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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by elanor roosevelt on December 9, 2007, at 19:14:31
I took my first 50 mg of trivastal last nighti expected a bit of tummy trouble but...
i was up in the middle of the night puking and sweating
i was one sick puppy
Posted by cumulative on December 9, 2007, at 22:04:06
In reply to Trivastal day 1, posted by elanor roosevelt on December 9, 2007, at 19:14:31
Some thoughts:
1) It took Mishal a week or more to really start getting the therapeutic effects, IIRC.
2) Don't take it at night, take it first thing in the morning.
3) Take it with a meal.
4) Early nausea with DA agonists is common, it's something that should fade with time.Good luck to you, and keep with the updates! There are a lot of people here interested in this medication.
Posted by Phillipa on December 9, 2007, at 22:42:15
In reply to Re: Trivastal day 1, posted by cumulative on December 9, 2007, at 22:04:06
Okay what is it????Phillipa
Posted by Mishal on December 9, 2007, at 22:46:46
In reply to Trivastal day 1, posted by elanor roosevelt on December 9, 2007, at 19:14:31
>
> I took my first 50 mg of trivastal last night
>
> i expected a bit of tummy trouble but...
>
> i was up in the middle of the night puking and sweating
> i was one sick puppy
No wonder since you are triggering your dopaminergic system with a powerful med.As >>cumulative<< noted above, I too had some side effects at the initial stage. Right after taking Trivastal, I switched into an agitated state for which I had to take a good dose of Ativan. All that was at night, in the morning I felt fairly well.
Now, after raising my dose from 50 to 100mg, I am really getting fired up. I am finding pleasure in almost everything. Other than this, libido has been increased to a pleasant level.
No noticable side effects. Most dopaminergics cause sleep attacks which limits their use. But Trivastal is devoid of this side effect. Could be because of its action on noradrenergic receptors.
Anyway, don't give up. You may feel discomfortable for some days and even would feel like an increase in depressive symptoms. But these would definitely pass. And once you have passed these, you will never regret it.
cheers
Posted by elanor roosevelt on December 9, 2007, at 23:18:03
In reply to Re: Trivastal: hang on there, don't give up » elanor roosevelt, posted by Mishal on December 9, 2007, at 22:46:46
thanks
i'm going to take it again tonight
might take half to ease in a bit
Posted by Mishal on December 9, 2007, at 23:27:24
In reply to Re: Trivastal: hang on there, don't give up, posted by elanor roosevelt on December 9, 2007, at 23:18:03
> thanks
> i'm going to take it again tonight
> might take half to ease in a bit
Oh NO. Don't break those pills. Trivastal Retard is a special formulation designed to break up quite slowly in your system. Breaking or crushing those pills will interfere with these sustained release action. Besides there will be an extreme emetic effect too.Dose it with a glass of water. If you experience any tummy troubles, take 10mg of Domperidone, not other anti-emetic meds. Domperidone has a unique action without crossing blood-brain barrier. So it will not nullify the good effects of Trivastal.
If you have any benzo, taking them at night would be helpful to arrest the initial side effects. You would not have to take them beyond a week. I got adjusted to this med fairly quickly. Hope you can't be different.
cheers.
Posted by Sigismund on December 10, 2007, at 1:38:05
In reply to Re: Trivastal: Don't break the pills..! » elanor roosevelt, posted by Mishal on December 9, 2007, at 23:27:24
I've never felt any nausea from Hydergine, bromocriptine, deprenyl (no one does, I guess) or cabergoline.
Therefore, and because I have some trouble with sleep, I had hoped to cut my Trivastal in half and take it with a big feed at breakfast.
I might have a careful look at how the delivery system works, but then again, likely it will mean nothing to me.
Still, I'd like to try a half dose, mainly for the sleep angle.
Posted by Mishal on December 10, 2007, at 4:20:50
In reply to Re: Trivastal: Don't break the pills..! » Mishal, posted by Sigismund on December 10, 2007, at 1:38:05
> I had hoped to cut my Trivastal in half and take it with a big feed at breakfast.
> Still, I'd like to try a half dose, mainly for the sleep angle.Don't know it well, but I don't think cutting Trivastal Retard is wise. It would definitely damage the slow or sustained release action.
I never altered the neatly formed round pills. I think taking half at night will serve you nothing except disturbing your sleep, as the effects won't carry for the day after.
Servier has four slow release formulations namely: Diamicron MR, Natrilix SR, Vastarel MR, Trivastal Retard. Docs advice not to break any of the sustained release or long acting preparations.
Posted by cumulative on December 10, 2007, at 6:00:45
In reply to Re: Trivastal: Don't break the pills..! » Mishal, posted by Sigismund on December 10, 2007, at 1:38:05
The half-life of Trivastal is something like 1.9 hours without the special formulation. This might mean you'll get the blood levels from 21 hours of half-life in those 1.9. I wouldn't do it.
Posted by Sigismund on December 10, 2007, at 6:29:59
In reply to I wouldn't do it. »Sigismund, posted by cumulative on December 10, 2007, at 6:00:45
So the 1.9 hour half life is the reason it is only available in a slow release formulation?
I see.
Posted by clipper40 on December 10, 2007, at 17:38:08
In reply to Re: Trivastal: Don't break the pills..! » elanor roosevelt, posted by Mishal on December 9, 2007, at 23:27:24
That's really scary. I want to try this medication but I'm so meds sensitive. I usually start out on much smaller dosages than the normal starting point. With this medication, there's no doing that. I wish they'd make at least a 25 mg. slow release pill.
Posted by bleauberry on December 10, 2007, at 18:49:26
In reply to Trivastal day 1, posted by elanor roosevelt on December 9, 2007, at 19:14:31
I know about half-lives from experience with mercury chelation using DMSA. This relates to trivastal, so bear with me. People who take DMSA once, twice, or 3 times a day get worse. That's because as the drug wears off, mercury that has not yet been excreted gets re-deposited in the body. Redistribution. Poisoned all over again. The mercury has to go all the way from the body to the toilet, and the only way to do that is to maintain a steady level of DMSA, which means taking it every 4 hours around the clock...including setting an alarm to wake up in the middle of the night for a dose.
Trivastal taken every two hours at 4mg per dose would come out to 50mg for a 24 hour period. That would accomplish the same steady blood level as the timed release. Timed release is not a factor in how the drug works, it is a convenience because people just do not want to take multiple doses throughout a day. Or people might forget doses. The timed release just makes it much easier, more user friendly, and more marketable. If you can cut the pill into 12 fairly equal pieces, or crush it to a powder and divide it into 12 fairly equal piles, you would have a workable strategy. But you gotta stick to the every two hour dose. You could probably skip the night doses if you wanted to and just take it during the day.
If someone really wants to try the drug, but they are senstive, scared, or worried of side effects, taking 4mg every 2 hours is a way to go. Or if really sensitive and scared, take 2mg every 2 hours.
Posted by elanor roosevelt on December 11, 2007, at 2:46:57
In reply to Re: Trivastal: Don't break the pills..! » elanor roosevelt, posted by Mishal on December 9, 2007, at 23:27:24
second night i did okay
took th emeds with some dry toast and went to sleepon the third night i tried taking the dose earlier
about 4 hours later it slammed me
nausea, headache and then so very sleepy
but then i fell into to troubled sleep and never took my ambien
now it's 3:30 and too latei can't imagine taking this during the day
my eyes were rolling into my headwhat is dopmeridone?
will the pharmacy have it?
will it help with the nausea?i am going to stick with bedtime dose with toast
strange
so counter intuitive to take something that makes me so sickthanks for the advice about not splitting the tab
Posted by anonymoose on December 11, 2007, at 2:59:54
In reply to Re: Trivastal: hang on there, don't give up » elanor roosevelt, posted by Mishal on December 9, 2007, at 22:46:46
Hey Mishal, et. al.
I've been on fellow dopamine agonist Mirapex for 3 weeks now. .75mg/day for the first 2 weeks, then up to 1.5mg/day a few days ago.
Again, it took about 4 days to kick in, then had tremendous improvement through weeks 1 and 2. Then about 5 days ago I dumbly decided to stop taking my concurrent cholinergic cocktail because one of the supplements was giving me a slight headache (Alpha-GPC, Huperzine-A, and Acetyl-L-Carnitine).
Within a day I started regressing (slowed thinking, memory loss, decreased energy, and those sleep attacks). Now I'm not sure whether the sleep attacks were caused by the Mirapex or by acetylcholine deficits resulting from stopping the cocktail. But the problems began to resolve themselves after restarting the cholinergic cocktail.
Now I feel like I'm at a plateau with the Mirapex. The past few days, I've upped the dosage to 1.5mg/day, with no discernible effects yet.
How long did it take you to feel the effects of the increase in dosage of your trivastal? I guess I'm a little puzzled because I expected dopamine agonists to have faster onset of action than they seem to do for me. Not instantaneous like adderall/ritalin, but at least something noticeable within a day or two.
> Anyway, don't give up. You may feel discomfortable for some days and even would feel like an increase in depressive symptoms. But these would definitely pass. And once you have passed these, you will never regret it.
>
> cheers
>
>
Posted by clipper40 on December 11, 2007, at 6:04:16
In reply to Re: Trivastal day 1, posted by bleauberry on December 10, 2007, at 18:49:26
Thanks for all of that information. I like the idea of initially taking 2 mg. every 2 hours but it might be nearly impossible to break that pill down into 24 different pieces.
Posted by Mishal on December 12, 2007, at 3:33:24
In reply to Trvastal day 3, posted by elanor roosevelt on December 11, 2007, at 2:46:57
> about 4 hours later it slammed me
> nausea, headache and then so very sleepy
> but then i fell into to troubled sleep and never took my ambien
> now it's 3:30 and too late
I am sorry. I 'd like to know the other drugs you take. Trivastal Retard highly potentiates benzos. If you take it along with a benzo, it would further sedate you but not necessarily knock you out.
> i can't imagine taking this during the day
> my eyes were rolling into my headInitially, yes. These kind of adverse effects are noted. My suggestion is not to take it during the day, until you are getting adjusted to the night dose. It may take a week or so.
> what is dopmeridone?
> will the pharmacy have it?
> will it help with the nausea?If you are in U.S domperidone is not yet FDA approved but it is currently available at select compounding pharmacies with a doctor's prescription. Its advantage over other anti-emetic medications is it doesn't cross blood-brain barrier. Thus do not nullify the good effects of Dopaminergics. OTOH, you can either take Primperan or small dose of Phenergan to counteract nausea. Phenergan will help you sleep too. But I don't think it would be necessary beyond a week or so.
Hang on there. It is only a matter of some days. As I said earlier, once you are there, you will never regret it.
Posted by Mishal on December 12, 2007, at 3:44:18
In reply to Re: Trivastal: hang on there, don't give up » Mishal, posted by anonymoose on December 11, 2007, at 2:59:54
Now I'm not sure whether the sleep attacks were caused by the Mirapex or by acetylcholine deficits resulting from stopping the cocktail. But the problems began to resolve themselves after restarting the cholinergic cocktail.
>
> Now I feel like I'm at a plateau with the Mirapex. The past few days, I've upped the dosage to 1.5mg/day, with no discernible effects yet.
>
> How long did it take you to feel the effects of the increase in dosage of your trivastal? I guess I'm a little puzzled because I expected dopamine agonists to have faster onset of action than they seem to do for me. Not instantaneous like adderall/ritalin, but at least something noticeable within a day or two.Hi anonymoose,
Sad to know your experiment to suspend some meds went wrong. However, Mirapex is notorious for causing sleep attacks and I don't think there is another culprit here other than Mirapex. Luckily Trivastal is devoid of this side effect mainly due to its noradrenergic action. Taking a small dose of Provigil might help you here.
It took a week or so to Trivastal to kick in. When I increased my dose to 100mg, surprisingly the effects were felt right away. My speculation is: When I messed with my dopamine system, it took a week to get adjusted. After that the system started to function well and an addition was thoroughly welcomed.
Cheers.
Posted by elanor roosevelt on December 12, 2007, at 22:37:28
In reply to Re: Trivastal: hang on there, don't give up » anonymoose, posted by Mishal on December 12, 2007, at 3:44:18
last night i took my dose at bedtime and with my dry toast
took an ambien to assure i would stay asleep and i slept really well (a rarity for me)
and today there is a shift what was just a glimmer is a bit more
that sense of future thingmoving all my meds to the afternoon
adderall, lexapro every now and then to help with waking up in the morning
no xanax til evening
then an ambien with the TMishal,
you upped your dosage quickly
how did you make that decision?
Posted by Mishal on December 13, 2007, at 3:35:47
In reply to Trivastal: Day 4, posted by elanor roosevelt on December 12, 2007, at 22:37:28
> Mishal,
> you upped your dosage quickly
> how did you make that decision?Hi Eleanor,
The decision was my own. I just felt I would be better on 100mg. The shift was made right after three days, as manufacturer recommends a three day gap between doses.
Wish you too success with Trivastal.
Posted by bulldog2 on December 13, 2007, at 18:46:55
In reply to Re: Trivastal: Day 4 » elanor roosevelt, posted by Mishal on December 13, 2007, at 3:35:47
> > Mishal,
> > you upped your dosage quickly
> > how did you make that decision?
>
> Hi Eleanor,
>
> The decision was my own. I just felt I would be better on 100mg. The shift was made right after three days, as manufacturer recommends a three day gap between doses.
>
> Wish you too success with Trivastal.
>
>Did the increase in dose increase either your anxiety or insomnia which I know you had ar 50? Do you take the 100 mg all at once?
Posted by elanor roosevelt on December 15, 2007, at 0:21:32
In reply to Re: Trivastal: Day 4, posted by bulldog2 on December 13, 2007, at 18:46:55
i'm starting to feel okay
Posted by Sigismund on December 15, 2007, at 17:16:29
In reply to Re: Trivastal: Day 6?, posted by elanor roosevelt on December 15, 2007, at 0:21:32
>i'm starting to feel okay
Nice to hear.
So.....
How has your sleep been?
How has the nausea been?
But you're feeling better in yourself, I take it?
Do you find it stimulating?
And anything else you want to mention.
Posted by Sigismund on December 15, 2007, at 17:17:47
In reply to Trivastal: Day 4, posted by elanor roosevelt on December 12, 2007, at 22:37:28
>today there is a shift what was just a glimmer is a bit more
that sense of future thingThat sounded encouraging too.
Posted by Phillipa on December 15, 2007, at 18:09:35
In reply to Re: Trivastal day 1, posted by bleauberry on December 10, 2007, at 18:49:26
So it's a parkinson drug used off label as a stimulant for depression did I get that right? Phillipa
Posted by Mishal on December 15, 2007, at 22:47:24
In reply to Re: Trivastal: Day 4, posted by bulldog2 on December 13, 2007, at 18:46:55
>
> Did the increase in dose increase either your anxiety or insomnia which I know you had ar 50? Do you take the 100 mg all at once?
Hi Bulldog2,Upping the dose to 100mg didn't cause any dramatic increase of anxiety, but the last couple of days there was intense anxiety, yesterday being particularly bad. I had to take some benzos to arrest it. I think it was a bout of anxiety since taking 2mg of Ativan fixed it altogether. Today I feel okay. Not anxious at all.
I take 50mg with my breakfast and the next dose at night. It doesn't interfere with my sleep anymore. I am experiencing the real antidepressant effect.
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