Tak21766: Tapering off saphris

[Tak21766]

I'm trying to get off saphris, been on 10mg for about 4 years. I just reduced to 5 mg for about a week but experience anxiety and insomnia. Just wondering should I go back up to 10 mg and gradually reduce slower, but I don't know how to do that.

Edited July 4, 2021 by Gridley

[Gridley]

Welcome to SA, Tak21766.

 

To start:

 

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.

 

Account Settings – Create or Edit a signature.

 

Your reduction from 10mg to 5mg was a large reduction, resulting in difficulties for your nervous system, which had become accustomed to 10mg over the 4 years your've been taking the drug.  Since it's only been a week, I suggest you go back up to 10mg and hold there until your system stabilizes.  This will take some time, at least 3 months and very likely longer.

 

Once you've stabilized--and not before--you can begin a slow taper of the Saphris.  We recommend tapering no ore than 10% of your current dose every four weeks  This link explains why:

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Saphris, including how to get the non-standard doses you'll need for a 10% taper.  The method that will work well is to buy a digital scale.  The Smart Weigh Gem-20 (also known as Gemini-20) scale is used by many of our members, myself included.  Please read the link carefully.  One of the comments to the post talks about using the scale to taper this drug.  

 

Tips for tapering off asenapine (Saphris)

 

The insomnia and anxiety you experienced were caused by withdrawal from the drug.  

 

What is withdrawal syndrome.

 

When we take psychiatric 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. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

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.

 

 

 

 

 

 

[Tak21766]

Thanks for the advice, but how do I reduce my saphris by 10 percent, I take 10 mg wafer tablets

[Gridley]

15 hours ago, Tak21766 said:

Thanks for the advice, but how do I reduce my saphris by 10 percent, I take 10 mg wafer tablets

 

Please do not start any more new Introduction topic for yourself.  Only one Introduction topic per member.  Make all your posts right here.

 

Here's the information about getting a 10% reduction I gave you in my previous post.

 

21 hours ago, Gridley said:

 

The method that will work well is to buy a digital scale.  The Smart Weigh Gem-20 (also known as Gemini-20) scale is used by many of our members, myself included.  

 

 

You are not ready to taper yet, as I explained.

 

When you are ready, you would do the following, using the scale I described in my previous post.  I am omitting some information to make this explanation easy to understand.  When you are ready to taper, I can explain each step in detail.  You will understand this better once you have the digital scale.

 

1.  Weigh one 10mg tablet.  This weight is the number you'll be using to calculate a 10% taper.

2. Grind the tablet into powder.  You can put the tablet between two spoons or use a metal mortar and pestle.

3.  Multiply the weight of the tablet (step #1) by 0.9.  This will give you the weight of your reduced dose, which is the original dose minus 10%.

4.  Put all the powder on the scale.

5.  Using tweezers or a microspoon (also known as a powder measuring spoon, available on Amazon.com) remove powder until the scale show the correct weight (the amount shown in step #3--original dose multiplied by 0.9).

6.  Put the extra powder into a small glass to use later.

6.  The amount in the capsule is your new dose.  Using a bent 3" Post-it or bent piece of paper, pour the powder into a size 0 or 00 (00 is a little larger) gelatin capsule.  It takes a little practice so you don't spill the powder but you will quickly become accustomed to the process.  

7.  I make 7 days' of capsules once a week and keep them in a empty pill bottle in a drawer.

 

Again, this is premature, because you are not ready to taper until you stabilize from the 10mg to 5mg reduction.  But I wanted to put your mind at ease that this process is not difficult.  It will soon become second-nature.

Edited July 5, 2021 by Gridley

[Tak21766]

I read about Gradley response to my post about my post, I went from 10mg of saphris to 5 mg in a week but that was too much, he said to go back up to 10 mg, but I was reading about reinstatement of the drug, is going back to 10 mg really the optimal way, do I just go back to 10 mg to stabilize over time or try a smaller increase, sorry for the confusion im just new to this and learning

[Shep]

@Tak21766I moved your latest post and placed it here in your intro thread. Please don't start any more intro threads. This thread is where you need to post your questions. 

 

If you feel that going back up to 10 mg is too much, you could aim for 8 or 9 mg and see how you feel. However, if you don't have a liquid preparation or a scale yet, you won't be able to accurately measure the dose accurately. If that's the case, especially since it's only been a week since you reduced, than going back up to 10 mg will be best.

 

Let us know how you do. 

 

 

On 7/4/2021 at 3:00 PM, Gridley said:

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.

 

Account Settings – Create or Edit a signature.

 

Please set up a signature so we know more about your history with psychiatric drugs. That will help us give you the most accurate advice we can.

 

For more on setting up a signature, please see:

 

How to List Drug History in Signature

[Shep]

1 hour ago, Tak21766 said:

Hi shep, I dont know how to navigate this site or my thread, im not too savy sorry for responding to you directly.  Since I take saphris do I cut it and weigh the wafer, Gridley talked about crushing it, weighing it and putting it in a capsule, but saphris is sublingual under the tongue, I went from 10 mg to 5mg in a week, and then went back up to 7.5 for a couple days, still experiencing some anxiety or should I just go ahead an go back up to 10 mg for a while?  Once again sorry I'm new to this

 

@Tak21766This is the PM you sent me. I'm posting your question in your intro thread so all of your information is here. I've also added a link to your intro thread in your signature. Please continue to post here. 

 

Please go back up to 10 mg and hold until you stabilize. 

 

Are you taking any other drugs or supplements? If so, please list the date you started, the dose, and if you're not longer taking them, the date you stopped. 

 

If you aren't able to list your drug history in your signature, simply post them here in your thread. We really need to have this information information before advising you further. 

 

This is the information we need for your drug history. 

[Tak21766]

I'm currently taking .5 mg of xanax for anxiety, no other medications besides the saphris, I was on effexor about 5 years ago but stopped after about 7 months, stopped that with no problems. I will go back to 10 mg saphris and stabilize then reach back out to you. Thanks

[Shep]

Thanks for the additional information, Tak. I'm glad you've decided to go back up to 10 mg saphris. 

 

How long have you been taking Xanax? 

 

Please note there is a "moderate" drug interaction between saphris and Xanax, so it's best to separate when you take these drugs by at least 2 hours. 

 

Drug Interaction Report - saphris and xanax

 

 

[Tak21766]

I've been on and off xanax for about a year

[Tak21766]

What exact magnesium can I take to help with anxiety, there are several variations

[Gridley]

15 minutes ago, Tak21766 said:

What exact magnesium can I take to help with anxiety, there are several variations

 

Magnesium glycinate has good absorption and fewer laxative effects than some other forms of magnesium.  You could start with 50mg once a day and see how you do with that.  If you do well with 50mg once a day, you could increase that to twice a day and, if you do well with that, three times a day.  Go slowly and make sure all is well before increasing there frequency of your doses.

 

I'm glad you decided to go back to 10mg Saphris.  We can deal with the tapering question you raised about dissolving the pill under your tongue when it's time to taper.  For right now, reinstate the 10mg and let your system stabilize on that.

[Tak21766]

Thanks for the support, much appreciated, I will reach back out once I stabilize

[Shep]

14 hours ago, Tak21766 said:

I've been on and off xanax for about a year

 

Have you been taking Xanax regularly for the past 2 - 4 weeks? If so, you may be dependent on it. Many times, this dependency can cause problems. Benzos can cause interdose withdrawal symptoms, especially with periodic use. Interdose withdrawal is going into withdrawal in between doses. Xanax has a half-life of 6 - 12 hours, depending on how fast you metabolize it, so some of your symptoms may be from Xanax interdose withdrawal. 

 

It's best to take benzos consistently at the same time(s) of the day each day. Also, please note that benzos are known for kindling the nervous system. Kindling is a neurological condition in which repeated withdrawals cause worsening symptoms. Some people are fine going on and stopping a benzo one time, but the next time they start and stop, the withdrawal symptoms are worse.

 

Please be consistent with both of your drugs. 

 

 

[Tak21766]

I've been on xanax for about a month, mainly a .5mg at night to help me calm and get to sleep.  Since I'm back on 10 mg saphris should I try to wean off the xanax now or keep taking it and wean off it after I wean off the saphris?

[Shep]

6 minutes ago, Tak21766 said:

I've been on xanax for about a month, mainly a .5mg at night to help me calm and get to sleep.  Since I'm back on 10 mg saphris should I try to wean off the xanax now or keep taking it and wean off it after I wean off the saphris?

 

You can become dependent on Xanax (and any other benzo) in 2 - 4 weeks, so you may already be dependent on it. 

 

On 7/3/2021 at 5:37 PM, Tak21766 said:

I just reduced to 5 mg for about a week but experience anxiety and insomnia.

 

Since you were at 10 mg just a week ago, but you were taking Xanax at night for sleep for the past month, it looks like you had insomnia prior to your saphris reduction. Is that correct? 

 

If so, you may want to remain on the Xanax and come off it after you come off Saphris. 

[Tak21766]

Yes I had insomnia, so stay on the xanax for now?

[Tak21766]

How does your group feel about cannabis use while on meds, I don't use it but have been offered.  Does it affect the overall health of the mind positively or negatively, just curious

[Shep]

19 hours ago, Tak21766 said:

Yes I had insomnia, so stay on the xanax for now?

 

Yes, you could stay on Xanax for sleep and then taper off slowly later.

 

13 hours ago, Tak21766 said:

How does your group feel about cannabis use while on meds, I don't use it but have been offered.  Does it affect the overall health of the mind positively or negatively, just curious

 

It's a hit or a miss. Please see:

 

Cannabis, marijuana, hashish, THC, & CBD (cannabidiol) or Hemp oil

[Tak21766]

Been back on saphris 10 mg for about 7 days, still experiencing a lot of anxiety, is this just because I haven't stabilized on it yet?

[Shep]

17 hours ago, Tak21766 said:

Been back on saphris 10 mg for about 7 days, still experiencing a lot of anxiety, is this just because I haven't stabilized on it yet?

 

When are you experiencing anxiety? When do you take your drugs? Please list the time(s) of day, the dose, and the name of the drug. And let us know when during the day or night you are experiencing anxiety (or any other withdrawal symptom). 

 

You mentioned cannabis. Did you start taking this, or any other supplement? If so, please let us know the name(s) and dose of any supplement you've added in or have been taking over the past few months. 

[Tak21766]

I dont use cannabis, I experience a lot of anxiety in the morning and throughout the day. I take .5 mg of xanax about twice a day, the saphris helps me sleep so I'm not experiencing insomnia that much

[Tak21766]

I dont use any other supplements, I bought some magnesium but didn't do anything with the anxiety

[Tak21766]

I sometimes have to take 1 mg of xanax to calm me because the anxiety gets so strong

[Shep]

Some of your anxiety may be rebound, paradoxical, or interdose withdrawal (going into withdrawal in between doses) from inconsistent Xanax dosing. It's best to take your drugs at the same times of the day every day. Adding in extra Xanax may also cause you to become dependent on a higher amount, depending on how often you're adding in extra doses. 

 

You may want to work on non-drug coping skills to deal with daytime anxiety. Please see:

 

Non-drug techniques to cope with emotional symptoms

[Tak21766]

I've been taking .5 mg xanax in the morning and one in the evening, im just wondering why I'm experiencing anxiety when I get up, is it because I haven't stabilized on the saphris yet, do I just need more time,? Also my doc prescribed Zyprexa for mania but I don't want to take another drug I want to eventually taper off saphris and xanax once I start feeling better. Thanks for the input

[Shep]

Morning anxiety is very common during withdrawal. Please see:

 

Early-morning waking - managing the morning cortisol spike

[Tak21766]

But am I withdrawing from the saphris, going down to 5mg from 10 mg, because it was too much or withdrawing from something else, and do you know much about Zyprexa would it help better with anxiety rather than xanax?

[Shep]

On 7/16/2021 at 10:54 AM, Tak21766 said:

But am I withdrawing from the saphris, going down to 5mg from 10 mg, because it was too much or withdrawing from something else, and do you know much about Zyprexa would it help better with anxiety rather than xanax?

 

Withdrawing from saphris can also cause early morning cortisol spikes. All psychiatric drugs can cause this. 

 

We don't recommend switching drugs to help with withdrawal symptoms. Zyprexa is an antipsychotic and Xanax is a benzodiazpines, so if you switch, you'll go into withdrawal from Xanax, which would likely make your anxiety worse. Also, replacing Xanax with Zyprexa would mean you'd be on two antipsychotics. 

 

Here are some links dealing with handling anxiety: 

 

Sudden fear, terror, panic, or anxiety from withdrawal

 

Ways to cope with daily anxiety
 
Rebuilding self-confidence, accepting anxiety

 

Dealing With Emotional Spirals

 

Withdrawal causing intrusive or repetitive thoughts, rumination, and increased panic?

Health anxiety, hypochondria, and obsession with symptoms

 

What dose of saphris are you currently taking? Are you still back at the 10 mg dose? 

 

[Tak21766]

Yes im back on 10mg saphris, been about 10 days

[Shep]

Please add a signature with your drug history. 

 

How to List Drug History in Signature

 

The first post gives instructions and an example of what we need. 

 

A direct link to your signature is here:

 

Create Your Signature in "Account Settings". 

 

 

[Tak21766]

Created signature but not sure it saved, taking .5 mg xanax 2x a day for anxiety but no real relief

[Shep]

Yes, your signature saved. Thank you for setting it up. 

 

How were you feeling on June 1, 2021, when you went back on Saphris at 10 mg after the May 15th cold turkey? Did returning to the 10 mg resolve withdrawal back then? 

[Tak21766]

Yes it resolved it when I went back on it

[Shep]

Thanks, Tak. It may take awhile for your symptoms to resolve from the cold turkey in May and then the 50% reduction in June. You're sleeping now, which is good, although the Xanax may be more responsible for that. 

 

I would hold for a couple of weeks (or longer) and see if you could get to a stronger baseline before tapering. 

[Tak21766]

Ok ill give it some more time, ugh I'm suffering though