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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by TomV on November 26, 2002, at 21:12:44
I have read everywhere that the maximum Remeron dosage is 45 mg per day (and usually an hour or two before bedtime). Is this known to be true? Has anyone taken more than 45mg? I'm taking 37.5 mg right now and about to go to 45mg. I've got a wierd feeling that I'll need to go over 45mg but that the literature and my Pdoc's opinion will be to stop there and try something else.
Anyway, it seems strange that the starting dose for Remeron is often 30mgs per day, and the max is 45. Not much of a range if you ask me.
Posted by LyndaK on November 27, 2002, at 1:56:47
In reply to Maximum Remeron dosage??, posted by TomV on November 26, 2002, at 21:12:44
I believe that 45mg is the highest dose that the pills come in, but it's not the highest prescribed dose. I'm currently on 60mgs per day; therefore I take two 30mg. pills per day.
Posted by 3 Beer Effect on November 27, 2002, at 2:58:49
In reply to Maximum Remeron dosage??, posted by TomV on November 26, 2002, at 21:12:44
I don't know what the official U.S. prescribing info says but i've read 60 mg is often the max dose used in common clinical practice since 45 mg is often still too sedating.
In Europe, they use higher dosages of Remeron both now & when it went under clinical trials, & 60 mg is a common dose there, especially for males who metabolize the drug at a much faster rate (see prescribing info). I did better on it at 60 mg, & I bet b/c of the use of more reasonable (less sedating) doses that is why Remeron is popular in Europe but a very slow seller (~1.4% of market) in the U.S.
I was on Neurontin 900 mg/day at the same time so I can't tell you if 60 mg was better/less sedating than 45 of Remeron, but from one of those 2 drugs I could never get out of bed & had to switch to Celexa.
3 Beers.
Posted by TomV on November 27, 2002, at 18:18:07
In reply to Re: Maximum Remeron dosage?? » TomV, posted by LyndaK on November 27, 2002, at 1:56:47
Lynda,
How is 60 mgs treating you? I'm still getting mixed results on 37.5 mg. I still feel sedated, although it only lasts until around noon. I've gained about 5 pounds in 2 weeks, so that could probably be worse. I got a positive response around the 5th day at 30mgs, taken 2 hours before bedtime. On the 10th day I upped it by a 1/4 of a pill, since it was starting to poop out. Now I'm due for another increase since it's starting to poop out again (at 14 days). When it works, it works really well.
I'll mention the 2 times a day thing to my Pdoc, which I'm sure will be ok with her if I start heading toward the 45 - 60 mg range.
Posted by ItsHowdyDudyTime on November 27, 2002, at 20:07:40
In reply to Maximum Remeron dosage??, posted by TomV on November 26, 2002, at 21:12:44
> I have read everywhere that the maximum Remeron dosage is 45 mg per day (and usually an hour or two before bedtime). Is this known to be true? Has anyone taken more than 45mg? I'm taking 37.5 mg right now and about to go to 45mg. I've got a wierd feeling that I'll need to go over 45mg but that the literature and my Pdoc's opinion will be to stop there and try something else.
>
> Anyway, it seems strange that the starting dose for Remeron is often 30mgs per day, and the max is 45. Not much of a range if you ask me.
If you dont respond adequately to 45 mg you should be able to go to 60 mg on Remeron. However you might need to go to a more aggressive psychopharmacology type doctor to do this. Some psychiatrists would refuse to go to 60 mg, especially if they are in private practice. But if you push it, you can get it done.You should keep in mind that when you go above the legal PDR dose of 45 mg you are going into a slight "danger" zone but the dangers are in most cases totally manageable if you are under the care of a good psychopharmacologist. You would definitely want to do liver profile tests if you go that high, as high dose Remeron can flare up liver enzymes sometimes. Also, watch the blood pressure on Remeron that high. some might find that high dose Remeron begins to cause mild elevations of BP.
Ive even read of doses of Remeron as high as 90 mg, but that was probably with people who were inpatient and constantly watched.
You can actually go higher than the PDR on all antidepressants. You just have to watch things like liver enzymes, blood pressure, in some cases you might begin to experience some EPS type symptoms with very high dose SSRIs due to dopamine depletion. Also, those with a history of seizures shouldnt normally do this practice of taking higher than PDR doses of antidepressants. You just have to watch things more closely and back off at any sign of problems
Howdy Doody
Posted by LyndaK on November 27, 2002, at 20:27:20
In reply to Re: Maximum Remeron dosage?? » LyndaK, posted by TomV on November 27, 2002, at 18:18:07
> Lynda,
>
> How is 60 mgs treating you? I'm still getting mixed results on 37.5 mg. I still feel sedated, although it only lasts until around noon. I've gained about 5 pounds in 2 weeks, so that could probably be worse. I got a positive response around the 5th day at 30mgs, taken 2 hours before bedtime. On the 10th day I upped it by a 1/4 of a pill, since it was starting to poop out. Now I'm due for another increase since it's starting to poop out again (at 14 days). When it works, it works really well.
>
> I'll mention the 2 times a day thing to my Pdoc, which I'm sure will be ok with her if I start heading toward the 45 - 60 mg range.Actually, I'm not taking it 2 times per day. I'm taking all 60mgs. (2 30mg. pills) at bedtime. I've been on 60mgs. for about a month and a half now and it's still working very well for me -- the best I've felt in a LONG time. I was on 45mgs at least a couple months before it pooped out -- my first sign was that I wasn't sleeping as well anymore, and then my anxiety started getting more troublesome again.
I thought 3 Beer's comment about males metabolizing it faster was very interesting -- might explain why it's pooping out more quickly for you. The sedation was a BIG problem when I first started taking it, but my pdoc warned me about it ahead of time, so I made plans to start it when I had a long weekend to get used to it. Now sedation is not a problem. I feel sleepy about 30 to 45 minutes after taking it which is why I take it at bedtime -- but I'm not sleepy the next day (unless I just stayed up too late and shortchanged my sleep). I've gained 20 pounds since I started it, but my weight has remained stable for at least the past 3 to 4 months. I feel so much better that I don't care that I'm a size or two bigger. I was probably 5 pounds underweight to begin with anyways.
I hope it works for you, but if it doesn't, don't get too discouraged. There's a long list of possibilities where medication is concerned.
Best Wishes,
Lynda
Posted by cubbybear on November 29, 2002, at 1:15:58
In reply to Re: Maximum Remeron dosage?? » TomV, posted by LyndaK on November 27, 2002, at 20:27:20
Hi Lynda,
You probably remember my name from previous postings. I was wondering how you were doing with the Remeron. I see that you're on maximum recommended dose and are feeling great. That's wonderful, and I hope it will contiunue to work for you. You've gained much weight, but if you don't mind, that's all that matters. Feeling good is paramount.
As for me, today is the day I've been waiting for, for a long time-- I get to start MAOI Aurorix. Will let you know how this works out.
Posted by LyndaK on November 29, 2002, at 2:25:15
In reply to Re: Maximum Remeron dosage??, posted by cubbybear on November 29, 2002, at 1:15:58
Yeah, Hi Steve (am I remembering your name right?),
Yes, I'm still doing well on the Remeron. I didn't know that 45mgs was the maximum recommended dose listed in the PDR though. Howdy Doody's post got me worrying a little (guess it hasn't cured that). I am seeing a psychiatrist as the prescribing physician, and he has me come in every 1 to 2 months for follow-up. No one's ever ordered a liver test though. I had my blood pressure checked when I went in for my flu shot; no one commented about it so I assume it was fine.
So today's the big day that you start Aurorix! Wow! That's great! I hope your start-up goes smoothly and that it ends up working well for you in the long haul. Definitely keep me posted!!
Good luck!
Sincerely,
Lynda
This is the end of the thread.
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