☼ KathyG: amitriptyline taper

[KathyG]

Hi there I am new to the group.  I have been on amitripline 20mg for about 3 years and want to taper off.  My doctor says no need just stop it.  I have contacted my compounding pharmacy as I have used them for my Klon taper which I have finished 7 months ago and they agree to taper but think it would not be as bad the K taper and maybe over 2 months could be done.   I am very sensitive to most meds.  They will go with whatever I feel comfortable with.  

My doctor scripted the pills for a year to another pharmacy I use and when I asked for the liquid suspension she only scripted 2 months because she does not feel I need to taper.  What difference does it make to her what method and how long.  I really do not get it.  I have read that new information out there says we should be tapering AD's

Any feed back appreciated.

 

Kathy 

[brassmonkey]

Hi Kathy-- welcome to SA. I'm so glad you have found us. Would you please start a thread for yourself in the Introductions Forum. That will be you personal thread for keeping a journal, asking questions and keeping all your information in one place. Questions asked on the sub forums like this on can sometimes get overlooked and we don't want that to happen for any of our members.

 

Brassmonkey

[KathyG]

About 4 years ago I developed Vertigo and with that came extreme anxiety as I saw the ground moving etc.  Long story short was ear crystals dislodged did some Elpey exercises and went back into place.  During that time before using the exercises I was put on a Benzo (klon)  and about 10 others AD's to try to help.  I am very sensitive and reacted badly to all and had to taper.  The only one I left was amitriptyline they gave me 25mg and could not tolerate so reduce down to 20mg.  I finally thought it has to be the benzo so I tapered off that been off 7 months and now still think the amitriptyline is not a good fit for me so would like to taper. 

I discussed with my doctor and she says I do not have to taper just to stop it.  I have been on it for about 3 years.  All that I have read it should be tapered.  I want to do compounding suspension taper and have a pharmacy in place creating for me but doctor only scripted 2 months worth.  I do have another script she did for 1 year with pills.  I think she does not want be to stop but it is my decision.

So looking for some feed back on others journey with amitriptyline.

 

KathyG

[KathyG]

I am using a compounding suspension and have setup a schedule to reduce like 2.5% every 7 days (is like 1/2mg so small cut). Will do the cut and then hold at that dose for 6 days. My doctor just said I could stop but I have done some reading and they do not recommend doing it that way and I want the least amount of w/d.

Any comments and tips greatly appreciated and I will keep you updated as I go along.

[brassmonkey]

Hi KathyG-- Looks like you have gotten your introduction thread in the right place. Welcome to the group.

 

The plan you are laying out is just like a Brassmonkey Slide but with out the additional two week hold period every four reductions. It is very important to include this hold period. The body is doing a lot of work in the background that we don't usually see when we are tapering, but if we don't let it complete it the leftovers build up and build up until they cause a crash. It can take a very long time to stabilize after a crash in order to start tapering again. I highly recommend that you add an additional two week hold every four reductions to your schedule. It may seem like it is adding unnecessary time, but in the long run we have found that a little slower is actually the faster way to go.

Edited February 24, 2021 by brassmonkey

[KathyG]

Thank you I was just thinking about adding extra hold time just didn't know were.  So even though I am holding 6 days after I cut I should still add in this extra?

 

KathyG

 

 

[brassmonkey]

Yes, so you would end up at the fourth dose level for a total of three weeks, then start the reduction pattern again. If you haven't seen it here is a good link about the Brassmonkey Slide: 

 

https://www.survivingantidepressants.org/topic/17671-the-brassmonkey-slide-method-of-micro-tapering/

 

[KathyG]

Okay here is the start of my schedule so hopefully a slow taper as I am super sensitive and more so because I am 7 months of doing a clon taper

Edited February 25, 2021 by KathyG
Added more info

[Rabe]

@KathyG Hi Kathy,

Wanted to welcome you to SA.  I use a compounding pharmacy and it have been going well...but I also have a very supportive doctor.  I am sorry you are having to deal with one who is less supportive.  But you are in the right place and will get lots of great information and help here.  Sounds like you have things well thought out.  Brass is wonderful at calculating all these things and many here use the Brass Money Slide as their tapering method....many!   I wanted to say hi and welcome!!  Take care!!💜

[KathyG]

Hi guys just wanted to update on my tapering. Started Feb 22 at 20mg and now down to 15.5mg been using compounding suspension and cutting 0.5mg every 7 days. Felt okay until about 2 days ago and then started feeling off and getting that weird scared feeling coming from nowhere. Hope it passes. I thought about when I hit 15mg might add 7 holding days and see if things settle. Any thoughts?  I think Brassmonkey suggested to hold after each 4th cut.  I was doing okay so just continued on and was thinking that maybe I would add in 7 holding days once I hit 15mg before continuing. 

 

KathyG

[KathyG]

So no one has any comments??  I am down to 15mg and was thinking of holding 7 days 

 

KathyG

 

[KathyG]

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Posted just now

So wanted to give an update and get some feedback.  I started tapering Feb 22, 2021 from 20mg and now down to 10mg.  I am using a compounding suspension and tapering 0.5mg every 7 days.  I did the first part of the taper and made it to 5mg and then I held for 14 days.  I then restarted in May and once again did the same rate 0.5mg every 7 days.  This last part was a little more intense than the first 5mg.  I will be holding for 21 days and then hopefully stabilize and then continue with the taper. 

Was thinking when restarting I would try for 0.5mg for 14 days which would be 1mg and then hold a week. 

Any thoughts on moving forward?

 

KathyG

[manymoretodays]

Hi KathyG and welcome back, @KathyG

I've got you all merged back to your original Introduction page.  And this will be the best place for you to post your questions around your particular case.

And I'll give you some of the basics, and links here now, so you can easily find them.

 

On 7/23/2021 at 12:00 PM, KathyG said:

So wanted to give an update and get some feedback.  I started tapering Feb 22, 2021 from 20mg and now down to 10mg.  I am using a compounding suspension and tapering 0.5mg every 7 days.  I did the first part of the taper and made it to 5mg and then I held for 14 days.  I then restarted in May and once again did the same rate 0.5mg every 7 days.  This last part was a little more intense than the first 5mg.  I will be holding for 21 days and then hopefully stabilize and then continue with the taper. 

Was thinking when restarting I would try for 0.5mg for 14 days which would be 1mg and then hold a week. 

 

 

How are you doing as far as WD(withdrawal) symptoms go?

Some of the more common WD symptoms are here

Dr.Glenmullen’s withdrawal symptom list.

 

We often recommend a 10% or less taper from the previous dosage.  What you are doing is a more linear taper.

*Why taper by 10% of my dosage?

this will explain ^

(Just click on the underlined passages to go to the links)

 

So far, you are not too far off from a hyperbolic taper, with each decrease percentage based on the previous dose.  I calculate out to a dose of 11.8 mg, IF you had been going down by 10% from each previous dose.

I'd HOLD a bit more than 21 days, from your last taper.  4-6 weeks is usually good.

 

Now, when you are ready to taper again, you certainly could go with a 5% taper every 2 weeks, for a total taper of 10% every 4 weeks, with a good 2 week HOLD before tapering further.  I do see some discussion above with brassmonkey on doing a slide or microtaper.

brassmonkey slide method of micro-tapering

 

To calculate a 10% taper from your current dose, just multiply current dose by .90 and you get the new dose.

10mg X .90= 9 mg  and yes, that's fine to do it in 2 drops of .5 mg, spaced 2 weeks apart, and then HOLD and additional 2 weeks.

Then, you'd take:

9 mg X .90= to get your next 10% drop done over a 6 weeks period, which is 8.1 mg.  The difference now is .9 mg and again, if you want to do 4.5 0.45 mg first, followed by another drop of 4.5  0.45 mg, and then a 2 week HOLD, that's great.

 

*And oops, I think you are describing splitting the 10% taper, into 4 drops, of 2.5%, every week and I went over 5% drops, every 2 weeks.  Maybe you have been doing a little of both??

 

In any case, it does appear that you are on the right track.

 

Please put your withdrawal history in your signature

This is all pretty self explanatory ^, be sure and list if you are on other drugs right now as well.  Very helpful for us, when trying to answer questions.

 

Also please see * Tips for tapering off amitriptyline

And these links may help further your understanding of why going slowly will pay off.

Brain Remodelling

What is withdrawal syndrome.

 

The Windows and Waves Pattern of Stabilization

 

When we take 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.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms may occur.

 

Please keep us updated and ask any further questions right here.  Do let us know how you are feeling this far too.  Thank you.

 

Love, peace, healing, and growth,

manymoretodays(mmt)

 

 

Edited July 25, 2021 by manymoretodays
strike out on dose typo error, 0.45 mg NOT 4.5 mg

[KathyG]

Okay thanks for the links and feed back.  I started doing 2.5% every 7 days so took 10 weeks to get to 5mg drop.  So you are saying I could continue as I stated but hold 14 days vs 7 days?

I hope someone responds or if Brass Monkey does just to say if my plan sounds doable as pretty close to his slide show

[manymoretodays]

Hi KathyG,

With the Brassmonkeyslide, each 6 weeks, you calculate a 10% drop from your current dose.

That's what I wanted you to understand.

Then......when you start tapering, you just do 2.5% taper every week, after 4 weeks, it will add up to 10%, of a taper from the last starting dose.  Then brassmonkey suggests a further 2 week HOLD to let everything settle.

 

So next calculating a drop of 10% from your current 10 mg dose of Amitriptyline, which is 9 mg.

Your going to divide the 1 mg drop into 4 increments.  .25 mg or a dose of 9.75 mg for a week, then 9.50 mg for the next week, then 9.25 mg for the 3rd week, and on week 4 you reach 9 mg.  HOLD for 2 weeks.  Let the change settle.  See how you are doing.

 

Then in 6 weeks if all is well.  You begin another round.  Only this time you are calculating the 10% off of what will be a current dose of 9 mg.  So you'll be dividing 0.9 mg by 4,  and then subtracting that from each weekly dose for 4 weeks, and then another 2 week HOLD.

 

Then you begin again, recalculate from the 8.1 mg dose, what 10% will be, break into 4 week increments, and so on and so forth.

 

It sounds like you have been dropping the same amount, every time, either 0.5 mg or 1 mg, which will slowly be too much, as you begin to go down in your dose.  The drop in dose is based on each previous dose, and will lessen each month or 6 weeks.   In simple terms you'll want to reduce by less, the lower the dose you are on.  That's how a hyperbolic taper works. 

 

I'm not sure what you are referring too, with the 21 days.

And wondering, if you have experienced any WD symptoms yet.

 

I can @brassmonkey for you, for when they might get a chance to take another look.  Sounds like he may have understood what you are talking about better than I am......   

 

Meantime, see how you do, with understanding, from the links given with information.  I'm afraid you might be going too fast.  3 and 1/2 years is long enough for the amitriptyline to have created some changes, and going slow will pay off and give your system time to readapt.

 

Were you put on both drugs for the vertigo?  Was it the benign positional postural vertigo?  Just asking, as my sister got that, bilaterally apparently, and has done well, just using Epley's manuevers.  Initially though, they did do meds, luckily short, short term.  I looked up the drugs she was prescribed and deterred her.  It was very anxiety producing though......her vertigo.  Hers acted up again with stress, but again......she's doing well.  And thankfully got it under control.

 

Thanks for getting to the signature.  Why don't you clarify what your plan is again, if you don't mind.......in another reply.  What you'd llike to do with your next taper, for brassmonkey.  He can take a fresh look that way when he gets a chance to come around.

And note if feeling any WD symptoms too, so far.

 

Slide show?  Are you meaning the brassmonkey slide method of tapering?  Likely so.

 

Have a great evening and weekend.

 

L, P, H, and G,

mmt

Edited July 24, 2021 by manymoretodays
an @ for brassmonkey to take a look

[KathyG]

Hi thanks for the reply.  I also sent BrassMonkey a Message.  but you could @ him just so he sees it.  I made another reply stating my next step as you suggested. 

The 21 days is like a 3 week hold after July 25 as that is the time I hit the 10mg cut.  BrassMonkey had said is his first reply to me that my plan was like the slide show minus the extra hold days.

Yes on all that you mentioned about your sister.  Same for me.  Yes Epley fixed as I had ear crystals dislodged and got them into place but was on this roller coaster from Hell so to speak.  So been a rough 4 years so far but will be so glad to be finally rid of big pharma.  Never put any of the other AD's that they tried and I had to taper through this 4 year period.  My poor CNS . 

 

 

Thanks Kathy

 

[KathyG]

Since I am using liquid have been dropping small amounts and can't go any smaller the only thing I can do is hold for longer periods which is what I think you are saying as was BrassMonkey.  I say 0.5mg or 2.5% as that is what the pharmacy started me with but do understand as I go down even though the cuts are the same the w/d hits faster because actually a larger cut.  So as I said I might have to hold longer to accomplish what you are saying in going slow.  That is why I wanted to see what BrassMonkey thought.  I am not in any hurry it takes how long it takes. 

Plan is using a 3ml syringe I will be at the 2ml which equates to 10mg and from there I will start cutting one small line item.  So first cut will be I am attaching a screen shot of the next part of the taper plan as you can see small cuts can't go any smaller. I can only change the hold days and when I make the next cut I am thinking.   BrassMonkey said to hold I think 3 weeks after 4 cuts but I think with how I am feeling  I want to do 2 cuts then hold 2-3 weeks.

The w/d are anxiety, unease jittery feeling inside and that weird scared feeling that comes from nowhere for no reason and fatigue. 

 

Thanks

KathyG

[brassmonkey]

Hi Kathy-- MMT has given some great information above. It is very important to base your reductions on the previous dose and not the original dose. The accelerating nature of a linear taper will cause some real problems as you proceed lower. It is also very important to allow enough hold time after each reduction. That is why I mentioned earlier that you should be doing 2-3 weeks holds after each 10%. For right now you need to let your body catch up with the changes and, as MMT says hold for 4-6 weeks. Let you body tell you when to start tapering again.

 

Tapering with a liquid is the best way to do it because you have such great control of the dose strength and volume. Check with the pharmacist and find out what liquid base they are using. It will probably be Ora-plus or Ora-sweet. Either one of these can be further diluted with water. If you use half water and half your liquid you would have to take a dose that is twice the volume of what you take now. This would make it easier to make smaller reductions, and just as accurate. We can work through the details later.

 

You have mentioned several different plans for tapers above. A 2.5% of your previous dose every 2 weeks followed with a 2-3 week hold every other time would be quite workable and should be pretty gentle.

[KathyG]

Hi Brassmonkey - Thank you for the reply.  Yes she gave some great information.

Yes they are using Ora Sweet same as they used for my benzo taper.  Yes was going to hold at least 4 weeks as I have 10mg pills so will work out great. 

Once I resume the taper will be straight liquid.  So in looking at the schedule it is gong from previous dose not original correct? 

I would continue with cutting 0.5mg every 7 days to make it to 1mg and then this is were I was thinking of holding either 2-3 weeks before moving forward and then do the same until I hit another 5mg cut which would leave me with 5mg left to taper. Then was thinking of doing a longer hold before resuming the final taper on the final 5mg which I have read is the hardest. 

Prior since Feb was doing 0.5mg every 7 days until I hit the 5mg point and then held 2 weeks then resumed the taper and continued the same but this time I am feeling the w/d more which is why I reached out to see if holding longer   will help and then moving forward only go to the 1mg cut and gauge how I am feeling and hold at least 2 weeks more if still not feeling great.  

How does that sound? 

[brassmonkey]

The schedule you show above takes a set amount (0.5mg) off of the previous dose. This will give the linear taper that I mentioned, and will cause problems.

The taper we recommend is to reduce by a percentage of the previous dose. A reduction of 0.5mg from a 10mg dose would be 5%.

 

Start point                     10mg

Reduction            Mg reduced      Dose          % Reduced       Dose

      1                               0.5            9.5                      5                 9.5

      2                               0.5            9.0                      5                 9.02

      3                              0.5             8.5                      5                 8.57

      4                              0.5             8.0                      5                 8.14

      5                              0.5             7.5                       5                 7.7

      6                              0.5             7.0                       5                 7.3 

      7                              0.5             6.5                       5                7.0

      8                              0.5             6.0                       5                6.6

      9                              0.5             5.5                       5                6.3 

      10                            0.5             4.5                       5                6.0

 

As you can see doing a linear taper reduces you dose a lot faster. After 7 reductions you are taking 05mg less and after 10 reductions 1.5mg less, and it only gets faster. This causes a buildup of unresolved WD symptoms which in turn causes a lot of discomfort.

 

To calculate a 5% reduction you multiply the previous dose volume by 0.95 to bet the reduced dose volume. If your previous dose is 2mL it would look like this  2mL X 0.95 = 1.9mL your next reduction would be 1.9mL X .95 = 1.8mL then 1.8mL X .95 = 1.71mL.

 

If you want to reduce in larger steps then I would do a 5% reduction and hold for 2 weeks then a 5% reduction and hold for 4 weeks. then keep repeating this pattern until you get down to 1mg. At that point we will have to discuss how to do an Endgame Taper, but that will be awhile.

[KathyG]

Hi I am a little confused as it looks like what you are suggesting is close to what I am doing. 

 My confusion lies in that I reduce by 1.9 on syringe for 7 days (according to my schedule) and then was thinking of holding 2-3 weeks (you are saying 2 week hold) before I do the next cut which would be 1.8 at this that point would be 1mg down from the 10mg.  On your calc for 5% same numbers appear the same until were you are at 1.71 it changes and I assume it would continue to change as I moved forward?  Am I missing anything?  By calc 5% can I still use the syringe?   

Reducing in larger steps  - hold longer like you say 4 weeks when at 1.8 when I resume the taper and then do the 1.7 cut and hold 2 weeks and the 1.6 and that would be another 1mg and hold that for 4 weeks?  Continue this way until I hit the next 5mg and then I was thinking of holding longer before I start the Endgame Taper as you call it which I think will be rough from what I have read and what I experienced in my Klon taper.

 

Sorry brain not working so great right now trying to wrap it around your numbers.  I want to continue using the syringes as it is easier and in your number of 1.71 does not work on the syringe. 
 

[KathyG]

BrassMonkey - how does this sound using Reducing in Larger Steps as you mentioned cutting 5% ?  

I have held 1 week so far and still feel not right guess it takes time for the brain and body to catch up as you have said

KathyG

[KathyG]

Brassmonkey -  Crap I just took 20mg vs. 10mg as forgot I took before.  I have never done this before.  I guess will see how things go.  Should not be to bad since only one time

[KathyG]

@brassmonkeydon't know if you saw my last posts but looking for input 

[brassmonkey]

Making a one time "mistake" is usually not a problem. It may take a few days to level out but should be fine.

 

Making larger reductions is all up to how your body reacts. We recommend that people don't reduce by more than 10% at a time.

 

Our recommended hold period is for a minimum of four weeks for each reduction. Holding longer is no problem. Holding for a shorter time will cause a backlog of unresolved symptoms that can lead to a major crash.

[KathyG]

@brassmonkeyJust wanted to updated as been awhile since I posted.  I made it to 5mg left to taper.  Seems  a little harder as I get lower.  I know you mentioned to only do 10% off previous dose.  I have compounding solution and use syringes so a little difficult to do that.  So what I have been doing is cutting 0.5mg over 14 days and then holding 7 days.  This last time when I reached the 5mg I decided to add in an extra 7 days hold which is what I am doing now.  So if at 5mg 10% would be 0.5mg is that correct?  So not much different than what I have been doing.  Maybe Adding in the extra hold weeks might help I think that is what you mentioned before as well.  This will be the tail end  or maybe not quite yet and I think you mentioned something about that before can you elaborate once again.  

 

My biggest sxs right now is the scared unease internal feeling that sits with me most days.  Sleep is not bad but wake early morning with that same feeling.  

Any suggestions or comments greatly appreciated.  

[brassmonkey]

I'm glad to hear things are going so well. But you need to be careful because you are right on the verge of getting in trouble.  Yes 0.5 in 10% of 5, so this reduction will be fine. But if you follow this plan your next reduction will be 15% and the one after that 20%. Those will be much too large. If you are using a liquid and syringes, then you can decrease the volume of your dose by 10%. This will give a better flow to your taper, and you can use the 10% of your previous dose method. 

 

For example, if you are currently taking a dose of 10mL by reducing that to 9mL you would get the 10% reduction in strength you are looking for. So, whatever the volume is of your current dose, multiply that number by 0.9 to get the volume of your new dose. Then measure that volume using your syringes. Next time multiply that number by 0.9 to get your next reduced dose volume.

 

Adding the extra hold time is a good idea. The lower doses tend to be trickier, so it is a good idea to take your time.

[KathyG]

Thanks for the response.  Yes I have the same feeling on this last part which is why I am reaching out.  I understand to go lower but not understanding the way you are explaining it in regards to volume.  I use a compounding suspension premixed and a 1ml syringe.  I was using the larger 3ml syringe but will be switching to the 1ml syringe as I see I can reduce smaller amounts.  Is that what you are talking about?  So my first cut would be 0.9 (longer line) below that and so in moving forward.  Trying to wrap my brain around but still having a hard time getting it .  Can you explain referring to the lines on the 1ml syringe?

So first cut 4.5 (0.9 on 1ml syringe) then next cut 4.5 x 0.9 = 4.05 then next cut 4.05 x 0.9 = 3.645   so how does that work on the 1ml syringe?  Do I use the lines between 0.9 and 0.8?  That is the part I am confused on using the lines on the syringe.  Seems similar to what I have been doing except mine like you say are bigger cuts in the long run.

 

This is the schedule I have left if I use 0.5mg as the cut which is linear if I remember you mentioning that could get me in a world of hurt.  That is using the lines on the 1ml syringe.
0.9 = 4.5

0.8 = 4.0

0.7 = 3.5

0.6 = 3.0

0.5 = 2.5

0.4 = 2.0

0.3 = 1.5

0.2 = 1.0

0.1  = 0.5

 

So if this is confusing but I am confused   Hopefully you can clarify as I plan on resuming the taper this Monday.

 

 

 

[manymoretodays]

Hi KathyG,

What is the concentration of your liquid?  How many mg(milligrams) of Amitriptyline in each mL(millileter)?

How are you doing with symptoms?  Any symptoms that you attribute to WD?

It's always good to listen to your body when tapering. 

Congrats on getting from 10 mg to 5 mg since last July.

So did you just taper down by 1 mg each month?

Did you do a brassmonkeyslide at all, or just monthly tapers by 1 mg?

 

23 hours ago, KathyG said:

This is the schedule I have left if I use 0.5mg as the cut which is linear if I remember you mentioning that could get me in a world of hurt.  That is using the lines on the 1ml syringe.
0.9 = 4.5

0.8 = 4.0

0.7 = 3.5

0.6 = 3.0

0.5 = 2.5

0.4 = 2.0

0.3 = 1.5

0.2 = 1.0

0.1  = 0.5

 

So if this is confusing but I am confused   Hopefully you can clarify as I plan on resuming the taper this Monday.

 

What are you representing on the right left?  Is it mL's or millileters?  Since you said you are using a 1 mL syringe, I think it might be mL's. 

 

Then on the right, what does that mean?  Or is it mg's? 

Again, we don't want you to taper in 0.5 mg drops anymore.

You are okay, with going down from 5 mg, to 4.5 mg next.

But after that you would be going down by less than 0.5 mg.

You'd calculate your taper drop from 4.5 mg next time.

 

Again, I'm wondering what concentration your compounded liquid is too.  If it's not on the bottle, you should be able to find that out from your compounding pharmacy.

 

Hope you are doing well, and the new year is treating you okay. 

L, P, H, and G,

mmt

Edited January 7, 2022 by manymoretodays
left not right

[KathyG]

Hi thanks for the response.  I have quoted your question and then my answer in color green

 

What is the concentration of your liquid?  How many mg(milligrams) of Amitriptyline in each mL(millileter)?

The concentration is 5mg/ml Oral Suspension.

 

How are you doing with symptoms?  Any symptoms that you attribute to WD?

My sxs are internal unease feeling inside, weird scared feeling that comes from nowhere and anxiety which I think these are all part of and I think its a chemical anxiety from the amitrip.

 

It's always good to listen to your body when tapering. 

Yes I always have

 

Congrats on getting from 10 mg to 5 mg since last July.

Thanks.  Once I hit 10mg July 25 I held for 6 weeks as Brassmonkey suggested that a good idea and worked out well.

 

So did you just taper down by 1 mg each month?

No when I restarted the taper Sept 6 I reduced by 1.0mg every 14 days and then held 7 days until I got to the 5mg Dec 26.  Then holding for 14 days and will resume the taper Jan 10 which is why I reached out to see how to proceed. 

 

Did you do a brassmonkeyslide at all, or just monthly tapers by 1 mg?

No I was already tapering and looked at the slide but continued with the schedule that me and the pharmacy came up with.  At the beginning  in Feb I started at 20mg and tapered 0.5mg every 7 days until I got to the 15mg May 2 and was getting a little more intense so that is when I slowed things after reaching out to Brassmonkey.  So held for 14 days.

Then on the right, what does that mean?  Or is it mg's? 

Dose in milliltres Amitrip 5 mg/ml This is on my schedule that I follow

Again, we don't want you to taper in 0.5 mg drops anymore. You'd calculate your taper drop from 4.5 mg next time.

Yes that is why I reached out but just confused on figuring out the amount to drop after doing the calc using the 1ml syringe and using the lines on it.  I was thinking maybe 0.25mg

You are okay, with going down from 5 mg, to 4.5 mg next. But after that you would be going down by less than 0.5 mg.

Thought of maybe doing 4.75mg instead

 

Hopefully it is easier to understand now and maybe you can explain how to proceed.  As I said I get doing the calc as Brassmoneky suggested but need to know how to measure on the 1ml syringe that is were I am confused.  I understand making the cuts smaller like maybe 5% from prior dose.   I also might add in 14 day holds vs/ the 7 days I have been doing. 

 

KathyG




 

 

 

 

 

 

 

 

 

 

Edited January 8, 2022 by KathyG
Needed to add more information

[KathyG]

Then on the right, what does that mean?  Or is it mg's? 

Dose in milliltres Amitrip 5 mg/ml This is on my schedule that I follow  so

0.9 = 4.5mg cut

0.8 = 4.0mg cut

0.7 = 3.5mg cut

0.6 = 3.0mg cut

0.5 = 2.5mg cut

0.4 = 2.0mg cut

0.3 = 1.5mg cut

0.2 = 1.0mg cut

 

Those are the lines on the 1ml syringe that I would be using for the final way down.  That is what I was talking about not understanding how to make the cuts on using the last dose

 

 

[manymoretodays]

Hi KathyG,

And thanks so much for answering questions and further clarity.

Especially that concentration of amitrip is so helpful.

I don't think you are going to want to follow the schedule you have shared.

With the first taper of 10% off of your present 5 mg dose you would be okay.

Then the next one based on another 10% off the 4.5 mg dose, you'd be close, with the .8 mL.

By the time you get to the 3rd 10% taper from the previous dose of 4.05 mg, you would want to be at .73 mL rather than at .7 mL.

 

And then that is all based on 10% tapers every 2 weeks.

 

15 hours ago, KathyG said:

How are you doing with symptoms?  Any symptoms that you attribute to WD?

My sxs are internal unease feeling inside, weird scared feeling that comes from nowhere and anxiety which I think these are all part of and I think its a chemical anxiety from the amitrip.

 

Why do you think this is from the drug, and not WD?  I'm just interested, as these can be WD symptoms that we often encounter here too.

When do you take your amitrip?  And when do the symptoms seem most prevalent?

Are you on other drugs at all now?

Those don't sound fun at all, your symptoms.  How are you dealing/coping with them?

Any windows?  The windows and waves pattern of stabilization

 

15 hours ago, KathyG said:

Again, we don't want you to taper in 0.5 mg drops anymore. You'd calculate your taper drop from 4.5 mg next time.

Yes that is why I reached out but just confused on figuring out the amount to drop after doing the calc using the 1ml syringe and using the lines on it.  I was thinking maybe 0.25mg

You are okay, with going down from 5 mg, to 4.5 mg next. But after that you would be going down by less than 0.5 mg.

Thought of maybe doing 4.75mg instead

 

Hopefully it is easier to understand now and maybe you can explain how to proceed.  As I said I get doing the calc as Brassmoneky suggested but need to know how to measure on the 1ml syringe that is were I am confused.  I understand making the cuts smaller like maybe 5% from prior dose.   I also might add in 14 day holds vs/ the 7 days I have been doing. 

 

This is great that you reached out again to get clarity. 

And going down to 4.75 mg would be a 5% taper from the present 5 mg.  So I think that is a good idea.

Yes the 1 mL syringe is going to be difficult to do measurements beyong  .02 mL increments. 

Is this what yours looks like?:

I am seeing increments of .02 mL's between each 0.1 mL measurement.  And that's good for now, as you can go in between the 1.0 mL, and 0.9 mL, and 0.8 mL measurements.

 

I think for now, for ease of measurement, you might want to do a 4% taper off the 5 mg dose of Amitrip next.

When I do the math for that I come up with a dose of 4.8 mg, and then your measurement on the 1 mL syringe would be 0.96 mL,

That might be gentler than the tapers of the past too.  It's also easier to measure out or draw up in your syringe.

 

And then, to go down another 5% from the 4.8 mg dose, I come up with a 4.56 mg dose.

4.8 mg X .95 = 4.56 mg

And then when I do the math, based on your 5 mg/1 mL concentration of Amitrip, I get that you could then measure it out to be 0.9 mL on your syringe.
 

So that should cover you for your next 2 tapers.

15 hours ago, KathyG said:

need to know how to measure on the 1ml syringe that is were I am confused.  I understand making the cuts smaller like maybe 5% from prior dose.   I also might add in 14 day holds vs/ the 7 days I have been doing. 

 

So, I bolded and colored in blue what your measurements will be with the 1 mL syringe.

And yes, definitely......on adding in 14 day holds after a taper, rather than the 7 days you had been doing. 

If your body and symptoms tell you, you need longer HOLDS, then do so.

 

Remember, it's not a race to the finish line.  If you can go slow enough now, and find a smooth transition into stable symptoms that are manageable, that is going to be ideal.

And I will notify brassmonkey too now, @brassmonkey-check my math, and explanations when you can please.  And thank you very much.

 

KathyG, brass has posted in their thread recently about some visual difficulties and headaches and such too.  If I know our friend brassmonkey though, they'll be checking in anyway......they always do. 

Here's their page:  Tao of the Brassmonkey

 

And best,

L, P, H, and G,

mmt

 

Edited January 8, 2022 by manymoretodays

[KathyG]

1 hour ago, manymoretodays said:

Why do you think this is from the drug, and not WD?  I'm just interested, as these can be WD symptoms that we often encounter here too.

When do you take your amitrip?  And when do the symptoms seem most prevalent?

Are you on other drugs at all now?

Those don't sound fun at all, your symptoms.  How are you dealing/coping with them?

I think that it is a combination of both actually.  I call it chemical because it is different that let's say normal anxiety.

I take if at about 4:30pm and sxs seem to stay with me all day.  I try and distract like walking volunteering and that helps.  Evening are much better more like my old self.

No other drugs this is the last one.  I came off a klon taper a little over a year.  Was 8 months off and then started the ami taper as just still did not feel right.

 

1 hour ago, manymoretodays said:

Especially that concentration of amitrip is so helpful.

I don't think you are going to want to follow the schedule you have shared.

With the first taper of 10% off of your present 5 mg dose you would be okay.

Then the next one based on another 10% off the 4.5 mg dose, you'd be close, with the .8 mL.

By the time you get to the 3rd 10% taper from the previous dose of 4.05 mg, you would want to be at .73 mL rather than at .7 mL.

 

And then that is all based on 10% tapers every 2 weeks.

Yes I know the schedule is pushing it and I think I may have to slow things down which as I mentioned why I reached out.

1 hour ago, manymoretodays said:

This is great that you reached out again to get clarity. 

And going down to 4.75 mg would be a 5% taper from the present 5 mg.  So I think that is a good idea.

Yes the 1 mL syringe is going to be difficult to do measurements beyong  .02 mL increments. 

Is this what yours looks like?:

Yes I think I will go with the 4.75mg cut as it comes pretty close to what you have in blue and then maybe continue continue with the 5% after a 14 day hold and see how I am feeling.  Is there a way you could calc using 5%  for the remainder of my taper so I would have a visual as that really helps.  I will add it to my schedule and cross out as I go that helps me as well.  Yes it looks like pretty much like the skinny 1ml syringe

 

1 hour ago, manymoretodays said:

 

I think for now, for ease of measurement, you might want to do a 4% taper off the 5 mg dose of Amitrip next.

When I do the math for that I come up with a dose of 4.8 mg, and then your measurement on the 1 mL syringe would be 0.96 mL,

That might be gentler than the tapers of the past too.  It's also easier to measure out or draw up in your syringe.

So on the syringe just to clarify 4.8mg would be one line after the 4.75mg?  As I mentioned above I think I will restart at 4.75mg

 

 

Thanks

 

Kathy

 

[manymoretodays]

 

Hi again,

 

And no.  The 4.8 mg would not be a line on your syringe at all.

That is the amount in dose that you are taking.

You have 5 mg per 1 mL of solution.

So when you want to get 4.8 mg, then you just want to measure .96 mL out of the bottle and into your syringe.

 

Let me try this:

Dose in mg                    Measurement with 1 mL syringe

5 mg                                  1.0 mL

4.8 mg                               .96 mL

4.56 mg                             .90 mL

 

And here I'll turn that around too:

Measurement with 1 mL syringe     to give   Dose in mg  (using a 5 mg/1mL concentration of Amitriptyline)

1.0 mL                                                                  5 mg

.96 mL                                                                 4.8 mg

.90 mL                                                                 4.56 mg

 

Your syringe is likely marked in .02 mL increments just by lines, so you might see the 1 marking, and then the .9 marking, and then the .8 marking, with 4 lines in between each of those.

So, to get 4.8 mg for your dose, you would then draw into your syringe your liquid up to the .96 mL line, 3 lines up from the .9 mL marking.

I've been trying to show the lines below, that might be on your syringe.  You won't have all these numbers marked,  I'm doing that so you can see.  And then imagine this is a 1mL syringe lying on it's side.  I bolded the slashes that represent the volumes for some of the doses we've been talking about.

 

1.0mL  .98 mL     .96 mL   .94 mL     .92 mL    .9 mL       .88 mL    .86 mL  .84 mL    .82 mL  .8 mL   

  /            /              /             /               /               /                 /              /             /            /              /                                                            

                

( and then this is ^ way larger than a 1 mL syringe would ever be, and leaves off at the .8 mL mark)

 

And then when you do the next taper, you draw up .9 mL, which is 4.56 mg in dose, or for your dose strength.

That's not the greatest representation, but hopefully will help.

I did do some rounding up or down too, depending on if my final calculations were less than or greater than .05

 

What do you see on your 1 mL syringe for markings?  If you can, send a screenshot. 

 

And then, look that all over and see if it feels clearer. 

 

1 hour ago, KathyG said:

So on the syringe just to clarify 4.8mg would be one line after the 4.75mg?  As I mentioned above I think I will restart at 4.75mg

 

The milligrams(mg) are not in lines.  The lines mark the volume, or the millileters(mL) only.

They are 2 different things completely.

I mean unless your compounded liquid concentrate of Amitriptyline came with a syringe of it's own markings, not in mL's??  Do tell, if this is the case.

 

I can calculate further, no problem. 

I do want to be assured that you are able to measure your doses right , now though.

And then it's always possible that you may decide to do tapers of even less than 5% too.

Schedules are great, but understanding what you are doing is also very important.

 

Best, L, P, H, and G,

mmt

 

 

 

Edited January 8, 2022 by manymoretodays
?'s and clarity, and fun with formatting

[manymoretodays]

And thanks for answering questions so well KathyG,  I posted more about mainly measuring your doses above.

 

I am glad to see that at least by evening you are having some reprieve of symptoms.

Have you been able to feel any lessening of the symptoms you describe, at such and such a time after each tapering drop?

Sometimes, we get to the point of while tapering, recognizing our own patterns, after each taper.

So it is good to keep some notes going for yourself too.

I've always used a block calendar, others will just journal, or perhaps keep some kind of online sheet going daily.

It's up to you.

It can be really helpful.

 

Noting when you make a drug change, and then noting if you do feel WD symptoms and when.  And then when they might start to lift.

That can help you know, and help you plan each taper.

 

If you scroll up, you'll see a link to Dr. Glenmullen's WD symptoms checklist.

And then, I gave you links to more basic WD 101 stuff too.  I just think knowledge is power, and does help with coping too.

 

No problem here, if you want to Hold longer where you are at with the Amitrip.  It's always possible that your symptoms may lighten up a bit while you are holding.  And that your body just needed more time to adjust to the changes in the Amitrip.

No one said this was always a quick process.

No problem here either, if you do wish to go forward, and as you've said, taper by less too, and with longer intervals between tapers.

 

Thanks for updating, while answering my questions, and reaching out for more help and information too.

Don't be a stranger.  Update us more often, so we know how you are doing.  You don't have to hang out all the time here if you don't want, but we appreciate the updates a lot.  Thanks.

 

Best.  L, P, H, and G,

mmt

 

[KathyG]

2 hours ago, manymoretodays said:

et me try this:

Dose in mg                    Measurement with 1 mL syringe

5 mg                                  1.0 mL

4.8 mg                               .96 mL

4.56 mg                             .90 mL

 

And here I'll turn that around too:

Measurement with 1 mL syringe     to give   Dose in mg  (using a 5 mg/1mL concentration of Amitriptyline)

1.0 mL                                                                  5 mg

.96 mL                                                                 4.8 mg

.90 mL                                                                 4.56 mg

 

Your syringe is likely marked in .02 mL increments just by lines, so you might see the 1 marking, and then the .9 marking, and then the .8 marking, with 4 lines in between each of those.

So, to get 4.8 mg for your dose, you would then draw into your syringe your liquid up to the .96 mL line, 3 lines up from the .9 mL marking.

I've been trying to show the lines below, that might be on your syringe.  You won't have all these numbers marked,  I'm doing that so you can see.  And then imagine this is a 1mL syringe lying on it's side.  I bolded the slashes that represent the volumes for some of the doses we've been talking about.

 

1.0mL  .98 mL     .96 mL   .94 mL     .92 mL    .9 mL       .88 mL    .86 mL  .84 mL    .82 mL  .8 mL   

  /            /              /             /               /               /                 /              /             /            /              /                                                            

                

( and then this is ^ way larger than a 1 mL syringe would ever be, and leaves off at the .8 mL mark)

 

And then when you do the next taper, you draw up .9 mL, which is 4.56 mg in dose, or for your dose strength.

That's not the greatest representation, but hopefully will help.

I did do some rounding up or down too, depending on if my final calculations were less than or greater than .05

 

What do you see on your 1 mL syringe for markings?  If you can, send a screenshot. 

 

And then, look that all over and see if it feels clearer. 

 

2 hours ago, manymoretodays said:

The milligrams(mg) are not in lines.  The lines mark the volume, or the millileters(mL) only.

They are 2 different things completely.

I mean unless your compounded liquid concentrate of Amitriptyline came with a syringe of it's own markings, not in mL's??  Do tell, if this is the case.

 

Ops sorry yes they are and I was doing what you are saying just made a mistake when saying 4.75 and then mentioning the lines as on my schedule I have a column that has the dose amount and then another showing like for instance the 0.9 which would be what I draw to.  So I think we are on the same page.    I did try and add a screen shot of the syringe and it says the file is to large.  The lines on mine are say 1.0ml then like 10 lines to get to 0.9 etc.  so I think they are in 0.1ml increments. One side is mil and the other side is drops. I will send it to you as a message maybe that will work.

 

48 minutes ago, manymoretodays said:

Have you been able to feel any lessening of the symptoms you describe, at such and such a time after each tapering drop?

Sometimes, we get to the point of while tapering, recognizing our own patterns, after each taper.

So it is good to keep some notes going for yourself too.

I've always used a block calendar, others will just journal, or perhaps keep some kind of online sheet going daily.

It's up to you.

It can be really helpful.

 

Noting when you make a drug change, and then noting if you do feel WD symptoms and when.  And then when they might start to lift.

That can help you know, and help you plan each taper.

 

If you scroll up, you'll see a link to Dr. Glenmullen's WD symptoms checklist.

And then, I gave you links to more basic WD 101 stuff too.  I just think knowledge is power, and does help with coping too.

 

No problem here, if you want to Hold longer where you are at with the Amitrip.  It's always possible that your symptoms may lighten up a bit while you are holding.  And that your body just needed more time to adjust to the changes in the Amitrip.

No one said this was always a quick process.

No problem here either, if you do wish to go forward, and as you've said, taper by less too, and with longer intervals between tapers.

2 hours ago, manymoretodays said:

Yes I have kept a running journal since starting the journey a little over 4 years when I started on the benzo and then they also tried like 8 other benzo/AD and I tapered off those even though short duration as had reactions and left the amitrip and tackled the K taper.  I also have used a schedule so I can mark off so always on the right dose and taper amount.  As you know how our brains at times go into brain fog. 

As I mentioned I think I will start at 4.75mg dose and draw 0.95 which on my syringe is 5 lines.  I think that I will make 2 cuts as I have been doing every 7 days and then instead of the 7 days hold will see how I feel might add in another 7 days and continue from there.  So instead of cutting 1mg over 14 days it will now be 0.5mg.   So calc 5% on previous dose right?  So that is slowing things down right?  Will see how that goes. 

Yes I will try and update more often as I may need some more advise.

Thanks for helping.  Yes would be nice to see your schedule and as you say could change as I get lower.  I will have to look above for the links you mention as I do not see them right now.  All I see is the one you sent on the syringes.  Is that were more information is?

 

Kathy