Elexis: tapering fluoxetine / Prozac - did I come off too fast?

[Elexis]

sorry guys, does anyone have an answer on my question about bulk solutions?

Have injured my hands & can't make  my own solutions  anymore... relying on others but they're not always available 3 times a day to make it for me, would be so much easier to do in bulk if possible without compromising dosage accuracy   what do you think?

[scallywag]

Hi Elexis, sorry you haven't got an answer to your question in the last few days.  It is possible to make multiple doses of a do-it-yourself liquid. Two main issues that are easily addressed: (1) unevenly dispersed undissolved particles, and (2) microbial growth in the liquid.  To deal with these you

1. Shake the suspension each time you take a dose.
    
2. Only make a few days liquid (solution or suspension) at a time and keep the unused solution in the refrigerator.

Hope you're feeling better.

[Elexis]

Hi Scallywag,

 

Thanks for the tips!  

I've been on 6mg (3x a day) Betahistine for about 4 weeks now, symptoms seem okay (I have symptom diaries I can post lately), mostly not scoring above a '4' which seems typical for me. What would the next step on the taper be - another 25% reduction?

[Elexis]

Hi guys,

 

Sigh. I've just screwed up.

 

I'm currently in the long process of withdrawing from Prozac.

I also take 60mg amitriprtline at night. Took my dose  last night, now this morning wasn't paying attention and just took one of the 10mg amitripyline tablets.

 

So... should I still take my usual dose at night or reduce it by 10mg for one night to compensate?

Is this likely to mess up my withdrawal process?

[Elexis]

Sigh. I've just screwed up.

 

I take 60mg amitriprtline at night. Took my dose  last night, now this morning, wasn't paying attention and just took one of the 10mg amitriptyline tablets.

So... should I still take my usual dose at night or reduce it by 10mg for one night to compensate?

Is this likely to mess up my withdrawal process?

 

Going to post this in Tapering forum as well as I really need an answer by tonight, hope that's okay - please feel free to delete the  duplicate post if necessary.

 

Thanks

[brassmonkey]

It shouldn't cause you much trouble.  It takes four days for these drugs to reach a steady state in a persons blood so, unless you're extremely sensitive to dose changes, the extra 10mg shouldn't make any difference.  It's possible that it could give you a change in symptoms for a few days, but that should short itself out pretty quickly.  I doubt that  you've caused yourself any real trouble.  Be more aware of your symptom pattern the next few days but don't micro focus on it.  Let us know how things are going.

[Elexis]

Phew, that's really reassuring, thank you!
Been annoyed with myself all day for mixing up my medications. Organising them into separate drawers now so I don't get day / night time meds mixed up. Oh to be pill-free one day....

[scallywag]

I don't know and it's probably too late for you because it's now after midnight in the UK.  Let us know which action you chose and how things are going for you.

[Elexis]

Hi,

Someone on the other thread suggested it probably wouldn't have made a big difference, just  being 10mg, so I took my tablet at night as normal. Don't seem to have had any adverse effects so far, one night of symptoms slightly higher than usual but that could just be coincidence.

Would I be right in thinking it would be best to leave any further Betahistine reductions until we know whether my mistake with the amitripryline is having an effect?

[scallywag]

Probably wise to delay any changes for at least a few days, if not a full week.  Good thinking!

[Elexis]

Hi,

Seem to have been okay after my mistake with the dosages

Would my next step be another 25% reduction held for 3-4 weeks?

[Elexis]

Been having a flare up for the past 5 days or so.  I haven't reduced betahistine dosage yet.... would it be wise to wait till the flare has passed?

And would the next reduction be another 25%?

 

Thanks

[Elexis]

wow this flare-up is really dragging on... been over a week I think. probably one of the longest flares I've had in a while.

I can't figure  out why this is happening.... I haven't changed any medication or supplement dosages. I've been using a different box of fluoxetine for the  past month that was kept in humid conditions but the tablets seem fine and I've had no problems up till now... it couldn't be that could it?

 

trying not to panic and praying this will  just settle down! god, I hate PGAD. and Prozac.

[scallywag]

Elexis, I'm sorry that I don't have any good information for you about this situation. Often the best thing to do during a flare-up of symptoms is to hold steady. Occasionally people find relief with a decrease or, surprisingly enough, with an updose. It's a craps shoot.

 

What's your "gut" telling you about this?

[Elexis]

Hmm... I think I'd hold a little while longer to see if this flare up  will calm down. I've never had one go on  this long - is this part of the 'windows and waves' thing do you think?

I guess if it doesn't calm down I could try reducing the betahistine and see how that goes. I don't think the flare can be  a result of reducing the betahistine dose earlier... pretty sure that was over 6 weeks ago - a reaction would normally show within about 4 weeks, right?

[Elexis]

Actually, just checked and the flare-up began 5 weeks after I went from Betahistine 8mg 3 x a day to Betahistine 6mg 3 x a day.

 

It looks like it could be a reaction to the drop in betahistine dosage perhaps.... though is 5 weeks too long for that to be possible? I see 4 weeks mentioned a lot, I'm not sure how strict a cut off point that is.

 

If I was to try going back up to my previous dose, would I do that for just one of the three daily doses or all of them?

 

Thanks very much x

[Elexis]

Hi guys,

 

Just a quick query. I'm currently trying to wean myself off betahistine. I did a 25% reduction from 8mg to 6mg. 5 weeks later I had a flare up of my withdrawal symptoms that has now been going on for about 10 days.

 

I've heard people say you should hold a dose reduction for 4 weeks as sometimes a reaction can be delayed, just wondering how strict is this 4 week cut-off? Is it possible I could be having a reaction 5 weeks later?

 

Willing to try returning to my previous dosage if so.

 

Thanks

 

Elexis

[Elexis]

Okay things don't seem to be improving at all so I  think I'll try an updose... I suspect my betahistine reduction may be the cause of this (only thing I can think of anyway!)

 

How would I go about doing this?

We reduced my dose by 25%, doing one dose at a time, held for a couple of days, until I had all three done. Would it be the same but in reverse? (go back up by 25% one dose at a time)?

 

Thanks

[scallywag]

Making a change gradually is a good idea. You may want to allow more time between the dose increases than you did when you decreased, say 7-10 days rather than "a couple of days." This way you're less likely to dose over your CNS's unknown acceptable "target level."

[Elexis]

Okay, thanks, I'll give that a go

 

So will go back up to 8mg for first dose, 6mg for the other two and hold that for 7-10 days and then do the others (if all goes well!)

[Elexis]

Update:

 

So that's been about 10 days on 8mg, 6mg and 6mg doses of Betahistine. I'd say the flare-up is about 75% gone. I'm not totally back to where I was before but there's been a massive improvement. Would it be wise to just hold at this dose since it seems to have improved things?

[scallywag]

If you've seen improvement and can tolerate the symptoms, try holding for longer than previously to see if you continue to see improvements. As you know, the lower dose the less time required to come off it.

[Elexis]

Okay, will do! Yeah, it's been in the back of my mind what a drag it will be to have to come off it from a full dose again  hopefully this will work and I won't have to

 

Thanks

[Elexis]

I didn't seem to be getting much further improvement so I tried upping my dose so I'm taking 8mg, 8mg, 6mg a day now. Unforuntately it seems to have made things worse. I'm only on my 4th day of the new dose -  is it possible this early on to try dropping back to the previous one?

I could keep going to  see if it settles down but worried about then  ending up  'trapped' on this dose and having to slowly taper off.

[scallywag]

That's a tough call, Elexis.  On the other hand, it's only been 5-6 days since the up-dose. If you can tolerate your symptoms, give your CNS more time -- maybe closer to 3 weeks?

[Elexis]

I have PGAD since coming off Prozac last year. In February this year I went on Betahistine tablets for dizziness. My doctors have now decided they want me off the tablets. Turns out they are ineffective for my dizziness condition and I should never have been given them in the first place (don't ya just love doctors!).

They won't give me much time to  get off them. I reckon I can maybe persuade them to give me 6-8 weeks at best. At a loss for what to do now  no idea what this will do to my withdrawal symptoms... probably nothing good since I tried tapering off the Betahistine myself and had a reaction with just a 25% reduction.

 

I guess if I've got limited time I should try and devise a tapering schedule and stick to it, that's presumably better for my CNS than suddenly running out of tablets and stopping cold turkey, right?

I know it's impossible to predict but generally speaking how much could a sudden halt of a neuroactive medication like betahistine mess up my recovery? It wouldn't do any permanent harm, would it?

 

Any advice appreciated, in a bit of a panic about the whole thing.  

 

[Elexis]

Oops. meant to post that on the tapering board and can't find a delete button.

[Elexis]

I have PGAD since coming off Prozac last year. In February this year I went on Betahistine tablets for dizziness. My doctors have now decided they want me off the tablets. Turns out they are ineffective for my dizziness condition and I should never have been given them in the first place (don't ya just love doctors!).

They won't give me much time to  get off them. I reckon I can maybe persuade them to give me 6-8 weeks at best. At a loss for what to do now  no idea what this will do to my withdrawal symptoms... probably nothing good since I tried tapering off the Betahistine myself and had a reaction with just a 25% reduction.

 

I guess if I've got limited time I should try and devise a tapering schedule and stick to it, that's presumably better for my CNS than suddenly running out of tablets and stopping cold turkey, right?

I know it's impossible to predict but generally speaking how much could a sudden halt of a neuroactive medication like betahistine mess up my recovery? It wouldn't do any permanent harm, would it?

 

Any advice appreciated, in a bit of a panic about the whole thing.  

[Elexis]

I should add that to address my dizziness I've been prescribed  prochlorperazine. I'm not going to touch it with a bargepole, having just googled and discovered it's an anti-psychotic.... the last thing my CNS needs right now...

[brassmonkey]

I did some research and there is very little information on withdrawing from Betahistine. The little I could find indicated that there should be little or no trouble.  There have been a very limited number of reports of WD symptoms.  I did discover that it does play with several different neurotransmitter levels, which raises a caution flag for me. I would stretch out the taper as much as I could and divide it into as small of drops as possible just to be on the safe side. If I was tapering any other medication I would put that taper on hold for the duration of the Betahistine taper and then add several weeks to stabilize before restarting.

 

Good call on not taking the Betahistine. We wouldn't recommend taking an anti-psychotic for dizziness in the first place but the side effects and such from this one are particularity nasty. 

[Elexis]

Hi,

Thanks for the advice and looking into it for me, that's really reassuring to hear it shouldn't present much of a problem. I can tolerate my symptoms getting worse for a little while if they do, was scared of ending up with the sorts of severe & pro-longed symptoms so many of us end up with coming off anti-depressants.   I'll stretch it out as much as I can, I speak to my Dr in a few days and I'm hoping I can persuade them to give me 8 weeks... then will calculate how best to do it. 

 

My current dose is 8mg three times a day, I think the Drs will want me to drop to 8mg twice a day, then once a day, then off. I'm assuming it would be a lot better to keep to the three doses and just reduce them..... seems a bit more consistent to my mind anyways.

 

I was kinda shocked when I read about the prochloperazine side effects, my dr didn't mention any side effects at all when he gave me the script. I guess I shouldn't be surprised by that by now though, eh?

[Elexis]

Hi Scallywag,

 

Just to  let you know I decided to drop back to the 6mg dose because of this fast taper I'm gonna have to do soon..... not ideal but I figured I best start ASAP  

 

 

[scallywag]

Elexis - you're the boss of your taper!   Thanks for the update.

[Elexis]

I'm looking into getting a digital scale as I think that will make my tablets last longer than making liquid solutions...

 

I've found one but it says it can only measure accurately to 1mg. So  would that mean it wouldn't be able to measure amounts like 2.5mg or 3.7mg etc.?

 

Probably a silly question but this stuff really hurts my brain lol.

[brassmonkey]

Getting a scale that is accurate to less than 1mg will be very expensive, and not necessary.  Because the tablets are made with a filler material calculating a fraction of a mg is possible.  Divide the strength of your tablet by the weight of your tablet and get a number.  For me, I used 40mg tablets (listed on the bottle) but they weigh 500mg each (calculated by averaging ten tablets).  So 40mgai (active ingredient) divided by 500mgpw (pill weight) = 0.08. This means that for each 1mgpw of tablet that I weigh out I get 0.08mgai if medicine.  By using this method you can make very find adjustments using a scale and powered tablets.

 

The problem with using a homemade liquid is not the accuracy of the dose, but rather, as your are concerned about, the shelf life.  A homemade liquid is only good for a few days so there will be a lot of wastage, especially at the lower doses.

 

Many of the other members here use the Gemini-20 scale, available on line.  I used it myself with very good results.  I recommend getting a bag of 1000 size "0" gel caps at the same time.  Crushing the tablets into powder makes it a lot easier to measure the dose and the gel caps make it easier to handle the powder once it's weighted out.

[Gridley]

Thanks, Brass.  This is just what I need for when I get down to the lower numbers using my Gemini scale.