![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 6 to 30 of 55. Go back in thread:
Posted by jojo on August 21, 2001, at 18:59:52
In reply to Re: Another Question for Elizabeth, posted by JahL on August 20, 2001, at 20:23:46
> Hope you don't mind me jumping on yr thread Neal but since we're talking Temgesic....
>
> Mine arrived today (evidently UK customs are more lax than their US counterparts...). My question Elizabeth, or anyone else 4 that matter, is are there any contraindications I should be aware of? Do you foresee any problems combining Temgesic with the following: Lamictal+Sulpiride+Prozac+Wellbutrin+Klonopin?
>
> Also, what would be a reasonable limit on dose (comes in 0.2mg sublinguals)?
>
> Thanks v. much,
> J.JahL-
I'm taking around 0.9 mg. of buprenorphine intrnasally per day. I was transferring from effective Celexa therapy, not treating an active depression, so I can't notice much of a change. Sex may be better, but I'm not completely sure yet (that was the reason I changed). It's been close to 2 months and I haven't crashed, so I think that there is an antidepressive effect. There might be a greater intra-day variation in my "mood', if we can use that medically undefined term, worse in the morning and better in the evening, but I'm not sure, as there is so much else other than the use of pharmacological agents going on. Also, it could be that I've been down so long I don't really know which way is up. If I were playing poker, I think that I'd stick with this hand, if that communicates the idea to you. I may play around with the dose somewhat, but 0.9 mg. is a good "ballpark figure". If you're British, that means that an effective dose may be somewhere near this figure. I hope it works for you.
jojo
Posted by jojo on August 21, 2001, at 22:23:03
In reply to Re: Another Question for Elizabeth » JahL, posted by jojo on August 21, 2001, at 18:59:52
> > Hope you don't mind me jumping on yr thread Neal but since we're talking Temgesic....
> >
> > Mine arrived today (evidently UK customs are more lax than their US counterparts...). My question Elizabeth, or anyone else 4 that matter, is are there any contraindications I should be aware of? Do you foresee any problems combining Temgesic with the following: Lamictal+Sulpiride+Prozac+Wellbutrin+Klonopin?
> >
> > Also, what would be a reasonable limit on dose (comes in 0.2mg sublinguals)?
> >
> > Thanks v. much,
> > J.
>
> JahL-I think you should read the following article, which I obtained on the Web, but don't have the URL for it, so I can't give you the link. It's rather long, so I won't post it.
Buprenorphine Treatment of Refractory Depression
Bodkin, J.A., et al, J. Clin. Pharmacology 15: 1995, pp. 49-57.jojo
>
> I'm taking around 0.9 mg. of buprenorphine intrnasally per day. I was transferring from effective Celexa therapy, not treating an active depression, so I can't notice much of a change. Sex may be better, but I'm not completely sure yet (that was the reason I changed). It's been close to 2 months and I haven't crashed, so I think that there is an antidepressive effect. There might be a greater intra-day variation in my "mood', if we can use that medically undefined term, worse in the morning and better in the evening, but I'm not sure, as there is so much else other than the use of pharmacological agents going on. Also, it could be that I've been down so long I don't really know which way is up. If I were playing poker, I think that I'd stick with this hand, if that communicates the idea to you. I may play around with the dose somewhat, but 0.9 mg. is a good "ballpark figure". If you're British, that means that an effective dose may be somewhere near this figure. I hope it works for you.
>
> jojo
Posted by shelliR on August 21, 2001, at 22:25:42
In reply to Re: Another Question for Elizabeth, posted by JahL on August 20, 2001, at 20:23:46
> Hope you don't mind me jumping on yr thread Neal but since we're talking Temgesic....
>
> Mine arrived today (evidently UK customs are more lax than their US counterparts...). My question Elizabeth, or anyone else 4 that matter, is are there any contraindications I should be aware of? Do you foresee any problems combining Temgesic with the following: Lamictal+Sulpiride+Prozac+Wellbutrin+Klonopin?
>
> Also, what would be a reasonable limit on dose (comes in 0.2mg sublinguals)?
>
> Thanks v. much,
> J.Hey Jah.
Don't think there's any problems with the drugs you're taking and temgesic, but I don't really know anything about sulpride. My pdoc today increased my oxycontin and started me on wellbutrin tomorrow. I brought in all this stuff about buprenorphine because it was obvious that I've become habituated to the oxy, but he made a comment about if you're going to use opiates, use opiates. I'll try to ask him more when I see him on Thursday, what exactly he meant. I did read a small study out of Johns Hopkins that says buph can be abused, but I also had an article from a pdoc in Utah, saying it does not give you a high. So I don't get why anyone would want to abuse it.
Anyway, I'm really anxious to know how you're doing on your first few days. I have a netfriend in Canada, that is not doing well. He has a lot of the symptoms you do, so please let me know if it's working out well for you., so I can pass on the info. I hope so. Tomorrow is my first try with wellbutrin, I only bought ten pills (I'm such an optimist). But I could have a yard sale with all my bottles of unused drugs if it wasn't illegal.
Later, Shelli
Posted by JahL on August 21, 2001, at 23:23:19
In reply to Re: Another Question for Elizabeth » JahL, posted by jojo on August 21, 2001, at 18:59:52
> I'm taking around 0.9 mg. of buprenorphine intrnasally per day. I was transferring from effective Celexa therapy, not treating an active depression, so I can't notice much of a change. Sex may be better, but I'm not completely sure yet (that was the reason I changed). It's been close to 2 months and I haven't crashed, so I think that there is an antidepressive effect. There might be a greater intra-day variation in my "mood', if we can use that medically undefined term, worse in the morning and better in the evening, but I'm not sure, as there is so much else other than the use of pharmacological agents going on. Also, it could be that I've been down so long I don't really know which way is up. If I were playing poker, I think that I'd stick with this hand, if that communicates the idea to you. I may play around with the dose somewhat, but 0.9 mg. is a good "ballpark figure". I hope it works for you.
Thanks jojo.
Tried it today & it didn't like me. And vice-versa. Dizziness, sedation & nausea were the order of the day. This was on just 0.2 mg & I'm normally pretty med-tolerant. I'd seen the article you quoted thanks. It's actually been one of the prime sources of my motivation to try Bupe. But it doesn't appear to be the one for me. Onto the next drug...
>If you're British, that means that an effective dose may be somewhere near this figure.
Dosage by nationality? What if I'm a German? :-)
J.
Posted by JahL on August 21, 2001, at 23:59:35
In reply to Re: Another Question for Elizabeth » JahL, posted by shelliR on August 21, 2001, at 22:25:42
Hi Shelli.
> Don't think there's any problems with the drugs you're taking and temgesic, but I don't really know anything about sulpride.
Sulpiride is v. selective for D3 & goes with practically anything.
> My pdoc today increased my oxycontin [LUCKY YOU!] and started me on wellbutrin tomorrow.
I'm about 10 days into Wellbutrin. No problems so far. A little extra insomnia maybe.
>I brought in all this stuff about buprenorphine because it was obvious that I've become habituated to the oxy, but he made a comment about if you're going to use opiates, use opiates. I'll try to ask him more when I see him on Thursday, what exactly he meant.
I'd be interested to know. I want yr doctor! :-)
> I did read a small study out of Johns Hopkins that says buph can be abused, but I also had an article from a pdoc in Utah, saying it does not give you a high. So I don't get why anyone would want to abuse it.
Nor do I. Tried it today. Maybe felt a little high/giddy to begin with but soon felt weak & light-headed. No niceness. After about 4 hrs I felt nauseous & extremely tired. Also felt kinda stoned/dumb. It takes about 12 hours to wear off & I'm glad it's outta my system. I don't see the point in continuing. It's my understanding that opioids should yield their benefits in mins/hrs, not days? Time to get some *real* opioids. No time left for messin about...
> Anyway, I'm really anxious to know how you're doing on your first few days. I have a netfriend in Canada, that is not doing well. He has a lot of the symptoms you do, so please let me know if it's working out well for you., so I can pass on the info. I hope so. Tomorrow is my first try with wellbutrin, I only bought ten pills (I'm such an optimist). But I could have a yard sale with all my bottles of unused drugs if it wasn't illegal.
I could open a pharmacy.
Something that may be of interest to you. I got in touch with this country's 1st specialist 'Depersonalisation Unit'. Looks like I may get to talk to a few clued-up academic types (as opposed to the psychoanalysis-obsessed frauds I'm used to). They're looking into pharmacologic treatments (& psychotherapeutic ones, but I'll overlook that...) for DD & associated dissociation disorders (which I believe you have?).
They've got some interesting things to say. Apparently those with endogenous depression AND *severe* depersonalisation (ie ME) "may be less responsive to ADs & may require pharmacotherapy directed at the depersonalisation" (Nuller 1982). This makes sense in my instance & gives me a novel way of approaching my problem. I hear they're having a lot of success with Lamotrigine which of course helps me some. All v. interesting...
Here's hoping the Wellbutrin's better than the Parnate (couldn't have been much worse, huh?).....
J.
Posted by Neal on August 22, 2001, at 0:18:35
In reply to Re: Another Question for Elizabeth » JahL, posted by shelliR on August 21, 2001, at 22:25:42
>but I also had an article from a pdoc in Utah, saying it does not give you a high. So I don't get why anyone would want to abuse it.
Shelli,
I'd be interested in seeing that article. Is it on the internet or??Neal
Posted by shelliR on August 22, 2001, at 1:09:38
In reply to Re: VERDICT/depersonalisation. » shelliR, posted by JahL on August 21, 2001, at 23:59:35
Hey Jahl,
> >I brought in all this stuff about buprenorphine because it was obvious that I've become habituated to the oxy, but he made a comment about if you're going to use opiates, use opiates. I'll try to ask him more when I see him on Thursday, what exactly he meant.
>
> I'd be interested to know. I want yr doctor! :-)
You're welcome to split my 6 minute sessions; just come on over. He's right in this nation's capital, it could be an educational trip.> Nor do I. Tried it today. Maybe felt a little high/giddy to begin with but soon felt weak & light-headed. No niceness. After about 4 hrs I felt nauseous & extremely tired. Also felt kinda stoned/dumb. It takes about 12 hours to wear off & I'm glad it's outta my system. I don't see the point in continuing. It's my understanding that opioids should yield their benefits in mins/hrs, not days? Time to get some *real* opioids. No time left for messin about...
Well, I believe that Elizabeth said initially buph made her feel really nauseated, but immediately took away her depression. So I think the nausea would pass, but it doesn't sound like it did anything else good. Have you tried any other "real" opiates? Because lots of people say the same thing about them--that they make them sick in their stomach and disoriented. Me, I was an opiate girl first time around. I loved it (took it first for stomach pain). But with the depression, I don't get that pure wonderful high I got the first time. And now I'd settle for just getting rid of the depression.
I wonder if my pdoc's strategy is to find something else that works for me, then get me off the oxycontin. I don't believe he's just gonna go higher and higher. Once he said he couldn't justify going any higher than he put me on originially, so I'm not sure what changed his mind. I truely think he's trying to keep me alive. I am also.
I have the kind of depression that is extremely painful, like it hurts so much that I don't think I can stand it--sort of like physical pain. Do you have any of that type of depression some of the time (makes you want to die immediately) or more a constant lack of pleasure/enjoyment type feeling?
>>
> Something that may be of interest to you. I got in touch with this country's 1st specialist 'Depersonalisation Unit'. Looks like I may get to talk to a few clued-up academic types (as opposed to the psychoanalysis-obsessed frauds I'm used to). They're looking into pharmacologic treatments (& psychotherapeutic ones, but I'll overlook that...) for DD & associated
>dissociation disorders (which I believe you have?).I do have a DD, but it's much less painful than the depression in the last year. Also valium helps me with the dissociation. If I'm really depressed I can't take it because valium can make me more depressed. But normally, it grounds me. Does valium have any effect on you? Have you compared it to klonopin?
> They've got some interesting things to say. Apparently those with endogenous depression AND *severe* depersonalisation (ie ME) "may be less responsive to ADs & may require pharmacotherapy directed at the depersonalisation" (Nuller 1982). This makes sense in my instance & gives me a novel way of approaching my problem. I hear they're having a lot of success with Lamotrigine which of course helps me some. All v. interesting...
That is really interesting. How did you get in touch with these people? Are they going to meet with you? Lamotrigine did help me but I couldn't deal with the weight gain. Nardil and Lamictal (brand) was my best combination. It was the kind of weight that came off immediately after I stopped taking the pill. But I felt really uncomfortable all the time, like it wasn't my body. Let me know if they mention anything else. They may be onto something there (so what have they been doing since 1982?)
> Here's hoping the Wellbutrin's better than the Parnate (couldn't have been much worse, huh?).....
Thanks. Sorry about the buph.
>
Shelli
Posted by shelliR on August 22, 2001, at 1:13:58
In reply to Re:Article you mentioned » shelliR, posted by Neal on August 22, 2001, at 0:18:35
> >but I also had an article from a pdoc in Utah, saying it does not give you a high. So I don't get why anyone would want to abuse it.
>
> Shelli,
> I'd be interested in seeing that article. Is it on the internet or??
>
> NealSorry Neal, it was out of University of Iowa: http://www.vh.org/Patients/IHB/Psych/Medications/buprenor.html
Why does the buph make you high?
Posted by Zo on August 22, 2001, at 1:40:00
In reply to Re: VERDICT/depersonalisation. » shelliR, posted by JahL on August 21, 2001, at 23:59:35
> It's my understanding that opioids should yield their benefits in mins/hrs, not days?
Minutes. Have just been nipping at some Vicodin myself (to get thru Effexor dose reduction. whew.) Amazing: minutes.
>But I could have a yard sale with all my bottles of unused drugs if it wasn't illegal.
>
> I could open a pharmacy.My pdoc takes expensive med "returns" to tuck away for low- income patients to sample.
Don't tell.
Zo
Posted by jojo on August 22, 2001, at 2:08:29
In reply to Re: Temgesic. » jojo, posted by JahL on August 21, 2001, at 23:23:19
>
>
> > I'm taking around 0.9 mg. of buprenorphine intrnasally per day. I was transferring from effective Celexa therapy, not treating an active depression, so I can't notice much of a change. Sex may be better, but I'm not completely sure yet (that was the reason I changed). It's been close to 2 months and I haven't crashed, so I think that there is an antidepressive effect. There might be a greater intra-day variation in my "mood', if we can use that medically undefined term, worse in the morning and better in the evening, but I'm not sure, as there is so much else other than the use of pharmacological agents going on. Also, it could be that I've been down so long I don't really know which way is up. If I were playing poker, I think that I'd stick with this hand, if that communicates the idea to you. I may play around with the dose somewhat, but 0.9 mg. is a good "ballpark figure". I hope it works for you.
>
> Thanks jojo.
>
> Tried it today & it didn't like me. And vice-versa. Dizziness, sedation & nausea were the order of the day. This was on just 0.2 mg & I'm normally pretty med-tolerant. I'd seen the article you quoted thanks. It's actually been one of the prime sources of my motivation to try Bupe. But it doesn't appear to be the one for me. Onto the next drug...Fast results. I hope you didn't buy a great deal,
or, possibly you have a friend....> >If you're British, that means that an effective dose may be somewhere near this figure.
>
> Dosage by nationality? What if I'm a German? :-)
>
> J.Germans prefer St. John's Wort.
Actually, medicne is now showing indications
for dosage adjustments, and may eventually make
drug "guesses", based on racial background.
Posted by JahL on August 22, 2001, at 10:13:30
In reply to Re: VERDICT/depersonalisation. » JahL, posted by shelliR on August 22, 2001, at 1:09:38
>Have you tried any other "real" opiates?
Tried weak opium once. Felt sleepy but good! Never tried H; knew it would feel too good. If you've never tasted euthymia the next best thing is to get high. I used to drink to get high as opposed to drunk.
Absolutely no chance of getting opioids prescribed here for anything. Even when they'd opened up my hand to dig out & reattach a severed tendon (drink-related) I was refused (tho' I'm almost certain that a professional-looking gent with a similar injury was given different painkillers. Hmmm...). Have to go through unofficial channels.
> I wonder if my pdoc's strategy is to find something else that works for me, then get me off the oxycontin. I don't believe he's just gonna go higher and higher. Once he said he couldn't justify going any higher than he put me on originially, so I'm not sure what changed his mind. I truely think he's trying to keep me alive. I am also.He sounds like a good'un. A *compassionate* pdoc. Whatever next? :-)
> I have the kind of depression that is extremely painful, like it hurts so much that I don't think I can stand it--sort of like physical pain. Do you have any of that type of depression some of the time (makes you want to die immediately) or more a constant lack of pleasure/enjoyment type feeling?Both. I originally presented an anxious/dysthymic condition with inability to concentrate. However Effexor threw me into my first major depressive episode (still there) which is a different animal alltogether. Unmedicated it's as you describe; ball of (psychic) pain. I'm bed-ridden & obsessing about mainlining huge doses of H or just taking my head off. Medicated, as I am now, I have the constant, gnawing type of depression that *never* lets up. I'm completely mood-unreactive; no pleasure or excitement.
With enough pot on hand I can 'happily' stare @ walls all day. No less pleasurable than anything else.
>
> >
> > Something that may be of interest to you. I got in touch with this country's 1st specialist 'Depersonalisation Unit'.
> I do have a DD, but it's much less painful than the depression in the last year. Also valium helps me with the dissociation. If I'm really depressed I can't take it because valium can make me more depressed. But normally, it grounds me. Does valium have any effect on you? Have you compared it to klonopin?Benzos just make me a little sedated. Xanax helps a little if I'm particularly stressed.
> How did you get in touch with these people?Funnily enough I dx'd (correctly) a friend with Depersonalisation disorder. Him not being a lazy-arse depressive like me, he found them on the net. He e-mailed them & he's just received a load of questionnaires & suchlike. Ironically this is the very place I was referred to last year. Never got there because I fell out with my lazy-arse pdoc prior to my appt. I then forgot all about it.
> Are they going to meet with you?
Waiting for a reply. It's a govt. funded *rsch* programme so I think they're actually keen to recruit new 'bodies'. I'll let you know what comes of it. Had any of that Wellbutrin mood-lability thang? Seems to have passed for me.
J.
Posted by Elizabeth on August 22, 2001, at 13:45:12
In reply to Followup for Elizabeth, posted by Neal on August 18, 2001, at 2:09:50
> That would be great, as Customs seized my last shipment of Temgesic. My part of the coast is LA, but anywhere nearby is good enough. If you want me to post my email address, I will. Anyway, thanks.
I don't know anyone in LA, but I do know a great pdoc in Santa Barbara. If only I could remember his name! I'll see if I can find it anywhere.
-e
Posted by Elizabeth on August 22, 2001, at 13:48:33
In reply to Re: Another Question for Elizabeth, posted by JahL on August 20, 2001, at 20:23:46
> Mine arrived today (evidently UK customs are more lax than their US counterparts...).
Without a doubt.
> My question Elizabeth, or anyone else 4 that matter, is are there any contraindications I should be aware of? Do you foresee any problems combining Temgesic with the following: Lamictal+Sulpiride+Prozac+Wellbutrin+Klonopin?
Opioid antagonists or full agonists probably shouldn't be mixed with buprenorphine, as the results are unpredictable. None of the drugs you listed should be a problem, AFAIK.
> Also, what would be a reasonable limit on dose (comes in 0.2mg sublinguals)?
I don't know about sublingual administration. The dosing is probably different from intranasal dosing (the IN dose seems to be close to the IM dose).
-elizabeth
Posted by Elizabeth on August 22, 2001, at 13:49:49
In reply to Re: Another Question for Elizabeth » jojo, posted by jojo on August 21, 2001, at 22:23:03
> Buprenorphine Treatment of Refractory Depression
> Bodkin, J.A., et al, J. Clin. Pharmacology 15: 1995, pp. 49-57.
Posted by Elizabeth on August 22, 2001, at 13:53:14
In reply to Re: Temgesic. » jojo, posted by JahL on August 21, 2001, at 23:23:19
> Tried it today & it didn't like me. And vice-versa. Dizziness, sedation & nausea were the order of the day.
These side effects go away with time, IME. Try taking 1/2 a pill (i.e., 0.1 mg) to start.
> I'd seen the article you quoted thanks. It's actually been one of the prime sources of my motivation to try Bupe. But it doesn't appear to be the one for me. Onto the next drug...
The primary author of that article is the person who recommended buprenorphine to me. He's really cool. :-)
> Dosage by nationality? What if I'm a German? :-)
Yeah, I was a little confused by that too!
-elizabeth
Posted by Elizabeth on August 22, 2001, at 13:58:39
In reply to Re: Another Question for Elizabeth » JahL, posted by shelliR on August 21, 2001, at 22:25:42
> I did read a small study out of Johns Hopkins that says buph can be abused, but I also had an article from a pdoc in Utah, saying it does not give you a high. So I don't get why anyone would want to abuse it.
It's not really abuse as such; buprenorphine "covers" for opioid withdrawal symptoms and alleviates protracted withdrawal (and the mood disorder that causes people to try opioids in the first place), so addicts will take it if they can't get any of the "real" stuff.
> I could have a yard sale with all my bottles of unused drugs if it wasn't illegal.
I'm sure that idea has occurred to many of us!
-elizabeth
Posted by JahL on August 22, 2001, at 15:16:23
In reply to Re: Temgesic. » JahL, posted by Elizabeth on August 22, 2001, at 13:53:14
> > Tried it today & it didn't like me. And vice-versa. Dizziness, sedation & nausea were the order of the day.
>
> These side effects go away with time, IME. Try taking 1/2 a pill (i.e., 0.1 mg) to start.Hi elizabeth.
Thanx (as per usual) for yr answers. I started out on half a pill the previous day but felt nothing. 0.2mg & then 0.3mg also had no positive effect upon any of my symptoms & exacerbated one or two of them. No way could I handle more than 0.3. I'd be comatose.
If Bupe was going to be of any benefit wouldn't I have at least *some* idea by now (given that opioids are fast-acting)? As yet no indication whatsoever.
Ta,
J.
Posted by jojo on August 22, 2001, at 21:05:46
In reply to Re: Temgesic. » JahL, posted by Elizabeth on August 22, 2001, at 13:53:14
> > Tried it today & it didn't like me. And vice-versa. Dizziness, sedation & nausea were the order of the day.
>
> These side effects go away with time, IME. Try taking 1/2 a pill (i.e., 0.1 mg) to start.
>
> > I'd seen the article you quoted thanks. It's actually been one of the prime sources of my motivation to try Bupe. But it doesn't appear to be the one for me. Onto the next drug...
>
> The primary author of that article is the person who recommended buprenorphine to me. He's really cool. :-)
>
> > Dosage by nationality? What if I'm a German? :-)
>
> Yeah, I was a little confused by that too!
>
> -elizabeth
Elizabeth-You were confused by that? I guess it shows how people hear things differently. JahL mentioned that he got it through customs in the U.K. Being British, I assumed that he would not understand the phrase "in the ballpark, or ballpark figure", whatever I said. They generally don't play baseball in the U.K., and I assume that this is a baseball term, not a cricket or football term, so I was explaining, jocularly, the meaning of the term. I took JahL's remark
"Dosage by nationality? What if I'm a German? :-) as a very humorous statement. Remember, his emoticon was smiling. I wasn't suggesting dose by nationality. But then I thought that I would mention that there actually is some validity of dose by "race", published in the scientific literature.jojo
Posted by JahL on August 22, 2001, at 23:03:12
In reply to Re: Temgesic. » Elizabeth, posted by jojo on August 22, 2001, at 21:05:46
>Being British, I assumed that he would not understand the phrase "in the ballpark, or ballpark figure", whatever I said.
The phrase has actually been adopted pretty widely here, especially by the media.
> They generally don't play baseball in the U.K.
No but I've been to a Blue Jays match & I'm kinda an honoury fan (does this make me unpopular?)
>I took JahL's remark "Dosage by nationality? What if I'm a German? :-) as a very humorous statement.
Thankyouverymuch. And may I say what a hugely perceptive person you are. :-)
> I wasn't suggesting dose by nationality. But then I thought that I would mention that there actually is some validity of dose by "race", published in the scientific literature.
I've seen plenty of stuff on this. Certain races being slower metabolizers etc. In the future yr racial background could well influence yr treatment.
J.
Posted by Neal on August 22, 2001, at 23:38:44
In reply to Followup for Neal Re: Followup for Elizabeth, posted by Elizabeth on August 22, 2001, at 13:45:12
> I don't know anyone in LA, but I do know a great pdoc in Santa Barbara. If only I could remember his name! I'll see if I can find it anywhere.
>
> -eElizabeth,
That would be a lifesaver! I had a really amazingly good response to the Temgesic; life became a pleasure again! It was wonderful! But I see, as you pointed out earlier, that I can't depend on overseas sources. So the problem becomes finding a pdoc to prescribe, something I haven't been able to do, so any little clue . . . .Thanks for your help,
Neal
Posted by Elizabeth on August 23, 2001, at 11:02:44
In reply to Re: Temgesic. » Elizabeth, posted by JahL on August 22, 2001, at 15:16:23
> Thanx (as per usual) for yr answers.
You're welcome. I'm sorry I couldn't be more helpful.
> I started out on half a pill the previous day but felt nothing. 0.2mg & then 0.3mg also had no positive effect upon any of my symptoms & exacerbated one or two of them.
What I would do is take 0.1 mg for a few days (at least), then go up to 0.2 mg for a bit, then try 0.3, and so on until it works (or you get to ridiculous doses, I guess!). This way you develop tolerance to the side effects so you can get up to an effective dose (if there is one for you). I started out with 0.5 mL of the injectable sol'n (0.3 mg/mL), which wasn't really optimal for me but did help some, and then increased it to 1 mL after about 10 days (IIRC). When I missed it for a few days and then tried taking 1 mL without titrating, I was vomiting all day. (The story is really kind of funny: I went to see _The Matrix_ that day, and I threw up before the movie and again several hours afterwards, but not during or shortly after the movie. With the FX in that movie, I would have expected to be throwing up through the whole thing without even taking anything! < g >)
FWIW, I've heard of people taking as much as 16 mg/day of the SL formulation (these are addicts, mind you, so their tolerance is through the roof).
I have serious doubts about the reliability of the sublingual route, though. Seems to me you'd end up swallowing an unpredictable amount of the pill before it got absorbed.
> No way could I handle more than 0.3. I'd be comatose.
Tolerance is your friend here.
> If Bupe was going to be of any benefit wouldn't I have at least *some* idea by now (given that opioids are fast-acting)? As yet no indication whatsoever.
I would expect so. But then again, I have no idea what the effective dose range would be for SL buprenorphine. For all I know, taking 0.2 mg SL is like taking 0.1 mL (0.03 mg -- it's potent, but not *that* potent) IN!
Something from another post of yours, BTW:
> I've seen plenty of stuff on this. Certain races being slower metabolizers etc. In the future yr racial background could well influence yr treatment.I doubt it. The various "races" aren't really as easily distinguishable as all that. In the USA, at least, most "black" people really have some "white" ancestry, for example. I was always in favour of the melting pot idea (i.e., the "races" aren't distinguished, we're all just human beings), but that's become unfashionable lately. :-P
-elizabeth
Posted by Elizabeth on August 23, 2001, at 11:05:48
In reply to Re: Temgesic. » Elizabeth, posted by jojo on August 22, 2001, at 21:05:46
> I wasn't suggesting dose by nationality. But then I thought that I would mention that there actually is some validity of dose by "race", published in the scientific literature.
That is true, there have been some observed differences, but they're statistical -- you can predict that someone's relatively *likely* to be a slow or rapid metaboliser of a particular drug based on their ethnic background, but you can't be certain without doing a test.
-elizabeth
Posted by Elizabeth on August 23, 2001, at 11:09:24
In reply to Re: Elizabeth, Santa Barbara Guy, posted by Neal on August 22, 2001, at 23:38:44
Okay, I'll see if I can find his name somewhere. I feel like I could probably pick out his name if I had a Santa Barbara phone book.
I saw him while I was attempting grad school at UCSB. I was in pretty bad shape, and I remember him as being kind, open-minded, and smart.
-elizabeth
Posted by JahL on August 23, 2001, at 11:50:21
In reply to Re: Temgesic » JahL, posted by Elizabeth on August 23, 2001, at 11:02:44
> What I would do is take 0.1 mg for a few days (at least), then go up to 0.2 mg for a bit, then try 0.3, and so on until it works (or you get to ridiculous doses, I guess!). This way you develop tolerance to the side effects so you can get up to an effective dose (if there is one for you).Mmmm. I could do but it's beginning to nudge my depression the wrong side of suicidal. Not good for someone who recognises this a legimate way out. I wouldn't mind the side-effects if it didn't feel so 'wrong'. I've taken almost as many meds as you & think I've developed some degree of intuition regarding what meds are going to help.
> In the USA, at least, most "black" people really have some "white" ancestry, for example.
I can believe it. My cousin, to the casual observer *is* a 'white man'. He's actually half Afro-American.
>I was always in favour of the melting pot idea
Same. It's pretty 'multicultural' where I live.
> (i.e., the "races" aren't distinguished, we're all just human beings), but that's become unfashionable lately.
As in 'race' has become such an issue?
Ta,
J.
Posted by jojo on August 23, 2001, at 23:37:46
In reply to Re: Temgesic » JahL, posted by Elizabeth on August 23, 2001, at 11:02:44
> > Thanx (as per usual) for yr answers.
>
> You're welcome. I'm sorry I couldn't be more helpful.
>
> > I started out on half a pill the previous day but felt nothing. 0.2mg & then 0.3mg also had no positive effect upon any of my symptoms & exacerbated one or two of them.
>
> What I would do is take 0.1 mg for a few days (at least), then go up to 0.2 mg for a bit, then try 0.3, and so on until it works (or you get to ridiculous doses, I guess!). This way you develop tolerance to the side effects so you can get up to an effective dose (if there is one for you). I started out with 0.5 mL of the injectable sol'n (0.3 mg/mL), which wasn't really optimal for me but did help some, and then increased it to 1 mL after about 10 days (IIRC). When I missed it for a few days and then tried taking 1 mL without titrating, I was vomiting all day. (The story is really kind of funny: I went to see _The Matrix_ that day, and I threw up before the movie and again several hours afterwards, but not during or shortly after the movie. With the FX in that movie, I would have expected to be throwing up through the whole thing without even taking anything! < g >)
>
> FWIW, I've heard of people taking as much as 16 mg/day of the SL formulation (these are addicts, mind you, so their tolerance is through the roof).
>
> I have serious doubts about the reliability of the sublingual route, though. Seems to me you'd end up swallowing an unpredictable amount of the pill before it got absorbed.
>
> > No way could I handle more than 0.3. I'd be comatose.
>
> Tolerance is your friend here.
>
> > If Bupe was going to be of any benefit wouldn't I have at least *some* idea by now (given that opioids are fast-acting)? As yet no indication whatsoever.
>
> I would expect so. But then again, I have no idea what the effective dose range would be for SL buprenorphine. For all I know, taking 0.2 mg SL is like taking 0.1 mL (0.03 mg -- it's potent, but not *that* potent) IN!
>
> Something from another post of yours, BTW:
> > I've seen plenty of stuff on this. Certain races being slower metabolizers etc. In the future yr racial background could well influence yr treatment.
>
> I doubt it. The various "races" aren't really as easily distinguishable as all that. In the USA, at least, most "black" people really have some "white" ancestry, for example. I was always in favour of the melting pot idea (i.e., the "races" aren't distinguished, we're all just human beings), but that's become unfashionable lately. :-P
>
> -elizabethElizabeth-
That's why I put the word "race" in quotes. Whatever scientific meaning that it may posses is statistical and says nothing about the individual, but it does refer to one's chance of possessing certain genes, which has an effect on their disease susceptibility and drug response, and is more than just being a fast or slow metabolizer. As to individual drug response, the proof is still in the pudding, as they say.BTW, it sounds like you and JahL (don't know about Neal) would make really lousy heroin addicts. Do either of you know if you respond to amphetamine with euphoria. There was an article some years ago about that being a predictor of one's chance of responding to imipramine vs amitriptylene, if one was going to respond to one of them. I don't know if anyone claims that as being a predictor for the newer ADs.
jojo
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