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mmcdonald21

Hey,

 

I've been trying to get off medications for a while now, to no avail. I'm currently on 30mg Remeron, 300mg Effexor, and 10mg Abilify. I also take a lot of vitamins and fish oil with a high concentration of EPA. I don't feel very good right now, and I've had periods where I've felt good, but I'm pretty sure they were just times that were flukes. I think the things that really help me are exercise, meditation, and to some degree, my vitamins and fish oil, but I really do want to get off of the medications. For over four years I've been reliant on these medications, and still I haven't felt very good at all during the time. I started getting off of my medications by taking 75mg less of the Effexor XR (I was on 375mg). I will report back how that goes. Any tips or advice would be much appreciated.

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mammaP

Hi mmacdonald, welcome to SA.  That is a really high dose of Effexor and I am not surprised you don't feel well! 

 Can you give us some specific doses and date so we can figure the best advice for you?

 

When did you start to taper effexor and what dose are you at now?  300mg is a very high dose, I don't think

I've seen anyone on a dose that high before and and it makes me shudder! Just 37.5 made me so ill I was

housebound for years.

Is it effexor XR? (venlafaxine) or the rapid release?  

 

Here at SA we recommend tapering one med at a time and usually the antidepressant first.  We suggest no

more than 10% drop in the current dose to ensure a safe and reasonably pain free taper. Once I started 

tapering I felt better and better with each drop. 

 

Here are some links to topics you will need to read to get an understanding of the best way to taper.

 

Tapering effexor http://survivingantidepressants.org/index.php?/topic/272-tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine/

 

Tapering remeron http://survivingantidepressants.org/index.php?/topic/5301-tips-for-tapering-off-remeron-mirtazapine/

 

Tapering abilify   http://survivingantidepressants.org/index.php?/topic/1896-tips-for-tapering-off-abilify-aripiprazole/?hl=abilify

 

Why taper 10% http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/?view=findpost&p=44456&hl=abilify

 

Lastly, it would help us if you can put your drug history in your signature strip,  you can click

the link in my signature and it will  explain how to do that. 

It's good that you found us at the start of your taper and hopefully we will be able to support you through 

a slow and safe taper that will see you off those drugs in time.  

It seems like a very long drawn out process and most people want off NOW, but it really is best to go slowly,

you just have to read a few experiences in the introductions forum to see the devastation a too fast taper can cause! 

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Rhiannon

Hi, and welcome.

 

You can get off your meds, and we can help you do that. It's probably going to take longer than you expect, to do it safely and successfully, given the dosages that you're on and the fact that you're on multiple meds.  It's best to start on the slow side and just see how your body is going to respond; if you're one of the lucky folks who can go faster, you'll find that out, and you can speed up. 

 

It sounds like you've tried to come off in the past and had to go back on. If you go slowly enough, you'll be able to keep tapering and not have to go back on meds. Many of us have been in your situation.

 

75 mg off of 375 mg is a big drop. We would have recommended 37.5, which is 10%. If you find yourself having withdrawal symptoms, you might go back up to 337.5 for a while until you're stable and then taper down from there.

 

But sometimes at those really high doses people can get away with the bigger cuts. Hopefully you'll be okay.

 

Besides the links mammaP posted, once you've looked those over, let me suggest that you go to the Tapering page and read through the topics "pinned" there. Check out the links in the Important Topics section.

 

There's a lot of material here, a couple of books' worth probably, that we've accumulated over time and with lots of experience actually working with hundreds and hundreds of people tapering. It's worth taking the time to read and think and absorb.

 

Again, welcome, and best of luck to you in every way.

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mmcdonald21

Hey thanks for the responses. Sorry, I haven't been on this site for a while.

 

Should I ask my doctor to prescribe 37.5mg pills, or how should I go about reducing by 37.5mg?

 

Thanks - and I'm on the extended-release versions of Effexor. I also ordered a milligram scale in the mail and that should be here soon. I'm currently on 375mg Effexor XR, 30mg mirtazapine, and 10mg abilify. Experiencing low sex drive, as well as feeling somewhat apathetic. I just quit caffeine as well, and that has actually surprisingly helped a lot! My mind is feeling a lot clearer, but I want to still taper off of my psych meds.

 

Thanks.

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Lexy

Welcome

Please do as the moderators say, they have a lo of experience.  I wish I had learned of this site before cutting my dose in half. Now I'm suffering for it.

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Karma

Check out the link that MammaP provided on tapering effexor - it has guidance about how you can manage reducing your dosage: http://survivingantidepressants.org/index.php?/topic/272-tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine/

 

If you are taking capsules with beads inside, you can break open the capsule and count out the beads.  If the capsules are 75 mg, then you remove half the beads.  You can get empty capsules and place the beads you removed in an empty capsule so you don't waste any of your med.  If you have tablets, you can cut a 75 mg tablet in half to get to 37.5 mg.

 

For what it's worth - I was on 375 mg of Effexor at one time.  I am now down to 12 mg ... you read that correctly, just 12 mg.  I work a full-time, demanding job and still find that I can find calm and balance in my life and enjoy things around me.  I don't feel that way all the time, but I find it often enough that it keeps me going.  I just want to give you hope and encourage you.  I think you will find that as you slowly work your way off of Effexor you will be able to feel better.

 

The key is to go slow enough for your own body to adapt.

 

Karma

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mmcdonald21

That is awesome. Congrats on being on such a low dose!

 

My doctor just called me today wondering why I want to go off of meds. He quoted something like there's a 90% chance of me having a recurrence of symptoms in the next couple months. I was wondering if that's really true or not.

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Altostrata

Welcome, mm.

 

Your doctor is incorrect, but that's what they've been telling people for years.

 

Any doctor can prescribe psychiatric drugs. You may wish to work with one with whom you can better communicate.

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mmcdonald21

Hey guys,

 

I am back after a few years. I am still on medication. I am wondering how to get off of it (again).

 

I currently take 487.5 mg of Effexor XR, 45 mg mirtazapine, 30 mg Abilify, and 2 mg risperidone.

 

I was thinking about initiating a taper of the Effexor XR first by 37.5 mg, so my new dose would be 450 mg.

 

I am also going to try to find a different doctor who will actually help me through this process instead of leaving me behind when I want to initiate the withdrawal from medication. That's because last time I tried to withdraw he basically told me there was a very high chance of psychiatric relapse, etc. But actually what ended up happening is I went off of the medicine cold turkey, then a few months later I did actually start having psychiatric symptoms again. Then I was forced to go back on meds again, basically.

 

I guess this time I will not go off cold turkey. Anyway, just wanted to say I'm back, and wanting some guidance again.

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ChessieCat

Hi mm and welcome back.

 

Please put all the drugs you take in the Drug Interactions Checker and copy and paste the results here in your Intro topic.

 

You might find these links helpful:

 

Before you begin tapering what you need to know

 

Important topics in the Tapering forum and FAQ

 

Why taper by 10% of my dosage?

 

How do you talk to a doctor about tapering and withdrawal?


What should I expect from my doctor about withdrawal symptoms?

 

I found these have helped me to understand SA's recommendations:

 

Brain Remodelling


Video:  Healing From Antidepressants - Patterns of Recovery

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mmcdonald21
aripiprazole
mirtazapine
olanzapine
Effexor XR (venlafaxine)

Interactions between your selected drugs

Major

venlafaxine  mirtazapine

Applies to: Effexor XR (venlafaxine), mirtazapine

Using venlafaxine together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

venlafaxine  aripiprazole

Applies to: Effexor XR (venlafaxine), aripiprazole

Using venlafaxine together with ARIPiprazole may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

venlafaxine  olanzapine

Applies to: Effexor XR (venlafaxine), olanzapine

Using venlafaxine together with OLANZapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

mirtazapine  aripiprazole

Applies to: mirtazapine, aripiprazole

Using mirtazapine together with ARIPiprazole may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

olanzapine  aripiprazole

Applies to: olanzapine, aripiprazole

Using OLANZapine together with ARIPiprazole may increase side effects such as drowsiness, blurred vision, dry mouth, heat intolerance, flushing, decreased sweating, difficulty urinating, abdominal cramping, constipation, irregular heartbeat, confusion, and memory problems. Side effects may be more likely to occur in the elderly or those with a debilitating condition. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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mmcdonald21

Anyway, I am going to reduce the Effexor XR 487.5 mg to 450 mg (and leave everything else the same). 

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ChessieCat

Hi mcdonald,

 

That sounds like a good place and dose to start.  From:  about-going-off-mirtazapine-plus-venlafaxine-effexor-aka-california-rocket-fuel

 

 

"If you are taking this combination, you probably will want to taper the Effexor first with the hope that the remaining mirtazapine will maintain sleep.

 

See 
 
Why taper by 10% of my dosage?
 
Taking multiple psych drugs? Which drug to taper first?
 
Tips for tapering off Effexor (venlafaxine)
 
Also see Tips for tapering off Remeron (mirtazapine) for background"

 

 

Please update your signature whenever you make a change so that it remains current and we can see it at a glance.  Account Settings – Create or Edit a signature.

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mmcdonald21

Do you guys have any tips on sticking to the tapering philosophy? I have so much trouble sticking to it. My two desires: either go off of medicines completely (cold-turkey), or extol the virtues of medicine and stay on them the rest of my life. It's just hard for me to stick to the tapering philosophy. I have trouble sticking to it I think because I'm a little on the impulsive side. But I know that medicine is bad for me. And, for me, it's really tough to not have the impulse to go cold-turkey off of the drugs because I want to be off immediately, etc. Thus, any advice on how to just stay the course and go off of the medicine gradually instead of just taking it all away at once? I really have tons of trouble convincing myself of this. Thanks.

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baroquep

Hi there, Going cold turkey is a role of the dice and a recipe for disaster.  Withdrawal symptoms may resolve in a few months, or you may be suffering terribly for years and even become disabled.  I am currently tapering Effexor XR and I wouldn't wish withdrawal on my worst enemy.  It is not something you can push through or tough out and the effects on your central nervous system could last for many many years.  You would be wise to taper responsibly so that your central nervous system has adequate time to adjust to each decrease so you can minimize withdrawal symptoms and lead a normal life in the meantime.  I would encourage you to read the links below as well as visit the Tapering Forum to gain some insight as to why a slow and careful tapering recommendation is made at Surviving Antidepressants so that you can make an informed decision.

 

Ultimately it is your decision as to how you wish to discontinue these drugs, but if it were my brain, I would take whatever steps were necessary to ensure that I am making an educated decision when it comes to matters of my health and mental well-being.  

 

Why taper by 10% of my dosage?

Why taper paper: dose-occupancy curves
Icarus Project - Harm Reduction Guide to Coming Off Psychiatric Drugs
 

 

 

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mmcdonald21

Thanks for the reply. I am not going to go cold turkey again since I have in the past and it has ended in disaster. Thus, as I mentioned before, I am doing a 37.5 mg cut of Effexor XR first and am going to see how that goes.

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mmcdonald21

Hey, I am trying to get off of medicine, but I keep making changes too fast, I believe, and my problem is I cannot stick to them when I make changes. Is there any way you all know to trust the process and go with the tapering process instead of cold turkey-ing repeatedly? I am also in school right now, making it extremely difficult to go off of the drugs. (College). And my family doesn't want me to go off of the drugs either. Is there anything you all know of to help me stick to the process and get off of these awful medications? I just can't stay disciplined with it.

 

Another thing is that I kind of do feel bad after I make changes. This seems to be an inevitable piece of withdrawal, but then I start doubting that I should go off medicine in general and sometimes end up taking the full amount that I'm prescribed again.

 

Any help is appreciated...

 

It's also really difficult for me to be productive when I've made any changes to my medicines. I don't know why this is, necessarily. But I just can't attend to the basic things in my life like getting schoolwork done and things like that when I'm trying to go off of medicine at the same time.

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bheb

Hi mmcdonald. I'm also in college so I feel you there. And *also* have a hard time being patient...constantly feel like I'm standing by and watching my condition get worse. 

 

The only way I know to trust is by reading other threads and learning about experiences with holding.

 

You feel worse with what changes? Tapering? I think people here would say that's an indication you should hold at your dose or reduce at an even smaller percentage. Also, there's no shame in staying on the drug at present if you think it's best. Tapering might be something you do after grad. 

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baroquep

Hi mmcdonald21, Sorry that you are finding tapering so difficult.  You mention in your post above that you feel bad after making changes and then go back up to the full amount of your dose.  The central nervous system craves stability and it is in your best interest to take the same amount of the drug everyday and make as few changes to your dose (with the exception of when you are tapering) so that your CNS can become acclimated to the change over a period of time.  I'm not sure how much you have tried tapering in the past, but it may be that it was too high a percentage than is recommended here and you might want to try smaller reductions in order to lessen the severity of the symptoms.    

 

Your idea to concentrate on reducing Effexor first and to taper by 37.5mg is a good plan as it is less than 10% of your current dose.  For your future, you need to make a long-term plan for tapering and stick with it through what might sometimes be uncomfortable symptoms rather than increasing back up to your regular dose.  Every time you make a change, your central nervous system has to readjust to the change and if not done carefully and cautiously it can put you in a precarious situation.  The last thing you want to do is destabilize your central nervous system and the reason Surviving Antidepressants recommends tapering by no more than 10% of your current dose with at least a four week hold in-between decreases.  This is a harm reduction approach to going off of psychiatric drugs and if your desire is to discontinue these drugs, it's best to approach it with the utmost concern for your physical and emotional safety.  It is never recommended to cold turkey off of any of the drugs you are currently taking and you could put your health at risk if you aren't careful.

As well, as bheb mentioned, there is no shame in staying on any of the drugs that you are currently taking if this isn't the best time to start tapering, but I think it might be a good idea for you to consider reducing your drug burden to a more reasonable level ... 487.5mg of Effexor is a hefty dose, especially considering you are on a number of other drugs as well.  When done carefully, it is possible to safely withdrawal off of these drugs with as few symptoms as possible so that you can live your day-to-day life without too much disruption.  

 

4 hours ago, mmcdonald21 said:

Another thing is that I kind of do feel bad after I make changes. This seems to be an inevitable piece of withdrawal, but then I start doubting that I should go off medicine in general and sometimes end up taking the full amount that I'm prescribed again.

 

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mmcdonald21

Anyone have any ideas on how to go down on Zyprexa? I am currently taking 15 mg of it.

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ChessieCat

What drugs are you currently taking and at what doses?

 

What reductions/increases have you made this year?

 

It will depend on what drug changes you have made this year whether it is a good idea to taper now.

 

Please update your drug signature using the following format.   Keep it simple.  NO diagnoses or symptoms please - thank you.

  • details for last 2 years - dates, ALL drugs, doses
  • summary for older than 2 years - just years and drug/s

Account Settings – Create or Edit a signature

 

 

Tips for tapering off olanzapine (Zyprexa)

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mmcdonald21
Posted (edited)

I have updated my drug history in my signature.

 

Right now I am taking Zyprexa 7.5 mg, Abilify 30 mg, Effexor XR 450 mg, Remeron 45 mg, and Xanax 0.5 mg 3x per day.

 

I haven't made a significant amount of drug changes in the past year. I did move to a foreign country about 7 months ago. But I feel pretty stable right now.

 

The next move my doctor wants to make is lowering the Zyprexa to 5 mg. I am wondering if that is too fast, or also how I'm going to convince him that tapering is a good idea.

 

Edited by ChessieCat
removed quote

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ChessieCat

Drug interaction check:  Zyprexa Abilify Effexor Remeron Xanax

 

From https://reference.medscape.com/drug-interactionchecker

Monitor Closely

  • venlafaxine + aripiprazole

    venlafaxine, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

  • venlafaxine + olanzapine

    venlafaxine, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

  • venlafaxine + mirtazapine

    venlafaxine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • venlafaxine + aripiprazole

    venlafaxine will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

  • aripiprazole + olanzapine

    aripiprazole and olanzapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

  • alprazolam + aripiprazole

    alprazolam and aripiprazole both increase sedation. Use Caution/Monitor.

  • alprazolam + olanzapine

    alprazolam and olanzapine both increase sedation. Use Caution/Monitor.

  • alprazolam + mirtazapine

    alprazolam and mirtazapine both increase sedation. Use Caution/Monitor.

  • aripiprazole + olanzapine

    aripiprazole and olanzapine both increase sedation. Use Caution/Monitor.

  • aripiprazole + mirtazapine

    aripiprazole and mirtazapine both increase sedation. Use Caution/Monitor.

  • olanzapine + mirtazapine

    olanzapine and mirtazapine both increase sedation. Use Caution/Monitor.

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ChessieCat

From https://www.drugs.com/drug_interactions.html

Drug Interaction Report

This report displays the potential drug interactions for the following 5 drugs:

  • Zyprexa (olanzapine)
  • Abilify (aripiprazole)
  • Effexor (venlafaxine)
  • Remeron (mirtazapine)
  • Xanax (alprazolam)
 
Major (1)
Moderate (9)
Minor (0)
Food (5)
Therapeutic Duplication (4)

Interactions between your drugs

Major

venlafaxine mirtazapine

Applies to: Effexor (venlafaxine), Remeron (mirtazapine)

Using venlafaxine together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

ALPRAZolam venlafaxine

Applies to: Xanax (alprazolam), Effexor (venlafaxine)

Using ALPRAZolam together with venlafaxine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

mirtazapine ARIPiprazole

Applies to: Remeron (mirtazapine), Abilify (aripiprazole)

Using mirtazapine together with ARIPiprazole may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

mirtazapine OLANZapine

Applies to: Remeron (mirtazapine), Zyprexa (olanzapine)

Using OLANZapine together with mirtazapine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

venlafaxine ARIPiprazole

Applies to: Effexor (venlafaxine), Abilify (aripiprazole)

Using venlafaxine together with ARIPiprazole may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

venlafaxine OLANZapine

Applies to: Effexor (venlafaxine), Zyprexa (olanzapine)

Using OLANZapine together with venlafaxine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

ALPRAZolam ARIPiprazole

Applies to: Xanax (alprazolam), Abilify (aripiprazole)

Using ALPRAZolam together with ARIPiprazole may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

ALPRAZolam OLANZapine

Applies to: Xanax (alprazolam), Zyprexa (olanzapine)

OLANZapine should not be used with ALPRAZolam without first talking to your doctor. This combination may cause low blood pressure or slow heart rate. Low blood pressure can cause dizziness or feeling like you might pass out, especially when getting up from a sitting or lying position. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

ALPRAZolam mirtazapine

Applies to: Xanax (alprazolam), Remeron (mirtazapine)

Using ALPRAZolam together with mirtazapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

OLANZapine ARIPiprazole

Applies to: Zyprexa (olanzapine), Abilify (aripiprazole)

Using OLANZapine together with ARIPiprazole may increase side effects such as drowsiness, blurred vision, dry mouth, heat intolerance, flushing, decreased sweating, difficulty urinating, abdominal cramping, constipation, irregular heartbeat, confusion, and memory problems. Side effects may be more likely to occur in the elderly or those with a debilitating condition. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

No other interactions were found between your selected drugs. This does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

ALPRAZolam food

Applies to: Xanax (alprazolam)

Grapefruit and grapefruit juice may interact with ALPRAZolam and lead to potentially dangerous side effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor. Do not drink alcohol while taking ALPRAZolam. This medication can increase the effects of alcohol. You may feel more drowsy, dizzy, or tired if you take ALPRAZolam with alcohol. Talk to your doctor or pharmacist if you have any questions or concerns.

 

Moderate

venlafaxine food

Applies to: Effexor (venlafaxine)

Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with venlafaxine. Do not use more than the recommended dose of venlafaxine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

 

Moderate

mirtazapine food

Applies to: Remeron (mirtazapine)

Alcohol can increase the nervous system side effects of mirtazapine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with mirtazapine. Do not use more than the recommended dose of mirtazapine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

 

Moderate

OLANZapine food

Applies to: Zyprexa (olanzapine)

Alcohol can increase the nervous system side effects of OLANZapine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with OLANZapine. Do not use more than the recommended dose of OLANZapine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

 

Moderate

ARIPiprazole food

Applies to: Abilify (aripiprazole)

Alcohol can increase the nervous system side effects of ARIPiprazole such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with ARIPiprazole. Do not use more than the recommended dose of ARIPiprazole, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

 

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes five medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

  • Zyprexa (olanzapine)
  • Abilify (aripiprazole)
  • Effexor (venlafaxine)
  • Remeron (mirtazapine)
  • Xanax (alprazolam)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

Duplication

Psychotropic agents

Therapeutic duplication

The recommended maximum number of medicines in the 'psychotropic agents' category to be taken concurrently is usually three. Your list includes five medicines belonging to the 'psychotropic agents' category:

  • Zyprexa (olanzapine)
  • Abilify (aripiprazole)
  • Effexor (venlafaxine)
  • Remeron (mirtazapine)
  • Xanax (alprazolam)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

  • Effexor (venlafaxine)
  • Remeron (mirtazapine)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

Duplication

Antipsychotics

Therapeutic duplication

The recommended maximum number of medicines in the 'antipsychotics' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antipsychotics' category:

  • Zyprexa (olanzapine)
  • Abilify (aripiprazole)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

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ChessieCat

I will ask the other mods for their assistance.

 

We need to know your current symptoms and see if they follow any pattern related to time you take your drug.

 

Please post 3 consecutive days of daily symptoms notes:

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

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Altostrata

mmcdonald21, what times of day do you take your drugs, and their dosages? We need to see your symptom pattern before and after you take the drugs, throughout the day.

 

Did you see the drug interaction report? Do you have any of those interactions?

 

What is your drug cocktail supposed to fix?

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mmcdonald21

Hi everyone, sorry for the lateness on this, I sometimes get off and on this site.

 

So, morning, I take 300 mg venlafaxine extended release. Also in the morning, I take 0.5 mg Xanax, 30 mg aripiprazole, and 2.5 mg of Zyprexa.

 

Early afternoon, I take 150 mg venlafaxine extended release, and 0.5 mg Xanax.

 

Late afternoon, I take 0.5 mg Xanax.

 

At nighttime, I take 30 mg mirtazapine, and 7.5 mg Zyprexa.

 

I just feel incredibly lost as to what to do! I do have a tremor. So that's not good. I know that's not good and I know I've had said tremor for some time!

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Altostrata
On 8/22/2019 at 10:44 AM, Altostrata said:

mmcdonald21, what times of day do you take your drugs, and their dosages? We need to see your symptom pattern before and after you take the drugs, throughout the day.

 

Did you see the drug interaction report? Do you have any of those interactions?

 

What is your drug cocktail supposed to fix?

 

Please include times of day (such as 10:30 a.m.), drugs, dosages, symptoms in your daily notes.

 

Please answer all questions from the staff, we need this information to understand what's going on.

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mmcdonald21

Sept. 13:

8:00 AM: woke up tired with tremor. Woke up disoriented as well. This usually happens. Took 300 mg Effexor XR, 30 mg Abilify, 2.5 Zyprexa, 0.5 mg Xanax. Tremor continued as usual. Also anxiety present before drinking coffee.

8:20 AM: Coffee (black) ingested. 

2:00 PM: took 0.5 mg Xanax and 150 mg Effexor XR.

6:00 PM: took 0.5 mg Xanax.

9:00 PM: ate dinner. Had a coffee at dinner along with some ice cream after.

12:00 AM: took 30 mg Remeron and 7.5 mg Zyprexa. Fell right asleep after taking this combo.

 

Sept. 14:

 

6:00 AM: woke up tired and with a bit of a tremor. Woke up disoriented. Took 300 mg Effexor XR, 30 mg Abilify, 2.5 mg Zyprexa, 0.5 mg Xanax. Tremor continued. 

6:20 AM: drank a cup of black coffee, tremor got worse. 

8:00 AM: ate breakfast with another large cup of black coffee (tremor continued). Still moderately tired at this hour.

9:00 AM: my class started. I felt depersonalized during class.

10:30 AM: took a break from class. Had another cup of coffee (black).

1:00 PM: took 0.5 mg Xanax and Effexor XR 150 mg. Also lunch break. Had a large lunch with another cup of black coffee.

5:00 PM: class over. Went home a little exhausted still.

6:00 PM: took a nap. Felt bad upon getting up (anxious and disoriented).

7:00 PM: took another Xanax 0.5 mg.

9:00 PM: ate a very large dinner. Included two glasses of wine. Had an espresso after dinner.

12:00 AM: Had a raging headache and took 1000 mg Tylenol. Seemed to get rid of the headache.

1:30 AM: took 30 mg Remeron and 7.5 mg Zyprexa. The combination of these meds knocks me out. Fell asleep.

 

Sept. 15:

 

10:40 AM: woke up tired. Woke up disoriented and slightly depressed and anxious as well. Mild tremor present upon waking up. Took 300 mg Effexor XR, 30 mg Abilify, 2.5 mg Zyprexa, 0.5 mg Xanax. Tremor continued as usual.

11:00 AM: drank a cup of black coffee, tremor worsened.

1:00 PM: had some food (brunch). Also had another cup of black coffee. Also took my 0.5 mg Xanax and 150 mg of Effexor XR.

3:00 PM: went home and took a nap of about 2 hours. Felt anxious after waking up.

5:30 PM: had another cup of black coffee. 

7:00 PM: tremor is bad still. Also feel slightly nauseous.

 

I saw the drug interaction report. I think alcohol definitely makes me impaired more than normal whenever I drink alcohol on this combo.

 

Also, the tremor might be potential serotonin syndrome, though I'm not sure. That's a little scary.

 

My drug cocktail is supposed to fix psychotic symptoms like delusions and depression and anxiety.

 

 

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ChessieCat
11 hours ago, mmcdonald21 said:

6:20 AM: drank a cup of black coffee, tremor got worse.

 

11 hours ago, mmcdonald21 said:

11:00 AM: drank a cup of black coffee, tremor worsened.

 

caffeine-in-coffee-or-tea-tolerance-issues

 

Looks like you are drinking 2 to 3 cups a day.  If you do decide to eliminate caffeine it would be better to do this gradually.

 

11 hours ago, mmcdonald21 said:

9:00 PM: ate a very large dinner. Included two glasses of wine.

 

11 hours ago, mmcdonald21 said:

I think alcohol definitely makes me impaired more than normal whenever I drink alcohol on this combo.

 

alcohol-and-beer

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