Robynne: tapering Neulactil

[ChessieCat]

Yes even if you only change to taking the same dose daily is a good start.

 

[ChessieCat]

Okay I've worked it out several times with a break in between and keep getting the same answer.

 

2.5mg      50mL

 

divide both sides by 50 (to find what dose is in 1mL)

 

0.05 =      1mL

 

divide 0.125mg (dose you need to take extra) by 0.05 = 2.5mL

 

to double check multiply 0.05 by 2.5 = 0.125mg

 

So you would take 2.5mL of liquid made from 2.5mg tablet in 50mL water.

[Robynne]

27 minutes ago, ChessieCat said:

Okay I've worked it out several times with a break in between and keep getting the same answer.

 

2.5mg      50mL

 

divide both sides by 50 (to find what dose is in 1mL)

 

0.05 =      1mL

 

divide 0.125mg (dose you need to take extra) by 0.05 = 2.5mL

 

to double check multiply 0.05 by 2.5 = 0.125mg

 

So you would take 2.5mL of liquid made from 2.5mg tablet in 50mL water.

I’m trying to get my head around this ! I’m going to have to go over this again tommorrow as wouldn’t you know it im

Feeling awful again 🥴I thought I’d just take 3/4 tablets each night for a while then I do the above 

[Robynne]

19 hours ago, ChessieCat said:

Okay I've worked it out several times with a break in between and keep getting the same answer.

 

2.5mg      50mL

 

divide both sides by 50 (to find what dose is in 1mL)

 

0.05 =      1mL

 

divide 0.125mg (dose you need to take extra) by 0.05 = 2.5mL

 

to double check multiply 0.05 by 2.5 = 0.125mg

 

So you would take 2.5mL of liquid made from 2.5mg tablet in 50mL water.

I took 3/4 tablet last night instead of whole one feeling quite awful today bad nausea and anxiety. I’ve driven 2 hours away and 

going to new doctor that hopefully will write out script for lower dose tablets. I’ll take 3/4 tablet tonight instead of half. This is the absolute pits I can hardly think what to do 

[ChessieCat]

You were already feeling awful alternating doses.  It might take a few more days before you notice real improvement once the amount of drug in your body levels out.

[Robynne]

10 minutes ago, ChessieCat said:

You were already feeling awful alternating doses.  It might take a few more days before you notice real improvement once the amount of drug in your body levels out.

Yes you are certainly right! I just rung chemist what do you think if when I get the 1mg and 0.25 mg capsules I take 1.75 mg maybe next week which will be just about 10% reduction from this week 

[ChessieCat]

Wait until then before reassessing.  You might find that taking it every day is enough. 

 

Keep notes on paper of what improvements you notice so that you have a reference to look back on.

[Robynne]

3 minutes ago, ChessieCat said:

Wait until then before reassessing.  You might find that taking it every day is enough. 

 

Keep notes on paper of what improvements you notice so that you have a reference to look back on.

Ok! Thanks for helping it’s almost impossible to get support for withdrawal off prescription meds I’ve come up against many roadblocks 

[Robynne]

22 hours ago, Robynne said:

Ok! Thanks for helping it’s almost impossible to get support for withdrawal off prescription meds I’ve come up against many roadblocks 

Well my update is better ! On advice from a friend I drove a couple hours to new doctor. She is taking over my tapering and agrees must be done very slowly agrees with 3/4 tablet every night andnim

nit to taper again until she says which may take weeks . She’s given me good anti nausea meds which have made big difference already. She also said she will support me all the way. Feeling less panicked 

[ChessieCat]

That is good news.  But please remember to listen to your body/symptoms.  It is you who is affected if you go too quickly, not the doctor.

 

And no skipping days to taper!!!

[Robynne]

Thanks I’ve taken all your advice on board and the doctor even listens 

[ChessieCat]

I just urge caution because in many cases what the medical profession thinks is a slow taper is much faster than SA's recommended taper rate.  SA members have posted saying that their doctor thinks they are going too slowly.  And the other one is that you are only taking a tiny dose so it's okay to stop.

 

The main thing is to be able to keep getting your prescription for the duration of your taper.

 

A suggestion to keep in mind if a doctor suggests something and you would prefer to do it differently, eg go slower, change/add a different drug etc, is say something like, I realise eg that other people might be able to get off their drug faster but I have experienced withdrawal symptoms before and would prefer to go more slowly than what you are suggesting.  You could even add that you realise that it might take a lot longer but that you want to make sure that you keep any withdrawal symptoms to a minimum and that even though it might be slow, you will get there eventually.  Or I would prefer to try it this way.

 

I'm not saying that you say this exactly, I'm just giving you an idea of how to advocate for yourself and the way to express what yourself so that you are keeping the doctor on side but are doing it in a tactful way.

[Robynne]

Ok Thankyou I will do exactly what you have suggested, I don’t care if this takes all year I just don’t want withdrawal symptoms they are awful. 

[Robynne]

I’ve read your post so many times I think I’ve got it firmly in my head now! 

[Robynne]

20 hours ago, Robynne said:

Ok Thankyou I will do exactly what you have suggested, I don’t care if this takes all year I just don’t want withdrawal symptoms they are awful. 

Feeling disappointed today as I am suffering anxiety! When I was on these meds I never had this I’m questioning why I’m going off 🤷🏼‍♀️I’m up and down like a yo yo 

[ChessieCat]

I have just managed to find the half life for periciazine.  It is only 5-7 hours, so you are most likely experiencing interdose withdrawal.  My assumption is that you are possibly starting to feel worse from 8 hours (or earlier or later) after taking the last dose.

 

If you are currently taking it at night, then you might find it better to take it in the morning.  This way the interdose withdrawal would occur overnight, but that might make you feel really bad just before you take the next dose and up until the new dose kicks in.

 

The other option would be to split your dose and take it morning and night.  Even though accuracy and consistency is important and the best way to do it, for dose splitting (ie dividing the daily dose into two doses) it is not quite as important.

 

If the drug is activating (ie wakes you up) you will need to be careful that taking a dose in the afternoon/evening does not affect your sleep.

 

Please update your drug signature with the date and the dose and state that you started taking every day.  Account Settings – Create or Edit a signature

 

 

Edited July 17, 2022 by ChessieCat

[ChessieCat]

Okay I've managed to find a NZ patient information leaflet which states that Neulactil / periciazine is taken in divided dose.

 

According to the monograph the tablets only come in 2.5mg and 10mg doses yet the doses mentioned below are much higher, so I'm assuming that people taking, for example, 75mg have to take 7x10mg + 2x2.5mg to get their dose. 

 

Maintenance therapy would not normally
be expected to exceed 300mg per day.

 

Then the above would be 30x10mg tablets a day - shake me I rattle!

 

Anyway back to the divided dosing.

 

https://www.medsafe.govt.nz/profs/Datasheet/n/Neulactiltab.pdf

 

Quote

4.2 DOSE AND METHOD OF ADMINISTRATION

Dosage requirements vary with the individual and the severity of the condition being treated.
Initial dosage should be low with progressive increases until the desired response is obtained,
after which dosage should be adjusted to maintain control of symptoms.
Severe conditions (Indication 1)

Adults
Initially 75 mg per day in divided doses. Dosage should be increased by 25 mg per day at
weekly intervals until optimum effect is achieved. Maintenance therapy would not normally
be expected to exceed 300mg per day.

Elderly
Initially 15-30 mg per day in divided doses. If this is well tolerated the dosage may be
increased if necessary for optimum control of behaviour.
Mild or moderate conditions (Indication 2)

Adults
Initially 15-30 mg daily, divided into two portions, with a larger dose being given in the
evening.

Elderly
5-10mg per day is suggested as a starting dose. It may be divided so that a larger portion is
given in the evening. Half or quarter the normal adult dose may be sufficient for maintenance
therapy.

 

 

[ChessieCat]

And I also found this:

 

https://www.nps.org.au/medicine-finder/neulactil-tablets#s4

[Robynne]

1 hour ago, ChessieCat said:

And I also found this:

 

https://www.nps.org.au/medicine-finder/neulactil-tablets#s4

Scares me ! Doctor given me temazapan to sleep and maximin for nausea I’m also been on blood pressure tablets for 5 years . 

[Robynne]

2 hours ago, ChessieCat said:

I have just managed to find the half life for periciazine.  It is only 5-7 hours, so you are most likely experiencing interdose withdrawal.  My assumption is that you are possibly starting to feel worse from 8 hours (or earlier or later) after taking the last dose.

 

If you are currently taking it at night, then you might find it better to take it in the morning.  This way the interdose withdrawal would occur overnight, but that might make you feel really bad just before you take the next dose and up until the new dose kicks in.

 

The other option would be to split your dose and take it morning and night.  Even though accuracy and consistency is important and the best way to do it, for dose splitting (ie dividing the daily dose into two doses) it is not quite as important.

 

If the drug is activating (ie wakes you up) you will need to be careful that taking a dose in the afternoon/evening does not affect your sleep.

 

Please update your drug signature with the date and the dose and state that you started taking every day.  Account Settings – Create or Edit a signature

 

 

So I should divide the dose ? I’m taking 3/4 of a 2.5 mg tablet not sure how I’d achieve the divided dose. Can’t bekeice my dose is so low and it’s causing me this much withdrawal anyway I’ve got to battle on 

[ChessieCat]

1 hour ago, Robynne said:

Doctor given me temazapan to sleep

 

I would suggest not going down that route.  I think it would cause mores issues than it would solve.

 

1 hour ago, Robynne said:

maximin for nausea

 

Please do your research about what this drug is and possible side effects.

 

49 minutes ago, Robynne said:

So I should divide the dose ? I’m taking 3/4 of a 2.5 mg tablet not sure how I’d achieve the divided dose.

 

Going by the info I found they say to take the larger dose in the evening, but that may depend on the reason for them taking it.  In your case you aren't really taking it for the effect of the drug but because you get withdrawal symptoms when you reduce/stop it.

 

Personally I would be taking 1/2 tablet in the morning and then taking 1/4 in the evening.

 

Be sure to tell your doctor that you need to take it twice a day.

[Robynne]

Im going to doctor in a weeks time I’ll try to keep taking 3/4 tablet at night then I’ll ask her about splitting dose as you have said. Hopefully I’ll get through the week 

[ChessieCat]

Just now, Robynne said:

I’ll try to keep taking 3/4 tablet at night

 

I think you should change to split dosing straight away.

[Robynne]

33 minutes ago, ChessieCat said:

 

I think you should change to split dosing straight away.

Ok I’ll try 1/4 tablet tonight and half first thing in the morning 

[Robynne]

1 hour ago, Robynne said:

Ok I’ll try 1/4 tablet tonight and half first thing in the morning 

[Robynne]

Feeling worse by the minute actually, it’s only 4.45 in arvo don’t no if I’ll make it to bedtime to take 1/4 tab I just took 2 Panadol I no they won’t help but got to try something I just have this awful pulling feeling in my tummy my poor husband has taken me away for weekend and he doesn’t no how to help me. 

[ChessieCat]

1 minute ago, Robynne said:

Feeling worse by the minute

 

So you took your dose about 7 or 8 hours ago?

 

If you are sure it is due to withdrawal then I think it would be okay to take 1/4 tablet now.

 

Take 1/2 tablet at the regular time tomorrow morning and the second dose 1/4 tablet about 5pm tomorrow and if you can at 5pm every day after that.  You don't want to have too much time in between the 1st and 2nd doses.  You will probably feel bad in the morning before you take the next dose.

 

Take note of how you feel during the time leading up to each dose and how long it takes to feel improvement after a dose.

 

And remember you have only just started taking the same dose every day.  It might take a few days before you see really obvious improvement.

 

Because of the 6-7 hours half life, if things improve but you still experience bad withdrawal before the morning dose they you might have to divide the dose into 3 and take it early morning, mid afternoon and late evening.

 

So keeping notes will help you to work out if they might be a good idea.

 

 

 

 

[Robynne]

I actually took my last 3/4 tablet nearly 20 hours ago which was bedtime 8 pm last night 

[Robynne]

1 minute ago, Robynne said:

I actually took my last 3/4 tablet nearly 20 hours ago which was bedtime 8 pm last night 

I guess you right it’s only been 2 doses of the 3/4 tablet I’ve got to toughen up 

[ChessieCat]

6 minutes ago, Robynne said:

I actually took my last 3/4 tablet nearly 20 hours ago which was bedtime 8 pm last night 

 

To put it bluntly, no wonder you feel crap.

[ChessieCat]

4 minutes ago, Robynne said:

I guess you right it’s only been 2 doses of the 3/4 tablet I’ve got to toughen up 

 

I just assumed that you were taking your dose in the morning.

 

No you don't need to toughen up you need to be kind to yourself and you do need to be very patient and use non drug coping to get through it.  Remind yourself that there is a reason that you are feeling so awful BUT also remind yourself that you are in the process of things getting better.

 

Hopefully you will notice a different tomorrow.  It might not be much but any little bit of improvement will be a sign that you are on the right track.

 

Non-drug techniques to cope

[ChessieCat]

11 minutes ago, Robynne said:

I actually took my last 3/4 tablet nearly 20 hours ago which was bedtime 8 pm last night 

 

Because it has been so long you might take 1/2 a tablet tonight and then take 1/2 a tablet in the morning and then 1/4 tablet tomorrow night.

[Robynne]

3 minutes ago, ChessieCat said:

 

To put it bluntly, no wonder you feel crap.

Why do the doctors tell me to do this ? I just feel crap alright, I’ll take a 1/4 tab now but I don’t reckon I’ll get through to morning but I’ll try really hard 

[ChessieCat]

I've just posted saying to take 1/2 a tablet tonight.  Please see the post before your reply.

[Robynne]

1 minute ago, ChessieCat said:

 

Because it has been so long you might take 1/2 a tablet tonight and then take 1/2 a tablet in the morning and then 1/4 tablet tomorrow night.

Ok I just saw this post ! I better take a half then 

[ChessieCat]

Please do keep notes for yourself because even at your best it is hard to remember things.  It's even harder when you feel awful.  It will make it much easier for you to see any pattern.