Alternative7: Nortriptyline Taper Advice

[Alternative7]

I was put on 10mg of Nortriptyline and was on it for 8 months. I was tapering Gabapentin at the time. I had a horrific taper off Gabapentin and am still far from healed. I am nearly 3 months off but feel dreadful evey day. I am still in acute withdrawal with no real windows, however, I needed to get off Nortriptyline too and am now at 1.9mg. I have been dropping by 0.1mg at a time. 

 

I am concerned that my slow taper off Nortriptyline is hindering rather than helping my overall recovery. What do I do? 

Edited August 21, 2021 by manymoretodays

[DataGuy]

Hi @Alternative7

 

Welcome to SA. Sorry to hear about your rough withdrawal from Gabapentin. I think if you are still suffering acute withdrawal symptoms, the best thing to do is pause the nortriptyline taper. Usually tapering into difficult withdrawal symptoms only makes the situation worse. We generally recommend holding until symptoms have stabilized and, ideally, improved significantly. 

 

Have you read our topic on tapering, Why Taper By 10%? You sound like you are already familiar with tapering, but there are some good tips in there even for people who know what they are doing. Tapering slowly helps minimize both symptoms and symptom severity, ensuring you can remain functional while you get off the drug. Generally the goal should be to keep symptoms to a minimum. If you are already suffering distressing symptoms, you should take this as a sign from your CNS that it needs a break. Tapering into rough withdrawal symptoms or tapering too fast can result in a significant injury to the nervous system that can hang around for months or years for some. Here are some specific tips for tapering off nortriptyline, for when you are feeling a bit better and ready to taper. 

 

Some drugs and supplements can interfere with drug metabolism and can also have psychotropic effects (antibiotics, steroids, some supplements, coffee, nicotine etc.). It would be very helpful if you could create a drug history in your signature like this one. This link will take you directly to the signature. Signatures generally look like this: 

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

This will allow any moderator or member to quickly see your history and where you are in your taper, and thus be able to help more easily without too much reading (most people here are volunteers and have other jobs).

 

In the meantime, you might find some of these non drug coping techniques helpful to ease your symptoms. Hope you start feeling better soon : )

[Alternative7]

Thank you for replying. I can't pause or slow my taper down. My doctor will not prescribe me another bottle of the liquid Nortriptyline because it costs the NHS too much money and you can only keep it for 3 months and then you have to throw it away. This bottle runs out the first week in Ocotber.

[Altostrata]

Hello, @Alternative7 Why do you need to go off nortriptyline?

 

Your doctor should continue your prescription. See 

 

[Alternative7]

The side effects. My Heart rate in particular. I want off all prescription meds. They have caused me more harm than good. 

 

I've spoken to my doctor. They refuse to prescribe any more liquid Nortriptyline. I am unable to water titrate as it makes me really sick so I have no choice 

[DataGuy]

@Alternative7, a bit unclear on the advice you want. Do you want to go faster or slower? 

[Alternative7]

I'm wondering weather to go quicker or taper as slow as I can up to when the liquid has to be thrown away.

[DataGuy]

I think given your symptoms, I would just pause tapering and see if that improves things. If it does, you can always acquire some more nortriptyline and dry taper using a scale. If you can't do that, I would just taper as slow as possible until supply runs out, making sure you don't have too big of a jump at the end. 

 

What problems is nortriptyline causing with your heart? 

[Alternative7]

Heart rate went from low 60s to high 90s.

 

My doctor won't prescribe any more, even of the tablet. Dry cutting is also not advisable; filler vs active ingredient.

 

I will just have to carry on and hope for the best. These drugs are horrific. I feel like I'm permanently damaged. I wake evey morning between 4 and 5am becaeue of the abnormally raised cortisol which causes horrific anxiety and means I am unable to get back to sleep. I suffer with severe hypersomnolence every day and have to sleep many times during the day and feel fatigued all the time. Not to mention severe Eustachian tube dysfunction and constant head pressure. I can't function at all.  I wish I could sue my doctor 

[DataGuy]

Ok @Alternative7. Are you sure the heart rate is due to the drug's effects and not due to withdrawal? If you tapered more quickly or did a large drop, do you think your heart rate would improve or get worse? 

[Alternative7]

My heart rate change when I started taking the Nortriptyline in October 2020. As I have been tapering it has lowered. 

[DataGuy]

Ok, I think you are in the best position to decide what is good for you. It will be about balancing withdrawal and the harmful adverse effects of taking the drug. If you feel better when tapering, that is a sign that the adverse effects are outweighing the withdrawal effects. Just be cautious, because withdrawal effects can be a bit delayed sometimes. 

[Alternative7]

I guess ultimately the only choices I have is to 1) stop where I'm at, 2) taper at the rate I'm currently tapering or 3) stretch out the taper so that it goes up to point where I have to throw the liquid away..

 

Not great choices. 

[composter]

@Alternative7, we are still missing your drug signature and a more detailed timeline of your medication changes and tapers. Can you add it please? 
 

This link will take you directly to the signature. Signatures generally look like this: 

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

It would be important to know what your current tapering rate has been as well as your Gabapentin taper. You might be suffering from PAWS from Gabapentin as well as adverse effects or withdrawal symptoms from the Nortriptyline. While taking the Nortriptyline was there a point where you were feeling stable and did not have these symptoms?
 

I am tapering Amitriptyline which is a precursor to Nortriptyline and it has caused increased heart rate as well as head symptoms when I tapered too quickly.

 

It is not advisable to stop the drug. It may be best for you to stabilize first and then do a slow taper. You mention your NHS doctor refuses to prescribe refills of the liquid due to cost. You can prepare your own liquid by dissolving the tablet in water. Can you speak with your doctor and let them know you would like to do a slow, safe taper off the medication and that a tablet will reduce costs? 

[Kathyliz]

I hope you are feeling much more recovered from you gabapentin ordeal! Did you find that nortriptyline helped you during your horrific gabapentin taper?

I am currently in the throes of horrific gabapentin withdrawal myself after having to abandon my taper when I developed a severe adverse reaction to gabapentin in any dosage amount.  Like you when you posted above, I feel dreadful every day with no real windows.

My doctor has just prescribed nortriptyline as a temporary measure to try to help me get through my agonizing gabapentin withdrawal, but I have yet to take the first dose.  I was on nortriptyline for a few months 32 years ago (under very different circumstances) and tolerated the medication well without side effects or withdrawal issues.  But my CNS has been ravaged by gabapentin and I am now a geriatric patient...so I don't know if my experience with nortriptyline this time around will be comparable.  I feel I am taking a big risk with another psychotropic drug but I don't know how I continue to 'tough it out' unaided with gabapentin withdrawal.