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Guilietta
Posted (edited)

Hello all,

 

I am new to the forum after reviewing some of the posts intermittently since December 2018.

 

I have posted my intro as a PDF (note: pasted below). When I tried to post it - the fonts and spacing were inconsistent and I couldn't edit it. This is my first online forum on any subject so please bear with me on the technical goofs I will make. 😉 Fortunately I did find the emoji and finally get the introduction written.

 

Thank you!

 

 

PDF information pasted below (CC manually reformatted as best as possible):

 

Hello all,

 

I am a new member and trying to liberate myself from duloxetine/Cymbalta 20 mg (compounded in a LIQUID). My goal is mood management without medication – and being able to cope positively with unwelcome (or sometimes welcome) events.

 

I have been viewing information on the web site off and on since last December.

 

My thanks and empathy to all of you on this site who are ridding themselves of Cymbalta and other ADs, benzos, etc. I remain optimistic that the light at the end of the tunnel is not that of an oncoming locomotive. J I am grateful for having found SurvivingAD and to the subject matter experts and people who administer it.

 

I have been tapering duloxetine 20 mg (compounded) since December 15, 2018 under the care of an
MD. I am at 10 mg (3.3 ml) as of July 20, 2019. I am decreasing by about 10% a month.

 

I am also taking clonazepam 2 mg (my next taper goal) as well as meds for a childhood neurological illness (lamotrigine XR 600 mg and gabapentin 1000 mg). I have taken many medications since age 9 due to the latter. Because of my medical history and the many meds tried or used over the years to manage it, their efficacy, safety and side effects – I am anxious about medications. Anxiety exacerbates the neurological health issue. I was prescribed ADs about 15 years ago (and the clonazepam) to manage moods amid traumatic life events. I took Duloxetine for about the last 4 or 5 years; the highest dose was 60 mg.

 

About my taper:

 

The taper started in December 2018. However – before I knew better – I stopped cold turkey (per prescriber’s advice) in August 2018. I endured subsequent bouts of panic, elevated anxiety, auras and some agoraphobia - so I restarted the duloxetine and the symptoms went away. I figured out that cutting the medication maybe caused the symptoms.

 

I found a new MD who reluctantly agreed to the taper. After learning I lack the fine motor skills to count beads, I found a compounding pharmacy and get the duloxetine in an oil-suspension. I decreased by 2 MG (10%) per his direction and I experienced 3 weeks of bad symptoms. Thereafter I tried a ‘micro-taper’ approach – a series of mini-cuts - per this website. This approach seems to have moderated many of the side effects– but the symptoms are still a problem a good proportion of the time. My process for the micro-taper is to reduce by about .5 mg a week (about 2 mg a month total) – with mini decrements across the week (in ml). I have symptoms for a few days, then a few days where I am feeling mostly OK, and then I make another mini-cut. This is fatiguing and difficult to manage.

 

Some side effects I experience(d) on this medication at 20 mg– and they continue:

 

• Hot flushing over head and torso and perspiration (in 70 F) and not attributable to endocrine function.

• Blurry vision


• Short-term memory impact

• Focus and concentration and recall

• Insomnia – awakening 2-3x night many nights….

• SSRI/SNRI sexual side –effects

• And many more…

 

Withdrawal effects

 

Generally - the most consistent and prevalent withdrawal effects (thus far) have been:

 

• Anxiety - which may often be markedly worse in mid to late afternoon and into the evening (about 7-8 hours after my dose).

• Jitteriness/tremors/shakiness

• Auras and other sensations (related to the neurological illness) which may be extremely uncomfortable

• Tinnitus (hearing loss was ruled out as a cause)

• Insomnia

• Lower GI (one extreme or the other)

• Appetite issues (one extreme or the other)

• Maybe more sensitive to cloudy days – particulary when they cluster

Less consistent:

• Dizziness when quickly turning my head

• Postural hypotension

• Sinus headaches

• Lightheadedness

• Panic

• Dysphoria

• Short-term memory impact – worse at times during this taper than on the full dose

• Focus and concentration and recall– worse at times during this taper than on the full dose June – July Withdrawal Symptoms

 

Out of the blue in June I experienced additional and horrendous symptoms for 2-3 weeks (see ‘less consistent’ above). They were so acute I asked myself if this is worth it, whether I will ever get off this drug and so on with the nefarious what if’s. I have no idea what caused it but I made it through and I am now doing much better.

 

Looking for another MD or NP

 

The psych MD (started in December 2018) does not have my full confidence to taper me successfully off Duloxetine. I am looking for an MD or NP who sincerely wants to taper me off and take a holistic approach to mood management moving forward. Spending much time online and looking things up (like about ADs, tapering, etc.) elevates my anxiety to unhealthy levels. It’s therefore important to have an MD or NP on whom I may depend for this information.

 

If it had not been for information I found on Surviving AD and other web sites – he would have tapered me to Viibryd or off duloxetine in 4 weeks.

What I am doing to help myself

• Joining Surviving AD and searching for an in person support group

• Helping others through this and letting everyone I know about Cymbalta and AD withdrawal • (Re-) learning Cognitive Behavioral Therapy

• Meditate (10 – 15 minutes a day I practice this – but 5 minutes are better than no minutes) – this may take me a while to learn….

• Exercise daily ( 45 minutes on the treadmill in the morning (and it would be good to do some walking in the afternoon).

• Physical therapy and hand weight exercises most nights.

• Eating plenty of protein, healthy (whole grain) carbohydrates, salad a day, nuts, and could do better with vegetables

• Searching for a faith that aligns (mostly) with mine

• Looking for a group to volunteer with

• Write down (most days) what I am grateful for – even if I need to repeat things from one day to another J

A few things I have learned – and wish I had known earlier – about exercise and diet and spending too much time online

 

Maybe this may help someone out…

 

1. You may not want to start a ketogenic (or low carb) diet (depending on your medical circumstances). My personal experience with this: I was advised/told to restrict carbs (40%) to lower my a1c. I did 50% - and I suffered more anxiety, panic, etc. Ended up in ER with panic. No one told me about this and my MD wasn’t aware. Learn more about keto diets and psych meds: https://www.psychologytoday.com/us/blog/diagnosis-diet/201803/ketogenic-diets-andpsychiatric- medications.

2. Activate dopamine receptors and generate serotonin by EXERCISE (aerobic and/or weight lifting) and PROTEIN. Exercise releases endorphins and helps with dopamine receptor activation.

Activating dopamine receptors is ‘critical’ to this process. A diet rich in protein helps with this. (this from the neuro RN)

3. A good snack in the mid to late afternoon – whole grains and protein - may help me with anxiety. It helps with blood glucose management –and a low BG will cause anxiety and a number of the symptoms that are also caused by AD withdrawal

4. To help cope with anxiety – I have found that doing something anything physical or with your hand (and focusing on it) can help (for example, clean the bathroom, knit, weed, etc.).

I have a few questions, which I will post separately – and I would really appreciate your comments.

 

Thank you

 

 

 

 

 

 

 

Surviving AD Intro.pdf

Edited by ChessieCat
copied and reformatted PDF and added to post

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Gridley
Posted (edited)

Welcome to SA, Guilietta.  You have done some excellent research and it seems you are very much on top of this process.

I have a couple of comments and a few links to share with you.

 

The 0.5mg a week (2mg a month) taper is tapering 10% of your original 20mg dosage per month.  We recommend tapering by 10% of current dose.  If you continue the 2mg a month taper, you will be tapering an increasing percentage every month, which will be too much.  You found the 10% per month taper to be too fast (which many people do) and altered it to a weekly taper, which was wise.  What you are doing is not so much a micro-taper but rather a variation of the Brassmonkey slide taper, which calls for tapering with four equal cuts of 2 1/2% of current dose for four weeks, followed by a two-week hold.  The two-week hold is important to let your system "catch up" and avoid delayed withdrawal symptoms to build up.  At several points in my taper I've had to increase the hold to three weeks and recently, because I was sick, I held for four weeks before continuing my taper.  If you find 2 1/2% every week to be too much, you could go slower and taper by 1% every week.

 

Using this method, since you're tapering by percentage rather than a fixed milligram cut, your cuts will grow progressively smaller as your current dose grows progressively smaller.  I've been tapering 20mg Lexapro using this method for the past 2 1/2 years and am down to 2.3mg (see my signature below).  This link explains further:

 

The Brassmonkey Slide Method of Micro-tapering

 

I understand your desire to find an M.D. or N.P. who can guide you through this process and I wish you luck  Unfortunately, it has been our experience that the vast majority of doctors are abysmally ignorant of withdrawal and tapering.  This is true of both medical and alternative practitioners.  Many alternative practitioners will load you up on supplements, which we have found generally don't help and in fact are often too much for our sensitized systems in withdrawal.  I understand that looking everything up increases your anxiety, but the moderators here are well-informed and stand ready to answer your questions.  In my opinion, Altostrata, the founder and administrator of this site, is likely the most knowledgeable person on the planet on matters of psychiatric drug tapering and withdrawal.

 

The withdrawal symptoms you report are typical.  When tapering there will  be withdrawal symptoms; the idea of slow tapering is that they remain tolerable.

 

 
 
When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  
 
These explain it really well:

 

 

   On 8/30/2011 at 2:28 PM,  Rhiannon said: 
When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.
We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.
 
While it is often a first response to stress to take a B-Complex, in withdrawal it can be overstimulating.
 
 
You said your goal is mood management without medicine, and we strongly support this approach.  You've already developed a good set of non-drug coping skills.  Take a look at this link and see if any might be helpful to you.
 
 
Here are some coping techniques specifically for anxiety.
 


I know this is a lot of information.  Please take your time reading it.  

 

This is your Introduction topic, the place for you to ask questions, provide updates and connect with other members.  We're glad you found your way here.

 
 
Edited by ChessieCat
added link to BM slide

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Guilietta

Thank you, Gridley and ChessieCat. I will look at all the good information you sent me. Also - kindest thanks to you for copying/pasting my introduction into html.

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ChessieCat

You are very welcome.

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Guilietta

I was not doing a 2 week hold every 4 decreases. Because I had been making what I thought were smaller and gradual decrements from week to week - and hold a few days before repeating - I would not have so many symptoms. It is also quite reasonable that I have been decreasing a little too rapidly. 

 

Here is my timeline for June and my targets for the next few weeks - what do you think?

 

HOLD: June 20 - July 19: 10.2 mg

Week 1: July 20: 10 mg (~2%)

Week 2: July 28: 9.75 mg (2.5%) - today

Week 3: August 4: 9.5 mg (2.5%)

Week 4: August 18: 9 mg (2.5%)

Week 5 & 6 (Aug 25 through September 7): 9 mg

 

On MDs

I watched Alto's video YouTube. What a remarkable, brave and intelligent woman. Her work has been pivotal. In addition to Alto's (and both of yours) expertise - I need to find an MD or NP who is on the same page with me and will support me with my goal of mood management without meds.

 

You are right. Most MDs don't know about this. It seems that MDs who appreciate information of an educational nature coming from patient are few and far between. Patients may be quickly labeled as difficult and people don't want to work with them.

 

I am seeing people at one of the top tier teaching hospitals in the country.  The (prospective new) neuro admitted to me that the physical symptoms can be horrific and that they can last for '3' months. She told me 'it's about quality of life' - and I read this as - why are you putting yourself through this - just keep taking the medication.  Maybe this means I don't see this MD again.

 

The psych indicates that I am tapering 'really, really slowly' (this was after 2 mg cuts a month). I am not convinced he wants to help me taper off the med and live happily ever after without the med (or another like it).

 

Have a good night. thank you.

 

 

 

 

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Gridley
28 minutes ago, Guilietta said:

 

Here is my timeline for June and my targets for the next few weeks - what do you think?

 

HOLD: June 20 - July 19: 10.2 mg

Week 1: July 20: 10 mg (~2%)

Week 2: July 28: 9.75 mg (2.5%) - today

Week 3: August 4: 9.5 mg (2.5%)

Week 4: August 18: 9 mg (2.5%)

Week 5 & 6 (Aug 25 through September 7): 9 mg

 

 

This looks very good.  It is not, as your psych said, "really, really slow," but rather a safe, reasonable taper rate that will get you off the drugs with a minimum of discomfort.

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Guilietta

Thank you Gridley.

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Guilietta

Thanks, Alto, for the explanation. As I had taken the extended-release 20 mg capsules - I assumed that the liquid would also be extended-release and it would work the same way (neither the MD or the pharmacy volunteered this info and I didn't know that there were 2 forms). That the medication is not extended release would help explain why I experience worse symptoms starting mid to late afternoon.

 

Does this affect my body's healing process when this drug doesn't maintain a steady state?

 

Based on a 10 mg dose at 7 a.m. - what do you estimate (or know) the plasma dose be about 3 -4 pm? At 7 pm?

 

Would you recommend splitting the dose? If so - by what proportions and about what times might you suggest? For example - 60% of 10 mg dose at 7 a.m. and 40% of 10 mg at 3 pm?  

 

Thanks

 

 

 

 

 

 

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Guilietta

I posted this question - and think I do so in the wrong place - so I have reposted it here in hopes that someone may respond.

 

Since my duloxetine is not extended release as it is liquid (compounded)  - is splitting my dose in two recommended?  I take my medication at 7 a.m. 

 

My anxiety is generally worse in the afternoon/evening and I often have trouble falling and staying asleep. If duloxetine peaks at 12 hours - would I have less anxiety?

 

Thanks

 

 

 

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manymoretodays
Posted (edited)

Hi Guiletta!  And welcome aboard.

On 7/28/2019 at 3:19 PM, Guilietta said:

Here is my timeline for June and my targets for the next few weeks - what do you think?

 

HOLD: June 20 - July 19: 10.2 mg

Week 1: July 20: 10 mg (~2%)

Week 2: July 28: 9.75 mg (2.5%) - today

Week 3: August 4: 9.5 mg (2.5%)

Week 4: August 18: 9 mg (2.5%)

Week 5 & 6 (Aug 25 through September 7): 9 mg

 

40 minutes ago, Guilietta said:

Since my duloxetine is not extended release as it is liquid (compounded)  - is splitting my dose in two recommended?  I take my medication at 7 a.m. 

 

My anxiety is generally worse in the afternoon/evening and I often have trouble falling and staying asleep. If duloxetine peaks at 12 hours - would I have less anxiety? 

And.......good, thanks for reposting this in your introduction.  It's good to keep specifics around your case right here and ask questions.

 

I think, that, since you have just done a taper, that splitting your dose right now would not be a good idea.  We usually go with just one change at a time, in medications.  The reasoning being so that it will be clearer just what is what.......or what might be causing what.  And I'm not sure, if splitting your dose would relieve the afternoon anxiety.  As if it is a WD symptom, it may gradually improve, as you adjust to each taper.  How was your anxiety before tapering?

Are you keeping notes yet?  We have this format, that you can use, and then post here, again, on your introduction........that helps quite a bit to see the relationship of your drugs and symptoms.

Keeping daily notes

Give this ^ a try please.

Include all drugs taken.

 

Tips for tapering off Cymbalta(duloxetine)

^  I'm guessing that you have already referred to this, posting it now, here for ease to further reference.

 

Can you update your signature, with tapering information too, just briefly, the date and new dose?  Account Settings

Sorry about that......looks like you have done this.  Good job!  I did not see it at the top, on first look. 

 

Okay and welcome, welcome again!

Love, peace, healing, and growth,

manymoretodays(mmt)

Edited by manymoretodays
corrections, did not see updates to signature, at first

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manymoretodays
Posted (edited)
On 7/30/2019 at 9:23 AM, Guilietta said:

Thanks, Alto, for the explanation. As I had taken the extended-release 20 mg capsules - I assumed that the liquid would also be extended-release and it would work the same way (neither the MD or the pharmacy volunteered this info and I didn't know that there were 2 forms). That the medication is not extended release would help explain why I experience worse symptoms starting mid to late afternoon.

 

Does this affect my body's healing process when this drug doesn't maintain a steady state?

 

Based on a 10 mg dose at 7 a.m. - what do you estimate (or know) the plasma dose be about 3 -4 pm? At 7 pm?

 

Would you recommend splitting the dose? If so - by what proportions and about what times might you suggest? For example - 60% of 10 mg dose at 7 a.m. and 40% of 10 mg at 3 pm?  

 

Thanks

 

 

Hi again,

Here's your post from yesterday.......I moved it over here.  Once moved, they line up in chronological order, so now it's up a few.  I'll add an @Altostrata here as well.

If you could work on the notes, Guilietta, in the meantime.  Then post right here. 

This one is a sample note, from the link I gave you.

And so forth. A diary, in chronological order, looking something like this:
 
6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

Best,

mmt

Edited by manymoretodays

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Altostrata

As I explained in the Tips for Tapering topic, it is impossible to make an extended-release oral liquid.

 

Guillieta, why did you decide not to taper by counting beads? That's the way most people do it.

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Guilietta

Thanks for the kind introduction and advice, mmt. I see you have also taken AEDs. I have taken, like you, trileptal and its previous generations, and multiple others. Lamotrigine may elevate anxiety if the level is too high so the MD is ordering a lab test. As you indicated - one med change at a time - if needed.

 

I am tracking my doses and only new/significant/significantly bothersome symptoms on a daily basis but in such a detailed fashion unless I'm having bad day(s).

 

Alto - I was unsuccessful at counting beads. My fine motor skills didn't make it a viable approach for me. One local pharmacy would compound with beads - but not in increments needed. Their cost was also prohibitive - more than $400 a month.

 

 

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Guilietta

July 30

6.30 a.m. awoke, breakfast and meds (300 mg gabapentin, 2.5 mg lisinopril, 10 mg crestor, .5 mg clonazepam, 9.75 mg liquid duloxetine) and supplements (calcium 250 mg, omega 3 fish oil 1000 mg, B12 sublingual tablet)

12 p.m. lunch

1 p.m. gabapentin 300 mg

4 p.m. anxiety/tinnitus

6  p.m. dinner and lamotrigine XR 600 mg

9 p.m. gabapentin 400 mg and clonazepam 1.5 mg

10.30 p.m. bed

July 31

2 a.m. Awaken (hot, sweaty – room temperature is 70 F), some anxiety, bad sore throat (odd!) and trouble swallowing

4.30 a.m. fell asleep
6.30 a.m. awoke, breakfast and meds (300 mg gabapentin, 2.5 mg lisinopril, 10 mg crestor, .5 mg clonazepam, 9.75 mg liquid duloxetine) and supplements (calcium 250 mg, omega 3 fish oil 1000 mg, B12 sublingual tablet)
10-11 a.m. Intermittent auras

12 p.m. lunch
1 p.m. 300 mg gabapentin
2 p.m.  auras
3.30-5 p.m. anxiety, tinnitus, feelings of jitteriness, auras, lower gi, chills, heart pounding
6 p.m. dinner. anxiety, jitteriness and chills through dinner.  Lamotrigine XR 600 mg.
6-8 p.m. anxiety, tinnitus, feelings of jitteriness, hot and sweaty (70 F room temp), heart pounding continued
9 pm 400 mg gabapentin and 1.5 mg clonazepam9

9-10 pm bed

 

I may be enjoying a good day - and out of nowhere comes intense anxiety and associated symptoms like those that started today at 3.30 (and are still hanging on).

Thank you 😉

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manymoretodays

Hey Guilietta,

Please go ahead and use the Drug Interaction Checker at Drugs.com

Put all your meds/drugs in there.

And then copy and paste results right here on your introduction page as well.

 

Oh boy, that's a lot of medications Guilietta.  I'm glad you are getting started, reducing that combination.

And yes, Trileptal was my last medication to taper off of.

 

Oh, nice notes!  You can also use a rating scale for the anxiety and other symptoms, if you want.  A general 1-10 type thing. 

 

Thank you.

L, P, H, and G,

mmt

 

 

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Guilietta

Hi there,

 

I did a report - which I had done previously - but chosen not to post. I have a significant number of moderate to minor interactions.  Should I copy/paste the document in here? Attach a file? Please advise - thanks.

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Guilietta

To 'rate' the symptoms as listed above - I have done so below for the 31st.

 

2 a.m. Awaken (hot, sweaty – room temperature is 70 F), some anxiety, bad sore throat (odd!) and trouble swallowing -

4.30 a.m. fell asleep
6.30 a.m. awoke, breakfast and meds (300 mg gabapentin, 2.5 mg lisinopril, 10 mg crestor, .5 mg clonazepam, 9.75 mg liquid duloxetine) and supplements (calcium 250 mg, omega 3 fish oil 1000 mg, B12 sublingual tablet)
10-11 a.m. Intermittent auras - 4

12 p.m. lunch
1 p.m. 300 mg gabapentin
2 p.m.  auras - 6
3.30-5 p.m. anxiety, tinnitus, feelings of jitteriness, auras, lower gi, chills, heart pounding between 8 and 9
6 p.m. dinner. anxiety, jitteriness and chills through dinner.  Lamotrigine XR 600 mg. 7
6-8 p.m. anxiety, tinnitus, feelings of jitteriness, hot and sweaty (70 F room temp), heart pounding continued between 8 and 9
9 pm 400 mg gabapentin and 1.5 mg clonazepam9

9-10 pm bed

 

I ended up awakening at 2.45 this morning  - falling asleep around 3.45-4 - and awakening at 5.20 a.m....with  anxiety about 4

 

Thanks again for your help (and patience). 

 

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Guilietta

Note about this (long) list: I never drink alcohol and the lorazepam is rarely used (maybe about 3 or 4 tabs in the last 7 months). It's an emergency med only. I pasted the report in its entirety when I didn't hear back from you.

Moderate

LORazepam lisinopril

Applies to: lorazepam, lisinopril

Lisinopril and LORazepam may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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

clonazePAM lisinopril

Applies to: clonazepam, lisinopril

Lisinopril and clonazePAM may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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
LORazepam lamoTRIgine
Applies to: lorazepam, lamotrigine
Using LORazepam together with lamoTRIgine 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.
Moderate

clonazePAM lamoTRIgine

Applies to: clonazepam, lamotrigine

Using clonazePAM together with lamoTRIgine 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

LORazepam DULoxetine

Applies to: lorazepam, duloxetine

Using LORazepam together with DULoxetine 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

clonazePAM DULoxetine

Applies to: clonazepam, duloxetine

Using clonazePAM together with DULoxetine 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.


Moderate

gabapentin DULoxetine

Applies to: gabapentin, duloxetine

Using gabapentin together with DULoxetine 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.

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Moderate

lamoTRIgine DULoxetine

Applies to: lamotrigine, duloxetine

Using lamoTRIgine together with DULoxetine 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.

Minor

gabapentin lamoTRIgine

Applies to: gabapentin, lamotrigine

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist.

Drug and food interactions

Moderate

LORazepam food

Applies to: lorazepam

Alcohol can increase the nervous system side effects of LORazepam such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with LORazepam. Do not use more than the recommended dose of LORazepam, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

 

Moderate

lisinopril food

Applies to: lisinopril

It is recommended that if you are taking lisinopril you should be advised to avoid moderately high or high potassium dietary intake. This can cause high levels of potassium in your blood. Do not use salt substitutes or potassium supplements while taking lisinopril, unless your doctor has told you to.

Moderate

gabapentin food

Applies to: gabapentin

Alcohol can increase the nervous system side effects of gabapentin such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with gabapentin. Do not use more than the recommended dose of gabapentin, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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Moderate

lamoTRIgine food

Applies to: lamotrigine

Alcohol can increase the nervous system side effects of lamoTRIgine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with lamoTRIgine. Do not use more than the recommended dose of lamoTRIgine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

DULoxetine food

Applies to: duloxetine

DULoxetine may cause liver damage, and taking it with alcohol may increase that risk. You should avoid or limit the use of alcohol while being treated with DULoxetine. Call your doctor immediately if you have fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, dark colored urine, or yellowing of the skin or the whites of your eyes, as these may be symptoms of liver damage. 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.

 

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes five medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

  • gabapentin
  • clonazepam
  • duloxetine
  • lamotrigine
  • lorazepam

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

uplication

Anticonvulsant agents

Therapeutic duplication

The recommended maximum number of medicines in the 'anticonvulsant agents' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'anticonvulsant agents' category:

  • gabapentin
  • clonazepam
  • lamotrigine
  • lorazepam

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication

Tranquilizers

Therapeutic duplication

The recommended maximum number of medicines in the 'tranquilizers' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'tranquilizers' category:

  • clonazepam
  • lorazepam

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication

Benzodiazepine anticonvulsant agents

Therapeutic duplication

The recommended maximum number of medicines in the 'benzodiazepine anticonvulsant agents' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'benzodiazepine anticonvulsant agents' category:

  • clonazepam
  • lorazepam

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

uplication

Benzodiazepines

Therapeutic duplication

The recommended maximum number of medicines in the 'benzodiazepines' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'benzodiazepines' category:

  • clonazepam
  • lorazepam

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

 

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manymoretodays

Thank you Guilietta for posting it all.

That was what I would have said to do.

 

....and patience required too.  I'm more out, than here, for a bit of a stretch now.  Just without a lot of internet access.  Back soon, more regularly, another week or so.

And so good to see you getting around the site and offering others support too!  Thank you. 🤓 😻

Makes me smile.

 

L, P, H, and G,

mmt

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Guilietta

All of us have been greatly wronged by drug companies, regulatory agencies, MDs and news outlets. Supporting each other is one of the keys to success.  Tomorrow I'll be able to post an update on how I have been on the split dose. As I have a summer cold - I'm not sure how much of the fatigue may be due to that and how much due to the dosing.

 

Good to be off-line....

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Guilietta

Help! Re possible dosage error this morning

 

I started splitting my dose 3 days ago - my total was then 9.75 mg (60% 1.95 mg a.m. and 40% 1.3 ml p.m.)

 

Today I am to go to 9.5 mg / 3.16 ml (50/50% would be 1.58 ml and 1.58 ml).

 

Because I have 2 syringes to contend with - I am very attentive to the amount of medication I draw into my 2 syringes. Between the change AND my terrible short term memory I am confident I made an error with my dosage and I don't know what to do.  To add insult to injury - I don't know how much I took and I don't know what to do.

 

Would someone kindly advise.

 

Thanks,

 

G.

 

 

 

 

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Gridley
1 hour ago, Guilietta said:

Today I am to go to 9.5 mg

 

Why don't you hold where you were supposed to be yesterday (9.75mg) for a couple of days for stability? 

 

 

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Guilietta

Hi Gridley - this is a possibility (as far as what the math shows) to take the regular dose tomorrow and hold for a couple of days before the next .25 mg cut.

 

However - the possible differences between what I might have taken and what I planned to take may be significant so I don't know if the above still bears weight in a 24 hour window for dosing purposes.

 

After 2 hours doing multiple calculations/variations (I am REALLY bad at math) and yes, I used a calculator, here is what I came up with:

If I made an error - the best of possible worlds would be relatively small increases - so not an issue.

 

However at the high end of my possible errors, eke, I could have taken my entire daily dose this morning. So - if I knew that to be the case - I would just not redose in the afternoon and suffer the consequences (feel really lousy until tomorrow a.m.'s dose).

 

So - does one still hold - or take more this afternoon if the W/D effects show up (meaning I took close to my planned morning dose)?

 

Thanks,

G.

 

 

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Guilietta

Hi David.

 

I just may have made a goof this morning with my morning dose. I either took a wee bit more (no problem really) or I took up to the entire day's worth.

 

Even though I am fastidious about writing down how much I should take, checking it off, etc. - when I got back to my desk to write this down - well, I wasn't sure.

 

I suppose one could have this issue with counting beads. I wonder what people do to manage this.

 

G.

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Gridley
19 minutes ago, Guilietta said:

So - does one still hold - or take more this afternoon if the W/D effects show up (meaning I took close to my planned morning dose)?

 

If you get WD symptoms this afternoon, I would take your regular afternoon dose.  If no WD, then wait until tomorrow morning, then take your previous AM and PM doses tomorrow and maybe for a few more days before making any changes.

 

Skipped doses and double doses are pretty common errors.  Things normally shake out within a reasonably short time, so I wouldn't be too worried.  

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Guilietta

Thanks Gridley. That is a sensible approach. I have made an error only once or twice in the past 7 months - and never one as potentially huge as this.

 

G.

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DavidfromTexas

Hi Guilietta. You know, I would defer to what one of the moderators say here. 

 

Is there really no way to tell how much liquid you took? Is there a remainder left in the syringe or anything?

In this situation, if I had no idea how much I took, I would wait until tomorrow morning to take my next split dose. But again I would see what the mods have to say. 

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Guilietta

Hi there.

 

Gridley was able to assist with the decision making. I decided to see how I felt this afternoon - and if I felt symptomatic - take what I had planned to take. Otherwise - I could wait until tomorrow morning.  As I was experiencing symptoms by 2.30 (whether 'real' or contrived by my own mind!) I took my planned dose.  Tomorrow I will hold and the day after I will start my 4th reduction of 4 - before a 2 week hold.

 

G.

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Guilietta

Hello - I hope you all are doing OK.

 

I have an update for you and a couple of questions. If someone would advise - that would be most appreciated.

 

How I am doing:

I am doing better 😊 in the afternoons (less anxiety and tinnitus, etc.) since spliting my dose (so about 4.7 mg @ 7 a.m. and 4.7 mg @ 1.30 pm).

 

Sleep -

For the past few years my sleep (and its quality) have declined.  I wake up once sometimes twice a night - nearly every night.

 

Would you advise I try melatonin? If so how much would you start with? I don't generally like supplements. I just added magnesium per AD recommendations.

 

My duloxetine RX soon needs to be refilled and I am not sure if I should continue with the liquid. 

 

Given that I am doing better on the split dose - would you consider making a change at all?

 

Are the beads materially better / more efficacious that split-dose liquid?

 

Thank you.  And hope everybody's well.

 

G.

 

 

 

 

 

 

 

 

 

 

 

 


 

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Gridley
37 minutes ago, Guilietta said:

Would you advise I try melatonin? If so how much would you start with? I don't generally like supplements. I just added magnesium per AD recommendations.

 

My duloxetine RX soon needs to be refilled and I am not sure if I should continue with the liquid. 

 

Some members have found Melatonin helpful with insomnia.   
See Melatonin for sleep   
 
It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  Doses above 2-3mg can have a paradoxical effect (keep you awake).
 
If these any reason to change from the liquid?  If  not, it's best to make a few changes as possible.  
 
Given that you're doing better on the split dose, I wouldn't make a change in that.  If the change you're talking about is adding the melatonin, that would be fine if you start at a low dose.  Make only one change at a time is a solid rule.
 

 

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Guilietta

Thank you, Gridley.

 

I will start at .25 melatonin if the sleep doesn't improve in a week. Good advice. Thanks.

 

Re: considering a change in drug formula....

 

And first - quite agree - unless it is medically necessary or there will be a material advantage making changes to medical therapies is not something one wants to do. I want to give myself the best chance for a successful taper.

 

My reasons for considering / asking relates to the success of tapering off duloxetine in a liquid compound. As my dosages decrease I wonder how / if this will effect withdrawal symptoms.

 

1. Might a split dose mean 2 spikes of the drug - not just the one? Does this actually matter for treatment/tapering purposes? I attached a screen shot of the image from somewhere on AD.

 

2. I have a few possible flags about the liquid formulation -

  • Since being on AD I haven't noticed anyone tapering duloxetine using compounded liquid (which doesn't mean there aren't any people doing this). 
  • Of the 4 (other) compounding pharmacies I contacted - the two who compound duloxetine use powder in capsules (delayed release). Is powder in delayed release capsules the standard, I wonder. The PCCA won't tell me.

 

Thanks ever so much.

 

G.

 

 

Screen Shot 2019-07-31 at 10.23.55 AM.png

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Gridley
18 minutes ago, Guilietta said:

Re: considering a change in drug formula....

 

I don't have an answer to your questions.  I will bring your post to the attention of the other moderators.

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Altostrata
On 7/31/2019 at 11:15 AM, Altostrata said:

As I explained in the Tips for Tapering topic, it is impossible to make an extended-release oral liquid.

 

Guillieta, why did you decide not to taper by counting beads? That's the way most people do it.

 

Still don't understand what you're doing with the Cymbalta liquid.

 

Since you're taking a basket of drugs, why did you decide to start tapering with Cymbalta?

 

What is your daily drug schedule, with dosages? We need to see your symptom pattern as well. Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms. You can post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

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Guilietta

Hello Alostrata,

 

I am compounding the duloxetine because after two accidents with bead counting, I explored the compounding option.

 

Why I couldn't count/what happened: I could not get past opening the capsules containing the beads. After struggling to open the capsule, about 1/2 of the beads bounced everywhere. I don't have sufficiently good fine motor skills in my left hand for fine work  (plus some tremor). I really do not want to have these beads where one of the dogs can get them and I also make sure I measured dosages correctly. I couldn't see doing this for several months. Does that make sense?

 

I was willing to pay a compounding pharmacy rather than (try to) count beads.

 

Why taper duloxetine first?

 

All but duloxetine and clonazepam are maintenance meds for other medical problems so there are no plans to change them any time soon. (special note re: lorazepam. It is prn and is rarely used - and most recently in early February '19 related to this taper).

 

Duloxetine and clonazepam are my first tapering goals. Duloxetine was initially CT (thanks to an unknowing MD) last summer. After reinstating I had the side effects of 'getting on' the drug for 3 + months.  I saw a new MD in December '19 - who has not so easily bought into the taper idea. I'm grateful he writes a script to the compounding pharmacy.

 

Here is my daily medication/dosage summary - I will do an update tomorrow and include symptoms. This is by way of a quick reply.

 

6.30 - 7 a.m. Breakfast with 4.25 mg dulox & other meds (300 mg gabapentin, 2.5 mg lisinopril, 10 mg crestor, .5 mg clonazepam) and supplements (calcium 250 mg, omega 3 fish oil 1000 mg, B12 1000 mcg sublingual tablet, magnesium citrate 250 mg)

 

12 p.m. lunch
1 p.m. 300 mg gabapentin

1 -1.30 p.m. 5 mg liquid duloxetineanxiety

5-7 anxiety and some jitters
6 p.m. dinner Lamotrigine XR 600 mg.
9 pm 400 mg gabapentin and 1.5 mg clonazepam

 

Note that today is the first cut from 9.6 mg to 9.25 so I have experienced anxiety and mild tinnitus this afternoon.

 

Thank you,

G.

 

 

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