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Re:Guillotine ... and variable dosage

Posted by JohnL on October 25, 1999, at 4:41:59

In reply to Re:Guillotine ... and variable dosage, posted by Bob on October 24, 1999, at 23:57:09

> As for variable dosage, 1mg difference may not sound like much, but I think you need to think about proportion and not brute size. That 3mg pill has 50% more medicine than the 2mg pill does. Now, if I lost a few milligrams to pill dust and fragments in splitting a 100mg zoloft tab, I wouldn't be concerned. On the other hand, the way I respond to clonazepam I was quite concerned about splitting my 1mg tabs -- if one of those half-tabs turns out to be .35 to .4mg instead of .5mg, then I'm losing 20-30% of the dose I need.
> Thank goodness I'm up to a full tab now. Phew.
> Bob

Like I said though, "as long as the fluctuations are at or above the therapeutic level". And you're right, with meds that involve very small amounts as therapeutic doses, the issue becomes more important. And even though 3mg Pindolol is 50% more than 2mg, both amounts are so small compared to therapeutic doses it has to be irrelevent. Even so, I wouldn't be cutting the pills in a way or in a place where I could lose dust/small fragments. That stuff can be licked up on the finger or scraped up and mixed in juice or whatever. No need to waste it.

The idea of the fluctuating dose is an extension of an idea discussed in Dr Bob's Tips. There is a discussion of irregular Prozac dosing (once, twice, three times a week instead of daily) to minimize sexual side effects. Something about avoiding a steady state. I always had that in the back of my mind. It praticularly applied to Prozac's long half-life, but I wondered if the concept could be modified and applied to shorter half-life meds.

When I was titrating up on Zoloft, I couldn't tolerate making the leap from say 50mg everyday to 75mg everyday. So I would do 50mg one day, 75 the next, 50 again, and so on until the 75mg didn't seem like such a huge jump anymore. Then I would stay at 75 for a while. Then start the same process with 75mg/100mg. But somewhere along the line I realized I was having better days when I was in the mode of alternating doses and not at a steady level. Donb't know why. But like I said, it was in the back of my mind and one day I just made the accidental connection. Could be hocus pocus, could be for real. Whatever works, right?




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