Tips for tapering off Zyprexa (olanzapine)

[hayduke]

@Emily02I've been concerned about TD too, especially when my original prescriber said "it's not such a big deal".  Like a Hammer horror film or something, yuck.

 

I don't really have tremors, but feel more urges to stretch my fingers and hands while I taper.  A trend to more twitchy.

 

I think this, and akathisia, are probably largely induced by dopamine receptors opening up as the blockade reduces.  My hunch is it's not just about particular dopamine levels, especially once you hold and your neurology catches up, but about rate of change of dopamine levels.  I would love to taper faster but when things like this start looking like flaring up, I'd rather read the signs.

 

I found an old paper that reckoned Niacin and manganese worked in one trial.  I have both but don't take them that often. 

 

I had a blood test to check my manganese levels before getting the supplements to ensure it was safe.  It's good to do this before looking at any supplements, seeing where your body's already at with each of them.

 

I had a course of B12 booster shots which helped all round.  I had got a bit low on those.  I started taking 1500IU of Vitamin E, which I reduced to 1000IU after reading you don't want to overdo it.  I also found methyl folate helps, again you don't want to overdo it.

 

Probably the Vitamin E has been the most calming in the sense of most days seeing no tendency to tremor at all.  But still wise for me to hold when it seems helpful and let dopamine levels even out and my neurology readjust to increased amounts of it.

 

[Hopela]

Some studies says Pyridoxine aka vitamin B6 reduces symptoms of TD. Here's a summary: https://cdn.mdedge.com/files/s3fs-public/Document/September-2018/cp01710042.pdf

 

There's some support for it as cure but more for it as at least symptom relief while taking it at 300 - 1200 mg/day. Adverse effects reported are low. However the tolerable upper limit for long term use is set by EFSA to 25 mg/day. The recommended daily intake is around 1.5 mg so those are large doses in the studies. 

 

 

[Emily02]

Hi @hayduke

TD ‘it’s not such a big deal’ OMG!

What I realised is that psychiatrists usually don’t have any empathy.

Thanks for your reply and the suggestions, I really appreciate them.

Thanks @Hopela for the excellent advice. I’ll starts supplementing with B6.

I hope you’re well.

Take care

[hayduke]

1 hour ago, Emily02 said:

Hi @hayduke

TD ‘it’s not such a big deal’ OMG!

What I realised is that psychiatrists usually don’t have any empathy.

Thanks for your reply and the suggestions, I really appreciate them.

Thanks @Hopela for the excellent advice. I’ll starts supplementing with B6.

I hope you’re well.

Take care

 

Yeah I think he's a sadist.

 

I feel I should reiterate the SA policy of not recommending any supplements besides magnesium and omega-3.  I did my own homework and experiments with those I listed.

 

One potential snag with the Vitamin B6 @Hopela mentioned is that many members have reported it as tending to induce akathisia.  I found akathisia reduced a lot for me when I put aside the mega-B multivitamins for specific B vitamins.

 

Interestingly I generally find berocca helpful, but I was raised a drinker.

[hayduke]

I was thinking it would be helpful to get a round-up of what people's final olanzapine dosage was when they 'jumped off'.

 

I know a lot of people were up around 0.625mg (1/4 of 2.5mg tab) which I would've found a bumpy ride.  I'm at 0.30mg now and starting to think about it. 

 

Would be good to hear from everyone who has tapered (rather than gone cold turkey) off this drug about how much/little they were taking just before they stopped.

 

Cheers

[Spideygsm]

I tapered for approximately 3 months. My last dose was 0.625mg which is nearly impossible to cut with any accuracy. Not fun but about 16 weeks after my last dose I started to feel much better. It wasn’t slowly feel better it was one night I slept and knew I kicked Olanzapine. 

[Nicjk]

3 hours ago, Spideygsm said:

I tapered for approximately 3 months. My last dose was 0.625mg which is nearly impossible to cut with any accuracy. Not fun but about 16 weeks after my last dose I started to feel much better. It wasn’t slowly feel better it was one night I slept and knew I kicked Olanzapine. 

Did you have nights where you didn’t sleep at all after tapering? Amazing that your change happened overnight

[Nicjk]

On 2/8/2013 at 2:00 PM, Altostrata said:

Since olanzapine comes in many dosages, at least initially, tapering can take place using tablets and splitting them.

I’m on 5mg of Olanzapine and I’m planning to use a compounding pharmacy to make capsules until I reach 2.5mg and then I will shave/trim my pill and weigh it until I reach dust. Does anyone know if the coated Zyprexa brand tablet can be cut? I was told by a mental health nurse and pharmacist that the Zyprexa brand can not be cut because the medication isn’t evenly distributed throughout the pill. 

[hayduke]

30 minutes ago, Nicjk said:

I’m on 5mg of Olanzapine and I’m planning to use a compounding pharmacy to make capsules until I reach 2.5mg and then I will shave/trim my pill and weigh it until I reach dust. Does anyone know if the coated Zyprexa brand tablet can be cut? I was told by a mental health nurse and pharmacist that the Zyprexa brand can not be cut because the medication isn’t evenly distributed throughout the pill. 

 

From here:

 

'One of the biggest fears regarding tapering we encounter here at SA is that the active ingredients in a medication are not evenly distributed throughout the fillers. This leads to people thinking that if they are taking a small portion of a tablet or of the powder in a capsule that they will not be getting the “full dose” that they are expecting. This assumption is totally wrong.'

[hayduke]

4 hours ago, Spideygsm said:

I tapered for approximately 3 months. My last dose was 0.625mg which is nearly impossible to cut with any accuracy. Not fun but about 16 weeks after my last dose I started to feel much better. It wasn’t slowly feel better it was one night I slept and knew I kicked Olanzapine. 

 

Thanks, @Spideygsm.  So you felt on the hook for about 4 months after that.  Good to hear you were feeling ok before too long.  Interested to hear more people's experiences with their last dosages.

[Nicjk]

2 hours ago, hayduke said:

 

From here:

 

'One of the biggest fears regarding tapering we encounter here at SA is that the active ingredients in a medication are not evenly distributed throughout the fillers. This leads to people thinking that if they are taking a small portion of a tablet or of the powder in a capsule that they will not be getting the “full dose” that they are expecting. This assumption is totally wrong.'

Thank you @hayduke. That is a good read. I'm wondering though, because Zyprexa tablets are coated with a hard "shell" - how can you work out that you're actually removing say 2% of the active ingredient when you shave the tablet? 

[Nicjk]

2 hours ago, hayduke said:

 

From here:

 

'One of the biggest fears regarding tapering we encounter here at SA is that the active ingredients in a medication are not evenly distributed throughout the fillers. This leads to people thinking that if they are taking a small portion of a tablet or of the powder in a capsule that they will not be getting the “full dose” that they are expecting. This assumption is totally wrong.'

Thank you @hayduke. That is a good read. I'm wondering though, because Zyprexa tablets are coated with a hard "shell" - how can you work out that you're actually removing say 2% of the active ingredient when you shave the tablet? 

[Nicjk]

I have another question for everyone. I have read on this forum somewhere that when you switch from taking regular Olanzapine/Zyprexa tablets to taking liquid made by dissolving orodispersible in water, you are actually taking an extra "cut".  Why is this? Last year I switched from taking a 5mg Zyprexa tablet to dissolving an Orodispersible tablet in water and I dropped .250mg. Did I technically drop more than .250mg by switching to orodispersible in water? Perhaps you will know the answer to this @Altostrata. Thanks so much 

[Spideygsm]

18 hours ago, Spideygsm said:

I tapered for approximately 3 months. My last dose was 0.625mg which is nearly impossible to cut with any accuracy. Not fun but about 16 weeks after my last dose I started to feel much better. It wasn’t slowly feel better it was one night I slept and knew I kicked Olanzapine. 

My sleep sucked before, while taking, while withdrawing, and even after kicking Olanzapine. It was really bad getting off Olanzapine. I went days with zero sleep, then 1-3 hours sleep, then zero sleep. I didn’t take Olanzapine to sleep. I took it for a mental health condition. 
 

I tried CBD while tapering. It was at about 12 weeks off Olanzapine. I think CBD and the fact I was off Olanzapine for a few months helped me feel a little better. I’ve had insomnia since a young child. I wouldn’t recommend any drugs to help sleep. For me it’s not restful or deep sleep. I got a cpap machine and it helps me. 

[Altostrata]

14 hours ago, Nicjk said:

I have another question for everyone. I have read on this forum somewhere that when you switch from taking regular Olanzapine/Zyprexa tablets to taking liquid made by dissolving orodispersible in water, you are actually taking an extra "cut".  Why is this? Last year I switched from taking a 5mg Zyprexa tablet to dissolving an Orodispersible tablet in water and I dropped .250mg. Did I technically drop more than .250mg by switching to orodispersible in water? Perhaps you will know the answer to this @Altostrata. Thanks so much 

 

I have no idea what you're talking about. You must have read this somewhere else. Have you read this topic from the beginning?

 

Switching forms of drugs may require some dosage adjustment, but nowhere do we say you're taking a reduced dosage. You may feel the liquid form is stronger or weaker. 

[hayduke]

17 hours ago, Spideygsm said:

My sleep sucked before, while taking, while withdrawing, and even after kicking Olanzapine. It was really bad getting off Olanzapine. I went days with zero sleep, then 1-3 hours sleep, then zero sleep. I didn’t take Olanzapine to sleep. I took it for a mental health condition. 
 

I tried CBD while tapering. It was at about 12 weeks off Olanzapine. I think CBD and the fact I was off Olanzapine for a few months helped me feel a little better. I’ve had insomnia since a young child. I wouldn’t recommend any drugs to help sleep. For me it’s not restful or deep sleep. I got a cpap machine and it helps me. 

 

As I recall, you did a much faster taper than 10%/mo on medical advice?

 

I've been tempted by CBD earlier in the taper, but it's so costly over here.  I don't also mind my body having one less thing in the mix as I go, but I can see how it would've helped you.

[Spideygsm]

4 hours ago, hayduke said:

 

As I recall, you did a much faster taper than 10%/mo on medical advice?

 

I've been tempted by CBD earlier in the taper, but it's so costly over here.  I don't also mind my body having one less thing in the mix as I go, but I can see how it would've helped you.

Tapered from November  2017-March 2018 from 30mg. This was under a doctors supervision and for severe side effects. I wouldn’t recommend anybody ever go Cold Turkey. I actually went slower than my Doctor recommend. Do what’s comfortable for you. For me it sucked the entire time and 4 months after. I wouldn’t recommend CBD only because I tried it near the end of my withdrawals and I think it was more of a placebo effect. 

[hayduke]

On 5/25/2021 at 3:54 AM, Spideygsm said:

Tapered from November  2017-March 2018 from 30mg. This was under a doctors supervision and for severe side effects. I wouldn’t recommend anybody ever go Cold Turkey. I actually went slower than my Doctor recommend. Do what’s comfortable for you. For me it sucked the entire time and 4 months after. I wouldn’t recommend CBD only because I tried it near the end of my withdrawals and I think it was more of a placebo effect. 

 

That's a crash taper for sure.  I would've been wrung out by that too, I'm actually having trouble thinking of a setting where I could've stood that. 

 

But you've come through which is really good.

 

I don't think I'm aware of anyone who's successfully CT'd olanzapine and got off the hook that way.

[Spideygsm]

I developed dangerous side effects including high liver panels, pre diabetic, and Tardive Dyskinesia. Knowing that made it important and a reason to stop. 

[hayduke]

On 5/29/2021 at 9:09 AM, Spideygsm said:

I developed dangerous side effects including high liver panels, pre diabetic, and Tardive Dyskinesia. Knowing that made it important and a reason to stop. 

 

Had those, reset pre diabetes twice by fasting.  What was the deal with your TD?  I've been getting twitchier hands and hope they will settle down as my dopamine levels even out.

 

Did the crash taper make your TD symptoms worse, and did they improve over time after that?

[Spideygsm]

My head twitched uncontrollably. The taper did not make things worse. The symptoms did reduce quite a bit after about a year but I still get occasion twitching but not to the extent that it interferes or bothers me. 

[hayduke]

Sorry you've had to suffer that @Spideygsm.  I'm glad to hear it's much improved.

[Desiderata]

Hi Hayduke, I am wanting to taper off 2.5 mg olanzapine. I have recently gotten a prescription of 2.25 mg custom capsules from a local compounding pharmacy. I haven’t seen where anyone else has used this method and I’m wondering why. It seems like a practical way to taper but my anxiety is causing me to think I’m missing something. I would very much appreciate any input and / or assurances that this is a safe and effective plan. Thank you very much! 

[Altostrata]

@Desiderata, please see the first post in this topic.

 

Having olanzapine compounded into custom capsules is a reasonable way to taper. People probably don't use it as often because of the expense.

 

 

[Desiderata]

Thank you Altostrata! Much appreciated! I was also able to make and print Brass Monkey sliding scale taper and think I will go that route. As you can probably tell, I am very nervous about all of this! Thanks for being there!

[hdmiTable]

Hi all,

 

Can someone please help me understand this?

 

Quote

Olanzapine is sparingly soluble in aqueous buffers. For maximum solubility in aqueous buffers, olanzapine should first
be dissolved in DMSO and then diluted with the aqueous buffer of choice. Olanzapine has a solubility of approximately
0.5 mg/ml in a 1:1 solution of DMSO:PBS (pH 7.2) using this method. We do not recommend storing the aqueous
solution for more than one day.

 

Does this mean that if I want to dissolve a 7.5mg tablet, I would need 7.5ml DMSO and 7.5ml PBS? Would I need to first dissolve the tablet in 7.5ml DMSO and then add the PBS?

 

Thanks in advance

 

 

[brassmonkey]

"Olanzapine has a solubility of approximately
0.5 mg/ml in a 1:1 solution of DMSO:PBS (pH 7.2) using this method."

 

A 1:1 solution of DMSO:PBS means that the liquid is 1/2 DMSO and 1/2 PBS

 

This statement says you can dissolve 0.5mg of Olanzapine in 1mL of a liquid that is 1/2 DMSO and 1/2 PBS. 

 

The tablets you are using contains 7.5mg of Olanzapine so you would need 3.5mL of DSMO mixed with 3.5mL of PBS to dissolve all of the Olanzapine. This will give you a solution containing 1mg of Olanzapine for every 1mL of liquid.

 

Mix the DSMO and the PBS then add one crushed tablet. Shake it up and let it sit in a cool dark place for several hours. Shake it up occasionally while it sits. According to the statement above the new liquid is only good for one day, so it needs to be used right away.

[hdmiTable]

Many thanks @brassmonkey for making it clear.

 

I couldn't get my hands on PBS so will try with physiological saline solution instead, if it doesn't work will use pure DMSO

 

Thanks again will try this tomorrow.

 

 

[brassmonkey]

You could also use homemade 9% saline. All the buffering agents do it stabilize the pH (acidity) of the saline. This could be important for an injectable solution, but for one you drink it shouldn't make much difference.

[hdmiTable]

Thank you @brassmonkey

 

Earlier you said that mixing 3.5ml of the saline solution and 3.5ml DMSO would dissolve a 7.5mg tablet yielding a solution of 1mg / 1ml Olanzapine. Did you mean 3.75?

[brassmonkey]

Good catch. The number gods have been unhappy with me lately. Yes, 3.75.

[Mahadeva]

Hi, im tappering of 5mg of olanzapine with micro taper water solution method.

 

My question is, the white particles that suspends trough the liquid like tiny "dust", that is something else used for capsules or have the olanzapine active principle on it?

 

I'm taking 2ml's of 20ml's water solution, sometimes that white particles come in a little more amount in the syringer and others a little less, and i try to match them some times.

 

If the drug active principle is evenly distributed in on the liquid i would just need to take the same amount in ml's everytime not worring about the white particles amount, but if not, i cant mess with the particles amount.

 

Someone can clarify that?

[hayduke]

1 minute ago, Mahadeva said:

Hi, im tappering of 5mg of olanzapine with micro taper water solution method.

 

My question is, the white particles that suspends trough the liquid like tiny "dust", that is something else used for capsules or have the olanzapine active principle on it?

 

I'm taking 2ml's of 20ml's water solution, sometimes that white particles come in a little more amount in the syringer and others a little less, and i try to match them some times.

 

If the drug active principle is evenly distributed in on the liquid i would just need to take the same amount in ml's everytime not worring about the white particles amount, but if not, i cant mess with the particles amount.

 

Someone can clarify that?

 

Hi Mahadeva,

 

Typically the flakes are filler, and you needn't worry as long as the mixture is well shaken/stirred.  I also find it helps to let the tablet disintegrate fully, for up to half an hour with some generics I've had.

 

I'm in the habit of agitating with syringe or pipette (i.e draw in some suspension and push out a few times to mix it better) just before drawing out your dose. 

 

You should find you can get a very consistent dosage this way.

 

Cheers

[Mahadeva]

13 minutes ago, hayduke said:

 

Hi Mahadeva,

 

Typically the flakes are filler, and you needn't worry as long as the mixture is well shaken/stirred.  I also find it helps to let the tablet disintegrate fully, for up to half an hour with some generics I've had.

 

I'm in the habit of agitating with syringe or pipette (i.e draw in some suspension and push out a few times to mix it better) just before drawing out your dose. 

 

You should find you can get a very consistent dosage this way.

 

Cheers

alright good, im doing like that, i let half hour, than i mix before drawing with the syringer and move the syringer slowly trought the solution to draw 2 ml

 

thank you!

[Nicjk]

On 12/24/2013 at 5:33 AM, Tuskentank said:

Hi folks, I'm thinking a daily microtaper might be easier on the CNS? Given olanzipine's 17 receptor hits I was thinking this might make for an easier taper. Is there anyone who does microtapering? Looking for some encouragement to get off this junk.

Hi @Tuskentank, just wondering how you did your Olanzapine microtaper? did you use liquid or did you shave/file a regular tablet? Thank you

[Nicjk]

Does anyone know if it is possible to do a daily micro taper off Olanzapine with the regular tablets? I unfortunately can't tolerate either the liquid version or the orodispersible/wafers in water. I have found an expensive scale that weighs 0.0001g and it theoretically could be possible to reduce by minuscule amounts per day but I just wonder how difficult that would be. Any ideas and input is most welcome. Thanks everyone