Posted by ed_uk2010 on December 2, 2014, at 5:47:55
In reply to Re: Your dosing is too low. » ed_uk2010, posted by seekinginformation on November 29, 2014, at 19:07:27
Sorry to hear about your setback.
> Thanks for response Ed!
You're welcome.
>I've actually had some major life stresses this week, and experienced quite a setback. I have more of the "Pure-O" OCD, and the flare up has been intense, especially these past few months.... lots of hyper arousal, ruminating thoughts, and anxiety. I really hope that the clomipramine kicks in and starts to ease it.
Horrible isn't it...
>I know that my PDOC definitely will not exceed 10 MGS of prozac (which is reassuring as far as toxicity issues go).
That's good. You should not need a full dose of Prozac because clomipramine is a potent serotonergic drug in its own right.
>I am also fairly sure that my PDOC will check blood levels, but I will be sure to ask about that if it's not brought up.
Checking blood levels is not usual practice for clomipramine except in very specific circumstances. Taking it with fluoxetine or paroxetine (Paxil) is a special circumstance. It's valuable to check its major metabolite (desmethylclomipramine) and not just clomipramine itself. Clomipramine's major metabolite is active. Checking the clomipramine level alone is not very useful.
Doing an EKG (12-lead electrocardiogram) is standard for this type of combination. Have you had one? It takes about 5 minutes. The major purpose is to check that the various 'intervals' are normal, especially QTc. This is to ensure that the medication is not interfering excessively with normal cardiac conduction.
>I've considered asking to up my Gabapentin (I'm on a tiny dose of 300 MGS total a day) but am wondering if that would really be beneficial at all.
Gabapentin is probably more useful for generalised and social anxiety than OCD, but you could ask to try a higher dose because it works quickly and does not interact with any of your other medication. The fast-acting nature of gabapentin allows you to avoid spending a long time on a higher dose if it clearly isn't helping. Gabapentin generally needs to be taken in divided doses for anxiety, usually three, and not a single daily dose. Except for the elderly, the minimum effective dose is probably about 300mg three times a day for most people, but much more can be taken - and is often necessary. Gradual withdrawal is needed if you stay on a high dose for a while and then decide to reduce.
>I am hopeful that the clomipramine will have a chance to kick in and ease some of the OCD issues.
Annoyingly, clomipramine is not a fast-acting drug for OCD (neither are the SSRIs). Benefit usually occurs gradually but can take over 12 weeks to become maximal at any particular dose. In the mean time, other drugs such as benzos (eg. clonazepam, often around 0.25mg-0.5mg twice a day) and gabapentin may offer a little relief but the waiting game is still difficult. Have you had any CBT for your OCD?
Unless you believe that 10mg fluoxetine is highly beneficial, you could ask your pdoc about stopping it (you can stop 10mg abruptly, especially while on another serotonergic drug). Because it's very long-acting, you'd still need to be very cautious with the clomipramine dose for around a month after stopping. Fluoxetine's metabolite persists for several weeks and has the same drug interactions as fluoxetine itself. There are a few people who do better on an SSRI + clomipramine but most can take one or the other, and safety issues are less of a concern.
Take care. I sympathise with your situation very much.
poster:ed_uk2010
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