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concernedmom

Tapering off Vicodin after longterm psych meds

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concernedmom

hi

i am writing on behalf of a friend. due to her severe withdrawal symptoms she is having difficulty posting on this website herself

 

she has been on psych drugs for 20 years and prescription vicodin for chronic pain around 8 years. she tapered off most of the vicodin, a lot of the klonopin, and all of the prozac, zyprexa, adderall and atavin. she says she might still be in withdrawal from these drugs because she didn't know at the time to taper slowly.( that was about 4 years ago)

in the last year, she's been trying to withdraw from the rest of her benzos, and it's been nightmarish.

 

she is having trouble getting off her benzos and recently decided that she had to stop her tapering the benzos and get off the rest of the vicodin first. she has a feeling that they are interacting in some way that is causing more anxiety/derealisation/what is called "psychosis" sometimes.-during the last year of benzo tapering, she has become supersensitive to everything-she was hoping that someone could share information on the way these medications interact. she is interested in any information that might help her to make the taper easier, she is in an extreme state of hyperarousal/terror/flashbacks all the time and knows that it's generally considered wiser

to come off meds when not so overstressed, but she believes the meds are directly causing her to be overstressed.

her plan right now is to keep the benzos where they are and come off the vicodin at around half a pill a week. she is

down to 7.5 mg of vicodin twice a day. she is also taking propranolol, and wants to know if anyone knows of any interactions with this that could cause problems with coming off the vicodin

 

we were wondering(and hoping) if anyone could explain and /or give links to articles that discuss the mechanisms of vicodin or opioids in general, on the brain, and how that relates to the way

that the benzos are affecting the brain and the way they interact. she knows she is experiencing withdrawal from the benzos all the time, she can feel it. she is hoping

that understanding the way they are interacting might help her figure out the safest way to come off both. she thinks

at this point the next step is to do the vicodin because she thinks the benzo will have to go much more slowly for her to be able to do it

and she doesn't think the vicodin can wait much longer. she has trouble thinking clearly, barely sleeps, her anxiety is pretty out of control,and she is having a lot of flashbacks

 

 

thank you for you help.

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Altostrata

Hello, concernedmom.

 

You might look up drug interactions here http://www.drugs.com/drug_interactions.html For example:

Interactions between your selected drugs

clonazepam ↔ hydrocodone

 

Applies to: Klonopin (clonazepam), Vicodin (acetaminophen/hydrocodone)

 

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

 

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

This sounds like what your friend might be suffering from, complicated by withdrawal syndrome.

 

Tapering off opioids isn't the focus of this site, but the same general rules apply to tapering all neurologically active medications:

  • A trial taper of 10% per month for 2 months (the 10% is taken off the last dosage; the amount of reduction gets progressively smaller).
  • If withdrawal symptoms appear, reduce to 5% or less of the last dosage, per month
  • If no withdrawal symptoms appear, tapering may be accelerated to a 10% reduction (of the last dosage) every 3 weeks, then every 2 weeks.
There is a lot of discussion on this site about a technique we call micro-tapering, in which tiny dosage reductions are made more frequently. Only people who already understand their withdrawal symptom pattern and nervous system tolerance for dosage changes should try this. Often, it isn't any faster in total than a 10% or 5% reduction, but for people whose nervous systems are exceptionally sensitive, it may be more tolerable than the relatively larger reductions.

 

As with any tapering schedule, if withdrawal symptoms appear, the patient is advised to slow tapering or hold on the current dosage until the nervous system stabilizes.

 

Here is more information about Vicodin http://www.drugs.com/ppa/hydrocodone-bitartrate-acetaminophen.html

 

One brand, Zamicet, comes in a liquid solution (hydrocodone 10 mg/acetaminophen 325 mg per 15 mL).

 

Liquid solutions are helpful because they enable very gradual, controlled tapering. Otherwise, it may be possible for Vicodin to be made into a liquid by a compounding pharmacy.

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concernedmom

altostrata: thank you so much for responding to our cry for help- i will pass along this information

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alexjuice

Hey concernedmom,

 

Sounds like a very complicated situation, pharmacologically. Like Alto said opiate withdrawal is not a major theme here.

 

I can't speak from experience on the painkillers, though i know a good bit of it. However, you mention a lot of psych med history. If I were you, I'd give the weight of the concern to the psych meds unless your friend is an opiate addict and/or has some liver damage from excessive apap.

 

She's been through a lot. Sometimes I have found that slowing down for some oxygen is the wisest move. If I were you I'd keep that in mind.

 

Best,

Alex

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concernedmom

Hey Alex,

thank you so much for your thoughtful and heartfelt reply

i am sure she will find this very validating since her doctors and therapist don't seem to understand the connection between these drugs and the horrible way she is feeling

concerned mom

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Rhiannon

Just want to add that I would suspect, from the symptoms you describe, that she is tapering her benzo too fast and experiencing benzo withdrawal. If she has a past history as you describe of abrupt discontinuation of other psych meds, she's at extra high risk for problems with any future tapers. "Extreme state of hyperarousal/terror/flashbacks" sounds very much like benzo withdrawal symptoms to me.

 

That feeling, when in benzo withdrawal, that you need to withdraw even faster, is in my experience actually a symptom of benzo withdrawal. Something about it produces this sense of urgency and anxiety and a need to "push push faster harder." Actually what needs to happen is the reverse of that--stopping the taper and holding dose for a long time. Perhaps a very long time, if the symptoms are really bad.

 

I don't know your friend's schedule of her benzo taper, I'm just speculating that she's probably going too fast based on her symptoms and the fact that it sounds like she doesn't have past experience with slow tapers. People almost always think they can go faster than they really safely can, particularly given a history like hers.

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concernedmom

thank you silver star

and congratulations on your tapers

i know how hard it can be

concerned mom

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Shanti

Hi Concernedmom. I'm on a lot of Vicodin and decided it's going to be the very last to go. I've never had trouble with interactions of the Vicodin with my Xanax and Paxil. I'm finished tapering the antidepressant and slowly working on the benzo. Since my CNS has been through the ringer for so long, I'm going extremely slow on the Xanax. I'm not even measuring them, I'm simply taking an emery board and filing off a couple of swipes from the pill every 10 days. I plan on spending a very long time doing this, but this method is making it totally event-free. I've had to come off of Vicodin several times in my past and the withdrawals last a couple of weeks. It's not near as bad and long as the antidepressants and benzos. But it's very unpleasant if you don't taper slow. I'm personally not worried about coming off the Vicodin, and I feel like the Vicodin has helped in ways to ease the withdrawal symptoms of the other meds, which is one reason I'm doing it last. (Not to mention the pain I'm waiting to resolve hopefully soon with some more cortisol shots). The pain is the only thing that scares me about coming off of Vicodin.

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Skyler

The pain is the only thing that scares me about coming off of Vicodin.

 

Shanti, you still find Vicodin helps your pain? I blew through that effect by month 3. After that it did nothing whatsoever to help with the fibro burning (neurasthenia) which was the worst of the fibro. Do you mind sharing how it still helps?

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Shanti

It doesn't help much but it does a little. I can't say why it still works for me. Of course, it's not near as effective as it used to be. Ibuprophen does nothing so I still take the Vicodin. It doesn't help with the Neuropathy in my arms and legs. It does take the edge off the pain in my back. In another month or so I'll get a cortisol shot in my thoracic spine. It's agonizing but the Vicodin helps. After the shot the doctor said he will switch me to patches instead of the Vicodin, and use Vicodin for breakthrough pain. But I'm hoping the shot will be enough and I'll quit the Vicodin. If the Vicodin did nothing for me, then I'd taper it now. I hate taking it. I've had a partial colonectomy already and these side effects scare me. I have to take laxatives often.

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concernedmom

Thanks Shanti,

I will pass along your insights. Hope you are able to get off the vicodin soon and will pain free.

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Barbarannamated

I was on opiates for 8 years for neck and head pain (musculoskeletal, not fibro). I only had to change preparations to straight oxycodone because I had elevated liver enzymes and couldn't take the acetaminophen in the hydrocodone preparations. Roxicodone comes without acetaminophen. I was *really* freaked about coming off of it. I slowly decreased my dosage on my own, then pain doc gave me Suboxone which I used about 2x/week as needed. The only trouble I had was anticipatory anxiety about opiate withdrawal. I had no physical effects. It was simple in comparison to Pristiq withdrawal. Ive heard this from many people.

 

Ive had to use hydrocodone since DCing it in 2008, once for a broken wrist (2010) and surgery. Ive used it recently for neck pain. I had no trouble discontinuing it after the wrist surgery and several weeks of use. It worked well for pain even though "addiction specialists" claim it *shouldn't*.

 

I hope my experience eases your mind somewhat. I believe the 'hype' about opiate withdrawal and abuse is just that. Ive read of too many similar stories for my experience to be considered unusual.

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concernedmom

sorry it has taken me so long to respond to your comments, i havent been online in awhile

your experience with the opiates provides much needed encouragement

i will pass this info along

thanks!

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