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SoggyEconomist: doctor told me to cold turkey 2.5mg olanzapine, any advice?

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SoggyEconomist

Hi, in march I decided to go to a shrink after dealing with depression/anhedonia for a couple months. I was put on paroxetine 30mg and olanzapine 2.5mg. 

During my last visit with my previous doctor I told her I still had anhedonia, to which she replied: "let's increase the olanzapine to 5mg,  you'll sleep better".

I told her: "I dont think blocking my dopamine receptor further will resolve my anhedonia". Anyways, I decided to find another doctor who told me I could just 

cold turkey the current 2.5mg because I don't need it. I also started venlafaxine 75mg to see if it alleviates my anhedonia.

 

Any advice regarding the olanzapine? 

 

Thanks in advance for the replies, and sorry if my post is not very organized, I am not very good at writing. 

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Gridley

Welcome to SA, SoggyEconomist.

 

Doctors know nothing about safe tapering or the painful withdrawal symptoms that can result from the cold turkey of a powerful antipsychotic like olanzapine/zyprexa.  After months of using the drug, your body has become accustomed to it and a slow taper is necessary.  

 

We recommend tapering by no more than 10% of current dose every four weeks.  

 

 http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

So your first taper would be to reduce by 10% of 2.5mg, or 0.25mg, making your dose 2.25mg.  The following link is specifically about tapering olanzapine, including instructions on how to take the small doses you'll need for your taper.

 

Tips for tapering off olanzapine (Zyprexa)

 

When did you start the Venlafaxine?   Please put this information in a drug signature, listing dates you started, dose and name of all your psychiatric drugs..   Please use this link.

 

Account Settings – Create or Edit a signature.

 

You should be aware that there is a major interaction between paroxetine and venlafaxine.    

 

Interactions between your drugs

Major

 

Using PARoxetine together with venlafaxine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. 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.

 

This is your Introduction topic, where you should complete your drug signature, answer my questions and ask your own questions.  We're glad you found your way here.

 

 

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SoggyEconomist

I started the venlafaxine yesterday at 75mg.

I don't know how I am gonna be able to reduce 10% of a miniscule 2.5mg pill

 

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Gridley
26 minutes ago, SoggyEconomist said:

I don't know how I am gonna be able to reduce 10% of a miniscule 2.5mg pill

 

 

The link about tapering Olanzapine I sent you has specific instructions about taking tiny doses, basically making a liquid or weighing.  Here's the relevant portion. 

 

Using tablets to taper
Since olanzapine comes in many dosages, at least initially, tapering can take place using tablets and splitting them. Plan your taper and, via prescription, convert any dosage to some number of lower-dosage tablets.

Zyprexa tablets can be safely split, according to http://ps.psychiatryonline.org/article.aspx?articleID=84368
 

  Quote

patients should be cautioned that because of the coating of Zyprexa, split tablets must be used within seven days.

summed up at http://depression.about.com/od/depressionmedication1/a/savemoneyonmeds.htm
and Consumer Reports http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/money-saving-guides/english/PillSplitting-FINAL.pdf
 

However, the tablets can be difficult to split because they tend to be very small.


Use a digital scale to weigh tablet fragments
To control your dosage more exactly, you may wish to weigh tablet fragments, see Using a digital scale to measure doses
 
Using a liquid to taper: Pharmacy compounding
At a very low dose of olanzapine, if you are sensitive to dosage reductions, you may wish to request a prescription for a liquid from a compounding pharmacy. This will enable tapering by a fraction of a milligram.

A pharmacy compounding formula using crushed tablets is here http://www.pharminfotech.co.nz/manual/Formulation/mixtures/olanzapine.html
It is also attached to this post. (It notes olanzapine is "practically insoluble in water.") This formula says the suspension will expire in 14 days.
 
You will need a prescription written for the custom-compounded liquid. The only drawback is this can be quite expensive.
 
Using a liquid to taper: Make your own liquid
However, like other drugs that are not particularly soluble, you can make a suspension as our member Rhi describes below

 


According to http://www.pharminfotech.co.nz/manual/Formulation/mixtures/olanzapine.html

  Quote

Olanzapine (as crushed Zyprexa® tablets) is stable for up to 6 hours at room temperature and up to 48 hours refrigerated in water and the following beverages; orange juice, apple juice, cola and milk.

 
Also see http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/
 
If you want to experiment with dissolving the tablet further:
 
https://www.caymanchem.com/pdfs/11937.pdf

 

  Quote
Olanzapine is sparingly soluble in aqueous buffers. For maximum solubility in aqueous buffers, olanzapine should first
be dissolved in DMSO and then diluted with the aqueous buffer of choice. Olanzapine has a solubility of approximately
0.5 mg/ml in a 1:1 solution of DMSO:PBS (pH 7.2) using this method. We do not recommend storing the aqueous
solution for more than one day.

 

http://www.perrigo.com/files/rx/pdfs/pds173-ORA-Plus.pdf

 

  Quote
ORA-Plus is an aqueous-based vehicle consisting of a synergistic blend of suspending agents that have a high degree of colloidal
activity. The suspending agents form a structured, gel-like matrix which suspends particles and allow for little settling. ORA-Plus
is buffered to a slightly acidic pH to help reduce degradation of medicinal agents through oxidation. An anti-foam agent is incorporated in
ORA-Plus to allow for vigorous shaking with minimal foam.

 

Using orally disintegrating Zyprexa tablets or wafers to taper
Orally disintegrating tablets (ODT) or wafers, which dissolve in the mouth, come in a range of dosages (see above). Conceivably, one might very carefully cut up the wafers to taper, but they may be difficult to cut accurately. (I haven't done this and don't know of anyone who has, please let us know if you try this.)
 
Making a liquid with water would seem to be a better way to taper utilizing these tablets or wafers. In fact, in Europe, patient instructions for the orally disintegrating tablets state

 

  Quote

it may be dispersed in a full glass of water or other suitable beverage (orange juice, apple juice, milk or coffee) immediately before administration

 

Also see http://www.medicines.org.uk/emc/medicine/25020/spc
 
One of our members has tapered successfully by making a liquid with the orodispersible wafers, see http://survivingantidepressants.org/index.php?/topic/3743-tips-for-tapering-off-zyprexa-olanzapine/?p=163188
 
I would dispose of any homemade liquid left over from a dose -- do not save for another dose.
 
Using a combination of tablets or capsules and liquid
Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.
 
If your doctor prescribes compounded liquid and tablets or capsules at the same time, most likely he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

 

 

 

 

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SoggyEconomist

Any sucess stories of people tapering zyprexa?

After reading shane's and luke's stories I'm a bit scared

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brassmonkey

Hi Soggy-- welcome to SA. I think you got here just in time.  The recommendations that you doctor is making are going to cause you a lot of trouble in the long run between the interactions and the need to taper off of each of the drugs in a slow careful manner. The 30mgai paxil is what is causing the anhedonia.  It's one of those side effects that is going to be there no matter what you do.  The way paxil works is to make it so you feel nothing, it doesn't fix depression or anxiety. It just removes their feeling and the feelings of everything else.  I lived through many years of it before I tapered off and regained my life. The only way to get rid of the lack of feeling is to taper off of the paxil. 

 

Adding the venlafaxine will only make matters worse. It can interact very badly with the paxil to cause a paradoxical reaction, increasing your symptom load.  They also interact to greatly increase your serotonin  levels which leads to serotonin toxicity and eventually to serotonin syndrome. The first is very unpleasant (understatement) and the second is deadly.

 

ATM you RE in a good position to start a taper and have good success with it, but PLAYING around with other drugs  can really cause  real trouble.  You should stop the venlafaxine immediately, hold for a few weeks to get past the affects of that. Then I would do a 10% Brassmonkey slide of the paxil down to about 10 to 15mgai.  That will take about a year but should resolve some of the anhedonia.  At that point I would hold for a while then reduce the olanzapine to "0". Wait a while and then complete the paxil taper.

 

It's all a great balancing act to try and reduce the drugs while minimizing the WD symptoms.

 

Brassmonkey

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SoggyEconomist

Hi brassmonkey. First I'd like to thank you for your response and your advice.

I was quite depressed to be honest (I had a SA planned and letters written and all...) and I think the paxil helped me. 

I had anhedonia before the paxil also. I read on wikipedia that venlafaxine inhibits DAT at higher doses so I think I might

try that before tapering.  

The main drug that I want to taper right now is olanzapine, because it  is giving me cognitive and memory impairment and absurd amounts of weight gain. 

 

SoggyEconomist

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Altostrata

Hello, Soggy. 

 

How long have you been taking olanzapine? Did you discuss the side effects with your doctor?

 

It's not good medical practice to take venlafaxine together with an SSRI. Please discuss the potential serious adverse drug-drug interaction with your doctor.

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SoggyEconomist

Hi altostrata

 

I have been taking the olanzapine since the start of may.

 

I had to switch doctors after the previous one suggested I take 5mg of olanzapine, even after I told her my symptoms.

 

The new doctor didn't warn me about didn't tell me about stopping the paxil, nor about seratonin syndrome.

These past those 2 days I have been taking the venlafaxine and I haven't noticed any effects, either bad or positive.

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Altostrata

If you are taking these drugs for "depression/anhedonia for a couple months" (by the way, NOT a sufficient indication for antidepressants or any psychiatric drug treatment), they haven't done you any good.

 

If I were you, I would not add venlafaxine. It could be that the Paxil and olanzapine are making you dull, that is how they work.

 

Olanzapine does not in any way treat "anhedonia," was it prescribed for sleep? Did you have sleep problems after starting Paxil?

 

Please put ALL your drugs in the interactions checker https://www.drugs.com/drug_interactions.html

 

Paxil can be very, very difficult to go off.

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SoggyEconomist

Yes, I was prescribed olanzapine for sleep, at the same time I started the paxil.

 

What is the harder to get off of? paxil or olanzapine?

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SoggyEconomist

Is it a good idea to crush the pill, dissolve it in 100ml and remove 5ml, by using a kitchen scale?

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hayduke

Hey SoggyEconomist,

 

What an appalling drug to prescribe for sleep!  2.5mg is a better point to start a taper than 5, though.

 

I described my titration process here

all the best with your taper!

 

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Miko789

Hi there,

 

The worse drug to come off is paxil. Taken then both paxil and olanzapine.

Currenty taking olanzapine . Its hard. Cog-fogWhich part of Europe you based?

I use same method to taper olanzapine. Weighting dry. I think is harder with liquid.

 

Good luck

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SoggyEconomist

Hi @Miko789,

I am from portugal, where are you from?

I am starting my taper when my scale arrives. 

I can't stand any more of this emptiness and lack of creativity in my brain.

Good luck with your taper

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SoggyEconomist

Do compounding pharmacies make pills with a desired dose?(e.g 2.3mg) 

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brassmonkey

Yes, that's the whole idea of a compounding pharmacy.  The problem is you have to get a doctors prescription for each of the different doses that you want made up.  That can be a problem and get expensive.

 

Once you start tapering, given time the emptiness will go away and your creativity will return.  It can be very frustrating waiting for it to come back, but it will.

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SoggyEconomist

My scale arrived in the mail today. 

I am cutting to 2.25 tonight.

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crashcourse
On 9/26/2019 at 12:08 AM, SoggyEconomist said:

Hi brassmonkey. First I'd like to thank you for your response and your advice.

I was quite depressed to be honest (I had a SA planned and letters written and all...) and I think the paxil helped me. 

I had anhedonia before the paxil also. I read on wikipedia that venlafaxine inhibits DAT at higher doses so I think I might

try that before tapering.  

The main drug that I want to taper right now is olanzapine, because it  is giving me cognitive and memory impairment and absurd amounts of weight gain. 

 

SoggyEconomist

Please do not use venlafaxine, like brassmonkey suggested. Youre already taking a SSRI and venlafaxine is SNRI. It will do nothing to help you. My new doctor is also getting me off the venlafexine. 

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SoggyEconomist

Hey @hayduke

So far I haven't noticed any difference.

Cheers

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SoggyEconomist

@hayduke how is yours going?

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hayduke

Glad you're feeling ok.  Have you thought about the venlafaxine as others suggested?

 

I'm pretty well, thanks.  I was thinking about a cheeky 5th cut in this set but decided I'll just stick to the plan.

 

 

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SoggyEconomist

I think I am gonna keep taking the venlafaxine and hopefully taper the paroxetine.

Which cut was the hardest for you»

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hayduke

Going from 5mg to 3 1/3mg in one go before I'd read up on tapering properly was the worst.  It just kept feeling worse instead of better, spaced out and low moods, so after a couple of weeks so I reverted to the 5mg and didn't think much more about it.  Happily a friend nudged me to look into getting off all the way some time after so I read Breggin, and found this site among others then started tapering properly by 10%.  Certainly some challenging times since then, especially when life gets stressful (I have to work) but nothing really alarming.  Working with my supportive clinical psychologist helps a lot to defang potential issues.  Yoga is a huge help too.

 

Cheers

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SoggyEconomist

I haven't noticed any withdrawal effects. how longer should I hold until the next cut?

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Gridley
4 hours ago, SoggyEconomist said:

I haven't noticed any withdrawal effects. how longer should I hold until the next cut?

According to your signature, your previous cut was on Oct. 1.  Your next cut should be four weeks from that date and should be 10% of 2.25mg.  I wouldn't be tempted to speed it up.  Going slowly is very important at the low doses, and withdrawal symptoms can be delayed.

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Miko789
On 9/30/2019 at 4:20 PM, SoggyEconomist said:

Hi @Miko789,

I am from portugal, where are you from?

I am starting my taper when my scale arrives. 

I can't stand any more of this emptiness and lack of creativity in my brain.

Good luck with your taper

Hi @SoggyEconomist

Im from greece.

I have same feeling lack of creativity.

And this feeling pressure.

I read that cutting/splitting tabl. have a maximum 6hours  at room temperature.

How have you been so far wiith tapering?

 

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SoggyEconomist

HI miko,

I havent had any withdrawal symptoms.

I am tempted to cut again tomorrow

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Miko789
On 10/13/2019 at 4:09 PM, SoggyEconomist said:

HI miko,

I havent had any withdrawal symptoms.

I am tempted to cut again tomorrow

 

when was previous cut? maybe wait till 30 Oct. for next cut, maybe so you are sure you dont get wd

miko

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SoggyEconomist

The last cut was on 1st oct.

I have been feeling a bit anxious and have had strange dreams this last week, so I think I will hold until 1st november.

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