mkat71: Liquid risperidone

[Altostrata]

This is a common tapering technique.

I added this to http://survivingantidepressants.org/index.php?/topic/1716-tips-for-tapering-off-risperdal-risperidone/
 

Compounding pharmacies can crush the tablets and put the powder into smaller capsules by weight. You will need a doctor's prescription for this telling the pharmacy exactly how much to put in a capsule and how many capsules to make.

See http://survivingantidepressants.org/index.php?/topic/1425-compounding-pharmacies-us-uk-and-elsewhere/

 

[Altostrata]

mkat, you will need to decide how much to put in a capsule. I don't know what will work for you. .03125mg might be a place to start, or even less.

[mkat71]

Hi everyone. I'm going to see my "doctor" on Friday, and I will ask him then if I can have a prescription to take to a compounding pharmacy to make some custom capsules. I will probably make them for .03 mg. That's a little more than half of .0625 mg (quarter of a .25 mg pill), which is what I've been trying to reduce by for awhile now, without a great deal of success.

 

Actually, I tried to go from 2.0625 mg to 2 mg on Friday, and I may have finally made it. It's been five days now at 2 mg, and my sleep is ok and I'm making it to dose times (twice a day). It was a bit bumpy the first couple of days, but it seems to have settled. I still don't feel quite right yet, but hopefully that will get better.

 

I probably shouldn't have done this, but the morning after my first day at 2 mg I woke up early at 4 am (dose time is at 8 am), and I was worried I wouldn't make it to dose time, so I took a .5 mg tablet of Ativan to get me to dose time. I fell back asleep and made it to dose time. The next day I woke up early again, but fell back asleep without an Ativan. Now I'm sleeping fine and making it to dose time without any extra pharmaceutical assistance. However, since I'm still not feeling quite right, and have a bit of a spacey feeling in my head, I'm a little worried that using an Ativan to "get over the hump" of the med cut may have been a bad idea.

 

If I needed an Ativan to get to that first dose time after dropping to 2 mg, does that mean I made too big of a drop? Do I need to updose now, or should I just wait another few days or a week to see how things pan out?

 

Thanks everyone!

[mkat71]

bump

[Altostrata]

It's not a crime to take an occasional Ativan to get over the hump, as you did.

 

You may wish to hold for a while, since this last change was such a bear.

 

What works, works. Good for you.

[mkat71]

Hello all...this is my eighth day at 2 mg Risperdal, down from 2.0625 mg (as approximate as that can get with a pill cutter). I'm stable, sleeping fine, and making it to each dose time. However, I feel even more listless and lifeless than I did before the drop, and it doesn't seem to be clearing up. I also have a sort of spacious, spacey feeling in my head. All this makes me wonder whether I made too big a cut.

 

Does anybody else feel like this after a cut, and does it usually fix itself after a while? Or do any of you end up updosing a bit?

 

Thanks.

[Altostrata]

Sounds like you're weathering this cut. Be patient, mkat.

[mkat71]

Hi everyone. It seemed that my brain and body told me Sunday that I was ready for another cut, so on Monday I took approximately 1.9375 mg (as close as I can get with a pill cutter) instead of the 2 mg I was on for 17 days. After a bit of a bumpy day yesterday it seems to be leveling out today.

 

My only concern is with the spacing of the two doses I'm taking. I have my two daily dose times set at 8 am and 8 pm. The question I have is, if the morning dose is less than the evening dose, am I going to need to take my evening dose earlier? I've got my dose times exactly twelve hours apart. If the morning dose is .9375 mg, and the evening dose is 1 mg, should I expect the need to take the evening dose earlier? Or should I keep the evening dose at 8 pm, no matter how I feel?

 

Do any of you have experience with tapering while splitting dose times to twice a day? I kind of want to keep the evening dose at 1 mg for a long time, while slowly reducing the morning dose until it is gone. Is it better instead to go back and forth between lowering morning and evening doses in tandem, or perhaps reduce them both equally together?

 

Thanks! (By the way, I'm still waiting for my doctor to call in a prescription for some custom capsules of .03125 mg. I would have preferred to wait to get those capsules before making another cut, but I needed to go ahead and make the cut, so I had to cut by approximately .0625 mg instead. I hope that wasn't too much.)

[Altostrata]

Since you're so sensitive, mkat, it seems you'll have to listen to your body to answer those questions.

 

Hopefully, after a few days the transition will be smooth.

[mkat71]

But generally speaking, when reducing the dose of a medicine being taken twice a day, should one keep the dose times the same, even though the respective amounts of medicine may be different?

 

I know if I was only taking one dose per 24 hours I would want to keep the dose time the same, even after a cut. I assume that same rule applies to taking two doses 12 hours apart, right?

[Altostrata]

It depends. If the drug helps you sleep, you might want to take a little more at night than in the morning. If the drug keeps you awake, you might want to take a little less at night than in the morning.

 

In your case, it seems if the dosage isn't just right, you'll feel it. This may be the only way to figure out how to divide your doses.

[mkat71]

Thank you! That helps me regarding how to divide the amounts I'm taking, but I'm still confused as to when to take the two doses. Should I be firm about keeping the dose times 12 hours apart, at 8 in the morning and 8 in the evening, even if I'm taking less in the morning? Or should I be flexible with dose times? I thought that it was important to always keep the time of day that we take our doses the same.

 

(Sorry for being dense, I just get confused when dividing doses into twice a day instead of once. Thanks again.)

[mkat71]

Thank you! That helps me regarding how to divide the amounts I'm taking, but I'm still confused as to when to take the two doses. Should I be firm about keeping the dose times 12 hours apart, at 8 in the morning and 8 in the evening, even if I'm taking less in the morning? Or should I be flexible with dose times? I thought that it was important to always keep the time of day that we take our doses the same.

 

(Sorry for being dense, I just get confused when dividing doses into twice a day instead of once. Thanks again.)

 

bump

[Altostrata]

Given how sensitive you are, it would be best for you to be very regular and systematic with your dosing.

 

I can't tell you exactly when to take your doses, you'll have to negotiate that with your nervous system. Try taking them 12 hours apart for a week and see how that works.

[mkat71]

Hi everyone. For a few weeks now I've been using custom capsules (made at a compounding pharmacy) to fine-tune my taper cuts, and that seems to be helping a lot. I'm finding that I'm a lot more stable now between cuts, now that I'm not cutting pills, which is inherently inaccurate.

 

I think I may be able to make more frequent cuts now that I am working with small-increment capsules. I'm down to exactly 1.9375 mg, from the ~2.0625 mg I was at throughout the holidays. I'm using .03125 mg capsules at the moment, but I may eventually have to get smaller ones.

 

I find after making a cut that it takes me about four or five days to adjust, then I sleep fine and am virtually symptom free. I stayed at 1.96875 mg for one week (after 18 days at 2 mg), and didn't have too much problem getting down to 1.9375 mg this week. I've been at that dose since March 1st, and am now sleeping fine after a few bumpy days.

 

My concern now is how long to wait after achieving that stable state to make another cut. I know nobody here knows that, and that I have to listen to my body, but are there any general guidelines I should follow? Should I give myself at least a week of stability (after the adjustment period) before making another cut? (These are fairly small cuts, ~1.6%)

 

Thanks for your help!

[Altostrata]

I would take at least a week of stability before making another cut.

 

Good for you, you figured out a method that's working.

[mkat71]

Hi everyone. I've down to 1.8125 mg of risperidone from the 2.0625 mg I was on over the holidays. I've been making cuts of .03125 mg every 10-15 days, using custom capsules.

 

The latest cut I made was on Tuesday, so today is the fifth day at 1.8125 mg. I seem to be having a little trouble getting through the adjustment period. Usually after four or five days, withdrawal symptoms start clearing up, but that doesn't seem to be happening this time, and I'm wondering if I should go back to 1.84375 mg and hold for a bit. The reason I made the drop is I thought I was beginning to feel adverse effects from too much medicine. I was having trouble concentrating on my schoolwork, and was feeling pressure in my head. That was after 10 days at 1.84375 mg.

 

After making the cut to 1.8125 mg, I initially felt better, but now at the fifth day, I'm not feeling quite right. I'm really depressed, and I feel physical withdrawal sensations in my head. I'm also having trouble sleeping, but that could be from too much caffeine.

 

At five days, is it too early to go back up to my previous dose? Is it most likely that I'm still weathering this cut?

 

Thanks.

[Altostrata]

Sounds like you might reduce caffeine and see if that's the culprit. Give that experiment a few days at least.

 

Caffeine needs to be tapered or you'll get a wicked headache at the least.

[mkat71]

I had a little less caffeine today, but my low-energy state and general depression were bad enough that I experimented with taking an extra .03125 mg capsule of risperidone in the middle of the day, putting me back at 1.84375 mg instead of the 1.8125 mg that I've been at for five days. I theorized that if I started feeling better, it means that I should go back to my previous dose and hold for awhile.

 

I did temporarily start feeling better--better mood, more focus--but that wore off. So either that wasn't the answer, or I didn't take enough extra medicine. I don't know which it is. (My depression could also be circumstantial. I'm very frustrated at the slow progress of this taper and how much life I've lost, and am still losing. I've already lost almost a quarter of a century to psychiatry.)

 

Now I don't know whether to stick with 1.8125 mg or go back to 1.84375 mg. I had five full days at 1.8125 mg, but the withdrawal symptoms weren't getting much better. Perhaps I need to keep holding steady at that dose, and the symptoms will clear up. I never know at what point to stop trying to tough out withdrawal symptoms at one dose before going back to the previous dose.

 

Any words of wisdom? I'm inclined to hold steady at 1.8125 mg instead of going backwards, but I'm open to feedback from others who have more experience than me.

[Altostrata]

It sounds like possibly you're at such a low dose, it's getting metabolized faster and you're experiencing withdrawal when it does. You had this problem before, too.

 

How about dividing your dose into two doses 4 hours or so apart?

 

Or, I wonder if there's some kind of synergy with perphenazine or fluvoxamine http://www.drugs.com/ppa/perphenazine.html

 

http://www.drugs.com/interactions-check.php?drug_list=1832-0,2019-0

 

http://www.drugs.com/interactions-check.php?drug_list=1128-0,1832-0,2019-0

 

What was this combination of drugs supposed to do for you?

[mkat71]

Well, I do divide my dose into two doses 12 hours apart, one at 8 am and the other at 8 pm. I try to divide it roughly in half.

 

Originally (in 1991) I was prescribed antidepressants for a pretty mild case of OCD. No combination of any medication "cured" me like they led me to believe it would, so I was prescribed a benzo. When I was taken off clonazepam too quickly five years ago, the withdrawal anxiety was so severe that I became delusional, so they gave me neuroleptics. That's what the risperidone and perphenazine were for. The fluvoxamine was for the OCD.

 

Now that the withdrawal anxiety has calmed down, and I've had a lot of CBT, I'm slowly working my way off this stuff, because it's squashing my emotions. As a music major I can't tolerate that.

 

I've been thinking about holding the risperidone for awhile and switching to tapering the perphenazine or fluvoxamine, and maybe periodically switching between all three. That way I could make progress on other meds while keeping others steady.

 

I'm actually at a lower dose of risperidone (switched from Invega) than I have been for a couple of years, so things seem to be getting better.

 

It may be that I just need to go back up to 1.84375 mg and hold for another week or so.

[Altostrata]

It's possible you've run into the receptor occupancy problem Edted has described (look for his content).

 

In that case, I might reduce the fluvoxamine rather than perphenazine (it may affect the same receptors as risperidone).

[mkat71]

It's possible you've run into the receptor occupancy problem Edted has described (look for his content).

 

In that case, I might reduce the fluvoxamine rather than perphenazine (it may affect the same receptors as risperidone).

 

Thanks Alto. I'm still in the process of going through Edted's posts. In the meantime, I'm trying to decide whether to stick with the 1.84375 mg I went back up to today or go back to 1.8125 mg. I know if I do something I need to do it and stick with it, so I'm trying to do the right thing. Going back up today has caused a lot of uncomfortable pressure in my head, so I don't know if that was appropriate. Maybe that will wear off if I stick with it? On the other hand, the physical withdrawal and depression I was feeling at 1.8125 mg might have worn off if I had stuck with that.

 

I'll keep going through Edted's posts to see what worked for his son. Maybe this one day back at 1.84375 mg was enough, and I'm ready to go back to 1.8125 mg???

[Altostrata]

Are you feeling better now?

[mkat71]

I seem to be feeling better now, thanks so much! It seems that my one day going back up to 1.84375 mg on Sunday helped me make it back to 1.8125 mg the next day. I'm holding steady at that dose now without the depression. I finally got some sleep last night, too, which helped. Cutting back on caffeine a bit also seems to have helped.

[Altostrata]

mkat, you might find this discussion interesting http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

It's about receptor occupancy in SSRIs, but the curves might be applicable to risperidone as well -- the withdrawal curve is probably steeper.

[mkat71]

Very interesting, Alto. Thanks so much for that. I found the exact thing to be true for me: no problem dropping from high doses, but once I got below the minimum effective dose I started having a tough time withdrawing.

 

I am also finding that the lower I get, I need to not only divide my doses a couple of times a day, but I need to make the two doses as even and equal as possible. Last week I really started feeling the disparity between the two doses I was taking, and had to equalize them, or even them out. That may have been why I started feeling depression after five days at 1.8125 mg: the two doses I was taking each day were not divided equally. Either that or that one day back at 1.84375 mg allowed me to more comfortably make the transition to 1.8125 mg. Not sure which it is.

[Altostrata]

Curious. But glad it's working.

[mkat71]

Hi everyone. I've been doing very well with my risperidone taper using custom capsules. I'm down to 1.71875 mg from the ~2.0625 mg I was at over the holidays.

 

Having said that, I haven't had much relief from the emotional numbness and Parkinsonism caused by these dreadful neuroleptics (I'm on two.) I'm beginning to wonder if the second neuroleptic I'm taking--perphenazine--is a worse offender with regard to those symptoms. It's an old school neuroleptic, rather than the atypical, "newer generation" risperidone that I've been tapering from.

 

So I'm thinking about taking a break from tapering the risperidone, and start tapering the perphenazine. The obvious concern I have is what size increments to decrease by. It's a different drug, so I don't know how to equate it with risperidone.

 

I've found info that suggests that 8 mg perphenazine is equivalent to 2 mg risperidone. I'm on 4 mg perphenazine, so that would suggest it's equivalent to 1 mg risperidone. But 4 mg perphenazine seems to be the minimum effective dose of that drug, whereas 2 mg risperidone seems to be the minimum effective dose of that drug. So 4 mg perphenazine may not be like 1 mg risperidone.

 

Does anyone have any thoughts on neuroleptic equivalencies, and how to go about calculating them for tapering purposes? I went through an agonizing trial and error process of trying to find the right increment of risperidone to taper by. (.03125 mg) Am I going to have to go through that process with perphenazine, or can I simply calculate the equivalency and go from there?

 

Thank you all so much.

 

P.S. Or would it simply be easier to replace the perphenazine I am taking with an equivalent amount of risperidone, so I would be on one neuroleptic instead of two?

[mammaP]

Hi Mkat, glad you are doing well with your taper.  I'm afraid I haven't a clue about the 

perphenazine  but just wanted to say well done so far and bump your thread to the top for

someone more experienced  to see  

[Altostrata]

Yes, if I were you, I might hold the risperidone and reduce the perphenazine.

 

I don't think you can extrapolate from your experience with risperidone. Maybe try a cautious 5% reduction?

[mkat71]

Yes, if I were you, I might hold the risperidone and reduce the perphenazine.

 

I don't think you can extrapolate from your experience with risperidone. Maybe try a cautious 5% reduction?

 

Hi Alto. What I've been thinking of doing instead is replacing my perphenazine with an equivalent amount of risperidone, so I am on one neuroleptic. I think this might make things a lot simpler, and it might relieve a lot of my parkinsonian torment. 

 

Do you have any thoughts on this strategy?

[Altostrata]

I have no idea how that will work.

 

Dr. Purssey swapped an antipsychotic for acetyl and it seemed to go okay.

[mkat71]

I have no idea how that will work.

 

Dr. Purssey swapped an antipsychotic for acetyl and it seemed to go okay.

 

Since perphenazine and risperidone are both neuroleptics maybe it will be okay to substitute one for the other. When I first got ill after my benzo withdrawal I was on one neuroleptic, and it was no problem. (Until I cold turkey'd it.)

[Altostrata]

I don't know. They are both neuroleptics but different drugs with different effects on the neurons.

[mkat71]

Hello everyone...

 

Doing very well with my risperidone taper. Getting closer and closer to 1 mg, from the 2 mg I was at last year.

 

Because this is taking so long, I'm thinking about beginning to concurrently taper the 25 mg of fluvoxamine I'm also taking. I know it's not advisable to taper two drugs at once, but I think the fluvoxamine is affecting my libido, and I don't want to wait until I'm through tapering the risperidone (not to mention the perphenazine).

 

I've read the post about Luvox withdrawal, but it doesn't make clear to me what to do after reaching the "lowest effective dose," which I believe is 25 mg (my dose). It's easier to make bigger cuts at higher doses, but it's going to be much harder to taper from 25 mg. What confuses me about that post is that it suggests cutting a 25 mg pill into fourths, or 6.25 mg. That's a much greater percentage of 25 mg than 10%, which is what is usually recommended. I doubt that would work for me to make such a big cut.

 

If I'm going to pursue a concurrent fluvoxamine taper with my risperidone taper, do you recommend cutting the 25 mg pill into fourths, or going to my compounding pharmacy and getting something closer to 10%?

 

Thank you all for your help!