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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by geekUK on October 2, 2001, at 17:49:11
depakote really tires me, used to send me to sleep without fail 3 hrs after taking. still sedated and feels slowing. so I am thinking of trying lithium to test if it is better or worse, also the isea of taking a elemental salt is more apealing than a long chain fatty acid - in a body temple way. the idea of a bastardised drug is also offputting, espec. in the uk where dep. is only officaly used for epilepsy. lead to probems convincing (w****rs) that you are not epileptic. so any ideas?
Posted by Chloe on October 2, 2001, at 18:15:44
In reply to considering switching depakote to lithium?, posted by geekUK on October 2, 2001, at 17:49:11
I just switched from an long line of AC's (Tegretol, depakote, trileptal) over the years to lithium and I am so glad I did.
I was quite hesistant to try Li, since I have tried it in the past, and hated the side effects of tremor and nausea. BUT, this go around, I am taking the extended release form and it is so much easier to tolerate! No complaints really, in the side effect department.
I vote for giving it a try. But make sure your doctor gives you the ER formula. It has a much smoother, gentler effect. And I too, prefer putting a more "natural" salt in my body opposed to a drug.
I am sorry you have to suffer with stigmas over there.Take care
Chloe
Posted by Squiggles on October 2, 2001, at 21:52:23
In reply to Re: considering switching depakote to lithium? » geekUK, posted by Chloe on October 2, 2001, at 18:15:44
> I just switched from an long line of AC's (Tegretol, depakote, trileptal) over the years to lithium and I am so glad I did.
> I was quite hesistant to try Li, since I have tried it in the past, and hated the side effects of tremor and nausea. BUT, this go around, I am taking the extended release form and it is so much easier to tolerate! No complaints really, in the side effect department.
> I vote for giving it a try. But make sure your doctor gives you the ER formula. It has a much smoother, gentler effect. And I too, prefer putting a more "natural" salt in my body opposed to a drug.
> I am sorry you have to suffer with stigmas over there.
>
> Take care
> Chloe
That's good to know Chloe. I do recall asking
for the ER formula from my doctor, but I think
it is not available in Canada. I sometimes
get some gastro difficulty, no tremor that I
can identify ( I believe that tremor occurs in
the hands when it does with lithium from what
I have read ). I am quite amazed by this drug
as I have been taking it for close to 20 years
and have never felt depressed. I do have to
take a thyroxine supplement though.Squiggles
Posted by Chloe on October 3, 2001, at 22:16:32
In reply to Re: considering switching depakote to lithium?, posted by Squiggles on October 2, 2001, at 21:52:23
Hi Squiggles,
I would be suprised if they did not have the ER formula in Canada. But of course I have no idea living in the states. But when you have to renew your script, perhaps you should ask you doc then. Can't hurt!Now you are quite a veteren of lithium. May I ask, do you ever experience any internal pulsing or a caffeinated feeling (without caffeine)? I feel this energized throbbing in my body, and I just can't seem to find anyone else on Li who experiences this. Do you have any insight on this?
Thanks,
Chloe
Posted by SLS on October 6, 2001, at 0:05:14
In reply to considering switching depakote to lithium?, posted by geekUK on October 2, 2001, at 17:49:11
> depakote really tires me, used to send me to sleep without fail 3 hrs after taking. still sedated and feels slowing. so I am thinking of trying lithium to test if it is better or worse, also the isea of taking a elemental salt is more apealing than a long chain fatty acid - in a body temple way. the idea of a bastardised drug is also offputting, espec. in the uk where dep. is only officaly used for epilepsy. lead to probems convincing (w****rs) that you are not epileptic. so any ideas?
Why don't you take all of your Depakote at bedtime? There is also a new ER extended release preparation. You should be able to take either version once a day.
Is Depakote effectively treating your condition otherwise? What other mood stabilizers have you tried, and how did you respond to them?
If Depakote is your best choice disregarding sleepiness, perhaps you can either reduce the dosage (I'm really not sure that would help) or treat the sedation with caffeine or a stimulant.
Lithium is a good drug, to be sure. Although it is but a simple ion, it can very quickly become toxic - more so than Depakote. Lithium and arsenic are both simple elements.
- Scott
Posted by Squiggles on October 8, 2001, at 12:47:04
In reply to Re: considering switching depakote to lithium? » Squiggles, posted by Chloe on October 3, 2001, at 22:16:32
> Hi Squiggles,
> I would be suprised if they did not have the ER formula in Canada. But of course I have no idea living in the states. But when you have to renew your script, perhaps you should ask you doc then. Can't hurt!
>
> Now you are quite a veteren of lithium. May I ask, do you ever experience any internal pulsing or a caffeinated feeling (without caffeine)? I feel this energized throbbing in my body, and I just can't seem to find anyone else on Li who experiences this. Do you have any insight on this?
> Thanks,
> Chloe
Chloe please excuse me, I did not reload the
messages on Dr. Bob's site and just saw your
question:Coffee consumption does have an effect on lithium.
If I remember correctly, coffee consumption
increases Li levels, here is a link:Squiggles
http://www.healthwell.com/healthnotes/Drug/Lithium.cfm
Posted by SLS on October 8, 2001, at 14:16:52
In reply to Re: considering switching depakote to lithium?, posted by Squiggles on October 8, 2001, at 12:47:04
> > Hi Squiggles,
> > I would be suprised if they did not have the ER formula in Canada. But of course I have no idea living in the states. But when you have to renew your script, perhaps you should ask you doc then. Can't hurt!
> >
> > Now you are quite a veteren of lithium. May I ask, do you ever experience any internal pulsing or a caffeinated feeling (without caffeine)? I feel this energized throbbing in my body, and I just can't seem to find anyone else on Li who experiences this. Do you have any insight on this?
> > Thanks,
> > Chloe
>
>
> Chloe please excuse me, I did not reload the
> messages on Dr. Bob's site and just saw your
> question:
>
> Coffee consumption does have an effect on lithium.
> If I remember correctly, coffee consumption
> increases Li levels, here is a link:
Hi.I think it's the other way around.
Generally speaking, one can drink caffeinated beverages as long as the intake remains the same on a daily basis. If you establish your therapeutic blood levels while drinking 10 cups of coffee a day, then they should remain the same as long as you continue to drink the same 10 cups a day. I you were to reduce this to 2 cups a day, the blood-level of lithium would rise, necessitating a reduction in dosagee. I guess caffeine makes you piss out lithium quicker.
- Scott
Posted by Squiggles on October 9, 2001, at 11:08:22
In reply to Re: considering switching depakote to lithium?, posted by SLS on October 8, 2001, at 14:16:52
> > > Hi Squiggles,
> > > I would be suprised if they did not have the ER formula in Canada. But of course I have no idea living in the states. But when you have to renew your script, perhaps you should ask you doc then. Can't hurt!
> > >
> > > Now you are quite a veteren of lithium. May I ask, do you ever experience any internal pulsing or a caffeinated feeling (without caffeine)? I feel this energized throbbing in my body, and I just can't seem to find anyone else on Li who experiences this. Do you have any insight on this?
> > > Thanks,
> > > Chloe
> >
> >
> > Chloe please excuse me, I did not reload the
> > messages on Dr. Bob's site and just saw your
> > question:
> >
> > Coffee consumption does have an effect on lithium.
> > If I remember correctly, coffee consumption
> > increases Li levels, here is a link:
>
>
> Hi.
>
> I think it's the other way around.
>
> Generally speaking, one can drink caffeinated beverages as long as the intake remains the same on a daily basis. If you establish your therapeutic blood levels while drinking 10 cups of coffee a day, then they should remain the same as long as you continue to drink the same 10 cups a day. I you were to reduce this to 2 cups a day, the blood-level of lithium would rise, necessitating a reduction in dosagee. I guess caffeine makes you piss out lithium quicker.
>
>
> - Scott______________
Scott,
I think "The Virtual Hospital" is as good an
authoritative guide as you can get on psychiatric
drugs, etc.On the issue, of coffee consumption and lithium;
take a look at the bottom part of this article:'reduction of coffee consumption (form the normal
habit presumably) INCREASES toxic and side effects
of lithium.I understand that you would imagine that you
urinate the lithium out, but keep in mind, that
you may also urinate water, and liquids, it would
act as a diuretic in other words. And as
you probably know diuretics are not good with
lithium because they are dehydrating.Squiggles
http://www.vh.org/Patients/IHB/Psych/Medications/lithium2.html
Posted by lizbeth on May 13, 2002, at 16:54:36
In reply to Re: considering switching depakote to lithium?, posted by Squiggles on October 9, 2001, at 11:08:22
Hi,
I'm on Depakote Sprinkle 625 mg. and Prozac 30 mg. My pdoc suggested trying Lithium 300 mg. to start and moving up to 600 mg. if it really works (lowering the Dep. to 500 mg. and lower if I stay on it).
From past posts, it sounds like I should push for an Extended Release version. I asked him about it and he said he's seen no huge difference, but I think he was thinking in terms of efficacy and not side effects. I've got a script for the regular Lithium. Should I call and ask for ER? Will it make that much of a difference. Part of me just wants to try the regular Lithium tonight to give it a try (I'll have to wait until tomorrow to try ER).
Thanks,
Elizabeth
Posted by JohnX2 on May 13, 2002, at 22:49:53
In reply to Starting Lithium--should I ask for ER version?, posted by lizbeth on May 13, 2002, at 16:54:36
> Hi,
>
> I'm on Depakote Sprinkle 625 mg. and Prozac 30 mg. My pdoc suggested trying Lithium 300 mg. to start and moving up to 600 mg. if it really works (lowering the Dep. to 500 mg. and lower if I stay on it).
>
> From past posts, it sounds like I should push for an Extended Release version. I asked him about it and he said he's seen no huge difference, but I think he was thinking in terms of efficacy and not side effects. I've got a script for the regular Lithium. Should I call and ask for ER? Will it make that much of a difference. Part of me just wants to try the regular Lithium tonight to give it a try (I'll have to wait until tomorrow to try ER).
>
> Thanks,
> ElizabethHi Elizabeth,
Today I popped my 1st lithobid (extended release lithium).
My pdoc seemed to indicate that the extended release may have
"smoother" action and less overbearing side effects as the
medicine does not spike up in your body.I haven't heard much anecdotal information from other patients
who have tried the ER vs regular version.Some people recommended "Eskalith", but I don't recall off the top
of my head what is different from that and lithobid? (There were
some long threads on this for me..)Good Luck,
John
Posted by Ritch on May 14, 2002, at 9:16:42
In reply to Re: Starting Lithium--should I ask for ER version? » lizbeth, posted by JohnX2 on May 13, 2002, at 22:49:53
> > Hi,
> >
> > I'm on Depakote Sprinkle 625 mg. and Prozac 30 mg. My pdoc suggested trying Lithium 300 mg. to start and moving up to 600 mg. if it really works (lowering the Dep. to 500 mg. and lower if I stay on it).
> >
> > From past posts, it sounds like I should push for an Extended Release version. I asked him about it and he said he's seen no huge difference, but I think he was thinking in terms of efficacy and not side effects. I've got a script for the regular Lithium. Should I call and ask for ER? Will it make that much of a difference. Part of me just wants to try the regular Lithium tonight to give it a try (I'll have to wait until tomorrow to try ER).
> >
> > Thanks,
> > Elizabeth
>
> Hi Elizabeth,
>
> Today I popped my 1st lithobid (extended release lithium).
> My pdoc seemed to indicate that the extended release may have
> "smoother" action and less overbearing side effects as the
> medicine does not spike up in your body.
>
> I haven't heard much anecdotal information from other patients
> who have tried the ER vs regular version.
>
> Some people recommended "Eskalith", but I don't recall off the top
> of my head what is different from that and lithobid? (There were
> some long threads on this for me..)
>
> Good Luck,
> John
Hi John (and Elizabeth),There is Eskalith CR (coated release), and it is a scored 450mg tab only (unless they have changed things since I last took it in 1992). Lithobid (from what I remember) just came in 300mg doses and it was a light beigy-pink satin-finished shellaqued tablet and CIBA-GEIGY pharmaceuticals was making it. It is supposed to release more gradually, but I think just for the first hour or so to avoid the blood-level rush you mentioned. It also is supposed to have some sodium in the tabs to help the lithium not be as "competitive" (ionwise). That was the stuff I was on the longest (1980-1988 I think). I liked it the best. They started me on "Lithane" which were nasty green tablets that often would start dissolving before you swallowed them and I sometimes ended up spitting one out and hurling down a different one. They stopped making the Lithobid for some time in the early 90's, and I couldn't get it. Evidently they must have started making it again. The last lithium I was on (in the mid-late 90's) were the pink Eskalith 300mg IR capsules. Price-wise, any of it was never very expensive, similar to generic tricyclic antidepressants $2-3 can get you a full bottle!
Posted by Chloe on May 14, 2002, at 14:25:37
In reply to Re: Starting Lithium--should I ask for ER version? » JohnX2, posted by Ritch on May 14, 2002, at 9:16:42
> There is Eskalith CR (coated release), and it is a scored 450mg tab only (unless they have changed things since I last took it in 1992).Hey Mitch,
I take the Eskilith CR. But the CR stands for "controlled release." It's a hard, densely packed, scored yellow pill, that in theory is release gradually in the stomach and small intestine.I find it works very well for me, since I can take a small dose, like 1/2 of the 450 mg pill without effecting the extended release.
It's not cheap though. It's a brand name, costs about $20 a month...instead of the $3 or 4 you mentioned.
Got to love this lithium trivia!
Chloe
Posted by Ritch on May 14, 2002, at 21:50:20
In reply to Re: Starting Lithium--should I ask for ER version? » Ritch, posted by Chloe on May 14, 2002, at 14:25:37
>
> > There is Eskalith CR (coated release), and it is a scored 450mg tab only (unless they have changed things since I last took it in 1992).
>
> Hey Mitch,
> I take the Eskilith CR. But the CR stands for "controlled release." It's a hard, densely packed, scored yellow pill, that in theory is release gradually in the stomach and small intestine.
>
> I find it works very well for me, since I can take a small dose, like 1/2 of the 450 mg pill without effecting the extended release.
>
> It's not cheap though. It's a brand name, costs about $20 a month...instead of the $3 or 4 you mentioned.
>
> Got to love this lithium trivia!
> Chloe
Hi Chloe,Thanks for the correction-yes it should be controlled release ("coated release is nonsensical!). From what I remember the Eskalith 450mg CR was a light green colored tab, right? So you are paying $20 for *fifteen pills*?? It surely can't *cost* nowhere near that much to put a few cents worth of lithium carbonate in a controlled release formulation. The stuff has a 24-hr half-life (immediate release), do they claim a longer half-life with the controlled release? Hmm. might be worth investigating. I'll let ya know. Actually, the only kind of lithium I would be interested in is lithium citrate. It is supposed to be easier on your stomach (esp. *less* laxative effect). I wonder how much *that* costs.
Mitch
Posted by JohnX2 on May 14, 2002, at 22:01:20
In reply to Re: Starting Lithium--should I ask for ER version? » Chloe, posted by Ritch on May 14, 2002, at 21:50:20
> >
> > > There is Eskalith CR (coated release), and it is a scored 450mg tab only (unless they have changed things since I last took it in 1992).
> >
> > Hey Mitch,
> > I take the Eskilith CR. But the CR stands for "controlled release." It's a hard, densely packed, scored yellow pill, that in theory is release gradually in the stomach and small intestine.
> >
> > I find it works very well for me, since I can take a small dose, like 1/2 of the 450 mg pill without effecting the extended release.
> >
> > It's not cheap though. It's a brand name, costs about $20 a month...instead of the $3 or 4 you mentioned.
> >
> > Got to love this lithium trivia!
> > Chloe
>
>
> Hi Chloe,
>
> Thanks for the correction-yes it should be controlled release ("coated release is nonsensical!). From what I remember the Eskalith 450mg CR was a light green colored tab, right? So you are paying $20 for *fifteen pills*?? It surely can't *cost* nowhere near that much to put a few cents worth of lithium carbonate in a controlled release formulation. The stuff has a 24-hr half-life (immediate release), do they claim a longer half-life with the controlled release? Hmm. might be worth investigating. I'll let ya know. Actually, the only kind of lithium I would be interested in is lithium citrate. It is supposed to be easier on your stomach (esp. *less* laxative effect). I wonder how much *that* costs.
>
> MitchI think I paid $20 for 60 lithobid (300mg) tablets manufactured
by Solvay Pharmaceuticals (makers of brand name Luvox).John
Posted by Chloe on May 14, 2002, at 22:16:23
In reply to Re: Starting Lithium--should I ask for ER version? » Chloe, posted by Ritch on May 14, 2002, at 21:50:20
> Hi Chloe,
>
> Thanks for the correction-yes it should be controlled release ("coated release is nonsensical!). From what I remember the Eskalith 450mg CR was a light green colored tab, right? So you are paying $20 for *fifteen pills*?? It surely can't *cost* nowhere near that much to put a few cents worth of lithium carbonate in a controlled release formulation. The stuff has a 24-hr half-life (immediate release), do they claim a longer half-life with the controlled release? Hmm. might be worth investigating. I'll let ya know. Actually, the only kind of lithium I would be interested in is lithium citrate. It is supposed to be easier on your stomach (esp. *less* laxative effect). I wonder how much *that* costs.
>
> MitchMitch,
No, the pills are a light yellow, rather large, scored, and very hard. And no, it's not $20 for 15 pills...Believe it or not, my pdoc wrote the script for 1 pill BID! So I get sixty for $20. But I only take 1/2 pill/day. I really wonder why the pharmacy doesn't question me that I refill some of my meds about every 4 months or so!I think I tried Li citrate years and years ago. It's very syrupy, thick and pink. I remember it burning my stomach some, like it had alcohol in it. Might not be so great if you have GERD? Don't recall much else about it...I must have switched over to the pills...I imagine the citrate would come in generic, and might be cheap. But that is only a guess.
Chloe
Posted by Ritch on May 15, 2002, at 9:54:38
In reply to Re: Starting Lithium--should I ask for ER version?, posted by JohnX2 on May 14, 2002, at 22:01:20
> > >
> > > > There is Eskalith CR (coated release), and it is a scored 450mg tab only (unless they have changed things since I last took it in 1992).
> > >
> > > Hey Mitch,
> > > I take the Eskilith CR. But the CR stands for "controlled release." It's a hard, densely packed, scored yellow pill, that in theory is release gradually in the stomach and small intestine.
> > >
> > > I find it works very well for me, since I can take a small dose, like 1/2 of the 450 mg pill without effecting the extended release.
> > >
> > > It's not cheap though. It's a brand name, costs about $20 a month...instead of the $3 or 4 you mentioned.
> > >
> > > Got to love this lithium trivia!
> > > Chloe
> >
> >
> > Hi Chloe,
> >
> > Thanks for the correction-yes it should be controlled release ("coated release is nonsensical!). From what I remember the Eskalith 450mg CR was a light green colored tab, right? So you are paying $20 for *fifteen pills*?? It surely can't *cost* nowhere near that much to put a few cents worth of lithium carbonate in a controlled release formulation. The stuff has a 24-hr half-life (immediate release), do they claim a longer half-life with the controlled release? Hmm. might be worth investigating. I'll let ya know. Actually, the only kind of lithium I would be interested in is lithium citrate. It is supposed to be easier on your stomach (esp. *less* laxative effect). I wonder how much *that* costs.
> >
> > Mitch
>
> I think I paid $20 for 60 lithobid (300mg) tablets manufactured
> by Solvay Pharmaceuticals (makers of brand name Luvox).
>
> John
Interesting, that Solvay is manufacturing that stuff now. They obviousy picked up making it after CIBA stopped. I suppose the price for Lithobid and Eskalith CR is fairly reasonable in light of the price of other drugs! I really must be starting to get a little depressed-I am starting to concern myself with prices (I am *definitely* over my couple of little hypomanic spells).Mitch
Posted by Ritch on May 15, 2002, at 10:04:33
In reply to Re: Starting Lithium--should I ask for ER version? » Ritch, posted by Chloe on May 14, 2002, at 22:16:23
>
> > Hi Chloe,
> >
> > Thanks for the correction-yes it should be controlled release ("coated release is nonsensical!). From what I remember the Eskalith 450mg CR was a light green colored tab, right? So you are paying $20 for *fifteen pills*?? It surely can't *cost* nowhere near that much to put a few cents worth of lithium carbonate in a controlled release formulation. The stuff has a 24-hr half-life (immediate release), do they claim a longer half-life with the controlled release? Hmm. might be worth investigating. I'll let ya know. Actually, the only kind of lithium I would be interested in is lithium citrate. It is supposed to be easier on your stomach (esp. *less* laxative effect). I wonder how much *that* costs.
> >
> > Mitch
>
> Mitch,
> No, the pills are a light yellow, rather large, scored, and very hard. And no, it's not $20 for 15 pills...Believe it or not, my pdoc wrote the script for 1 pill BID! So I get sixty for $20. But I only take 1/2 pill/day. I really wonder why the pharmacy doesn't question me that I refill some of my meds about every 4 months or so!
>
> I think I tried Li citrate years and years ago. It's very syrupy, thick and pink. I remember it burning my stomach some, like it had alcohol in it. Might not be so great if you have GERD? Don't recall much else about it...I must have switched over to the pills...I imagine the citrate would come in generic, and might be cheap. But that is only a guess.
>
> ChloeHi Chloe,
Well, let's hope I don't have to restart lithium again! I have got three (personal) knocks against it: 1) It causes bad diarrhea/cramping (for me), 2) I got hypercalcemic while taking it (connection-don't know?), 3) I have half a thyroid gland instead of a whole one (would it matter?-not sure). That's why I asked about the lithium citrate (just in case!). I was told by *one* pdoc that it is supposed to be easier on your stomach. He meant in my case-less diarrhea problems. I posted a question about it once and got ZERO responders. I don't know if it would exacerbate GERD or not-being a liquid. Lithium absorbs from the gut so rapidly you wouldn't think there would be anything left around to reflux. I do know that Celexa aggravates the heck out of it (worse than anything thus far).
Mitch
Posted by RanK on November 23, 2003, at 10:21:45
In reply to Re: Starting Lithium--should I ask for ER version? » lizbeth, posted by JohnX2 on May 13, 2002, at 22:49:53
I've been on (Lithobid) Lithium ER with good results but now they want to put me on the new generic - can they force me to switch? Should I be concerned? I -and definitely the insurance company- will save money, but the insurance company doesn't have to deal with side effects. I started on Lithobid (brand name for lithium er slow release by SOL) due to gastrointestinal problems with Lithium Carbonate (not slow release).
Posted by Larry Hoover on November 23, 2003, at 10:59:19
In reply to Lithium ER- should I go to the generic?, posted by RanK on November 23, 2003, at 10:21:45
> I've been on (Lithobid) Lithium ER with good results but now they want to put me on the new generic - can they force me to switch? Should I be concerned? I -and definitely the insurance company- will save money, but the insurance company doesn't have to deal with side effects. I started on Lithobid (brand name for lithium er slow release by SOL) due to gastrointestinal problems with Lithium Carbonate (not slow release).
Any med change requires some concern....you do need to pay attention, is all.
If the generic is also a slow-release formulation, I wouldn't be *overly* concerned.
Lar
Posted by KimberlyDi on November 25, 2003, at 10:23:57
In reply to Re: Lithium ER- should I go to the generic? » RanK, posted by Larry Hoover on November 23, 2003, at 10:59:19
Lithium ER. ER? I think of Emergency Room. Why would anyone want to associate an emergency room with the drugs they take daily? LOL
> > I've been on (Lithobid) Lithium ER with good results but now they want to put me on the new generic - can they force me to switch? Should I be concerned? I -and definitely the insurance company- will save money, but the insurance company doesn't have to deal with side effects. I started on Lithobid (brand name for lithium er slow release by SOL) due to gastrointestinal problems with Lithium Carbonate (not slow release).
>
> Any med change requires some concern....you do need to pay attention, is all.
>
> If the generic is also a slow-release formulation, I wouldn't be *overly* concerned.
>
> Lar
>
>
This is the end of the thread.
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