mrsalw: preparing to taper nortriptyline

[mrsalw]

I am new to this website, and am interested in gathering information regarding a safe taper from Nortriptyline.

 

My history of antidepressants began with a benzodiazepine (0.25mg alprazolam).  I had issues from the first pill, and took me a couple years before I realized it was the drug.  I had to do a water-titrated slow taper off the 0.25mg over the course of two years, and jumped off on November 13, 2014.  I'm very glad to be off it.

 

I have been on 20mg nortriptyline at bedtime for almost 8 years (started it when I was in tolerance-withdrawal from the benzo but didn't know it at the time).  I honestly haven't had troubles with the nortriptyline, as it helped stabilize me in coming off the benzo (which I REALLY had troubles with).  

 

About 1.5 years ago, my pharmacy switched manufacturers of my nortriptyline (from Watson to Taro).  I was on the Taro version for 4-5 months and was not doing well (I was having lots of withdrawal-type symptoms again).  I mentioned it to my doctor, and she scripted me for the Watson-specific version from then on.  Once back on the Watson, I returned to my pre-Taro "normal".  

 

Almost 3 months ago, my Watson manufacturer version of nortriptyline went on "backorder" status, so I was forced back onto the Taro version.  I am now 3 months into taking it, and am struggling and unstable at current.  My symptoms include: elevated heartrate, panic attacks, increased anxiety, irrational fears, nausea, loose stools, internal "vibrations" (stomach-intestines area), and a decreased ability to handle "life".

 

I am on propranolol (20mg in divided doses) daily now to help control the heartrate (more for my mental sanity than anything else), and have come to the realization that I don't want something like this to "control my destiny".  I am scared to taper because coming off the benzo was horrific for me, and I don't want to duplicate that process again.  But I recognize that it's probably time to approach the conversation of tapering so I don't run into this issue again.

 

I am wondering...has anyone noticed differences in how they feel with manufacturer changes?  I am also curious to find out if nortriptyline can be water (or juice?) titrated?  It tastes AWFUL so being able to put it into something with flavor would be ideal, but I'm open to suggestion.  Gauging how sensitive I've been to the switch in manufacturer, I'm concerned with switching to the liquid version in concern that I may tolerate it worse than the Taro version.

 

Anyone with success regarding either water-titration with nortriptyline, or with using the liquid version of nortriptyline, would be appreciated greatly!

 

I was on benzobuddies.org as "mrsalw" for most of 2012-2015, in case anyone hear may remember me!

 

Thanks in advance,

 

Mrs.

Edited November 20, 2020 by Gridley

[Gridley]

Welcome to SA, mrsalw. Congratulations for being off the benzo.  That's a great accomplishment.

 

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.  Please include the dates of the differing manufacturers.

 

Account Settings – Create or Edit a signature.

 

Many of us have had difficulties with manufacturer changes, myself included.  And there can be difficulties switching from tablet to liquid.  We recommend mitigating problems with a gradual crossover from brand to brand or from tablet to liquid, usually 3/4 old, 1/4 new for 3 to 7 days, 1/2 -1/2 for three to 7 days, 1/4-3/4 for 3 to 7 days.  No tapering until the crossover is complete.

 

To start the conversation about your tapering, as you probably know, we recommend tapering no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The following link is specifically about tapering Norttriptyline, including information about the various methods of tapering.  Nortriptyline comes in a prescription liquid in the U.S., and you can make your own liquid, as discussed in the link.  Other methods are also described.  

 

Tips for tapering off nortriptyline 

 

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. Get supplements that are single ingredient (not mixed with other types of supplements).

 

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

 

 

 

 

 

 

 

[mrsalw]

Thanks Gridley.  I've just updated my signature.

 

I learned of these supplements (and sensitivities to others) during my taper off of my benzodiazepine.  I am currently taking 400mg of magnesium glycinate/lycinate, and about 1,000mg of omega-3s in divided doses throughout the day.  I do take some other supplements that work well for me personally, and am very mindful of putting anything new into my body in case I might react to it.

 

I will most likely need to move slower than a 10% cut every 4 weeks, just knowing how my body has been in the past.  Low and slow is the name of the game for me!  I also need to re-reach a place of stability, as I've been unstable since being switched to a different manufacturer about 3 months ago.  I previously used the Watson manufacturer with very little issue.  They switched me to Taro, because Watson is on backorder indefinitely.  I've been on Taro for 3 months unsuccessfully.  I've done some research and found that there is a third alternative, Teva manufacturer, that I'm going to cross over to this month and see if it works better for me.  I'm scared that it might be worse for me, but am willing to try it to see if it's better.  

 

I need advice on how to liquid taper from Nortriptyline.  I was able to dissolve my benzo into water and drink with no issues.  But the flavor of Nortriptyline is horrid to me -- I'm not sure if I can do it in water.  Would juice or a pedialyte of some sort work as well?  I know to do it at room temperature, but don't want to mess with the chemical makeup of the drug.

 

Thank you so much for replying! I appreciate your thoughts.

 

Mrs.

[Gridley]

11 minutes ago, mrsalw said:

 

I will most likely need to move slower than a 10% cut every 4 weeks, just knowing how my body has been in the past.  Low and slow is the name of the game for me! 

There are a number of alternate tapers.  

 

You could taper at a 5% rate every four weeks.  

 

A popular taper is the Brassmonkey slide taper, which is four weekly 2.5% cuts for four weeks followed by a two-week hold.  I used this for my Lexapro taper.

 

The Brassmonkey Slide Method of Micro-tapering

 

A micro-taper is the gentlest way to come off these drugs.

 

Micro-taper instead of 10% or 5% decreases

 

17 minutes ago, mrsalw said:

need advice on how to liquid taper from Nortriptyline.  I was able to dissolve my benzo into water and drink with no issues.  But the flavor of Nortriptyline is horrid to me -- I'm not sure if I can do it in water.  Would juice or a pedialyte of some sort work as well?  I know to do it at room temperature, but don't want to mess with the chemical makeup of the drug.

I'm going to tag another of our moderators who is very familiar with liquid tapers to answer your question  @manymoretodays - could you address mrsalw's question about juice or pedialyte to dissove her Nortriptyline? 

 

 

 

 

[manymoretodays]

Hi mrsalw,

And welcome aboard.  I just saw your PM sent on friday, December 18th, and am copying it over here, back on your introduction thread.  It's so helpful to keep stuff all together in one place, for context.  And then if someone else pops in, they also know, what information has been given.

 

And apologies, as I did not see the tag, when that was done to me, way back! 

 

@mrsalw

Hello,

 

Grindley recommended I reach out to you for some advice on liquid tapering.

 

I am on 20mg of nortriptyline daily, and looking to taper off as gently as possible.

 

From 2012-2014, I tapered off of 0.25mg alprazolam via water titration and it was absolute h-e-double-hockey-stick. It's taken me every bit of the past six years to build up courage to even approach the idea of tapering the nortriptyline, as I'm not wanting to repeat the hell.

 

Since I'm practiced at it, I'd love to duplicate the water titration again if possible. Except nortriptyline tastes awful in water. My first question is: can I dissolve it in something with a little flavor, to distract from the bad taste? Like juice, pedialyte, etc.? I'd consider crossing over to a liquid compound, but I'm very sensitive to changes in manufacturers and don't wanna rock the boat if I can avoid it.

 

As a side story, in August of this year, my preferred manufacturer (Watson) went on backorder. I was therefore switched suddenly to Taro manufacturer, which I do not do well on. Since I didn't have an option, we rolled with it. September and October came and went, and I was still on Taro and Watson had no end to the backorder in site. In November, I crashed. My mental state and physical symptoms backslid and I felt like I was in year 1 or 2 of benzo withdrawal. At the time I was a little confused, as I just didn't think a silly manufacturer switch would create such a problem (I was wrong!).

 

In December, we discovered that Watson merged with a company called Teva, and so we ordered Teva right away. I'm now in the process of transitioning back to Teva/Watson. My Number One goal is to re-establish stability again, before beginning a taper. I had small quirky symptoms on the Watson/Teva brand that are now returning as I transition back onto it. Its not an instant return to stability, but I'm hoping I am able to achieve it.

 

Anyways, first things first: stability. In the meantime, if you could let me know if you know anything about mixing water-soluble meds with flavored fluids, I would love to hear your input!

 

Thanks so much for your time, and I look forward to hearing from you soon.

 

Did you get a chance to look at: Tips for tapering off nortriptyline

And then I take it you would want to do it yourself with a liquid? 

There is a pharmacy liquid available with cherry flavoring.  So that's something you could find out more about, cost and availability.

 

And then when going from solid to liquid we do recommend that you do it gradually, without any dose change, or tapering while crossing over:

In general this is a good formula to go by:

Day 1-3  3/4 dose with tablet and 1/4 dose liquid,  no change in dose

Day 4-6   1/2 tablet and 1/2 liquid

Day 7- 9  1/4 tablet and 3/4 liquid

And then from day 10 on to all liquid.  And then of course you might alter or adapt, and go longer at any stage if needed.

Some also will stay with 1/2 and 1/2 and do the taper using the liquid portion for ease of measurement.

 

I did my last taper with making my own liquid.  It wasn't bitter, but sometimes that can be got around by, just squirting your dose into your mouth quickly, and then following it with something to basically "cleanse the palate" so to speak.  Some juice or better flavored liquid.  And I would think you could even use some of the flavored syrup, to add to your liquid, after you've got it measured out, or add your dose to an ounce of juice prior to taking.

I never went with pharmaceutical grade liquid, as it proved to only come in a large amount(more than I needed), which expired nearly every month, and so I would have had to spend more $$ than was realistic at that time, getting refills.  I was tapering off of oxcarbazapine/Trileptal, a whole different class of medication, last.

 

You can always talk with a pharmacist or ask them too.  I had good luck with that.  Some members have, and then others not so much.

 

Generally, when making ones own liquid, it's best to mix and use it, within 3-7 days.  I always went with just 3 days.  And then it's best kept protected from light and in the refrigerator.  An amber colored bottle or small jar works.   I used a sterile urine cup and then put it in a brown paper sack, in the fridge.

 

More on making liquids and measuring:

How to make a liquid from tablets or capsules

 

Using an oral syringe and other tapering techniques

 

And it sounds like you are just adjusting back to Teva/Watson brand now, and so this is great, that you are thinking ahead onto when you will begin tapering.

And good, good......that you want to feel "ready" and stabilized before tapering too.

 

When was the propranolol started and for what?

 

And best mrsalw, I may have given you more than you asked for above. 

Apologies again, for not catching the tag that Gridley sent way back.

 

L, P, H, and G,

mmt

 

 

 

 

Edited December 20, 2020 by manymoretodays