Paul2014: Zyprexa withdrawal insomnia - looking for help

[Paul2014]

I had been on Ziprexa 5 mg for about 4 years. Believe it or not a Dr prescibed this to me to help with chronic fatigue syndrome. I stopped taking it over 3 months ago cold turkey. Call me naïve but I new nothing about tapering off or withdrawal.  I am learning the hard way.  I am having horrible insomnia since I stopped the medication.  It is now that I am learning that my insomnia is a result of stopping the medication.  Sleeping pills are not working for me.

 

I have tried prescription and non prescription from Ambien, Temazepan, Xanax etc to benadryl and the likes and all king of natural remedies. I found taking 600 mg of Gabapentin helped me sleep a little bit more but it stopped working after a few days.

 

I am scared.  I don't know what to do at this point to get well again and if it is ever going to happen.  I have lost my job because I can no longer function.  I am too exhausted from the lack of sleep.  I read that is too late for me to go back into taking the medication to relieve the withdrawal symptoms.  What can I do at this point to relieve my symptoms? Please help. I hope to find some guidance on this forum.  Thanks

[Meimeiquest]

Hi Paul, the moderators will be along soon, but I wanted to let you know of my experience reinstating Zyprexa. I stopped in Dec. 2012, maybe an eight month taper off 5mg. In March 2013 I tried a dose of 0.2mg and it totally zonked me. As I am still able to work I didn't take it again, but nothing bizarre happened. It is a killer insomnia ( I have to confess to restarting a benzo in my last weeks on it that I am still tapering), but now I never think about Zyprexa. Hopefully you will get to that point too!

[Paul2014]

Meimeiquest thank you for your reply.  How do you do a 0.2 mg dose?  I can cut the pill in 2 and make two halves of 0.25 mg or maybe cut it in 4 and make 0.125 mg each.

 

I have been reading around the forum and I am not clear if I should try reinstating Zyprexa since I have been off it for so long now.  I am afraid to get worse.  On the other hand I don't know what else to do.  I wonder what are my alternatives at this stage

[Meimeiquest]

One of the moderators will be along soon with some real advice, that's just my little story. You can read the topic in the tapering section on tapering Zyprexa while you wait for them.

[Paul2014]

Thanks.  I am anxiously waiting for the moderators advice.

[Altostrata]

Welcome, Paul2014.

 

It's possible a very small amount of Zyprexa might somewhat relieve the symptoms at this point. But your system has been sensitized by the cold turkey and going on and off all the other drugs.

 

As meimei indicated, even 0.1mg might have an effect. For information about titrating Zyprexa, see http://survivingantidepressants.org/index.php?/topic/3743-tips-for-tapering-off-zyprexa-olanzapine/

[Paul2014]

Hi Altostrata,

 

Thanks for your message.  At the risk of sounding stupid let ask Would 1.25 mg be too much to try?  I only ask because the options to have a pharmacy prepare a liquid seems to me would  take a while.  First I have to get a prescription for it which means going to a doctor.  I currently have no job and no insurance.  In addition I am so desperate that I would want to try this possibly starting tonight   I have plenty of Olanzapine at home (5 mg tabs) and I can cut them in quarters.  One quarter would be 1.25 mg.  I don't think I can cut them smaller than this.  The other option from Rni to prepare my own liquid I don't understand it.  How do you measure the amount of drug once you have it evenly suspended? If you could please help me understand.  Thanks again.

[Altostrata]

You might cut the tablet into quarters and then take a crumb of one of the quarters to test your reaction.

 

To make a liquid, see http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

You measure your dose of the liquid with an oral syringe.

[bubble]

Hi Paul,

 

I'm just chiming in to offer some help with preparing a liquid suspension of the drug. I've been doing this with xanax for 5 months now and people here had a lot of trouble with me till I finally understood the concept. I thought I would never be able to do it and now it's a piece of cake and look very simple.

 

All you need is to buy an oral syringe, crush the tablet with the back of the spoon against a hard surface BUT the real question is in how much water to get 0.1 mg of drug in 1ml of suspension???

 

this is were my expertise stops since we are talking maths here and quite complex for me It's easy if you can do 1 : 1 ratio. You have 5 mg of a pill and suspend it in 5 ml of water. then if you take 1 ml you will get 1 mg. 

 

But you have to get such a small amount that I can only hope expert mathematicians come in at this point.

 

( I think the link Alto provided gives as clear explanation as possible but for dummies like me it was still beyond grasp so areyouthere here saved me.

 

sorry I couldn't be more helpful but hope this will inspire somebody who knows to write...

 

I;m glad you came here.

 

best,

 

bubble

[Paul2014]

Hi Bubble,  Thank you so much for your reply.  I am a dummy myself when it comes to this.  In addition, I am so sleep deprived that it's hard for me to concentrate.  I had to read over and over the info on the link and I think I get most of it.   What is still giving me trouble is that Ziprexa is not soluble in water.  So if I make a preparation of crushed Ziprexa with water I do not understand how to get an even dose each time out of the preparation.

 

There is a post from Rhi ( http://survivinganti...nzapin/?p=45153 )http://survivingantidepressants.org/index.php?/topic/3743-tips-for-tapering-off-zyprexa-olanzapin/?p=45153 where he explains that his meds are not soluble in water however he somehow measures them up while suspended in the water.  I am having a hard time with this.  I don't understand it. How do you measure up the particles to get the dosage you need?  I hope some good soul on this forum can help me figure this out.

 

I read that Ziprexa (Olanzapine) is quite soluble in DMSO, is this the way to go?  I Googled DMSO and I found this http://www.amazon.com/DMSO-Liquid-Concentrate-99%25-Pure/dp/B001L538IY/ref=sr_1_4?ie=UTF8&qid=1395956782&sr=8-4&keywords=dmso

 

Is this what I should buy?

 

I hope someone has the patience to help me out

 

Thanks again

[Paul2014]

You might cut the tablet into quarters and then take a crumb of one of the quarters to test your reaction.

 

To make a liquid, see http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

You measure your dose of the liquid with an oral syringe.

Thanks Altos I am going to do the test tonight.  If I don't feel an adverse reaction to it tomorrow then it means I can continue to take it or it might take several days of taking it for the reaction to show?  Sorry for having so many questions... 

[Altostrata]

A crumb is an inexact way to measure. You'd have to take the same amount over 4 days at least to see if it's beneficial or not.

[Paul2014]

If after 4 days I do not see an improvement should I try increasing the dose? 

[Altostrata]

Not necessarily, but you'll have to figure out how to measure it. So get your oral syringes etc. now.

[Paul2014]

Can you help me out with the questions I have on my reply to Bubble above? 

[Altostrata]

I don't know anyone who's used DMSO as base for a homemade liquid.

 

You make an even suspension either by using the pharmacy liquid (kind of syrupy) or stirring the powder so it's fairly evenly distributed in the water and vacuuming it up with your oral syringe.

[Paul2014]

Thank you for your replies.  Sorry for being such dummy.  This water with powder is good for how long? Can I prepare enough to last me more than a month?  

 

The pharmacy liquid you are talking about is the one named Ora-Plus?

[Altostrata]

Yes, Ora-Plus.

 

Your stability questions are answered in http://survivingantidepressants.org/index.php?/topic/3743-tips-for-tapering-off-zyprexa-olanzapine/

[bubble]

Hi Bubble,  Thank you so much for your reply.  I am a dummy myself when it comes to this.  In addition, I am so sleep deprived that it's hard for me to concentrate.  I had to read over and over the info on the link and I think I get most of it.   What is still giving me trouble is that Ziprexa is not soluble in water.  So if I make a preparation of crushed Ziprexa with water I do not understand how to get an even dose each time out of the preparation.

 

There is a post from Rhi ( http://survivinganti...nzapin/?p=45153 )http://survivingantidepressants.org/index.php?/topic/3743-tips-for-tapering-off-zyprexa-olanzapin/?p=45153 where he explains that his meds are not soluble in water however he somehow measures them up while suspended in the water.  I am having a hard time with this.  I don't understand it. How do you measure up the particles to get the dosage you need?  I hope some good soul on this forum can help me figure this out.

 

I read that Ziprexa (Olanzapine) is quite soluble in DMSO, is this the way to go?  I Googled DMSO and I found this http://www.amazon.com/DMSO-Liquid-Concentrate-99%25-Pure/dp/B001L538IY/ref=sr_1_4?ie=UTF8&qid=1395956782&sr=8-4&keywords=dmso

 

Is this what I should buy?

 

I hope someone has the patience to help me out

 

Thanks again

 

 

Hello!

 

We here have lots of patience heer (unless someone lets WD get the better of him/her, or actually me;). The only things is we in Europe go to bed very early for your standards

 

Rhi is she and while waiting for soembody with more knowledge and experience , I will offer my modest ones.

 

As far as I know most of our drugs are not soluble in water so we all make liquid suspensions. To ensure the particles get evenly dispersed while measuring the liquid with a syringe you have to shake and stir the bottle well, take from the middle and other small tricks. It's not perfect accuracy but it's  more perfect than crumbling a pill since pharma hasn't been kind enough to provide us with small dosages of drugs that would help us taper. 

 

I keep my suspension in water for 4 days which is a max time (and will switch to 3 days). 1 month sounds a lot for a home made thing... The only reason for this is probably to avoid inconvenience of making it too often but once you get the hang of it, you will se it's actually very easy and doesn't take more than 5 mins...

 

write about anything that you need or that comes to your mind. If people don't reply, just repeat

[Paul2014]

Thank you so much Bubble  You are really cool. Your words have helped me understand better.  I think it is much less complicated than I was making it to be.  Sorry.

 

Corect me if I am wrong, the way I understand it, you have to waste part of the medication.  What I mean is that if I prepare 5 mg in 5 ml and I take 1 ml = 1 mg per night for 4 nights then I throw away the last ml.  Right?

 

In my case, I have been advised to take 0.1 mg per night.  So I have to prepare 5 mg in 50 ml so that 1 ml = 0.1 mg.  Then I take 1 ml = 0.1 mg per night for 4 nights and throw the rest away, I'll be throwing away 46 ml = 4.6 mg.  This is a lot of medication to throw away.

 

I guess I'll cut the pill in 4 quarters and use 1 quarter (1.25 mg) to prepare the water suspension.  I take 0.1 mg per night for 4 nights =  0.4 mg.  I'll thow away the rest.  This is still a lot of medication wasted.

 

I wish someone could confirm this is the way they do it.

 

I'll remember to take from the middle as you mentioned.  What are the other small ticks?

 

Thanks again

[Meimeiquest]

The tapering thread for Zyprexa says it is stable as a suspension for 48 hrs. under refrigeration, 6 hours at room temperature.

[Paul2014]

Meimequest thank you for pointing that out.  so I can only use the preparation for 2 nights.  This means throwing away a lot of medication.  Right?

 

If it's not too much to ask, How did you do your preparations of Ziprexa when you had to taper at lower dose?  With crushing a quarter pill of 2.5 mg ?

[Meimeiquest]

I did it before I found this forum. I cut by quarters of 2.5mg tablets. At the end I sorted them into small, medium, large. Then we were traveling and my husband put his wet toothbrush in my small bag...and that ended my taper . So I jumped at about 0.6mg.

[Rhiannon]

Let's see, maybe I can clarify a couple of things.

 

If you get an oral syringe that's marked in 0.1 mL (tenths of a mL) then you can mix your 5 mg in less than 50 mL and still get 0.1 mg.  Diluting in 50 mL is a bit excessive and unwieldy, I think, unless you need to get very tiny increments like 0.001 mg, which you don't right now.

 

Do you have the syringes yet? I use pipettes, not syringes, but I've seen some very good looking syringes posted here which are marked in tenths of a mL. (Someone correct me if that's wrong). Take a look at those under the Tapering section.

 

Here's an example of the math: 5 mg in 25 mL is 1 mg in 5 mL, which means 0.1 mg would be 0.5 mL or a half of a mL. I think you should be able to get a syringe that can easily measure a half of a mL. I think even the free ones from Walgreens can do that.

 

Then if you get those classy syringes that are described over in Tapering, you can tweak it in even finer increments.

 

Let me know if that's unclear.

 

As for the "soluble" versus "not soluble" thing:  Most psych meds are not soluble in water, or only partially. It's not really a problem. "Soluble" means the molecules of the substance dissociate from each other completely and are completely separate.  You don't really need them to do that; you just need them to be in very small particles, hanging in the water, pretty evenly distributed.  

 

The pills themselves, which are made up mostly of fillers and binders with only a very small amount of actual active drug, usually dissolve pretty well (that is, the binders dissolve so the pill can come apart). Sometimes you need to let them sit in the water for a bit, five or ten minutes maybe. (I don't even crush mine with a spoon, I just let the pill slowly dissolve in water.)

 

Then stir the liquid up well with the tip of your syringe. You want it to look pretty much even throughout, well stirred, not thicker in some places than others. It's not hard to do. When it looks pretty even, give it a stir and then draw it up. 

 

I don't have any experience with your particular pills. You might just take one and dissolve it now and see how quickly it dissolves and how smooth-looking your suspension is, just to get a feel for it.

 

As far as wasting the medication: Yes, at small doses, you do end up wasting a lot of the medication. This is only a problem if you don't have a doctor who is willing to prescribe you as much as you need, or if you don't have access to an affordable source either by insurance or by getting a generic. Wal-Mart sells a lot of generic drugs really cheap. So the best approach is to work on getting a reliable affordable source of the drug so you don't have to worry about wasting it.

 

If you absolutely can't do that, you can get a milligram scale and split the tablet into three quarters (you'll have to waste the fourth one because in the process of measuring out those pieces there will inevitably be some lost as powder so you won't be able to use the entire tablet). I think there's discussion in Tapering of how to use a milligram scale. "Eyeball" cutting tablets is NOT adequate at small doses like you're going to be trying. I don't actually think it's accurate enough even at larger doses. You would get such large variations that the math for making a liquid would be inaccurate and useless.

 

I know that's probably just more confusing.

 

To start with I would say: Read up about the syringes over in the Tapering section. Work on getting a reliable affordable source of the drug so you don't have to worry about tossing out most of the tablet after using your two days' worth. Try dissolving one just to see how it dissolves and what those features are.

 

Start there and then take it from there one small step at a time.

[Paul2014]

Rhi  Thank you so much for your reply.  You have clarified some important points for me.  I do have  a 10 ml and a 3 ml syringe.  The 3 ml measures in 0.1 ml increments.

 

The part about the miligram scale and splitting the tablet into three quarters I did not understand so much but I'll check the discussion you mentioned of how to use a miligram scale.  I think for now (tonight and the coming days) I'll stick with the water preparation.  Your math example has been very helpful as well.

 

I have checked Waltmart, Walgreens and target pharmacies but unfortunatly Olanzapine (the generic for ziprexa) is not in the list of generics they offer at discount.  I'll be going to a DR on Monday to explain my situation and try to get a prescription with as many refills as possible.

 

I have a question, can you clarify for me what do you mean by "Eyeball" cutting tablets? (sorry English is not my native language and I am not sure)  Do you mean like cutting a pill into quarters with a pill cutter?  and then using a quarter to make the preparation?   I was thinking of precisely doing this.  This is why I need to confirm.

 

I tried last night a small crumble of the pill to test my reaction to it and have no bad reaction today.  I will prepare a liquid tonight.  I'm not sure weather to stick with the 0.1 ml or maybe try something like 0.2 mg

[Paul2014]

I did it before I found this forum. I cut by quarters of 2.5mg tablets. At the end I sorted them into small, medium, large. Then we were traveling and my husband put his wet toothbrush in my small bag...and that ended my taper . So I jumped at about 0.6mg.

Did you get any withdrawal effects after stopping a 0.6 mg?

[Meimeiquest]

It's hard to say because I went right into mania-like symptoms once the Zyprexa wasn't holding the effect of the Wellbutrin back. I was only saved by this forum. I don't really know where the Zyprexa WD ended and the Wellbutrin side effects started. Towards the end of the taper, the last two months, I was extremely irritable, horrible insomnia, withdrawal head symptoms, all sorts of memories, and had one episode where I couldn't stop laughing, and sometimes I heard things or saw things in my peripheral vision that weren't thee. Before that I had to increase my dose sometimes, but the symptoms would go away. Good times. And that was my easiest taper so far .

[Paul2014]

I need help.

 

I am trying reinsteintment because the withdrawal is killing me and I don't know what else

to do

I really need guidance on this from some of the experts on this board.

 

I am not sure how to go about doing the reinstatement (given that I have been off the drug

for over 3 months) I was at 2.5 mg /day when I abruptly stopped taking it.  Some one please

help me.

[Meimeiquest]

Alto, this site's owner, suggested a 0.1mg dose.

[Meimeiquest]

Did you sleep last night? If you are seeing the dr., maybe you would rather get it compounded by a compounding pharmacist? That's what I did for my one dose. BUT he put it in methyl cellulose which means the drug is absorbed over eight hours. With such a sedating drug, that is not a good thing. You wan to start at 0.1 mg, you can increase to 0.2 mg if needed later. It will be half as much to taper later if the 0.1mg works.

[Paul2014]

No sleep last night.  Thanks for your feedback.  I'll look into it.  I'll do the 0.1 mg tonight and go from there.  Altos says that you'd have to take the same amount over 4 days at least to see if it's beneficial or not.  So I'll do that

 

I know I am being anxious and I know I am anticipating myself but I would like to know what to do if after 4 days I do not see an improvement.

[Meimeiquest]

I think with no improvement you would increase dose, with side effects would need to regroup. Sweet dreams!

[Meimeiquest]

Also, I think you would benefit from a search in the symptoms forum for non-drug help in managing insomnia.

[Altostrata]

Believe me, Paul, many of us have been there. We know how you feel. You need to be patient and let your nervous system heal itself.

[Paul2014]

Thank you for your words.  I feel so bad that there are moments I feel like calling 911 to get rushed to a hospital but aside from not having medical insurance I have learned from your site that Doctors would not understand what I am going through and that they could actually mess me up worse.  An acquaintance gave me the name of a neurologist/siquiatrist that treats her mother.  She says that he is an excellent doctor and I should see him.  I'm still afraid to go to him.  What does he know about withdrawal symptoms?

 

I emailed the doctor that originally prescribed me the Ziprexa explaining what I was going through and asking for his help.  All I got from him was to start taking the Ziprexa again.  I feel so betrayed for having put my trust in him.

[Meimeiquest]

Dealing with our feelings about our doctors is a tough part of this experience. Did you read the thread about insomnia? It is very important. One reason Zyprexa is so nasty is that it is a strong anti-histamine. Some people benefit from a low histamine diet. You have your magnesium going? Epsom salts baths help a lot of people.