![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by TexasChic on June 20, 2008, at 22:21:43
I am on my 4th day. I took 40mg Tuesday, Wednesday, and Thursday, and then I'm supposed to take 60MG for 3 more days and then go up to 80MG. The first couple of days I was very nauseous, but today I felt okay. I went ahead and took the 60mg, but am worried that the increased dose with make me nauseous again. Does it work that way?
I also take:
80mgProzac
300mgWellbutrin
25mg Lisinopril (hi blood pressure med)Is this a strange combo? The nurse practitioner added the Strattera at my request for an ADD med. I told her I had high blood pressure and what I'm taking (I get that from another doc) and she said Strattera would be the only one I could take as the others were all stimulants. Now I'm kind of worried about the combo, especially how the Stattera added to my combo will effect my blood pressure.
Any thoughts would be appreciated.
-T
Posted by TexasChic on June 20, 2008, at 22:27:37
In reply to Strattera - nausea will it go away?, posted by TexasChic on June 20, 2008, at 22:21:43
The first two days I was also taking 12 Hour Sudafed until I read about Strattera increasing blood pressure, then I stopped the Sudafed. I am still taking Benadryl though.
-T
Posted by dbc on June 21, 2008, at 0:18:25
In reply to Re: Strattera - nausea will it go away?, posted by TexasChic on June 20, 2008, at 22:27:37
The strattera hasnt kicked in yet so no its not a blood pressure thing. I felt sick for a while daily the first week and it went away. Remember to eat before you take the stuff.
Posted by twinch42085 on June 21, 2008, at 1:29:35
In reply to Strattera - nausea will it go away?, posted by TexasChic on June 20, 2008, at 22:21:43
Texas,
To say the most about Strattera it is not that good of an ADD medication in my opinion. I felt stimulated the first week that I was on it, but after that I had horrible sexual side effects which are rare but have been documented. Strattera is like a mood stabilizer or an antidepressant. I am not comparing in any such way or form. I am simply saying that Strattera has to build up in your system before you can benefit from it. Until you reach a Therapeutic range nothing will seem right. I believe 80mg is the minimum therapeutic range. I felt no benefits at all. I have tried stimulants such as Vyvanse and it did wonders since it was a pro-drug.GoodLuck ; )
Twinch
Posted by TexasChic on June 21, 2008, at 10:25:05
In reply to Re: Strattera - nausea will it go away?, posted by dbc on June 21, 2008, at 0:18:25
Thanks you guys. So far so good today (as far as the nausea is concerned).
I really hope this helps what I believe to be ADD. I've taken a few ADD tests, including the one at the pdoc, and they always reflect that I do have it. But I always have some doubts because I know what answers will reflect ADD, and I'm afraid I might unknowingly skew my answers in that direction because I so much want to find an explanation for some of my problems.
But there are some definite signs that have been with me all my life. People always seem to perceive me as spacey or dingy, when I'm actually fairly intelligent. And I have a history in various jobs of being on the defensive with my supervisor, usually because they are telling me I'm being careless or not focusing on my work, when I know I'm trying SO hard!
So I'm (in)patiently waiting for the mind clearing I've heard about with people who have found ADD medicine that works for them. Wish me luck!
-T
Posted by Phillipa on June 21, 2008, at 11:18:48
In reply to Re: Strattera - nausea will it go away?, posted by TexasChic on June 21, 2008, at 10:25:05
Haven't been online in about two days so T I wish you much good luck. And please keep us posted. Phillipa
Posted by 10derHeart on June 21, 2008, at 22:18:47
In reply to Strattera - nausea will it go away?, posted by TexasChic on June 20, 2008, at 22:21:43
Hi TC,
I have been on Strattera (80 mgs/day) for 4.5 years. See the threads linked from this one (but warning, they may bore you to tears as I drone on and on...):
http://www.dr-bob.org/babble/20080606/msgs/834180.html
Never had the nausea, but had severe dry mouth and some annoying headaches - all gone within a week or two, as best I can recall.I did want to post a caution, which may not be needed as I'm hoping your doc discussed this with you already. I had also been taking Prozac daily (only 20mg) when pdoc and I decided to try Strattera. There is a documented interaction between atomoxetine and fluoxetine (Prozac), as well as Paxil, [not sure what mechanism of action there is with the Wellbutrin???] that my pdoc was cautious about when I first started. In layman's terms, I think it's correct to say having Prozac on board can significantly increase the action of the atomoxetine because there's more concentrated in the blood, so it's all about care with adjusting the dose, not so much contraindication. But if I've described this incorrectly * please* one of you brilliant folks here correct me!
So in 2004, my pdoc had me taper down to (I think) 20mgs Prozac 2x a week before he'd go past 40mg/day. with Strattera. Now in my case, I was having near complete remission from depression at the time, though, and the man focus was a non-stim ADD medication. The plan was to get rid of the Prozac, hoping Strattera would treat primarily ADD symptoms, but if it helped with any low-level depression as well, fine. It turned out to work very well just that way. Possibly, the depression continued to be kept at bay due to the huge help w/ADD stuff from the Strat, which in turn meant I felt so much less lost and overwhelmed in the psycho-social realm, I didn't become depressed. For me, I always felt after much research and talking with other sufferers, that the undiagnosed, untreated ADD likely led to the depression.
See the package/prescribing cautions:
>>CYP2D6 Activity and Atomoxetine Plasma Concentration<<
Atomoxetine is primarily metabolized by the CYP2D6 pathway to 4-hydroxyatomoxetine. In EMs, inhibitors of CYP2D6 increase atomoxetine steady-state plasma concentrations to exposures similar to those observed in PMs. Dosage adjustment of atomoxetine HCl in EMs may be necessary when coadministered with CYP2D6 inhibitors, e.g., paroxetine, fluoxetine, and quinidine (see DRUG INTERACTIONS). In vitro studies suggest that coadministration of cytochrome P450 inhibitors to PMs will not increase the plasma concentrations of atomoxetine.
------------------------------------------------
"In children and adolescents over 70 kg body weight and adults administered strong CYP2D6 inhibitors, e.g., paroxetine, fluoxetine, quinidine, atomoxetine HCl should be initiated at 40 mg/day and only increased to the usual target dose of 80 mg/day if symptoms fail to improve after 4 weeks and the initial dose is well tolerated."
--------------------------------------------I have hypertension as well, as was on a beta blocker at the time, and still am, at twice the dose it was in 2004, with no problems. (I know Lisinopril is an ACE inhibitor - I tried it once - cough, cough, cough - day and night = discontinue) I'd watch the BP a little closer than usual, though, as Strattera has been known to elevate BP readings very slightly in some people. But as we all know, YMMV.
I so hope this helps you, TC....I am one of the blessed ones who had an immediate response, which I know is rare. Hope you can give it at least 4 weeks, barring intolerable S/Es and I think it's great your doc is willing to try it.
Posted by Jay_Bravest_Face on June 21, 2008, at 23:00:43
In reply to Re: Strattera - nausea will it go away?, posted by TexasChic on June 21, 2008, at 10:25:05
> Thanks you guys. So far so good today (as far as the nausea is concerned).
>
> I really hope this helps what I believe to be ADD. I've taken a few ADD tests, including the one at the pdoc, and they always reflect that I do have it. But I always have some doubts because I know what answers will reflect ADD, and I'm afraid I might unknowingly skew my answers in that direction because I so much want to find an explanation for some of my problems.
>
> But there are some definite signs that have been with me all my life. People always seem to perceive me as spacey or dingy, when I'm actually fairly intelligent. And I have a history in various jobs of being on the defensive with my supervisor, usually because they are telling me I'm being careless or not focusing on my work, when I know I'm trying SO hard!
>
> So I'm (in)patiently waiting for the mind clearing I've heard about with people who have found ADD medicine that works for them. Wish me luck!
>
> -THiya TC. I just wanted to add, don't be doing anything for what you think is the sake of your boss. The bottom line is, she will *never* be pleased, because she is so insecure about herself, that she has to cut down others to try to compensate. I'd honestly avoid her as much as possible, and it's up to you what you say to her. You can be assertive, and back yourself up with facts. But, again, she is far gone, and likely has a personality disorder. I prescribe her 5mg of Haldol 3-4x a day. :-) Maybe try setting your sights on a different job, if you can. Just don't put up with the b*llsh*t anymore. :)
Take care,
Jay
Posted by 10derHeart on June 22, 2008, at 0:08:23
In reply to Re: Strattera - nausea will it go away? » TexasChic, posted by Jay_Bravest_Face on June 21, 2008, at 23:00:43
Jay has made a great point - I've been reading and that woman is so NOT okay!! You could be rid of all ADD tendencies by Monday and she likely wouldn't notice/care/understand/be satisfied, from what I can tell.
Do it for YOU and hang in there, TC, you rock!!
Posted by TexasChic on June 22, 2008, at 19:59:32
In reply to Re: Strattera - nausea will it go away?, posted by 10derHeart on June 22, 2008, at 0:08:23
Thanks you guys! I was worried it might sound like I was doing this because of my boss, but its more like she brought to my attention certain problems that have always been there. And having read up on these things, I recognized her complaints about me as being classic symptoms of ADD.
I think before now I've always been too busy being defensive to ever make the connection. Don't get me wrong, I do think I've compensated well over the years and she is blowing things that are very minor out of proportion, but that doesn't change the fact that I do have a difficult time staying focused, and if a med could help that, hey, bring it on!
Thanks again everyone for your advice and support. I'm hanging in there. I was only slightly nauseous and dizzy off and on today, but the real test will be at work tomorrow. The side effects aren't as obvious when I'm just laying around the house.
-T
Posted by TexasChic on June 22, 2008, at 20:38:29
In reply to Re: Strattera - nausea will it go away? » TexasChic, posted by 10derHeart on June 21, 2008, at 22:18:47
> I did want to post a caution, which may not be needed as I'm hoping your doc discussed this with you already.
I guess this is what I was most worried about, I kept reading that about Prozac, but my doc didn't discuss anything like that with me. And I'm on a fairly high dosage at 80mg a day. I wouldn't be as concerned except that I only spoke with the nurse practitioner about it. I do have to go back next week though, so I will ask about it then. Do you know what the consequences would be of an increase the action of the atomoxetine in my blood?
> Possibly, the depression continued to be kept at bay due to the huge help w/ADD stuff from the Strat, which in turn meant I felt so much less lost and overwhelmed in the psycho-social realm, I didn't become depressed... the undiagnosed, untreated ADD likely led to the depression.That's awesome (not to mention fascinating)! I can only hope for such a great outcome.
> I have hypertension as well, as was on a beta blocker at the time, and still am, at twice the dose it was in 2004, with no problems. (I know Lisinopril is an ACE inhibitor - I tried it once - cough, cough, cough - day and night = discontinue) I'd watch the BP a little closer than usual, though, as Strattera has been known to elevate BP readings very slightly in some people. But as we all know, YMMV.
Yes, I read that as well and will certainly keep an eye on it. That's why I stopped taking the Sudafed (as much as it pains me with my allergies!).
> I so hope this helps you, TC....I am one of the blessed ones who had an immediate response, which I know is rare.
It definitely helps!
>Hope you can give it at least 4 weeks, barring intolerable S/Es
I hope that too. Really the most intolerable side effect of any med to me is nausea, so hopefully that will not come back.
Thanks 10derheart!
-T
Posted by 10derHeart on June 23, 2008, at 3:48:52
In reply to Re: Strattera - nausea will it go away? » 10derHeart, posted by TexasChic on June 22, 2008, at 20:38:29
>>Do you know what the consequences would be of an increase the action of the atomoxetine in my blood?
well, if I understand what I've read, I think the way these drugs can interact is simply that *because* of the action of the Prozac, atomoxetine hangs around longer (slowly metabolized) and is more highly concentrated (I could be wrong that *both* of those happen though....)
and that doesn't change how it works - but it's just that you need a smaller dose 'cause the SSRI is "amplifying" it and maybe even to take it less often, too.....?But honestly, I'm guessing at some of this based on piecing together different things I've read explaining it, and I may be way off....where are our experts?!!
Have you now gone up to 60? Feel any diffferent that 40?
Posted by texaschic on June 23, 2008, at 11:13:36
In reply to Re: need a med board experts to explain better! » TexasChic, posted by 10derHeart on June 23, 2008, at 3:48:52
I took my last 60 mg last night, and tonight I start the 80 mg. So far today I feel pretty good, but the nausea and dizziness has been mostly in the afternoon, so we'll see how that goes. I feel slightly more alert today, but I don't trust my judgement on that type of thing - I know I'm easily influenced by what I expect to happen. Plus, today I'm at work and the last few days I was at home laying around, so it stands to reason I'd feel more alert today.
-T
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.