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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by KathrynLex on March 28, 2004, at 12:12:01
In reply to Xanax?, posted by vjw on March 26, 2004, at 20:53:38
Hi VJW,
I take Xanax (.25 mgs) or Klonopin (.5 mgs) on an as needed basis along with my daily doses of Lex and Wellbutrin. Xanax is a much more potent drug, and it makes me tired. Just .5 mgs knocks me out. Klonopin doesn't seem to have as many side effects and doesn't cause me as much drowsiness as Xanax. But of course, everyone is different. Plus, I've heard that if you take either Xanax or Klonopin on a daily basis they stop making you tired.
K.
Posted by awatts on March 28, 2004, at 18:38:40
In reply to Re: Xanax?, posted by KathrynLex on March 28, 2004, at 12:12:01
>... Plus, I've heard that if you take either Xanax or Klonopin on a daily basis they stop making you tired.
>
> K.
True - the tiredness usually ends within a few weeks. This is why people get into trouble trying to to use them as sleep aids on a regular basis. You have to keep increasing the dosage to keep them working.
Posted by vjw on March 28, 2004, at 21:48:51
In reply to Re: Xanax?, posted by awatts on March 28, 2004, at 18:38:40
Thanks, everyone. I will ask my doc about it tomorrow.
Posted by vjw on March 29, 2004, at 22:33:06
In reply to Re: Xanax?, posted by Vera on March 27, 2004, at 12:28:15
> Hi -
>
> I took Wellbutrin and I've posted previously about this - Wellbutrin is known for increasing anxiety, as it sure did for me. I was given 1mg Xanax, and told to take .5 twice a day to start, as needed. Well, in order to counteract the anxiety, I needed to be on in constantly, and I didn't want that. I was taken off Wellbutrin completely and put on Pamelor, and now I have to start taking Ativan, too. They say these AD's help w/both depression and anxiety - I've been on several and NONE help both. There is a long-acting type of Xanax, however, so maybe ask your Pdoc about - sorry, I forget exactly what it's called, but he/she will know. When I have taken Xanax, I only notice blissful calm, not fatigue, but everyone is different, of course. Good luck.
>
> VeraThanks, Vera. I asked my doc about it today and she said Xanax was too addicting. She's giving me an RX for "a few" when I feel I really need it. I guess that's better than nothing.
Posted by Vera on March 29, 2004, at 23:16:39
In reply to Re: Xanax?, posted by vjw on March 29, 2004, at 22:33:06
Oh, yeah, I know, I know. I hear this from time to time, and many years ago I had a Doc who felt the same. HOWEVER, more recently they have found that Xanax isn't as addicting as they once thought. But, there are still pdocs from the "old school" who insist you'll become a raving street addict in no time. I believe if pills are taken responsibly, docs should give the benefit of the doubt, at least for the first RX. I was put on Ativan which is taken daily, and, I'm guessing, doesn't have the same potential for addiction. If your anxiety continues, mention this one to your doc, or Klonopin, as no one should have to suffer. This is what they're made for! Good luck!'
Vera
Posted by watergirl on March 30, 2004, at 11:34:17
In reply to Xanax?, posted by vjw on March 26, 2004, at 20:53:38
my pdoc added .5 mg xanex xr to take in the morning. it works all day, very sm0oth
Posted by vjw on April 8, 2004, at 21:06:28
In reply to Re: Xanax?, posted by KathrynLex on March 28, 2004, at 12:12:01
> Hi VJW,
>
> I take Xanax (.25 mgs) or Klonopin (.5 mgs) on an as needed basis along with my daily doses of Lex and Wellbutrin. Xanax is a much more potent drug, and it makes me tired. Just .5 mgs knocks me out. Klonopin doesn't seem to have as many side effects and doesn't cause me as much drowsiness as Xanax. But of course, everyone is different. Plus, I've heard that if you take either Xanax or Klonopin on a daily basis they stop making you tired.
>
> K.Do you feel you're getting dependant on the Xanax or Klonopin??
My doc is concerned about that and only gave me 20 .25mg with one refill.
Posted by chemist on April 9, 2004, at 0:07:58
In reply to Re: Xanax?, posted by vjw on April 8, 2004, at 21:06:28
chemist here. you are dealing with 2 different entities. xanax (alprazolam) is not a true benzodiazepine: it is a triazolobenzodiazepene, and klonopin is one of the 1,4-benzodiazepines. thus, you cannot substitute one for the other. klonopin is known for its long half-life, 30-40 hours after dosing. xanax has documented anti-depressant activity, which can alter your course of treatment if you tend towards the hypomanic or manic side of the spectrum. xanax has a half-life of about 12 hours, which is a blessing and a curse, as if you are predisposed to addictive tendancies, you will be dosing more frequently. the good news is that it is very effective for panic attacks, generalized anxiety disorder, and the like. if you are on xanax, and you want to taper, do so slowly and disregard ANY advice from your doctor that you can substitute another ``benzo'' instead: you can't. if you want to take the slow road, swith to the extended release form (Xanax XR) and go from there....best, chemist
Posted by vjw on April 9, 2004, at 20:24:59
In reply to Re: Xanax?, posted by vjw on April 8, 2004, at 21:06:28
Thanks to everyone who responded. I've been taking the .25 Xanax as needed for a week now. It seems to help with what I call the "churning" in my stomach and doesn't make me TOO sleepy so far.
Posted by Vera on April 10, 2004, at 13:15:55
In reply to Re: Xanax? » vjw, posted by chemist on April 9, 2004, at 0:07:58
I'm confused - everything I've seen states that Xanax is a benzo. Don't understand. But can I ask your opinion on what my Pdoc has prescribed for me? He added Lexapro to the Pamelor I've been taking, plus Ativan as neither were helping the anxiety. A while back he'd also prescribed Xanax,1mg, so I asked him if I should then discontinue using it. He said if I'm having a very bad day, I could also take it. I haven't, because I feel like this is toooo much. I take 75mg Pamelor, I'm SUPPOSED to take Lex,10mg, and Ativan,1mg,both twice a day, but only take both once because I'm afraid that this is all just too much. Thoughts?? Thanks
Posted by zeugma on April 10, 2004, at 13:50:47
In reply to Re: Xanax? » chemist, posted by Vera on April 10, 2004, at 13:15:55
> I'm confused - everything I've seen states that Xanax is a benzo. Don't understand. But can I ask your opinion on what my Pdoc has prescribed for me? He added Lexapro to the Pamelor I've been taking, plus Ativan as neither were helping the anxiety. A while back he'd also prescribed Xanax,1mg, so I asked him if I should then discontinue using it. He said if I'm having a very bad day, I could also take it. I haven't, because I feel like this is toooo much. I take 75mg Pamelor, I'm SUPPOSED to take Lex,10mg, and Ativan,1mg,both twice a day, but only take both once because I'm afraid that this is all just too much. Thoughts?? Thanks
Vera
I'm not chemist (or a chemist), but I take Pamelor (nortriptyline) 75 mg/day. I found this to be adequate for relieving symptoms of my depression, but not for my anxiety symptoms. So I currently also take .5 mg clonazepam which is pretty effective in controlling most anxiety. Pamelor and Lexapro are both antidepressants, but they have different mechanisms of action. 10 mg Lexapro is considered to be a therapeutic dose, and unlike a benzo it will not work prn. I can only guess that your doctor thinks the 10 mg is insufficient even in conjunction with the 75 mg of Pamelor. I think that 1 mg Ativan is roughly equivalent to .5 mg clonazepam. IMO if your anxiety and depression are under control at your present dosages it means that more will leave you 'over-medicated.'
Posted by Vera on April 10, 2004, at 17:47:31
In reply to Re: Xanax? » Vera, posted by zeugma on April 10, 2004, at 13:50:47
Wow!! You're the first person I've found who takes Pamelor! I was initially put on it because of chronic pain (fibromyalgia, scoliosis, deg. disk disease and arthritis) but it did little for depression and anxiety, unfortunately. I feel *OK* at these dosages, but I'm not really sure I'm *there* yet - still don't feel "normal". So, this is why I wondered about the dosages...but you're right - I don't want to feel out-of-it, just normal. The anxiety, of course, is why I have all these worries about meds!! Thank you so much for your thoughts.
Posted by chemist on April 10, 2004, at 19:41:54
In reply to Re: Xanax? » chemist, posted by Vera on April 10, 2004, at 13:15:55
hi vera, xanax is *truly* not a benzodiazepene: it has a structural element in the molecule that makes it a triazolobenzodiazepene, and that is why one cannot swap out, for instance, ativan for xanax. your nortriptyline and citalopram combo is not necessarily great, given that there is evidence that nortriptyline toxicity could result when SSRIs (among other drugs/foods) are taken concurrently. it is very sedating, and the ativan is adding to that effect. your regimen of taking half the doses prescribed for lexapro and ativan is, in my opinion, wise only for the ativan: you are robbing yourself of some of the activating qualities of lexapro, but again, i would be wary of potential problems with pamelor and lexapro...all the best, chemist
> I'm confused - everything I've seen states that Xanax is a benzo. Don't understand. But can I ask your opinion on what my Pdoc has prescribed for me? He added Lexapro to the Pamelor I've been taking, plus Ativan as neither were helping the anxiety. A while back he'd also prescribed Xanax,1mg, so I asked him if I should then discontinue using it. He said if I'm having a very bad day, I could also take it. I haven't, because I feel like this is toooo much. I take 75mg Pamelor, I'm SUPPOSED to take Lex,10mg, and Ativan,1mg,both twice a day, but only take both once because I'm afraid that this is all just too much. Thoughts?? Thanks
Posted by zeugma on April 10, 2004, at 20:47:32
In reply to Re: Xanax? » Vera, posted by chemist on April 10, 2004, at 19:41:54
I know nortriptyline is problematic to combine with several SSRI's. But I thought that citalopram was one of the safer ones, because it is not a strong inhibitor of the CYP 2D6 pathway that metabolizes both drugs.
Posted by Vera on April 10, 2004, at 20:59:22
In reply to nortriptyline, citalopram toxicity » chemist, posted by zeugma on April 10, 2004, at 20:47:32
For Zeugma and Chemist -
Hey, guys! Maybe a bit of English please!?? :-)
I am now concerned about the combo of Pamelor and Lexapro??? Chem, are you saying, then, that I should stick with the Ativan 1mg, once daily, but increase the Lex10mg to twice a day?? Sorry to bother both of you again. I just want to feel normal - not comatose. :-) Thanks again.
Posted by chemist on April 10, 2004, at 21:27:22
In reply to Re: nortriptyline, citalopram toxicity » zeugma, posted by Vera on April 10, 2004, at 20:59:22
hi there, chemist again....i quote from forest pharmaceuticals white-paper: ``However, there are limited in vivo data suggesting a modest CYP2D6 inhibitory effect for escitalopram (lexapro), i.e., coadministration of (lexapro) (20 mg/day for 21 days) with the tricyclic antidepressant desipramine (single dose of 50 mg), a substrate for CYP2D6, resulted in a 40% increase in C_{max} and a 100% increase in AUC of desipramine...Nevertheless, caution is indicated in the coadministration of (lexapro) and drugs metabolized by CYP2D6.'' play it safe....best, chemist
> For Zeugma and Chemist -
>
> Hey, guys! Maybe a bit of English please!?? :-)
> I am now concerned about the combo of Pamelor and Lexapro??? Chem, are you saying, then, that I should stick with the Ativan 1mg, once daily, but increase the Lex10mg to twice a day?? Sorry to bother both of you again. I just want to feel normal - not comatose. :-) Thanks again.
Posted by zeugma on April 10, 2004, at 23:21:56
In reply to Re: nortriptyline, citalopram toxicity » Vera, posted by chemist on April 10, 2004, at 21:27:22
Apparently lexapro can raise the plasma levels of nortriptyline. (Now I see why my dr. wasn't adamant that I try an SSRI before a benzo to control my anxiety.) Nortriptyline is only effective within a fairly limited range- long before it becomes toxic, it will become ineffective. You can ask your dr. about a plasma level test on the nortriptyline.
I think it is reasonable to raise the Lexapro to 20 mg if you are still depressed and have given 10 mg a reasonable trial. It takes about a month at a given dose of an antidepressant (whether pamelor or Lexapro) to see if it is adequate. You should not hesitate to share your concerns with your doctor.
Posted by Vera on April 11, 2004, at 1:13:51
In reply to Re: nortriptyline, citalopram toxicity, posted by zeugma on April 10, 2004, at 23:21:56
Thanks for the info, Zeugma. I understand better now, tho Chemist? I don't understand your last post. Waaay to techy for me - sorry. But thanks to you both!!
Posted by rod on April 11, 2004, at 4:46:23
In reply to Re: nortriptyline, citalopram toxicity » Vera, posted by chemist on April 10, 2004, at 21:27:22
Hi chemist,
sorry for sneaking in and starting an off topic question.
You really seem to know a lot about the enzyme interaction issues. So I have to ask you the following.
I once were taking 75mg(and for some time 100mg) of Amitriptyline and 40mg Prozac (thats the strongest 2D6 inhibitors of the SSRIs, as far as I know). I really felt extremely worse on that combo and after I did quit cold turkey and switched to celexa alone, and I felt better very very fast. And even my doctor, although he didnt seem to be aware of the enzyme interaction said:"hmm, it seems there was something wrong with the medication".
Do You know, if the administered dosages were high enough to get toxic amitriptlyine levels?Thank You very much!
Roland
Posted by terrics on April 11, 2004, at 10:53:31
In reply to Re: Xanax? » vjw, posted by Vera on March 29, 2004, at 23:16:39
Is ativan a controlled substance? I don't think so ,but I'm not sure. Is it also called vistaril? It is a good anti-anxiety if it is the drug I am thinking about; and Docs are not too afraid to prescribe it cause it is not controlled. terrics
Posted by Vera on April 11, 2004, at 10:56:23
In reply to Re: nortriptyline, citalopram toxicity » Vera, posted by chemist on April 10, 2004, at 21:27:22
Chemist -
Been reading up a bit and I'm wondering why you discussed the combo of Lexapro with desipramine - I take Lexapro with Pamelor. So does this change anything you had written about the combo I take? Thanks again
Posted by Vera on April 11, 2004, at 10:59:05
In reply to Re: nortriptyline, citalopram toxicity » Vera, posted by chemist on April 10, 2004, at 21:27:22
Chemist -
Been reading up a bit and I'm wondering why you discussed the combo of Lexapro with desipramine - I take Lexapro with Pamelor. So does this change anything you had written about the combo I take? Thanks again
Posted by zeugma on April 11, 2004, at 12:43:44
In reply to Re: nortriptyline, citalopram toxicity, posted by Vera on April 11, 2004, at 10:59:05
Desipramine and nortriptyline are close chemical cousins. So if the ability to process desipramine is blocked, then it's likely that nortriptyline will be subject to the same problem. Since Lexapro is probably a much weaker inhibitor of the relevant enzymes than Prozac or Paxil, the interaction is likely to be less dangerous, but it's still something to be aware of. Getting a plasma test for nortriptyline is standard practice, anyway- it is the antidepressant with the most well-defined 'therapeutic window', meaning plasma levels have to be within a certain range for optimal results to occur. I got a plasma test for nortriptyline last year, and had my dosage adjusted as a result. This made the drug more effective even though there was no concern about toxicity- it turned out my plasma levels had been too low.
Posted by chemist on April 11, 2004, at 13:30:44
In reply to Re: nortriptyline, citalopram toxicity » Vera, posted by zeugma on April 11, 2004, at 12:43:44
hi vera, zeugma....zeugma is right on target in re: potential for toxicity of nortriptyline and desipramine associated with SSRIs, and i apologize for not making my logic clearer. as zeugma states, the TCAs are structurally and mechanistically similar in action and metabolism, and he/she is also correct that lexapro is a *weak* inhibitor of the metabolic isoenzymes that are involved, so the prudent advice is to follow zeugma's suggestion about checking your liver function and blood plasma levels. it always helps to establish a baseline CBC panel should any problems arise, although it is rather unlikely with lexapro given the weak inhibitory effect....all the best, chemist
> Desipramine and nortriptyline are close chemical cousins. So if the ability to process desipramine is blocked, then it's likely that nortriptyline will be subject to the same problem. Since Lexapro is probably a much weaker inhibitor of the relevant enzymes than Prozac or Paxil, the interaction is likely to be less dangerous, but it's still something to be aware of. Getting a plasma test for nortriptyline is standard practice, anyway- it is the antidepressant with the most well-defined 'therapeutic window', meaning plasma levels have to be within a certain range for optimal results to occur. I got a plasma test for nortriptyline last year, and had my dosage adjusted as a result. This made the drug more effective even though there was no concern about toxicity- it turned out my plasma levels had been too low.
>
>
Posted by Speed on April 11, 2004, at 16:44:55
In reply to Re: nortriptyline, citalopram toxicity » zeugma, posted by Vera on April 10, 2004, at 20:59:22
Xanax may no be a true Benzo, but I have taken it, and I also have taken Ativan and Clonopin. They all worked, relieving my anxiety symtoms. Not really sure which one I prefer.
This is the end of the thread.
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