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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by MuseMemento on June 4, 2014, at 15:46:21
Hi, all. If you notice your condition worsening after initiating a new medication or raising the dose of a medication, how do you differentiate between an organic worsening of the condition versus response to the new medication or dosage? I'm loathe to quit a medication trial too soon but I also don't want to continue down a road that's contributing to my feeling worse. Any insights?
Posted by Phillipa on June 4, 2014, at 22:01:53
In reply to Worsening due to condition or medication?, posted by MuseMemento on June 4, 2014, at 15:46:21
If noticed when introduced a new med I would stop the med and hope to return to previous level. Any improvement at all. And what is the meds you are taking. And the new med. Phillipa
Posted by MuseMemento on June 5, 2014, at 11:54:48
In reply to Re: Worsening due to condition or medication? » MuseMemento, posted by Phillipa on June 4, 2014, at 22:01:53
I started clomipramine at 50 mg four and a half weeks ago and just increased it to 150 mg three days ago after three weeks on 100 mg. I take .5 mg lorazepam at night and have been taking 300 mg bupropion xl since January. Prior to switching over to clomipramine, I'd been taking 20 mg escitalopram for 6 weeks, I believe. I've felt less energy on the clomipramine and greater drowsiness, as well as increased confusion.
Posted by Christ_empowered on June 5, 2014, at 12:29:37
In reply to Re: Worsening due to condition or medication? » Phillipa, posted by MuseMemento on June 5, 2014, at 11:54:48
wellbutrin can increase tca levels considerably.
Posted by MuseMemento on June 5, 2014, at 12:41:21
In reply to Re: Worsening due to condition or medication?, posted by Christ_empowered on June 5, 2014, at 12:29:37
How significantly? Is it possible that my 150 mg dose is already the equivalent of being above the typical max therapeutic dose of 250 mg? My pdoc and I discussed the interaction and they were unconcerned unless I start to have severe side effects. I'm not sure what my current experiences would be considered.
Posted by MuseMemento on June 5, 2014, at 15:32:49
In reply to Re: Worsening due to condition or medication?, posted by Christ_empowered on June 5, 2014, at 12:29:37
Also worth noting, I smoke half a pack of cigarettes daily. I know that this increases clearance of clomipramine through cyp1a2 activity but I'm not sure of how it affects things overall.
Posted by phidippus on June 7, 2014, at 13:20:29
In reply to Worsening due to condition or medication?, posted by MuseMemento on June 4, 2014, at 15:46:21
The best way to tell if a medication is worsening your condition is to stop it for a few days and if you improve you know the drug is to blame.
Eric
Posted by MuseMemento on June 9, 2014, at 15:33:27
In reply to Re: Worsening due to condition or medication? » MuseMemento, posted by phidippus on June 7, 2014, at 13:20:29
That seems most reasonable, phidippus. My only concern is that I've only been on the medication in question, clomipramine, for five weeks altogether and four weeks at a dose of 100 mg, and I don't want to pre-empt a delayed therapeutic response by stopping it for a couple of days to see if it's responsible for the worsening. Is this a possible risk if I don't take it for only a few days?
Posted by Christ_empowered on June 10, 2014, at 9:20:36
In reply to Re: Worsening due to condition or medication? » phidippus, posted by MuseMemento on June 9, 2014, at 15:33:27
hey...I'm no expert, but it seems to me that if the problem is high blood levels of the tca, a couple days worth of wash out might be beneficial, and might get your blood levels back down to normal, therapeutic levels.
or not, lol.
Posted by MuseMemento on June 11, 2014, at 15:05:28
In reply to Re: Worsening due to condition or medication?, posted by Christ_empowered on June 10, 2014, at 9:20:36
That suggestion makes perfect sense but I'm just not sure, short of a blood level test, how to know for sure if it's the clomipramine that's responsible. It's not as if it's been an unqualified success or anything but I don't want to give up too soon on it and risk non-response. Just confused.
Posted by phidippus on June 11, 2014, at 17:59:17
In reply to Re: Worsening due to condition or medication? » phidippus, posted by MuseMemento on June 9, 2014, at 15:33:27
After five weeks, putting the pause button on the clomipramine should be ok-you're on a low dose anyway. I would stop it for a week, see how you feel then restart it if it makes sense to.
Eric
Posted by MuseMemento on June 11, 2014, at 21:01:31
In reply to Re: Worsening due to condition or medication? » MuseMemento, posted by phidippus on June 11, 2014, at 17:59:17
Thank you. I think I'll do just that.
This is the end of the thread.
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