41Woodie: disastrous amitriptyline taper, next time I'll read the directions first

[41woodie]

Greetings all, being a guy and biologically averse to reading instruction manuals and following directions I began a taper last fall and it has been  five months of misery.  I was taking Ami 10mg for nerve pain for 14 years and my plan was to drop 25% every 30 days or sooner depending on how the reduction was tolerated..  November 1st I dropped to 7.5 mg, November 25th 5.0 mg, January 2.5mg and discontinued completely on March 1st. The drop to zero on March 1st was delayed because I was feeling lousy and my wife had knee replacement surgery and I didn't want to add to the difficulties.

 

As each reduction became more difficult it finally dawned on me that my math was deeply flawed.  While the first 2.5mg reduction was from 10mg to 7.5  and was in fact 25% I believe the subsequent reductions were actually 33%, 50% and 100%. ( In addition to not reading directions well mathematics was never a strong suit).  Quite likely the original drop from 10 to 7.5 was too aggressive and each subsequent drop compounded the problem.

 

The first drop was fairly well tolerated but from the second reduction forward things have gotten progressively worse but I stupidly thought that this was expected and continued.  It became more and more obvious that things weren't improving so in desperation I began reading tapering info on this site and the light bulb over my head flickered dimly.  My "plan" was too aggressive in the beginning and compounded by bad math became increasingly difficult.

 

On March 28th I reinstated from 0mg to 2.5 and finally had a decent nights sleep and on the 29th woke pretty much pain and anxiety free.  I woke this morning with some return of pain and mild anxiety and that's where we stand now.  From the information I'm still reading on the site I believe I should try to stabilize the symptoms and possibly adjust the dosage to allow things to settle down before making another attempt at tapering.

 

Any thoughts, advice, comments etc would be greatly appreciated.

 

[Frogie]

@41woodie

 

Welcome to SA. We are a volunteer ran site, helping members taper off antidepressants and benzodiazepines or have tapered off and are healing.

 

This is your introduction page where you will receive information, ask questions and meet other members on the site. We ask that each member only have on introduction page so we can keep all your information in one place.

 

Thank you for creating your signature.

 

I'm glad you were able to read about tapering off Amitriptyline and you have reinstated. You may have some symptoms until your body fully stabilizes.

 

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

What is withdrawal syndrome?

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

The Windows and Waves Pattern of Stabilization

 

You are doing the right thing, by holding on a dose for stability. It will take quite a while and then you would do a very slow taper.

 

Tips for tapering off amitriptyline

 

Why taper by 10% of my dosage?

 

The slowness of slow tapers

 

We don't suggest supplements on here except 2 that are calming to other members nervous system.

 

Magnesium

Omega-3 Fish Oil

 

After you have read the links provided, please reach out to us with any questions you may have.

 

 

 

 

[41woodie]

Frogie, thank you so much for your input.  As I said in my original post I reinstated to 2.5 mg after being completely off Amitriptyline for 28 days.  The first few days after reinstating showed some relief but the symptoms have returned since then.  Since March 28th I've maintained the 2.5 dosage hoping for some benefits but so far things haven't improved.  Some pain areas have improved but been replaced with new areas of pain.  Anxiety was diminished for several days but is now returning. I have added a conservative dose of Omega-3 to my regimen hoping for some tiny relief and it does seem to have very slightly improved the pain symptoms.

 I'm at a loss as to how to proceed.  Do I stop completely again and simply ride it out or increase the reinstatement dosage slightly back toward the 10 mg I was on, or try to stick with the 2.5mg longer hoping for stabilization.  I realize that my system must be in turmoil after I completely botched the attempt at tapering but it's beginning to look like there is no relief to be had.  I understand that you don't offer medical advice etc but perhaps your experience would indicate some possibilities to explore.  

Edited April 13, 2022 by 41woodie
clarification

[Frogie]

@41woodie

 

You could try a little updose to 3 mg and see how you do. It takes 7-10 days for it to reach fully in your body. 

 

Sometimes it takes a while to find a small amount that works best for you.

 

 

[41woodie]

Frogie, thanks for the input, I have been on the reinstated 2.5 mg for 16 days and was hoping for a miracle.  I'll up the dose slightly to 3 mg for awhile and see if some relief is forthcoming.  I'll be back in touch after 2-3 weeks at the new dosage. 

PS it wouldn't have killed the drug companies to make 10mg Amitriptyline tablets a tiny bit larger to accommodate splitting them

[41woodie]

@frogie

I'm still struggling with my reinstatement and holding at 3mg hoping for some relief.  Is there any advantage or disadvantage to splitting the dose into 1/2 every 12 hours rather than the whole dose every 24 hours.  Thanks

[ChessieCat]

I'm assuming that you are talking about Amitriptyline. 

 

Q:  Have you noticed any improvement, however small, since you updosed?

 

Q:  How accurate are you managing to get your doses?

 

You might find it better to make your own liquid:

 

On 8/16/2011 at 12:20 PM, Altostrata said:

 

It turns out that Amitriptyline is very soluble (25mgai/1mL) in ethanol, or as most people know it vodka. Once the Amitriptyline is dissolved in the vodka it can then be added to water to make up a workable volume. However, according to the manufacturer, this new liquid will only be usable for the day it is made.

 

To create 10mL of the new liquid: measure out 1mL of vodka into a container and add one entire crushed tablet up to 25mgai in strength. For larger tablets double the amounts for each 25mgai that is used. So a 50mgai tablet uses 2mL and a 100mgai tablet uses 4mL. In the next step increase the water in the same manner. Mix this up and let it stand for an hour, shaking occasionally. Do not worry about any sediment, that is just filler and does not count. Then add 9mL (18mL, 36mL) of water to the vodka to make the final liquid solution. This will yield 10mL (20mL, 40mL) of solution that will have the strength of the original tablet so you can calculate the volume of your dose from there

 

 

 

When changing to liquid it is usually better to do a cross over, however this may be difficult for you.  Please read:

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

Generally there is no problem splitting the dose and taking it more than once a day.  HOWEVER, you need to take into consideration that if the drug you are taking is activating (as opposed to sedating) then if you take 1/2 of the dose at night time it may affect your sleep.

 

If you do decide to try splitting your dose you would move part of the dose forward by 1 hour each day (I'm assuming you are currently taking it in the morning).  You would need to be alert to how it is affecting your sleep.  If you notice that it is, then you could either stop at that time or move back one hour. 

 

dose-splitting-for-interdose-withdrawal-from-short-half-life-drugs

 

doses-twice-a-day

 

[41woodie]

@ChessieCat 

Sorry, yes I was asking in regard to Amitriptyline.  I haven't noticed any appreciable difference in physical symptoms but the depression/anxiety has diminished.  Last week I found a compounding pharmacy nearby and had my MD rewrite the prescription for a compounded liquid.  They are making it as an oil suspension which requires shaking it thoroughly to maintain some semblance of consistency.  

 

I was originally on 10 mg Ami and trying to 1/4 those tablets is difficult and accuracy, particularly in the 1 mg range is nearly impossible.  I'm currently taking 1.5mg at 8 AM and 9PM hoping to maintain a smoother blood level.  

 

Your advice and experience is much appreciated

[41woodie]

1 hour ago, 41woodie said:

@ChessieCat 

Forgot to mention your suggestion to cross-taper.  Seems like the smart thing to do although I took my first liquid dose this morning so hopefully "no harm/no foul".  As small as my dose is it'll be difficult trying to divide the tiny 10mg tablets but I'll give it my best shot.  In the past I would have thought that the tiny amounts of medication we're dealing with wouldn't require such accuracy but it's obvious that even minuscule variations produce misery.  It's hard to believe that a dose of medication that wouldn't cover the top of a finishing nail can be so potent.

 

[41woodie]

@Frogie@ChessieCat

Needing guidance on reinstatement please.  My zero dose of Amitriptyline was on 3/1/22, overwhelmed with symptoms I reinstated to 2.5 on 3/28. On 4/19 I began using a liquid suspension form to allow easier and more accurate measurement.

My WD symptoms abated slightly for 3-4 days but have returned with a vengeance in the last week, the anxiety/depression symptoms had almost disappeared when I reinstated they are now back along with all of the ever-changing physical symptoms.

 

My question is do I continue as is hoping for improvement or should I very slowly increase the dosage hoping to find some relief.  Obviously my system is in complete disarray after I made so many mistakes in my rush to get off Amitriptyline.  I’m beginning to worry that this isn’t correctable.  As it stands I don’t know whether to attempt another correct taper, stand pat or increase the dosage hoping to stabilize.

[Frogie]

@41woodie

 

Did you go straight from tablet to liquid? Because that could be a lot of the problem. Your body absorbs liquid much faster than the tablet form.

 

If you did, you will just need to hold until the symptoms get better.

 

You could try a little magnesium and see if that helps.

 

Magnesium

[41woodie]

46 minutes ago, Frogie said:

@41woodie

 

Did you go straight from tablet to liquid? Because that could be a lot of the problem. Your body absorbs liquid much faster than the tablet form.

 

If you did, you will just need to hold until the symptoms get better.

 

You could try a little magnesium and see if that helps.

 

Magnesium

@Frogie

Thanks for the very prompt response, by the time I obtained the liquid suspension I only had a couple of 10mg tablets left.  I was only able to mix the forms for 4-5 days as 1/2 liquid plus a tiny chip of tablet.  Is any particular form of magnesium that would be better?

[Frogie]

@41woodie

 

That could be the problem then and unfortunately you'll just have to wait for the symptoms to subside.

 

I take Magnesium Citrate, 100 mg 3 times a day. That's the only one that I found that didn't upset my stomach. I buy it at Walmart fairly cheap.  But I hear good things about the glycinate also. 

 

You may just have to try one in a small amount and see how you do.

[41woodie]

@FrogieSo your'e taking 300 mgm of Magnesium a day?  I have some of this on hand https://www.amazon.com/dp/B000BD0RT0?psc=1&ref=ppx_yo2ov_dt_b_product_details

[Frogie]

11 hours ago, 41woodie said:

@FrogieSo your'e taking 300 mgm of Magnesium a day?  I have some of this on hand https://www.amazon.com/dp/B000BD0RT0?psc=1&ref=ppx_yo2ov_dt_b_product_details

That would be fine to try and see how you do. You might start with 100 mg and work your way up to the 300 mg a day over a week or so.

[41woodie]

@Frogie

Sounds like a good approach, I'll split the 100mg during the day and hope for good results.  Thank you again for the prompt responses and guidance.

[Frogie]

@41woodie

 

You are welcome. Just be aware that magnesium can make you sleepy also. I take it before bed and it calms me down from the day.

[41woodie]

@Frogie

I wasn't aware of that but will try it, a good night's sleep is great medicine

[41woodie]

@Frogie

After a poor conversion from tablet to liquid, I've now been on 3 mg of oil suspension Amitriptyline nearly 5 weeks.  There has been no improvement in the physical symptoms and in fact things have deteriorated slightly. In your opinion should I soldier on at the present dosage hoping for an eventual improvement or is it time to consider a small updose?  OBTW I took your recommendation for 100mg Magnesium but can't tell that it has been beneficial so far.  Thanks for your help.

[Frogie]

@41woodie

 

You might try a little updose and see if that might help. I wouldn't go up more than 0.50 mg and hold for 7-10 days for it reach full stability in your system.

 

You could go up a little with the magnesium and see if it makes a difference. Sometimes taking a little more in the evening that the rest of the day will help.

 

Let me know what you think.

[41woodie]

@Frogie

I hate the idea of losing ground on my previous disastrous taper but I agree that 5 weeks is a fair test for the effectiveness of my reinstatement.  I'll increase by .5 mgm daily as well as increase my Magnesium dosage from 100 to 125 with the majority at supper and bedtime.

Again I'm grateful for your prompt advice. 

 

[ChessieCat]

40 minutes ago, 41woodie said:

I'll increase by .5 mgm daily as well as increase my Magnesium dosage from 100 to 125

 

SA recommends only making one change at a time otherwise if things change (for better or worse) you will not know what is causing it.

[41woodie]

@Frogie@ChessieCat

Perhaps I misunderstood the advice, I'll hold off on the Magnesium updose for a bit to see if there are any improvements from the increase in Amitriptyline.  Last night I increased the Ami dosage by the suggested amount and had a great nights sleep and woke in better condition this morning.  Probably not the result of the increase but I'll gratefully take a good nights sleep anytime I can.  Thanks to you both for the guidance.

[41woodie]

@Frogie In need of further advice please.  As discussed I raised my reinstatement dosage by .5 mg on May 28th.  There was little to no change in the day to day symptoms.  On June 12th I increased my dosage by .25 mg still hoping for some stability in symptoms but no change.  

My question is do I continue to very gradually (.25mg) increase my dosage hoping to eventually reach a point of stability or what.  My original dosage was 10 mg and very occasionally 20 (maybe 4-5 times in a year) so I still have quite a ways to go before I reach that level.  

My mental symptoms subsided for the most part when I originally reinstated but the physical symptoms still rage.  As soon as one area of pain begins to subside another pops up with a vengeance.  Itching, burning, stabbing, throbbing, along with nausea, instability and fatigue that varies in location and intensity from day to day

I've never been sure what kindling entails but I seem to fit the description.  Where does it go from here? Is the only cure "tincture of time", or do I continue to slowly updose hoping to find relief at some point. Thanks in advance

[Frogie]

@41woodie

 

you could try to increase it .25 mg. Just remember it takes 7-10 days to reach fully in your system so you don’t want to go too fast😊

[41woodie]

@Frogie Is there a limit to those increases or do I continue to updose every 7-10 days until I improve?

[Frogie]

@41woodie

 

You could try a .25 mg increase and give it a little time before increasing again. It just takes 7-10 days to reach full dose in your body. I wouldn’t increase every 7-10 days. Let’s wait a good couple of weeks and see how you are doing after this increase.

[41woodie]

@Frogie, thanks will do

 

[41woodie]

Haven't posted in quite some time as I continue to try and return to normal.  After reinstating and getting no relief I slowly updosed to 8mg in hopes of improvement.  Symptoms seemed to reach a plateau and I began a very, very slow taper back to my present dose of 2.8 mg of amitriptyline taken in a split dose am/pm. 

For some time I've been experiencing what for want of a better description feels like my skin is over sensitive to contact.  If I scratch an itch the skin feels like it's burning at the point I scratched.  It seems to effect my scalp, arms, abdomen, legs etc pretty much everywhere.  My skin tingles, burns, itchs, and often feels as if it's stretched too tight.  Has anyone else experienced this delightful symptom?  If so is there any relief or just tincture of time.  As it stands now I've pretty much resigned myself to the fact that this will always be with me.