Nanda: Reinstating Duloxetine - Help-me!

[Nanda]

25 minutos atrás, Shep disse:

@NandaObrigado por iniciar seu diário de medicamentos e sintomas.

 

 

 

Observe a interação medicamentosa "moderada" entre esses dois medicamentos:

 

Relatório de Interação Medicamentosa

 

Perguntas:

 

• Você sempre dividiu a dose de clonazepam 4 vezes ao dia?
• Você toma todos os dias nesses mesmos horários do dia?
• Você acorda com pressão na cabeça e descobre que tomar a dose de .4 mg de clonazepam às 7:30 da manhã interrompe a pressão?

 

1. I always split 3 times a day
 

2. I always take it at the same times, sometimes with a maximum variation of 30 minutes

 

3. taking clonazepam does not completely stop the pressure on the head, it just improves.

[Nanda]

How do you think I should adjust my dose schedules?  What would be better?  I'm pretty bad now, I had a drop in blood pressure, a bad nausea just now, and I felt short of breath too. 

 

I need help and now I'm sure my doctor won't be able to help me
 

[Altostrata]

Please post 24 hours of daily notes at a time.

 

So far, it appears you are having an adverse reaction to 30mg duloxetine. If the daily symptom pattern continues, if I were you, I'd reduce to 20mg duloxetine.

 

Your clonazepam dosing may need to be rescheduled, too. We need to see more of your daily symptom pattern to tell.

 

Adding in zolpidem because your reduction of clonazepam caused insomnia makes no sense at all. You can get physiologically dependent on zolpidem, too, it's related to clonazepam. It's better to be stuck on 2 drugs than 3 drugs.

[Nanda]

@Altostrata

my doctor also thinks I have an adverse reaction to duloxetine and has suggested that I have a bridge to fluoxetine.  do you think it's safe?  Thank you so much for responding, for your attention and support!

[Altostrata]

You've been taking duloxetine since 2017. It doesn't make sense to switch drugs, which may bring on duloxetine withdrawal again, if you can reduce it and taper duloxetine after stabilizing.

[Nanda]

@Altostrata

 

I understood!  I'm afraid of going down to 20 mg and having severe withdrawal symptoms.  I took 60mg and made a very quick reduction, when I got to 25mg I had a strong panic attack, a lot of nausea, so I went to the doctor and he told me to stop the medication.  I was only able to stay 4 days as the symptoms were terrible.  I reinstated 30mg and the beginning was very difficult, I had serious anxiety attacks, strong pressure in the chest and throat with a lot of belching, that's when the doctor introduced that clonazepan plan, I felt improvement, but the symptoms of chest pressure and belching continued in the following weeks.  the pressure in the head and ears started when I took the nightly dose of clonazepan to test mirtazapine.

[Nanda]

I think I will try to reduce this to 20mg of duloxetine and see how I react.  And clonazepam?  Do you think I should try to hold that dose of 1.2mg daily?  Or do I try to increase it a little bit to 1.4mg to see if the pressure in my head improves a little?  Then I would put the higher night dose to avoid taking zolpidem.  It would be 0.4mg in the morning, 0.4mg in the afternoon and 0.6mg at night.  What do you think?
 

Thanks so much @Altostrata You’re amazing 

[Altostrata]

5 hours ago, Altostrata said:

We need to see more of your daily symptom pattern to tell.

 

Before you make changes, we need to see more of your daily notes, 24 hours at a time.

 

Please do not change the clonazepam.

[Nanda]

6/25

 7:20 am awake, pressure in the head and ears moderate, mild anxiety (with pressure in the throat)
 7:30 am Clonazepam 0.4mg
 08:00 Duloxetine 30mg
 09:00 - 11:00 Moderate pressure in the head and ears.  Slight shortness of breath.
 12:00 Light pressure on the head and ears
 14:00 Clonazepan 0.4mg
 14:30 - 16:00 light pressure on the head
 17:00 chest and throat pressure with belching, no pressure on the head
 20:30 Clonazepam 0.4
 19:00 light pressure on the head and moderate pressure on the chest
 21:00 clonazepam 0.6
 21:00-22:00 No symptoms
 22:00 slept

 

@Altostrata 
 

I only saw the message about not changing the dose of clonazepam after I had taken it.  Excuse me, please!  what do I do now? 
 

tanks so much 

[Nanda]

6/25

 7:20 am awake, pressure in the head and ears moderate, mild anxiety (with pressure in the throat)
 7:30 am Clonazepam 0.4mg
 08:00 Duloxetine 30mg
 09:00 - 11:00 Moderate pressure in the head and ears.  Slight shortness of breath.
 12:00 Light pressure on the head and ears
 14:00 Clonazepan 0.4mg
 14:30 - 16:00 light pressure on the head
 17:00 chest and throat pressure with belching, no pressure on the head
 20:30 Clonazepam 0.4
 19:00 light pressure on the head and moderate pressure on the chest
 21:00 clonazepam 0.6
 21:00-22:00 No symptoms
 22:00 slept

 

@Altostrata 
 

I only saw the message about not changing the dose of clonazepam after I had taken it.  Excuse me, please!  what do I do now? 
 

tanks so much 

[Nanda]

once about 2 years ago, I went on a trip and I was without medicine for 3 days, when I returned and managed to buy the medicine I had the same symptoms that I'm having now, pressure in the chest, throat and a lot of belching.  Did I have an adverse reaction to duloxetine at the time as well?  Because the nausea and zaps in the head went away as soon as I took the pill, but these symptoms of pressure in the chest, throat and belching lasted for about 3 months. 

[Matheus]

oi, nanda! Espero q esses sintomas passem logo e vc consiga estabilizar. 

Eu acho q esses sintomas nao sao reação adversa e sim pq vc parou de tomar os três dias. Quando eu parei com a minha paroxetina e depois voltei alguns sintomas pararam mas outros continuaram la e axo q só aos poucos vai melhorando sabe? 

[Altostrata]

1 hour ago, Nanda said:

Did I have an adverse reaction to duloxetine at the time as well?  Because the nausea and zaps in the head went away as soon as I took the pill, but these symptoms of pressure in the chest, throat and belching lasted for about 3 months.

 

You got withdrawal from not taking the drug for 3 days.

[Nanda]

2 hours ago, Matheus said:

oi, nanda! Espero q esses sintomas passem logo e vc consiga estabilizar. 

Eu acho q esses sintomas nao sao reação adversa e sim pq vc parou de tomar os três dias. Quando eu parei com a minha paroxetina e depois voltei alguns sintomas pararam mas outros continuaram la e axo q só aos poucos vai melhorando sabe? 

Oi Matheus, obrigada pelo apoio! Está sendo bem complicado. Tenho 2 filhas, trabalho, marido. É difícil ter que lidar com todos esses sintomas e ter que seguir a vida. 
 

Estou sendo muito forte, mas tem horas que choro pedindo a Deus pra isso passar logo. 

[Nanda]

2 hours ago, Altostrata said:

 

You got withdrawal from not taking the drug for 3 days.

@Altostrata 

 

I went 3 days without taking it because I was traveling and I didn't have a prescription to buy duloxetine 60mg.  On the third day without the medicine I already had nausea and zaps in the brain, I got the prescription and took duloxetine 60mg and after two days I didn't have nausea or zaps anymore, but I spent about 3 months feeling what I'm feeling now, this pressure in chest and throat with belching.  At the time, my doctor said this was anxiety and that I needed to increase my dose to 90mg, but I didn't follow his advice and hoped to stabilize.  It was very difficult, but I endured it.  Understand that this was an event that happened in the past, about 2 years ago.

 

 

[Nanda]

@Altostrata @Frogie

 

should I take 0.6mg of clonazepam at night today?  or do I continue with the previous dose of 0.4mg? 
 

thanks so much 

[Frogie]

I think I would take the .06 and see how you are in a few days.

[Nanda]

57 minutes ago, Frogie said:

I think I would take the .06 and see how you are in a few days.

@Frogie Thank you for replying, my friend.  I will follow your advice.  Right now I have strong pressure in my chest.  It's 20:00, I just took the 0.6mg of Clonazepan.  did you read my history  saw about the doctor's plan to decrease 0.2mg per week?  And his attempt to take my nightly dose to put on the mirtazapine?  This destabilized me a lot, so I went back to the night dose and stopped reducing the weekly doses at the suggestion of @Altostrata
 

 

 

you who know well about benzos, what do you think about it all?  I have a huge fear of benzo dependency, even though I've only been on clonazepan for 1 month, I know I'm already dependent on it and I think the longer I stay on it, the more difficult it will be to get out.  Could you give me your opinion, suggestion, advice?

 

thanks so much! 

 

 

[Frogie]

Unfortunately you have become dependent on it on that short time. Dr.’s have no clue how to taper and will taper way too fast. I hope they have agreed to do it on your request so you can stabilize and then do a nice slow taper. 

[Frogie]

1 hour ago, Nanda said:

@Altostrata @Frogie

 

should I take 0.6mg of clonazepam at night today?  or do I continue with the previous dose of 0.4mg? 
 

thanks so much 

Are you currently taking it at night? If you are I would stick with that. Because it’s sedating it’s best to take it in the evening but don’t change from day to night at once. Let me know😊

[Nanda]

1 hour ago, Frogie said:

Are you currently taking it at night? If you are I would stick with that. Because it’s sedating it’s best to take it in the evening but don’t change from day to night at once. Let me know😊

I'm taking 0.4mg in the morning, 0.4mg in the afternoon and since yesterday 0.6mg at night.  A total of 1.4 per day

[Altostrata]

3 hours ago, Nanda said:

@Altostrata 

 

I went 3 days without taking it because I was traveling and I didn't have a prescription to buy duloxetine 60mg.  On the third day without the medicine I already had nausea and zaps in the brain, I got the prescription and took duloxetine 60mg and after two days I didn't have nausea or zaps anymore, but I spent about 3 months feeling what I'm feeling now, this pressure in chest and throat with belching.  At the time, my doctor said this was anxiety and that I needed to increase my dose to 90mg, but I didn't follow his advice and hoped to stabilize.  It was very difficult, but I endured it.  Understand that this was an event that happened in the past, about 2 years ago.

 

Thanks for the explanation. However, you're going to have to negotiate drug changes with your own nervous system, not with us.

 

Increasing the dosage does not cure withdrawal symptoms.

 

Nanda, we keep telling you not to make drug changes. Clonazepam is a drug. Please read our suggestions carefully. If you continue to change your drugs, we're not going to be able to help you.

[Nanda]

12 hours ago, Altostrata said:

 

Thanks for the explanation. However, you're going to have to negotiate drug changes with your own nervous system, not with us.

 

Increasing the dosage does not cure withdrawal symptoms.

 

Nanda, we keep telling you not to make drug changes. Clonazepam is a drug. Please read our suggestions carefully. If you continue to change your drugs, we're not going to be able to help you.

Okay, I won't make any changes.  I will continue to post my daily notes and will not make any changes.  I really appreciate all your attention and support.  I want to continue here counting on your guidance.  About decreasing the duloxetine to 20mg you suggested the other day, should I wait to see the pattern of symptoms and or would you advise me to try this reduction soon?  Thank you so much for everything, you guys are amazing!

[Altostrata]

On 6/26/2021 at 4:30 PM, Altostrata said:

 

Before you make changes, we need to see more of your daily notes, 24 hours at a time.

 

Please do not change the clonazepam.

 

[Nanda]

hello, passing by to ask for directions!  I continue taking 30mg of duloxetine and clonazepan.  But my doctor asked me to continue the 0.2mg reductions of clonazepan per week.  When I reduced the dose from 1.2mg a day to 1.0mg a day I started to have a lot of anxiety, especially in the morning.  I have been on this 1mg dose for 3 days divided into 3x (0.3 at 08:00, 0.3 at 14:00 and 0.4 at 20:00).  In addition to this anxiety, I still have the previous symptoms of pressure and headache. @Frogie  can you help me Please? 

[Nanda]

I have insomnia too.  friend @Frogie, what do you think about me going back to 1.2mg a day, with a dose of 0.3 in the morning, 0.3 in the afternoon and 0.6 at night to help me sleep and see if I can stabilize and then start to taper?

I really need your help, please help me! 

[Frogie]

You could try to go back up to 1.2 mg and see if that improves your sleep. But just don’t go up or down with your dose inconsistently as that will just destabilize your body more. Then hold and see how you do before trying anymore up and down in your dosage. Have you tried melatonin? A lot of people on here find it helps with sleep. The recommended dosage would be .3 mg. It won’t make you stay asleep but will relax you.

[Nanda]

thank you so much for helping me, friend @Frogie.  I won't make any further changes to clonazepan doses until I've stabilized, although I'm very scared of WD symptoms when I get off it.  When I go to funnel, will you help me please?

 

I started taking clonazepan because I was having severe anxiety and panic attacks with duloxetine WD.  I have been trying to stabilize on the 30mg dose of duloxetine for almost two months now, but I still have many symptoms of WD, mainly anxiety, pressure and headaches.  I'm thinking about reinstating a little more duloxetine, some 5mg to see if I can stabilize and from there start taking clonazepan with your help.  What do you think? @Frogie

[Frogie]

I will be happy to help you. You are having very normal wd symptoms. I would stay on the current dose of duloxetine for right now and see how you do, but  @Altostrata or perhaps @Gridleyhelp you with that? We just need to stabilize you in the clonazepam and move on from there. 

Edited July 6, 2021 by Frogie

[Nanda]

OK thank you!  You are too kind!  About the symptoms of WD, it's been about 2 months and it doesn't go away, it takes so long even though I have reinstated part of the medication?

[Matheus]

oi, nanda. Vc trabalha com oq? To sentindo muita dificuldade em trabalhar( eu apenas faço estagio ainda) e estudar tbm. Axo q nao vou dar conta... ☹️☹️

[Nanda]

Oi Matheus! Tudo bem com vc? Minha vida é bem corrida, tenho 32 anos, sou empresária, tenho duas filhas e um enteado, marido, casa e por aí vai. Só Deus sabe como estou dando conta de tudo, só Ele sabe o sacrifício que é levantar pela manhã, me arrumar e ir trabalhar. É um processo muito difícil e vejo que ninguém pode ajudar a gente, o jeito é esperar essa bendita estabilidade. 
 

Tenho feito terapias holísticas, tomo magnésio, valeriana, melatonina, faço yoga, rezo muito, qualquer coisa que ajude a melhorar esse inferno eu tô fazendo. 
 

Como você está?? Se quiser me chamar no Whats, acho que podemos trocar ideias. 

 

86 98800-3073

 

Um forte abraço! 

[Frogie]

It’s very normal to have wd symptoms for sometimes a very long time unfortunately. I hope that getting on a constant schedule will help you!

[Nanda]

12 hours ago, Frogie said:

It’s very normal to have wd symptoms for sometimes a very long time unfortunately. I hope that getting on a constant schedule will help you!

Tks very much @Frogie 🥰

[Altostrata]

@Nanda you may find once you get stable on clonazepam, your duloxetine withdrawal symptoms will go away. 

 

Brazilian members, please post in 

 

 

Please let us know how you're doing.

[Greatful]

@Nadia  How are you doing?  It's been pretty quite over here.