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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 122 to 146 of 212. Go back in thread:
Posted by SLS on August 5, 2009, at 15:52:33
In reply to Re: Blood tests, posted by qbsbrown on August 5, 2009, at 15:36:47
> You mean try the 600mgs today and see how i feel tomorrow?
That's what I was thinking, since you have been taking Tegretol for over a week. Remember, 400mg now does not equal 400mg before. The drug autoinduces its own metabolism. You would have to take 600mg now to equal the 400mg when you first started. Give it a shot. You can always discontinue the drug should you be reluctant to go any further. It would certainly be an important discovery if you were to only need 200mg.
- Scott
Posted by qbsbrown on August 5, 2009, at 16:10:01
In reply to Re: Blood tests, posted by SLS on August 5, 2009, at 15:52:33
> > You mean try the 600mgs today and see how i feel tomorrow?
>
> That's what I was thinking, since you have been taking Tegretol for over a week. Remember, 400mg now does not equal 400mg before. The drug autoinduces its own metabolism. You would have to take 600mg now to equal the 400mg when you first started. Give it a shot. You can always discontinue the drug should you be reluctant to go any further. It would certainly be an important discovery if you were to only need 200mg.
>
>
> - ScottOh, i didn't realize that it was equaling 400mgs anymore. And also the worry that it is metabolizing the diazepam quicker too huh? If i were to come off of it, there would be a serious backlash and flood of crap coming over me. There was just for taking 2 pills of depakote. Same with a couple doses of trileptal, effected me for a while.
300 was good in the sense as i was out the door, still feeling high and crazy etc, but not seeing ugly/dysphoric/depressive things.
Let's hope for the best.
Regards,
Brian
Posted by qbsbrown on August 5, 2009, at 17:16:32
In reply to Re: Blood tests, posted by qbsbrown on August 5, 2009, at 16:10:01
"Fundamental withdrawal symptoms (like hypersensitivity to sensory stimuli, abnormal perception of movement, depersonalisation or derealisation) were also less severe in the group treated with CBZ compared with the group not receiving that treatment"
http://www.springerlink.com/content/p487785278614552/
Brian
Posted by qbsbrown on August 5, 2009, at 17:57:49
In reply to Re: Blood tests, posted by SLS on August 5, 2009, at 15:28:38
if 600 would go 200-200-200, what would 800 be? 200-200-400?
Regards,
Brian
Posted by qbsbrown on August 5, 2009, at 21:09:03
In reply to Re: Blood tests, posted by qbsbrown on August 5, 2009, at 17:57:49
Well, the 200mg doses seem to work better. But they work pretty well for a couple of hours, then crash, and bad headaches. I've read that some take it 4 times per day, but any dose under 200mgs doesn't do anything for me.
Is this a matter of getting through the initial side effects, and getting a steady blood state going?
I do like dosing at same time as diazepam, and I think that there might be something to that, considering that they are both immediately released.
Can you let me know if you find any more benefit to 4 doses a day? If there's a chance that I can make it to 800mgs, perhaps then it'd be easier to do 4 times a day.
Regards,
Brian
Posted by qbsbrown on August 5, 2009, at 23:06:00
In reply to Dosing Scott, posted by qbsbrown on August 5, 2009, at 21:09:03
Well the 200mgs only seems to last a couple of hours. Does it need to build up in my system? Or is it more beneficial to switch to the ER version and take it 3 times a day. I did not like it in the fact that it felt like the trileptal, some weird/strange things that were very similar.
Your thoughts?
Regards,
Brian
Posted by SLS on August 6, 2009, at 8:22:47
In reply to Dosing Scott, posted by qbsbrown on August 5, 2009, at 21:09:03
Based upon your favorable response to raising the dosage to 600mg, I would go up one more time to 800mg when you are ready - perhaps 5 more days. Then, it will be your decision as to when you would like to continue your taper of diazepam.
Sound like a plan?
- Scott
Posted by qbsbrown on August 6, 2009, at 12:22:10
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 8:22:47
What about the medication lasting a couple of hours, then totally fading off? Is it more beneficial to switch to the ER version, or to dose 4 times a day if/when ready to raise dose?
The ER version was giving me some of the exact yucky feelings that I had from Trileptal that I didn't like.
Your thoughts?
Regards,
Brian
Posted by SLS on August 6, 2009, at 13:12:23
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 12:22:10
> What about the medication lasting a couple of hours, then totally fading off? Is it more beneficial to switch to the ER version, or to dose 4 times a day if/when ready to raise dose?
One is supposed to dose four times a day. However, once you are at a high enough dosage, you might be able to dose three time a day. You'll just have to experiment. At 600mg, I would first try 200mg every 8 hours. At 800mg, you could try 200mg-200mg-400mg.
- Scott
Posted by qbsbrown on August 6, 2009, at 13:52:09
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 13:12:23
> > What about the medication lasting a couple of hours, then totally fading off? Is it more beneficial to switch to the ER version, or to dose 4 times a day if/when ready to raise dose?
>
> One is supposed to dose four times a day. However, once you are at a high enough dosage, you might be able to dose three time a day. You'll just have to experiment. At 600mg, I would first try 200mg every 8 hours. At 800mg, you could try 200mg-200mg-400mg.
>
>
> - ScottI do have a fast med metabolism. I can feel the effects, then it completely wears off after a couple of hours.
I have been dosing 8 hours apart, along w/ the diazepam, and for sure feels like interdose wd.
I wonder about the ER version 3 times a day, but just taking that for 2 days, and having really bad memories of my trileptal day came back.
So I could hold this for 5 days, then try the 800 if tolerable. Then I could dose 250-250-300 would probably work better for me, or 2-2-4.
Or if on the ER version, I could go 200-200-400.
Why do you think that the ER version would mimic some effects of trileptal, that the immediate release doesn't?
Posted by qbsbrown on August 6, 2009, at 15:03:48
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 13:52:09
Even with Trileptal, which is supposed to be 2 times daily, I had to take multiple times, due to my peaks and valleys.
Do you think that the ER version, 3 times a day is worth a week trial? Or the regular version 4 times a day? It seems to last about 4 hours.
Posted by SLS on August 6, 2009, at 15:45:16
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 15:03:48
> Do you think that the ER version, 3 times a day is worth a week trial? Or the regular version 4 times a day? It seems to last about 4 hours.
My guess is that the ER version would serve you well. You probably just weren't taking enough at the time you experienced instability. However, I think you should stay with what you see is working right now. You need to be more patient and allow the blood levels to build up. I do think you will end up at 800mg, but you still need to be methodical in your titration.
- Scott
Posted by qbsbrown on August 6, 2009, at 16:01:09
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 15:45:16
So are you saying not to jump ship yet to the ER version quite yet? I mean it HAS to be the same med, just the extended version right?
How long would you advise staying on the generic immediate release, before switching?
As you can tell from my history, I have a bad habit of upping, lowering, changing, switching etc.
But if I feel a benefit from 200mgs, and that it fades w/ in a couple of hours, then isn't it common sense that a 200mg med that is extended released, would be of more benefit?
And how could/would it be acting just like the trileptal did? I promise it wasn't psychosomatic. It was strange, just after a few doses.
Regards,
Brian
Posted by SLS on August 6, 2009, at 16:42:29
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 16:01:09
> So are you saying not to jump ship yet to the ER version quite yet? I mean it HAS to be the same med, just the extended version right?
It is up to you. In retrospect, do you believe that had you continued with the ER, you would be feeling better now?
> How long would you advise staying on the generic immediate release, before switching?
I would switch right now. 200mg three times a day.
Wait 5 days.
400mg twice a day.
Wait 5 days.
Begin taper of diazepam.
- Scott
Posted by qbsbrown on August 6, 2009, at 16:57:49
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 16:42:29
> > So are you saying not to jump ship yet to the ER version quite yet? I mean it HAS to be the same med, just the extended version right?
>
> It is up to you. In retrospect, do you believe that had you continued with the ER, you would be feeling better now?
>
> > How long would you advise staying on the generic immediate release, before switching?
>
> I would switch right now. 200mg three times a day.
>
> Wait 5 days.
>
> 400mg twice a day.
>
> Wait 5 days.
>
> Begin taper of diazepam.
>
>
> - ScottIn retrospect, me taking it for 3 days, and experiencing some of the exact horrible same things that I did on Trileptal scared the living the crap out of me, and I said I would not go back to feeling like that again. I am afraid that if i do go back, that those similar feelings will return.
If I took it, i'd rather stay at the 3 doses. Even at 800, I think i'd feel more comfortable going 200-200-400
I've taken 2 doses of 200mgs generic today, so it's a no go for today. I have a stressful event tomorrow, so I probably don't want to switch it up tomorrow after being on generic for 4 straight days do i? Or would it perhaps aleviate things for me, or my brain might be adjusting?
Saturday is wide open for me, and Sunday I have very little affairs going on. So the weekend could be a prime trial time.
Regards,
Brian
Posted by qbsbrown on August 6, 2009, at 17:41:41
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 16:57:49
If I wanted to make the switch to the ER, and I've already taken 2 200mg generics today, can I start the ER tonight? Or best to start on a clean slate tomorrow?
Regards,
Brian
Posted by qbsbrown on August 6, 2009, at 20:16:36
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 17:41:41
Yesterday was first night on 600. Some symptoms better, some worse. Did not wake up to the extreme first shade of light. I did have heart palpitations just from rolling over in bed.
Typing worse.
Some of my extreme obsessional/compulsive habits decreased.I was able to go to the mall today, and things were not depressing and/or dysphoric, good sign.
Dry mouth worse.
Interdose wd between diaz doses worse.
I think we're on the right track. Think need to get the dose up and start cutting the diazepam. I don't like to hold the diaz longer than 2 weeks, but looks like we might be looking at a month hold on this one. Longest i've gone is 3 weeks.
Now the major decision is to ER or not to ER, that is the question.
Thanks for the input.
Regards,
Brian
Posted by qbsbrown on August 6, 2009, at 20:45:20
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 20:16:36
Wow Scott, I feel like my head is on fire, and that I'm speed. This happens. But it's better than being stuck in my hell of a prison.
I wonder if the ER version would help keep the flames out, or keep me in a worse hell of a prison. I wonder if the generic does what it does, wears off, then my head is OFF to the races.
Posted by qbsbrown on August 6, 2009, at 21:21:26
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 20:45:20
Could this be the tegretol lowering the diaz? this is what it feels like when i cut the dose. Like i'm on speed, things going a million miles an hour, like my nails are dug in holding on for dear life. But it's not being depressed and being stuck in my head.
Your thoughts, observations?
Brian
Posted by SLS on August 6, 2009, at 22:20:07
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 21:21:26
Tegretol will lower the blood levels of diazepam. I just don't know by how much.
- Scott
Posted by qbsbrown on August 6, 2009, at 22:25:46
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 22:20:07
> Tegretol will lower the blood levels of diazepam. I just don't know by how much.
>
>
> - ScottWell I'm back to feeling stoned, high, on acid/lsd and speed at the same time.
Isn't it defeating the purpose of a medicine that is supposed to help tapering, that actually lowers the blood levels?
So basically I'm decreasing my dose w/o actually decreasing it? Great.
I hate anticonvulsants in general because they slow down my racing thoughts a little, but so that i'm stuck and trapped in my head and can watch those thoughts. It takes a really large dose of an anticonvulsant to slow down the racing thoughts and to be comfortable.
Well are we back to square 1, or is this progress?
What is your advice?
Brian
Posted by qbsbrown on August 6, 2009, at 23:31:45
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 22:20:07
So I am 100 percent completely out of my mind now, lol. It's kinda funny. And the ironic thing is, is that anxiety is the last thing that i feel. i was just running a bunch of errands with my friend, which I would never do, and was just high out of my mind.
So either this crap is working, or has just completely lowered my diaz levels making me more out of my mind.
Regards,
Brian
Posted by SLS on August 7, 2009, at 7:30:45
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 23:31:45
I think the cognitive effects will dissipate. You know, one is supposed to start at 400mg and increase by 100mg or 200mg every week. You've gone faster than that, so side effects must be expected to be more prominent at first.
I would continue with the Tegretol. If you feel the need, you can take a bit more diazepam, but my feeling is that this won't be necessary in a few more days. Try to push past the side effects.
- Scott
Posted by qbsbrown on August 7, 2009, at 9:34:07
In reply to Re: Dosing Scott, posted by SLS on August 7, 2009, at 7:30:45
> I think the cognitive effects will dissipate. You know, one is supposed to start at 400mg and increase by 100mg or 200mg every week. You've gone faster than that, so side effects must be expected to be more prominent at first.
>
> I would continue with the Tegretol. If you feel the need, you can take a bit more diazepam, but my feeling is that this won't be necessary in a few more days. Try to push past the side effects.
>
>
> - ScottWell I actually was at 400mgs for 6 days, so not that much out of the norm right.
My night was pretty good (my last 3 days have been seemingly improved), but I was up in the middle of the night (I have intrusive thoughts 24/7), and the sunrise/sunlight sensitivity came back. This seems to only go away after raising the Tegretol dose. This went away yesterday after my first night of 600mgs, now has gone away after 2 days of 600.
Today is day 3 on 600mgs, do I want to hold for at least 5 days? I wonder how high I will have to chase it. I saw a prominent bipolar doc that said he gets his patients to at least 1200mgs, but I'm sure it's different for benzo wd.
I think i'm a very fast metabolizer obviously.Regards,
Brian
Posted by SLS on August 7, 2009, at 9:47:09
In reply to Re: Dosing Scott, posted by qbsbrown on August 7, 2009, at 9:34:07
> > I think the cognitive effects will dissipate. You know, one is supposed to start at 400mg and increase by 100mg or 200mg every week. You've gone faster than that, so side effects must be expected to be more prominent at first.
> >
> > I would continue with the Tegretol. If you feel the need, you can take a bit more diazepam, but my feeling is that this won't be necessary in a few more days. Try to push past the side effects.
> >
> >
> > - Scott
>
> Well I actually was at 400mgs for 6 days, so not that much out of the norm right.
>
> My night was pretty good (my last 3 days have been seemingly improved), but I was up in the middle of the night (I have intrusive thoughts 24/7), and the sunrise/sunlight sensitivity came back. This seems to only go away after raising the Tegretol dose. This went away yesterday after my first night of 600mgs, now has gone away after 2 days of 600.
> Today is day 3 on 600mgs, do I want to hold for at least 5 days? I wonder how high I will have to chase it. I saw a prominent bipolar doc that said he gets his patients to at least 1200mgs, but I'm sure it's different for benzo wd.
> I think i'm a very fast metabolizer obviously.
>
> Regards,
>
> BrianI think you are on the right track. I think it is ideal to wait for the WD symptoms to stabilize before beginning your taper. Waiting 5 days to raise the dosage to 800mg seems prudent. You could get a blood level of Tegretol, but I am not sure how useful that would be. You would want to find the minimum dosage necessary to allow you to taper the diazepam successfully. The best way to go about this is to titrate the dosage clinically and observe the results.
- Scott
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