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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by qbsbrown on March 6, 2006, at 2:36:50
I am new to this med, although not the AEDs or mood stabilizers. What are your experiences with it?
I am primarily taking this med to help me wean off of a benzo (valium). I've had a tough time w/ instability, irritability, depression, anxiety, obsessions, ruminations, derealization etc,,..
I have just moved to china, was able to get the med, but have little direction, as the docs know nothing. I basically chose it, due to studies w/ tegretol and benzo WD. Pretty much same med w/ less SEs.
I understand that 600mg is the typical starting dose. Would it be less if simply for withdrawing from another medication?
Target dose? Starting dose? What time do you take it (i know 2 times daily, but morning and night, or morning and afternoon?)?
Thanks for the help,
Brian
Posted by med_empowered on March 6, 2006, at 6:41:40
In reply to Experiences with Trileptal??????, posted by qbsbrown on March 6, 2006, at 2:36:50
hi! using an AED for benzo-withdrawal is a good idea. Trileptal is usually dosed 2X daily; some docs do it evenly, others do a heavier dose at night (ex: 150AM 450PM). The primary use of an AED in benzo withdrawal is to prevent seizures and reduce withdrawal symptoms; my advice would be to keep the dose low (600-900) and do the taper very, very slowly. Personally, I found 1200mgs/day too heavy to deal with. Also, Valium tapers are pretty ideal, since the half-life and strengths are easier to work with than other benzos (ex: xanax, klonopin) which makes the withdrawal process a bit easier anyway.
GOod luck!
Posted by qbsbrown on March 6, 2006, at 7:30:12
In reply to Re: Experiences with Trileptal??????, posted by med_empowered on March 6, 2006, at 6:41:40
> hi! using an AED for benzo-withdrawal is a good idea. Trileptal is usually dosed 2X daily; some docs do it evenly, others do a heavier dose at night (ex: 150AM 450PM)"
I hopefully agree. I am finding that if i take am and pm, i am dead tired by 5pm, so i wonder how i could alter the dosage there (im only on 300mgs)
"The primary use of an AED in benzo withdrawal is to prevent seizures and reduce withdrawal symptoms"
I'm not worried about seizures, seeing as i went cold turkey and didn't get any.
"my advice would be to keep the dose low (600-900) and do the taper very, very slowly"
Start trileptal at 600mgs? I have been tapering too slowly for my taste. I'm hoping that with trileptal, i could taper 2.5 mgs per week (im at 15mgs)
I appreciate the advice!
Regards,
Brian
Posted by qbsbrown on March 6, 2006, at 8:54:19
In reply to Re: Experiences with Trileptal??????, posted by med_empowered on March 6, 2006, at 6:41:40
Why would they prescribe most at night? I understand the sedation, but with the half-life only being 3-9 hours, you would think it'd be missing the beneficial effects.
Am i wrong?
Posted by Larry Hoover on March 6, 2006, at 11:30:03
In reply to Re: Experiences with Trileptal??????, posted by qbsbrown on March 6, 2006, at 8:54:19
> Why would they prescribe most at night? I understand the sedation, but with the half-life only being 3-9 hours, you would think it'd be missing the beneficial effects.
> Am i wrong?It lets your body do most of its adaptation while you are sleeping, so that the lower blood level during the day permits normal functioning. You get much the same benefit, but you don't have to "be there" for the plasma peak concentration.
Lar
Posted by qbsbrown on March 6, 2006, at 19:21:31
In reply to Re: Experiences with Trileptal?????? ?qbsbrown, posted by Larry Hoover on March 6, 2006, at 11:30:03
Is that the same as xanax? Ithought that if you took it at night, you weren't really receiving the benefits during the day.
But trileptal is tyipcally taken in evenly divided doses, correct?
Brian
Posted by Phillipa on March 6, 2006, at 19:55:39
In reply to Re: Experiences with Trileptal??????, posted by qbsbrown on March 6, 2006, at 19:21:31
I was prescribed trileptal 300mg at night to help with sleep. Fondly, Phillipa
Posted by yxibow on March 7, 2006, at 2:47:50
In reply to Experiences with Trileptal??????, posted by qbsbrown on March 6, 2006, at 2:36:50
> I understand that 600mg is the typical starting dose. Would it be less if simply for withdrawing from another medication?It works on sodium channels, not GABA so it would not help directly in those cases necessarily. 600mg is a bit high to start with personally -- but that's just my doctor being a bit conservative. It carries a risk, a small one, of liver problems, but not nearly as carbamezapine. I think I started at 150 to see if it had any reaction but then I have a polypharmacy so that was the issue, slowly to 300 and now 375 until I can get my liver values measured at my next physical. As they say, your miles may vary.
As for the psychoactive experience -- I dont think I'm at a clinical dose nor have we exhausted the medication yet. It caused a headache at 150 and a mini migraine like headache (I dont get migraines) around 300, temporarily. Those have disappeared as far as I can tell.
Posted by qbsbrown on March 7, 2006, at 3:07:07
In reply to Re: Experiences with Trileptal?????? » qbsbrown, posted by yxibow on March 7, 2006, at 2:47:50
Good to hear from you yxibow!
"It works on sodium channels, not GABA so it would not help directly in those cases necessarily."
Is it not GABA enchancing? So it sounds like another Lamictal (sodium channels), but not the AD effects?
"It caused a headache at 150 and a mini migraine like headache (I dont get migraines) around 300, temporarily."
Interesting, i got migraines on lamictal, and insomnia, hence dropping the med.
One other thing that it does the same to me as lamictal is, if i take in morn, i hit a HUGE wall at 4-5 pm. I wonder if i should change schedule to take at around 2pm and bedtime. If it seems to hit me hard 8-10 hours later, i should set it up so it hits me at bedtime, right?
But hey, i'll be tired, sedated, and with a headache, if it helps me get off benzos quicker.
Thanks,
Brian
Posted by yxibow on March 7, 2006, at 14:47:16
In reply to Re: Experiences with Trileptal??????, posted by qbsbrown on March 7, 2006, at 3:07:07
> Good to hear from you yxibow!
You too!
>
> "It works on sodium channels, not GABA so it would not help directly in those cases necessarily."
>
> Is it not GABA enchancing? So it sounds like another Lamictal (sodium channels), but not the AD effects?I am not too familiar with the sodium (and actually Trileptal also has effects on potassium and certain calcium channels) channel model, so I can't say how it would affect GABA at all directly since it doesn't affect neurotransmitters. It is considered in psychiatry a mood stabilizer.
>
> "It caused a headache at 150 and a mini migraine like headache (I dont get migraines) around 300, temporarily."
>
> Interesting, i got migraines on lamictal, and insomnia, hence dropping the med.These were transient, like minutes before bedtime, a few days.
>
> One other thing that it does the same to me as lamictal is, if i take in morn, i hit a HUGE wall at 4-5 pm. I wonder if i should change schedule to take at around 2pm and bedtime. If it seems to hit me hard 8-10 hours later, i should set it up so it hits me at bedtime, right?Well, truth be known, the human body has a dip the midday / late afternoon (hense siestas in certain countries). I currently take Trileptal at night as a single dose -- it hasnt yet added significant tiredness more than I already have. I dont know if it will change or the dosing scheme, should it work towards my condition.
>
> But hey, i'll be tired, sedated, and with a headache, if it helps me get off benzos quicker.Like walking on hot coals ? :) Like I say I think its a transient. I hope. It is one of those "known issues" in the PI I think. And don't rush off that benzo taper! It'll happen.
>
> Thanks,
>
> Brian
>
>np.
Tidings
- J
Posted by qbsbrown on March 7, 2006, at 17:47:29
In reply to Re: Experiences with Trileptal?????? » qbsbrown, posted by yxibow on March 7, 2006, at 14:47:16
"it is considered in psychiatry a mood stabilizer"
I could use as much as that possile jay.
>
"Well, truth be known, the human body has a dip the midday / late afternoon (hense siestas in certain countries). I currently take Trileptal at night as a single dose -- it hasnt yet added significant tiredness more than I already have. I dont know if it will change or the dosing scheme, should it work towards my condition."I understand this dip, but i've only had this HUGE of a dip on lamictal and now 5 day of trileptal. It doesn't make me tired at bedtime, but have found it to make sleep better, more lucid/linear dreams, w/ not as much aggrivation/anxiety.
>
"And don't rush off that benzo taper! It'll happen."Gosh i wish i could. Man it's taken me what, almost 2 months to go from 25mg valium to 15. I hope w/ the trileptal, i can go down 2.5 per weeks. I know this is not a-la Dr Ashton, but that is far too conservative for me.
Thanks,
Brian
Posted by qbsbrown on March 7, 2006, at 20:00:07
In reply to Re: Experiences with Trileptal??????, posted by qbsbrown on March 7, 2006, at 17:47:29
does BID typcially mean morning and night?
Posted by yxibow on March 7, 2006, at 21:32:48
In reply to Re: Experiences with Trileptal??????, posted by qbsbrown on March 7, 2006, at 20:00:07
> does BID typcially mean morning and night?
Yes. It could also mean noon and midnight, but its a general direction for twice a day, it comes from Latin which is used to this day for shorthand prescription writing... bis in die, or twice a day.
Some abbreviation searches :
http://www.medterms.com/script/main/art.asp?articlekey=6954
http://www.bluemarblemeds.com/RxShorthand.html
(acrobat) http://www.medschool.ucsf.edu/curriculum/clinical/guide/section3/notations.pdf
(acrobat)
http://www1.cs.columbia.edu/~paley/spring03/assignments/HWFINAL/ewi2001/VeriScrip_poster.pdf
I'm sure Ed on here can give me a better list.So trileptal 300 would be *T (dotted T) bid, per the PDR. Although I take it **TT qd. I think thats how its written. I could be wrong.
I think its part of the medical conspiracy to confuse patients... j/k :). There must be a course or contest in medical school on how to write in the worst signatures possible.
Posted by ed_uk on March 8, 2006, at 15:31:41
In reply to Re: Experiences w Trileptal script abbreviations » qbsbrown, posted by yxibow on March 7, 2006, at 21:32:48
Hi Yxi
It's interesting that the latin abbreviations used on prescriptions are different in England.
eg.
American......English
qd = od
bid = bd
tid = tds
qid = qds
hs = nocte
qam = omSome doctors write all sorts of rubbish eg.
1gtteeqdsprn = use one drop in each eye four times a day when required
Ed
Posted by yxibow on March 10, 2006, at 2:21:34
In reply to Re: Experiences w Trileptal script abbreviations » yxibow, posted by ed_uk on March 8, 2006, at 15:31:41
> Hi Yxi
>
> It's interesting that the latin abbreviations used on prescriptions are different in England.
>
> eg.
>
> American......English
>
> qd = od
> bid = bd
> tid = tds
> qid = qds
> hs = nocte
> qam = om
>
> Some doctors write all sorts of rubbish eg.
>
> 1gtteeqdsprn = use one drop in each eye four times a day when required
>
> Ed
Curious... the Anglican church ? :) I don't know.. actually some of those abbreviations you illustrated I think I recall mentioned on sites (on this side of the pond) that were considered "archaic" or deprecated.The one thing that definately is different is medication naming, e.g. Paxil vs. Seroxat. Why they come up with different names isn't entirely clear, but it probably has to do with 1) what sounds good in a particular reason due to linguistic and cultural sociology and more importantly 2) what won't be confused at a pharmacy.
Posted by Phillipa on March 10, 2006, at 18:05:05
In reply to Re: Experiences w Trileptal script abbreviations » ed_uk, posted by yxibow on March 10, 2006, at 2:21:34
I thought serozat was prozac with zyprex? Fondly, Phillipa
Posted by yxibow on March 11, 2006, at 1:49:55
In reply to Re: Experiences w Trileptal script abbreviations » yxibow, posted by Phillipa on March 10, 2006, at 18:05:05
> I thought serozat was prozac with zyprex? Fondly, Phillipa
Symbyax, approved in the US is Zyprexa and Prozac. It is not from what I can tell in the BNF/NHS. But I'm sure ed could tell you that.
Posted by ed_uk on March 11, 2006, at 12:48:06
In reply to Re: Experiences w Trileptal script abbreviations » ed_uk, posted by yxibow on March 10, 2006, at 2:21:34
Hi Yxi :)
>actually some of those abbreviations you illustrated I think I recall mentioned on sites (on this side of the pond) that were considered "archaic" or deprecated.
Which ones?
Edx
Posted by yxibow on March 11, 2006, at 14:25:50
In reply to Re: Experiences w Trileptal script abbreviations » yxibow, posted by ed_uk on March 11, 2006, at 12:48:06
> Hi Yxi :)
>
> >actually some of those abbreviations you illustrated I think I recall mentioned on sites (on this side of the pond) that were considered "archaic" or deprecated.
>
> Which ones?
>
> EdxJCHAO National Patient Safety Goal (and these are mistaken ones on both sides)
od = mistaken for right eye "oculus dexter"
hs = mistaken for bedtime instead of "half strength"http://www.ismp.org/Tools/errorproneabbreviations.pdf
Thre are a few others I saw somewhere else, I wasn't implying they were all deprecated! :) Its more what certifying body made a uniform list.
Posted by ed_uk on March 11, 2006, at 14:55:08
In reply to Re: Experiences w Trileptal script abbreviations » ed_uk, posted by yxibow on March 11, 2006, at 14:25:50
Hi Yxi
>od = mistaken for right eye "oculus dexter"
hs = mistaken for bedtime instead of "half strength"OD always means once daily in England. Doctors sometimes write re or just R to refer to the right eye.
Latanoprost eye drops 0.005%
1dr.re.od
1xOPI've never seen HS on a prescription, it's not used here. ON is used a lot - it means 'every night' eg.
Amitriptyline 25mg tablets
1on
(56)Nocte is used less commonly - it means 'at night' eg.
Zolpidem 10mg tablets
1 nocte prn
(28)Another favourite is mdu - which means take/use 'as directed'. Some docs write ASD instead, I know of one doc who writes 'et dict'. How silly ;-)
PVC ring pessary 77mm
mdu
1xOPProctosedyl suppositories
asd
(12)For controlled drugs, the total quantity has to be written in words AND figures eg.
Dexedrine 5mg tablets
1tds
(42) FORTY-TWO TABLETSRegards
Ed
Posted by yxibow on March 11, 2006, at 19:07:41
In reply to Re: Experiences w Trileptal script abbreviations » yxibow, posted by ed_uk on March 11, 2006, at 14:55:08
> Hi Yxi
>
> >od = mistaken for right eye "oculus dexter"
> hs = mistaken for bedtime instead of "half strength"
>
> OD always means once daily in England. Doctors sometimes write re or just R to refer to the right eye.
>
> Latanoprost eye drops 0.005%
> 1dr.re.od
> 1xOP
>
> I've never seen HS on a prescription, it's not used here. ON is used a lot - it means 'every night' eg.
>
> Amitriptyline 25mg tablets
> 1on
> (56)
>
> Nocte is used less commonly - it means 'at night' eg.
>
> Zolpidem 10mg tablets
> 1 nocte prn
> (28)
>
> Another favourite is mdu - which means take/use 'as directed'. Some docs write ASD instead, I know of one doc who writes 'et dict'. How silly ;-)
>
> PVC ring pessary 77mm
> mdu
> 1xOP
>
> Proctosedyl suppositories
> asd
> (12)
>
> For controlled drugs, the total quantity has to be written in words AND figures eg.
>
> Dexedrine 5mg tablets
> 1tds
> (42) FORTY-TWO TABLETS
>
> Regards
>
> Ed
>
>
What a Latin soup :) Sometimes here its hs, sometimes is qhs. I guess as directed is not the same as as needed, which is prn. But as directed seems redundant, I suppose except in certain circumstances when the doctor has given verbal information to a compus mentis patient.
Posted by Phillipa on March 11, 2006, at 22:32:33
In reply to Re: Experiences w Trileptal script abbreviations » ed_uk, posted by yxibow on March 11, 2006, at 19:07:41
As needed means you have to ask for the med it will not be given to you unless you ask. And if you unable to ask just hope you have family memebers there or a really good nurse. Fondly, Phippipa
Posted by yxibow on March 12, 2006, at 3:05:57
In reply to Re: Experiences w Trileptal script abbreviations » yxibow, posted by Phillipa on March 11, 2006, at 22:32:33
> As needed means you have to ask for the med it will not be given to you unless you ask. And if you unable to ask just hope you have family memebers there or a really good nurse. Fondly, Phippipa
In the hospital, you are correct I am sure as you have been a nurse. On a script bottle for home use, as needed I think would be notated PRN, or simply an example as I've seen "as needed for extreme anxiety."
Posted by ed_uk on March 12, 2006, at 9:16:19
In reply to Re: Experiences w Trileptal script abbreviations » ed_uk, posted by yxibow on March 11, 2006, at 19:07:41
Hi Yxi!
Docs write 'mdu' or 'asd' because if they didn't we would wonder whether they'd forgotten to write the dose on the prescription!
Ed
This is the end of the thread.
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