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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Nickengland on March 20, 2005, at 10:33:56
Thanks for your replys to the previous messages
I have just began taking carbamazepine and on the box the brand is not tegretol, its made from ALPHARMA.
I was wondering if it really makes much difference, i.e is the tegretol brand better for less side-effects and more so the tegretol xr version, rather than this one i have? Could the overall effectiveness be better with tegretol to?
Also ive been taking Pro-Banthine (Propantheline bromide) for the sweating I have and have noticed since I started taking the carbamazepine it does not seem effective anymore...could this be the carbamazepine stopping it working? Gp said it shouldnt be a problem.
And the final question lol...if the carbamazepine was effecting the pro banthine am i right in thinking trileptal would not pose this problem with the 2 taken together?
Many thanks if your able to anwswer these questions for me
Posted by ed_uk on March 20, 2005, at 14:55:41
In reply to Ed_uk Question about Carbamazepine, posted by Nickengland on March 20, 2005, at 10:33:56
Hi Nick!
>Thanks for your replys to the previous messages.
You're welcome :-)
>I have just began taking carbamazepine and on the box the brand is not tegretol, its made from ALPHARMA.
Alpharma is one the major UK generic manufacturers. APS, Generics, Hillcross and IVAX also make carbamazepine.
>I was wondering if it really makes much difference, i.e is the tegretol brand better for less side-effects and more so the tegretol xr version, rather than this one i have? Could the overall effectiveness be better with tegretol to?
I expect that it will be just as effective as Tegretol.
Controlled release formulations of carbamazepine can sometimes be helpful in reducing the incidence of side effects, they are also more convenient.
There are three main brands of controlled realease carbamazepine in the UK...
Tegretol Retard (2 doses per day)
Teril CR (1-2 doses per day)
Timonil Retard (1-2 doses per day)>Also ive been taking Pro-Banthine (Propantheline bromide) for the sweating I have and have noticed since I started taking the carbamazepine it does not seem effective anymore...could this be the carbamazepine stopping it working?
Carbamazepine speeds up the metabolism of many drugs, reducing their effectiveness and duration of action.
I couldn't find any info on the interaction between carbamazepine and propantheline, I wouldn't be surprised if there was one though. Since I'm at home rather than at uni, I don't have access to much information.
If carbamazepine is speeding up the metabolism of propantheline, you should be able to restore the effectiveness of propantheline by increasing the dose. Propantheline is usually taken four times a day. If, in future, you increase the dose of carbamazepine, you may need to increase the dose of propantheline even more.
>if the carbamazepine was effecting the pro banthine am i right in thinking trileptal would not pose this problem with the 2 taken together?
Yes, *if* carbamazepine is speeding up the metabolism of propantheline, Trileptal would probably have less effect. If you increase your propantheline dose while you're taking carbamazepine, you would probably need to decrease it again if you switched to Trileptal. If you didn't decrease it, the side effects of propantheline would be increased.
Regards,
Ed.PS. What doses of propantheline and carbamazepine are you on?
How many times a day do you take them?
Any side effects?
Are you on any other medication?
Posted by Nickengland on March 21, 2005, at 11:04:55
In reply to Re: Carbamazepine and Propantheline » Nickengland, posted by ed_uk on March 20, 2005, at 14:55:41
Hi Ed thanks for the info : )
I thought/think it is the case the carbamazepine is stopping the propantheline.
>
> PS. What doses of propantheline and carbamazepine are you on?
>
I've just recently started the carbamazepine, i'm on a low one of 200mg.
As for the propantheline im not on a set dose, but have been fine with 15-30mg (1 or 2 aday) that was however before the carbamazepine.
How many times a day do you take them?
>
Once a day at the moment for the carbamazepine and once or twice for the propantheline.Any side effects?
Some pretty negative ones from the carbamazepine, general sickness feeling, sleepy and a kinda semi depressive mood - but i guess thats how all mood stabiliers make you feel to do their job!
None really that bother me for the probantheline.
>
Are you on any other medication?Propranolol - as needed basis.
I have tried in the past years different anti-depressants but overall they do no good for my condition as they just seem to set up a crash into depression for the future, or do not work.
Although my highs have never been too extream they are enough to send me into a deep depression lasting 6-8 months, so i've come to the conclusion its best in the long run to stay away from anything that can push my mood up as it will eventually cycle back down.
As for things now, my mood isn't too bad, however im on the constant search for the right med to go on with long-term. I deal with anxiety quite badly but my pdoc refused my request for clonazepam, although let me have propranolol - i think the clonzepam could be of some help.
Sorry about this waffle - just getting things off my chest i think! lol
I feel that what I need is the weakest mood stabiliser I can get. I know you can reduce dose's etc.. but in your opinon, which of all the anti convulsants does nothing for depression and has fairly "mild" anti-manic effects?
Many thanks for your thoughts on this ed
Nick
Ps I see you used to suffer from anxiety quite badly and relate to what you said - very pleased to see your over that now : ) Hope you dont mind me asking, but what is your diagnosis Ed and which medication, if any, are you taking?
Posted by ed_uk on March 21, 2005, at 14:04:12
In reply to Re: Carbamazepine and Propantheline, posted by Nickengland on March 21, 2005, at 11:04:55
Hi!
>once or twice for the propantheline.
You could try taking 15mg three times a day- at least one hour before meals. Ask your doc if s/he will let you increase.
>Some pretty negative ones from the carbamazepine, general sickness feeling, sleepy and a kinda semi depressive mood - but i guess thats how all mood stabiliers make you feel to do their job!
Will you ask for the controlled release?
> I deal with anxiety quite badly but my pdoc refused my request for clonazepam, although let me have propranolol - i think the clonzepam could be of some help.
Clonazepam isn't popular in the UK at all, it's not approved for anxiety here, only epilepsy. Have you tried diazepam? Gabapentin might help your anxiety- it's rarely an effective anti-manic though.
>which of all the anti convulsants does nothing for depression and has fairly "mild" anti-manic effects?
What do you mean by 'mild'? Do you mean somthing that's not very sedating?
>Hope you dont mind me asking, but what is your diagnosis Ed and which medication, if any, are you taking?
Mainly anxiety, OCD and atypical depression. I just take lofepramine 140mg at the moment, I often take an SSRI as well but not at the moment.
Best regards,
Ed.
Posted by Nickengland on March 21, 2005, at 16:37:27
In reply to Re: Carbamazepine and Propantheline » Nickengland, posted by ed_uk on March 21, 2005, at 14:04:12
>
> Will you ask for the controlled release?
>
Yes im considering asking for that or possibly trileptal>
> Clonazepam isn't popular in the UK at all, it's not approved for anxiety here, only epilepsy. Have you tried diazepam? Gabapentin might help your anxiety- it's rarely an effective anti-manic though.No i've never tired any benzodiazepines, is diazepam easy to get prescribed by a psychiatirst? Now that makes sense why he wouldn't let me have clonazepam I remember him saying about we normally use that for epilesy. He also said that having these type of drugs can be addictive and would look bad on my record?!..Surely if they helped though that would look better than being ill. I feel they are afraid to presribe them. Do you think diazepam would be the most likely one they would give out of all the benzodiazepines?
>
>
> What do you mean by 'mild'? Do you mean somthing that's not very sedating?Yes in a sense, I mean lithium and sodium valproate are very strong antimanic's and I feel these push my mood too far down if you know what I mean. How I mean by mild is, if say lithium and sodium valproate have strong anti-manic features, which mood stabilisers still have an anti manic features that would be less so than those 2.
My thinking is all thats left would be gabapentin and topiramate. Would these seem mild anti-manic's compared to the others, or just simply not effective where mania is concerned.
Thanks for all your help with this Ed : )
>
>
> Mainly anxiety, OCD and atypical depression. I just take lofepramine 140mg at the moment, I often take an SSRI as well but not at the moment.Glad to see you seem to be coping well without the ssri.
>
Kind regardsNick
>
>
>
>
Posted by ed_uk on March 21, 2005, at 17:21:45
In reply to Re: Carbamazepine and Propantheline, posted by Nickengland on March 21, 2005, at 16:37:27
Hi Nick!
>Is diazepam easy to get prescribed by a psychiatirst?
Diazepam is by far the most widely prescribed anti-anxiety benzo in the UK. Many elderly people have been on it for decades. In the UK, doctors are STRONGLY discouraged from starting any new patients on long-term diazepam, even for severe anxiety. Some doctors are happy to prescribe diazepam for 'as required' use or short-term use for a couple of weeks. Some doctors will refuse to prescribe it at all, which I personally think is dumb.
>Surely if they helped though that would look better than being ill.
There is always the concern that you would develop tolerance and that the treatment would no longer work. It is impossible to predict who will develop tolerance, some people find it effective in the long-term, others do not. The withdrawal symptoms can be severe when you stop, it is necessary to reduce the dose gradually if you've take it for more than a couple of weeks, this helps to reduce the severity of the withdrawal symptoms. Some people are angry because they are having side effects from their benzo but they can't come off it because of the withdrawal symptoms. Diazepam is often best used in 2-4 week courses, to treat periods of severe anxiety. Some people do seem to benefit greatly in the long run, but it is important to remember the risks of long-term treatment. After long-term use, physical dependence on benzos is very common, withdrawal symptoms are likely if the drug is stopped. 'Drug addiction' in the sense of 'drug addict' is very unlikely unless the patient abuses their medication in an attempt to get high.
>I feel they are afraid to presribe them.
Yes, they are. They are protecting themselves from future legal action!
In England, primary care trusts (PCTs, groups of GPs surgeries) are given 'star ratings' for performance- you've probably heard about these on the news. Several different 'performance indicators' are used to assess the quality of service. Surprisingly, benzo prescribing is one of the official 'performance indicators'. The more benzos GPs prescribe, the lower the star rating of their PCT!!!!!!!!! I don't think this applies to psychiatrists though because they work in secondary care. Personally, I think this is pretty dumb system, the total 'volume' of benzos prescribed is hardly an accurate indicator of whether GPs are prescribing the drugs appropriately. Furthermore, GPs are strongly discouraged from prescribing benzos (2-4 weeks) to patients who might really benefit. Anyway, I don't like the idea of people being forced to stop the sleeping tablets they've been taking for the last 30 years just because their GP wants his PCT to get a better rating.
>Do you think diazepam would be the most likely one they would give out of all the benzodiazepines?
Yes.
Doctors often prescribe diazepam at very low doses, you'll need to find the dose which is most effective for you, there is a lot of variation between individuals. In general, I wouldn't recommend long-term use of diazepam unless your anxiety is very severe and you've exhausted all the other options.
>Yes in a sense, I mean lithium and sodium valproate are very strong antimanic's and I feel these push my mood too far down if you know what I mean.
What was your lithium level when you were 'stabilised'? It may have been too high- lithium can work as an antidepressant and as an antimanic at low levels.
>My thinking is all thats left would be gabapentin and topiramate.
Gabapentin isn't usually that effective as an anti-manic, it can be effective for anxiety and insomnia though. The anti-manic effectiveness of topiramate compared to other anticonvulsants hasn't been well studied yet, if carbamazepine CR and Trileptal are not to your liking, you could ask for a trial of topiramate. Topiramate often causes quite a lot of cognitive impairment, it is popular among overweight people though becasue it often causes weight loss!
I'm not sure how easy it will be to get Trileptal prescribed, you may have to find some research to show your psychiatrist!
Take care,
Ed.PS. Where in England do you live?
Posted by Nickengland on March 24, 2005, at 10:38:13
In reply to GP benzo prescribing lowers PCT star rating (UK) » Nickengland, posted by ed_uk on March 21, 2005, at 17:21:45
Hi Ed,
Wow!!...I can't believe all the politics involved with presribing a benzo !!!
It seems that prescribing a benzo can be like a lottery as to regards with if the patient will benefit in the longterm, possible risks of addiction and lastly making the overall problem worse.
I think i will forget the whole idea of trying to get one now, after all I wouldn't want more problems than I already have and sometimes I think its best to take as little medication as possible.
Very interesting what you say about the star ratings and PCT's. What a joke! I've taken venlafaxine before and It is well known that withdrawing from that can be very difficult, (as i discovered) as with some other anti-depressants. Surely Id imagaine coming off of a benzo must be somewhat similar with regards to the pain you suffer...Gps love giving out lots of anti depressants though - ssri's - makes you wonder if they receive more stars for giving out that type of drug! lol.
When I go in my gps room there is so much "merchandise" advertisiing these particular anti depressants, seroxat etc..It seems these particular drug companies have pushed lots of £££££££'s and used lots of marketing strategy's to push their drugs forward. It will be interesting to see in the future if these types of drugs in years to come will go down the same path as the benzo's?...Many conspricey theories! lol
All in all though, a pathectic approach with regards to the benzo's in the uk.
I think im going to take the route of seeing if I can get trileptal and gabapentin to help with the anxiety. Which kind of data would be a good idea to show the psychiatrist with regards to going for the trileptal?
I dont think my mind could taking being impaired much more than it already with these drugs so I think I'll rule out topamax.Im from the south-east, xxx. How about you?
Kind regards,Nick
Posted by ed_uk on March 24, 2005, at 13:07:23
In reply to Re: GP benzo prescribing lowers PCT star rating (UK), posted by Nickengland on March 24, 2005, at 10:38:13
Hi Nick!
>I think i will forget the whole idea of trying to get one now, after all I wouldn't want more problems than I already have and sometimes I think its best to take as little medication as possible.
If you suffer from severe anxiety, it can be helpful to have a few diazepam 5mg tablets to take if things get really bad.
>venlafaxine
I've also taken venlafaxine. The doctors always underestimate the withdrawal, they tell you it's really mild and insignificant!
>I think im going to take the route of seeing if I can get trileptal and gabapentin to help with the anxiety.
Sounds good. Don't start them both at the same time though or else you won't know what's helping!! Do you think you might be giving up on carbamazepine too early?
>Which kind of data would be a good idea to show the psychiatrist with regards to going for the trileptal?
Type oxcarbazepine and bipolar into the search box on PubMed and print out some abstracts.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
Here is an example of an abstract..........
Int J Neuropsychopharmacol. 2004 Dec;7(4):507-22. Epub 2004 Sep 30.
A review of the evidence for carbamazepine and oxcarbazepine in the treatment of bipolar disorder.
Hirschfeld RM, Kasper S.
Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, TX 77555-0188, USA. rohirsch@utmb.edu
Bipolar disorder is a recurrent lifelong condition associated with significant morbidity and mortality. The main goals of treatment are the acute management of manic/depressive episodes and the prevention of recurrence. Mood stabilizers are the basis of most treatment regimens. Although lithium is the classical mood stabilizer, dissatisfaction with its efficacy and tolerability has led to increased use of other mood- stabilizing agents, including anticonvulsants. Newer anticonvulsants such as oxcarbazepine may offer improved tolerability and fewer drug-drug interactions compared to older drugs like carbamazepine. A search of the literature shows that data from controlled clinical studies support the efficacy of carbamazepine in treating acute mania and as maintenance therapy. In addition, a growing body of data for oxcarbazepine suggests that this newer agent may have a similar efficacy profile to carbamazepine, with improved tolerability. This review presents a balanced selection of the key studies on carbamazepine and oxcarbazepine in bipolar disorder.
>Im from the south-east, Essex. How about you?
I'm from Yorkshire but I'm living in Manchester at the moment.
Kind regards,
Ed.
Posted by Nickengland on March 24, 2005, at 18:02:13
In reply to Re: GP benzo prescribing lowers PCT star rating (UK) » Nickengland, posted by ed_uk on March 24, 2005, at 13:07:23
If you suffer from severe anxiety, it can be helpful to have a few diazepam 5mg tablets to take if things get really bad.
Yes I guess it some ways it would be safer to know I have them just in case. All deprends on whether the psychiatrist will give diazepam to me though. He refused clonazepam and didn't offer an alternative, but I can always ask again. Is diazepam the least likely to be abused?
Sounds good. Don't start them both at the same time though or else you won't know what's helping!! Do you think you might be giving up on carbamazepine too early?Yes in some repects I am. I've cut back on the dose , well I haven't taken it in the past couple of days and feel so much better. Through the past Ive had this effect of mood stabiliers pushing my mood down like this and have continued for a couple months only to cease the medication because of this. I think if I continued with carbamazepine I'd end up dis-continuing it anyway. With the trileptal maybe having less side-effects, im hoping (praying!) that'll i'll be able to handle that on a long-term basis.
Hmmm..I wonder if I will have any problems getting the gabapentin, as like you say I wont know which is working? Unless I can get both, start with the trileptal for a few weeks and if all goes well (if i can the side effects) add the gabapentin later if needed...
Thanks for the data on pub med : )..Is it mainly used by professionals in the US or Uk too?
Oh forgot to mention about the lithium the last time. I was taking a small dose 400mg for about 2 months. I could see how it works, but for me the weightgain was too much. I felt useless and at my worst point was in bed till 4:00pm in the afternoon!!!! Again this was another that pushed me too far down.
Ahh Manchester and Yorkshire, I've never even been that far up north. Been all over the south, lived in xxx for while and xxx..God i miss that place! Hope that oneday soon when Ive got my medication sorted to move again.
Kind regards,
Nick
Posted by ed_uk on March 24, 2005, at 18:34:23
In reply to Re: GP benzo prescribing lowers PCT star rating (UK), posted by Nickengland on March 24, 2005, at 18:02:13
Hi!
>Is diazepam the least likely to be abused?
No, diazepam actually seems to have a slightly higher abuse potential than most benzos- few doctors in the UK seem to know this however. Diazepam it prefered by drug misusers for its rapid onset of action.
Since diazepam is the 'standard' benzo used for tapering, many pdocs in the UK incorrectly assume that it's got a lower abuse potential. Diazepam is used for tapering because it's often easier to withdraw than other benzos- this doesn't have anything to so with its abuse potential though! It's easier to withdraw because it's slowly eliminated from the body and it comes in low-dose tablets which are useful for making small dosage reductions.
>Unless I can get both, start with the trileptal for a few weeks and if all goes well (if i can the side effects) add the gabapentin later if needed...
Sounds reasonable :-)
>Is it mainly used by professionals in the US or Uk too?
It's used by both.
>Gran Canaria
:-D Sounds great!
Best regards,
Ed.
This is the end of the thread.
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