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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 Sheilac on September 13, 2015, at 13:38:20
Does anyone know how much Trileptal reduces Geodon?
I take 160mg of Geodon and yesterday I took 300mg Trileptal for my neuropathy and today I did, in fact notice a difference in my mood for the worse. I felt like I needed more Geodon.
I'm searing to see if I can find out the percentage or something.
Posted by SLS on September 13, 2015, at 14:34:11
In reply to Trileptal reduces Geodon? How much?, posted by Sheilac on September 13, 2015, at 13:38:20
> Does anyone know how much Trileptal reduces Geodon?
>
> I take 160mg of Geodon and yesterday I took 300mg Trileptal for my neuropathy and today I did, in fact notice a difference in my mood for the worse. I felt like I needed more Geodon.
>
> I'm searing to see if I can find out the percentage or something.Do you make these changes with your doctor's consent?
Tegretol can reduce Geodon by 35% or more via induction of P450 3A4/5. I don't know about Trileptal.
Maybe you can talk to your doctor about using another drug for neuropathy instead of Trileptal.
Cymbalta can treat both depression and neuropathy at the same time. However, you might need additional protection against mania when you use an antidepressant of any sort. You could *possibly* combine Trileptal and Cymbalta without Geodon, but with another antipsychotic if necessary.
- Scott
Posted by Sheilac on September 14, 2015, at 7:09:36
In reply to Re: Trileptal reduces Geodon? How much? » Sheilac, posted by SLS on September 13, 2015, at 14:34:11
Thank you. That's interesting. Because on just 300mg of Trileptal I noticed a decrease of my Geodon.
I may try 150mg of Trileptal for neuropathy. I may have to up my Geodon.
I'll have to ask my doc about this too. But for now my stability on Geodon is what's most important.
Posted by SLS on September 14, 2015, at 7:58:10
In reply to Re: Trileptal reduces Geodon? How much? » SLS, posted by Sheilac on September 14, 2015, at 7:09:36
> Thank you. That's interesting. Because on just 300mg of Trileptal I noticed a decrease of my Geodon.
>
> I may try 150mg of Trileptal for neuropathy. I may have to up my Geodon.
>
> I'll have to ask my doc about this too. But for now my stability on Geodon is what's most important.I agree.
Your remedy of increasing the dosage of Geodon when adding Trileptal is simple and makes a great deal of sense. Generally, 160 mg/day is considered to be the maximum dosage. I wonder how high your doctor will allow you to go. Just be sure that you are taking Geodon with meals.
If you do elect to add Trileptal, I wonder if your feeling depressed would only be a temporary condition. You might rebound from the depression given time on both drugs. I would be surprised to learn that 300 mg of Trileptal would induce the P450 enzymes within 24 hours so as to reduce the levels of Geodon and allow for depression to emerge so quickly. Overall, enzyme induction is a gradual process. If it were ME, I would interpret this data to indicate that one add the Trileptal at a dosage of 600 mg/day and maintain the dosage of Geodon at 160 mg/day taken at meals and be patient. Ask your doctor about this. Of course, it is possible that the Trileptal itself is producing depression. Still, I would try to be patient when combining these drugs. This is easier said than done, but you need to give your system some time to establish a new equilibrium.
How do you react to gabapentin (Neurontin) and pregabalin (Lyrica)? Some people really like these drugs for neuropathy. For me, both drugs produced severe cognitive impairments and perhaps some dissociation. These things persisted for 3 weeks after discontinuing them. This seems to be atypical, though.
By the way, duloxetine (Cymbalta) and ziprasidone (Geodon) both inhibit the reuptake of serotonin and norepephrine. Although I doubt anyone could give you a guarantee, but these properties might be functioning to relieve your depression. This was the rationale I used to suggest combining Cymbalta with Trileptal. Mixed states sometimes respond to Trileptal + Lamictal with or without Abilify. I am hoping that it will ease your mind knowing that there are still alternatives for you.
Keep us informed of your progress. You sound better on your current treatment.
- Scott
Posted by Sheilac on September 14, 2015, at 9:26:03
In reply to Re: Trileptal reduces Geodon? How much? » Sheilac, posted by SLS on September 14, 2015, at 7:58:10
Both Lyrica and neurontin hurt my bladder causing pain, so they didn't work for the neuropathy.
I see my doc today. I'm losing hope for the anticonvulsants.
I like the 160mg of Geodon, I wouldn't mind a little something else thrown in to keep me even more stable (low dose zyprexa? - maybe low enough to be effective without weight gain?).
I can't remember how cymbalta effected me. It may have caused some urine retention which was painful.
I may have to give up on meds for neuropathy and just deal with my bipolar. I can always use lidocaine and hydrocodone or Tramadol for the neuropathic pain.
At this point, I'd be afraid to try another anticonvulsant. I've failed: Lamictal, Topamax, Depakote, zonegran, anything higher than 150mg of Trileptal causes terrible joint pain. All the others hurt my bladder. At this limit the only thing left is Keppra and I'm kinda afraid to try that. My bladder is finally starting to heal from the damage Depakote did to it.
I seem to do very well on the AAPs. I liked Abilify, but it made me very hungry and caused weight gain. Risperdal was ok, it just caused some swelling. I did take 2.5 -5mg of zyprexa about 6 years ago for a short time to get me through a rough patch and I loved it. It made me feel great.
I can't do antidepressants. With my bladder condition, (Interstial Cystitis), bladder docs like to RX Elavil, cymbalta, any of the SSRIs & SNRIs, Lyrica and gabapentin - which I have successfully failed all of them.
So, I may have to just deal with the neuropathy with lidocaine and pain pills and find a little something to add to my 160mg Geodon. The depression from 300mg of Trileptal sucks.
Posted by Sheilac on September 14, 2015, at 10:55:43
In reply to Re: Trileptal reduces Geodon? How much? » Sheilac, posted by SLS on September 14, 2015, at 7:58:10
Here is the list I'm taking into my doc's office today. I don't want to forget anything. I also want to maybe think of some things that might be a good add-on to my Geodon;
Anticonvulsants tend to hurt my bladder - Depakote, Topamax, Zonegran
Lamictal -manic feeling, mouth soresSeroquel can make me irritable
Lithium interfered with my thyroid (nodule, byopsy)
Trileptal - causes terrible joint & muscle pain, some depression (helps at low doses 150mg for my neuropathy, but it feels like it lessens my Geodon)
Tegretol - very stuffed up nose, felt like it canceled out my allergy & asthma meds
Geodon - great for depression and stability but still lacking a bit
Zyprexa - good, former doc wouldn't continue due to possible serious weight gain
Invega -can't rememberAbilify - made me very hungry, weight gain
Risperdal - edemaKlonopin is good, but can depress me
Caffeine is bad
All antidepressants are bad
Adderall is working wellMeds for neuropathy I've failed - all ADs, Elavil, Cymbalta, Lyrica, gabapentin
I'm ready to give up and just treat my neuropathy & bladder pain (when I'm having an Interstitial Cystitis flare) with lidocaine and hydrocodone or Tramadol and just treat my bipolar.
Geodon 160mg is good, I still feel like I need a little something to take the edge off. Klonopin can depress me so I try not to take too much of that.
Posted by SLS on September 14, 2015, at 12:09:29
In reply to Re: seeing doc today any ideas? » SLS, posted by Sheilac on September 14, 2015, at 10:55:43
The information you gave is very helpful. After reading through it once, no ideas come to me immediately. I don't think it makes sense to discontinue the Geodon at this juncture. You are lucky to have found it. So, the obvious path to take for now is to keep taking Geodon and research treating the neuropathy aggressively.
Good luck.
- Scott
Posted by Sheilac on September 14, 2015, at 17:28:04
In reply to Re: seeing doc today any ideas? » Sheilac, posted by SLS on September 14, 2015, at 12:09:29
Doc was very upset about Depakote causing cystitis, but even my pharmacist said it was listed as a side effect.
I asked if I could add Zyprexa or another AAP and she flatly said no. She said I had to be on an anticonvulsant as they are the only true mood stabilizers.
As a "last resort" she gave me Keppra. She told me to take 500mg twice a day, but I think I might dose up to avoid any issues. I think I might start with 250mg twice a day then move up from there. She doesn't really Rx Keppra and didn't really know how much to throw at me.
Not sure if 1,000mg right away would knock me out or what. I'm not sure what to expect from this med.
I hope it works, because she's really not happy with me and my bad bladder.
Posted by SLS on September 14, 2015, at 18:00:32
In reply to Re: seeing doc today any ideas? » SLS, posted by Sheilac on September 14, 2015, at 17:28:04
> As a "last resort" she gave me Keppra. She told me to take 500mg twice a day, but I think I might dose up to avoid any issues. I think I might start with 250mg twice a day then move up from there. She doesn't really Rx Keppra and didn't really know how much to throw at me.
Phidippus likes Keppra for certain things. I tried it once, but it didn't help for depression. I hope it helps you.
- Scott
Posted by Sheilac on September 14, 2015, at 18:21:23
In reply to Re: seeing doc today any ideas? » Sheilac, posted by SLS on September 14, 2015, at 18:00:32
We're trying it for my mood stabilizer.
Geodon takes great care of my depression.
Posted by SLS on September 14, 2015, at 18:32:04
In reply to Re: seeing doc today any ideas? » SLS, posted by Sheilac on September 14, 2015, at 18:21:23
> We're trying it for my mood stabilizer.
>
> Geodon takes great care of my depression.
http://www.ncbi.nlm.nih.gov/pubmed/15582854
- Scott
Posted by Sheilac on September 14, 2015, at 19:06:48
In reply to Re: seeing doc today any ideas? » Sheilac, posted by SLS on September 14, 2015, at 18:32:04
That article pretty much sums me up!
I'm really hoping it works and if it helps my neuropathy too even better!
Posted by SLS on September 14, 2015, at 22:45:51
In reply to Re: seeing doc today any ideas? » SLS, posted by Sheilac on September 14, 2015, at 19:06:48
> That article pretty much sums me up!
>
> I'm really hoping it works and if it helps my neuropathy too even better!I met the author of that article "by accident". He tends to think outside of the box.
- Scott
This is the end of the thread.
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