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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on February 18, 2003, at 16:16:33
In reply to Re: Straterra or Wellbutrin Sr for ADHD » disney4, posted by Essence on February 18, 2003, at 15:20:52
> Straterra and Adderall are not available here in Canada where I live.Have you ever tried desipramine (Norpramin)? It might make a good substitute for Strattera. Like Strattera, desipramine is a selective and potent norepinephrine (NE) uptake inhibitor. Wellbutrin is known to make tics worse.
- Scott
Posted by essence on February 18, 2003, at 18:27:08
In reply to Re: Straterra or Wellbutrin Sr for ADHD » Essence, posted by SLS on February 18, 2003, at 16:16:33
Scott, does Wellbutrin cause tics or just exacerbate tics? Thnx
Ess
Posted by SLS on February 18, 2003, at 21:30:49
In reply to Re: Straterra or Wellbutrin Sr for ADHD » SLS, posted by essence on February 18, 2003, at 18:27:08
> Scott, does Wellbutrin cause tics or just exacerbate tics? Thnx
> EssHi Ess.
I read that Wellbutrin (bupropion) both produced and exacerbated tics.
- Scott
--------------------------------------------------------
"Bupropion was effective in its few controlled trials, but tics and (especially in youth) skin rash limit its value."http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9418743&dopt=Abstract
--------------------------------------------------------" We present four cases of children with ADHD and comorbid TS treated with bupropion in whom tics were exacerbated by this medicine. This series suggests that bupropion may not be an appropriate alternative to stimulants in the treatment of ADHD in TS."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8428875&dopt=Abstract
--------------------------------------------------------
Posted by bennett on February 18, 2003, at 23:44:10
In reply to Re: Straterra or Wellbutrin Sr for ADHD » bennett, posted by disney4 on February 18, 2003, at 15:56:13
I don't know if my dosage history will help, given I'm older than your son but I posted the dosage increases in an earlier post at:
http://www.dr-bob.org/babble/20030204/msgs/140009.html
basically I started at 18 for 3 days and worked my slowly up to 72 (36 and 36) over a 2 week period - I didn't feel much + effect until then.
hope this helps
bennett
Posted by JohnnyB on February 25, 2003, at 20:32:26
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
I started reading messages at the beginning of this thread, 12/28/02, and haven't managed to wade through them all yet, so if any points or questions in this message are addressed in previous postings, please post a reply with links. I will catch up.
I am a 47 y/o male, 6', 180#. I am my doc's first patient on Strattera, her "guinea pig". For ADHD, Inattentive, she started me
on 40 mg. x 1 per day, increasing to 40 mg. x 2 per day after seven days, as per the medical newsletter she subscribes to.
On night one, I slept 3 hrs. On night two, I slept 2 hrs. On night three,
I slept 3 - 4 hrs. Last night I slept around 4 hrs. Each of these nights,
I fell asleep O.K., but then woke right around 2:00 A.M. Eli Lilly says
some adults in the clinical trials had insomnia and it went away. They said
to start with a lower dose. The pharmacist says to cut back to a lower dose.
My doc left town for two weeks, but another doc in her practice says cut
back and will write another script.I'm trying to get a sense of what sorts of start-up regimens different
adults are using. I am finding some talk of dosages on some message boards,
but was wondering how your doc started you on it. From the message boards,
it seems like many adults are starting 18 mg. x 1 for a week, then 18 x 2
for a week, then .......I'd like to report to you other effects, but being this sleep deprived, I
can't really tell about mood, focus, etc. It's all pretty bad right now.
I'm a little short tempered, but otherwise feeling stretched quite thin.
One other side effect hit yesterday and was pretty bizarre. My testicles
started aching like I was wearing pants that were way too tight. I didn't
take another 40 mg. this morning and the testicle thing has passed by now.
About two hours after taking a 40 mg. pill, the inside of my chest feels
tense and I can feel my carotid pulse without palpating with my fingers.
Pulse rate is good and blood pressure is only slightly higher than normal. While the drug was at it's peak effect (I guess), my eyes were taking longer then normal to focus when looking up at distant objects after focussing close in for awhile. That could be from a lack of sleep. No dry eyes, mouth, etc. and I live in arid Colorado. Peeing seems normal.
Since starting this message, I got a script called in and picked up 18 mg. caps to last for 14 days @ 1/day , then the docs says I'll go up to 40 mg. again, if all is well. I'll wait till tomorrow A.M. to take the first 18 mg. Maybe I can sleep past 2:00 A.M. this time.I'm thinking I am a poor metabolizer, which I take to mean that I don't get
rid of the drug as fast as good metabolizers, therefore needing less of it
for the same effect. ??????????It's been helpful to read all these postings.
Thanks,
John
Posted by mshyper on February 26, 2003, at 0:02:24
In reply to Re: Straterra approval., posted by JohnnyB on February 25, 2003, at 20:32:26
My doc bumped me up to 40 after 9 days on 18. I nearly came out of my skin at 40. Plus, I had few side effects at 18, but really nasty ones at 40. My doc took me back down to 18. On Thursday, he is supposed to make it 18 morning and 18 evening. The 18 was plenty to give me the focus and everything until about 4:30 in the afternoon, hence the possible addition of the second pill. Hope yours balances out soon!
Posted by JohnnyB on February 26, 2003, at 9:15:46
In reply to Re: Straterra approval., posted by JohnnyB on February 25, 2003, at 20:32:26
For backround details, see http://www.dr-bob.org/babble/20030224/msgs/203834.html
Night 5: After 3.5 hrs. of sleep, I woke at 2:30 A.M. and couldn't get back to sleep the rest of the night. I took no Straterra yesterday and took the an 18 mg. this morning around 6:30. No other meds at all.
With this sleep deprivation, I still can't tell about the benefits of this med. Still none of the typical SE's I've seen mentioned here with the exception of some erectile difficulties, but that could easily be attributed to lack of sleep. I just want more sleep and it's hard to be patient and give this med a chance.
If just one person out there could tell me they had this degree of sleep difficulty and it went away while staying on Straterra, that would be reassuring. Anyone?
Posted by JohnnyB on February 26, 2003, at 9:55:29
In reply to Re: Straterra and sleep experiences?, posted by JohnnyB on February 26, 2003, at 9:15:46
I've seen a fair number of posts mentioning opening and dividing up Strattera capsules. I was going to get gel caps and split my 40 mg. caps. When I asked my pharmacist, she was wary of the idea and called Eli Lilly for me. They said the contents of the capsules are caustic with direct contact with skin. Of course they stand to profit from me having to buy 18 mgs. but then it could also really be caustic too. Comments?
Posted by Hattree on February 26, 2003, at 9:56:58
In reply to Re: Straterra approval., posted by JohnnyB on February 25, 2003, at 20:32:26
Sounds like too high a dose to me. I'd go slower. This is a wild guess, but I think we inattentive types might need less. Certainly can't hurt to drop it down...maybe you should take a day or two off and get some sleep, then restart.
I started and after a couple of days stopped, because I was feeling depressed...I'm hoping it wasn't the Strattera. I had an intense weekend and thought I was better off with old dex.
Posted by Hattree on February 26, 2003, at 10:01:14
In reply to Don't split Strattera caps according to Lilly, posted by JohnnyB on February 26, 2003, at 9:55:29
I split 'em and haven't noticed a problem. I've been pouring about a quarter in a shot glass, mixing it and drinking it, but then I'm pretty tolerant about bad tastes of that nature. It's too haphazard, though. I'm thinking of springing for smaller caps.
Posted by paulk on February 26, 2003, at 10:45:27
In reply to Don't split Strattera caps according to Lilly, posted by JohnnyB on February 26, 2003, at 9:55:29
Total spin - I've had it all over my hands. They just want your money.
I split the 25mg to get 12.5 mg. Taste is bad - you can split them to empty capsuls.
Posted by not exactly on February 26, 2003, at 14:10:19
In reply to Don't split Atomoxetine (Straterra)caps according » JohnnyB, posted by paulk on February 26, 2003, at 10:45:27
You're not going to get an honest and unbiased opinion from the manufacturer, because they have nothing to lose and everything to gain by advising against splitting the caps. Not only do they "want your money", they also want to keep their money. If they told you that splitting a cap was OK, thereby "officially condoning the practice", then they could be liable for a lawsuit in the event that something bad happened as a result (even if causation could not be proven).
As a general rule of thumb, information should not be regarded as absolute truth without considering the source of said information, and what they stand to gain or lose by telling the truth. [If I hinted that this principle should be applied to religion & politics as well, Dr. Bob would redirect this post to Psycho-Babble Faith or Psycho-Social-Babble. :-) ]
BTW, as a chemist (with nothing to gain or lose by this claim) I can assure you that neither atomoxetine nor any of the fillers in a Strattera capsule would be harmful in contact with normal skin. It's possible that some people might be allergic or hypersensitive to the capsule contents, but they will have a more negative reaction to ingesting the caps than they would to opening them.
I stand by the comments I made on this subject in a previous posting [http://www.dr-bob.org/babble/20030125/msgs/137561.html].
- Bob
Posted by viridis on February 26, 2003, at 14:27:37
In reply to Re: Don't split Strattera caps according to Lilly, posted by not exactly on February 26, 2003, at 14:10:19
I've mentioned this here before, but will repeat my experience with Wellbutrin SR. The literature says don't divide them, and people seem to think that this is because they have a slow-release coating. But when I called GSK and spoke with one of the people who actually developed the slow-release form, he said that splitting the pills was fine, and they'd even tested this quite extensively. The slow release is controlled by the wax matrix inside, which dissolves at the same rate whether split or not. When I asked why they discourage people from splitting them, he said it's just because it's hard to get accurate dosing (the pills aren't scored so don't split exactly evenly). Also, if they sit around split for days, they take up moisture from the air. But the product info makes it sound like splitting the pills will cause dire consequences. It certainly didn't for me.
I have no idea whether this applies to Strattera (which I realize is a capsule), but it's a case in point with many potential parallels.
Posted by viridis on February 26, 2003, at 14:41:07
In reply to Re: Don't split Strattera caps according to Lilly, posted by not exactly on February 26, 2003, at 14:10:19
This "caustic ingredients" thing is interesting. Years ago, when I took Prozac, I found the 20 mg pills (the only size available at the time) too strong. I asked my doctor if I could divide the contents into two capsules; he checked with the rep (I think this was Lilly too?) and she said no, the contents are too caustic.
Interesting...of course, they do have to cover themselves. I'm a biologist, and have containers of sodium chloride (table salt) and sucrose (common sugar) in my lab. They each warn that in case of contact with skin, one should flush with water for 15 minutes and call a doctor if any reaction occurs. I wonder if it's a similar CYA situation with pharmaceuticals?
Posted by juanantoniod on February 26, 2003, at 17:09:32
In reply to Caustic contents?, posted by viridis on February 26, 2003, at 14:41:07
FWIW, yesterday I started my first dosage of Strattera. In the evening I had the first instance of really sour stomach that I have had in a long time. I can tell because when I belched, some of the stomach's contents were coming up. The only thing I can attribute this taste to was the Strattera in my stomach.
However, if the medication can be handled by the stomach, it defies logic that it would caustic to skin.
And, as far as the Strattera goes, if any of you are as interested as I am in how it works, I will keep you apprised of any effects it has on me.
Antonio
Posted by JohnnyB on February 26, 2003, at 17:49:19
In reply to Re: Straterra and sleep experiences?, posted by JohnnyB on February 26, 2003, at 9:15:46
All the responses to my mention of Lilly saying not to split capsules have been interesting and express valid points of view, but this comment was really an asside for me. Please review: http://www.dr-bob.org/babble/20030224/msgs/203963.html
I'm a walking zombie when I can get my butt out of the chair. Oh, what I would do for a solid 6 - 8 hr. night! After 3 yrs. of nursing my sleep habits along, I finally started getting full nights of sleep this last fall. I'm really wrestling with whether I should continue with Strattera at the risk of undoing my recently acquired sleep habits. I'm not keen on taking a sleep med to counter the side effects of another med and I haven't the resources for another such expense. Sleep deprivation only amplifies my ADD sx. But, I really want to give Strattera a chance for me to at least see if there are any beneficial effects for me.
Perhaps I'm being as impatient with this message board as I am with Strattera, but please don't anyone take it personally. I've only been checking here for a day or so and may not quite get the pace of things. We all have lives to live, ehh? If anyone could speak to my quandry, I would most welcome your words.
John
Posted by not exactly on February 26, 2003, at 19:49:19
In reply to I repeat, sleep wanted, please respond, posted by JohnnyB on February 26, 2003, at 17:49:19
I don't think there's any magic solution here. Since the problem started when you began the Strattera, it's certainly reasonable to assume a causal relationship. So the first thing to try is completely discontinuing the Strattera. You haven't been on it long enough for withdrawal to be a concern, so there's no need to taper. It's got a relatively short half life, so the insomnia s/e should go away in a day or 2. Once your sleeping is normal (or acceptable) again and you've gotten a few good nights' sleep, then you could try the Strattera again at a significantly reduced dosage (I wouldn't start with more than 1/4 the amount that caused the intolerable insomnia). It's quite likely that you're one of the "poor metabolizers". Don't increase the dose until you're comfortable that you can handle the level of stimulation (which will hopefully diminish over time). Ramp up very slowly and see if you gain any benefit before the s/e problems recur.
If you really need to get some sleep and completely discontinuing Strattera is not providing relief fast enough, then a sedative hypnotic is the obvious short-term remedy.
- Bob
Posted by paulk on February 26, 2003, at 20:06:47
In reply to I repeat, sleep wanted, please respond, posted by JohnnyB on February 26, 2003, at 17:49:19
> I'm a walking zombie when I can get my butt out of the chair. Oh, what I would do for a solid 6 - 8 hr. night! After 3 yrs. of nursing my sleep habits along, I finally started getting full nights of sleep this last fall. I'm really wrestling with whether I should continue with Strattera at the risk of undoing my recently acquired sleep habits. I'm not keen on taking a sleep med to counter the side effects of another med and I haven't the resources for another such expense. Sleep deprivation only amplifies my ADD sx. But, I really want to give Strattera a chance for me to at least see if there are any beneficial effects for me.
>
> Perhaps I'm being as impatient with this message board as I am with Strattera, but please don't anyone take it personally. I've only been checking here for a day or so and may not quite get the pace of things. We all have lives to live, ehh? If anyone could speak to my quandry, I would most welcome your words.
>
> John
I found that even 25 mg/day was too much for me (I now take 12.5mg/day) - try a lower dose. Reading between the lines - I have a hunch that 40mg/day is way too much for a number of folks.I also tried Reboxitine, a related drug, and found it a disaster. I wonder now if it was because the dose was way to high? Why not try 5mg/day until you can sleep, then work it up and retreat when it interferes with sleep.
I found that not only did it screw up my sleep if I take too much, but it made my focus WORSE! At the higher dose I found I was impatient, irritable, spacy-sleepy and couldn't sleep. But on a lower dose it works very well and I'm getting a lot more tasks completed.
Based on my experience (at 200 lbs) I would start on 10mg/day and work up - and even less if you weigh less.
The good news is, because it works at 10-12mg/day I can get the 40mg caps and split them - giving me a very cost effective med.<g>
Posted by Ritch on February 27, 2003, at 0:27:15
In reply to Re: Don't split Strattera caps according to Lilly, posted by viridis on February 26, 2003, at 14:27:37
> I've mentioned this here before, but will repeat my experience with Wellbutrin SR. The literature says don't divide them, and people seem to think that this is because they have a slow-release coating. But when I called GSK and spoke with one of the people who actually developed the slow-release form, he said that splitting the pills was fine, and they'd even tested this quite extensively. The slow release is controlled by the wax matrix inside, which dissolves at the same rate whether split or not. When I asked why they discourage people from splitting them, he said it's just because it's hard to get accurate dosing (the pills aren't scored so don't split exactly evenly). Also, if they sit around split for days, they take up moisture from the air. But the product info makes it sound like splitting the pills will cause dire consequences. It certainly didn't for me.....
Aha! So, that's why splitting WB SR tabs results in clean cracking (little powder or dust evidently due to the wax matrix inside). The generic bupropion crumbles really easily in comparison and makes a lot of dust.
thanks for that info.
Posted by Ed on February 27, 2003, at 7:33:54
In reply to I repeat, sleep wanted, please respond, posted by JohnnyB on February 26, 2003, at 17:49:19
I had insomnia that went away after a few days. I take 40 mgs a day without much in the way of side effects. I had taken 80 mgs. a day for a few days, but my brain and body was telling me 80 mgs was too much. Good luck.
> All the responses to my mention of Lilly saying not to split capsules have been interesting and express valid points of view, but this comment was really an asside for me. Please review: http://www.dr-bob.org/babble/20030224/msgs/203963.html
>
> I'm a walking zombie when I can get my butt out of the chair. Oh, what I would do for a solid 6 - 8 hr. night! After 3 yrs. of nursing my sleep habits along, I finally started getting full nights of sleep this last fall. I'm really wrestling with whether I should continue with Strattera at the risk of undoing my recently acquired sleep habits. I'm not keen on taking a sleep med to counter the side effects of another med and I haven't the resources for another such expense. Sleep deprivation only amplifies my ADD sx. But, I really want to give Strattera a chance for me to at least see if there are any beneficial effects for me.
>
> Perhaps I'm being as impatient with this message board as I am with Strattera, but please don't anyone take it personally. I've only been checking here for a day or so and may not quite get the pace of things. We all have lives to live, ehh? If anyone could speak to my quandry, I would most welcome your words.
>
> John
Posted by JohnnyB on February 27, 2003, at 10:50:24
In reply to Re: I repeat, sleep wanted, please respond » JohnnyB, posted by Ed on February 27, 2003, at 7:33:54
Thanks. The two responses I received, before I needed to decide whether to continue or not, were helpful. Especially Ed telling me his insomnia went away. Bob's advise will come into play if Ed's doesn't work. I wasn't looking for magic as much as wanting to hear from someone besides Lilly that the insomnia had gone away.
I opened an 18 and mixed half in some juice. Waiting a couple of hours before eating did not produce a sour stomach.
I believe I only slept 4 hrs. last night but layed in bed relaxing. Perhaps I was dozing from 3:00 till 6:00 while lieing there. I certainly slept from 11:00 till 3:00, and odly I feel much better today, much more with it mentally and more energy too. The lack of sleep is still very apparent, but there is a marked improvement over yesterday.
If anyone else reads my request for responses about sleep, I'd still like to hear from you.
Thanks again,
John
Posted by JohnnyB on February 27, 2003, at 11:21:21
In reply to Re: I repeat, sleep wanted, please respond » JohnnyB, posted by Ed on February 27, 2003, at 7:33:54
Thanks for the news of your fading insomnia. I've been reading, in this thread, allot of recomendations to start at lower doses and work up, but I thought that dropping to 18 from 40 would be low. Dropping even futher to 9(+ or -) makes good sense and the initial effects of feeling tense inside and my mental state feel much better on that dose, so far.
May I ask, how long have you been taking it? Are you taking it for ADHD, as an AD, both? Moreover, are you finding it effective in treating your symptoms?
Posted by JohnnyB on February 27, 2003, at 11:56:53
In reply to Atomoxetine (Straterra) and sleep » JohnnyB, posted by paulk on February 26, 2003, at 20:06:47
Didn't mean to leave you out of the thanks. You were the first to respond, but since that was yesterday, I forgot about your message while composing thanks this morning. Of course yesterday was nothing but a blurr.
Prior to today, it was hard to tell if the spacey lack of focus and other mental/emotional sx were due to sleep deprivation or due to the effects of Strattera. Maybe both, but I think you are on to something, at least for me.
I feel much better today, on all counts, yet I don't believe I slept much more last night than previous nights. So, with three days of 40, one day without, then 18 yesterday, it seems your theory may hold up. The sx seem to be lessening and the benefits (improved focus, etc.) seem to be more prominent. We'll just have to wait more to see for sure. Perhaps this is one way we find out if we are poor metabolizers (PMs) of CYP2D6.
I've been reading your messages in this thread, but have seen nothing from you between 2/10 and today. You seemed happy with the earlier results and in todays message you still sound pleased, yes?
Well, thanks for you input,
John
Posted by Ed on February 27, 2003, at 12:05:12
In reply to Strattera benefits, Ed?, posted by JohnnyB on February 27, 2003, at 11:21:21
Straterra somewhat decreases my general aggitation level. For example, I don't step on other peoples' sentences as much or feel so compelled to voice my own opinion. Also, I am more focused when I read books-- and no headaches and/or sudden sleepiness when I read books.
> Thanks for the news of your fading insomnia. I've been reading, in this thread, allot of recomendations to start at lower doses and work up, but I thought that dropping to 18 from 40 would be low. Dropping even futher to 9(+ or -) makes good sense and the initial effects of feeling tense inside and my mental state feel much better on that dose, so far.
>
> May I ask, how long have you been taking it? Are you taking it for ADHD, as an AD, both? Moreover, are you finding it effective in treating your symptoms?
Posted by paulk on February 27, 2003, at 15:53:33
In reply to Sorry paulk, posted by JohnnyB on February 27, 2003, at 11:56:53
> Didn't mean to leave you out of the thanks. You were the first to respond, but since that was yesterday, I forgot about your message while composing
> thanks this morning. Of course yesterday was nothing but a blurr.
>Yeah – isn’t that strange – when I take too much I can’t hardly remember anything and it is hard to function – almost exactly the opposite of the good effect. It even makes it hard to decide what to do about the med itself.
>The sx seem to be lessening and the benefits (improved focus, etc.) seem to be more prominent. We'll just have to wait more to see for sure.
>Perhaps this is one way we find out if we are poor metabolizers (PMs) of CYP2D6.
>
It appears that there is a 5 fold difference in blood level depending on ones metabolism (wonder if that is just for kids – could be worse for adults?) What is an interesting coincidence is that Desipramine, which also acts in part as a SNRI, has a 35 fold range of blood-level for the same dosage. I bet you sleep tonight.>I've been reading your messages in this thread, but have seen nothing from you between 2/10 and today. You seemed happy with the earlier
>results and in today’s message you still sound pleased, yes?I’m getting more done AND my sex life is enhanced. It seems that I need to be pickier about the dosage than with other meds I’ve tried. Start low and work up slowly would seem to be good advice. They probably should change the monograph if they want wide success.
I think I felt a bit euphoric the first week – haven’t felt that good again, but overall things are good. The only other drug that gave me anything close was Nardil – this is better so far at week 3.
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Dr. Bob is Robert Hsiung, MD,
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