![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 26 to 50 of 77. Go back in thread:
Posted by Phillipa on May 27, 2006, at 21:02:31
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 27, 2006, at 19:42:25
For more money? It makes no sense. Love Phillipa
Posted by yxibow on May 27, 2006, at 22:00:48
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on May 27, 2006, at 19:42:25
> This doesn't make much sense to me. Surely, the patch was not created to people could wear a sticker instead of swallowing a pill.
No, it was created in hopes (I think) of avoiding severe MAOI problems, but in the end, as the monograph reads, that only is with the lowest dose with caveats to protect their behinds. When you need more than that, it does seem to me to be maybe not a zero sum gain but not much of a notch down from just generic selegeline (I think its generic now).
Posted by cecilia on May 28, 2006, at 0:59:05
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by yxibow on May 27, 2006, at 22:00:48
I think the goal with Emsam (besides making big bucks) was hopefully to decrease the MAO side effects and food interactions. No way of administration is going to completely eliminate them. People in the hospital getting pain meds via IV instead of orally still get GI side effects. Cecilia
Posted by pulse on May 28, 2006, at 18:05:08
In reply to Re: Are Family Doctors prescribing EMSAM? » pulse, posted by Iansf on May 27, 2006, at 19:42:07
No, sorry, I realized too late that my post might give folks the impression that you've now asked about.
It was just a coincidence that the lowest priced Emsam in my area happened to be at a compounding pharmacy. They did not compound my Emsam. The price there was still quite high at $427 for 30 of the lowest dose patches.
Perhaps it could be done with selegiline (?), but I did ask about compounding Wellbutrin, and the "active ingredient" i.e. (Wellbutrin itself) would still HAVE to remain - thus no help for the even more severe GI problems (than Emsam) that Wellbutrin causes me.
I would then have to assume compounding would not take away any of the bad side-effects that never diminish for some - like me- no matter what those particular side-effects are...if they are inherent to the med itself, and not from gelatin, binders. etc.
pulse
Posted by pulse on May 28, 2006, at 18:14:36
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by cecilia on May 28, 2006, at 0:59:05
For me, though, when I've very rarely had to take antibiotics, my GP will order in a anti-biotic shot, administer that, and I have NO GI side-effects whatsoever...plus I'm virtually well in 3 days vs. the standard 10.
pulse
Posted by Donna Louise on May 29, 2006, at 6:43:17
In reply to Re: Are Family Doctors prescribing EMSAM? » cecilia, posted by pulse on May 28, 2006, at 18:14:36
It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.Donna
Posted by crazy777girl on May 30, 2006, at 6:17:33
In reply to Re: Are Family Doctors prescribing EMSAM? » cecilia, posted by pulse on May 28, 2006, at 18:14:36
I think, in part, it (the Rx of transdermal delivery) may be the illusion (delusion?) that we are merely swallowing one less pill. Call me crazy.
A.> For me, though, when I've very rarely had to take antibiotics, my GP will order in a anti-biotic shot, administer that, and I have NO GI side-effects whatsoever...plus I'm virtually well in 3 days vs. the standard 10.
>
> pulse
Posted by SFY on May 30, 2006, at 10:38:05
In reply to delivery difference, posted by Donna Louise on May 29, 2006, at 6:43:17
> It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
> At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.
>
> DonnaI posted this below in another thread that may have been overlooked:
EMSAM does deliver selegiline directly into the blood thereby significantly reducing its exposure to the GI tract. But because blood flows to all internal organs including the liver, intestines, and stomach there will be some selegiline exposure which explains why some people are having GI tract-related side effects.
According to one study:
Transdermal delivery of selegiline provides several pharmacological advantages over oral delivery. First, it sufficiently reduces exposure of the gastrointestinal tract to the drug to limit inhibition of intestinal MAOA activity. Thus, adequate gastrointestinal MAOA enzyme is left
intact to metabolize dietary tyramine. Second, transdermal administration of selegiline circumvents first-pass hepatic metabolism, which results in sustained high plasma levels of the parent compound with a concomitant decrease in metabolite formation. This provides sufficient brain concentrations of selegiline to produce an antidepressant effect, presumably involving substantial MAOA as well as MAOB inhibition. This also may permit the expression of additional pharmacological properties of selegiline other than MAO inhibition previously observed in vitro. At the same time, there is less exposure to L-methamphetamine and L-amphetamine metabolites than observed with oral selegiline.http://ajp.psychiatryonline.org/cgi/content/full/159/11/1869
The EMSAM drug insert clearly states that at least 1 in 100 users may experience GI-related side effects such as "Constipation, flatulence, anorexia, gastroenteritis, vomiting."
Posted by Iansf on May 30, 2006, at 11:53:05
In reply to Re: delivery difference, posted by SFY on May 30, 2006, at 10:38:05
Again, my question: wouldn't sublingual delivery work in the equivalent manner? Liquid forms of selegiline meant for sublingual delivery are available. If 6mg of selegiline delivered suglingually turns out to be equivalent to 6mg delivered transdermally, then what you achieve with Emsam can be achieved at less than a sixth the price with liquid preparations. This may not be an issue for those whose insurance pays for Emsam, but it is for those of us without insurance.
So does anyone know if 6mg suglingual and 6mg transdermal are equivalent? (And please forget 6mg oral - I know that's not equivalent, and that's not part of the question.) Thanks.
Ian
> > It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
> > At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.
> >
> > Donna
>
> I posted this below in another thread that may have been overlooked:
>
> EMSAM does deliver selegiline directly into the blood thereby significantly reducing its exposure to the GI tract. But because blood flows to all internal organs including the liver, intestines, and stomach there will be some selegiline exposure which explains why some people are having GI tract-related side effects.
>
> According to one study:
>
> Transdermal delivery of selegiline provides several pharmacological advantages over oral delivery. First, it sufficiently reduces exposure of the gastrointestinal tract to the drug to limit inhibition of intestinal MAOA activity. Thus, adequate gastrointestinal MAOA enzyme is left
> intact to metabolize dietary tyramine. Second, transdermal administration of selegiline circumvents first-pass hepatic metabolism, which results in sustained high plasma levels of the parent compound with a concomitant decrease in metabolite formation. This provides sufficient brain concentrations of selegiline to produce an antidepressant effect, presumably involving substantial MAOA as well as MAOB inhibition. This also may permit the expression of additional pharmacological properties of selegiline other than MAO inhibition previously observed in vitro. At the same time, there is less exposure to L-methamphetamine and L-amphetamine metabolites than observed with oral selegiline.
>
> http://ajp.psychiatryonline.org/cgi/content/full/159/11/1869
>
> The EMSAM drug insert clearly states that at least 1 in 100 users may experience GI-related side effects such as "Constipation, flatulence, anorexia, gastroenteritis, vomiting."
>
>
Posted by yxibow on May 30, 2006, at 13:50:34
In reply to Re: delivery difference, posted by Iansf on May 30, 2006, at 11:53:05
Sublingual and orally disintegrating pills merely make them easier to swallow in an oral method -- they still pass through your mouth, the esophagus, and the GI tract and eventually the liver or kidney system depending on the drug.
Remeron e.g. has a orally disintegrating preparation, or it did at one time.]
Frequently you see Zinc and Vitamin C sublingual tablets for colds (which typically through studies only cut a day off one at best), and they dissolve in anywhere from 5-15 minutes at most.
Posted by Jakeman on May 30, 2006, at 20:01:48
In reply to Re: delivery difference, posted by Iansf on May 30, 2006, at 11:53:05
Good question. So far I have not seen any studies comparing sublingual and transdermal delivery. Maybe do an experiment? Emsam is outrageously expensive. But Squibb is pushing it and you can probably get a two week sample supply from your medical professional. I'm cutting the patch in half for now so maybe a months supply for some people. Might be a worthwhile trial.
good luck, Jake
> Again, my question: wouldn't sublingual delivery work in the equivalent manner? Liquid forms of selegiline meant for sublingual delivery are available. If 6mg of selegiline delivered suglingually turns out to be equivalent to 6mg delivered transdermally, then what you achieve with Emsam can be achieved at less than a sixth the price with liquid preparations. This may not be an issue for those whose insurance pays for Emsam, but it is for those of us without insurance.
>
> So does anyone know if 6mg suglingual and 6mg transdermal are equivalent? (And please forget 6mg oral - I know that's not equivalent, and that's not part of the question.) Thanks.
>
> Ian
>
> > > It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
> > > At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.
> > >
> > > Donna
> >
> > I posted this below in another thread that may have been overlooked:
> >
> > EMSAM does deliver selegiline directly into the blood thereby significantly reducing its exposure to the GI tract. But because blood flows to all internal organs including the liver, intestines, and stomach there will be some selegiline exposure which explains why some people are having GI tract-related side effects.
> >
> > According to one study:
> >
> > Transdermal delivery of selegiline provides several pharmacological advantages over oral delivery. First, it sufficiently reduces exposure of the gastrointestinal tract to the drug to limit inhibition of intestinal MAOA activity. Thus, adequate gastrointestinal MAOA enzyme is left
> > intact to metabolize dietary tyramine. Second, transdermal administration of selegiline circumvents first-pass hepatic metabolism, which results in sustained high plasma levels of the parent compound with a concomitant decrease in metabolite formation. This provides sufficient brain concentrations of selegiline to produce an antidepressant effect, presumably involving substantial MAOA as well as MAOB inhibition. This also may permit the expression of additional pharmacological properties of selegiline other than MAO inhibition previously observed in vitro. At the same time, there is less exposure to L-methamphetamine and L-amphetamine metabolites than observed with oral selegiline.
> >
> > http://ajp.psychiatryonline.org/cgi/content/full/159/11/1869
> >
> > The EMSAM drug insert clearly states that at least 1 in 100 users may experience GI-related side effects such as "Constipation, flatulence, anorexia, gastroenteritis, vomiting."
> >
> >
>
>
Posted by Jakeman on May 30, 2006, at 21:34:12
In reply to Re: delivery difference » Iansf, posted by Jakeman on May 30, 2006, at 20:01:48
Another thought..maybe a compounding pharmacy could provide a patch for selegiline. A court case this week seems to have gotten the FDA off their backs. I'm a layman, but it appears to be an old, well tested drug with many benefits. And now we have a new method of delivery that may work better.
http://www.upi.com/HealthBusiness/view.php?StoryID=20060526-014622-8737r
Posted by Donna Louise on May 30, 2006, at 22:02:43
In reply to Re: delivery difference, posted by Iansf on May 30, 2006, at 11:53:05
> Again, my question: wouldn't sublingual delivery work in the equivalent manner? Liquid forms of selegiline meant for sublingual delivery are available. If 6mg of selegiline delivered suglingually turns out to be equivalent to 6mg delivered transdermally, then what you achieve with Emsam can be achieved at less than a sixth the price with liquid preparations. This may not be an issue for those whose insurance pays for Emsam, but it is for those of us without insurance.
>
> So does anyone know if 6mg suglingual and 6mg transdermal are equivalent? (And please forget 6mg oral - I know that's not equivalent, and that's not part of the question.) Thanks.
>
> Ian
>
> > > It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
> > > At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.
> > >
> > > Donna
> >
> > I posted this below in another thread that may have been overlooked:
> >
> > EMSAM does deliver selegiline directly into the blood thereby significantly reducing its exposure to the GI tract. But because blood flows to all internal organs including the liver, intestines, and stomach there will be some selegiline exposure which explains why some people are having GI tract-related side effects.
> >
> > According to one study:
> >
> > Transdermal delivery of selegiline provides several pharmacological advantages over oral delivery. First, it sufficiently reduces exposure of the gastrointestinal tract to the drug to limit inhibition of intestinal MAOA activity. Thus, adequate gastrointestinal MAOA enzyme is left
> > intact to metabolize dietary tyramine. Second, transdermal administration of selegiline circumvents first-pass hepatic metabolism, which results in sustained high plasma levels of the parent compound with a concomitant decrease in metabolite formation. This provides sufficient brain concentrations of selegiline to produce an antidepressant effect, presumably involving substantial MAOA as well as MAOB inhibition. This also may permit the expression of additional pharmacological properties of selegiline other than MAO inhibition previously observed in vitro. At the same time, there is less exposure to L-methamphetamine and L-amphetamine metabolites than observed with oral selegiline.
> >
> > http://ajp.psychiatryonline.org/cgi/content/full/159/11/1869
> >
> > The EMSAM drug insert clearly states that at least 1 in 100 users may experience GI-related side effects such as "Constipation, flatulence, anorexia, gastroenteritis, vomiting."
> >
> >
>
>regardless of the origin of absorbtion, 6mg EMSAM is equal to 20mg of selegiline as oppossed to 6mg of sublingual selegiline. so it is at least not equal in terms of selectivity. AT 20mgs it is not selective and inhibits MAO-A and B. At 6mg it only deanimates MAO-B, generally not useful as an antidepressant in that case. The substitution would fail for me.
Donna
Posted by Iansf on May 31, 2006, at 1:11:35
In reply to Re: delivery difference » Iansf, posted by Jakeman on May 30, 2006, at 20:01:48
> Good question. So far I have not seen any studies comparing sublingual and transdermal delivery. Maybe do an experiment? Emsam is outrageously expensive. But Squibb is pushing it and you can probably get a two week sample supply from your medical professional. I'm cutting the patch in half for now so maybe a months supply for some people. Might be a worthwhile trial.
>
> good luck, Jake
>
Unfortunately my medical professional is at a city clinic and the Squibb reps won't give Emsam samples to the clinic. They give samples only to doctors who are likely to prescribe it, which the clinic doctors aren't because Emsam is not on the city formulary. Not that I blame the city - with resources for public health stretched extremely thin, I can see why it wants to avoid paying for $400 a month medicines if it doesn't absolutely have to.
Posted by Jakeman on June 3, 2006, at 13:28:43
In reply to Re: delivery difference, posted by Iansf on May 31, 2006, at 1:11:35
Iansf,
Squibb has a patient assistance program:
http://www.bmspaf.org/A few posters on anxietyhelp.org have been approved for Emsam.
warm regards, Jake
> Unfortunately my medical professional is at a city clinic and the Squibb reps won't give Emsam samples to the clinic. They give samples only to doctors who are likely to prescribe it, which the clinic doctors aren't because Emsam is not on the city formulary. Not that I blame the city - with resources for public health stretched extremely thin, I can see why it wants to avoid paying for $400 a month medicines if it doesn't absolutely have to.
Posted by Last Chance on June 3, 2006, at 14:32:28
In reply to Re: delivery difference, posted by Iansf on May 31, 2006, at 1:11:35
Iansf - if you want to take Emsam give the patient assistance program a try - just download the form on their website - fill out your part, and ask your doc if he or she would just fill in their little part - it is very short, easy (I hate paperwork) and have doc fax in. It can't hurt - it took about 5 weeks, but I got a free 3 mos. supply of the 6mg, with approval for 11 mos. if it is working for me. After that I don't know, but one day at a time. I have been cutting in half for a week, but today I stuck on the full patch. I am still optimistic, but guarded. Richard
Posted by Jakeman on June 3, 2006, at 16:03:49
In reply to Squibb Patient Assistance - Iansf, posted by Last Chance on June 3, 2006, at 14:32:28
Here's a link to the application:
http://www.needymeds.com/papforms/brispa0042.pdf
> Iansf - if you want to take Emsam give the patient assistance program a try - just download the form on their website - fill out your part, and ask your doc if he or she would just fill in their little part - it is very short, easy (I hate paperwork) and have doc fax in. It can't hurt - it took about 5 weeks, but I got a free 3 mos. supply of the 6mg, with approval for 11 mos. if it is working for me. After that I don't know, but one day at a time. I have been cutting in half for a week, but today I stuck on the full patch. I am still optimistic, but guarded. Richard
Posted by Iansf on June 3, 2006, at 17:40:10
In reply to Re: Emsam patient assistance program » Iansf, posted by Jakeman on June 3, 2006, at 13:28:43
Thanks for the link. I'll give it a try.
Iansf,
>
> Squibb has a patient assistance program:
> http://www.bmspaf.org/
>
> A few posters on anxietyhelp.org have been approved for Emsam.
>
> warm regards, Jake
>
> > Unfortunately my medical professional is at a city clinic and the Squibb reps won't give Emsam samples to the clinic. They give samples only to doctors who are likely to prescribe it, which the clinic doctors aren't because Emsam is not on the city formulary. Not that I blame the city - with resources for public health stretched extremely thin, I can see why it wants to avoid paying for $400 a month medicines if it doesn't absolutely have to.
>
>
Posted by jealibeanz on June 19, 2006, at 4:13:14
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Phillipa on May 27, 2006, at 19:38:11
Are there any updates to this question?
Posted by Donna Louise on June 19, 2006, at 6:41:58
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 4:13:14
> Are there any updates to this question?
I don't know about other's but mine is not pleased that my pdoc has put me on it. We had a little talk about it and it seems the problem is he is afraid he will prescribe something that is contraindicated and that I will get sick or die. I told him that I know what I can take, I made it my business to know as I don't expect any other dr.'s to know. For example, he didn't know that demeral is a big no-no. Which scared him. I said but I know it. But I guess most of the patients won't know and neither does he. I told my husband if he wants to try the patch he will need to see my pdoc. I think most family dr.'s are mostly comfortable with just the sri's. At least they feel they can't kill us with those. I told him it was a shame that a milestone drug won't reach many due to ignorance on everyone's part.donna
Posted by jealibeanz on June 19, 2006, at 15:15:31
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 19, 2006, at 6:41:58
really? I'm a little surprised since there's been so much press about it.
Posted by jealibeanz on June 19, 2006, at 17:18:18
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 19, 2006, at 6:41:58
Really? Well that makes me a little discouraged and depressed. I like to think there's hope for my future. Possibly soon. There's no way I'm going to make it past August without help. :(
Posted by Donna Louise on June 19, 2006, at 17:31:03
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 17:18:18
> Really? Well that makes me a little discouraged and depressed. I like to think there's hope for my future. Possibly soon. There's no way I'm going to make it past August without help. :(
Oh please, don't let what I said discourage you from asking. That is just the attitude I have encountered and then generalized which may or may not be accurate. It sure doesn't hurt to ask and you could take info from the internet to help plead your case. You could assure hiim that you know which drugs are forbidden and that on the 6mg you don't even need to watch the diet. (I will be finding out it that is true for the 9mg as I suspect you don't need to watch diet on that dose either). Some people go to psychiatric nurse practioners who are usually pretty up to speed on things too. Do you have other dr.'s you could appeal to if your gp turns you down?donna
Posted by jealibeanz on June 19, 2006, at 20:49:24
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 19, 2006, at 17:31:03
Well, actually I was hoping he may have this idea on trying EMSAM on his own, since it's the newest antidepressant to be released. Apparently it may not be terribly attractibe to doctors?
I do think it could possibly help. I'm mood reactive... happy when around happy people and encouraged by others. The second I'm by myself (like even stepping away into the bathroom!) I want to cry. I'm afraid to mention the crying part though, because that may suggest serotonin deficits, right? I don't think I cry because of that. I cry because I know I am unhappy and let my guard down when alone.
Posted by lisa67 on June 20, 2006, at 11:45:36
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 20:49:24
My GYN.. prescribed Emsam for me. She was going to put me on an SSRI but I told her my neg. experiences with all SSRI's. I then told HER about Emsam. She had never heard of it but investigated it on her own. She decided it might be worth a try. I pick up my RX soon, had to be ordered. She is making me come in every 2 weeks to have my blood pressure checked. I will be cutting the patch in quarters due to the advice here and removing it at bedtime. So thanks to all for good advice.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.