mkat71: Liquid risperidone

[mkat71]

Hi everyone.

 

I am finally back down to 2 mg risperdal (pills), and am ready to switch to the liquid so I can make smaller cuts. I am taking a 1 mg pill in the morning, and a 1 mg pill in the evening.

 

I am seeking some advice. Perhaps tezza could help, since she has tapered liquid risperdal before. But I would welcome advice from anyone.

 

I thought I would leave the evening dose the way it is, at 1 mg, and start working on the morning dose. My doctor thinks I should go back and forth between morning and evening, reducing the morning by a little then reducing the evening by a little. Does this sound like a good idea? Or should I leave the evening dose the way it is until I completely reduce the morning 1 mg dose?

 

If I decide to hold the evening dose steady at 1 mg, should I keep taking that dose as a 1 mg tablet, while using the liquid for the morning dose? Or should I use the liquid for both morning and evening? I don't know if the liquid and the pills are exactly equivalent.

 

Thank you to everyone in advance for your help.

[Rhiannon]

I think if the point of taking it twice a day is to keep blood levels smooth and not so bouncy, then doing it the way your doctor says makes more sense.

[mkat71]

Hello everyone,

 

After getting down to 2 mg of risperdal tablets, I tried switching to liquid risperdal for one day, but I felt so unstable the next morning I immediately went back to the pills, and have decided to try tapering from the pills instead. I don't want what happened six months ago (getting off track and increasing the dose) to happen again, so I'm sticking with the pills. I don't think 1 ml of the liquid is really the same as 1 mg of the pills. My brain doesn't seem to respond well to it.

 

Anyway, I went back to 2 mg of the pills for a few weeks, then successfully dropped to 1.9375 mg on Oct. 1. I stayed there for almost two weeks, and tried to drop to 1.875 mg, but didn't make it, so I immediately went back to 1.9375 mg. Five days later (Saturday) I tried to drop to 1.875 mg again, and again I didn't make it. I woke up a few hours before the next morning dose time on Sunday needing medicine, so I took a fragment of .0625 mg and went back to sleep. At dose time, instead of taking 1.9375 mg like I should have, I tried taking 1.875 mg again.

 

This was an unforgivable decision. After what I went through for the last six months, I should have known to go immediately back up to the previous dose and restabilize. Instead I destabilized myself and got off track again. Now it may be a while before I get back to 1.9375 mg. I went up to 2.125 mg to "put out the fire." My psychiatrist wants me to stay there for a week to restabilize, then work my way back down again.

 

My concern with this is staying too long at 2.125 mg. I'm afraid it will not be as easy to get back to 1.9375 mg as my psychiatrist may think. I don't want to spend another month at 2 mg, because I can't feel anything at that dosage. I was just beginning to feel a little bit of emotions at 1.9375 mg. I was making progress, then I screwed everything up. I'm studying music in college, and I need to be able to feel. The holidays are also coming up, and I was looking forward to feeling good.

 

My question is, since my baseline was 1.9375 mg before destabilizing for one day, is it a good idea for me to stay a whole week at 2.125 mg? That will become my new baseline, and then it may be hard to reduce back to 1.9375 mg. I feel like I need to get back to 1.9375 mg quickly, but it may be too late to do that now.

 

Does anyone have any advice for me? What would you all do? Since I seemed to have made it to 2.125 mg, and am making it through the night all the way to morning dose time on that dose, should I stay a few days at 2.125 mg, then go down to 2.0625 mg for a few days, then 2 mg, then 1.9375 mg? Or should I go faster than that, since it's only been four days since getting off track? What will happen if I stay too long at 2.125 mg?

 

Thank you all.

[Altostrata]

I would stay at least a week at 2.125mg. Actually, I would stay at that dosage a lot longer, since it seems you got destabilized. Your nervous system needs a break from dosage changes.

 

It seems you are now very sensitive to dosage decreases. This calls for even smaller decreases and periodic holds.

[Altostrata]

Perhaps you should think in terms of micro-tapering http://survivingantidepressants.org/index.php?/topic/2878-micro-taper-instead-of-10-or-5-decreases/

[tezza]

Perhaps you should think in terms of micro-tapering http://survivingantidepressants.org/index.php?/topic/2878-micro-taper-instead-of-10-or-5-decreases/

I agree...

[mkat71]

Thank you all for your responses.

 

I hear what you are saying about staying at 2.125 mg for awhile. The only problem is that this dose is EXTREMELY uncomfortable. I feel the medication "compressing" my brain. It is painful, like a vice. I can't think clearly. Not to mention I lose my ability to feel my emotions.

 

Doesn't this suggest the dose is too high? Shouldn't I take some time to stabilize at a comfortable dose that allows me to function? I'm in school now, and I have the holidays coming up, and I would like to be comfortable around my family.

 

(I was comfortable at 1.9375 mg, and was beginning to feel my emotions a little bit. I just needed to stay at 1.9375 mg for awhile. I wasn't quite ready for 1.875 mg.) 

 

Thanks.

[Altostrata]

How about 2.10mg? It looks like you are adept at measuring precisely, there is a huge range of dosages between 2.15mg and 1.9375mg.

 

Because you got destabilized, 1.9375mg may not be the sweet spot it once was. There is no reason to make it a goal. Listen to your body and make very small careful changes to find your next sweet spot. Then hold for a while.

[mkat71]

Thanks Alto.

 

I tried going down to 2.0625 mg yesterday, but didn't quite make it through the night without what seemed like withdrawal symptoms. (Couldn't sleep, felt some mild psychiatric symptoms emerging.) I can't always tell if it's a withdrawal symptom that needs to be corrected immediately, or if I should tough it out and keep going. I didn't want to risk getting into further trouble, so I went back to 2.125 mg, which is a torturous dose.

 

The problem is, I've been using 1 mg, .5 mg, and .25 mg tablets to take the medicine, and I've been cutting the .25 mg tablets into four pieces to get precise, so I've been going down in increments of .0625 mg. I don't know if that's the best method or not, but I don't know how else to do it. I can't cut the quarter fragments accurately.

 

Do you know how else I could get more precise? Are there scales that I could use to weigh small fragments of pills? Where might I find a scale like that, and how much might it cost?

 

Thanks again!

[tezza]

Yes, there's a scale but it can be difficult to get precision, measuring tiny amounts. (Risperidone)

 

Making a liquid might be a good choice for you. I've been making a liquid with Remeron over a year, now, and it has worked well.

 

Here is a link explaining how:

 

http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

[mkat71]

Hi everyone,

 

After destabilizing a bit at 1.9375 mg of Risperdal (I tried to go down to 1.875 mg when I wasn't quite ready), I went up to 2.125 mg in an attempt to stabilize and "put out the fire" of my psychiatric symptoms before they got worse. I don't think it was necessary for me to go up as high as 2.125 mg, but that's what I did. I guess I sort of panicked.

 

Anyway, this is my 7th day at 2.125 mg. It doesn't "feel" like 2.125 mg used to feel, I guess because I was destabilized. It doesn't feel quite as uncomfortable as it should, and I can still enjoy music, which I'm not usually able to do at 2 mg or higher. I usually start feeling my emotions at doses lower than 2 mg, but for some reason I'm still feeling pretty good at 2.125 mg.

 

My concern is that the longer I stay at 2.125 mg, the less I will be able to feel. As I get used to 2.125 mg, and as the dose slowly builds up in my blood stream, I'm afraid it will slowly become more physically uncomfortable, and I will start to lose my emotions and become emotionally numb.

 

So the question is, is it possible to hold TOO long at a dose after reinstating? Should I try to move slowly back down to where I was (1.9375 mg) before I become numb, or should I hold at 2.125 mg until it really FEELS like 2.125 mg? (i.e. physical discomfort and emotional numbness)

 

Thanks!

[Altostrata]

Please don't worry about how it's going to feel. Our nervous systems are dynamic; continuous adaptation means you can't step in the same river twice, neurologically.

 

If it starts to feel uncomfortable, then think of reducing. In the meantime, let yourself and your nervous system enjoy the relative stability.

[mkat71]

Thanks Alto! That helps.

[mkat71]

Hello everyone.

 

After becoming destabilized at 1.9375 mg in mid-October, I restabilized at 2.125 mg. I stayed at that dose for 18 days, until I started to feel discomfort in my head. I decided to drop to 2.0625 mg then. It looks like I didn't stay long enough at 2.0625 mg. I was feeling discomfort after four days at that dose, so I thought I was ready to go down to 2 mg, but I guess I wasn't, because I started experiencing withdrawal headaches and some insomnia.

 

Now I'm trying to find the right dose to restabilize at, but I'm having a hard time finding it.

 

The question is, do I keep increasing the dose until the weird feeling in my head goes away? Or do I stay PUT at a dose until I restabilize? I tried going back to 2.0625 mg, and that didn't seem to work, so now I'm back at 2.125 mg. The funny feeling in my head still hasn't gone away.

 

I don't want to keep increasing the dose like I did earlier this year, because that resulted in so, so much misery, and took six months to get back to where I was.

 

So should I just stay put at 2.125 mg until things straighten out? Will it eventually straighten out if I stay put? Or will the withdrawal symptoms get worse if I don't increase the dose?

 

I know it's impossible for anyone to magically have the answers to these questions, but it seems like there should be some science to this process, like for instance, does staying at one dose for awhile eventually build the medicine up in your system and relieve withdrawal symptoms? I know, sometimes it does, sometimes it doesn't. Aren't there alternatives to increasing the dose every single day?

 

Thanks.

[Petunia]

Hi Mkat71,

 

I don't have a lot of experience with tapering anti-psychotics, but from what I have learned about tapering in general and from advice in your thread specifically, it seems its just as important to hold long enough after a dosage change as it is to find the next best dose.

 

How about 2.10mg? It looks like you are adept at measuring precisely, there is a huge range of dosages between 2.15mg and 1.9375mg.

Because you got destabilized, 1.9375mg may not be the sweet spot it once was. There is no reason to make it a goal. Listen to your body and make very small careful changes to find your next sweet spot. Then hold for a while.

 

 

I would stay at least a week at 2.125mg. Actually, I would stay at that dosage a lot longer, since it seems you got destabilized. Your nervous system needs a break from dosage changes.

It seems you are now very sensitive to dosage decreases. This calls for even smaller decreases and periodic holds.

 

Staying at 2.0625 mg for 4 days was nowhere near long enough to find out if you could stabilize there, after a cut, most people expect to have some increased symptoms for a while, 2 - 3 weeks is not unusual, sometimes even longer.

 

Now that you are back at 2.125mg, if it were me, I would stay there for several weeks and give your nervous system a chance to settle down again, the weird feeling in your head will probably go away as you begin to stabilize again, but it may take several weeks.

 

Here is our Risperdal tapering topic:

 

http://survivingantidepressants.org/index.php?/topic/1716-tips-for-tapering-off-risperdal-risperidone/?hl=risperdal

 

I hope you start to feel better again soon.

 

Petu.

[mkat71]

Thank you for the advice.

 

When I went back up to 2.125 mg several days ago, I split it up by taking 1.0625 mg in the morning and 1.0625 mg at night, in order to make it even in my system.

 

After four days at that configuration, it is starting to become very uncomfortable in my head, painful even. It's like there's pressure in my brain, a sort of "squeezing" sensation. It's hard to think or focus on my school work.

 

The last time I was at 2.125 mg, I split it up in the same way, and this same sensation happened. So I decided to shift some of the morning dose to the evening time. I took 1 mg in the morning and 1.125 mg at night, and that helped. That's what I did last time I was at this dose.

 

The question is, is taking more at night time than I take in the morning a good idea? Is the painful "squeezing" in my brain a sign that I am on too much medicine? Or should I just shift some of the morning dose to the evening to make it more tolerable, and hold at 2.125 mg for a while longer? How do I know when I am ready to go down to 2.0625 mg?

 

Thanks!

[mkat71]

Hello everyone.

 

I have some questions that I hope someone can help with. I have been holding steady at 2.0625 mg for a little more than two weeks now, and I'm having a hard time judging when I am ready for another drop. My usual approach is to wait until I am in torturous pain before reducing. When I am feeling a squeezing pressure in my head from the medicine, that is a sign that I am ready for a drop.

 

After more than two weeks at the same dose, I think I am beginning to feel that old pressure in my head. The problem is, I'm not entirely sure whether this pressure is from too much medicine, or not enough. I don't think after two weeks of stability I would suddenly start to experience withdrawal, but I could be wrong.

 

Complicating matters is the fact that I am dividing my medicine into two daily doses, 1 mg in the morning and 1.0625 mg in the evening. By doing this, I can't tell what the right dose times are. Here are the questions:

 

-Does it matter what time in the morning and evening I take the medicine? 

 

-After taking a dose (morning or evening), does it reach its peak and begin to wear off 12 hours later, or 24 hours later?

 

-How do I tell whether I am experiencing peak drug time (too much medicine) or wear off time (too little medicine)?

 

-Is it possible that after more than two weeks of stability I am experiencing withdrawal, or is it more likely that I am beginning to be ready for a drop?

 

Thank you all. I appreciate any advice you can give me.

[Altostrata]

If you are very sensitive to dosage changes -- which you are -- making sure you take the drug at the same time every day can make a big difference.

 

Risperidone has an estimated half-life of 20 hours, but there can be a lot of variability. If you take it steadily over about 4 days, the amounts in your bloodstream overlap to a "steady state." However, a very sensitive person might feel the effects when the "steady state" is at its lowest point, which would be right before a dose is due.

 

After you take it, risperdone takes about 1-3 hours to reach "peak plasma." You might feel the effects then, too.

[mkat71]

Thanks Alto.

 

I just took my evening dose about four hours ago, and I took 1 mg instead of 1.0625 mg. Over the last several days I've been becoming more and more emotionally numb, and I wonder if that's a sign that I'm ready for a drop.

 

Anyway, I took my dose just a few hours ago, and I'm already feeling a weird feeling in my head. I'm pretty sure the feeling will go away if I take .0625 mg, but I'm hesitant to do that. It's been almost three weeks at 2.0625 mg, and I'm becoming emotionally flatlined, right before the holidays. I am absolutely fed up. I don't understand why my brain won't cooperate. How long am I going to have to stay at 2.0625 mg? How many more life experiences have to be ruined because I can't emotionally feel them?

 

I understand experiencing withdrawal the day or the morning after taking a dose, but three or four hours after? I don't think this has happened before. I don't understand what's going on.

 

What's a good way to tell whether one should tough out a few minor symptoms to get to a lower dose, or go back up and stay steady for a while longer? Is my increasing emotional numbness a sign I am ready for a drop?

 

Thanks.

[Altostrata]

Yes, you are very sensitive to dosage changes.

 

The only way you can tell if a withdrawal symptom is temporary is to stick with the lowered dose for a few days.

 

It's possible taking just a smidgeon extra will help you get over the symptom hump. When we're talking in terms of a .0625mg decrease, a smidgeon would be maybe .02mg.

[mkat71]

Hi everyone...

 

I've now been at 2.0625 mg of Risperdal for almost a month now, more than a month if you don't consider the brief attempts to drop down to 2 mg on a couple of occasions over the last two months. I never know whether I have to start all over after a failed attempt to drop. Does a failed attempt to drop destabilize my brain enough that I have to set the calendar back to the beginning again? If not, I've been at 2.0625 mg for two months.

 

Anyway, it's been at least one month, and I don't know when to make a drop. Generally I like to wait to make a drop until I am feeling physical discomfort from the medicine. That's usually the sign I go by. However, it's been a month, and I'm still not feeling much physical discomfort. I've been stable for a long time, and I keep waiting for the uncomfortable pressure in my head to start so I can make another drop.

 

Is that what I should wait for? Or should I try to make a drop anyway? If my attempt fails, do I have to set the calendar back to the beginning and start from scratch?

 

Thanks everyone.

[Petunia]

If you have been at that dose for over a month and have been without symptoms, then its probably safe to make another 10% cut.  If symptoms return after the cut and don't subside after several weeks then you can updose slightly, you don't have to start from scratch.

 

Now that your dose is lower and you are becoming more stabilized, you might not experience uncomfortable head pressure.  Please let us know what you decide to do.

[mkat71]

Hi guys...

 

I decided to make a cut from 2.0625 mg down to 2 mg last night. So far so good. The only thing I'm worried about is that I didn't quite make it to my usual dose time this morning. Yesterday I took 1 mg in the morning at about 8 am, then instead of my usual 1.0625 mg at 8 pm, I took 1 mg. This morning I felt the need to take my morning 1 mg at 7:30 am instead of 8 am.

 

Is that a bad sign? Should I have been able to make it to my usual morning dose time? Or is it possible that there will be a period of adjustment that will sort itself out?

 

Thanks so much!

[Altostrata]

It's going to take about 4 days for the decrease to fully register. If you feel you need to take your morning dose earlier and earlier, that could be a sign you've gone too far.

[mkat71]

Thank you.

 

If I decide that going down to 2 mg was premature, and I go back to 2.0625 mg to give it a while longer, am I going to have to start the calendar over and stay at that dose for another month? If I hadn't attempted a cut I probably only needed to give it another week. Have I destabilized my brain by going down to 2 mg for just one day? Do I have to start over?

[Altostrata]

You'd do well to let it stabilize. How long depends on what your body tells you.

 

If you take your morning dose earlier, do you need to take your evening dose earlier as well?

[mkat71]

Somehow I made it to my evening dose roughly on time, although a bit early. However, I couldn't sleep very well, and I woke up at 3 am, so I took two fragments to make up for what I missed, and today I plan on going back to 2.0625 mg. I don't think I was quite ready for a cut, but I was pretty close, because I was starting to feel pressure in my head. I should have waited another week. Now who knows how long I have to wait. I think I need to be really suffering physically before making a cut.

 

This is so maddening. I was at that dose for two months, if you don't count the two attempts to cut I made during that time. I was at that dose for a full month without any changes, though. I don't understand why my brain is so resistant to change. My frustration is compounded by the fact that the new school semester starts today, and my passion and energy are still squashed. That's not good when studying music. I have no choice but to do it anyway, because this taper will take years.

 

Concerning listening to what my body tells me, what are some of the signs you and others go by to determine when you're ready for a cut?

[mkat71]

Ok, this taper is going nowhere. If you don't count the occasional brief (failed) attempts to drop, I've been at the same dose (2.0625 mg) for more than two months. I've been stable throughout that time. I've been taking 1 mg at 8 in the morning and 1.0625 mg at 8 in the evening. Every time I try to drop the evening dose from 1.0625 mg to 1 mg, I don't feel right. An hour after leaving off the .0625 mg fragment, I have a funny feeling in my head, and if I barrel through, I wake up before my morning dose time feeling like I need to take medicine.

 

What is going on? Why can't I make this drop? Maybe I should wait until I'm feeling pain in my head before making the drop. I'm starting to feel pain, but I don't know if it's enough pain. I don't know how to tell how much pain is the right amount. I am becoming more and more emotionally numb from the medicine. I don't know if that's a sign that I'm ready to make a drop or not.

 

I'm having a terrible time knowing what sorts of physical and mental signs or signals to be aware of before making a drop. I know my body should "tell me" when it's ready to make a drop, but I don't know how to listen, or what to listen for! Blistering pain? Emotional deadening? What are the signs that say I'm ready for a drop?

 

Can anybody help? Thanks.

[Petunia]

Hi mkat71,

 

I will try and help, but I'm not experienced with tapering atypical antipsychotic meds and there may be some differences I'm not aware of, hopefully someone who is more experienced in this area will chime in.

 

I've been at the same dose (2.0625 mg) for more than two months. I've been stable throughout that time. ...

 

I know my body should "tell me" when it's ready to make a drop, but I don't know how to listen, or what to listen for! Blistering pain? Emotional deadening? What are the signs that say I'm ready for a drop?

 

Can anybody help? Thanks.

 

Unless there is a significant difference between tapering an anti-psychotic and tapering an SSRI, the signs to look for when deciding if its time to reduce the dose is an absence of symptoms or a significant, consistent reduction of symptoms.  Ideally, you should return to feeling like you did before you started to taper, as long as you were stable before the taper was started and you weren't having adverse effects from the drug.

 

So giving what you have written, you are ready to make a reduction because you have been stable, if by stable, you mean generally free from symptoms or unpleasant sensations.

 

What often happens when the dose is then cut, is a temporary re-appearance of symptoms, or unpleasant sensations.  There may be no symptoms, mild symptoms or moderate symptoms. But over time, maybe days or up to several weeks, those symptoms should slowly reduce until you are back at a stable state, like you were before the cut.  Once again, this is the point you are looking for, when you know you are ready for another reduction.

 

It sounds to me like you have been making a cut and then experiencing the normal effects of dose reduction.  I would say that waking up earlier and feeling uncomfortable is a symptom of a recent cut.  If you give it a few days, your body may adjust and this will slowly go away.  You might wake up earlier and feel uncomfortable for a while, but you could occupy yourself with a pleasant activity until its the proper time to take your dose.

 

You are supposed to feel symptoms right after making a cut.  You are not supposed to wait for symptoms to make a cut.

 

Hopefully, someone with more experience will be able to confirm this.  I hope we can get this sorted out for you soon.

 

Petu.

[Altostrata]

Holding for 2 months in your situation is not an excessively long time. You may wish to give your nervous system a break and hold for 6 months.

 

A lot of people find the last leg of going off an antipsychotic is the most difficult.

 

Please don't be impatient, it seems your nervous system is finally fairly calm. If you've tried decreases and they've been too much, just continue to hold for a while.

[mkat71]

Holding for 2 months in your situation is not an excessively long time. You may wish to give your nervous system a break and hold for 6 months.

 

A lot of people find the last leg of going off an antipsychotic is the most difficult.

 

Please don't be impatient, it seems your nervous system is finally fairly calm. If you've tried decreases and they've been too much, just continue to hold for a while.

 

Thank you for that. The problem with holding is I am beginning to feel adverse effects from too much medicine. I am increasingly emotionally numb, which is affecting my schoolwork, my mood, and my state of mind. I am also beginning to feel physical discomfort from the medicine. Shouldn't I take that into account?

[Altostrata]

Yes, it is important.

 

As Petu said, usually people wait until they feel better before making a decrease. You are one of our few taperers who decrease when they feel more adverse effects of the drug. It's hard to know what to do in those situations.

 

Perhaps make a decrease of less than .0625mg?

 

I've asked Edted to drop by and add his 2 cents.

[mkat71]

Thanks Alto. Do you have any suggestions as to how to split a quarter of a .25 mg pill (.0625 mg)? I've been having a hard time cutting that quarter fragment in half. Am I going to need to invest in a scale to do this, or are there other ways?

[Altostrata]

I think a compounding pharmacy, to make up custom capsules, would be your best bet.

[mkat71]

I think a compounding pharmacy, to make up custom capsules, would be your best bet.

 

Is there a previous thread that explains custom capsules, and how to use and measure them? I've never heard of this before.

[mkat71]

Sorry, I think I understand about the custom capsules. I called a local compounding pharmacy and he explained it to me. I would just need to decide what strength to make the capsules. Perhaps half of .0625 mg? .03125 mg? It might be difficult to know what strength to make the capsules.