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PLS5: Which drug to wean off first?

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I have no withdrawal history, but I am on a daily cocktail of 5 prescription drugs: pravastatin; klonazepam; seroquil; tamulosin and generic Effexor. I have restless leg syndrome which is predominant in the evening and most severe just before I fall asleep as I read in bed. I also involuntarily and periodically scratch my wrists when sitting down in the latter half of the day. My history began in 2000 with Wellbutrin prescribed as an antidepressant after my father passed away unexpectedly. I was 45 and had no history of prior prescription drug use other than Allegra, which was not yet OTC. I do continue to take Allegra for a range of allergies and it remains effective.
I began to self-medicate klonazepam to help with insomnia, taking from my wife’s prescription around 2000. My psychiatrist shortly thereafter (2002) gave me my own script for 1 milligram. The tamulosin (Flomax) was added in 2006. Seroquil was added in 2009 as a sleep medication with the intent of getting off the klonazepam (but I never weaned myself off the Klonazepam). Effexor replaced Wellbutrin in 2010. I am 66 yrs old and looking/hoping to reduce the symptoms I’ve described, with a protocol for reducing my drug intake safely. I'm looking to taper off my current medications and wonder which I should approach first?

Edited by manymoretodays
name to topic title, tag

Venlafaxine Hcl ER 150 MG Cap

1 daily (started taking 2002)

Tamsulosin HCL 0.4 MG Capsule 

1 daily (started taking 2005)

Pravastatin Sodium 80 MG tab

1/2 tablet daily (started 2005)

Clonazepam 1 MG tablet

1 at bedtime (started 2000)

Quetiapine ER 150 MG Tablet

1 at bedtime (started 2004)

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  • manymoretodays changed the title to PLS5: Which drug to wean off first?
  • Moderator
Posted (edited)

Hi @PLS5, welcome to SA. 


We have two principles when we have to choose which drug to taper first. 

1) more harmful drug first 

2) more activating drug first (as withdrawal ends causing insomnia to many (but not all) people) 


In your case quetiapine and clonazepam are sedating and venlafaxine is activating. At the same time quetiapine is the more harmful drug as it is anticholinergic and increases risks of alzheimers and other issues. Also, as we get older the sedating drugs end up being more sedating and causing dizziness and falls. If I were you I would start tapering the quetiapine first and then the venlafaxine. Alternatively, you can alternate - you can taper one drug for a while and then the other but only one at a time. Some people have tapered multiple drugs at once at much lower rates than 10% every four weeks but it is risky as you will not know which drug to reinstate or updose if things got bad. 


This post contains a bunch of links that will be useful to read before you start tapering including how to taper specific drugs. Have a careful look at the relevant topics. 


Edited by Onmyway

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 


I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 


If you would like to get a response from me directly please type @Onmyway some place in your message so I get notified of your post. I am not able to follow all of the threads all the time.


Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48


Supplements: magnesium citrate and bi-glycinate

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  • Mentor

Welcome to SA. Sorry you need to be here, but glad you are here. The good news is that you came here before beginning to taper. Many of us were not so lucky. This is huge. You’re in good hands.


The first thing that caught my eye was in regards to your restless legs at night. I’m wondering if you take that large dose of clonazepam at the same time as the quetiapine? If so, they could possibly be causing a paradoxical reaction with one another since they are both sedating to your system. It’s like our bodies have a keen sense of when things get too sedating, that it automatically tries revving things up again. Just a thought.


I did a quick search of the Symptoms forum and got quite a few results regarding restless legs that you may find of interest.


https://www.survivingantidepressants.org/search/?q=Restless legs&quick=1&type=forums_topic&nodes=8


1988-1996  Various AD’s, all classifications.  1996-2019  Effexor XR 37.5mg to 150mg. Jan 2017 onward, 37.5 mg.

2019  Apr 11 - July 24: Trials of Latuda then Rexulti. CT'd off per dr.  Jul 24: CT Effexor (per dr)  Sep 9-19: Viibryd, CT (per dr).  Sep 23-27: Trintellix. CT (per dr).  Sep 28 - Oct 24:  Prozac 10mg.  Oct 24:  Stop Prozac, began Pristiq 25mg->50->25mg.

2020  Feb 1: CT Pristiq. Feb 1: Reinstated Effexor XR (10 large beads) gradually increasing to 22 beads (15L+7M) or 9.072mgai on Mar, 2020.

2021  Started Jan w 21 beads (13L+8M) or 8.47mgai ended Dec: 17 beads (7L+9M+1S) or 6.19mgai. Severe COVID + TIA.

2022  Ended yr w 14 beads (3L+5M+5S+1XS) or 4.5mgai. Major jaw injury during year.


Current: January, 2023: Effexor XR - 14 beads (3L+5M+5S+1XS) or 4.5mgai

Other current meds: Ambien 10mg 3.935mg , clonazepam .125mg .107mg, omeprazoleSynthroid, Premarin.  Supplements: D3, C, probiotic, K2-MK7, Mg Glycinate

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