Hollyweird02: Help tapering off meds

[Hollyweird02]

I have been taking limbitrol ds 10/25  since 2008 I need help tapering o don’t think my doctor had suggested enough time she told me half for 7 days then half for 10 days every other day and stop I don’t feel that would be long enough!

 

Mod note:  Limbitrol: This product contains 2 medicines (amitriptyline, chlordiazepoxide) and is used to treat mental/mood disorders such as depression with symptoms of anxiety. Amitriptyline belongs to a class of medications called tricyclic antidepressants. It may help improve mood and feelings of well-being, relieve anxiety and tension, and help you sleep better. It works by affecting the balance of certain natural chemicals (neurotransmitters such as serotonin) in the brain. Chlordiazepoxide helps to reduce anxiety. It acts on the brain and nerves to produce a calming effect. It belongs to a class of drugs known as benzodiazepines. (from WebMD)

Edited March 5, 2020 by manymoretodays
added name to title, and medication after looking it up

[Gridley]

Welcome to SA, Hollyweird02.

 

You are right and your doctor is wrong.  Doctors know nothing about safe tapering or about the withdrawal that can occur when the taper is too fast, as is your doctor's.  We strongly recommend against every other day tapering, which makes the concentration of the dug in your blood go up and down, battering the nervous system and making withdrawal worse.

 

Here is the information I found on limbitrol ds:

 

"LIMBITROL combines for oral administration, chlordiazepoxide, an agent for the relief of anxiety and tension, and amitriptyline, an antidepressant. It is available in DS (double strength) white, film-coated tablets, each containing 10 mg chlordiazepoxide and 25 mg amitriptyline."

 

We recommend tapering by no more than 10% of your current dose every four weeks--no faster.

 

Why taper by 10% of my dosage?

 

Since limbitrol contains different dosages for the two drugs it combines, I would choose the higher dose, 25mg to make your 10% calculation.  This would give you a 2.5mg reduction, with your first tapering being 25mg minus 2.5mg = 22.5mg, which you would take for 4 weeks.

 

That leaves us with the question, how do you get 22.5mg limbitrol?  One method many members use is weighing tablets.  This link explains how.

 

 

Using a digital scale to measure doses

 

Many members use the Gemini-20 AWS scale available on Amazon. 

 

The GEMINI-20 Scale

 

The other possibility is to have your limbitrol dosages compounded at a compounding pharmacy.

 

Tapering too fast puts you at risk of some very unpleasant and long-lasting withdrawal symptoms, which doctors don't even believe exists.

 

What is withdrawal syndrome.

 

When we take psychiatric medications the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

Likely you will have many questions.  Please feel free to ask.

 

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

 

 

 

 

 

 

 

 

 

 

 

[Gridley]

@Hollyweird02

 

I have moved your PM here to your thread.  It is better to give tapering advice here rather than in PM so that other moderators can participate.  Here's what you wrote:

 

"You replied to my message was wondering if you could give me some further help as my medicine has been broken into two pills now I need help please"

 

Please clarify something for me: are you now taking 25mg Amitriptyline in one pill and 10mg chlrordiazepoxide in a separate pill?  Once I have this formation, I can advise you further..  Please respond here in this thread.

[Hollyweird02]

1 hour ago, Gridley said:

@Hollyweird02

 

I have moved your PM here to your thread.  It is better to give tapering advice here rather than in PM so that other moderators can participate.  Here's what you wrote:

 

"You replied to my message was wondering if you could give me some further help as my medicine has been broken into two pills now I need help please"

 

Please clarify something for me: are you now taking 25mg Amitriptyline in one pill and 10mg chlrordiazepoxide in a separate pill?  Once I have this formation, I can advise you further..  Please respond here in this thread.

Yes I am currently on 5 mg of Librium which is the one I want away from and it’s a capsule 

[Gridley]

12 hours ago, Hollyweird02 said:

Yes I am currently on 5 mg of Librium which is the one I want away from and it’s a capsule 

Are you also on 25mg Amitriptyline in a separate pill?

 

What is inside the Librium capsule?  Is it powder?

Edited March 8, 2020 by Gridley

[Hollyweird02]

3 hours ago, Gridley said:

Are you also on 25mg Amitriptyline in a separate pill?

 

What is inside the Librium capsule?  Is it powder?

Yes I take half of the amitiyriptyline I am not sure what’s inside the capsule I have not opened it

[Gridley]

24 minutes ago, Hollyweird02 said:

3 hours ago, Gridley said:

 

Yes I take half of the amitiyriptyline

I need more information, please.

1. Were you originally on 25mg Amitriptyline?  Or was your original dose half of the pill?  

2. If you were originally on the whole pill (25mg), did you taper down to half or cut your dose in half without tapering?

3. If so, when did you do that?

4. If you went for 25mg to half of that, how did you feel after decreasing your dose?  How are you feeling now?

5. Why do you want to get off the Librium instead of the Amitriptyline?

 

Regarding the librium, on an FDA website it says Librium (chlordiazepoxide) is:

 

"Librium ... A white to practically white crystalline substance, it is soluble in water."

‎

We recommend tapering by no more than 10% of your current dose every four weeks.  Because the librium is soluble in water, you have two choices of tapering method.  One method is making your own liquid from the crystalline substance in the capsule.

This link explains how:

 

How to make a liquid from tablets or capsules

 

The other method is weighing by removing removing the crystalline powder from the capsule and weighing it using a digital scale,  Here is information on using a scale.

 

Using a digital scale to measure doses

 

Many members use the AWS Gemini 20 scale available on Amazon.

 

The GEMINI-20 Scale

 

Both methods work for tapering.  Please read the links and see which method you're more comfortable with.

 

 

 

 

 

 

 

 

 

 

 

 

[Hollyweird02]

18 minutes ago, Gridley said:

I need more information, please.

1. Were you originally on 25mg Amitriptyline?  Or was your original dose half of the pill?  

2. If you were originally on the whole pill (25mg), did you taper down to half or cut your dose in half without tapering?

3. If so, when did you do that?

4. If you went for 25mg to half of that, how did you feel after decreasing your dose?  How are you feeling now?

5. Why do you want to get off the Librium instead of the Amitriptyline?

 

Regarding the librium, on an FDA website it says Librium (chlordiazepoxide) is:

 

"Librium ... A white to practically white crystalline substance, it is soluble in water."

‎

We recommend tapering by no more than 10% of your current dose every four weeks.  Because the librium is soluble in water, you have two choices of tapering method.  One method is making your own liquid from the crystalline substance in the capsule.

This link explains how:

 

How to make a liquid from tablets or capsules

 

The other method is weighing by removing removing the crystalline powder from the capsule and weighing it using a digital scale,  Here is information on using a scale.

 

Using a digital scale to measure doses

 

Many members use the AWS Gemini 20 scale available on Amazon.

 

The GEMINI-20 Scale

 

Both methods work for tapering.  Please read the links and see which method you're more comfortable with.

 

 

 

 

 

I had no choice it was origanlly one pill which was the limbitrol It was out of stock everywhere and there was nothing I could do but cut all my dose is down on my own because it’s all I had left.  I want it off of the Librium because my doctor said that is the one that is the controlled substance. I feel ok other than headaches but I also have neck tension and eye issues lately so hard to pinpoint the cause. Is there something wrong with the amitriptalyne? I don’t know much about it she said it helps me sleep?  This started in first week of feb when I was forced  to cut the dose 

 

 

 

 

 

 

 

[Gridley]

16 minutes ago, Hollyweird02 said:

 

 

I had no choice it was origanlly one pill which was the limbitrol It was out of stock everywhere and there was nothing I could do but cut all my dose is down on my own because it’s all I had left.  I want it off of the Librium because my doctor said that is the one that is the controlled substance. I feel ok other than headaches but I also have neck tension and eye issues lately so hard to pinpoint the cause. Is there something wrong with the amitriptalyne? I don’t know much about it she said it helps me sleep?  This started in first week of feb when I was forced  to cut the dose 

 

 

To be sure I have it correct you are now on two separate pills: 12.5mg of Amitriptyline and 5mg of Librium.  Is that correct? 

 

There is nothing wrong with the Amitriptyline.  It is a tricyclic antidepressant (the old kind that came out before SSRI's; my Imipramine is the same type of drug).

 

Doctors are under pressure to take their patients off benzodiazepines like Librium.  This is happening all over the place.

 

I hope your doctor will be cooperative with letting you do the 10% taper of the Librium.  Doctors almost invariably want to taper their patients far too fast.  A terrible way to taper, which increases withdrawal symptoms, is skipping doses or alternate day tapering. I hope your doctors doesn't want you to do this.

 

Under the 10% taper,  your first taper would be 10% of 5mg, which is 0.5mg. 5mg minus 0,5 = 4.5mg.  That would be your dose for 4 weeks.  Your next decease would be 10% of 4.5mg would 0.45 = 4.05mg.  I can help you make the calculations.

 

Did you have a chance to looks at the links on weighing and on making your own liquid?

 

If you taper too fast, especially with a benzo, you run into the danger of withdrawal.

 

What is withdrawal syndrome.

 

[Hollyweird02]

20 minutes ago, Gridley said:

 

To be sure I have it correct you are now on two separate pills: 12.5mg of Amitriptyline and 5mg of Librium.  Is that correct? 

 

There is nothing wrong with the Amitriptyline.  It is a tricyclic antidepressant (the old kind that came out before SSRI's; my Imipramine is the same type of drug).

 

Doctors are under pressure to take their patients off benzodiazepines like Librium.  This is happening all over the place.

 

I hope your doctor will be cooperative with letting you do the 10% taper of the Librium.  Doctors almost invariably want to taper their patients far too fast.  A terrible way to taper, which increases withdrawal symptoms, is skipping doses or alternate day tapering. I hope your doctors doesn't want you to do this.

 

Under the 10% taper,  your first taper would be 10% of 5mg, which is 0.5mg. 5mg minus 0,5 = 4.5mg.  That would be your dose for 4 weeks.  Your next decease would be 10% of 4.5mg would 0.45 = 4.05mg.  I can help you make the calculations.

 

Did you have a chance to looks at the links on weighing and on making your own liquid?

 

If you taper too fast, especially with a benzo, you run into the danger of withdrawal.

 

What is withdrawal syndrome.

 

Yes they have me skipping doses 😭 I don’t know what to do 

[Gridley]

33 minutes ago, Hollyweird02 said:

Yes they have me skipping doses 😭 I don’t know what to do 

Can you tell her you aren't comfortable doing it this way and that you'd prefer going off much more slowly?  Doctors have no respect for the Internet, but maybe you can show her this if you think it's a good idea:

The 10% per month reduction method is recommended by

• Peter Breggin in Your Drug May Be Your Problem (1999, 2007)
• The Icarus Project Harm Reduction Guide To Coming Off Psychiatric Drugs
• MIND-UK's Coping With Coming Off Psych Drugs Guide
• NHS Advice: Benzodiazepine and z-drug withdrawal - Management
• Gianna Kali's Withdrawal 101 on BeyondMeds.com
• and many peer support groups -- people who know what withdrawal symptoms are like

AND

 

The following was written by the founder of SurvivingAntidepressants.org who is, in my opinion, one of the most knowledgeable people in the world on the subject of tapering psychiatric drugs.

 

"Skipping doses is equivalent to reducing your dose by 50%.  Skipping days is NOT recommended by SA.  SA recommends tapering by 10% of the previous dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

Skipping Days vs Every Day Dosing Graph

 

We don't recommend tapering by alternating doses. The half-lives of almost all psychiatric drugs are too short for this to make any sense. It causes the amount of the medication in your bloodstream to go up and down, battering your nervous system, and makes withdrawal worse."

 

AND

 

If your doctor want a more medically credentialed source, the Ashton Manual is the gold standard of benzo tapering and has been used in hospitals in the U.K for decades.  The manual recommends tapering benzos no more than 5%-10% of current dose every 2-4 weeks.  I suggest you read the link and print out the relevant portion about the taper rate and also Professor Ashton's credentials.  When she was in practice, she was the leading expert in tapering benzos.  If you are courteous and bring supporting material in favor of a slow taper, perhaps, if your doctor is reasonable, she may listen.  I'm not providing this link to recommend a switch to Diazepam, as Dr. Ashton recommends, but rather to show how slowly you need to go.

Ashton Manual - benzo.org.uk

 

 

 

Edited March 8, 2020 by Gridley

[Hollyweird02]

13 minutes ago, Gridley said:

Can you tell her you aren't comfortable doing it this way and that you'd prefer going off much more slowly?  Doctors have no respect for the Internet, but maybe you can show her this if you think it's a good idea:

The 10% per month reduction method is recommended by

• Peter Breggin in Your Drug May Be Your Problem (1999, 2007)
• The Icarus Project Harm Reduction Guide To Coming Off Psychiatric Drugs
• MIND-UK's Coping With Coming Off Psych Drugs Guide
• NHS Advice: Benzodiazepine and z-drug withdrawal - Management
• Gianna Kali's Withdrawal 101 on BeyondMeds.com
• and many peer support groups -- people who know what withdrawal symptoms are like

AND

 

The following was written by the founder of SurvivingAntidepressants.org who is, in my opinion, one of the most knowledgeable people in the world on the subject of tapering psychiatric drugs.

 

"Skipping doses is equivalent to reducing your dose by 50%.  Skipping days is NOT recommended by SA.  SA recommends tapering by 10% of the previous dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

Skipping Days vs Every Day Dosing Graph

 

We don't recommend tapering by alternating doses. The half-lives of almost all psychiatric drugs are too short for this to make any sense. It causes the amount of the medication in your bloodstream to go up and down, battering your nervous system, and makes withdrawal worse."

 

AND

 

If your doctor want a more medically credentialed source, the Ashton Manual is the gold standard of benzo tapering and has been used in hospitals in the U.K for decades.  The manual recommends tapering benzos no more than 5%-10% of current dose every 2-4 weeks.  I suggest you read the link and print out the relevant portion about the taper rate and also Professor Ashton's credentials.  When she was in practice, she was the leading expert in tapering benzos.  If you are courteous and bring supporting material in favor of a slow taper, perhaps, if your doctor is reasonable, she may listen.  I'm not providing this link to recommend a switch to Diazepam, as Dr. Ashton recommends, but rather to show how slowly you need to go.

Ashton Manual - benzo.org.uk

 

 

 

Yes I can show this to her but I can’t see her until the Monday after next what do you suggest that I do right now she has me on it every other day 

[Gridley]

Just now, Hollyweird02 said:

Yes I can show this to her but I can’t see her until the Monday after next what do you suggest that I do right now she has me on it every other day 

How long have you been skipping doses?

 

[Hollyweird02]

About 2 weeks

[Hollyweird02]

1 hour ago, Gridley said:

How long have you been skipping doses?

 

Almost 2 weeks 

[Gridley]

1 minute ago, Hollyweird02 said:

Almost 2 weeks 

I don't know.  I'm going to bring your situation to the attention of the other moderators.

[Hollyweird02]

5 minutes ago, Gridley said:

I don't know.  I'm going to bring your situation to the attention of the other moderators.

Ok thank you 

[Gridley]

@Hollyweird02

 

 Some more information for you to consider.  Librium is long acting, with a half life of 5-30 hrs(36- 200 hours for the active metabolite)

 

And so, you might not feel the skipped doses for awhile.  My understanding though, is that it will catch up with you, and you might find yourself in serious benzo withdrawal after awhile.

 

I'd call your doctor or write, which ever you think is best, and say you're very uncomfortable with the skipping doses and would like to continue on your regular dose until your appointment when you can talk face-to-face about other options for getting off the Librium.  

 

 

[Altostrata]

Hello, Hollyweird.

 

Since you've been skipping doses, how do you feel? How's your sleep?

 

What times of day do you take each of your drugs, at what dosages?

[Hollyweird02]

10 minutes ago, Altostrata said:

Hello, Hollyweird.

 

Since you've been skipping doses, how do you feel? How's your sleep?

 

What times of day do you take each of your drugs, at what dosages?

I feel like crap lots of headaches I take them at night every other night. They took me from the full dose to half

[Altostrata]

You might notice we want details. Please look carefully at questions from the staff and answer them completely.

 

What times of day (o'clock) do you take each of your drugs (ALL drugs, not just Limbitrol), at what dosages (in milligrams)?

 

What do you mean by "feel like crap"?

 

The headaches are probably from skipping doses. Stop skipping doses. Take a dose each day.

[Hollyweird02]

59 minutes ago, Gridley said:

@Hollyweird02

 

 Some more information for you to consider.  Librium is long acting, with a half life of 5-30 hrs(36- 200 hours for the active metabolite)

 

And so, you might not feel the skipped doses for awhile.  My understanding though, is that it will catch up with you, and you might find yourself in serious benzo withdrawal after awhile.

 

I'd call your doctor or write, which ever you think is best, and say you're very uncomfortable with the skipping doses and would like to continue on your regular dose until your appointment when you can talk face-to-face about other options for getting off the Librium.  

 

You mean back to the oriiginal full dose before she cut it?
 

 

[Hollyweird02]

1 minute ago, Altostrata said:

You might notice we want details. Please look carefully at questions from the staff and answer them completely.

 

What times of day (o'clock) do you take each of your drugs (ALL drugs, not just Limbitrol), at what dosages (in milligrams)?

 

What do you mean by "feel like crap"?

 

The headaches are probably from skipping doses. Stop skipping doses. Take a dose each day.

I’m sorry I just do not feel myself and I have a lot going on. 730 Pm I take 5 mg of Librium and half of a 25 mg amityriptyline. I feel lots of anxiety and the headaches 

[Gridley]

6 minutes ago, Hollyweird02 said:

 

You mean back to the oriiginal full dose before she cut it?

Yes, 5mg every day, no skipping days.

[Hollyweird02]

8 minutes ago, Gridley said:

Yes, 5mg every day, no skipping days.

Thank you so much 

[Altostrata]

Why are you making these drug changes? Is your doctor telling you that you have to go off Librium?

[Hollyweird02]

6 minutes ago, Altostrata said:

Why are you making these drug changes? Is your doctor telling you that you have to go off Librium?

This is what happened at first I was on Limbitrol DS 10 to 25 mg for almost 10 years early February I was forced to come off of it with no warning because it was on back order everywhere. I had to get to my doctors office and they had to figure out how to get me these two separate drugs into two different pills and I told her I wonder if I should try to start weaning off of it if this if it’s going to be an issue with this drug so she says yes so she cut me down to 5 mg of Librium and half of a and aMitriptlyne. And I was told to take it every Day for seven days and then every other day for 10 days and stop but I started feeling bad I did not stop but I was still doing it the every other day like she told me and then I started doing my research myself online and I came across this board And I thought maybe y’all could help me everybody seem so informative here until I could Figure out what to do. I had to find myself a psychiatrist because maybe they can help me taper off this medicine correctly and I can’t see them until Wednesday afternoon 

[Altostrata]

That makes sense.

 

You made a change from Limbritol to the combination 5mg Librium and 12.5mg (?) amitriptyline. That change alone can cause an upset.

 

Then you started skipping doses. Not surprising you have headaches and other symptoms of withdrawal.

 

If I were you, I'd stay on the combination 5mg Librium and 12.5mg (?) amitriptyline for at least a month, let your nervous system settle down from that change.

 

We generally recommend reducing the antidepressant before the benzodiazepine (Librium), as the benzo will help you sleep while you're tapering the other drug. A psychiatrist may or may not agree with this. I hope you talk to one who knows these drugs need to be tapered gradually.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[Hollyweird02]

1 minute ago, Altostrata said:

That makes sense.

 

You made a change from Limbritol to the combination 5mg Librium and 12.5mg (?) amitriptyline. That change alone can cause an upset.

 

Then you started skipping doses. Not surprising you have headaches and other symptoms of withdrawal.

 

If I were you, I'd stay on the combination 5mg Librium and 12.5mg (?) amitriptyline for at least a month, let your nervous system settle down from that change.

 

We generally recommend reducing the antidepressant before the benzodiazepine (Librium), as the benzo will help you sleep while you're tapering the other drug. A psychiatrist may or may not agree with this. I hope you talk to one who knows these drugs need to be tapered gradually.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

Thank you so much I really appreciate your time and help I sure hope the doctor can help me too if not I will look for another one and thank you again❤️

[Hollyweird02]

6 minutes ago, Altostrata said:

That makes sense.

 

You made a change from Limbritol to the combination 5mg Librium and 12.5mg (?) amitriptyline. That change alone can cause an upset.

 

Then you started skipping doses. Not surprising you have headaches and other symptoms of withdrawal.

 

If I were you, I'd stay on the combination 5mg Librium and 12.5mg (?) amitriptyline for at least a month, let your nervous system settle down from that change.

 

We generally recommend reducing the antidepressant before the benzodiazepine (Librium), as the benzo will help you sleep while you're tapering the other drug. A psychiatrist may or may not agree with this. I hope you talk to one who knows these drugs need to be tapered gradually.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

Is there another doctor besides a psychiatrist that you think would be better

[Gridley]

@Hollyweird02

 

Any M.D.can prescribe psychiatric drugs, not just psychiatrists.  If you have another M.D. you feel comfortable with and you think would be cooperative, that would be great.

 

Here is our list of recommended doctors.  Some of the posts are old so I'd start at the end of the thread and work back until you find one in your area.

Recommended doctors, therapists, and clinics - Tapering ...

Edited March 10, 2020 by Gridley

[Hollyweird02]

5 hours ago, Gridley said:

@Hollyweird02

 

Any M.D.can prescribe psychiatric drugs, not just psychiatrists.  If you have another M.D. you feel comfortable with and you think would be cooperative, that would be great.

 

Here is our list of recommended doctors.  Some of the posts are old so I'd start at the end of the thread and work back until you find one in your area.

Recommended doctors, therapists, and clinics - Tapering ...

Thank you going to see someone tomorrow to see if they can help if not I’ll keep searching