![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Melissa33 on April 21, 2004, at 20:24:07
I have been on anti-depressants and other meds for over 10 years now. I recently began having trouble with high blood pressure...this seemed to come out of nowhere. My doctor is concerned because I am not responding to several increases that have been made with blood pressure med he started me on. My internist and psychiatrist have decided that being on high doses of meds for such a long time could be causing this and to confirm or rule out they are in the process of working together to get me off of all my medications. I currently take
Effexor 450mg
Klonopine - 1mg 3x's day, 2mg night
Adderal - 30mg 2x's day
neurontin - 600mg 3x's day
Despite a continued increase in depressive symptoms and difficulty functioning at work...I guess my psychiatrist feels like my physical health is top priority. Today he discontinued my adderal, decreased my klonopine to 1mg 2x's day and 2mg at night, and decreased my effexor to 300mg. I know getting off of some antidepressants in the past has been a living nightmare.Should I expect any withdrawal symptoms going from 450 to 300 with effexor? If so, what?
What about suddenly stopping a stimulant after me being on ritalin, dexedrine or adderal for years?
I realize the concern about my physical health and share the concern. But, I am scared about med changes when I am not at a very stable place as it is.
Any suggestions or information would be greatly appreciated!!!
Posted by chemist on April 21, 2004, at 23:02:23
In reply to What should I expect? Being taken off several meds, posted by Melissa33 on April 21, 2004, at 20:24:07
> I have been on anti-depressants and other meds for over 10 years now. I recently began having trouble with high blood pressure...this seemed to come out of nowhere. My doctor is concerned because I am not responding to several increases that have been made with blood pressure med he started me on. My internist and psychiatrist have decided that being on high doses of meds for such a long time could be causing this and to confirm or rule out they are in the process of working together to get me off of all my medications. I currently take
> Effexor 450mg
> Klonopine - 1mg 3x's day, 2mg night
> Adderal - 30mg 2x's day
> neurontin - 600mg 3x's day
> Despite a continued increase in depressive symptoms and difficulty functioning at work...I guess my psychiatrist feels like my physical health is top priority. Today he discontinued my adderal, decreased my klonopine to 1mg 2x's day and 2mg at night, and decreased my effexor to 300mg. I know getting off of some antidepressants in the past has been a living nightmare.
>
> Should I expect any withdrawal symptoms going from 450 to 300 with effexor? If so, what?
>
> What about suddenly stopping a stimulant after me being on ritalin, dexedrine or adderal for years?
>
> I realize the concern about my physical health and share the concern. But, I am scared about med changes when I am not at a very stable place as it is.
>
> Any suggestions or information would be greatly appreciated!!!hi there, chemist here....expect mild to moderate discomfort from effexor tapering, and do it at your own pace, not your doctor's: if you start feeling out of it or anxious, go back up to the effective dose and do a more gradual taper. as for dexedrine (my favorite, and life-saver): no cold turkey, not for dexedrine, adderall, or ritalin. bad news. again, taper. the neurontin you are taking is likely doing nothing at all, abort. the klonopin, adderall (racemic mix of L- and D- amphetamine, les potent than dexedrine) and effexor will require tapering at *YOUR* comfort level. my advice is to go about it in terms of how you feel, as opposed to what your doc may or may not suggest as the best course....give a shout id i can be of any help, and all the best, chemist
Posted by Melissa33 on April 21, 2004, at 23:58:24
In reply to Re: What should I expect? Being taken off several meds » Melissa33, posted by chemist on April 21, 2004, at 23:02:23
hi there, chemist here....expect mild to moderate discomfort from effexor tapering, and do it at your own pace, not your doctor's: if you start feeling out of it or anxious, go back up to the effective dose and do a more gradual taper. as for dexedrine (my favorite, and life-saver): no cold turkey, not for dexedrine, adderall, or ritalin. bad news. again, taper. the neurontin you are taking is likely doing nothing at all, abort. the klonopin, adderall (racemic mix of L- and D- amphetamine, les potent than dexedrine) and effexor will require tapering at *YOUR* comfort level. my advice is to go about it in terms of how you feel, as opposed to what your doc may or may not suggest as the best course....give a shout id i can be of any help, and all the best, chemist
Hi chemist,
Thank you for your reply.
So, you would not advise that I stop my adderall cold turkey like doc told me to do today? I take 30mg twice a day...should I try 30mg once/day for a while?Right now my main concerns are the adderal and effexor. I can handle decreasing my klonopin by 1mg/day. I just assumed that I would be tapered off the adderal and he would not stop it all at once. Are there any withdrawal symptoms, adverse reactions, etc. to just suddenly stopping the adderall?
With the Effexor xr....I am hoping I can handle going down to 300 with no problems...if it seems I need to do it more gradually, how do I do this? I only have the 150mg capsules.
I agree and doubt the neurontin is doing anything for me. I could probably stop it cold turkey and be okay. I am trying to be the compliant patient (which I admit I am not always) But, at the same time I would like to remain a sane patient.
Thank you so much for your help
Posted by chemist on April 22, 2004, at 1:50:02
In reply to Re: What should I expect? Being taken off several meds » chemist, posted by Melissa33 on April 21, 2004, at 23:58:24
> hi there, chemist here....expect mild to moderate discomfort from effexor tapering, and do it at your own pace, not your doctor's: if you start feeling out of it or anxious, go back up to the effective dose and do a more gradual taper. as for dexedrine (my favorite, and life-saver): no cold turkey, not for dexedrine, adderall, or ritalin. bad news. again, taper. the neurontin you are taking is likely doing nothing at all, abort. the klonopin, adderall (racemic mix of L- and D- amphetamine, les potent than dexedrine) and effexor will require tapering at *YOUR* comfort level. my advice is to go about it in terms of how you feel, as opposed to what your doc may or may not suggest as the best course....give a shout id i can be of any help, and all the best, chemist
>
> Hi chemist,
> Thank you for your reply.
> So, you would not advise that I stop my adderall cold turkey like doc told me to do today? I take 30mg twice a day...should I try 30mg once/day for a while?
>
> Right now my main concerns are the adderal and effexor. I can handle decreasing my klonopin by 1mg/day. I just assumed that I would be tapered off the adderal and he would not stop it all at once. Are there any withdrawal symptoms, adverse reactions, etc. to just suddenly stopping the adderall?
>
> With the Effexor xr....I am hoping I can handle going down to 300 with no problems...if it seems I need to do it more gradually, how do I do this? I only have the 150mg capsules.
>
> I agree and doubt the neurontin is doing anything for me. I could probably stop it cold turkey and be okay. I am trying to be the compliant patient (which I admit I am not always) But, at the same time I would like to remain a sane patient.
>
> Thank you so much for your helphey there....do NOT stop addarall cold-turkey, it will mess with your sleep and, potentially, cause depression...always, always *TAPER*. you are taking amphetamine, a drug that is not to be messed with, not in the least bit. as for effexor, your dose is WAY high: i can only quote wyeth in telling you that you should taper by 75 mg each week. if you need to cut your meds in half (even roughly), then do so: if you start feeling lousy, bring it up, then reduce. the klonopin is helping you and is the least of your worries in re: adderall aand effexor. you are being over-stimulated thanks to these last two, and take the effexor taper very slow. you mentioned capsules (XR), and i would aadvise you to ask your doc to go with traditional effexor (tablets), which are available in 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg doses. i was never on effexor, but my frieds in even the 37.5 mg range found it very hard to dismiss. note bene: the adderall can be taken down more easily, just watch it with effexor.......let me know, and all the best, chemist
Posted by Sad Panda on April 22, 2004, at 11:55:47
In reply to What should I expect? Being taken off several meds, posted by Melissa33 on April 21, 2004, at 20:24:07
> I have been on anti-depressants and other meds for over 10 years now. I recently began having trouble with high blood pressure...this seemed to come out of nowhere. My doctor is concerned because I am not responding to several increases that have been made with blood pressure med he started me on. My internist and psychiatrist have decided that being on high doses of meds for such a long time could be causing this and to confirm or rule out they are in the process of working together to get me off of all my medications. I currently take
> Effexor 450mg
> Klonopine - 1mg 3x's day, 2mg night
> Adderal - 30mg 2x's day
> neurontin - 600mg 3x's day
> Despite a continued increase in depressive symptoms and difficulty functioning at work...I guess my psychiatrist feels like my physical health is top priority. Today he discontinued my adderal, decreased my klonopine to 1mg 2x's day and 2mg at night, and decreased my effexor to 300mg. I know getting off of some antidepressants in the past has been a living nightmare.
>
> Should I expect any withdrawal symptoms going from 450 to 300 with effexor? If so, what?
>
> What about suddenly stopping a stimulant after me being on ritalin, dexedrine or adderal for years?
>
> I realize the concern about my physical health and share the concern. But, I am scared about med changes when I am not at a very stable place as it is.
>
> Any suggestions or information would be greatly appreciated!!!
>
>Hi,
How high is your BP? This will determine how fast you should come of something. I would suggest coming off one thing at a time, I'd start with Effexor as it is possibly the one that is causing you to have high BP. Try & get a 7 day sample pack of Effexor 75mg from your doctor so you can step down to 375 for a week. I felt mildy sick & dizzy for a few days going from 300 down to 225mg & that was after spending just 4 weeks at 300. Also, has your doctor done any liver tests?
Cheers,
Panda.
Posted by Melissa33 on April 24, 2004, at 2:40:37
In reply to Re: What should I expect? Being taken off several meds » Melissa33, posted by Sad Panda on April 22, 2004, at 11:55:47
Hi Panda,
My BP has been in the range of 150-175/95-115.
I have not been successful in getting any 75mg capsules or 150mg pills. I did try. So, all I have are the 150mg xr capsules. And both of my doctors feel that I wont have any problems going from 450 - 350. I discussed trying to go down 75mg at a time and was told that I could handle the 150mg decrease right now. I get so frustrated because they don't know how hard it is to go through things like this and don't realize how much it impacts daily functioning.Why do you ask about liver test? It has been a few months since I have had liver tests done. I have had 5 surgeries in the past 3 years and after my last surgery my liver enzymes were out of wack. went back and forth with this for a while...but the last two times I have had test done they have been normal. Does effexor mess with the liver??
>
> Hi,
>
> How high is your BP? This will determine how fast you should come of something. I would suggest coming off one thing at a time, I'd start with Effexor as it is possibly the one that is causing you to have high BP. Try & get a 7 day sample pack of Effexor 75mg from your doctor so you can step down to 375 for a week. I felt mildy sick & dizzy for a few days going from 300 down to 225mg & that was after spending just 4 weeks at 300. Also, has your doctor done any liver tests?
>
> Cheers,
> Panda.
>
>
>
Posted by Melissa33 on April 24, 2004, at 2:42:46
In reply to Re: What should I expect? Being taken off several meds » Melissa33, posted by chemist on April 22, 2004, at 1:50:02
I had an appointment with my internist today. He agreed with you and disagreed with my psychiatrist. He couldn't believe that my psychiatrist was stopping my adderall cold turkey. He wants me to take one 15mg for 10 days then stop it. He told me that 15mg wouldn't be enough to continue with helping my ADD...but, it would be enough to prevent my body from having major withdrawal symptoms. What do you think about this?
I also asked him about my effexor. He agrees with my psychiatrist and told me that since I will be coming down from 450mg to the actual highest recommended dose of effexor he doesn't think it will really impact me. I am not sure what to do because it does seem like a lot going down 150mg at once. I only have the capsules and my internist wouldn't give me a script for the pills since my psychiatrist gave me a script for the capsules earlier this week. I don't know what to do other than just wait and see what happens. Any suggestions? I asked my pharmacist if I could open a capsule and take half of it...she said no..since it is the xr..doing that wouldn't work. any suggestions?
Posted by Sad Panda on April 24, 2004, at 3:55:19
In reply to Re: What should I expect? Being taken off several meds » chemist, posted by Melissa33 on April 24, 2004, at 2:42:46
From http://www.effexor.com/c/c20.asp
"it should not be divided"
and
"The capsule can also be carefully opened and its contents sprinkled onto a spoonful of applesauce. This should be swallowed immediately and followed by drinking a glass of water. Do not chew this mixture before swallowing."
This suggests to me that emptying half out can not guarantee half dosage, but I still would take a 150mg & tip 1/4 out for a few days & then tip 1/2 out for a few days & take the tip out 3/4 for a few days. (Or just take the tipped out 1/4 for a few days.)
Cheers,
Panda.
Posted by Sad Panda on April 24, 2004, at 4:06:16
In reply to Re: What should I expect? Being taken off several meds » Sad Panda, posted by Melissa33 on April 24, 2004, at 2:40:37
> Hi Panda,
> My BP has been in the range of 150-175/95-115.
> I have not been successful in getting any 75mg capsules or 150mg pills. I did try. So, all I have are the 150mg xr capsules. And both of my doctors feel that I wont have any problems going from 450 - 350. I discussed trying to go down 75mg at a time and was told that I could handle the 150mg decrease right now. I get so frustrated because they don't know how hard it is to go through things like this and don't realize how much it impacts daily functioning.
>
> Why do you ask about liver test? It has been a few months since I have had liver tests done. I have had 5 surgeries in the past 3 years and after my last surgery my liver enzymes were out of wack. went back and forth with this for a while...but the last two times I have had test done they have been normal. Does effexor mess with the liver??
> >
>
>Hi Melissa,
It's not 100% certain that you will have withdrawl symptoms. Some people have none, some have a little & some have a lot. I went from 300 to 225 & was sick for a few days. I would still err on the side of caution however & you can open the capsule up, it's just that it's not 100% accurate.
I ask about your liver because it effects how much is circulating in your blood. If your liver has suddenly become a little sick, it would cause a lot of drugs to have a higher level in your blood & this might cause your BP to raise.
Cheers,
Panda.
Posted by chemist on April 24, 2004, at 11:14:07
In reply to Re: What should I expect? Being taken off several meds » chemist, posted by Melissa33 on April 24, 2004, at 2:42:46
> I had an appointment with my internist today. He agreed with you and disagreed with my psychiatrist. He couldn't believe that my psychiatrist was stopping my adderall cold turkey. He wants me to take one 15mg for 10 days then stop it. He told me that 15mg wouldn't be enough to continue with helping my ADD...but, it would be enough to prevent my body from having major withdrawal symptoms. What do you think about this?
***i think it's a good idea. remember, this is amphetamine we're talking about. taper, and bump up the dose if you get uncomfortable, then bring it down again *****
>
> I also asked him about my effexor. He agrees with my psychiatrist and told me that since I will be coming down from 450mg to the actual highest recommended dose of effexor he doesn't think it will really impact me. I am not sure what to do because it does seem like a lot going down 150mg at once. I only have the capsules and my internist wouldn't give me a script for the pills since my psychiatrist gave me a script for the capsules earlier this week. I don't know what to do other than just wait and see what happens. Any suggestions? I asked my pharmacist if I could open a capsule and take half of it...she said no..since it is the xr..doing that wouldn't work. any suggestions?*** hmmm, the logic makes sense, in that above 400 mg you pbrobaly drive no benefit from extra effexor, asymptotically hit the therepeutic window limit, so to speak....don't go breaking up the capsuls...again, try the 150 mg step-down but stay there for a godd 7-10 days before you go for another. your body will tell you if you are tapering too fast. all the best, chemist
Posted by awatts on April 24, 2004, at 18:58:54
In reply to Re: What should I expect? Being taken off several meds » Melissa33, posted by chemist on April 24, 2004, at 11:14:07
> *** hmmm, the logic makes sense, in that above 400 mg you pbrobaly drive no benefit from extra effexor, asymptotically hit the therepeutic window limit, so to speak....don't go breaking up the capsuls...again, try the 150 mg step-down but stay there for a godd 7-10 days before you go for another. your body will tell you if you are tapering too fast. all the best, chemist
Just from my experience, 150 mg is too much at a time. You can break up the capsuls if you are CAREFUL NOT TO CRUSH THE LITTLE BEADS INSIDE. Get some empty gelatin capsuls and put half in each of 2 of the empty capsuls. The medication releases when the little beads are crushed or disolved. Most of the beads are not water soluble and react at different rates with the HCL in the gut.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.