Pegstan: Hello and help please - paroxetine & propranolol

[Pegstan]

Hi, my name's Steph (used to be 'Poppy' on Paxilprogress)

 

I've been on the %**&£ Seroxat (paroxetine, Paxil) for over 20 years. Tried every method possible to withdraw without success so I'm stuck on a low dose until I can afford to give up work. (After titrating for 2.5 years, the withdrawal & restart cost me my job after 23 years in the civil service).

 

One thing I've noticed since being on this drug is that I'm hypersensitive to any other meds even a simple paracetomol and some have the paradoxical effect eg diazepam. I hate taking meds anyway but sometimes they are necessary.

 

Anyhow, I've got a question about propanalol & how extended release works. I've read the extremely helpful thread about weaning off alpha & beta blockers and the scales are winging their way from Amazon as we speak. Do I post my question in that thread even though it's a couple of years old? I don't want to cause a fuss by raising my own topic.

 

Advice on forum etiquette would really be appreciated.

 

TIA

 

Steph x

 

 

[hayduke]

Hi Steph, and welcome.  Paxil sounds awful. 

 

I can relate to the impact of these compounds on career etc, and I hope you can heal and maybe even find a better vocation.

 

Please post your questions in your intro thread here for now, and someone more knowledgeable should be able to assist with your question before long.

[Pegstan]

Thanks. Sorry this will be a lengthy read.

 

Weaning off propanalol ER. (sorry not Paxil/paroxetine)

 

A few weeks ago after some serious stressful events I had adrenaline rushes that overwhelmed my usual dose of paroxetine.  I panicked and upped my Seroxat dose and suffered the consequences of any slight increase/decrease then reduced it again and suffered again. The doc gave me 10mg propanolol to take 3-4 times a day as required. The side effects of instant release & quick withdrawal were very unpleasant so I refused to take them.  Then stupidly (& because I was desperate) I agreed to take the ER proranolol 80 mg once a day - and it worked insofar as it stopped the physical effects of the adrenaline releases. However the side effects have become unbearable - insomnia, violent nightmares, depressive moods, sweating, shaking and more.

 

So I need to get off them. Because I've only been taking them for a couple of weeks the doc suggested I just stop taking them! I understand that for probably 99% of patients this would be fine but a) I've been ultra sensitive to all meds since being on Seroxat and b) paroxetine increases the blood plasma/ toxicity levels of propanolol (which the doc did not know about and I only found this recently). When I said no to just stopping them he said well take 40mg instant release twice a day - no doc that would be like taking 4 x 10mg at once with the spike and withdrawal after 3-4 hours being 4 times worse. He would only agree to the following - one day at 6 x 10mg IR, one day at 4 x 10 mg and one day at 2 x 10 mg and did a prescription for 12 tablets. ( I have loads more in stock which he prescribed weeks ago & has obviously forgotten). I asked about switching to atenalol which has fewer side effect & would be easier to wean off but because it's not on the NHS list for anxiety he poo pooed that immediately. I can't blame him he doesn't know me from Adam & the majority of people taking BBs don't have such dramatic reaction to them or difficulty stopping them especially when they've only been taking them a couple of weeks. I've also spoken to the pharmacist a few times who gave me good advice on how to deal with the side effects BUT didn't think I would ever need to come off them🙄

 

Because of the spikes and withdrawal effects of the instant release 10mg I can't face that multiple times a day. So I have 14 x 80mg ER capsules left which I intend to remove beads from. For Sun, Mon  & Tues I just took 20, 25, 30 beads out without knowing what that equated to but scales & gel caps etc arrived yesterday so I now know that was 71mg, 69mg and 67mg. This morning hasn't been brilliant.

 

Today I've taken 60mg eqivalent . I live on my own, my sister is working full-time & staying with me overnight and I'm off work unpaid so I can't do this very slowly as would be ideal. Plus the doc will not prescribe me any more ER as he just wants me off BB as soon as poss and he would never condone breaking the capsules up. So I'm between a rock & a hard place as they say. 

 

I suppose my question is would it be better for example to take 30mg ER equivalent twice a day rather than 60 mg ER one a day (then 25mg twice a day rather than 50mg ) If the half life is say 10 hours and both doses are extended release - my brain is fried & I can't work out what the dosage would be or if the 'withdrawl effects would be better.

 

Thank you so much for reading all this - hopefully there's a good mathematician out there!

 

Steph x

[manymoretodays]

Hi Pegstan,

Would you please do a signature for us?

How to Summarize Your Drug History in Your Signature

This is an important part of our forum etiquette.

 

And to be honest I don't know what is best for your propranolol now.

I do know that with too fast a taper you may be in for some increased heart rate, as well as blood pressure spikes, and that would not be good for you, your heart, or your general health at all.

 

I notice you say you have looked at the tapering topic:  Tapering Beta Blockers or Alpha Blockers

I trust you got this far:

And have read and understand the Why taper by 10% of my dose and then as applied to a non-psychiatric medication

I'm not sure why your doctor will not manage the mess that they created, and am floored as to the numbers coming in lately who are put on high dose propranolol for WD symptoms.  It is not what we deal with here primarily.

 

I'll go ahead and approve your second post.  This is custom at this site, that the first two posts of a newbie get moderator approval.

I will also go ahead bring it to the attention of the rest of the staff now as well.

 

I certainly cannot do all the math you request, right now.......I expect it would take me hours......or sort through all the you've given- around IR and ER, and what you've got to work with.

 

You might, if you can keep a supply around, work with a scale, to get doses that are successively 10% off of the previous doses, so that you can do this thing right.  And you may tolerate a shorter time frame between your tapers too.  We usually start with evaluating each taper for about 4 weeks, before going on to the next.  As you are experiencing adversities from the drug, that necessitates a faster taper, yet......the safest, most harm free taper you can do.  I would sure hate to see you wind up in the ER.

 

So do you have scales, like a Gem20, that you have used for your Paxil taper?

I don't offhand know about solubility of propranolol, and if it is soluble in water, or would work to taper in a suspension at all, so for right now am going to leave you links.

 

Drugs.com (perhaps you've been there when you learned about the interaction with Paxil and propranolol)

I googled propranolol solubility in water, and it does appear to be soluble in water and ethanol.  I just glanced at the FDA site, and granted this deserves further study.

DrugBank or FDA information may prove helpful now too.

 

Using a scale to weigh and measure doses

How to make a liquid from tablets or capsules

 

Important Topics in the Tapering Forum

 

 

Okay, and best,

Love, peace, healing, and growth,

moderator manymoretodays or mmt

Edited November 11, 2021 by manymoretodays

[manymoretodays]

Hello again Pegstan,

In addition to the beta and alpha blocker topic, we do have one more specific to propranolol.

Tips for tapering off propranolol

You'll find more specifics there in how to get the changes in doses you need for the safest taper.

 

Please keep us updated.  Thank you.

Edited November 11, 2021 by manymoretodays

[Altostrata]

Propranolol XR comes in 60mg capsules, why can't your doctor prescribe that?