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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 274 to 298 of 1242. Go back in thread:
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.
Posted by HADD Enough on February 28, 2003, at 11:59:14
In reply to I repeat, sleep wanted, please respond, posted by JohnnyB on February 26, 2003, at 17:49:19
Now 4 weeks, 1st week at 40mg/day in AM, next 3 at 60mg/day in AM. Most of the side effects have gone away except for these...dry skin, especially around my knuckles and heels...fixed with moisturizing lotion. Weight loss...NOT! a problem for me. :-D I've lost about 8lbs. since I started Strattera and need to lose about 15 more. Suppressed appetite...related to the weight loss I'm sure. D'oh! It's kind of like I can eat if I choose, but if I don't, it's no big deal from a physical standpoint. I told my pdoc that I have to consciously CHOOSE to eat. Again, not a terribly bad thing to cope with for me, especially in light of the lousy weight GAIN situation with most of the SSRIs. These appetite/weight loss issues are very similar to the ones I was getting with Ritalin/Concerta. Sleep is an interesting deal...I can fall asleep very easily in the evening, but I tend to wake up after about 6 or 7 hours. To put this in perspective, I used to sleep 9 to 11 hours a night prior to Strattera, so from my and my wife's perspective this is a good thing.
Aside from these issues, the good effects contnue. I'm much better able to focus, my task completion quotient is much higher, I'm not as prone to "drift off" during conversations or tasks that need focus, and I can tolerate frustration more easily. My wife notes that I'm not as quick to anger as I was prior to Strattera, and there has been a very pleasant positive synergy between my wife and I. Our relationship is much better than it was a month ago! She is not as tense waiting for my next outburst and so she is more relaxed and receptive to me.
I'm going to try going to 80mg/day within the next week or so just to see what will happen. If the side effects get worse with no appreciable gain in the positive effects, I'll drop back to 60.
All in all, I'd rate Strattera a solid 9 out of 10 for me.
I'm a 50 year old male 175lbs. diagnosed with severe ADD and my pdoc is following me very closely as I am his "guinea pig" for Strattera. He is beginning to talk about going to Strattera as his 1st line drug of choice for ADD/ADHD instead of stims if my and his other early Strattera adopters continue to do well. Maybe it's time to buy stock in Lilly! :-D
Cheers,
HADD Enough
Posted by zenclear on February 28, 2003, at 14:03:33
In reply to Strattera - 4 week report and sleep » JohnnyB, posted by HADD Enough on February 28, 2003, at 11:59:14
Glad it works well for you!
If only you'd said the DRY SKIN side effect had gone away. That's the one prohibitive problem for me, as it exacerbates many underlying sensitivites.
Posted by HADD Enough on February 28, 2003, at 17:28:44
In reply to Re: Strattera - 4 week report and sleep » HADD Enough, posted by zenclear on February 28, 2003, at 14:03:33
Sorry to hear that the dry skin is a show-stopper for you. For what it's worth, my pdoc did say that if Strattera continues to be a success for ADD/ADHD then it will be only a matter of time before more similar drugs begin to hit the market. He noted the evolutionary way the neurotransmitter-altering drugs are progressing. He noted that the "selective" in selective reuptake inhibitors is getting better so that each new generation of drug is better focused in its good effects and produces fewer side-effects. Hopefully, there will be a drug in the not-too-distant future that will provide the positive effects you need without the bad ones. Hang in there and good luck!
Cheers,
HADD Enough
Posted by JohnnyB on March 2, 2003, at 10:18:09
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
Day 9: I got ss little as two hours of sleep night before last. The most sleep I've gotten since starting this med is 4.5 and that was last night, so maybe the insomnia is retreating. I took 1200 mg. of calcium and 600 mg. of magnesium yesterday, as per some sleep experts.
I called my doc's office on Friday and spoke with the nurse (my PCP left town for two weeks after prescribing Strattera for me). The nurse said that the doc who is covering for my PCP instructed me not to split the 18 mg. because it will delay or arrest the passing of the side effects. She told me to stop by and pick some sleep med samples they had for me. It turned out to be Zyprexa which is designed for schizophrenia and appears to carry some scary side effects. One person on an insomnia message board said she slept well on Zyprexa, but when she stopped taking it, she couldn't sleep at all for a month. I didn't take the Zyprexa.
Well, I can't function on even 18 mg. of Strattera. I get quite listless, my responses are delayed, flat affect, a friend told me my speech was slurred, and my ability to focus is terrible. It seems to amplify my ADD sx. 9 mg. is quite managable. I took 18 on day 5, 9 on days 6 & 7, and 18 on day 8 (as per doc's instructions). I was a mess yesterday untill it started to wear off around 4:00 P.M. Today, I will try 9 in the morning and 9 in the early afternoon.
Posted by not exactly on March 2, 2003, at 17:16:06
In reply to Strattera/sleep update, posted by JohnnyB on March 2, 2003, at 10:18:09
> I called my doc's office on Friday and spoke with the nurse (my PCP left town for two weeks after prescribing Strattera for me). The nurse said that the doc who is covering for my PCP instructed me not to split the 18 mg. because it will delay or arrest the passing of the side effects. She told me to stop by and pick some sleep med samples they had for me. It turned out to be Zyprexa...
Your substitute doc sounds like a real loser:
* advising _against_ discontinuing or reducing dose of a med that you are having a serious allergic reaction to
* prescribing an _antipsychotic_ to counter the insomnia s/e> I didn't take the Zyprexa.
Good for you! Although it's generally a good idea to follow your doctor's advice, this doesn't mean that you should ignore your own better judgement. The Zyprexa could have interacted unfavorably with the Strattera and/or caused additional problematic s/e's.
> Today, I will try 9 in the morning and 9 in the early afternoon.
If you can tolerate 9 mg/day of Strattera, I would think that the prudent course of action would be to stay at that level until you repay your sleep debt before considering any dose increment.
- Bob
Posted by teacherkris on March 3, 2003, at 20:27:34
In reply to Strattera/sleep update, posted by JohnnyB on March 2, 2003, at 10:18:09
Hi everyone, I've been reading these posts after someone put the link in at the healthyboards posts. I started Strattera almost 3 weeks ago now. My doctor started me extremely slow and I was irritated about it in the beginning. I started with 10 mg once a day for 7 days, then 10 mg in the am and 10 mg pm for 10 days, now yesterday I started 20 mg am and 10 mg pm, next week I'll go to 20 mg am 20 mg pm and then we'll meet again. Although I was frustrated with the slow start up I am happy I'm taking my time after reading some of the posts. I want this medicine to work so I'll take as long as it needs. As for side effects the only ones I've had are dizziness, some sleepiness and possibly irritability. I think it's hard to decide where irritability comes from! :-) Anyway, today I decided to try just taking half my concerta dose (normally 72/day) and see if any of the strattera was kicking in, it went great! I'm so excited. I felt calm and focused all day. If this is how it's going to be I'm thrilled and I'm not even at a therapeutic level yet. I also take zoloft 50 mg and I'm trying to get off of that so we'll see how that goes, but I only do one thing at a time so that's down the road. Anyway, sorry for the long winded post, I hope others keep posting their updates and I'll keep posting mine. For those who have commented that people seem to be having trouble with strattera I was thinking about something last night. We all tend to do something if we don't like how things are going but if things are good we do nothing. The only reason I sought out these boards is because I was having side effects, if I wasn't I wouldn't have put in the time so maybe that's why? Just a thought. Hope everyone else is doing well!
Posted by zenclear on March 4, 2003, at 19:28:09
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
As the PI warns, sexual dysfuntion is a potential side effect. Any reports, neutral, positive, or negative? Either for men or women?
Someone mentioned to me the other day that Strattera binds to lipids, and this may account for some of the sexual problems, as well as the postive therapeutic effects.
I suspect this may also explain why some people -- like me -- may have problems with skin sensitivity, as lipids are an essential part of our dermis (skin).
Thanks for the feed back!
Posted by HADD Enough on March 5, 2003, at 8:59:12
In reply to Re: Straterra approval--Any sexual side effects?, posted by zenclear on March 4, 2003, at 19:28:09
Thus far, after over a month, I have had no sexual side effects. If anything, my libido has been enhanced (maybe because my mind is not as cluttered and I can focus on the good feelings).
Physically I can see no difference using Strattera. I am fully able to perform, and have no trouble having orgasms. This was not the case when I was taking Zoloft. On Zoloft, I could not perform physically, let alone have an orgasm.
Hope this helps.
Cheers,
HADD Enough
Posted by paulk on March 5, 2003, at 15:57:13
In reply to Re: Straterra approval--Any sexual side effects?, posted by zenclear on March 4, 2003, at 19:28:09
As a 48 year old male, I've found that it's put me about 20 years younger in the sex department (more drive and results). This could be quite variable with dosage and person. I'm not a doc, but I would think that a real doc will soon find it good to advise to start out at a low dosage and increase after 2-4 days if there is no effect - once there is an effect wait a couple weeks and evaluate if it needs to be adjusted.
Too high a dose caused me to have LESS focus and want to sleep all the time. The right dose is great.
Posted by Rachel2 on March 5, 2003, at 16:30:35
In reply to Atomoxetine (Straterra) and sex » zenclear, posted by paulk on March 5, 2003, at 15:57:13
Thanks to everyone who has been posting their experiences on straterra. I've been very hesitant to start it because I've had such bad experiences with meds the last few months. Right now I'm coming off lexapro and my depression has been much worse. I'm wondering if anyone who has discontinued this drug has had bad withdrawal symptoms.
Posted by Steve_Ray on March 5, 2003, at 18:45:38
In reply to Re: Straterra approval--Any sexual side effects?, posted by zenclear on March 4, 2003, at 19:28:09
I have been taking 40 mg for three weeks, and the effects have been sexually positive, stronger libido,more fantacising,and better sex, the only thing is i have been having much stronger orgasms,almost to the point of being painful,also when i urinate it is slightly painful, has anyone else had this?
Posted by dancingdp on March 6, 2003, at 8:47:45
In reply to Re: Straterra approval--Any sexual side effects?, posted by zenclear on March 4, 2003, at 19:28:09
Hi all,
Just wanted your imput on my sons current situation on Straterra. Stats: 10 yr. old boy...59lbs...ADD/OCD. Since he was 3 he has ADD. We started with the stims in grade 1. It has been 7 yrs. of all kinds of stims. Because he has OCD, the stims brought out the worst and he also got ticks as well as some awful side effects. We Started as guinea pigs as the pdoc was one of his first to try Strat. Doc was very hopeful. He has been currently taking risperdal for his OCD which has helped a lot. Doc started him off on a starter pac 18mg for 4 days then 25mg. along with 5mg of Adderal in the am. He stayed on 25mg. for 22 days. We saw no results on his abiltiy to focus and no change in him. He had minimal side effects so the pdoc uped him to 35 mg. and stoped the Adderal. He has been on 35 mg. for 16 days and still no changes. I give him 35 mg. in the am with food. His doc is away for 3 weeks. I am still waiting for something good to happen and I am getting very discouraged. Any thoughts would be really helpful. Howlong does this med take??? I will honor your suggestions. We have tried everything from Homeopathy, Chiropractors, allergy testing. Thanks, dancing
Posted by Ritch on March 6, 2003, at 9:36:25
In reply to Re: Help! It has been weeks on Straterra!, posted by dancingdp on March 6, 2003, at 8:47:45
> Hi all,
> Just wanted your imput on my sons current situation on Straterra. Stats: 10 yr. old boy...59lbs...ADD/OCD. Since he was 3 he has ADD. We started with the stims in grade 1. It has been 7 yrs. of all kinds of stims. Because he has OCD, the stims brought out the worst and he also got ticks as well as some awful side effects. We Started as guinea pigs as the pdoc was one of his first to try Strat. Doc was very hopeful. He has been currently taking risperdal for his OCD which has helped a lot. Doc started him off on a starter pac 18mg for 4 days then 25mg. along with 5mg of Adderal in the am. He stayed on 25mg. for 22 days. We saw no results on his abiltiy to focus and no change in him. He had minimal side effects so the pdoc uped him to 35 mg. and stoped the Adderal. He has been on 35 mg. for 16 days and still no changes. I give him 35 mg. in the am with food. His doc is away for 3 weeks. I am still waiting for something good to happen and I am getting very discouraged. Any thoughts would be really helpful. Howlong does this med take??? I will honor your suggestions. We have tried everything from Homeopathy, Chiropractors, allergy testing. Thanks, dancing
From what I read he has been on the Straterra for about six weeks? The mode of action of Strat. is similar to antidepressants like desipramine and they can take up to eight weeks for some people to kickin. However, the lack of response may have more to do with coming off of stimulants. It may also take awhile for his body to adjust to the absence of the stimulants. Has his tics stopped since he has stopped the Adderall?
Posted by reif5 on March 7, 2003, at 9:45:32
In reply to Re: Straterra approval-Day 6, posted by nmk on January 12, 2003, at 16:08:08
My son has been on Straterra for 1 week. He started with a 40mg 4 pack then switched to 60mg. He has had a significant lose of appetite to the tune of a 15lb weight loss. The first few days he had a head rush everytime he stood up, but those have now subsided. He is still having upset stomachs at different times of the day and is very tired. We have experimented with different times of day to take the medication so that he can have a normal sleep pattern...still working on that. I am wondering how long do we allow these
systems to continue until we call the doctor to have his dosage decreased or are these normal and will eventually disapate in time.
Posted by HADD Enough on March 7, 2003, at 19:49:43
In reply to Re: Straterra approval-Day 6, posted by reif5 on March 7, 2003, at 9:45:32
> My son has been on Straterra for 1 week. He started with a 40mg 4 pack then switched to 60mg. He has had a significant lose of appetite to the tune of a 15lb weight loss. The first few days he had a head rush everytime he stood up, but those have now subsided. He is still having upset stomachs at different times of the day and is very tired. We have experimented with different times of day to take the medication so that he can have a normal sleep pattern...still working on that. I am wondering how long do we allow these
> systems to continue until we call the doctor to have his dosage decreased or are these normal and will eventually disapate in time.
You might want to let your son's Dr. know, if you haven't already, about the side effects he is having. I don't know how often your son gets a med check, but if you've got one coming up soon, you could discuss whether or not to change to dosage or the time he takes his meds then.For me, the first week was the worst by far as far as side effects go. I also started with the sample pack, 40Mg/day for four days, then 60Mg/day for two weeks. I'm now on 80Mg/day. My body was still adjusting to the new drug, and the dose change. I stuck with it though and most of the side effects have either gone away or have become manageable.
In my case, the stomach upset mostly went away after about a week or so, BUT, I still find that I get beter results if I eat small amounts during the day. If I let my stomach get too empty, I'm more prone to get the slightly nauseated/upset stomach feeling than I was before I started Strattera.
I've lost between 8 and 10lbs. in the five weeks I've been on Strattera. It may be due to the fact that Strattera has depressed my appetite also. It looks as though I've stablized at my new weight though, and I'm hoping that I won't get too much more dramatic weight loss.
I had some daytime tiredness for the first week or so, but it seems to have completely gone away.
As far as sleep, I'm sleeping, on average, about 2 to 3 hours less per night than I was without Strattera, 6 to 7 hours now vs. 9 to 11 before. I have no trouble falling asleep but I wake up earlier. So far this has not changed and I'm not sure it will, but for me it's not a problem.
I am a 50yr old male and, once again, I take 80Mg/day of Strattera once in the AM.
Hope this helps. These are my results, your son's may vary.
Good luck,
HADD Enough
Posted by jones on March 7, 2003, at 23:34:49
In reply to Anybody else sedated on Straterra? Please respond, posted by Cindylou on February 7, 2003, at 7:13:57
I was on 18mg and I was very tired! I felt like there was cement around my feet and I couldn't wait to get home and take a nap. I'm sorry that it didn't work for you, but, I am happy that I'm not alone.
Posted by james on March 8, 2003, at 22:15:04
In reply to Re: Anybody else sedated on Straterra? Please respond, posted by jones on March 7, 2003, at 23:34:49
I started Strattera about a week or two ago and titrated up to my current dose of 50mgs a day. No adverse effects, truthfully, I haven't noticed any effects at all.
--James
Posted by Hattree on March 9, 2003, at 21:09:16
In reply to Re: Anybody else sedated on Straterra? Please respond, posted by jones on March 7, 2003, at 23:34:49
Cindy,
I understand you are a med-sensitive person like me. I think 18mg is too much. I'm experiencing a little sleepiness on 5-10mg (I'm splitting a 40mg capsule so its hard to be sure). That is tolerable in the short run but unfortunately I think its also making me depressed.
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