Venkat: tapering olanzapine / Zyprexa

[Venkat]

Hi hayduke

 

I must confess I chew tobacco.

It was very helpful initially to overcome some mental blocks caused by olanzapine.

 

I don't take tobacco 4hrs before sleep. Was supposed to give it up by new year 2020 but couldn't do it .will gradually taper it too.

 

I have access to benzodiazepines, occasionally I take 2 mg of diazepam. 

 

Regards, venkat 

[Venkat]

Sleapt for about 8hrs last night on 5mg olanzapine. 

[Venkat]

Zero sleep last night on 5mg olanzapine. Due to extreme restlessness early in the morning had to take 0.25mg of clonazepam. 

[hayduke]

Nicotine is a bear...I gave up cigs in 2003 and it was bloody difficult.  But much better afterwards and really boosted my willpower once I'd succeeded.

 

If I were you I'd postpone giving up tobacco for now because it's obviously too much stress at the moment. 

 

Just stabilise on your normal tobacco and 5mg until you've been sleeping properly for a few weeks.

 

If it were me I'd try and quit the tobacco again after that.  Definitely consult a trustworthy GP if you have sleep problems again while doing that.  After you are comfortably clear of the tobacco habit I'd have a look at tapering the olanzapine again.  At least this should only set you back a few months.

 

[Venkat]

Hi hayduke 

Did I updose olanzapine too rapidly.

I am not getting sleep.

I am developing restlessness legs as well. 

Should I lower the dose of olanzapine a bit.is it safe ? 

 

Will take your advice about tobacco. 

 

Regards, venkat 

[hayduke]

Hey Venkat,

 

In general, feel free to adjust your dosage by small amounts and get a feel for managing it yourself.  Learn to listen to your body and what it's telling you and asking you for.  When you change things, get a feel for how it reacts.  Over time you learn how to navigate your own taper as you see how your body and mind react to it.  (FWIW when I was reducing from 5mg to 2.5 I took a lot of smaller steps like 4.9, 4.8 etc - stabilising after each one.  Just keep the 10%/mo or less guideline in mind overall).

 

But for now I think your best bet is to get stable on your present dose, don't try and give up tobacco yet, and get your sleep sorted out before thinking about more changes. 

 

Unfortunately updosing doesn't really seem to have restored good sleep for you.  It sounds like the nicotine withdrawals we didn't know about in here before might have a hand in your insomnia.  You were sleeping ok on 5mg before you tapered, yeah? 

 

The restless legs are likely from your updose but will probably settle before long.  Again, in your position, I would be looking for a trustworthy doctor who understands and is sympathetic to your situation for guidance on how to improve your sleep.

[Venkat]

Hi hayduke 

 

Was sleeping well on 5mg earlier .

 

Will try to find a good GP to help me out.

 

Thank you for your response. 

 

Regards, venkat 

[hayduke]

How are you getting on Venkat, getting some good sleep?

 

Cheers

[Venkat]

Hi hayduke 

 

Things went extremely wrong for me. Updosing did not work for me. 

 

I am again on 6.25mg of olanzapine.

 

1500gms of sodium valproate. 

 

0.5mg of clonazepam. 

 

Just beginning to stabilize with the above after a very bad time.

 

Hope you are doing ok.

 

Regards, venkat 

[Bokart]

Hang in there, Venkat! Slow and steady is the best way to taper olanzapine, I feel. You know, there was this one time I had to have 6 month break to stabilize so I could start tapering again. But experiences vary. But I can definitely say that you will get your emotions back, you will have a good life (even while tapering! the prices are not collected at the end but along the way 🙂). Tapering this medicine just takes time, and I have been set back by my mistakes. An example is that I could do 10% drops before, now I can only do drops of 2,5 - 5%. I failed, had to reinstate and now my body reacts to the medicine differently and it doesn't tolerate changes in doses as well as it did before. That is why a slower taper will beat a faster taper time-wise.

 

You do have to learn to listen to your body. For listening, you need to be open. Sometimes your body will say "go slower, hold on, this is too fast for me", and that is fine. Then you will know to take it slow. Taking it fast will generate instability, and it's hard to listen and be open and without ambition (with the taper) if you are unstable. And with instability it will be harder to be patient. Instability kind of feeds itself, as instability generates impatience and impatience will make you want to taper faster. And if you taper faster, it generates more instability.

So take it slow. You will see that you get better. Time is a great healer. I am doing fine right now, but not always. I take 3,5mg of olanzapine. I had 2 crisis situations in my latest taper. They both were caused by too big drops, or actually too short waiting time between drops. I do not wish to have those situations again. I could lose everything again. I hope you are spared from that as well.

 

So here's my best wishes to you. Take it slow and don't forget to listen to how you feel.

 

Bokart

[Venkat]

Hi Bokart

 

Thanks a lot for your time and suggestions. 

 

Wish you all the best in your journey. 

 

 

Right now I am too scared to  taper. 

 

Will stabilize for some more time before starting. Will try to do it very slowly this time. 

 

I understand how you must have felt losing a few times. 

 

Regards, venkat 

[Venkat]

Which one should I start tapering first ??

[hayduke]

Hi Venkat,

 

Sorry you've had a hard time of it.

 

6.5mg is not a huge dose in the grand scheme of things so it sounds like you could've done worse there.  I have no knowledge on the sodium valproate so can't advise which to work on first.

 

Once you're stable for a good 6-12 weeks - including recreational things like tobacco and/or coffee - and feeling more or less ok, I agree with Bokart, consider making much smaller cuts at a time (say 1% or 2.5%), hold for some few weeks and stabilise before making the next.  If insomnia resurfaces you'll have to find ways to manage it, there's guidance on the site and a fair bit in your thread here.  But never cut further if you're not sleeping well enough.  Clearly addressing that is not as simple as a small updose there in all cases.

 

There are (not always, but) typically underlying issues when they prescribe strong drugs like this, and it's important to deal with them as part of the process of coming off, or they'll flare up again just like before you were given them.  I got a long way with meditation and eventually found a clinical psychologist who was able to help me with the really hard stuff that was coming up and essentially give me my life back.  The pain and noise I grew up with settled markedly after that.

 

All the best

[Venkat]

Hi hayduke 

 

Thanks for your concern and suggestions. 

 

Will do the taper this time very slowly after I stabilize for some more time. 

 

I strongly feel 10% per month does not apply to olanzapine, atleast for me. 

 

Hope you are doing well. 

 

Thanks again. 

 

 

Regards ,venkat 

[manymoretodays]

On 3/23/2020 at 1:09 AM, Venkat said:

Hi hayduke 

 

Things went extremely wrong for me. Updosing did not work for me. 

 

I am again on 6.25mg of olanzapine.

 

1500gms of sodium valproate. 

 

0.5mg of clonazepam. 

 

Just beginning to stabilize with the above after a very bad time.

 

Hope you are doing ok.

 

Regards, venkat 

 

On 3/25/2020 at 12:56 AM, Venkat said:

Which one should I start tapering first ??

 

Hi Venkat!  And thank you hayduke for being such a champ tapering buddy and support for Venkat!

 

Could you, Venkat, clarify a bit more via your signature?  This link will take you to it again:  AccountSettings/signature update

I'm seeing this months medications but nothing from before.  More about what we like to see here:  Please put your withdrawal history in your signature

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

Make sure and hit the SAVE button when you are done.

 

And then what are you taking now, and when?    Keeping daily notes

Look at the link.  And this is really not as hard as it seems, at first to do.  If for starters you just want to list the times on the left, and then your 3 medications/drugs by name, and dose on the right, that would be helpful for us to see.  Then go on and try one with symptoms on the right as well, as they occur throughout the day, include sleep, and any supplements taken.  And post a whole 24 hours here too.

 

1st march 2020 ;Tab olanzepine 6.5mg ; Tab sodium valproate 1500mg ; Tab valium 5mg

(taken from your present signature)

 

And......my final request, but a important one!  Could you do a Drug Interaction Report?  You just go to Drugs.com, and fill in with your drugs.  And then you could link us to it, and/or copy and paste it here on your introduction page.

 

And okay, thank you in advance. 

 

Best, L, P, H, and G,

mmt

 

 

 

 

 

[Venkat]

Hi manymoretodays

 

I just managed to upgrade my signature. But couldn't do the drug checker properly.Just poor computer knowledge. 

 

1000mg of sodium valproate at 7pm

6.25mg of olanzapine at 7pm - feel drowsy

500mg of sodium valproate at 9am

5mg of diazepam at 8am- feel less anxiety 

 

 

 

Regards, venkat 

 

 

 

 

 

 

[hayduke]

Some food for thought Venkat

 

[manymoretodays]

8 hours ago, Venkat said:

Hi manymoretodays

 

I just managed to upgrade my signature. But couldn't do the drug checker properly.Just poor computer knowledge. 

 

1000mg of sodium valproate at 7pm

6.25mg of olanzapine at 7pm - feel drowsy

500mg of sodium valproate at 9am

5mg of diazepam at 8am- feel less anxiety 

 

 

 

Regards, venkat 

 

 

Yes!  I see your signature update.

1st march 2020 ;Tab olanzepine 6.5mg ; Tab sodium valproate 1500mg ; Tab valium 5mg

 

Withdrawn from sodium valproate in2019 dec

Withdrawn from clonazepam in September 2019

Was on 5mg of olanzapine, was trying to withdraw at the rate of 10% of the current dose per month when things went very bad mainly due to insomnia for many nights.

And so was back on all of the above mentioned medications. 

 

How did you withdraw from the sodium valproate, and from what dose?

How did you withdraw from the clonazepam, and from what dose?

How is your sleep now?

(you can just answer right here on your introduction page)

 

Drug Interaction Report- Drugs.com

^ please take a look, and if you want to give it a try, you could copy and paste here.

 

Give a try at the notes too.  Just start in the morning.  Add in a bit more, after the times, around symptoms you might be having in your own words.  I'll just take what you did, and then in purple I'll add in some prompts for you.

add when you woke up, how you slept

8 am  5 mg diazepam  feel less anxiety

9 am 500 mg sodium valproate

10 am symptoms

12 noon  symptoms

2 pm  symptoms

4 pm  symptoms

7 pm 6.25 mg olanzapine feel drowsy

          1000 mg sodium valproate

add in bedtime

 

Add in, if taking any supplements as well, after the time, by name and dose

 

Add in a date, at the top of the notes, as well, and do another.  I'm guessing that you are pretty tired most of the time now.  Those are a lot of brakes, as we call them.

 

And so, if you would do another day of notes next.  And good job Venkat.

 

Best, L, P, H, and G,

mmt

 

Edited March 31, 2020 by manymoretodays
color code signature copy

[Venkat]

Hi manymoretodays 

 

Withdrawn from 1500mg of sodium valproate by slow taper by 100mg every month. 

 

Withdrawn from 0.5mg of clonazepam following Ashton manual over a period of 6 months. 

 

Right now I sleep for about 8 to 10 hrs.

 

 

Today

Woke up at 7 am, confused,sleapt for 10 hrs

8AM 5mg diazepam, feel less anxiety 

9AM 500mg sodium valproate, mild anxiety 

10AM  working with stress and like a zombie. 

12noon still feel like a zombie 

2pm feeling like a zombie but with little anxiety 

4pm anxiety is back,

7pm 6.25mg of olanzapine - feel drowsy 

Bed time 10pm 

 

Supplements- none.

 

 

Regards, venkat 

 

[Altostrata]

11 hours ago, Venkat said:

8AM 5mg diazepam, feel less anxiety 

 

Venkat, you've just woken up. When did this anxiety start, before you take diazepam at 8 a.m.?

[Venkat]

Hi Alto mam

 

Anxiety starts as soon as I get up .Thank you mam. 

 

Regards, venkat 

[Altostrata]

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

[Venkat]

Hi Alto mam 

 

I am  really not able to do the drug interaction checker in spite of repeated attempts. But will keep trying. 

 

Regards, venkat 

[manymoretodays]

Hi Venkat,

Here you go:

 

Drug Interaction Report

This report displays the potential drug interactions for the following 3 drugs:

• valproic acid
• Valium (diazepam)
• olanzapine

Edit list (add/remove drugs)

• Consumer
• Professional
• Email this report

Major (1)

Moderate (2)

Minor (0)

Food (3)

Therapeutic Duplication (0)

Interactions between your drugs

Major

diazePAM OLANZapine

Applies to: Valium (diazepam), olanzapine

GENERALLY AVOID: The safety and efficacy of intramuscular olanzapine administered in combination with benzodiazepines have not been established. Deaths have been reported in patients who received IM olanzapine during postmarketing use. The cause has not been determined but in many of the deaths, patients were treated with multiple concomitant drugs including IM benzodiazepines and other IM antipsychotics that are known to have the potential to induce hypotension, bradycardia, and respiratory or CNS depression. In addition, IM olanzapine may have been administered to some patients in a manner that was inconsistent with product labeling and also to patients with significant medical comorbidities or other medical conditions associated with potentially fatal outcomes. As of September 30, 2005, there have been 29 cases of spontaneously reported fatalities temporally associated with the use of IM olanzapine. Nineteen of these fatal cases had been or were concurrently being treated with benzodiazepines (seven with more than one benzodiazepine; six with IM or IV benzodiazepines; five treated within 2 hours of death). Based on estimated exposure, the incidence of fatal reports was less than 0.01%, which is similar to that reported for other parenteral agents used to treat patients with acute agitation associated with mental illness. A causal relationship is difficult to establish because there tends to be a higher risk of mortality associated with this particular patient population regardless of treatment.

MONITOR CLOSELY: CNS- and/or cardiorespiratory-depressant effects may be increased during concomitant use of olanzapine and benzodiazepines, especially in elderly or debilitated patients. In clinical trials of elderly patients with dementia-related psychosis, the incidence of death in olanzapine-treated patients was significantly greater than in placebo-treated patients (3.5% vs. 1.5%). Risk factors for the increased mortality with olanzapine include age greater than 80 years, dysphagia, sedation, malnutrition and dehydration, concomitant use of benzodiazepines, and presence of pulmonary conditions such as pneumonia. Limited data in 15 healthy subjects receiving IM olanzapine followed by an IM benzodiazepine (lorazepam) found that the combination prolonged somnolence by 3.3 hours compared to IM olanzapine alone and 5.8 hours compared to IM lorazepam alone.

MANAGEMENT: Caution is necessary when olanzapine is used in combination with benzodiazepines. Ambulatory patients should be made aware of the possibility of additive CNS effects and counseled to avoid activities requiring mental alertness until they know how these agents affect them. They should also be advised to avoid rising abruptly from a sitting or recumbent position and to contact their physician if they experience symptoms of hypotension such as dizziness, lightheadedness, or fainting. Concomitant administration of IM olanzapine and parenteral benzodiazepine has not been studied and is therefore not recommended. Patients given this combination when necessary should be closely monitored for excessive sedation and cardiorespiratory depression.

References

1. Zacher JL, Roche-Desilets J "Hypotension secondary to the combination of intramuscular olanzapine and intramuscular lorazepam." J Clin Psychiatry 66 (2005): 1614-1615
2. Naso AR "Optimizing patient safety by preventing combined use of intramuscular olanzapine and parenteral benzodiazepines." Am J Health Syst Pharm 65 (2008): 1180-3
3. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.

Switch to consumer interaction data

 

Moderate

valproic acid diazePAM

Applies to: valproic acid, Valium (diazepam)

GENERALLY AVOID: One case series has suggested that benzodiazepines may amplify the teratogenic effects of valproate in the offspring of epileptic women. Both drugs individually have been associated with adverse effects to the fetus. Another study has suggested that valproate may displace diazepam from plasma protein binding sites and inhibit its metabolism; however, the clinical significance has not been established. Other benzodiazepines may interact with valproate in a similar fashion.

MANAGEMENT: Both valproate and benzodiazepines should be avoided during pregnancy unless the potential benefits outweigh the risks to the fetus. In other patients, close observation for clinical evidence of benzodiazepine toxicity (excessive sedation) is recommended if valproate and a benzodiazepine must be used together.

References

1. Laegreid L, Kyllerman M, Hedner T, Hagberg B, Viggedahl G "Benzodiazepine amplification of valproate teratogenic effects in children of mothers with absence epilepsy." Neuropediatrics 24 (1993): 88-92
2. Dhillon S, Richens A "Valproic acid and diazepam interaction in vivo." Br J Clin Pharmacol 13 (1982): 553-60

Switch to consumer interaction data

 

Moderate

valproic acid OLANZapine

Applies to: valproic acid, olanzapine

MONITOR: Concurrent use of olanzapine and valproic acid may potentiate the risk of hepatotoxicity. The exact mechanism of interaction is unknown. In a retrospective study of 52 children, combined treatment with olanzapine and divalproex was associated with more frequent elevations of hepatic enzymes than either agent alone, and mean and peak hepatic enzyme levels during the observed course of treatment were also higher. All 12 patients who received combined treatment had at least one peak enzyme elevation above the normal range, versus 10 of 17 who received olanzapine alone and 6 of 23 who received divalproex alone. With the exception of 2 patients who required discontinuation of combination treatment (due to development of pancreatitis in one and steatohepatitis in the other), the observed peak and mean enzyme levels were less than 3 times the upper limit of normal (ULN) and were asymptomatic. The long-term significance of these findings is unknown.

MANAGEMENT: The authors of the study recommend monitoring liver function tests every 3 to 4 months during the first year of treatment with either olanzapine or valproic acid, at least in pediatric patients. If no elevations of liver enzymes or marked weight gain occur after one year, a decrease in frequency of monitoring to every 6 months can be considered. Patients should be advised to notify their physician if they experience signs and symptoms of hepatotoxicity such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

References

1. Gonzalez-Heydrich J, Raches D, Wilens TE, Leichtner A, Mezzacappa E "Retrospective study of hepatic enzyme elevations in children treated with olanzapine, divalproex, and their combination." J Am Acad Child Adolesc Psychiatry 42 (2003): 1227-33

Switch to consumer interaction data

No other interactions were found between your selected drugs. This does not necessarily mean no other interactions exist. Always consult your healthcare provider.

 

Drugs.com Drug Interaction Report

and then there is a bit more ^, that I did not copy and paste, regarding food reactions, particularly alcohol

 

Did you skip a dose of sodium valproate on Wednesday?

 

And best, L, P, H, and G,

mmt

Edited April 3, 2020 by manymoretodays
copy and pasting

[Venkat]

Hi manymoretodays 

 

Thank you so much for your help. 

 

I have just started to taper sodium valproate .

 

By the way I did not skip sodium valproate dose on Wednesday. 

 

 

Regards, venkat 

[manymoretodays]

Hi Venkat,

Okay good, I wondered if that was just an oversight.

Did you see our topic:

Tips for tapering off sodium valproate and valproic acid(divalproex sodium, Depakote, Depakene)

 

Also:  Taking multiple psych drugs? Which drug to taper first?

 

And how are you doing Venkat?

You did great with your daily notes too!  Can you do another please? Thank you.

 

L, P, H, and G,

mmt

[Venkat]

Hi manymoretodays 

 

Notes on 05/04/2020

Got up at 7 AM- not much anxiety but confusion and severe fatigue. 

8AM- took 5mg of valium and 400mg of sodium valproate 

9AM off to work like a zombie 

10 AM still at work with out a clear mind.

5pm return home from work still like a zombie. 

7pm - 6.25mg of olanzapine and 1000 mg of sodium valproate ,feeling drowsy. 

8pm off to bed.

 

 

Regards, venkat 

 

 

 

[Venkat]

Hi manymoretodays 

 

You are showing so much concern for me. I don't know how to thank you.

 

Right now I am not doing well. 

 

Going through all the side effects of olanzapine.

 

No emotions, no feelings, no memory. 

 

Feeling of impending doom with fear all the time.

 

Unable to be a good father to my teen aged son.

 

Unable to be a good husband to my wife.

 

Is there hope for me ?

 

Regards, venkat 

 

 

 

 

 

[hayduke]

You can get through this Venkat.  Just give yourself time, don't rush things, look after yourself and keep working on your healing.

 

All the best

[manymoretodays]

Hi Venkat,

Yes, much hope for you Venkat. 

If you would, go ahead a post a couple days notes.

And oh man, sounds brutal right now. 

It may be the combination of all these more brake like drugs too. 

The notes will help to see.

 

And as hayduke said above.

 

L, P, H, and G,

mmt

[Venkat]

O7/04/2020

 

7AM  -  got up with difficulty, extreme fatigue 

8AM   - 1/2 tab of 0.25mg of clonazepam,400mg of sodium valproate 

9AM   - off to work as usual dragging myself 

10AM  - working like a zombie, not interested in work

5pm -  back home, depressed

7pm - 6.25mg of olanzapine and 1000mg of sodium valproate 

9PM  - off to bed ,disturbed sleep 

 

 

Regards, venkat 

[Venkat]

O7/04/2020

 

7AM  -  got up with difficulty, extreme fatigue 

8AM   - 1/2 tab of 0.25mg of clonazepam,400mg of sodium valproate 

9AM   - off to work as usual dragging myself 

10AM  - working like a zombie, not interested in work

5pm -  back home, depressed

7pm - 6.25mg of olanzapine and 1000mg of sodium valproate 

9PM  - off to bed ,disturbed sleep .

 

 

Regards, venkat 

[Altostrata]

Venkat, do you sometimes take Valium and sometimes clonazepam in the morning?  Do you always take a benzo in the morning? Why do you do this?

 

Benzos can also cause someone to feel like a zombie, be fatigued, and not have any feelings.

This is from your signature:

Quote

 

Withdrawn from clonazepam in September 2019

Was on 5mg of olanzapine, was trying to withdraw at the rate of 10% of the current dose per month when things went very bad mainly due to insomnia for many nights.

 

 

How did you go off clonazepam?

 

When did the insomnia start? When did your olanzapine taper "go bad"?

[Venkat]

Hi Alto mam 

 

I have almost stopped taking a benzo in the mornings after slow taper. I was taking it to calm my nerves down a bit as I was having anxiety attacks .Now I take a benźo as and when needed only.

 

I went off 0.5mg clonazepam in September 2019 after following Ashton manual. 

 

My insomnia started 4 months back when I started to taper olanzapine at 10% pm .Things went very very bad when I updosed olanzapine to overcome insomnia and landed with my psychiatrist who put me on above medications. I realised updosing olanzepine rapidly did a lot of harm than any good to me.

 

 

 

Regards, venkat 

 

 

[Altostrata]

How did you feel after you went off clonazepam in September 2019?

 

How often are you taking clonazepam or diazepam now, at what dosages, when did you start taking a benzo again?

 

When did you start olanzapine? Was it after you went off clonazepam in September 2019? Please clarify your signature.

 

It's VERY IMPORTANT you keep a daily record of your drugs and dosages. The benzo may be causing the symptoms you attribute to olanzapine tapering. Please stop tapering for the time being.

[Venkat]

Hi Alto mam 

 

I felt very good after going off clonazepam in September 2019. It was as though half my problems had gone. 

 

I am taking 2.5mg of diazepam as and when needed.

 

I was taking olanzapine and clonazepam since 4yrs .No I did not start olanzapine after I went off clonazepam. 

 

Regards, venkat