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Dr. Bob is Robert Hsiung, MD,
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Posted by qbsbrown on August 5, 2009, at 12:00:50
In reply to Re: Blood tests, posted by qbsbrown on August 5, 2009, at 11:53:53
But that's a good question. If my symptoms are so revved up and jacked up from 400mgs, perhaps a lower dose is more beneficial. It's tough to tell. I wonder if raising at this point would only increase my wd symptoms, of if it'd help put out the flames? Not sure. What is your theory?
Brian
Posted by qbsbrown on August 5, 2009, at 12:15:27
In reply to Re: Blood tests, posted by SLS on August 5, 2009, at 7:12:14
> I'm sorry that things are so complicated for you. I don't think adding Lexapro at this point is ideal if the depression that is now occurring is due to some effect of the Tegretol. Phenobarbital is something for you to move onto if it has an established utility in BZD withdrawal. I don't know enough about it to help you make any decisions. I am thinking that Tegretol might still be useful. The only way to find out is to try. Perhaps you would do better at a higher dosage. If things get significantly worse, then it will be up to you what to do next. Is it possible that very low dosages are ideal for you? You would have to taper the Tegretol to prevent seizures, so you'll get a chance to find out.
>
> It's too bad you can't go right up to 800mg of Tegretol to see how you would react to it. I think at this point, you might not find the stability at 400mg that was hoped for. I don't know what is best for you because I don't have a crystal ball. If it were me, I would want an answer as soon as possible. I would go right up to 600mg at this point and evaluate how you feel on it. If things get worse, then it is time to make a change.
>
> I would just bring up that Topamax (topiramate) seems to be of utility in benzodiazepine and alcohol withdrawal. Still, it sounds like the you would like phenobarbital to be your next drug trial. Interestingly, Topamax works directly on glutamate receptors, something the other anticonvulsants you have tried fail to do. The others have in common the blocking of sodium channels. Maybe that's not what you need.
>
> http://www.ncbi.nlm.nih.gov/pubmed/17071548?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
>
> http://www.ncbi.nlm.nih.gov/pubmed/15510234?ordinalpos=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
>
> http://www.ncbi.nlm.nih.gov/pubmed/12858324?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
>
>
> Overall, I think the phenobarbital is a good choice as long as you respect the drug and its potential to produce respiratory depression if you decide to play with dosages.
>
>
> - Scott
>
>
>
>
>
>Topamax never gave me depression or dyshporia like the others. Just bad derealization, which I hate.
Brian
Posted by SLS on August 5, 2009, at 13:57:53
In reply to Re: Blood tests, posted by qbsbrown on August 5, 2009, at 12:15:27
I'm not working on theory at this point. I think you need to act on empirical observation and make decisions based upon what is known about the drug and how you react to it. I would raise the dosage to 600mg beginning tonight by taking 200mg as your evening dose. Let's see what happens. If you feel a little better tomorrow, maybe you can begin to taper the diazepam after your speaking engagement.
- Scott
Posted by qbsbrown on August 5, 2009, at 14:45:53
In reply to Re: Blood tests, posted by SLS on August 5, 2009, at 13:57:53
> I'm not working on theory at this point. I think you need to act on empirical observation and make decisions based upon what is known about the drug and how you react to it. I would raise the dosage to 600mg beginning tonight by taking 200mg as your evening dose. Let's see what happens. If you feel a little better tomorrow, maybe you can begin to taper the diazepam after your speaking engagement.
>
>
> - ScottWell it sure feels on the verge of a nervous/psychotic breakdown, and I don't know if taking more of the drug is going to push me over the edge, or to provide some relief, like it initially was.
My head feels like it's on fire, from the med, the wd, and the stress. If it could possibly put the fire out, I'd be forever grateful.
And I would for sure be kicked off a benzo site for taking another med to possibly lessen the wd, as they think they are all evil and only make symptoms worse. I was the one, who no matter what vitamin, supplement, herb i tried, all seemed to make my symptoms worse. That was until the first couple of doses of tegretol. But one of them said that since I had some success tapering in the past with one, and the situation that I'm in, that it might be worth a shot, and to expect an initial flare up of symptoms.
Regards,
Brian
Posted by SLS on August 5, 2009, at 15:28:38
In reply to Re: Blood tests, posted by qbsbrown on August 5, 2009, at 14:45:53
Well, if you feel worse tomorrow morning at 600mg, what will you do?
Again, if you were to make decisions based solely on your observations, you would probably opt to discontinue the Tegretol, but stay at a dosage of 200mg for a few days to see whether you can recapture the improvement you experienced on the way up. If, on the other hand, you feel better tomorrow, you can then remain there for another 5 days to see how you do before going up to 800mg. If 800mg produces a stable reduction in symptomatology, then you can proceed to taper the diazepam.
Phenobarbital acts at several different sites that serve to increase GABA receptor activity and decrease glutamate activity. However, it works quite differently from Tegretol or Depakote. Since I don't know anything about its use in BZD withdrawal, you will need to be sure that it has some history of success.
- Scott
Posted by qbsbrown on August 5, 2009, at 15:36:47
In reply to Re: Blood tests, posted by SLS on August 5, 2009, at 15:28:38
> Well, if you feel worse tomorrow morning at 600mg, what will you do?
>
> Again, if you were to make decisions based solely on your observations, you would probably opt to discontinue the Tegretol, but stay at a dosage of 200mg for a few days to see whether you can recapture the improvement you experienced on the way up. If, on the other hand, you feel better tomorrow, you can then remain there for another 5 days to see how you do before going up to 800mg. If 800mg produces a stable reduction in symptomatology, then you can proceed to taper the diazepam.
>
> Phenobarbital acts at several different sites that serve to increase GABA receptor activity and decrease glutamate activity. However, it works quite differently from Tegretol or Depakote. Since I don't know anything about its use in BZD withdrawal, you will need to be sure that it has some history of success.
>
>
> - ScottYou mean try the 600mgs today and see how i feel tomorrow? Or did you think to lower the dose back down to 200-300?
Yeah, the phenobarbitol is pretty iffy. I think that the Uk is much more benzo savy than the US, and even they banned using it in hospitals, deeming it "barbaric". But it is still commonly used in the US.
But it sounds much more fun to feel drunk and out of it while you go through this.
Regards,
Brian
Posted by SLS on August 5, 2009, at 15:52:33
In reply to Re: Blood tests, posted by qbsbrown on August 5, 2009, at 15:36:47
> You mean try the 600mgs today and see how i feel tomorrow?
That's what I was thinking, since you have been taking Tegretol for over a week. Remember, 400mg now does not equal 400mg before. The drug autoinduces its own metabolism. You would have to take 600mg now to equal the 400mg when you first started. Give it a shot. You can always discontinue the drug should you be reluctant to go any further. It would certainly be an important discovery if you were to only need 200mg.
- Scott
Posted by qbsbrown on August 5, 2009, at 16:10:01
In reply to Re: Blood tests, posted by SLS on August 5, 2009, at 15:52:33
> > You mean try the 600mgs today and see how i feel tomorrow?
>
> That's what I was thinking, since you have been taking Tegretol for over a week. Remember, 400mg now does not equal 400mg before. The drug autoinduces its own metabolism. You would have to take 600mg now to equal the 400mg when you first started. Give it a shot. You can always discontinue the drug should you be reluctant to go any further. It would certainly be an important discovery if you were to only need 200mg.
>
>
> - ScottOh, i didn't realize that it was equaling 400mgs anymore. And also the worry that it is metabolizing the diazepam quicker too huh? If i were to come off of it, there would be a serious backlash and flood of crap coming over me. There was just for taking 2 pills of depakote. Same with a couple doses of trileptal, effected me for a while.
300 was good in the sense as i was out the door, still feeling high and crazy etc, but not seeing ugly/dysphoric/depressive things.
Let's hope for the best.
Regards,
Brian
Posted by qbsbrown on August 5, 2009, at 17:16:32
In reply to Re: Blood tests, posted by qbsbrown on August 5, 2009, at 16:10:01
"Fundamental withdrawal symptoms (like hypersensitivity to sensory stimuli, abnormal perception of movement, depersonalisation or derealisation) were also less severe in the group treated with CBZ compared with the group not receiving that treatment"
http://www.springerlink.com/content/p487785278614552/
Brian
Posted by qbsbrown on August 5, 2009, at 17:57:49
In reply to Re: Blood tests, posted by SLS on August 5, 2009, at 15:28:38
if 600 would go 200-200-200, what would 800 be? 200-200-400?
Regards,
Brian
Posted by qbsbrown on August 5, 2009, at 21:09:03
In reply to Re: Blood tests, posted by qbsbrown on August 5, 2009, at 17:57:49
Well, the 200mg doses seem to work better. But they work pretty well for a couple of hours, then crash, and bad headaches. I've read that some take it 4 times per day, but any dose under 200mgs doesn't do anything for me.
Is this a matter of getting through the initial side effects, and getting a steady blood state going?
I do like dosing at same time as diazepam, and I think that there might be something to that, considering that they are both immediately released.
Can you let me know if you find any more benefit to 4 doses a day? If there's a chance that I can make it to 800mgs, perhaps then it'd be easier to do 4 times a day.
Regards,
Brian
Posted by qbsbrown on August 5, 2009, at 23:06:00
In reply to Dosing Scott, posted by qbsbrown on August 5, 2009, at 21:09:03
Well the 200mgs only seems to last a couple of hours. Does it need to build up in my system? Or is it more beneficial to switch to the ER version and take it 3 times a day. I did not like it in the fact that it felt like the trileptal, some weird/strange things that were very similar.
Your thoughts?
Regards,
Brian
Posted by SLS on August 6, 2009, at 8:22:47
In reply to Dosing Scott, posted by qbsbrown on August 5, 2009, at 21:09:03
Based upon your favorable response to raising the dosage to 600mg, I would go up one more time to 800mg when you are ready - perhaps 5 more days. Then, it will be your decision as to when you would like to continue your taper of diazepam.
Sound like a plan?
- Scott
Posted by qbsbrown on August 6, 2009, at 12:22:10
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 8:22:47
What about the medication lasting a couple of hours, then totally fading off? Is it more beneficial to switch to the ER version, or to dose 4 times a day if/when ready to raise dose?
The ER version was giving me some of the exact yucky feelings that I had from Trileptal that I didn't like.
Your thoughts?
Regards,
Brian
Posted by SLS on August 6, 2009, at 13:12:23
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 12:22:10
> What about the medication lasting a couple of hours, then totally fading off? Is it more beneficial to switch to the ER version, or to dose 4 times a day if/when ready to raise dose?
One is supposed to dose four times a day. However, once you are at a high enough dosage, you might be able to dose three time a day. You'll just have to experiment. At 600mg, I would first try 200mg every 8 hours. At 800mg, you could try 200mg-200mg-400mg.
- Scott
Posted by qbsbrown on August 6, 2009, at 13:52:09
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 13:12:23
> > What about the medication lasting a couple of hours, then totally fading off? Is it more beneficial to switch to the ER version, or to dose 4 times a day if/when ready to raise dose?
>
> One is supposed to dose four times a day. However, once you are at a high enough dosage, you might be able to dose three time a day. You'll just have to experiment. At 600mg, I would first try 200mg every 8 hours. At 800mg, you could try 200mg-200mg-400mg.
>
>
> - ScottI do have a fast med metabolism. I can feel the effects, then it completely wears off after a couple of hours.
I have been dosing 8 hours apart, along w/ the diazepam, and for sure feels like interdose wd.
I wonder about the ER version 3 times a day, but just taking that for 2 days, and having really bad memories of my trileptal day came back.
So I could hold this for 5 days, then try the 800 if tolerable. Then I could dose 250-250-300 would probably work better for me, or 2-2-4.
Or if on the ER version, I could go 200-200-400.
Why do you think that the ER version would mimic some effects of trileptal, that the immediate release doesn't?
Posted by qbsbrown on August 6, 2009, at 15:03:48
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 13:52:09
Even with Trileptal, which is supposed to be 2 times daily, I had to take multiple times, due to my peaks and valleys.
Do you think that the ER version, 3 times a day is worth a week trial? Or the regular version 4 times a day? It seems to last about 4 hours.
Posted by SLS on August 6, 2009, at 15:45:16
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 15:03:48
> Do you think that the ER version, 3 times a day is worth a week trial? Or the regular version 4 times a day? It seems to last about 4 hours.
My guess is that the ER version would serve you well. You probably just weren't taking enough at the time you experienced instability. However, I think you should stay with what you see is working right now. You need to be more patient and allow the blood levels to build up. I do think you will end up at 800mg, but you still need to be methodical in your titration.
- Scott
Posted by qbsbrown on August 6, 2009, at 16:01:09
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 15:45:16
So are you saying not to jump ship yet to the ER version quite yet? I mean it HAS to be the same med, just the extended version right?
How long would you advise staying on the generic immediate release, before switching?
As you can tell from my history, I have a bad habit of upping, lowering, changing, switching etc.
But if I feel a benefit from 200mgs, and that it fades w/ in a couple of hours, then isn't it common sense that a 200mg med that is extended released, would be of more benefit?
And how could/would it be acting just like the trileptal did? I promise it wasn't psychosomatic. It was strange, just after a few doses.
Regards,
Brian
Posted by SLS on August 6, 2009, at 16:42:29
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 16:01:09
> So are you saying not to jump ship yet to the ER version quite yet? I mean it HAS to be the same med, just the extended version right?
It is up to you. In retrospect, do you believe that had you continued with the ER, you would be feeling better now?
> How long would you advise staying on the generic immediate release, before switching?
I would switch right now. 200mg three times a day.
Wait 5 days.
400mg twice a day.
Wait 5 days.
Begin taper of diazepam.
- Scott
Posted by qbsbrown on August 6, 2009, at 16:57:49
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 16:42:29
> > So are you saying not to jump ship yet to the ER version quite yet? I mean it HAS to be the same med, just the extended version right?
>
> It is up to you. In retrospect, do you believe that had you continued with the ER, you would be feeling better now?
>
> > How long would you advise staying on the generic immediate release, before switching?
>
> I would switch right now. 200mg three times a day.
>
> Wait 5 days.
>
> 400mg twice a day.
>
> Wait 5 days.
>
> Begin taper of diazepam.
>
>
> - ScottIn retrospect, me taking it for 3 days, and experiencing some of the exact horrible same things that I did on Trileptal scared the living the crap out of me, and I said I would not go back to feeling like that again. I am afraid that if i do go back, that those similar feelings will return.
If I took it, i'd rather stay at the 3 doses. Even at 800, I think i'd feel more comfortable going 200-200-400
I've taken 2 doses of 200mgs generic today, so it's a no go for today. I have a stressful event tomorrow, so I probably don't want to switch it up tomorrow after being on generic for 4 straight days do i? Or would it perhaps aleviate things for me, or my brain might be adjusting?
Saturday is wide open for me, and Sunday I have very little affairs going on. So the weekend could be a prime trial time.
Regards,
Brian
Posted by qbsbrown on August 6, 2009, at 17:41:41
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 16:57:49
If I wanted to make the switch to the ER, and I've already taken 2 200mg generics today, can I start the ER tonight? Or best to start on a clean slate tomorrow?
Regards,
Brian
Posted by qbsbrown on August 6, 2009, at 20:16:36
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 17:41:41
Yesterday was first night on 600. Some symptoms better, some worse. Did not wake up to the extreme first shade of light. I did have heart palpitations just from rolling over in bed.
Typing worse.
Some of my extreme obsessional/compulsive habits decreased.I was able to go to the mall today, and things were not depressing and/or dysphoric, good sign.
Dry mouth worse.
Interdose wd between diaz doses worse.
I think we're on the right track. Think need to get the dose up and start cutting the diazepam. I don't like to hold the diaz longer than 2 weeks, but looks like we might be looking at a month hold on this one. Longest i've gone is 3 weeks.
Now the major decision is to ER or not to ER, that is the question.
Thanks for the input.
Regards,
Brian
Posted by qbsbrown on August 6, 2009, at 20:45:20
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 20:16:36
Wow Scott, I feel like my head is on fire, and that I'm speed. This happens. But it's better than being stuck in my hell of a prison.
I wonder if the ER version would help keep the flames out, or keep me in a worse hell of a prison. I wonder if the generic does what it does, wears off, then my head is OFF to the races.
Posted by qbsbrown on August 6, 2009, at 21:21:26
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 20:45:20
Could this be the tegretol lowering the diaz? this is what it feels like when i cut the dose. Like i'm on speed, things going a million miles an hour, like my nails are dug in holding on for dear life. But it's not being depressed and being stuck in my head.
Your thoughts, observations?
Brian
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Dr. Bob is Robert Hsiung, MD,
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