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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by linkadge on October 3, 2008, at 18:17:06
Hi, I am going to be starting a regiment of fluoxetine and dexedrine.
I have heard that fluoxetine can taken effectively every second or third day. Does anybody have experience or data on such a regiment?
Linkadge
Posted by azalea on October 3, 2008, at 19:04:22
In reply to least effective fluoxetine dosing strategy?, posted by linkadge on October 3, 2008, at 18:17:06
Fluoxetine has a very long half life as well as an active metabolite. This also means it takes a while to get to steady state. Quoting wikipedia, "the concentration of the drug [fluoxetine] and its active metabolite [norfluoxetine] in the blood continues to grow through the first few weeks of treatment, and their steady concentration in the blood is achieved only after four weeks. Moreover, the brain concentration of fluoxetine and its metabolites keeps increasing through at least the first five weeks of treatment. That means that the full benefits of the current dose a patient receives are not realized for at least a month since its initiation. For example, in one 6-week study, the median time to achieving consistent response was 29 days."
Because of this, you probably want to take it everyday for the 1st few months at least. Fluoxetine is available as a $4 presciption for a 30 day supply at Kroger, Target, and Walmart.
> Hi, I am going to be starting a regiment of fluoxetine and dexedrine.
>
> I have heard that fluoxetine can taken effectively every second or third day. Does anybody have experience or data on such a regiment?
>
>
> Linkadge
>
>
Posted by desolationrower on October 3, 2008, at 19:09:28
In reply to least effective fluoxetine dosing strategy?, posted by linkadge on October 3, 2008, at 18:17:06
It has a very long halflife, especially norfluoxetine metabolite. I see no problem with this, although no advantage either. I woudl forget if i had taken it or not.
-d/r
Posted by Phillipa on October 3, 2008, at 20:48:07
In reply to Re: least effective fluoxetine dosing strategy?, posted by desolationrower on October 3, 2008, at 19:09:28
I was told by a pdoc to take it every three days as it increased my anxiety. Good to see you Link. Love Phillipa
Posted by bleauberry on October 3, 2008, at 21:28:20
In reply to least effective fluoxetine dosing strategy?, posted by linkadge on October 3, 2008, at 18:17:06
I'm not sure if it is still available but there is/was a 90mg version of prozac that is intended to be taken once weekly. I have also heard of others dosing on a non-daily basis.
Like all things in psychiatry though, theory is not always predictive of result. I started to come off prozac, and then returned to the higher dose, and then began coming off it again, and finally did wean all the way off it. During this see-saw time of about 6 months I got to know prozac very well. This after being on it steady for 8 years.
What I always liked about prozac was that the first 4 or 5 hours after the morning dose was kind of a warm smooth stimulant kind of feel, subtle but enjoyable. Later in the day that particular effect faded away. But every day it would repeat over again after the morning dose and I always looked forward to it. On days that I skipped a dose that feeling was gone.
So there is something else besides the halflife, something else besides the ssri, soemthing else besides the 5ht antagonism. Don't know what it is.
So sure, due to its long halflife prozac can work on a non-daily dosing strategy. Personally I liked the daily dosing just because I liked that smooth warm stimulant feel that lasted a few hours. I don't know what that was, but I liked it, and I missed it on days I skipped a dose. It was most pronounced, to me, at 20mg.
Posted by Racer on October 4, 2008, at 8:44:30
In reply to least effective fluoxetine dosing strategy?, posted by linkadge on October 3, 2008, at 18:17:06
>
> I have heard that fluoxetine can taken effectively every second or third day. Does anybody have experience or data on such a regiment?
>A little experience -- in the course of trying to find something tolerable which helped, I was for a while taking 5mg every other day. It helped resolve some of the problems I had with the daily dose, didn't seem to diminish the mild benefits I had from it, and might have worked out for me.
Then again, I don't do well with SSRIs or SNRIs, and it was ultimately a failed trial. Therefore, it might not be all that helpful. (The apathy leaves me sitting in one spot, staring at the wall -- and hating myself, for being "lazy" and so forth. Add in the frustration at the anorgasmia, which is pretty complete from the lowest dose, and that makes the weight gain the icing on that cake. At this point, I am highly resistant to trying another SRI for any reason.)
By the way, I just started on Vyvanse, and I'm loving it. I'm not sure it's available in Canada, but if it is, it might be worth looking into. Dexedrine was good for me, but this is better -- different, it's not just like a long acting Dexedrine, it's got a very different sort of "feel" to it. The only problem I'm having is that it wears off a bit abruptly -- at which point, I often find myself asleep on my feet. Then again, I wake up at about the same time regardless of when I get to bed, so that's partly just lack of sleep.
I wish you luck with it. If you're trying to adjust the dose to a lower level, every other day dosing might be a good answer for you. If you try it, I hope it does what you need it to do.
Posted by linkadge on October 4, 2008, at 8:52:29
In reply to Re: least effective fluoxetine dosing strategy? » linkadge, posted by azalea on October 3, 2008, at 19:04:22
Hey, I was under the impression that fluoxetine was cheap too. I got it at Walmart (in Canada), but it was $32 for a one months supply! And thats without the dispensing fee.
WTF? Is why is it so much cheaper in the states?
Linkadge
Posted by Racer on October 4, 2008, at 10:33:54
In reply to Re: least effective fluoxetine dosing strategy?, posted by linkadge on October 4, 2008, at 8:52:29
Posted by desolationrower on October 4, 2008, at 16:26:21
In reply to Re: least effective fluoxetine dosing strategy?, posted by linkadge on October 4, 2008, at 8:52:29
When i took it was cover by student health, but it is on the $4/month plan that many of the large chains offer.
-d/r
Posted by linkadge on October 4, 2008, at 18:00:11
In reply to Whoa! Was that for a generic? (nm), posted by Racer on October 4, 2008, at 10:33:54
Yes, it came to $42.34 with tax and dispensing fee for generic fluoxetine 20mg 30 count.
Linkadge
Posted by bleauberry on October 4, 2008, at 22:12:42
In reply to Re: Whoa! Was that for a generic?, posted by linkadge on October 4, 2008, at 18:00:11
Ah, I'm too late. I was going to say stay away from the generic. Pay the extra money for the real stuff. Lilly Prozac is way better than generic. Just my experience anyway. Generic can work, sometimes, sometimes not, but Lilly Prozac is just a lot better. Don't ask me why because I don't know. It just is.
Posted by Jeroen on October 5, 2008, at 14:56:07
In reply to Re: least effective fluoxetine dosing strategy?, posted by Phillipa on October 3, 2008, at 20:48:07
hey philippa, where on earth is Ed_Uk??????????????????
Posted by Larry Hoover on October 5, 2008, at 15:12:56
In reply to to philippa, posted by Jeroen on October 5, 2008, at 14:56:07
> hey philippa, where on earth is Ed_Uk??????????????????
Ummm, in the U.K.?
Sorry. Couldn't resist.
Lar
Posted by Phillipa on October 5, 2008, at 18:56:29
In reply to Re: to philippa » Jeroen, posted by Larry Hoover on October 5, 2008, at 15:12:56
Yup he is and doesn't post any more Jeroen. Such a pity. He's okay though. Phillipa
Posted by sdb on October 9, 2008, at 13:58:37
In reply to least effective fluoxetine dosing strategy?, posted by linkadge on October 3, 2008, at 18:17:06
> Hi, I am going to be starting a regiment of fluoxetine and dexedrine.
>
> I have heard that fluoxetine can taken effectively every second or third day. Does anybody have experience or data on such a regiment?
>
>
> Linkadge
>
>
hi linkadgethere are some studies on that issue saying it should work, personally I really don't know.
warm regards
sdb
Posted by yxibow on October 10, 2008, at 4:21:34
In reply to Re: Whoa! Was that for a generic?, posted by bleauberry on October 4, 2008, at 22:12:42
> Ah, I'm too late. I was going to say stay away from the generic. Pay the extra money for the real stuff. Lilly Prozac is way better than generic. Just my experience anyway. Generic can work, sometimes, sometimes not, but Lilly Prozac is just a lot better. Don't ask me why because I don't know. It just is.
I don't know, I would think that you are just increasing Lilly's stock. But that's up to you. I mean Prozac was the first SSRI to be released in the US while Luvox was the first to be released in Europe, in some countries a decade before Prozac was released in the US. The previous two efforts at SSRIs were quickly removed from the European market because of notable side effects.
They're both generic and have been for a while.
Anyhow, to each their own.
-- Jay
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