Psycho-Babble Medication Thread 1066447

Shown: posts 1 to 12 of 12. This is the beginning of the thread.

 

Worsening due to condition or medication?

Posted by MuseMemento on June 4, 2014, at 15:46:21

Hi, all. If you notice your condition worsening after initiating a new medication or raising the dose of a medication, how do you differentiate between an organic worsening of the condition versus response to the new medication or dosage? I'm loathe to quit a medication trial too soon but I also don't want to continue down a road that's contributing to my feeling worse. Any insights?

 

Re: Worsening due to condition or medication? » MuseMemento

Posted by Phillipa on June 4, 2014, at 22:01:53

In reply to Worsening due to condition or medication?, posted by MuseMemento on June 4, 2014, at 15:46:21

If noticed when introduced a new med I would stop the med and hope to return to previous level. Any improvement at all. And what is the meds you are taking. And the new med. Phillipa

 

Re: Worsening due to condition or medication? » Phillipa

Posted by MuseMemento on June 5, 2014, at 11:54:48

In reply to Re: Worsening due to condition or medication? » MuseMemento, posted by Phillipa on June 4, 2014, at 22:01:53

I started clomipramine at 50 mg four and a half weeks ago and just increased it to 150 mg three days ago after three weeks on 100 mg. I take .5 mg lorazepam at night and have been taking 300 mg bupropion xl since January. Prior to switching over to clomipramine, I'd been taking 20 mg escitalopram for 6 weeks, I believe. I've felt less energy on the clomipramine and greater drowsiness, as well as increased confusion.

 

Re: Worsening due to condition or medication?

Posted by Christ_empowered on June 5, 2014, at 12:29:37

In reply to Re: Worsening due to condition or medication? » Phillipa, posted by MuseMemento on June 5, 2014, at 11:54:48

wellbutrin can increase tca levels considerably.

 

Re: Worsening due to condition or medication? » Christ_empowered

Posted by MuseMemento on June 5, 2014, at 12:41:21

In reply to Re: Worsening due to condition or medication?, posted by Christ_empowered on June 5, 2014, at 12:29:37

How significantly? Is it possible that my 150 mg dose is already the equivalent of being above the typical max therapeutic dose of 250 mg? My pdoc and I discussed the interaction and they were unconcerned unless I start to have severe side effects. I'm not sure what my current experiences would be considered.

 

Re: Worsening due to condition or medication? » Christ_empowered

Posted by MuseMemento on June 5, 2014, at 15:32:49

In reply to Re: Worsening due to condition or medication?, posted by Christ_empowered on June 5, 2014, at 12:29:37

Also worth noting, I smoke half a pack of cigarettes daily. I know that this increases clearance of clomipramine through cyp1a2 activity but I'm not sure of how it affects things overall.

 

Re: Worsening due to condition or medication? » MuseMemento

Posted by phidippus on June 7, 2014, at 13:20:29

In reply to Worsening due to condition or medication?, posted by MuseMemento on June 4, 2014, at 15:46:21

The best way to tell if a medication is worsening your condition is to stop it for a few days and if you improve you know the drug is to blame.

Eric

 

Re: Worsening due to condition or medication? » phidippus

Posted by MuseMemento on June 9, 2014, at 15:33:27

In reply to Re: Worsening due to condition or medication? » MuseMemento, posted by phidippus on June 7, 2014, at 13:20:29

That seems most reasonable, phidippus. My only concern is that I've only been on the medication in question, clomipramine, for five weeks altogether and four weeks at a dose of 100 mg, and I don't want to pre-empt a delayed therapeutic response by stopping it for a couple of days to see if it's responsible for the worsening. Is this a possible risk if I don't take it for only a few days?

 

Re: Worsening due to condition or medication?

Posted by Christ_empowered on June 10, 2014, at 9:20:36

In reply to Re: Worsening due to condition or medication? » phidippus, posted by MuseMemento on June 9, 2014, at 15:33:27

hey...I'm no expert, but it seems to me that if the problem is high blood levels of the tca, a couple days worth of wash out might be beneficial, and might get your blood levels back down to normal, therapeutic levels.

or not, lol.

 

Re: Worsening due to condition or medication? » Christ_empowered

Posted by MuseMemento on June 11, 2014, at 15:05:28

In reply to Re: Worsening due to condition or medication?, posted by Christ_empowered on June 10, 2014, at 9:20:36

That suggestion makes perfect sense but I'm just not sure, short of a blood level test, how to know for sure if it's the clomipramine that's responsible. It's not as if it's been an unqualified success or anything but I don't want to give up too soon on it and risk non-response. Just confused.

 

Re: Worsening due to condition or medication? » MuseMemento

Posted by phidippus on June 11, 2014, at 17:59:17

In reply to Re: Worsening due to condition or medication? » phidippus, posted by MuseMemento on June 9, 2014, at 15:33:27

After five weeks, putting the pause button on the clomipramine should be ok-you're on a low dose anyway. I would stop it for a week, see how you feel then restart it if it makes sense to.

Eric

 

Re: Worsening due to condition or medication? » phidippus

Posted by MuseMemento on June 11, 2014, at 21:01:31

In reply to Re: Worsening due to condition or medication? » MuseMemento, posted by phidippus on June 11, 2014, at 17:59:17

Thank you. I think I'll do just that.


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] 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.