![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 86. Go back in thread:
Posted by want2breal on November 27, 2006, at 17:00:46
In reply to Re: ENSAM: DAY 10+ and counting, posted by stargazer on November 27, 2006, at 11:30:11
Glad you are doing so well, Stargazer.
I am on day 4 of EMSAM, and I'm not feeling too well.
I posted today, but can't find it anywhere on the board.
I am on Emsam 6 mg. patch, and take Ambien 10 mg......last night I did not sleep AT ALL!!!!
Seriously, I will not be able to stay on this if I can't sleep. This is starting to feel like Concerta and the diet pill I was once on. I had 3 good days, and then by day 4 couldn't sleep, got sick, and then got off!
Don't know if I can cut this thing in half or what.
If I have another bad night I will call my dr. tomorrow.
Take care!
Posted by want2breal on November 27, 2006, at 17:23:29
In reply to Re: ENSAM: DAY 10+ and counting, posted by stargazer on November 27, 2006, at 11:30:11
I think it may be too strong for me.
Can I take it off before bedtime, and if so, like what time? I am SO very sensitive to everything, I cannot handle any kind of caffeine or decongestants...everything keeps me awake.ANd...I know this is probably a question for the doctor, but what about cutting the thing in half or quarters?
Thanks so much, and glad you're doing well, Stargazer.
If I don't start getting some sleep, I will not be able to stay on it....PS....WHERE in the heck do my posts go....????
I can't find where I posted last....
Posted by Phillipa on November 27, 2006, at 19:32:56
In reply to Can I take it off before bed and/or cut it in half, posted by want2breal on November 27, 2006, at 17:23:29
Hey you two hooked up that' great. I know the answer to cutting the patch you can. My pdoc said if I try it I might just need a quarter of a patch. Just don't get it on your hands. Carefully cut it. I think someone said the were scored? Not sure. And yes you can take it off at night. Did you google EMSAM at the bottom on Dr. Bob's side? Love Jan/Phillipa
Posted by stargazer on November 28, 2006, at 10:05:49
In reply to Re: Can I take it off before bed and/or cut it in half » want2breal, posted by Phillipa on November 27, 2006, at 19:32:56
Real...
I'm taking a very small dose of seroquel (25-50 mg) at night to help with insomnia. Pdoc gave me loads of samples of these.
Seroquel may help more than Ambien for insomnia. May want to discuss with your pdoc B4 giving up on EMSAM. Alot of times the sleep meds stop working after being on them for awhile.
Are you still having heart palpitations or other symptoms of anxiety during the day?
SG
Posted by mindevolution on November 29, 2006, at 1:10:39
In reply to EMSAM......2 WKS.... Seroquel for imsomnia? /Real, posted by stargazer on November 28, 2006, at 10:05:49
> Real...
>
> I'm taking a very small dose of seroquel (25-50 mg) at night to help with insomnia. Pdoc gave me loads of samples of these.
>
> Seroquel may help more than Ambien for insomnia. May want to discuss with your pdoc B4 giving up on EMSAM. Alot of times the sleep meds stop working after being on them for awhile.
>
> Are you still having heart palpitations or other symptoms of anxiety during the day?
>
> SGhave to be careful of antipsychotic side effects so I wouldn't recommend it, who wants tardive dyskinesia from a sleep med???
Posted by SLS on November 29, 2006, at 6:24:59
In reply to EMSAM......2 WKS.... Seroquel for imsomnia? /Real, posted by stargazer on November 28, 2006, at 10:05:49
> Real...
>
> I'm taking a very small dose of seroquel (25-50 mg) at night to help with insomnia. Pdoc gave me loads of samples of these.In the past, there was a tendency to be scared of using antipsychotics for fear of developing tardive dyskinesia. More recently, the tendency is to be less scared of using the newer ones, known as the atypicals, particularly Seroquel. Unfortunately, there is still a tendency to be scared of using benzodiazepines. Ativan worked particularly well for me when I had to deal with MAOI-induced insomnia. The fear of benzodiazepines revolves around the word "addiction", when the true issues are of tolerance and dependence. Sometimes you need to adjust the dosage upwards to retain the beneficial effect - big deal. Isn't that what we have to do with the antidepressants? Discontinuing the benzodiazepines often involves a managed tapering of dosage - big deal. Isn't that what we have to do with the antidepressants? What there usually is not is the tendency to compulsively use and crave the benzodiazepines to obtain a psychotropic effect - to get "high". This would be addiction.
I am currently taking an antipsychotic, Abilify, to help mitigate the symptoms of severe bipolar depression. I would not be so afraid to take Seroquel at dosages between 25-50mg for sleep. However, I think I would try a benzodiazepine first. It is a hard decision to make, though. As to which one to choose, there are so many, I can't keep up with them all. I favor Ativan. Restoril isn't quite strong enough for me.
Ed_UK or Yxibow might be able to better help you choose a benzodiazepine for sleep.
- Scott
Posted by stargazer on November 29, 2006, at 9:18:49
In reply to Seroquel for imsomnia? Ed_UK or Yxibow for BZD, posted by SLS on November 29, 2006, at 6:24:59
I was originally put on Seroquel for depression, not insomnia. My depressions tend to be the
hypersomnic type, almost never have had insomnia, but when I did have it, I know what a hellish experience that is."Seroquel as a Monotherapy for Depression", my original posting, did not completely work for me, but DID pull me out of a downward spiral straight into hell, which for me seemed to be precipitated by Cymbalta.
The only reason I stayed on Seroquel after I stopped Cymbalta, was to prevent me from crashing during the washout period before starting EMSAM.
Once I started EMSAM, I asked my pdoc if I could get off Seroquel and he was reluctant to do that, I think from fear of having me relapse. Being aware of all the negatives associated with AP's including TD, I elected to SLOWLY taper myself. This is where I'm at, last night took 25 mg and did not wake up during the night.
Interestingly, my pdoc NEVER said that Seroquel could cause TD and he expressed NO reluctance in prescribing it. He's usually very forthcoming with warnings. I was very reluctant to try it since I have a thing about using meds for other diagnoses (psychoses,schizo) for depression, although it seems to have become the norm, at least here. I'll have to ask him about why he didn't mention TD as a risk. He was very gungho about using Seroquel as a monotherapy for depression. Perhaps at a higher dosage it may have worked.
How common is TD with atypicals? Since my pdoc never mentioned it, I'm thinking the incidence of it may be overblown. My pdoc wanted me to go higher than 200 mg, but the SE's of vertigo (4 falls in the last few months) was too great and I resisted any increase in dosage.
I'll probably be off it in a matter of days. If anyone knows me, I'm a big proponent of only taking what one absolutely needs and at the lowest dose possible. Drug companies hate my type since I'm too conservative for them.
Stargazer
Posted by yxibow on November 29, 2006, at 17:36:36
In reply to Re: Seroquel for imsomnia? Ed_UK or Yxibow for BZD, posted by stargazer on November 29, 2006, at 9:18:49
> I was originally put on Seroquel for depression, not insomnia. My depressions tend to be the
> hypersomnic type, almost never have had insomnia, but when I did have it, I know what a hellish experience that is.
>
> "Seroquel as a Monotherapy for Depression", my original posting, did not completely work for me, but DID pull me out of a downward spiral straight into hell, which for me seemed to be precipitated by Cymbalta.
>
> The only reason I stayed on Seroquel after I stopped Cymbalta, was to prevent me from crashing during the washout period before starting EMSAM.
>
> Once I started EMSAM, I asked my pdoc if I could get off Seroquel and he was reluctant to do that, I think from fear of having me relapse. Being aware of all the negatives associated with AP's including TD, I elected to SLOWLY taper myself. This is where I'm at, last night took 25 mg and did not wake up during the night.
>
> Interestingly, my pdoc NEVER said that Seroquel could cause TD and he expressed NO reluctance in prescribing it. He's usually very forthcoming with warnings. I was very reluctant to try it since I have a thing about using meds for other diagnoses (psychoses,schizo) for depression, although it seems to have become the norm, at least here. I'll have to ask him about why he didn't mention TD as a risk. He was very gungho about using Seroquel as a monotherapy for depression. Perhaps at a higher dosage it may have worked.
>
> How common is TD with atypicals? Since my pdoc never mentioned it, I'm thinking the incidence of it may be overblown. My pdoc wanted me to go higher than 200 mg, but the SE's of vertigo (4 falls in the last few months) was too great and I resisted any increase in dosage.I'm sorry to hear you've had falls -- I take Seroquel and I'm not sure if its vertigo or not but I take it at night and I have to be in bed when it is effective because it tends to cause orthostatic hypotension (low blood pressure), hence no sharp up and down movements. So that type of situation is not uncommon I would imagine.
It's unknown but the aggregate statistics in one study put atypicals at 2% per year as opposed to a much higher percentage for old line drugs. But, this isn't meant to scare you away -- it still isn't known entirely and though there have been cases, they may not have the severity of old line drugs. TD and EPS exist on a sort of continuum and are at least partially dose related.
> I'll probably be off it in a matter of days. If anyone knows me, I'm a big proponent of only taking what one absolutely needs and at the lowest dose possible. Drug companies hate my type since I'm too conservative for them.Actually most reasonable psychopharmacologists are in favour of what is known as the MED (minimum effective dose) of any medication. So you're not at all off kilter there. So are a couple of the leading experts in TD (Drs. Wirshing and Wirshing) in favour of using the least amount of neuroleptic needed.
>
> Stargazer
Posted by yxibow on November 29, 2006, at 17:43:11
In reply to My day 4 not so good, posted by want2breal on November 27, 2006, at 17:00:46
> Glad you are doing so well, Stargazer.
> I am on day 4 of EMSAM, and I'm not feeling too well.
> I posted today, but can't find it anywhere on the board.
> I am on Emsam 6 mg. patch, and take Ambien 10 mg......last night I did not sleep AT ALL!!!!It's possible to take Ambien up to 20mg for sleep. This is obviously up to your doctor and health plan but its now known that it can be taken long term. I've switched back to Lunesta to try it again at 4mg but Lunesta still is somewhat weaker at keeping one asleep than Ambien, for me anyhow.
Otherwise, there are all the usual offlabel antidepressants but I don't particularly favour those concepts, especially Trazodone. Remeron is allright but one would really need to monitor weight.
There's Restoril, but I believe it is more habituating than the pseudobenzodiazepines (Ambien, Lunesta, etc.)
Some also believe in a 25-50mg dose of Seroquel -- the risk of TD is probably in the extreme noise level. I don't know if it would be my first choice before upping the dose of Ambien but you'll have to discuss these choices with your doctor.
> Seriously, I will not be able to stay on this if I can't sleep. This is starting to feel like Concerta and the diet pill I was once on. I had 3 good days, and then by day 4 couldn't sleep, got sick, and then got off!
> Don't know if I can cut this thing in half or what.
> If I have another bad night I will call my dr. tomorrow.
> Take care!
>
Posted by stargazer on December 1, 2006, at 15:16:11
In reply to Re: EMSAM......2 WKS.... Seroquel for imsomnia? /Real, posted by mindevolution on November 29, 2006, at 1:10:39
I will not be posting on my Emsam trial for the next week and a half as I will be on vacation, so the final word is I think it's doing something, mostly enabling me to be functional and regain some of my lost abilities, specifically with motivation and focus. Also my exteme depressed mood has brightened a bit. Stay tuned, I will update post when I return. Good luck to the other Emsam users, new and seasoned vets. P.S I do have residual dizziness but not incapacitating, so hopefully will diminish further.
Stargazer
Posted by maryhelen on December 5, 2006, at 16:36:57
In reply to Re: My day 4 not so good » want2breal, posted by yxibow on November 29, 2006, at 17:43:11
After all of my years of med trials it seems to me that I should know what TD means, but I don't. I am so confused about medications I don't know if I am coming or going half the time. I had a hospitalization for 2 months earlier this year ( about my 8th time as well as 4 treatment centres) and ended up having 13 ECT treatments (third time, ineffective) and was sent home on the following meds:
50 mg. clomipramine
150 mg. trazadone
100 mg. seroquel
15.0 zopicloneI still do not sleep well. I am so tired after 25 years of battling this depression. I use to research every med I was ever on ..... I cannot even remember all of them. Now I feel so hopeless as to ever being helped I don't even have the energy to be proactive in my care. I also have a problem with pain medications .... have a lot of physical disabilities. Percocett, for example, or other types of opiates, is the only relief I get from the depression. Of course I have to take too much to be effective and they are not easily available. My psych is working on me going on buprenorphine and a higher than normal dose of an antidepressant. My system metabolizes drugs at an alarming rate. He seems to indicate Effexor something like 600 mg. I am just waiting, as the bupe has not been available in Canada and special permission has been required for approval from the government. However, I understand now that bupe was made available in November here. I read other sites, and there is an indication for bupe being used for refractory depression. My doc told me that it is just indicated for pain management and to stop taking the other opiates. I just do not know anymore. The depression is devastating and I do know that I cannot continue much longer living such a useless and pointless life. Sorry to go off topic. Just got carried away. I don't even know why I continue to take these meds as they are obviously not working or I would not be so depressed. They were prescribed by the psych doc at the hospital whom I do not see anymore. I guess I am just waiting to see what my own doc puts me on. Thanks for listening.
maryhelen
Posted by yxibow on December 6, 2006, at 0:29:44
In reply to What is TD??, posted by maryhelen on December 5, 2006, at 16:36:57
> After all of my years of med trials it seems to me that I should know what TD means, but I don't. I am so confused about medications I don't know if I am coming or going half the time. I had a hospitalization for 2 months earlier this year ( about my 8th time as well as 4 treatment centres) and ended up having 13 ECT treatments (third time, ineffective) and was sent home on the following meds:
>
> 50 mg. clomipramine
> 150 mg. trazadone
> 100 mg. seroquel
> 15.0 zopiclone
>
> I still do not sleep well. I am so tired after 25 years of battling this depression. I use to research every med I was ever on ..... I cannot even remember all of them. Now I feel so hopeless as to ever being helped I don't even have the energy to be proactive in my care. I also have a problem with pain medications .... have a lot of physical disabilities. Percocett, for example, or other types of opiates, is the only relief I get from the depression. Of course I have to take too much to be effective and they are not easily available. My psych is working on me going on buprenorphine and a higher than normal dose of an antidepressant. My system metabolizes drugs at an alarming rate. He seems to indicate Effexor something like 600 mg. I am just waiting, as the bupe has not been available in Canada and special permission has been required for approval from the government. However, I understand now that bupe was made available in November here. I read other sites, and there is an indication for bupe being used for refractory depression. My doc told me that it is just indicated for pain management and to stop taking the other opiates. I just do not know anymore. The depression is devastating and I do know that I cannot continue much longer living such a useless and pointless life. Sorry to go off topic. Just got carried away. I don't even know why I continue to take these meds as they are obviously not working or I would not be so depressed. They were prescribed by the psych doc at the hospital whom I do not see anymore. I guess I am just waiting to see what my own doc puts me on. Thanks for listening.
>
> maryhelen
TD is Tardive Dyskinesia, a movement disorder caused by primarily neuroleptic (antipsychotic) medications. It is characterized in severity by the AIMS scale and can consist of stereotypy such as orofacial movements, limb jerks, cogwheel rotation, and other displays. To have definite TD, contradictory to intuition, one generally is not aware (at first) that they even have the motions and generally have to be pointed out. Awareness is included in AIMS exams but is not a primary part of diagnosis necessarily. TD and EPS (a fancy name for side effects of neuroleptic and other agents) are sort of on a sliding scale, TD being a more permanent result and EPS being various ongoing side effects as a result of treatment.
Tricyclics such as clomipramine are slightly more common in rareness than SSRIs to cause TD but this is not a major issue in their usage; side effects such as sedation, sweating and other characteristics of that drug class are far more common side effects.
The Seroquel you are taking, while there have been cases of TD, atypical (new) antipsychotics have varyingly been assigned about a 2% per year risk rate across the board by various studies, and Seroquel itself is probably even below that. It unfortunately is the most sedating of all antipsychotics, new or old.
TD can also be caused by extreme alcoholism, although this is also a rare event, and use of benzodiazepines such as Xanax, which is probably even more rare. Generally TD is most common in old line antipsychotics such as haloperidol.Roughly 30% of patients remit, 30% go no further, and 30% develop further problems. There is ongoing research in attempts to tackle TD but it remains an unfortunate part of treatment for BP and Schizophreniform disorders as well as other conditions with antipsychotics. At least a dozen agents have been tried against it, with some minor results with high dose Vitamin E and high dose BuSpar (which itself is a weak antipsychotic in disguise at high doses). Tetrabenazine has had some luck in some cases at the expense of pseudoparkinsonism (handshaking, etc.)
-- Jay
Posted by maryhelen on December 9, 2006, at 21:27:28
In reply to Re: What is TD?? » maryhelen, posted by yxibow on December 6, 2006, at 0:29:44
Hi Jay:
Thank you for your response to my question about TD. Your information is beyond incredible. It is so impressive. Unfortunately, I have to admit that some of it is still hard for me to understand. I have been in psychiatric care for 25 years, and I could not begin to tell you about all the medications I have tried, 3 rounds of shock therapy, four or five treatment centres. So much talk therapy, I cannot stand hearing myself speak anymore. The past is the past, at least for me. Yet, here I sit at 54 years old, disabled still by my depression, hopeless. scared. The only thing I have found that helps to lift my mood is opiates, which are not easy to obtain. Sometimes I do not think I can make it. If it wasn't for my daughter and 4 grandchildren I honestly think I would be gone. I am not proud of this. My life has become useless and pointless. My brain does not work properly. I held a high stress job or 30 years, where you really had to be sharp, think on your feet. I would be incabable to do this now. I even have trouble brushing my teeth. Not being able to work for the last 6 years has been devasating. I used to think that was the worst thing that could happen. Now, it is my inabililty not to be able to see my family.
By the way you described the meds that I told you that I am on now, certainly seem to be indicated for sedation to be able to sleep. Of course this is of major importance. However, they are not helping with the depression and I do not see the doctor who prescribed them at the hospital. I need the depression to be, if not gone, than to get some relief from it. My goodness, this is such a devastating illness.
When I was hosptialized earlier this year, I came to know some of the other patients. What I found disturbing was the way Seroquel was prescribed. It did not seem to matter what diagnosis one had, Seroquel was the first line medication prescribed to almost everyone.... for instance I have depression, either seriously depressed, suicially depressed, depressed, never happy and it is getting worse, I do not have psychosis (don't really know what it is, I do not hear voices, yes I can obesses, and I do take percs for my pain if I can get them, .... although I have unrelenting pain and the opiates help, it is the lift in my mood that drives me to try and get them. At the hopital, I was put on 100 mg. of Seroquel. Another young women, mid twenties presented with bipolar, cocaine addiction, of course the ups and down to suicidal depression. She was on 825 mg. of seroquel. I had never heard anyone on such a high dose. Others hearing voices, talking to the voices inside their head, catotonic patients, eating disordered patients, paranoid, dilusional,etc... all on Sereqouel. How can this be? I understand that it is an antipsycotic med. I really do not know what being antipsychotic means, and except being on it for sleep, it kinda freaks me out. One pill fits all patients ... After all of my years of med trials it seems to me that I should know what TD means, but I didn't. I am so confused about medications I don't know if I am coming or going half the time. During my hospitalization this year (about my 8th time as well as 4 treatment centres) ended up having 13 ECT treatments (third rounds, ineffective). I still do not sleep well. I am so tired after 25 years of battling this depression. I use to research every med I was ever on ..... I cannot even remember all of them. Now I feel so hopeless as to ever being helped I don't even have the energy to be proactive in my care. I also have a problem with pain medications .... have a lot of physical disabilities. Percocett, for example, or other types of opiates, is the only relief I get from the pain and the depression. Of course I have to take too much to be effective and they are not easily available. My psych is working on me going on buprenorphine and a higher than normal dose of an antidepressant. My system metabolizes drugs at an alarming rate. He seems to indicate Effexor something like 600 mg. I am just waiting, as the bupe has not been available in Canada and special permission has been required for approval from the government. However, I understand now that bupe was made available in November here. I read other sites, and there is an indication for bupe being used for refractory depression. My doc told me that it is just indicated for pain management and to stop taking the other opiates. I just do not know anymore. The depression is devastating and I do know if I can continue much longer living such a useless and pointless life. Sorry to go off topic. Just got carried away. I don't even know why I continue to take these meds as they are obviously not working or I would not be so depressed. I guess I will just keep taking them until my psych doc makes a decision on the new meds. I have told thim the best way I know how I am feeling without him having to hospitalize me.
Now that I have the information from you about TD, the only time I could say that I notice it is when I am falling asleep. Sometimes I jerk so bad I think I am two feet off the bed. For any other movement disorder, I live alone so there would be no one around me to notice anything.
Thank you again Jay, I hope I wasn't too much off track trying to understand.
maryhelen
Posted by stargazer on December 13, 2006, at 9:10:19
In reply to Thank you for your response Jay about TD...., posted by maryhelen on December 9, 2006, at 21:27:28
Hi, just checking in to update my Emsam post for anyone interested.
Duration: approx 1 month now.
Effects:
Positive: more motivation, decrease in anxiety, better focus, no dietary restrictions.Negative: patch falls off sometimes, cost (have samples now but not sure if my insurance will cover it, I will fight if they don't)
I see my pdoc today and although I am feeling better than a few months ago, I don't really feel great. That is one of the problems with depression...being able to judge how you feel and knowing that you are getting some response or not.
I'd like to keep posting and hear from others on Emsam.
P.S. Still take 25 mg of seroquel to sleep prn.
Stargazer
Posted by Phillipa on December 13, 2006, at 19:24:05
In reply to Emsam Users, length of time, effects,pros/cons?, posted by stargazer on December 13, 2006, at 9:10:19
Please keep posting about the EMSAM. So far you are the only one that has posted that didn't develop insomnia or anxiety. Love Phillipa
Posted by stargazer on December 15, 2006, at 8:44:29
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by Phillipa on December 13, 2006, at 19:24:05
About a month now on Emsam 6 mg patch. Little side effects, depression seems relatively quiet now. No great highs or lows but I have interest in doing things, don't seem comatose, often hard to tell how it's working in the early phases.
My pdoc wanted me to increase the Seroquel which I occasionally taken if I can't sleep. I told him I was reluctant to do this now since I want to see how another month or so goes before messing with the Emsam alone. He was oK with this plan.
That's it...slow, uneventful course w Emsam.
Stargazer
Posted by CrimsonVik on December 18, 2006, at 0:06:13
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by Phillipa on December 13, 2006, at 19:24:05
> Please keep posting about the EMSAM. So far you are the only one that has posted that didn't develop insomnia or anxiety. Love Phillipa
------------------------------------------------
I never got insomnia on Emsam, just oral Selegiline the first few nights.
Actually I have a couple patchs left and using a bit of both.Vik
Posted by CrimsonVik on December 18, 2006, at 0:26:13
In reply to Emsam Users, length of time, effects,pros/cons?, posted by stargazer on December 13, 2006, at 9:10:19
> Hi, just checking in to update my Emsam post for anyone interested.
>
> Duration: approx 1 month now.
>
> Effects:
> Positive: more motivation, decrease in anxiety, better focus, no dietary restrictions.
>
> Negative: patch falls off sometimes, cost (have samples now but not sure if my insurance will cover it, I will fight if they don't)
>
> I see my pdoc today and although I am feeling better than a few months ago, I don't really feel great. That is one of the problems with depression...being able to judge how you feel and knowing that you are getting some response or not.
>
> I'd like to keep posting and hear from others on Emsam.
>
> P.S. Still take 25 mg of seroquel to sleep prn.
>
> Stargazer
>_________________________________________________
If it's too costly you can get Selegiline pills in Generic. At least in the US.
Vik
Posted by stargazer on December 18, 2006, at 0:39:14
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by CrimsonVik on December 18, 2006, at 0:26:13
Thanks I was wondering if the two are interchangable? I though others had said they didn't work the same way. Have you found them to be similar? I may have to pay for the Emsam if my insuror doesn't cover it, but I'm allfor the cheapest way to go as it works. Im a firm believer in generics although my pdoc feels otherwise. No sense supporting drug companies that make billions off us every year and most of the drugs don't work and I end up with hundreds (try to avoid this) of pills that never get used.
Stargazer
Posted by CrimsonVik on December 18, 2006, at 4:19:12
In reply to Re: Emsam Users,/Oral Selig-same as Emsam?/Vik, posted by stargazer on December 18, 2006, at 0:39:14
> Thanks I was wondering if the two are interchangable? I though others had said they didn't work the same way. Have you found them to be similar? I may have to pay for the Emsam if my insuror doesn't cover it, but I'm allfor the cheapest way to go as it works. Im a firm believer in generics although my pdoc feels otherwise. No sense supporting drug companies that make billions off us every year and most of the drugs don't work and I end up with hundreds (try to avoid this) of pills that never get used.
>
> Stargazer_________________________________________________
You would have to follow the MAOI diet if you take the 5 mg. tablet more than twice a day (as with 9 and 12 mg. Emsam) but Emsam is Selegiline, like the tablets.
I'm on 10 mg., 2 tabs, morning and night.
If you are on 6 mg. and want to stay on Emsam, there's always 9 and 12.Vicki
Posted by Phillipa on December 18, 2006, at 18:25:30
In reply to Re: Emsam Users,/Oral Selig-same as Emsam?/Vik, posted by CrimsonVik on December 18, 2006, at 4:19:12
So you went off the EMSAM? May I ask the reason? Love Phillipa
Posted by stargazer on December 19, 2006, at 0:15:27
In reply to Re: Emsam Users, length of time, effects,pros/cons? » stargazer, posted by CrimsonVik on December 18, 2006, at 0:26:13
Emsam will not be covered by my insurance so I may not fight them on it but try selegilene. I only have about 6 patches left and I am not due to see my doc until 1/2/07. He gave me a script for Emsam but if I take Selegilene what dose should I take if I'm on the 6 mg patch of Emsam?
I wasn't clear from your post what the conversion is between the patch and the pill.
If it works I don't really care that much as I have been able to heed the dietary restrictions before but I hope the selegilene works like Emsam else I will have to fight my insuror.
Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
SG
Posted by CrimsonVik on December 19, 2006, at 1:33:53
In reply to Re: Emsam Users,/Oral Selig-same as Emsam?/Vik » CrimsonVik, posted by Phillipa on December 18, 2006, at 18:25:30
> So you went off the EMSAM? May I ask the reason? Love Phillipa
6 mg. patch wasn't helping anymore and at the $45 cost I wanted to try the pills.
I possibly will try the 12 mg. patch down the road, though.Vik
Posted by CrimsonVik on December 19, 2006, at 1:54:29
In reply to Just found out Emsam is nonformulary/Vik, posted by stargazer on December 19, 2006, at 0:15:27
> Emsam will not be covered by my insurance so I may not fight them on it but try selegilene. I only have about 6 patches left and I am not due to see my doc until 1/2/07. He gave me a script for Emsam but if I take Selegilene what dose should I take if I'm on the 6 mg patch of Emsam?
>
> I wasn't clear from your post what the conversion is between the patch and the pill.
>
> If it works I don't really care that much as I have been able to heed the dietary restrictions before but I hope the selegilene works like Emsam else I will have to fight my insuror.
>
> Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
>
> SG__________________________________________________
From what I get from the insert that came with Emsam, there is only 6 mg. Selegiline in your patch, with 20 being the patch size.
It's just my guess they would still give you two of the 5 mg. per day, one in the morning and one in the aft. That seems to be a common dose for even Parkinson's and I don't think it requires the DIET like the 9 & 12 patch and any oral dose over 10 mg.Vik
Posted by psychobot5000 on December 19, 2006, at 15:08:18
In reply to Just found out Emsam is nonformulary/Vik, posted by stargazer on December 19, 2006, at 0:15:27
It is almost impossible to get an equivalent to 6mg EMSAM from oral selegiling--the doses would be alost absurdly high. --According to my math, you would need not five or ten mg, but 102mg of oral tablets to equal just a 6mg EMSAM patch. This is because the transdermal system is far more effective at getting it into your bloodstream. The oral version has 4.4% bioavailability, compared with about 74% from the patch--about seventeen times higher.
As far as I understand, the normal max-dose for oral pills is 60mg, but that some docs push it to about 85mg. It's still not equivalent to EMSAM, as far as I understand, but you also have to deal with significant levels of amphetamine metabolites that are almost absent in the patch. And there are the dietary restrictions. So basically, the two delivery systems are not really equivalent in terms of their effects.Here's some more of my blather about it:
http://www.dr-bob.org/babble/20061206/msgs/711307.htmlPsychbot
> Is the 6 mg patch the equivalent of 5 mg pill or 10 mg (2 pills)?
>
> SG
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