Psycho-Babble Medication Thread 104737

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Re: concerta - prescription problem... Ritch

Posted by krazy kat on May 22, 2002, at 14:47:39

In reply to Re: concerta - prescription problem... krazy kat, posted by Ritch on May 22, 2002, at 14:22:33

Mitch:

That's not a bad idea at all. I can't figure out how quickly the ritalin goes through my system - it seems slow in the morning (I need at least 10 mg to get up), then faster, then slower, then faster. So I don't get to sleep until 1:00 am or so, even if I take the last 5 mg. of 20 mg. by early afternoon.

I get weepy as it wears off too. And I over react to things. I am so hopeful that won't happen with the Concerta.

Concerta price - it was going to be around $250.00 for 90 days, BUT I'm not certain if that was with insurance covering some of the first 30 days. I believe it was. So, 18 mg. tablets, one a day...let's see if I can do this anymore...$2.70 a pill. Is that expensive? I don't even know...

I have been drinking a beer or glass of wine when the ritalin goes too far the other way, when I get paranoid and anxious. Obviously not the best solution, but one drink does solve the jitters. And, luckily, when on Depakote, I don't desire more than a drink or two. Of course, I could not do this if I were at an office.

So, hopefully the Concerta will offer an even solution.

Here's a link with cost info:

http://www.medletter.com/freedocs/metadate.pdf

$73.13 for 30 days supply of 36 mg according to it.

And here's a person who says:

"My concerta 180 count was $416."!!!!! (Added the !!! for effect. :)). That was 2 36 mg. tabs a day -- http://www.healthboards.com/add/2435.html

- kk

 

Re: concerta - prescription problem... krazy kat

Posted by Ritch on May 22, 2002, at 16:47:58

In reply to Re: concerta - prescription problem... Ritch, posted by krazy kat on May 22, 2002, at 14:47:39

> Mitch:
>
> That's not a bad idea at all. I can't figure out how quickly the ritalin goes through my system - it seems slow in the morning (I need at least 10 mg to get up), then faster, then slower, then faster. So I don't get to sleep until 1:00 am or so, even if I take the last 5 mg. of 20 mg. by early afternoon.


Hey, you could try it and see what happens (several tiny doses spaced close together). Not needing any after early afternoon in order to get to sleep (much later) sounds mighty suspicious to me, IMO. That stuff (methylphenidate and d-methylphenidate) goes through your system so rapidly. When I was trying Focalin, the absolute maximum amount of time that I could even tell it was in my system was about 3 1/2 hrs. I could take 5.0mg of Focalin (that is 10mg Ritalin-wise) about 4 hrs before bedtime, be quite alert/focused and then crash and sleep like a rock (four hours later)! I wonder if your Depakote blood levels (fluctuating)or other meds have more to do with your responses than the Ritalin??

>
> I get weepy as it wears off too. And I over react to things. I am so hopeful that won't happen with the Concerta.

I wonder if you did break up your daily dosage into eight same-sized nuggets and took a nugget every two hours all daylong-could you still sleep OK, *and* would you feel less anxious *and* not feel a weepy "crash"??

I had to break down and take 37.5 mg of Wellbutrin today. I am just starting to get soooo fatigued and tired. It is starting early this year I am afraid. I wasn't taking any Depakote with Wellbutrin during my wintertime SAD episode, so...maybe I won't get grouchy. I need to find out if the Depakote is the *one* that is keeping my temper under control. So, by challenging myself with meds that have triggered temper flares previously (WB)with the Depakote staying the same..perhaps I can tolerate it this time around?
I think I am going to tinker with some imipramine, or possibly some Wellbutrin+imipramine (i.e.), unless my pdoc has something else in mind.


>
> Concerta price - it was going to be around $250.00 for 90 days, BUT I'm not certain if that was with insurance covering some of the first 30 days. I believe it was. So, 18 mg. tablets, one a day...let's see if I can do this anymore...$2.70 a pill. Is that expensive? I don't even know...

.........
> - kk


That's all subjective and depends on what insurance you have and how much pocket money you carry around! I can tell you right now that I probably can not afford Concerta (or rather do not *want* to afford it). That is pricey. I remember Adderall and dexedrine being very, very, cheap.


 

Provigil/Dex Study Details

Posted by JonW on May 22, 2002, at 20:56:48

In reply to Re: concerta - prescription problem... Ritch, posted by krazy kat on May 22, 2002, at 14:47:39

Hi all,

In the study I've pasted below it says that both dextroamphetamine and modafinil were superior to placebo, but does anyone know more about this study? Were the two meds comparable or was one superior to another?

--------------------------------------------------
Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults.

Taylor FB, Russo J.

Rainier Associates, Tacoma, Washington 98467, USA. taylor2@earthlink.net

Our objective was to compare the efficacy of the new wake-promoting drug modafinil to that of dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) in adults. Twenty-two adults who met DSM-IV criteria for ADHD participated in a randomized, double-blind, placebo-controlled, three-phase crossover study comparing placebo, modafinil, and dextroamphetamine for the treatment of ADHD. The twice-daily study medications were titrated to doses of optimum efficacy over 4-7 days and then held constant during the rest of each 2-week treatment phase. Measures of improvement included the DSM-IV ADHD Behavior Checklist for Adults, the Controlled Oral Word Association Test (COWAT, using the letters C, F, and L version), Stroop, and Digit Span (Wechsler Adult Intelligence Scale version). For the 21 (96%) completers, the mean (+/- SD) optimum doses of modafinil and dextroamphetamine were 206.8 mg/day +/- 84.9 and 21.8 mg/day +/- 8.9, respectively. Scores on the DSM-IV ADHD Checklist (p < 0.001) were significantly improved over the placebo condition following treatment with both active medications. Performance on the COWAT (p < 0.05) reached trend levels of significance. Both medications were generally well tolerated. This preliminary study suggests that modafinil may be a viable alternative to conventional stimulants for the treatment of adults with ADHD.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 11191692 [PubMed - indexed for MEDLINE]
--------------------------------------------------

 

Re: provigil jitters--Lorraine (and Dr. Kramer??)

Posted by Rick on May 22, 2002, at 22:11:50

In reply to Re: provigil jitters, posted by Lorraine on May 12, 2002, at 11:50:24

Hi, Lorraine -

Glad to hear that Provigil has continued to prove helpful for you, and at a low dose. Does the small 25mg still raise your blood pressure some? If so, are you taking something else to help counter that side-effect?

I've been so busy lately I've had to steer clear of P-B for awhile, and that will continue after this short break -- except that I've set an auto-notification for updates to this specific thread.

I have to admit I'm a more than a tad frustrated to see that I missed the "live" appearance by the esteemed Dr. Thomas A.M. Kramer a few weeks ago. I've posted here in the past about how logical,level-headed and on-the-money his Medscape commentaries are, and his posts here sure did nothing but reinforce my admiration! In fact, it was a Kramer column in Medscape about two years that first gave me the idea of asking my pdoc to add Provigil to my Klonopin+Serzone Social Anxiety Cocktail. Glad I did!!

I've found this thread fascinating, from IsoM's continued fantastic response to adrafinil, to Emme's micro-dosing saga (jeez, I can barely cut a 100 mg Provigil in *half* cleanly, even with a pill splitter!) to everything else.

Rick


> I take 25 mg a day to keep me alert and awake, some mood elevation, without the wired feeling. If it is making you jittery for more than the first week, you might try cutting your dose until you find one that works for you or you might find that even with cutting the dose it doesn't work for you.
>
> Lorraine

 

more on these mood/energy shifts... Ritch

Posted by krazy kat on May 22, 2002, at 22:22:29

In reply to Re: concerta - prescription problem... krazy kat, posted by Ritch on May 22, 2002, at 16:47:58

Mitch:

>> Not needing any after early afternoon in order to get to sleep (much later) sounds mighty suspicious to me, IMO.

-- Sounds suspicious to me, too. It's as if it builds up during the day. I take all my Depakote at night so maybe that does affect it. Thanks for the good observation. I'm also a "night person" which may contribute to it.

>> I wonder if you did break up your daily dosage into eight same-sized nuggets and took a nugget every two hours all daylong-could you still sleep OK, *and* would you feel less anxious *and* not feel a weepy "crash"??

-- I am going to try this starting tomorrow. Thanks for the advice. Getting those leetle tablets into even smaller pieces is going to be tough though.


>> I had to break down and take 37.5 mg of Wellbutrin today. I am just starting to get soooo fatigued and tired. It is starting early this year I am afraid.

-- I recall that you have seen a seasonal relationship to your disorder.

>> I wasn't taking any Depakote with Wellbutrin during my wintertime SAD episode, so...maybe I won't get grouchy.

-- I reacted Horribly to Wellbutrin. Interesting, isn't it? I'm a 31 year old female, and similar reactions. But if you survived it w/o Dep. last winter...

>> I need to find out if the Depakote is the *one* that is keeping my temper under control.

-- Stressful test, Mitch. Good luck! Have you ever taken Lithium? That will be my next trial (should have been my first :)).

> I think I am going to tinker with some imipramine, or possibly some

-- I'm not certain what this is...

-- I have problems with anger and irritable moods, too, though it's different since I am a woman (or at least it's perceived differently).

Has Depakote helped me? I don't know! When manic on AD's, I'm sweet and interesting as can be. What did my husband say? Oh, "unusually pleasant". ;) The way spouses can stick their foots in their mouths sometimes...

Depakote is definitely a "life-saver" for me - stops the up's and down's - but the in-between ain't so very great. ;)

- kk

 

Re: Provigil/Dex Study Details JonW

Posted by Ritch on May 22, 2002, at 23:02:12

In reply to Provigil/Dex Study Details, posted by JonW on May 22, 2002, at 20:56:48

> Hi all,
>
> In the study I've pasted below it says that both dextroamphetamine and modafinil were superior to placebo, but does anyone know more about this study? Were the two meds comparable or was one superior to another?
>
> --------------------------------------------------
> Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults.
>
> Taylor FB, Russo J.
>
> Rainier Associates, Tacoma, Washington 98467, USA. taylor2@earthlink.net
>
> Our objective was to compare the efficacy of the new wake-promoting drug modafinil to that of dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) in adults. Twenty-two adults who met DSM-IV criteria for ADHD participated in a randomized, double-blind, placebo-controlled, three-phase crossover study comparing placebo, modafinil, and dextroamphetamine for the treatment of ADHD. The twice-daily study medications were titrated to doses of optimum efficacy over 4-7 days and then held constant during the rest of each 2-week treatment phase. Measures of improvement included the DSM-IV ADHD Behavior Checklist for Adults, the Controlled Oral Word Association Test (COWAT, using the letters C, F, and L version), Stroop, and Digit Span (Wechsler Adult Intelligence Scale version). For the 21 (96%) completers, the mean (+/- SD) optimum doses of modafinil and dextroamphetamine were 206.8 mg/day +/- 84.9 and 21.8 mg/day +/- 8.9, respectively. Scores on the DSM-IV ADHD Checklist (p < 0.001) were significantly improved over the placebo condition following treatment with both active medications. Performance on the COWAT (p < 0.05) reached trend levels of significance. Both medications were generally well tolerated. This preliminary study suggests that modafinil may be a viable alternative to conventional stimulants for the treatment of adults with ADHD.
>
> Publication Types:
> Clinical Trial
> Randomized Controlled Trial
>
> PMID: 11191692 [PubMed - indexed for MEDLINE]
> --------------------------------------------------


I think one would have to gain access to the complete study, not just the abstract. My question is--when was this study done? Sounds interesting. I learned something new: there are *tests* that have *names* for ADHD testing! The COWAT test sounds interesting. I need to find a sample of that one.

Mitch

 

Re: more on these mood/energy shifts... krazy kat

Posted by Ritch on May 22, 2002, at 23:26:30

In reply to more on these mood/energy shifts... Ritch, posted by krazy kat on May 22, 2002, at 22:22:29

> Mitch:
>
> >> Not needing any after early afternoon in order to get to sleep (much later) sounds mighty suspicious to me, IMO.
>
> -- Sounds suspicious to me, too. It's as if it builds up during the day. I take all my Depakote at night so maybe that does affect it. Thanks for the good observation. I'm also a "night person" which may contribute to it.


Aha! That Ritalin isn't building up--I'll bet you are getting a Depakote *withdrawal* in the late afternoon-evenings. You take 2G of Depakote all at nite? No wonder you get that weird stuff in the evening! I would strongly suggest pulling out 500mg of that 2G hs dose and take that midday. I have withdrawn from Depakote before and it can be fairly nasty (agitation/anxiety/insomnia) withdrawing from just 500mg/day. Keep in mind it just has a half-life of 14-18 hrs.....


>
> >> I wonder if you did break up your daily dosage into eight same-sized nuggets and took a nugget every two hours all daylong-could you still sleep OK, *and* would you feel less anxious *and* not feel a weepy "crash"??
>
> -- I am going to try this starting tomorrow. Thanks for the advice. Getting those leetle tablets into even smaller pieces is going to be tough though.


Let us know what happens? I guess we are becoming real-time guinea pigs.

>
>
> >> I had to break down and take 37.5 mg of Wellbutrin today. I am just starting to get soooo fatigued and tired. It is starting early this year I am afraid.
>
> -- I recall that you have seen a seasonal relationship to your disorder.

Yes, most definitely.

>
> >> I wasn't taking any Depakote with Wellbutrin during my wintertime SAD episode, so...maybe I won't get grouchy.
>
> -- I reacted Horribly to Wellbutrin. Interesting, isn't it? I'm a 31 year old female, and similar reactions. But if you survived it w/o Dep. last winter...
>
> >> I need to find out if the Depakote is the *one* that is keeping my temper under control.
>
> -- Stressful test, Mitch. Good luck! Have you ever taken Lithium? That will be my next trial (should have been my first :)).


Oh yeah, I was on that for many, many years. It works good for grouchiness, too. But, I must say that Dep. is a little better in that department. Lithium clearly has better antidepressant properties for me, however.


>
> > I think I am going to tinker with some imipramine, or possibly some
>
> -- I'm not certain what this is...


Imipramine (Tofranil)-the first tricyclic antidepressant developed (TCA). It is the most serotonergic TCA of the bunch except for clomipramine. Have't tried it yet. Tried its metabolite-desipramine and it made me too nervous, but worked as good as Adderall for inattentiveness/focus problems. So..I am wondering if it will be as good for focus/attentiveness as desipramine, but also actually *reduce* anxiety rather than aggravate it.


>
> -- I have problems with anger and irritable moods, too, though it's different since I am a woman (or at least it's perceived differently).
>
> Has Depakote helped me? I don't know! When manic on AD's, I'm sweet and interesting as can be. What did my husband say? Oh, "unusually pleasant". ;) The way spouses can stick their foots in their mouths sometimes...
>
> Depakote is definitely a "life-saver" for me - stops the up's and down's - but the in-between ain't so very great. ;)
>
> - kk


I seem to have this "two-fold" problem with explosiveness (like an intermittent explosive disorder) that Depakote really helps, and really bad fatigue, excessive daytime drowsiness, inattentive probs., that stimulants or stimulating AD's seem to work on. Who knows, maybe Depakote+stimulant might be the perfect combo? I have never actually done that one, just yet.

Mitch

 

Re: Provigil/Dex Study Details Ritch

Posted by Rick on May 22, 2002, at 23:30:22

In reply to Re: Provigil/Dex Study Details JonW, posted by Ritch on May 22, 2002, at 23:02:12

> > Hi all,
> >
> > In the study I've pasted below it says that both dextroamphetamine and modafinil were superior to placebo, but does anyone know more about this study? Were the two meds comparable or was one superior to another?
> >
> > --------------------------------------------------
> > Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults.
> >
> > Taylor FB, Russo J.
> >
> > Rainier Associates, Tacoma, Washington 98467, USA. taylor2@earthlink.net
> >
> > Our objective was to compare the efficacy of the new wake-promoting drug modafinil to that of dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) in adults. Twenty-two adults who met DSM-IV criteria for ADHD participated in a randomized, double-blind, placebo-controlled, three-phase crossover study comparing placebo, modafinil, and dextroamphetamine for the treatment of ADHD. The twice-daily study medications were titrated to doses of optimum efficacy over 4-7 days and then held constant during the rest of each 2-week treatment phase. Measures of improvement included the DSM-IV ADHD Behavior Checklist for Adults, the Controlled Oral Word Association Test (COWAT, using the letters C, F, and L version), Stroop, and Digit Span (Wechsler Adult Intelligence Scale version). For the 21 (96%) completers, the mean (+/- SD) optimum doses of modafinil and dextroamphetamine were 206.8 mg/day +/- 84.9 and 21.8 mg/day +/- 8.9, respectively. Scores on the DSM-IV ADHD Checklist (p < 0.001) were significantly improved over the placebo condition following treatment with both active medications. Performance on the COWAT (p < 0.05) reached trend levels of significance. Both medications were generally well tolerated. This preliminary study suggests that modafinil may be a viable alternative to conventional stimulants for the treatment of adults with ADHD.
> >
> > Publication Types:
> > Clinical Trial
> > Randomized Controlled Trial
> >
> > PMID: 11191692 [PubMed - indexed for MEDLINE]
> > --------------------------------------------------
>
>
> I think one would have to gain access to the complete study, not just the abstract. My question is--when was this study done? Sounds interesting. I learned something new: there are *tests* that have *names* for ADHD testing! The COWAT test sounds interesting. I need to find a sample of that one.
>
> Mitch

The study cited above is apparently over two years old. The Medline header is:

J Child Adolesc Psychopharmacol 2000 Winter;10(4):311-20

Take a look at the passage below, from

http://www.ncpamd.com/NewADD_Meds.htm

The last line indicates that modafinil was found no better than placebo for adult ADHD. Despite this, I know that anecdotal reports indicate it works quite well for some people. And if memory serves (no guarantees on that count!), Cephalon plans additional study for Provigil in adult ADHD.

"Modafinil (Provigil) has been approved for treatment of narcolepsy in adults. It is chemically unrelated to methylphenidate or amphetamine. When compared to methylphenidate and amphetamine, it seems less likely to cause irritability and jitteriness. It appears to act on the frontal cortex and is more selective in its area of action than the traditional stimulants. Cephalon will be doing studies to assess the efficacy of modafinil in children with ADHD. In studies of adults with ADHD, there was a promising study (Taylor and Russo) suggesting that it might be effective for adults with ADHD. However a larger study sponsored by Cephalon indicated that Modafinil was no more effective than placebo."

Rick

 

provigil update

Posted by zoe on May 23, 2002, at 9:28:49

In reply to Re: more on these mood/energy shifts... krazy kat, posted by Ritch on May 22, 2002, at 23:26:30

Hi, all.
Well, it took about 2-3 weeks to get the jitters (i love that word, it describes it so perfectly) out of my system, and i restarted the provigil 2 days ago at 1/4 of a 200 mg tab (theoretically 50 mg but i'm not the greatest pill splitter). thus far i feel okay, but i am hypersensitive now to that spacey, awful feeling. we'll see how it goes. i have pretty high hopes now for the whole stimulant class, it seems to be one of the few areas i haven't tried yet. fortunately i have a doc who is pretty open to new things.
social anxiety is a very weird thing. i have a hard time convincing people who know me that i really have it. my psychiatrist is the only one who seems to agree with me that it is a real thing. others are like, 'you are fine, everyone gets a little nervous in big groups'. i guess that's the difference between the subjective and objective experience.
cheers.
zoe

 

Ritch...

Posted by krazy kat on May 23, 2002, at 10:34:50

In reply to Re: more on these mood/energy shifts... krazy kat, posted by Ritch on May 22, 2002, at 23:26:30

Thanks. That really clarifies it. I wonder why pdoc said all at night? I'll try the 500 mg during the day.

I'm having some trouble with my social skills on the site right now, apparently, and feel quite certain a block is coming. So if I don't post immediately, that will be why.

Probably won't have Concerta until sometime next week anyway.

- kk

You've been such a help. Thank you.

 

Re: Provigil/Dex Study Details Rick

Posted by Ritch on May 23, 2002, at 10:40:22

In reply to Re: Provigil/Dex Study Details Ritch, posted by Rick on May 22, 2002, at 23:30:22

> > > Hi all,
> > >
> > > In the study I've pasted below it says that both dextroamphetamine and modafinil were superior to placebo, but does anyone know more about this study? Were the two meds comparable or was one superior to another?
> > >
> > > --------------------------------------------------
> > > Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults.
> > >
> > > Taylor FB, Russo J.
> > >
> > > Rainier Associates, Tacoma, Washington 98467, USA. taylor2@earthlink.net
> > >
> > > Our objective was to compare the efficacy of the new wake-promoting drug modafinil to that of dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) in adults. Twenty-two adults who met DSM-IV criteria for ADHD participated in a randomized, double-blind, placebo-controlled, three-phase crossover study comparing placebo, modafinil, and dextroamphetamine for the treatment of ADHD. The twice-daily study medications were titrated to doses of optimum efficacy over 4-7 days and then held constant during the rest of each 2-week treatment phase. Measures of improvement included the DSM-IV ADHD Behavior Checklist for Adults, the Controlled Oral Word Association Test (COWAT, using the letters C, F, and L version), Stroop, and Digit Span (Wechsler Adult Intelligence Scale version). For the 21 (96%) completers, the mean (+/- SD) optimum doses of modafinil and dextroamphetamine were 206.8 mg/day +/- 84.9 and 21.8 mg/day +/- 8.9, respectively. Scores on the DSM-IV ADHD Checklist (p < 0.001) were significantly improved over the placebo condition following treatment with both active medications. Performance on the COWAT (p < 0.05) reached trend levels of significance. Both medications were generally well tolerated. This preliminary study suggests that modafinil may be a viable alternative to conventional stimulants for the treatment of adults with ADHD.
> > >
> > > Publication Types:
> > > Clinical Trial
> > > Randomized Controlled Trial
> > >
> > > PMID: 11191692 [PubMed - indexed for MEDLINE]
> > > --------------------------------------------------
> >
> >
> > I think one would have to gain access to the complete study, not just the abstract. My question is--when was this study done? Sounds interesting. I learned something new: there are *tests* that have *names* for ADHD testing! The COWAT test sounds interesting. I need to find a sample of that one.
> >
> > Mitch
>
> The study cited above is apparently over two years old. The Medline header is:
>
> J Child Adolesc Psychopharmacol 2000 Winter;10(4):311-20
>
> Take a look at the passage below, from
>
> http://www.ncpamd.com/NewADD_Meds.htm
>
> The last line indicates that modafinil was found no better than placebo for adult ADHD. Despite this, I know that anecdotal reports indicate it works quite well for some people. And if memory serves (no guarantees on that count!), Cephalon plans additional study for Provigil in adult ADHD.
>
> "Modafinil (Provigil) has been approved for treatment of narcolepsy in adults. It is chemically unrelated to methylphenidate or amphetamine. When compared to methylphenidate and amphetamine, it seems less likely to cause irritability and jitteriness. It appears to act on the frontal cortex and is more selective in its area of action than the traditional stimulants. Cephalon will be doing studies to assess the efficacy of modafinil in children with ADHD. In studies of adults with ADHD, there was a promising study (Taylor and Russo) suggesting that it might be effective for adults with ADHD. However a larger study sponsored by Cephalon indicated that Modafinil was no more effective than placebo."
>
> Rick

Thanks Rick,

That still is fairly recent (2 years). Isn't it interesting how one study can show no better effectiveness than placebo and yet another one shows equal effectiveness to dexedrine? I guess about the only thing you can trust is anecdotal experience (here for example), or a large clinical trial (even then..). I wonder if there has been or will be a study done with "stimulant naive" adult subjects?

Mitch

 

Good luck with Concerta-let us know.... (nm) krazy kat

Posted by Ritch on May 23, 2002, at 10:43:32

In reply to Ritch..., posted by krazy kat on May 23, 2002, at 10:34:50

 

Re: provigil update zoe

Posted by krazy kat on May 23, 2002, at 12:36:49

In reply to provigil update, posted by zoe on May 23, 2002, at 9:28:49

Heh, zoe.

I've got my 200 mg tablet down to 25 mg pieces. That was tough. I couldn't believe it didn't just turn to dust!

I, too, suffered jitters from Provigil, which is why we switched to Ritalin, but it's too quick-acting, so I'm waiting on a Concerta prescription.

This is fun, isn't it?

So, I took 5 mg of Ritalin this morning and 25 mg of Provigil (this is all O.K. with my pdoc). Now, three hours later, I've taken 25 mg. of Provigil again.

Then, in three hours, thought I'd go back to 5 mg of Ritalin and 25 mg of Provigil (maybe), then probably stop for the day.

No jitters thus far...

- kk

 

Research (Re: Provigil/Dex Study Details) Ritch

Posted by JonW on May 23, 2002, at 13:01:42

In reply to Re: Provigil/Dex Study Details Rick, posted by Ritch on May 23, 2002, at 10:40:22

> That still is fairly recent (2 years). Isn't it interesting how one study can show no better effectiveness than placebo and yet another one shows equal >effectiveness to dexedrine? I guess about the only thing you can trust is anecdotal experience (here for example), or a large clinical trial (even then..). >I wonder if there has been or will be a study done with "stimulant naive" adult subjects?

Hi Mitch,

Seemingly inconsistent performance in controlled clinical trials could be explained by a drug not being very potent. Moclobemide, for example, isn't a very potent drug for treating social phobia. In at least two controlled studies it performed no better than placebo, while there are at least two other controlled studies where it was shown to be effective for social phobia.

I don't think anecdotal research is useless, but it should definitely be confirmed by controlled studies. If there is one type of research you can trust, it's not anecdotal. Anyone could get lucky and be led to the drug that saves their life, but the chances of success are far greater if you try drugs based on real data. Interestingly, I remember reading an article not too long ago about how the majority of outpatients wouldn't qualify for many of the clinical studies that get drugs approved. I wonder how significant that is. As a treatment resistent case, I can't help but think that's a bad thing.

Jon

 

Re: Research (Re: Provigil/Dex Study Details) JonW

Posted by Ritch on May 23, 2002, at 20:54:45

In reply to Research (Re: Provigil/Dex Study Details) Ritch, posted by JonW on May 23, 2002, at 13:01:42

> > That still is fairly recent (2 years). Isn't it interesting how one study can show no better effectiveness than placebo and yet another one shows equal >effectiveness to dexedrine? I guess about the only thing you can trust is anecdotal experience (here for example), or a large clinical trial (even then..). >I wonder if there has been or will be a study done with "stimulant naive" adult subjects?
>
> Hi Mitch,
>
> Seemingly inconsistent performance in controlled clinical trials could be explained by a drug not being very potent. Moclobemide, for example, isn't a very potent drug for treating social phobia. In at least two controlled studies it performed no better than placebo, while there are at least two other controlled studies where it was shown to be effective for social phobia.
>
> I don't think anecdotal research is useless, but it should definitely be confirmed by controlled studies. If there is one type of research you can trust, it's not anecdotal. Anyone could get lucky and be led to the drug that saves their life, but the chances of success are far greater if you try drugs based on real data. Interestingly, I remember reading an article not too long ago about how the majority of outpatients wouldn't qualify for many of the clinical studies that get drugs approved. I wonder how significant that is. As a treatment resistent case, I can't help but think that's a bad thing.
>
> Jon


Hi Jon,

Good points. I wasn't really advocating individual anecdotal experiential "hearsay" should *replace* "hard data", I just think that the "hard data" that you see floating about unfortunately just *probably*, isn't a lot more *trustworthy* than a *collection* of anecdotal experiences that you might find here (or elsewhere). The trouble is..how do you get the "hard data" to be *MORE* reliable than a collection of shared anecdotal experiences? You can't do that with a dozen people here and there, IMO. A lot of the abstracts that you read have a very small number of subjects-I have seen "studies" done on eight people. Hmmmm. Also, treatment resistant and treatment intolerant cases tend to be statistical *anomalies* that fall "outside the curve". As a treatment resistant or treatment intolerant *individual*, the findings of a given "study" aren't going to be nearly as relevant to *you* as it wouldbe to a random "typical" person experiencing a major depressive episode, panic attack, etc.

Mitch

 

Re: provigil update krazy kat

Posted by zoe on May 24, 2002, at 8:23:08

In reply to Re: provigil update zoe, posted by krazy kat on May 23, 2002, at 12:36:49

what is concerta? is it in the US?

 

concerta zoe

Posted by krazy kat on May 24, 2002, at 11:29:03

In reply to Re: provigil update krazy kat, posted by zoe on May 24, 2002, at 8:23:08

It is in the US. It's basically an extended version of Ritalin, from my understanding.

 

Re: provigil update zoe

Posted by schuyler on June 1, 2002, at 17:42:19

In reply to Re: provigil update krazy kat, posted by zoe on May 24, 2002, at 8:23:08

> what is concerta? is it in the US?

I believe that Concerta and Metadate CD are timed-release (up to 12 hours) versions of Ritalin. Metadate CD comes only in 20 mg, I think, and Concerta comes in 18. 36, and 54? mg.

 

Re: provigil update/ elevated heartrate???help

Posted by noelle on June 2, 2002, at 15:00:27

In reply to Re: provigil update zoe, posted by schuyler on June 1, 2002, at 17:42:19

My pdoc gave me samples of provigil after some failed attempts on adderal, welbutrins. I split 100 mg. The first day was fine, but now even hours after taking it my heart feels like it is going to jump out of my chest. The last time I went to the doctor I had elevated bp on wellbutrin, never happened. I'm not sure if its axiety or what but last night it had me scared to death!
Noelle

 

Re: Is this an elite club?

Posted by noelle on June 4, 2002, at 14:44:42

In reply to Re: provigil update/ elevated heartrate???help, posted by noelle on June 2, 2002, at 15:00:27

I know I shouldn't that this personally but since I've been posting questions, I haven't gotten one response, am I missing something
Noelle

 

Re: Is this an elite club? noelle

Posted by JonW on June 4, 2002, at 17:34:48

In reply to Re: Is this an elite club?, posted by noelle on June 4, 2002, at 14:44:42

> I know I shouldn't that this personally but since I've been posting questions, I haven't gotten one response, am I missing something
> Noelle

Hi Noelle,

Don't take it personally. It's easy for posts to get lost in the sea of questions here... it's happened to me lots of times! But then I ask some pretty stupid questions -- I know, I know there's no such thing as a stupid question ;)

Anyway, in response to your question about provigil... I had a similar experience with adrafinil where my BP went up very high at times. However, on provigil I had no such problem. I don't know if this is an argument to try adrafinil but since they are very similar to each other it might be worth a shot to see if you get the same possitive effects withouth the negative effects.

Hang in there,
Jon

p.s. What are you taking provigil for? What did wellbutrin and adderall fail to do? What are your symptoms?

 

Re: provigil update/ elevated heartrate???help noelle

Posted by Rick on June 4, 2002, at 18:19:02

In reply to Re: provigil update/ elevated heartrate???help, posted by noelle on June 2, 2002, at 15:00:27

Provigil 100 mg, which I take with Klonopin, definitely raises my heart rate. 200 mg, which I take once in awhile, raises it even more. I don't feel any symptoms from this, though. I do get a bit concerned when my non-resting HR goes up to 120 bpm (although it's still symptomless, other than a bit of decline in the anti-Social Anxiety benefits).

Interestingly, when I was taking a typical dose of Serzone along with the Provigil, the heart rate increases became minimal, and the blood pressure increases Provigil can cause for me completely went away. None of Provigil's mental benefits diminished with the combo, though.

Rick

 

Re: provigil update/ elevated heartrate???help

Posted by zoe on June 5, 2002, at 12:56:55

In reply to Re: provigil update/ elevated heartrate???help noelle, posted by Rick on June 4, 2002, at 18:19:02

Hi.
I found provigil to be intolerable at 200 mg, so i stopped taking it entirely. Then I re-started at 50 mg and then slowly up to 100 mg. That is plenty for me. You may want to split the pill in half.

 

Re: provigil update/ elevated heartrate???help

Posted by Spongemomsquarepants on June 8, 2002, at 1:35:47

In reply to Re: provigil update/ elevated heartrate???help, posted by noelle on June 2, 2002, at 15:00:27

Noelle,

I ended up in the hospital from 100 mg of provigil. I had a heartate of 166 (I am 41, not overweight) and BP of 180/110 or something nasty. It was not a good med for me. For some reason the Pdoc I went to prescribed it for my newly diagnosed ADHD. Not a common med for that.

Good luck!
Viki

> My pdoc gave me samples of provigil after some failed attempts on adderal, welbutrins. I split 100 mg. The first day was fine, but now even hours after taking it my heart feels like it is going to jump out of my chest. The last time I went to the doctor I had elevated bp on wellbutrin, never happened. I'm not sure if its axiety or what but last night it had me scared to death!
> Noelle

 

Re: provigil update/ elevated heartrate???help Spongemomsquarepants

Posted by Rick on June 8, 2002, at 12:40:13

In reply to Re: provigil update/ elevated heartrate???help, posted by Spongemomsquarepants on June 8, 2002, at 1:35:47

Viki -

I know Provigil can raise heart rate and BP in some people (including me), but WOW!

A few questions, if you don't mind:

-- Were you, or had you recently, taken MAOI's at the time you had the Provigil? This is an unstudied area, although I and a few others have reported taking low-dose MAOI's with Provigil with no problems (sticking to the usual MAOI precautions, of course, such as certain food restrictions for non-reversible MAOI's).

-- Do you have a history of NON-med-induced high blood pressure or elevated heart rate? (The Provigil monograph doesn't contra-indicate use in hypertensives, but points out that this is an unstudied area and that patients should be monitored).

-- Do you think you may have anxiety, especially panic disorder?

-- Do you have any kind of heart disorder? Provigil IS specifically contra-indicated in this case.

-- What other meds, if any, were you also taking at the same time. If you don't mind, please include non-psychotropics and supplements/herbs as well.

-- Are you, or have you, used any other stimulants (psychotropics and/or caffeine and/or stmulating supplements) without significant increases in BP or heart rate? If so, which ones?

Thanks!
Rick


> Noelle,
>
> I ended up in the hospital from 100 mg of provigil. I had a heartate of 166 (I am 41, not overweight) and BP of 180/110 or something nasty. It was not a good med for me. For some reason the Pdoc I went to prescribed it for my newly diagnosed ADHD. Not a common med for that.
>
> Good luck!
> Viki
>
> > My pdoc gave me samples of provigil after some failed attempts on adderal, welbutrins. I split 100 mg. The first day was fine, but now even hours after taking it my heart feels like it is going to jump out of my chest. The last time I went to the doctor I had elevated bp on wellbutrin, never happened. I'm not sure if its axiety or what but last night it had me scared to death!
> > Noelle


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