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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by rtcstudio on June 24, 2011, at 10:37:34
Thank you for any help - My wife's desipramine levels are mysteriously dropping.
She has been steady and well for a long time on her current meds. We see a psychiatrist/psychopharmacologist every 6 mos to check her maintenence.
Over last 2 weeks her symptoms of anxiety/depression returned culminating with a panic attack on this past Saturday. Monday, we had bloodwork done to check levels.
All was okay except desipramine which showed an almost 50% drop. The blood level that has worked wonderfully for her for years is between 250 and 300 (I know this is high by the book, but her doc says that 5% of patients do well on a level that is higher or lower than the statistical window). On Monday, the blood drawn showed a level of 153. Thinking this was a mistake, we had the desipramine test done again. Blood drawn on Wednesday showed a further drop with a level of 128. Within 2 days the level had dropped 25 points.
She is showing clear signs of having practically stopped taking the desipramine. We are seeing her regular physician on Monday to see if there could be an underlying physical cause, but what could target desipramine selectively??
Her thyroid was good, estrogen was good, tegretol was good. She had a urinary tract infection about three weeks ago and took antibiotics, but we've never seen what is happening now.
Thank you for any help, suggestions! I'm desperate!
Posted by Phillipa on June 24, 2011, at 12:35:07
In reply to Desipramine levels suddenly dropping drastically, posted by rtcstudio on June 24, 2011, at 10:37:34
Some antibiotics lower the levels of other meds could this have happened? Google and see if you can find it. As it's very possible. Phillipa
Posted by rtcstudio on June 24, 2011, at 14:04:25
In reply to Re: Desipramine levels suddenly dropping drastically » rtcstudio, posted by Phillipa on June 24, 2011, at 12:35:07
> Some antibiotics lower the levels of other meds could this have happened? Google and see if you can find it. As it's very possible. Phillipa
Thanks so much for the reply!
I did check that, but she's not taken any since probably 3 weeks ago. She did take some because of a urinary tract infection, but that was over 3 wks ago.
I'm just perplexed as to what would have caused her additional drop from Monday to Wed of this week.
Posted by jono_in_adelaide on June 24, 2011, at 18:25:41
In reply to Re: Desipramine levels suddenly dropping drastically, posted by rtcstudio on June 24, 2011, at 14:04:25
Very strange indeed!
She hasnt added any new meds of late, or started any natural supplements or anything has she?
I guess a liver function test would be a good start?
Posted by desolationrower on June 24, 2011, at 20:41:46
In reply to Re: Desipramine levels suddenly dropping drastically, posted by jono_in_adelaide on June 24, 2011, at 18:25:41
changes in diet can do this too.
-d/r
Posted by Phillipa on June 24, 2011, at 20:41:57
In reply to Re: Desipramine levels suddenly dropping drastically, posted by jono_in_adelaide on June 24, 2011, at 18:25:41
Jono if took antibiotics three weeks ago couldn't the levels have gone down and now feeling the change? I don't know? Phillipa
Posted by jono_in_adelaide on June 25, 2011, at 3:30:13
In reply to Re: Desipramine levels suddenly dropping drastically » jono_in_adelaide, posted by Phillipa on June 24, 2011, at 20:41:57
I would have thought that if she had taken them three weeks ago, the effects would have passed by now, but i dont realy know.
Is it possible that she has recieved a dud bottle of tablets with her latest script? Maybe try getting some pills from a different batch and see if the levls start to come back?
Posted by rtcstudio on June 25, 2011, at 9:39:51
In reply to Re: Desipramine levels suddenly dropping drastically, posted by jono_in_adelaide on June 25, 2011, at 3:30:13
Hey all, thanks so much for the replies!
We're thinking (doc and all) that since the antibiotics were stopped 3 weeks ago that the effects would be negligible the past 2 weeks at least.
Her psych/pharmacologist says that the fact that the 2nd blood test was lower than the first test within 2 days is just a reflection of the plus/minus accuracy of the blood test for desipramine. He says the only real thing it means is that she is confirmed LOW for her and she needs to get back up in level. So he has increased the desipramine and we will test again around Wed or Thur of this next week.
We are assuming that she did get a bad batch of meds in the last prescription. I did confirm with the pharmacist that their supplier for desipramine has not changed in over a year. However, the psych doc brought up the fact that even though the supplier has not changed, THEY may have changed factories, even as far as shifting operations to an overseas factory to manufacture this generic drug.
He also said that it is not unusual for the body/liver etc to change in the way it metabolizes a certain substance, while leaving others alone. So while her other meds are in fine levels, and thyroid and estrogen show fine levels, it is possible for desipramine to change.
So just when you think you're safe and running smoothly, another challenge gets thrown in the way of a maintenance program.
So right now the plan is increasing the desipramine dosage per day. We are also going to do a panel of tests that will check liver function, just to be on the safe side, this next week.
Thanks again!!!
This is the end of the thread.
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