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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 41. Go back in thread:
Posted by morganpmiller on August 9, 2009, at 2:11:23
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 9, 2009, at 1:27:30
Gayle, thanks so much for getting back to me..I decided to go back to Zoloft for the time being. Your experience and others will definitely help me make a decision to take Parnate and Nortriptyline in the future if I feel it is necessary. Thanks again!
Morgan
Posted by SLS on August 9, 2009, at 4:58:41
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 9, 2009, at 1:27:30
Hi Gayle.
> My pdoc believes Parnate should be taken with one of a few copacetic TCAs.
I wish my doctor would approach things like yours does. I really had to "break him in" in order to get him to mix drugs in this fashion. I would love to be able to speak to your doctor and pick his brains. It sounds like you have a good one there.
- Scott
Posted by SLS on August 9, 2009, at 5:04:40
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by morganpmiller on August 9, 2009, at 2:11:23
> Gayle, thanks so much for getting back to me..I decided to go back to Zoloft for the time being. Your experience and others will definitely help me make a decision to take Parnate and Nortriptyline in the future if I feel it is necessary. Thanks again!
Would you first add nortriptyline to the Zoloft and see what happens? It would be an efficient use of time. You could then d/c the Zoloft and add Parnate if necessary.
Good luck with the Zoloft.
- Scott
Posted by floatingbridge on August 9, 2009, at 12:04:10
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 9, 2009, at 1:27:30
Gayle,
Sounds like you have a great doctor!
fb
Posted by ColoradoSnowflake on August 9, 2009, at 22:07:45
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by SLS on August 9, 2009, at 4:58:41
Hi all:
I'm very fortunate having such a great pdoc. I just wished he would have pushed me into taking Parnate years ago, but he's not like that and I'm hard-headed.
The scary thing is, he's 70, doesn't need/want any more $$, works half time because he enjoys his patients. If he gets too much static he may just totally retire. There is no one else with my insurance providers who would do what he does. And we know/trust each other so well.
Eeek. So I'd better not worry about it now!
From what he tells me, I really do think that taking the Parnate + Nortrip is what makes it work so well. I have very few side effects and those I do have, mostly some times of fatigue, some hyper times and dry mouth, I think I can ameliorate by dosing.
Scott, thanks so much! and I hope your remission becomes more steady! I know my pdoc would love to talk to you, also!!
fb, I hope your present course continues to be OK. At least you know if it doesn't, you're not at a dead-end!
gayle
Posted by morganator on August 10, 2009, at 22:28:48
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 9, 2009, at 22:07:45
Hi Gayle,
How do you dose Parnate? Do you post it one time in the morning? Or, do you dose it 2 times a day, once in the morning and another in the evening?
Morgan
Posted by ColoradoSnowflake on August 11, 2009, at 9:20:05
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by morganator on August 10, 2009, at 22:28:48
Hi Morgan:
I'm trying to figure this out as we speak.
Right now, I take 20mg when I get up am (7am) along with a big cup of coffee.
Then I try to take the next 3 (10mg. ea) pills one at a time over the day but before 4pm. (So I can sleep)
Then I take the 25mg nortrip at 6pm.If I'm tired through the day I add some 1/2 pills (50mg ea) of Provigil up to 200mg over the day, not after 4pm.
I want to ask Scott how he doses his Parnate and Nortrip.
I'm wondering about adding another 25mg nortript at night, maybe 8pm?
I'm sort of confused about what I'm doing. But I do sleep fairly well. I'd like to add a little sleep enhancement but I'm so sensitive to "downers" that I'm afraid of a hangover. I'll ask my pdoc for some Sonata when I see him Aug 31st.
Any ideas?
gayle
Posted by morganator on August 11, 2009, at 17:21:25
In reply to Re: ColoradoSnowflake Parnate Dosing » morganator, posted by ColoradoSnowflake on August 11, 2009, at 9:20:05
Yeah I was just curious because I am trying to avoid having to dose something 2 or 3 times a day. I have heard that some people take Parnate once in the morning. Right now Zoloft may be what I need. We will see in the following 3 or 4 weeks.
Posted by FredPotter on August 11, 2009, at 20:59:12
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by morganator on August 11, 2009, at 17:21:25
not parnate and zoloft at the same time I hope?
Posted by ColoradoSnowflake on August 12, 2009, at 1:27:14
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by morganator on August 11, 2009, at 17:21:25
Morgan,
Yes, I'd rather make my med dosing simpler, too! That's why I'd like to talk to Scott.
One day when I was fairy new on Parnate I accidentally took all five pills in the a.m. BAD
I kept falling down and lurching around. I fell in my exercise class. I felt totally out of it.Then I'm afraid to take it too late in the day because I don't want to give myself sleep problems. And maybe I'm mistaken in thinking an evening dose would do that?
I don't know, but I'm doing pretty darn well so I probably shouldn't change too many things around!
I'm still really liking the Parnate/Nortrip....a lot!! I'm feeling so much better!!! I'm very clear headed which is nice. I don't feel full of chemicals. I don't have any side effects to speak of either!
I have not taken Parnate and Nortrip at the same time yet. Not because I'm afraid of it, but I just don't understand it's functioning.
I think you'd like Parnate!! Why don't you take it so we can figure it out together?? I need some company and help!
(sort of kidding).I'm Unipolar so it might affect me differently, I don't know.
I hope you're doing well.
gayle
Posted by morganator on August 12, 2009, at 1:39:44
In reply to Re: ColoradoSnowflake Parnate Dosing » morganator, posted by ColoradoSnowflake on August 12, 2009, at 1:27:14
Gayle,
Thanks for getting back to me as usual, I appreciate it. Yeah I am not crazy about having to spread out the dosing of anything.
I think for now I am going to stick with Zoloft and give it another 4 to 6 weeks. By that time I will figure out if I should get off zoloft and try something else, or merely add something like Nortriptyline.
It is so awesome that you are feeling that much better. Yeah I would love to go on that ride with you and figure things out. That would mean I was feeling like you are right now.
Keep feeling good!!!!
Morgan
Posted by SLS on August 12, 2009, at 6:53:24
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by morganator on August 12, 2009, at 1:39:44
It makes sense to add the nortriptyline to the Zoloft, unless you are intolerant of the Zoloft. Combining the two really enhances both serotonin and norepinephine. Then, you can discontinue the Zoloft and move on to something else while remaining on the nortriptyline.
Of course, depending on results and side effects, you might need to remain flexible and deviate from "the master plan". If you do add nortriptyline, you might need to allow 3 weeks for it to work after you get up to a therapeutic dosage - 75mg.
Wouldn't it be nice if Zoloft by itself did the trick?
Good luck.
- Scott
Posted by SLS on August 12, 2009, at 7:07:09
In reply to Re: ColoradoSnowflake Parnate Dosing » morganator, posted by ColoradoSnowflake on August 12, 2009, at 1:27:14
Two ways to dose Parnate are most used.
1. Spit into two equal doses; taking one at breakfast and the other no later than 3:00pm. I prefer this method now that I no longer experience hypotension.
2. Take one pill every few hours. You can take more at breakfast if necessary. This is good if you have problems with hypotension. With this method, I used to take my last dose at 7:00pm. You might find that taking it too late will disturb your sleep, so try to be somewhat flexible with dosing. Take 2 pills every few hours if necessary to make your last dose no later than 3:00pm. Also, having caffeine at 4:00pm helps to raise blood pressure at a time of day when blood pressure is normally at its lowest.
If you seem to plateau with your treatment, you still have quite a bit of room to raise the dosage of nortriptyline.
- Scott
Posted by FredPotter on August 12, 2009, at 16:42:24
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by SLS on August 12, 2009, at 7:07:09
Apparently there are good reasons for thinking that postural hypotension shows you're at a therapeutic dose of Parnate
Posted by SLS on August 12, 2009, at 17:13:27
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by FredPotter on August 12, 2009, at 16:42:24
> Apparently there are good reasons for thinking that postural hypotension shows you're at a therapeutic dose of Parnate
Exactly.
- Scott
Posted by morganator on August 12, 2009, at 22:16:00
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by SLS on August 12, 2009, at 6:53:24
>Wouldn't it be nice if Zoloft by itself did the trick?
For 7 years it did do the trick all by itself..If I had only stayed on it, I still be on it alone. I think I still would have had to eventually add a mood stabilizer like depakote(which I am currently on) or lithium. I will forever miss those days of popping Zoloft in the morning with a few fish oil caps and working out and feeling great at times. I have to admit, I probably needed a moderate dose of depakote, maybe 500 mgs, for much of the time during those 7 years. My behavior and work performance would have benefitted. I do believe that some forms of therapy could have helped me modify many of my bipolar behaviors.
Posted by ColoradoSnowflake on August 12, 2009, at 22:51:31
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by SLS on August 12, 2009, at 6:53:24
> It makes sense to add the nortriptyline to the Zoloft, unless you are intolerant of the Zoloft. Combining the two really enhances both serotonin and norepinephine. Then, you can discontinue the Zoloft and move on to something else while remaining on the nortriptyline.
>
> Of course, depending on results and side effects, you might need to remain flexible and deviate from "the master plan". If you do add nortriptyline, you might need to allow 3 weeks for it to work after you get up to a therapeutic dosage - 75mg.
>
> Wouldn't it be nice if Zoloft by itself did the trick?
>
> Good luck.
>
>
> - Scott
>Scott :
This sounds like a great idea and great way for Morgan to "bridge the gap". It's like I did with the Wellbutrin.
(sort of......... zzzz zzzzz zzzz amytriptyline)Could have done without that side trip!
Hello nortrip.!!gayle
Posted by ColoradoSnowflake on August 12, 2009, at 23:12:01
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by SLS on August 12, 2009, at 7:07:09
> Two ways to dose Parnate are most used.
>
> 1. Spit into two equal doses; taking one at breakfast and the other no later than 3:00pm. I prefer this method now that I no longer experience hypotension.
>
> 2. Take one pill every few hours. You can take more at breakfast if necessary. This is good if you have problems with hypotension. With this method, I used to take my last dose at 7:00pm. You might find that taking it too late will disturb your sleep, so try to be somewhat flexible with dosing. Take 2 pills every few hours if necessary to make your last dose no later than 3:00pm. Also, having caffeine at 4:00pm helps to raise blood pressure at a time of day when blood pressure is normally at its lowest.
>
> If you seem to plateau with your treatment, you still have quite a bit of room to raise the dosage of nortriptyline.
>
>
>
> - Scott
Hi Scott:Thanks for the information!!
I think it helps to take the Parnate with a little bit of a Nuvigil pill or a little bit of a caffeine pill, or a cup of coffee.
I think I'll try your #1 suggestion. That's sort of what I do now only simpler. Should I cut a Parnate in half and take 2 1/2 in the AM and 2 1/2 at 3pm? Or take 3 at once and then 2 at once??
Then I take the Nortriptyline about 7pm (or later if I get home later.
Last night I took 25mg nortrip at about 6pm and then 25mg at 11pm. I was tired this morning, but I had a big meeting at my house last night and I would have been tired anyway. I took nortrip to sleep better "for sure" and it did do that. So maybe it's not good for me to take nortrip that late. When I try 50mg again I'll do them both earlier. Is that right?
I am still feeling better!!! I can't believe it!!
I had a group of women at my house for a meeting last night and normally I would have been a walking, talking panic attack, but I was FINE....just regular. WOWThanks so much, Scott, for all your help!
I sure hope you're feeling better!!!! Remember what you told me about it not being up and up!! Maybe it's just a settling in period and you will feel really good again, soon.
I HOPE SO!!Thanks again for all your help!
gayle
Posted by SLS on August 13, 2009, at 5:15:55
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 12, 2009, at 23:12:01
Hi Gayle.
I wouldn't worry about splitting pills. Take 30mg in the morning and 20mg in the afternoon, ideally before 3:00pm. Many people find that taking it any later disturbs their sleep.
Thanks for your kind sentiments.
- Scott
Posted by FredPotter on August 13, 2009, at 16:01:18
In reply to Re: ColoradoSnowflake Parnate Dosing » FredPotter, posted by SLS on August 12, 2009, at 17:13:27
Scott do you know the mechanism that connects postural hypotension and low MAOI?
Posted by FredPotter on August 13, 2009, at 16:02:26
In reply to Re: ColoradoSnowflake Parnate Dosing » FredPotter, posted by SLS on August 12, 2009, at 17:13:27
...sorry I should have said "connects postural hypotension and low MAO"
Posted by SLS on August 13, 2009, at 16:42:10
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by FredPotter on August 13, 2009, at 16:01:18
> Scott do you know the mechanism that connects postural hypotension and low MAOI?
I really don't know. I have wondered about this many times myself, but have never found an answer.
Stimulation of central postsynaptic NE alpha-2 receptors?
I don't believe that peripheral NE alpha-1 antagonism is involved.
- Scott
Posted by morganator on August 23, 2009, at 22:58:19
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 9, 2009, at 1:27:30
Gayle,
You posted that you are feeling better than you have in 15 years. Do you contribute that more to Parnate or Nortriptyline or both?
Posted by ColoradoSnowflake on August 24, 2009, at 19:19:19
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by morganator on August 23, 2009, at 22:58:19
Why has my post to Morgan disappeared?
gayleAlso, there was a post from a fellow living in Costa Rica for 25 years who had had success with Parnate for 25 years. He was coming back to the US. It was up a few hours and then gone.
Who does this? and why?
Posted by Dr. Bob on August 26, 2009, at 8:20:37
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by morganator on August 10, 2009, at 22:28:48
> How do you dose Parnate? Do you post it one time in the morning? Or, do you dose it 2 times a day, once in the morning and another in the evening?
Thanks for participating, but please don't post under more than one name at the same time or change your posting name without following these steps:
http://www.dr-bob.org/babble/faq.html#names
Please don't take this personally, either, this doesn't mean I don't like you or think you're a bad person, and I'm sorry if this hurts you.
More information about posting policies is in the FAQ:
http://www.dr-bob.org/babble/faq.html#enforce
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Thanks,
Bob
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