Psycho-Babble Medication Thread 471753

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Re: Paxil w/drawal question..anyone? Ritch

Posted by katia on March 19, 2005, at 14:36:46

In reply to Re: Paxil w/drawal question..anyone? katia, posted by Ritch on March 19, 2005, at 13:53:25

Yes, it's all hard to figure out. Even pdocs (at least mine) doesn't seem to give me any real answers as to what to do. Hence me coming to these boards to figure it out myself, less going to medical school and getting letters after my name to know about as much as I do now! Just kidding...feeling a bit bitter with the lack of help/knowledge on the pdoc front.

I was just looking at Lithium Orotate nasal spray by HBC protocols. I may give that a go for the depression. Li. Carb did not work for me. I'm on Trileptal now at only 450mg. It seems to help. I've definitely evened out over the past year compared to where I was.

I've halved my Paxil, trying to ween off. But now I'm wondering if I should just stay on it?! I hate the idea of staying on something that is so addicting/hard to get off of.

Do you normally have four cycles a year?
Katia

 

Re: Paxil w/drawal question..anyone? katia

Posted by Ritch on March 20, 2005, at 11:47:13

In reply to Re: Paxil w/drawal question..anyone? Ritch, posted by katia on March 19, 2005, at 14:36:46

> Yes, it's all hard to figure out. Even pdocs (at least mine) doesn't seem to give me any real answers as to what to do. Hence me coming to these boards to figure it out myself, less going to medical school and getting letters after my name to know about as much as I do now! Just kidding...feeling a bit bitter with the lack of help/knowledge on the pdoc front.
>
> I was just looking at Lithium Orotate nasal spray by HBC protocols. I may give that a go for the depression. Li. Carb did not work for me. I'm on Trileptal now at only 450mg. It seems to help. I've definitely evened out over the past year compared to where I was.
>
> I've halved my Paxil, trying to ween off. But now I'm wondering if I should just stay on it?! I hate the idea of staying on something that is so addicting/hard to get off of.
>
> Do you normally have four cycles a year?
> Katia


I definitely have two different "levels" of cycling. One is a seasonal thing.. I have two distinct depressive episodes every year, year after year for as long as I can remember.. one that starts in mid November which ends in mid-January. Then, I rev up big time and have the most prominent hypomanic spells in the Spring which are the peakiest in April and May. Then I crash big time in late June and that episode lasts until early-September. Then I get another briefer hypomanic spell in late-September and through most of October before I crash again.

The "second level" of cycling is an approximate 3 week pattern that is embedded inside all of the seasonal stuff. It follows a D-M-E pattern, depressed-manic-normal. I tend to "bounce out" of these three week cycle depressions into hypomania rather suddenly and tend to "fade in" to depressions from relative normalcy. In the middle of a seasonal depression, often the hypomanic phase of the 3 week cycle presents as hostility instead.

 

Re: Paxil w/drawal question..anyone? Ritch

Posted by SLS on March 20, 2005, at 12:05:08

In reply to Re: Paxil w/drawal question..anyone? katia, posted by Ritch on March 20, 2005, at 11:47:13

Your having figured out your cycles is amazing.

I wonder if using light therapy during your depressed phase might not make you manic if you expose yourself to too much of it.

What drugs are you currently taking?

What has been your history of using mood stabilizers? Ever tried lithium?


- Scott

 

Re: Paxil w/drawal question..anyone?

Posted by SLS on March 20, 2005, at 12:06:15

In reply to Re: Paxil w/drawal question..anyone? Ritch, posted by SLS on March 20, 2005, at 12:05:08

> Your having figured out your cycles is amazing.
>
> I wonder if using light therapy during your depressed phase might not make you manic if you expose yourself to too much of it.
>
> What drugs are you currently taking?
>
> What has been your history of using mood stabilizers? Ever tried lithium?


Oops. I forgot about combining lithium + Lamictal.


- Scott

 

Re: Paxil w/drawal question..anyone? Ritch

Posted by katia on March 20, 2005, at 15:37:56

In reply to Re: Paxil w/drawal question..anyone? katia, posted by Ritch on March 20, 2005, at 11:47:13

Hey Ritch,
You really do have your cycles down. How long have you been monitoring your cycles under and watchful and knowing eye coming through the BP lens?
Yours actually sound similar to what I experience. Even with meds you experience this? Do meds do anything to help? Are you using the light box too? I just started that this year (nov. 15th! - your schedule) and it pulled me out of a depression I was falling into.

Katia

 

Re: Paxil w/drawal question..anyone? SLS

Posted by Ritch on March 20, 2005, at 17:18:21

In reply to Re: Paxil w/drawal question..anyone? Ritch, posted by SLS on March 20, 2005, at 12:05:08

> Your having figured out your cycles is amazing.
>
> I wonder if using light therapy during your depressed phase might not make you manic if you expose yourself to too much of it.
>
> What drugs are you currently taking?
>
> What has been your history of using mood stabilizers? Ever tried lithium?
>
>
> - Scott

Hi Scott,

I'm on 250mg-500mg/day of Depakote ER--I had 125mg sprinkle caps and it was 250mg-375mg day, but I'm out of sprinkle caps now. When I take 500mg it is just when I get a little "tweaky" and scatterbrained (every week or so for a couple of days). I'm also on Clonazepam .5mg most days, sometimes up to 1.0mg for a day or two here and there. I was also on a tiny bit of Celexa 1/2mg every other day, but I've been off it for about a week, and I am going to see if I can stay off of it.

Mood stabilizer-wise.. I was on lithium the longest from 1980 until 1998 (with exception to a year or so in there where I stopped it with near disastrous results). Also during the '80's I was on low doses of Thorazine or Mellaril. More recently have tinkered with (for at least a month or two) Topamax, Neurontin, Gabitril, Trileptal, Keppra, verapamil. The only thing I haven't tried that might be helpful would be Dilantin or Tegretol or Lamictal. Did try Tegretol, but for just two weeks as a switch from lithium back in 1990 or so. I was in the middle of a nasty depression, and the depression seemed to get worse but that may have been stopping the lithium.. (no side effects though that I can remember with Teg @ 200mg/day).

Generally, I've found the best times to try something new or stop something is when I am in a high phase, NOT a depressive one.

Hmmm.. the light exposure thing.. Well, I never wind up getting a light box, although every time the winter depression approaches I swear I'll buy one.. this time I'm going to get the thing in September well BEFORE I get hip-deep in a depressive spot and lack the motivation. I've actually tinkered with taking melatonin at night as an antimanic, and it seems to help! I HAVE thought quite a bit about light triggered mania, and I sometimes get quite a robust euphoric high spell or two in January or February if there is snow cover that persists with a lot of sunshine. The problem is the summertime depression. There is more anxiety and hostility, more mixed. The leaden paralysis thing as well. There is NOTHING worse for me than to be super agitated and feel like a block of lead at the same time. The wintertime one is more of a "classic" unipolar atypical depression, just super sleepy and hungry, and thick headed.

The three week thing I've noticed even before I sought treatment.. I didn't quite connect the dots though-- because back then you were just manic depressive period, or something else, no splintering..

 

Re: Lithium and Lamictal SLS

Posted by Ritch on March 20, 2005, at 17:28:57

In reply to Re: Paxil w/drawal question..anyone?, posted by SLS on March 20, 2005, at 12:06:15

> > Your having figured out your cycles is amazing.
> >
> > I wonder if using light therapy during your depressed phase might not make you manic if you expose yourself to too much of it.
> >
> > What drugs are you currently taking?
> >
> > What has been your history of using mood stabilizers? Ever tried lithium?
>
>
> Oops. I forgot about combining lithium + Lamictal.
>
>
> - Scott

Yeah, that would probably make a "golden" combo for many folks here. But... I've found something out over the years about me and lithium.. The lithium *does* help with depression generally, but it doesn't do much at all to dampen down my cycling patterns and oddly enough it is a rather poor antimanic for me. Even when I was up to 1200-1500-1800mg/day I still got some rather wild hypomanias.. but it definitely helped depression no doubt about that. Also, I've only got 1/3 of my thyroid left and lithium shreds my GI tract.. so I don't want lithum in the mix again. Depakote or Trileptal worked the best (of what I've tried) for manic symptoms and for cycling (esp Trileptal). But Trileptal is too barfogenic for me.. yack.

Actually, I think Depakote with *Lamictal* would be a better fit for me.. but those are the worst two bipolar meds to put together...

 

Re: Paxil w/drawal question..anyone? katia

Posted by Ritch on March 20, 2005, at 17:38:35

In reply to Re: Paxil w/drawal question..anyone? Ritch, posted by katia on March 20, 2005, at 15:37:56

> Hey Ritch,
> You really do have your cycles down. How long have you been monitoring your cycles under and watchful and knowing eye coming through the BP lens?
> Yours actually sound similar to what I experience. Even with meds you experience this? Do meds do anything to help? Are you using the light box too? I just started that this year (nov. 15th! - your schedule) and it pulled me out of a depression I was falling into.
>
> Katia

I've been mood charting since the early '80's. I've noticed the seasonal patterns throughout my teenage years, but the 3-week thing really kicked in when I was about 20 or so. No light box yet.. later this year I will make a point of it though. Even with meds... OH YES, the cycling "flattens" when I back off the antidepressants, but the 3week *frequency* doesn't change as much as the amplitude of the peaks and troughs. Basically, I can just take Depakote and clonazepam and greatly reduce the hypomania, but when the depressions hit, especially coincident with the seasonal pattern and OUCH... gotta do something! IOW, I can put up with a little tweaky cycling during a seasonal depressive episode and feel better on AD's. It would be really NICE to just use a light box and an antimanic during the wintertime thing..! I would like that.

 

Re: Depakote + Lamictal Ritch

Posted by ed_uk on March 20, 2005, at 18:00:57

In reply to Re: Lithium and Lamictal SLS, posted by Ritch on March 20, 2005, at 17:28:57

Hi Mitch!

>Actually, I think Depakote with *Lamictal* would be a better fit for me.. but those are the worst two bipolar meds to put together...

You generally can combine them provided that you start at suitably low doses and titrate carefully. For a patient on Depakote, the starting dose of Lamictal must always be very low.

Here are the UK guidelines for starting Lamictal (for epilepsy) in a patient who is already taking Depakote..........

Initiate Lamictal at 25mg every other day for 14 days. Next take 25mg daily for a further 14 days. The dose can then be increased in steps of 25-50mg every 7-14 days as required.

Depakote often raises the plasma concentration of Lamictal - hence the low Lamictal starting dose and gradual titration. As you know, gradual titration of Lamictal helps to minimise the risk of rash. Lamictal only seems to produce small changes in the plasma concentration of Depakote.

When Lamictal is combined with Depakote, tremor of the hands/arms is a very common side effect. It can generally be minimised by dosage adjustments, the dosage of one or both drugs may need to be reduced. Other side effects which may occur when the two drugs are combined include incoordination and sedation. In general, people on Depakote tend to take quite low doses of Lamictal, often about half the 'usual' dose.

Best regards,
Ed.

 

Re: Depakote + Lamictal ed_uk

Posted by Ritch on March 20, 2005, at 22:47:01

In reply to Re: Depakote + Lamictal Ritch, posted by ed_uk on March 20, 2005, at 18:00:57

> Hi Mitch!
>
> >Actually, I think Depakote with *Lamictal* would be a better fit for me.. but those are the worst two bipolar meds to put together...
>
> You generally can combine them provided that you start at suitably low doses and titrate carefully. For a patient on Depakote, the starting dose of Lamictal must always be very low.
>
> Here are the UK guidelines for starting Lamictal (for epilepsy) in a patient who is already taking Depakote..........
>
> Initiate Lamictal at 25mg every other day for 14 days. Next take 25mg daily for a further 14 days. The dose can then be increased in steps of 25-50mg every 7-14 days as required.
>
> Depakote often raises the plasma concentration of Lamictal - hence the low Lamictal starting dose and gradual titration. As you know, gradual titration of Lamictal helps to minimise the risk of rash. Lamictal only seems to produce small changes in the plasma concentration of Depakote.
>
> When Lamictal is combined with Depakote, tremor of the hands/arms is a very common side effect. It can generally be minimised by dosage adjustments, the dosage of one or both drugs may need to be reduced. Other side effects which may occur when the two drugs are combined include incoordination and sedation. In general, people on Depakote tend to take quite low doses of Lamictal, often about half the 'usual' dose.
>
> Best regards,
> Ed.
>
>
>
>

Thanks Ed! Yeah, I know you can take the two together, but 1) My current pdoc won't go for it, 2) I've had some spooky skin reactions and allergies the last few years, and 3) Depakote already causes tremor with the low dose I'm taking now.. and I've heard that Lam tends to cause backaches and body aches, something that the Depakote seems to make worse for me also. I'm beginning to wonder if trying Tegretol (this time during a high period), and hanging in there with that for several weeks might be the next step (barring anything new coming around). While the Trileptal was super nauseating, one thing I liked about it was the analgesic effect, no tremor, and better sleep... I've also thought about Dilantin.. my Mom was on high doses of that for epilepsy for nearly two decades, and the worst effects she got was gingival hyperplasia.. no black box warning for Dilantin...

any thoughts?

 

Re: Paxil w/drawal question..anyone? Ritch

Posted by katia on March 21, 2005, at 3:08:24

In reply to Re: Paxil w/drawal question..anyone? katia, posted by Ritch on March 20, 2005, at 17:38:35

How old are you Ritch?

Mood charting since the teen years? Yikes. I wish I'd have been. Just in my thirties before I realized what was happening to me.

At the moment, I feel like I want to slit my wrists, only to be able to shed my skin because this paxil withdrawal is not going well. I feel awful and irritable and want to jump out of my skin. I am worried that I'll do something drastic, like REALLY slit my wrists in the midst of this intense mood swing and irritability. It's only happened since I halved my Paxil. I tried coming off of Paxil in Jan. and couldn't because of this. Any help out there? I want a sane life. I want to be normal. And I feel like this Paxil withdrawal is sucking any normalcy I've felt and making me a raging lunatic. This is not who I am.
Katia

 

Re: Paxil w/drawal question..anyone? katia

Posted by SLS on March 21, 2005, at 6:52:04

In reply to Re: Paxil w/drawal question..anyone? Ritch, posted by katia on March 21, 2005, at 3:08:24


> At the moment, I feel like I want to slit my wrists, only to be able to shed my skin because this paxil withdrawal is not going well.

How are you going about it? Maybe I can offer some suggestions. If you are not doing it already, I would split the dosage of Paxil and take it 2-3 times a day. It minimizes the peaks and troughs in blood levels. I have written more on the Withdrawal board about using a flexible dosing strategy. It works so wonderfully. I am hoping that it helps others as well.


- Scott

 

Redirected to Withdrawal board link includedKatia SLS

Posted by gardenergirl on March 21, 2005, at 9:38:52

In reply to Re: Paxil w/drawal question..anyone? katia, posted by SLS on March 21, 2005, at 6:52:04

I redirected this thread to the Withdrawal board. Here is a link to it.

http://www.dr-bob.org/babble/wdrawl/20050228/msgs/473530.html

Thanks,

gg

 

Re: Tegretol, Dilantin..... Ritch

Posted by ed_uk on March 21, 2005, at 10:10:24

In reply to Re: Depakote + Lamictal ed_uk, posted by Ritch on March 20, 2005, at 22:47:01

Hi Mitch!

>1) My current pdoc won't go for it, 2) I've had some spooky skin reactions and allergies the last few years, and 3) Depakote already causes tremor with the low dose I'm taking now.. and I've heard that Lam tends to cause backaches and body aches, something that the Depakote seems to make worse for me also.

OK! What caused the skin reactions and allergies?

>Tegretol

I think it's definitely worth trying. Perhaps you could try the controlled release, I remember reading that it's supposed to be less likely to cause nausea.

>Dilantin

Hopefully it would work as well as Trileptal without making you feel sick! It can be difficult to get the dose right, lots of blood tests at first- that might remind you of lithium. Plaque control is the most important thing you can do to reduce the risk of gingival hyperplasia- lots of trips to the dentist I'm afraid :-(

Best regards,
Ed.

 

Re: Paxil w/drawal question..anyone? katia

Posted by Ritch on March 21, 2005, at 10:41:34

In reply to Re: Paxil w/drawal question..anyone? Ritch, posted by katia on March 21, 2005, at 3:08:24

> How old are you Ritch?
>

Approaching 50.

> Mood charting since the teen years? Yikes. I wish I'd have been. Just in my thirties before I realized what was happening to me.

When I was in my teens, there definitely was something wrong-just wasn't really sure what. I wasn't *formally* mood charting in my teens. I just realized suddenly when I was 16 that I was always depressed every winter at about the same time, and the following year when I was 17 it hit really hard, then it happened even worse when I was 18 at the same time, so much worse that I dropped out of college, and lost a job. I developed a mixed-state in the summer a year after that-when I sought treatment-couldn't endure the agitation.

>
> At the moment, I feel like I want to slit my wrists, only to be able to shed my skin because this paxil withdrawal is not going well. I feel awful and irritable and want to jump out of my skin. I am worried that I'll do something drastic, like REALLY slit my wrists in the midst of this intense mood swing and irritability. It's only happened since I halved my Paxil. I tried coming off of Paxil in Jan. and couldn't because of this. Any help out there? I want a sane life. I want to be normal. And I feel like this Paxil withdrawal is sucking any normalcy I've felt and making me a raging lunatic. This is not who I am.
> Katia

Wow, your situation sounds a lot like Slinky's above. Paxil half-life is just too short.. My brother-in-law's mom was put on it for a bad depressive episode.. she got better and recovered.. but didn't get off of it.. I saw her visit one time and she left it at home.. and she was clearly JONESING

 

Re: Tegretol, Dilantin..... ed_uk

Posted by Ritch on March 21, 2005, at 10:53:03

In reply to Re: Tegretol, Dilantin..... Ritch, posted by ed_uk on March 21, 2005, at 10:10:24

> Hi Mitch!
>
> >1) My current pdoc won't go for it, 2) I've had some spooky skin reactions and allergies the last few years, and 3) Depakote already causes tremor with the low dose I'm taking now.. and I've heard that Lam tends to cause backaches and body aches, something that the Depakote seems to make worse for me also.
>
> OK! What caused the skin reactions and allergies?

Effexor makes me itch a LOT, even with small doses, Vicodin caused some serious itching after my thyroid surgery.. never had that trouble with hydrocodone before.. Even with Depakote (cause?) I get some small purple spots on my skin that come and go rarely, that are weird-docs don't seem concerned blood tests show oK..and occasionally some unexplained hives (rarely). My dad had rheumatoid arthritis.. I just suspect an immune system thing that's a little touchy and I don't want to poke that hornet's nest with Lamictal.

>
> >Tegretol
>
> I think it's definitely worth trying. Perhaps you could try the controlled release, I remember reading that it's supposed to be less likely to cause nausea.

Yes, there is a new one called Equitrol for bipolar that has a three-phase releasing system that is unique. But, I bet it's pricey. However, the nausea I had from Trileptal was like a daylong affair.. I could even take T just at night and *still* feel nauseous most of the next day.. felt a little better a few hours before nighttime dose of course!

>
> >Dilantin
>
> Hopefully it would work as well as Trileptal without making you feel sick! It can be difficult to get the dose right, lots of blood tests at first- that might remind you of lithium. Plaque control is the most important thing you can do to reduce the risk of gingival hyperplasia- lots of trips to the dentist I'm afraid :-(
>
> Best regards,
> Ed.

Thanks! The thing I like about Dilantin.. is that it has a long half-life and you can get away with once a day dosing. My Mom was on 400mg/day, and had the gum problems. I'm wondering since I'm so med sensitive, that I could get by with just 100mg/day (i.e.)

 

Re: Tegretol, Dilantin..... Ritch

Posted by ed_uk on March 21, 2005, at 13:43:49

In reply to Re: Tegretol, Dilantin..... ed_uk, posted by Ritch on March 21, 2005, at 10:53:03

Hi Mitch!

>Yes, there is a new one called Equitrol.

We've got three different controlled release carbamazepine brands here, we don't have Equitrol though, it sounds good. Do you think you'll try it soon?

>I'm wondering since I'm so med sensitive, that I could get by with just 100mg/day

Most people need 200-500mg phenytoin for epilepsy, the plasma concentration of phenytoin is *not* proportional to dose. At doses <200mg, the plasma conc is often very low indeed. It's difficult to to say though because you're on Depakote. Depakote often raises the plasma conc of phenytoin- but may lower it in some people!! Also, phenytoin often lowers the plasma conc of Depakote. During the period of dose titration of phenytoin, measuring the plasma conc is important because small dosage increases (eg 25mg) can produce large increases in plasma conc, this is because the relationship betweeen dose and plasma conc is non-linear. Phenytoin's also got quite a narrow therapeutic index, toxicity may occur if the plasma conc is too high. With phenytoin, it's often best to avoid generics and to always use the same brand name, different brands may have slightly different bioavailabilities, this can sometimes be enough to produce a clinically significant change in the plasma concentration.

Best regards,
Ed.

 

Re: Tegretol, Dilantin..... ed_uk

Posted by Ritch on March 21, 2005, at 23:16:52

In reply to Re: Tegretol, Dilantin..... Ritch, posted by ed_uk on March 21, 2005, at 13:43:49

> Hi Mitch!
>
> >Yes, there is a new one called Equitrol.
>
> We've got three different controlled release carbamazepine brands here, we don't have Equitrol though, it sounds good. Do you think you'll try it soon?

Actually, not *soon*, if at all really. After reading about all the hassles with drug-drug interactions... I'm thinking I'll just stay on the Depakote, by itself.

>
> >I'm wondering since I'm so med sensitive, that I could get by with just 100mg/day
>
> Most people need 200-500mg phenytoin for epilepsy, the plasma concentration of phenytoin is *not* proportional to dose. At doses <200mg, the plasma conc is often very low indeed. It's difficult to to say though because you're on Depakote. Depakote often raises the plasma conc of phenytoin- but may lower it in some people!! Also, phenytoin often lowers the plasma conc of Depakote. During the period of dose titration of phenytoin, measuring the plasma conc is important because small dosage increases (eg 25mg) can produce large increases in plasma conc, this is because the relationship betweeen dose and plasma conc is non-linear. Phenytoin's also got quite a narrow therapeutic index, toxicity may occur if the plasma conc is too high. With phenytoin, it's often best to avoid generics and to always use the same brand name, different brands may have slightly different bioavailabilities, this can sometimes be enough to produce a clinically significant change in the plasma concentration.
>
> Best regards,
> Ed.
>
>

Wow, there's another drug-drug interaction biggie. My Mom was on on the 100mg phenytoin-sodium Kapseals made by Parke-Davis. She also took phenobarbitol with it. Hey, isn't there a non-linear pharmacokinetic thing with Depakote as well, with regards to plasma protein binding or something? Something to do with *other* meds that bind highly to plasma protein? What other meds do that? ..

 

Re: Redirected to Withdrawal board link includedKatia gardenergirl

Posted by katia on March 22, 2005, at 2:02:07

In reply to Redirected to Withdrawal board link includedKatia SLS, posted by gardenergirl on March 21, 2005, at 9:38:52

And who are you garden girl?

 

Re: Redirected to Withdrawal board link includedKatia katia

Posted by gardenergirl on March 22, 2005, at 7:32:32

In reply to Re: Redirected to Withdrawal board link includedKatia gardenergirl, posted by katia on March 22, 2005, at 2:02:07

Hi katia,
I'm just another Babbler who tries to help Dr. Bob with some housekeeping stuff from time to time.

gg

 

Re: Tegretol, Dilantin..... Ritch

Posted by ed_uk on March 22, 2005, at 8:22:20

In reply to Re: Tegretol, Dilantin..... ed_uk, posted by Ritch on March 21, 2005, at 23:16:52

Hi Mitch!

>Actually, not *soon*, if at all really. After reading about all the hassles with drug-drug interactions... I'm thinking I'll just stay on the Depakote, by itself.

:-) OK, I suppose it would be a hassle!

>Hey, isn't there a non-linear pharmacokinetic thing with Depakote as well....

I'm not sure- it's easier to titrate than phenytoin though!

Are there any other treatments that you'd like to try?

Best regards,
Ed.

 

Re: Tegretol, Dilantin..... ed_uk

Posted by Ritch on March 22, 2005, at 10:12:29

In reply to Re: Tegretol, Dilantin..... Ritch, posted by ed_uk on March 22, 2005, at 8:22:20

> Hi Mitch!
>
> >Actually, not *soon*, if at all really. After reading about all the hassles with drug-drug interactions... I'm thinking I'll just stay on the Depakote, by itself.
>
> :-) OK, I suppose it would be a hassle!
>
> >Hey, isn't there a non-linear pharmacokinetic thing with Depakote as well....
>
> I'm not sure- it's easier to titrate than phenytoin though!
>
> Are there any other treatments that you'd like to try?
>
> Best regards,
> Ed.


I was just wondering about the specific "problem" of serum protein binding by medications and how this presents an entirely different "interaction" phenomenon from the kind you typically read about regarding liver enzymes and elimination. From what I remember I think the serum protein binding is what creates a significant interaction between Depakote and Lamictal. I was just curious if there were any other meds (off the top of your head), which could interact in this manner. Actually, I'm a little worn out from "trying" different meds. At this point, I'm more interested in avoiding any unintended interactions with the meds I do take (Depakote and clonazepam). Thanks for your help!

 

Re: Tegretol, Dilantin..... Ritch

Posted by ed_uk on March 22, 2005, at 10:29:33

In reply to Re: Tegretol, Dilantin..... ed_uk, posted by Ritch on March 22, 2005, at 10:12:29

Hi Mitch!

>I was just wondering about the specific "problem" of serum protein binding by medications and how this presents an entirely different "interaction" phenomenon from the kind you typically read about regarding liver enzymes and elimination.

Here is a summary from the BNF....

'DUE TO CHANGES IN PROTEIN BINDING
To a variable extent most drugs are loosely bound to plasma proteins. Protein-binding sites are non-specific and one drug can displace another thereby increasing its proportion free to diffuse from plasma to its site of action. This only produces a detectable increase in effect if it is an extensively bound drug (more than 90%) that is not widely distributed throughout the body. Even so displacement rarely produces more than transient potentiation because this increased concentration of free drug results in an increased rate of elimination.

Displacement from protein binding plays a part in the potentiation of warfarin by sulphonamides, and tolbutamide but the importance of these interactions is due mainly to the fact that warfarin metabolism is also inhibited.'

'Plasma protein binding (of Lamictal) is 55% and none of the metabolites are active as anticonvulsants.'

For Depakote, plasma protein binding is about 90%

>From what I remember I think the serum protein binding is what creates a significant interaction between Depakote and Lamictal.

Although the mechanism of this iinteraction is not fully understood, it is thought that the two drugs may compete for glucuronidation by the liver, this may result in decreased lamotrigine clearance. I'm not sure whether the interaction involves plasma protein binding.

> Thanks for your help!

LOL- I'm not sure that I've been that helpful :-)

Ed.


 

Thanks, GG (nm) gardenergirl

Posted by Mark H. on March 22, 2005, at 13:06:42

In reply to Re: Redirected to Withdrawal board link includedKatia katia, posted by gardenergirl on March 22, 2005, at 7:32:32

 

Re: plasma protein binding- thanks! (nm) ed_uk

Posted by Ritch on March 22, 2005, at 23:09:36

In reply to Re: Tegretol, Dilantin..... Ritch, posted by ed_uk on March 22, 2005, at 10:29:33


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