Lamictal maximum dosage
racing thoughts and insomnia
2024.05.16 18:49 The12thparsec racing thoughts and insomnia
What have you found helps you stay asleep?
My main issue, off and on for over a decade now, has been that I can't stay asleep. I'll wake up at 3 or 4 am after I go to be around 11 or 12 at night and am just WIRED. My brain is racing with a million thoughts and I can't go back to sleep.
I took Remeron for years and added some medical marijuana. That worked for a good while, but I quite weed for good about six months ago.
So far, I've tried Ambien and Seroquel. Ambien, even at the highest dosage and with the controlled release, doesn't keep me asleep.
Seroquel does seem to keep me asleep better than Ambien, but I feel like shit the next day. Poor mood, exhausted and lethargic...
What have people found that helps with this particular type of insomnia (waking up with racing thoughts)?
I just started lamictal, so it's early days. My NP also mentioned Abilify.
submitted by The12thparsec to cyclothymia [link] [comments]
My main issue, off and on for over a decade now, has been that I can't stay asleep. I'll wake up at 3 or 4 am after I go to be around 11 or 12 at night and am just WIRED. My brain is racing with a million thoughts and I can't go back to sleep.
I took Remeron for years and added some medical marijuana. That worked for a good while, but I quite weed for good about six months ago.
So far, I've tried Ambien and Seroquel. Ambien, even at the highest dosage and with the controlled release, doesn't keep me asleep.
Seroquel does seem to keep me asleep better than Ambien, but I feel like shit the next day. Poor mood, exhausted and lethargic...
What have people found that helps with this particular type of insomnia (waking up with racing thoughts)?
I just started lamictal, so it's early days. My NP also mentioned Abilify.
2024.05.16 15:43 JustKam347 Really bad nightmares on Lamictal
Hey y’all! I was previously on lamictal 200mg for a long time but have recently been switched to 300mg. This was my 1st night taking it but I had like three nightmares (super realistic) in one night and it freaked me out. Anyone have a similar side effect and if so, is it a sign the dosage may be too high/ I’m reacting poorly to the increase?
submitted by JustKam347 to bipolar2 [link] [comments]
2024.05.16 13:22 warganz10 Splitting dosages
I asked my provider, Emerge, about splitting dosages. They responded that they do not recommend splitting doses. The medication is set up to build concentration gradually in your body for maximum results.
Has anyone here had their professional provider suggest splitting doses?
submitted by warganz10 to compoundedtirzepatide [link] [comments]
Has anyone here had their professional provider suggest splitting doses?
2024.05.16 09:16 Outrageous-Guitar909 Psychiatrist who prescribed medication beyond maximum dosage found guilty of professional misconduct
 | submitted by Outrageous-Guitar909 to SingaporeRaw [link] [comments] |
2024.05.16 04:24 yodabutter69 Does anybody have experience with intermittent fasting? Is it safe?
So I have had 3 seizures before. Over the course of 8 or so years. After the second one I started taking lamictal but the doctor was trying to switch me to something else, so we cut my lamictal dosage and half and I was supposed to be starting the other one. I don’t remember exactly what happened and yes maybe I am an idiot for not doing it right and I do feel dumb about it. But I was taking a less than therapeutic dose. 200 mg a day instead of 400. And I believe I was taking the 200XR. When I had the seizure the doc immediately did a blood test and found the level of lamotrigine in my body was not a therapeutic dose. I slowly increased my dosage to 400.
So now I take 400 mg, I have been tested and there is a therapeutic dose in my blood. I have not had any seizures since I started the proper dosage.
So after the second seizure is when I started the meds and about 2 years later I had another seizure. I was very sleep deprived, was mourning, hadn’t ate properly and was playing a music festival and it happened during my set. I say these bc they all can be factors.
Anyway it has been about 10 months since my last seizure. I have been gaining weight Ever since I can remember. I started an SSRI a while back that just made me gain more. I haven’t been able to go to the gym much bc I injured my wrist, I know I could still go but I want to play basketball and climb and not just sit on a machine the whole time. I want to be better at it but I am working towards getting more exercise.
The main problem with my diet is late at night. I will eat healthy all day and then at night I just want to eat trash and sugar sugar sugar. I have found that it is super effective for me to fast bc if I stop eating at a certain time I will consume no garbage and sugar that night bc I have already stopped eating.
My neuro said that keto or being in ketosis is effective in treating seizures and I have heard fasting is a big part of keto. My concern is that I did not have proper food in my body at the time of the last seizure. I am just wondering if intermittent fasting is ok or if it would put me more at risk for having a seizure. I know ketosis can achieved by the diet and or fasting. So kind of seems confusing.
I would appreciate any helpful or positive input.
Also side note in case it matters- I am also taking pantaprozale for acid reflux and recently started vyvanse again but am not taking it every day.
TIA! ❤️
submitted by yodabutter69 to Epilepsy [link] [comments]
So now I take 400 mg, I have been tested and there is a therapeutic dose in my blood. I have not had any seizures since I started the proper dosage.
So after the second seizure is when I started the meds and about 2 years later I had another seizure. I was very sleep deprived, was mourning, hadn’t ate properly and was playing a music festival and it happened during my set. I say these bc they all can be factors.
Anyway it has been about 10 months since my last seizure. I have been gaining weight Ever since I can remember. I started an SSRI a while back that just made me gain more. I haven’t been able to go to the gym much bc I injured my wrist, I know I could still go but I want to play basketball and climb and not just sit on a machine the whole time. I want to be better at it but I am working towards getting more exercise.
The main problem with my diet is late at night. I will eat healthy all day and then at night I just want to eat trash and sugar sugar sugar. I have found that it is super effective for me to fast bc if I stop eating at a certain time I will consume no garbage and sugar that night bc I have already stopped eating.
My neuro said that keto or being in ketosis is effective in treating seizures and I have heard fasting is a big part of keto. My concern is that I did not have proper food in my body at the time of the last seizure. I am just wondering if intermittent fasting is ok or if it would put me more at risk for having a seizure. I know ketosis can achieved by the diet and or fasting. So kind of seems confusing.
I would appreciate any helpful or positive input.
Also side note in case it matters- I am also taking pantaprozale for acid reflux and recently started vyvanse again but am not taking it every day.
TIA! ❤️
2024.05.15 20:28 Outrageous-Guitar909 Psychiatrist who prescribed medication beyond maximum dosage found guilty of professional misconduct
| | Psychiatrist who prescribed medication beyond maximum dosage found guilty of professional misconduct |
2024.05.15 13:20 punhnutrition Punh: The Mantra of Perseverance
 | SkinCare tablets submitted by punhnutrition to u/punhnutrition [link] [comments] In today's world oftentimely consumers have nutrient deficiency due to environmental pollutants and nutrient deficient food diet. Also, due to the inactivities and long exposures to UV, our ability to collect essentials would be reduced as before fathers. That's where Punh enters the scene, a strong antioxidant products. In here, the emotive power will be leveraged to create an image for a skincare product which is really a little kind of encouragening phrase; it is more like just to give a fighting chance to try it one more time so that you can enjoy the amazing results you would see by using this product in case the bad days and their inappropriate moods make you feel like abandoning your skin goals. Each capsule is filled with a powerful concentrated blend of extracts from the plant and vitamins that increase regulated cell regeneration, brightening, and evening up of your tone. 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The decision to go ahead with the medical treatments requires the intervention of highly qualified medical practitioners with the /significance of expertise to steer clear of risks and boost the possibility of maximum benefits according to your individual circumstance. Always get your doctor's advice if you take any medicine or supplements that may interact or be prohibited by the doctor. Involvement with healthcare workers along the way is vital towards your safety and also so that the full potential of glutathione supplementation is reached Visit the site - https://punhnutrition.com/skin-radiance-brightening-l-glutathione-astaxanthin-curcumin-alpha-lipoic-acid/ |
2024.05.15 11:39 sleepingtime12 Tapentadol 100mg: Unlocking the Secrets of Potent Pain Relief
 | Understanding Tapentadol 100mg: submitted by sleepingtime12 to u/sleepingtime12 [link] [comments] Tapentadol 100mg is a formidable weapon in the arsenal against pain. As an opioid analgesic, it operates by targeting the central nervous system to alter the perception and response to pain stimuli. Unlike traditional opioids, Tapentadol combines two mechanisms – mu-opioid receptor agonism and norepinephrine reuptake inhibition – offering a dual approach to pain management. https://preview.redd.it/ecoi0r649k0d1.png?width=500&format=png&auto=webp&s=6d795f2035e1b1bd601f3c65e103e1f46ab10556 The Versatility of Tapentadol 100mg:This mighty medication isn't limited to a single type of pain. It's a versatile solution for various pain scenarios:
Navigating Tapentadol 100mg Dosage:Proper dosing is essential for effective pain management and safety:
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2024.05.15 09:52 Ok_Sundae_712 TSH slowly rising
TSH slowly rising
Hey! For 6 years, I've been taking levothyroxine after being diagnosed with Hashimoto's. Over the years, I've done everything to balance my body and alleviate symptoms of high TPO or low T3 and T4. I'm currently on 175mcg of generic levothyroxine, gradually increased over the years. I thought this would be the maximum dosage for a thyroid patient.
For the first time in years, my TSH is elevated again. My T4 is at the upper limit, but my T3 is still relatively low. My doctor advises slowly increasing to 200mcg, which is the highest dose available on generic levothyroxine. Is this an excessively high dose? Is it the right choice? I'm already taking all cofactors to support T4 to T3 conversion like selenium, zinc, vitamin A, vitamin D, vitamin K, etc.
Since my T4 is already at the upper limit, I'm wondering about the effects of too much T4 on the body. If I increase to 200mcg, it will likely push my T4 above the upper limit. Is this concerning? Or should I just focus on the active T3 bloodlevels and take these as a reference.
Also, are there others that might know if there are other medications I could try? Maybe I should take a combination of T4 and active T3? Also I heard a lot about Tirosint? Is this worth trying? Do people here have experience with this? Bless you!
submitted by Ok_Sundae_712 to Hashimotos [link] [comments]
Hey! For 6 years, I've been taking levothyroxine after being diagnosed with Hashimoto's. Over the years, I've done everything to balance my body and alleviate symptoms of high TPO or low T3 and T4. I'm currently on 175mcg of generic levothyroxine, gradually increased over the years. I thought this would be the maximum dosage for a thyroid patient.
For the first time in years, my TSH is elevated again. My T4 is at the upper limit, but my T3 is still relatively low. My doctor advises slowly increasing to 200mcg, which is the highest dose available on generic levothyroxine. Is this an excessively high dose? Is it the right choice? I'm already taking all cofactors to support T4 to T3 conversion like selenium, zinc, vitamin A, vitamin D, vitamin K, etc.
Since my T4 is already at the upper limit, I'm wondering about the effects of too much T4 on the body. If I increase to 200mcg, it will likely push my T4 above the upper limit. Is this concerning? Or should I just focus on the active T3 bloodlevels and take these as a reference.
Also, are there others that might know if there are other medications I could try? Maybe I should take a combination of T4 and active T3? Also I heard a lot about Tirosint? Is this worth trying? Do people here have experience with this? Bless you!
2024.05.15 09:51 Ok_Sundae_712 TSH slowly rising
TSH slowly rising
Hey! For 6 years, I've been taking levothyroxine after being diagnosed with Hashimoto's. Over the years, I've done everything to balance my body and alleviate symptoms of high TPO or low T3 and T4. I'm currently on 175mcg of generic levothyroxine, gradually increased over the years. I thought this would be the maximum dosage for a thyroid patient.
For the first time in years, my TSH is elevated again. My T4 is at the upper limit, but my T3 is still relatively low. My doctor advises slowly increasing to 200mcg, which is the highest dose available on generic levothyroxine. Is this an excessively high dose? Is it the right choice? I'm already taking all cofactors to support T4 to T3 conversion like selenium, zinc, vitamin A, vitamin D, vitamin K, etc.
Since my T4 is already at the upper limit, I'm wondering about the effects of too much T4 on the body. If I increase to 200mcg, it will likely push my T4 above the upper limit. Is this concerning? Or should I just focus on the active T3 bloodlevels and take these as a reference.
Also, are there others that might know if there are other medications I could try? Maybe I should take a combination of T4 and active T3? Also I heard a lot about Tirosint? Is this worth trying? Do people here have experience with this? Bless you!
submitted by Ok_Sundae_712 to Hypothyroidism [link] [comments]
Hey! For 6 years, I've been taking levothyroxine after being diagnosed with Hashimoto's. Over the years, I've done everything to balance my body and alleviate symptoms of high TPO or low T3 and T4. I'm currently on 175mcg of generic levothyroxine, gradually increased over the years. I thought this would be the maximum dosage for a thyroid patient.
For the first time in years, my TSH is elevated again. My T4 is at the upper limit, but my T3 is still relatively low. My doctor advises slowly increasing to 200mcg, which is the highest dose available on generic levothyroxine. Is this an excessively high dose? Is it the right choice? I'm already taking all cofactors to support T4 to T3 conversion like selenium, zinc, vitamin A, vitamin D, vitamin K, etc.
Since my T4 is already at the upper limit, I'm wondering about the effects of too much T4 on the body. If I increase to 200mcg, it will likely push my T4 above the upper limit. Is this concerning? Or should I just focus on the active T3 bloodlevels and take these as a reference.
Also, are there others that might know if there are other medications I could try? Maybe I should take a combination of T4 and active T3? Also I heard a lot about Tirosint? Is this worth trying? Do people here have experience with this? Bless you!
2024.05.15 08:10 SundayJan2017 Fluvoxamine Dosage
 | Fluvoxamine DosageFluvoxamine is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed to treat various mental health conditions, particularly obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). It is also sometimes used to manage anxiety disorders, including social anxiety disorder and panic disorder. The appropriate dosage of fluvoxamine can vary significantly based on the condition being treated, the patient's age, and their individual response to the medication.Key Considerations for Fluvoxamine Dosage Initial Dosage: Adults: For treating OCD, the typical starting dose for adults is 50 mg once daily at bedtime. For depression, the starting dose may range from 50 to 100 mg per day, taken either in a single dose or divided into two doses. Children and Adolescents: For younger patients with OCD, the initial dose usually starts lower, at around 25 mg daily, and is gradually increased to minimize side effects. Maintenance Dosage
Swiss Chems Fluvoxamine, 3000 mg (50 mg / 60 capsules) Maximum Dosage
While fluvoxamine is generally well-tolerated, it can cause side effects, especially when starting the medication or adjusting the dose. Common side effects include nausea, headache, dizziness, insomnia, and dry mouth. More severe side effects, such as serotonin syndrome, can occur, particularly when fluvoxamine is combined with other serotonergic drugs. Therefore, close monitoring by a healthcare provider is essential. Conclusion Determining the correct dosage of fluvoxamine is a nuanced process that should be tailored to each individual's needs and medical condition. Regular consultations with a healthcare provider are crucial to ensure the medication is effective and to adjust the dosage as necessary. Adhering to prescribed guidelines and promptly reporting any side effects can help optimize treatment outcomes and enhance overall well-being. Disclaimer: Not For Human Consumption. Visit Swiss Chems Full Product List and Latest Coupon Code Here. |
2024.05.15 04:51 bay_bug Lamotrigine (Lamictal) causing weird side effect?
Ever since I increased my dosage of Lamotrigine (Lamictal), I constantly feel like I'm wearing a headband? It's just, like, a gentle squeezing around my forehead, down the back of my skull (base of my neck), and behind my ears. Is this a common experience?
submitted by bay_bug to Epilepsy [link] [comments]
2024.05.14 17:24 Disastrous-Buffalo33 Maximum daily dosage of minoxidil
How many 2.5mg minoxidil pills is safely advisable to rake in one day?
Im currently taking 1mg finesteride and 2.5 oral minoxidil daily but was thinking about taking finesteride every other day from now on as I'm not sure whether it's making much of a difference.
Awaiting your comments
submitted by Disastrous-Buffalo33 to Hairloss [link] [comments]
Im currently taking 1mg finesteride and 2.5 oral minoxidil daily but was thinking about taking finesteride every other day from now on as I'm not sure whether it's making much of a difference.
Awaiting your comments
2024.05.14 12:06 themoorofvenice Psychiatrist who prescribed medication beyond maximum dosage found guilty of professional misconduct
| | submitted by themoorofvenice to ChannelNewsAsia [link] [comments] |
2024.05.14 06:11 BikeMinistry26 Maximum loperamide dosage
Hey everyone so I have been taking loperamide for a couple of years now. My doctor told me its safe but I m curious whats the maximum dosage to take per day on a daily basis? I m taking around 4mg a day - 2 tablets.
submitted by BikeMinistry26 to ibs [link] [comments]
2024.05.14 05:55 elaaura Doctor suggested upping lamictal but I'm already on such a high dose.
Does anyone know the highest dosage that someone should have for lamictal?
I had a tonic seizure in November and he suggested upping lamictal because my levels were on the lower side. I've had three accidental over doses so I was nervous to take to much because I don't want my liver problems to be worse. We upped vimpat instead and I went almost 5 months without one. I had a tonic seizure last month and one tonight before I took my pm meds. So I'm thinking he might suggest upping lamictal again. I take 800mg a day. 400mg at morning and 400mg at night. I don't want to try another medication. I was on kepra for a little and it made me really tired. I googled it but I couldn't find any answer.
submitted by elaaura to Epilepsy [link] [comments]
I had a tonic seizure in November and he suggested upping lamictal because my levels were on the lower side. I've had three accidental over doses so I was nervous to take to much because I don't want my liver problems to be worse. We upped vimpat instead and I went almost 5 months without one. I had a tonic seizure last month and one tonight before I took my pm meds. So I'm thinking he might suggest upping lamictal again. I take 800mg a day. 400mg at morning and 400mg at night. I don't want to try another medication. I was on kepra for a little and it made me really tired. I googled it but I couldn't find any answer.
2024.05.14 03:18 True_Reaction_148 Seeking support from others who are on lithium
I struggle with medication compliance. I also have extremely disordered eating and body dysmorphia. **I hope this isn’t taken down because I’m not asking for med review or advice on dosage My psych is dead set on keeping me on lithium but everytime I start it I feel bloated and I start getting obsessed about weight gain. However, it significantly helps my mood and paranoia. I would like to try and stay on so I’m wondering if anyone has any positive experiences with Lithium they can share. I’m also taking Lamictal.
submitted by True_Reaction_148 to BipolarReddit [link] [comments]
2024.05.14 01:46 AppropriateArticle40 TMJ specialist recommended to take max dosage of ibuprofen for eight weeks
I’ve been having chronic jaw pain for about six months, I saw a specialist and he told me to just take ibuprofen for two weeks straight, 4 times a day at 800mg, so 3,200mg a day. I told my doctor I was still experiencing jaw pain after doing this and he said to take the maximum dosage of ibuprofen for eight weeks, and to do a soft food diet. Is it safe or reasonable to take this much ibuprofen for so long?
submitted by AppropriateArticle40 to TMJ [link] [comments]
2024.05.13 17:55 redsowhat More Is Not Always Better: Outdated Drug Dose Strategy in Breast Cancer
Copied from article (link below also):
“Despite decades of progress in cancer treatment, dosing remains stuck in the past and patients are likely suffering unnecessary treatment-related side effects, according to authors of a recent survey-based analysis.
Dosage recommendations on drug labels are still typically based on the maximum tolerated dose from phase 1 testing, a holdover from when chemotherapy was about the only thing medical oncologists had to offer patients.
Experts now question the more-is-better approach for chemotherapy as well as for targeted and immunotherapies where lower, less toxic doses often work as well as higher ones.
But with maximum tolerated dose still holding sway, many patients receive this dose when starting therapy and can experience significant treatment-related side effects.
The survey-based analysis, published in the Journal of Clinical Oncology, supported this view.
The survey, which asked patients with metastatic breast cancer about the toxicities associated with the maximum tolerated dose, found that nearly 90% of respondents reported at least one significant treatment-related side effect.
Overall, 1221 patients completed the 27-question survey, developed by the Patient-Centered Dosing Initiative (PCDI), a patient advocacy group launched in 2019 to improve treatment of metastatic breast cancer.
The survey aimed to assess the prevalence and severity of patients' treatment-related side effects, communication between patients and physicians about these issues, as well as perceptions about the efficacy of higher vs lower doses and a willingness to discuss different dosing strategies.
Patients were invited to take the survey on social media. Most patients were postmenopausal, and almost half had been diagnosed in the past 2 years. Treatments included targeted, endocrine, and chemotherapy, as well as radiation, surgery, and immunotherapy.
Overall, about 86% of patients (1051 of 1221) reported at least one significant treatment-related side effect. Among these patients, more than 20% went to the emergency room or hospital as a result, and 43.2% missed at least one cancer treatment.
The most common side effects were fatigue, nausea, low blood counts, diarrhea, and neuropathy.
Almost all respondents (97.6%) told their doctors about the treatment toxicities. More than half (54.2%) received a dose reduction to minimize the side effects, and among these patients, 82.6% reported symptom relief.
The analysis had several limitations, however, including possible selection bias because only patients with internet access could participate, an underrepresentation of minority populations, and self-reported side effects that could not be confirmed.
Still, the results indicate that patients are likely struggling with potentially unnecessary treatment-related side effects because of an outdated dosing paradigm, said investigators led by PCDI founder Anne Loeser, BS, who recently died of metastatic breast cancer.
The group continues to work with the US Food and Drug Administration on initiatives to optimize cancer drug dosing and update labels. But in the meantime, PCDI recommends talking with patients about dosing options. The survey indicated that such conversations are welcome.
Nearly all survey respondents (92.3%) said they would be willing to discuss alternative dosing options to optimize quality of life. One in five, however, did not know that dose reductions were an option to control side effects. And more than half of respondents (53.3%) did not think the highest dose was necessarily the most effective.
There are "no real surprises" in the survey, but "clearly patients want to be engaged in decision-making," said William J. Gradishar, MD, a breast oncologist at Northwestern University, Chicago, who discussed the initial survey results when Loeser presented them in 2021 at the American Society of Clinical Oncology annual meeting. The survey "really highlights the need for a two-way conversation" between patients and caregivers throughout treatment.
"We have to recognize that many of our treatments do not actually improve survival, and if they do, in some cases, it's quite modest, so anything we can do to make therapy more tolerable is important," especially when the goal of care is palliation, not cure, said Gradishar.
No funding was reported for the work. Loeser and Gradishar did not have any disclosures.”
https://www.medscape.com/viewarticle/more-not-always-better-outdated-drug-dose-strategy-breast-2024a10008xa
submitted by redsowhat to LivingWithMBC [link] [comments]
“Despite decades of progress in cancer treatment, dosing remains stuck in the past and patients are likely suffering unnecessary treatment-related side effects, according to authors of a recent survey-based analysis.
Dosage recommendations on drug labels are still typically based on the maximum tolerated dose from phase 1 testing, a holdover from when chemotherapy was about the only thing medical oncologists had to offer patients.
Experts now question the more-is-better approach for chemotherapy as well as for targeted and immunotherapies where lower, less toxic doses often work as well as higher ones.
But with maximum tolerated dose still holding sway, many patients receive this dose when starting therapy and can experience significant treatment-related side effects.
The survey-based analysis, published in the Journal of Clinical Oncology, supported this view.
The survey, which asked patients with metastatic breast cancer about the toxicities associated with the maximum tolerated dose, found that nearly 90% of respondents reported at least one significant treatment-related side effect.
Overall, 1221 patients completed the 27-question survey, developed by the Patient-Centered Dosing Initiative (PCDI), a patient advocacy group launched in 2019 to improve treatment of metastatic breast cancer.
The survey aimed to assess the prevalence and severity of patients' treatment-related side effects, communication between patients and physicians about these issues, as well as perceptions about the efficacy of higher vs lower doses and a willingness to discuss different dosing strategies.
Patients were invited to take the survey on social media. Most patients were postmenopausal, and almost half had been diagnosed in the past 2 years. Treatments included targeted, endocrine, and chemotherapy, as well as radiation, surgery, and immunotherapy.
Overall, about 86% of patients (1051 of 1221) reported at least one significant treatment-related side effect. Among these patients, more than 20% went to the emergency room or hospital as a result, and 43.2% missed at least one cancer treatment.
The most common side effects were fatigue, nausea, low blood counts, diarrhea, and neuropathy.
Almost all respondents (97.6%) told their doctors about the treatment toxicities. More than half (54.2%) received a dose reduction to minimize the side effects, and among these patients, 82.6% reported symptom relief.
The analysis had several limitations, however, including possible selection bias because only patients with internet access could participate, an underrepresentation of minority populations, and self-reported side effects that could not be confirmed.
Still, the results indicate that patients are likely struggling with potentially unnecessary treatment-related side effects because of an outdated dosing paradigm, said investigators led by PCDI founder Anne Loeser, BS, who recently died of metastatic breast cancer.
The group continues to work with the US Food and Drug Administration on initiatives to optimize cancer drug dosing and update labels. But in the meantime, PCDI recommends talking with patients about dosing options. The survey indicated that such conversations are welcome.
Nearly all survey respondents (92.3%) said they would be willing to discuss alternative dosing options to optimize quality of life. One in five, however, did not know that dose reductions were an option to control side effects. And more than half of respondents (53.3%) did not think the highest dose was necessarily the most effective.
There are "no real surprises" in the survey, but "clearly patients want to be engaged in decision-making," said William J. Gradishar, MD, a breast oncologist at Northwestern University, Chicago, who discussed the initial survey results when Loeser presented them in 2021 at the American Society of Clinical Oncology annual meeting. The survey "really highlights the need for a two-way conversation" between patients and caregivers throughout treatment.
"We have to recognize that many of our treatments do not actually improve survival, and if they do, in some cases, it's quite modest, so anything we can do to make therapy more tolerable is important," especially when the goal of care is palliation, not cure, said Gradishar.
No funding was reported for the work. Loeser and Gradishar did not have any disclosures.”
https://www.medscape.com/viewarticle/more-not-always-better-outdated-drug-dose-strategy-breast-2024a10008xa
2024.05.13 17:45 CanOWood My experience with Vyvanse and Family
Good Morning !
This is my first post on reddit, I thought it would be nice to share my Vyvanse/Familial experience with some people that have the fun brain like me.
Growing up I was always on ADHD medication, since about 3rd grade I had been on Focalin, and then Daytrana because I couldn't take pills. Both were fine, but never lasted long enough according to my parents at the time, or I refused/forgot to take them. Around comes highschool, and I get a new psychiatrist that recommended Vyvanse because it lasted longer, and would work even when I was at home.
I was a quiet child when I was medicated, and my parents spoke up for me when talking with the doctor. They would say it wasn't working, they could tell I was 'resisting' it, or I was getting chaotic at home again, and the dosage should be higher. I was agreeing with my parents to the doctor, and I did this because of the "I can tell you aren't on your meds" comments that would make me feel like a burden to everyone around me. Long story short at the worst of it I ended up on the maximum recommended dosage of Vyvanse, and every time I took it, it felt like my world narrowed, and my personality was locked away in a cage as I rode a permanent adrenaline rush. But it kept me quiet and out of trouble, so it must be working as intended, I told myself.
For other familial reasons, I was short about a week's worth of medication every month, At the end of every month I would go through what could only be described as the most intense withdrawal I think I have evewill ever experience. It felt like was like getting hit with a freight train of emotions that I had to wade through while genuinely trying to survive these violently intense depressive episodes.
Each time I survived to the end of the week, I saw light that I wanted more of. A fun, silly, pleasant to be around version of myself that didn't want to bother with doing things that were boring, and could really throw themselves at their passions, all that had been locked away because of the medication- but I went right back on it because that's what my family and teachers wanted. No friends, barely living, existing only on the internet, and even with the medication I was barely passing school because I still didn't do any homework or projects, it didn't matter how good I did in class. It changed who I am for the better or worse.
Those intense depressions forced me to sort through my emotions, and engraved a fear of failure and disgust with who I let myself become. Those thoughts urge me to improve myself every day.
8 years later without any medication, and I'm only just now etting back on the lowest dosage of Focalin XR, I had a very long conversation with my new doctor about my hesitance to take new medication, but I was suffering too much in my work to not make an attempt to seek proper treatment. It's going well so far two weeks in, I hope it continues to be smooth sailing. I've noticed my personality flatten ever so slightly, but as it generally wears off at the end of the day when I get out of work.
submitted by CanOWood to ADHD [link] [comments]
This is my first post on reddit, I thought it would be nice to share my Vyvanse/Familial experience with some people that have the fun brain like me.
Growing up I was always on ADHD medication, since about 3rd grade I had been on Focalin, and then Daytrana because I couldn't take pills. Both were fine, but never lasted long enough according to my parents at the time, or I refused/forgot to take them. Around comes highschool, and I get a new psychiatrist that recommended Vyvanse because it lasted longer, and would work even when I was at home.
I was a quiet child when I was medicated, and my parents spoke up for me when talking with the doctor. They would say it wasn't working, they could tell I was 'resisting' it, or I was getting chaotic at home again, and the dosage should be higher. I was agreeing with my parents to the doctor, and I did this because of the "I can tell you aren't on your meds" comments that would make me feel like a burden to everyone around me. Long story short at the worst of it I ended up on the maximum recommended dosage of Vyvanse, and every time I took it, it felt like my world narrowed, and my personality was locked away in a cage as I rode a permanent adrenaline rush. But it kept me quiet and out of trouble, so it must be working as intended, I told myself.
For other familial reasons, I was short about a week's worth of medication every month, At the end of every month I would go through what could only be described as the most intense withdrawal I think I have evewill ever experience. It felt like was like getting hit with a freight train of emotions that I had to wade through while genuinely trying to survive these violently intense depressive episodes.
Each time I survived to the end of the week, I saw light that I wanted more of. A fun, silly, pleasant to be around version of myself that didn't want to bother with doing things that were boring, and could really throw themselves at their passions, all that had been locked away because of the medication- but I went right back on it because that's what my family and teachers wanted. No friends, barely living, existing only on the internet, and even with the medication I was barely passing school because I still didn't do any homework or projects, it didn't matter how good I did in class. It changed who I am for the better or worse.
Those intense depressions forced me to sort through my emotions, and engraved a fear of failure and disgust with who I let myself become. Those thoughts urge me to improve myself every day.
8 years later without any medication, and I'm only just now etting back on the lowest dosage of Focalin XR, I had a very long conversation with my new doctor about my hesitance to take new medication, but I was suffering too much in my work to not make an attempt to seek proper treatment. It's going well so far two weeks in, I hope it continues to be smooth sailing. I've noticed my personality flatten ever so slightly, but as it generally wears off at the end of the day when I get out of work.
2024.05.13 16:30 Admirable_Pop_9024 What's your go to treatment plan for mixed states? Is this a mixed state rather than unipolar depression?
A new patient(F45) mildly obese was brought in who was planned for ECT in a week. Though she might actually be bipolar (atleast on the spectrum). She was terrified of ECT.
She had severe depression including suicidality and severe agitation.
She was on Lithium 600mg/day (Started recently), Lamotrigine 200mg, Lexapro 20mg and clonazepam 1mg with quietiapine 50mg for sleep.
Since 2023 she'd been experiencing strange episodes according to her family.
Here's all the history and symptoms provided about these episodes since 2023 :
Benzos would do nothing even injectable ones for the agitation.
Then today when she came to me during the severe agitation I immediately thought of a mixed state. Gave her zyprexa and asked to taper down the lexapro.
After she took the zyprexa (sublingual) in about 2 hours experienced tremendous relief - felt calm, brain went silent and took a long nap quite refreshing. She wasn't bothered by people talking. She wasn't irritated. She just felt normal. The relief seemed never-ending.
It makes sense now how being put on lamictal back in 2023 put her into remission and it kept masking Lexapro's rebound effect(in bipolar)
I'm honestly unsure why high dose Lexapro was continued over a year (even though there was a clear worsening of symptoms with dosage increase) and why high dose benzodiazepines were constantly being used to control the agitation despite having little to no effect. Even effexor was started in cross-titration with Lexapro which further worsened her suicidality etc?
Sorta leaning towards ECT and later on adjusting the medications because it does seem to be severe and ECT it is quite effective though the patient wants to try the no-ssri approach.
If we do go with the latter approach, I plan on : - Switch to Vraylar for its good evidence in mixed states. Cariprazine is dirt cheap here.
What's your go to treatment for mixed states? What about the efficacy of Lithium in mixed bipolarity? Which mood stabilizers seem to work best?
submitted by Admirable_Pop_9024 to Psychiatry [link] [comments]
She had severe depression including suicidality and severe agitation.
She was on Lithium 600mg/day (Started recently), Lamotrigine 200mg, Lexapro 20mg and clonazepam 1mg with quietiapine 50mg for sleep.
Since 2023 she'd been experiencing strange episodes according to her family.
Here's all the history and symptoms provided about these episodes since 2023 :
- Agitation/Inner restlessness: Unable to remain calm/sit still. Blaming all of her symptoms on this restlessness. When this comes the other symptoms which I'll mention come along too:
- Crying and shouting loudly (simply can not control this to sorta escape)
- Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
- Very Irritable.
- Suicidality (to escape the restlessness). Suicidal attempts in aggression where she had to be stopped with a lot of physical force.
- Guilt and worthlessness
- Irrational/Questionable decisions and behaviors were almost always noted by family members during these periods accompanied with extreme impatience.
- Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
- Pupils were dilated when I saw her.
Benzos would do nothing even injectable ones for the agitation.
Then today when she came to me during the severe agitation I immediately thought of a mixed state. Gave her zyprexa and asked to taper down the lexapro.
After she took the zyprexa (sublingual) in about 2 hours experienced tremendous relief - felt calm, brain went silent and took a long nap quite refreshing. She wasn't bothered by people talking. She wasn't irritated. She just felt normal. The relief seemed never-ending.
It makes sense now how being put on lamictal back in 2023 put her into remission and it kept masking Lexapro's rebound effect(in bipolar)
I'm honestly unsure why high dose Lexapro was continued over a year (even though there was a clear worsening of symptoms with dosage increase) and why high dose benzodiazepines were constantly being used to control the agitation despite having little to no effect. Even effexor was started in cross-titration with Lexapro which further worsened her suicidality etc?
Sorta leaning towards ECT and later on adjusting the medications because it does seem to be severe and ECT it is quite effective though the patient wants to try the no-ssri approach.
If we do go with the latter approach, I plan on : - Switch to Vraylar for its good evidence in mixed states. Cariprazine is dirt cheap here.
- Stick to Lamotrigine and increase Lithium/ Switch to Valproate(Good evidence in mixed features).
- Wellbutrin for depression if it does not or only partially responds to psychotherapy.
- Gabapentin.
- Low dose Trazodone for insomnia.
What's your go to treatment for mixed states? What about the efficacy of Lithium in mixed bipolarity? Which mood stabilizers seem to work best?
2024.05.13 13:50 nourr_15 how high is the average and maximum dosage of dextroamphetamines/adderall?
TL;DR at the bottom; the rest is just a litte backstory and extra information
was diagnosed at age 11 and after being prescribed 30mg of methylpehnidate a day which made me feel completely numb for months, i stopped taking medication until i was 16. then i started taking dextroamphetamine (adderall) and now at 18 i take 40-45 mg a day.
i was started on 10 mg a day which increased to 25. unfortunately it very suddenly stopped working about a year ago so last february i finally went to the doctor for help and he increased my dosage to 45 mg a day, (and thankfully it now works again).
my dad takes the same meds and a similar dosage, but i take mine from 7am to 1:30pm while he takes his from 7am to 8:30pm. so he also has 6 doses a day instead of 3. it seems like i take a lot more at once eventho my weight is only about 60% of his weight.
it made me wonder how much the average amount and maximum amount is (just to keep in mind in case it stops working again) and if its normal that i take this much. i cant really find anything on the internet or only stats that all differ a lot from each other, so i figured i'd ask here.
i'm a little under 50kgs (110 lbs) if that matters btw and i dont actually take the brand adderall but that's the most common and well known type of dextroamphetamines and mine are brandless.
TL;DR
my dad and i both take 45 mg adderall a day but the time range in which we take it differs a lot (mine 7 hours, his 13), same as the amount we take per dose and weight. what is the average dosage and do i take a lot compared to the average? and is there a maximum dosage per day?
submitted by nourr_15 to ADHD [link] [comments]
was diagnosed at age 11 and after being prescribed 30mg of methylpehnidate a day which made me feel completely numb for months, i stopped taking medication until i was 16. then i started taking dextroamphetamine (adderall) and now at 18 i take 40-45 mg a day.
i was started on 10 mg a day which increased to 25. unfortunately it very suddenly stopped working about a year ago so last february i finally went to the doctor for help and he increased my dosage to 45 mg a day, (and thankfully it now works again).
my dad takes the same meds and a similar dosage, but i take mine from 7am to 1:30pm while he takes his from 7am to 8:30pm. so he also has 6 doses a day instead of 3. it seems like i take a lot more at once eventho my weight is only about 60% of his weight.
it made me wonder how much the average amount and maximum amount is (just to keep in mind in case it stops working again) and if its normal that i take this much. i cant really find anything on the internet or only stats that all differ a lot from each other, so i figured i'd ask here.
i'm a little under 50kgs (110 lbs) if that matters btw and i dont actually take the brand adderall but that's the most common and well known type of dextroamphetamines and mine are brandless.
TL;DR
my dad and i both take 45 mg adderall a day but the time range in which we take it differs a lot (mine 7 hours, his 13), same as the amount we take per dose and weight. what is the average dosage and do i take a lot compared to the average? and is there a maximum dosage per day?