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Rabe: how to taper and adjust Viibryd while on Clonazepam

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Rabe

Please could anyone help?  I have had electrolyte issues since rapid taper in Sept. Had dehydration in summer when in ER.  Each time go to ER potassium is low so have been trying to eat K+ foods and not go but has been two days straight now and I am feeling not well.  Wondering if anyone has any suggestions?  Is it taper or Viibryd or ?

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Kristine

Hi Rabe,  Hypokalemia (low potassium) is a known side effect of Viibryd (vilazodone)....there could be many reasons but that may be the culprit. I'm sorry you are feeling so unwell. Take care. K 🌻

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nz11
On ‎1‎/‎17‎/‎2018 at 7:49 PM, Rabe said:

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.

The problem is it is difficult to find a doctor who acknowledges wdl symptoms. Very few if any are able to help and will simply call wdl symptoms a relapse and tell you you have to take drugs ...here try this one.

SA is the best place to check out how to taper.  

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Rabe
39 minutes ago, Kristine said:

Hi Rabe,  Hypokalemia (low potassium) is a known side effect of Viibryd (vilazodone)....there could be many reasons but that may be the culprit. I'm sorry you are feeling so unwell. Take care. K 🌻

Im sorry...I messaged cause I couldn't figure out how to do this...and then it appeared!  Well, if is side effect then I need to get off it but don't know how.  My muscles and joints are a mess and it seems to flare up the more I walk and use my muscles if the makes sense.  I started viibryd last January and this started just a little in June and had some other not as severe episodes and then it really kicked in after Sept taper of Viibryd and also I seem to get more agitated and heart races after taking the Viibryd which wasn't as prominent when Clonazepam dose was higher.

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Rabe

wondering where the information r/t the potassium side effects of Viibryd are? My doctor sure doesn't seem to know about them!

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Rabe

also, anyone know of a good doctor in MKE, WI area to help with the Clonazepam, but particularly the Viibryd if it is indeed causing the potassium issues...cause that is affecting so many other things!!

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nz11

Tips for tapering off Viibryd (vilazodone)

 

If I were you I would taper a lot slower than the 10% maybe start at 2.5% or no higher than 5% to start with.

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Rabe

I don't know how to do that without help from a compounding pharmacy and they can't help...said can't be cut or crushed tho was told

here it could.  Have you heard of it causing electrolyte issues?  Have you used it?  Thank you for your help!  I don't know what to do.  I feel so crummy yet can't taper it.

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Rabe

and could you please tell me why you recommend those lower tapers?  I just am ready to deal with the side effects and get off it!!  This potassium thing is scary...

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Kristine
42 minutes ago, Rabe said:

wondering where the information r/t the potassium side effects of Viibryd are? My doctor sure doesn't seem to know about them!

Hi Rabe,  I read it in a FDA report. I'll try and locate it! I'll get back to you. K 

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nz11
48 minutes ago, Rabe said:

and could you please tell me why you recommend those lower tapers?  I just am ready to deal with the side effects and get off it!!  This potassium thing is scary...

Withdrawal off these drugs has the ability to induce suffering that is unimaginable. Your drug sig goes back quite a few years.

Many people cant cope with the wdl  experience and end up back at the doctors to get relief only to be given more drugs or ri at double the dose.  

Being on and off these drugs for many years can create  a  very sensitized nervous system and its not as robust as one with a much shorter drug exposure. You would be best to proceed very cautiously. Even the last line of your drug sig suggests 10% is too much for you. 

imo if you try to taper fast you may well end up in hospital. 

You can get off these drugs if you taper slowly.

 

I'm sorry I have never taken viibryd. Did you read altos comment on the viibryd link about it not being time released so you can split the tablet.

There is info there about liquid if that's an option. 

 

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Rabe

 

You are all so very wise here and I am grateful for your knowledge!  I did read Altos suggestions and they ahem been very helpful.  The liquid would have to be something I make up myself ...correct?  THATS scary in and of itself!! :0  

I started the Viibryd last Jan tapered to 10 in May or June with not too much difficulty but was blown away at what happened in December!!!  It was awful and I feel I can tolerate quite a bit.  And then so very few avenues to take with it.  My Dr today suggested switching to Prozac for tapering but not sure about that either....tried so many before ended up on the CLonazepam.  These medications just don't agree with me.  DO you think the change in symptoms is due to now being on it 7 months longer?  Also, is there a list of doctors anywhere?  I am in the MKE are now and sure would like some one knowledgable...but from what I read that is a needle in a haystack!  Thank you again for your insights and help!!!

 

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nz11

You're welcome no problem.

Well I'm certainly not one of the wise ones with all the doctor nonsense ive fallen for. 'Don't worry nz11 its not addictive.'   

 

Why not print out that page on viibryd tapering and take it back to the compounding pharmacy and ask them again if they can do it.

If they say no ask another compounding pharmacy. 

 

The problem when you add more drugs to the mix is that if you start changing more than one at a time then its difficult to guess which change has caused worsened symptoms.

When you joined SW asked you to run an interactions checker .and post the results here in your intro. What do you think about that idea. It could be helpful to see whos doing who and whos not paying! Just a thought.

The switch to Prozac is a high risk. Doctors think its a good idea because of the long half life of Prozac and so assume its easier to get off but that is not a fact.

 

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Kristine
1 hour ago, Rabe said:
3 hours ago, Rabe said:

wondering where the information r/t the potassium side effects of Viibryd are? My doctor sure doesn't seem to know about them!

Hi Rabe,  I read it in a FDA report. I'll try and locate it! I'll get back to you. K 

Hi again Rabe,  Sorry it took me so long!!!  I didn't intend to frighten you and this drug is not necessarily the cause of your low potassium.  This is a link to a FDA clinical review of vilazodone 2010... not the one I was looking for.  

https://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/022567.  Look at page 101.  If you present this to your doctor he/she will most likely say this is clinically insignificant.  But......

 

"....vilazodone should not be given to patients with bradycardia...hypokalemia....Expect hypokalemia and hypomagnesmia to be corrected before vilazodone therapy is begun" page 1172 (2018 Nurses Drug Handbook byJones & Bartlett Learning)....they can't argue with this...

Hope this helps a little. K 🌻

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Kristine

That link doesn't work...let me try again x K

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Kristine
10 minutes ago, Kristine said:

Hi again Rabe,  Sorry it took me so long!!!  I didn't intend to frighten you and this drug is not necessarily the cause of your low potassium.  This is a link to a FDA clinical review of vilazodone 2010... not the one I was looking for.  

  https://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/022567Orig1s000MedR.pdf  Look at page 101.  If you present this to your doctor he/she will most likely say this is clinically insignificant.  But......

 

"....vilazondone should not be given to patients with bradycardia...hypokalemia....Expect hypokalemia and hypomagnesmia to be corrected before vilazodine therapy is begun" page 1172 (2018 Nurses Drug Handbook byJones & Bartlett Learning)....they can't argue with this...

Hope this helps a little. K 🌻

The report I had in mind was a more recent publication, just can't find it with mushy brain!!!! K 

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Rabe

Hi Kristine,

It says page cannot be found.  But thank you.  I can at least tell him what you said.  If you come upon it or something else let me know.  I am so grateful for all your time and thoughts!!! 

It mat not be the cause but it does seem interesting it seems to be a part of things in some way.  I generally feel good in AM and then after Viibryd things start downward seems.

 

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Rabe

Hi Nz11,

Well, I certainly went against all my instincts taking this "gentle SSRI that is easy to get on and easy to get off" from this treatment 

center doctor that I kept saying 'no thank you' to because I have reacted to so much in the past!  I am not happy with myself or with him! 

I have done the drop checker even before coming here and it always comes up as no interactions found but I do know that both Viibryd and

Clonazepam are substrates of the same liver enzyme and have found more than one sight that says to be careful using the Viibryd with 

benzodiazepines and noticed that when we tapered the Clonzepam it affected the Viibryd (Viibryd seemed stronger) and when tapering the Viibryd it affected the Clonazepam (Clonazepam seemed to be withdrawing as well).  So not sure what all that is about.  When they started the Viibryd I remember feeling as though I was withdrawing from the Clonazepam....

Can I ask what you mean by who's doing who and who's not paying?

Yes I was not sure about the Prozac idea just because I do know we tried every AD available back then and I did not do well. And this Dr suggested it for just the reasons you said....longer half life so easier to get off.....but the switch over he said might be ify....

I talked to both pharmacies and the first larger one said 'no' right away...its under patent, no bulk powder available, says can't cut or crush so that is what they have to follow.  The did some more looking and even called other places, pharmacist friends and the company and he called back and also said not doable, but said to take dupplementHTP? or something like that and then skip doses of the Viibryd????  Id have to call back but it seemed not right. 

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Rabe

am wondering for now about taking the Viibryd sooner in the morning so that it is closer to the night Clonazepam dose...maybe the SE of it would 

be less?  I don't know.  I had shoved it out to 1030 and the noon CLonazepam .25 to 430..just keep pushing it back and then thought perhaps I could just drop it at some point...dont know about that either. But just saw the doctor yesterday and talked to him about his inpatient notes that were not accurate because that was really upsetting to me.  We also talked re meds and he mentioned the Prozac and long half life and also would like to get the CLonazepam on a stable dose rather than my cutting pills all the time...I cut just the blue 1mg because of the yellow dye that was causing issues along with the liquid form and other meds and foods after the taper, :( So I guess I can do that but would be using both tablets and liquid nd right now my stomach has been pretty good on just the tablets, but he wants to go to .2 at noon and .7 at night....

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nz11

Morning Rabe

well sounds like you have certainly done your homework. It was just a cheeky way to say run the interactions checker to see who is interacting with who and who is doing nothing.

please don’t consider skipping doses.

 

 

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Kristine
5 hours ago, Rabe said:

Hi Kristine,

It says page cannot be found.  But thank you.  I can at least tell him what you said.  If you come upon it or something else let me know.  I am so grateful for all your time and thoughts!!! 

It mat not be the cause but it does seem interesting it seems to be a part of things in some way.  I generally feel good in AM and then after Viibryd things start downward seems.

 

Hi Rabe, the second link didn't work? Sorry, I don't know what happened...me and computers don't mix! K 🌻

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SkyBlue

Hi Rabe, 

 

Wow, you've certainly been through the wringer with some very potent meds and it sounds like doctors who just keep trying one med after another, the medication carousel. Your nervous system is likely now very sensitized. It can and will heal! It's a matter of doing things (tapering) as slowly as possible to ensure as little disruption to the nervous system as possible.

 

Like nz11 said, it sounds like slower might be better for you (not even 10 percent but maybe 5 or 2.5 percent)

You may have heard of one of our famous moderators, Brassmonkey. Stop by his thread (it's inspiring!) and take

a look at what he calls the Brassmonkey slide. He talks about spreading the 10% cuts over a month so a person is still decreasing by 10% but it's gentler, not all at once. 

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brassmonkey

I sent you this in a PM, but wanted to add it to your thread so there would be a good record of it.

 

Viibyrd is a very new drug to the AD field so the manufacturer is being very tight with any information about it.  It's the only drug I have found where large parts of the technical information has been redacted from the studies that are published on line. I found a summery of the FDA study (a link is below).  Of the 5346 people studied only one (1) reported electrolyte problems.  That person had many other problems including MS and diabetes and was on a massive cocktail of other drugs.  I suspect that the Viibyrd had very little to do with the problem.

 

Because of this I think it would be a good idea to have your potassium problem checked out by doctors other than the ones involved with the ADs.

 

Dark roads always seem brighter when you have a lot of friends traveling with you.  That's what SA is all about, helping each other through the dark patches.

 

https://www.ehealthme.com/ds/viibryd/electrolyte-imbalance/

 

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Rabe

Hi SkyBlue,

Actually have really only been on the Clonazepam(25 years?)and Viibryd (year)...the Nardil was a year or less and the AD's tried before the Nardi were many but short lived d/t side effects.  But my system has always been so reactive to all medications and foods etc.  

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SkyBlue
On 1/25/2018 at 9:24 PM, Rabe said:

Actually have really only been on the Clonazepam(25 years?)and Viibryd (year)...the Nardil was a year or less and the AD's tried before the Nardi were many but short lived d/t side effects.  

 

Oh, ok. But that's like me (or Brass) saying we were "only" on Paxil for years and years. They're all toxic, horrible, addictive, destructive drugs. And yes it does sound like your system is very sensitive (mine is too). So it makes sense that you are having a tough time right now, but I do believe you will heal

 

(I'm having some cognitive trouble at the moment [so if I don't respond in a timely matter, that is why], but will try to keep up with this thread. Keep us posted and please take things slowly.) <3

 

 

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Rabe

have you ever looked at the road back?

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Rabe

Thank you!  I thought that if it were so wonderful, there wouldn't be so many people on this site!  

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Rabe

I'm just wanting to restart getting off these medications...but I'm sure everyone would like that to happen yesterday.  I still get so very undone totally by ANY amount of ANY stress...which is a tad ridiculous in the real world.  Its like my body just cannot handle it...I have aged 20 years in the last 2!  So it is wistful to think of getting off them whilst being nourished by all these wonderful nutrients, which I didn't do well with even before tapering.  Anyway, thank you again for information, Altostrata...I am grateful for your advice and knowledge.  

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SkyBlue
On 1/28/2018 at 8:09 PM, Rabe said:

I'm just wanting to restart getting off these medications...but I'm sure everyone would like that to happen yesterday.  I still get so very undone totally by ANY amount of ANY stress...

 

Hi Rabe,

Yes, feeling "undone" by ANY amount of stress is pretty common in withdrawal. Our systems are so sensitive and overwrought. The best thing is to try to rest as much as you can, and find non-drug ways of coping (meditation, etc.; there are a lot of threads on this site with ideas). Your sensitivity isn't "ridiculous" by any means; you've survived a very real iatrogenic (caused by medication/doctors) injury. 

 

I'm glad Alto weighed in on The Road Back (grrrr). I believe these companies are particularly insidious, preying on the extremely distraught state of people desperately trying to survive withdrawal. 

 

Hope you are doing okay; please update when you get a chance. 

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Rabe

Please does anyone have any experience with Viibryd and hypokalemia?  I have been on it a year and for 8 months have had electrolyte issues and since October have had repeated hypokalemic episodes that are limiting my life beyond belief...I can't plan ahead a day or even part of a day things are so all over the place!  I am getting SO extremely tired of all this..body and mind.  If anyone has any thoughts I sure would appreciate it!  The doctor says I have excreting too much K+...ahhh that would make sense...but didn't have this before the Viibryd!  I feel more and more defeated....and hate how it affects my family.  I just had another grand daughter and I can hardly get out of bed!  Would appreciate any help.  Thanks!

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Rabe

I have a friend who has gone on and off antidepressants and she says to just keep pushing back the AD dose an hour, wait a week, do it again...until you are taking it every 36 hours instead of every 24 and then go every other day and then ever third day and then she is basically off it..that was celexa.  

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ChessieCat

I'll bring it to the other mods' attention.

 

4 minutes ago, Rabe said:

until you are taking it every 36 hours instead of every 24 and then go every other day and then ever third day

 

Skipping days is NOT recommended.  It is better to take the same dose at about the same time EVERY DAY.

 

Skipping Days vs Every Day Dosing Graph

 

From Post #1 of this topic Tips for tapering off Viibryd (vilazodone)

 

Make your own liquid
Like other non-timed-release drugs, one might make a Viibryd liquid out of tablets and water for more precise titration. See How to make a liquid from tablets or capsules

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Altostrata

Rabe, please Google Viibryd and hypokalemia. I found this https://www.ehealthme.com/ds/viibryd/hypokalemic-syndrome/

 

Many serious adverse effects of psychiatric drugs appear after the drug goes on the market, while people are taking them, and doctors are not very well aware of them.

 

If you get a serious adverse effect from a drug, the rule of thumb is to reduce or go off the drug. Since you've been taking Viibryd for more than a year, we advise tapering to avoid withdrawal symptoms.

 

It may be that at lower doses, your hypokalemia resolves. Please work with your doctor to get periodic electrolyte tests. That will demonstrate it was the Viibryd.

 

Please let us know how you're doing.

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Rabe

I tried tapering the Viibryd in Dec by about 10% and it was so horrendous I went back up to 10mg Alto.  I had tapered to 10 in the spring and was not expecting all those side effects!  Have called 3 compounding pharmacies who say they cannot compound it?  Though a different pharmacist at one place thought she  could because she could not see where it says not to split and thought if I bring in pills she could do it...but I,m guessing the other pharmacist will correct her.  So I don't know what to do with the Viibryd.  The kidney doctor wants me to try a K sparing diuretic but if is the med Im leery.  I sure don't feel well majority of time anymore with the K going low so often.  

Thank you I will check that site....I have googled it often but didn't seem to find much.

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Rabe

I have that site bookmarked Alto thank you!  My doctor doesn't think the K is from the rapid taper or Viibryd but after that taper is when it all started and when my nervous system went really off the rails.

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