Mirtazapine withdrawal schedule

Trattamento e farmaci
1

Can anyone give me a schedule on how they reduced the dosages. The folks on this board seems inwilling to do so. They seem very vague on the specifics. Cmon folks, help someone out. Because most doctors are too scared to help. (Liability issues) its a sad state iof affairs we have in the US.

I had to take action against my doctors advice, over and over again, to get her better. After tapering her original dosage fown from 40 mg to 15, she started urinating better -- signaling better. Her BM management improved greatly. She was on the 30 mg for 4 months before we tapered. I kept her at 15 mg for a month, then we went to 7.5 for two weeks, then to 3,5 for two weeks. That's where we are today. Should I fall off now? She!s sleeping ok, with a little help from ibprofuen and an occasional antihistamine. Her side effects now are headaches, itching, confusion, and some hullceinations. But she had suffered these and more while on the drug. (Entire duration) she will always have headaches, etc. doctors say. She had a brain hemmorage, then had more complications. She sufferes from encephalomalacia now. She was in the hospital for 6 months. ( meningitis, c-diff etc etc) To say the least, the girl has been through hell. But she fought through it and has been home for 4 months. The doctors put her on this terrible drug because she wasn't eating. Ok, I will admit, after a while she began too eat. She's been eating just fine since tapering. The doctors never really though she had depression. But, after all she had been through, who wouldn't be depressed? But I think another, non lethal, appetite enhancer should've been used.

This is just one of many issues we had with drugs that were given to her hastily.

The other was Keppra. That was a pure, and unnecessary, nightmare that we finally stood up agains, after much dansge was done. Another story for another day ..,

Words of advice. You must take charge of your own healthcare. Research, research, and pray.

2

Hi Stacy, I didn't even read your whole post to know that you are pushing this taper too fast.  Side effects/symptoms are a sure sign that her nervous system is destabilized, so cutting further will end up in failure/disaster.  Mirt is not a forgiving drug, and sometimes when people rush it, updosing doesn't work.  It is much better to go too slowly than to go too fast and try to back pedal.

Rebound insomnia is a huge problem with coming off mirt too fast, so you are lucky that she's still got her sleep.

Since you have two weeks under her belt on 3.75, I would hold there for a couple of months, no joke.  Her nervous system needs to catch up with the cutting you've been doing. 

These drugs cause neuron remodeling, the nervous system pushing back against the neurotransmitter imbalance the drug created by blocking receptors, etc.  The nervous system is slower to remodel back with less drug than it was to react to the action of the drug.  Withdrawal authorities recommend a 10% taper per month calculated on the previous month's dosage.  People get into the most trouble reducing at the low end.  For the spead that you have been tapering, jumping off from 3.75 will amount to a cold turkey.

Cuts should never be made while there are withdrawal symptoms.  Now, you've said that she's had those symptoms while on the full dose, so certainly I wouldn't cut if there are any new symptoms.  Digestive upsets, headaches and itching are all withdrawal symptoms.

Where do you live?  If you are in the UK, I would talk to her doctor about getting the liquid version of mirtazapine.  This can be dosed with an oral syrninge and will be easier to make the smaller cuts necessary at the low end.  If you can't get the liquid, Evergreen on this board has successfully gone off mirt making her own liquid.  Search for her username and her threads about coming off mirt.  She powdered the tablet and mixed it with half water and half maple syrup to make a 1mg/ml solution, and then dosed accordingly.

The low end of these drugs occupy the most receptors, so big cuts lead to large numbers freeing up and causing instability.  Therefore, it is even more important to make smaller cuts the lower you go.

Is this for your daughter, and if so how old is she?  Listen to her about what her body is telling her about the cuts, and don't cut if she is having trouble.  It may be that her body didn't get along well with mirt to begin with and so had lots of side effects, but those side effects going on the drug and the same ones we can have coming off, and going off too fast leads to protracged withdrawal syndrome which can last months and even years for some.

I hope this helps!

3

Sorry to hear of your (daughter ??) suffering, we are all here trying to support one another, I am not sure why youu havn't been successful finding a taper method.  

Betsy has given excellent advise, I can only add that the method so far has been fast, you were more than likely told to do it this way by your doctor, they don't seem to have the training or knowledge regarding tapering from Mirtazapine.

I agree with Betsy, try to stay at 3.5 for longer than you feel is right, this is important as explained above.  Then no more than 10% cuts - you may need the liquid Mirt' for this, or Betsy will explain a method to make your own if you need it.  

I hope your search is over for a taper plan, keep with us, and let us know how you are going on.

Wishing you well.

4

Thanks for the advice. My wife had the stroke. She is doing fairly well at the moment. But has some depersonalization issues. And some other side effects: itching, some earaches, headaches, some coughing, slight insomnia and a few others.

I must of missed some of Betsy's writings. I've bounced around these forums for a while. They're a great source for info. I'll move a little slower in the process. I'll hold her at around 3 mg for a week, and drop 10 per week thereafter. Does that sound reasonable?

Sounds like I should decrease 10 percent more, from 3.7 to little less than 3. That seems like a very small amount. But better do that than mess this thing all up.

5

Thanks for all that, Betsy. I will keep her going at 3.75 until some of the side effects dissipate. My wife is 52. She never suffered from depression. She does not handle drugs well. A valium will knock her out for days. She has a feeding tube. She weighs 91 lbs. Her normal weight is around 110. She hasn't had any bolis feeding in two months - and she has maintained her weight. She eats like a bird -- always did. She has problems emptying her bladder. I'm cathing her once a day. She has had many uti's since the stroke. Her brain is not communicating properly to the bladder.

But since taking this drug, she had no urgency feelings. But she was voiding. How much? Not really sure? But since the taper, she is gaining her urges,but we've had a couple uti's in the last month or so too. None since we started the catheter. We're emptying anywhere from 100 to 250 mil a day out, on average.

I have my hands full, as you all can see. And would appreciate any advice. I will give prompt updates on her recovery.

(We're up against the clock - I need to get her moving, she's now walking about 75 to 100 steps a day with a walker.(assisted) The doctor said we had about a year to get her better, after that, it will be what it is, with a prognosis of no better or no worse afterwards.

She can't walk by herself. Although I've seen her take steps by herself with the walker, but that was when she was stronger, before the infections, c-diff, concussions, catatonic deep sleep. But that was after her encephalomalacia was discovered. And it hadn't worsened since.So when they sent her home, she had not had any real therapy for months. And after she got home, we had a bout of pnemonuia (walking around) and the two uti's. So getting her strong enough is becoming time critical. The mirtz was keeing her tired. I have seen an improvement in her attitude towards excercise. A big improvement. She was barely getting 20 steps in a day a month ago, now she is almost transferring on her own. I feel her strength building. It's slow, but steady.

6

This thread gives day by day details of my exact taper. https://patient.info/forums/discuss/how-to-make-a-home-made-liquid-to-taper-off-mirtazapine-502540

I had a painless withdrawal from mirt using this method. I am not feelling well right now after 6 weeks off it but i felt great for 4 weeks afterwards. My doctor is convinced my problems (anorexia) are not to do with WD but an underlying physical issue. I am awaiting the results of extensive blood tests right now.

7

That's great. Will start the process in June. How long do you suggest I hold at each 10 % taper before proceeding ?

8

My taper was a little faster than 10%. I started off holding each drop for 14 days. Then when it seemed I was tolerating it well I reduced the time as detailed above. Good luck!  

9

I see where they suggest 1 month taper intervals. That's too sllow for my timeline " master plan." I will just have to rework my plan, because this drug ain't no joke. Jez, I need a medical degree to keep up with this girl. Does anybody know where I can order one?

Thanks for all the help Godspeed to each and every one of you. Stacey & Kelly

10

Hi evergreen,

I have only been on mirt for 2 months , do you think I should taper slow? I have went from 15 mg to 11.25 mg 1 week ago.

11

Yes, I would not make your cuts too big and hold for at least a week each time, longer if you get WDs. Good luck!