Elavil1: advice on tapering amitriptyline / Elavil

[Elavil1]

I have tapered down from 125mg to 25mg of Elavil and now each time I try and reduce I get quite severe side effects. It's like I have hit a wall and cannot reduce further. 

 

I have been trying to get off this drug for over 30 years and I have not been able to work full-time over that whole period.

 

What got me down to 25mg was a herbal preparation (Corydalis/Chapparal) but it still took over 2 years of slow reductions to get there.

 

Last time I tried to reduce I went down by 1/80th of 25mg (24.69) (last night) and still had immediate effects the next day including brain fatigue and changed (reduced) sleeping.

 

I really need to find a way to bust through this wall and would be grateful for any advice. Surely I can't make the reductions even smaller??? Very hard to measure the quantities as it is. I am in New Zealand and we have no compounding pharmacies. I use a plastic beaker and oral syringe. Sometimes cold water and sometimes hot water as solvent. Did try vodka solvent last night 1ml to 79ml water.

 

Admin: Can't find any way to add signature.

 

Edited September 16, 2020 by ChessieCat
removed whate space at bottom of post

[ChessieCat]

Hi Elavil and welcome to SA,

 

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  If we reduce the drug too quickly we can experience withdrawal symptoms.

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's WD Symptoms Checklist

 

We need to know the timeline for your taper.  Please create your drug signature and include ALL DRUGS including supplements and state the doses and the dates you made the reductions and any increases.

 

Instructions:  Withdrawal History Signature

Account Settings – Create or Edit a signature

 

Once we have more information we will be better able to offer suggestions.

 

Please do not make any reductions in your dose at this time.

 

There are details instructions in Post #1 of this topic about how to make a liquid from tablets:

 

tips-for-tapering-off-amitriptyline

 

This is your own Introduction topic where you can ask questions and journal your progress.

 

[Elavil1]

Tried again last night to go below 25mg by cutting 25mg by 1/160th (24.84mg). This is a 0.625 % taper - way under 10% recommended. Side effects (brain fatigue, eye soreness) when woke up and throughout day. Used vodka 1ml and 79ml water (cold) to do the taper. Have noticed hot water works much better. Now I will go back up to 25mg for at least 4 days to stabilize before next attempt. Will use hot water and no vodka this time as I have on some of my previous tapers. Any advice would be appreciated.

[ChessieCat]

Thank you for creating your drug signature.

 

2019 brand changed to another manufacturer (defunded) back up to 150mg and tapered quickly to 25mg

2020 all attempts to go below 25mg failed

 

We need to know when you made dose changes and the dates you made those changes.  Like this:

 

dose, date; dose, date; dose, date;

 

59 minutes ago, Elavil1 said:

Now I will go back up to 25mg for at least 4 days to stabilize before next attempt.

 

It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.  If this is the way you have been tapering then your brain is getting very confused.  It would be a good idea to do a hold at this stage and provide the information requested above so that we can see exactly what reductions you have made and when.  Once we have this information we will be better able to make suggestions about when you might resume your taper.

 

Please also answer these questions:

 

Were you experiencing withdrawal symptoms just prior to making last night's reduction?  If yes, what were those symptoms?

[Elavil1]

Have attached daily records (Excel spreadsheet) going back to 2016. Have no accurate dates before that. Changed from Mylan brand to Arrow brand on October 17th 2019 and had to go back up to 150mg because the new brand didn't work the same. Reduced quickly to 25mg with some problems. Was previously on 12.7mg of the old Mylan brand.

 

Some columns on spreadsheet for other things such as herbal supplements and breathing exercises. Any missing dates are because I just continued at the last recorded dose.

 

Your question: 

Were you experiencing withdrawal symptoms just prior to making last night's reduction?  If yes, what were those symptoms?

Answer: Yes, kind of a stunned chemical feel in my head behind eyes but sleep was pretty good the night before.

 

Thank you for your help.

Elavil Withdrawal.xls

[ChessieCat]

I've had a quick glance at your spreadsheets.

 

You tapered from 150mg (October 2019) to 25mg (January 2020) which is only about 3 months.  That is much too quickly.  If you had tapered at SA's recommended taper rate (explained previously) it would have taken you a minimum of 72 weeks to go from 150mg to 25mg.  That's about 1 year and 5 months. 

 

I also noticed that you have often got drunk in 2020 (I didn't check 2019).  That may be making your withdrawal symptoms worse.

 

alcohol-and-beer

 

You've also done a liver flush in May 2020 (haven't check any other years).  This can also worsen your withdrawal symptoms.

 

liver-detox-gallbladder-flush-internal-cleansing-enemas-fasting-other-detoxification-methods

 

You've also been taking Corydalis/Chapparal for a long time.  I can't find any members using this on SA.  However, some members have used different things and they worked for a while but then turned paradoxical.

 

October 2019 there is an entry stating "hard exercise".  Have you been over doing the exercise since reducing to 25mg?  exercise-do-more-do-less-do-nothing-what-worked-for-you

 

Q:  Do you drink caffeine beverages?  Eg strong or lots of coffee, cola drinks (Coke), energy drinks.

 

Q:  Do you go to bed and get up at a regular time?

 

My suggestion would be to start looking after yourself better:  cut out the alcohol (if you drink regularly you may need to reduce it gradually), stay off the caffeine and try to keep yourself as stress free as possible.  This will give your brain and nervous system a chance to recover.

 

I think it would also be a good idea to do a nice long hold and not even think about reducing for at least 3 months.

[Elavil1]

Hi

 

Thank you for your reply.

 

1. Have only had alcohol on two nights in the last 16 months so I think you might have clicked on the wrong year.

2. I note your points on caffeine beverages.

3. I was only at 150mg for one day when I was converting to a new amitriptyline brand. Then I quickly reduced to 25mg. I will hold at 25mg as you suggest for three months before tapering although I did hold at this level for quite some time before. The only symptoms I have at this level are a moderate swimming feeling in my head and moderate inflammation for my  kidneys and liver.

4. I go to bed and get up at pretty regular times. My problem is the severe symptoms when I taper.

5. Using deep breathing technique twice a day and it has had a positive effect on my sleep quality.

 

Will report back after I try to taper after three months at 25mg.

 

Thanks again.

[Elavil1]

Question: I don't want to use alcohol to make a solution for compounding amitriptyline as suggested in your page on this. Is there a suspension vehicle or compounding solution I could use instead? Have had some success with very hot water. I live in a pretty backward country (New Zealand) where there are no compounding pharmacies at a reasonable price. Thanks.

[ChessieCat]

pharmaceutical-liquids-to-make-suspensions

 

[brassmonkey]

Amitriptyline is highly soluble in lipids (fats/oils) . Whole fat milk is the "goto" medium for making this sort of solution. Use the same volume of milk as the strength of you tablets. Crush the tablet and mix with the milk and let stand for several hours or over night, shaking it every once in a while. This will give a 1:1 solution (1mg active ingredient for 1mL of liquid).  You can calculate the needed dose from there. The liquid can be kept in the refrigerator for about four (4) days before you have to discard it. This will work if you can drink milk, if you can't then soy milk or almond milk could also be used.

[Elavil1]

On 10/13/2020 at 8:04 AM, brassmonkey said:

Amitriptyline is highly soluble in lipids (fats/oils) . Whole fat milk is the "goto" medium for making this sort of solution. Use the same volume of milk as the strength of you tablets. Crush the tablet and mix with the milk and let stand for several hours or over night, shaking it every once in a while. This will give a 1:1 solution (1mg active ingredient for 1mL of liquid).  You can calculate the needed dose from there. The liquid can be kept in the refrigerator for about four (4) days before you have to discard it. This will work if you can drink milk, if you can't then soy milk or almond milk could also be used.

Thanks for this idea. i will give it a try. Is it necessary to use hot milk when first dissolving?

[brassmonkey]

It is better to use room temperature milk. Heating things up can cause damage to the active ingredient and make the medication less effective.

 

[Mia1]

How are you doing?

[Elavil1]

On 5/5/2021 at 12:19 AM, Mia1 said:

How are you doing?

Still at the same point - 25mg per night. Haven't been able to reduce. Too many side effects and sleep disruption. Using full fat milk as a solvent didn't work.

 

I appreciate you asking after me. I guess I'll have another try some time. Just been diagnosed as a diabetic as a result of the weight I put on taking this shocking drug over 30 years. Think I can fix this with low carb diet as glucose coming down on low carb.

 

Any ideas would be most welcome.

[Mia1]

What are your most bothersome symptoms when you reduce and how long do they last before you start to feel w/d normal?

[Elavil1]

10 hours ago, Mia1 said:

What are your most bothersome symptoms when you reduce and how long do they last before you start to feel w/d normal?

Hi, the most bothersome symptom is quite extreme neurasthenia; nervous fatigue. Similar to the feeling if you stayed up all night although I do get some sleep with small reductions.

 

I don't feel normal withdrawal and the symptoms don't improve with time.

[Mia1]

My best advice would be to develop a daily meditation practice. This will help to slow your thoughts down and give you more awareness on what your thoughts are telling you. Over time, and again done daily, this can help with anxiety as well as insomnia. I found the more work I put in the greater I was/am able to manage my symptoms.

I find mindfulness work helpful as well as yoga and long walks in nature. This would be a great time to find what works for you before you start the taper again. 

[Elavil1]

Thanks for the suggestions. I did TM many years ago but did not find it helpful. Perhaps my approach was wrong in that I didn't integrate the slowed thinking into my time not meditating.

 

One thing I have found helpful has been Win Hof Breathing Exercises. They have helped my sleep.

 

Many thanks for your suggestions again.

[Mia1]

13 hours ago, Elavil1 said:

I didn't integrate the slowed thinking into my time not meditating.

The slowed thinking is actually a benefit of the meditation over time, it’s not something you do. Maybe practicing mindfulness through the day will help? I’m happy to hear the breathing exercises work for you. Best of luck to you!

[Mia1]

How are you doing?

[Elavil1]

Hi there. Sorry for the delay in replying and I hope you are doing well.

 

I am currently on 25mg and making no attempt to reduce at the moment.

 

One thing I have noticed when restricting carbohydrates is that I have sleep problems similar to when I try to reduce Elavil. I wonder why this is; my naturopath told me 

Elavil would have affected my nervous system with respect to processing fewer carbs for sleep.

 

Any thoughts on this would be appreciated.

 

Cheers.

[Elavil1]

Update:

 

No progress has been made and currently on 26.25mg Elavil.

 

Now 33 years unemployed and alone.

 

I believe that what I have gone through is downregulation of the serotonergic receptors in the brain. I have read articles about this.

 

In some people these receptors never grow back and I believe I'm unfortunately one of those.

 

Have sold all my possessions as I am currently homeless in my country.

 

Thank you so much to the evil bastard doctors I have dealt with over the years.

 

There is no hope left and only one solution.

 

I wish those whose brains have not been permanently damaged by the medical (so-called) profession, good luck and recovery.

 

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