Gussy's Mum: Dr dropped Gussy's Mum's olanzapine from 5 mg to 2.5 mg? Now risperidone.

[Gussy]

Hi all you good Folk, I haven't posted in this group for a long-time. I posted a little bit in 2017 when I got  to 0 with my effexor taper, which was far too fast. There was no choice for me given my scenario, so I know how devastating withdrawal can be from these drugs. I'm a moderator in an  effexor group. My dear Mum, bless her angelic soul, has been on these drugs longer than she hasn't, and although i.ve told her much about the need for very careful tapering and drs cluelessness around this her dr has reduced her dose of olanzapine from 5-2.5 mg. I.ve told her to write down anything at all that.s out of the ordinary and tell me. My dad.s watching out for her but from his dr believing position i feel he wont be of much use to her. Nor will her dr. I guess i.m asking if wd symptoms are in the same park between effexor and olanzapine. I think i already know the answer but just want to be aware of any possible different wd symptoms between them. Another probably difficult to answer question, might dropping from 5-2.5 olanzapine be similar to dropping effexor from 75-37.5? You know, entering the danger zone as the lower end is approached? Her drs reduced her effexor from 225-112.5 in 37.5 increments over quite a while and she.s well and truly stable from that. I do cringe at the size of the drops and am frustrated by the belief some of my family have in the "wisdom" of drs in this regard. I know how dangerous this is. I.ve told her much about wd so hopefully she.ll be on red alert and ready to consider my help when the need arises. I saw a link on how to prepare a liquid solution here with olanzapine and will have a good look at it. Thanks for your time.

Edited May 22, 2023 by manymoretodays

[Gridley]

Welcome back, Gussy.

 

As you know, WD symptoms are pretty much all over the place in variety, but I think you're talking generally about the same type of symptoms whether from effexor or olanzapine.

 

You've already guessed the answer to your second question: the low end reductions could cause more problems than the high end.

 

Sorry you and your mom are having these doctor/drug problems.

[Gussy]

8 hours ago, Gridley said:

Welcome back, Gussy.

 

As you know, WD symptoms are pretty much all over the place in variety, but I think you're talking generally about the same type of symptoms whether from effexor or olanzapine.

 

You've already guessed the answer to your second question: the low end reductions could cause more problems than the high end.

 

Sorry you and your mom are having these doctor/drug problems.

Can a liquid form of olanzapine be made at home somehow? Will it be absorbed properly etc?

[Gridley]

45 minutes ago, Gussy said:

Can a liquid form of olanzapine be made at home somehow?

Quote

 

Yes.  I have excerpted the instructions from our post about tapering olanzapine.  The full post is here:

 

Tips for tapering off olanzapine (Zyprexa)

 

Here are the excerpted instructions:

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 explains. Also see http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

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.

 

The preparation and stability of a liquid olanzapine preparation for oral administration in hospitals

The Pharmaceutical Journal Vol 265 No 7110 p275-276 August 19, 2000

 

  Quote

 

....We have found that Zyprexa tablets 10mg, crushed and suspended in Guy's hospital "paediatric base", provides a more palatable liquid oral olanzapine preparation than crushed tablets suspended in water.

....

Zyprexa tablets (3 x 10mg) were halved and then crushed using a mortar and pestle and the powder suspended in 30ml Guy's hospital formula base for paediatric mixtures (paediatric base), a syrup-based mixture containing carboxymethylcellulose BP, methylhydroxybenzoate BP and propylhydroxybenzoate BP.3 Each batch of olanzapine suspension was stored at 2?8C in a 50ml amber glass bottle in the dark.

....

The suspension settled quickly and powdered tablet fragments formed a visible layer on the bottom of the glass bottle. Experience with the analogous clozapine suspension3 has shown that the need for vigorous shaking must be emphasised to nursing staff who may be asked to administer the suspension to patients. As with the clozapine suspension, informal assessment of the palatability of the olanzapine suspension has shown it to be well tolerated, some patients in fact preferring it to tablets.

....
No tests of microbiological stability have been performed although paediatric base is preserved. It therefore seems prudent to recommend a shelf-life of two weeks when the product is stored in a refrigerator. Such a shelf-life is adequate for hospital use. We have no information on the bioavailability of olanzapine from the suspension, although it seems unlikely that olanzapine bioavailabilty will prove to be less than that from Zyprexa tablets.

 

 

Guy's hospital "paediatric base" appears similar to Ora-Plus suspension base, which is commercially available:

 

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.

 

Ingredients

Purified water, microcrystalline cellulose, carboxymethylcellulose sodium, xanthan gum, carrageenan, calcium sulfate, trisodium phosphate, citric acid and sodium phosphate as buffers, dimethicone antifoam emulsion. Preserved with methylparaben and potassium sorbate.....

If you want to experiment further with dissolving the tablet:
 
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.

 

 

[Gussy]

Hi Gridley. Wow thanks for the detailed info you.ve provided. You.ve gone to quite an effort here and it.s much appreciated. It sounds like the idea is to mix it at 1mg/ml of water if done at home and shake it well before extracting the required dose. It also sounds like it might have to be used quite quickly after preparation. Do you know if others in the group taper their olanzapine by crushing their tabs and mixing with normal water at home? Mum had her 1st half dose last night and did notice some differences. After having a quick look at a receptor saturation/occupancy article about seroquel with some references to olanzapine i can see how significant the drop from 5-2.5 is. Thanks again for all this info. I.ll have a good look through it. Gus.

[Gussy]

Sorry, I have another question. Might it be able to be typered by 10% by weighing the tablet and using a little nail file or something to file off 10% of the total weight? or might this just be filing off fillers etc and not give an accurate 10% reduction of the active drug? Does this make sense?

[Gussy]

12 hours ago, Gridley said:

Welcome back, Gussy.

 

As you know, WD symptoms are pretty much all over the place in variety, but I think you're talking generally about the same type of symptoms whether from effexor or olanzapine.

 

You've already guessed the answer to your second question: the low end reductions could cause more problems than the high end.

 

Sorry you and your mom are having these doctor/drug problems.

Sorry, I've asked a few more questions without quoting your post so you may not be aware I was asking you questions. You may also be having some sleepy time. In my usual fashion I have another, if a liquid preparation were made might it void and extended Release Property of olanzapine? Is olanzapine an extended release drug like the effexor I took or does it not matter? Thanks again for all your help. Gus

[Altostrata]

Hello, Gussy. 

 

How did your Mum react to the decreased dosage? If after a week she seems okay, it's possible she can tolerate this decrease. I wouldn't do the same from 2.5mg olanzapine, though.

 

Why is she taking olanzapine?

[Gridley]

10 hours ago, Gussy said:

if a liquid preparation were made might it void and extended Release Property of olanzapine? Is olanzapine an extended release drug like the effexor I took or does it not matter?

Making a liquid voids any extended release property, but the best I can tell Olanzipine is not extended release.

[Gussy]

6 hours ago, Altostrata said:

Hello, Gussy. 

 

How did your Mum react to the decreased dosage? If after a week she seems okay, it's possible she can tolerate this decrease. I wouldn't do the same from 2.5mg olanzapine, though.

 

Why is she taking olanzapine?

Thanks for your reply Alto. It.s been a long time since we.ve spoken. I hope you.re well. I know she takes it to help her sleep. I don.t know if its anti p use is also wanted. Last night was her 1st at the lower dose. She woke during the night and may.ve struggled to get back to sleep. She said she felt a bit anxious this morn but it passed. I think she.s a little worried about possible consequences. Sorry my feedback isn.t very informative. I still have a vision in my mind of her in a hospital bed from when i was little, i found out later she.s had a breakdown and was having shock treatment. She had ect done a few years back and got switched to effexor (from aropax/paxil i believe) after taking a turn which after finding a lot more out about this stuff i think was brought on from tollerance wd. Thank you very much for your opinion here, i will pass it on. 

[Gussy]

16 minutes ago, Gridley said:

Making a liquid voids any extended release property, but the best I can tell Olanzipine is not extended release.

Thanks for your reply. I.ll double check the box. Surely it.d say xr on it if it was. Gus.

[Gussy]

A little update. It.s been 5 days and so far so good. I know this can change. Gus.

[Gussy]

Can i expect the likelihood of wd to decrease as time goes on with this drop or should i stay on alert for a good while? Some in the group i.m in report being good for a good while then get struck by wd. I wonder if the same could happen with this drug? Thanks again for your help, Gus.

[Gussy]

Mum just told me her doctor her off 2.5 mg of olanzapine 10 days ago. Saying it's only a low dose. I've seen the olanzapine curve and I know 2.5 is right in the middle of where  **** goes South. I just told her  to be very careful  and write down anything that seems out of the ordinary without trying to worry her too much. I'm the only one in our family with any idea about this and sadly I'm not very likely to be believed by the rest of my family. I don't want this for her.  She's an angel of a woman. Please tell me what to look out for and what the hell to do about it if and when it hits the fan. My mum also takes one 112.5 of effexor. What sizes of reinstatement doses might help in the event of it going soutg? Are there many different dose sizes available in olanzapine? I'm very concerned for my mum. Thanks in advance for any help you might give. Gus.

[ChessieCat]

tips-for-tapering-off-zyprexa-olanzapine

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

[Gussy]

2 minutes ago, ChessieCat said:

tips-for-tapering-off-zyprexa-olanzapine

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Thanks for your reply my nsw ally. I.ll check it out in my break.

[Gussy]

21 minutes ago, ChessieCat said:

tips-for-tapering-off-zyprexa-olanzapine

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Sorry to keep bombarding. Things don.t occur to me all at once. I.ve asked my brother to keep an eye on my mum and given him some warning. Might i be able to share the info you gave me with him or share this page with him etc? He's not a member. Thanks, Gus.

[ChessieCat]

Yes, you can most certainly share that information.  The more people who get the information the better.

 

There is also these:

 

https://www.madinamerica.com/mia-manual/information-psychiatric-medication-withdrawal-melanie-davis/

 

https://www.madinamerica.com/2020/09/slow-taper-best-antipsychotic-discontinuation/

 

 

[Gussy]

1 hour ago, ChessieCat said:

Yes, you can most certainly share that information.  The more people who get the information the better.

 

There is also these:

 

https://www.madinamerica.com/mia-manual/information-psychiatric-medication-withdrawal-melanie-davis/

 

https://www.madinamerica.com/2020/09/slow-taper-best-antipsychotic-discontinuation/

 

 

Thank you. I might share this page too. My brother needs to know this stuff. 

[Emily02]

Hi Gussy!

How is your Mum? Did she stopped taking olanzapine at 2.5mg?

[Gussy]

38 minutes ago, Emily02 said:

Hi Gussy!

How is your Mum? Did she stopped taking olanzapine at 2.5mg?

Hi. Thanks for your response. Yes she did, under the very misguided advice of her dr. She's been off for 7 weeks give or take and besides some different headaches that seem controllable with paracetamol and different sleep/wake times she seems ok. I know it's early days and I'm praying for her, i have my brother watching out for her. I know this can go south and sadly will be the only one in our family who'd know why. 

[Emily02]

I’m really glad she seems to be ok so far.

When I dropped Olanzapine from 5 to 2,5 I was simply unable to sleep and I had to reinstate. Now I’m nearly down to 2.5.

I’ll pray for her too. God bless her.

Please keep us updated

I really hope she will get through this very soon.

[Gussy]

20 minutes ago, Emily02 said:

I’m really glad she seems to be ok so far.

When I dropped Olanzapine from 5 to 2,5 I was simply unable to sleep and I had to reinstate. Now I’m nearly down to 2.5.

I’ll pray for her too. God bless her.

Please keep us updated

I really hope she will get through this very soon.

Thanks for your wishes, I appreciate it. She tolerated the drop from 5 to 2.5 , at the time I was very concerned. I'm more concerned with this one as I came off effexor quickly out of necessity and know what can happen, I don't want her to suffer like that that.

[Emily02]

I read your thread and I’m really glad that you’re much better and you’re a success story.

Many thanks for your kind words. I hope it too that I can be off the drug and I hope your mum will be ok too.

I’m doing dry cuts at the moment. I tried liquid suspension and I got insomnia so I had to go back to solid form. I’m making an even line out of the crushed tablet and I’m taking away 10 percent. I read it on this site, someone used it successfully to come off Olanzapine. So if it still works for me then I’ll stick to it.

Kind regards 

[manymoretodays]

Gussy, @Gussy

How is your Mom now?  Is she still off the olanzapine then?

On 4/3/2021 at 2:17 AM, Gussy said:

Hi. Thanks for your response. Yes she did, under the very misguided advice of her dr. She's been off for 7 weeks give or take and besides some different headaches that seem controllable with paracetamol and different sleep/wake times she seems ok. I know it's early days and I'm praying for her, i have my brother watching out for her. I know this can go south and sadly will be the only one in our family who'd know why. 

 

It is confusing as your signature is below posts about your Mom.  Anyway, I thought I should ask.  Oh, I hope she is doing well.

[Gussy]

6 minutes ago, manymoretodays said:

Gussy, @Gussy

How is your Mom now?  Is she still off the olanzapine then?

 

It is confusing as your signature is below posts about your Mom.  Anyway, I thought I should ask.  Oh, I hope she is doing well.

Hi. Thanks for your responses to me. This is an older post. Mum's doing alright. She kind of got "lucky" with it. She suffered but not the higher level you know. She said she was glad she had me, someone who wouldn't oppose what happened to her. 

[Gussy]

Can risperidone cause cognitive demolition?

 

Hi everyone. It's been a long time since I've asked anything here and my question mightn't be the right one for this group. I don't know where else to seek real advice while waiting to get a referral to talk to a psych colleague of Horo. My mum had psychosis come on since my dad passed last year. She now takes 3mg risperidone(2mg night, 1mg morn) and her effexor was upped from 112.5 to 225. She came off olanzapine in a not so good way a few years ago but made it to an ok place and spent quite some time getting from 225 to 112.5 on the effexor. I couldn't help her with her tapers. Anyway, my question if it's ok to ask here is: can risperidone cause people to become like deers in headlights? What I mean is, can it cause people to become non responsive to questions, to need to be asked the same question a few times to slowly think of an answer? To not know how to perform simple tasks like setting the water in the shower, to operate a microwave or to cook when they used to love cooking? Can it cause people to not be able to think or just stand in the middle of a room not knowing what to do? Mum tells me she's already feeling significant pressure in her brain and I fear those "treating" her may not be giving enough thought to current drug additions/increases/effects as they suggest adding mirtazapine to the mix, something I really don't want to happen after what I felt in my brain from coming off my lovely drug. I asked how it would be taken away if it had to be, I found the answer unsatisfactory and potentially harmful. I'm more worried by this than by my journey off effexor. All knowledgeable responses will be greatly appreciated if this question's accepted. Gus.

Edited May 22, 2023 by manymoretodays
Added something, merged to preexisting Gussy's Mom topic, title added to this post

[Gussy]

Mum also had 3 sessions of ect before withdrawing consent so there's 3 things that've already been done that could've caused this. I did what I could to protect her from the system, the only thing I've been able to achieve is make sure mum gets the same brand effexor. I've asked questions of those "caring" for her that make it clear they aren't aware of wd etc so I have little trust in them. It isn't just me involved here though.

[Gussy]

Or can anyone see another way anything I've mentioned here could've caused this?

[Gussy]

Anyone??

[Gussy]

 

 

Hi everyone. It's been a long time since I've asked anything here and my question mightn't be the right one for this group. I don't know where else to seek real advice while waiting to get a referral to talk to a psych colleague of Horo who it turns out I can't afford. I posted this in symptoms and self care but haven't got a response so trying here too. Mum had psychosis come on since my dad passed last year. She's been in the psych system longer than she hasn't. She now takes 3mg risperidone(2mg night, 1mg morn) and her effexor was upped from 112.5 to 225. She came off olanzapine in a not so good way a few years ago but made it to an ok place and spent quite some time getting from 225 to 112.5 on the effexor. I couldn't help her with her tapers. Anyway, my question if it's ok to ask here is: can risperidone cause people to become like deers in headlights? What I mean is, can it cause people to become non responsive to questions, to need to be asked the same question a few times to slowly think of an answer? To not know how to perform simple tasks like setting the water in the shower, to operate a microwave or to cook when they used to love cooking? Can it cause people to not be able to think or just stand in the middle of a room not knowing what to do? Mum tells me she's already feeling significant pressure in her brain and I fear those "treating" her may not be giving enough thought to current drug additions/increases/effects as they suggest adding mirtazapine to the mix, something I really don't want to happen after what I felt in my brain from coming off my lovely drug. I asked how it would be taken away if it had to be, I found the answer unsatisfactory and lining her up for harm. I'm more worried by this than by my journey off effexor. Mum also had 3 sessions of ect before withdrawing consent so there's 3 things that've already been done that could've caused this. I did what I could to protect her from the system, the only thing I've been able to achieve since the system  became really involved again is to make sure mum gets the same brand effexor. I've asked questions of those "caring" for her that make it clear they aren't aware of wd etc so I have little trust in them. It isn't just me involved here though. Or can anyone see another way anything I've mentioned here could've caused this? All knowledgeable responses will be greatly appreciated if this question's accepted. Gus.

 

•  
• Quote

 

  

[manymoretodays]

Hi Gussy, sorry to hear your Mum is still so medicated and not at all herself,  I merged recent new topics started, back here for you.

Yes for sure could be the risperidone, sometimes called the "shut up pill".

Tips for tapering topic on risperidone  you'll see that in the first post

Unfortunately, the intended action of risperidone is pretty much a loss of self, and blankness.

 

Also see the side effect profile of risperidone:  Risperidone Side Effects, from Drugs.com

 

You might be able to suggest a lowered dose.  It can't hurt to try, even though you are not the sole primary medical support for her.

 

There may also be WD from the olanzapine now, and perhaps a lingering effect from the ECT.  I'd vote that if the risperidone is a recent change, that it may account for her "blankness" now.

 

Tough stuff to witness I'm sure.  They had Haldol on my Mum's medication list prior to her death and before she moved to Hospice.  I told the Nurse that I really didn't think she needed that.  She was getting Ativan and had had a major stroke.......wasn't agitated, nor was she ever.  Anyway.....  😞

How old is your Mum?

 

And hugs, L, P, H, and G,

mmt

 

Why don't you do a signature for your Mum in a reply only.  If you change your signature, as you are the poster, that wouldn't work.

So just put some dates, and medications history for your Mum here in a reply.  I suppose I could then link it to your signature and title it Gussy's Mum's signature.

Hang in there.

Edited May 22, 2023 by manymoretodays
signature for Gussy's Mum

[Altostrata]

Hello, Gus. Your mother's drugs or ECT treatment or both may cause her to have memory or concentration problems.

 

Apparently she was considered capable at the time she withdrew consent for ECT. Did she consent to the more recent drug changes?

 

If you want to change her treatment plan, either she will need to make a stand about it or you will need legal status to do it for her.

 

If she is no longer considered capable, you may have to make legal arrangements to participate in decisions about your mother's care. It's highly possible that if you do not have legal status and report that her behavior has changed for the worse since ECT and drug dosage increases, her doctors will say she has dementia or another organic brain condition.

[Gussy]

2 hours ago, Altostrata said:

Hi manymoretodays and Alto

Thanks for your repies and thank you for moving mum's info with the last stuff I posted about her. My mum's 78 yeats old. I have to say that when my dad died I asked the chemist in what steps mum came off olanzapine. I was wrong and it was worse than I thought. She came off 10mg in 5mg steps. I think she made it to an alright place but suffered a reasonable amount, just not the highest level. I feel strongly that risperidone, ect, the doubling of effexor or some of the combined effects of these has shut mum down as even at the height of her psychosis she was able to shower etc. She consented to start a "low dose" of mirtazapine, 7.5mg and has taken it for about 5 days now. Her mood has changed at times to slightly happier but I don't know if mum might already have slowly been turning a corner of if it's a drug effect. I feel I'm going to lose her to this system and anything I/we say is used as a reason to further "diagnose/treat" more and not to pause and assess the effects of changes already made. I raised my concerns re risperidone shutting mum down with my sibling who agreed with me but once the psych registra said it doesn't do that (and ignored my pleas to pause, possible ect effects, risp etc) and said all the things we'd mentioned were signs of depression, I feel my sibling switched to that mode. I even tried to explain the need for hyper tapering incase the introduction of mirtazapine caused adverse effects etc after a period of time, it was like an alien was in the room, me. Yeah I've looked at all these drugs on drugs.com and know what can do what, I've offered it to my sibling but they've not looked and told me in the past to not send info of harms/effects as they don't read it. A reduction of 0.5mg of risperidone in the morning(it went from 1mg-0.5mg in the morning, well in line with an article written by Mark, Sameer and maybe others re reducing a.p's but more than 10%, which I presented to the psych nurse in anticipation of a reduction attempt)but it was deemed a negative move due to excess worries from mum afterwards. So I doubt reductions of risperidone will be considered any time in the near future. I'm powerless to manipulate doses with others involved having the thoughts they have about all this. My sibling's making moves to get p.o.a for when mum can't decide and with the laws in Australia I think they'll have the final say, being older than me. Any suggestions on how I might find others here who've been so dulled by risperidone? Manymoretodays, it might be best if I ask the psych team for a report of mum's recent drug history so I can be accurate. It may take a little while to get blood from that stone ok?

Gus.

[Altostrata]

@Gussy we can't do anything if a consenting adult takes the drugs. You will have to work through bureaucratic or legal channels if you want a say in her care.

[Gussy]

1 hour ago, Altostrata said:

@Gussy we can't do anything if a consenting adult takes the drugs. You will have to work through bureaucratic or legal channels if you want a say in her care.

Yeah I know, was mainly wondering if people here have experienced what mum seems to've from risperidone. I drugs.com'd it when she started it months ago and saw the potential for this. I saw it flatten her when she took the 1mg morning dose a few days ago, it's an awful drug. A nurse was here a few days ago assessing an area of aged care and said she could see its effects on mum's cognition. I wish the psych team would stop seeing it as signs of "depression" to be treated with another drug. I'll leave it at that.

Gus.