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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 40 to 64 of 89. Go back in thread:
Posted by theo on August 24, 2004, at 17:02:44
In reply to Re: Cymbalta at Walgreens Pharmacies, posted by SLS on August 24, 2004, at 13:46:34
My doc left some samples at the front desk so I couldn't ask any questions, but he gave me Cymbalta samples and they are 60mg pills.
When you go to 60mg are you going to take it b.i.d. or once daily? What did your doc suggest?
I'm kinda of freaked out to try 60mg first dose, but those are the only samples I got.
Posted by SLS on August 24, 2004, at 17:27:11
In reply to Re: Cymbalta Samples-Question » SLS, posted by theo on August 24, 2004, at 17:02:44
> My doc left some samples at the front desk so I couldn't ask any questions, but he gave me Cymbalta samples and they are 60mg pills.
>
> When you go to 60mg are you going to take it b.i.d. or once daily? What did your doc suggest?
>
> I'm kinda of freaked out to try 60mg first dose, but those are the only samples I got.
When I go up to 60mg tomorrow, I'll go 30mg b.i.d. just on principle. I think my doctor started me low because there was still some tricyclic in my system.Your doctor is doing exactly what the manufacturer says to do. Except for some added sleepiness, I feel no effects at all. Lexapro gave me anxiety and made me feel uncomfortable and fatigued. There isn't a hint of anxiety or fatigue so far.
You'll be fine.
- Scott
Posted by theo on August 24, 2004, at 18:23:14
In reply to Re: Cymbalta Samples-Question, posted by SLS on August 24, 2004, at 17:27:11
I was reading the insert in my samples and it says: Take a total dose of 40 mg/day (given as 20mg BID) to 60 mg/day (given either once a day or 30 mg BID).
A little confusing on what the Lilly thinks the dose range should be and if the half life is long enough for once a day dosing.
Also, are they assuming at 60mg means it's a high enough dose to extend the half life and take it once a day? At 40mg/day it says MUST be taken BID but at 60mg you can take it once daily, I'm so confused.
Posted by owensmar on August 24, 2004, at 19:59:15
In reply to Re: Cymbalta Samples-Question, posted by SLS on August 24, 2004, at 17:27:11
Scott, what dosage formulations does it come in? 20mg? 40mg & 60mg?
From what I've read, it's enteric coated so you aren't supposed to break tablets in half. It's designed to be absorbed after leaving the acidic environment of the stomach. So how can people take 30mg bid and/or take 40mg bid?
Marsha
Posted by theo on August 25, 2004, at 7:03:29
In reply to Re: Cymbalta Samples-Question » SLS, posted by theo on August 24, 2004, at 18:23:14
> I was reading the insert in my samples and it says: Take a total dose of 40 mg/day (given as 20mg BID) to 60 mg/day (given either once a day or 30 mg BID).
>
> A little confusing on what the Lilly thinks the dose range should be and if the half life is long enough for once a day dosing.
>
> Also, are they assuming at 60mg means it's a high enough dose to extend the half life and take it once a day? At 40mg/day it says MUST be taken BID but at 60mg you can take it once daily, I'm so confused.WHAT DO YOU THINK ABOUT THE ABOVE POST??
Posted by SLS on August 25, 2004, at 7:05:38
In reply to Re: Cymbalta Samples-Question, posted by owensmar on August 24, 2004, at 19:59:15
Here's the information that one would find in the PDR:
http://www.rxlist.com/cgi/generic/cymbalta_ids.htm
DOSAGE AND ADMINISTRATION
Initial TreatmentCymbalta should be administered at a total dose of 40 mg/day (given as 20 mg BID) to 60 mg/day (given either once a day or as 30 mg BID) without regard to meals.
There is no evidence that doses greater than 60 mg/day confer any additional benefits.
HOW SUPPLIED
Cymbaltaź (duloxetine hydrochloride) capsules are available in 20, 30, and 60 mg strengths.- Scott
Posted by theo on August 25, 2004, at 7:28:59
In reply to Re: Cymbalta Samples-Question, posted by SLS on August 25, 2004, at 7:05:38
I guess my question would be, in the past 4-5 days you've been taking 30mg, do you think it can be taken once daily? Any peaks and valleys? How far are you planning to split your doses apart while taking 30mg BID to avoid the 2nd dose causing "possible" insomnia?
My doctor will prescribe Cymbalta however I want to and all the studies I've read, even at high doses, show Cymbalta taken BID. I've never seen anything about taking 60mg once daily, except in Lilly's prescribing info. Do you think Cymbalta can realistically be taken as once daily dosing after your experiance taking 30mg once daily?
Did your doctor have any input on dosing?
Posted by SLS on August 25, 2004, at 7:53:22
In reply to Re: Cymbalta Samples-Question » SLS, posted by theo on August 25, 2004, at 7:28:59
> I guess my question would be, in the past 4-5 days you've been taking 30mg, do you think it can be taken once daily? Any peaks and valleys? How far are you planning to split your doses apart while taking 30mg BID to avoid the 2nd dose causing "possible" insomnia?
>
> My doctor will prescribe Cymbalta however I want to and all the studies I've read, even at high doses, show Cymbalta taken BID. I've never seen anything about taking 60mg once daily, except in Lilly's prescribing info. Do you think Cymbalta can realistically be taken as once daily dosing after your experiance taking 30mg once daily?
>
> Did your doctor have any input on dosing?
I didn't speak to him at length regarding the dosing of Cymbalta because I basically had him write me a script over the phone as soon as I heard it was approved. He has been speaking to the drug reps for quite a few months regarding Cymbalta, so I assume he knew what he was doing when he prescribed it. I'll know more when I see him next week.I would rather take Cymbalta b.i.d. only because it seems to make sense intuitively. However, if cost is an issue, purchasing the 60mg must surely be more economical than using twice as many 30mg.
I know how urgently you require definitive information. I really can't provide you with anything more at the moment. If you are a litte bit bashful about taking 60mg as your first dose, perhaps you can open the capsule and dump half of it for a couple of days. Otherwise, I would go ahead and try the 60mg once a day and see what happens. With the short half-life, you can always skip a dose to relieve you of any adverse effects that emerge.
I'll be increasing from 30mg to 60mg b.i.d. today. I generally dose at 7:00am and 10:00pm. I doubt I will know much about side effects for a few days. Right now, somnolence is becoming an issue.
Good luck.
- Scott
Posted by jrbecker on August 25, 2004, at 10:00:53
In reply to Re: Cymbalta Samples-Question » theo, posted by SLS on August 25, 2004, at 7:53:22
This strategy will probably only work for a very small minority of people since most will definitely have to push the dose up to 40-60mg to see beneficial results...but for those that want to be conservative and start low and go slow, here's some reassuring news.
Int Clin Psychopharmacol. 1997 May;12(3):137-40.An open-label study of duloxetine hydrochloride, a mixed serotonin and noradrenaline reuptake inhibitor, in patients with DSM-III-R major depressive disorder. Lilly Duloxetine Depression Study Group.
Berk M, du Plessis AD, Birkett M, Richardt D.
Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa.
Duloxetine hydrochloride, a mixed reuptake inhibitor of serotonin and noradrenaline, was studied in a 6 week open-label uncontrolled multicentre design at a dose of 20 mg daily both in in- and outpatients meeting DSM-III-R criteria for unipolar major depressive disorder. Seventy-nine patients took part in the study. The mean score on the 17-item Hamilton Depression Rating Scale at baseline was 24.9 (SD 4.4), decreasing to 8.5 (SD 7.8) after 6 weeks using a last observation carried forward analysis. Clinical response, defined as a 50% reduction in 17-item Hamilton Depression Rating Scale scores, occurred in 78.2% of patients, whereas remission, defined as a 17-item Hamilton Depression Rating Scale score of < or = 6, occurred in 60.3% of patients. Duloxetine hydrochloride was safe and well tolerated in this patient population.
PMID: 9248869 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9248869
Posted by Mr. Scott on August 25, 2004, at 10:09:47
In reply to Re: Cymbalta Samples-Question » SLS, posted by theo on August 25, 2004, at 7:28:59
I just started Cymbalta today. 30mg capsules 1x daily. Apparently reps are not even detailing the 20mg size. Some anyways are telling docs the 20mg are only for the a taper process which will involve withdrawal. Who cares I just want to get out of bed without so much a struggle.
Basically...The dosing situation is akin to prozac's where 20mg was used for Everybody. It's the same with Cymbalta apparently at except at 30mg BID. My doc says Lilly want's everybody to take 60mg right off the bat.
My greatest hope is that I don't develop the now well known and often experienced cluster of neurologic/serotonin/hypomanic symptoms that I always get on standard doses of ssri/snri antidepressants. I just want to get feeling okay without too many damn side effects or a switch into hypomania/mixed land.
Be well everyone.
Mr.Scott
Posted by Mr. Scott on August 25, 2004, at 10:15:18
In reply to Re: Cymbalta Samples-Question, posted by owensmar on August 24, 2004, at 19:59:15
The samples anyway of the 30mg size are old fashion looking gelatin capsules with little balls inside. I haven't looked to see if they are individually coated. There is no splitting these up however.
Mr.Scott
Posted by Mr. Scott on August 25, 2004, at 10:23:19
In reply to Re: Cymbalta Samples-Question » SLS, posted by theo on August 24, 2004, at 18:23:14
Hey Scott,
You mentioned Somnolence as a potential problem... At what dose this appear for you?
Mr.Scott
Posted by theo on August 25, 2004, at 11:46:37
In reply to Re: Cymbalta Samples-Question, posted by Mr. Scott on August 25, 2004, at 10:09:47
When you said the reps are pushing 60mg, did your doc suggest taking 30mg twice daily or one 60mg capsule once daily?
Posted by caraher on August 25, 2004, at 12:45:31
In reply to Re: Cymbalta Samples-Question » Mr. Scott, posted by theo on August 25, 2004, at 11:46:37
FYI, in the study I'm in the instructions are such that if you got duloxetine the dose would be 60 mg every morning (they specifically ask that you NOT split the dose morning/evening even though the capsules are 30 mg)
Posted by sarytyr on August 25, 2004, at 13:28:16
In reply to Re: Cymbalta Samples-Question, posted by caraher on August 25, 2004, at 12:45:31
I was wondering if any has information yet on anyone switching to Cymbalta from Effexor. I am currently taking 75mg Effexor XR in the evening and 300mg Wellbutrin in the A.M. While this combination in working very well for me, I read on the Lilly Home page states that studies are showing that Cymbalta may be an effective treatment for stress urinary incontinance as well. This is something that would really benefit me. Duloxetine hydrocloride (marketed under the name Yentreve) has already been approved for SUI in Europe. Maybe a switch to this medication could treat my depression and SUI. Any opinions?
Thanks, Sandy
Posted by owensmar on August 25, 2004, at 14:45:53
In reply to Re: Cymbalta Samples-Question, posted by SLS on August 25, 2004, at 7:05:38
Thanks, that makes sense. So you could take 20 bid =40 total or 30bid =60 total or just 60 hs.
Posted by owensmar on August 25, 2004, at 14:57:31
In reply to Question for SLS, posted by Mr. Scott on August 25, 2004, at 10:23:19
Give me somnolence over insomnia.
And give it to me now!
Marsha
Posted by owensmar on August 25, 2004, at 15:02:26
In reply to Any thoughts on moving to Cymbalta from Effexor?, posted by sarytyr on August 25, 2004, at 13:28:16
Sandi,
I'd say the biggest risk you'd be taking is changing a regimen that's working well. I was doing well on Effexor years ago then tried to get off because I thought something else might work better. It didn't. I went back on Effexor but that time did less well. So I tried something else. Even worse. Back to Effexor again. This time it worked even less well (but with the full complement of side effects.) Every time I've gone off and back on it has worked less well.
If Cymbalta turns out to be great for you, you'll win. But if not, getting back to your current good state might not be so easy.
Good luck,
Marsha
Posted by Mr. Scott on August 25, 2004, at 16:43:47
In reply to Re: Cymbalta Samples-Question » Mr. Scott, posted by theo on August 25, 2004, at 11:46:37
He said start at 30mg 1x daily, and move to 2x daily if I can tolerate.
I think the 60mg's are also there for BID dosing despite what the dosing literature suggests. However that is just my opinion... The FDA approval study showed no benefit above 60mg daily, but I'm sure some people will need 60mg BID or at least be prescribed it...
Mr.Scott
Posted by SLS on August 25, 2004, at 21:11:59
In reply to Question for SLS, posted by Mr. Scott on August 25, 2004, at 10:23:19
> Hey Scott,
>
> You mentioned Somnolence as a potential problem... At what dose this appear for you?
>
> Mr.Scott
I have been taking only 30mg. Somnolence appeared Sunday, Monday, and Tuesday. I slept 12 hours at night and another 4 hours during the day. I had no episodes of somnolence today, so it might be a transient startup side effect. I will be increasing to 60mg tonight. I'll report if the somnolence returns.Good luck!!!
- Scott
Posted by theo on August 26, 2004, at 7:24:25
In reply to Re: Question for SLS » Mr. Scott, posted by SLS on August 25, 2004, at 21:11:59
I'm going to see my pdoc today (my general doc was the one that gave me 60mg Cymbalta samples) and get her blessing before I start it.
A couple of questions, can you compare the initial strartup feeling of Cymbalta to any other med you've tried, Prozac, Paxil, Effexor XR etc? Also, do you know what dose of Cymbalta would equal 20mg Prozac, Paxil?
It seems like from past posts you said you are taking 150mg of Lamictal. Are you still at this dose? I've been lucky and have always been able to get effects from minimum doses of meds. My pdoc keeps pushing up my Lamictal but for me, at 150mg (8 days now) I've felt slothy and and extremely unmotivated with know desire to do anything. She wants me to go to 200mg and I'm fearful that will just increase these side effects. I'm mainly only taking it for an antidepressant. Would this be a sign to maybe drop back to 100mg? My pdoc is one that goes by the book and not by how the patient really is being effected by the meds. I wonder about psychiatrists sometimes.
Posted by SLS on August 26, 2004, at 8:39:17
In reply to Re: Question for SLS » SLS, posted by theo on August 26, 2004, at 7:24:25
Hi Theo.
> I'm going to see my pdoc today (my general doc was the one that gave me 60mg Cymbalta samples) and get her blessing before I start it.
That sounds like a good idea. At least you would still be working as a team, and you would feel more comfortable with whichever way the two of you choose to initiate treatment with Cymbalta.
> A couple of questions, can you compare the initial strartup feeling of Cymbalta to any other med you've tried, Prozac, Paxil, Effexor XR etc? Also, do you know what dose of Cymbalta would equal 20mg Prozac, Paxil?
I took 60mg yesteday after being at 30mg for a week. This stuff seems very clean so far. The only thing I notice is a slight bit of sleepiness, but this seems to be a very passing side effect.
> It seems like from past posts you said you are taking 150mg of Lamictal.
I keep bobbing up and down between 150mg and 300mg. I have been trying to stay at the lower dosages because higher dosages produce memory and cognitive impairments. Unfortunately, I need the higher dosages to afford me greater relief from depression. Even so, the improvement is mild at best. I don't know how to counsel you on the dosage of Lamictal you should take. If you raise the dosage of Lamictal while you are beginning treatment with Cymbalta, you might confuse the side effects of one for the other. You can always raise the dosage of Lamictal at a later time if you need to. Still, I wouldn't be afraid to try 200mg. Either do it before adding Cymbalta, or do it after establishing Cymbalta at 60mg.
Please let us know how things go with your doctor, and which direction you decide to go.
- Scott
Posted by theo on August 26, 2004, at 11:08:02
In reply to Re: Question for SLS, posted by SLS on August 26, 2004, at 8:39:17
I forgot one thing, when you went up to 60mg did you split your dose or take it all at once? If you took it 30mg BID, how far apart did you split the doses?
Posted by SLS on August 26, 2004, at 11:21:00
In reply to Re: Question for SLS » SLS, posted by theo on August 26, 2004, at 11:08:02
> I forgot one thing, when you went up to 60mg did you split your dose or take it all at once? If you took it 30mg BID, how far apart did you split the doses?
30mg b.i.d.
7:00am and 10:00pm
This drug feels pretty clean. I don't know if that's good or bad.
- Scott
Posted by theo on August 26, 2004, at 18:06:10
In reply to Re: Question for SLS » theo, posted by SLS on August 26, 2004, at 11:21:00
I saw my pdoc today and she told me to drop the Lamictal down from 150mg to 100mg. The only other med I'm taking is Keppra 250mg 3 times a day for anxiety.
In three weeks if I don't feel better, she wants me to drop the Lamictal completely and then add either Prozac or Cymbalta to the Keppra.
She's a big fan of Keppra for anxiety and I would have to agree it works on anxiety better than Lamictal for me. She also said the only reason she had me try Lamictal was for an antidepressant.
I was surprised at her response to Cymbalta. She said she wasn't to sure about it because meds that usually are well proven have much more positive feedback (psychiatric seminars, etc) before their release, if that makes any sense. She didn't say anything negative but just hasn't seen any overwhelming proven fact it will be superior over other SSRI's, SNRI's.
The good news is, we won't know till we try!
The Lilly rep said that 60mg was the minimum dose and they are just giving 30mg and 60mg samples out, which makes me wonder why they even mention 40mg (20 BID) in the prescribing info. Oh well.
All that being said, I won't add anything for a few weeks which should be enough time to get feedback from you and others at theraputic doses, so keep me posted.
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