Depeche07: tapering amitriptyline / Elavil 40mg

[Depeche07]

Hi everyone, my name is Chris and I I have been on 40 mg Amitriptyline for 5.5 years for IBS. Started my taper 10 days ago.

I am on 4 x 10 mg tablets and my first reduction is quarter of a tab so, 2.5%.

I felt normal last week but this week I have headaches, body aches and am SO tired. Not normal for me at all.

Is this to be expected? I won't make another reduction until these feelings pass.

 

[Gridley]

Welcome to SA, Depeche07.  It's very good you wrote in early on in your taper.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  Include how long you've been on the drug and your current method of tapering

 

Account Settings – Create or Edit a signature.

 

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

 

Why taper by 10% of my dosage?

 

The fact that you're experiencing withdrawal symptoms indicates that you, like many others, may have to go more slowly than 10%.  Definitely wait it out and see how your symptoms are.   Are you leaving your Elavil in place while you taper the Amitriptyline?  We recommend tapering only one drug at a time.  Otherwise, if there are problems you won't know the cause.

 

You may  want to switch to a micro-taper going forward. This is the gentlest way to come off these drugs. 

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month. 

 

The Brassmonkey Slide Method of Micro-tapering

 

This link is specifically about tapering Amitriptyline, including how to get the nonstandard doses you'll need for your taper.  These include checking to see if liquid Amitriptyline is available in New Zealand, using a compounding pharmacy, making your own liquid and using a digital scale.

 

Tips for tapering off amitriptyline

 

If you want to continue cutting your bars, you should probably get a digital scale to make sure your cuts are consistent and accurate.  Many members use the Gemini-20 scale, available on Amazon.

 

The GEMINI-20 Scale

 

Using a digital scale to measure doses

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introdcution topic, where you can complete your drug signature, ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[Depeche07]

Thank you Gridley - I've completed my signature for where I'm at. I had to reinstate last night after my first cut 11 days ago. It was only 2.5% and 3 days ago the withdrawals hit, yesterday very bad. Crying, extreme anxiety and bad body image thoughts, migraines, aching all over. I feel normal now. I want to get off because i am controlling my IBS with the Fodmap diet. Amitrip has made me gain weight, cognitive function has slowed.

[Gridley]

7 hours ago, Depeche07 said:

normal now.

I';m glad you're feeling better. 

[bijay]

@Depeche07  hi Chris, welcome!  Glad you found this forum to help guide you.  You are way ahead of the game by going slow with your taper the first time around.  
 

I may have misunderstood your post but if  you reduced your dose by 1/4 tablet (2.5 mg), the reduction is 2.5/40 = 6.25%.  Well within the guidelines but not sure how you calculated 2.5%
 

I’m also tapering amitriptyline. It is important to be as accurate and consistent as possible about the dose reduction, so I shave down the tablets with a nail file,  then weigh the tablet with a very accurate scale.  It is readable to 0.1 mg. My 10 mg tablets are small and difficult to split, so this is the best option for me.  
 

Hope this helps.  Good to hear you feel better now.  

[Depeche07]

Thanks so much for this advice bijay - that mistake was just my bad maths!

i am going to ask my GP is the liquid is available in NZ, if not I’ll try your method. 
I’m glad I did make a mistake because now I know it IS possible to taper without feeling as bad as I did! 

[bijay]

Chris, if the liquid is not available commercially, it is possible to make your own - see the link from Gridley above on Tips for Tapering Amitriptyline.

 

I see from your profile you are from NZ.  I spent my honeymoon there, and then we took a second vacation there when I worked in Singapore.  I have such wonderful memories of your country.  Glad to see NZ is especially doing well during the pandemic.

 

All the best,

BJ

 

[Depeche07]

That’s so much bijay ☺️

There’s so much information to read, I’ll do that before I attempt to start again.

 

Yes my husband and I live in Auckland, NZ. We feel very lucky here to be in such a sheltered country with good border management. It’s terrifying to see what’s going on overseas 😖

[Depeche07]

Just a general question : I’m still not feeling right after my failed / incorrectly calculated first reduction and then reinstatement.

Very weak, minor headaches and diarrhea.

is this normal? Thanks in advance 😞

[bijay]

Is the diarrhea a new problem?  Don’t remember you talking about that before.
 

If it is new, have you started taking the magnesium and/or fish oil yet?  I know these are helpful for calming the nervous system, and have been used by many here, but either can also cause diarrhea as a side effect.

 

[Depeche07]

It must be un-related and connected to my IBS.

I started Magnesium yesterday and Fish Oil about 20 minutes ago.

I have SUCH bad brain fog today, memory and recall is bad.

That's the worst thing about Amitriptyline for me, I'm not as sharp as I was - it really worries me.

 

[bijay]

Chris, please make sure to get input from @Gridleywho as a moderator has the experience to help out someone just starting out.

 

Just a couple of suggestions if I were you -  stay at your original dose of 40 mg. until you are back to your regular “normal” for awhile.  Then try a small ( 2%) dose reduction by weighing your tablet with an accurate scale.   I wouldn’t make the switch to liquid right now just to ensure there are no effects due to transitioning to that.  Especially since you have IBS I would also skip any new supplements for the meantime.  The main point is that you want to try holding everything else constant when you reduce the dose, so you can understand what the withdrawal symptoms, if any, are and how long they last.  This will help guide you for future dose reductions and hold times, although that will always be subject to change depending how you feel at the time.  Keeping a journal can help you track things day to day.  

 

Please also try using the self care approaches discussed on the forum.  Meditation, breathing exercises, etc. can be so important for coping with any withdrawal symptoms that pop up.  Starting now would be a good idea.

 

Hope you feel better soon.

 

[Depeche07]

All great advice - thank you 😇

 

My normal isn’t back yet, feel really off, I think my body is still recovering from that cut.

 

GP told me that the liquid is not available in NZ.

So when I start again it will be with the scales.

 

i really don’t think I can face trying again until the New Year 😞

 

thanks for being here X 

[Depeche07]

How long to “reset” after failed Amitriptyline reduction

 

Hi, I made an incorrect, larger reduction on my first cut of 40 mg of Amitriptyline 3 weeks ago.

Instead of a 2.5% cut, I made over 6%.

I had to reinstate after 7 days when the withdrawals set in which were terrible.

That was 2 weeks ago and I still don’t feel right 😔 I feel like I have the flu - headaches and body aches and just general malaise - it’s hard to front up at my very demanding job at the moment.

i need to know if this is normal and roughly how long my system will take to calm down?

I’m so tired and keep getting cold sores too.

 

Thanks in advance - I’m having a bad night tonight 😞

 

Edited October 18, 2020 by ChessieCat
added topic title

[Depeche07]

PS - I found out about a week ago that I have a stomach ulcer from taking Voltarin for terrible periods. I’m on Losec 20 mg a day for this and have been put on Cerazette too to stop my periods (I am perimeno)  
I’ll put this in my signature soon. 
I’m hoping the drugs above haven’t made things worse. 

[Depeche07]

Hi @Gridley do you have any ideas about the above?

[bijay]

@Depeche07. So sorry to hear about your ulcer.  I developed gastritis as a result of taking antibiotics a few years ago.  
 

An ulcer can also give you flu-like symptoms like malaise and fatigue, so some of what you’ve been going through  lately may not be related to withdrawal.

 

Amitriptyline does also suppress stomach acid.  I would definitely recommend waiting until your ulcer heals before trying to taper it again. When I did my first taper of 10 mg. of amitriptyline (two weeks - way too fast) I wound up with acid rebound symptoms.

 

FYI - when you come off the acid reducing drug you are taking, you should taper that also to avoid acid rebound.  There are instructions on the forum here on how to do that.  In my case I was using time -release Dexilant where I could open the capsules and count beads, and went down  to 75%, 50%, 25%, 12.5% of the original dose every week.  I only had a little bit of excess acid for a couple of days after the drop to zero, and used some tums for that.

[Depeche07]

Hi Bijay,

thanks for your reply.

My doctor thinks I’ve had the ulcer for about a year 😖 I just thought I suffered from heartburn as part of my ibs and just casually mentioned it recently to her. The Losec is time release and there’s little beads inside the capsules - good to know I need to taper this too.

it just seems a weird coincidence that my failed taper / withdrawal / feeling like this is all recent.

The only ulcer symptoms that I have experienced from it are the burning sensation in my stomach.

I felt really good before I attempted this taper, I can’t seem to get back feeling like that! 😞

[bijay]

@Depeche07  It’s good the Losec will be easy to taper when you’re ready- you can put the beads in applesauce, just don’t bite down on the them.
 

Hope it does the trick for you.  PPIs like Losec do have downsides, however, like all drugs, so try to stay on it for no longer than necessary.  

 

Just curious, did you have an endoscopy to diagnose the ulcer?

 

I hope your other symptoms start to clear up soon.  You really did a reasonable first taper (at 6%) which is well within the 10% recommended by SA, and sounds like you also reinstated pretty quickly.  You did things right.  Maybe @Gridley or one of the other moderators can comment on this.  

[Depeche07]

I’m really scared of having the endoscopy - I’ve been stalling on that - I have a choking phobia, so for me having that procedure would be my worst nightmare 😒 

Did you have one to diagnose your Gastritus?

My GP said that if I haven’t had the burning pain for 6 weeks when I go back for a follow up and the Losec has worked, it was is / was most likely an ulcer.

But I know I SHOULD have the endoscopy 😭

 

[Gridley]

@Depeche07

 

Depeche, this is from your PM to me:

 

"Nearly 2 weeks later after the reinstatement I still have flu symptoms, diarrhea off and on and my emotional state is really raw."

 

I'm sorry you're feeling bad, Depeche.

 

It seems to me that you are very sensitive and the the 6% reduction disregulated your system.  This is not uncommon.  It's good that you reinstated so soon thereafter.  Sometimes reinstatement works quickly, but sometimes not.  It can take a while for your system to recover, and two weeks isn't that long.

I was in a somewhat similar situation a few years back (this is in my Introduction).  I was on Imipramine, another tricyclic, for ulcerative colitis.  I tapered too fast, got hit with symptoms and updated.  It took me around four months to stabilize.  I'm not saying that it's going to take your four months, just that it can take a while to stabilize.  I'm hoping you feel better very soon.

Edited October 19, 2020 by Gridley

[bijay]

@Depeche07. I was scared too at first but I’ve had three endoscopes and had no problems.  The anesthesia used was propofol and I was completely knocked out - so there should be no sense of discomfort or choking in any way.  As always, make sure you do your due diligence to find a good, experienced GI doctor to do it.  

[Depeche07]

Thanks @Gridley and @bijay

I've had a couple of good days, been exercising and enjoying life again.

 

Thanks for your words of wisdom / comfort re. the Endoscope @bijay its good to get as much information as possible in my decision-making process.

I've had IBS (never had an Endo for diagnosing that either) for 5 years, so I know its best to actually get a clear look at everything.

 

We have free healthcare here in NZ with waiting lists of about 4 months.

But i have medical insurance through work so will be fast-tracked for my specialist referral.

[bijay]

@Depeche07  It is really great to hear you are feeling better!  Don’t get discouraged if you have  an off day, as healing doesn’t always travel in a straight line.

Endoscopies can be used for diagnosing stomach ulcers, gastritis, esophagitis, and they can biopsy the upper intestine to test for celiac disease.  It would be a good idea to know for sure what is going on - they can also biopsy for bacteria that could be causing an ulcer too.
 

If you have IBS you may want to do a SIBO breath test for small intestinal bacterial overgrowth - SIBO is thought to often cause IBS, and can be treated with an antibiotic called rifaximin.  You can even do the breath test through the mail if it is not easily available near you.  

[Mia1]

Hi, I just read your thread and was wondering how you are doing? Did you taper down anymore? I have been tapering this drug for a year, two more weeks and I’m done! 

[Depeche07]

Hi Mia!

Thanks for checking in.

At the end of last year I ran into massive gyno issues and discovered I had a grapefruit sized (benign) growth attached to my uterus.

I have medication sorted for that now as far as heavy bleeding goes, but it was a lot to deal with, so i have put the amitrip taper on the back-burner for now.

I also have a bad stress related acid issue in my stomach, so am on Losec for that.

I want so badly to be off the Amitrip, but it was horrible when I attempted to last year, I'm not sure I want to try again :-(

Christine x

 

[Mia1]

I’m happy to hear you’re taking care of your medical issues,  and I wish you a speedy recovery on all fronts.