpful.

 

Gosh that sounds so painful. Rest up! I'm going to be signing off from here for the day too. Actually going to walk to a local farmers market 😊

[Stacy]

After many weeks of worry and stress (long story), I have secured a doctor that will prescribe my 10mg of Amitriptyline and give me enough refills to begin tapering down. The 10mg pills are incredibly tiny and are not scored. I do have a scale that I purchased but I think it would be easier to make a water solution out of the pills and measure it out that way. With that being said I am terrified to switch over to the water solution after what happened to me a few weeks ago when I missed a single dose and ended up in the ER. I read somewhere that dry cutting is less accurate than making a water solution. I don't know if that's true. I'm assuming it may be because the filler and the medicine is possibly not distributed evenly throughout the pill. @Altostrata, can you advise me on the best and easiest method to taper these tiny pills? It all seems very complicated. If I do a slow crossover to a water solution by splitting pills into quarters as @Carmie suggested above how do I cut the same exact amount each night or does it matter if it's not exact each night when I'm using a quarter pill in water, then 1/2, and so on until I get to all water solution? 

[Stacy]

Not positive if i took my medicine last night. Wondering if i should try to take it earlier today. It's not a good feeling waiting to see if disaster strikes. 

[Altostrata]

Stacy, when pills are tiny, tapering with a liquid is the way to go.

 

You'll have to remember your doses. @ChessieCat has a system.

[Stacy]

I finally transformed my Amitriptyline to a water solution 5 nights ago (Tuesday). After skipping a dose two months ago (as advised by my doctor in order to taper off) and ending up in the ER with horrible and frightening withdrawal symptoms, I had been paralyzed with fear to make any changes up until this point. I found a new doctor online to prescribe my Amitriptyline, made sure I was stabilized first, and then gathered up the courage with help from all of you to turn my pill into a water solution. I wanted to crossover a little at a time but as tiny as my pill was it seemed too complicated and I was tired of prolonging the inevitable. 

 

For several days after transitioning over to the water solution (Wed. - Fri.), I felt a little nauseous off and on, but other than that I had no major symptoms. I feel like I have overcome a couple of big obstacles already. Now it's time to start tapering. @Carmie, @ChessieCat, @Altostrata, should I wait a little while longer before beginning the taper since it hasn't even been a week that I switched over to a liquid solution. I have felt fine since Sat. but I know that's not very long. 

 

I am concerned with the fact that the medicine seems to sit at the bottom of the cup after the pill has dissolved. I know I need to stir it before suctioning any of the solution out but within a second or two of stirring it the medicine has settled back on the bottom again. Is this normal and how can I make sure the medicine is evenly distributed throughout the water so I can know that I'm getting the same amount each time? 

 

Thank you for your help. 

 

 

 

 

[Altostrata]

Yes, stay on your normal dose in liquid form for a while, let your system get used to it.

 

The filler and coating from the tablet will settle on the bottom this is normal. Be sure to stir before withdrawing your dose.

[Stacy]

On 6/2/2019 at 7:24 PM, Altostrata said:

Yes, stay on your normal dose in liquid form for a while, let your system get used to it.

 

Hi @Altostrata. Thank you for the information. When you say "a while", how long are you referring to? 

[Altostrata]

A month. Also, be sure to keep that homemade liquid fresh -- it will last only about 4 days in the fridge.

[Carmie]

Hi Stacy, 

 

All the best with your liquid taper. I’ve been liquid tapering for ages. 

 

Sending hugs🤗

[composter]

Hi @Stacy I am making my own liquid solution from Amitriptyline tablets too. How is your taper going?

[Stacy]

Hi @composter! I finished my taper Christmas of last year. I'm so happy to be done with that. How is your taper going? 

[composter]

Congratulations @Stacy! Sounds like you’re doing well too!

Were you able to tolerate a taper schedule that was greater than 10% per month? When did you start the taper?

 

I’m using a water taper and I’m currently at 5.4 mg. I like a slow pace of about 0.1 mg reductions every 1-2 weeks or so. Things are going steady. 

[Stacy]

@composter

 

Thank you! Yes, I'm doing pretty well.

 

I agree. A slow taper is best. I went down .2mg every few days or so. Sometimes I would wait longer according to how I felt, just to make sure. I started March 2019 and finished Dec. 24, 2019. 

 

When did you start your taper this last time? It is a slow process but it will be worth it.