Posted by ChicagoKat on October 1, 2012, at 16:55:05
In reply to Re: Jono, sorry to bother you, but need rpt info » ChicagoKat, posted by SLS on October 1, 2012, at 15:33:17
> > if you could also tell me the final dosage you think I should be on that would be great.
>
> I am missing something. Why are you limiting yourself to 45 mg/day Nardil? Was ataxia a problem?
>
> I still like the idea of your starting nortriptyline at 10 mg/day taken at night. You might wish to stay at that dosage for 5 - 7 days. You could then increase to 25 mg/day taken at night. You can either wait there for 2 - 3 weeks or proceed to 50 mg/day after 1 week. You are going to need to use your judgment based upon how you feel and how well you are tolerating side effects. People who are slow metabolizers usually settle on a dosage of 50 - 75 mg/day. Rapid metabolizers often need 150 mg/day. It is almost as if there were no middle ground. Fortunately, you can take blood tests to help guide you on nortriptyline dosage. I like to split my dose to three times a day. You can just as easily continue to take 75 mg at night. If you need to go higher, I would split it.
>
> I would think about starting Nardil at 7.5 mg/day and move up to 15 mg/day after 5 - 7 days. I would go from 15 mg/day to 30 mg/day after 1 week. Thereafter, you can go up by 15 mg every 2 - 3 weeks. This is a rather gradual titration schedule.
>
> These are only guidelines that seem appropriate based upon my experience with these two drugs. Increasing the dosage of either drug too quickly might lead to intolerable hypotension, urinary retention, and other autonomic side effects. With time, things like dry mouth, constipation, sweating, and blurred vision should dissipate if they do occur. They may not.
>
> For me, I need full therapeutic dosages of both the MAOI and the TCA in order for the combination to be effective. Just because the two drugs are being administered together doesn't mean that you can use lower dosages of each. I hope you don't suffer too much while you are going through the dosage discovery process.
>
> I kind of like the idea of your going to Nardil 45 mg/day and nortriptyline 50 mg/day as your initial target dosages. It might take 3 weeks to respond to this. If you don't respond, I would then move the nortriptyline to 75 mg/day if you are tolerating the drug. After two weeks at this dosage, you could then get a blood test. If you are in the therapeutic range, you could then continue for another 1 - 2 weeks. If you are below the therapeutic range and you are tolerating it, you will need to consider increasing the nortriptyline by 25 mg every 2 weeks and get blood levels. If there is no response to a therapeutic dosage of nortriptyline as per blood tests, it would make sense to increase the Nardil to 60 mg/day if you can tolerate it. Again, I remember someone having an ataxia problem with higher dosages of Nardil. I thought it was you, but it is likely that my memory fails me.
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> I would be curious to see what you and your doctor come up with.
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> Good luck.
>
>
> - Scott
>Yes Scott, it was me who had the ataxia problem. Thanks for your dosage recommendations. But I think I will go up faster on the Nardil (only) b/c I was titrated to 60mg/day within a week the first time I took it and had no problem, except the eventual ataxia...but I had the very good side effect from the rapid titration of my anxiety disappearing almost overnight. Thanks again.
Kat
poster:ChicagoKat
thread:1027203
URL: http://www.dr-bob.org/babble/20121001/msgs/1027227.html