![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 262 to 286 of 1242. Go back in thread:
Posted by JohnnyB on February 26, 2003, at 9:15:46
In reply to Re: Straterra approval., posted by JohnnyB on February 25, 2003, at 20:32:26
For backround details, see http://www.dr-bob.org/babble/20030224/msgs/203834.html
Night 5: After 3.5 hrs. of sleep, I woke at 2:30 A.M. and couldn't get back to sleep the rest of the night. I took no Straterra yesterday and took the an 18 mg. this morning around 6:30. No other meds at all.
With this sleep deprivation, I still can't tell about the benefits of this med. Still none of the typical SE's I've seen mentioned here with the exception of some erectile difficulties, but that could easily be attributed to lack of sleep. I just want more sleep and it's hard to be patient and give this med a chance.
If just one person out there could tell me they had this degree of sleep difficulty and it went away while staying on Straterra, that would be reassuring. Anyone?
Posted by JohnnyB on February 26, 2003, at 9:55:29
In reply to Re: Straterra and sleep experiences?, posted by JohnnyB on February 26, 2003, at 9:15:46
I've seen a fair number of posts mentioning opening and dividing up Strattera capsules. I was going to get gel caps and split my 40 mg. caps. When I asked my pharmacist, she was wary of the idea and called Eli Lilly for me. They said the contents of the capsules are caustic with direct contact with skin. Of course they stand to profit from me having to buy 18 mgs. but then it could also really be caustic too. Comments?
Posted by Hattree on February 26, 2003, at 9:56:58
In reply to Re: Straterra approval., posted by JohnnyB on February 25, 2003, at 20:32:26
Sounds like too high a dose to me. I'd go slower. This is a wild guess, but I think we inattentive types might need less. Certainly can't hurt to drop it down...maybe you should take a day or two off and get some sleep, then restart.
I started and after a couple of days stopped, because I was feeling depressed...I'm hoping it wasn't the Strattera. I had an intense weekend and thought I was better off with old dex.
Posted by Hattree on February 26, 2003, at 10:01:14
In reply to Don't split Strattera caps according to Lilly, posted by JohnnyB on February 26, 2003, at 9:55:29
I split 'em and haven't noticed a problem. I've been pouring about a quarter in a shot glass, mixing it and drinking it, but then I'm pretty tolerant about bad tastes of that nature. It's too haphazard, though. I'm thinking of springing for smaller caps.
Posted by paulk on February 26, 2003, at 10:45:27
In reply to Don't split Strattera caps according to Lilly, posted by JohnnyB on February 26, 2003, at 9:55:29
Total spin - I've had it all over my hands. They just want your money.
I split the 25mg to get 12.5 mg. Taste is bad - you can split them to empty capsuls.
Posted by not exactly on February 26, 2003, at 14:10:19
In reply to Don't split Atomoxetine (Straterra)caps according » JohnnyB, posted by paulk on February 26, 2003, at 10:45:27
You're not going to get an honest and unbiased opinion from the manufacturer, because they have nothing to lose and everything to gain by advising against splitting the caps. Not only do they "want your money", they also want to keep their money. If they told you that splitting a cap was OK, thereby "officially condoning the practice", then they could be liable for a lawsuit in the event that something bad happened as a result (even if causation could not be proven).
As a general rule of thumb, information should not be regarded as absolute truth without considering the source of said information, and what they stand to gain or lose by telling the truth. [If I hinted that this principle should be applied to religion & politics as well, Dr. Bob would redirect this post to Psycho-Babble Faith or Psycho-Social-Babble. :-) ]
BTW, as a chemist (with nothing to gain or lose by this claim) I can assure you that neither atomoxetine nor any of the fillers in a Strattera capsule would be harmful in contact with normal skin. It's possible that some people might be allergic or hypersensitive to the capsule contents, but they will have a more negative reaction to ingesting the caps than they would to opening them.
I stand by the comments I made on this subject in a previous posting [http://www.dr-bob.org/babble/20030125/msgs/137561.html].
- Bob
Posted by viridis on February 26, 2003, at 14:27:37
In reply to Re: Don't split Strattera caps according to Lilly, posted by not exactly on February 26, 2003, at 14:10:19
I've mentioned this here before, but will repeat my experience with Wellbutrin SR. The literature says don't divide them, and people seem to think that this is because they have a slow-release coating. But when I called GSK and spoke with one of the people who actually developed the slow-release form, he said that splitting the pills was fine, and they'd even tested this quite extensively. The slow release is controlled by the wax matrix inside, which dissolves at the same rate whether split or not. When I asked why they discourage people from splitting them, he said it's just because it's hard to get accurate dosing (the pills aren't scored so don't split exactly evenly). Also, if they sit around split for days, they take up moisture from the air. But the product info makes it sound like splitting the pills will cause dire consequences. It certainly didn't for me.
I have no idea whether this applies to Strattera (which I realize is a capsule), but it's a case in point with many potential parallels.
Posted by viridis on February 26, 2003, at 14:41:07
In reply to Re: Don't split Strattera caps according to Lilly, posted by not exactly on February 26, 2003, at 14:10:19
This "caustic ingredients" thing is interesting. Years ago, when I took Prozac, I found the 20 mg pills (the only size available at the time) too strong. I asked my doctor if I could divide the contents into two capsules; he checked with the rep (I think this was Lilly too?) and she said no, the contents are too caustic.
Interesting...of course, they do have to cover themselves. I'm a biologist, and have containers of sodium chloride (table salt) and sucrose (common sugar) in my lab. They each warn that in case of contact with skin, one should flush with water for 15 minutes and call a doctor if any reaction occurs. I wonder if it's a similar CYA situation with pharmaceuticals?
Posted by juanantoniod on February 26, 2003, at 17:09:32
In reply to Caustic contents?, posted by viridis on February 26, 2003, at 14:41:07
FWIW, yesterday I started my first dosage of Strattera. In the evening I had the first instance of really sour stomach that I have had in a long time. I can tell because when I belched, some of the stomach's contents were coming up. The only thing I can attribute this taste to was the Strattera in my stomach.
However, if the medication can be handled by the stomach, it defies logic that it would caustic to skin.
And, as far as the Strattera goes, if any of you are as interested as I am in how it works, I will keep you apprised of any effects it has on me.
Antonio
Posted by JohnnyB on February 26, 2003, at 17:49:19
In reply to Re: Straterra and sleep experiences?, posted by JohnnyB on February 26, 2003, at 9:15:46
All the responses to my mention of Lilly saying not to split capsules have been interesting and express valid points of view, but this comment was really an asside for me. Please review: http://www.dr-bob.org/babble/20030224/msgs/203963.html
I'm a walking zombie when I can get my butt out of the chair. Oh, what I would do for a solid 6 - 8 hr. night! After 3 yrs. of nursing my sleep habits along, I finally started getting full nights of sleep this last fall. I'm really wrestling with whether I should continue with Strattera at the risk of undoing my recently acquired sleep habits. I'm not keen on taking a sleep med to counter the side effects of another med and I haven't the resources for another such expense. Sleep deprivation only amplifies my ADD sx. But, I really want to give Strattera a chance for me to at least see if there are any beneficial effects for me.
Perhaps I'm being as impatient with this message board as I am with Strattera, but please don't anyone take it personally. I've only been checking here for a day or so and may not quite get the pace of things. We all have lives to live, ehh? If anyone could speak to my quandry, I would most welcome your words.
John
Posted by not exactly on February 26, 2003, at 19:49:19
In reply to I repeat, sleep wanted, please respond, posted by JohnnyB on February 26, 2003, at 17:49:19
I don't think there's any magic solution here. Since the problem started when you began the Strattera, it's certainly reasonable to assume a causal relationship. So the first thing to try is completely discontinuing the Strattera. You haven't been on it long enough for withdrawal to be a concern, so there's no need to taper. It's got a relatively short half life, so the insomnia s/e should go away in a day or 2. Once your sleeping is normal (or acceptable) again and you've gotten a few good nights' sleep, then you could try the Strattera again at a significantly reduced dosage (I wouldn't start with more than 1/4 the amount that caused the intolerable insomnia). It's quite likely that you're one of the "poor metabolizers". Don't increase the dose until you're comfortable that you can handle the level of stimulation (which will hopefully diminish over time). Ramp up very slowly and see if you gain any benefit before the s/e problems recur.
If you really need to get some sleep and completely discontinuing Strattera is not providing relief fast enough, then a sedative hypnotic is the obvious short-term remedy.
- Bob
Posted by paulk on February 26, 2003, at 20:06:47
In reply to I repeat, sleep wanted, please respond, posted by JohnnyB on February 26, 2003, at 17:49:19
> I'm a walking zombie when I can get my butt out of the chair. Oh, what I would do for a solid 6 - 8 hr. night! After 3 yrs. of nursing my sleep habits along, I finally started getting full nights of sleep this last fall. I'm really wrestling with whether I should continue with Strattera at the risk of undoing my recently acquired sleep habits. I'm not keen on taking a sleep med to counter the side effects of another med and I haven't the resources for another such expense. Sleep deprivation only amplifies my ADD sx. But, I really want to give Strattera a chance for me to at least see if there are any beneficial effects for me.
>
> Perhaps I'm being as impatient with this message board as I am with Strattera, but please don't anyone take it personally. I've only been checking here for a day or so and may not quite get the pace of things. We all have lives to live, ehh? If anyone could speak to my quandry, I would most welcome your words.
>
> John
I found that even 25 mg/day was too much for me (I now take 12.5mg/day) - try a lower dose. Reading between the lines - I have a hunch that 40mg/day is way too much for a number of folks.I also tried Reboxitine, a related drug, and found it a disaster. I wonder now if it was because the dose was way to high? Why not try 5mg/day until you can sleep, then work it up and retreat when it interferes with sleep.
I found that not only did it screw up my sleep if I take too much, but it made my focus WORSE! At the higher dose I found I was impatient, irritable, spacy-sleepy and couldn't sleep. But on a lower dose it works very well and I'm getting a lot more tasks completed.
Based on my experience (at 200 lbs) I would start on 10mg/day and work up - and even less if you weigh less.
The good news is, because it works at 10-12mg/day I can get the 40mg caps and split them - giving me a very cost effective med.<g>
Posted by Ritch on February 27, 2003, at 0:27:15
In reply to Re: Don't split Strattera caps according to Lilly, posted by viridis on February 26, 2003, at 14:27:37
> I've mentioned this here before, but will repeat my experience with Wellbutrin SR. The literature says don't divide them, and people seem to think that this is because they have a slow-release coating. But when I called GSK and spoke with one of the people who actually developed the slow-release form, he said that splitting the pills was fine, and they'd even tested this quite extensively. The slow release is controlled by the wax matrix inside, which dissolves at the same rate whether split or not. When I asked why they discourage people from splitting them, he said it's just because it's hard to get accurate dosing (the pills aren't scored so don't split exactly evenly). Also, if they sit around split for days, they take up moisture from the air. But the product info makes it sound like splitting the pills will cause dire consequences. It certainly didn't for me.....
Aha! So, that's why splitting WB SR tabs results in clean cracking (little powder or dust evidently due to the wax matrix inside). The generic bupropion crumbles really easily in comparison and makes a lot of dust.
thanks for that info.
Posted by Ed on February 27, 2003, at 7:33:54
In reply to I repeat, sleep wanted, please respond, posted by JohnnyB on February 26, 2003, at 17:49:19
I had insomnia that went away after a few days. I take 40 mgs a day without much in the way of side effects. I had taken 80 mgs. a day for a few days, but my brain and body was telling me 80 mgs was too much. Good luck.
> All the responses to my mention of Lilly saying not to split capsules have been interesting and express valid points of view, but this comment was really an asside for me. Please review: http://www.dr-bob.org/babble/20030224/msgs/203963.html
>
> I'm a walking zombie when I can get my butt out of the chair. Oh, what I would do for a solid 6 - 8 hr. night! After 3 yrs. of nursing my sleep habits along, I finally started getting full nights of sleep this last fall. I'm really wrestling with whether I should continue with Strattera at the risk of undoing my recently acquired sleep habits. I'm not keen on taking a sleep med to counter the side effects of another med and I haven't the resources for another such expense. Sleep deprivation only amplifies my ADD sx. But, I really want to give Strattera a chance for me to at least see if there are any beneficial effects for me.
>
> Perhaps I'm being as impatient with this message board as I am with Strattera, but please don't anyone take it personally. I've only been checking here for a day or so and may not quite get the pace of things. We all have lives to live, ehh? If anyone could speak to my quandry, I would most welcome your words.
>
> John
Posted by JohnnyB on February 27, 2003, at 10:50:24
In reply to Re: I repeat, sleep wanted, please respond » JohnnyB, posted by Ed on February 27, 2003, at 7:33:54
Thanks. The two responses I received, before I needed to decide whether to continue or not, were helpful. Especially Ed telling me his insomnia went away. Bob's advise will come into play if Ed's doesn't work. I wasn't looking for magic as much as wanting to hear from someone besides Lilly that the insomnia had gone away.
I opened an 18 and mixed half in some juice. Waiting a couple of hours before eating did not produce a sour stomach.
I believe I only slept 4 hrs. last night but layed in bed relaxing. Perhaps I was dozing from 3:00 till 6:00 while lieing there. I certainly slept from 11:00 till 3:00, and odly I feel much better today, much more with it mentally and more energy too. The lack of sleep is still very apparent, but there is a marked improvement over yesterday.
If anyone else reads my request for responses about sleep, I'd still like to hear from you.
Thanks again,
John
Posted by JohnnyB on February 27, 2003, at 11:21:21
In reply to Re: I repeat, sleep wanted, please respond » JohnnyB, posted by Ed on February 27, 2003, at 7:33:54
Thanks for the news of your fading insomnia. I've been reading, in this thread, allot of recomendations to start at lower doses and work up, but I thought that dropping to 18 from 40 would be low. Dropping even futher to 9(+ or -) makes good sense and the initial effects of feeling tense inside and my mental state feel much better on that dose, so far.
May I ask, how long have you been taking it? Are you taking it for ADHD, as an AD, both? Moreover, are you finding it effective in treating your symptoms?
Posted by JohnnyB on February 27, 2003, at 11:56:53
In reply to Atomoxetine (Straterra) and sleep » JohnnyB, posted by paulk on February 26, 2003, at 20:06:47
Didn't mean to leave you out of the thanks. You were the first to respond, but since that was yesterday, I forgot about your message while composing thanks this morning. Of course yesterday was nothing but a blurr.
Prior to today, it was hard to tell if the spacey lack of focus and other mental/emotional sx were due to sleep deprivation or due to the effects of Strattera. Maybe both, but I think you are on to something, at least for me.
I feel much better today, on all counts, yet I don't believe I slept much more last night than previous nights. So, with three days of 40, one day without, then 18 yesterday, it seems your theory may hold up. The sx seem to be lessening and the benefits (improved focus, etc.) seem to be more prominent. We'll just have to wait more to see for sure. Perhaps this is one way we find out if we are poor metabolizers (PMs) of CYP2D6.
I've been reading your messages in this thread, but have seen nothing from you between 2/10 and today. You seemed happy with the earlier results and in todays message you still sound pleased, yes?
Well, thanks for you input,
John
Posted by Ed on February 27, 2003, at 12:05:12
In reply to Strattera benefits, Ed?, posted by JohnnyB on February 27, 2003, at 11:21:21
Straterra somewhat decreases my general aggitation level. For example, I don't step on other peoples' sentences as much or feel so compelled to voice my own opinion. Also, I am more focused when I read books-- and no headaches and/or sudden sleepiness when I read books.
> Thanks for the news of your fading insomnia. I've been reading, in this thread, allot of recomendations to start at lower doses and work up, but I thought that dropping to 18 from 40 would be low. Dropping even futher to 9(+ or -) makes good sense and the initial effects of feeling tense inside and my mental state feel much better on that dose, so far.
>
> May I ask, how long have you been taking it? Are you taking it for ADHD, as an AD, both? Moreover, are you finding it effective in treating your symptoms?
Posted by paulk on February 27, 2003, at 15:53:33
In reply to Sorry paulk, posted by JohnnyB on February 27, 2003, at 11:56:53
> Didn't mean to leave you out of the thanks. You were the first to respond, but since that was yesterday, I forgot about your message while composing
> thanks this morning. Of course yesterday was nothing but a blurr.
>Yeah – isn’t that strange – when I take too much I can’t hardly remember anything and it is hard to function – almost exactly the opposite of the good effect. It even makes it hard to decide what to do about the med itself.
>The sx seem to be lessening and the benefits (improved focus, etc.) seem to be more prominent. We'll just have to wait more to see for sure.
>Perhaps this is one way we find out if we are poor metabolizers (PMs) of CYP2D6.
>
It appears that there is a 5 fold difference in blood level depending on ones metabolism (wonder if that is just for kids – could be worse for adults?) What is an interesting coincidence is that Desipramine, which also acts in part as a SNRI, has a 35 fold range of blood-level for the same dosage. I bet you sleep tonight.>I've been reading your messages in this thread, but have seen nothing from you between 2/10 and today. You seemed happy with the earlier
>results and in today’s message you still sound pleased, yes?I’m getting more done AND my sex life is enhanced. It seems that I need to be pickier about the dosage than with other meds I’ve tried. Start low and work up slowly would seem to be good advice. They probably should change the monograph if they want wide success.
I think I felt a bit euphoric the first week – haven’t felt that good again, but overall things are good. The only other drug that gave me anything close was Nardil – this is better so far at week 3.
Posted by HADD Enough on February 28, 2003, at 11:59:14
In reply to I repeat, sleep wanted, please respond, posted by JohnnyB on February 26, 2003, at 17:49:19
Now 4 weeks, 1st week at 40mg/day in AM, next 3 at 60mg/day in AM. Most of the side effects have gone away except for these...dry skin, especially around my knuckles and heels...fixed with moisturizing lotion. Weight loss...NOT! a problem for me. :-D I've lost about 8lbs. since I started Strattera and need to lose about 15 more. Suppressed appetite...related to the weight loss I'm sure. D'oh! It's kind of like I can eat if I choose, but if I don't, it's no big deal from a physical standpoint. I told my pdoc that I have to consciously CHOOSE to eat. Again, not a terribly bad thing to cope with for me, especially in light of the lousy weight GAIN situation with most of the SSRIs. These appetite/weight loss issues are very similar to the ones I was getting with Ritalin/Concerta. Sleep is an interesting deal...I can fall asleep very easily in the evening, but I tend to wake up after about 6 or 7 hours. To put this in perspective, I used to sleep 9 to 11 hours a night prior to Strattera, so from my and my wife's perspective this is a good thing.
Aside from these issues, the good effects contnue. I'm much better able to focus, my task completion quotient is much higher, I'm not as prone to "drift off" during conversations or tasks that need focus, and I can tolerate frustration more easily. My wife notes that I'm not as quick to anger as I was prior to Strattera, and there has been a very pleasant positive synergy between my wife and I. Our relationship is much better than it was a month ago! She is not as tense waiting for my next outburst and so she is more relaxed and receptive to me.
I'm going to try going to 80mg/day within the next week or so just to see what will happen. If the side effects get worse with no appreciable gain in the positive effects, I'll drop back to 60.
All in all, I'd rate Strattera a solid 9 out of 10 for me.
I'm a 50 year old male 175lbs. diagnosed with severe ADD and my pdoc is following me very closely as I am his "guinea pig" for Strattera. He is beginning to talk about going to Strattera as his 1st line drug of choice for ADD/ADHD instead of stims if my and his other early Strattera adopters continue to do well. Maybe it's time to buy stock in Lilly! :-D
Cheers,
HADD Enough
Posted by zenclear on February 28, 2003, at 14:03:33
In reply to Strattera - 4 week report and sleep » JohnnyB, posted by HADD Enough on February 28, 2003, at 11:59:14
Glad it works well for you!
If only you'd said the DRY SKIN side effect had gone away. That's the one prohibitive problem for me, as it exacerbates many underlying sensitivites.
Posted by HADD Enough on February 28, 2003, at 17:28:44
In reply to Re: Strattera - 4 week report and sleep » HADD Enough, posted by zenclear on February 28, 2003, at 14:03:33
Sorry to hear that the dry skin is a show-stopper for you. For what it's worth, my pdoc did say that if Strattera continues to be a success for ADD/ADHD then it will be only a matter of time before more similar drugs begin to hit the market. He noted the evolutionary way the neurotransmitter-altering drugs are progressing. He noted that the "selective" in selective reuptake inhibitors is getting better so that each new generation of drug is better focused in its good effects and produces fewer side-effects. Hopefully, there will be a drug in the not-too-distant future that will provide the positive effects you need without the bad ones. Hang in there and good luck!
Cheers,
HADD Enough
Posted by JohnnyB on March 2, 2003, at 10:18:09
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
Day 9: I got ss little as two hours of sleep night before last. The most sleep I've gotten since starting this med is 4.5 and that was last night, so maybe the insomnia is retreating. I took 1200 mg. of calcium and 600 mg. of magnesium yesterday, as per some sleep experts.
I called my doc's office on Friday and spoke with the nurse (my PCP left town for two weeks after prescribing Strattera for me). The nurse said that the doc who is covering for my PCP instructed me not to split the 18 mg. because it will delay or arrest the passing of the side effects. She told me to stop by and pick some sleep med samples they had for me. It turned out to be Zyprexa which is designed for schizophrenia and appears to carry some scary side effects. One person on an insomnia message board said she slept well on Zyprexa, but when she stopped taking it, she couldn't sleep at all for a month. I didn't take the Zyprexa.
Well, I can't function on even 18 mg. of Strattera. I get quite listless, my responses are delayed, flat affect, a friend told me my speech was slurred, and my ability to focus is terrible. It seems to amplify my ADD sx. 9 mg. is quite managable. I took 18 on day 5, 9 on days 6 & 7, and 18 on day 8 (as per doc's instructions). I was a mess yesterday untill it started to wear off around 4:00 P.M. Today, I will try 9 in the morning and 9 in the early afternoon.
Posted by not exactly on March 2, 2003, at 17:16:06
In reply to Strattera/sleep update, posted by JohnnyB on March 2, 2003, at 10:18:09
> I called my doc's office on Friday and spoke with the nurse (my PCP left town for two weeks after prescribing Strattera for me). The nurse said that the doc who is covering for my PCP instructed me not to split the 18 mg. because it will delay or arrest the passing of the side effects. She told me to stop by and pick some sleep med samples they had for me. It turned out to be Zyprexa...
Your substitute doc sounds like a real loser:
* advising _against_ discontinuing or reducing dose of a med that you are having a serious allergic reaction to
* prescribing an _antipsychotic_ to counter the insomnia s/e> I didn't take the Zyprexa.
Good for you! Although it's generally a good idea to follow your doctor's advice, this doesn't mean that you should ignore your own better judgement. The Zyprexa could have interacted unfavorably with the Strattera and/or caused additional problematic s/e's.
> Today, I will try 9 in the morning and 9 in the early afternoon.
If you can tolerate 9 mg/day of Strattera, I would think that the prudent course of action would be to stay at that level until you repay your sleep debt before considering any dose increment.
- Bob
Posted by teacherkris on March 3, 2003, at 20:27:34
In reply to Strattera/sleep update, posted by JohnnyB on March 2, 2003, at 10:18:09
Hi everyone, I've been reading these posts after someone put the link in at the healthyboards posts. I started Strattera almost 3 weeks ago now. My doctor started me extremely slow and I was irritated about it in the beginning. I started with 10 mg once a day for 7 days, then 10 mg in the am and 10 mg pm for 10 days, now yesterday I started 20 mg am and 10 mg pm, next week I'll go to 20 mg am 20 mg pm and then we'll meet again. Although I was frustrated with the slow start up I am happy I'm taking my time after reading some of the posts. I want this medicine to work so I'll take as long as it needs. As for side effects the only ones I've had are dizziness, some sleepiness and possibly irritability. I think it's hard to decide where irritability comes from! :-) Anyway, today I decided to try just taking half my concerta dose (normally 72/day) and see if any of the strattera was kicking in, it went great! I'm so excited. I felt calm and focused all day. If this is how it's going to be I'm thrilled and I'm not even at a therapeutic level yet. I also take zoloft 50 mg and I'm trying to get off of that so we'll see how that goes, but I only do one thing at a time so that's down the road. Anyway, sorry for the long winded post, I hope others keep posting their updates and I'll keep posting mine. For those who have commented that people seem to be having trouble with strattera I was thinking about something last night. We all tend to do something if we don't like how things are going but if things are good we do nothing. The only reason I sought out these boards is because I was having side effects, if I wasn't I wouldn't have put in the time so maybe that's why? Just a thought. Hope everyone else is doing well!
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