Mario77: Multiple medication mishaps

[Frogie]

 

 

@Mario77

2 hours ago, Mario77 said:

I know, and that is what I am trying to do. I thought I was supposed to go slowly and stabilize in between changes.  Believe me, If I would be able to get rid of all my meds tonight, I would do it.

I was just trying to get you to realize that because you were having anxiety you took your meds early. No one is perfect. I'm far from it. I messed up A LOT. But I learned to distract if I knew my next dose was an hour or so away. I learned that I controlled them, they didn't control me. It's hard to do. I still struggle.

 

2 hours ago, Mario77 said:

I am not relying on them; I am stuck with them. I cannot discard all my meds tonight and use only CBT or other psychotherapy (Yes, I do see a therapist weekly at the local university).

I am not taking meds to feel better; I am tapering them and I am looking for guidance.

But at one point you were relying on them, as you knew "I can take this at 10 am, and I can take this at noon etc..." That's what I meant about relying on them. I know you can't just discard them and I would never ask someone to do that. That would be a horrendous mistake. I'm glad you are seeing a therapist. That does help. Have you tried CBT in addition to tapering off your medications? I went through 5 courses of CBT before I actually understood it and it does help. You can even google it and find a website that can guide you also. I know you are looking for guidance and that's what we are hear for. I know you are stuck with them, and it's the pits. You might want to read Anatomy of an Epidemic. It really is a good book. Just a suggestion.

 

This is all really hard to deal with, I know. But you can do it. Hang in there.

[Altostrata]

Even cardiologists are not infallible and if you've not communicated the adverse effects of the drugs they prescribe -- with mirtazapine stupidly added by your psychiatrist -- they will never consider alternatives.

 

The issue here is that you'll convey your complaints here, Mario, rather than to your doctors. We're not no-pay substitutes for your doctors, and we can't prescribe. If you won't do anything to resolve your own symptoms, we can't swoop in and fix them for you. You have to do it yourself.

[Mario77]

Yes, I did CBT. Yes, I read that book. And many other. No, my cardiologist doesn't think the antihypertensive are involved. I had no side effects from them for years.

Thanks.

[Mario77]

@Frogie

I am trying to stay where I am with the meds, and maybe space them 1.5 hrs apart. Maybe hold everything here for 3 more weeks and continue tapering the midday benzo? Initially I was told to keep the benzo last, but Alto suggested that I take too much.  Or should I keep my total benzo where it is, at 2mg, at start tapering the escitalopram /or mirtazapine? 

[Frogie]

@Mario77

 

I would do as @Altostrata said. I think it could be the benzo also.

[Mario77]

So, try to get rid of the midday benzo for now?  Going by 10%? Or 0.25mg at once?

[Frogie]

@Mario77

 

You are at .25 mg at your mid dose now. I wouldn't cut it completely out all at once. Try cutting the .25 mg in 1/4's for a week, then another 1/4 for a week and so on until you are off that dose. Then we will work on the next dose. 

 

I think the benzo is causing a lot of your problems. They can "mask" symptoms, but they can also create huge symptoms. You are on a relatively big dose. We need to work on getting you off of it.

 

From now on, can you please just tag me? Altostrata is really busy at the moment.

 

Thanks...

[Mario77]

@Frogie I am at 0.5mg midday for 10 days now. And on total liquid mirtazapine for 2 weeks or so. And confused. Today I spaced my drugs 1.5 hrs apart, but I can't see a difference. I was able to fall asleep with clonazepam only last evening (maybe 9:30PM), but I took my mirtazapine when I woke up at midnight. Should I go to 3/4 tab (3.75mg) clonazepam mid-day? My main symptom is huge back pain, I guess expected when tapering benzo.  Or should I hold here for a while, at 0.5mg? Thank you very much.

[Frogie]

@Mario77

 

I'm sorry I didn't read far enough up to see that you were on .50 mg. So I would 1/4 that and hold a week, just like I explained on the other response.

 

Why did you take your mirtazapine at midnight? I thought you were taking it before bed? 

 

Here is the schedule we set up on January 7:

 

7 am - 40 mg propranolol 

 

8 am -  .75 mg clonazepam

 

9 am - 12.5 mg Lexapro

 

10 am - 10 mg amlodipine 

 

2 pm - .75 mg clonazepam

 

8 pm - .75 mg clonazepam

 

10 pm -  18.75 mg  Mirtazapine

 

Except you are now tapering the 2 pm Clonazepam.

[Mario77]

So, quarter the 0.5 pill and take 3/4 (0.375mg)  at 2PM. Starting tomorrow, 10 days since last reduction in benzos?

Yesterday I fell asleep after my clonazepam, so I took mirtazapine 1 hour or 1 hour and a half later than usual. 

 

[Mario77]

Forgot to tag you, @Frogie...

 

[Frogie]

Yes please 1/4 your dose for 10 day’s.

 

Understood falling asleep. Just try to take it at the same time if you can.

[Mario77]

@FrogieIsn't it a lot to cut? 2 weeks ago I was taking 2.25mg clonazepam (for a month or more), today I am going to 1.875?  Should I ask for liquid clonazepam from my doc?

[Frogie]

@Mario77

 

If you can get liquid, that would be fantastic. Then you can taper by drops, not cutting the tablets.

[Mario77]

Still take 3/4 of the 0.5mg tablet today at 2pm?

[Mario77]

@Frogie Again, I did forget to tag you. Sorry.

[Frogie]

@Mario77

 

Yes, you want to take 3/4 of it for a week or so before you make another cut.

[Mario77]

@FrogieI did take 3/4 (0.375mg) pill only, but I'm kinda shaky...Are we doing this hoping I am not yet dependent on that midday dose? Because, as I said, I was at 2.25 not long time ago, and today I went to 1.875...

[Mario77]

@FrogieWhat would be a good concentration for my liquid clonazepam (if I can get any)? 0.5mg per ml? Or the pharmacy will do whatever? 

[Frogie]

@Mario77

 

This website makes clonazepam liquid.

 

https://www.rosemontpharma.com/

[Mario77]

That place it's over the ocean.

 

I had disabling back pain one hour prior and 2 hrs. following my reduced midday clonazepam. I had to lay in bed for hours. Is this supposed to get better?

[Mario77]

You tapered escitalopram before benzo, right, @Frogie?

But in my case, the general consensus is that the reason for my instability is too much clonazepam. Based on...my symptoms? 

The general rule is to taper accelerators first, no?

As I said, 2 weeks ago I was taking 2.25 of clonazepam and yesterday 1.875. Isn't that a bit too fast? My back pain is horrendous, I am totally disabled  by it. And in 9 days I am supposed to cut to 1.75...

I am ready for the suffering, but I want to understand the reason behind it.

Thank you very much.

[manymoretodays]

3 hours ago, Mario77 said:

You tapered escitalopram before benzo, right, @Frogie?

But in my case, the general consensus is that the reason for my instability is too much clonazepam. Based on...my symptoms? 

The general rule is to taper accelerators first, no?

As I said, 2 weeks ago I was taking 2.25 of clonazepam and yesterday 1.875. Isn't that a bit too fast? My back pain is horrendous, I am totally disabled  by it. And in 9 days I am supposed to cut to 1.75...

I am ready for the suffering, but I want to understand the reason behind it.

Thank you very much.

 

Hi Mario77,  Not Frogie, but noticed your post,

 

01/02/2022 18.75 mirtazapine (liquid and pills), 15 Lex, 0.75 x 3 clonazepam

01/15/2021 18.75mg liquid mirtazapine,12.5mg escitalopram, 2 mg clonazepam, propranolol 40mg, amlodipine 5mg 

 

Is that last line up to date, in your signature?  I copied it to look at.

And then are you still on Lexapro too?

 

I mean I don't know your full situation but benzo's and mirtazapine, Lexapro, amlodipine, propranolol are not generally used for back pain specifically that I am aware of.  You are on a lot of drugs.

 

And if the clonazepam has shown itself to be problematic in some way now......have you been doing any Notes?  I mean that is how we can see how your drugs and symptoms are interacting.  We like to see symptoms before and after each drug taken.

And again, if you've noted symptoms, without notes even that might attribute some of your difficulties to the clonazepam.........well, often it is best to taper that first, or even maybe taper it to a lower dose, before tapering your next drug. 

Just saying all this......as yes, we have really good protocols, yet sometimes an individual case might require something else.  And I do trust that you've been getting some good input from other moderators, and trust their wisdom.

 

So......on Notes, daily drug and symptom logs:

You simply list the date, and then note the times throughout the day and night, a nice 24 hours, on the left.  On the right you note your drugs by name, and dose, as well as any supplements name and dose, and on the right you also note symptoms throughout the day and night.(of course in the night you might do notes after and when you are awake, or just summarize that you slept well or something)

More about daily drug and symptoms logs aka Notes

 

Post a full day.  And then when you have a couple days, 3, post those all together too.  Trust me, they are helpful.

 

So if the clonazepam is problematic, then actually, yes that IS the drug to be tapering first.  You can check with Frogie as to doing perhaps less of a taper than what I am calculating out to be a 17% drop.

Like could you just drop from 2.25 mg dose to a 2.00 mg dose?   That would be a 10 % taper. 

 

So there is my 2 cents so to speak.  And I will look forward to seeing some of your Notes soon.

 

Best, L, P, H, and G,

mmt

 

 

[Mario77]

@manymoretodays Thank you very much for your reply. I used to post my daily notes, but as you can see in my thread Alto said she is not interested anymore and I stopped.

Yes, I tapered to 2 mg clonazepam 12 days ago. The last 2 days I took only .375 at 2pm, instead of the 0.75 I used to take 2 weeks ago. I was worried that is too fast or to big of a cut.

If my symptoms from the daily notes point to the benzo, obviously I would taper that first (even if it is contrary to the brake/accelerator rule).

Thanks again.

[Mario77]

23 hours ago, manymoretodays said:

So if the clonazepam is problematic, then actually, yes that IS the drug to be tapering first.  You can check with Frogie as to doing perhaps less of a taper than what I am calculating out to be a 17% drop.

Like could you just drop from 2.25 mg dose to a 2.00 mg dose?   That would be a 10 % taper.

@Frogie @manymoretodays Keep the mid-day clonazepam at 0.375mg (17% drop) ? Or go back to 0.5mg ( 10-11% drop)? for the last 3 days I was at 0.375...Thanks.

[Frogie]

@Mario77

 

I would keep it where you are and hold a little while. Then drop 10% of your dose.

[Mario77]

@Frogie Will do. I hope I can get the liquid clonazepam. If not, I'll have to try cutting the 0.5mg in 1/8...Thank you!

[Frogie]

@Mario77

 

Sounds good. Hopefully you can get the liquid.

[Mario77]

Not sure I can do it, @Frogie...My back pain is horrendous. Usually 1 hr prior and 1 hr after the mid dose.

[Frogie]

@Mario77

 

Can you provide notes so we can see what’s going on.

 

Thanks.

[Mario77]

• 1/28

 

6:30 Woke up

7:00 Propranolol 40 mg with toast

8:00 bit of agitation, clonazepam 0.75

9:00 escitalopram 12.5

10:20 brain fog, shivers, 

11:00 lunch

12:00 brain fog, agitation

1 pm back pain

2 pm 0.375 clonazepam

3 pm huge back pain

4pm a bit better

6pm TV

7 pm dinner

8pm lethargy

9pm 0.75 clonazepam

10:30pm 18.75 mirtazapine

 

Thank you!

[Frogie]

@Mario77

 

Is it that excruciating that you can't function? Have you tried some tylenol or ibuprofene for the pain? Maybe a heating pad. Sometimes laying on the floor and stretching or rolling on a tennis ball will relieve tension also. 

 

It is wd symptoms. Your body wants all the drug and when you don't give it to your body, it throws a fit. 

 

Do you think you could try some of these suggestions and see how you do?

[Mario77]

Sure, @Frogie, I can take some NSAID.  But I was under the impression that ibuprofen (or other NSAID) is not recommended during tapering.

32 minutes ago, Frogie said:

It is wd symptoms. Your body wants all the drug and when you don't give it to your body, it throws a fit.

I am sure about it; I have had it whenever using benzos. Diazepam. But not so bad and so long.

 

33 minutes ago, Frogie said:

Is it that excruciating that you can't function?

Yes, it is. All I can do is lay on my belly. And pray.

 

Should I keep the notes coming? 

Thank you from the bottom of my heart!

[Frogie]

@Mario77

 

Please keep the notes coming.

 

Yes you can take tylenol or ibuprofene in wd. 

 

Would your dr change you over to diazepam if you have an easier time with it?

[Mario77]

Yes, I hope she would. But it should be some overlap with clonazepam, right? Or, one day clon everything, next diazepam only?

And I am afraid she will underdose me...from my 1.875 clon I need almost 38 mg diazepam daily? If they use 1:10 instead of 1:20 I am in trouble...

I am trying to stay here at least 2 weeks...

How about the liquid clonazepam? Would that be better than c/o to diazepam?

[Mario77]

@Frogie How about if you travel across time zones? Keep your original timing? That would be tough, to take my mirtazapine at 6PM local time...