gdsequoia: quadriceps cramps and eye accommodation problems - paroxetine, Abilify

[gdsequoia]

@Altostrata

Thanks for the info.

 

Sig updated.

[Altostrata]

I see you're taking a lot of stuff for your gut. You might be overdoing it and one or more of those things is causing your gut trouble.

 

You are also taking a lot of psychoactive drugs. I suggest you look up the adverse effects of each of them and see if any could be causing your gut problems. 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.

 

When was the last time you had a blood test for liver and kidney function?

 

[gdsequoia]

@Altostrata

Thanks.

 

Here you go:

 

https://www.drugs.com/interactions-check.php?drug_list=233-0,1013-0,384-0

 

(drugs.com doesn't know about tolperisone*, and also I've left the supplements out, in order to not convolute the info here)

 

* see CC's post for information from drugbank

 

I've added 2 links to my signature.

 

Last liver test was in November 2019. All levels were normal except "Anti-CCP".

 

Never had a kidney test, to the best of my knowledge. I did a CBC and electrolytes blood test recently. All levels were normal. Also tested glycated hemoglobin recently; the level was below the healthy minimum.

 

I'll try pausing the probiotic.

 

My main suspicions (about the stomach pain) are:

* The high (and long-term) magnesium dose

* As you said, the probiotic and the laxative which I've been taking for 3 months non-stop

* The fact that I take the biperiden with little water. The leaflet says I should take it with a lot of water.

* The fact that I tried cutting the tolperisone pill in two halves (2 months ago). That did give me stomach pain, but the pain was sort of short-lived.

 

Taking baking soda + vinegar + water does help me.

 

Edited June 17, 2020 by ChessieCat
added link to CC's post

[ChessieCat]

From https://www.drugbank.ca/drugs/DB06264

 

Quote

 

 

Tolperisone is an oral, centrally acting muscle relaxant. Its precise mechanism is not completely understood, though it blocks sodium and calcium channels. It possesses a high affinity for nervous system tissue, reaching highest concentrations in brain stem, spinal cord and peripheral nerves. Based on existing clinical data, Tolperisone is not sedating and does not interact with alcohol.

 

 

 

Tolperisone may increase the central nervous system depressant (CNS depressant) activities of Biperiden.

 

The risk or severity of adverse effects can be increased when Aripiprazole is combined with Tolperisone.

 

The risk or severity of adverse effects can be increased when Tolperisone is combined with Escitalopram.

[gdsequoia]

Thanks, @ChessieCat.

 

The thing about drugbank.ca is that I've tried putting basically any 2 random drugs in it, and it says the same thing every time. So I've stopping used that site.

[Altostrata]

Do you have any of the symptoms in the drug interactions report?

 

9 hours ago, gdsequoia said:

My main suspicions (about the stomach pain) are:

* The high (and long-term) magnesium dose

* As you said, the probiotic and the laxative which I've been taking for 3 months non-stop

* The fact that I take the biperiden with little water. The leaflet says I should take it with a lot of water.

* The fact that I tried cutting the tolperisone pill in two halves (2 months ago). That did give me stomach pain, but the pain was sort of short-lived.

 

Any of the above could be causing your stomach pain.

 

If I were you, I would eliminate each of these for several days one by one, see if your stomach issues diminish. Please use common sense about your symptoms.

 

We do not offer general medicine advice here. Please let us know if you have any symptoms related to psychiatric drugs.

[gdsequoia]

12 hours ago, Altostrata said:

Do you have any of the symptoms in the drug interactions report?

Yes, I have the following:

* biperiden+aripiprazole: stomach pain

* escitalopram+aripiprazole: abnormal muscle movements (dyskinesia)

 

I will heed your advice, thanks.

[gdsequoia]

The stomach pains disappeared when I stopped one of my laxatives. Thanks for the help!

 

Another question to anyone who might know:

 

The last maybe 30-50 days I've began having a slowly-worsening blepharospasm (BSP for short). I'm tapering Abilify as you can see in my signature.

 

I wonder: should I slow down the Abilify taper (maybe the BSP is a WD symptom) or should I accelerate it (maybe the BSP is caused by the current insanely-high Abilify dose).

 

My psychiatrist said I should pause all my supplements and the BSP will go away. But I can't do that, because I'm dependant on most of my supplements.

 

TIA

[Altostrata]

How are you dependent on your supplements?

 

How bad is this twitch? It looks like you are tapering Abilify and biperiden at the same time. Is that so?

[gdsequoia]

12 hours ago, Altostrata said:

How are you dependent on your supplements?

Supps I'm dependent on:

• vitD and magnesium: To be able to walk (without paralyzing muscle pain in the legs). When I decrease the magnesium, those pains get persistently worse, by which I mean they don't go away even if I reinstate my magnesium dose.
• melatonin, fish oil and Sedorelax: To be able to feel rested after sleep. If I pause them, I will be very sleepy during the day, so I will be defenseless with regards to my OCD. Note: Sedorelax's contents are valerian and balm.

Writing that stuff out made me make a couple of decisions:

• I will decrease vitD from 2x1000 IU to 2x400 IU which *is* enough for me. Can't go below that dose.
• I will pause the probiotic as I'm not dependent on it. Unlikely to be related, but still.
• I will stop the vitB6 (4.2mg) as I'm not dependent on it. (it is bundled into my melatonin supp, so I'll change melatonin brands)

Thanks for the writing-prompt. It helped me.

 

12 hours ago, Altostrata said:

How bad is this twitch?

Currently it is mild. Doesn't interfere with my life. On a 0-10 scale it's a 2. I'm just worried because it seems to slowly progress (*and* to be incurable since it is likely a form of dystonia). I read that it can progress to functional blindness (due to being unable to open the eyelid) that requires botox injections in the eyelid.

 

12 hours ago, Altostrata said:

It looks like you are tapering Abilify and biperiden at the same time. Is that so?

I'm no longer decreasing biperiden - my current dose is necessary-and-sufficient for suppressing my cervical dystonia.

 

I admit I was tapering both at the same time - for a brief period. I had to.

 

Edited June 26, 2020 by ChessieCat
added then removed note - wrong product

[Altostrata]

A lot of us have twitches that go away as we taper the drugs. I would not leap to conclusions about that twitch.

 

How do you feel on a lower dose of Abilify?

 

In your signature, you have noted some reductions in July 2020. Do you mean June?

[gdsequoia]

1 hour ago, Altostrata said:

A lot of us have twitches that go away as we taper the drugs. I would not leap to conclusions about that twitch.

Ok, thanks! Still, I decided to reinstate 2.7mg biperiden starting tomorrow.

 

The biperiden leaflet says (my attempt at translating from Bulgarian to English):

"One should avoid sudden discontinuation because of a danger of a victory of the counterregulation". And I had stupidly done two 10% reductions separated by only 2 weeks.

 

I know for a fact that I'm in danger of eyelid-dystonia (aka blepharospasm), as I already have another kind of dystonia (cervical).

 

1 hour ago, Altostrata said:

How do you feel on a lower dose of Abilify?

I had a moderate worsening of my OCD, but I then started going to psychotherapy and am feeling mentally well already.

 

Also, the constipation is much reduced now, which is nice.

 

Those are the two "tangible" (observed) changes so far.

 

1 hour ago, Altostrata said:

In your signature, you have noted some reductions in July 2020. Do you mean June?

Yeah, sorry, my bad. Fixed.

[gdsequoia]

Another question for everybody:

 

Say I'm taking 2 drugs, "A" and "B" that are both substrates of the same enzyme (namely CYP2D6). I'm decreasing my oral dose of "A". Does that mean I should increase my oral dose of "B", in order to still get the effect I require of "B"?

 

(in my case, "A" is abilify and "B" is tolperisone)

[Altostrata]

On 6/30/2020 at 6:12 AM, gdsequoia said:

Say I'm taking 2 drugs, "A" and "B" that are both substrates of the same enzyme (namely CYP2D6). I'm decreasing my oral dose of "A". Does that mean I should increase my oral dose of "B", in order to still get the effect I require of "B"?

 

What is the effect you require of B? As this is a site for going off drugs, we're not much for tinkering with cocktails.

[gdsequoia]

@Altostrata

Ok, I see.

 

The effect I require of "B" (tolperisone) is a suppression of my severe cervical dystonia.

 

I can't afford to have cervical dystonia, since it's ruining my spine (if I don't suppress it with meds).

 

So the idea is to taper drug "A" (Abilify), while (approximately) maintaining my blood levels of my other 3 meds (Escitalopram, Tolperisone, Biperiden).

 

Quote

As this is a site for going off drugs, we're not much for tinkering with cocktails.

Does this mean "we don't approve of tinkering with cocktails" or "we're not very good at tinkering with cocktails"? Sorry, English is not my native language.

[ChessieCat]

The admins, mods and mentors are all assisting members on a voluntary basis, and are not doctors.

 

SA is a site for helping people get off or reduce their psychiatric drugs, because very few medical professionals know how to get people off their drugs.

 

From the topic About Surviving Antidepressants:

  

On 3/17/2011 at 11:02 AM, Altostrata said:

 

SurvivingAntidepressants.org provides volunteer peer support for psychiatric drug withdrawal, while tapering and after you've quit.

 

(This site offers information to empower you to talk with your doctor. For medical advice, consult a knowledgeable medical caregiver.)

 

Taking a harm reduction approach to psychiatric drugs, we recommend reducing your dosage to the lowest effective dose for you, minimizing your drug burden for the sake of your general health. Many will continue to wean off psychiatric drugs entirely.

 

 

 

From drugs.com:

 

"Tolperisone is an oral, centrally acting muscle relaxant. Its precise mechanism is not completely understood, though it blocks sodium and calcium channels. It possesses a high affinity for nervous system tissue, reaching highest concentrations in brain stem, spinal cord and peripheral nerves. Based on existing clinical data, Tolperisone is not sedating and does not interact with alcohol."

 

SA is not able to provide assistance regarding what dose you should be taking of Tolperisone.  That is your doctor's responsibility.  Please discuss this with your prescribing doctor.

[Altostrata]

We don't help you fine-tune drug cocktails for a specific effect, that's your doctor's job.

 

If I were you, I'd wait to see the effect of the Abilify reduction before tinkering with your cocktail. Your theory may not be borne out in reality.

[gdsequoia]

@Altostrata

 

Ok, thank you.

[gdsequoia]

AN UPDATE (and a question) FROM ME.

For the last 6 months, I've tapered escitalopram (12% down) and aripiprazole (24% down). I know you advise against tapering 2 things at once, but my dyskinesia is so bad it's damaging my spine, so I've been trying different approaches to managing that.

I suffer from severe OCD, or at least did until I landed on my right meds.

I currently suffer from no WD effects. Also, I am mentally well, thanks to CBT therapy.

I worry about possible delayed worsening of my OCD. Meaning, if I keep tapering at this rate, and get an OCD crash at some point, then I'll have to updose by a lot, right? And that defeats the point of the tapering.

What are your thoughts on this, everyone?

[Nocturna]

That's great progress with the tapering, congratulations! I guess a lot of people (including me) have the same worries as you - what if I get a relapse of my condition after lowering the doses of my meds. But what if you get a relapse without lowering those doses? Then you'll have to go even higher... I've heard it's possible in theory, so my approach is to use the time I have in remission and reduce the meds as much as possible, while trying to keep myself stable with alternative approaches (such as therapy and mindfulness). Then, if I get mentally worse, I'll worry about it when (and if) it happens. Hope this helps at least a bit.

[Altostrata]

6 hours ago, gdsequoia said:

I worry about possible delayed worsening of my OCD. Meaning, if I keep tapering at this rate, and get an OCD crash at some point, then I'll have to updose by a lot, right? And that defeats the point of the tapering.

 

1. You decided to taper your way. You say you didn't have a choice.

 

2. No one can tell what will happen in the future.

 

3. Does it matter what the answer is to your question? Since you've already embarked on this plan, whatever happens, you'll have to deal with it.

 

4. We don't treat OCD here. If your OCD comes back, you'll have to figure out how to manage it. Updoses are for withdrawal symptoms, not for OCD.

 

5. If you're asking whether we will be able to dig you out if your plan goes wrong, I don't know. This was your decision.

 

 

[gdsequoia]

Thanks for the replies, @Altostrata and @Nocturna

 

[gdsequoia]

Update:

I reduced aripiprazole by 2.5%  2 days ago.

 

The good: Dyskinesia got much reduced with the aripiprazole cuts that I've done the last 30 days.

The bad: Yesterday, for the first time ever, I got tinnitus outside the house, and today I still have the tinnitus. It's mild for now.

Today, I feel some mild hearing loss in my right ear, and got some feet burning while bending over. The feet burning hadn't happened for half an year for me.

 

I'm undoing the latest aripiprazole reduction.

[ChessieCat]

3 minutes ago, gdsequoia said:

I'm undoing the latest aripiprazole reduction.

 

Do you mean that you are going back to the previous dose?  If yes, then why not try a smaller updose.

[gdsequoia]

2 minutes ago, ChessieCat said:

Do you mean that you are going back to the previous dose?

Thanks for replying.

Yep, that's what I mean.

 

 

For the past month, I've done 3 aripiprazole cuts of approx. 2.3% each, totalling a 7% reduction.

 

I'm not undoing the full 7%, I'm undoing only the most recent 2.5%. That should be a good move, right ChessieCat?

[ChessieCat]

If you were okay after the 2nd of the 3 reductions, you could try only going back up by half of the last reduction instead of the whole amount.  When I first started tapering I tried a 10% reduction (it was a bit too soon after I'd made a 25% reduction - suffering mild serotonin syndrome I was trying to reduce quickly) and I got ear pain.  I just took a tiny bit more and the ear pain went.

 

You could try the smaller amount first and if after 4 days things are still bad, with NO improvement, then you could try a tiny bit more.  Because you are talking in % reductions I'm not able to give you specific doses.  But talking in "your language" try an increase of 1.25% to start (so half of the 2.5% reduction amount).  Then after 4 days if needed, try adding back in 0.25% of the reduction amount.

[gdsequoia]

Thanks @ChessieCat, I understand you perfectly.

 

I'm using a digital scale (and fingernail-scraping) for tapering aripiprazole. Which is not a very accurate method. So most days I end up taking 1-2% more (or 1-2% less) than the "correct dose". That's why I feel that a "half-updose" (like you suggest) would not be enough (it would get "lost in the noise", so to speak).

 

When I started tapering aripiprazole, I researched the "liquid" method in this forum. It turned out aripiprazole is insoluble in water (I even tried dissolving it, to make sure). In my country we don't have liquid aripiprazole (except injection liquid), nor the "DISCMELT" form. I also considered using Rhi's technique from the above link, but I fear it might require much dexterity and "confidence in my hands", and I don't feel like I have those qualities. For someone like Rhi, who is an actual lab technician, it might be possible.

 

What do you think, Ches?

 

[btw: if you prefer to talk about milligrams rather than percent, check my signature - I write things in milligram form there]

[gdsequoia]

An update from me.

 

About a month ago, I did a 2.5% abilify updose, because of WD (tinnitus and worsened leg pain). To no avail. So then, 5 days, later, I did another 2% abilify updose. It helped remove the WD.

 

Then I waited a month to stabilize, and did a 3% Abilify reduction. Immediately got worsened leg muscle pain, as well as worsened eyesight. So 3 days later (i.e. yesterday), I went 1% up.

 

Now I'm waiting to see the effect.

 

I'm considering stopping the Abilify taper (Abilify is a "brake", in SA.org's term) and starting a escitalopram taper (escitalopram being an "accelerator"). Because I seem to tolerate escitalopram reductions WAY better than Abilify reductions. Then again, when my Abilify-escitalopram ratio goes up, my constipation gets worse (I read this somewhere, and it holds true for me).

 

BTW, I have a question. How precise must I be with my pill-weighing? Is it ok if I do a ±2% error every day? Or should I take the absolutely-precise number of milligrams every day, in order to avoid destabilizing my CNS?

 

Cheers,

gds

[ChessieCat]

Because of all the Abilify dose changes you've made recently it would be a good idea to hold for at least 2 months or longer before you start tapering the escitalopram.

 

11 minutes ago, gdsequoia said:

BTW, I have a question. How precise must I be with my pill-weighing? Is it ok if I do a ±2% error every day? Or should I take the absolutely-precise number of milligrams every day, in order to avoid destabilizing my CNS?

 

It's better to be as accurate and consistent as possible.

 

It is possible to make escitalopram liquid using a saline solution.  You could then take the majority of the dose in tablet and supplement it with the liquid.

 

The instructions of how to make the liquid is in Post #1 of this topic.

 

tips-for-tapering-off-escitalopram-lexapro

 

[ChessieCat]

Please condense your drug signature so that it doesn't take up so much room.  Since the software upgrade, some of the topics appear on the left side of the screen.  I'm using a desktop computer and your drug signature takes up the whole length of my screen so it makes it difficult to read posts.

 

I suggest that you post your current drug signature into a post so you still have access to the information.  Once that is done you can copy the link location and include that in your drug signature.

 

You could just put a summary for the drugs you are not currently tapering.

 

The bullet points are not necessary because the drug names are in green so can easily be seen.  Also, you do not need to add the year to every date, just the first mention of the date in the new year is okay.

 

Thank you.

 

I maintain a spreadsheet for SA.org - click here to view.

 

My drug interactions

 

[I’ve never taken 2 neuroleptics concurrently, or 2 antidepressants concurrently. Just 1 neuroleptic + 1 antidepressant]

• Aripiprazole: 22.5mg (Feb 2019), 15mg (Jul 2019); 3.75mg (23 Nov 2019); 4x3.75mg (12 Dec 2019); 5x3.75mg (10 Feb 2020); 34.46mg (26 Apr 2020); 32.71mg (18 May 2020); 31.75mg (13 Jun 2020); 30.48mg (22 Jun 2020); 29.56mg (28 Jun 2020),  28.96mg (30 Jul 2020), 28.09mg (20 Aug 2020), 27.44mg (28 Sep 2020), 26.80mg (20 Oct 2020), 26.17mg (22 Oct 2020), 25.53mg (28 Oct 2020), 26.17mg (30 Oct 2020), 26.81mg (4 Nov 2020), 26.01mg (7 Dec 2020)

• Antidepressants: Escitalopram 30mg (2014); Paroxetine 40mg (Sep 2019); 15mg (Oct 2019); Escitalopram 7.5mg (24 Nov 2019); Paroxetine 15mg (Nov 2019); 20mg (Nov 2019); 30mg (23 Jan 2020); Switch to escitalopram 15mg (26 Apr 2020); 18mg (12 Jun 2020), 18.54mg (28 Jun 2020), 18.16mg (3 Jul 2020), 17.8mg (22 Jul 2020), 17.44mg (30 Jul 2020), 17.09mg (30 Aug 2020),  16.92mg (24 Sep 2020), 16.25mg (10 Oct 2020), 16.58mg (5 Nov 2020)

• Baclofen: 10mg (approx. 20 Aug 2020)

• Biperiden: Started in 2013. Partial history: 2mg (22 Dec 2020); 1.5mg (5 March 2020); 3mg (26 April 2020); 2.7mg (1 May 2020); 2.43mg (14 May 2020)

• Supplements: Currently vitD3 800 IU, chelated magnesium 400mg (+60g pumpkin seeds), probiotic, melatonin 5mg, low-dose vitamin B-complex, fish oil 1000mg, vitE 12mg, enzymes

I am not a doctor. My posts are not medical advice. They are just my own opinions, thoughts and experiences.

 

 

 

 

[gdsequoia]

I have chronic constipation when my Abilify-Lexapro ratio gets high (the two seem to have opposing effects on my bowel motility).

 

I take 400mg magnesium glycinate/lysinate chelate, as well as 60g roasted pumpkin seeds for the magnesium in them. The reason I take all this magnesium is to reduce my leg spasticity (and neck twisting), so I can be able to walk.

 

I'm thinking maybe I should switch to another magnesium type, in order to reduce the constipation. I think I should avoid magnesium citrate, as it's an osmotic laxative (and therefore it can pull electrolytes from the body causing an electrolyte dysbalance).

 

I used to take 250mg magnesium oxide for years (before I ever got in the WD game) and it helped me a lot against the constipation. But it doesn't do very much for my leg/neck problems.

 

I once tried to mix the oxyde with the chelate, but IIRC got some stomach upset out of that.

 

The other thing I've used is psyllium husk. It worked great for the constipation, but decreased the absorption of my myriad meds, so it's a no go.

 

Any ideas, thoughts?

[ChessieCat]

Too much psyllium husk makes the stools sticky and stretchy.

 

Are you able to consume dates?  They are high in fibre but also quite high in sugar so please be aware of that.  Raw oats are also good.  I chop up 3 dates (the dried packet variety, but I do like the fresh ones but they are dearer) and have with my muesli every morning.

 

Prunes, which are dried plums, are also good.

 

And of course eating bread / flour which contains fibre, instead of the white processed varieties.

[gdsequoia]

Thanks @ChessieCat!

I never eat any kind of sugar, not even fruit and honey. They worsen my pains and cervical dystonia. I eat the best bread available (made of crushed wheat grains with zero flour).

I'll try the raw oats suggestion.

[gdsequoia]

Drugs.com says the following about "biperiden <->ARIPiprazole":

 

Quote

excessive anticholinergic effects may occur in combination use, which can result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of anticholinergic intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation.

 

I do have mydriasis, blurred vision and constipation. I wonder if I should do anything about this anticholinergic intoxication syndrome (AIS). I mean, most doctors would recommend reducing one or both of the meds in case of AIS, but they don't know about withdrawal.

[gdsequoia]

Oh, and some updates from me.

 

- I had to gradually updose the latest abilify reduction back to 26.81mg. My muscle pains are now manageable, though they are permanently worsened by like 15%. The eye symptoms are back to normal. Constipation has returned.

- I reduced my vitB6 intake from 9mg to 4.5mg, because I read that B6 is activating.

- I've started being milligram-precise about my meds. In other words, I use a nail filer now, instead of just my finger nails.

[Altostrata]

10 minutes ago, gdsequoia said:

I do have mydriasis, blurred vision and constipation. I wonder if I should do anything about this anticholinergic intoxication syndrome (AIS). I mean, most doctors would recommend reducing one or both of the meds in case of AIS, but they don't know about withdrawal.

 

If they're affecting your health, you may want to taper one of the anticholinergic drugs rather than continuing to taper escitalopram.