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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by Larry Hoover on May 28, 2005, at 18:16:20
In reply to Cymbalta capsule splitting ?, posted by flmm on May 28, 2005, at 16:06:13
> Is it ok to split a capsule with half in one side and half in the other, open ended, and take Cymbalta this way? I want to go from 30mg to 45mg.
> thanxYes, but there's a problem if any of the little pellets get damaged. Why don't you paste the little fellas in their little capsule end with a dab of peanut butter or similar, to seal it up temporarily?
Lar
Posted by flmm on May 28, 2005, at 18:38:08
In reply to Re: Cymbalta capsule splitting ? » flmm, posted by Larry Hoover on May 28, 2005, at 18:16:20
Thanx for your reply Larry! But I don't understand how they would get damaged. Is the potency ok this way?
Posted by Phillipa on May 28, 2005, at 19:40:15
In reply to Re: Cymbalta capsule splitting ?, posted by flmm on May 28, 2005, at 18:38:08
I do know they're enteric coated. So don't chew them. Fondly, Phillipa
Posted by Larry Hoover on May 28, 2005, at 21:17:03
In reply to Re: Cymbalta capsule splitting ?, posted by flmm on May 28, 2005, at 18:38:08
> Thanx for your reply Larry! But I don't understand how they would get damaged. Is the potency ok this way?
The potency is fine. It's if those little pellets (mini-pills, really, each individually enteric coated) get loose in your mouth, and get crunched by your teeth, you expose the drug to stomach acid. Stomach acid destroys it. The enteric coating is to get it past the stomach. An enteric coating only dissolves in basic solution (i.e. the opposite of acid), and the first place that the pellets get to that is like that is in the intestine. Getting the little pellets into your stomach *intact* is important. How you get them there is not.
Lar
Posted by flmm on May 28, 2005, at 21:42:25
In reply to Re: Cymbalta capsule splitting ? » flmm, posted by Larry Hoover on May 28, 2005, at 21:17:03
Excellent reply! Thanx Larry!
Posted by Phillipa on May 28, 2005, at 21:42:40
In reply to Re: Cymbalta capsule splitting ? » flmm, posted by Larry Hoover on May 28, 2005, at 21:17:03
Lar, the best discription I've read yet. Better keep this one on file. It will come up again. Fondly, Phillipa
Posted by Sarah T. on May 28, 2005, at 22:06:08
In reply to Re: Cymbalta capsule splitting ? » flmm, posted by Larry Hoover on May 28, 2005, at 21:17:03
> > > The potency is fine. It's if those little pellets (mini-pills, really, each individually enteric coated) get loose in your mouth, and get crunched by your teeth, you expose the drug to stomach acid. Stomach acid destroys it. The enteric coating is to get it past the stomach. An enteric coating only dissolves in basic solution (i.e. the opposite of acid), and the first place that the pellets get to that is like that is in the intestine. Getting the little pellets into your stomach *intact* is important. How you get them there is not.> Lar
Hi Larry. Thanks for this information. Is this true of pellets contained in capsules of all medicines that are in capsule form or is this specific to Cymbalta?
Posted by Larry Hoover on May 29, 2005, at 7:54:01
In reply to pellets in capsules » Larry Hoover, posted by Sarah T. on May 28, 2005, at 22:06:08
> > > > The potency is fine. It's if those little pellets (mini-pills, really, each individually enteric coated) get loose in your mouth, and get crunched by your teeth, you expose the drug to stomach acid. Stomach acid destroys it. The enteric coating is to get it past the stomach. An enteric coating only dissolves in basic solution (i.e. the opposite of acid), and the first place that the pellets get to that is like that is in the intestine. Getting the little pellets into your stomach *intact* is important. How you get them there is not.> Lar
>
> Hi Larry. Thanks for this information. Is this true of pellets contained in capsules of all medicines that are in capsule form or is this specific to Cymbalta?This is true for Cymbalta, because Cymbalta is destroyed by stomach acid. Any other med that is acid-sensitive would be enteric-coated, but usually those are pills that are coated. Enteric coating can also be used to protect the stomach from drugs that irritate it.
Some capsules have mixtures of different coatings on different pellets, all in one capsule. One coating type instantly dissolves, giving you quick activity. Another coating is enteric, but rather thin. That gives some pellets quick release, but only when the pellets have moved out of the stomach (1-3 hours later). So, kind of a time-release mechanism. Still other pellets might have a really thick enteric coating, and they somewhat gradually get released from the intestine, further extending the maximum time of first release of part of the dose.
This can allow you to take a med, for example, once every 12 hours instead of once every 4. The mix of coatings delays the release of some of medication. This also reduced the height of the peak of blood concentration, and broadens it. You get a more stable, long-term peak.
General concepts.
Lar
Posted by Cairo on May 30, 2005, at 8:05:09
In reply to Re: pellets in capsules, posted by Larry Hoover on May 29, 2005, at 7:54:01
What about Effexor XR? I tried counting out pellets with that and I remember having different effects: one time not much, then another time feeling incredibly spacey (but my muscles completely relaxed for the first and only time since onset of Fibromyalgia). Is Effexor XR one of those that has different coatings on different pellets? That would explain my inconsistent results. Thanks.
Cairo
> Some capsules have mixtures of different coatings on different pellets, all in one capsule. One coating type instantly dissolves, giving you quick activity. Another coating is enteric, but rather thin. That gives some pellets quick release, but only when the pellets have moved out of the stomach (1-3 hours later). So, kind of a time-release mechanism. Still other pellets might have a really thick enteric coating, and they somewhat gradually get released from the intestine, further extending the maximum time of first release of part of the dose.
>
> This can allow you to take a med, for example, once every 12 hours instead of once every 4. The mix of coatings delays the release of some of medication. This also reduced the height of the peak of blood concentration, and broadens it. You get a more stable, long-term peak.
>
> General concepts.
>
> Lar
>
>
Posted by Sarah T. on May 30, 2005, at 20:52:48
In reply to Re: pellets in capsules, posted by Larry Hoover on May 29, 2005, at 7:54:01
Posted by Larry Hoover on May 30, 2005, at 22:43:18
In reply to Re: pellets in capsules » Larry Hoover, posted by Cairo on May 30, 2005, at 8:05:09
> What about Effexor XR? I tried counting out pellets with that and I remember having different effects: one time not much, then another time feeling incredibly spacey (but my muscles completely relaxed for the first and only time since onset of Fibromyalgia). Is Effexor XR one of those that has different coatings on different pellets? That would explain my inconsistent results. Thanks.
I can only speculate. That is an explanation that fits the circumstances. Maybe they fill the capsule in sequence, e.g. 1/3 rapid release, 1/3 delayed release, 1/3 extended release. If you didn't know to mix them up before you separated them into portions, you'd conceivably have different formats in each little pile you made.
I really don't know what they might have done with Effexor specifically. There are so many different microencapsulation processes, each dealing with factors like the solubility and hydophilic (water-loving) or hydrophobic (water-repelled, or fat-loving) nature of the drug, half-life, and so on. There's an entire industry growing up around developing these types of delivery systems.
From the cynical perspection, developing an XR formulation lets them extend the patent. The XR may not be any advance over simple oral pharmacokinetics.
Lar
Posted by Larry Hoover on May 30, 2005, at 22:43:53
In reply to Larry, thank you again! (nm), posted by Sarah T. on May 30, 2005, at 20:52:48
Posted by katia on May 31, 2005, at 14:31:40
In reply to Re: pellets in capsules » Cairo, posted by Larry Hoover on May 30, 2005, at 22:43:18
> I can only speculate. That is an explanation that fits the circumstances. Maybe they fill the capsule in sequence, e.g. 1/3 rapid release, 1/3 delayed release, 1/3 extended release. If you didn't know to mix them up before you separated them into portions, you'd conceivably have different formats in each little pile you made.
Larry,
The way you just speculated on Effexor above, do you know if Cymbalta is the same speculation? I want to take only a few pellets a day.
Thanks
Posted by Larry Hoover on May 31, 2005, at 16:30:31
In reply to Re: pellets in capsules » Larry Hoover, posted by katia on May 31, 2005, at 14:31:40
> > I can only speculate. That is an explanation that fits the circumstances. Maybe they fill the capsule in sequence, e.g. 1/3 rapid release, 1/3 delayed release, 1/3 extended release. If you didn't know to mix them up before you separated them into portions, you'd conceivably have different formats in each little pile you made.
>
> Larry,
> The way you just speculated on Effexor above, do you know if Cymbalta is the same speculation? I want to take only a few pellets a day.
> ThanksAs far as I know, all the Cymbalta pellets are the same. They're enteric coated, to get them past the stomach acid intact. They're not XR formulated. Just plain enteric coating.
Lar
Posted by katia on May 31, 2005, at 17:03:36
In reply to Re: pellets in capsules » katia, posted by Larry Hoover on May 31, 2005, at 16:30:31
> > > I can only speculate. That is an explanation that fits the circumstances. Maybe they fill the capsule in sequence, e.g. 1/3 rapid release, 1/3 delayed release, 1/3 extended release. If you didn't know to mix them up before you separated them into portions, you'd conceivably have different formats in each little pile you made.
> >
> > Larry,
> > The way you just speculated on Effexor above, do you know if Cymbalta is the same speculation? I want to take only a few pellets a day.
> > Thanks
>
> As far as I know, all the Cymbalta pellets are the same. They're enteric coated, to get them past the stomach acid intact. They're not XR formulated. Just plain enteric coating.
>
> Lar
>Hi Lar,
That's not what I was referring to. I was referring to the above statement of yours "a 1/3 is....etc.". I worry about splitting the pills up because of this.
Do you know if each pellet could be different, therefore not an accurate dose each time??
Thaks
Posted by dog on May 31, 2005, at 17:25:46
In reply to Re: pellets in capsules » Larry Hoover, posted by katia on May 31, 2005, at 17:03:36
i was recently diagnosed with MS. i have been taking various SSRIs and other anti-depressants since 1987 for depression. i believe i have had the MS for a long time and that the MS has caused the depression.
does anyone know anything about this?
i am taking cymbalta and have been since last fall, when my leg pain increased in the PDR reads leg pain can be a side-effect of wellbutrin, so i got off wellbutrin and started cymbalta... recently the depression increased probably due to the interferon, so i am now taking 120 mg/day of cymbalta.
does anyone have any advice?
Posted by Phillipa on May 31, 2005, at 18:14:24
In reply to Re: cymbalta, MS, posted by dog on May 31, 2005, at 17:25:46
I'm so sorry you have MS. Is the interferon helping you with this? Cymbalta decreased muscular pain for me. Fondly, Phillipa
Posted by Larry Hoover on May 31, 2005, at 18:49:46
In reply to Re: pellets in capsules » Larry Hoover, posted by katia on May 31, 2005, at 17:03:36
> > > > I can only speculate. That is an explanation that fits the circumstances. Maybe they fill the capsule in sequence, e.g. 1/3 rapid release, 1/3 delayed release, 1/3 extended release. If you didn't know to mix them up before you separated them into portions, you'd conceivably have different formats in each little pile you made.
> > >
> > > Larry,
> > > The way you just speculated on Effexor above, do you know if Cymbalta is the same speculation? I want to take only a few pellets a day.
> > > Thanks
> >
> > As far as I know, all the Cymbalta pellets are the same. They're enteric coated, to get them past the stomach acid intact. They're not XR formulated. Just plain enteric coating.
> >
> > Lar
> >
>
> Hi Lar,
> That's not what I was referring to. I was referring to the above statement of yours "a 1/3 is....etc.". I worry about splitting the pills up because of this.That was meant only to apply to Effexor XR, and only because the earlier poster had noted a difference in efficacy, and was seeking an explanation for same. I was speculatively offering a *possible* mechanism, because of the physical chemistry that is involved in XR specifically.
> Do you know if each pellet could be different, therefore not an accurate dose each time??
> Thaks
>I believe all the Cymbalta pellets can be considered to be identical. 10 Cymbalta pellets in one pile would be the same as any 10 Cymbalta pellets in another pile. Any difference would be too small to be of any significance.
The microencapsulation technology for the Effexor XR and Cymbalta pellets are quite different, so the implications are also quite different.
Lar
Posted by AuntieMel on June 1, 2005, at 17:00:21
In reply to Re: pellets in capsules » Larry Hoover, posted by Cairo on May 30, 2005, at 8:05:09
I went from 300mg Effexor XR to 150mg by pouring out pellets, and I didn't have any inconsistant results.
But, yes, I think the different sized pellets are for release at different times. They seem to be randomly in the capsules, so just pouring worked.
Posted by dog on June 2, 2005, at 7:49:45
In reply to Re: cymbalta, MS » dog, posted by Phillipa on May 31, 2005, at 18:14:24
> I'm so sorry you have MS. Is the interferon helping you with this? Cymbalta decreased muscular pain for me. Fondly, Phillipa
thanks for the reply. i don't know for sure if its helping: i think it is, but i still have some pretty intense pain at times. it seems almost every day is different as to the amount of pain. one day i'll be OK and the next i can't get out of bed. depression is hard to cope with also. as i said before i think the interferon is exacerbating the depression. things getting worse instead of better.
i think the pain is not as much of an issue as the tolerance of the pain itself. with depression, i am not able to tolerate pain as well as when i am not depressed.
Posted by Phillipa on June 2, 2005, at 16:47:04
In reply to Re: cymbalta, MS, posted by dog on June 2, 2005, at 7:49:45
That is true. No matter what type pain you have if a person is depressed it's worse. You often hear a person say I have such a bad headache but they are laughing and forgetting about it. They aren't in a depression. Depression is focused inward. Fondly, Phillipa
Posted by dog on June 2, 2005, at 17:05:29
In reply to Re: cymbalta, MS » dog, posted by Phillipa on June 2, 2005, at 16:47:04
> That is true. No matter what type pain you have if a person is depressed it's worse. You often hear a person say I have such a bad headache but they are laughing and forgetting about it. They aren't in a depression. Depression is focused inward. Fondly, Phillipa
thanks for the insight and example. pain can be relative and a person can do a lot to upgrade his/her response to it. however, this cursed depression is a battle of mine of which i have been fighting so long, that i am getting so tired of fighting. i am doubtful i will ever win over it. the most i can do is manage it. it is so overwhelming at times and now that i have to take a medicine that makes the depression worse, it is like a stab in the back. i haven't had counseling in awhile, so i am currently seeking a good counselor.... i hate pain.
Posted by Phillipa on June 2, 2005, at 17:18:04
In reply to Re: cymbalta, MS » Phillipa, posted by dog on June 2, 2005, at 17:05:29
dog, First of all why do you call yourself that? Also is this a normal side effect of the medication? Is there anything else you can take? Fondly, Phillipa
Posted by dog on June 3, 2005, at 8:09:41
In reply to Re: cymbalta, MS » dog, posted by Phillipa on June 2, 2005, at 17:18:04
> dog, First of all why do you call yourself that? Also is this a normal side effect of the medication? Is there anything else you can take? Fondly, Phillipa
"dog" is unique to PB, don't you agree?
1. i am not very creative
2. i like dogs.
3. its kind of an african-american cultural nickname...a "term of endearment"... although i am not african-american, i do like to study and/or attempt to identify w/ other cultures.
4. if my daughter would have been a boy, which i am glad she wasn't because she is a wonderful person, her name would have been "Caleb", which means dog in Hebrew.a side-effect of the MS drug beta interferon, brand name Rebif, can be depression. Statistically, i have at least two strikes against me:
1. i have MS and i am a man: women, although they are twice as likely to have MS as men, do better statistically once they have it.
2. i am 45 years old and was just diagnosed. statistically, people who are diagnosed in their 40s do worse than others diagnosed earlier.taking Rebif via self-injection 3 x a week has not been fun. but, the regimen/drug seems to be rightly agressive for my condition, both statistically and clinically according to my condition.... atleast from what i understand (my knowledge being very, very limited).
do you know, or does anyone else reading this have MS or know anyone who has MS?
i am psychologically trying to work this whole thing out...i have to do some radical self-evaluation and re-do my whole frame of reference...this helps me a great deal to communicate with others who have similar struggles, ie. depression, etc.; thank you for reading this!
Posted by dog on June 3, 2005, at 8:12:59
In reply to Re: cymbalta, MS, posted by dog on June 3, 2005, at 8:09:41
> > dog, First of all why do you call yourself that? Also is this a normal side effect of the medication? Is there anything else you can take? Fondly, Phillipa
>
> "dog" is unique to PB, don't you agree?
> 1. i am not very creative
> 2. i like dogs.
> 3. its kind of an african-american cultural nickname...a "term of endearment"... although i am not african-american, i do like to study and/or attempt to identify w/ other cultures.
> 4. if my daughter would have been a boy, which i am glad she wasn't because she is a wonderful person, her name would have been "Caleb", which means dog in Hebrew.
>
> a side-effect of the MS drug beta interferon, brand name Rebif, can be depression. Statistically, i have at least two strikes against me:
> 1. i have MS and i am a man: women, although they are twice as likely to have MS as men, do better statistically once they have it.
> 2. i am 45 years old and was just diagnosed. statistically, people who are diagnosed in their 40s do worse than others diagnosed earlier.
>
> taking Rebif via self-injection 3 x a week has not been fun. but, the regimen/drug seems to be rightly agressive for my condition, both statistically and clinically according to my condition.... atleast from what i understand (my knowledge being very, very limited).
>
> do you know, or does anyone else reading this have MS or know anyone who has MS?
>
> i am psychologically trying to work this whole thing out...i have to do some radical self-evaluation and re-do my whole frame of reference...this helps me a great deal to communicate with others who have similar struggles, ie. depression, etc.; thank you for reading this!
>
>does anyone else take 120 mg of Cymbalta each day? i would like to hear from you...
This is the end of the thread.
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