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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by 4WD on February 21, 2008, at 22:22:42
Have most of you started at your maximum dose? Or have you started slowly and worked your way up?
I weigh 51 kg and pdoc wants me to start at 45 mg.
Marsha
Posted by Phillipa on February 21, 2008, at 22:42:24
In reply to Do you need to titrate Nardil when starting it?, posted by 4WD on February 21, 2008, at 22:22:42
Marsha I feel I know you may I follow your thread? Phillipa
Posted by Jedi on February 22, 2008, at 0:16:42
In reply to Do you need to titrate Nardil when starting it?, posted by 4WD on February 21, 2008, at 22:22:42
> Have most of you started at your maximum dose? Or have you started slowly and worked your way up?
>
> I weigh 51 kg and pdoc wants me to start at 45 mg.
>
> Marsha______________________________________________________________________
Hi Marsha,
I have been prescribed Nardil by five different MDs. Each one titrated the dose over several weeks. This reduces some of the side effects of the medication. I do use a higher dosage than you, however. I'm currently at 90mg and would like to go even higher. I know there are some abstracts in PubMed on high doses of Nardil. I'll just have to find them for my Doc.
Best wishes,
Jedi
Posted by 4WD on February 22, 2008, at 10:10:39
In reply to Re: Do you need to titrate Nardil when starting it? » 4WD, posted by Phillipa on February 21, 2008, at 22:42:24
> Marsha I feel I know you may I follow your thread? Phillipa
Of course Phillipa. I will be posting a regular update as soon as I start the Nardil. I'm not too worried about the washout period. I quit Celexa cold turkey once before for two weeks when I was about to try EMSAM and I actually felt better off it.
Marsha
Posted by 4WD on February 22, 2008, at 10:16:08
In reply to Re: Do you need to titrate Nardil when starting it? » 4WD, posted by Jedi on February 22, 2008, at 0:16:42
> > Have most of you started at your maximum dose? Or have you started slowly and worked your way up?
> >
> > I weigh 51 kg and pdoc wants me to start at 45 mg.
> >
> > Marsha
>
> ______________________________________________________________________
>
> Hi Marsha,
> I have been prescribed Nardil by five different MDs. Each one titrated the dose over several weeks. This reduces some of the side effects of the medication. I do use a higher dosage than you, however. I'm currently at 90mg and would like to go even higher. I know there are some abstracts in PubMed on high doses of Nardil. I'll just have to find them for my Doc.
> Best wishes,
> Jedi
>Hi Jedi,
Thanks for answering. I found it a litle strange that he wanted me to start at what would be my maximum dose. ( I only weigh 51kg and so I guess my maximum would be 45 or there abouts). I don't understand why he wants me to start at such a high dosage. But he's the doctor. Maybe I can start at 45 and if the side effects are too severe I can go back down to 30 for a while.
I believe he may be thinking that I am in such bad shape that I can't afford the time it takes to titrate the dose. And wants to get results as soon as possible. He knows me pretty well and knows that if something doesn't work fairly quickly (at least a little) that I am likely to give up on it without giving it a fair trial.
Good luck with getting your doctor to up your dosage.
Marsha
Posted by stargazer2 on February 22, 2008, at 11:09:25
In reply to Re: Do you need to titrate Nardil when starting it? » Jedi, posted by 4WD on February 22, 2008, at 10:16:08
4WD, when I started,it was 15 mg x 2 day, 30 mg X 4 days, then 45 mg X many weeks. I did up it to 60 mg a few months ago and have been at 60 since then.
I usually have many side effects with meds, but with nardil I had the problems with gas and constipation and still have those problems. Weight gain is also a side effect and I did experience swollen ankles which only lasted a week or two.
It is worth it though since Nardil can work very well for depression, better than most of the other meds I've taken for TRD. The meds that worked for TRD (Celexa, wellbutrin and adderall) before Nardil were always combinations and I would rather take one med than 2 or three if at all possible.
Good luck with your trial of Nardil.
Stargazer
Posted by 4WD on February 22, 2008, at 19:07:20
In reply to Re: Do you need to titrate Nardil when starting it?, posted by stargazer2 on February 22, 2008, at 11:09:25
Hi Stargazer,
Thanks for replying to my post. I am full of questions, I know. I kind of think that is what I may do. Instead of just starting out at 45, I will start with 15 for a couple of days, then go to 30 for a couple of days, then go to the full dose. I can't figure out why my pdoc wanted me to start at the full 45mg. I guess I could call him and ask him but I don't want to seem to be questioning his expertise.OTOH, I may do exactly as he has ordered and try to start out at the full dose. If side effects are too horrible, then I can titrate down and tell him why and he won't think I am arbitrarily making my own decisions about how to take the med.
What is your dosage schedule? I am supposed to take 15 mg three times a day. I read here I think that taking most of the dose as early in the day as possible helps mitigate the insomnia problem. I think I will start a thread on this and get an idea of how other Nardil users space their dosage.
I have some time to figure it out. I am only on my second day off Celexa so I have 12 days to go before starting the Nardil.
Thanks again,
Marsha
> 4WD, when I started,it was 15 mg x 2 day, 30 mg X 4 days, then 45 mg X many weeks. I did up it to 60 mg a few months ago and have been at 60 since then.
>
> I usually have many side effects with meds, but with nardil I had the problems with gas and constipation and still have those problems. Weight gain is also a side effect and I did experience swollen ankles which only lasted a week or two.
>
> It is worth it though since Nardil can work very well for depression, better than most of the other meds I've taken for TRD. The meds that worked for TRD (Celexa, wellbutrin and adderall) before Nardil were always combinations and I would rather take one med than 2 or three if at all possible.
>
> Good luck with your trial of Nardil.
>
> Stargazer
Posted by stargazer2 on February 22, 2008, at 19:29:45
In reply to Re: Do you need to titrate Nardil when starting it? » stargazer2, posted by 4WD on February 22, 2008, at 19:07:20
4WD, dosage is usually 15 mg at a time until you get to 45 and then you can take 30 in the am and 15 at night or the reverse, depending on if it makes you sleepy or energized. Since I am on 60, I take 30 in the am and 30 at night. I don't find it makes me too tired or energized, just about right.
I think months ago I tried to take the majority at night since it made me sleepy, but I was on other meds (nortriptyline) too that I feel was complicating my response.
Once I eliminated the other meds, I had less side effects. The constipation is unpredictable, probably is related to my diet too. The gas has been a problem since I started back in May.
Interestingly enough, the current version of Nardil had Simethecone added to it, the previous version did not have it. Simethecone is the active ingredient in all the anti-gas products, so you can see the manufacturer,Pfizer, was aware of changing the formula of Nardil even though they denied it. Consumers were aware of the formula change since they claimed the newer version of Nardil did not work as well as the previous version. I took the older version and got a great response back in 1989 without any side effects.
Unfortunately there are side effects but most have been tolerable for me. it works better than the SSRI's and other typical AD's.
stargazer
Posted by 4WD on February 22, 2008, at 19:57:44
In reply to Nardil dosage and other tidbits..., posted by stargazer2 on February 22, 2008, at 19:29:45
Well, my pdoc has prescribed it for me to start at 15mg three times a day. I guess I will just have to experiment with the dosage schedule. I did ask him if it would be okay to take 30 in the morning and 15 in the afternoon and said (a bit reluctantly) that yes, I could try that.
I just am not sure how often to take it. Maybe 15 when I get up in the morning (8), 15 at midday (1pm)and 15 in the afternoon about 4 or 5pm.
I've done some searching of the archives and a lot of people have posted that it didn't really matter when they took it as far as the insomnia issue was concerned. That is my main concern about dosing schedule. I'm afraid taking it too late in the day might increase the insomnia. That is my biggest side effect fear. I've had terrible insomnia most of my life and I fear it like the plague. I don't have it now. What cured it was (and I swear this is true) was being on Cymbalta for 4-5 months. I was put on the Cymbalta at a time when I was having moderate insomnia and within a week the insomnia just went away completely. That was in 2004 and the insomnia has never come back (well except for waking up too early for the past few months which is well controlled by 100mg of Trazadone at bedtime.)
So I'm doubly scared of the insomnia issue. I developed such a horror of lying in bed tossing and turning during my insomnia period of 8-10 years when it was especially bad due to Prozac. I am really scared to rock the boat since I have had such relief for the past three and a half years.
I guess it's a measure of my desperation that I'm willing to accept it as a side effect. And I have to keep reminding myself - it may not happen. My trazadone may take care of it perfectly well. I am trying not to project what side effects I'm likely to have - or I'll surely get them.
Anyway...
Marsha
Posted by Justherself54 on February 23, 2008, at 12:05:21
In reply to Re: Nardil dosage. Also insomnia phobia » stargazer2, posted by 4WD on February 22, 2008, at 19:57:44
I can't remember exactly how I started nardil..but I believe I increased it by 15 mg a week until I was at 45..then I increased it about a month later to 60, where I'm still at..
I was terrified to go on Naril, but I've found it to be the best AD I've ever been on..the worst side effect unfortunately for me is insomnia, but I've been able to work with my pdoc to find a combo of nite meds to combat it..otherwise I wouldn't have been able to stay on it..
I haven't experienced any hypotension. For me and some others terrible gas is a problem..and constipation, some balance problems and I tend to transpose lots of letters when I type..plus I am more forgetful, however, for me other than the insomnia, they are more physical sensations, which I have no problem tolerating. It has settled my racing mind a lot and made me so much more social..I was a terrible self-isolator. It was too much for me to be around people.
I'm so glad I overcame my fears of taking a MAOI and worked with my pdoc about the insomnia..it truly has turned my life around.
This is the end of the thread.
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