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Manny78: Multiple psychotropic drugs - which one first?

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Manny78

Hello, my name is Manny. I was diagnosed 0CD and schizophrenic in 2008, but I been taking benzos and amiptriptiline since 2005. Currently,taking abilify 20mg,risperidone 2mg,cymbalta 60mg,biperiden 4mg. I am tapering klonopin down to 0,27mg from a dose of 1,25mg. I went to see my doctor this week because a blood test that I did. He said my hepatic transaminases are high because of the medication that I take. I am assuming the APs that I take. What can I do to get my liver function well? I know, quitting the APs, but I can t cold turkey. Any advice,please.  

 

 

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Manny78

Hi everyone. My name is Manny. I have been polydrugged. I take abilify 20mg,risperdal 2mg,klonopin 0,27mg and cymbalta 60mg. I was tapering klonopin, but I read that abilify can make your liver to not function very well. My transaminases are high.My question is what drug do I taper first? Can I stop klonopin taper and start abilify taper. I use an scale,but my abilify is the one that disintegrates in your mouth.

 

Thanks,

 

Manny

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ChessieCat

Hi Manny and welcome to SA,

 

We ask all members to create a drug signature.  Please follow the preferred format explained below:

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

  • Please leave out symptoms and diagnoses.
  • A list is easier to understand than one or multiple paragraphs. 
  • Any drugs prior to 24 months ago can just be listed with start and stop years.
  • Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
  • Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
  • Link to Account Settings – Create or Edit a signature.

 

Q:  Have you had a liver function test done?

 

I have used this interactions checker with these results:

Monitor Closely

  • duloxetine + risperidone

    duloxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

  • aripiprazole + risperidone

    aripiprazole and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

  • clonazepam + aripiprazole

    clonazepam and aripiprazole both increase sedation. Use Caution/Monitor.

  • clonazepam + risperidone

    clonazepam and risperidone both increase sedation. Use Caution/Monitor.

  • aripiprazole + risperidone

    aripiprazole and risperidone both increase sedation. Use Caution/Monitor.

Minor

  • duloxetine + aripiprazole

    duloxetine will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

 

I'll ask the other mods for their opinions on your situation.

 

These are links to some helpful topics:

 

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).


Dr Joseph Glenmullen's WD Symptoms Checklist
 

How do you talk to a doctor about tapering and withdrawal?


What should I expect from my doctor about withdrawal symptoms?


The first post in topic has links to tips for tapering various drugs:

 

Important topics in the Tapering forum and FAQ

 

These helped me to understand SA's recommendations:

 

Brain Remodelling


Video:  Healing From Antidepressants - Patterns of Recovery

 

This is your own Introduction topic where you can ask questions and journal your progress.

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Manny78

Hello. I created a signuture of meds I take, but I went back to time to 2005.

 

May 2005-ativan 5 mg and elavil(amiptriptiline) 10mg -Spain

 

Went back to the US, hospilized with Lexapro 10 mg, and 1.5 mg de clonazepam.

 

October, 2005

switched to 1,25 mg of klonopin to 25 mg of valium- tapered off from 25 mg of v to 4,5 mg of vcold turkeyed it at 4,5 mg of valium because OCD.

 

January 2007 to January 2008

took occasionally zyprexa,seroquel, cymbalta and ativan while being hospitalized again in the US

 

4/25/2008

Ziprasidona 80mg: 1.1.1

klonopin 0,5 mg: ½,0,0

klonopin 2mg: 1.0,0

 

changed to Zyprasidona 60mg: 1,0,1

ativan 5 mg: ¼,1/4, ½

biperiden 4 mg:1,0,0

 

 

 

february,6,2009

risperidone 3mg:0,0,1

abilify 15mg: 1,0,0

cymbalta 60mg: 2.0,0

Ativan 5 mg:¼,1/4, ½

 

6/28/11

abilify 15mg:1,0,0

cymbalta 60mg: 2.0,0

biperiden 4 mg:1,0,0

risperidone 3mg:0,0,2

ativan 1mg:2.2 ½ or 1,2

 

february,19,2013

risperidone 6mg:0.0,1

risperidone 3mg:0,0,1

biperiden 4mg:1,0,0

abilify 15mg: 1,0,0

abilify 10mg:1.0,0

cymbalta 60mg:1,0,0

cymbalta 30mg:1,0,0

ativan 1mg:0,5,1,1

 

06/05/2014

biperiden 4mg:1,0,0

abilify 15mg: 1,0,0

ativan 1mg:1,1,1

abilify 10mg:1.0,0

risperidone 6mg:0.0,1

risperidone 3mg:0,0,1

cymbalta 60mg:1.0.0

 

september,11,2014

risperidone 6mg:0.0,1

risperidone 3mg:0,0,1

biperiden 4mg:1,0,0

abilify 15mg:2,0,0

cymbalta 60mg:1.0,0

ativan 1mg:0,5,1,1

 

february,2,2015

 

abilify 10mg:2,0,0

ativan 1mg: 0,5,1,1

risperidone 1mg:0,0,1

risperidone 6mg:0,01

cymbalta 60mg:1,0,0

biperiden 4 mg:1,0,0

 

june,25,2015

risperidone 6mg:0.0,1

risperidone 3mg:0,0,1

biperiden 4mg:1,0,0

abilify 10mg:2,0,0

cymbalta 60mg:1.0.0

rivotril 2 mg:3/4

take ativan out

 

 

 

january,3rd,2016

started tapering 1.25 mg of k till now (0,27mg of k-25/11/2017)

 

february,5,2016

 

risperidone 1mg:0,0,1

risperidone 6mg:0,01

biperiden 4 mg:1,0,0

abilify 10mg:2,0,0

cymbalta 60mg:1,0,0

klonopin 2mg: 0,0,1/2

 

 

september,29,2016

risperidone 1mg:0,0,1

risperidone 6mg:0,01

biperiden 4 mg:1,0,0

abilify 10mg:2,0,0

cymbalta 60mg:1,0,0

klonopin 0,5mg: 0,0,1 ½

 

 

 

 

 

october,26,2017

biperiden 4mg:1,0,0

risperidone 2mg:0,0,1. tapered on my own risperidone from 6mg to 2 mg.

klonopin 0,5mg:0,0,1

abilfy 10mg:2,0,0

cymbalta 60mg:1,0,0

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Manny78

Hello, chessiecat. I did a blood test where my hepatic transaminases came a little high,the ALTs, but my Gp didn`t give me a diet or take off abilify and risperdal.

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Manny78
On 26/11/2017 at 2:02 PM, Manny78 said:

Hello. I created a signuture of meds I take, but I went back to time to 2005.

 

May 2005-ativan 5 mg and elavil(amiptriptiline) 10mg -Spain

 

Went back to the US, hospilized with Lexapro 10 mg, and 1.5 mg de clonazepam.

 

October, 2005

switched to 1,25 mg of klonopin to 25 mg of valium- tapered off from 25 mg of v to 4,5 mg of vcold turkeyed it at 4,5 mg of valium because OCD.

 

January 2007 to January 2008

took occasionally zyprexa,seroquel, cymbalta and ativan while being hospitalized again in the US

 

4/25/2008

Ziprasidona 80mg: 1.1.1

klonopin 0,5 mg: ½,0,0

klonopin 2mg: 1.0,0

 

changed to Zyprasidona 60mg: 1,0,1

ativan 5 mg: ¼,1/4, ½

biperiden 4 mg:1,0,0

 

 

 

february,6,2009

risperidone 3mg:0,0,1

abilify 15mg: 1,0,0

cymbalta 60mg: 2.0,0

Ativan 5 mg:¼,1/4, ½

 

6/28/11

abilify 15mg:1,0,0

cymbalta 60mg: 2.0,0

biperiden 4 mg:1,0,0

risperidone 3mg:0,0,2

ativan 1mg:2.2 ½ or 1,2

 

february,19,2013

risperidone 6mg:0.0,1

risperidone 3mg:0,0,1

biperiden 4mg:1,0,0

abilify 15mg: 1,0,0

abilify 10mg:1.0,0

cymbalta 60mg:1,0,0

cymbalta 30mg:1,0,0

ativan 1mg:0,5,1,1

 

06/05/2014

biperiden 4mg:1,0,0

abilify 15mg: 1,0,0

ativan 1mg:1,1,1

abilify 10mg:1.0,0

risperidone 6mg:0.0,1

risperidone 3mg:0,0,1

cymbalta 60mg:1.0.0

 

september,11,2014

risperidone 6mg:0.0,1

risperidone 3mg:0,0,1

biperiden 4mg:1,0,0

abilify 15mg:2,0,0

cymbalta 60mg:1.0,0

ativan 1mg:0,5,1,1

 

february,2,2015

 

abilify 10mg:2,0,0

ativan 1mg: 0,5,1,1

risperidone 1mg:0,0,1

risperidone 6mg:0,01

cymbalta 60mg:1,0,0

biperiden 4 mg:1,0,0

 

june,25,2015

risperidone 6mg:0.0,1

risperidone 3mg:0,0,1

biperiden 4mg:1,0,0

abilify 10mg:2,0,0

cymbalta 60mg:1.0.0

rivotril 2 mg:3/4

take ativan out

 

 

 

january,3rd,2016

started tapering 1.25 mg of k till now (0,27mg of k-25/11/2017)

 

february,5,2016

 

risperidone 1mg:0,0,1

risperidone 6mg:0,01

biperiden 4 mg:1,0,0

abilify 10mg:2,0,0

cymbalta 60mg:1,0,0

klonopin 2mg: 0,0,1/2

 

 

september,29,2016

risperidone 1mg:0,0,1

risperidone 6mg:0,01

biperiden 4 mg:1,0,0

abilify 10mg:2,0,0

cymbalta 60mg:1,0,0

klonopin 0,5mg: 0,0,1 ½

 

 

 

 

 

october,26,2017

biperiden 4mg:1,0,0

risperidone 2mg:0,0,1. tapered on my own risperidone from 6mg to 2 mg.

klonopin 0,5mg:0,0,1

abilfy 10mg:2,0,0

cymbalta 60mg:1,0,0

Klonopin 0,5mg: 0,0,1/2

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Altostrata

Welcome, Manny.

 

You have abnormal liver test results because your liver is having a hard time processing all the drugs you take. In the past, it might also have been overloaded and possibly injured.

 

You need to reduce the load of drugs on your liver. It is unfortunate your doctors did not think of this. It's very difficult to get a liver transplant if yours should fail and impossible to live without a liver.

 

As ChessieCat indicated, these drugs interact with each other; the interactions may cause adverse effects. Some of the interactions occur because the drugs are competing for liver enzymes. If the enzymes are used up by metabolization of one drug, there's none left to metabolize the second (or third, or fourth) drug. Then the second (and third, and fourth) drug may damage the liver.

 

One way to help your liver is to minimize your drug burden. Risperdone and Abilify are both antipsychotics, they are redundant. You might want to very gradually go off risperdone, see Tips for tapering off Risperdal (risperidone) Have you had any withdrawal symptoms from reducing it so far?

 

Either risperdone or Abilify might cause movement disorders. Biperiden was added to counter this adverse reaction. However, movement disorders are quite serious; the correct way to treat them is to minimize the drugs rather than add another drug.

 

You are taking a hefty amount of an antidepressant, Cymbalta. Why are you taking Klonopin? Do you have trouble sleeping? That is a benzodiazepine and technically addictive.


Your doctors must be very afraid of you to overdrug you so thoroughly, or they are deeply incompetent. It's a wonder that you're not a zombie. It's possible you are a fast metabolizer who doesn't show much reaction to high dosages of drugs until your liver is damaged.

 

Please be aware that if you reduce your drugs, you will need to manage your behavior so you are not hospitalized and piled with more drugs.

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Manny78

Hello, I went to my psychiatrist. I told him all the sxs that I have like I have my back blocked, same with memory. I can t focus, concentrate very well. All he said  for the memory blocks was that it was a sx of my mental condition and there was nothing to do. He said that it could be the risperdal the memory problem,but that is the  main drug to that helps me to feel (well).also, he said the abilify could be be the drug that causes me to feel constipated. libido problems, the risperdal and also cymbalta and lastly the constipation, it could be the abilify and I need to have it with food in the morning. said all the causes, but didn't give me a solution. This guy is not helping me.

 

Edited by ChessieCat
removed quote

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Manny78

Hello altotrasta. Thank you for your reply. I haven t talked to anybody yet about my hepatic transaminases. I only spoke with my friends.

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Manny78
4 hours ago, Manny78 said:

 

 

 

Hello, I went to my psychiatrist. I told him all the sxs that I have like I have my back blocked, same with memory. I can t focus, concentrate very well. All he said  for the memory blocks was that it was a sx of my mental condition and there was nothing to do. He said that it could be the risperdal the memory problem,but that is the  main drug that helps me to feel (well).also, he said the abilify could be be the drug that causes me to feel constipated. libido problems, the risperdal and also cymbalta and lastly the constipation, it could be the abilify and I need to have it with food in the morning. Hesaid all the causes, but didn't give me a solution. This guy is not helping me.

This is what my damn psychiatrist told me on my recent appoinment(10/26/17)with him.  At that time I didn t know my hepatic transaminases where high. I am angry. They just don t give a damn about you.  They basically lie in your face.I  know I can`t concentrate because of the damn benzo withdrawal and APs. The APs are messing with the enzymes in the liver.

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Manny78

Hello altotrasta. Thank you for your reply. I really appreciate it.I guess I have to change my gp and psychiatrist.I can die and they don't  give a damn. I am a little hypochondriac.That was the reason why I started taking ativan and elavil in 2005. I am taking klonopin for anxiety and sleep. I don't know if I can taper two or three drugs at the same time like a 2% per month.I don't want to cold turkey the APs. It could be worse. Is there a test that you can do on your own to check how the liver is functioning?

 

Edited by ChessieCat
extracted response

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Manny78

I quit tapering klonopin taper to taper abilify 20 mg. Should I taper risperdal first? I hate this. I am basically tied hands. If I stop one drug, the other is still causing damage.if I go to my psychiatrist,he is going to quit my drugs decreasing more than 10%.All I can do is do it on my own like I have been doing with the klonopin.

 

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Manny78

I told my dad too. My dad has been brainwashed by a psychologist and psychiatrist.

 

 

Edited by ChessieCat
extracted response

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Manny78

 I am thinking to taper abilify 20 mg because it is the one that it is higher in amount(20mg)and reading the secondary side effects can cause the liver to stop working,inflammation liver and abnormal hepatic results. the problem is that pills are the oral mouth disintegrated.I use and scale to weigh down them and then I take a tiny piece. 

 

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Manny78

Is shakeness a withdrawal side effects of antipsychotics? 

 

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Altostrata
On 11/28/2017 at 7:40 AM, Manny78 said:

This guy is not helping me.

 

^ This looks to be the truth, Manny.

 

You are vastly overdrugged. You probably have been misdiagnosed. You have serious side effects from the drugs, not your "condition," whatever that is. Your liver is sending up warning signals.

 

You need a new doctor, one who will help you minimize drugs.

 

Any one of several drugs you're taking would make most people dopey. Taking that cocktail, it's a wonder that you are coherent.

 

If you feel stable on Risperdal, you could switch to tapering Abilify. We urge people not to change more than one drug at once, the situation gets too confusing.

 

Yes, you can get shaky from withdrawal, and you can also get shaky from drug-drug interactions or taking too many drugs. When did the shakiness start?

 

It would be a good idea for you to keep daily notes on paper about your symptoms, when you take your drugs, and their dosages.

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Manny78

Hi altostrata. I still I don't know how I keep going. I go to school every day. I am studying English. Not that I don't know it to keep myself busy.i can't concentrate very well.the shakiness started when I switched to abilify taper mostly,yesterday and today. Like inner vibrations. Also,it can be from my benzo taper which I stopped tapering. I don't know what the hell to do,taper first the benzo or antipsychotic.I keep an excel spreadsheet with the doses I take. For example, I am at 0,27mg of klonopin.klonopin 0,5mg weighs an average of 0,061mg. I am taking 0,033mg of powder of klonopin which is equal to 0,27mg.

IMG-20170803-WA0002.jpg

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Manny78

This is my taper schedule for abilify.

 

 

Screenshot_20171125-201110.png

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Manny78

Started tapering abilify 2Omg-26/11/17

17 hours ago, Manny78 said:

 

 

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Manny78
On 27/11/2017 at 10:02 PM, Manny78 said:

Klonopin 0,5mg: 0,0,1/2

I can t find a good a good doctor to taper me off of these drugs. I commented in other group my situation, a group of people that are diagnosed with was it is called a mental illness,here in Spain. I don't know how bad my liver can be. I am tapering off abilify, 10% per month and hold it. I am tricked to reduce at a higher rate.what are the sxs of liver disease? If I switch doctors, my primary doc. I don't know if I will do better. 

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Altostrata

If I were you, I would stop tapering the benzo. Taper only one drug at a time. Did this inner vibration start upon your first reduction of Abilify?

 

Please update this list

october,26,2017

biperiden 4mg:1,0,0

risperidone 2mg:0,0,1. tapered on my own risperidone from 6mg to 2 mg.

klonopin 0,5mg:0,0,1

abilfy 10mg:2,0,0

cymbalta 60mg:1,0,0

 

You are doing a very good job of keeping records. When you need to round your dosage, I would round so the amount of decrease is smaller rather than larger.

 

Very few doctors know how to taper, the best you can do is finding one that will write the prescriptions you need to maintain your taper plan.


If it's not too damaged, the liver has miraculous powers to regenerate. Liver damage can become very serious, leading to a liver transplant. You are taking care of your liver by reducing drugs. Your liver transaminases should be lower the next time they're tested.

 

"Mental illness" can be very difficult to diagnose and even harder to treat with drugs. Misdiagnosis and mistreatment are quite common. However, your drug cocktail is excessive no matter what the diagnosis. There is no "mental illness" that calls for that drug combination. Many psychiatrists would recognize that.

 

Your English is very good, you should be proud of yourself.

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Manny78

Hello altostrata. I checked my records and here is  the signature of what I am taking right now:

Abilify 18 mgs: 11/26/17.

Risperdal 2 mgs: 5/4/17

Klonopin 0,27 mgs: 11/22/17

Cymbalta 60mgs: 6/05/14

Biperiden 4mgs: 6/28/11

 

 

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Manny78
Just now, Manny78 said:

Hello altostrata. I checked my records and here is  the signature of what I am taking right now:

 

 

Just now, Manny78 said:

December,7,2017

 

 

Just now, Manny78 said:

Abilify 18 mgs: 11/26/17.

Risperdal 2 mgs: 5/4/17

Klonopin 0,27 mgs: 11/22/17

Cymbalta 60mgs: 6/05/14

Biperiden 4mgs: 6/28/11

 

 

 

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Manny78

Hello altostrata. How long it will take me to get rid off of abilify? Should I hold on to 18mgs of abilify a month? I mean do I need to stay at 18 mg one month and so on,cutting 10% per month? My next cut should be 16,2mg?

 Thanks,

 

Manny

 

I have a lot of cognitive problems. My ribs hurt a lot and I started having muscle twitching.

 

 

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Manny78

Hello altostrata. How long it will take me to get rid off of abilify? Should I hold on to 18mgs of abilify a month? I mean do I need to stay at 18 mg one month and so on,cutting 10% per month? My next cut should be 16,2mg?

 Thanks,

 

Manny

 

 

 

I have a lot of cognitive problems,shakiness,inner vibrations,

 muscle twitching,anxiety and need to move around.

 

 

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