KiwiR: Risperidone 0nly on for 10 weeks total.Tapering advise

[KiwiR]

Can anyone Help me with how to taper my daughter off Risperidone please. shes only been on it for 10 weeks and first reduction has seen an improvement what next with doctors meeting coming up 17th Dec 2019.

 

thanks Rob

 

Tapering Risperidone.

3mg Risperidone for 6 weeks

2.5mg Risperidone for 4 weeks (till 17^th December)

8^th October 2019 3mg Risperidone prescribed.

19^th November 2019 .5mg reduction to 2.5mg (Positive effects)

17^th December 2019 (Want further reduction and tapering plan in place)

 

Psychotic Event 20^th August 2019, In France on Holiday before going to Italy for completion of University degree, was to return home for Christmas 2019 to New Zealand.

 

Lead up to Event

Previous 2-3 years build up of stresses boy friend, University studies. late night parties working at bar. 6 months prior to event Stresses even greater with overseas trip planning and organization and having to achieve b+ average grades.

Key stressors immediately prior to event.

Break up with boyfriend, afraid of boyfriends mothers actions.

Lots of alcohol and lack of sleep.

Time line.

20^th August 2019 call for help.

Phone calls and paranoia close to being admitted in France. Looked after by friends and slipped some mild anti anxiety pills. Paranoid and little sleep.

27^th August 2019 Dad Arrives in France.

Need to bring her back to NZ as soon as. Paranoia no sleep and very distressed. Mild sleeping pills and anti anxiety pills from gp but said he cant help.

7^th September 2019 Arrived back in New Zealand. Condition worsening.

10^th September 2019 Hospitalised.

Tried with a medley of drugs until psychosis was interrupted with Risperidone 3mg showing real improvement from 8^th of October. 2019.

8^th October 2019 3mg Risperidone

15^th October 2019 released from hospital.

Side effects stiffness flat no spark.

19^th of November .5 mg reduction in Risperidone from 3-2.5mg per day.

Benzatropine taken for 5 days to see affect improved side affects. But reduced meds seems to have the same affect and Benzatropine no longer taken.

10^th Of December Today.  I has improved with the drop in dose and is showing signs of improvement. She sleeps 12 hours a day movemnets are slow and sluggish and she is flat without much spark. Stable and well doing exercise, staying with family, working as painting helper with dad 4-5 hours a day 5 days a weelk. Has had no anxiety, strange thoughts disrupted sleep or paranoia feelings at all and is talking lucidly about her experience. Both her parents would like to see her tapered right off Resperidone safely (and obviously as quickly as possible but fully aware of the risks)

17^th December 2019 next meeting with Doctor when we will be requesting a tapering program and reduction till zero

 

Edited December 10, 2019 by Sassenach
identifying info.

[Gridley]

Welcome to SA, KiwiR.  We're happy to help you with a tapering plan for Risperidone.

 

We recommend tapering psychiatric drugs no faster than 10% of current dose every four weeks. Some have to go more slowly.  As you get to the lower doses, such as 1mg, it is often advisable to taper more slowly.  Be aware that the vast majority of doctors know nothing about safe tapering or the withdrawal that can result from too fast tapering.

Why taper by 10% of my dosage?

 

The following link is specifically about tapering Risperidone and includes instruction about how to obtain the small doses needed foe a safe  taper.

Tips for tapering off Risperdal (risperidone)

 

It's also advisable to taper as low as possible before jumping to zero, if at all possible 0.1mg or smaller.  Those tiny doses are difficult to work with, but it will really pay off in the end.

 

It's good that your daughter was on the drug for only 10 weeks, but that's still long enough to run the risk of withdrawal symptoms if your taper is too fast.

 

This is your Introduction topic where you can ask questions and connect with other members.  We're glad you found your way here..

 

 

[KiwiR]

On 12/11/2019 at 6:31 AM, Gridley said:

Welcome to SA, KiwiR.  We're happy to help you with a tapering plan for Risperidone.

 

We recommend tapering psychiatric drugs no faster than 10% of current dose every four weeks. Some have to go more slowly.  As you get to the lower doses, such as 1mg, it is often advisable to taper more slowly.  Be aware that the vast majority of doctors know nothing about safe tapering or the withdrawal that can result from too fast tapering.

Why taper by 10% of my dosage?

 

The following link is specifically about tapering Risperidone and includes instruction about how to obtain the small doses needed foe a safe  taper.

Tips for tapering off Risperdal (risperidone)

 

It's also advisable to taper as low as possible before jumping to zero, if at all possible 0.1mg or smaller.  Those tiny doses are difficult to work with, but it will really pay off in the end.

 

It's good that your daughter was on the drug for only 10 weeks, but that's still long enough to run the risk of withdrawal symptoms if your taper is too fast.

 

This is your Introduction topic where you can ask questions and connect with other members.  We're glad you found your way here..

 

 

Hello Gridley,

 

Thank you so very much for all this help. There seems to be such a balance between tapering too fast and staying on to long. negatives to both. Being free of risperidone is the goal and Id like to snap my fingers and do it tomorrow because the dullness is crappy. my daughter says she doesn't feel dull which she is happy about because that would be depressing. She experienced no withdrawl symptoms when dropping from 3mg to 2.5mgs and the dullness scale fell quite significantly which is good. she is helping me write this. we would very much like to drop to 2mg on the 17th Dec which is another .5 drop and see what happens ie monitoring very closely for symptoms. Then after a month continue with 10%-15% drops down to 1mg then 10% reducing after that.

 

When you said you could help with a tapering plan would this be a written document. I mean is there someone i could talk to on the phone or skype with or something or is the written word good enough.

 

My gut tells me she will taper well and strongly and never go on a gain. for whats that worth.

 

In appreciation Rob.

[Gridley]

39 minutes ago, KiwiR said:

i could talk to on the phone or skype with or something or is the written word good enough.

Sorry, but we can't do phone calls.  All the staff here are volunteers who are, almost without exception, going through their own withdrawal.

 

By tapering plan I didn't mean a written document but rather that you should taper by 10% or less every four weeks.  You have your own plan and of course you are free to taper as you wish.  

 

All I can say is that a 10% taper or less is what we have found from experience to work best with fewer risks of withdrawal symptoms.  I know from personal experience when I have exceeded that amount I have paid the price with increased symptoms.  Many times members have, in their understandable desire to be off these terrible drugs, gone too fast, suffered unpleasant withdrawal and had to updose, ending up taking longer than they would have if they'd tapered more slowly.  A 15% drop at these low doses is risky.. You should also be aware that often withdrawal symptoms are delayed.  

 

Regardless of how you choose to taper, I urge you to read the link I sent you.  It contains important information about tapering an antipsychotic.

 

Tips for tapering off Risperdal (risperidone)

 

Please keep us updated on your progress.

 

 

[KiwiR]

Thanks so much for your timely response I hear you load and clear. I have started reading all the info and will continue I will keep corresponding and be completely straight up with you on all matters.

 

Love Rob

[KiwiR]

On 12/12/2019 at 11:42 AM, Gridley said:

Sorry, but we can't do phone calls.  All the staff here are volunteers who are, almost without exception, going through their own withdrawal.

 

By tapering plan I didn't mean a written document but rather that you should taper by 10% or less every four weeks.  You have your own plan and of course you are free to taper as you wish.  

 

All I can say is that a 10% taper or less is what we have found from experience to work best with fewer risks of withdrawal symptoms.  I know from personal experience when I have exceeded that amount I have paid the price with increased symptoms.  Many times members have, in their understandable desire to be off these terrible drugs, gone too fast, suffered unpleasant withdrawal and had to updose, ending up taking longer than they would have if they'd tapered more slowly.  A 15% drop at these low doses is risky.. You should also be aware that often withdrawal symptoms are delayed.  

 

Regardless of how you choose to taper, I urge you to read the link I sent you.  It contains important information about tapering an antipsychotic.

 

Tips for tapering off Risperdal (risperidone)

 

Please keep us updated on your progress.

 

 

Hi Gridley, I have been reading info you have supplied and very helpful thanks. I may not have read enough but at what level, is there a level of dose of risperidone that the drug becomes ineffective. Its a question I will be asking the doctor today or it may come up. I see that under 1mg dose its is very important to reduce slowly to nothing so I'm guessing the drugs still have a significant effect down to very low doseages but I don'.t quite understand why.

 

Thanks Rob

[Gridley]

1 hour ago, KiwiR said:

I may not have read enough but at what level, is there a level of dose of risperidone that the drug becomes ineffective. Its a question

According to medical literature, minimum effective dose ranges from 1 to 6mg.  But the drug changes the architecture of the brain and even at the very low doses, receptor occupancy (parts of the brain affected by the drug) remains very high.  In the following study, at 6mg occupancy was 82%.  At 3mg, half the dose, occupancy was not halved but only reduced slightly, to 72%.  Extrapolating from this at 1mg it would still be very high.   So, yes, they still have a significant effect, but  in tapering it's not so much a question of whether the drug is doing anything therapeutically but rather how much of your brain remains "occupied"  or affected by the drug and how to get that as low as possible to make the transition to zero as smooth as possible.

 

In sum, the goal of slow tapering and jumping to zero at the lowest possible dose is to avoid abrupt changes to the brain and thus to minimize withdrawal symptoms.  A gradual smooth slide to zero is ideal,,but at some point all of us will have to make a !00% jump from the previous dose, and we want that jump to be from as low a level as possible.

 

Suggested minimal effective dose of risperidone based on PET-measured D2 and 5-HT2A receptor occupancy in schizophrenic patients.

At the 6-mg/day dose, mean D2 receptor occupancy was 82% (range = 79%-85%), 5-HT2A receptor occupancy was 95% (range = 86%-109%), and six patients had developed extrapyramidal side effects. After dose reduction to 3 mg/day, D2 receptor occupancy was 72%