Mario77: Multiple medication mishaps

[Mario77]

As of yesterday, 11.25 liquid (3/4 ml) plus 7.5 ml in pills. I was half a ml ( 7.5 mg) liquid and 11.25 pills for a week. 

[Altostrata]

I see you increased the Lexapro yesterday, to 15mg? Why did you do that?

[Mario77]

@AltostrataI did that maybe 4-5 days ago  (Only the signature was updated yesterday) . The reason was that I was not feeling well and that was the Dr' plan...Also, some pressure from my wife, who is siding with the Doc...:)🙄

Both are convinced that Lexapro is covering and helping against my anxiety. And that I can taper faster the mirtazapine, because I am "protected" by my Lexapro. 

 

I am seeing my Doc tomorrow and I would like to recruit her to support my new plan of tapering. But I am afraid she will propose some addition to the drug cocktail. 

 

If you have any suggestions, please, I can use them to work my way out of this predicament.

[Frogie]

@Mario77

 

When you see your dr tomorrow stand firm that you want to stay at the 12.5 mg Lexapro. It is a very strong antidepressant and will be a lot harder to taper off of at a higher dose. I don't think your wife understands that either. Lexapro is not an anti anxiety medication. It is an antidepressant. You take Clonazepam for your anxiety.

 

The Mirtazapine you've gone to liquid on so you can stabilize on it and taper off of it much easier. It is also an antidepressant.

 

Keep the Clonazepam until you are done with the other 2 tapers so that can help with the withdrawal symptoms. This is an anti anxiety medication and will help with withdrawal symptoms.

 

You have to be your own advocate when it comes to dr's. They will just add and make dosages higher because that is all the know how to do.

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

 

Please keep me posted. 

[Mario77]

@Frogie Thank a lot! I'll keep you posted for sure. So, even now, after 4-5 day, I can back down to 12.5 lex , hopefully without a lot of issues?

[Frogie]

1 hour ago, Mario77 said:

@Frogie Thank a lot! I'll keep you posted for sure. So, even now, after 4-5 day, I can back down to 12.5 lex , hopefully without a lot of issues?

Yes you can. You've only been on the 15 mg for a few days, so you are still ok to drop it back down to the 12.5. It will take about 4 days to get through your system.

[Altostrata]

Suggest you not expect your doctor or wife to know anything about tapering, withdrawal, or even drug adverse effects (which may be revealed by your daily notes). See How to talk to a doctor about tapering and withdrawal? What to expect?

[Mario77]

@Altostrata@Frogie

How about my anxiety? How am I going to deal with that if I start tapering my Lex?

[Frogie]

@Mario77

 

You don't want to taper your Lexapro yet. You only want to get back to the 12.5 mg dose of Lexapro and hold that for quite a while.

 

You have received liquid mirtazapine so you will taper it first.

 

The clonazepam should combat the anxiety, if you have any for the taper.

 

Lexapro is an antidepressant not an anti anxiety medication.

 

Clonazepam is an anit-anxiety medication.

 

Also, read what I wrote you last night. It explains everything about talking to your dr.

Edited January 4, 2022 by Frogie

[Mario77]

@Frogie

Hi Frogie, I am not stable and suffering a lot. I  raised my Lex dose from 12.5 to 15 because of that. How will I deal with my anxiety if I return to 12.5? With my clonazepam only?

My Doc proposed clonidine or Lyrica, but I don't want to add more to the cocktail. We decided to stay where I am, finishing my transition to liquid mirtazapine at the end of the week. Not sure about the Lex, 15 (as she said) or go back to 12.5. Why the reduction, just to make it easy to taper later? As I said, I am not stable at all.

[Altostrata]

36 minutes ago, Mario77 said:

Why the reduction, just to make it easy to taper later?

 

Because you said the increase to 15mg Lexapro did not make you feel better.

 

It is very possible that your "anxiety" is an adverse effect from the way you're taking clonazepam and the addition of Lexapro was unnecessary.

 

Your "anxiety" symptoms may be adverse effects of the benzodiazepines you've been taking since 2005. This is not unusual. We intend to straighten that out and see if that stabilizes your symptoms, in order to taper the other drugs first. Your wife and doctor may not agree with any of this.

 

If you deeply believe you need drug treatment for your symptoms, this is the wrong Web site for you. We're about minimizing the drugs, not treating psychiatric disorders.

[Mario77]

@AltostrataI took benzos first in 2005, but I have had years without any. Since then I was on them maybe 3 years total, on and off (mostly Valium). Do you think the benzos are the culprit here? Or they could be?

This time the anxiety started like a regular anxiety, from a health scare. Previous time was from stress, or out of the blue.

 

" We intend to straighten that out and see if that stabilizes your symptoms, in order to taper the other drugs first".

How do we do that? I am more than willing to follow your advice, but I would like a more detailed plan. I already cut my Lex to 12.5 today. 

I am not arguing here, I just want to see a ray of hope. I was on 15 mg Lex for less than a week. People are arguing that I need 4-6 week at a dose...

 

Please don't get frustrated; it's just  the fact that I don't know what path to follow and can't decide. Maybe some clarification will help me.  How do we figure out if my "present anxiety" is due to clonazepam?

Thank you again.

 

[Altostrata]

Yes, your "anxiety" may be caused by drugs such as diazepam, clonazepam, or Ambien. We see this all the time. We need the daily notes, at least 24 hours at a time, to figure out what's going on.

[Mario77]

@Altostrata

OK, will do. Do you suggest 12.5mg Lex?

 

[Frogie]

@Mario77

 

How did the appointment go? Were you able to speak to the dr about staying on the 12.5 Lexapo?

[Mario77]

Yes, I did.  She wants me at 15 and offered Clonidine or Lyrica. I declined those, but she still wants me to stay at 15 Lex (with the idea of raising to 20!). Not sure what to do, yesterday I took 12.5. I am still very anxious about everything, the clon is helping a bit.

[Frogie]

@Mario77

 

As @Altostrata said if you want to do what your dr is suggesting, then there is nothing we can do to help you.

 

If you want to continue to follow our suggestions, we can move forward.

 

I'm sorry to say, I was on Lexapro for 20+ years and the MANY dr's and psychiatrists I went to knew absolutely nothing about tapering. They thought a therapeutic dose was 20 mg, because that's all they new from the pharmaceutical companies have every taught them.

[Mario77]

I am ready to follow your suggestions. But I am very unstable right now. Should I start tapering anyway? How am I going to deal with my anxiety if I start tapering now? I was hoping to stabilize a bit first...What would be the plan? I will be on liquid mirt only at the end of the week...

[Mario77]

3 hours ago, Mario77 said:

I am ready to follow your suggestions. But I am very unstable right now. Should I start tapering anyway? How am I going to deal with my anxiety if I start tapering now? I was hoping to stabilize a bit first...What would be the plan? I will be on liquid mirt only at the end of the week...

@Frogie @Altostrata Please give me a sign and most important, a plan I should follow. I will post my 24hr diary soon.

Thanks.

[Frogie]

@Mario77

 

You can't taper anything until you are on full liquid Mirtazapine and hold for at least 4 weeks, then you can begin to taper that.

 

You need to hold at 12.5 mg Lexapro and not go up or down on the dosage. 

 

Take the Clonazepam 3 times a day as you are doing. Just make sure you are taking it at least an hour after the Mirtazapine and Lexapro.

[Mario77]

@Frogie I am taking my clonazepam at the same time with the mirtazapine in the evening...Should I take the mirtazapine 1 hr before going to bed , and the clonazepam at bed time?

How do I deal with my anxiety meanwhile? I'm lost. And in pain.

[Frogie]

@mario77

 

Yes take the mirtazapine and hour before bed and make sure it't an hour after the clonazepam.

 

You could be having side effects from taking the clonazepam at the same time, or you may need to taper it a little.

 

But don't make any changes other than moving the clonazepam and keep notes for a few days and we will see what's going on from there.

[Mario77]

@FrogieAlso, I am taking my clonazepam and 1 hr later the lex. Should I switch?

[Frogie]

@Mario77

 

No, that should be ok. You just want to take everything an hour apart from each other. Did you go back to 12.5 mg Lexapro? If you did, hold on that dose and don't change it please.

[Mario77]

So clonazepam around 9, mirt around 10 and go to bed 11? Right now I am taking both right before bed and sleeping OK.

[Mario77]

@FrogieSo, no moves for a month? Even if I feel like crap? What do I do with my anxiety and depression? Psychotherapy only?

[Frogie]

After you get to full liquid, you'll need to hold it for 3-4 weeks for your body to get used to it because it metabolizes faster than a tablet. 

 

Please no changes except to move the clonazepam an hour from the other medications.

 

Keep notes and post them please. Then we can see if the clonazepam is causing problems and we can address it then.

[Altostrata]

As explained many times, we think your anxiety may be caused by the way you've been taking benzos. We think if you take clonazepam on a regular schedule, you'll feel better, or at least we'll see if your anxiety is drug-induced.

[Mario77]

@AltostrataI am taking clonazepam regularly, at 8 with breakfast, around noon with lunch  and when I go to sleep at 10:30PM.

6:30 AM waking up anxious, tossing and turning in bed

7:00 AM Propranolol 40mg and Amlodipine 10mg, still anxious

8:00 AM breakfast and 0.75mg Clonazepam

9:00AM  Escitalopram 12.5mg 

Anxiety is increasing during morning, foggy brain, lip fasciculations

11:30AM Stiff back, agitation, shakes and chills

Noon- lunch with 0.75mg clonazepam

Increased jitteriness, feeling cold, slight headache

1 PM urge to call for help 

3 PM slight headache

5 PM -a bit better

Symptoms decrease in the evening, more calm

10:30PM Mirtazapine 18.75 plus 0.75 clonazepam 

Falling asleep pretty fast, maybe 15-20 min

 

[Altostrata]

Looks like adverse reactions to one of your drugs or a combination, since you take 4 more or less at the same time in the morning. We need to see more notes to pin this down.

 

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

[Mario77]

https://www.drugs.com/interactions-check.php?drug_list=1956-0,172-0,1013-0,703-0

 

[Mario77]

Interactions between your drugs

Moderate

propranolol  clonazePAM

Applies to: propranolol, clonazepam

Propranolol and clonazePAM may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

propranolol  amLODIPine

Applies to: propranolol, amlodipine

Propranolol and amLODIPine may have additive effects in lowering your blood pressure and heart rate. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart beat. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

clonazePAM  escitalopram

Applies to: clonazepam, escitalopram

Using clonazePAM together with escitalopram may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

No other interactions were found between your selected drugs. This does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

propranolol  food

Applies to: propranolol

Food can enhance the levels of propranolol in your body. You shoud take propranolol at the same time each day, preferably with or immediately following meals. This will make it easier for your body to absorb the medication. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking propranolol. Propranolol is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

Switch to professional interaction data

Moderate

escitalopram  food

Applies to: escitalopram

Alcohol can increase the nervous system side effects of escitalopram such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with escitalopram. Do not use more than the recommended dose of escitalopram, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Minor

amLODIPine  food

Applies to: amlodipine

Information for this minor interaction is available on the professional version.

[Altostrata]

Yes, you can see these interactions here:

18 hours ago, Mario77 said:

Anxiety is increasing during morning, foggy brain, lip fasciculations

 

[Mario77]

@AltostrataWhat can I do to avoid that? Thanks.

[Altostrata]

We need to see a couple more days of your daily notes. 

 

As explained earlier, you are getting adverse effects from your drugs. You may have been taking TOO MUCH clonazepam, and the escitalopram was unnecessary. Now the escitalopram may be participating in generating more adverse effects.

[Mario77]

OK, thanks. I'll post my notes this evening.