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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by iforgotmypassword on August 21, 2009, at 17:52:09
other than reduced potency (by how much) is there any danger? i would be doing this having taken selegiline regularly at 5-10mg, haven't taken it today.
i want to do an experiment one dose of 25mg-50mg fluvoxamine + 10-20mg buspirone.
by my crumby logic, it may help me know for sure if tandospirone is the response i should be chasing, by letting serotonin do its work specifically in the frontal cortex. it's very shoddy, but it's the best i have right now, aside from another trial of buspirone + grapefruit juice that will take days to figure out, and then there's always the D2 risk.
this i imagine will help me know if my only real option is tandospirone or *possibly* maybe something like fluoxetine (not fluvoxamine) + buspirone, but i worry about SSRIs long term. i think one trial is safe, otherwise i worry about long term issues, esp. since paroxetine is the drug that started all of my movement issues (possibly in concert with low dose chlorpromazine)
Posted by SLS on August 21, 2009, at 18:31:30
In reply to 5 yr old fluvoxamine, what could be wrong with it?, posted by iforgotmypassword on August 21, 2009, at 17:52:09
> by my crumby logic, it may help me know for sure if tandospirone is the response i should be chasing,
Where would you get the tandospirone from?
Does tandospirone have 1-PP as one of its metabolites? I'm afraid to try anything that is a NE alpha-2 autoreceptor antagonist. These drugs seem to make me feel worse.
- Scott
Posted by iforgotmypassword on August 21, 2009, at 19:32:52
In reply to Re: 5 yr old fluvoxamine, what could be wrong with it? » iforgotmypassword, posted by SLS on August 21, 2009, at 18:31:30
i am fairly certain 1-PP is a metabolite.
i am unsure if dizziness side effect of buspirone is due to the 1-PP metabolite, or is an effect of 5-HT1A agonism period. i wonder this, as they seem to be fairly confident prescribing tandospirone at much much higher doses (losing selectivity for subcortical areas to affect the post-synaptic 5-HT1A receptors in the PFC.)
in articles, when studying the effect of tandospirone on certain ailments (there is a fairly broad range), they often stick around 30mg. in normal prescribing i think tandospirone can go up to something like 180mg/day. (may not be exact number.)
i would likely try to get the drug through the federal special access programme. i can think of no way, i don't think, that i could go to japan or china in person, being sure to be able to fill the rx, and able to come back with it, and necessarily be able to afford going through all that. but don't underestimate my desperation. :(
i could probably easily find a cheap way to vancouver if i planned ahead, and there flights to tokyo airport are likely frequent, deals may be possible (again if planned ahead.) if i had papers that made everything sure, that i knew where pharmacy-wise i could go to and get by speaking english, that i would be authorised to get the rx with what documentation i had with me, and take it back home through customs; but this may not be within the bounds of the SAP.
Posted by viper1431 on August 21, 2009, at 23:55:49
In reply to 5 yr old fluvoxamine, what could be wrong with it?, posted by iforgotmypassword on August 21, 2009, at 17:52:09
Well we had a doc here on tv in AUS talking about and was asked this Q in general. He said other than reduced efficiency (i think that was the word) there wasn't any real danger in taking old medications past their used by date.
I've taken AP's that are 8 years old and been ok :P
Posted by yxibow on August 23, 2009, at 0:37:46
In reply to 5 yr old fluvoxamine, what could be wrong with it?, posted by iforgotmypassword on August 21, 2009, at 17:52:09
> other than reduced potency (by how much) is there any danger? i would be doing this having taken selegiline regularly at 5-10mg, haven't taken it today.
The key is regularly...
> i want to do an experiment one dose of 25mg-50mg fluvoxamine + 10-20mg buspirone.
DONT. You risk a hypertensive crisis. Why mess around with that. Do you have 5 year old nifedipine ?Admittedly 25mg of Luvox will do almost nothing for you psychotropically since a typical working dose starts close to 200mg, but why risk yourself?
As for the "5 year issue"... I don't see the problem with it since today medications are labeled from pharmacies 18 months +. And then of course there are the army tests of a selective set of medications, which doesn't prove that yours is the same result though.
If you haven't stored it in a humid bathroom "medicine cabinet" (bad place to actually store medicine) or left it sitting in a hot car or out of the range of say 40 to 90 degrees F for long periods of time, 5 years is really insignificant then.But if its crumbly, don't quote me on that.
> by my crumby logic, it may help me know for sure if tandospirone is the response i should be chasing, by letting serotonin do its work specifically in the frontal cortex. it's very shoddy, but it's the best i have right now, aside from another trial of buspirone + grapefruit juice that will take days to figure out, and then there's always the D2 risk.Why take BuSpar and grapefruit juice to trick your P450 system instead of a larger dose of BuSpar?
> this i imagine will help me know if my only real option is tandospirone or *possibly* maybe something like fluoxetine (not fluvoxamine) + buspirone, but i worry about SSRIs long term.
Well, SSRIs can be used safely for years -- for some people, they probably have been on Prozac or Luvox since they came out... some fit into the class of what is colloquially called "poop out", which really means that transmitters have been hyper-extended.A flushout may or may not allow this to heal (neuroplasticity). Responses to further SSRIs may require greater amounts or a diffent SSRI.
This isn't a comment on their "safety" -- its just a theoretical scenario.
>i think one trial is safe, otherwise i worry about long term issues, esp. since paroxetine is the drug that started all of my movement issues (possibly in concert with low dose chlorpromazine)
I think the Thorazine is far more likely for any movement culprits.
Yes, SSRIs can potentially increase the risks of movement disorders when combined with APs... but there are reasons for doing that combination, such as in psychotic cases of OCD.
I believe they have caused things for me (still have a tic on my right index finger from Risperdal and Prozac after only about two weeks + discontinuation 8 years later -- though my doctor disagrees with the assesment.. .yes, there is causality and causation but its pretty obvious in my mind).... this is for an entirely different situation than I noted above.-- Jay
Posted by iforgotmypassword on August 24, 2009, at 12:08:48
In reply to Re: 5 yr old fluvoxamine, what could be wrong with it? » iforgotmypassword, posted by yxibow on August 23, 2009, at 0:37:46
is a hypertensive crisis through the interaction of low dose selegiline and serotonergics likely?
Posted by yxibow on August 24, 2009, at 23:26:54
In reply to hypertensive crisis, posted by iforgotmypassword on August 24, 2009, at 12:08:48
> is a hypertensive crisis through the interaction of low dose selegiline and serotonergics likely?
Possible, yes. I wouldn't want to give wrong advice and say its impossible, so caution is warranted. Even with the EMSAM "low dose" patch it was discovered that this was imperfect.
You may not have to carry around nifedipine like someone with a high dose MAOI, but you should ask your doctor about such things.-- Jay
This is the end of the thread.
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