Daily Micro-Tapering Support Group

[[Ma...]]

Maya, my experience with k was that once I was crossways with it, every change that I made made things worse. I started out with one dose, split it into to two and finally to three, getting worse with every change. k, for me at least, was a very unforgiving drug. Definitely try a long hold and don't make any other changes (would be my advice).

My taper from 8mg-4mg was very easy. After 4mg it became so different. The most I can cut now is 5% or it's bad. I definitely can't cut 10% like so many. I have always been on 3 or 4 doses. I metabolize it quickly. Was crossing over to valium hard to do? Thanks for the advice! I am definitely not going to cut. I don't know if I should go back to my old dose. I was stabilized and ready to start my MT and I evened out my doses and it's crazy how my body freaked out.

 

XO Maya

 

My pdoc doesn't like valium. He has incorrect views on it. I probably could convince him, but I'm not sure. I will definitely keep it in mind if things are going to unbearable like they are now. I fortunately do not have to work right now. I wouldn't be able to. My fears out valium is that is might make me more depressed a stirred since it's longer acting. My worse tolerance wd symtoms are depressio and fatigue. I'm glad that your taper was pretty easy and you were able to work. Congrats on being completely off benzos!

 

The crossover was incredibly difficult but the subsequent taper was relatively easy. I don't think I would have been able to taper from k directly without losing my job or worse. You can always keep it in your pocket as an option if the taper becomes unbearable.

[[...]]

This is puzzling.  As I remember your old doses were not all that much different than now.  You used to dose 4x and had I think .5mg at night and now do .81mg at night.  A change but not a drastic change.  And the updose was from 3.206mg to 3.241mg - that's 1%...hardly any change.  So really I don't see any big changes.  Can you remind me, what exactly was your old dose schedule?  Anything else going on?  Like new foods or meds?  If you are able I would just hold steady until it settles.  I don't see where you are lacking the drug.

I was shocked. Sunday I thought oh maybe I just need a day to adjust, but I didn't. Also itthought it would help my sleep, but I've waking up several times. Yes it isn't that different. I was dosing 4x.

Wake up- .831

3pm- .875

8pm-1mg

Bedtime- .5mg

On 8/11 my GI switched me from protonix to dexilant and switched my bran of probiotic. That didn't affect me at all.

I did drink on Tues night I did drink and I think that made things worse for yesterday. I have in the past drank occasionally while tapering. I won't be doing that again. That didn't didn't help, but it didn't cause the problem.  I have been feeling bad since the first day I evened out my doses Sun. I can hold steady until it settles. I don't have anything that I have to do until Sat. I'm feeling too bad to leave my house. I just want it to go away ASAP because it's not tolerable the sxs I'm having now. I only had them this bad once when I cut too much. Made my body is sensitive enough where 1% affects it? I wouldn't think going up would affect me like this. My CNS is going crazy. The paresthesia is so bad. Thank you for all your help!

 

That's right.  It is only 1% and you went up, not down.  And your doses went from...

 

AM .831/.810 - down 2.5%

3pm .875/.810 - down 7.4%

8pm 1/.810 - down 19%

bed .5/.810 - up 62%

 

The night is kind of perturbed.  But you are taking the same dose per day so it should settle out.

 

I'm glad you mentioned the protonix.  If I'm not mistaken protonix is a 3A4 inhibitor.  Since you stopped it it could be that your processing of K has been sped up.  I'm suspicious right now that it may have gone like this: you stopped protonix on 8/11; that took a few days to hit (lag time) just about the time you rearranged your doses.  Then doses got rearranged which didn't help, as well as the alcohol which certainly didn't help.  But my main suspicion is the protonix may be behind this.  If true it effectively cut your dose.

[[Ma...]]

This is puzzling.  As I remember your old doses were not all that much different than now.  You used to dose 4x and had I think .5mg at night and now do .81mg at night.  A change but not a drastic change.  And the updose was from 3.206mg to 3.241mg - that's 1%...hardly any change.  So really I don't see any big changes.  Can you remind me, what exactly was your old dose schedule?  Anything else going on?  Like new foods or meds?  If you are able I would just hold steady until it settles.  I don't see where you are lacking the drug.

I was shocked. Sunday I thought oh maybe I just need a day to adjust, but I didn't. Also itthought it would help my sleep, but I've waking up several times. Yes it isn't that different. I was dosing 4x.

Wake up- .831

3pm- .875

8pm-1mg

Bedtime- .5mg

On 8/11 my GI switched me from protonix to dexilant and switched my bran of probiotic. That didn't affect me at all.

I did drink on Tues night I did drink and I think that made things worse for yesterday. I have in the past drank occasionally while tapering. I won't be doing that again. That didn't didn't help, but it didn't cause the problem.  I have been feeling bad since the first day I evened out my doses Sun. I can hold steady until it settles. I don't have anything that I have to do until Sat. I'm feeling too bad to leave my house. I just want it to go away ASAP because it's not tolerable the sxs I'm having now. I only had them this bad once when I cut too much. Made my body is sensitive enough where 1% affects it? I wouldn't think going up would affect me like this. My CNS is going crazy. The paresthesia is so bad. Thank you for all your help!

 

That's right.  It is only 1% and you went up, not down.  And your doses went from...

 

AM .831/.810 - down 2.5%

3pm .875/.810 - down 7.4%

8pm 1/.810 - down 19%

bed .5/.810 - up 62%

 

The night is kind of perturbed.  But you are taking the same dose per day so it should settle out.

 

I'm glad you mentioned the protonix.  If I'm not mistaken protonix is a 3A4 inhibitor.  Since you stopped it it could be that your processing of K has been sped up.  I'm suspicious right now that it may have gone like this: you stopped protonix on 8/11; that took a few days to hit (lag time) just about the time you rearranged your doses.  Then doses got rearranged which didn't help, as well as the alcohol which certainly didn't help.  But my main suspicion is the protonix may be behind this.  If true it effectively cut your dose.

I would think it would settle down. I've gotten worse. I don't know much about how protonix works. I was on it for awhile. My GI said dexilant was like protonix, but stronger and it stays in your system longer. I haven't noticed a difference. Should I try going back to the protonix? It would make sense because my body is reacting as if I made a big cut. It is the worst or close to the worst I have felt in my taper. The last time I had these sxs due to a big cut, it took me like a month and a half to stabilize. I really hope that will not be the case here.

[[ga...]]

Maya, my experience with k was that once I was crossways with it, every change that I made made things worse. I started out with one dose, split it into to two and finally to three, getting worse with every change. k, for me at least, was a very unforgiving drug. Definitely try a long hold and don't make any other changes (would be my advice).

My taper from 8mg-4mg was very easy. After 4mg it became so different. The most I can cut now is 5% or it's bad. I definitely can't cut 10% like so many. I have always been on 3 or 4 doses. I metabolize it quickly. Was crossing over to valium hard to do? Thanks for the advice! I am definitely not going to cut. I don't know if I should go back to my old dose. I was stabilized and ready to start my MT and I evened out my doses and it's crazy how my body freaked out.

 

XO Maya

 

 

Maya, I had a somewhat similar experience with my Xanax taper. I was cutting along just fine and then BAM I hit a wall so hard I thought I would die. (I did not. ) It seemed I crossed some magic line and nothing was the same after that. That's what made me decide to cross over to Librium.

 

I don't know why some people have such a hard time crossing over to Valium, but my Librium crossover was not nearly as bad as the symptoms I was having 24/7 on the Xanax. It's been a month now so I have reached a steady state of Librium. I'm now able to taper my Xanax faster than before. I am beginning to think my issue was the Xanax itself being too fast a benzo for me rather than the rate of my taper, which was absurdly slow at the point I crossed over.

 

I intend to stay halfway crossed over to Librium and continue to taper my Xanax for as long as I can. I know there are other people doing this method as well (crossing over part way and then continuing to taper the fast benzo). It's worth considering.

 

I also think Librium is worth considering. For me it was a no-brainer because I knew my liver enzyme profile made Valium a risk for me. But, X and K and L are all believed to be metabolized by the same enzyme, 3A4. Valium is much more complicated. Ashton tapers people directly off of Librium without changing them to Valium. All others she changes to Valium. Librium only comes in capsules and they are low potency so if you are on a high dose, you have a lot of dissolving to do. I'm on a low dose and only half crossed, so that was not an issue for me.

 

If you have a helpful doctor, it would be worth asking him what he thinks about a crossover and his opinion on Valium vs. Librium. In fact, I'd be very interested if anybody has any information on this. I only have my own experience and can find very few others who have used Librium. As near as I can tell, it's just an "old fashioned" benzo and so is over-looked as an option. My pharmacist thought it was a good option. If anyone else knows otherwise, I'd love to hear about it!

 

BTW, I agree with SG that if you have changed a 3A4 inhibitor, it could definitely affect your K! Other factors are alcohol and rearranging doses, true, but a 3A4 inhibitor would be a big factor!

 

Valium is metabolized by 3A4, but also by several other enzymes, so I'm going guessing that protonix wouldn't have such a big effect on it. Notice I said guessing! My doctor isn't into this enzyme stuff, but perhaps yours is. Or perhaps your pharmacist?

 

Hang tight and this wave will ease up. Then you can decide what you want to do about sticking with K or making a change.

[[...]]

That's right.  It is only 1% and you went up, not down.  And your doses went from...

 

AM .831/.810 - down 2.5%

3pm .875/.810 - down 7.4%

8pm 1/.810 - down 19%

bed .5/.810 - up 62%

 

The night is kind of perturbed.  But you are taking the same dose per day so it should settle out.

 

I'm glad you mentioned the protonix.  If I'm not mistaken protonix is a 3A4 inhibitor.  Since you stopped it it could be that your processing of K has been sped up.  I'm suspicious right now that it may have gone like this: you stopped protonix on 8/11; that took a few days to hit (lag time) just about the time you rearranged your doses.  Then doses got rearranged which didn't help, as well as the alcohol which certainly didn't help.  But my main suspicion is the protonix may be behind this.  If true it effectively cut your dose.

I would think it would settle down. I've gotten worse. I don't know much about how protonix works. I was on it for awhile. My GI said dexilant was like protonix, but stronger and it stays in your system longer. I haven't noticed a difference. Should I try going back to the protonix? It would make sense because my body is reacting as if I made a big cut. It is the worst or close to the worst I have felt in my taper. The last time I had these sxs due to a big cut, it took me like a month and a half to stabilize. I really hope that will not be the case here.

 

I checked and protonix is a 3A4 inhibitor and dexilant does not seem to do any interacting with your K enzyme.  So the switch would amount to a dose cut on 8/11.  The problem is we don't know how much it reduced your K.  I think you are better off not depending on the protonix to maintain your dose as it may make your levels waver, but to do that you would need to ride this out.  So maybe it makes sense to go back on it.  IDK, that's up to you.  I would think going back on protonix would give you quick relief.

[[ga...]]

P.S. I have found sources that say Protonix inhibits 3A4 and that others that say its effects are insignificant. I would not be surprised if this varied quite a bit from person to person.

[[Ma...]]

That's right.  It is only 1% and you went up, not down.  And your doses went from...

 

AM .831/.810 - down 2.5%

3pm .875/.810 - down 7.4%

8pm 1/.810 - down 19%

bed .5/.810 - up 62%

 

The night is kind of perturbed.  But you are taking the same dose per day so it should settle out.

 

I'm glad you mentioned the protonix.  If I'm not mistaken protonix is a 3A4 inhibitor.  Since you stopped it it could be that your processing of K has been sped up.  I'm suspicious right now that it may have gone like this: you stopped protonix on 8/11; that took a few days to hit (lag time) just about the time you rearranged your doses.  Then doses got rearranged which didn't help, as well as the alcohol which certainly didn't help.  But my main suspicion is the protonix may be behind this.  If true it effectively cut your dose.

I would think it would settle down. I've gotten worse. I don't know much about how protonix works. I was on it for awhile. My GI said dexilant was like protonix, but stronger and it stays in your system longer. I haven't noticed a difference. Should I try going back to the protonix? It would make sense because my body is reacting as if I made a big cut. It is the worst or close to the worst I have felt in my taper. The last time I had these sxs due to a big cut, it took me like a month and a half to stabilize. I really hope that will not be the case here.

 

I checked and protonix is a 3A4 inhibitor and dexilant does not seem to do any interacting with your K enzyme.  So the switch would amount to a dose cut on 8/11.  The problem is we don't know how much it reduced your K.  I think you are better off not depending on the protonix to maintain your dose as it may make your levels waver, but to do that you would need to ride this out.  So maybe it makes sense to go back on it.  IDK, that's up to you.  I would think going back on protonix would give you quick relief.

I looked it up too. It said the interaction between protonix and klonopin is unknown, but it does inhibit 3A4. I felt stable and didn't have bad sxs until Sunday. I notice a Difference on 8/11. but I guess maybe there was still protonix in my system then? I really don't think switching doses alone would do this to me. I feel as if I took a really big cut and CNS is freaking out. It reduced my k by way more than I can handle. I think maybe I should try to ride this out. I haven't noticed any difference with my stomach with the dexilant. I want to do what's best for me. I don't want to be on protonix if it can make my levels waiver. Also I metabolize k fast as it is. Being off protonix means I metabolize it faster? I am so drained right now. I guess I will just see how I feel tomorrow. Thank you so much for taking the time to help me!

[[ga...]]

SG, my brain is having trouble with this.

 

If K is metabolized (broken) by 3A4, that means that more 3A4 means less K in your system?

 

And if something (such as protonix) inhibits 3A4 that means less 3A4 is produced, right?

 

If more 3A4 = less K in the system, then less 3A4 = more K in the system, right?

 

Or is K one of those meds that has active metabolites so breaking it down makes it last longer?

 

I'm kinda right now trying got get my brain around this. Probably I should just go to bed!

 

 

[Guest [Ma...]]

Gardner,

K is acetylated by NAT2.

 

https://www.pharmgkb.org/pathway/PA165111375

 

Marija.

 

 

[[Ma...]]

Maya, my experience with k was that once I was crossways with it, every change that I made made things worse. I started out with one dose, split it into to two and finally to three, getting worse with every change. k, for me at least, was a very unforgiving drug. Definitely try a long hold and don't make any other changes (would be my advice).

My taper from 8mg-4mg was very easy. After 4mg it became so different. The most I can cut now is 5% or it's bad. I definitely can't cut 10% like so many. I have always been on 3 or 4 doses. I metabolize it quickly. Was crossing over to valium hard to do? Thanks for the advice! I am definitely not going to cut. I don't know if I should go back to my old dose. I was stabilized and ready to start my MT and I evened out my doses and it's crazy how my body freaked out.

 

XO Maya

 

 

Maya, I had a somewhat similar experience with my Xanax taper. I was cutting along just fine and then BAM I hit a wall so hard I thought I would die. (I did not. ) It seemed I crossed some magic line and nothing was the same after that. That's what made me decide to cross over to Librium.

 

I don't know why some people have such a hard time crossing over to Valium, but my Librium crossover was not nearly as bad as the symptoms I was having 24/7 on the Xanax. It's been a month now so I have reached a steady state of Librium. I'm now able to taper my Xanax faster than before. I am beginning to think my issue was the Xanax itself being too fast a benzo for me rather than the rate of my taper, which was absurdly slow at the point I crossed over.

 

I intend to stay halfway crossed over to Librium and continue to taper my Xanax for as long as I can. I know there are other people doing this method as well (crossing over part way and then continuing to taper the fast benzo). It's worth considering.

 

I also think Librium is worth considering. For me it was a no-brainer because I knew my liver enzyme profile made Valium a risk for me. But, X and K and L are all believed to be metabolized by the same enzyme, 3A4. Valium is much more complicated. Ashton tapers people directly off of Librium without changing them to Valium. All others she changes to Valium. Librium only comes in capsules and they are low potency so if you are on a high dose, you have a lot of dissolving to do. I'm on a low dose and only half crossed, so that was not an issue for me.

 

If you have a helpful doctor, it would be worth asking him what he thinks about a crossover and his opinion on Valium vs. Librium. In fact, I'd be very interested if anybody has any information on this. I only have my own experience and can find very few others who have used Librium. As near as I can tell, it's just an "old fashioned" benzo and so is over-looked as an option. My pharmacist thought it was a good option. If anyone else knows otherwise, I'd love to hear about it!

 

BTW, I agree with SG that if you have changed a 3A4 inhibitor, it could definitely affect your K! Other factors are alcohol and rearranging doses, true, but a 3A4 inhibitor would be a big factor!

 

Valium is metabolized by 3A4, but also by several other enzymes, so I'm going guessing that protonix wouldn't have such a big effect on it. Notice I said guessing! My doctor isn't into this enzyme stuff, but perhaps yours is. Or perhaps your pharmacist?

 

Hang tight and this wave will ease up. Then you can decide what you want to do about sticking with K or making a change.

Gardener,

That is exactly how I felt after 4mg. I can't imagine being on xanax. It leaves your system so fast. I was on it for like a day and it was awful, so then I was given klonopin. I'm glad the librium is helping. I've noticed people who are on klonopin and valium they didn't completely crossover and it works for them. I think it makes sense to partially c/o and cut the faster benzo. It is definitely something I'm considering. My pdoc doesn't like valium. He puts people tapering xanax and ativan on klonopin. He doesn't put anyone on valium. I think I could convince because he does what I say usually, but I'm not positive. He told me there is no difference between klonopin and valium. He is clueless. I had never heard of librium. I don't know how he feels about it. I'm on a high dose so I would prefer not to have capsules. I don't know the conversion for librium, but I am on what is equal to over 60mg of v. I do like that Librium is metabolized the same as k.

 

I really wish I had helpful Dr. I kinda gave up on that, but I should make some more calls. My Dr thinks valium is old fashioned. I also don't trust anything he says. He just lets me do whatever I want. He asks how much to I want. I get nervous that the longer lasting benzos are more sedating. I got really bad depression and fatigue from tolerance wd. A long time ago a pdoc gave me valium on top of klonopin to help me sleep. I know crazy prescribing 8mg of k and then 5mg of valium. I tried it for a week, but it had no affect on me. I now know that was a really low dose.

 

none of my Drs are into the enzyme stuff unfortunately. My pdoc has made mistakes before about drug interactions. My PCP wasn't great and she just left the practice anyway. It's hard to find new Drs especially good ones.

 

Im definitely guessing that stopping the protonix affected me. It's the only thing that makes sense.

 

Thanks! I hope this wave eases up soon because this is too much for me to handle. Also I haven't been able to start MT. I hope you are having a good night!

 

XO Maya

[[Ma...]]

SG, my brain is having trouble with this.

 

If K is metabolized (broken) by 3A4, that means that more 3A4 means less K in your system?

 

And if something (such as protonix) inhibits 3A4 that means less 3A4 is produced, right?

 

If more 3A4 = less K in the system, then less 3A4 = more K in the system, right?

 

Or is K one of those meds that has active metabolites so breaking it down makes it last longer?

 

I'm kinda right now trying got get my brain around this. Probably I should just go to bed!

 

 

I don't get it either. My cog fog and feeling sick it's too confusing for me to try and understand at the moment 

[Guest [Ma...]]

SG, my brain is having trouble with this.

 

If K is metabolized (broken) by 3A4, that means that more 3A4 means less K in your system?

 

And if something (such as protonix) inhibits 3A4 that means less 3A4 is produced, right?

 

If more 3A4 = less K in the system, then less 3A4 = more K in the system, right?

 

Or is K one of those meds that has active metabolites so breaking it down makes it last longer?

 

I'm kinda right now trying got get my brain around this. Probably I should just go to bed!

 

Gardener,

I've attached a good article on induction & inhibition. 

 

http://www.pharmacologyweekly.com/articles/medications-inhibitors-CYP3A4-enzyme

 

Marija

[[Ma...]]

If I stay off protonix, I will metabolize k even faster? If so will it be even harder for me to cut? I just want to do what's best for my taper in the long run. I just am hoping I at least don't feel worse tomorrow because I can't stay like this. Sorry for all the ques

[[...]]

I checked and protonix is a 3A4 inhibitor and dexilant does not seem to do any interacting with your K enzyme.  So the switch would amount to a dose cut on 8/11.  The problem is we don't know how much it reduced your K.  I think you are better off not depending on the protonix to maintain your dose as it may make your levels waver, but to do that you would need to ride this out.  So maybe it makes sense to go back on it.  IDK, that's up to you.  I would think going back on protonix would give you quick relief.

I looked it up too. It said the interaction between protonix and klonopin is unknown, but it does inhibit 3A4. I felt stable and didn't have bad sxs until Sunday. I notice a Difference on 8/11. but I guess maybe there was still protonix in my system then? I really don't think switching doses alone would do this to me. I feel as if I took a really big cut and CNS is freaking out. It reduced my k by way more than I can handle. I think maybe I should try to ride this out. I haven't noticed any difference with my stomach with the dexilant. I want to do what's best for me. I don't want to be on protonix if it can make my levels waiver. Also I metabolize k fast as it is. Being off protonix means I metabolize it faster? I am so drained right now. I guess I will just see how I feel tomorrow. Thank you so much for taking the time to help me!

 

Drugs interact through the liver enzymes.  K is metabolized by 3A4 and protonix slows the action of 3A4 so any drug metabolized by 3A4 gets removed more slowly, so yes protonix was effectively making you metabolize K more slowly and being off it will speed you up.  I don't know what the half life of protonix is, but that would help delay the onset of the symptoms if it were long I would think.

 

It may not be so bad being on it.  After all, you got this far with it and it does lengthen the half life, which may be helpful.  You just would need to be aware of its effect and now you know.  But I think if you can ride this out and get rid of it, in the long run your blood levels would be more steady without it and that may help your taper.  Of coarse, the ideal solution would be to know how much K you are short so you could updose that amount to get rid of the lousy symptoms and stay off it too.

 

This all assumes that this is what is really going on.  It makes sense to me.  I don't really buy the other stuff about dose switching and the tiny updose.

[Guest [Ma...]]

Maya & Gardener,

Here's another good link looking at phase I and II liver detoxification.

 

http://www.bespokeclinic.ca/wp-content/uploads/2015/02/integrativefig_large3.jpg

 

Maya,

Previously, I was tapering Klonopin.  I had significant problems with the drug leading me to testing the NAT2 liver pathway, the pathway responsible for acetylating klonopin prior to phase II glucoronidation

I learned two important pieces of information.

1.  I'm a slow acetylator for NAT2. Klonopin became neuro toxic in my body.

2.  I have many genetic polymorphisms for phase II liver glucoronidation of benzo detoxification, making it difficult for my body to detox klonopin, in particular.

I found testing helpful but not curative. Also, despite the short 1/2 life of Xanax, for me, is a better drug to taper than klonopin ever was. I'm a normal metabolizer for CYP3A.

These benzos effect people so differently. No two people are genetically alike. It's a shame doctors do not factor in liver and genetic testing prior to prescribing.

 

Good luck!

Marija.

[[...]]

SG, my brain is having trouble with this.

 

If K is metabolized (broken) by 3A4, that means that more 3A4 means less K in your system?

 

And if something (such as protonix) inhibits 3A4 that means less 3A4 is produced, right?

 

If more 3A4 = less K in the system, then less 3A4 = more K in the system, right?

 

Or is K one of those meds that has active metabolites so breaking it down makes it last longer?

 

I'm kinda right now trying got get my brain around this. Probably I should just go to bed!

 

I don't know how the effect actually occurs, but the end result is that a 3A4 inhibitor slows the action of 3A4 so that drugs metabolized by it stay in the body longer.  Effectively, this increases their half life.  As far as I know K has no metabolites.

[[Ma...]]

I checked and protonix is a 3A4 inhibitor and dexilant does not seem to do any interacting with your K enzyme.  So the switch would amount to a dose cut on 8/11.  The problem is we don't know how much it reduced your K.  I think you are better off not depending on the protonix to maintain your dose as it may make your levels waver, but to do that you would need to ride this out.  So maybe it makes sense to go back on it.  IDK, that's up to you.  I would think going back on protonix would give you quick relief.

I looked it up too. It said the interaction between protonix and klonopin is unknown, but it does inhibit 3A4. I felt stable and didn't have bad sxs until Sunday. I notice a Difference on 8/11. but I guess maybe there was still protonix in my system then? I really don't think switching doses alone would do this to me. I feel as if I took a really big cut and CNS is freaking out. It reduced my k by way more than I can handle. I think maybe I should try to ride this out. I haven't noticed any difference with my stomach with the dexilant. I want to do what's best for me. I don't want to be on protonix if it can make my levels waiver. Also I metabolize k fast as it is. Being off protonix means I metabolize it faster? I am so drained right now. I guess I will just see how I feel tomorrow. Thank you so much for taking the time to help me!

 

Drugs interact through the liver enzymes.  K is metabolized by 3A4 and protonix slows the action of 3A4 so any drug metabolized by 3A4 gets removed more slowly, so yes protonix was effectively making you metabolize K more slowly and being off it will speed you up.  I don't know what the half life of protonix is, but that would help delay the onset of the symptoms if it were long I would think.

 

It may not be so bad being on it.  After all, you got this far with it and it does lengthen the half life, which may be helpful.  You just would need to be aware of its effect and now you know.  But I think if you can ride this out and get rid of it, in the long run your blood levels would be more steady without it and that may help your taper.  Of coarse, the ideal solution would be to know how much K you are short so you could updose that amount to get rid of the lousy symptoms and stay off it too.

 

This all assumes that this is what is really going on.  It makes sense to me.  I don't really buy the other stuff about dose switching and the tiny updose.

That makes sense. I never knew anything about liver enzymes. It doesn't have a long half life, but it takes about a week to build in your system and start working. I also was on the extended release pills.

I don't know how long it would stay in my system in that case. I am going to try riding it out. If I at least see improvent tomorrow I think I can do it. I don't have a lot that I have to do coming up. I am now scared about dexilant. I hope that doesn't affect me badly. I feel like I cut .25mg. This is how I felt after cutting that much. Hopefully I will not have to hold a month and half to stabilize.

 

It is the only thing that makes sense to me. This kind of reaction is exactly like a big cut. A little more klonopin and slightly changing doses would not make my CNS go crazy. I am also thinking of going back on gabapentin tonight, but I'm nervous to. I was on it when I tapered from 6mg to 4mg. I wish my Drs could be of help. You should get paid instead of them!

[[Ma...]]

Maya & Gardener,

Here's another good link looking at phase I and II liver detoxification.

 

http://www.bespokeclinic.ca/wp-content/uploads/2015/02/integrativefig_large3.jpg

 

Maya,

Previously, I was tapering Klonopin.  I had significant problems with the drug leading me to testing the NAT2 liver pathway, the pathway responsible for acetylating klonopin prior to phase II glucoronidation

I learned two important pieces of information.

1.  I'm a slow acetylator for NAT2. Klonopin became neuro toxic in my body.

2.  I have many genetic polymorphisms for phase II liver glucoronidation of benzo detoxification, making it difficult for my body to detox klonopin, in particular.

I found testing helpful but not curative. Also, despite the short 1/2 life of Xanax, for me, is a better drug to taper than klonopin ever was. I'm a normal metabolizer for CYP3A.

These benzos effect people so differently. No two people are genetically alike. It's a shame doctors do not factor in liver and genetic testing prior to prescribing.

 

Good luck!

Marija.

Marija,

Thank you for all the helpful links! Did your insurance cover the testing? I would love to get those tests done. I could never be on xanax. I metabolize benzos fast. I wonder if valium would affect me differently because it affects different liver enzymes. It is definitely a shame that these things are not factored in.

 

Thank you!

XO Maya

[[ga...]]

Gardner,

K is acetylated by NAT2.

 

https://www.pharmgkb.org/pathway/PA165111375

 

Marija.

 

I think that after my taper and I have my brain back I may have a chance  of understanding this! Waaaaait a minute. You understand this and you're tapering! Switch that to blaming it on sleep deprivation. 

[[ga...]]

 

Gardener,

That is exactly how I felt after 4mg. I can't imagine being on xanax. It leaves your system so fast. I was on it for like a day and it was awful, so then I was given klonopin. I'm glad the librium is helping. I've noticed people who are on klonopin and valium they didn't completely crossover and it works for them. I think it makes sense to partially c/o and cut the faster benzo. It is definitely something I'm considering. My pdoc doesn't like valium. He puts people tapering xanax and ativan on klonopin. He doesn't put anyone on valium. I think I could convince because he does what I say usually, but I'm not positive. He told me there is no difference between klonopin and valium. He is clueless. I had never heard of librium. I don't know how he feels about it. I'm on a high dose so I would prefer not to have capsules. I don't know the conversion for librium, but I am on what is equal to over 60mg of v. I do like that Librium is metabolized the same as k.

 

I really wish I had helpful Dr. I kinda gave up on that, but I should make some more calls. My Dr thinks valium is old fashioned. I also don't trust anything he says. He just lets me do whatever I want. He asks how much to I want. I get nervous that the longer lasting benzos are more sedating. I got really bad depression and fatigue from tolerance wd. A long time ago a pdoc gave me valium on top of klonopin to help me sleep. I know crazy prescribing 8mg of k and then 5mg of valium. I tried it for a week, but it had no affect on me. I now know that was a really low dose.

 

none of my Drs are into the enzyme stuff unfortunately. My pdoc has made mistakes before about drug interactions. My PCP wasn't great and she just left the practice anyway. It's hard to find new Drs especially good ones.

 

Im definitely guessing that stopping the protonix affected me. It's the only thing that makes sense.

 

Thanks! I hope this wave eases up soon because this is too much for me to handle. Also I haven't been able to start MT. I hope you are having a good night!

 

XO Maya

 

Oh my God!

 

BTW, the longer benzos are more sedating at first, but this wears off, at least it did for me.

 

I think you and SG are right about the protonix, but I just can't figure out the relationship between the two. That's why he's the guru and I'm the Princess of Paranoia.

[[ga...]]

SG, my brain is having trouble with this.

 

If K is metabolized (broken) by 3A4, that means that more 3A4 means less K in your system?

 

And if something (such as protonix) inhibits 3A4 that means less 3A4 is produced, right?

 

If more 3A4 = less K in the system, then less 3A4 = more K in the system, right?

 

Or is K one of those meds that has active metabolites so breaking it down makes it last longer?

 

I'm kinda right now trying got get my brain around this. Probably I should just go to bed!

 

Gardener,

I've attached a good article on induction & inhibition. 

 

http://www.pharmacologyweekly.com/articles/medications-inhibitors-CYP3A4-enzyme

 

Marija

 

Thanks! That one was actually a little easier to understand! I haven't given up on the other article yet. Just for tonight!

[[...]]

That makes sense. I never knew anything about liver enzymes. It doesn't have a long half life, but it takes about a week to build in your system and start working. I also was on the extended release pills.

I don't know how long it would stay in my system in that case. I am going to try riding it out. If I at least see improvent tomorrow I think I can do it. I don't have a lot that I have to do coming up. I am now scared about dexilant. I hope that doesn't affect me badly. I feel like I cut .25mg. This is how I felt after cutting that much. Hopefully I will not have to hold a month and half to stabilize.

 

It is the only thing that makes sense to me. This kind of reaction is exactly like a big cut. A little more klonopin and slightly changing doses would not make my CNS go crazy. I am also thinking of going back on gabapentin tonight, but I'm nervous to. I was on it when I tapered from 6mg to 4mg. I wish my Drs could be of help. You should get paid instead of them!

 

The way to really take this by the horns is to updose.  We think we know what happened and the way to compensate is to put back the missing K.  I am always very hesitant to suggest someone go backwards, mainly because it does not always bring relief depending on how much time has passed.  We also don't know how much your effective cut was.  A way to cheat the system and try to get an idea of what an updose would do would be to take a one-time rescue dose and see what happens.  Just floating these ideas.

[[ga...]]

I checked and protonix is a 3A4 inhibitor and dexilant does not seem to do any interacting with your K enzyme.  So the switch would amount to a dose cut on 8/11.  The problem is we don't know how much it reduced your K.  I think you are better off not depending on the protonix to maintain your dose as it may make your levels waver, but to do that you would need to ride this out.  So maybe it makes sense to go back on it.  IDK, that's up to you.  I would think going back on protonix would give you quick relief.

I looked it up too. It said the interaction between protonix and klonopin is unknown, but it does inhibit 3A4. I felt stable and didn't have bad sxs until Sunday. I notice a Difference on 8/11. but I guess maybe there was still protonix in my system then? I really don't think switching doses alone would do this to me. I feel as if I took a really big cut and CNS is freaking out. It reduced my k by way more than I can handle. I think maybe I should try to ride this out. I haven't noticed any difference with my stomach with the dexilant. I want to do what's best for me. I don't want to be on protonix if it can make my levels waiver. Also I metabolize k fast as it is. Being off protonix means I metabolize it faster? I am so drained right now. I guess I will just see how I feel tomorrow. Thank you so much for taking the time to help me!

 

Drugs interact through the liver enzymes.  K is metabolized by 3A4 and protonix slows the action of 3A4 so any drug metabolized by 3A4 gets removed more slowly, so yes protonix was effectively making you metabolize K more slowly and being off it will speed you up.  I don't know what the half life of protonix is, but that would help delay the onset of the symptoms if it were long I would think.

 

It may not be so bad being on it.  After all, you got this far with it and it does lengthen the half life, which may be helpful.  You just would need to be aware of its effect and now you know.  But I think if you can ride this out and get rid of it, in the long run your blood levels would be more steady without it and that may help your taper.  Of coarse, the ideal solution would be to know how much K you are short so you could updose that amount to get rid of the lousy symptoms and stay off it too.

 

This all assumes that this is what is really going on.  It makes sense to me.  I don't really buy the other stuff about dose switching and the tiny updose.

 

Ah ha! I am beginning to get the protonix thing at last! 

[[ga...]]

SG, my brain is having trouble with this.

 

If K is metabolized (broken) by 3A4, that means that more 3A4 means less K in your system?

 

And if something (such as protonix) inhibits 3A4 that means less 3A4 is produced, right?

 

If more 3A4 = less K in the system, then less 3A4 = more K in the system, right?

 

Or is K one of those meds that has active metabolites so breaking it down makes it last longer?

 

I'm kinda right now trying got get my brain around this. Probably I should just go to bed!

 

I don't know how the effect actually occurs, but the end result is that a 3A4 inhibitor slows the action of 3A4 so that drugs metabolized by it stay in the body longer.  Effectively, this increases their half life.  As far as I know K has no metabolites.

 

Thanks, I think the missing piece was not understanding protonix. Too many variables for my brain to hold at once. But I get it now.

 

I hate this new brain of mine. I think I need to learn acceptance of my benzo brain and then I would be less stressed by this taper. Somehow, I don't think that is likely to happen, though!

 

Thank you for your enduring patience!

[[ga...]]

Maya & Gardener,

Here's another good link looking at phase I and II liver detoxification.

 

http://www.bespokeclinic.ca/wp-content/uploads/2015/02/integrativefig_large3.jpg

 

Maya,

Previously, I was tapering Klonopin.  I had significant problems with the drug leading me to testing the NAT2 liver pathway, the pathway responsible for acetylating klonopin prior to phase II glucoronidation

I learned two important pieces of information.

1.  I'm a slow acetylator for NAT2. Klonopin became neuro toxic in my body.

2.  I have many genetic polymorphisms for phase II liver glucoronidation of benzo detoxification, making it difficult for my body to detox klonopin, in particular.

I found testing helpful but not curative. Also, despite the short 1/2 life of Xanax, for me, is a better drug to taper than klonopin ever was. I'm a normal metabolizer for CYP3A.

These benzos effect people so differently. No two people are genetically alike. It's a shame doctors do not factor in liver and genetic testing prior to prescribing.

 

Good luck!

Marija.

Marija,

Thank you for all the helpful links! Did your insurance cover the testing? I would love to get those tests done. I could never be on xanax. I metabolize benzos fast. I wonder if valium would affect me differently because it affects different liver enzymes. It is definitely a shame that these things are not factored in.

 

Thank you!

XO Maya

 

In my case, my insurance covered some testing. In my sister's case, hers covered more. It's worth looking into. My niece's psychiatrist did a whole panel of enzyme tests before she prescribed any meds. I only got two enzymes tested. Sadly, 3A4 was not one of them, but I'm just guessing I'm a rapid metabolizer for 3A4 from the way I reacted to the Xanax. Librium is also 3A4, so at last I knew I was going from a quick 3A4 (X) to a slow 3A4 (L) and that would be a simple transition compared to switching from X (3A4) to V (more complicated relationship with enzymes). I also had taken one dose of L in my life and did not have any bizarre reaction, so figured that was a good sign. Turned out the switch was pretty smooth.