![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by SheilaC on August 7, 2010, at 8:22:34
Ok - I have a question. My new doc has me taking 60mg of Geodon at night along with 1mg of Klonopin. I sleep great.
In the morning I take 300mg of Lithium. I find this makes me a little hyped up. Could this be?
Also, I am feeling a little irritability - not as bad as in the past, but still. So I am wondering, should I take 150mg of Lithium in the morning and then another 150mg of Lithium at lunch? Would this help the irritability?
Or, should I leave the 300mg alone and divide my Geodon dose? Maybe I need a tiny dose of Geodon with my Lithium?
At least with the Lithium I feel more alive and alert. I feel like I can do things, where as before when I only took Geodon I felt drugged all the time.
What do you think?
Posted by Phillipa on August 7, 2010, at 10:53:29
In reply to Lithium / Geodon question..., posted by SheilaC on August 7, 2010, at 8:22:34
Sheila sounds like you're making progress which is good. Now the fine tuning comes in. Hoping for lots of responses. Phillipa
Posted by ed_uk2010 on August 7, 2010, at 13:10:58
In reply to Lithium / Geodon question..., posted by SheilaC on August 7, 2010, at 8:22:34
>I am wondering, should I take 150mg of Lithium in the morning and then another 150mg of Lithium at lunch?
If you are taking one of the sustained release brands of lithium, taking it as a single daily dose should be sufficient. If not, it is normally given twice a day.
>Would this help the irritability?
It might do. I can't see any harm in trying.
>Or, should I leave the 300mg alone and divide my Geodon dose? Maybe I need a tiny dose of Geodon with my Lithium?
Geodon is normally given twice a day. If you are taking the entire dose at night, its effectiveness might not be optimal. You might benefit from a small dose in the morning eg. 20mg in the morning (and 40-60mg at night).
>At least with the Lithium I feel more alive and alert.
That's great news Sheila. I expect that with a little 'fine tuning' you could feel even better :)
Posted by Maxime on August 7, 2010, at 15:25:03
In reply to Re: Lithium / Geodon question..., posted by ed_uk2010 on August 7, 2010, at 13:10:58
Wow, that's great about the lithium. I just got off Lithium for several reasons, and it certainly didn't give me any energy .... quite the opposite.
Posted by herpills on August 7, 2010, at 16:48:48
In reply to Lithium / Geodon question..., posted by SheilaC on August 7, 2010, at 8:22:34
I think Geodon has a short half-life, you might want to split the dose so that you have a more even amount in your system. I take 20mg in the morning, and 40mg at night, 2-3 hours before I want to be asleep. herpills
Posted by Dan_MI on August 7, 2010, at 21:59:12
In reply to Lithium / Geodon question..., posted by SheilaC on August 7, 2010, at 8:22:34
Great news about lithium. I tolerate it very well, and get great relief from it, too.
I found taking it only once a day left me irritable, and prone to moodswings.
I recommend taking the lithium up several notches, and see if you still need that geodon. There are ways to avoid lithium side effects.
> Ok - I have a question. My new doc has me taking 60mg of Geodon at night along with 1mg of Klonopin. I sleep great.
>
> In the morning I take 300mg of Lithium. I find this makes me a little hyped up. Could this be?
>
> Also, I am feeling a little irritability - not as bad as in the past, but still. So I am wondering, should I take 150mg of Lithium in the morning and then another 150mg of Lithium at lunch? Would this help the irritability?
>
> Or, should I leave the 300mg alone and divide my Geodon dose? Maybe I need a tiny dose of Geodon with my Lithium?
>
> At least with the Lithium I feel more alive and alert. I feel like I can do things, where as before when I only took Geodon I felt drugged all the time.
>
> What do you think?
>
Posted by morgan miller on August 7, 2010, at 22:51:31
In reply to Re: Lithium / Geodon question..., posted by Dan_MI on August 7, 2010, at 21:59:12
> There are ways to avoid lithium side effects.
Can you elaborate on this?
Posted by Dan_MI on August 8, 2010, at 8:35:25
In reply to Re: Lithium / Geodon question..., posted by morgan miller on August 7, 2010, at 22:51:31
Here are my Lithium Secrets (admittedly, some ameliorate rather than avoid side effects):
1) Salt tablets: Take one with your morning dose, especially in the summer, to feel less "drugged".
2) Glucose tablets: Upset stomach from lithium is caused by lithium's tendency to lower blood sugar.
3) Gum: Hydrates your mouth during the day
4) Oral Balance Gel from Biotene: Hydrates your mouth during the night.
5) Chapstick: Keeps your lips from mummifying during the night.
> > There are ways to avoid lithium side effects.
>
> Can you elaborate on this?
Posted by morgan miller on August 8, 2010, at 10:52:19
In reply to Re: Lithium / Geodon question..., posted by Dan_MI on August 8, 2010, at 8:35:25
Thanks Dan. I have also read that fish oil and/or flax or chia seed/oil, combined with vitamin E, may help reduced the potential adverse effects of lithium.
The salt pill is an interesting one. Since I may not get enough salt in my first meal(usually a super healthy smoothie-whey protein, chia seed, coconut oil, wheat grass, frozen wild blueberries, teaspoon of xylitol, and some organic vanilla been extract-sometimes raw cacao powder).
Posted by ed_uk2010 on August 8, 2010, at 11:49:03
In reply to Re: Lithium / Geodon question..., posted by Dan_MI on August 8, 2010, at 8:35:25
Increasing your salt (sodium chloride) intake might reduce your lithium level. Take care.
Posted by morgan miller on August 8, 2010, at 12:29:41
In reply to Lithium / Geodon question..., posted by SheilaC on August 7, 2010, at 8:22:34
I would stick with dosing lithium in the morning and evening, whether you try the extended release version or not.
I don't believe that the extended release version of lithium affects you for long enough to positively impact you throughout the day.
Posted by Dan_MI on August 8, 2010, at 12:31:56
In reply to Re: Lithium / Geodon question..., posted by ed_uk2010 on August 8, 2010, at 11:49:03
The goal in to have a robust collection of all electrolytes. I don't eat enough salt, personally.
But salt pills in the summer are a must to anyone taking lithium. You can sweat too much and all of the sudden feel like your under seven feet of water - that's lithium toxicity not from too much lithium, but too little salt.
> Increasing your salt (sodium chloride) intake might reduce your lithium level. Take care.
Posted by ed_uk2010 on August 8, 2010, at 12:36:16
In reply to Re: Lithium / Geodon question... » SheilaC, posted by morgan miller on August 8, 2010, at 12:29:41
>I don't believe that the extended release version of lithium affects you for long enough to positively impact you throughout the day.
That could depend on the brand.
Posted by ed_uk2010 on August 8, 2010, at 12:38:55
In reply to Re: Lithium / Geodon question..., posted by Dan_MI on August 8, 2010, at 12:31:56
>The goal is to have a robust collection of all electrolytes. I don't eat enough salt, personally.
That's unusual. Most people consume more salt than they require. Do you eat a special diet?
>But salt pills in the summer are a must to anyone taking lithium.
Wouldn't that depend on their dietary intake?
>You can sweat too much and all of the sudden feel like your under seven feet of water....
Definitely a risk in very hot weather.
Posted by morgan miller on August 8, 2010, at 12:55:43
In reply to Re: Lithium / Geodon question... » Dan_MI, posted by ed_uk2010 on August 8, 2010, at 12:38:55
The need for salt intake, whether you are on Lithium or not, also depends on how much exercise you are getting. Moderate to intense exercise will require an increase in salt intake, at least it does for me.
I have bee doing the Himalayan sea salt thing for a while. I'm hoping there is some benefit to this over regular salt.
Posted by ed_uk2010 on August 8, 2010, at 13:10:34
In reply to Re: Lithium / Geodon question... » ed_uk2010, posted by morgan miller on August 8, 2010, at 12:55:43
> The need for salt intake, whether you are on Lithium or not, also depends on how much exercise you are getting. Moderate to intense exercise will require an increase in salt intake, at least it does for me.
Definitely. Anything that increases sweating (and hence sodium loss) will require an increased salt intake.
Posted by morgan miller on August 8, 2010, at 13:11:19
In reply to Re: Lithium / Geodon question... » Dan_MI, posted by ed_uk2010 on August 8, 2010, at 12:38:55
Dan, how much lithium do you take and how long have you been on it? Do you take an extended release version?
Ed, what version of extended release version do you think might last long enough to warrant one time a day dosing? Lithobid?
I just switched to generic extended release Lithium. I asked for lithobid and was prescribed it, but my insurance company paid for the generic.
Posted by ed_uk2010 on August 8, 2010, at 13:49:50
In reply to Re: Lithium / Geodon question..., posted by morgan miller on August 8, 2010, at 13:11:19
>Ed, what version of extended release version do you think might last long enough to warrant one time a day dosing? Lithobid?
We don't have Lithobid here. Priadel is the most widely used brand. It can be given once or twice per day.
Posted by Phillipa on August 8, 2010, at 19:42:25
In reply to Re: Lithium / Geodon question... » morgan miller, posted by ed_uk2010 on August 8, 2010, at 13:49:50
Lithobid was the preferred lithium when working in psych didn't they stop making it for a while as wasn't available and the other brand didn't seem to work as well. The pdocs at the time were not happy as they also preferred lithobid. Phillipa
Posted by Dan_MI on August 9, 2010, at 3:51:38
In reply to Re: Lithium / Geodon question..., posted by morgan miller on August 8, 2010, at 13:11:19
I've been on the Lith for 15 years now, at exactly the same dose (600 mg twice a day) and blood level (0.6).
I take generic lithium carbonate and one of my shrinks once told me it was OK to take my whole dose at night. What an idiot he was. Not only was I on the verge of hypomania, I had awful dehrydration issues while I slept.
Even Lithobid - whose name I gather is derived from the shorthand "bid" for "twice daily" - is meant to be taken twice a day. I once found delightfully retro magazine ad for Lithobid from the 1970's which said exactly that.
From what I understand, Lithium's half life is 24 hours and of course there are no metabolites.
> Dan, how much lithium do you take and how long have you been on it? Do you take an extended release version?
>
> Ed, what version of extended release version do you think might last long enough to warrant one time a day dosing? Lithobid?
>
> I just switched to generic extended release Lithium. I asked for lithobid and was prescribed it, but my insurance company paid for the generic.
Posted by ed_uk2010 on August 9, 2010, at 14:59:36
In reply to Re: Lithium / Geodon question..., posted by ed_uk2010 on August 7, 2010, at 13:10:58
>If you are taking one of the sustained release brands of lithium, taking it as a single daily dose should be sufficient.
Just wanting to clarify....
I was wrong to generalise here. Some of the lithium products available in the UK (such as Priadel) are frequently given once daily. This does not apply to other brands.
Posted by morgan miller on August 9, 2010, at 21:33:33
In reply to Re: Lithium / Geodon question..., posted by ed_uk2010 on August 9, 2010, at 14:59:36
> >If you are taking one of the sustained release brands of lithium, taking it as a single daily dose should be sufficient.
>
> Just wanting to clarify....
>
> I was wrong to generalise here. Some of the lithium products available in the UK (such as Priadel) are frequently given once daily. This does not apply to other brands.I wonder how Priadel could differ that much from Lithobid. Are you sure they are not the same exact thing and Priadel is just the name used in the U.K.? Maybe it is often prescribed to take once a day, and it works for many, but some need to take all brands/forms of Lithium twice a day to maintain therapeutic levels.
Posted by ed_uk2010 on August 10, 2010, at 15:01:16
In reply to Re: Lithium / Geodon question..., posted by morgan miller on August 9, 2010, at 21:33:33
Hi there,
>I wonder how Priadel could differ that much from Lithobid.
The formulation of a tablet/capsule can affect the rate at which the drug is released. This can affect the number of times per day that the medicine needs to be taken eg. Wellbutrin SR (twice a day) versus Wellbutrin XL (once a day).
Priadel and Lithobid have different excipients. (Excipients are tablet ingredients other than the actual drug). Excipients have a variety of uses. In the case of modified-release products, excipients are used to control the rate at which the tablets release the drug.
>Are you sure they are not the same exact thing and Priadel is just the name used in the U.K.?
Yes, they are different products made by different manufacturers. Priadel is available as 200mg and 400mg tablets. The second most popular brand of lithium in the UK is Camcolit, which is marketed as 250mg tablets (rapid release) and 400mg tablets (sustained release).
>Maybe it is often prescribed to take once a day, and it works for many, but some need to take all brands/forms of Lithium twice a day to maintain therapeutic levels.
You're right. It is sometimes necessary to give Priadel twice a day. As is the case with all lithium products, there are significant individual differences in response.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.