Tips for tapering off Zyprexa (olanzapine)

[Svie]

Hello all.

I have a question about this medicine. I want to start taper, again. I do not want to cut and weight on a scale. I want to try to make a liquid suspension. 

 

However. I can not find or get ora-plus here in europe. I know the medicine is not water soluble. But will it work by only water? 

 

I read that it would, here: 

But according to this post, here, says it needs ora-plus. 

Thanks for any answer

 

 

[hayduke]

I wouldn't worry about that stuff unless you really need it @Svie

Titrating a suspension in water works fine for many of us.  Plenty of info around the site.

Edited April 30, 2023 by hayduke
Tag member

[hayduke]

e.g. https://www.survivingantidepressants.org/topic/20131-hayduke-coming-off-olanzapine-zyprexa/?do=findComment&comment=446819

[Intense]

So I have a friend on a Facebook tapering support group and he was originally on 5mg olanzapine. He started doing these big cuts and he eventually went down to 2.5mg. And then what ended up happening was he tried to do some more cuts and his body wasn't responding well to the cuts, he wasn't able to go to sleep, so went back to 2.5mg. And then tried to hold on 2.5mg until he could a get a digital milligram scale. He lives in Egypt and they don't have Amazon there, so he couldn't get one like the one I have. So he was waiting for my father to get enough money to buy one there because apparently they're very expensive. But the whole process was taking too long. He ended up not getting good sleep, he was only getting like 3-4 hours of sleeping and then he'd wake up. And this kept going on for like 3-5 months and I think he ended up frying his brain from the lack of sleep. Then he recently told me he's looking at jewelry shops to see if they have them. He told me that he did go back to 5mg and he even stayed on it for 4 months, but he still was not getting good amounts of sleep, so his brain/mind kept deteriorating. And now he's told me that he started taking 100mg of quietapine. And I warned him he should not be taking another medication just because his olanzapine isn't working. Also that it would result in him having to now taper off of two medications instead of just one. I told him the reason the 5mg olanzapine may not be working is because there's a critical window of reinstating where if the olanzapine isn't working, you have to go back to your original dose. I think it's like 3 weeks. And he obviously went past the 3 weeks and he was on the 2.5mg for a very long time before he decided to go back to 5mg. So for some reason his 5mg doesn't seem to be working anymore. Do you think maybe he needs to stay on the 5mg olanzapine a little longer until his body readapts to it? Or what do you think he should do?

[FireflyFyte]

10 hours ago, Intense said:

So I have a friend on a Facebook tapering support group and he was originally on 5mg olanzapine. He started doing these big cuts and he eventually went down to 2.5mg. And then what ended up happening was he tried to do some more cuts and his body wasn't responding well to the cuts, he wasn't able to go to sleep, so went back to 2.5mg. And then tried to hold on 2.5mg until he could a get a digital milligram scale. He lives in Egypt and they don't have Amazon there, so he couldn't get one like the one I have. So he was waiting for my father to get enough money to buy one there because apparently they're very expensive. But the whole process was taking too long. He ended up not getting good sleep, he was only getting like 3-4 hours of sleeping and then he'd wake up. And this kept going on for like 3-5 months and I think he ended up frying his brain from the lack of sleep. Then he recently told me he's looking at jewelry shops to see if they have them. He told me that he did go back to 5mg and he even stayed on it for 4 months, but he still was not getting good amounts of sleep, so his brain/mind kept deteriorating. And now he's told me that he started taking 100mg of quietapine. And I warned him he should not be taking another medication just because his olanzapine isn't working. Also that it would result in him having to now taper off of two medications instead of just one. I told him the reason the 5mg olanzapine may not be working is because there's a critical window of reinstating where if the olanzapine isn't working, you have to go back to your original dose. I think it's like 3 weeks. And he obviously went past the 3 weeks and he was on the 2.5mg for a very long time before he decided to go back to 5mg. So for some reason his 5mg doesn't seem to be working anymore. Do you think maybe he needs to stay on the 5mg olanzapine a little longer until his body readapts to it? Or what do you think he should do?

 

I would encourage your friend to create an account here and post in the introductions forums. We can provide better guidance with a full history from him.

[Intense]

On 8/24/2023 at 11:47 AM, FireflyFyte said:

 

I would encourage your friend to create an account here and post in the introductions forums. We can provide better guidance with a full history from him.

He told me he went to the registration page and he's trying to register an account and after he got everything filled out and tried to register, he says it doesn't do anything, doesn't process anything, and the page just reloads.

[kinetic]

Hey, I am new to the forum, but I am getting close to the end of the taper. I use the cut and weight method. When making reductions, I found it easier to cut a series of doses in advance (maybe 4 or 5), instead of going through the process of doing the actual reduction the night of the cut. I found myself often ruminating about the cut at night, but when I made the cut in advance, it became much more tolerable. Maybe this is purely psychological, but having a routine like this can seem to fool the brain into believing everything is normal rather than having to make a big choice all in one day. Just my thoughts on this topic.

[hayduke]

17 hours ago, kinetic said:

Hey, I am new to the forum, but I am getting close to the end of the taper. I use the cut and weight method. When making reductions, I found it easier to cut a series of doses in advance (maybe 4 or 5), instead of going through the process of doing the actual reduction the night of the cut. I found myself often ruminating about the cut at night, but when I made the cut in advance, it became much more tolerable. Maybe this is purely psychological, but having a routine like this can seem to fool the brain into believing everything is normal rather than having to make a big choice all in one day. Just my thoughts on this topic.

Prepared dosages are a good idea if you know you're on track.  Keeps things simple at the end of long days.

 

Adjustable pipette is another good approach to this.

[kinetic]

On 10/17/2023 at 8:13 AM, hayduke said:

Prepared dosages are a good idea if you know you're on track.  Keeps things simple at the end of long days.

 

Adjustable pipette is another good approach to this.

Yes, sometimes it is easier said than done. I just recently disregarded my own tip and went for a cut after only 5 days. I am currently on .06mg of Olanzapine and it feels amazing. I can run 20 miles a week. I quit video games, weed, and pornography. I just picked up my 2 year key tag at NA. I believe that getting off this drug requires a complete lifestyle change and a good diet to accompany it. I can not wait to finally reach 0 and I know that I will be much better prepared mentally to face whatever comes my way than the last time I tried. I want you to know Hayduke that you are still an inspiration for those of us that haven't made the final jump yet. 

[Svie]

12 hours ago, kinetic said:

Yes, sometimes it is easier said than done. I just recently disregarded my own tip and went for a cut after only 5 days. I am currently on .06mg of Olanzapine and it feels amazing. I can run 20 miles a week. I quit video games, weed, and pornography. I just picked up my 2 year key tag at NA. I believe that getting off this drug requires a complete lifestyle change and a good diet to accompany it. I can not wait to finally reach 0 and I know that I will be much better prepared mentally to face whatever comes my way than the last time I tried. I want you to know Hayduke that you are still an inspiration for those of us that haven't made the final jump yet. 

HI @kinetic Sounds like you´re doing alright. I applaude everyone who gets off this medicine. I´ve had some difficulties with this medicine. Would you please elaborate how you do your taper? I´ve been on 2.5mg for a year now and want to make a second (and successfull) attempt going under 2.5mg. I´m hesitant to switch to liquid, therefor i wonder about your method. I´m sure it can help anyone else here reading as well. You said you count beads, and weigh. Does your pill not turn to powder when you handle it? And what scale do you use that can measure small amounts accurate enough?

 

I´ve read the recommended threads about cutting and weighing but to me it seem that my gemini scale just isnt accurate enough.

[kinetic]

14 minutes ago, Svie said:

HI @kinetic Sounds like you´re doing alright. I applaude everyone who gets off this medicine. I´ve had some difficulties with this medicine. Would you please elaborate how you do your taper? I´ve been on 2.5mg for a year now and want to make a second (and successfull) attempt going under 2.5mg. I´m hesitant to switch to liquid, therefor i wonder about your method. I´m sure it can help anyone else here reading as well. You said you count beads, and weigh. Does your pill not turn to powder when you handle it? And what scale do you use that can measure small amounts accurate enough?

 

I´ve read the recommended threads about cutting and weighing but to me it seem that my gemini scale just isnt accurate enough.

 

Hey Svie,

I don't count beads, I cut and weight the pill on the Gemini scale. I measure in the grain or "gr" on the scale. I use a razor blade to do the actual cutting. Yeah, I didn't like the idea of liquid either so I never made the switch. I have only been on Olanzapine for two years and I was lucky to find the site after one year when I had already made it to 5mg. I started the taper going at a rate of 10% per week instead of the 10% per month. Since I wasn't on the drug that long, I knew that I could go faster. I made it to 1.25 before I had to slow down and then I tried 10% per month while I was getting my master's degree. I realized that I could handle a fixed amount, rather than going off of percentages around .85mg. So I started dropping at .15mg per month. On the Gemini scale, .1 =.15mg or .02=.03mg. Eventually, the .15 drops started to feel noticable, so I decided to break them up during the month and go for .03 drops more frequently. The important thing to note is that I completely stopped "updosing" around 1.25. So this whole year, I have never once "updosed". I believe that updosing is very counterproductive when trying to get off of Olanzapine and is very confusing for the body. Of course I had many nights where I had trouble sleeping, but not updosing taught me to really accept the consequences of my actions and commit to my decision even if I have to go through a difficult moment. I will admit that I occasionally used some antihistamines like benadryl (I also got a prescription for hydroxyzine), but I also have a deviated spetem. It has not been easy to go through the taper while having breathing problems. If I know that I am having a "tough" night", then I just get out of bed, fix some herbal chamomile tea, and try to relax on the sofa and chill. Sometimes if I feel anxiety, then I suspect that I might really just be hungry, so my night foods are some non-sugar oatmeal, a banana, and yogurt. I know that this sort of method is not the recommended method for SA, but to be honest, you have to find a way that works for you and did not be afraid to take charge of your own healing. I hope some of that was helpful. Oh, and the pill does not turn into power once you get used to the razor blade. I can cut to the lowest dose on the scale (.03mg) without trouble, it just takes more time. It is possible to be precise with a razor blade, it just requires some practice. Now, I can get up to 6 doses with a single pill (maybe more if I wanted to) and I have not even seen my psychiatrist since July because I know that I do not need any more Olanzapine to complete the taper. 

 

Thanks,

Kinetic 

[Svie]

29 minutes ago, kinetic said:

 

Hey Svie,

I don't count beads, I cut and weight the pill on the Gemini scale. I measure in the grain or "gr" on the scale. I use a razor blade to do the actual cutting. Yeah, I didn't like the idea of liquid either so I never made the switch. I have only been on Olanzapine for two years and I was lucky to find the site after one year when I had already made it to 5mg. I started the taper going at a rate of 10% per week instead of the 10% per month. Since I wasn't on the drug that long, I knew that I could go faster. I made it to 1.25 before I had to slow down and then I tried 10% per month while I was getting my master's degree. I realized that I could handle a fixed amount, rather than going off of percentages around .85mg. So I started dropping at .15mg per month. On the Gemini scale, .1 =.15mg or .02=.03mg. Eventually, the .15 drops started to feel noticable, so I decided to break them up during the month and go for .03 drops more frequently. The important thing to note is that I completely stopped "updosing" around 1.25. So this whole year, I have never once "updosed". I believe that updosing is very counterproductive when trying to get off of Olanzapine and is very confusing for the body. Of course I had many nights where I had trouble sleeping, but not updosing taught me to really accept the consequences of my actions and commit to my decision even if I have to go through a difficult moment. I will admit that I occasionally used some antihistamines like benadryl (I also got a prescription for hydroxyzine), but I also have a deviated spetem. It has not been easy to go through the taper while having breathing problems. If I know that I am having a "tough" night", then I just get out of bed, fix some herbal chamomile tea, and try to relax on the sofa and chill. Sometimes if I feel anxiety, then I suspect that I might really just be hungry, so my night foods are some non-sugar oatmeal, a banana, and yogurt. I know that this sort of method is not the recommended method for SA, but to be honest, you have to find a way that works for you and did not be afraid to take charge of your own healing. I hope some of that was helpful. Oh, and the pill does not turn into power once you get used to the razor blade. I can cut to the lowest dose on the scale (.03mg) without trouble, it just takes more time. It is possible to be precise with a razor blade, it just requires some practice. Now, I can get up to 6 doses with a single pill (maybe more if I wanted to) and I have not even seen my psychiatrist since July because I know that I do not need any more Olanzapine to complete the taper. 

 

Thanks,

Kinetic 

Hey, thanks for the reply! We have the same scale. Don´t the result  fluctuate on your scale at low cuts? Mine does, so I had to weigh many times to get a fairly right result, and doing that can consume a lot of time. Also, when you say you cut with a razorblade, lets say and want to remove 20% on a whole tablet, do you just use the blade to cut away small segments untill it weighs correct? This was the method i previously used, but was frustrating due to the scale.

 

I recommend chamomile as well, Valerian root is good too.

 

Hope your surgery goes well!

[kinetic]

1 hour ago, Svie said:

Hey, thanks for the reply! We have the same scale. Don´t the result  fluctuate on your scale at low cuts? Mine does, so I had to weigh many times to get a fairly right result, and doing that can consume a lot of time. Also, when you say you cut with a razorblade, lets say and want to remove 20% on a whole tablet, do you just use the blade to cut away small segments untill it weighs correct? This was the method i previously used, but was frustrating due to the scale.

 

I recommend chamomile as well, Valerian root is good too.

 

Hope your surgery goes well!

Thanks, yeah I've never had a surgery before where I go under and I am nervous about the idea of pain or having to take a painkiller just to get by for a few days. Also, I am nervous about sleeping with my mouth instead of my nose the week after the surgery. Yes, I understand the problem of the weight fluctuation. Unfortunately, the method is not perfect and if you go through with this, then you have to accept a certain margin of error of about .01mg. I do not believe that this amount is significant because Olanzapine has a long half life and your body is essentially taking the average amount of the past two weeks. My solution is to just turn off the scale and let it reboot each time that I make a small cut. Then you just have to wait until the weight stops on a specific number and hope that it is the target number. It took some practice, but I believe that I can reliably cut amounts in .02gn or .03mg. However, the limit to the scale itself is .08mg and you have to use the weight that comes with the scale to go below that threshold. I read Dr. Mark Horowitz "A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse" to serve as a basic guide. There is a useful chart that shows the different stages of Olanzapine tapering. I believe that the chart is helpful because it can illustrate how you are progressing and how far you need to go to get to the next stage. The recommendation is that it should take 3-5 months to progress from one stage to another, but I thought that was too slow for me. I made smaller cuts more frequently. The main problem with the article is that the suggestion is that .4mg of Olanzapine is sufficient for discontinuation. This might be true for many people, but it also says that some patients may need to go down to 1/40 of a therapeutic dose as an exit dose. The term "therapeutic dose" widely varies, so my definition is the lowest available amount that is prescribed. I only want to follow the recommendation at the very end (5 months from .4 to 0), so hopefully sometime in December I should be able to make the final jump. You are right about it consuming time and my only solution is to make at least 5 doses during a cutting session. It will get easier as the cuts get lower though because the technique will improve as with anything in life. The benefit is seeing the actual pill reduce and you start to realize that you are a giant fighting an ant. 

[hayduke]

23 hours ago, kinetic said:

Yes, sometimes it is easier said than done. I just recently disregarded my own tip and went for a cut after only 5 days. I am currently on .06mg of Olanzapine and it feels amazing. I can run 20 miles a week. I quit video games, weed, and pornography. I just picked up my 2 year key tag at NA. I believe that getting off this drug requires a complete lifestyle change and a good diet to accompany it. I can not wait to finally reach 0 and I know that I will be much better prepared mentally to face whatever comes my way than the last time I tried. I want you to know Hayduke that you are still an inspiration for those of us that haven't made the final jump yet. 

It sounds like you are cutting down on things that release a lot of dopamine, which is wise coming off this drug.  Glad to hear things are going well.

 

If I knew then what I know now, I would have done longer holds at the tail end of the taper when I started seeing signs of dopamine supersensitivity, and of course kept clear of alcohol, even at 18 months out.  My hunch was I would've found homeostasis at around 3 years.

[kinetic]

1 hour ago, hayduke said:

It sounds like you are cutting down on things that release a lot of dopamine, which is wise coming off this drug.  Glad to hear things are going well.

 

If I knew then what I know now, I would have done longer holds at the tail end of the taper when I started seeing signs of dopamine supersensitivity, and of course kept clear of alcohol, even at 18 months out.  My hunch was I would've found homeostasis at around 3 years.

Yeah cutting video games and weed has made a difference for sure. My primary sources of dopamine now are from running (natural high) and I allow myself to have ice cream once a week. I try to get outside more. Socializing is a challenge since I just finished school and I mostly use support groups like NA and GAA to talk to people. I have also tried a local French meetup group, but it's not really active right now. Also, I've tried the local chess group. The main problem is that most people is the chess club play blitz (speed chess) and practice heavily online on chess.com. I view online chess as essentially the same thing as a video game so I restrict myself to "over the board" chess. So basically I am at a huge disadvantage at the chess club and no one wants to play "classical" chess with a longer timer. I may play in a tournament a few months from now to play longer games. I do not care if I win or lose and I decided not to do too much studying or memorization before the tournament. I am also trying to learn Swedish to keep my brain sharp. I know that Olanzapine can literally shrink the brain, which is absolutely horrifying for someone like me who was always one of the top students in the classroom. 

[Svie]

20 hours ago, kinetic said:

Thanks, yeah I've never had a surgery before where I go under and I am nervous about the idea of pain or having to take a painkiller just to get by for a few days. Also, I am nervous about sleeping with my mouth instead of my nose the week after the surgery. Yes, I understand the problem of the weight fluctuation. Unfortunately, the method is not perfect and if you go through with this, then you have to accept a certain margin of error of about .01mg. I do not believe that this amount is significant because Olanzapine has a long half life and your body is essentially taking the average amount of the past two weeks. My solution is to just turn off the scale and let it reboot each time that I make a small cut. Then you just have to wait until the weight stops on a specific number and hope that it is the target number. It took some practice, but I believe that I can reliably cut amounts in .02gn or .03mg. However, the limit to the scale itself is .08mg and you have to use the weight that comes with the scale to go below that threshold. I read Dr. Mark Horowitz "A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse" to serve as a basic guide. There is a useful chart that shows the different stages of Olanzapine tapering. I believe that the chart is helpful because it can illustrate how you are progressing and how far you need to go to get to the next stage. The recommendation is that it should take 3-5 months to progress from one stage to another, but I thought that was too slow for me. I made smaller cuts more frequently. The main problem with the article is that the suggestion is that .4mg of Olanzapine is sufficient for discontinuation. This might be true for many people, but it also says that some patients may need to go down to 1/40 of a therapeutic dose as an exit dose. The term "therapeutic dose" widely varies, so my definition is the lowest available amount that is prescribed. I only want to follow the recommendation at the very end (5 months from .4 to 0), so hopefully sometime in December I should be able to make the final jump. You are right about it consuming time and my only solution is to make at least 5 doses during a cutting session. It will get easier as the cuts get lower though because the technique will improve as with anything in life. The benefit is seeing the actual pill reduce and you start to realize that you are a giant fighting an ant. 

Hey again, thanks for the response. I hope your nervousness goes away. I guess one have to trust the process just as one needs to do with tapering.

 

One concern with this method. Looking at how small dose you are at now, how do you manage to cut away 10% from a small small piece like that? And can the scale even differentiate 10% from that small piece? This seems to be to most difficult thing to handle, when it becomes tiny.

 

Thanks for that Dr-recommendation

[kinetic]

51 minutes ago, Svie said:

Hey again, thanks for the response. I hope your nervousness goes away. I guess one have to trust the process just as one needs to do with tapering.

 

One concern with this method. Looking at how small dose you are at now, how do you manage to cut away 10% from a small small piece like that? And can the scale even differentiate 10% from that small piece? This seems to be to most difficult thing to handle, when it becomes tiny.

 

Thanks for that Dr-recommendation

Hey Svie,

 

I actually stopped doing the 10% method around April when I was at 0.7mg. I realized that the measurement of 10% was going to be eventually impossible, as you pointed out. This is where I feel that people tapering Olanzapine or any other drug with a low milligram dosage can legitimately question the 10% per month recommendation on SA. Our end goal is going to look much different than someone trying to get off a drug like lamictal, effexor, gabapentin, wellbutrin, or seroquel. If the goal is truly to avoid withdrawal symptoms at final discontinuation (or at least manageable enough for sleep, the main concern), then I believe that the target exit dose for Olanzapine should be at around 0.03mg. I only came up with this number because it is the absolute lowest amount that the Gemini scale will allow for. Also, Dr. Mark Horowitz suggests that some patients will need to go down to 1/40 of a therapeutic dose, which I interpret to mean 1/40 of the lowest available dose (2.5mg) or .06mg. Therefore, I am willing to go at half of Dr. Mark Horowitz's lowest possible recommendation for discontinuation. I also recognize that it is not simply a race to the target dose, but closer to a long distance marathon because at the final stage (.4mg) one needs to take at least 3-5 months to get to 0mg. So, the quick answer to your question is that I plan to make a 50% cut before the final jump because now I taper in a linear fashion instead of the hyperbolic method due to the limitations of using cut and weight over liquid tapering. While some people here may object to the idea of a 50% cut before the final jump, I would like to state the obvious that the final jump means a 100% cut, and the theoretical reasoning is that the overwhelming majority of occupancy receptors at this stage are operating without the need for the drug. It is likely that I have already reached 1% or less occupancy by the drug, so cuts at this point feel much more positive than negative. Throughout this process, I have learned new coping techniques on my own and I do not dread the future or the past. I see the cut as a good thing because I know deep down that I do not really need the drug and I am ready to move on with my life.

 

Thanks,

Kinetic 

 

[Svie]

On 10/22/2023 at 4:12 PM, kinetic said:

Hey Svie,

 

I actually stopped doing the 10% method around April when I was at 0.7mg. I realized that the measurement of 10% was going to be eventually impossible, as you pointed out. This is where I feel that people tapering Olanzapine or any other drug with a low milligram dosage can legitimately question the 10% per month recommendation on SA. Our end goal is going to look much different than someone trying to get off a drug like lamictal, effexor, gabapentin, wellbutrin, or seroquel. If the goal is truly to avoid withdrawal symptoms at final discontinuation (or at least manageable enough for sleep, the main concern), then I believe that the target exit dose for Olanzapine should be at around 0.03mg. I only came up with this number because it is the absolute lowest amount that the Gemini scale will allow for. Also, Dr. Mark Horowitz suggests that some patients will need to go down to 1/40 of a therapeutic dose, which I interpret to mean 1/40 of the lowest available dose (2.5mg) or .06mg. Therefore, I am willing to go at half of Dr. Mark Horowitz's lowest possible recommendation for discontinuation. I also recognize that it is not simply a race to the target dose, but closer to a long distance marathon because at the final stage (.4mg) one needs to take at least 3-5 months to get to 0mg. So, the quick answer to your question is that I plan to make a 50% cut before the final jump because now I taper in a linear fashion instead of the hyperbolic method due to the limitations of using cut and weight over liquid tapering. While some people here may object to the idea of a 50% cut before the final jump, I would like to state the obvious that the final jump means a 100% cut, and the theoretical reasoning is that the overwhelming majority of occupancy receptors at this stage are operating without the need for the drug. It is likely that I have already reached 1% or less occupancy by the drug, so cuts at this point feel much more positive than negative. Throughout this process, I have learned new coping techniques on my own and I do not dread the future or the past. I see the cut as a good thing because I know deep down that I do not really need the drug and I am ready to move on with my life.

 

Thanks,

Kinetic 

 

Thanks. That sounds reasonable. It´s something I´ve thought about alot, at what happens at lower doses with this method. So how much did you cut from 0.7mg and under, and how did you keep track how much you cut? By the scale?

[kinetic]

1 hour ago, Svie said:

Thanks. That sounds reasonable. It´s something I´ve thought about alot, at what happens at lower doses with this method. So how much did you cut from 0.7mg and under, and how did you keep track how much you cut? By the scale?

Good question. The truth is, once I decided to switch from a hyperbolic taper to a linear taper, I realized that thinking in terms of percentages or even milligrams only complicate the process even more. The true measurement becomes pill weight, or the grain in my case (GN). Here is a 7-8 month chart from 2.5mg, which equals 1.66gn. I believe .81 equals 1.25mg. So I started linear tapering on 3/9/2023, I thought that much too much on 5/18/2023 and started cutting less amounts but not monthly. 

[Svie]

On 10/24/2023 at 4:21 PM, kinetic said:

Good question. The truth is, once I decided to switch from a hyperbolic taper to a linear taper, I realized that thinking in terms of percentages or even milligrams only complicate the process even more. The true measurement becomes pill weight, or the grain in my case (GN). Here is a 7-8 month chart from 2.5mg, which equals 1.66gn. I believe .81 equals 1.25mg. So I started linear tapering on 3/9/2023, I thought that much too much on 5/18/2023 and started cutting less amounts but not monthly. 

Hey, much thanks for this information. It makes lots of sense. Glad it´s working for you! Hope that jump to nothing goes well for you.

 

 

[kinetic]

1 hour ago, Svie said:

Hey, much thanks for this information. It makes lots of sense. Glad it´s working for you! Hope that jump to nothing goes well for you.

 

 

No problem, I wanted to share my method with someone and I am glad that I had the chance. I feel like there should be more options available on SA considering how the site has been around over 10 years now. People have found success with the cut and weight method, but I felt that there is a gap on how to proceed at the lower doses. The literature shows that half of the lowest dose (1.25) and even a quarter (0.6) are likely to be insufficient exit doses (Horowitz 2021). However, not everyone is willing to make the switch to liquid. I believe that the ability to see the pill reduce has value and helps keep me on track to the finish line. I reject the notions that cutting and weighting is "crude" or "inaccurate". There is a lot of skill involved in cutting and weighing. The scale is actually quite good, more than enough to get the job done. It requires patience, persistence, courage, care, discernment, responsibility, acceptance, and efficiency all in one. There is no “12-step” program for getting off of Olanzapine. This is a true David vs Goliath scenario, where the fight clearer favors one over the other. Yet, I do not believe that some human beings are powerless while others are not. I refuse to surrender my individuality to group thinking. So, I forged my own path and I am starting to see the light at the end of Plato’s cave.

[Altostrata]

On 10/22/2023 at 7:12 AM, kinetic said:

This is where I feel that people tapering Olanzapine or any other drug with a low milligram dosage can legitimately question the 10% per month recommendation on SA.

 

This doesn't make any sense. Psychotropic drugs are not equivalent milligram for milligram of active ingredient. Olanzapine is dosed lower than venlafaxine because it's an entirely different drug with powerful effects even at low milligram dosages.

 

It's even more important to gradually taper olanzapine exponentially or hyperbolically at lower doses because of dopamine supersensitivity as the drug level gets lower in the brain.

 

On 10/21/2023 at 6:12 AM, kinetic said:

made it to 1.25 before I had to slow down and then I tried 10% per month while I was getting my master's degree. I realized that I could handle a fixed amount, rather than going off of percentages around .85mg. So I started dropping at .15mg per month. On the Gemini scale, .1 =.15mg or .02=.03mg. Eventually, the .15 drops started to feel noticable, so I decided to break them up during the month and go for .03 drops more frequently.

 

10% is a guideline as it seems it suits most people. We have explained repeatedly that people can taper by larger amounts and others will find that they can tolerate only smaller decreases. 

 

You were able to decrease from 1.25mg by 0.15mg per month for a while because that was within your personal tolerance, which might have been 20% exponential. When you exceeded that 20% calculated on the last dosage, you had difficulty. This does not disprove the advisability of exponential or hyperbolic decreases.

 

In fact, if someone starts at 5mg, for example, for ease of use we might suggest decreasing by 0.25mg, a decrease within the 10% guideline, until the dose is below 2.5mg. Then, the decreases might be 0.15mg per step until the dose is below 1.5mg. And so on. This is not linear per se but playing within the exponential margin.

 

4 hours ago, kinetic said:

I feel like there should be more options available on SA considering how the site has been around over 10 years now.

 

You're welcome @kinetic.

 

I strongly advise anyone taking olanzapine to be very careful in reductions so as to avoid emergence of dopamine supersensitivity, which can cause symptoms that appear to be psychosis and get you hospitalized and throughly re-medicated. 

 

Do not assume you will be able to taper with a 20% reduction.

 

If you are tapering olanzapine or another antipsychotic and you follow @kinetic's  advice to experiment with reductions greater than 10% exponential and you run into trouble, please contact @kinetic for advice on what to do next. 

[kinetic]

8 minutes ago, Altostrata said:

 

This doesn't make any sense. Psychotropic drugs are not equivalent milligram for milligram of active ingredient. Olanzapine is dosed lower than venlafaxine because it's an entirely different drug with powerful effects even at low milligram dosages.

 

It's even more important to gradually taper olanzapine exponentially or hyperbolically at lower doses because of dopamine supersensitivity as the drug level gets lower in the brain.

 

 

10% is a guideline as it seems it suits most people. We have explained repeatedly that people can taper by larger amounts and others will find that they can tolerate only smaller decreases. 

 

You were able to decrease from 1.25mg by 0.15mg per month for a while because that was within your personal tolerance, which might have been 20% exponential. When you exceeded that 20% calculated on the last dosage, you had difficulty. This does not disprove the advisability of exponential or hyperbolic decreases.

 

In fact, if someone starts at 5mg, for example, for ease of use we might suggest decreasing by 0.25mg, a decrease within the 10% guideline, until the dose is below 2.5mg. Then, the decreases might be 0.15mg per step until the dose is below 1.5mg. And so on. This is not linear per se but playing within the exponential margin.

 

 

You're welcome @kinetic.

 

I strongly advise anyone taking olanzapine to be very careful in reductions so as to avoid emergence of dopamine supersensitivity, which can cause symptoms that appear to be psychosis and get you hospitalized and throughly re-medicated. 

 

Do not assume you will be able to taper with a 20% reduction.

 

If you are tapering olanzapine or another antipsychotic and you follow @kinetic's  advice to experiment with reductions greater than 10% exponential and you run into trouble, please contact @kinetic for advice on what to do next. 

The main point I am trying to make is that the 10% is literally impossible for the cut and weight method because it is a medication with a low dosage. The required amount to taper is extremely low. Also, I am limited in the information I can post here because of attachment rules. I have another photo which details the taper from July 2023 to the present, which would illustrate my argument more effectively.

[hayduke]

On 10/27/2023 at 6:26 AM, kinetic said:

The main point I am trying to make is that the 10% is literally impossible for the cut and weight method because it is a medication with a low dosage. The required amount to taper is extremely low. Also, I am limited in the information I can post here because of attachment rules. I have another photo which details the taper from July 2023 to the present, which would illustrate my argument more effectively.

This is a great argument for making a liquid to taper with.

 

On 10/27/2023 at 6:18 AM, Altostrata said:

I strongly advise anyone taking olanzapine to be very careful in reductions so as to avoid emergence of dopamine supersensitivity, which can cause symptoms that appear to be psychosis and get you hospitalized and throughly re-medicated. 

 

Do not assume you will be able to taper with a 20% reduction.

Can confirm.

[kinetic]

On 10/28/2023 at 5:51 PM, hayduke said:

This is a great argument for making a liquid to taper with.

 

Can confirm.

The problem with liquid tapering is that there are very few success stories on this website and the Internet in general. The majority of success stories have been those that did the cut and weight method (Andy is the true Olanzapine success story in my opinion). I understand that you personally found success Hayduke, but a 5-6 year taper is hardly what one would call "success". The problem is that there are people who have not been on the drug very long (less than one year) and have the ability to taper faster, but do not because they are convinced that liquid tapering is supposedly superior. This could not be any further from the truth. While I did find the 10% method useful up to a certain point, I quickly realized that I would never reach my target dose until many years later. I was motivated to get off faster, however I still tapered within the general "spirit" of hyperbolic tapering as Alto pointed out. "Playing with exponents" or whatever you want to call it, this method is highly effective. I do not deny that this is a symptom-free approach, I will be completely transparent and admit that I have experienced sleep disruptions, headaches, anxiety, and all sorts of other things, but I do not panic when this happens. I am happy to report that I have not experienced a single night with 0 sleep this entire year and I have never once updosed this year either. These symptoms generally only last a few days and I am able to run 24 miles per week now. So, I believe that Alto's post regarding the possibility of "dopamine hypersensitive" and the fear of the hospital are not grounded in reality. I would encourage the citation of peer-reviewed articles to strengthen the argument and I would be happy to find flaws in those articles. I have a completely different body than I did two years ago I have accepted my past and ready to move on. This pill does not control me, I control it now. 

[hayduke]

6 hours ago, kinetic said:

The problem with liquid tapering is that there are very few success stories on this website and the Internet in general. The majority of success stories have been those that did the cut and weight method (Andy is the true Olanzapine success story in my opinion). I understand that you personally found success Hayduke, but a 5-6 year taper is hardly what one would call "success". The problem is that there are people who have not been on the drug very long (less than one year) and have the ability to taper faster, but do not because they are convinced that liquid tapering is supposedly superior. This could not be any further from the truth. While I did find the 10% method useful up to a certain point, I quickly realized that I would never reach my target dose until many years later. I was motivated to get off faster, however I still tapered within the general "spirit" of hyperbolic tapering as Alto pointed out. "Playing with exponents" or whatever you want to call it, this method is highly effective. I do not deny that this is a symptom-free approach, I will be completely transparent and admit that I have experienced sleep disruptions, headaches, anxiety, and all sorts of other things, but I do not panic when this happens. I am happy to report that I have not experienced a single night with 0 sleep this entire year and I have never once updosed this year either. These symptoms generally only last a few days and I am able to run 24 miles per week now. So, I believe that Alto's post regarding the possibility of "dopamine hypersensitive" and the fear of the hospital are not grounded in reality. I would encourage the citation of peer-reviewed articles to strengthen the argument and I would be happy to find flaws in those articles. I have a completely different body than I did two years ago I have accepted my past and ready to move on. This pill does not control me, I control it now. 

You might personally be able to go faster, but it is very poor advice to others who may not be able to.

 

Your body's reaction to dosage cuts determines the safe rate of withdrawal, not wishful thinking.

[kinetic]

4 hours ago, hayduke said:

You might personally be able to go faster, but it is very poor advice to others who may not be able to.

 

Your body's reaction to dosage cuts determines the safe rate of withdrawal, not wishful thinking.

I am not advocating wishful thinking, just science. My advice to people who are unable to go faster is to exercise (running in particular, though I also play tennis), eat a healthy diet, go outside, cut out unhealthy activities (smoking/drinking/etc.) and find ways to socialize (even joining a cult like NA can be useful to a degree). I do not believe that some people are simply "stuck" at a certain rate of taper and that is completely out of control for the individual. The body can be improved, thus the rate of taper can improve over time as well. Learning how to cope with withdrawal symptoms is also a skill that can be improved. Honestly, I had no choice but to taper faster. I was starting to get the early symptoms of TD and it was scary. Also, I gained 40 pounds within a short period of time. I am just now starting to lose some of the weight even though I am on such a low dose. I cut 10% per week because I had to, not because I wanted to. I can not tolerate the drug well. I also recognize that I do not likely have bipolar or schizophrenia. I was put on Olanzapine for a weed-induced psychosis, though the hospital of course said it was bipolar. No one wants to admit that weed legalization might be having negative consequences in the USA. I just want to be able to provide some sort of general blueprint for someone else who has no choice but to go faster and I believe my method is viable because it is largely based on what I learned here on SA, Dr. Mark Horowitz's article, and the numerous accounts on the Internet that I read. In other words, I did my homework and I did not come with my method completely on my own. Your story actually pushed me to taper even beyond your own final exit dose (.205mg), and I will not likely drink alcohol after reading what happened. 

[hayduke]

Another D2RO graph for those with an interest in such ( @DataGuy )

[kinetic]

On 11/25/2023 at 9:31 AM, hayduke said:

Another D2RO graph for those with an interest in such ( @DataGuy )

These charts are useful illustrations for sure. The only problem I had was trying to estimate what D2 receptor occupancy would be at doses lower than 1.25. Basically, I had to take an educated guess, but it doesn't seem to be as simple as "We can infer that .613mg equals roughly 11% occupancy if 1.25mg equals 22%".

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://cdn.taperingstrip.org/presordfrm/antipsychotics/LNZP_bestel_GB.pdf&ved=2ahUKEwj0zJToq_uCAxX0mYQIHaO8DwgQFnoECBUQAQ&usg=AOvVaw25dJG8SmVEjsqL1_8EWTcg. 

I saw a guide on tapering strips for Olanzipine that says that it doesn't even reach 11% until around .2mg, which is interesting 🤔. 

[N2deep]

1 hour ago, kinetic said:

These charts are useful illustrations for sure. The only problem I had was trying to estimate what D2 receptor occupancy would be at doses lower than 1.25. Basically, I had to take an educated guess, but it doesn't seem to be as simple as "We can infer that .613mg equals roughly 11% occupancy if 1.25mg equals 22%".

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://cdn.taperingstrip.org/presordfrm/antipsychotics/LNZP_bestel_GB.pdf&ved=2ahUKEwj0zJToq_uCAxX0mYQIHaO8DwgQFnoECBUQAQ&usg=AOvVaw25dJG8SmVEjsqL1_8EWTcg. 

I saw a guide on tapering strips for Olanzipine that says that it doesn't even reach 11% until around .2mg, which is interesting 🤔. 

I wonder where they got that data for the receptor occupancy chart in that tapering strip link, or whether it was purely for educational purposes. I find it peculiar that they show two different methods, Ashton and Regular, and both getting you to ZERO at entirely different paces, with Ashton being fast at the start, and slow at the end, and regular being more gradual to start, but then offering the option to go from 5mg or 2.5mg right to zero in a 28 day span. Either way, the tapering speed is much faster than espoused here at this forum.

[kinetic]

3 hours ago, N2deep said:

I wonder where they got that data for the receptor occupancy chart in that tapering strip link, or whether it was purely for educational purposes. 

 

3 hours ago, N2deep said:

Either way, the tapering speed is much faster than espoused here at this forum.

At the bottom of the link, there is the contact information of the two doctors from university. Maybe you could reach out to one of them and ask how they came up with the receptor occupancy data. Clearly the information is inconsistent between the chart from Dr. Horowitz (2021) and the tapering strips chart presented by Dr. Groot and Prof. Jim Van Os. The tapering strips lists 2.5mg as 50% while 1.25mg is like 36%. These are figures much higher than the Dr. Horowitz (2021) chart, which lists 2.5mg as 36% and 1.25mg as 22%. Indeed, 2.5mg to 0mg in a month is fast, but others have pulled it off on YouTube and other forum sites. It is not impossible, but I imagine some sort of protracted withdrawal could occur for a while. Not everyone has the patience for a year-long+ taper. There are also legitimate health concerns to taper faster, like diabetes, weight gain, TD, or sexual dysfunction that could cause a doctor to advocate getting off faster. TD is far much common than what we would like to believe (Breggin and Cohen 1999) and the odds of getting it increase each year on the drug (Horowitz 2021).

[N2deep]

Yeah, here is a meta-analysis on the prevalence of TD. Unbelievable how common it is.

 

https://pubmed.ncbi.nlm.nih.gov/28146614/

[JandD]

The receptor occupancy of Olanzapine is important to understand that one must be very careful with reductions, especially at low doses.
However, each person is different, as this graph shows (sorry, don`t know the source anymore):

Tardive Dyskinesia:

I have heard of the following products that have a positive/protective effect on TD (and I have also noticed this in my wife): 
Vitamin E, vitamin C, resveratrol (grape seed extract), vitamin B6, magnesium (L3) L-threonates, polyphenols (green tea).

Also very positive effects:
Ginkgo Biloba, Rice Bran Oil, Yi-gan san

Important: Always check beforehand with the Drug Interaction Checker. This is why we have not yet used Ginkgo or Yi-gan san. 

Avoid:
Coffee, aspartame, tyrosine (energy drinks)

 

 

[hayduke]

On 12/8/2023 at 8:43 AM, JandD said:

The receptor occupancy of Olanzapine is important to understand that one must be very careful with reductions, especially at low doses.
However, each person is different

Very good points.  This is why it's so important to listen to what your body is telling you about your taper.

Edited December 8, 2023 by hayduke

[kinetic]

On 12/7/2023 at 4:43 PM, JandD said:

The receptor occupancy of Olanzapine is important to understand that one must be very careful with reductions, especially at low doses.
However, each person is different, as this graph shows. 

While I would generally agree with this, I do believe that there is such as a thing as too long of a taper. Lader, Tylee, and Donoghue (2009) state that "Our recommendation is to aim for withdrawal in <6 months, otherwise the withdrawal process can become the morbid focus of the patient’s existence". While they are talking about benzodiazepine withdrawal, the same concept could be applied to tapering Olanzapine. There is certainly some overlap in terms of withdrawal symptoms experienced by benzodiazepines and Olanzapine, which is technically classified as a thienodiazepine. Some specific symptoms that I am referring to are insomnia, panic attacks, anxiety, headache, increased urinary frequency, mood swings, muscular spasms, impaired memory and concentration, nightmares, akathisia, depression, and obsessive compulsive disorder. From personal experience, I do not think that the actual dosage under .4mg made that much of a difference (a dosage that Horowitz 2021 states as sufficient to discontinue), but rather what was going on in my life at the time. At some point, you have to stop blaming the drug for every little hiccup in life. 

[hayduke]

3 minutes ago, kinetic said:

While I would generally agree with this, I do believe that there is such as a thing as too long of a taper. Lader, Tylee, and Donoghue (2009) state that "Our recommendation is to aim for withdrawal in <6 months, otherwise the withdrawal process can become the morbid focus of the patient’s existence". While they are talking about benzodiazepine withdrawal, the same concept could be applied to tapering Olanzapine. There is certainly some overlap in terms of withdrawal symptoms experienced by benzodiazepines and Olanzapine, which is technically classified as a thienodiazepine. Some specific symptoms that I am referring to are insomnia, panic attacks, anxiety, headache, increased urinary frequency, mood swings, muscular spasms, impaired memory and concentration, nightmares, akathisia, depression, and obsessive compulsive disorder. From personal experience, I do not think that the actual dosage under .4mg made that much of a difference (a dosage that Horowitz 2021 states as sufficient to discontinue), but rather what was going on in my life at the time. At some point, you have to stop blaming the drug for every little hiccup in life. 

 

We've already established that you were able to withdraw more quickly than most people.  We can't generalise from your experience.  We also haven't seen how things go for you long term yet, and advise caution.

Please don't generalise from your own experience on that basis.