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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 39 to 63 of 1242. Go back in thread:
Posted by Jim Boardman on January 12, 2003, at 11:36:51
In reply to Re: Straterra updates - PeterS., posted by RAR on January 12, 2003, at 9:46:15
Damn, Peter, I forgot to mention the burning in my eyes at night. Kind of an itching at the outer corners. Actually, I didn't even attribute it to the Straterra, but now that you mention it... This is also a side effect I can live with! Stay with the med, Pete, and tell us how it goes!
Jim
Posted by Noa on January 12, 2003, at 11:46:41
In reply to Re: Straterra updates - PeterS., posted by Jim Boardman on January 12, 2003, at 11:36:51
I wonder--several of you mentioned the dry mouth and throat and decreased urination. Is that "anticholinergic" effects? If so, could the burning eyes be due to dryiness, as well? Maybe it could help to put in some artificial tears earlier in the day, to prevent the burning later. Just a thought.
Posted by nmk on January 12, 2003, at 15:57:25
In reply to Re: Straterra approval-Day 5- nmk, posted by BekkaH on January 11, 2003, at 19:51:51
> NMK, no I have not had enough of your updates. Please keep us informed. We really appreciate it. If you don't mind my asking, are you on any other medications besides Strattera? I noticed that Jim Boardman is on some other meds.
Yep, I am on Trileptal, 150 mg x 2 per day, and 25mg of seroquel 15 mg at night for sleep. I am weaning off zoloft and am currently down to 50 mg.
Posted by nmk on January 12, 2003, at 16:08:08
In reply to Re: Straterra approval-Day 5- nmk, posted by nmk on January 12, 2003, at 15:57:25
Day 6- I am not experiencing any dry mouth or throat, nor are my eyes burning. This is probably due to being on 18mg per day. Still doing well, no depression but today noticed that the dizziness that I had on day two came back. I can't figure that one out. Also, am feeling a bit more agitated today than I have in the past few days. Not enough to be too bothersome, but still there.
Posted by BekkaH on January 12, 2003, at 21:19:02
In reply to Re: Straterra approval-Day 5- nmk, posted by nmk on January 12, 2003, at 15:57:25
Hi nmk. Thank you for the information. I'm not familiar with Trileptal or Seroquel. I'll look them up.
Posted by BekkaH on January 12, 2003, at 21:37:15
In reply to Re: Straterra approval., posted by Jim Boardman on January 12, 2003, at 8:44:54
> It took my pdoc a lot of med "tweaking" to get the right combination of drugs. I think this is different for each person. But if you stick to a regimen for enough time to let it kick in, then you will have a better idea of the total effect of any med cocktail.
>
> I'm sorry to hear someone say after one dose that he/she is quitting the med. GIVE YOUR MEDS A CHANCE!
>
> STICK WITH THE MEDS, and of course, the counselling. And as long as you don't get bored with them, I'll stick with the updates.
>
**************************************************Hi Jim. You gave us some excellent advice.
Congratulations on your progress! Please continue to give us updates.Bekka
Posted by BekkaH on January 13, 2003, at 7:21:34
In reply to Re: Straterra updates - PeterS., posted by RAR on January 12, 2003, at 9:46:15
> Hi Jim and everyone...>
> I jumped onto this board in the hope of staying in touch re: Straterra.> RuthJumped? Hmmm. . . must be all that extra norepinephrine.
Posted by jrbecker on January 13, 2003, at 13:29:36
In reply to Re: Straterra updates - RAR, posted by BekkaH on January 13, 2003, at 7:22:13
Although there already seems to be a lot of positive feedback for Straterra, it seems some are already having some problems on it as well.
My psychiatrist is on the Lilly advisory board for this med and she told me a few things to keep in mind in starting this drug:
1) Strattera does not work right away like a stimulant. Just like in starting an AD, be patient. It takes a full 5-6 days to feel the full noradrenergic effects in the CNS.
2) A lot of the side effects, especially involved with the peripheral nervous system, including dry eyes, heart rate increase, sweating, tiredness, and the like, start to fade at around a week. It can take anywhere from 10-30 days to subside. In most cases, the SEs are minimized by this period.
3) It takes some time to reach biochemical efficacy for affecting the noradrenergic activity in the forebrain. Peak NE brain levels aren't reached usually at the starting dose. And so your starting dose won't probably be the effective dose you will need a few weeks down the line.
So all in all, it takes some patience on two fronts: waiting for the effectiveness to kick in about a week, and secondly, waiting for the side effects to subside slowly in the days thereafter.
If there is no effect after a week and the side effects are tolerable, then consider a dosage increase.
I'm starting at a low dose of 18mg today. I'll keep you posted on how it's going.JB
Posted by Optimistic on January 13, 2003, at 16:35:04
In reply to Re: Straterra - patience involved, posted by jrbecker on January 13, 2003, at 13:29:36
Does anyone know if it is likley that Straterra would cause an increase in tics? Every time I tried a stimulant my tics would get worse. (Tourette's) I would like to try Straterra but am afraid of the tics worsening.
Posted by Noa on January 13, 2003, at 17:57:09
In reply to Re: Straterra - patience involved, posted by Optimistic on January 13, 2003, at 16:35:04
I don't know but Straterra is not a general stimulant, it is supposed to be quite selective on certian norepinephrine receptors, so I guess it would depend on whether those were involved in producing the tics. But I would think it is less likely to do so than psychostims that are not specific at all.
Posted by ZeeZee on January 13, 2003, at 17:58:46
In reply to Re: Straterra - patience involved, posted by jrbecker on January 13, 2003, at 13:29:36
If you don't mind, I'd like to pick your brain. My son who has ADD has been using Dex since age 9, he is now 19. We just got back from seeing my internist (he's in from college) because his blood pressure has been running high normal to high (mid 130-'s to high 130's sometimes low 140's over mid 70's to high 80's). The doc says this is a result of his 10 years of stimulant use and recommends a change in medication. My son has an appt. with his pdoc in a few weeks (he never took his b/p). Do you happen to know if Straterra avoids this type of internal stimulation or is it basically doing the same thing?
Thanks
Posted by zenclear on January 13, 2003, at 19:21:27
In reply to Re: Straterra - patience involved, posted by jrbecker on January 13, 2003, at 13:29:36
Well, that makes sense, to a degree. I am concerned that according to the PI, water retention, consitpation, etc, were much more prevalent than placebo. And I assume these side effects were not merely ones that disappeared after treatment initiation.
During my brief exposure, I did indeed experience terrible water retention, urinary hestiancy, and constipation-like symtoms. If those go away after 3-4 weeks, I would be impressed. And I hope you report back, saying they do go away!
Meanwhile, I'm just not up for a month of that, with no promise that they will indeed disappear. Or the fear that it would decrease my desire to do rigourous daily cardio exercise, which I am currently doing.
I was pleased with the results -- alertness, etc -- but I would not be able to tolerate the AEs for long. And I do worry about the potential sexual AEs, as the PI indicates. At least Wellbutrin improves sexual function, rather than dampening it.
I do hope you consistently report good news and prove me wrong! I look forward to daily reports. :)
Posted by jodie on January 13, 2003, at 19:43:26
In reply to Re: Straterra - patience involved (nm), posted by jodie on January 13, 2003, at 19:26:53
I'm now on day 4 of Strattera. I'm now on 80 mg's. I still feel I could cry for no reason at any minute. I have the " typical side effects" dry eyes, dry mouth. I have been really lethargic the past couple of days. I'm still waiting to feel the benefits, I know its still a little early, but I've noticed nothing. I'm also wondering why my pdoc took me off my lexapro. She said she wanted to see what med is doing what. Since I have problems with depression shouldn't I still be taking something. She also took me off Klonopin, which I have been on for quite a while to control my severe aggitation that I get. I was taking .5 mg's everyday. I'm wondering if I should have been tapered off it a little, instead of quitting cold turkey. So now, I'm just on the Strattera, thats it. Yes, I can do w/o the klonopin, but still wonder if its normal that I was taken off my A/D. Any ideas, suggestions?
Posted by zenclear on January 13, 2003, at 19:46:11
In reply to Re: Straterra - patience involved, posted by jodie on January 13, 2003, at 19:43:26
That's a bit too high, 80 mg, for starters. Why not try less in the beginning?
I was on 10 mg, and THAT was certainly enough for me!
Posted by zenclear on January 13, 2003, at 21:19:08
In reply to Re: Straterra - patience involved » jrbecker, posted by zenclear on January 13, 2003, at 19:21:27
Oh yes, I also had nightmares. I dreamed -- incredibly vividly -- that I subjected my little dog to medical experimentation. They cut him open, put tubes in him, and then placed him in a plastic bag. When I saw the plastic bag I was horified, and only then realized the enormity of my mistake in letting that happen. It was a very disturbing dream! No kidding.
Posted by jodie on January 14, 2003, at 9:24:20
In reply to Re: Straterra - patience involved » jodie, posted by zenclear on January 13, 2003, at 19:46:11
> That's a bit too high, 80 mg, for starters. Why not try less in the beginning?
>
> I was on 10 mg, and THAT was certainly enough for me!
My pdoc took the paper out that came with the sample bottle of Strattera 40 mg. It stated for adults or adolescents over 70 kg: "dose should be initiated at 40 mg and increased after a minimum of 3 days to a target total daily dose of 80mg administered either as a single daily dose in the morning or as evenly divided doses in the morning and late afternoon." That is what my pdoc went by. I also looked up on Strattera website, which gave me the same info. I still thought it sounded high. I went as far as to call a Pharmacist, he said Strattera is still very new, but the dose was not unusual for my age and weight (27...120lbs), even for beginners. The dose I'm taking now hasn't benefited me yet (now on my 5th day). I'm just still concerned as to why she took me off of my antiD. I know she likes to try one med at a time, but I thought that was a little strange. Oh well, maybe I just need to shut up and keep giving it a chance. I have a problem with finding the negative in everything.
Posted by jrbecker on January 14, 2003, at 10:29:08
In reply to Re: Straterra - patience involved » jrbecker, posted by ZeeZee on January 13, 2003, at 17:58:46
ZeeZee,
Strattera is a quite potent NARI (noradrenergic reuptake inhibitor). Meaning it works both on the the CNS and peripheral nervous system of epinephrine receptors. This would indeed mean that it causes rapid heart rate and the like amongst its core effects on the body.
I am somewhat like your son in his situation. I am only 26 but suffer from slightly elevated blood pressure. I believe this is due more to the stress of my atypical depression than anything else. In trying stimulants in the past, they had a very acute effect on my heartrate, blood pressure, as well as other effects such as sweating, muscle tension. Moreover, they usually worsened my depressive symptoms and made me quite irritable.
My psychiatrist mentioned that Strattera only causes a moderate increase in heart rate (an average of 3-4 beats more per minute above normal). This would of course mean a rise in blood pressure as well. Unfortunately, I do not have any data handy for comparison about the heart rate effects of dex and methylphenidate. I tend to believe they would be quite comparable though. Stimulants work on both dopamine and norepinephrine receptors, but it is now believed that they work more on NE than on dopamine itself. So biochemically, Strattera is not extremely different.
Here's the real difference with Strattera, however, by exerting its affects over a longer duration it is much more smooth than the stimulants. Similarly, by only affecting NE, it has been shown to cause much less behavioral issues and irritability than the stimulants. This can mean that the onset and rebound effects are much less jarring, mentally, as well as physically.
This is only my second day on Strattera. 1st day I was a little spacy as expected, with bouts of tiredness at the end of the day (all as expected). Today, so far so good. Expecting a logarithic improvement of efficacy and a lessesing of side effects throughout the week. I feel much more "calmer," focused, and even more cheery, than I ever did on a stim. As for the physical effects, I noticed that my heart rate is a little elevated -- just as it was on the stims -- but I am definitely not sweating as much and it causes a lot less muscle tension.
I never make early conclusions though, so stay tuned to hear how it's working by the week's end.
If the peripheral effects turn out to be a problem, my doc and I have already discussed adding a beta-blocker to the mix to control heart rate. I don't know if this will be necessary at this point.
I would suggest you discuss the same options with your son's doctor.
Good luck and let me know how it goes.
Posted by nmk on January 14, 2003, at 11:47:50
In reply to Re: Straterra - patience involved » zenclear, posted by jodie on January 14, 2003, at 9:24:20
>
> My pdoc took the paper out that came with the sample bottle of Strattera 40 mg. It stated for adults or adolescents over 70 kg: "dose should be initiated at 40 mg and increased after a minimum of 3 days to a target total daily dose of 80mg administered either as a single daily dose in the morning or as evenly divided doses in the morning and late afternoon." That is what my pdoc went by. I also looked up on Strattera website, which gave me the same info. I still thought it sounded high. I went as far as to call a Pharmacist, he said Strattera is still very new, but the dose was not unusual for my age and weight (27...120lbs), even for beginners. The dose I'm taking now hasn't benefited me yet (now on my 5th day). I'm just still concerned as to why she took me off of my antiD. I know she likes to try one med at a time, but I thought that was a little strange. Oh well, maybe I just need to shut up and keep giving it a chance. I have a problem with finding the negative in everything.Jodie,
I would question a doctor who has to read the prescribing info. out of the sample bottle. Like you, I do not have ADD but have been diagnosed with postpartum depression/anxiety. I am on day 7 of Strattera 18 mg and have not felt this good in 8 months. I had some dizziness and spaceyness the first few days, which eventually subsided. I can't imagine starting at a dose of 80 mgs...I don't think I would be able to walk. If you read Jim Boardman's posts, he started at a lower dose and titrated up. I also read in another post that although Strattera is being marketed as an ADD med, it is used as an antidepressant. The dosages listed on the prescribing information may not reflect accurate dosages for those with depression only. Maybe someone out there has some answers about therapeutic dosage recommendations for various diagnoses.
Posted by jrbecker on January 14, 2003, at 12:42:09
In reply to Re: Straterra - patience involved-JODIE, posted by nmk on January 14, 2003, at 11:47:50
I agree with Nicole. Start low and the side effects won't be so overwhelming. I am a 6'1'' 180 lb male and I have started at 18mg dosing. I am already feeling an effect. I plan on titrating up only every 3-4 days to find the window that's appropriate for me.
If you have a mood disorder dx and take other meds along with the Strattera, it's more likley you're going to be all the more susceptible to all the SEs involved. Equally, having a borderline ADHD diagnosis means that you might not need the 80 mg as your final dosage level.
Too many doctors are too eagar to get you up there too fast. Start low, take it slow, and reserve making any conclusions until a week or two down the line.
Good luck
Posted by ZeeZee on January 14, 2003, at 13:44:14
In reply to Re: Straterra - patience involved ZeeZee, posted by jrbecker on January 14, 2003, at 10:29:08
Thank you so much for all your help!
We did a test to see if my son's b/p goes up after taking his dose of Dex and in fact it did not. But his pulse shoots up from the 70's to the high 90's and above 100. He complains of severe muscle tension in his jaw after days of continuous use, but has never experienced the sweating. He hates the overall effect of the Dex; the flattening of his personality, sleep disturbance, anorexia and sex. dysfunction.
I will definitly inquire about the Strattera and I too thought a beta blocker would be helpful in addition.I just really worry, he's so young to be bothered with "middle age" health problems. As a college sudent he doesn't take the best care of himself so I worry about him damaging his health even futher.
Thank you again. Hope this drug works well for you and I'll keep you posted on my son.
Regards,
ZeeZee
Posted by Noa on January 14, 2003, at 15:35:32
In reply to Re: Straterra - patience involved » zenclear, posted by jodie on January 14, 2003, at 9:24:20
I agree with the others about starting slow. No matter what the insert says, my experience for myself is that it is often a good idea to start slower, because some people (like myself) need time to adjust to the med. Also, since this med is so new and doctors don't have experience with it, it would make sense to start slow, in case someone had a reaction to it.
A second possibility, as you've mentioned is that at the same time you are adjusting to a new med, you are also adjusting to not being on your previous AD. It could be hard to separate out the effects.
But also (and I am not sure how much it matters), but when I saw the weight info, I had to pull out my calculator because it didn't look right to me--I believe 120 lbs is the equivalent of about 54 kilos, which puts you well under 70 kilos. 70 kilos is equivalent to more than 150 lbs.
Posted by Jim Boardman on January 15, 2003, at 8:26:42
In reply to Re: Straterra - patience involved, posted by Noa on January 14, 2003, at 15:35:32
I'm on the 14th day of Straterra, 80 mg in the morning along with 12mg per day gabitril, lexapro 10 mg and remeron (one at night). I am feeling better and am more focused than I have in years. The side effects aren't bothersome enough to outweigh the way I feel. Dry eyes, a bit of constipation, dry throat... all I can handle. This stuff is so much better than the stims.
Posted by jodie on January 15, 2003, at 9:37:25
In reply to Re: Straterra - patience involved, posted by Jim Boardman on January 15, 2003, at 8:26:42
Well this morning I only took my 40 mg pill. I think that is all I will take for today, and call my pdoc. If she still says I should continue w/ the 80, then maybe I should get a 2nd opinion. I actually started out on 40, then on my 3rd day, I started taking 80. Thanks for all of the input. I was diagnosed as being bipolar in the past, I tried many mood stabilizers, including depakote and lithium, but had awful side effects. My new pdoc believes I have ADHD. I have an 8 yr old son who was diagnosed with it almost 3 yrs ago. He has tried Dex, adderall, and now on Ritalin, which seems to be working best for him. But "best" does not mean I'm pleased with it. He has several tics, aggitation, and severe bouts of depression. He is on Wellbutrin for the depression, and clonodine as needed for sleep. I would really like to try Strattera on him, but I wanted to see if I had any probs with it first. I want to get him off of the stimulants. Well I'm getting ready to call my doc, once again, thanks. Oh, one more thing, a little off the subject, but has anyone read books by Dr. Amen? I recently read his book about the 6 different types of ADD. It's I book I would recommend to everyone!!!
Posted by jodie on January 15, 2003, at 10:27:45
In reply to Re: Straterra - patience involved, posted by jodie on January 15, 2003, at 9:37:25
Well, I just spoke with my pdoc. She said the dosage I am taking is ok for me. She stated the "over 70 kg" applies to the children and adolescents only. She said a typical adult dosage on the 3rd day and after is 80 mg, and if not working after 2 to 4 weeks, the norm would be to bump up to 100 mg. I told her I just don't feel comfortable taking the 80. She said maybe I should go back down to 40, for a few days, then back to 80. If I am still having probs with it after a week or so, she is taking me off of Strattera.
Posted by cybercafe on January 15, 2003, at 11:32:45
In reply to Re: Straterra - patience involved, posted by jodie on January 15, 2003, at 10:27:45
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