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Honingbij: tapering off Amitriptyline again


honingbij

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Hi everyone!

I'm here because I'm about to start to taper Amitriptyline 75 mg that I've been taking for my migraines.

This is not my first drug-tapering rodeo, but I'm still not looking forward to it.

I was first prescribed medication for my migraines in 2004. I was put on trials of amitriptyline, depakine and then topamax. None of these worked, and I had a severe reaction to the topamax that resulted in panic attacks, agoraphobia and suicidal ideation [i had a plan]. During this crisis, I was prescribed Ativan, but I became addicted to it after 8 weeks. I crossed over to Valium 10 mg and tapered off that in 7 months.

I was off all migraine preventative drugs for 6 years. Then my migraines started to become much more severe and frequent. After a lot of procrastination, I agreed to start Depakine again. Amitriptyline was added because I was having scalp allodynia – my hair and scalp always felt like it was on fire.

I tapered off the Depakine in 2013 because I was starting to feel very ill taking it and the side effects were becoming worse. I stayed on the amitriptyline and needed to increase the dose as my migraines and allodynia continued.

Last year, I tried to do a 10% taper of the amitriptyline, but was unsuccessful and needed to reinstate.

In the meantime, I started to do the program of Dr. David Buchholz, “Heal Your Headache”. Between the dietary prescriptions and the radical reduction of my migraine rescue remedies, my migraines became significantly better – less frequent and much less severe.

The funny thing is, now that my migraines are more under control, I feel quite well on the amitriptyline. The side effects – chronic constipation, chronic dry mouth and weight gain – are annoying, but manageable.

Nevertheless, I don't like the idea of being on it and would like to see if I can taper off it and still have good migraine control. If I don't, I'd rather try a calcium-channel blocker like verapamil or diltiazem.

Having done this before, however, doesn't make me any less apprehensive about starting the ordeal again.

I am planning to do a very slow taper this time, starting at a 2.5% taper and seeing how that goes. I also plan to do a liquid taper. I didn't know about this option in the past, but I think it will be ideal for me this time around

My plan is to begin next month. In the meantime, I am upping my supplements, getting my diet lower carb, so that I can get into ketosis, and preparing myself mentally for the long slog.

I do have a question: at the present, I am taking tablets for my daily dose.
Would it be preferable to start to take my doses of 75 mg as a liquid dose before I start the taper? Or is it advisable to continue with the tablets until I'm ready to start my first cut with a liquid dose?

Thanks for any counsel. I've been reading the forum for a few weeks now and already I have gotten so much information. Thank you for all you do!
 

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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  • Moderator Emeritus

Welcome Honingbij,

I'm glad you have found the site helpful so far, thank you for posting your history in your signature, that makes it easier to understand your circumstances.

 

It looks like you are well organized and have a good plan, I'm sure you will be successful this time.

 

You may have already seen it but here is our Amitriptyline tapering topic:   Tips for tapering off amitriptyline

 

Because you are planning on tapering slower than 10%, you may also find this topic helpful:  Micro-taper instead of 10% or 5% decrease

 

To answer your question about when to change to the liquid. If I were you I would change before you started decreasing and give yourself some time to adjust to the different formula. Sometimes switching to a liquid can cause a slight, temporary reaction, so its good to give yourself some time to stabilize from this, if it happens, before you start to taper.

 

Please feel free to write whenever you want, you will find a lot of friendly help and support here.

 

Petunia.

I'm not a doctor.  My comments are not medical advise. These are my opinions based on my own experience and what I've learned. Please discuss your situation with a medical practitioner who has knowledge of tapering and withdrawal...if you are lucky enough to find one.

My Introduction Thread

Full Drug and Withdrawal History

Brief Summary

Several SSRIs for 13 years starting 1997 (for mild to moderate partly situational anxiety) Xanax PRN ~ Various other drugs over the years for side effects

2 month 'taper' off Lexapro 2010

Short acute withdrawal, followed by 2 -3 months of improvement then delayed protracted withdrawal

DX ADHD followed by several years of stimulants and other drugs trying to manage increasing symptoms

Failed reinstatement of Lexapro and trial of Prozac (became suicidal)

May 2013 Found SA, learned about withdrawal, stopped taking drugs...healing begins.

Protracted withdrawal, with a very sensitized nervous system, slowly recovering as time passes

Supplements which have helped: Vitamin C, Magnesium, Taurine

Bad reactions: Many supplements but mostly fish oil and Vitamin D

June 2016 - Started daily juicing, mostly vegetables and lots of greens.

Aug 2016 - Oct 2016 Best window ever, felt almost completely recovered

Oct 2016 -Symptoms returned - bad days and less bad days.

April 2018 - No windows, but significant improvement, it feels like permanent full recovery is close.

VIDEO: Where did the chemical imbalance theory come from?



VIDEO: How are psychiatric diagnoses made?



VIDEO: Why do psychiatric drugs have withdrawal syndromes?



VIDEO: Can psychiatric drugs cause long-lasting negative effects?

VIDEO: Dr. Claire Weekes

 

 

 

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  • Moderator Emeritus

Welcome from me too.

 

In addition to all the very helpful information Petunia gave you I would just liek to check one more thing.

 

You say that you weren't successful in coming off the drug despite 10 % reductions. How often did you take make them? We advise waiting for at least 30 days between making cuts. Just wanted to check on that...

 

Best,

Bubble

Current: Xanax 0.26 (down from 2 mg in 2013), Lexapro 2.85 mg (down from 5 mg 2013)

Amitriptyline (tricyclic AD) and clonazepam for 3 months to treat headache in 1996 
1999. - present Xanax prn up to 3 mg.
2000-2005 Prozac CT twice, 2005-2010 Zoloft CT 3 times, 2010-2013 Escitalopram 10 mg
went from 2.5 to zero on 7 Aug 2013, bad crash 40 days after
reinstated to 5 mg Escitalopram 4Oct 2013 and holding liquid Xanax every 5 hours
28 Jan 2014 Xanax 1.9, 18 Apr  2015 1 mg,  25 June 2015 Lex 4.8, 6 Aug Lexapro 4.6, 1 Jan 2016 0.64  Xanax     9 month hold

24 Sept 2016 4.5 Lex, 17 Oct 4.4 Lex (Nov 0.63 Xanax, Dec 0.625 Xanax), 1 Jan 2017 4.3 Lex, 24 Jan 4.2, 5 Feb 4.1, 24 Mar 4 mg, 10 Apr 3.9 mg, May 3.85, June 3.8, July 3.75, 22 July 3.7, 15 Aug 3.65, 17 Sept 3.6, 1 Jan 2018 3.55, 19 Jan 3.5, 16 Mar 3.4, 14 Apr 3.3, 23 May 3.2, 16 June 3.15, 15 Jul 3.1, 31 Jul 3, 21 Aug 2.9 26 Sept 2.85, 14 Nov Xan 0.61, 1 Dec 0.59, 19 Dec 0.58, 4 Jan 0.565, 6 Feb 0.55, 20 Feb 0.535, 1 Mar 0.505, 10 Mar 0.475, 14 Mar 0.45, 4 Apr 0.415, 13 Apr 0.37, 21 Apr 0.33, 29 Apr 0.29, 10 May 0.27, 17 May 0.25, 28 May 0.22, 19 June 0.22, 21 Jun updose to 0.24, 24 Jun updose to 0.26

Supplements: Omega 3 + Vit E, Vit C, D, magnesium, Taurine, probiotic 

I'm not a medical professional. Any advice I give is based on my own experience and reading. 

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Hi Bubble:

 

Actually, I made only one cut [from 50 mg to 45 mg] but had strong symptoms immediately. They built up and by day 6, I had a big, 3 day migraine crisis. I just threw the towel in at that point and decided I would try again later. 

 

It was that experience that decided me on doing a slow liquid taper.

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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Thanks, Petunia for the welcome, advice and information. I'll do as you suggest. 

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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  • 3 years later...
  • Moderator Emeritus

Just noticed that you are online.  How are you doing these days?

 

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 27 Mar 2021:  Pristiq 0.295 mg

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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  • ChessieCat changed the title to Honingbij: tapering off Amitriptyline again
  • 1 year later...

Titled:  Having problems holding dose, 2 weeks doing microtaper

 

I have been using the micro-taper technique for several years, with a lot of success [2.5% drop every week]. I am tapering amitriptyline.

Recently, however, I have run into a curious problem.

When it comes time to hold my dose for the 2 weeks, I am having problems with symptom flare up.


I have few, if any symptoms in the first days of the taper. They start to increase in severity from  about day 10 on, so much so that I am having problems holding for the two weeks. I can't even get to the 14 days many times.

When I cut earlier than the 14 days, my symptoms often become better immediately. It seems my brain wants me to cut, even though I haven't been able to hold the dose for the recommended 2 week window.

There are times I would like to hold a dose for even longer, but I am not able to do this, because of the uptick in symptoms.  I didn't have problems doing this when tapering from a higher dose; I am noticing it as I get to the comparatively lower doses [presently 10.7 mg].

I would love to be able to let my brain rest at a dose for a time, but it seems it doesn't like it. I don't want to push it, but I'm really at a loss as to how to proceed. 

Does anyone have an explanation for this phenomenon? Where symptoms get worse instead of better with a tapering dose?

Has anyone else experienced this?

Any suggestions on how I might proceed?

Thanks in advance!



 

Edited by manymoretodays
merged to introduction, from tapering, added title

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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  • Moderator
manymoretodays

Hi honingbij and welcome back,  @honingbij

 

I found your most recent post and moved it from tapering, on back to your Introduction here.  This is like your Home page, and a good place to post your questions, around your case.  That way we've got your stuff all in one place too.  And welcome back too!

On 4/11/2020 at 4:16 AM, honingbij said:

When it comes time to hold my dose for the 2 weeks, I am having problems with symptom flare up.


I have few, if any symptoms in the first days of the taper. They start to increase in severity from  about day 10 on, so much so that I am having problems holding for the two weeks. I can't even get to the 14 days many times.

When I cut earlier than the 14 days, my symptoms often become better immediately. It seems my brain wants me to cut, even though I haven't been able to hold the dose for the recommended 2 week window.

There are times I would like to hold a dose for even longer, but I am not able to do this, because of the uptick in symptoms.  I didn't have problems doing this when tapering from a higher dose; I am noticing it as I get to the comparatively lower doses [presently 10.7 mg].

I would love to be able to let my brain rest at a dose for a time, but it seems it doesn't like it. I don't want to push it, but I'm really at a loss as to how to proceed. 

Does anyone have an explanation for this phenomenon? Where symptoms get worse instead of better with a tapering dose?

 

So, you are tapering the Amitriptyline still.  And thank you for updating your signature too!  Super.

 

Are you doing the brassmonkey slide method then.......where you basically taper 10% of your previous dose, but split it into 2.5 % tapers each week, for 4 weeks, and then HOLD for 2 weeks before resuming another taper?

The Brassmonkey Slide Method of Micro-tapering

 

Or just tapering 2.5% from each previous dose every 2 weeks?

What do you do when you can't HOLD the dose then?

And what kind of symptoms are you finding intolerable? 

This may help:

Dr. Glenmullens withdrawal symptom list

 

It may just be that you ARE tapering a bit fast.  Sometimes, over time all the previous taper reductions will catch up to us.  Or you may be getting to a more critical point, with the taper, and might need to taper even more cautiously.

 

Good, good that you are listening to your body.  And yes, sometimes, with a longer HOLD, you will actually re calibrate a bit, and your nervous system will have more time to adapt to the drug changes.  So, HOLDING longer is not always a bad thing.

 

Tell us a bit more.  I left a few questions for you too.

 

Best honing, L, P, H, and G,

mmt

Edited by manymoretodays
symptom list link, another ?

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016. 

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider. manymoretodays

 

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@manymoretodays:

Many thanks for your reply and thank you for moving my inquiry! I had a suspicion that I had put it in the incorrect place. My apologies! It has, indeed, been a long time since I've posted, and I forgot the procedure.

 

1 hour ago, manymoretodays said:

Or just tapering 2.5% from each previous dose every 2 weeks?

What do you do when you can't HOLD the dose then?

And what kind of symptoms are you finding intolerable? 

This may help:

Dr. Glenmullens withdrawal symptom list

 

I am tapering 2.5% from each previous dose every 7 -10 days for 4 weeks and then holding for 2 weeks. Have I been doing it incorrectly all this time? So, I should have been doing only 2 cuts per month, holding for 2 weeks each? 😱


What I am doing when I can't hold the dose is cut again, sometime a smaller amount. I don't like doing this, but I feel boxed in and don't know what the best thing to do is. I've had pretty smooth sailing up to this point, but it's starting to get tricky for me, that's why I am asking for advice.

Would you advise me to try the BrassMonkey method of 10% split into 2.5% over 4 weeks with a 2 week hold?

My big, big withdrawal symptom is migraines, which is why I started taking the amitriptyline in the first place. Occasionally, it's insomnia, but it's the increased number and intensity of the migraines that's giving me problems. The funny thing is, most of the time when I cut, my symptoms decrease and they get worse about day 10.

I use Dr. Glenmullens symptom list religiously!

I would love to hold a dose longer at times. It's clear to me that I need to change what I'm presently doing with my taper.

I might add that I am doing part of my dose in tablet form, and part of it in liquid. I had tried to convert to all liquid, but I had a lot of problems with it.

I appreciate any further advice, because I'm really stuck.


 

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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  • Administrator

If a 2.5% reduction every week has been working, why are you worrying about holding for 2 weeks?

 

On 4/11/2020 at 3:16 AM, honingbij said:

I have few, if any symptoms in the first days of the taper. They start to increase in severity from  about day 10 on, so much so that I am having problems holding for the two weeks. I can't even get to the 14 days many times.

When I cut earlier than the 14 days, my symptoms often become better immediately. It seems my brain wants me to cut, even though I haven't been able to hold the dose for the recommended 2 week window.

There are times I would like to hold a dose for even longer, but I am not able to do this, because of the uptick in symptoms.  I didn't have problems doing this when tapering from a higher dose; I am noticing it as I get to the comparatively lower doses [presently 10.7 mg].

 

On 4/13/2020 at 9:48 AM, honingbij said:

My big, big withdrawal symptom is migraines, which is why I started taking the amitriptyline in the first place. Occasionally, it's insomnia, but it's the increased number and intensity of the migraines that's giving me problems. The funny thing is, most of the time when I cut, my symptoms decrease and they get worse about day 10.

 

What symptoms get better for 10 days after a decrease? What symptoms get worse? Are you taking any other drugs?

 

Is your amitriptyline tablet immediate-release?

 

Amitriptyline and nortriptyline:
 

Quote

 

Nortriptyline is an active metabolite of amitriptyline by demethylation in the liver. Its pharmacologic profile is as the table to the right shows (inhibition or antagonism of all sites).[17][29]

Chemically, it is a secondary amine dibenzocycloheptene and pharmacologically it is classed as a first-generation antidepressant.[30]

These effects account for some therapeutic actions as well as for most side effects such as sedation, hypotension, anticholinergic effects, etc.[clarification needed] Nortriptyline may also have a sleep-improving effect due to antagonism of the H1 and 5-HT2A receptors.[31] In the short term, however, nortriptyline may disturb sleep due to its activating effect.

 

 

Nortriptyline has a half-life of about 18–44 hours (mean 30 hours). Amitriptyline has a half-life of about 20-25 hours.

 

This means that after you take one dose of amitriptyline, in a little while, it starts making nortriptyline. You initially feel effects from amitriptyline, then the active metabolite adds its effects as well. The two drugs overlap until the dose amitriptyline is fully metabolized, which takes about 6 x 20-25 hours or 5-6.25 days, then the nortriptyline effects take over. Nortriptyline is a stronger drug than amitriptyline.

 

Nortriptyline washes out in 6 x 18–44 hours or 4.5-11 days.

 

With nortriptyline, an active metabolite, a dose of amitriptyline has an effect over 20-44 hours. When you taper amitriptyline, you reduce both these drugs -- but the amount of amitriptyline in your bloodstream will lower at a faster rate than the nortriptyline, amitriptyline continually producing nortriptyline all the while.

 

My guess is when you reduce amitriptyline, you initially feel the benefit of less amitriptyline for 5-6.25 days, which is when the amount of amitriptyline gets lower in your blood level. However, as the amitriptyline goes lower, nortriptyline gradually dominates in your blood stream, which you feel a few days after the amitriptyline reduction settles. (If this theory is correct, you'd feel better for about a week after a reduction, then worse for about 4 days, then better 14 days after the reduction, when the nortriptyline bump has been metabolized.)

 

My guess is you're sensitive to nortriptyline. If so, reducing by 2.5% every week or 10 days makes sense -- with the continual reduction of amitriptyline, you are also reducing nortriptyline while benefiting from that 5-6.25 day holiday from amitriptyline.

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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41 minutes ago, Altostrata said:

If a 2.5% reduction every week has been working, why are you worrying about holding for 2 weeks?

 

I was trying to follow the microtaper schedule of cutting once a week for 4 weeks and then holding for 2 to give my brain a rest.

 

41 minutes ago, Altostrata said:

 

What symptoms get better for 10 days after a decrease? What symptoms get worse? Are you taking any other drugs?

 

My migraines and scalp allodynia get better after the decrease. Nothing else gets worse; these are really my only noticeable withdrawal symptoms.

I am also taking 5 mg of melatonin at bedtime, as prescribed by my migraine doctor. She said that research shows that migraineurs have lower levels of melatonin than non-migraineurs.

 

41 minutes ago, Altostrata said:

 

Is your amitriptyline tablet immediate-release?

Yes.

41 minutes ago, Altostrata said:

 

Amitriptyline and nortriptyline:
 

 

Nortriptyline has a half-life of about 18–44 hours (mean 30 hours). Amitriptyline has a half-life of about 20-25 hours.

 

This means that after you take one dose of amitriptyline, in a little while, it starts making nortriptyline. You initially feel effects from amitriptyline, then the active metabolite adds its effects as well. The two drugs overlap until the dose amitriptyline is fully metabolized, which takes about 6 x 20-25 hours or 5-6.25 days, then the nortriptyline effects take over. Nortriptyline is a stronger drug than amitriptyline.

 

Nortriptyline washes out in 6 x 18–44 hours or 4.5-11 days.

 

With nortriptyline, an active metabolite, a dose of amitriptyline has an effect over 20-44 hours. When you taper amitriptyline, you reduce both these drugs -- but the amount of amitriptyline in your bloodstream will lower at a faster rate than the nortriptyline, amitriptyline continually producing nortriptyline all the while.

 

My guess is when you reduce amitriptyline, you initially feel the benefit of less amitriptyline for 5-6.25 days, which is when the amount of amitriptyline gets lower in your blood level. However, as the amitriptyline goes lower, nortriptyline gradually dominates in your blood stream, which you feel a few days after the amitriptyline reduction settles. (If this theory is correct, you'd feel better for about a week after a reduction, then worse for about 4 days, then better 14 days after the reduction, when the nortriptyline bump has been metabolized.)

 

My guess is you're sensitive to nortriptyline. If so, reducing by 2.5% every week or 10 days makes sense -- with the continual reduction of amitriptyline, you are also reducing nortriptyline while benefiting from that 5-6.25 day holiday from amitriptyline.

 

 

 

Thank you so much for that great information!
 

Yes, I think you're correct about the nortriptyline sensitivity. It has, indeed, been my pattern to feel good for a week and then worse. I have been holding my current dose for 16 days now, and I do feel better.

So, my question is: should I just taper 2.5% every week to 10 days without having a holding period at all?

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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  • Administrator
2 hours ago, honingbij said:

Yes, I think you're correct about the nortriptyline sensitivity. It has, indeed, been my pattern to feel good for a week and then worse. I have been holding my current dose for 16 days now, and I do feel better.

 

Interesting. That fits with the theory.

 

My guess is you can make 2.5% cuts every week to avoid the nortriptyline build-up, until you get to 1mg. Then you might want to make cuts every 2 weeks to allow adjustment to low levels of both amitriptyline and nortriptyline and reduce risk of withdrawal symptoms from either. The lower level of nortriptyline may not trigger those symptoms you've been getting.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • Moderator
manymoretodays
On 4/13/2020 at 10:48 AM, honingbij said:

Have I been doing it incorrectly all this time? So, I should have been doing only 2 cuts per month, holding for 2 weeks each? 😱


What I am doing when I can't hold the dose is cut again, sometime a smaller amount. I don't like doing this, but I feel boxed in and don't know what the best thing to do is. I've had pretty smooth sailing up to this point, but it's starting to get tricky for me, that's why I am asking for advice.

 

No, you did nothing wrong honingbij.

 

3 hours ago, Altostrata said:

My guess is you can make 2.5% cuts every week to avoid the nortriptyline build-up, until you get to 1mg. Then you might want to make cuts every 2 weeks to allow adjustment to low levels of both amitriptyline and nortriptyline and reduce risk of withdrawal symptoms from either. The lower level of nortriptyline may not trigger those symptoms you've been getting.

 

And oooh, that's some good stuff, on the nortriptyline and and Amitryptiline, from Alto.  In that whole post to you!  Thanks Alto!

 

L, P, H, and G,

mmt

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016. 

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider. manymoretodays

 

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6 hours ago, Altostrata said:

My guess is you can make 2.5% cuts every week to avoid the nortriptyline build-up, until you get to 1mg. Then you might want to make cuts every 2 weeks to allow adjustment to low levels of both amitriptyline and nortriptyline and reduce risk of withdrawal symptoms from either. The lower level of nortriptyline may not trigger those symptoms you've been getting.

 

Many, many thanks!
 

I do have one more question:

I take my dose every night at 9 pm and go to bed at about 10 pm.

When I am having withdrawal problems, I wake up with a bad migraine between 0100 and 0400, which is 4 to 7 hours after I've taken my dose.

Do you think it would be helpful if I started to take my dose later, and adjusted the time I go to bed?
 

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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3 hours ago, manymoretodays said:

 

 

3 hours ago, manymoretodays said:

No, you did nothing wrong honingbij.

 
That's a relief!

 

3 hours ago, manymoretodays said:

And oooh, that's some good stuff, on the nortriptyline and and Amitryptiline, from Alto.  In that whole post to you!  Thanks Alto!


Absolute solid gold!

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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  • Administrator
2 hours ago, honingbij said:

I take my dose every night at 9 pm and go to bed at about 10 pm.

When I am having withdrawal problems, I wake up with a bad migraine between 0100 and 0400, which is 4 to 7 hours after I've taken my dose.

Do you think it would be helpful if I started to take my dose later, and adjusted the time I go to bed?

 

Interesting again! More evidence that it's the metabolite. Does taking your dose make you sleepy?

 

Maybe you want to work around "withdrawal problems" with those 2.5% decreases weekly.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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1 minute ago, Altostrata said:

Interesting again! More evidence that it's the metabolite. Does taking your dose make you sleepy?

 

 

Maybe you want to work around "withdrawal problems" with those 2.5% decreases weekly.

 

Yes, about an hour after I take my amitriptyline dose, I start getting sleepy. I take the melatonin just before getting into bed.

So, do you think that I should maintain the same dose time and just do the 2.5% weekly drops?

I am reluctant to experiment with the timing of my dose without advice, in case that muddies the waters.

 

 

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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46 minutes ago, Altostrata said:

Maybe you want to work around "withdrawal problems" with those 2.5% decreases weekly.


So, just to be clear: That would be 2.5% of whatever my current dose is?
 

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

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  • Administrator
11 hours ago, honingbij said:

When I am having withdrawal problems, I wake up with a bad migraine between 0100 and 0400, which is 4 to 7 hours after I've taken my dose.

 

When you are tapering 2.5% weekly, you do not get this regular symptom, correct?

 

If so, I would taper 2.5% weekly, calculated on your current dose. This is 10% monthly, it's not unusually fast, but may enable you to work around the regular emergence of the metabolite.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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2 hours ago, Altostrata said:

When you are tapering 2.5% weekly, you do not get this regular symptom, correct?

 

To be honest, some weeks I did taper 3-3.5%. I thought that as long as I was feeling well, I could cut a bit more while staying within the 10% per month limit. So I wasn't always totally consistent with the 2.5%.
 
I can see now that was not wise.


I will tighten up and stick strictly to the 2.5% per week and see what happens.

Many thanks, Alto. Your information has been invaluable.

 

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

Link to post
2 hours ago, Altostrata said:

If so, I would taper 2.5% weekly, calculated on your current dose. This is 10% monthly, it's not unusually fast, but may enable you to work around the regular emergence of the metabolite.

 

So, I can cut 2.5% every week without doing a 2 week hold at the end of 4 weeks?

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

Link to post

I just checked my data, and I have tapered 2.5% a week for the past 3+ weeks [I have held my present dose for 16 days].


I had migraines in the middle of the night 4 times during that period.
 

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

Link to post
  • Administrator
1 hour ago, honingbij said:

I just checked my data, and I have tapered 2.5% a week for the past 3+ weeks [I have held my present dose for 16 days].


I had migraines in the middle of the night 4 times during that period.

 

When did these migraines occur? If they occur regularly, that may help guide you in your tapering schedule.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to post
19 minutes ago, Altostrata said:

 

When did these migraines occur? If they occur regularly, that may help guide you in your tapering schedule.


One week they were on day 2, 3 and 7 of the taper
Another week they were on day 1, 2 and 10.

These are only the migraines that I've had in the middle of the night.

I have other migraines that occur during other times during the day. These are more like my "normal" migraines.

The middle-of-the-night ones are different and are always very severe. The pain quality is not the same; it's hard to describe exactly how that is. The only word I can think of is "chemical", although that is an odd way to put it. It just doesn't feel like my usual migraine pain. I always have to take my strongest rescue migraine meds for this kind, whereas I don't automatically treat my usual migraines with medication. I am very careful not to overmedicate my migraines.


 

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

Link to post

I wanted to add that this many night migraines in such a short time span is not usual for me. I do have them occasionally, but not as frequently as they have been in the past 3+ weeks.

It's one of the reasons I have asked for some help troubleshooting my tapering. I feel like I'm starting to get into the weeds.

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

Link to post
  • Administrator
4 hours ago, honingbij said:

I just checked my data, and I have tapered 2.5% a week for the past 3+ weeks [I have held my present dose for 16 days].


I had migraines in the middle of the night 4 times during that period.
 

 

I'm confused. If you're tapering 2.5% every week, how can you get a nighttime migraine on day 10? Wouldn't that be after an additional reduction?

 

Or are you reducing every 2 weeks, with no migraines days 11-14? When was the last time you reduced? Might be good to hold for now.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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5 hours ago, Altostrata said:

I'm confused. If you're tapering 2.5% every week, how can you get a nighttime migraine on day 10? Wouldn't that be after an additional reduction?

 

Or are you reducing every 2 weeks, with no migraines days 11-14? When was the last time you reduced? Might be good to hold for now.


I last tapered on March 31. I usually taper every 7 days. 


I usually do not hold a dose this long because of the problems I'm having as described in my post of April 11.

 

I was trying to follow what I understood were the guidelines of microtapering -- reduce every week x 4 [not exceeding 10%] and then holding for 2 weeks to allow the brain to stabilize. This worked well in the past, when my dose was higher, but is not working well now.

 

 I'm only holding this dose while waiting for clarification on how to proceed.

I'm still not clear on the answer to my initial problem:
Can I reduce 2.5% every 7 days without having to do the 2 week hold after 4 weeks, since I start to feel worse on day 10 when I try to follow to guidelines to hold?

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

Link to post
  • Administrator
12 hours ago, honingbij said:

I was trying to follow what I understood were the guidelines of microtapering -- reduce every week x 4 [not exceeding 10%] and then holding for 2 weeks to allow the brain to stabilize. This worked well in the past, when my dose was higher, but is not working well now.

 

12 hours ago, honingbij said:

I'm still not clear on the answer to my initial problem:
Can I reduce 2.5% every 7 days without having to do the 2 week hold after 4 weeks, since I start to feel worse on day 10 when I try to follow to guidelines to hold?

 

You don't have to do the 2-week hold if it doesn't work for you. Those aren't rules, they're a place to start. You modify your method according to how your own nervous system responds.

 

Please let us know how you're doing.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Thanks for all the great guidance and information, Alto.
I'll give it a go and see where it takes me.
I will definitely post back when I've been further down the road a bit.
I'm very optimistic that this will work out.

Drug History:

2004-2005: Tapered off Depakine Chrono, Amitriptyline and Topomax that were prescribed for migraine prophylaxis
2005:Tapered off Valium 10 mg
2006-2012: drug free
2012: migraines increased in severity and frequency
2012: Restarted Depakine Chrono [1000 mg] and low dose Amitriptyline
2013: Tapered off Depakine Chrono
2014: 75 mg Amitriptyline [began taper]
2019: presently on 22 mg, still tapering
2020: 10.7 mg, still tapering

Link to post
  • 2 weeks later...

Hi honingbij,

 

My daughter takes 25mg amitriptyline and we just started her taper yesterday.  I'm in the US and the tablets are SO TINY it's going to be difficult to get accurate measuring because my scale is only accurate +/- 4mg.  If the tablet weighed more this wouldn't matter so much.

 

Anyway, I have a call into her Dr. to change her Rx to 10mg tablets.  That way I can do part pill,  and then make a liquid for the funky measurements (make my own by dissolving it in water).  I see that you are doing part pill and part liquid too, and that you said you had difficulty transitioning to all liquid.

 

My question is if the liquid you are using is a prescription liquid, or are you making your own with water.  I'm just trying to figure out if she might have issues by converting the tablet to liquid.  Like does that increase rate of absorption or anything.  

 

Great job with your taper so far.  I'm impressed with your steady progress.  I'm sorry you are experiencing migraines, those are the worst.  I hope your 2.5% steady taper without the 2 week hold works for you.

 

Thanks for sharing your story here - you may be helping me, because I can use your experience as a guide.  This is the only place to get REAL help, so the more people who are willing to talk about their experience, the better the information pool we have.

 

Thanks!

(my daughter: 20yrs old)  

Sertraline*: 2010: Aug 6:  START 50mg, Aug 17:  75mg, Sept 3: 100mg, Sept 10: 150mg, Oct 8: 75mg, Nov 17: 100mg / 2012:  Mar 15: 125mg, May 14: 150mg / 2016: Sept 1: 100mg /  2017: July 27: 50mg / 2019: July 1 - Aug 10 6-week taper from 50 to 0mg, Nov 6: begin severe withdrawal symptoms,  Nov 10: Reinstate 1mg

 

Other meds: (for genetic neurological movement disorder HSP diagnosed Sept 2016, prescribed by neurologist)

2017 May: begin: Baclofen* 20mg

2017 May: begin: Amitriptyline* 25mg  / 2020: Apr 20: reduced by 5% due to interaction with Noscapine, Jul 20: started 2%/month taper.

2018 Oct:  begin  Noscapine Base* 200mg / 2020 Apr 20: reduce to 150mg due to unavailability due to Covid19.  Withdrawal symptoms ensued.  Was able to get more late May.  Stayed at 150mg until stabilized.  2020 Aug 2 began 3.5%/month taper.

                                                                                                                                                                           

*Currently taking:     Sertraline 1mg / Amitriptyline 17.15mg / Baclofen 20mg / Noscapine Base 110mg

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