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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 48. Go back in thread:
Posted by SLS on June 6, 2005, at 16:39:21
In reply to Neurontin to Topomax, posted by Larry Hoover on June 6, 2005, at 12:46:58
Hi Larry.
What a yummy list.
How does your titration schedule compare to the one below?
http://www.postgradmed.com/issues/2002/01_02/beydoun.htm
"Topiramate has significant efficacy when used as adjunctive therapy (15). Because of potential adverse cognitive events, it should be started at a low dose, with gradual adjustment in dosage thereafter. A starting dose of 25 or 50 mg per day is appropriate, with weekly increments of 25 to 50 mg per day. The usual target dose for adjunctive therapy is 400 mg taken twice daily, with a dose range between 100 and 1,000 mg per day."
What is the Topamax for?
Have you thought to try Trileptal. Most people have good things to say about it - including me.
- Scott
- Scott
Posted by SLS on June 6, 2005, at 16:42:08
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 13:02:42
Sorry. I didn't read this post before submitting mine. I have to parcel out my mental energy, so I can't read everything.
Try Cymbalta or Lyrica.
- Scott
> > Dear Lar,
> >
> > Are you taking Topamax for pain?? The side effects sound horrible, perhaps you should stick with the oxycodone!
> >
> > Ed.
>
> The intention is to treat the nerve pain. The oxycodone really doesn't do much more than to "round the edges" off of that. I'm already at the practical limit of oxycodone, I imagine. At least, the practical prescribing limit? I see my doctor tomorrow. I've only been on the topomax since Friday. It is a horror show of side effects, but it actually works for the nerve pain, believe it or not. So did the gabapentin. It's the side effects that are unbearable.
>
> On topomax, I remain tender at the site of the nerve injury. If I bump it, it will hurt like the dickens. But the chronic pain part goes away, with the topomax. I'm truly between a rock and a hard place right now. And I'm at my limit.
>
> My doctor had talked about valproic acid. Ever heard of it used this way?
>
> Lar
>
>
Posted by Larry Hoover on June 6, 2005, at 17:03:55
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by ed_uk on June 6, 2005, at 14:08:57
> Hi Lar!
>
> >I'm only at 75 mg/day........
> >I've only been on the topomax since Friday.............
>
> Oops, I didn't notice that!!!!!
>
> Maxi is absolutely right. Most people need to titrate Topamax VERY gradually. Perhaps you could return to 25mg and increase more gradually eg. 25mg/day every *two weeks*. Some people titrate even more gradually than this!
>
> Ed.Aaaaak!
Maybe that's the problem!
Morontin to Stupimax, and I've messed up the friggin titration schedule.
I did not get instructions to only take 25 mg/day for a week.
I was told to start at 25 mg b.i.d. for a week, and I think one day I messed up and took it twice, and thus I related my side effects to 75 mg. I'm not even sure I took 75. It might only have been 50 all along. But NOBODY TOLD ME TO START AT TWENTY FIVE! NOBODY TOLD MR. FRIGGIN SIDE EFFECT TO START AT 25!
<RANT MODE OFF>
Thanks all.
Now I don't know what to do. I had made up my mind to simply ditch this sh*t. Probbly will, anyway.
Lar
Posted by Larry Hoover on June 6, 2005, at 17:06:39
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by SLS on June 6, 2005, at 16:39:21
> Hi Larry.
>
> What a yummy list.
>
> How does your titration schedule compare to the one below?
>
> http://www.postgradmed.com/issues/2002/01_02/beydoun.htm
>
> "Topiramate has significant efficacy when used as adjunctive therapy (15). Because of potential adverse cognitive events, it should be started at a low dose, with gradual adjustment in dosage thereafter. A starting dose of 25 or 50 mg per day is appropriate, with weekly increments of 25 to 50 mg per day.Thanks, Scott. A yummy list, indeed. But, according to crazymeds, and other sources, as I don't have temporal problems, it's not the right med for me.
Lar
Posted by Larry Hoover on June 6, 2005, at 17:11:25
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by ed_uk on June 6, 2005, at 14:02:17
> Hi Lar,
>
> >My doctor had talked about valproic acid. Ever heard of it used this way?
>
> Yes.....but AFAIK, it's not often prescribed for this purpose - at least not in the UK. I suppose you've already tried Tegretol. Trileptal might also be helpful, it generally seems to have less side effects than Tegretol. Nortriptyline or desipramine can be effective for neuropathic pain, they seem to be better tolerated than amitriptyline. I've got a feeling that you said you can't tolerate TCAs though.Thanks for helping me, Ed. I can't think well right now. The neurologist mentioned nortriptyline, but I was kind of put off by the potential anticholinergic effects. Does it have many? Or was my reaction out of line?
> >The oxycodone really doesn't do much more than to "round the edges" off of that. I'm already at the practical limit of oxycodone, I imagine.
>
> RE OxyContin........
>
> The manufacturer suggests that most patients never need more than 400mg oxycodone/24hours.....I've never heard of anyone taking more than 1000mg/24hours. As you know, most people take much less than this.Whoa.... I've got room, there, after all. I'm not even close. It's my doctor that is limited. Maybe I need a referral to a pain specialist. Or a copy of the manufacturer's recommendations.
> Kind regards,
> Ed.Thanks, buddy. I see my doctor in eighteen hours, after (hopefully) a good sleep. I need to put together at least one good proposal for where we go from here.
Lar
Posted by ed_uk on June 6, 2005, at 17:12:54
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 17:03:55
Hi Lar,
>I did not get instructions to only take 25 mg/day for a week.
A lot of people seem to stay at 25mg for two weeks! Go VERY slow, it really helps :-) It sounds like a low dose will be sufficient to control your pain.
>Now I don't know what to do.
You could start taking 25mg at night and see how it goes. If necessary, you could get the 15mg caps to aid titration.
Kind regards,
Ed.
Posted by Larry Hoover on June 6, 2005, at 17:31:17
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by ed_uk on June 6, 2005, at 17:12:54
> Hi Lar,
>
> >I did not get instructions to only take 25 mg/day for a week.
>
> A lot of people seem to stay at 25mg for two weeks! Go VERY slow, it really helps :-) It sounds like a low dose will be sufficient to control your pain.
>
> >Now I don't know what to do.
>
> You could start taking 25mg at night and see how it goes. If necessary, you could get the 15mg caps to aid titration.
>
> Kind regards,
> Ed.The very first dose of 25 mg made me feel like I had food poisoning. It wasn't until I realized that the side effects were stable over time that I was certain that they were associated with the topiramate. I cannot believe that this medication is going to be one that I tolerate nicely.
For example, I forgot to add a new side effect to the list....oligohydrosis (decreased sweating). It was very hot and humid today. I do not have air conditioning in my car, and it is painted a very dark colour. I normally sweat *buckets*. My skin was dry, and very warm and flushed. Not good. Not good at all. I was half way to hyperthemia from a 45 minute outing.
Time to move on to a different med.
Lar
Posted by ed_uk on June 6, 2005, at 17:47:46
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 17:11:25
Hi Lar!
>The neurologist mentioned nortriptyline, but I was kind of put off by the potential anticholinergic effects. Does it have many?
Although it often causes dry mouth and constipation, it's quite a lot less anticholinergic than most TCAs. Low doses can be useful for pain, an initial dose of 10mg/day could be useful. Nortriptyline is essentially a norepinephrine reuptake inhibitor, 'pseudo-anticholinergic' side effects may occur as a result. Given your previous (bad!) responses to various antidepressants, I wondered whether you might be uncomfortable taking nortriptyline. Nevertheless, it does seem to be quite an effective antidepressant...........it's also sometimes useful for relieving the pain and diarrhea of IBS.
From Martindale............
Studies in vitro showed antidepressant affinities for human muscarinic acetylcholine receptors and therefore the likelihood of antimuscarinic effects to be, in *descending* order:
amitriptyline
protriptyline
clomipramine
trimipramine
doxepin
imipramine
nortriptyline
desipramineDesipramime, another norepinephrine reuptake inhibitor, is also sometimes effective for neuropathic pain. It is less likely to cause sedation than nortriptyline. Desipramine is sometimes quite 'activating' - it can cause insomnia. Nortriptyline is much less sedating than trimipramine- which I believe you've taken in the past.
Scott mentioned Cymbalta. I wondered whether you might be uncomfortable taking an SNRI given your previous bad reactions to SSRIs. I suppose you could start Cymbalta at a VERY low dose and see how it goes.
If you want to try another anticonvulsant, I think Trileptal is worth considering. What do you think??? Depakote is another option - you said your doc suggested it.
>Whoa.... I've got room, there, after all. I'm not even close.
Like morphine, oxycodone does *not* have a maximum dose. Provided that it is titrated *gradually*, tolerance develops to the respiratory depressant effect of the drug, allowing the dose to be increased as required.
RE morphine, doses in excess of 2500mg every four hours have been recorded!!! Obviously, such a high dose would be rapidly fatal to a person who was not tolerant to the respiratory depressant effect of morphine.
>Maybe I need a referral to a pain specialist.
That could be very useful :-)
>Or a copy of the manufacturer's recommendations.
Here is the UK data sheet........
http://emc.medicines.org.uk/emc/industry/default.asp?page=displaydoc.asp&documentid=2579
Kind regards,
Ed.
Posted by ed_uk on June 6, 2005, at 17:52:08
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 17:31:17
Hi Lar,
>I cannot believe that this medication is going to be one that I tolerate nicely.
Me neither :-(
>oligohydrosis........
Can be dangerous, permanent neuro damage has been reported to have occured following topiramate-induced hyperthermia. Topiramate is thought to decrease sweating by acting as a carbonic anhydrase inhibitor.
Kind regards,
Ed.
Posted by Maxime on June 6, 2005, at 17:53:56
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 17:31:17
Hi Larry. If you do decide to stay on, make sure you drink LOTS of water. Many people develop UTIs and even kidney stones from the med. When I was on it I had a very bad UTI. Then the med made me go psychotic and I ended up in the hospital.
Not my favourite med either. :-)
Maxime
> > Hi Lar,
> >
> > >I did not get instructions to only take 25 mg/day for a week.
> >
> > A lot of people seem to stay at 25mg for two weeks! Go VERY slow, it really helps :-) It sounds like a low dose will be sufficient to control your pain.
> >
> > >Now I don't know what to do.
> >
> > You could start taking 25mg at night and see how it goes. If necessary, you could get the 15mg caps to aid titration.
> >
> > Kind regards,
> > Ed.
>
> The very first dose of 25 mg made me feel like I had food poisoning. It wasn't until I realized that the side effects were stable over time that I was certain that they were associated with the topiramate. I cannot believe that this medication is going to be one that I tolerate nicely.
>
> For example, I forgot to add a new side effect to the list....oligohydrosis (decreased sweating). It was very hot and humid today. I do not have air conditioning in my car, and it is painted a very dark colour. I normally sweat *buckets*. My skin was dry, and very warm and flushed. Not good. Not good at all. I was half way to hyperthemia from a 45 minute outing.
>
> Time to move on to a different med.
>
> Lar
>
Posted by SLS on June 6, 2005, at 17:56:10
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 17:31:17
Larry,
> Time to move on to a different med.
I don't know if you noticed in one of my posts that I offered as suggestions either Cymbalta or Lyrica.
- Scott
Posted by Phillipa on June 6, 2005, at 17:57:18
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by Maxime on June 6, 2005, at 17:53:56
Scott may have been on to something with the cymbalta. The one good thing that it did for me was I no longer had any muscle, bone, or joint pain. I didn't realize this until I went off it and they all came back. Fondly, Phillipa
Posted by Larry Hoover on June 6, 2005, at 18:02:24
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by SLS on June 6, 2005, at 17:56:10
> Larry,
>
> > Time to move on to a different med.
>
> I don't know if you noticed in one of my posts that I offered as suggestions either Cymbalta or Lyrica.
>
>
> - ScottI appreciate the thought, Scott, by neither one is available in Canada.
Lar
Posted by Larry Hoover on June 6, 2005, at 18:04:09
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by ed_uk on June 6, 2005, at 17:52:08
> Hi Lar,
>
> >I cannot believe that this medication is going to be one that I tolerate nicely.
>
> Me neither :-(
>
> >oligohydrosis........
>
> Can be dangerous, permanent neuro damage has been reported to have occured following topiramate-induced hyperthermia. Topiramate is thought to decrease sweating by acting as a carbonic anhydrase inhibitor.
>
> Kind regards,
> Ed.As soon as I noticed it, I *mentally* blanched. My skin didn't, of course. I immediately knew the consequences.
No way I'm playing around with temperature regulation.
Lar
Posted by Larry Hoover on June 6, 2005, at 18:13:29
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by ed_uk on June 6, 2005, at 17:47:46
> Desipramime, another norepinephrine reuptake inhibitor, is also sometimes effective for neuropathic pain. It is less likely to cause sedation than nortriptyline. Desipramine is sometimes quite 'activating' - it can cause insomnia. Nortriptyline is much less sedating than trimipramine- which I believe you've taken in the past.
I still take trimipramine, 25 mg QHS. Back on 30 mg temazepam QHS as well, as the Imovane interacted adversely with the Neurontin. Maybe the Imovane caused some of the problems I attributed to Neurontin? It all gets so friggin complicated. What role does the oxycodone play?
> Scott mentioned Cymbalta.
Not available in Canada, yet.
> If you want to try another anticonvulsant, I think Trileptal is worth considering. What do you think??? Depakote is another option - you said your doc suggested it.I dunno what to think about anticonvulsants. I've not had good luck with them so far. I've not looked to them on purpose, ya know?
> >Whoa.... I've got room, there, after all. I'm not even close.
>
> Like morphine, oxycodone does *not* have a maximum dose. Provided that it is titrated *gradually*, tolerance develops to the respiratory depressant effect of the drug, allowing the dose to be increased as required.Maybe that's the answer. The problem is, I don't like the psychoactive effect at all. I know, properly titrated, the psychoactive effect is minimized.....but as the dose escalates, it does get harder to manage, in some respects. I've been using the IR product. Maybe it's time to switch to the XR, or the Contin format.
> RE morphine, doses in excess of 2500mg every four hours have been recorded!!! Obviously, such a high dose would be rapidly fatal to a person who was not tolerant to the respiratory depressant effect of morphine.
Thanks. I grock it. (For any Heinlein fans.)
> >Maybe I need a referral to a pain specialist.
>
> That could be very useful :-)If the queue isn't too lengthy.
> >Or a copy of the manufacturer's recommendations.
>
> Here is the UK data sheet........Ta.
http://emc.medicines.org.uk/emc/industry/default.asp?page=displaydoc.asp&documentid=2579
>
> Kind regards,
> Ed.Thanks, buddy.
Lar
Posted by ed_uk on June 6, 2005, at 18:33:44
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 18:13:29
Hi Lar!
>I've been using the IR product. Maybe it's time to switch to the XR, or the Contin format.
.........could be useful. You could take additional dose of IR oxycodone 'when required'.
Ed.
Posted by Maxime on June 6, 2005, at 18:55:13
In reply to Re: Neurontin to Topomax » SLS, posted by Larry Hoover on June 6, 2005, at 18:02:24
Larry, Cymbalta will be available in Canada by July.
Maxime
> > Larry,
> >
> > > Time to move on to a different med.
> >
> > I don't know if you noticed in one of my posts that I offered as suggestions either Cymbalta or Lyrica.
> >
> >
> > - Scott
>
> I appreciate the thought, Scott, by neither one is available in Canada.
>
> Lar
>
>
Posted by Larry Hoover on June 6, 2005, at 18:55:19
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by ed_uk on June 6, 2005, at 18:33:44
> Hi Lar!
>
> >I've been using the IR product. Maybe it's time to switch to the XR, or the Contin format.
>
> .........could be useful. You could take additional dose of IR oxycodone 'when required'.
>
> Ed.Having had the good response to the other non-opioid agents, though, I wonder if that's the best strategy. I wish I knew why I am Mr. Side Effect. Which drug? I know that's always the problem, but my sensitivity to both low-dose Neurontin and Topomax are exasperating.
Lar
Posted by ed_uk on June 6, 2005, at 19:14:15
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 18:55:19
Hi Lar,
>Having had the good response to the other non-opioid agents, though, I wonder if that's the best strategy.
You could try another antiepileptic!!
About Trileptal........
J Pain Symptom Manage. 2003 May;25(5 Suppl):S31-5.
Rationale and evidence for the use of oxcarbazepine in neuropathic pain.Carrazana E, Mikoshiba I.
Neuroscience, Clinical Development and Medical Affairs, Novartis Pharmaceuticals, East Hanover, NJ 07936-1080, USA.
Oxcarbazepine is a second-generation antiepileptic drug (AED) with proven efficacy in managing partial epileptic seizures, with or without secondary generalization, in adults and children. The overlap between the underlying pathophysiologic mechanisms of some epilepsy models and neuropathic pain models supports the rationale for using certain AEDs in the treatment of neuropathic pain. Several AEDs have reportedly produced analgesia in a range of neuropathic pains, including painful diabetic neuropathy (PDN) and post-herpetic neuralgia. Increasing evidence suggests that oxcarbazepine can provide significant analgesia in several neuropathic pain conditions, including trigeminal neuralgia and PDN, and is also may be effective in treating neuropathic pain refractory to other AEDs, such as carbamazepine and gabapentin. The analgesic effects of oxcarbazepine, and its generally improved safety and tolerability profile compared with other standard AEDs, suggests that oxcarbazepine will be an important addition to the neuropathic pain armamentarium. The rationale and evidence to support the efficacy of oxcarbazepine are presented here.
Kind regards,
Ed.
Posted by Larry Hoover on June 6, 2005, at 19:58:07
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by ed_uk on June 6, 2005, at 19:14:15
> Hi Lar,
>
> >Having had the good response to the other non-opioid agents, though, I wonder if that's the best strategy.
>
> You could try another antiepileptic!!
>
> About Trileptal........
>
> J Pain Symptom Manage. 2003 May;25(5 Suppl):S31-5.
>
> Rationale and evidence for the use of oxcarbazepine in neuropathic pain.
>
> Carrazana E, Mikoshiba I.
>
> Neuroscience, Clinical Development and Medical Affairs, Novartis Pharmaceuticals, East Hanover, NJ 07936-1080, USA.
>
> Oxcarbazepine is a second-generation antiepileptic drug (AED) with proven efficacy in managing partial epileptic seizures, with or without secondary generalization, in adults and children. The overlap between the underlying pathophysiologic mechanisms of some epilepsy models and neuropathic pain models supports the rationale for using certain AEDs in the treatment of neuropathic pain. Several AEDs have reportedly produced analgesia in a range of neuropathic pains, including painful diabetic neuropathy (PDN) and post-herpetic neuralgia. Increasing evidence suggests that oxcarbazepine can provide significant analgesia in several neuropathic pain conditions, including trigeminal neuralgia and PDN, and is also may be effective in treating neuropathic pain refractory to other AEDs, such as carbamazepine and gabapentin. The analgesic effects of oxcarbazepine, and its generally improved safety and tolerability profile compared with other standard AEDs, suggests that oxcarbazepine will be an important addition to the neuropathic pain armamentarium. The rationale and evidence to support the efficacy of oxcarbazepine are presented here.
>
> Kind regards,
> Ed.I really appreciate the effort, Ed.
When I checked the monograph for Trileptal, however, the frequencies for e.g. nausea and dizziness are greater for this med than for Topomax. How does that come through as being more tolerable?
Lar
Posted by Maxime on June 6, 2005, at 20:11:39
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 19:58:07
Hi Larry. I take Trileptal and the nausea and dizziness went away in about a week. Plus I take it at night so it wasn't too much of an issue. Tegretol I couldn't even walk straight on. I've been on all the mood stabilisers available in Canada and Trileptal has been the best one for me in terms of effect and side effects.
Maxime
> > Hi Lar,
> >
> > >Having had the good response to the other non-opioid agents, though, I wonder if that's the best strategy.
> >
> > You could try another antiepileptic!!
> >
> > About Trileptal........
> >
> > J Pain Symptom Manage. 2003 May;25(5 Suppl):S31-5.
> >
> > Rationale and evidence for the use of oxcarbazepine in neuropathic pain.
> >
> > Carrazana E, Mikoshiba I.
> >
> > Neuroscience, Clinical Development and Medical Affairs, Novartis Pharmaceuticals, East Hanover, NJ 07936-1080, USA.
> >
> > Oxcarbazepine is a second-generation antiepileptic drug (AED) with proven efficacy in managing partial epileptic seizures, with or without secondary generalization, in adults and children. The overlap between the underlying pathophysiologic mechanisms of some epilepsy models and neuropathic pain models supports the rationale for using certain AEDs in the treatment of neuropathic pain. Several AEDs have reportedly produced analgesia in a range of neuropathic pains, including painful diabetic neuropathy (PDN) and post-herpetic neuralgia. Increasing evidence suggests that oxcarbazepine can provide significant analgesia in several neuropathic pain conditions, including trigeminal neuralgia and PDN, and is also may be effective in treating neuropathic pain refractory to other AEDs, such as carbamazepine and gabapentin. The analgesic effects of oxcarbazepine, and its generally improved safety and tolerability profile compared with other standard AEDs, suggests that oxcarbazepine will be an important addition to the neuropathic pain armamentarium. The rationale and evidence to support the efficacy of oxcarbazepine are presented here.
> >
> > Kind regards,
> > Ed.
>
> I really appreciate the effort, Ed.
>
> When I checked the monograph for Trileptal, however, the frequencies for e.g. nausea and dizziness are greater for this med than for Topomax. How does that come through as being more tolerable?
>
> Lar
>
>
Posted by ed_uk on June 6, 2005, at 20:16:49
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 19:58:07
Hi Lar,
>When I checked the monograph for Trileptal, however, the frequencies for e.g. nausea and dizziness are greater for this med than for Topomax. How does that come through as being more tolerable?
Well, it does seem to be more tolerable than Tegretol!
A lot of babblers seem to have initiated Trileptal at very low doses and increased gradually. Most people seem to have tolerated it quite well. Maxime finds it useful for hypomania, perhaps you could talk to her about it.
How do you feel about nortriptyline/desipramine?
Kind regards,
Ed.
Posted by ed_uk on June 6, 2005, at 20:21:04
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by ed_uk on June 6, 2005, at 20:16:49
>perhaps you could talk to her about it........
Maxi already came to the rescue!!!
Ed
Posted by Larry Hoover on June 7, 2005, at 7:59:03
In reply to Re: Neurontin to Topomax » Larry Hoover, posted by Maxime on June 6, 2005, at 20:11:39
> Hi Larry. I take Trileptal and the nausea and dizziness went away in about a week. Plus I take it at night so it wasn't too much of an issue. Tegretol I couldn't even walk straight on. I've been on all the mood stabilisers available in Canada and Trileptal has been the best one for me in terms of effect and side effects.
>
> MaximeThank you for your feedback.
Thank you, everybody.
Inherent in the discussion, it seems, is that feedback tends to come from people who have used these drugs for mood effects. My mood is within stable parameters already. I need a drug for an off-label use. I don't need a mood stabilizer. Maybe that's why I'm having such a problem with adverse effects.
That said, I will discuss Trileptal, nortryptiline, and my own doctor's earlier recommendation of valproic acid, as possible successors to Topomax.
Lar
Posted by Larry Hoover on June 7, 2005, at 8:12:24
In reply to Re: Neurontin to Topomax, posted by ed_uk on June 6, 2005, at 20:21:04
It is a bizarre place I have been. Sometimes, only hindsight reveals the journey.
I can only say that Topomax required me to expend extremes of energy and focus to achieve only minimal degrees of cognitive performance. In this man's body, I do believe that it deserves its nickname of Stupimax. I also believe that it is little wonder that people lose weight on this stuff, given the degree of GI disturbance wrought by it. I wonder if topiramate is one of the toxic saccharide conjugates released by pathogenic enteric bacteria? <sarcastic>
Anyway, I'm halfway feeling somewhat myself, though still greatly fatigued. Thanks for the help.
Lar
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Dr. Bob is Robert Hsiung, MD,
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