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Jmizz: Lamictal taper suggestions

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Altostrata

Good observations about your symptom pattern, Jmizz. It could be you are a fast metabolizer of lamotrigine.

 

If you get the 5mg tablets, they can help you space out your dosing to 3 or 4 times a day. Would you like to try this?

 

There's an extended-release form, but the lowest dosage is 25mg, and it cannot be split.

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Jmizz

So I have no history of bipolar anything. But I went full blown some sort of hypomanic something today. I haven’t felt this way since the first week off lexapro, before the post acute withdrawal set in. I’ve been restless and keeping moving the past week or so but it seemed more like akathisia bc I was restless on the inside and anxious. Today I haven’t really felt anxious since I took my dose this morning. But I have been one project to the next, not wanting to sit down at all. What in the world is wrong with me. I wish I could punch big pharma in the mouth.

 

how would the extended release dosing work and the subsequent taper at some point down the road?

 

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Altostrata

One iatrogenic episode does not make one bipolar.

 

To go off the extended-release, you'd have to switch to part immediate-release and then use liquid to taper.

 

What you might try: 25mg extended-release lamotrigine for one of doses -- evening is most likely, since you find it anxiolytic -- and a lower immediate-release dosage for the other dose, preferably in 5mg tablets. Do you think you could get your doctor to prescribe that?

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Jmizz

I’ll see what I can do. But I need to update you and see what you think. Im so lost and confused now.

 

i like the idea of the medicine not hitting me all at one time based off how I’ve been feeling. Here’s today’s symptoms list.

 

5:30 wake

5:30-7:30 feel like I need a dose bad

7:30 take 20mg, seems to calm the need a dose feelings but makes me horribly nauseous despite eating with food, almost immediately within 30 minutes. This continues for about 3 hours. Stay busy outside to try and ignore nausea.

11:30 go get lunch, feel sleepyish while driving and maybe a little depression I haven’t felt in a while.

12:00 eat lunch, son takes a nap, I go into a hypomanic like state, don’t feel much anxiety at all if any, just energized and going from task to task for the rest of the afternoon basically. Nausea is gone and I don’t feel bad physically, I just can’t stop doing things. It’s almost as if I’m scared to go inside and try to relax bc I’ll focus on how I feel.

5:30 take evening dose 20mg, with a sandwich, the need to take a dose feeling was not as noticeable to me today in the evening, maybe the last 15-30 min before I took it.

6:00-feel bad again, nausea hits and I seem to get itchy for a little while within the first hour. 

7:00-Eat dinner, sit down for first time all day, nausea gets a little better.

8:30-50mg trazodone/5mg melatonin/bedtime

 

i dont know if it’s the dose time changes, the drop in mg, or the water solution making this stuff hit me quicker and harder. But this nausea is brutal for a few hours after both my doses. It feels like I felt on lexapro all over again. The medicine is causing me issues but I can’t just stop taking it. 

 

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Altostrata

Not sure what's going on. Could be lamotrigine doesn't agree with you. It appears that the evening dose, at least, wears off sometime during the night.

 

I'm concerned about the nausea, the itching, and the sense of being overstimulated. The liquid may be being absorbed too fast in your stomach. Can you get the 5mg tablets?

 

Lexapro is a very strong SSRI. Celexa is a weaker sibling. Could be that reinstatement of perhaps 0.5mg Celexa, which comes in a prescription liquid, may relieve your withdrawal syndrome.

 

 

 

 

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Jmizz

I just don’t understand, the first month wasn’t as bad as this past 12 days moving doses? Should I try going back to the pills at 25 mg until I can get 5s? Idk though I haven’t really felt overstimulated the last couple days, it’s just the nausea that’s kicking my butt? It’s been just over 3 months since my last lexapro pill? Is that too far out? And the only thing that concerns me is that it never really helped me. But prob bc I was on too high of a dose.

 

i think the lamictal helps for sure, and to be honest I think I could wait out this withdrawal if I could just figure out how to minimize the lamictal symptoms, mainly the nausea, I gotta get my hands on some 5mg pills, it seems my nausea really kicked in when I started with water

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Altostrata

It seemed 50mg lamotrigine was too much for you? Also, you got the itching every night.

 

Not sure the experiment with liquid is working. You might take a 25mg tablet in the morning and 20mg in liquid in the evening.

 

5mg tablets would give you more dosing flexibility.

 

Could be a reinstatement  (0.5mg Celexa) would work better than lamotrigine. All we can do is make small changes and see what happens.

 

 

 

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Jmizz

What about if I bought a pill cutter and took 12.5 at 730 12.5 at 1230 and 12.5 at 630-7p?

 

still trying to get the 5s

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Altostrata

Yes, you could try splitting the tablets and taking them that way.

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Jmizz

Ok, I took a 25 pill this morning to see how that effects the nausea. All it did was prolong the time until I felt it and made me itchier. My brother is bringing his prescription pad to thanksgiving dinner. So I should be able to get some 5s. Is there going to be problems with insurance needed 240 pills per month?

 

im in a bad spot here, right? I haven’t felt much anxiety the last few days, and my mood seems pretty level. I’m sure the medicine is working to help some of the issues of the ssri withdrawal, but it seems like im narrowing down that most of the problems I’ve been experiencing as of late are caused by too much lamotrigene. And this isnt something I can rectify quickly, is it?

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Jmizz

What’s the rules on nausea medicine like Dramamine? Nogo?

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Jmizz

Today’s morning dose experiment was a total failure:

 

6:30-wake

7:30-25mg pill

8:00-10:00 haze foggy itchy weird head and skin sensations

11:00-nausea itchy

12:00-nausea itchy lunch

1:00-nausea jittery restless

2:00-nausea jittery restless

3:00-nausea jittery restless 0.25 ativan

4:00 nausea

5:00 nausea

6:00-nausea 

6:30-big meal/20mg water

7-9- no nausea/don’t feel horrible/headache/tiny bit of head pressure

9:00-50mg trazodone/melatonin

 

Big mistake trying 25 pill. I’d almost rather the water bc the nausea seems to come and go quicker instead of dragging out all day. I’m going to try and eat a big breakfast and take 20mg water tomm morning and see if that helps, as my evening doses aren’t as bad with my biggest meal of the day. My brother is gonna try to hook me up with a script for 5mg pills thanksgiving day.

 

i think I want to get this dose down lower as soon and safely as possible. If tomorrow sucks again maybe Thursday I’ll do 15 water 10 water 15 water at 730-1-630....

@Altostrata does that seem reasonable? If my brother gets the pills and I have them by Friday or Saturday we can discuss other options?

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Altostrata

Did you get any itching from the 25mg dose?

 

Another option is to take 15mg in liquid in the morning and 25mg tablet in the evening, since it seems your lamotrigine-induced queasiness is worse from the morning dose. As the amount in your bloodstream reduces over the night, the morning dose represents a bigger jump in your system. A lower dose in the morning may phase in the lamotrigine so your system may not react as badly in the afternoon.

 

13 hours ago, Jmizz said:

If tomorrow sucks again maybe Thursday I’ll do 15 water 10 water 15 water at 730-1-630

 

I'd take the evening dose at 7:30 p.m.

 

If you can get the 5mg tablets, it will be easier for you to keep a distributed schedule.

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Jmizz

Yes I got very itchy from 25mg pill yesterday and was horribly nauseous almost all day. However it’s interesting that I finally got to 12 hours apart in my doses, last night I took a water 20 and this morning I took a water 20 with a bigger breakfast than usual. This morning has been almost good. I had a little bit of nausea around 2 hours after I took it, and a slight hazy foggy feeling, but it seemed to lift pretty quick and I’ve been feeling pretty ok since then. I agree that the morning dose has hit me harder but maybe now that the doses are evenly spread it will get better? I’m very hopeful with how today is going so far. No itching today either.

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Altostrata
1 hour ago, Jmizz said:

last night I took a water 20 and this morning I took a water 20 with a bigger breakfast than usual.

 

Okay, this is good. Stick with this, it may work out. The queasiness should gradually go away when the amount of the drug in your bloodstream is more consistent.

 

Because of the itching, I would not take any one dose larger than 20mg. The itching is a red flag.

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Jmizz

@Altostrata

 

ok so things pretty much went downhill since we spoke last. I don’t understand I take it with food at the same time every day. The other day my nausea wasn’t as bad and I had an ok day. Yesterday I was nauseous and overly fatigued most of the day. Today I wasn’t fatigued but nausea all day. The only difference I see with the good day is that I had taken ativan the day before my good day and today is my 3rd day without ativan. 1st somewhat good, 2nd a little worse. 3rd pretty bad. I don’t know if that has anything to do with it. The day I took it, it didn’t seem to help with the nausea after I took it, but that night and the next day my nausea didn’t seem as bad after my doses. I may be over exerting bc i dont like how it feels to sit down and do nothing bc I just feel everything more, jitters and nausea.

 

Do I just need to be patient and hope the nausea goes away? Maybe it’s just windows and waves, idk.  I feel like im methodically poisoning myself everyday. This nausea is brutal, never felt anything like it in my life. When I get these 5mg pills my brother is prescribing me, what do you suggest. Should I maybe try 12.5 split 25 pills 3 times tomorrow until I get the script. I really wish I could just get off this medicine but I know that’s just another disaster in the making. He’s going to mail me a script for 5mg (4) twice daily.

 

should I take ativan tomm and see if I end up having another good day, to rule that out or confirm it has an effect?

 

 

 

 

 

 

 

 

 

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Altostrata

What is the progress on those 5mg tablets? Confused about why they're so difficult to get.

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Jmizz

My brother is going to mail me a prescription, my psych acted like it wasn’t offered in a dose under 25. So I’m getting my brother to do it. Thanksgiving day was the middle of the two decent days I had so I told him I’d get him to mail it to me if things changed. I just spoke to him. Once I get them in hand, what do you suggest. 

 

 

 

 

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Jmizz

5mg Prescription is in the mail.

 

6:30 wake restless legs as usual

8:00am 20mg with breakfast

10:00am nausea which I think is worse when my anxiety is up

10:00 took ativan 0.5 to see if my symptoms improve 

11:30 nausea lifts and I feel pretty good all afternoon, about the same as a few days ago

12-8 I feel pretty good, made myself anxious around 2pm for about 30 min reading stuff and nausea kicked up but I got up and distracted myself and it was gone the rest of the afternoon

8:00pm 20mg water

9:00pm- haven’t felt the medicine like I’ve been the past few nights

 

so I think the nausea correlates with my anxiety level, I’m worried that I keep getting rebound anxiety from ativan and that’s why the past few weeks it seems like I can’t get past day 3 without it. But I definitely always feel the nausea around 2 hours post lamotrigene dose.

 

How long do you think i would need to push through if I stopped ativan. Is it going to be bad even with a few weeks of sporadic use? I don’t really want to create another problem, it just sucks that these are the only times I feel close to normal.

 

 

 

 

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Jmizz

12-1-19

6:30 wake restless legs 

8:00am 20mg

9:30 start feeling the dose, some nausea, activation makes me want to move around

12:00- delayed thanksgiving at sisters, feeling some anxiety, nausea, eat lunch, helps nausea 

afternoon- start feeling some depression

4:00pm- another wave of mild nausea eat a snack 

8:00pm eat dinner take 20mg

9:30- take trazodone and melatonin sleep good

 

curious if the 10mg drop is starting to hit my body the past few days and that’s led to some low moods?

 

will give symptoms for today around 9:00pm

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Altostrata
15 minutes ago, Jmizz said:

curious if the 10mg drop is starting to hit my body the past few days and that’s led to some low moods?

 

Nausea, etc. still could be too much lamotrigine. When 5mg tablets arrive, I might try 15mg in morning, 10mg in afternoon, 15mg at night. Could be the 10mg in afternoon is not necessary and can gradually be dropped.

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Jmizz

I definitely agree it’s too much lamotrigene at least playing a big part in my symptoms. On lexapro I would get activated 1-2 hours after my morning dose and then have a second wave around 2-3pm and then sometimes I’d feel ok all afternoon. Yesterday I paid close attention and it seemed sort of the same. The last few afternoons have been relatively ok once I get past 3-4 pm, up until I get close to dose time. I’m hoping to have 5mg pills in my hand by this evening if the prescription gets here today.

 

12-2-19

 

6:30-wake restless legs

8:00- 20mg then I tried to sit and really feel how the medicine effects me

9:30-mild nausea starts, begin feeling activated, get up start distracting myself with chores, kinda itchy 

10-2 nausea isn’t as bad as a few days last week but I still have no desire to eat lunch really 

3:00 feel like maybe a second wave of activation, kinda itchy again, go outside with son distract myself

5-7 I feel decent 

7-8 it’s easier to eat in the evenings, sometimes crave sugar, started to get weird sensations, facial flushing, tingling on right side of my head..maybe need to take a dose feelings 

8:00- take 20mg feel kinda jittery up until I take my trazodone and melatonin 

9:45- trazodone and melatonin sleep fine minus son waking up at 3 with fever, took another small chunk of melatonin to get back asleep at 4am and slept til 7:30am

 

*no ativan in 2 days 

 

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Jmizz

12-3-19

7:30-wake

8:00- 20mg

9:30-very mild nausea, little activated feeling

mid morning - mentally I’m feeling more like myself 

Noon- sinus pressure/ear popping/headache in my temples/ sore neck and upper back feelings 

4:00-feel slightly activated again maybe but not for very long...headache won’t go away

7:00 headache eases some just before dinner and evening dose, still there but not as bad as from noon til 7

8:00 20 mg

8:30 shower-headache gets stronger

9:00 traz 50mg and melatonin5mg

 

frustrating, mentally I felt good today, more like myself, I seemed to eat better, but the headache was awful almost all afternoon, I felt a couple like this when I was first starting out on the medicine but today seemed more intense. Take away the headache and today would have been a good day, best in a while, nausea was very minimal from like 9:30-12. The script didn’t come today. That means I should definitely get it tomorrow.

 

*3rd day no ativan 

 

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Jmizz

@Altostrata

 

 

12-4-19

7:00am wake burning sensation headache seemed to go away when I was up and moving before my dose

8:00am 20mg

9-12 feel overall crappy as I have been, some nausea, little activated

1:00 feel jittery, which causes anxiety, my kid is sick so I can’t get outside much which is usually my outlet, stay anxious all afternoon. This manifests as jitteriness, tingly itchy skin, itching numb jawline, facial flushing, and nausea spikes when I feel anxious and goes away when I calm down. 

6:00 dinner/ not as anxious after dinner

8:00 20mg

9:00 traz 50 and melatonin 5

 

so when I was just withdrawing from lexapro, before lamotrigene,  in the afternoons my anxiety would get bad. A lot of times I would feel physical symptoms even when not necessarily psychologically feeling anxious. These would be an itchy numb feeling in my jawline, a feeling of being flushed in the face, weird electric sensations in my head (not necessarily zaps), tingly/itchy skin. I assume these are normal withdrawal symptoms? 

 

I have a reason for asking

 

 

 

 

 

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Altostrata

Your daily symptom pattern looks better. Are you using the DIY lamotrigine liquid?

 

3 minutes ago, Jmizz said:

so when I was just withdrawing from lexapro, before lamotrigene,  in the afternoons my anxiety would get bad. A lot of times I would feel physical symptoms even when not necessarily psychologically feeling anxious. These would be an itchy numb feeling in my jawline, a feeling of being flushed in the face, weird electric sensations in my head (not necessarily zaps), tingly/itchy skin. I assume these are normal withdrawal symptoms? 

 

Yes, withdrawal symptoms don't have to have any psychological triggers.

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Jmizz

@Altostrata

 

Yes, I dropped off the 5mg prescription last night and will go pick them up today. I have still been using DIY 20mg at 7-8 am and 7-8 pm. I think the liquid is the reason some days i feel the effects from lamotrigene more than others, like maybe sometimes my concoction is a little stronger than others. The pills will be easier.

 

i think a lot of my issues are just plain old anxiety, the side effects of the medication may just exacerbate it at times.

 

I will update tonight with the 5mg pills in hand. 

 

Its day 5 of no ativan so that’s a plus at least.

 

 

 

 

 

 

 

 

 

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Jmizz

Well had a little set back. Went to get the script and it was 107 dollars for a month. I could see spending that when I’m down low enough to not have much choice. I’m disappointed but life goes on. I browsed good rx for coupons without much luck. Maybe if I stabilize enough to get back working part time I can look into getting those pills monthly at that price. For now though I guess I’ll keep making liquid and maybe just make bigger batches of it instead of mixing it each dose. The other thing I’ve considered is taking 12.5 three times a day and splitting the 25s. What do you think @Altostrata

 

today I felt the usual funkiness. I didn’t sleep much with a kid spiking fever all night and was up early to go with my wife to a doctors appointment. I felt the normal kind of funky feeling after taking my morning dose, and the doctors appointment was uncomfortable, however I dealt with it better than I would have several weeks ago. I also feel like I had a pretty nice 2-3 hour window today around 12-3 before my usual evening symptoms kicked up. I’ve felt more myself mentally the past couple days, starting to get my sense of humor back at times and showing interest in things I used to enjoy again. If I can just shake the physical stuff, maybe the 12.5 three times a day would help not feel funky after my morning dose and maybe help the evening stuff if the dose is wearing off around 3-4 in the afternoons. There have been some positives though, I want to emphasize that. I’ve been managing without ativan also, and that makes me happy.

 

6:00am wake, intermittent sleep

7:30 20mg

8-10 some anxiety at the doctors office with my wife, nausea was there but not debilitating

12- I had a headache begin so I took ibuprofen which I usually try not to but I was bringing my son to the doc

12-3 I had a nice window, I didn’t experience anxiety at the doctor and was cracking jokes like my old self

3-6- lingering mild headache, neck and back of head tension, still feel good mentally

7- pretty relaxed watching football 

8- took 20mg

9:00- trazodone 50mg and melatonin 5mg

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Altostrata

Sorry to hear those tablets are so expensive. Your health insurance should cover them.

 

It sounds to me like you're stabilizing. Are you having any itching?

 

29 minutes ago, Jmizz said:

maybe the 12.5 three times a day would help

 

I don't know what that would do, it's a decrease of 6% over the 40mg per day you're taking, and you just now seem to be getting used to the twice-a-day dosing.

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Jmizz

I think I’m going to ride this out for a little bit, that would also be a 35% drop in a couple weeks. Good point. I was just considering it so I could actually take pills instead of liquid, for convenience. I guess I could always get a pill cutter and a scale. Im on a high deductible insurance plan, I need to look into the ins and outs of it. 25mg tabs are only 5 dollars. Not sure why the 5s are so expensive. It’s aggravating. I’m going to ask my brother if he has any ideas how to get the price down. 

 

I havent been itching after my doses anymore that I can tell. Mainly it’s just the nausea but it doesn’t seem as bad. Hoping I’m getting used to it. I began to notice I feel itchy when my anxiety spikes, like an itchy tingly skin feeling. it’s part of the physical symptoms of anxiety I get since my lexapro withdrawal began, was never an issue in my life prior. But it happens any time of the day if I feel anxious, so that makes me think it’s not medicine related. When first starting the meds and changing doses towards twice a day I would feel itching on my shins not long after I took the medicine. I haven’t been feeling that lately. 

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Jmizz

@Altostrata

 

my brother explained it like this. The insurance will cover up to 60pills bc that’s the way it doses. Even though he specified on the script 4 pills twice a day. Anything beyond 60 you pay cash for. 25mg twice a day for a month is 60 pills and costs me 5 dollars. 5mg 8x a day is 240 pills and costs 107. 

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Jmizz

They are pretty credible? Have you or someone you know used them before? I’ll check it out for sure!

 

so here goes today 👎🏻

 

Im trying not to get frustrated, I just really wish I knew what caused the things I feel. I tried to take it easy today and really pay attention to how and when I felt things.

 

8:00am -woke up took 20mg

I decided to not do much at all this morning to see exactly when and how I felt

8:45- by this time I can feel the medicine hitting me, it’s not a pleasant feeling, nausea begins, I felt itchy again today, and I started getting a little restless here

10-11 usually about 2 hours after I take my dose I get to the point where I want to be up doing things bc I don’t like how I feel

12:30-1:30 I had more nausea, tingles/itchy skin, mainly on my neck right at the jawline, and jitters

3:00- by 3 I start to feel bad in general, nausea,  just overall ill feeling, this is typical most afternoons, but some days it doesn’t seem as bad, like yesterday

5-7 I feel like I got hit by a bus from the shoulder blades up, everything is sore

8:00pm take 20mg

9:00 50mg trazodone and 5 mg melatonin

10:30- didn’t go straight to bed, 3 hours post evening dose and feel some nausea 

 

 

mentally I still felt pretty good today. This physical stuff is so annoying.

 

This is what my body seems to be telling me. when I feel the medicine hit and don’t like how I feel,  it makes me anxious. Then my symptoms get worse with the itchy feelings and nausea and overall tension. The days I keep busy or have things going on seem to be better days. The days I’m not doing much and can focus on how the medicine is effecting me seem to be worse. By the afternoon I’ve been so tense all day, I’m sore everywhere. Yesterday I was busy, wasn’t as bad, today I wasn’t and it was worse. Not real sure what to do bc I think lamotrigene is helping me mentally but physically it’s a struggle, bc I wish I could just take the medicine and not feel it. I know I just need to stop messing with stuff but I’m wondering if I should slowly try to work down to a lower dose that maybe I won’t seem to feel as much? Sucks 

 

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Jmizz

@Rhiannon

 

hey how much of the lamotrigene liquid do you make at a time? And what do you make it in?

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Altostrata

Honeybee is very credible.

 

Jmizz, how old is your do-it-yourself liquid? You should be keeping it in a dark bottle in the refrigerator for only about 4 days.

 

The itching and nausea are a worry. Could you try taking 18mg rather than 20mg twice a day?

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Jmizz

@Altostrata I mix the dose each time I take it, I haven’t been storing it, but I was going to maybe make a little more and use it for maybe 2 days. I had another good day today, having stuff to do really helps me. I have to try not to dwell on how I feel and hyperfocus on it so much. I’ll see how the next few days go and if I still can’t seem to shake the nausea I’ll think about dropping to 18. Hopefully my body is slowly adjusting to the changes from the past two weeks.

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Jmizz

@Altostrata

 

15 and 15 would be way too much of a drop? Also is it bad to do two diff doses? Like 15 morning 20 evening for a while and then drop to 15 and 15 maybe? 

 

18 is going to be tough to figure out with the water, I can prob try and buy a syringe with more lines on it and figure it out. Or buy a scale a chip off the 25? Is there a scale you guys recommend?

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