Iman: weaning off nortriptyline, withdrawal battlefield

[Iman]

@Colonial

 

Hello dear Colonial

 

I hope all is well with you. The taper I made from Sep 2020 to Jan 2021 has been precisely accroding to the 10 percent of the current dose taper plan. However, I had to hold for a month or 2 on the dose of 13 due to being sold some counterfeit Nortriptyline drugs which ignited a huge wave of symptoms in me. The reason why I've stockpiled this number of pills is that I've been gun-shy and hurt so badly with the counterfeit drugs that the thought of it happening even once again scares the hell out of me. A pharmacist friend of mine provided me with the original batch which have served to stablize me and make tapering possible again. As for the heat issue, do you think I should dispose of my pills due to the 20 hour exposure to 33 centigrade heat? My pills are all in tablet form and sealed in 10-pill sheets. The temp in my room has always been set on 23 centigrade except for the 20 hour when i was away and the airconditioner had been automatically turned on and the room reached 33 degrees. Thanks for your and input and help. 🌷🙏🌹

[Colonial]

Oh, I completely understand stockpiling once you find a form that works for you!

 

If you can update your signature with the exact dates and dosages for the past 2 years it will be of great assistance answering questions in the future.

Staff do not always have the time to go back and read through a thread to find that information once we need assistance to find patterns.

 

I hope everything else is well for you and your family!

 

 

[Iman]

@Colonial

 

Thanks for the heads-up and the well wishes dear Colonial. I just updated my signature the way you instructed me. I'm just worried so bad about my heat-exposed pills. Do you think it's safe to continue taking them or should I be looking for a new stockpile? They were exposed to 33 centigrade heat from airconditioner for almost 20 hours and after that the storage temp returned to its steady 23 degrees.

[Altostrata]

Your current tablets may be fine. If the drug is hard to find, I would also look for a new stockpile, and perhaps keep it dry and in the refrigerator.

[Iman]

@Altostrata

 

Thanks a ton for your inavluable help dear Alto. It'd be pretty difficult for me to get my hands on the same batch number on which I've been doing so well. In fact, since yesterday I've been asking every single pharmacy and company about this batch number and none have any remaining supplies. So, do you think the chances of my current tablets having gone bad is high? I've been keeping my stockpile in a room with a steady tempreture of 23 degrees totally dark, dry and away from sunlight except for the 20 hour of heat exposure. Do you suggest I keep them in the refrigerator from now on or keep them in the same room where they are now? Thanks a lot for your time and help. 🙏🌹

[Altostrata]

Nobody can tell exactly what happened to your batch of tablets. As @brassmonkey said, the heat may have been within storage guidelines.You might be able to find a pharmacist who can test a sample.

[Colonial]

As long as you are not making any changes, as long a you feel ok, that should be your guide.

But you don't want to be so anxious that the stress gives you symptoms and you blame the pill.

 

The pharmacy is a good tip, perhaps they can assist you in finding out more about this particular pill. 

That being said, most guidelines have a few extra degrees and months built in to the recommendations to err on the side of caution. 

 

If a pill is still good at 36, but begins to degrade at 37, they may suggest 33 out of an abundance of caution.

The same is done with expiration dates and each company has their own recommendations.

 

For example, when I receive a prescription, the pharmacy says discard after one year.

But the manufacturer date on the side may say it's good for 19 more months.

So if they say 19 months to guarantee it is still 100%, how long is it actually good for? 3 years? 4?

It all depends on the construction and storage and how much the temperatures continue to fluctuate.

 

Eventually, You will not be able to find more of a particular "batch", they only make so many with that number.

The importance is the same manufacturer, ingredients and production line.

Having the old batch number, you should be able to determine if anything has changed in regards to those.

When you get some new, you can test them for a month and if all is well, stock up on those as well.

 

The issue is you really don't want to get more than you need before you will use them

If you have 1,000 and your using less than a pill a day, you may want to refrigerate those you won't need before 2023.

 

 

 

Edited October 13, 2021 by Colonial

[Iman]

@Colonial

 

So thoughtful and wise of you dear Colonial. Your guidlines are pretty constructive and reasonable. The expiry date for the pile I have now is september 2024, that's why I thought it'd be wise to anticipate how many I need up until my jump-off point and stockpile just as many. The reason why I didn't refrigrate the tablets was that I was advised against refrigration by a few of the members here. They say the ideal storage temp is 15 to 25 centigrades. It'd be a whole lot easier for me to keep my tablets in the refrigrator, of course. The pharmacist thing you and Alto quite rightly mentioned is also a good distinguishing factor. Would a pharmacist be able to detect if a pill has gone bad? If so, I'd have to have a pharmacist friend of mine check a few out just to make sure and in the meantime look for a new stockpile which would hopefully agree to my physiology. And as you correctly pointed out the stress of the pills having gone bad or not has taken the best of me leading to a few symptoms flaring up. Fortunately enough, I had taken a few tablets with me before my 2-day trip but even so i had symptoms and restless broken sleep which i'd definitely got the heat-exposed pills to blame for if I'd taken some in the past 2 days. I'll do my best to not to let this stress cloud my judgement. Thanks again for your great help and time dear. 🙏🌷🌹

 

 

[Carmie]

Hi Iman, 

 

Do you have an esky, a cooler? I put my medication and supplements in an esky, it keeps them insulated against the heat.  I’ve also got enough for a couple of years for just in case. 
 

I water titrate my medication, but once I do that I put it in the fridge. I just keep it for about four days in the fridge and then I make a new batch. 
 

Take care🤗

[Iman]

@Carmie

 

Hey there dear Carmie

 

Thanks for the great advice. To be honest, I hadn't heard of esky but as you say it seems to be quite a handy stuff for keeping meds cool and dry at least leaps and bounds better than dedicating a whole room to keeping them relatively cool. I'll go get one asap, i'm just hoping my tablets are still proper shape for consumption. I'm already on stress mode 😂 but doing my best to handle it. 

[brassmonkey]

I have found multiple warnings to protect the Nortriptyline from freezing. So it would not be a good idea to store it in the refrigerator. Keep it in a dark cabinet away from moisture, heat and light.

[Carmie]

10 hours ago, Iman said:

@Carmie

 

Hey there dear Carmie

 

Thanks for the great advice. To be honest, I hadn't heard of esky but as you say it seems to be quite a handy stuff for keeping meds cool and dry at least leaps and bounds better than dedicating a whole room to keeping them relatively cool. I'll go get one asap, i'm just hoping my tablets are still proper shape for consumption. I'm already on stress mode 😂 but doing my best to handle it. 

Hi Iman, 

 

You made me laugh when you said you are dedicating a whole room to keep your meds cool😂. The things we do to try and get through this journey. Yes, an esky has got insulation, it’s just a box that will keep the heat out. You don’t put ice or anything in it. As Brassmonkey said your medication has to stay away from moisture, heat and light.  I’ve been putting my meds and supplements in there for years. 
 

Hope you have a happy day☀️☀️

[Iman]

@brassmonkey

 

Hey there dear Brassmonkey

 

Had heard and read the same cautions against refrigrating Nori so decided not to risk my pills going bad due to temps below 15 centigrade. My best bet as you rightly said is to keep them away from heat, light and moisture as I've always done (in a dark room with a steady temp of 23 degrees) except for the 20 hour which things had gone out of control. I owe u a tremendous amount in my journey for your timely and all-time wise and valuable advice and guidelines. 🙏🌷

[Iman]

@Carmie

 

You have every right to laugh at this parody. 😂 never thought I'd be forced to do such comical things, anyway this journey is a tough one and there're hosts of things we do to get by and survive which sound quite odd to the unmedicated brains. As you instructed, esky is just the right tool to let my exclusively-dedicated-room-to-pills breathe and be back to life again. 😁 I ordered one online and will receive it in a few days hopefully. Thanks again for the pretty helpful and precious suggestion. I wish you the best of moments and most pleasant events. Take care and have fun. 🌹🙏🌷

[Carmie]

12 minutes ago, Iman said:

@Carmie

 

You have every right to laugh at this parody. 😂 never thought I'd be forced to do such comical things, anyway this journey is a tough one and there're hosts of things we do to get by and survive which sound quite odd to the unmedicated brains. As you instructed, esky is just the right tool to let my exclusively-dedicated-room-to-pills breathe and be back to life again. 😁 I ordered one online and will receive it in a few days hopefully. Thanks again for the pretty helpful and precious suggestion. I wish you the best of moments and most pleasant events. Take care and have fun. 🌹🙏🌷

You’re welcome Iman, 

 

This journey definitely isn’t comical at all, but we have to laugh at the lengths we need to go to just to survive withdrawals. Yes, unless someone is going through this situation, they wouldn’t understand. It’s such a scary thought not being able to get our hands on these meds while tapering, I would end up with severe Akathisia again, it’s horrific. 

 

I’m glad your room will get to breathe again😆

 

Wishing you all the best as well, sending hugs🤗

 

 

 

 

 

[Iman]

@Altostrata @Colonial @brassmonkey

 

Hi everyone

After a few good days of stablizing on my new batch of Nori and doing just great, last night all of a sudden I felt a terrible right-sided sore throat. Some of these sore throats are common during tapers and in the midst of withdrawals, they flare up and after a few hours of treatment mainly with gargling salt, go away on their own. However, this particular sore throat is a severe one along with body aches and headches and given that I've been in a window in the past few days, it appeared to me that it may not be withdrawal-related. I applied all the home remedies to make it disappear but it just keeps getting worse. So I went to see a doctor and he ordered a swab which came back having strep throat as positive. I'm now perscribed with Amoxiclove to treat the bacterial infection. When I was on 50 mg and 30 mg i did experience a one week course Amoxicilin for the same problem and I don't remember running into any difficulty at all. I'm now on 9.5 mg. Do you think I should go ahead and take the course or just let the strep throat resolve by itself. I'm a little bit scared and this resulted in a night of merely 3 hours of sleep for me last night. I'd infinitely appreciate your kind advice and guidance on this.

Thanks again for everything. 🌷🌹🙏

[Altostrata]

The strep throat needs to be treated. Please discuss optimal treatment with your doctor. You may have no choice but to take the antibiotic.

[Iman]

Thanks a ton dear Alto

 

I took amoxicilin a few times during my tapers and had no particular problem I can remember. Is it different each time? Is there a possibility of reacting? How do I know? Treatment options are just limited to antibiotics as instructed by my doctor in which case Amoxicilin is my safest option.

[Altostrata]

I cannot predict, but the strep throat needs treatment. You might as well expect the best.

[Iman]

Thanks a lot. I seem to have no other choice dear Alto. I'll have to give it my best shot.

[Colonial]

I had no problems with plain amoxicillin, and strep throat can lead to heart damage if untreated, I would take it.

Hope your feeling better soon!

[Iman]

@Colonial

 

Truly appreciate the word of encouragement. I'm now into my first day of taking amoxicilin and I can say so far so good. Strep is true pain in the neck, hits me once or twice in autumn and winter each year. Thanks again. Sendig you positive vibes and a big healing hug. 😊🌷🌹

[Iman]

@Altostrata @brassmonkey @Colonial

 

Hi there dear friends

 

Hope you're all doing great. Thought I'd throw an update on how I've been doing lately. My system seems to adjust quite well to the new batch of pills I'm on after the loss I suffered from the accidentally heated up pile of pills which left quite distressed for a few days before finding the new ones. I'm now on 9.5 mg of Nori. A problem I've been facing for more than 2 months now hindering my regualr tapers is the intermittent migraines I've been experiencing after I got the AZ jab. I was never a migraine person even during the worst times of withdrawal. The migraine happens out of nowhere and continues for almost 24 hours before it stops and hits me again almost a week after. This has been the trend for the past 2 months. Needless to say, this triggers a wave in me and puts a halt on my taper plans. Is there anything I can do to keep this under control? Will it ever stop or it's a part of the vaccine's immune response and will stay for long? I'd appreciate any input on this.

[ChessieCat]

I think you should see your doctor.

[Iman]

@ChessieCat

 

I did run all tests including D-dimer and Fibrinogen and they were all normal. My doctor says it's most probably my body's reaction to the vaccine as I have the covid arm (big red rashes growing on the injection arm) as well. I aslo did a brain image which was fine too. The only problem here is that the migraines decelerate my taper process.

[ChessieCat]

22 minutes ago, Iman said:

I did run all tests

 

It's good that you saw the doctor and got tested.  The d-dimer is to test for blood clots.  They usually do a second one to compare.  That's what happened with me.

 

22 minutes ago, Iman said:

The only problem here is that the migraines decelerate my taper process.

 

SA always suggests holding when experiencing stress or illness.  Your body is going through a very stressful time trying to build up the immunity to the vaccination and it sounds like you might have had some sort of reaction to it as well.

 

I was supposed to be completely off my Pristiq last Saturday but because I have other medical issues at this time, and I am also changing my diet, I have decided to hold for longer before stopping.  The reason I am doing this is because if I stop Pristiq and have symptoms I will not know if it is from withdrawal or my other medical issues.  It is better for me not to add any additional stress.

[Iman]

@ChessieCat

 

Expert advice truly. 👏 that's exactly what I did, not twice but 3 times just to make sure there's no inaccuracy in tests. Each time I did the D-dimer test it was normal and the last one was 60 which is extremely low. As you rightly said, I too believe it's part of my body's plan to build up immunity. My best bet as you instructed as well is to hold for at least another month to give my body enough time to deal with the vaccine-related stuff. You're doing a pretty wise thing to hold, many symptoms related to medical issues such as those of the Covid vaccine are similar to withdrawal's. Best not to have them co-occur. Thanks for the invaluable info dear ChessieCat. 🙏

[Colonial]

Sorry your not doing well.  The added stress of the pills leads me to think it's best to hold off on any change for another month at least as well.

What vaccinations did you receive, and on what dates?

 

[PsychologicalSafe15]

Are you not getting any emotional chanages or suicidal thoughts something like that ?

[Iman]

@Altostrata @brassmonkey @Colonial @ChessieCat

 

Hello all, 

 

Hope you're all doing great. As for myself, I've taken dear Moderators' advice on holding for a few weeks until the side effects of the jabs begin to wear off which has been the case for the past 6 or 7 days. My allergic reactions including the big hives all over my body and the severe migraine headaches are beginning to fade and lose potency after 2 months post 2nd jab. This has tempted me to get back on my tapering track once again. I'm cuurently on approximately 9.5 mg solid tablet Nortriptyline(I only cut a pretty tiny fragment using a blade). I've decided to switch to liquid solution for better measurement and a safer taper overall. I just got a bit scared when I read online that Nortriptyline is only "springly(very slightly) water soluble". This is a very sensitive part of the taper apparently. If the coated tablets aren't water soluble, what do you suggest I do? Do I continue with my former taper method or proceed to liquid solution and if so how exactly. I'd be greatly thankful for your invaluable advice and care. Thanks a billion in advance. 🌷🌹🙏

[brassmonkey]

You need to do the ethanol method. Nortriptyline dissolves at 15mg/mL of 190 proof alcohol so it will dissolve at 7mg/mL of 90 proof vodka. Use just enough vodka to dissolve your tablet and the  add water to make a usable dilution. Measure your dose from this.

[Iman]

@brassmonkey

 

Thanks a ton dear Brassmonkey. This seems a bit vague to me as I've never had the experience of dissolving tablets in vodka. Would you be so kind as to clarify this a bit more for me perhaps through an example or something? Isn't there a way to make this liquid solution in distilled water? Can I switch from tablet form to liquid form in one go or do I need to do this gradually? Things get a bit tricky here but I know once I get the hang of it by the aid of your precious guidance, I'll taper smoothly and neatly. Sorry for my being so wordy. 😁🙏🌹

[Iman]

@Altostrata

 

BTW, the changes made in the website are quite exciting. It's already given me a great sense of change for the better, sort of a pleasant feeling of being upgraded and elevated. So thanks a world for that dear Alto. The ranking system gives us the courage to contribute more and provides a big incentive to appear more active in helping each other. 👍👏 

[Iman]

On 10/28/2021 at 1:37 AM, Colonial said:

Sorry your not doing well.  The added stress of the pills leads me to think it's best to hold off on any change for another month at least as well.

What vaccinations did you receive, and on what dates?

 

@Colonial

 

Dear Colonial forgive me for my responding to you with such a delay. I'm not sure why I hadn't seen your post. My eyes fell upon ur post a few minutes ago. I took my first AZ jab almost 4 months ago and 2 months after received the second. So, I'm now 2 months post vaccination. I followed ur valuable advice and held my dose at 9.5 mg Nortriptyline. With the side effects of the vaccines gradually fading away, I've come to think of tapering my posion again. I'm just a bit confused about the ethenol method of tapering and a bit sad that Nori is hardly soluble in water and that makes things a bit tough for me. This is a truly delicate phase and I can't get cautious enough. Thanks again for ur kindness and care dear. 🌹🙏😊

[brassmonkey]

Here is part of an article I have in work for the benzo forum. It will explain a lot about using alcohol to make a solution.

 

Homemade Solutions Overview

(4)

 

For ease of calculations to determine an individual’s specific dose it is best to work with a liquid that has a dilution ration of 1:1. This would mean that there is 1mg of active ingredient for every 1mL of liquid. From there determining the volume for a specific dose strength is quite easy. (INSERT LINK)

 

The basic way to make a 1:1 liquid is to dissolve a tablet in as much liquid as the tablet’s listed strength. So, if you are using a 1mg tablet you would use 1mL of liquid, a 2mg tablet would need 2mL. For the weaker tablets, like a .5mg you could either use .5mL of liquid or dissolve two (2) tablets in 1mL of liquid.

 

Which liquid you use will depend on the medication and the strength of the tablets you have. In the case of using alcohol for the liquid it also depends on how a person tolerates alcohol, and their views on taking alcohol. Because of the good solubility of these medications in alcohol, it is possible to dissolve them in a minimum amount and round out the volume with water. It must be remembered that 1mL of alcohol is equal to 1/5 of a teaspoon so we are not dealing with large amounts of it.

 

Using water as a base is not a good option for most of the medications. Clorazepate being the exception as it dissolves quite well in water. It is possible to make a 1:20 solution using the .5mg tablets and 10mL of water for most of the medications. Otherwise, if a water base is desired you will have to make a very large amount of the liquid or make a suspension, which we will cover later.

 

Making a 1:1 liquid using alcohol is quite simple. You use the same volume of alcohol as the strength of the tablet. As mentioned above a 1mg tablet requires mL of alcohol while a 2mg tablet would use 2mL, but you would use two (2) 0.5mg tablets for 1mL.

 

A commonly seen method is to use 2mL of Vodka for each 1mg of benzo.  This gives a liquid dilution of 1:2. water can then be added, to make the desired dilution ration. The two methods are basically the same, it all depends on which dilution ratio is easier for you to work with.

 

The alcohol that we use is important too. When you read scientific studies about diluting benzos in alcohol, they are using laboratory grade materials and several different types of alcohol. These are much stronger than what we have available and in many cases are alcohols that people can’t consume.

 

The only alcohol we are interested in is ethanol. We don’t usually have laboratory grade ethanol available, nor do we want it. At laboratory strength it can be dangerous to consume and evaporates so quickly it is hard to work with, not to mention being a fire hazard. For our purposes 90proof vodka will be the most effective. Some people advocate the use of Grain Alcohol or Everclear. They are quite effective, but really are much too strong for our purposes.

 

Once an alcohol liquid had been made it is possible to further dilute it using water to get the desired dilution ration. For all the medications, except Clorazepate, it is possible to dissolve a 1mg tablet in .25mL of alcohol and then add .75mL of water to give a 1:1 liquid. This would keep the volume of alcohol to a minimum if consuming alcohol is a problem.

 

This thread as a lot of information about making and working with liquids.  https://www.survivingantidepressants.org/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

 

[Iman]

@brassmonkey

 

Thanks a bundle dear Brassmonkey. So helpful and eye-opening. I'll go ahead with the 90proof vodka as you instructed. Thanks again for everything. 🙏🌹😊