Posted by LouisianaSportsman on February 21, 2014, at 17:46:30
In reply to Re: protryptiline (Vivactil) safe with MAOI?, posted by LouisianaSportsman on February 21, 2014, at 16:28:20
Hey, Tom! I am in a bit of a rush, but I wanna get my thoughts out real fast like I said I would. This is not going to be written in the prose I like.
Just sharing my thoughts on what Id do in terms of your medications:
1.I would leave Desoxyn as is and augment with Vyvanse (lisdexamphetamine) at 50mg. which is ~= 22.5mg. of Dexedrine over an extended period of time which would probably feel like 15mg. of Desoxyn, but you have to consider that it would be time-released. Id dose: Vyvanse 50mg., Desoxyn 5-10mg. QAM; and as a booster, Desoxyn 10-15mg. QPM. For some reason, people seem to report that Vyvanse is smooth, and it seems to be good for people with treatment resistant depression.
2.I would titrate the Lamictal to the more common therapeutic dosage of 200mg.
3.I would change Mirapex to Mirapex ER with a target dose of 1.5mg.
4.I would go ahead and max out Marplan to 60mg.
5.I would order a blood test to have your lithium levels checked and adjust dosage accordingly.
6.I would titrate properly and prescribe Oxtellar XR (oxcarbazepine) with a target dosage of 1,200mg. This an extended-release version of Trileptal (Tegretol). It is effective for some bipolar patients, but I am worried about mania since you said that lithium induced it.
7.I would increase the Abilify to 15mg. This is the suggested dose on the PI sheet and it is good because of the addition of oxcarbazepine. Perhaps it would block potential mania. Lethargy would hopefully be resolved by Vyvanse.
8.Since you wanted a TCA and because it does make sense, Id add-on desipramine and not nortrip. I like it because its a metabolite of Tofranil (imipramine) which might be the best TCA for anxiety and that seems to be one of your issues right now. Id go for a target dose of 100mg.
9.I cannot make an educated opinion about Deplin and levothyroxine, honestly.Basically, Id make your meds look like this:
Abilify (aripiprazole) 15mg.
Deplin (levomefolic acid) 30mg.
Desoxyn (methamphetamine) 20mg.
Lamictal (lamotrigine) 200mg.
Levothyroxine 50mcg
Lithobid ER (lithium carbonate) 900mg.
Marplan (isocarboxazid) 60mg.
Mirapex ER (pramipexole) 1.5mg.
Norpramin (desipramine) 100mg.
Oxtellar XR (oxcarbazepine) 1,200mg.
Vyvanse (lisdexamphetamine) 50mg.Let me know what you think, bud.
poster:LouisianaSportsman
thread:1060964
URL: http://www.dr-bob.org/babble/20140214/msgs/1060988.html