PLS5: Which drug to wean off first?

[PLS5]

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 April 21, 2023 by manymoretodays
name to topic title, tag

[Onmyway]

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 April 21, 2023 by Onmyway

[FindRest]

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

 

[PLS5]

I started to taper off Quetiapine ER 150 ml in July with a 10% cut of the previous dose (weighed) on Aug. 1st and another 10% on Sept. 1st. I had no apparent withdrawal symptoms at this rate. When I made the next cut of 5% on Oct. 1st, I had a reaction about two days later that included brain zaps, shivers and deep fatigue. I stayed in bed for a day, went back to where I’d been before the cut and have felt better (but still not all that great) since. Possibly unconnected, but I started taking Omega-3 gel caps about 6 weeks ago. How should I precede?

Edited October 7, 2023 by PLS5
Corrected med name

[Altostrata]

Hello, @PLS5 What times o'clock do you take your drugs, with their dosages? 

 

It's unlikely your withdrawal reaction was related to the omega-3 capsules. You're taking 121.5mg quetiapine now?

 

It seems your system wanted a little more time to get used to the last 10% reduction.

 

Please update your signature with recent drug changes.