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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Four Feathers on June 21, 2008, at 18:00:55
Hello,
After a lot of consideration, research, and discussion with my pdoc I have decided to give Nardil a try. My pdoc actually takes this and has a number of patients on this. He says that he has seen good success for many patients in the 30-60mg range which is a bit less than I have read here from posters and seen elsewhere online.
My qustion is this. I tend to be very med sensitive and he has recommended that I start with a low dose of 7.5mg/day (split the 15mg tablet). I wondered if anyone had done this or had seen anything related to splitting these tablets. I have not even opened the bottle as I am beginning my second wash-out week prior to beginning Nardil, but I had understood that the coating on these was hard and may make it difficult to split. Probably nothing a pill splitter would not solve, but are there any concerns of the medication releasing too early, etc when the pill is split? Any comments/thoughts are appreciated.
Thank you,
4F
Posted by Phoenix1 on June 21, 2008, at 19:06:31
In reply to Nardil starting dosage question, posted by Four Feathers on June 21, 2008, at 18:00:55
Hi 4F,
The coating isn't too hard actually. A good pill splitter worked fine for me. If you are med sensitive, starting at 7.5mg sounds like a wise idea. The official prescribing insert recommends raising the dosage fairly quickly to 60mg, as long as you tolerate it OK. Good luck on Nardil, it's been a very effective AD for lots of people here!
Phoenix
> Hello,
>
> After a lot of consideration, research, and discussion with my pdoc I have decided to give Nardil a try. My pdoc actually takes this and has a number of patients on this. He says that he has seen good success for many patients in the 30-60mg range which is a bit less than I have read here from posters and seen elsewhere online.
>
> My qustion is this. I tend to be very med sensitive and he has recommended that I start with a low dose of 7.5mg/day (split the 15mg tablet). I wondered if anyone had done this or had seen anything related to splitting these tablets. I have not even opened the bottle as I am beginning my second wash-out week prior to beginning Nardil, but I had understood that the coating on these was hard and may make it difficult to split. Probably nothing a pill splitter would not solve, but are there any concerns of the medication releasing too early, etc when the pill is split? Any comments/thoughts are appreciated.
>
> Thank you,
> 4F
Posted by Tomatheus on June 21, 2008, at 22:05:24
In reply to Nardil starting dosage question, posted by Four Feathers on June 21, 2008, at 18:00:55
> I have not even opened the bottle as I am beginning my second wash-out week prior to beginning Nardil, but I had understood that the coating on these was hard and may make it difficult to split.
Nope, not anymore. The "old" Nardil that was manufactured up until the fall of 2003 had a hard enteric coating that protected the contents of the tablets until they reached the small intestine. Pfizer's "new" Nardil is film coated, and it's my understanding that the versions of the medication marketed in the U.K. and Australia are film coated as well.
> Probably nothing a pill splitter would not solve, but are there any concerns of the medication releasing too early, etc when the pill is split?
Not anymore with the film coating. In the past, splitting ("old") Nardil tablets would have stopped the enteric coating from protecting the contents of the tablets until they reached the small intestine. Now that Nardil's coating is designed to dissolve in the stomach, this is no longer an issue (so, 7.5 mg should be fine).
Hope this helps.
Tomatheus
Posted by blueboy on June 22, 2008, at 11:51:25
In reply to Nardil starting dosage question, posted by Four Feathers on June 21, 2008, at 18:00:55
> Hello,
>
> After a lot of consideration, research, and discussion with my pdoc I have decided to give Nardil a try. My pdoc actually takes this and has a number of patients on this. He says that he has seen good success for many patients in the 30-60mg range which is a bit less than I have read here from posters and seen elsewhere online.
>I maxed out at 60mg, and I'm over 200 lbs.
> My qustion is this. I tend to be very med sensitive and he has recommended that I start with a low dose of 7.5mg/day (split the 15mg tablet).
I started at 15 and went up by one tablet every 2 weeks. I kept an Excel spreadsheet and figured out I have a 10-day titration period.
I'm not sure that "med sensitive" is a general characteristic (I'm not sure that it's not, either). I'm very sensitive to some meds (such as SSRI's) but have very low sensitivity to others, especially sedating meds like benzo's and sleep aids.
Posted by 4WD on June 22, 2008, at 20:30:26
In reply to Nardil starting dosage question, posted by Four Feathers on June 21, 2008, at 18:00:55
Hi,
My first reaction was that 7.5 mg was a mighty low dose. And yes, splitting them is difficult, even with a pill splitter they tend not break not exactly in half and you get a lot of dust.
I started at 45mg a day. 15mg three times a day and I am extremely med sensitive also. I am glad I did start at 45 - it kicked in at that dose at about week 6. If I had started at a lower dose, it would have taken much longer to kick in and I'd just now be reaching therapeutic levels.
Personally, I wanted it work as quickly as possible so I wanted to start at 45. My pdoc originally thought I might need to be on 60 but I've done fine on 45.
The effect it has is definitely time related. The lower the dose, the longer it is going to take before you feel better.
Marsha
Posted by blueboy on June 24, 2008, at 8:52:45
In reply to Re: Nardil starting dosage question » Four Feathers, posted by 4WD on June 22, 2008, at 20:30:26
> Hi,
>
> My first reaction was that 7.5 mg was a mighty low dose. And yes, splitting them is difficult, even with a pill splitter they tend not break not exactly in half and you get a lot of dust.
>
> I started at 45mg a day. 15mg three times a day and I am extremely med sensitive also. I am glad I did start at 45 - it kicked in at that dose at about week 6. If I had started at a lower dose, it would have taken much longer to kick in and I'd just now be reaching therapeutic levels.
>
> Personally, I wanted it work as quickly as possible so I wanted to start at 45. My pdoc originally thought I might need to be on 60 but I've done fine on 45.
>
> The effect it has is definitely time related. The lower the dose, the longer it is going to take before you feel better.
>I'd be more careful. I have had terrible experiences titrating powerful drugs too fast. Impatience can be your worst enemy.
On the other hand, most sites say that 45mg/day is the "usual starting dosage", so maybe that's right for you. Obviously it has worked out well for some people.
My doctor, who prescribes it a lot, started me off slower, and it was fast enough, believe me. However, I don't think that "my way is the only way", LOL.
Posted by Four Feathers on June 24, 2008, at 20:23:57
In reply to Re: Nardil starting dosage question, posted by blueboy on June 24, 2008, at 8:52:45
> >
>
> I'd be more careful. I have had terrible experiences titrating powerful drugs too fast. Impatience can be your worst enemy.
>
> On the other hand, most sites say that 45mg/day is the "usual starting dosage", so maybe that's right for you. Obviously it has worked out well for some people.
>
> My doctor, who prescribes it a lot, started me off slower, and it was fast enough, believe me. However, I don't think that "my way is the only way", LOL.When you were on Nardil what dose did your doc start you out at? Did you notice many positive or negative effects initially at the lower dose, or did you find these to be much more dose dependent?
How long did you stay on Nardil?
Thanks!
4F
Posted by blueboy on June 25, 2008, at 13:36:42
In reply to Re: Nardil starting dosage question » blueboy, posted by Four Feathers on June 24, 2008, at 20:23:57
> > >
> >
> > I'd be more careful. I have had terrible experiences titrating powerful drugs too fast. Impatience can be your worst enemy.
> >
> > On the other hand, most sites say that 45mg/day is the "usual starting dosage", so maybe that's right for you. Obviously it has worked out well for some people.
> >
> > My doctor, who prescribes it a lot, started me off slower, and it was fast enough, believe me. However, I don't think that "my way is the only way", LOL.
>
> When you were on Nardil what dose did your doc start you out at?IIRC, it was 15mg for two weeks, 30mg for two weeks, etc. I could be wrong, though. I kept a chart but I can't find it.
>Did you notice many positive or negative effects initially at the lower dose, or did you find these to be much more dose dependent?
>The side-effects started fast. The positive effects did not really occur until I had been at 60mg/day for ten days.
I tried bringing my dose down by tiny steps, but even taking 45mg every third or fourth day caused a decrease in benefits.
> How long did you stay on Nardil?
>A little less than two years.
Posted by Girlnterrupted78 on June 28, 2008, at 1:02:13
In reply to Re: Nardil starting dosage question » Four Feathers, posted by Phoenix1 on June 21, 2008, at 19:06:31
I also started at 45mgs and had no problems at all. Went up to 90mgs, which turned out to be an overdose for me, giving me splitting headaches, went down to 75mgs, which was ALSO an overdose and it gave me flushing symptoms, so I finally settled at 60mgs.
Unfortunately, Nardil didn't do anything for me, so after a year of taking it faithfully, I quit once I realized all it was truly doing for me was making me gain weight.
Just a reminder about that - you will gain weight on Nardil. So be prepared. I didn't gain a pound the first 3 months, but gradually my appetite began to increase and my metabolism slowed down, so I ended up with some 15-20lbs in a year. Which seems low compared to what other people have gained. Someone else here gained 30lbs in the same time, and another gained 50lbs in 4 months.
Also remember you might have hypotension during the first months and might experience syncope. It isn't terrible, but it can be annoying. You just have to make sure you don't get up too fast from sitting or lying positions, otherwise you'll hit the floor.
Best of luck
--------------------------------o-----------------------------------
> Hi 4F,
>
> The coating isn't too hard actually. A good pill splitter worked fine for me. If you are med sensitive, starting at 7.5mg sounds like a wise idea. The official prescribing insert recommends raising the dosage fairly quickly to 60mg, as long as you tolerate it OK. Good luck on Nardil, it's been a very effective AD for lots of people here!
>
> Phoenix
>
> > Hello,
> >
> > After a lot of consideration, research, and discussion with my pdoc I have decided to give Nardil a try. My pdoc actually takes this and has a number of patients on this. He says that he has seen good success for many patients in the 30-60mg range which is a bit less than I have read here from posters and seen elsewhere online.
> >
> > My qustion is this. I tend to be very med sensitive and he has recommended that I start with a low dose of 7.5mg/day (split the 15mg tablet). I wondered if anyone had done this or had seen anything related to splitting these tablets. I have not even opened the bottle as I am beginning my second wash-out week prior to beginning Nardil, but I had understood that the coating on these was hard and may make it difficult to split. Probably nothing a pill splitter would not solve, but are there any concerns of the medication releasing too early, etc when the pill is split? Any comments/thoughts are appreciated.
> >
> > Thank you,
> > 4F
>
>
Posted by 4WD on June 28, 2008, at 14:38:47
In reply to Re: Nardil starting dosage question » Phoenix1, posted by Girlnterrupted78 on June 28, 2008, at 1:02:13
Hi,
I have been on Nardil 13 weeks now. I have not noticed an increased appetite and actually I've lost 5 pounds since starting Nardil. Admittedly, I lost the five pounds during the time I was dealing with my mothers's death and funeral arrangements. Also, the night after her funeral I fell from low BP spell fainting in the bathroom and got a compression fracture in my lower spine and was in the hospital for a week.
Before all that happened though, I might have gained a pound or two. I don't have a scale I just weigh myself when I see a scale handy.
I guess the point I am trying to make is that I have been on Nardil for a little over three months and I haven't gained any weight; have lost it instead. We'll see what happens in the future but for now it doesn't seem to be a problem for me.
I'm glad to hear the hypotension may go away after the first few months!
Marsha
Posted by blueboy on June 29, 2008, at 9:19:14
In reply to Re: Nardil starting dosage question, posted by 4WD on June 28, 2008, at 14:38:47
> I'm glad to hear the hypotension may go away after the first few months!
>I'm pulling for you, but don't count on it. My side effects didn't ever ameliorate for the two years I took Nardil. Well, maybe a little bit, come to think of it, but not the hypotension or weight gain. Insomnia and sexual side effects improved (from drastic to serious).
Posted by 4WD on June 29, 2008, at 15:02:07
In reply to Re: Nardil starting dosage question, posted by blueboy on June 29, 2008, at 9:19:14
Well, thanks, anyway for pulling for me. The insomnia thing is weird. I didn't have the insomnia issue at all at first. Then I had a spell of mild insomnia. (My insomnia always takes the form of waking up too early - like 2 or 3 hours after I have gone to sleep.) But I was sleeping 7 hours a night. 9 hours is normal for me. Then it went away again. Then I had a spell of severe insomnia - going to bed at 11 and waking up at 1:30 or 2 or 3. That was the worst. It was extremely unpleasant. I'd be hungover from the Trazadone I had taken from sleep. Even Ambien didn't help. Once when I woke up at 2, I got up and took two ambien and went back to bed. I slept for two more hours. Another time I tried the same thing and I didn't go back to sleep. Once it worked. Taking it at bedtime didn't help at all.
Then it eased up. Then I got a compression fracture in my lumbar spine (low BP spell from Nardil at 3am when I got out of bed to go to the bathroom and fainted and fell) and went into the hospital when I was on some heavy duty pain meds. No insomnia since then and that has been a month ago almost. Now that I'm home I am sleeping like 10 or 10 and a half hours a night. It's just weird.
I didn't mean to write a complete documentary history of my insomnia but maybe it will help someone who is struggling with Nardil insomnia right now. The message is that it *can* go away. It is different for everyone but on those days when the insomnia is bad and you think you'll go crazy from lack of sleep, remember mine went completely away and I am even sleeping longer than usual.
As for the hypotension I have found that it is very important to eat and drink lots of fluids. I have a tendency to not eat anything during the day. I have to make myself eat breakfast and dinner or lunch and dinner. The night I fainted and broke my spine, I had not eaten anything all day and had drunk a lot of diet Mt. Dew so I was probably dehydrated. My BP is normal now. Actually a bit high. I do still occasionally have spells where I get dizzy from getting up when I have been lying or sitting down. At those times I know it has dropped and I need to sit back down or get back in bed as quickly as possible. It's lowest while I am sleeping I think. So I use a little wheeled thing like a walker when I have to get up in the middle of the night. I think if my BP stays pretty stable I will be able to do away with the walker as soon as my fracture is healed. I just can't risk another fall right now.
And I haven't had overall any weight gain. I actually weigh less than before I started Nardil. I think I gained maybe 2 or 3 pounds in the first three months I was on Nardil (without increasing food intake). But now I have lost 5 pounds from all the stuff I'm dealing with, my Mom died, her funeral was on a Wednesday, on Thursday night/Friday morning I fell and broke my back. So the five pounds I've loss is from all the stress and just not feeling like eating.
Anyway there is hope for people starting Nardil. Even with the side effects I *am* having (elevated liver enzymes, low BP spells), it is a million times worth it. It gave me my life back after four years of suicidal depression and a lifetime of chronic dysthymia.
I am still on pain meds right now so I don't know how I am feeling mentally if I were in my natural state. The pain meds make me feel all happy and energetic when I take them and I think I'm going to have an issue with depression when I cut them off. I just need to remember it will pass and that I was happy and motivated on Nardil by itself (plus my other meds) naturally and that the feeling I had from Nardil will come back after the narcotics are out of my system.
Long post. Sorry
Marsha
> > I'm glad to hear the hypotension may go away after the first few months!
> >
>
> I'm pulling for you, but don't count on it. My side effects didn't ever ameliorate for the two years I took Nardil. Well, maybe a little bit, come to think of it, but not the hypotension or weight gain. Insomnia and sexual side effects improved (from drastic to serious).
Posted by 4WD on June 29, 2008, at 15:13:18
In reply to Re: Nardil starting dosage question, posted by blueboy on June 29, 2008, at 9:19:14
You said you took Nardil for two years. Would you mind telling us/me why you stopped it and what you switched to and what that experience was like? If my liver enzymes keep rising and reach a life-threatening point, there is a possibility I will have to go off Nardil.
Thanks,
Marsha
> > I'm glad to hear the hypotension may go away after the first few months!
> >
>
> I'm pulling for you, but don't count on it. My side effects didn't ever ameliorate for the two years I took Nardil. Well, maybe a little bit, come to think of it, but not the hypotension or weight gain. Insomnia and sexual side effects improved (from drastic to serious).
Posted by blueboy on June 30, 2008, at 10:39:54
In reply to Re: Nardil starting dosage question » blueboy, posted by 4WD on June 29, 2008, at 15:13:18
> You said you took Nardil for two years. Would you mind telling us/me why you stopped it and what you switched to and what that experience was like? If my liver enzymes keep rising and reach a life-threatening point, there is a possibility I will have to go off Nardil.
>I stopped it because I developed a disturbing body rash and my pdoc told me to stop immediately.
I had always had one kind of rash as a side effect (flushing, sometimes with itch, usually on face or neck). This rash was intermittant.
However, I suddenly got tiny bumps, some of them petichial (sp?)(like, tiny spots of blood), that started on my trunk and then spread over time. They didn't itch or hurt. My pdoc freaked out.
I tried to restart and the rash returned.
Since then, I have been rediagnosed as Bipolar II and I'm now titrating up on Lamictal.
Posted by Four Feathers on June 30, 2008, at 11:10:47
In reply to nardil insomnia » blueboy, posted by 4WD on June 29, 2008, at 15:02:07
I am sorry to hear about the difficulties you have had with Nardil. I will not begin Nardil for another couple of weeks as I have a business trip and the last thing I want to do is be out of town when starting any med if I can avoid it.
Honestly, I am still a bit on the fence regarding starting this med as I hear so much about the side effects. Albeit, I also see lives being changed as it appears yours has. I now realize that I have had social anxiety since I was a child and I believe that this went uncontrolled and has now turned into depression which I have suffered from for at least the last 20 years, getting worse with time.
In my situation my blood pressure actually is a bit high without medication to control it so my pdocs thought, and my hope, is that perhaps the Nardil will reduce the bp and allow me to get off of the Lisinopril I am taking for this.
As far as weight is concerned...I have never been overweight, and if anything some would say I have always been more on the slender side. I am usually a very physically active person, but this has been reduced during the last year with this recent bout of depression. Oh how I hope that Nardil will help me get the motivation back to begin working out again! :)
Thank you all for comments in this thread as it is so helpful to hear about others experiences and what I *may* experience.
Paul
Posted by 4WD on June 30, 2008, at 13:03:59
In reply to Re: Nardil starting dosage question, posted by blueboy on June 30, 2008, at 10:39:54
Wow. That's scary. I'm sorry you had to go through all that and that you had to go off Nardil. I am diagnosed as Bipolar II as well.
And now you are on Lamictal, the one that you have to titrate slowly or else it will cause a rash.
Good luck. I hope you do well on the Lamictal.
Thanks for answering
Marsha
> > You said you took Nardil for two years. Would you mind telling us/me why you stopped it and what you switched to and what that experience was like? If my liver enzymes keep rising and reach a life-threatening point, there is a possibility I will have to go off Nardil.
> >
>
> I stopped it because I developed a disturbing body rash and my pdoc told me to stop immediately.
>
> I had always had one kind of rash as a side effect (flushing, sometimes with itch, usually on face or neck). This rash was intermittant.
>
> However, I suddenly got tiny bumps, some of them petichial (sp?)(like, tiny spots of blood), that started on my trunk and then spread over time. They didn't itch or hurt. My pdoc freaked out.
>
> I tried to restart and the rash returned.
>
> Since then, I have been rediagnosed as Bipolar II and I'm now titrating up on Lamictal.
This is the end of the thread.
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