Marsha: can I taper off geodon before gabapentin?

[Marsha]

marsha-preparing-for-my-librium-taper

 

Hi. I hope I'm in the right place because antipsychotic drugs and antidepressants and benzodiazepines have caused permanent brain damage and I have trouble navigating on this sight. Is it possible to taper off geodon before gabapentin? I have read in the Road Back Program that I must taper off gabapentin and clonazepam before I can finish tapering off geodon.

 

I am terrified of antipsychotic drugs. I want to get off it after I finish tapering off clonazepam. I successfully completed tapering off trazodone and propranolol and have tapered the clonazepam to 1 mg and have tapered the geodon down to 80 mgs.

 

I was misdiagnosed as having schizophrenia and now am working with a team of doctors to taper me slowly off the drugs that robbed me of my memory and pleasure and motivation. I am desperate to get off these terrible drugs. Especially the clonazepam and geodon. I'm tapering off slowly the clonazepam right now.

 

I have read that if you taper off geodon before gabapentin and clonazepam it increases the clearance time of clonazepam and gabapentin by as much as 50% causing you to go into clonazepam and gabapentin withdrawal even without lowering the dosage of the clonazepam and gabapentin.

 

However, I have also read in the book "Psychiatric Drug Withdrawal" by Peter breggin md that you should make it a priority to get off the antipsychotic drug first especially if you are non psychotic. My doctor thinks I can just stop taking the geodon but I know that is wrong. I appreciate any help you can give me.

Edited January 7, 2019 by ChessieCat
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[mammaP]

Hi Marsha, welcome to SA. First we need a few more details if you can provide them for us.  When did you start each of the drugs and what are the doses? It will help us if you can list them in your signature strip, along with any previous drugs and tapers. You can find how to do that here. http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/?view=getnewpost

 

We do not recommend the road back programmes here, we recommend slow tapers and do not sell or advertise any particular supplements supplements, although we do recommend magnesium and fish oil as they help with withdrawal symptoms, but where they are bought and which brand is personal choice. 

 

When we have those details we will be be able to help you decide which drug to taper first. 

[Marsha]

Hi I added my recent drug withdrawal history. Of course, it is not a complete history. I have been on several antipsychotic drugs, antidepressants and xanax before clonazepam. Is my drug history in my signature sufficient or should I add more? Just want to know if I can taper geodon before gabapentin? I appreciate any help you can give me.

[Meimeiquest]

Everyone is different, but generally it is recommended by this forum to go off the benzo (clonazepam) last, unless you have a particular issue or concern.

[Meimeiquest]

I think both Geodon and clonazepam use the same cytochrome P450 isoenzyme for part of the drug metabolism process. This happens often when patients are on multiple drugs. So, yes, if an enzyme system has less work, it can break down the remaining chemical faster. But that will be true no matter which drug you taper first. I believe it happened to me, but it's impossible to know for sure. That is the benefit of going slowly, it gives your system time to adjust to all the changes. But being aware of it can help you not panic when a drop feels worse than you expected....there is just more shifting going on than just that drug.

[Marsha]

Because of having been prescribed benzodiazepines since 1997 and the link to dementia my psychiatrist and addiction Dr have made it a priority to taper off the clonazepam first. Then I should be able to taper the geodon since geodon and gabapentin do not metabolise through the same common cyp pathways. I am planning to reduce the geodon 10 mgs and see how that goes for a month. If successful, will taper another 10 mgs for a month and continue that tapering schedule until off. Then tackle the gabapentin. If I have any insomnia issues, I will make smaller reductions. Does that sound like a safe tapering plan?

[Meimeiquest]

No wonder with such a high Klonopin dose! My opinion (I'm not a mod) is that almost anything works as long as you go slowly. All your present drugs are sedating "brakes." Where you can get into serious trouble is in taking away the "brakes" with "accelerators" (antidepressants or stimulants) still at full doses. But even that can be survived. I did that, not knowing any better. Anyway, your plan sounds fine to me. Plus it helps to follow the doctor's advise when it is reasonable.

[Altostrata]

Welcome, Marsha.

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.
 

If I understand you, you are planning to taper clonazepam and Geodon at the same time? And you've also reduced your gabapentin dosage? When did you do that? How long has it taken for you to go from 8mg clonazepam to 1.25mg?

 

It can take some time for your nervous system to accommodate to drug changes. The upset of drug changes can make your nervous system vulnerable to withdrawal syndrome. In addition, making changes simultaneously in more than one drug at once clouds the picture should you develop withdrawal symptoms.

 

Slow tapering should help control the accelerating clearance problem.

 

You say you're "working with a team of doctors to taper me slowly off the drugs" -- what do they mean by slowly? What kind of taper schedules are they using? What's their rationale for changing dosages of multiple drugs at once?

 

Do any of the others have a plan for your going off Geodon?

 

Why didn't any of your doctors realize the drug-drug conflicts at the time the drugs were prescribed?

 

See

[Marsha]

Hello Altostrata. Thank you so much for responding to my questions. There is an interaction between geodon and gabapentin and clonazepam. It is a moderate drug interaction. The clonazepam and gabapentin increase the effects of the geodon. I also take levothyroxin and prevacid but no interaction exists for those two drugs. I am not tapering clonazepam and geodon together. I am only tapering clonazepam. So should I actually be tapering the geodon first? I was put on these drugs by an unethical psychiatrist. I managed to get out of his control last August. I was c/t off clonazepam 8 mgs in February of 2013 but reinstated 2 mgs. Have been tapering 1/4 mg every three weeks since the end of March this year with the help of an addiction Dr. My new psychiatrist says when I get down to 1/2 mg and stabilized then I should start to taper the rest of the geodon. He said yesterday that I could taper 20 mgs at a time until off. He left the length of time on each taper up to me. I think that 20 mgs is too much due to the increased clearance of the clonazepam and gabapentin. I would rather taper 10 mgs every three weeks. But I will do 20 mgs if I have to. He has pretty much left it up to me how fast and how much. No one else has made any tapering suggestions regarding the geodon. The geodon causes moderate akathisia at 80 mgs. Unbearable at higher doses. I know I will feel better if I can get off geodon. I feel that it is causing me to be anxious because of it's antidepressant properties. Please if you can offer your insights, I would be most appreciative.

[Fresh]

Hi Marsha ,   welcome.

There are a couple of threads you should read: "Why Taper by 10%' in Tapering and "What is Withdrawal Syndrome"

in Symptoms and Self Care.

 

Best wishes ,  Fresh

[Petunia]

Hi Marsha,

If it were me I would taper in this order, first geodon, then gabapentin and the clonazepam last.

 

Please see:  Why Taper By 10% of My Dosage?

 

Taking multiple psych drugs? Which drug to taper first?

Guides to tapering off psychiatric medications

Important topics in the Tapering forum and FAQ

 

 

[Altostrata]

Marsha, I'm sure you can tell that psychiatrist you'd rather go slower than risk withdrawal syndrome.

 

I agree, you may wish to hold on the clonazepam now and reduce the Geodon.

 

A brand-name oral suspension (liquid, 10 mg/mL oral suspension) for Geodon is available, that would make it easier to taper.

 

Other than that, you could make your own, see How to make a liquid from tablets or capsules

[Marsha]

Thank you Fresh, Petunia and Altostrata. I will stop tapering the clonazepam and finish tapering off geodon before gabapentin and clonazepam. Since geodon comes in a capsule I should be able to weigh out 10% of the 80 mg capsule with a milligram scale. Does that sound reasonable? Thank you so much everyone for sharing your experience and knowledge of how to taper off these terrible drugs. My psychiatrist is supportive and has allowed me to choose which drug to taper first and also the gradual 10% taper. I'm very happy to have found this site and I will continue to need help. I hopefully will be able to help someone else someday. I am very grateful.

[Altostrata]

You can weigh the powder from the capsule, but tapering with a liquid is easier.

 

Good to hear your psychiatrist is helping. If he seems to catch on to gradual tapering, perhaps at some point you can recommend him here http://tinyurl.com/7cp8l8v

[Marsha]

Hello Altostrata. I am afraid. My psychiatrist wants me to taper from 80mgs to 60 mgs and then 40 mgs and stop the geodon. I am not going to do it that way. I ordered a milligram scale and am going to taper by 10%. I have been trying to reach Dr Stephen Balt to take over but he hasn't responded to my messages yet. I know I can do this but I am still very scared. I'm afraid of the clearance problem of the benzodiazepine and gabapentin. Will I be okay?

[Altostrata]

What do you mean about the clearance problem?

 

Your doctor should be working with you. If he's intimidating you into doing something you don't want to do, you need a new doctor.

 

Any doctor can prescribe these drugs, it doesn't have to be a psychiatrist.

[Marsha]

I am going to find a new doctor who will work with me to slowly taper off the geodon. The clearance problem I'm talking about is that if you are taking multiple medications sharing the same cyp pathway to metabolize aren't you supposed to reduce the the medication that uses the fewest pathways first? If I reduce the geodon before the clonazepam and gabapentin then I would go into clonazepam and gabapentin withdrawal without their dosages being reduced. But I got off trazodone before gabapentin and clonazepam and was ok. But the psychiatrist and addiction Dr wanted me to reduce geodon 20 mgs from 80mgs or 25%! I had terrible withdrawal symptoms. Anxiety, panic attacks, sweating, insomnia. If I reduce by 8mgs or 10% will this handle the clearance problem? Also the psychiatrist said that tapering for extended periods less than 80 mgs will cause akathisia. I think he's wrong about everything. I'm finding new doctors. I appreciate any feedback you can give.

[Altostrata]

Finding a doctor who will help reduce gradually is difficult. See http://tinyurl.com/7cp8l8v

 

About the drugs affecting each others' metabolism:

Please check the CYP table for all your drugs (info http://survivingantidepressants.org/index.php?/topic/1466-flockhart-cytochrome-p450-drug-interaction-table/);table here http://medicine.iupui.edu/clinpharm/ddis/clinical-table/ and post the results in this topic.

 

I need to know which P450 cyp is involved for each, for example, buproprion substrate 2B6. This is in the gray bar in the P50 Drug Interaction table. Substrates and inhibitors are most germane.

[Marsha]

Hello Altostrata. Here is what I could find regarding the P450 enzyme pathways. Lansoprazole 2C19. Geodon 1A2, 3A, Aldehyde oxidase substrate. Librium 3A, CYP3A4. Neurontin SLC22A4-OCTN1. I could not find anything for levothyroxin but I'm not going to taper off it. Can you tell from this which one I should be tapering?

[Altostrata]

Please put Librium, a benzo, in your signature, with dosages of all your drugs.

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and copy and paste the results in this topic.

 

This is what I found:

 

Librium (Chlordiazepoxide) http://www.drugbank.ca/drugs/DB00475
P-glycoprotein substrate

CYP450 3A4 substrate

CYP450 1A2 inhibitor

CYP450 3A4 inhibitor

CYP450 high inhibitory promiscuity

 

Please do the same for each of your drugs by looking at http://drugbank.ca, look at the ADMET section. List the substrates, inhibitors, and CYP450 inhibitory promiscuity.

 

Here is Neurontin (gabapentin) http://www.drugbank.ca/drugs/DB00996

[Marsha]

How do I revise my signature?

[Marsha]

I figured out how to edit my signature.

[Altostrata]

Please put Librium, a benzo, in your signature, with dosages of all your drugs.

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and copy and paste the results in this topic.

 

This is what I found:

 

Librium (Chlordiazepoxide) http://www.drugbank.ca/drugs/DB00475

P-glycoprotein substrate

CYP450 3A4 substrate

CYP450 1A2 inhibitor

CYP450 3A4 inhibitor

CYP450 high inhibitory promiscuity

 

Please do the same for each of your drugs by looking at http://drugbank.ca, look at the ADMET section. List the substrates, inhibitors, and CYP450 inhibitory promiscuity.

 

Here is Neurontin (gabapentin) http://www.drugbank.ca/drugs/DB00996

[Marsha]

Hello Altostrata. Ok signature revised. Drug P450 enzyme pathways:

Librium (Chlordiazepoxide)

CYP450 3A4 substrate

CYP450 1A2 inhibitor

CYP450 inhibitor

CYP450 high inhibitory promiscuity

P-glycoprotein substrate

 

Neurontin (gabapentin)

CYP450 2C9 Non-substrate

 

CYP450 2D6 Non-substrate

CYP450 3A4 Non-substrate

CYP450 1A2 Non-inhibitor

CYP450 2C9 Non-inhibitor

CYP450 2D6 Non-inhibitor

CYP450 2C19 Non-inhibitor

CYP450 3A4 Non-inhibitor

CYP450 Low CYP inhibitory promiscuity

 

Geodon (ziprasidone)

CYP450 2C9 Non-substrate

CYP450 2D6 Non-substrate

CYP450 3A4 Substrate

CYP450 1A2 Inhibitor

CYP450 2C9 Inhibitor

CYP450 2D6 Non-inhibitor

CYP450 2C19 Inhibitor

CYP450 3A4 Non-inhibitor

CYP450 High CYP Inhibitory Promiscuity

P-glycoprotein substrate

P-glycoprotein I inhibitor

P-glycoprotein I I inhibitor

Renal organic cation transporter inhibitor

 

 

Lansoprazole (prevacid)

CYP450 2C9 Non-substrate

CYP450 2D6 Non-substrate

CYP450 3A4 Substrate

CYP450 1A2 Inhibitor

CYP450 2C9 Non-inhibitor

CYP450 2D6 Inhibitor

CYP450 2C19 Inhibitor

CYP450 3A4 Inhibitor

CYP450 High CYP Inhibitory Promiscuity

P-glycoprotein inhibitor I inhibitor

Renal organic cation transporter inhibitor

 

Levothyroxine

CYP450 2C9 Non-substrate

CYP450 2D6 Non-substrate

CYP450 3A4 Non-substrate

CYP450 1A2 Non-inhibitor

CYP450 2C9 Non-inhibitor

CYP450 2D6 Non-inhibitor

CYP450 2C19 Non-inhibitor

CYP450 3A4 Non-inhibitor

CYP450 Low CYP inhibitory promiscuity

 

I don't know how to copy and paste. But moderate drug interaction exist between geodon and gabapentin and librium.

[Marsha]

Would it be possible to taper the geodon 10% until I get to 60 mgs and then taper the librium and alternate between the two. Because I don't know if the librium and gabapentin are what is allowing me to sleep. I just feel like I want to just stop the geodon just to get off it. I am so anxious about it. Does anyone know about this situation? I appreciate any feedback.

[Altostrata]

Yes, it is possible to do that.

 

Why are you taking Prevacid? That's in there complicating things. As you can see, "the clearance problem" is not simple. The Road Back is not a good source for tapering information.

 

What are your current symptoms?

[Marsha]

My current symptoms are anxiety about getting off geodon. I have memory loss from benzodiazepines and probably geodon too as well as gabapentin. I gained 100 lbs from taking zyprexa. I had heartburn after I gained weight and was put on prevacid. Then I was switched to geodon and am now down to a weight where I don't need it anymore. I need to take control and tell the doctors how I am going to taper. What about eliminating the prevacid? I am quite sure that the librium and gabapentin are what is allowing me to sleep because the geodon is not sedating. So I really need to taper the geodon. If I don't start the geodon taper yet can I stop taking the prevacid? Then how long would I wait to begin the geodon taper? Thank you so much for taking the time to help me Altostrata.

[Marsha]

I meant to say I'm down to a weight where I don't need prevacid anymore.

[Altostrata]

Yes, I would take the Prevacid out of the picture.

 

It needs to be tapered, but it's not as difficult as other drugs, see Tips for tapering off stomach acid blockers or PPIs...

[Marsha]

Sorry Altostrata. I didn't understand that I was sending directly to you. I will have to taper to 15 mgs. I have a month supply. Then stop. I tried to pull apart the prevacid capsule and the beads were very small and I couldn't get them back into the capsule. It collapsed.

[Meimeiquest]

I buy empty capsules from Amazon. Between water suspensions and empty capsules, I can divide most anything that is not extended-release.

[Marsha]

Read the information about tapering PPI'S and readthe part about B12 deficiency. I have tried to use B12 but find it too stimulating. Is there a B12 that is non stimulating available?

[Altostrata]

When you open the capsule, open it over a creased piece of paper or a bowl so you don't lose the beads.

[Iamfine]

Hi. I hope I'm in the right place because antipsychotic drugs and antidepressants and benzodiazepines have caused permanent brain damage and I have trouble navigating on this sight. Is it possible to taper off geodon before gabapentin? I have read in the Road Back Program that I must taper off gabapentin and clonazepam before I can finish tapering off geodon. I am terrified of antipsychotic drugs. I want to get off it after I finish tapering off clonazepam. I successfully completed tapering off trazodone and propranolol and have tapered the clonazepam to 1 mg and have tapered the geodon down to 80 mgs. I was misdiagnosed as having schizophrenia and now am working with a team of doctors to taper me slowly off the drugs that robbed me of my memory and pleasure and motivation. I am desperate to get off these terrible drugs. Especially the clonazepam and geodon. I'm tapering off slowly the clonazepam right now. I have read that if you taper off geodon before gabapentin and clonazepam it increases the clearance time of clonazepam and gabapentin by as much as 50% causing you to go into clonazepam and gabapentin withdrawal even without lowering the dosage of the clonazepam and gabapentin. However, I have also read in the book "Psychiatric Drug Withdrawal" by Peter breggin md that you should make it a priority to get off the antipsychotic drug first especially if you are non psychotic. My doctor thinks I can just stop taking the geodon but I know that is wrong. I appreciate any help you can give me.

I have been on Geodon for about a year- 160 mg down to 40. It works for me so I think I will go off it last, if at all. I can't answer your question specifically but I cold turkeyed off Clonazepam with little trouble, it was making me feel worse so I was happy to see it go. I just got out my pills one day and said to myself why do I take you if you make me feel bad, and I never looked back. I don't recommend this for anyone else though, I think I was just lucky. You have done well, keep your head up and keep up the good fight.

[Marsha]

Well I don't know what is happening to me. I reduced the prevacid from 30 mgs to 15 mgs yesterday morning and by the afternoon I was having anxiety and by 8 o'clock pm I was having panic attacks. Could it be that I am still feeling the transition from clonazepam to librium? Clonazepam withdrawal? It might be too soon to start to taper anything else. Also the benzodiazepines dose conversion is only approximate. I might actually be in a clonazepam/librium taper and should wait another two weeks or more to taper the prevacid. I only made the clonazepam change to librium two weeks ago and started at 50 mgs of librium and after a week had panic attacks and the addiction Dr increased it to 75 mgs. What is going on. Does anyone have any information about this or can provide a link or something? Thank you for any help you can give.

[Altostrata]

Marsha, that is too much of a reduction of the Prevacid. It is also involved in "clearance."