Sac811 needs help deciding how to try to taper off Klonopin, Lyrica, Tramadol, and Cymbalta

[sac811]

To make this short and sweet, I got put on these drugs by my doctor that was treating me for Lyme Disease as a way to help me feel better through the symptoms and problems of Lyme disease.

 

And of course I believe that this actually made all the problems MUCH worse.

 

Cut to now, I'm ive been on:

 

1 mg of Klonopin a day, split into 2/0.5mg doses.

450 mgs of Lyrica a day, all at once before bed for sleep.

100 mgs of Tramadol a day, split into 2/50mg doses.

60 mgs of cymbalta a day taken all at once in the morning.

 

Basically before doing my research into the proper speed to taper, I was trying to drop klonopin first and basically had it down to 1/4 of a 0.5mg tablet.  But I was feeling terrible as you might imagine because I was tapered down to that from the full amount over just 8 weeks.  I though it may have just been lyme disease and feeling bad, but nope...So basically I went back up to the 1mg total again for now as to not completely fall apart mentally and physically.

 

It was making me a nervous anxious wreck, and drained me of all energy, willpower, physical stamina, or physical strength.

 

So now I'm here asking how I should go about getting rid of these medications and in which order please.

 

I want them all gone at some point, but I would just like to get moving on whichever one I SHOULD knock out first etc.

 

Any help would be appreciated.

 

Thank you.

 

Jeremy

Edited September 24, 2016 by scallywag
correct spelling in tag

[ChessieCat]

Hi sac, and welcome to SA,

 

You've come to the right place for information and support.

 

Firstly, it would help us for you to Please put your Withdrawal History in Signature.  Details of the last 12-18 months and a summary of anything prior.  Please include ALL DRUGS, dates, doses and how you decreased/increased.  Having this information will allow us to make suggestions based on your individual situation.  Please update as you change doses so it remains current and can be seen at a glance.

 

Because you are taking multiple drugs please use the Drug Interactions Checker and copy and paste the results here.  This will help to give some idea of what you should taper first.

 

Have a read of the following and then ask any questions you have:

 

Before you begin tapering what you need to know
 

Why taper by 10% of my dosage?

 

Taking multiple psych drugs? Which drug to taper first?
If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug).

 

Tips for tapering off Cymbalta (duloxetine)

 

Tips for tapering off Lyrica (pregabalin)

 

Tips for tapering off Tramadol

 

Once we have the additional information we will be able to make suggestions.  This is your Intro/Update topic to ask questions and to journal your progress.

[KarenB]

Hello Jeremy,

 

I'm glad you've found your way to SA.  A little info can go a long way!  You might like to start by reading Which Drug to Taper First.  That thread also has instructions for putting your drugs through the drug's checker, to check for interactions.  When you've done that, please post the results here - they are useful for working out which order to taper in. 

 

Once we've worked out which drug to start with, we recommend a gentle taper, reducing by no more than 10% of your current dose each month.  This allows your brain time to adjust as you go, and lessens any withdrawal. 

 

Many people find Fish oil and Magnesium useful during withdrawal - so you could start these now.

 

Please put your withdrawal history in your signature – all drugs/dates/dosages etc - so we can see your situation easily whenever you post, and help you more accurately.  Thanks.

 

The troublesome thing with SSRIs is that you can't just flush their effects out of your system.  They change the way your brain works, and that takes much longer to heal.  Suddenly stopping the drug puts your brain and Central Nervous System into shock.  It's like yanking a trellis out of a garden instead of gently untangling the plants and slowly removing the wood – it’s too much trauma for the plants/your brain.  (For the source of that simile, plus further discussion, see http://survivinganti...el-your-brain/)

 

Have a read of those and then you can come back to this thread to discuss things further.  This can be your journal to record your tapering and healing progress, and to ask questions. 

 

Welcome to SA,

Karen

Edited August 29, 2016 by KarenB
double up of info, as posted same time as CC.

[sac811]

I had a hard time with klonopin withdrawals. I haven't ever tried to get off of Cymbalta before. I have lowered and raised doses with Lyrica and Tramodol with SEEMINGLY relative ease. But on many occasions I feel so crappy regularly it is hard to tell.

 

But I feel Lyrica and Ultram are easiest for me to drop in the past.

 

Knowing all that, I would like everyones opinion on what I should work on first?

 

I'm leaning towards Ultram because Lyrica helps with sleep and pain more than any other. But I'm not sure about Cymbalta withdrawal.

 

Any help or suggestions?

 

Thanks

 

Jeremy

[ChessieCat]

Hi Jeremy,

 

When it comes to drugs, past experience is not an indicator of what may happen now or in the future.

 

Please check your drugs here:  Drug Interactions Checker then copy and paste the result here in your topic.

 

This information will help with deciding which drug to taper first.

[scallywag]

Sac811 - we can provide you with better information after you complete your signature.

 

Firstly, it would help us for you to Please put your Withdrawal History in Signature. 

• Details of the last 12-18 months and a summary of anything prior. 
• Please include ALL DRUGS, dates, doses and how you decreased/increased. 

Having this information will allow us to make suggestions based on your individual situation.  Please update as you change doses so it remains current and can be seen at a glance.

 

[sac811]

Drug Interaction Copy/Paste

 

Interactions between your selected drugs

Major tramadol  duloxetine

Applies to: tramadol, Cymbalta (duloxetine)

GENERALLY AVOID: Due to its serotonergic activity, coadministration of tramadol with serotonin-enhancing drugs such as SSRIs, SNRIs, nefazodone, trazodone, and mirtazapine may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Patients receiving tramadol with serotonin-enhancing drugs may also have an increased risk of seizures due to additive epileptogenic effects of these agents.

MANAGEMENT: In general, the use of tramadol in combination with highly serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk.Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when initiating or increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life.

References

1. Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
2. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals, Raritan, NJ.
3. Mason BJ, Blackburn KH "Possible serotonin syndrome associated with tramadol and sertraline coadministration." Ann Pharmacother 31 (1997): 175-7

View all 22 references

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Moderate clonazepam  pregabalin

Applies to: Klonopin (clonazepam), Lyrica (pregabalin)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
2. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
3. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35

View all 36 references

Switch to consumer interaction data

Moderate clonazepam  tramadol

Applies to: Klonopin (clonazepam), tramadol

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
2. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
3. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35

View all 36 references

Switch to consumer interaction data

Moderate clonazepam  duloxetine

Applies to: Klonopin (clonazepam), Cymbalta (duloxetine)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
2. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
3. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35

View all 36 references

Switch to consumer interaction data

Moderate tramadol  pregabalin

Applies to: tramadol, Lyrica (pregabalin)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
2. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
3. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35

View all 36 references

Switch to consumer interaction data

Moderate duloxetine  pregabalin

Applies to: Cymbalta (duloxetine), Lyrica (pregabalin)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
2. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
3. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35

View all 36 references

Switch to consumer interaction data

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

Other drugs and diseases that your selected drugs interact with

• tramadol interacts with more than 300 other drugs and 8 diseases.
• Cymbalta (duloxetine) interacts with more than 500 other drugs and 10 diseases.
• Klonopin (clonazepam) interacts with more than 400 other drugs and 10 diseases.
• Lyrica (pregabalin) interacts with more than 200 other drugs and 5 diseases.

Interactions between your selected drugs and food

Moderate tramadol  food

Applies to: tramadol

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
2. Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press Inc. (1990):
3. "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.

View all 4 references

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Moderate duloxetine  food

Applies to: Cymbalta (duloxetine)

GENERALLY AVOID: Use of duloxetine in conjunction with chronic alcohol consumption may potentiate the risk of liver injury. Duloxetine alone can increase serum transaminase levels. In clinical trials, 0.3% of patients discontinued duloxetine due to liver transaminase elevations. The median time to detection was about two months. Three duloxetine-treated patients had liver injury as manifested by transaminase and bilirubin elevations, with evidence of obstruction. Substantial intercurrent ethanol use was present in each of these cases, which may have contributed to the abnormalities observed. Duloxetine does not appear to enhance the central nervous system effects of alcohol. When duloxetine and ethanol were administered several hours apart so that peak concentrations of each would coincide, duloxetine did not increase the impairment of mental and motor skills caused by alcohol.

MANAGEMENT: Due to the risk of liver injury, patients prescribed duloxetine should be counseled to avoid excessive use of alcohol. Duloxetine should generally not be prescribed to patients with substantial alcohol use.

References

1. "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company, Indianapolis, IN.

Switch to consumer interaction data

Moderate pregabalin  food

Applies to: Lyrica (pregabalin)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
2. Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press Inc. (1990):
3. "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.

View all 4 references

Switch to consumer interaction data

[sac811]

I have now updated my signature with withdrawal history and posted all drug interactions as well from the site provided.

 

As I in earlier posts, I am looking for what drug recommendation to taper first.  

 

I could potentially taper Lyrica down to one 150mg but I would like to stay at that level until the rest of the drugs are gone because of how much it helps with my Fibromyalgia pain caused by Lyme Disease.

 

When I did drop Tramadol and Lyrica in the past, I just dropped a full pill or so a week, but I also wasn't working very much so the side effects wouldn't have been as obvious most likely.  But I currently work a physical labor job running my own Painting Company for New Construction Residential houses.  So I do not have the luxury of withdrawal symptoms anymore if at all possible.

 

Also take into consideration, if the first drug I taper helps me to feel better faster it would definitely help me keep my life together better.

 

Any help would be greatly appreciated.

 

Thank you greatly

 

Jeremy

[scallywag]

Jeremy - Thanks for posting your drug interactions report.  It looks to me that either the Ultram (tramadol) or the Cymbalta would be the place to start, given that there is a major interaction between them.

 

KarenB posted this topic, Which Drug to Taper First, above. The first post is particularly relevant.  Cymbalta is an "accelerator", Klonopin, tramadol, and Lyrica are all "brakes." 

 

Given those two pieces of information, what are your thoughts about starting with Ultram?

[sac811]

I can definitely start with ultram. I think it wI'll be one of the easiest to remove also.

 

So i will start the standard 10% per month taper?

 

I know it will be a year, but I am interested and what to get rid of after ultram.

 

Klonopin or down Lyrica some, then do Klonopin and leave Cymbalta for last?

[sac811]

I tend to have bad anxiety, so after ultram, I need to take that into account with the next taper.

[scallywag]

Start with the 10% taper, remembering that you calculate the 10% for the next cut from your current dose not your starting dose. Next would either be the Cymbalta or a partial reduction in Lyrica. It will depend on your symptoms, if any, at the time.

[JanCarol]

Hey Sac, what have you decided, and how it is going?

 

You said that this drug combo made you worse - and yet - normally Cymbalta causes a lot of problems too.

 

What are the symptoms that are causing you to want to reduce your cocktail?

See:  Dr. Joseph Glenmullen's Most Common symptoms of Withdrawal - these are common antidepressant side effects of the drugs and withdrawal from them

Looking at your signature, I would guess that the Cymbalta was highly effective at first, but as it started to "poop out," as many of these drugs do after 3-5 years, more drugs were added.

 

Here we would tend to taper Ultram first, then Cymbalta, before considering the Lyrica, leaving the Klonopin for last.  Again, as Scallywag said - depending on how you respond, what your symptoms are, etc.

 

Anxiety is caused by  a physical state of arousal that your brain interprets as "fear" and then you cycle in on the ruminations and make the fear worse.  What you need to do is learn to unhook the physical symptoms (sweat, heart-racing, pounding, nerves firing, agitation) from the emotions (always bad, and turn into ruminations which make it worse).  There was an Aussie MD named Claire Weekes who developed techniques for this.  She didn't even call it anxiety, she called it a nervous condition:

 

Dr. Claire Weekes - Recovering from a Sensitized Nervous System

 

It is important, when coming off of psych drugs - even if you never had a psychiatric condition to begin with - that you replace the drugs with a toolkit of Non Drug Techniques for Coping with Emotional Symptoms   Different tools work better with different people.

 

You wrote:

 

When I did drop Tramadol and Lyrica in the past, I just dropped a full pill or so a week, but I also wasn't working very much so the side effects wouldn't have been as obvious most likely. 

 

Both at the same time?  That was your first mistake.   3 KIS's Keep It Simple, Slow, Stable

More than 10%?  That was another mistake.  Why taper by 10% of my dosage?

The common mistake you didn't make?  Alternating doses (1 day off, 2 days on, etc.).  It's also very de-stabilizing, causes a lot of problems (kindling) and rarely achieves success.

 

I say this not to scold you - but so that you can learn from your mistakes and have a nice, smooth, even taper when you are ready.

 

I also bet you are wondering how to taper just 10% of the Ultram?  It's a wicked little drug, the doctor tells you it's a mild opiate.  Yeah.  There's a little opiate in there, but it's really a serotonin drug, a psych drug, meant to take away how much you care about the pain, not addressing the pain itself.

 

That's why it has so many interactions with your psych drugs.  It's a psych drug, too.  Not fair, is it?

 

So - here is how we address the fact that the pharmaceutical companies never give us the dosages we need to come off of their drugs in safe tapers. 

 

Some people dry-cut, which is less accurate, but doable.  I did dry cutting because I had 2 sized tablets and could get very far with it, and then finished that way.  When I started weighing my supplements on the Gemini 20 scale, I realized how much easier it is for the liquid taper people.

 

Dry cutting:

http://survivingantidepressants.org/index.php?/topic/2021-how-to-cut-up-tablets-or-pills-using-a-pill-cutter/

http://survivingantidepressants.org/index.php?/topic/1596-using-a-digital-scale-to-measure-doses/

 

Liquid tapers:

How to Make a Liquid from Tablets or Capsule

http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/

 

I have 3 friends in the States struggling  with Lyme and Lyme-like symptoms.  One is a mother and son, who, in 2000 got the target rash (while she was pregnant).  She is very sick, but fortunately, she and her son have been able to avoid psych drugs.  It's difficult to get well from Lyme - it seems that the treatments are extreme, and like with cancer, only achieve limited success.  

 

My other friend manifests the symptoms of Lyme.  No target rash ever (but I remember picking deer tick nymps off of her, and she of me, after an overnight hike), no antibodies, but her functional medicine doctor insists that she has Lyme and keeps insisting she pay more $$$$ for further antibody testing.

 

 My own symptoms look very Lyme like.  CFS/ME, Fibromyalgia, autoimmune looking fatigue (but not autoimmune, read on) - caused by psych and other pharmaceutical drugs - I keep getting asked (because I'm American, in Australia - and I did do the "tick picking" thing in the late 90's) if it is Lyme, but do not have an "autoimmune profile' in other blood tests, so they look no further.

 

I share this because Lyme is serious, and it's good that your doctors are aware of what you are going through.  Have your Lyme treatments been successful?  Have you achieved "remission" of the chronic symptoms?  

 

Or can you even tell, through the side effects of the drugs?

 

I hope you see the sun today!

[sac811]

I am tapering ultram (tramadol).

 

Doing well at first, and now going through some mild withdrawal symptoms but it's my fault for going slightly faster than I should have.

 

As for lyme, I feel like I've made no progress whatsoever. Wasted tons of time/money and am now addicted to these meds. I hate that I even tried to treat lyme at this point.

 

MAIN QUESTION: Would taking 5 minute cold showers be too much strain on my nervous system or would it be fine?

 

Thanks

 

Jeremy

[sac811]

MAIN QUESTION: Would taking 5 minute cold showers be too much strain on my nervous system or would it be fine?

[bubble]

Why do you want to take 5 min cold showers?

 

We generally advise people in withdrawal to avoid any harsh treatments because they might shock a sensitive nervous system even more.

 

Although it sounds stressing I find sauna to have a calming effect on me. Time in sauna is followed by showers in a relatively cold water.

 

Maybe others will have more information. You can always try it and see what it does to you and then take it from there

[scallywag]

I agree with bubble on the 5 minute showers with one addition: Rather than starting with 5 minutes, try 30 seconds for a 4-5 days to observe your reaction. Then increase 30 seconds every few days until you reach the limit you can tolerate or 5 minutes.