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Rabe: how to taper and adjust Viibryd while on Clonazepam

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Rabe
Posted (edited)

Moderator's note: link to benzo thread - Rabe: questions re how ro navigate clonazepam, viibryd, and amiloride

 

Hi, I am new on the site having been so impressed with the knowledge and personal experience that I have read as I continue my journey of tapering psychiatric medications.  

 

I have been on Clonazepam for many years for a severe panic disorder with agoraphobia and had no problems with it until I moved, had surgery, was exposed to environmental toxins and my doctor doubled the dose.  I broke out in a weeping rash and was so very ill.  

 

I tried tapering on my own and became very very ill, lost weight, muscle and fat and was extremely depressed.  My children brought me to a treatment center to get help with the tapering but instead I was put on an antidepressant.  I am now finding myself tapering the Clonazepam and the Viibryd with a doctors help, but his knowledge seems quite limited.  

 

We did taper the Viibryd to 10mg in the spring and it was not too bad.  I tried tapering by about 10% now and had horrible HA, nightmares, depression, stomach upset, agitation, anxiety, headache, electrical feelings in my head, weakness...

 

I saw the doctor today and he would like to split the dose to 5 in AM and 5 in PM to help in tapering.  My concern is that I take Premarin and the larger Clonazepam dose at night and I am concerned about having to eat that late d/t GERD, about less anxiety coverage during the day as well as the sleepiness from both the Viibryd and Clonazepam together at night.  

 

I was wanting to get any thoughts or experience on this if possible.  Thank you so very much.  This has been such an overwhelming and physically and mentally draining experience with little support for almost 2 years.  I am grateful to be here!

Edited by Shep
insert paragraph breaks for readability (Scallywag), added link to benzo thread (Shep)

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scallywag

RABE -- Welcome to Surviving Antidepressants (SA)

 

I'm very sorry to learn that you had to figure out tapering clonazepam on your own. These doctors!>!>!$&%*  And it's shameful that the "treatment center" gave you an anti-depressant to "treat" clonazepam withdrawal. I'm glad you found us so that you really truly find your way out of the medication horror house.
 

You may want to talk with a pharmacist about whether shifting half the vilazodone to the evening will cause problems with Premarin and clonazepam. When a someone is taking multiple medications, we ask that that you post an interactions report. The interactions report may also have some clues to answer your question about the split & shift your doctor is advising. Follow the link below to get your report. Just select the text, copy it and paste it in a post here.

Drugs-dot-com Drugs Interactions Checker.

 

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

  • 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.
  • Please leave out symptoms and diagnoses.
  • A list is easier to understand than one or multiple paragraphs.
  • Link to Account Settings – Create or Edit a signature.


What are your symptoms throughout the day? Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

We don't recommend tapering 2 neuroactive medications such as vilazodone (viibryd) and clonazepam at the same time because it can be too much change for the CNS (central nervous system). Have a read of this topic and come back here with any questions:

Taking multiple drugs? Which to taper first.

 

When you say you were tapering by 10% which medication(s) were you reducing? 

 

In all likelihood, the best next step is to do nothing for 6-8 weeks -- hold at your current doses and times to give symptoms time to settle into a steady pattern. When we see your tapering history, we may adjust that idea. 

 

This is YOUR introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community. I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

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Rabe

Scallywag, I want to thank you SO so  much for your response! 

 

I have been reading more and more on this sight about the 10% taper and the Rxisk report.

My gut, which I wish I would have listened to along the way but was too traumatized to,  is telling me not to divide the Viibryd into AM and PM though the doctor said that once this was done and I was stable it would make the tapering easier because the drops on each wouldn't be as far down???  Do you, or others, have further thoughts on that?  Makes sense on paper but I have found the mind does not read what is on paper...it simply is going to be what it is...and the 10% or less that I tried in December resulted in astonishing symptoms not present when we tapered in April. 

 

It is disheartening to be doing this when you clearly tell a doctor you are so sensitive to everything from food to chemicals to perfumes and medicines, etc, and for some reason they simply ignore it.  I would be more inclined, from the reading, to get a liquid of the Viibryd and VERY slowly decrease the 10mg in the morning, leaving the Clonazepam and Premarin where they are dose wise for now in the evening.  

 

From the get go I reacted to this medication (shaking, high BP, rash, swelling of eyes and lips) but the treatment facility doctor simply ignored it and taking the CLonazepam and Viibryd together did not seem to work well.  I have also noticed that as the Clonazepam dose has decreased, the Viibryd is more agitating and then sedating after that...and the Clonazepam I never quite know what I will get..same with the Premarin.  I told the doctor long ago that the Premarin seemed to help the interdose symptoms and he didn't know why...I researched it and Premarin also acts on the GABA receptors so would make sense.

 

Again I am SO very grateful to be here and hope to someday be the person I knew and the mother my children have lost and the grandmother my grandchildren have lost....two years already spent on this... 

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Rabe

Scallywag, Please could you also help me in navigating this site...how do I take part in discussions?  Thank you so much!

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Rabe

Hi,

I am new on this forum but have read and gleaned so much from what is shared here.

 

I am wondering how to taper Viibryd in very small increments when it cannot be crushed or compounded?

I called the compounding pharmacy and they said they are not able to compound Viibryd which was truly

upsetting.  Any tips please on how to get off this drug with just the pills?  

 

I tried tapering by about 1/10 of a 10mg pill in December and had a host of really bad side effects and returned

to the 10mg.  I want to start to get off it as for me that taper was worse than the Clonazepam tapers, which is 

hard to believe!

 

Any help would be much appreciated!  Thank you so much!!!  This drug really scares me!!

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Rabe

Please could someone help me? I think I forgot to take my Viibryd this morning but I'm not sure!!

 

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brassmonkey

Hi Rabe--  Welcome to SA. It's been four hours since you posted about maybe missing your morning dose which would put it in the middle of the evening back there in WI.  that would be too far out to try and take the missing dose, if in deed you did actually miss it. Because of those two factors it would probably be better to wait until tomorrow morning and take your dose at the proper time.  Your signature indicated that you were sensitive to a 10% reduction in December so there is a good chance that you will feel some affects if you did actually miss the dose this morning.  Those should settle out after a few days as you get your meds back on track.  Please try not to add secondary panic to the situation it will just make you feel worse.  Things should self correct really soon.

 

Brassmonkey

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Rabe

Hi Brassmonkey...thank you SO much for your reply.  This has consumed my whole day!  I am afraid and tearful because of the 

horrible result of the 10% taper attempt that I did not expect at all because I had tapered pretty well from 20 to 10 back in the spring. 

I am sitting here in tears thinking that I have or am losing my mind!!!  Thank you again for your advice!  I really didn't know what to do and 

still don't.  I talked to the compounding pharmacy and they said Viibryd cannot be crushed or compounded...and really should not be split.

How does one taper this medication at a rate less than 10%?  Thank you again for your help.  It is sad I think when a person asks their doctor and

he does not get back and you try to share with family but they back away...yet you come forward and respond...many of the tears are gratitude. 

This has become a lonely road.  Bless you!

RABE

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Rabe

Brassmonkey, Wanted you to know I really like your quote!

RABE

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Rabe

Brassmonkey, one more question...can the dose be taken early if things get lots worse?

RABE

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Altostrata

Hello, Rabe. How are you feeling now?

 

Please read Tips for tapering off Viibryd (vilazodone)

 

Despite what the pharmacist said, you can split the tablets. If you get bad withdrawal symptoms tonight, you might take a little crumb of one tablet, then your normal dose tomorrow.

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Rabe

Altostratta, 

You are all so very kind with such wisdom....thank you.  I have been struggling but its up and down.  Took my evening Clonazepam and 

perhaps that will help tho afraid to go to sleep because of the nightmares and such odd things that happened last time. My ears feel like there is a loud snake in there along with musical tones.  Hopefully all these things will fade...told my daughter I feel as though I am losing my mind sometimes, which is scary too...my memory...and just not who I was.  Have others ever felt that?

 

Do you have thoughts on how to taper in tiny amounts from a pill you cannot crush or compound?  Finding that out today did not help and I think the

past experience was so vivid and frightening that I was anxious and panicky just thinking about it!  Try to not be but my system since that

rapid taper does not seem to handle ANY stress well. I never tolerated meds well and never AD's, hence the Clonazepam.  But the Nardil I was on so many years ago I simply stopped....this is unbelievable!  As a nurse my eyes have been opened to so many things that I cannot even process it sometimes.  

 

Thank you so very much again, Altostratta!  You are so very thoughtful and kind and wise.  I am grateful.  I just wanted to be a mom and a grammy at this time in my life....blessings to you!

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brassmonkey

Hi Rabe-- just remember, we may not always be prompt, but SA is always here for you.  We all understand just how lonely and frightening this process is, and how very little support a person can get from those they count on.

 

The feeling that one is losing their mind is pretty common when a bad WD wave hits.  Thinking that you're going crazy is a very positive sign though, because it means that you're not.  People who go crazy don't know it's happening.  From reading your signature my first impression is that you're having protracted WD symptoms caused by reducing too fast back in June, and the small taper in December just tipped the scales over the edge and set things off.  Going back up the next day was a good thing, but it is going to take some time for your body to recover from the shock.  Once you get stabilized, then we can work out a safe taper plan.  For right now read through the link that Alto sent, it has a lot of good information about what is going on and what can be done.

 

Steven is a very interesting person and has many thoughts that go along with my way of thinking.  I really loved that quote when I read it, it sums up a lot of what I think people need to get through life in general and ADWD in specific.

 

Brass

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Rabe

brassmonkey that was wonderful to read this morning!  Thank you...I'm spending lots of time in tears but they are probably loud time coming and 

healing in their own right.  I did read through the link, thank you.  I am still confused as to how one would ever taper the Viibryd slowly given the 

information I received from a large compounding pharmacy near where I am now but I have to let that go for now.  I just want these drugs gone

and the memories of how they got there to begin with.  Lots of healing and forgiving and acceptance.  

Also I think I will not split the Viibryd dose for now and wait until I feel better?  Thoughts?  Thank you again for your advice and kind support.  I am SO grateful to have found all of you!

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Rabe

I take the Viibryd and am so agitated after...was from the beginning...since the Clonazepam has been decreased it has gotten worse.

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brassmonkey

Good Morning Rabe-- I can say that because it's still morning here for another few minutes.  I think not splitting your dose would be a good idea, it's best to keep your taper routine as simple as possible so it's less likely to make mistakes.  The manufacturers and providers of these drugs have a vested interest in maintaining control over how they are used and they are also vary worried about legal action against them.  So they come up with a lot of restrictions as to how to use their drug.  One common one is to not cut or crush the tablets.  In the case of extended release tablets crushing can change the release characteristics but not the effectiveness of the drug.  Bottom line is they do't want us to take control and taper off of the drugs.  Viibryd is still under patent protection and is an expensive drug to produce so we won't get many options for working with it. We have found that crushing the tablet and weighing out smaller doses is a very workable way to reduce a persons dependence on this drug.

 

Brassmonkey

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Rabe

Given so many road blocks, which is shameful on the part of companies and doctors, it is amazing anyone ever does get off these medications!  My doctor wanted to split the dose because he said that then when tapering the dip isn't so far and thus less WD symptoms?  Do you have any thoughts on that? Have not found that to be the case with Clonazepam..no matter what or where or how much the dose is that is cut the WD is pretty much the same...except when tapered rapidly!  Thank you again!!  

Pretty anxious today, but that may be due in part to how high my anxiety was yesterday.  It seems since that rapid taper not only is my whole system off but it doesn't reset well and has pretty much a zero tolerance for any kind of stress.  And my GI system is not well.  Is that the experience of others and will that improve?  My system has always been labile but not like this.  Blessings!

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Altostrata
18 hours ago, Altostrata said:

 

^This will answer your questions about tapering.

 

I would keep the clonazepam dosage steady while tapering Viibryd.

 

This site exists because people find their doctor's tapering advice doesn't work for them. Your doctor's suggestion to split the Viibryd dose because that's less to taper makes no logical sense.

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Rabe

I did want to clarify in fairness to the doctor and you as I may have not been clear...split the dose would not mean less to overall dose to taper but that since the dose being tapered at a time would then be 5mg instead of 10mg it would be less of a 'dip', per the dr, and therefore cause less side effects.  Still not sure on that but I wanted to be sure I was clear for you.  Would your answer be the same?  

 

I reread the tips for tapering Viibryd and they are very good.  I have contacted two compounding pharmacies...the largest and best known one in this area told me Viibryd could not be compounded because it cannot be crushed, not because is ER but something about the chemicals in the pills, and they are unable to get a powder form because of the patent and they said they are not able to weigh doses that small??  I called a second smaller compounding pharmacy and he was going to make some calls to the company and other sources and get back to me.  That leaves me, and in all honesty I have been cutting CLonazepam with no support...just me in my apartment... for almost 2 years and just have melt downs over it all...more so again lately I think because of the stress in general and because of the tapers.  But I suspect I am going to have to somehow pull myself together because I am fearing, though so much money has been spent on treatment and doctors here, I am going to end up in the same place as when I came...cutting pills and doing this alone....which once again makes me extremely grateful to have you and others on this site!

So I guess my question is where is the best place to start? 

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brassmonkey

I don't think your doctor is very good at working percentages.  It makes no difference whether you take 5% off of two doses a day or 10% off of one dose a day you will still be taking the same amount off each day.  So it will make no difference in how long the taper takes, either way it will be exactly the same amount of time.  As far as looking at the numbers you would see a smaller change in each number with the twice a day dose and a bigger change in the numbers with the once a day, but they would be equal amounts at the end of the day.  As far as symptoms go there would be no difference. These drugs require a minimum of four days to become steady state in the blood.  Meaning that there is a constant amount of drug in the blood at all times.  The small fluctuations that twice a day dosing would have would all average out and have no affect.  Split dosing is primarily used for drugs with very short a half-life such as Benzos.  Because of the short half-life it is possible to go into WD during the time between a normal single dose. The half-life of Viibryd is 25 hours so there should be no problems with inter-dose WD.

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Rabe

I think his plan was to divide it and then taper from only one dose at a time.  I am so troubled by these electrolyte issues...have you heard of people having these?  My potassium goes low so often since the rapid taper....scary.

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Rabe

Hmmm.....that makes the most sense I have heard from anyone in a long time...mainly the doctor that put me on this and the one

trying to get me off it and the Clonazepam.  When I listen to you it is logical...has not been so with the doctors and their teams...has made me understand my affinity for Alice in Wonderland more than usual this past year or so.  Craziness!  Thank you SO much for making it clear...grateful as usual!  Blessings!

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Rabe

I am often in interdose WD with the Clonzepam however...I have shoved the .25mg dose I used to take at noon to 1 and now

closer to 330 or so.  Then the Premarin at 830 interestingly I found is calming usually though after it I sometimes get the K changes but 

maybe they were on their way.  Then the .75 of Clonazepam at 12 to 1230AM at night.  I told my Dr re the Premarin and Prevacid affects and he just looked at me like I was from another planet so I looked the Premarin up and it does have a role with GABA and ion channels and the Prevacid is metabolized by the same enzyme as Viibryd and Clonazepam so I suppose one more person with a hand out at the water hole could make a 

difference if you are sensitive....I don''t know.  I never have answers, just know what is happening and that when I tell doctors they all probably would like to just toss a psych referral my way. :)  

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Rabe

Truth is brassmonkey I don't really trust this doctor...coaches here where I have stayed and friends who work at this hospital and tx center have told me that word has been he had a role in getting me back in the hospital in order to save his job, as I had written a letter to the president re the way I was  treated and essentially given no choice but take the AD...and what I witnessed there.  It is all very scary to me...the drugs, the drug companies, the doctors, the treatment centers and hospitals, the patents and how the companies don't want people to take control and get off these medications.  As a nurse and someone whose father was a very caring doctor it goes against everything I have learned and believed in and practiced for years...last 20 plus on an end stage dementia unit.  I would not have treated ANY of my patients one iota of the way I was treated or the way I saw others treated.  It's abusive.  My eyes have been and continue to be so opened that they are going to pop right out of my head soon!  It is sad and shocking and so very very wrong.  BUT is is also wonderful that this sight is here and that people are willing to help others following them.  If by Gods Grace I make it through all of this I WILL do SOMEthing to bring this to light somehow...not sure how...but I will. Thank you again!  

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Rabe

Have to say the lack of information from doctors, on the internet, from pharmacies, etc re getting off Viibryd is scary.  

 

Could someone tell me, do I need to purchase a scale and then crush pills and measure...will that be what I will be doing?  I just get nothing from

my doctor and it would help me a lot to know there IS a way forward...a way to taper slowly from the Viibryd.  

 

The Clonazepam is not a worry...been doing that and though it's awful at least there is a path.  There does not seem to be many people tapering from the Viibryd or many options on how to do so in small increments.  I do know that when I cut the pills in the first taper from it they affected

me differently...faster?  Just weird head feelings and allergy type symptoms. 

 

Talking to someone who has/is tapering this and/or having someone tell me of a best road forward would be truly helpful....hopeful.  I am going to 

have to move again soon and that will be extremely stressful so am just wanting to quell this stressor a bit.

Also, am wanting to start tapering soon because I fear being on the Viibryd longer will only make the taper worse?  Thank you!!! 

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Rabe

I'm sorry I didn't see this post [in Tapering forum].  Thank you. 

 

Could you please tell me....I had had such a nice run of days feeling better at least parts of days.  Yesterday I had the low K+ and today as well....

or at least same symptoms as all the times have gone to ER since Sept...dont want to go there anymore.  But feel so SOB tonight an have been 

teary since my longer walk today and so agitated and depressed....feeling like I have been such a burden to my children...and I have.  And I just keep

thinking over and over that I am losing my mind and I keep thinking that not being here would be better ... though on good days those thoughts are so much better.  I have tried yoga and meditating and music and distraction.  I don't quite know what is going on...just doesn't want to stop.

Its my daughters birthday tomorrow and I am not able to get there and I missed my sons wedding in September because of the hospital taper and 

I don't know how to move forward.  I have to get back home...3 hours...can hardly get out of the apartment....to pack things and decide where to go.

I just don't know if this is all potassium or withdrawal too?  If someone has any insights I would appreciate it.  Thank you!

Edited by Altostrata
moved posts

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Rabe

hard to believe I was had two jobs and raised my kids alone and took care of our home and all...I look in the mirror and see none of that person and am not handling life like that person or treating others like that person...this is not me!  I usually wake up better but when the medications start I just don't do well it seems ... or it is so unpredictable.  Idk

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Rabe

I love the mornings before take any medications because I feel clearer and not agitated or depressed...if is a steady state of meds in body I don't 

understand how my mood etc changes so....

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brassmonkey

Hi Rabe-- I read your PM's and think it would be a good idea if I gave the answers here on your intro thread.  That way you will have a better record of them and we can get more peoples input.

 

Would you please give me a rundown of all the symptoms you get during the day, when they happen, how bad they are and when they start to clear up.  It may be that you are already fairly stable in general but that you are getting a bit of an adverse reaction every time you take your dose.  Stability is going to be feeling  the same level of crappy most of the time with no big swings either direction, good or bad, over several weeks time.

 

Starting a taper is a pretty scary proposition for most people, I was scared to death to start mine.  So it would probably be a good idea to wait until after the move to get started.  Let your living situation normalize a bit before throwing another source of stress on top of it.  Also there are several things that are going to need to be done first.  The best way of doing the taper is to crush the tablets and weigh out a set amount of powder for each dose.  This will require a scale that will measure to 0.001grams or 1mg, that's just different ways of writing the same thing.  You will also need some size "0" gelcaps (get the bag of 1000). Both of these can be purchased online (amazon.com) fairly inexpensively.  Many of the members use the Gemini-20 scale, I had very good success with it.  but something else that is equivalent would work just as well.  There are a few household items that will be needed also but we can go into that later.

 

Would it be possible to get your daughter and the rest of the family to come here and read some of SA?  If they learned something about what was going on with others maybe they would understand what is happening to you a bit better.  It's a pretty scary place for them to be right now, not knowing what is going on or how to help.

 

Brassmonkey

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Altostrata
3 hours ago, brassmonkey said:

Would you please give me a rundown of all the symptoms you get during the day, when they happen, how bad they are and when they start to clear up.  It may be that you are already fairly stable in general but that you are getting a bit of an adverse reaction every time you take your dose.  Stability is going to be feeling  the same level of crappy most of the time with no big swings either direction, good or bad, over several weeks time.

 

Yes, please keep daily notes on paper regarding your symptoms, when you take your drugs, and their dosages. I agree with brassmonkey, we may have to isolate an adverse reaction.

 

On 1/12/2018 at 9:20 PM, Rabe said:

I think his plan was to divide it and then taper from only one dose at a time.  I am so troubled by these electrolyte issues...have you heard of people having these?  My potassium goes low so often since the rapid taper....scary.

 

If your doctor is willing to give you a prescription for a divided dose, that can be very helpful. Viibryd comes in 10mg and 20mg tablets. If he gave you a prescription for one 10mg tablet in the morning and one in the afternoon, for your first stage of tapering, you could take one whole tablet and part of the other -- all in the morning. That is a good way to reduce.

 

Could be his scrambled explanation was to communicate this to you. In that case, you should >wink wink< with him and take a "divided dose," meaning a daily 20mg prescription made up of 10mg tablets to facilitate tapering.

 

You will need a scale to cut up and measure the partial tablet. This is explained in the  Tips for tapering off Viibryd (vilazodone) topic. Where you see links, read them. We put them there for a good reason.

 

The content of your "depressed" thoughts indicate you have a lot of shame, guilt, and self-blame about your situation. These are thoughts you would do well to examine and learn to manage. See Non-drug techniques to cope with emotional symptoms

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Rabe

Thank you!

He wanted me to split the 10mg tablet I am currently on in the AM, split that tablet and take 1/2 in AM and 1/2 PM.  I have already been reading the tips on Viibryd...more than once...and have looked at scales...saw one on Amazon...nice cause of shipping.

Yes you are spot on...a HUGE amount of shame, guilt, and yes...I was the one who solved the problems, not the problem.

 I just talked to my son and am hoping he will look on this site and find things that might help the family.  He also asked about a lit of what I would need as far as support...how that would look.  Not being int he tapering of Viibryd again yet I am not exactly sure and it seems the support need changes.  I will look for a forum topic on that..if you have thoughts on this as well I would greatly appreciate it.  I am going to keep track of symptoms a bit longer and then will post those.  Thank you again!

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Altostrata
16 minutes ago, Rabe said:

He wanted me to split the 10mg tablet I am currently on in the AM, split that tablet and take 1/2 in AM and 1/2 PM.

 

This makes more sense. He probably thinks the tablet is timed-release and breaking will break the timed-release. He is mistaken, but he is being smart and concerned. This is good.

 

HOWEVER, if you are having an adverse reaction to the 10mg tablet in the morning, splitting the dose may relieve this adverse reaction because there's less Viibryd hitting your system at once. In this case, you probably would start reducing the afternoon dose first in your taper. Perhaps this was what he was trying to express.

 

At any rate, you're going to need that scale.

 

Your son might be interested in Helping Family Understand and other topics in the Relationships forum.

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Rabe

Thank you SO much!

 

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Rabe

I generally don't do well with split pills...dont know why...had problems when was tapering the first 10 of viibryd.  Tapered faster because taking the 

split pieces made me feel pretty yucky.

 

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Rabe

Could you please tell me..if I split a 1mg Clonazepam at night to get the .5 (allergy to yellow dye), do I have to split one each night and  try to get them as equal as possible every day or can I take the one half one day and the other half the next and be okay even though they are not exactly equal?  Same when I split the blue to get a .25...I end up TRYing to get the pieces to look the same.  My fingers and hands are so dry and nail black from scratching at these pills!!  Thank you!

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Rabe

How does one FIND a doctor that is wise in tapering these medications?  I am currently in the MKE area and don't have a clue where to

start.  I know no doctors here.  Is there a list?  My daughter and I had such a good talk tonight for which I am so grateful and she actually

suggested that I ask on the SA sight...thought it was a wonderful idea!  Thanks for any help.

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