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Tips for tapering off Abilify (aripiprazole)


Altostrata

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Abilify is an anti-psychotic also promoted as an "adjunct" or add-on to antidepressants. It has all the serious risks of the other anti-psychotics.


Following drug company advice, when a patient doesn't respond well to an antidepressant, doctors are arbitrarily prescribing Abilify as well -- instead of reducing or eliminating the antidepressant. This means you may experience adverse effects and no benefit from two drugs rather than one, and have to risk withdrawal from tapering both of them.

Like any other psychiatric drug, do not suddenly quit Abilify at any dose. If you are taking 2-15mg per day of Abilify, you are taking a full dose. While the Abilify dosage might seem like a "baby dose" compared to other drugs, milligram for milligram, it is a powerful drug.

 

Very careful tapering is necessary when you have had psychotic symptoms. Withdrawal symptoms that look like psychosis can appear even in those who never had psychosis. If you have a prior diagnosis of psychosis, emergence of these symptoms from dopamine supersensitivity can cause you to become diagnosed as "relapsed" and re-medicated. Read Psychiatrist: Some patients are better off without antipsychotics...

 

Depending on the sensitivity of your nervous system, even 2mg aripiprazpole might be difficult to quit, incurring terrible withdrawal symptoms. As with other psychiatric drugs, we recommend tapering at 10% per month, calculated on the last dosage   to let your nervous system accommodate safely to reduced dosages.

http://www.drugs.com/ppa/aripiprazole.html

Quote

Major Depressive Disorder
Adults

PO Recommended starting dosage for patients already receiving an antidepressant is 2 to 5 mg/day. Gradually make dose adjustments of up to 5 mg/day at intervals of no less than 1 wk. Efficacy of adjunctive therapy was established within the range of 2 to 15 mg/day.
....
Concurrent Use of Strong CYP3A4 (eg, ketoconazole) or CYP2D6 (eg, fluoxetine, quinidine) Inhibitors [many antidepressants inhibit or block the liver enzyme CYP2D6]

PO Reduce the usual dose of aripiprazole by 50%. Increase the dose when the CYP3A4 or CYP2D6 inhibitor is discontinued.

 
Please note aripiprazole will conflict with many antidepressants and other drugs. Also see US FDA information at http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=3650

Abilify has a very long half-life -- estimated at 4-7 days -- but still needs tapering. From http://www.drugs.com/pro/Abilify.html
 

Quote

Elimination

Approximately 25% of a single oral dose is excreted in urine (less than 1% unchanged) and 55% in feces (approximately 18% as unchanged drug). Elimination half-life is 75 h (aripiprazole) and 94 h (dehydroaripiprazole).
....
Aripiprazole has not been systematically studied in humans for its potential for abuse, tolerance, or physical dependence. In physical dependence studies in monkeys, withdrawal symptoms were observed upon abrupt cessation of dosing.

 
Tablets and oral solution
Abilify comes in these dosages (from FDA info at http://www.drugs.com/pro/abilify.html😞
- Tablets 2 mg
- Tablets 5 mg
- Tablets 10 mg*
- Tablets 15 mg*
- Tablets 20 mg
- Tablets 30 mg
- Abilify solution, oral 1 mg/mL 150-mL bottle NDC 59148-013-15 (also available as a generic)
*also available in DISCMELT® Orally Disintegrating Tablets

 

From http://www.drugs.com/abilify.html :

Quote

The orally disintegrating tablet form of this medicine may contain over 3 milligrams of phenylalanine per tablet. Before taking Abilify Discmelt, tell your doctor if you have phenylketonuria.

 

Abilfy MyCite monitored tablet

One type of Abilify tablet is embedded with an ingestible event marker (IEM) sensor (Abilify MyCite). From Medscape
 

Quote

 

The Abilify MyCite system is composed of the following components:

  • Aripiprazole tablet embedded with an ingestible event market (IEM) sensor
  • MyCite patch (wearable sensor) that detects the signal from the IEM sensor after ingestion and transmits data to a smartphone
  • MyCite APP, a smartphone application (app) which is used with a compatible smartphone to display information for the patient
  • Web-based portal for healthcare professionals and caregivers

 

 

To taper this type of tablet, you will have to 1) Refuse to take this type of Abilfiy; or 2) Get your doctor to prescribe the regular Abilify tablet or liquid instead; or 3) Disable the monitoring system, which may incur legal consequences if you are under court order to take this drug.

 

Aripiprazole injection

The injectable form comes in two versions, long-acting (every 4 weeks) or very long-acting. They are slightly different types of liquids; the hospital will make up the very long-acting form from a powder.

 

From the FDA https://medlineplus.gov/druginfo/meds/a615048.html

Quote

Aripiprazole extended-release injection is usually given either once every 4 weeks (Abilify Maintena) or once every 4 6 , or 8 weeks (Aristada).

 

See information about tapering the injectable form below.

Cutting up tablets
If you are taking the tablets, you can cut them up. (See:  Pros and cons of pill splitting: From Current Psychiatry 2006) For precise dosing, weigh the pieces with a digital scale.

Use the Abilify or generic aripiprazole liquid suspension

Since dosage tends to be low in milligrams, the best way to taper would be to use the oral solution. Titrating using a liquid is very good for very small measured decreases in dosage, allowing more precise measurements.

 

Use a tiny 1mL syringe to measure dosage changes that are less than 1 milligram, to hundredths of a milligram.

 

From http://www.drugs.com/ppa/aripiprazole.html:"Oral solution may be substituted for tablets on a mg-per-mg basis up to a 25 mg dose. Patients receiving 30 mg tablets should receive 25 mg of the solution."

 

The best way to switch from tablet to liquid forms is to take part of your dose in tablet form and part in liquid, gradually converting to all-liquid.
 
From http://www.drugs.com/abilify.html :

Quote

The liquid form (oral solution) of Abilify may contain up to 15 grams of sugar per dose. Before taking Abilify oral solution, tell your doctor if you have diabetes.


Using a combination of tablets or capsules and liquid
Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.
 
If your doctor prescribes liquid and tablets or capsules at the same time, most likely he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

 

Dissolving tablets in water
Technically, the ordinary Abilify tablet is insoluble in water. Yet even a drug that is "insoluble" in water may be made into a liquid suspension.


About solubility or insolubility, our esteemed member Rhi, a lab technician, has made many, many homemade liquids:

On 2/27/2013 at 9:30 AM, Rhi said:

.... I just wanted to toss in my usual bit on the subject of making preparations for liquid tapering, which is: I personally don't worry about solubility.

None of the meds I'm tapering are actually soluble in water. But the pills dissolve into small enough particles that I can stir them up and keep them suspended in water while I measure them out, and that seems to work for me. I stir well before I measure, I stir a little while pipetting them up; I dissolve the pills in glass and pipette out of glass so that I can see visually how evenly everything is suspended, and that's good enough for me.

I use water as a medium because I like it that I can easily see for myself how evenly the little particles are suspended or if they seem to be settling out. Also because it's handy and cheap and I don't have to carry it with me if I travel.

Mostly I would just say, I don't think it really matters if the medication is soluble in whatever vehicle you're using, as long as it can be evenly distributed. What really matters is that it be evenly distributed and that your method be repeatable and consistent.

 
For general instructions about making your own liquid http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

You may wish to use a pharmaceutical liquid to make suspensions, see http://survivingantidepressants.org/index.php?/topic/3068-pharmaceutical-liquids-to-make-suspensions/  (See compounding pharmacy section below.)

 

You may be able to make a solution with the Abilify DISCMELT® Orally Disintegrating Tablets (available in 10mg and 15mg dosages); I don't know what the stability would be -- how long the liquid would be good.
 
Have a compounding pharmacy make a liquid for tapering
Compounding pharmacies can make a liquid from the tablets. You will need a prescription written for the custom compound. The only drawback is this can be quite expensive.

 

Compounding instructions from USPharmacist.com https://www.uspharmacist.com/article/aripiprazole-1-mg-ml-oral-suspension

 

Quote

 

Method of Preparation: Calculate the quantity of each ingredient needed. Accurately weigh or measure each ingredient. Combine the aripiprazole with a few milliliters of Ora-Plus and mix to form a smooth paste. Geometrically, add the remainder of the Ora-Plus, with thorough mixing after each addition. Incorporate sufficient Ora-Sweet to final volume and mix well. As an alternative to the combination of Ora-Plus and Ora-Sweet, Ora-Blend may be used as the vehicle. Package and label.

....

Labeling: Keep out of reach of children. Keep refrigerated. Discard after ____ [time period]. Shake well.

Stability: A beyond-use date of up to 91 days may be used for this preparation.1,2

....

Abilify tablets are available in strengths of 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 30 mg. If these tablets are used as the source of the drug in this formulation, it should be noted that they also contain the following inactive ingredients: cornstarch, hydroxypropyl cellulose, lactose monohydrate, magnesium stearate, and microcrystalline cellulose. Colorants include ferric oxide (yellow or red) and FD&C Blue No. 2 Aluminum Lake.4

 

Ora-Plus is an oral suspending vehicle that accepts dilution of up to 50% or more with water, flavoring agents, or syrups while still retaining its suspending properties. It has a pH of approximately 4.2 and an osmolality of about 230 mOsm/kg. Ora-Plus is a thixotropic vehicle with a viscosity of approximately 1,000 cps at 25°C. Ora-Plus contains purified water, microcrystalline cellulose, sodium carboxymethylcellulose, xanthan gum, carrageenan, sodium phosphate, and citric acid as buffering agents; simethicone as an antifoaming agent; and potassium sorbate and methylparaben as preservatives.5

 

Tapering injectable aripiprazole: Let it wear off, then take tablet or liquid
The injectable forms are intended to last at "therapeutic" strength for a month or more, then you would get another injection to keep up the potency.

 

 

The blood level and side effects will be highest shortly after the injection, then wear off somewhat. Because side effects can be quite severe, a conscientious physician will prescribe the tablets first to establish your tolerance for aripiprazole. Given the very long half-life, if you have an adverse reaction to an injection, it could last a long while.

 

To go off an injection, you must let your body gradually metabolize it. Aripiprazole's half-life is long -- about 4-7 days; a tablet dose could take about 20-35 days to completely leave your body. Since an injection is intended to last a month or more, complete clearance of aripiprazole can be up to 35 days after that period is over. For example, if you get a monthly injection of aripiprazole, it will take about 2 months or more to wear off altogether.

 

(Since the injections come in a dosage range, if you are taking one of the higher injectable dosages, conceivably over months, to taper off, you might gradually lower the dosage of the injections to the lowest -- 300mg lasting a month -- then allow it to wear off. This requires the cooperation of a doctor.)

 

However, even with this gradual decline of the injectable form, you still might get withdrawal symptoms. For after the injection wears off, you might consider having liquid oral aripiprazole or tablets on hand so you can take a very small daily amount to stop withdrawal symptoms, then gradually taper off that.

Edited by Altostrata
updated

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

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  • 2 months later...

This was one of the many adjunctive therapies I was on over the years. It seemed to help slightly for about 6 months, then pooped out. An MSW friend who works in a state hospital said the brief effect followed by poop out is common with Abilify although I don't know why. I tapered from 10 to 5 to 2 over a few weeks, so not far from CT. I don't recall remarkable withdrawal, but that timeframe is all a blur.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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  • 2 months later...

Hi there

 

Just looking for some information on possible withdrawal symptoms from Abilify.

 

My son took his last dose of Abilify (2.5mg) on Saturday August 4th 2012.

 

He's been on a slower taper.

 

Per his neurologist he shouldn't have any withdrawal symptoms, however she's never taken Abilify, so I thought it best to check in with folks who have.

 

My son is 17, non verbal and profoundly disabled, so trying to see if any withdrawal symptoms are happening will be tricky.

 

How long does Abilify stay in the system after the final dose?

 

What are some typical withdrawal symptoms he could experience?

 

How long do the withdrawal symptoms stay, before normal life resumes?

 

Thanks for your help and insight!

gail

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Hello and thanks for the quick reply...

 

His highest dose was 20 mg. He started a slower taper.

 

15 mg for 10 days

10 mg for 10 days

7.5 mg for 10 days

5 mg for 10 days

2.5 for 10 days.

 

All under the direction of his Neurologist.

 

I just successfully tapered off of Imimprine, but had 11 days of withdrawals. Ugh..

 

His neurologist has never taken Abilify, thus she can't speak from experience if there are any withdrawals.

 

I do realize everyone will have a different experience.

 

Just wanted some insight!

 

We usually advise 10% cuts off the previous dose for psychotropics, with one month holds. Some people can taper more rapidly while others go more slowly. The taper schedule above is very fast. Alto, our admin, will advise you how to proceed. Abilify comes in a liquid which makes it possible to take small cuts. Most docs are woefully uninformed when it comes to helping folks come off meds. I wonder if your son is acting differently, in a way that would suggest he is in discomfort?

 

Are you still having withdrawal symptoms from Imiparmine? How long ago did you take your last dose?

As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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The tapering was given by my son's neurologist. I told her I wanted a slow, safe taper, thus the schedule was given.

 

I'm no longer on Imimiprine. My taper was over 5 months long!

 

I was on the medication for over 20 years. My dose went from 200 mg per day, down to 25 mg on my last dose.

 

However, I did have withdrawals, which I totally was not expecting. I thought doing a slow taper, my body/mind/brain would adjust accordingly.

 

Thus, my inquiry about possible withdrawal affects for my son who is now off Abilify.

 

gial

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The tapering was given by my son's neurologist. I told her I wanted a slow, safe taper, thus the schedule was given.

Hi Gail, The taper was very percipitous. Most docs do not know how to taper safely because they get their info from the drug companies whose vested interest it is to hold back on the difficulties involved. Some people can come off easily, but others have much difficulty. As this is a situation in which your son could not tell you if he is in distress a slow safe taper is important. Again, Alto will advise.

 

I'm no longer on Imimiprine. My taper was over 5 months long! I was on the medication for over 20 years. My dose went from 200 mg per day, down to 25 mg on my last dose.

 

However, I did have withdrawals, which I totally was not expecting. I thought doing a slow taper, my body/mind/brain would adjust accordingly.

Many people take two years or more to come off ADs. I am completing what will have been a more than 2 year taper to get off benzos, and will be doing the same length for Lyrica. All psychotropics have a similar withdrawal profile. Your taper was fast. Some people can come off more quickly, but those whose tapers are too abrupt can have withdrawal symptoms for months, sometimes years. I'm glad you did not taper more quickly as ADs' post withdrawal symptoms can reemerge long after you think they have gone away.

 

Thus, my inquiry about possible withdrawal affects for my son who is now off Abilify.

You are being very caring. Sounds like your experience with Imipramine may help spare your son considerable distress.

As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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Hello, bunny42.

 

Well, at least it's a taper. He may not suffer withdrawal symptoms. Whether someone suffers withdrawal is highly individual.

 

Yes, like all psychiatric drugs, Abilify can have withdrawal symptoms. Since it's fairly new, this is not well known.

 

We have several members who've experienced Abilify withdrawal. Go to the Introductions forum, use Search in the upper right of the page to look for "Abilify" (no quotes).

 

If you see agitation, you might reinstate at perhaps 1mg or 2mg to see if that helps, stabilize for a couple of weeks, and taper more slowly from there with a tiny 1mL oral syringe.

 

See Tips for tapering off Abilify (aripiprazole)

 

Also see FDA info at http://www.drugs.com/pro/abilify.html

Aripiprazole has not been systematically studied in humans for its potential for abuse, tolerance, or physical dependence. In physical dependence studies in monkeys, withdrawal symptoms were observed upon abrupt cessation of dosing.

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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I guess I was also looking to see if withdrawals do happen, how long after last dose.

 

When I took my last dose of Imimprimine, I didn't get withdrawals until 5 days later, and then they lasted for 11 days. ugh..

 

So since my son just stopped Abilify Saturday August 4th, he potentially could experience something in the next week or so.

 

Darn it! :)

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bunny, it could be your son's taper was sufficient.

 

Withdrawal symptoms usually show up within a week or two, but since his communication skills are limited, you might not know about the more subtle ones, like dizziness.

 

Sorry to hear of your withdrawal symptoms. If your taper had been a little more gradual, you might not have had any, but it's good that they lasted only a couple of weeks.

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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Hi again Gail..

 

I worked with blind/deaf profoundly retarded adolescents who had Cerebral Palsy. If one of them had withdrawal, and I was watching for it, I would have been able to tell something was wrong. I don't know if this situation is at all close to what you are dealing with with your son, but there really are cues. The restlessness would be unmistakable.

 

I'm sorry if I introduced complications needlessly. We see so much of the worst case scenario on this site, it's not so hard to lose track of the fact that not everyone goes thru the whole deal.. and your son is still young and may well be just fine. Seriously.. you did good to look for info preventatively.

 

Be well.. and don't worry quite so much, K? Schuyler

As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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  • 2 years later...

Hello. I just wanted to give some recent information about Abilify to those still taking this drug. The Abilify oral solution is being discontinued this year (5/15/2015). This means, for those of us who were wanting to do the slower taper using the liquid and a 1ml oral syringe, that this will be significantly harder, if not impossible. I guess a compounding pharmacy could still make liquid solution out of the pills and formulate a dose, but I'm not really sure. Also, the orally disintegrating tablets are being discontinued this year. All that is left are the solid pills. Even a 2 or 1mg dose of Abilify, when abruptly stopped, can cause withdrawal. A word to the wise. Hope this update is useful.

<p>Successfully weaned off of Prozac, Concerta, Effexor XR, Buspar, Celexa, Lexapro, Seroquel, Geodon, Risperdal, Cogentin, Xanax, Ativan, and Depakote. Currently taking Abilify (7.5mg) and Lamictal 200mg. Hope to complete taper by mid November 2016. <p>For more information see the "About Me" link on my profile.

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Thank you very much for this update. Let us know what the pharmacist says, can it be compounded only by them or can users make an oral solution? According to Alto's first post, she could not find any info on making a liquid and it seems to be insoluable in water but quotes Rhi as showing there are ways around this.

 

You can post what you find in this thread. Members who are tapering this need to be prepared.

What happened and how I arrived here: http://survivingantidepressants.org/index.php?/topic/4243-cymbaltawithdrawal5600-introduction/#entry50878

 

July 2016 I have decided to leave my story here at SA unfinished. I have left my contact information in my profile for anyone who wishes to talk to me. I have a posting history spanning nearly 4 years and 3000+ posts all over the site.

 

Thank you to all who participated in my recovery. I'll miss talking to you but know that I'll be cheering you on from the sidelines, suffering and rejoicing with you in spirit, as you go on in your journey.

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  • 3 weeks later...

Hello. I want to explain another way to taper off Abilify (or other crushable drugs). 

I’m using a dry product like powdered sugar or cocoa powder, a digital scale (0.001g Resolution) and a pill crusher.
I started tapering off Abilify from 20 mg and now I’m taking 9 mg.
For example, suppose you are taking 2 mg of Abilify and you want to decrease a 10%. Then, you can mix a crushed pill (2 mg) with some powdered sugar till get 2 g in total. In this case you would take a measurement of 1.8 g of the mixture to accomplish a decrease of 0.2 mg (10%).
This method is really useful when you make proportional dosages. We assume that this dry mixed powder is as good as the liquid suspension. Other proportions and concentrations can be made depending on the doses we need, of course.
Regards
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Interesting and creative, sofre.

 

How do you know the powders are evenly distributed?

 

Please start a topic for yourself in the Introductions forum so we can get to know you.

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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Good question Alto. 

It will depend on the mixing time, the particle size, density and shape.

But, the quality of a random mixture improves if the amounts of each component are equivalent.

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Not sure what "quality" means in that sentence. You'd have to give it a good stir to distribute everything evenly, which would be important to accurate dosing.

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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  • 3 weeks later...

Hello,

 

Another update on Abilify. This drug is finally going generic on 4/1/2015. This gives a positive spin on the bad news that the oral solution is being discontinued in May. My question is, how likely is it that the makers of generic aripiprazole put out an oral solution, similar to how risperidone now comes in oral solution? It's hard to tell. I'm going to have to make a tough decision as to whether to stock up on Abilify brand name oral solution by May so that I can taper responsibly, or have faith that eventually a generic Abilify liquid will be made available at a much cheaper cost. It's tough because I highly doubt I'll be able to taper this drug effectively without the liquid solution. I guess we can see what transpires in the 45 days between Abilify going generic and the discontinuation of the liquid on 5/15.

 

My Kaiser pharmacy has said they compound medicines, but the latest person I asked about it said that they do not. It's hard to get a straight answer.

<p>Successfully weaned off of Prozac, Concerta, Effexor XR, Buspar, Celexa, Lexapro, Seroquel, Geodon, Risperdal, Cogentin, Xanax, Ativan, and Depakote. Currently taking Abilify (7.5mg) and Lamictal 200mg. Hope to complete taper by mid November 2016. <p>For more information see the "About Me" link on my profile.

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Most likely there will be a generic, but you might stock up just before the liquid is discontinued so you have time to do some research.

 

Get an answer in writing from Kaiser.

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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I just wanted to add for anyone reading the whole thread that as of now (2018) there is indeed a generic available of the liquid solution.

Dextroamphetamine 30 mg, started 2011 -- still taking

Paxil 2004-2005

Wellbutrin/Bupropion 300 mg, started 2005 -- still taking

Prozac/Fluoxetine 40 mg, started 2006 -- still taking

Abilify/Aripiprazole 5 mg, started 2014 -- started taper in 2017, finished 2020

  • At 0.5 mg February 2018
  • At 0.2 mg/mL September 2018
  • At 0.18mg/mL October 30, 2018
  • At 0.17mg/mL December 20, 2018
  • At 0.16mg/mL January 10, 2019
  • At 0.15mg/mL February 19, 2019
  • At 0.14mg/mL April 25, 2019
  • At 0.13mg/mL June 22, 2019
  • At 0.12mg/mL August 5, 2019
  • At 0.11mg/mL September 5, 2019
  • At 0.10 mg/mL November 7, 2019
  • At 0.05 mg/mL February 1, 2020
  • Jumped off March 23, 2020

 

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Thanks, RubyJ. Updated post #1.

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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  • 3 months later...

Didn't find this method in the topic, so I decided to ask - since the half-life of Abilify is a few days, does it make sense to try and taper it by skipping days? E.g. since I take it once per day, skip 1/10 days for the first month, then 1/5 etc.

 

For some extra info, I managed once to get it down from 7.5 mg to ~2 mg by cutting a 15 mg pill (that was the only form available in my country at that time) and skipping every second day over the course of around an year. Didn't experience WD symptoms and was pretty okay with the 2 mg dose for more than an year.

In the end of 2015, got into a few days of psychosis and got an outpatient appointment with a psychiatrist, a diagnosis of schizo-affective disorder and a 2 month treatment with Risperidone. At the current point in time, my doctor is not convinced anymore in the diagnosis, rather points out depression and anxiety as my main condition, but I'm still taking Abilify as prevention therapy.

  • 2016 - 7.5 mg Abilify; 2017 - 2018 - 2 mg; April 2019 - May 2020 - 5 mg; June - December 2020 - 4.5 - 2.3 mg (-10% / month)

-> early 2021 - upped a little bit because of a depressive episode and insomnia

  • March 2021 to Jan 2022 - down to 0.7 mg

-> Feb 2023 - another depression+insomnia episode, so up again; added vit. B3, melatonin, L-tryptophan and split the Abilify dose in two

  • May 2022 to Nov 2022 - 2 mg down to 0.75 mg

-> middle of January 2023 - insomnia kicked in, some derealizations too; so up to:

  • Jan-April - 1 mg Abilify up to 1.5 mg; added Quetiapin 6 mg for a month, then down to 0 mg

Current: staying at 0.5 mg Abilify to stabilize

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  • 5 weeks later...

Hi, I’m new to this wonderful site. It’s got a wealth of information! 

Great to know that I’m not alone. 


Unfortunately, I’m not new to withdrawal.
Currently, trying to taper off of Abilify 2mg. 

Have been unsuccessful twice previously in trying to get off of this drug (high anxiety, constant eye twitching, and excessive dry mouth were main symptoms).

 

 Monday 6/8 I began cutting the 2mg tiny pill in half. So I’m on the 4th day of 1mg Abilify today. 
I saw in previous posts above about a liquid form of this drug.

I will ask my Doctor about this if the 1mg Abilify is not tolerated well. 
 

 

➡️ Fall 2011- Doctor switched me from Paxil XR to Citalopram (Celexa).

• First time experiencing withdrawal symptoms.
➡️  May 2012 - Doctor told me to taper off of Citalopram in 3 weeks, I did it in 6 weeks.
• Horrible withdrawal: Brain zaps, neck pain, crying spells, irritability, sensitivity to sounds & light, migraines, body aches, nerve pain, flu-like symptoms, depersonalization, tinnitus, chronic fatigue, depression, brain fog, and more.
➡️ January 2013 - Reinstated to Prozac.

➡️ Spring 2015 - New Doctor switched me to Wellbutrin. 
➡️ Spring 2016 - switched to Cymbalta. Added Gabapentin.

➡️ Spring 2018 - switched to Pristiq. Added Abilify. 
*** Currently on 25mg Pristiq, 2mg Abilify,       300mg Gabapentin. 

 

(Sorry I’m very foggy with my memory, don’t remember dates or doses very well).

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Good idea, @Neoisdaone. If your decrease to 1mg works out -- you'll have to wait several weeks to see -- you'll probably want the liquid to so you tiptoe off the 1mg.

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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  • 3 months later...
  • Moderator Emeritus
On 5/12/2020 at 11:27 AM, Nocturna said:

Didn't find this method in the topic, so I decided to ask - since the half-life of Abilify is a few days, does it make sense to try and taper it by skipping days? E.g. since I take it once per day, skip 1/10 days for the first month, then 1/5 etc.

 

For some extra info, I managed once to get it down from 7.5 mg to ~2 mg by cutting a 15 mg pill (that was the only form available in my country at that time) and skipping every second day over the course of around an year. Didn't experience WD symptoms and was pretty okay with the 2 mg dose for more than an year.

 

The brain likes consistency.  Even Prozac, which has a very long half life, should be taken every day:

  

See:

NEVER SKIP DOSES TO TAPER

 

Edited by ChessieCat

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

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 from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 9 months later...

> For example, if you get a monthly injection of aripiprazole, it will take about 2 months or more to wear off altogether.

 

Where are you finding this information or calculating?  I am on the 4 week injectables and can't seem to find any additional information.

 

I found this "the mean apparent aripiprazole terminal elimination half-life was
29.9 days and 46.5 days after multiple injections for every 4-week injection of ABILIFY
MAINTENA 300 mg and 400 mg, respectively"

 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/202971s008lbl.pdf

 

But I'm not sure how to calculate this.

 

I'm not certain if jumping off of Abilify Maintena will work.

My Intro FB Zyprexa 2015-September 2018

1st time I tried to come straight off of 10mg Zyprexa I was hospitalized for insane insomnia.

Current - Abilify Maintena & L Theanine(for akathisia)

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  • 6 months later...

It looks like the liquid form of Aripiprazole is available in the UK

 

https://bnf.nice.org.uk/medicinal-forms/aripiprazole.html#PHP74665

My son's drug history:

  • August 2020 Citalopram 30mg
  • October 2020 suicide attempt
  • November 2020 Citalopram 60mg (suicidality increased)
  • January 2021 Duloxetine 60mg
  • May 2021 anhedonia peaked
  • August-September 2021 Duloxetine 90mg + Aripiprazole 5mg added to augment
  • End of October 2021 Duloxetine withdrawn from 90mg to 1-week on 60mg, then stopped (Aripiprazole 5mg continued)
  • November 2021 Agomelatine 25mg started + Aripiprazole 5mg
  • December 2021 Agomelatine 50mg + Aripiprazole 5mg (increasing fatigue, anxiety, depression and suicidality)
  • January 2022 Agomelatine stopped (no tapering for - clinician decision), Aripiprazole 5mg stopped (no tapering - decision made by my son)
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  • 8 months later...

Just wanted to add comments about tapering off of Aripiprazole.  I just read Altostrata's "tip toeing off of one milligram" comment above and I had to pause on that --- it feels so hopeful to do that with these drugs.  Tip toeing is the way to go!  

I am trying to very slowly come off of Aripiprazole.  I am down from .8 ml to .58ml over almost four months months.  This feels huge to me. Its slow yes, but I am getting there.  YES there have been some hard days - where agitation, anxiety and intensity have been there - as well as this restlessness inside and out.  But I today feel hopeful that I can slowly come off of this drug.  I am grateful to the experiences shared here for all drugs - it is so valuable.  I have another drug to go - but need to get off of aripiprazole first due to circumstances of moving.  One step at a time.  

 

Question: Are expired compounded capsules worth trying to use? I had thought of trying to make a liquid myself from a pile of unused capsules - but   I think I know the answer would be no - as the effective dose would likely be diminished post expiry date.

1997 - effexor for 4 months. Came off without issue (as far as I recall)

2000 - 2004 - Celexa 10 mg (came off very quickly - and had a "nervous breakdown" to use my words. High anxiety, out of control and life became unmanageable. Reinstated briefly then came off successfully )

2006-2009 Celexa 10 mg - somehow came off for a while but then... things got hard.

2010 - started (Lexapro in the U.S.) 5 mg  2012 for 6 months I was on 2.5 lexapro,  ativan - for sleep very occasional use 2014 5 mg cipralex (lexapro) : attempts to come off 5mg  2014 failed - way too fast - terrible anxiety  2015 march ---- started a SLOW taper of Lexapro. I was able to get down to .5 mg Lexapro in early 2016 February and March started to get intense strange symptoms of shaking body, loss of control, panic, weight loss.  Especially in early morning.  Reinstated- on Psych. Docs advise. (sadly! now I think but didn't know what else to do). 

August 2016 was on 6 mg Lexapro and still having panic and anxiety. Re-instating was very hard. Took .5 mg Ativan 3 x per day for two months. August 2016 - started 1mg Abilify and tapered off of Ativan over three months. 

From November 2016 - Janaury 2018:  1mg Abilify - 6 mg Lexapro

 ABILIFY taper started May 2018:  lots general anxiety. Moved to a liquid dose of Abilify. September 2018: 6mg lexapro a day,  Abilify taper is at .4mg. Experienced terrible anxiety, worry, restlessness, sleeplessness. Then Father died traumatically. P-Doc said to go back up.  reinstated 1mg Abilify started Nov. 28, 2018.   LEXAPRO 6mg.

2019 April started taper of Lexapro to 5.5, June 2019. Lexapro 5 mg, Abilify 1mg.  Holding for now til life stabilizes. Fish oil, melatonin, vit d, bio identical hormones, magnesium citrate.

2020 - Abilify taper to .8mg, Lexapro 5 mg, Progesterone SR 300 mg

2022 - Abilify taper in progress started in june at .8mg.  September .58, Lexapro 5 mg, Progesterone SR 300 mg. Going as slow as possible - but worried I will be too old by the time I get off of everything to eventually have a life left to enjoy.

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2 hours ago, freeruby said:

Question: Are expired compounded capsules worth trying to use?

Not sure how the capsules are made, but both my doctors say pills are good for longer, one mentioned 5 years.

In the end of 2015, got into a few days of psychosis and got an outpatient appointment with a psychiatrist, a diagnosis of schizo-affective disorder and a 2 month treatment with Risperidone. At the current point in time, my doctor is not convinced anymore in the diagnosis, rather points out depression and anxiety as my main condition, but I'm still taking Abilify as prevention therapy.

  • 2016 - 7.5 mg Abilify; 2017 - 2018 - 2 mg; April 2019 - May 2020 - 5 mg; June - December 2020 - 4.5 - 2.3 mg (-10% / month)

-> early 2021 - upped a little bit because of a depressive episode and insomnia

  • March 2021 to Jan 2022 - down to 0.7 mg

-> Feb 2023 - another depression+insomnia episode, so up again; added vit. B3, melatonin, L-tryptophan and split the Abilify dose in two

  • May 2022 to Nov 2022 - 2 mg down to 0.75 mg

-> middle of January 2023 - insomnia kicked in, some derealizations too; so up to:

  • Jan-April - 1 mg Abilify up to 1.5 mg; added Quetiapin 6 mg for a month, then down to 0 mg

Current: staying at 0.5 mg Abilify to stabilize

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  • Moderator Emeritus
2 hours ago, freeruby said:

Question: Are expired compounded capsules worth trying to use? I had thought of trying to make a liquid myself from a pile of unused capsules - but   I think I know the answer would be no - as the effective dose would likely be diminished post expiry date.

 

It's not worth it.  There is no way of knowing if they would deteriorate or if they did, by how much.  And the not knowing would be stressful.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

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 from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Thanks @ChessieCat YES too stressful no knowing. I just changed from one pharmacy to another for liquid abilify - and even guessing if they have prepared it the same is a bit stressful.  I will sadly let go of the pile of unused expired capsules.  

I will note that I was using liquid abilify the past few weeks as I have been for a few months. I  noticed I was getting withdrawal symptoms. I clued into the fact that my liquid was just on the edge of expiring -- and ALSO it is supposed to be kept cold --- and I was camping and could not consistently keep it cold ... and I am pretty sure that is because of the drug not being at its full power. I suspect that was the source of my symptoms.

1997 - effexor for 4 months. Came off without issue (as far as I recall)

2000 - 2004 - Celexa 10 mg (came off very quickly - and had a "nervous breakdown" to use my words. High anxiety, out of control and life became unmanageable. Reinstated briefly then came off successfully )

2006-2009 Celexa 10 mg - somehow came off for a while but then... things got hard.

2010 - started (Lexapro in the U.S.) 5 mg  2012 for 6 months I was on 2.5 lexapro,  ativan - for sleep very occasional use 2014 5 mg cipralex (lexapro) : attempts to come off 5mg  2014 failed - way too fast - terrible anxiety  2015 march ---- started a SLOW taper of Lexapro. I was able to get down to .5 mg Lexapro in early 2016 February and March started to get intense strange symptoms of shaking body, loss of control, panic, weight loss.  Especially in early morning.  Reinstated- on Psych. Docs advise. (sadly! now I think but didn't know what else to do). 

August 2016 was on 6 mg Lexapro and still having panic and anxiety. Re-instating was very hard. Took .5 mg Ativan 3 x per day for two months. August 2016 - started 1mg Abilify and tapered off of Ativan over three months. 

From November 2016 - Janaury 2018:  1mg Abilify - 6 mg Lexapro

 ABILIFY taper started May 2018:  lots general anxiety. Moved to a liquid dose of Abilify. September 2018: 6mg lexapro a day,  Abilify taper is at .4mg. Experienced terrible anxiety, worry, restlessness, sleeplessness. Then Father died traumatically. P-Doc said to go back up.  reinstated 1mg Abilify started Nov. 28, 2018.   LEXAPRO 6mg.

2019 April started taper of Lexapro to 5.5, June 2019. Lexapro 5 mg, Abilify 1mg.  Holding for now til life stabilizes. Fish oil, melatonin, vit d, bio identical hormones, magnesium citrate.

2020 - Abilify taper to .8mg, Lexapro 5 mg, Progesterone SR 300 mg

2022 - Abilify taper in progress started in june at .8mg.  September .58, Lexapro 5 mg, Progesterone SR 300 mg. Going as slow as possible - but worried I will be too old by the time I get off of everything to eventually have a life left to enjoy.

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I was told my liquid abilify did not need to be refrigerated. 

Ativan 2004 - 2016. 20 month taper. Benzo free. 

Originally Prozac, on to Zoloft 100 mg, 2004 to present.

Gabapentin 100 - 200 as needed 2014 to present.

Aripiprazole: 2 months at 1.25, 4 months at 2 mg. Tried to stop 4 times over last 3 months. spent time at 1 mg. Currently at .5 mg. (Splitting 2 mg pill into quarters)

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  • Administrator

Liquid drugs might deteriorate in a spell of very hot weather.

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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4 hours ago, Altostrata said:

Liquid drugs might deteriorate in a spell of very hot weather.

I wondered this.  The abilify prescription I had  needed to be refrigerated - which was very unrealistic to do on a long hot summer road trip.... so I searched for a version that did not need to be refridgerated. (I am SURE the doses I was taking were lower due to the not being refrigerated etc)
I now have liquid abilify that does not need to be refrigerated - but I do hear you - a spell of hot weather could also impact this version.  

 

My sleep is being impacted by my taper now - for the past two weeks (when I was taking the deteriorated liquid) - so going to hold steady for a while til that resolves... I think this is best?

1997 - effexor for 4 months. Came off without issue (as far as I recall)

2000 - 2004 - Celexa 10 mg (came off very quickly - and had a "nervous breakdown" to use my words. High anxiety, out of control and life became unmanageable. Reinstated briefly then came off successfully )

2006-2009 Celexa 10 mg - somehow came off for a while but then... things got hard.

2010 - started (Lexapro in the U.S.) 5 mg  2012 for 6 months I was on 2.5 lexapro,  ativan - for sleep very occasional use 2014 5 mg cipralex (lexapro) : attempts to come off 5mg  2014 failed - way too fast - terrible anxiety  2015 march ---- started a SLOW taper of Lexapro. I was able to get down to .5 mg Lexapro in early 2016 February and March started to get intense strange symptoms of shaking body, loss of control, panic, weight loss.  Especially in early morning.  Reinstated- on Psych. Docs advise. (sadly! now I think but didn't know what else to do). 

August 2016 was on 6 mg Lexapro and still having panic and anxiety. Re-instating was very hard. Took .5 mg Ativan 3 x per day for two months. August 2016 - started 1mg Abilify and tapered off of Ativan over three months. 

From November 2016 - Janaury 2018:  1mg Abilify - 6 mg Lexapro

 ABILIFY taper started May 2018:  lots general anxiety. Moved to a liquid dose of Abilify. September 2018: 6mg lexapro a day,  Abilify taper is at .4mg. Experienced terrible anxiety, worry, restlessness, sleeplessness. Then Father died traumatically. P-Doc said to go back up.  reinstated 1mg Abilify started Nov. 28, 2018.   LEXAPRO 6mg.

2019 April started taper of Lexapro to 5.5, June 2019. Lexapro 5 mg, Abilify 1mg.  Holding for now til life stabilizes. Fish oil, melatonin, vit d, bio identical hormones, magnesium citrate.

2020 - Abilify taper to .8mg, Lexapro 5 mg, Progesterone SR 300 mg

2022 - Abilify taper in progress started in june at .8mg.  September .58, Lexapro 5 mg, Progesterone SR 300 mg. Going as slow as possible - but worried I will be too old by the time I get off of everything to eventually have a life left to enjoy.

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10 hours ago, seventyseven said:

I was told my liquid abilify did not need to be refrigerated. 

You probably have the version that does not need to be refridgerated. I have that now. My last version - had to be kept cold which was terrible for traveling.

1997 - effexor for 4 months. Came off without issue (as far as I recall)

2000 - 2004 - Celexa 10 mg (came off very quickly - and had a "nervous breakdown" to use my words. High anxiety, out of control and life became unmanageable. Reinstated briefly then came off successfully )

2006-2009 Celexa 10 mg - somehow came off for a while but then... things got hard.

2010 - started (Lexapro in the U.S.) 5 mg  2012 for 6 months I was on 2.5 lexapro,  ativan - for sleep very occasional use 2014 5 mg cipralex (lexapro) : attempts to come off 5mg  2014 failed - way too fast - terrible anxiety  2015 march ---- started a SLOW taper of Lexapro. I was able to get down to .5 mg Lexapro in early 2016 February and March started to get intense strange symptoms of shaking body, loss of control, panic, weight loss.  Especially in early morning.  Reinstated- on Psych. Docs advise. (sadly! now I think but didn't know what else to do). 

August 2016 was on 6 mg Lexapro and still having panic and anxiety. Re-instating was very hard. Took .5 mg Ativan 3 x per day for two months. August 2016 - started 1mg Abilify and tapered off of Ativan over three months. 

From November 2016 - Janaury 2018:  1mg Abilify - 6 mg Lexapro

 ABILIFY taper started May 2018:  lots general anxiety. Moved to a liquid dose of Abilify. September 2018: 6mg lexapro a day,  Abilify taper is at .4mg. Experienced terrible anxiety, worry, restlessness, sleeplessness. Then Father died traumatically. P-Doc said to go back up.  reinstated 1mg Abilify started Nov. 28, 2018.   LEXAPRO 6mg.

2019 April started taper of Lexapro to 5.5, June 2019. Lexapro 5 mg, Abilify 1mg.  Holding for now til life stabilizes. Fish oil, melatonin, vit d, bio identical hormones, magnesium citrate.

2020 - Abilify taper to .8mg, Lexapro 5 mg, Progesterone SR 300 mg

2022 - Abilify taper in progress started in june at .8mg.  September .58, Lexapro 5 mg, Progesterone SR 300 mg. Going as slow as possible - but worried I will be too old by the time I get off of everything to eventually have a life left to enjoy.

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  • Administrator

Even if it is not required to be refrigerated, liquid drug may deteriorate if exposed to high heat or bright light. If you look at the instructions, they probably tell you to store it at room temperature.

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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