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rafatennis Clonazepam and Nortriptyline withdrawal

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rafatennis

Really enjoyed reading the information by the administrator on this site. I too was sold on the idea that I needed to reduce a benzo Clonazepam before the Nortriptylene but have had little success. When I read that its best to taper off the activating AD first it made total sense. I'm currently holding at 1.5mg clonazepam and have recently started reducing the AD, dropped from  25mg to 23mg over the last two weeks using the water titration method from this site, what I did was put the 25mg capsule of Nort into 25 ml of water and shook the combination and drew out 2ml of the combination for a 2mg reduction. Lat night after two weeks I dropped to 20mg. My question is do I continue to reduce by 2mg all the way to zero or use some different % ratio. Thanks and glad to be connected with this group,

Edited by scallywag
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oskcajga

Definitely 10% every 4 weeks until you're at a very low dose.  Once you get to a very low dose of like 1mg of the AD, having tapered 10% or so, it's having almost negligible effects on your body at that point (only <5% or so of the original dose).  I would personally just go .5mg, .25mg, and then quit totally.  It can't really hurt to go 10%, but it's also another couple of months of being on the medicine that might not really be biologically necessary.

 

I don't really see any reason why you couldn't do both simultaneously.  A 10% reduction each month is a VERY SAFE taper, so it would just prolong things if you didn't do both at the same time.  That's a lot of clonozepam, so you're going to want to start getting your brain used to tapering sooner than later unless you want to taper from psych meds for the next 3 years of your life.  Remember, the longer your brain is exposed to these toxins, the more damage and neuroadaptations that are taking place.  Even if your tapering, your brain is still being chronically exposed to toxic material.

 

I personally stopped taking 1.5mg of clonzepam for 5 years in about a 2 month period, and experienced 3 months or so of brutal withdrawal before I was fully recovered.  I don't recommend that quick of a taper to anyone, but it does demonstrate that a 10% reduction isn't totally necessary to get full recovery, it's just the safest way to do it. The benzos are much less damaging, in my personal experience, than the antidepressants - but considering that many heavy drug users consider benzos to be the WORST of all the drugs, that's not saying very much. 

 

It's your call, ultimately.

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Altostrata

No, it's not a good idea to taper more than one drug at a time. If you get withdrawal symptoms, you won't know which drug is responsible. This complicates things quite a bit, particularly if a benzo is involved.

 

While none of these drugs is good for you, benzos are not nearly as harmful as, say, antipsychotics. Please do not worry about the continuing effect of the benzo on your health, unless you are getting adverse effects from the benzo.

 

As for when you stop taking a drug altogether, that depends on how your taper is going. If at a low dose you find a 10% decrease is difficult, you may be decreasing by 5% down to a tiny fraction of a milligram.

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chicken

Hi Raf,

I'm also tapering nortriptyline. I'm down to 5.5mg from 20 mg.

I too dissolve it in water and shake it really well.

 

I dissolve mine in 20 ml of water though. I have been reducing by 10%.

So far, it's going good.

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rafatennis

Thanks all for the feedback, I'm glad to hear that someone else is successfully using the water titration. 

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rafatennis

Hi, I have been withdrawing on Nortriptylene over the last three months, I started at 25mg and have been tapering 10% of the last dose reduction over a three to four week period each drop so I am down to 18.2mg, I'm also taking 1.5mg clonazepam at night along with the Nortriptylene.I'm withdrawing the Nortriptylene first. When I have attempted past reductions I reach a point where mostly at night I have a thought and what feels like an unpleasant adrenaline rush goes through my head. It is very unpleasant and sometimes can cause a wave of sweat after the rush. Does anyone have any feedback or experience this and is it common and can I do something about it?

Thanks

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rafatennis

Altostrata, could you please weigh in on my comments above, thanks

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erer

Seems to me like you are experiencing brain zaps. I have had (and are having) a lot of those.

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Petunia

rafatennis,

I moved your topic in the tapering forum to your introduction thread here because it was related to your own situation specifically. Please add information and updates about your changing circumstances, and ask questions here.

 

Adrenaline rushes and sweating are common withdrawal symptoms and an indication you may be tapering too fast. If these symptoms occur after a cut and don't settle down, you need to wait before making another cut. If these symptoms become intense, occur after each cut and take a long time to resolve, you might want to consider making smaller decreases, like 5%.

 

Are you experiencing these symptoms at the moment?

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Altostrata

What Petunia said. My guess is you need to hold for a bit and slow down for the next stage.

 

Fsh oil and magnesium supplements might help, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

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rafatennis

Hello, reaching out for a little help. I've been withdrawing from Nort. started at 25mg in June 2015 and using the 10% method of reduction from the last dose every 3 weeks ,I am now at 14.8mgs for 14 days ,  I had the usual one or two days of malaise, nausea, sweating higher anxiety with previous drops and it would typically pass. I've been stuck in a state of higher confusion, higher anxiety, fatigue, night sweats now for 8 days beyond when the last dose would have cleared. Should I slow it down to 5%, I'm strugggling, I also take 1.5mg of Clonazepam at night, have been on the clonazepam for 15 years, the Nort has a higher side effect profile so I started it first on the taper. Any advice would be appreciated.

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Altostrata

rafa, I moved your post here. Please follow or bookmark this topic so you can find it again and add your questions about tapering.

 

Are you tapering by 10% of the current dosage, rather than 10% of the original dosage? The amount of the decreases should get smaller.

 

If you are getting withdrawal symptoms from a 10% decrease every 3 weeks, it might be too much for you. You might want to try a 5% reduction every 3 weeks; if that works well, perhaps a 5% reduction every 2 weeks would be right for you. That would amount to about a 10% decrease per month, which is our general recommendation.

 

Since you've hit a rough patch, if I were you, I would hold for a good while, maybe a couple of months, and let your nervous system settle down.

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rafatennis

Thanks Altostrata, I have been reducing 10% of the last drop so they have been getting progressively smaller, I agree that I need to reduce the %, this last drop was 1.6 mgs,  how much impact do you think I'm feeling from the clonazepam because I know that when the Nort is reduced it also clears so much of the effectiveness of the benzo? Thanks again for your help.

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Altostrata

Hard to tell about the benzo interaction. Seems to me a hold is the way to go now, see what happens as your system adjusts.

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rafatennis

Hello, I'm writing for feedback or advice. I've been tapering until the last couple of days from 10mg of Nortriptylene by opening the capsule and pouring out what I thought to be 2-3 mg every 3 weeks of the powder, I adjusted to the first round but after pouring out another approximately 2-3 milligrams I got very nauseous, all of the usual CNS symptoms, high anxiety etc. I reread about water tapering and started that two nights ago at 4milligrams. Doing better, some symptoms diminished but others are still fairly strong. I weighed the 10mg powder with fillers and realized the total weight was 230 milligrams with all of the filler so almost a 20 to 1 ratio of filler to actual Nortriptylene. I started the anti-depressant  taper 1st because I'm also on 1.5 mg Clonazepam once daily. Just looking for reassurance that my above assumptions are correct where I went wrong? I realize too that I will get withdrawal symptoms from both meds since they interact and potentiate each other.

 

Thanks

 

Currently 4 mgs Norttriptylne tapering from 20mgs

started April 24th, 2016, dropping every 3 weeks

staying on 1.5 mg Clonazepam once at night.

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scallywag

Hi rafa, I've moved your post to your Introductions topic so that all your history and questions will be in one place.

 

I'm having a hard time understanding what you did.  I'll post my interpretation. Correct me where I've got it wrong.

 

 

Starting point April 2016:

10 mg noritriptyline

10 mg active ingredient (mgai) = 230 mg pill weight (mgpw)

 

I'll assume you removed 3 mg of powder (mgpw) each time you cut dose, every 3 weeks approximately

 

date      mgpw      mgai

Apr 24     227      9.87

May 15     224      9.75

Jun 05     221      9.61

Jun 26     218      9.48

Jul 17     215      9.35

Aug 07     212      9.22

 

I get that you're taking 4 mg of noritriptyline. Is the total powder weight 4 mg or is the dose 4 mg?

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rafatennis

Thanks for the response, I was just pouring straight out of the capsule about 1/3 of the entire capsule contents thinking it was about 3 milligrams of actual medicine but after thinking about it with all of the filler in the capsule there would be no way to know how much I was actually getting. So I started mixing the 10mg powder contents into 10 milliliters of water and then drawing out in a syringe the amount I needed because my understanding is the med is water soluble and a 1 to 1 ratio of milliliters to milligrams, I was in difficult withdrawals for three weeks doing the pour out of the capsule method. My system is still effevted but not as badly since I switched to water titration two nights ago. 

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scallywag

rafa Ok, now I understand. ;)

 

Yes, you figured out what the problem is - 1/3 of the capsule is about 3 mg which at 30-33% is a large reduction for your CNS (central nervous system). I hope you'll hold steady at 4 mg for 6-8 weeks to allow your system to catch up.

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rafatennis

Thanks you might be right but we are not connecting on my point possibly for other readers that there is 220mg of filler in a 10mg dose of Nortriptylene thus making it very inaccurate to just ingest a 1/3 of the powder because it is not evenly distributed in the capsule, thanks for your feedback though

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chicken

Thanks for the response, I was just pouring straight out of the capsule about 1/3 of the entire capsule contents thinking it was about 3 milligrams of actual medicine but after thinking about it with all of the filler in the capsule there would be no way to know how much I was actually getting. So I started mixing the 10mg powder contents into 10 milliliters of water and then drawing out in a syringe the amount I needed because my understanding is the med is water soluble and a 1 to 1 ratio of milliliters to milligrams, I was in difficult withdrawals for three weeks doing the pour out of the capsule method. My system is still effevted but not as badly since I switched to water titration two nights ago. 

I'm tapering nortrip and I am doing the same thing. I pour my whole capsule into water and shake it. I keep shaking it to keep the particles suspended right up until I draw out what I need with a syring. It doesn't appear to be soluble as particles float all around and will sink to the bottom. I'm down to .8 nortriptyline and have had no problems as long as I keep it suspended and don't let any sink to the bottom while I draw it out.

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rafatennis

Hi Chicken, thanks for your response, i'm at day 30 on the drop from 7mg Nort to 4 mg and still feeling ill most days, do you think I should just continue to wait it out? thanks

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scallywag

You made a large reduction, almost 50%, 4 weeks ago. It's best to hold until your symptoms settle down, i.e. your CNS (central nervous system) catches up to the change.
 
This is a helpful description of what happens during tapering and withdrawal: Brain remodeling

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rafatennis

Thanks any idea how long i should wait, or should I go up to 6mg?

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scallywag

rafa - No one can predict how long it will take for your symptoms to diminish to a stable level or to resolve entirely.  Once symptoms have started using a calendar is counter-productive. It's best to pay attention to your symptoms and keep a written record on paper. In this thread, there are multiple forms (PDF, DOCX, XLSX) of a symptom list that you could use to do that.

Glenmullen’s withdrawal symptom list  
 

 

As for updosing, I wouldn't. The safest route is to hold steady at your current dose.

3KIS: Keep it slow. Keep it simple. Keep it stable.

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rafatennis

Thanks I appreciate your response, i was unsure because I've struggled most today with trying to focus and concentrate on my job. 

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rafatennis

Hi Scallywag, you have been very helpful to me with your advice. I've hit a wall on my tapering of Nortriptylene, I started at 20 mg back in late April of this year and was dropping on average 3 milligrams every three weeks and was doing ok until I reached 4mgs dropping from 7mg, I went to the water titration and am now at almost 6 weeks with little relief from a multitude of symptoms, I posted earlier and was advised to stay at 4mg but I'm getting overwhelmed so i just added 2mg back today in water solution. I just wanted to check and make sure I'm actually mixing everything correctly. I'm currently emptying a 10mg powder from the capsule into 10 milliliters of water and drawing out the desired milliliters from a syringe. Is that correct? thank you for any feedback. I also take 1.5 mg clonazepam at night.

Edited by scallywag
moved from "How to make a liquid" in Tapering

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scallywag

Hi rafa!  I've moved your post to your introductions topic so that all your information is in one place.

 

Just to repeat: That cut from 7 to 4 mg was HUGE! It's the source of your symptoms. I hope your updose eases your symptoms at least a bit.  Please stay at 6mg until several weeks (maybe even 6-8 weeks) after you've stabilized to give your CNS (central nervous system) a chance to catch up.

 

Putting 10 mg noritriptyline in 10 ml water produces a solution where 1 mg = 1 ml. Taking 6 ml of the liquid is 6 mg.

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rafatennis

Hi rafa!  I've moved your post to your introductions topic so that all your information is in one place.

 

Just to repeat: That cut from 7 to 4 mg was HUGE! It's the source of your symptoms. I hope your updose eases your symptoms at least a bit.  Please stay at 6mg until several weeks (maybe even 6-8 weeks) after you've stabilized to give your CNS (central nervous system) a chance to catch up.

 

Putting 10 mg noritriptyline in 10 ml water produces a solution where 1 mg = 1 ml. Taking 6 ml of the liquid is 6 mg.

Thank you very much for the feedback, I sincerely appreciate it, I will stay put it for quite some time at 6mg, thanks for the quick answer

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scallywag

rafa, you asked me about early morning, 4 am, cortisol surges that wake you.  If you haven't read the discussion topic/thread about that here's the link: Waking with panic or anxiety -- managing cortisol spikes.

 

Sometimes this uncomfortable symptom can be caused by low blood sugar. If that's the cause, the low blood sugar can be minimized by eating a small amount of protein with a complex carbohydrate before bed.

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rafatennis

I'm tapering Norttripylene and titrating with a water mixture, how long is the solution good in the container and does it need to be refrigerated between doses? thanks

Edited by scallywag
moved from new topic started in Symptoms Forum

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scallywag

We discuss the safe "longevity" of do-it-yourself liquids in the Making a liquid from a tablet or capsules topic.

 

Quick summary: Make it, refrigerate. Withdraw doses as needed. Discard after 5-6 days.

 

edit: I've moved your post/question to your introduction topic so that all your information, questions and answers are in one place.

Edited by scallywag
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rafatennis
On 8/9/2016 at 11:02 PM, chicken said:

I'm tapering nortrip and I am doing the same thing. I pour my whole capsule into water and shake it. I keep shaking it to keep the particles suspended right up until I draw out what I need with a syring. It doesn't appear to be soluble as particles float all around and will sink to the bottom. I'm down to .8 nortriptyline and have had no problems as long as I keep it suspended and don't let any sink to the bottom while I draw it out.

 

On 6/20/2017 at 9:15 PM, scallywag said:

We discuss the safe "longevity" of do-it-yourself liquids in the Making a liquid from a tablet or capsules topic.

 

Quick summary: Make it, refrigerate. Withdraw doses as needed. Discard after 5-6 days.

 

edit: I've moved your post/question to your introduction topic so that all your information, questions and answers are in one place.

 

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rafatennis

Great, thanks for the feedback, has anybody experienced or can shed some light on the difference in generic clonazepam, I've noticed many pharmacies are becoming less receptive to sourcing a particular generic manufacturer that you may have been using for years as I have. For example I have taken the Qualitest generic clonazepam for years and now I cannot get it, having to go to Northstar made by Sandoz, any feedback would be appreciated, thanks

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