Tapering zyprexa 2.5 mg

Hi Kayla, I'm currently tapering quetiapine ( atypical antipsychotic used off-label for sleep, a big mistake in my case, but another story) I use a combination of commercial pills, which at my dose level come in 25mg, 50mg and 100mgs, with the liquid quetiapine making it up to the current dose. I get the liquid Q by my doctor's prescription from a compounding pharmacist, and they can use a choice of 2 suspension liquids of 2 different strengths. The first one I was offered (can't remember the brand name off-hand) had a ratio of 1 mg pill dose to 1 ml of the liquid, which could end up very expensive, would expire after 1 month, but didn't need to be refrigerated. So I chose the other brand, Suspendit Anhydrous, which has a ratio of 5mg/1ml liquid, which is much cheaper because although the fluid by itself is more expensive you only use one fifth of the amount you would have had to buy otherwise. It also lasts 3 months, but must be kept in the fridge, which can be a bit awkward if travelling overseas, but doable using ice packs and cooler bags, and seeing if the cabin crew can stow it in their fridge for the duration. Your doses will probably change over the 3 month period, but that's no problem as the pharmacist will calculate how much you will need if you send them a "weaning" chart before you order and pay, and probably toss in a little bit more in case of spillage, then send by courier along with an adaptor cap for the bottle plus a 1ml syringe to fit. It's more flexible than it sounds, because after a month, say, and you find 10% too much, you go up to the last dose you were comfortable at and stabilise then restart at the new reduction rate of your choice, use up what you have of the liquid using your new rate, then contact the chemist a reasonable time before you run out to send a revised weaning chart and get a new batch. I'm in the process of doing that right now. I can go into the logistics of tapering your zyprexa at a 10% rate, but don't want to go on too long and get confusing, but get back to me if you want to know that and I'm happy to help. The suspension liquid is made in the USA by a large, well-known pharmacutical firm (can't remember that name either right now but can find it in a minute) so there shouldn't be a problem at all to get it. Best, R.

Thank you for your response. I would like some help in figuring out the 2.5 mg zyprexa taper at 10%, how long i would stay at each level, how i would go about ordering this every 2 weeks as i guess zyprexa only lasts for 2 weeks, how this short time would work because the compounding pharmacy ships it yoi. how i would talk my psychiatrist into this as he said I dont need to taper it at all, and how to.find a deprescribing psychiatrist when money are listed in my state.

Hi Kayla, 10% is slightly on the high side if you are just starting out but not saying it won't work, it depends on how resilient your brain is, everyone is different. But if you do a 10% cut anyway, you cut to the next dose by multiplying your PRESENT dose by 0.9 (which in your case will come to 2.25mg) and do that for a month maybe, and if no withdrawal symptoms show up, make another 10% reduction, again PRESENT dose of 2.25mg x 0.9 which comes to 2.025mg. If w/d's start it's best to stay on your dose until they go away, again different for everyone. And maybe reduce your cut to, say, something smaller, like 8% and see how you go. As I mentioned in my last reply, your zyprexa solution should last at least a month if it's the one you don't need to put in the fridge, the other one that you have to put in the fridge lasts 3 months. Your psychiatrist is wrong, you have to taper or you risk, among other things, a horrible thing called protracted withdrawal which can last a lot longer than the actual taper to recover from. Not everybody gets it though, again, depends on an individual's unique brain, but a lot do if you cold turkey things. Many doctors and psychiatrists who trained before hyperbolic tapering became well-known, which was in the late 2010's, don't know about it, and are very dismissive. It's not a good idea to challenge them though, which will make them defensive, you want them on your side, so perhaps try saying something like this " Well doctor, I hear what you're saying, but I have heard about this hyperbolic tapering and I would like to try it. It won't hurt me and if you wouldn't mind, I'd like to give it a go. How about it?" And if that doesn't work, you don't need a psychiatrist to prescribe it, an ordinary doctor can. It's your right to accept, not accept, an offered treatment or seek a second opinion, so long as you aren't under some compulsory care, of course. Hang in there, R.👍☺️

Thank you so much for taking the time to send me this information. This is very helpful. Last question. When I was looking the zyprexa taper up on the computer one site said zyprexa liquid lasts 2 weeks. Is this true or false. If its true this taper would cost a lot of money. Its going to any way as the cost for one bottle will be about $150.

Hi Kayla, you need to ask a compounding chemist rather than Google AI on this one. An ordinary chemist can give you the name of one to call. They are very common, for example some people with degenerative diseases like motor neurone disease can't swallow pills anymore so need the liquid form of their drugs. Google AI got it wrong concerning whether or not I had to refrigerate my 3-month supply of liquid quetiapine. They said it should be kept at room temperature, WRONG. The 1-month liquid, yes but it's got a totally different suspension liquid, and Google didn't know about the 3-month one. If I don't keep mine in the fridge all day it's a gonner within half a day. Disaster! Zyprexa may need different conditions, so make sure your info is correct by calling the compounders. If they're like mine they will be only too happy to help you out. About the cost, I keep mine down as much as possible by using a combination of the prescribed pills and making up to the right dose with the liquid. And getting a 3-month batch at the same time means I only have to pay the courier fee once. I don't know what the pill sizes are for zyprexa, but I feel you could work out combos that will lessen the cost. Good luck and do let me know how it goes.

"Is this true or false" — @Kayla

False in my case. I'm in the midwest and my compound pharmacy charges me $80 for 70ml where 1ml:1mg and it says right on the bottle 2 months, not 2 weeks. I have it delivered for $10, so $90 every 2 months

I just tell my prescriber that I'm going to take 1mg every day. Then I take whatever meets my tapering schedule

1st call the Compound Pharmacy and verify cost and expiration, etc. Explain your Dr will send Rx soon. Here's the verbiage I supplied to my Dr as she had no idea how to prescribe it: ------ Please create a custom compounded liquid for Olanzapine where 1 milligram / 1 milliliter. The patient is going to take one milliliter (ml) daily and we're going to dispense 70ml for 60 days, with 10ml added to account for the residual medication loss in the syringe tip during dosing. Name of Compounding Pharmacy Address Phone & Fax # Phone # Fax ---------- Also ask for a refill option if you don't want to have to ask your Dr again 2 months later. After she told me she sent the Rx, I called the Pharmacy and gave them my cc info, etc and arranged exact timing, etc

Btw, they diluted it to the right mixture with some sweet vanilla frosting taste 😋

But I didn't use the liquid until I dropped from 1.25 (half a 2.5 tablet) to 1.1mg, then I used liquid. I chopped and shaved up tablets at the 2, 1.75, 1.5 doses best I could approximate. And I'm gonna tell you, the dosing between 1.5 and 1 were especially symptomatic. You're right on the very vertical portion of that receptor occupancy curve and where theres still enough of the drug to make a difference. Be prepared for some WD there, but don't let it scare you. You'll get windows between the waves 🙂

Thanks for that HopeNF, that's absolutely brilliant. I don't take Zyprexa so couldn't be more helpful but that's mostly everything I think Kayla needs. Right Kayla? Cheers, Renee. 👍☺️

Renee, I'm not sure if I'm doing this messaging thing right. I had a question to ask about what you meant when you said if I had withdrawal symptoms I should stay on the dose until they go away. What dose was I supposed to stay on - the one I reduced the zyprexa to or the dose I was on where I didn't have the symptoms? For example: if I had side effects from dropping from 2.25 to 2.025 should I stay at the 2.025 or go back to the 2.25? If I have to go back to the 2.25 I may not have any left to do that.

HopeNeverFails and Renee, I am so overwhelmed with all this information. I don't know if my psychiatrist would even go for writing out a RX 1 mg to 1ml indefinitely. He said I didn't need to taper so I can't see him going with this plan. I don't get how you came up with 70ml for 60 days . I'm not good at math so I don't know if this would even work for me with figuring out the amounts for tapering each month, whether you'll have enough liquid to cover the month. I feel I would really need someone like a describer helping me but there isn't one in my state. What do you do when you need help and there's no deprescriber? Hope, you mentioned that you went from 2.5 to 1.25. by cutting zyprexa in half. Was it hard to get it equal? Wasn't that a big taper for you or not?

Sorry Kayla, I meant that, when you cut the dose where you were comfortable, and then w/d starts in several days as it will, you wait for it to peak, usually by day 10. It varies from person to person though, important to remember that. Then it should gradually subside. If it does then you continue with that dose for a while because your brain/nervous system has stabilised, maybe a couple more weeks, then carry on with the planned taper. If it doesn't subside you have likely gone too fast for your brain to keep up and it may be time to return to the dose you were on before, stabilise ie. no or barely noticeable symptoms, and reduce again but at a slower rate. It's a bit of trial and error to find the best rate for you. Work out how much liquid you have left and how long it will last, and use it up because it's not cheap, then it's back to the doc for a new scrip with a new tapering plan doing the cut that works. Bit of a pain, eh. But don't cut the dose again until you stabilise, whatever you do. You wouldn't need to work out the math if it's like my chemist, they'll do it for you and put in on the label. Myself, as math is my thing, I do work it out from the weaning table I send for their approval, and they confirm my figures, then it's back to Dr Snake-oil to write the scrip, scan it and send to the chemists (the receptionist does that for me). If all's well I confirm the order, pay, work out when and where the delivery is done, and it's all on. I believe I'm right when I say that Hope's "70mls for 60 days" just applies to his/her particular plan, your's would be different, is that correct Hope? I'll get back in a while and quite likely Hope will get back before me. I just don't want to go too much and tire you out, I tend to be like that sorry.

@Kayla I went from 2.5 to 2 to 1.75 to 1.5 to 1.25 to 1 by chopping up and shaving 5mg and 2.5mg pills. The 2.5mg pills are very difficult because they are coated, so I mostly used 5mg pills. I eyeball estimated the best I could. I didn't have much issue at all until the 1.25 to 1 drop, then I had a lot of symptoms, got scared, and went back to 1.5 and started over from there. I dropped to 1.25 a few weeks later then when it was time to drop again, I used the liquid at 1.1mg. I also learned to quit being afraid of the WD effects, especially the insomnia. I prayed and gave thanks a lot, counting my blessings rather than my sufferings. 🙏 I then dropped from 1.1 to 1, then to 0.9,... and so on, using liquid. I even gently acclimated myself during a drop - I'd drop a ml each day for a few days before the rest of the drop, to avoid a sudden larger step down response. Easy to do with syringe. The 70ml comes from this: 60 days at 1ml, plus an additional 10ml for waste. Some of it sticks to the bottle, syringe, leaks out, etc. The writeup I gave you was nearly a copy from a Dr Josef Witt video and my pharmacist understood it perfectly. In a 2 month period I went from 1.1 to a little less than 0.9, so it all averaged out just fine, I even had a little left over. I wasn't scared to use the remainder a little after the expiration date lol.