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Rabe: how to taper and adjust Viibryd while on Clonazepam

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Altostrata

Are you still skipping doses of amiloride? Please don't do that.

 

On 5/16/2018 at 2:03 PM, Rabe said:

Funny you should ask re kidneys.  Their functioning has decreased since started too fast taper at home...have wondered if Clonazepam affected them.  Not what they were before all this though said rapid metabolizer on genetic test for meds and if I react to things it is soon after taking.  Shadows on kidneys that they think r/t numerous kidney infections as child.

 

If you don't want to take it at all, tell your doctor you refuse to take it. Your kidney problems are causing the hyperkalemia. They need to be addressed.

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Rabe

kidneys etc have been checked CT, things look ok n labs within ok range.  tubules waste K+ they say tho aldosterone has been high at times as well. so either take a med so won't or try to eat enough K but that didn't work. have had low K and NA, but way more of low K, that know of.

 

Cant take more cause risk hyperkalemia, low NA, fluid level, BP etc. 7 days of 1/4 tab vs 3 days of half tab: 1 3/4  vs 1 1/2. did not do well with it from beginning...made me so nervous...that subsided but rest followed.  Idk.  Had light acupuncture Monday...am tapering...have been doing weights and more exercise in past 2 weeks.  But felt fine in AM yesterday until took those 2 meds.  Had been taking it in afternoon 4 or 5....4/27 moved it to morning around 2 hours before Viibryd cause wanted to get it done for the day.  Seems more problems.  

 going to try it again tomorrow in the afternoon rather than morning and see how goes.  If have another day like yesterday I have to do something else cause think originally took in AM, moved it moved it again and now again...  

 

Im grateful to you.  have a message in to doctor asking bout smaller dose daily as opposed to as is now.

 

 am going to try it again tomorrow in the afternoon rather than morning and see how it goes.  If have another day like yesterday I have to do something else.  His only other thought was Propranolol..but I see that has Clonazepam interaction..but not Viibryd if any thoughts.

 

Altostrata can you tell me why you say not to take it MWF?  What is your thinking please?  I mean you would think taking a medicine for kidneys is ok..he said lots people take it this way...but I know these drugs affect more.

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Altostrata

Do you have hypokalemia rather than hyperkalemia?

 

I said do not skip doses, I would take a half-dose each day.

 

You have low blood pressure and your doctor is thinking propanolol? Is he insane?

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Rabe

Yes...hypokalemia.  

 

I know you did, I am just wondering why you said not to skip doses...could I know your thinking when dr so blithely prescribed TIW.  I mean I know not to skip my other meds...

 

LOL...wellllll....I've wondered that about many doctors I've seen...

 

They're overbooked, visits are 10 minutes, they don't know me/history and don't care.

Took 6 months to get ANY help at all and, you said you had electrolyte issues so you know, those months were horribly unpredictable and wreaked havoc on my body...only reason didn't stop med long time ago

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Rabe

I am finding if eat salty things, especially with sea salt, I don't feel well...have to ask dr bout that

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Rabe

I like to learn...hence the questions

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Altostrata

You have K+ in your signature. I read that as excessive potassium.

 

If you have hypokalemia, by all means, eat high-potassium foods! Many of them are delicious. Why try to correct your hypokalemia with a drug that makes you sick if you can change your diet and fix your imbalance?? Lots of vegetables are good for you regardless. Salt (sodium) opposes potassium.  Please consult Dr. Google for foods high in potassium.

 

We don't treat hypokalemia here. Please join a different support site for hypokalemia and kidney problems. Looking stuff up for you about that is not something we should be doing here. Also, you need a kidney specialist.

 

I have suggested taking a half-dose of amiloride each day repeatedly. This is so that you don't have symptom fluctuations due to the amiloride and we can tell what's going on with the psychiatric drugs. If you take amiloride on alternate days and get symptoms from it, we can't help you taper the other drugs, we won't be able to tell if the taper is going well or not.

 

I have no idea why your doctor told you to take amiloride TIW. Everything I see says it's taken daily. This is something you could have Googled yourself. Clearly, TIW is not working.

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Rabe

K+ is potassium..sorry didn't clarify.  Eating and drinking potassium was not enough for me, at this point in any case.  I NEVer want to take more meds but neither did I want the damages that fluctuating potassium levels can cause and have caused.

 

You are right, this is not a kidney sight, none the less for me the electrolytes are part of my journey with these medications as I did not have this problem prior to their tapering. I have gleaned all I can from every source I can, including the RN side of myself, and I thank you for clarifying the thoughts behind your thoughts...I appreciate it...what you have said makes sense. I would like to be able to share with others who may have the same or similar issue along the way because it is not fun.  There are times when I wonder if others aren't dealing with similar things, unknowingly.     

 

Thank you again for your time.  I am grateful. 

 

 

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Rabe

and yes Amiloride is typically given daily for BP and other issues but TIW is not unusual for hypokalemia alone.  It is working in that it has kept my K+ levels stable...but something else is going, just don't know what it is.  Thanks again.  

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Altostrata

Rabe, if the amiloride makes you sick on alternate days, we won't be able to tell if your taper of the other drugs is going bad.

 

Have you tried a half-dose of amiloride yet? It might not affect you as much as a full dose. Even a quarter-dose each day might be enough to correct your potassium.

 

Sincerely appreciate your willingness to learn and help others.

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Rabe

I understand that...if it frustrates me it would do more so for all of you.  I was going to take it this morning and cant make myself do it.  I may try the quarter of a tab later (currently take half).  In mean time messaged kidney doctor again and asked his thoughts...may just try to eat ton of K ... found coconut water without vit C so that would help.  Will let you know.  Thank you 

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Rabe

wanted to let you know got message from doctor saying 1/4 tablet would be ok.  So will try that.  Also asked if there is a tablet free of the yellow dye...

thanks

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Altostrata

Given this is a doctor who would prescribe propanolol for low blood pressure, good to hear he thinks 1/4 tablet is okay. 😽

 

I doubt you will find a dye-free tablet. You might have to get the drug compounded if you don't want additives.

 

PS Tomato juice. Goat whey protein. Bananas. Chard. Mushrooms.

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Rabe

Thank you ...didnt think about compounding with this...may have to do that.  Going to own that pharmacy soon!

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Rabe

Actually he's very good...propranolol would be very low dose aka the amiloride just for K issue...should not affect the BP much if at all though sounds like  you already know it inherently has more of an affect on BP than Amiloride so you are right in going 'WHAT???"

Thank you for suggesting 1/4 tablet...what I asked for initially...took today, felt poorly shortly after, not as bad as other dose, but symptoms still worsen and drag on and on alllll day and evening and historically part of next day...then another dose?  I can see now that much of the issues have been this medication...not all but lots.

Will see how goes over weekend and then may try just food...if that backfires then have to revisit meds.

Thank you again!  So wish one med would not cause issues!!   

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Rabe

5/18

woke 3 and 7, back to sleep

sleep broken and anxious..repeated hard to describe uncomfortable awakenings

1100 yoga and breathing

1200 Viibryd with oatmeal, nuts, seeds, few berries, milk

110 down, headache, irritable - passed

120 to Y - weights and walk

200 vision off, ears ringing loudly

315 Amiloride .125 with rice, chicken, avocado, cucumber, carrots, toast and peanut butter, milk, watermelon

cleaning

330 chills, wave of not feeling well with head odd, palpitations, heart fast then stopped, eyes irritated and puffy under

400 head ache and hot, palpitations, anxious, stomach upset

420 went for walk and back at 500 headache, down, heart palpitations, anxious, bladder burns, chest hot

530 some better, agitated Clonazepam .2 with oatmeal and nuts and seeds, flax, milk, egg, some banana545 bladder burns

700 headache worse, legs burn 

800 anxiety and agitation worse, bladder worse, head worse, depressed

830 just really feel sick, tired, weak

850 premarin with chicken, sweet potato, hamburger, cauliflower, broccoli, asparagus. milk, little ice cream

930 depressed, short of breath, nervous

1030 very depressed

1100 some better

1130 Clonazepam .7 with milk and water

sat to do mail and make copies

1145 headache, head hot, eyes sore, short of breath, weak, tired, foggy

meditation and breathing and heading to bed

 

 

 

 

 

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Rabe

5/18

up 4 and 7

sleep is broken n anxious with repeated awakenings

yoga n breathing

1200 Viibryd 9.5 with oatmeal, milk, nuts n seeds, few berries

115 Y - weights n walk

300 rice chicken avocado carrots cucumber watermelon milk toast n pb

310 amiloride 1.25 

325 chills, wave of not well with dizzy n rapid heart, eyes irritated n puffy under

350  heart palp, headache, anxious, head hot, stomach

420 worse n vision off, ears ring    - out for walk

back 5 - all above depressed, chest hot, bladder on fire

530 clonazepam.2 with oatmeal, nuts, milk, flax, egg, banana

700 headache eyes n bladder worse with anxiety n agitation

800 worse n just feel really sick at 830 so tired, weak, dizzy

round 9 premarin with hamburger n chicken sweet potato broccoli cauliflower asparagus milk little ice cream

930  depressed more, short of breath, more anxiety

1030 horriblydepressed, sobbing

1100 better

1130 clonazepam with milk

1145 bad headache, head hot, ears ring loud, stomach upset, tired, weak, feeling done with all this

meditation, to bed, still up 130, and up 3 and 530 still don't feel well..headache, bladder so sore, ears loud, sad, tired

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Hazel

Sorry to hear you are having a hard time, Rabe.  It looks like you are doing a good job of taking care of yourself with eating healthy, exercise and meditation.  I think that can only help you to heal.  

I just wanted you to know I am here for you and I understand how difficult this can be.

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Rosetta

Hi, Rabe, 

I'm thinking of you.  You are eating very well.  I'm sure that will help a lot.  I'm so sorry you aren't getting much of a break.  Thank you for your lovely post on my thread.  I hope you can get the hypokalimia sorted out soon.  You have been holding the AD for so long.  I'm sure you'll get relief from getting the hydroxizine issue fixed.

 

Peace, Rosetta

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Altostrata

Did you feel okay before taking amiloride?

 

The scientific literature is clear: The combination of amiloride and clonazepam may increase adverse effects from either drug. Please consult Dr. Google to read up on their adverse effects. Even if you were not taking the drugs in combination, you may have serious adverse effects from amiloride itself. If your doctor is not attending to this, he is remiss.

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Rabe

 

it affects me more so and then other medications affect me badly as well.  Viibryd this morning has my head feeling awful as well.  

There are no good answers...not right now anyway...it just is. 

Thank you...was going to write you but you beat me.  I've tried to find information on benzodiazepine sight but could not...lots of articles but not on this.  I feel exhausted and crazy.  

I have been googling for information for long time...still baffles me.

Can continue it and deal with side effects or stop and deal with potassium...those are choices per my doctor who said to weigh benefits vs side effects

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Altostrata

For example, from Dr. Google https://www.drugs.com/sfx/amiloride-side-effects.html

 

You are having recognized adverse effects from amiloride.

 

If you cannot tolerate 1.25mg, if you must take it, the next step would be to make a liquid from it so you can take less, such as 0.5mg. You can get a prescription for a compounded liquid from your doctor or make your own.

 

See https://sites.ualberta.ca/~csps/JPPS9_3/MS_973_Review/MS_973.html

 

Amiloride hydrochloride (84)

  • Tablet modified to an oral liquid mixture (solution/ suspension)
  • 2 vehicles: Glycerin BP 40 % w/v and sterile water; Glycerin BP 40 % w/v, sterile water and 0.1% Compound hydroxybenzoate solution APF.
  • 4a. 1 mg/mL mixture, with or without preservatives, stored in the dark was stable for 21 days at 5 ºC and < 7 days at 25 ºC. Mixtures prepared from pure powder are stable for 60 days at 25 ºC.
  • Mixtures prepared from pure powder were more stable than those prepared from tablets.

Amiloride liquid is light-sensitive. Keep it in a dark-colored container in the refrigerator, discard after a few days.

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Rabe

Thank you

 

Took very small piece yesterday..less than quarter. when I can get my head back on I'll try to think...thank you again.  

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Rabe

call pharmacy yesterday n they cannot compound it...trying to get away from fillers and dyes too

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Rabe

I want to go home..would be nice.....been staying here to get help and if can't then I need to shift gears.  

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Rabe

I didn't mean here as on this site here...I meant MKE....you have all been so kind and I thank you!  

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Rabe

Finally symptoms are easing after initially worsening after Viibryd but now letting up.  So grateful.  

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Rabe

seems to ebb n flow...while can think better

 

do you think the viibryd taper can be affecting things?

do you think it better to taper the Clonazepam first?

dO you think not taking a consistent dose of AMiloride each day makes difference...cant cut pills evenly

if stop it and try eating/drinking more K but have to restart...would/could restarting it be problem do you think ? 

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Hazel

Hi Rabe-just saw it looks like you are from Milwaukee.  I am in Green Bay.  We’re practically neighbors😉

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Rabe

reason ask is in looking back the symptoms got worse when started taking the smaller part of the cut pill each time, sometimes quite a bit smaller, rather that taking the one part one day and other part next time which was more consistent which was about a week to or so ago.

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Altostrata
3 hours ago, Rabe said:

reason ask is in looking back the symptoms got worse when started taking the smaller part of the cut pill each time, sometimes quite a bit smaller, rather that taking the one part one day and other part next time which was more consistent which was about a week to or so ago.

 

Please clarify what you'e saying here.

 

You have been inconsistent in your amiloride dosing for weeks. We're looking for a baseline derived from consistency. Your symptoms may fluctuate if you take ANY of your drugs inconsistently.

 

Rabe, please don't angle for our permission to stop taking amiloride. I have no idea how this would affect your health. You need to discuss this with your kidney specialist.

 

I have become, unwillingly, fairly well-informed about amiloride, and I don't want to spend any more time with it. Please join a Web site about kidney disease to discuss this with other people who are being treated similarly. Look at this -- this is the very last Googling I'm going to do for you regarding kidney issues. You need to do this work yourself.

 

If you continue to have symptoms from amiloride, we can't help you taper anything else, we won't know what's going on. You can hold on all your tapering.

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Rabe

 thank you Altostrata....

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Rabe

Not sure if I try to clarify it will make any more sense and yes you have spent too much time on this already and I can appreciate your frustration. Suffice to say I in essence made an inconsistent TIW dose even more inconsistent, decreased it, by starting to take just the smaller pieces when split pills rather than taking one half of a tablet one day and the other half of the same tablet the next scheduled day no matter what their size with splitting as I had been doing.

 

I truly was not asking your permission to stop Amiloride or speculate on health effects...of course that is not your responsibility.  Sorry the questions weren't clearer...my mind is better now.... was able to get out for a walk and helped.  Of course the tapering will have an effect, and of course not taking a consistent dose of any of the meds will make a difference...but only really learned that when was cutting CLonazepam and doctor suggested compounded capsules for CONSISTENCY and it made a very big difference...I had forgotten that.  Ought to have waited to write anything until had thought things through...I apologize Altostrata.   

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Rabe

they have already sent the .9 Viibryd capsules...got them yesterday and I have no others...

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Rabe

also messaged the doctor about the dose consistency...there is none whether I split them in half or quarters...only if compounded, which pharmacy cannot do, or if I make a liquid which is a scary thought but that may have to be...thank you for that information.  The pharmacy does have Spironolactone.  I will leave it up to him.  Also will make an appt with him because we need to talk about how to do this in a way that makes some sense with other meds.

 

I do want you to understand that I never worried about consistency before...I just took a half Clonazepam years ago or half a Viibryd last year when tapering and it didn't seem to matter.....but now everything seems to matter and I am REAlly learning that lesson in a most unpleasant way.  I feel pretty stupid actually...and believe I often am. ;) Thank you for the patience you have afforded me...I am truly grateful!!  

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