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Dr. Bob is Robert Hsiung, MD,
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Posted by headachequeen on October 26, 2003, at 11:11:58
In reply to Wellbutrin update question on Topamax dosage, posted by chicago77 on October 25, 2003, at 23:16:07
I wish I could state a definite dosage for weight loss <g>
I was originally seeing my neurologist for epilepsy -- had never considered migraine as a neurological problem -- duh -- and I am supposed to be a highly intelligent individual ....
until I saw the posters in his office...at one point when my doctor thought I was suffering from depression I was on Wellbutrin and Zyprexa and Imovane; the Wellbutrin was stopped when the epilepsy was diagnosed as it does not work well with most epilepsy meds I was told... no one told me it lowered the seizure threshold... at one time I was enduring twelve and more seizures in a two-month period of time... as my seizures are not the movie style I was not really aware of them and thought that they were related to the depression...
I was exhausted for a day or three following a seizure and sometimes would lose track of the days, would relive the same day over and over until someone pointed out that today was not Tuesday, it was Sunday... when I mentioned this to my doctor, he told me this behaviour was more seizure-related and ordered an eeg and other tests and epilepsy was diagnosed and Wellbutrin with its happy face trademark left my life (I always thought that was rather an overdone trademark to be honest)...
I forget the one that replaced it...
Tegretol was introduced by the neurologist in slow increments
A few months after that, my neurologist always sees patients in three month follow-ups, I asked about migraine and was asked why I had never asked about it before... well it hadn't occurred... this is when the Topomax was prescribed... with the warning that it often causes weight loss... well I decided I could live with that...
within a days of starting to take it.. 25 mg once a day in the evening, I had lost a couple of pounds and that was really exciting for me... I needed that boost for my morale at that particular time...
A month later as I had been told that I was not depressed by the psychiatrists who had examined me after my breakdown but needed a psychologist, I stopped taking the anti-depressants entirely and felt great.
Since taking the Topomax I have not had a migraine... almost eleven months now...
and now that I am up to 400 mg a day of it and have been increased to 400 mg of the Tegretol have had only one seizure since August...
and to me that is really great...
life is beginning to be normal.. or what I consider to be normal...
not only that, but I have dropped enough weight that I can wear a size 10 jean and look like it is meant to be not as if I am trying to squeeze into a sausage casing...
I no longer feel as if people look at my husband with sympathy... and I no longer feel uncomfortable going places...
this has to be contributing to my emotional or mental well-being too...
who knows? I may no longer need the shrink... he may be out of a job one of these days...
well, once we lay to rest the childhood traumas...
and that it seems takes longer than I planned...
but Topomax does not seem to have any massive side effects for me...the dry mouth someone had mentioned could be associated with it or with the meds that go with other problems I am dealing with... oh for the days when I was young and healthy... I guess it is pay back time...
and I drink gallons of water all the time now... since reading the advice here and the bit about kidney stones possibility...
and I do get drowsy at times...but other than that I think it is doing all right for me...
and not having migraines or seizures... well that is all right too
kat> I am also very curious about the dosage for Topamax for weight loss. I currently take Wellbutrin for depression and have no side effects that I am aware of. AND, if you didn't know, they came out with once-a-day dosing... Wellbutrin XL (which is great for me b/c I kept forgetting to take the evening dose, or I'd be somewhere w/out my meds).
> Anyway, I also have migraines, although I haven't had a full-blown attack in about a month. However, I am a grad student and was talking to a lecturer that spoke on migraines. I asked her if the prodrome/aura symptoms (visual disturbences in particular) are indicative of a neurological disorder, just as if I was experiencing full-out attacks. Her belief is that migraines are just as much of a neurological disorder as epilepsy (and she works at Diamond Headache Clinic- very famous). So, it would make sense that migraines at treated in a similar way.
> As far as the Wellbutrin/Topamax combo, since Wellbutrin typically lowers seizure threshold (making it more likely that you MIGHT have a seizure), I would think that adding on an anti-seizure med (which Topamax is) would be a good idea!
> So, back to my original questions... what is the typical dosage of Topamax for weight loss, because I've seen posts that range from 50 mg once a day to 200 mg twice a day! Has anyone noticed drowsiness to be a side effect of Topamax? If so, has taking the med at bedtime made any difference, or does the drowsiness seem to persist thoughout the day? (Geez- can you tell I'm studying for a medical profession?!) I have an appointment with my psychiatrist this coming Thursday (it's Saturday night), and would really appreciate any advice before then so I seem well informed. I will let everyone know how it goes and, if I get a Rx, will update my progress. Thanks everyone!!
Posted by chicago77 on October 26, 2003, at 12:01:16
In reply to Re: Don't Cut Your Pills in half children...... » Larry Hoover, posted by SLS on October 10, 2003, at 19:56:22
I don't know if this issue has been resolved yet, but I used to work in pharmacy and know why they say not to cut tablets in half. If a tablet is scored (that is, it has an indentation/line across on side), the med is perfectly safe to "break" in half (I say break b/c you should be able to hold the tablet and break it with your hands). The reason you should not CUT a tablet that is not scored is because the active medication may not be distributed evenly throughout the pill. Scored tabs are manufactured that way... so if you have a 50 mg tab and break it in half, you should have 25 and 25 in each half. If the tab is not scored, you may end up with 20/30, or 10/40, or who knows what. It's really a matter of consistency in your dosing regimen. You shouldn't be bouncing around on your dosage.
Capsules are similar in that it would be nearly impossible to measure out half, but that's not the biggest concern. The powder, liquid, "sprinkles", etc are placed in that nifty little gelatin casing because you are not meant to take the medication "straight" like that. The capsules (as well as other coatings on tablets, syrups, etc) are meant to get the medication to where it needs to be in order to be metabolized properly. So, that's what I know about cutting pills in half. It's not a ploy by the drug companies to make you have to spend more money or anything like that (the drug companies have plenty of other scams). It's a matter of drug safety and efficacy.
I would also like to add that CR, SR, XR, XL, etc. (any medication the has an controlled release) should NEVER be cut in half! This especially goes to anyone who is switching from WB SR to XL. I went from 150 SR bid to 300 XL and was amazed to see that the tablets are actually smaller than the 150s. Then I realized that the active medication is inside this neat little case and will be released over about 20 hours. That's why they mention (and most people don't actually know this for whatever reason) that you should not be worried or alarmed if you see what looks like the tablet you took (but is actually only the coating/casing)... in your stool! I've never personally seen it, but I haven't really looked!! Point being, controlled release tablets and capsules (even if they are not coated- one just popped into my mind) and NOT meant to be cut. If you need a lower dosage, find a lower dosage. If that is not possible, talk to your health care provider or your pharmacist (they can be very helpful and tend to know more about the meds) to see what you're other options are. Hope this has been helpful!
Posted by California_Princess on October 26, 2003, at 12:11:58
In reply to Cutting Your Pills in Half- esp. extended release, posted by chicago77 on October 26, 2003, at 12:01:16
Thank you so much for all the info!! I always cut my pills in half when starting a new medication because I am very sensitive to drugs and want to know how it will affect me with a low dose first.... fortunately all my pills lately have been scored, like you mentioned. :O)
Thanks again!
Melissa
Posted by Katt on October 26, 2003, at 12:49:22
In reply to pdoc? » Katt, posted by chicago77 on October 25, 2003, at 23:43:46
> just out of curiousity... what is a pdoc?!
sorry...short for psychiatrist.
Posted by Nissy on October 26, 2003, at 22:44:10
In reply to Cutting Your Pills in Half- esp. extended release, posted by chicago77 on October 26, 2003, at 12:01:16
you should not be worried or alarmed if you see what looks like the tablet you took (but is actually only the coating/casing)... in your stool!
**********************
What about seeing the little white balls that are inside the capsule in your stool? I am on effexor XR and I see those white balls all the time. Does this mean my body isn't metabolizing them or absorbing the medication? Do you know anything about this?
Thanks,
Nissy
Posted by chicago77 on October 27, 2003, at 9:01:38
In reply to Re: Cutting Your Pills in Half- esp. extended release » chicago77, posted by Nissy on October 26, 2003, at 22:44:10
> What about seeing the little white balls that are inside the capsule in your stool? I am on effexor XR and I see those white balls all the time. Does this mean my body isn't metabolizing them or absorbing the medication? Do you know anything about this?
Nissy,
I fact I do know about this. This is what I believe is called "sprinkles." There are quite a few meds that are capsules with "balls" inside. You will notice that these are all extended release formulations. This works the same way in that your body first processes the cap to release the sprinkles, then the "balls" are metabolized similarly to a controlled release tab. So, yes, you're body is using the drug and, no, it's no reason for concern. Talk to your doc if it really bothers/worries you.
I do believe that this is one of the exceptions about breaking open capsules. The gelatin capsule dissolves pretty rapidly and the sprinkles are released and go to work. On the other hand, capsules with powder are meant to be taken whole b/c the powder would start to absorb in your mouth, esophagus, etc... before it gets to your stomach. You may want to double check this with a pharmacist. From what I remember, "sprinkle" caps can be opened and (go figure) "sprinkled" over food or mixed in with something like apple sauce for those that may not be able to take it whole (esp. children and the elderly). Hope this was helpful, but remember that I am not an expert on this just b/c I have some experience with it. Be sure to follow your health care provider's instructions and any information provided with your Rx. And ASK as many questions as you want!! This is your health!!
Side note: I am working on my Master's degree to become a Physician Assistant. This is why you will often see me refer to a "health care provider" rather than your "doc." Keep in mind too that PAs are specifically trained to provide patient information and education, and we tend to spend quite a bit more time with patients until all questions are resolved. If there is a PA in the office/clinic that you go to, don't be afraid to talk to them seperately if you feel that your doc isn't "getting the job done." I give a 99% guarantee that you will be very happy with their service and caring!!
Posted by Nissy on October 27, 2003, at 13:12:16
In reply to Re: Cutting Your Pills in Half- esp. extended release » Nissy, posted by chicago77 on October 27, 2003, at 9:01:38
Thanks for all the information. You will be a wonderful PA someday!!
Good Luck,
Nissy
Posted by DarcyP on November 1, 2003, at 3:50:41
I have lost about 75 Pounds over the last year taking Topamax,but now I am faced with severe abdominal pain,I have been tested for everything,from Urinary Tract Infections,Kidney Stones to STD'S everything comes back clean(Thank-God)but my Doctor is totally baffled as to whats causing my pain,I see that one of the side effects is severe abdominal pain does anyone know if a person could start getting this after a year of taking it with no problems?Oh and the pain started on the right side and has spread to the left and doesnt leave even with painkillers it's a constant pain...Thanks for your help
Posted by DharmaMama on November 1, 2003, at 21:08:37
In reply to Topamax and Severe Abdomin Pain, posted by DarcyP on November 1, 2003, at 3:50:41
I take it you are female.
Posted by DarcyP on November 2, 2003, at 2:28:40
In reply to Re: Topamax and Severe Abdomin Pain, posted by DharmaMama on November 1, 2003, at 21:08:37
No Male...:)
Posted by karen_kay on November 2, 2003, at 17:21:07
In reply to Topamax and Severe Abdomin Pain, posted by DarcyP on November 1, 2003, at 3:46:00
Hmmm..... I have no idea. I hope that doesn't happen to me. I would check with the doctor first of course and get some advice. Karen
Posted by DharmaMama on November 2, 2003, at 21:52:53
In reply to Topamax and Severe Abdomin Pain, posted by DarcyP on November 1, 2003, at 3:46:00
Have you checked with a ob/gyn or midwife?
Posted by DharmaMama on November 2, 2003, at 21:58:17
In reply to Re: Topamax and Severe Abdomin Pain, posted by DarcyP on November 2, 2003, at 2:28:40
Sorry, saw this posted twice. Answered to it at another post. My other post would not apply.
Posted by DharmaMama on November 2, 2003, at 22:00:24
In reply to Topamax and Severe Abdomin Pain, posted by DarcyP on November 1, 2003, at 3:50:41
My only other suggestion would be to go see a chiropractor. Look for a good one. My family and I are into natural meds. I had to resort to Topamax. We use chiro for everything.
Posted by chik on November 3, 2003, at 12:22:32
In reply to Topamax Experiences?, posted by Kingfish on January 4, 2001, at 7:29:48
Hello everyone. I just started Topamax two days ago and I'm hoping I have as much success as you guys. I'm also on Celexa 20mg. In the last year my depression has gone more to the bipolar side and the Celexa isn't doing the job. When I was a kid I had Epilepsey and was on an antiseizure drug..just think it's interesting that I'm back on one for a mood disorder..thanx for all your imput..
Posted by TerryS on November 4, 2003, at 13:28:28
In reply to Re: Topamax and Severe Abdomin Pain, posted by DharmaMama on November 2, 2003, at 22:00:24
This condition may have nothing to do with the Topamax. I recommend modifying your diet with flax seed, oatmeal, - every day. Add fish oil. I used reglan for my stomach problems. Also dicyclomine works also.
Posted by msmelissa on November 5, 2003, at 12:54:22
In reply to Topamax Experiences?, posted by Kingfish on January 4, 2001, at 7:29:48
I will be starting Topamax Sunday night. I am taking 500 mg of Depakote-which has made me gain a lot of weight. Propanalol 40 mg for the tremors, Klonapan 1 mg at bedtime to sleep, and 75 mg of Lamactil--which has given me some bad side effects. My doc is taking me off the Lamactil slowly and that is why I start on the Topamax on Sunday...My depression has really messed me up since the Lamactil and the weight gain from the Depakote adds to the dep. I'm praying that the Topamax works for me.
Posted by PJ57 on November 5, 2003, at 23:58:56
In reply to Re: Topamax and Severe Abdomin Pain, posted by DharmaMama on November 2, 2003, at 22:00:24
I have tried topamax several times and have had problems with severe abdominal pain but it would go away, the most annoying problem was my feet would tingle has anyone experienced this? I can say this medication will make you lose weight. I just wondered what are the side effects of going on and off of this drug. I am also on effexor twice a day, valium 10mg three times a day or as needed and restarol sleeping pill. Please excuse the spelling it's been a long day I am so fatigued all the time and have no energy and wondering what could be causing this. Anyone have any info please email me, thanx chicap6@aol.com
Posted by msmelissa on November 6, 2003, at 11:57:39
In reply to Topamax Experiences?, posted by Kingfish on January 4, 2001, at 7:29:48
I am hoping for a great deal of relief with the bipolar issue but am desparate for help in the weight loss area as well. Since adulthood I have always been about 130 lbs. Even after having 3 children...with the depakote and other meds I've gained 30-40 lbs. since March of 2003. Just need to know if anyone else has had any luck with the medicine? I am willing to suffer some side effects to get somewhere with my disorder!
Posted by DarcyP on November 6, 2003, at 23:16:51
In reply to Re: Topamax-bipolar and weight loss?, posted by msmelissa on November 6, 2003, at 11:57:39
my doctor said to stop taking Topamax right away this was yesterday and my pain has decreased alittle not much but I will keep you posted on my results
Posted by headachequeen on November 7, 2003, at 11:35:55
In reply to Re: Topamax-bipolar and weight loss?, posted by msmelissa on November 6, 2003, at 11:57:39
> I am hoping for a great deal of relief with the bipolar issue but am desparate for help in the weight loss area as well. Since adulthood I have always been about 130 lbs. Even after having 3 children...with the depakote and other meds I've gained 30-40 lbs. since March of 2003. Just need to know if anyone else has had any luck with the medicine? I am willing to suffer some side effects to get somewhere with my disorder!
Optimsim beats pessimism any day ... and I guess I should be happy that I started Topomax before I decided I wanted information about it... as it has really helped me and without too many side effects...
so take heart <s>
As several others whose posts I have read, I found these boards in a search for information on Topomax... actually it began with a search for information on Tegretol, but somehow Topomax info came up and I was led here. A couple of years ago I was diagnosed with epilepsy, cause unknown, duration unknown.
I have an absurd sort of epilepsy, in that it is not the highly visible sort and only occurs when I am asleep, making it difficult at times to know whether or not I have had a seizure. The neurologists dealing with me are not sure if it may have been caused by injury or if I was born with it... life can be confusing indeed.
Originally I was put on Tegretol,but in January of this year (2003)when that was not eliminating the seizures, the neurologist decided to increase the dosage. When I asked him about my migraines (until I noticed the posters in his waiting room -- needed something to read while I waited -- it never occurred to me to ask him about them.) He immediately tore up the prescription and began to write out one for Topomax, at the same time telling me that I might want to consider the side effect, weight loss. Being overweight, I thought about it for a second and said I thought I could live with such a side effect. While I would admit it nowhere else, I was a couple of pounds over the 200 -- when I met my husband I was barely 95 pounds, the same height and the same bone structure, nothing else had changed. Other than overcoming anorexia to an extreme by putting on over one hundred pounds. I would struggle to take off weight but would regain it along with a few extra pounds -- life was so much fun...
Topomax apparently deals not only with migraine but with seizures and has the weight loss side effect -- my miracle drug it would seem.
However, I began at 25 mg with dinner for two weeks, then increased to 50 mg for two weeks, and so on until I reached 200 mg, then began the morning dosages, always with food -- for someone who never ate breakfast this was a challenge!!! <g> -- at 25 mg and increased at the same rate until I was taking 200 mg in the morning as well.
He told me that if I noticed any difficulty with the medication, I was to slow down the dosage increments and stay at the previous dosage until I was comfortable with it --- whatever that meant.
He told me about no other side effects and nor did my pharmacist who is notorious for listing all side effects in a leaflet and then sitting down and chatting about new meds with clients to be sure that each new med is understood totally.
Food lost its appeal within three days at the 25 mg once a day dosage... I was simply not interested in meals... taste didn't matter because I didn't want to eat anyway.
As for alcohol, my sister-in-law, who was prescribed Topomax for seizures related to head injuries and a broken back following a drastic accident, was warned that there would be serious side effects if she were to mix alcohol and Topomax -- one glass of wine at dinner and Topomax was a really vile combination she tells me. (In case anyone is wondering about the warning, apparently it is one you don't want to try for yourself)
I did not not know about the hair loss problem that has been mentioned here, but in recent weeks I find that my hair is extremely dry and hard to deal with. Related? I am not sure.
I read on these boards that some patients find nausea accompanies the use of Topomax. I can't say if it does or doesn't as I cannot say whether or not the occasional bouts of nausea are related to Topomax use or to other health problems that are being dealt with... or to other medications. My own physician has prescribed SERC to deal with the nausea. I do not have to take it all the time but those times when it does occur, it is most helpful. I had been using an over the counter product for motion sickness but he did not think this was really a good idea.
My neurologist did mention that pressure behind the eyes is sometimes associated with Topomax after I had been using the med for a couple of months, but it has not been a problem -- odd that it was not mentioned up front???
Other side effects mentioned here have not been mentioned by either of my neurologists, both of whom approve totally of the use of Topomax for the headaches and the seizures. (The other neurologist is dealing with a wretched condition known as myosthenia gravis -- not responsible for spelling)
Since January I have lost enough weight that I gone from size 15-16 to size 10, so in my case the weight loss side effect has been good...
my one concern about the weight loss side effect is wondering if it stops...
I have been without migraine, totally debilitating migraines that do not give any warning, since mid-January thanks to Topomax, and do not like to think of a return to that...
the only side effect that really is insurmountable from my point of view would be to continually lose weight...
it has to stop some time -- doesn't it???I have found that foods change taste with Topomax but was not sure if that were the Topomax or the Tegretol or perhaps another med that I have to take...
I also find that I am CONSTANTLY thirsty and that is only since starting the Topomax (have also been told by other users that it is a cause of kidney stones and to drink lots of water while taking it... not sure if this is accurate, but always thirsty so drink lots of water anyway)...
I have not found that it slowed down my thinking although sometimes I am unable to think of the exact word I want... of course that was sometimes a problem before Topomax too...
So far I have found more benefits than harm...
but I think from experience that I would be more inclined to start using it more slowly and cautiously...
Always take it with meals by the way... I know, hard to do when you do not feel like eating...
I have found that about 25 cents worth of cashews is enough to keep me going for the day... I eat a single serving of yoghurt in the morning with my meds and then have the handful of cashews that I get from a dispenser that raises funds for Child Find... hence the 25 cent measurement... it is a good handful... then in the evening for dinner I have some cashews again (something in the cashews seems to work with my system to really beat any nausea factor with the meds I am on) and then perhaps a bowl of soup and a light meal and I am fine... over time I have come to enjoy a bowl of home made soup at a restaurant near work...
something light and with real taste... and I notice the flavours... so the taste killing part must end...although I still find that there is no real interest in large meals or in snacking or in candy... used to enjoy potato chips and chocolate bars; no interest now... which of course is helping the weight factor -- no junk food leads to weight loss...
the one side effect that I have noticed is a repeated sleepiness or drowsiness.. I used to find that I could or would be awake late into the night and then awake again early into the day... now I am unable to stay awake in the afternoon and need to lie down for a short while in the early evening or the late afternoon.. but that is lessening as I become accustomed to the medication...
At the moment I am on the maximum dosage of 400 mg half in the morning and half in the evening btw...
You will hear of all sorts of side effects --
don't give up until you are sure...
katThey laugh at me because I am different;
I laugh at them because they are all the same.
Posted by msmelissa on November 7, 2003, at 12:26:36
In reply to Topamax Experiences?, posted by Kingfish on January 4, 2001, at 7:29:48
Thank-you for that message. It was very informative and helpful. I feel that I know a little more about what is to come.
msmelissa
Posted by galkeepinon on November 8, 2003, at 2:35:40
In reply to Re: Topamax-bipolar and weight loss?, posted by msmelissa on November 6, 2003, at 11:57:39
Hi, There is a binge-eating study in California USA currently to see if Topamax can possibly be approved for that disorder. I called to ask what medication was being used in this trial and low and behold, it was Topamax. I figured, but was curious. I lost 25 pounds while on Topamax, and the side effects were minimal for me. If you're interested in hearing about my experience, I would be happy to share it with you, if not, I still wish you all the best in getting relief for the bipolar issue as well as an added benefit of weight loss Topamax seems to have on a lot of people :-)
Best wishes,
Kristen
==============================================================================================> I am hoping for a great deal of relief with the bipolar issue but am desparate for help in the weight loss area as well. Since adulthood I have always been about 130 lbs. Even after having 3 children...with the depakote and other meds I've gained 30-40 lbs. since March of 2003. Just need to know if anyone else has had any luck with the medicine? I am willing to suffer some side effects to get somewhere with my disorder!
Posted by msmelissa on November 8, 2003, at 12:31:58
In reply to Re: Topamax-bipolar and weight loss? » msmelissa, posted by galkeepinon on November 8, 2003, at 2:35:40
I'm curious to how long it took you to lose the 25 lbs?
Posted by galkeepinon on November 8, 2003, at 13:13:51
In reply to Re: Topamax-bipolar and weight loss? Galkeepinon, posted by msmelissa on November 8, 2003, at 12:31:58
Sure :-)
At about 4 months at 200mg, I noticed I lost 25 pounds.
===================================================================================
> I'm curious to how long it took you to lose the 25 lbs?
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Dr. Bob is Robert Hsiung, MD,
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