![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by LD on April 11, 2000, at 9:16:35
I'm planning on changing from Effexor to the XR version, and I was wondering if anyone could help me with some dosage guidelines. My doc wanted me to go up to 375mg of the regular, but when I told her I wanted to go on the XR, she said the max I could go was 225mg. I am on 225mg of the regular right now. Is this an equivalent dose of the XR? Is the XR stronger? ALso, how do I go about the transition? Just take 3, 75mg XR all at once? I'm in the middle of having to change doctors because of insurance and I'm not going back for a month, so I'm kinda on my own in this. Thank you so much.
Posted by Carolyn on April 11, 2000, at 11:08:06
In reply to Effexor vs. Effexor XR dosage, posted by LD on April 11, 2000, at 9:16:35
> Hi I am the one who wrote about being from a psychiatrists dream family (in other words, my family could support a psychiatrist. However I read medical textbooks just for the fun of it so I am pretty knowledgable (call it survival). My new psychiatrist says he can "cure" me (and I have great faith) and has started me on effexor XR and is eventually going to get me over 400mg. Now I was on in years past, Effexor 225mg. It didn't do a whole lot but I was on it for 3 years. My Dr. said that when the dosage is raised to a high level, it is like a completely different medication and works in a completely different (and better I hope) way. Hope this helps, Carolyn
Posted by Noa on April 11, 2000, at 15:06:00
In reply to Re: Effexor vs. Effexor XR dosage, posted by Carolyn on April 11, 2000, at 11:08:06
I think it is wise to start out lower on the xr, to see how it works for you, but by no means is 225 the max. Word of advice. Taper off and on slowly.
Posted by Cam W. on April 11, 2000, at 18:58:42
In reply to Re: Effexor vs. Effexor XR dosage, posted by Noa on April 11, 2000, at 15:06:00
LD - The 'books' do say that 225mg of XR is the maximum dose, but in reality doses much higher are used by some psychiatrists. (I have seen 375mg daily and heard of - in hospital - 600mg daily for very severe depression). Your doctor is following the guidelines set down for him. At the doses above 225mg (regular or XR) Effexor changes from an SSRI (like Paxil or Zoloft) to an SNRI (more like a TCA without the heart problems, excessive drowsiness and dry mouth). At these higher doses Effexor blocks norepinephrine reuptake, as well as serotonin reuptake, essentially making it a different drug like Carolyn has said.The same 'books' say that you can switch from the regular to the XR at the same daily dose (if tolerated). For example, instead of taking 75mg of Effexor three times daily, you could take 225mg of Effexor XR once daily.
Hope this helps - Cam W.
Posted by medlib on April 11, 2000, at 19:08:12
In reply to Effexor vs. Effexor XR dosage, posted by LD on April 11, 2000, at 9:16:35
> I'm planning on changing from Effexor to the XR version, and I was wondering if anyone could help me with some dosage guidelines. My doc wanted me to go up to 375mg of the regular, but when I told her I wanted to go on the XR, she said the max I could go was 225mg. I am on 225mg of the regular right now. Is this an equivalent dose of the XR? Is the XR stronger? ALso, how do I go about the transition? Just take 3, 75mg XR all at once? I'm in the middle of having to change doctors because of insurance and I'm not going back for a month, so I'm kinda on my own in this. Thank you so much.
LD-- Many of us on this board are on Effexor XR up to 375mg/day. I take 300mg. Effexor XR (in two l50mg. capsules) in the morning. Keep in mind that Effexor acts on different neurotransmitters at different dose levels. I believe that it acts exclusively on serotonin receptors up to 150mg/day. Above that, it acts on norepinephrine NTs as well. I believe that it also acts on dopamine NTs at the highest levels.
You don't mention what you're taking the Effexor for. If it is GAD, there might be a reason to keep the dose lower; recruiting the NE NTs could increase anxiety. Higher doses are often prescribed for depression, as needed.
According to the drug monograph, Effexor XR has the same total absorption (and conversion to its active metabolite) as Effexor tablets; E XR just has a slower absorption rate. Therefore, it should not be necessary to taper off. If you were on Effexor tabs 75mg/3x/day, take Effexor XR 225mg in the morning. I would wait to increase the dosage until you check in with your new pdoc. It's likely you'll experience fewer side effects with the XR version--most do.
Hopefully, Cam (our highly-valued resident pharmacist) will be logging in soon and can check my data and maybe add more specifics.
Good luck! -medlib
Posted by Cam W. on April 11, 2000, at 23:35:59
In reply to Re: Effexor vs. Effexor XR dosage/ Hey, Cam, posted by medlib on April 11, 2000, at 19:08:12
medlib - You are absolutely right about the delayed absorption. There is no difference in excretion rates at all between the two types of Effexor. Did you attend one of my lectures? Or is this info really in the monograph (I'll have to check). I found it the hard way, by looking through stacks of journal articles. I find that monographs are lawyers documents; written by lawyers, for lawyers. (They do help when in a hurry, though). - Cam W.
Posted by medlib on April 12, 2000, at 3:02:04
In reply to Re: Effexor vs. Effexor XR dosage- correct medlib, posted by Cam W. on April 11, 2000, at 23:35:59
>
> medlib - You are absolutely right about the delayed absorption. There is no difference in excretion rates at all between the two types of Effexor. Did you attend one of my lectures? Or is this info really in the monograph (I'll have to check). I found it the hard way, by looking through stacks of journal articles. I find that monographs are lawyers documents; written by lawyers, for lawyers. (They do help when in a hurry, though). - Cam W.Cam--Our posts crossed electronically--wouldn't have posted had I seen yours before I began writing (I'm a slow composer). A Google search easily turned up the original Wyeth-Ayerst monograph at www.mdmultimedia.com/a/mono/mgl008.htm
The info I cited was under a section called "Multiple dose pharmacokinetic profile (tablets and extended release capsules)". While I wouldn't normally trust the company line re side-effects, etc., pharmacokinetics is harder to fudge, less reason to, and lawyers don't understand a word of it anyway--ergo, I rate it reasonably reliable. How about you?BTW,you mentioned library time doing research in one of your posts. Just wondered if you are aware of the Journal Browser feature of PubMed. It has links to 757 medical journals online, including a number of pharm titles. A number are full-text and free; others offer TOC + abstracts of feature articles w/ fee-based full text. University libraries sometimes pick up the fee for staff; publishers sometimes offer free web access to full-text from university servers when the university subscribes to the paper version of the journal. It might be worthwhile checking w/ your university library for its electronic journal access policies.
Hope I haven't mentioned this before--damned non-existent short-term memory; wonder if one can get a RAM transplant?
Thanks much for all your good work here--medlib
Posted by Cam W. on April 12, 2000, at 6:37:16
In reply to Re: Effexor monograph/Cam, posted by medlib on April 12, 2000, at 3:02:04
medlib - Thanks a lot for info on Journal browser. I have been relying on limks from medical sites (eg Biomednet, Medscape, Medmatrix, Elsevier Science, etc. About the U of Alberta. Nothing beats sitting among the stacks for 8 hours and browsing through current issues, but, yes, it is frustrating when trying to confirm a reference (found a mistake in Feb.'s Scientific American - author read a passage wrong - cool, huh.) and the journal is not there. I do not have an access code for the U of A's computers, but, last week, one of the doc's has let me use his name to order articles from any journal in the world (almost) out of a library service from our provincial mental health board (as long as I don't abuse it and give him a copy).I agree with you that pharmacokinetics are hard to fudge, but sometimes creative licence is used to downplay some factors (eg Take Zoloft with meals to help avoid first pass effect, not because it chews up your gut).
As for computers. I know less about them than I know about reboxetine (I have a beta.... er, I-Mac - sorry bob - he likes them). - Cam W.
Posted by LD on April 12, 2000, at 9:11:05
In reply to Re: Effexor monograph/Cam, posted by Cam W. on April 12, 2000, at 6:37:16
Thanks everyone for your advice, it really helped!
LD
Posted by Shar on April 15, 2000, at 12:29:43
In reply to Effexor vs. Effexor XR dosage, posted by LD on April 11, 2000, at 9:16:35
> I'm planning on changing from Effexor to the XR version, and I was wondering if anyone could help me with some dosage guidelines. My doc wanted me to go up to 375mg of the regular, but when I told her I wanted to go on the XR, she said the max I could go was 225mg. I am on 225mg of the regular right now. Is this an equivalent dose of the XR? Is the XR stronger? ALso, how do I go about the transition? Just take 3, 75mg XR all at once? I'm in the middle of having to change doctors because of insurance and I'm not going back for a month, so I'm kinda on my own in this. Thank you so much.
RE: E-XR Dose
I am on 300 mg E-XR per day. I always have to have the pharmacist call the insurance co. when I get a refill. My doc says they (Effexor-XR co.) are soon to announce the maximum dose can be even higher than the 300 I am on. Shar
Posted by Carolyn on April 17, 2000, at 15:57:36
In reply to Re: Effexor vs. Effexor XR dosage- correct medlib, posted by Cam W. on April 11, 2000, at 23:35:59
> I am now up to 450mg of Effexor XR. Though my Dr. said I will be able to have life just "roll off of me" instead of being so ultra sensitive. We will see. I suppose it takes a few weeks for that high of a dose to circulate in my system. Since I am almost 41 and have suffered from depression since I was 14, I will truly be amazed if it works as the Doc says. I am faithful and positive in my thinking. It will by my children and husband who will be able to tell the difference. I also decided to exercise and started the "Body for Life" program (it is on the internet). Perhaps having more oxygen running through me will be a big help too. I have been so desperate for relief from this "dragon" (depression, that changing my way of life and medication is what I am doing. I would love to hear of some success stories please. Thanks, Carolyn
> medlib - You are absolutely right about the delayed absorption. There is no difference in excretion rates at all between the two types of Effexor. Did you attend one of my lectures? Or is this info really in the monograph (I'll have to check). I found it the hard way, by looking through stacks of journal articles. I find that monographs are lawyers documents; written by lawyers, for lawyers. (They do help when in a hurry, though). - Cam W.
Posted by Kathy on April 19, 2000, at 0:36:55
In reply to Re: Effexor vs. Effexor XR dosage- correct medlib, posted by Carolyn on April 17, 2000, at 15:57:36
> > I am now up to 450mg of Effexor XR. Though my Dr. said I will be able to have life just "roll off of me" instead of being so ultra sensitive. We will see. I suppose it takes a few weeks for that high of a dose to circulate in my system. Since I am almost 41 and have suffered from depression since I was 14, I will truly be amazed if it works as the Doc says. I am faithful and positive in my thinking. It will by my children and husband who will be able to tell the difference. I also decided to exercise and started the "Body for Life" program (it is on the internet). Perhaps having more oxygen running through me will be a big help too. I have been so desperate for relief from this "dragon" (depression, that changing my way of life and medication is what I am doing. I would love to hear of some success stories please. Thanks, Carolyn
> > medlib - You are absolutely right about the delayed absorption. There is no difference in excretion rates at all between the two types of Effexor. Did you attend one of my lectures? Or is this info really in the monograph (I'll have to check). I found it the hard way, by looking through stacks of journal articles. I find that monographs are lawyers documents; written by lawyers, for lawyers. (They do help when in a hurry, though). - Cam W.-Carolyn - How do I find more about the Body for Life program? In the past few months I have gained about 35-40 pounds after never having a weight problem before. I find this extremely depressing and defeating. I am now on Effexor XR for ADD and depression. I am just starting to build up on it so haven't really noticed any effects yet. Thanks! Kathy
Posted by Carolyn on April 19, 2000, at 14:33:46
In reply to Re: Effexor vs. Effexor XR dosage- correct medlib, posted by Kathy on April 19, 2000, at 0:36:55
> > Hi Kathy, my email is IBJomamarama@hotmail.com. I gained 30 lbs this last year after being able to eat anything I wanted and not gaining much. Actually I went on hormaone shots and then quit and I believe that triggered the weight gain. The body for life is easy to find using your search tool on the internet. Just put in www.bodyforlife.com and it should come up. It is written by Phil somebody. It is in the top sellers of non fiction books and is $26 in bookstores. There is a contest for the 12 week program where you can win money but personally I am just doing it because I want to be a size 10 instead of 16. It is lifting weights for 45 minutes every other day, and on the other day aerobic activity for 20 minutes. It is a specific program however where you increase your weight and intensity as time goes along (daily). But I am game!! Good luck Carolyn
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.