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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Zoomzoom on November 30, 2008, at 10:06:49
Hi,
I've been on Cymbalta for just over three weeks.
The first week at 30mg I felt weak and the second week I felt
better than I have felt in years. It was remarkable.
The third week I started the 60mg pill as instructed. I am on the
9th day of the 60mg. The weakness, plus a shakiness feeling have returned but is not exclusively below the neck so to say:
My head and organization performance are a bit frazzled and shaky. The details here perhaps are not important. I just don't know whether this will lift-off the way it did with the 30mg on the second week (and I realize that whatever i experienced the 2nd week was still very EARLY), or if I am
"over dosing?" The weakness is perhaps increasing, or becoming the norm, it is unpleasant.
The pharmacist and my doc tell me it's my choice whether to
continue to see with the 60mg or go back to the 30mg. I understand that i can always increase to 60 later, should i revert to 30's now.
But I dont want to go through this difficult stage again. However no one seems to know if the 60's are just wrong for me, or if this is an adjustment period.
What do you think? Thank you so much.
Posted by bleauberry on November 30, 2008, at 10:40:04
In reply to Cymbalta overdose/rejection?, posted by Zoomzoom on November 30, 2008, at 10:06:49
Ask ten different doctors or people and you'll get a variety of different opinions. Ok, so this is just mine.
With any medication, the lowest effective dose is the best dose.
These meds take 6 to 12 weeks to fully manifest themselves, while early hints can be seen by week 1 or week 2.
At other forums I have seen people do very well on 15mg cymbalta, or 5mg prozac, or 3mg lexapro, where they did poorly at the so-called therapeutic doses.
With all this taken into perspective, it would seem to me to make sense to return to 30mg and stay there for at least 6 weeks before making a decision on any dose changes. You already saw hints of good things happening. See if that trend continues.
There have been numerous studies on a wide variety of meds that compared two things: 1)Continiued treatment at a partial-response dose, versus 2)a higher dose. In most cases, the continued treatment at the lower dose was equally as effective as the higher dose, except that it took longer to get there and it had far fewer side effects. In other words, 12 weeks at 30mg cymbalta stands a good chance of being as good as 6 weeks of 60mg.
You have to be your own judge. These are just some thoughts to ponder. Personally I would never go to a higher dose unless the lower dose had proven itself unsatisfactory. Two weeks is not enough time to prove that one way or the other. I would never go to a higher dose just because that's what the manufacturer says to do, or because a doctor is following pharm rep instructions, or just because it is the so-called correct way to do things, or just because that's what someone else did. There is no correct way. Nobody knows you better than you. Not your doctor or the drug manufacturer or the person who wrote the drug label's dosing instructions.
Posted by desolationrower on November 30, 2008, at 11:06:32
In reply to Re: Cymbalta overdose/rejection?, posted by bleauberry on November 30, 2008, at 10:40:04
I think bleuberry is right. Patients need to be clear about how drugs affect them. Doctors have experience with others that we don't have, but they don't know how much the drug is doing unless we tell them; it isn't like a wound where the surgeon can look and see if it is cleaned and sewn up, your brain is your own. I like to think of dosage increases as options to keep around in case. Personally, my response to meds is usually to wonder if they are doing much at all or just a sugar pill, so i'm the sort taht will keep increasing dosage. But for people who have strong responses, positive and negative, i think being less aggressive with dosing is a better idea. What may happen is the effect evens out at the 30mg dosage after a few more weeks, and you decide you need a stronger effect; your body will be a bit more adjusted and the side effects less as you transition up. But if you can get full benefit with less drug, that woudl be good too.
-d/r
Posted by Phillipa on November 30, 2008, at 12:43:13
In reply to Re: Cymbalta overdose/rejection?, posted by desolationrower on November 30, 2008, at 11:06:32
Agree with both of you. Why go higher if the lower dose was working. I had one doc that said to go to 120mg of cymbalta in a month. Well I'd taken 60mg a year or so before for over three months noticed nothing. He insisted I go to 120 it scared me so much couldn't tolerate the 30mg so aborted the trial. We're all different. Good luck and welcome to babble. Love Phillipa
Posted by Zoomzoom on November 30, 2008, at 13:39:19
In reply to Re: Cymbalta overdose/rejection?, posted by Phillipa on November 30, 2008, at 12:43:13
Thank you, thank you all,If I go down to 30mg, should i begin immediately at my next dose time? Is there any point in skipping one day so the excess can dissipate? (Cause the doc left the decision to me, I have a script for 30mg OR 60mg. Except the only thing is I'm not in my province (state) so I can't fill the script till tomorrow night, can I break open and divide a capsule of 60mg??)
I just wanna say that despite the points that: 1) we're all different and 2) The lowest effective dose is often the best.
The reason why I would or did consider continuing with the 60's is to explore the optimal result. At this stage, and considering everything you all have said, would you say my persistence and my concept of "optimal result," is just erroneous?Trying to absorb all this....
Thank you....
Posted by bleauberry on November 30, 2008, at 14:59:51
In reply to Re: Cymbalta overdose/rejection?, posted by Zoomzoom on November 30, 2008, at 13:39:19
You kind of have to follow your gut instincts on whether to stay at 60mg or return to 30mg. Even the doctor and pharmacist gave you that option, so it's up to you.
If going back down to 30mg, yes, you can split capsules. It might make the transition smoother. I mean, in my experience, even a couple days on cymbalta lowered to a lower dose can feel lousy. Kind of flu-like, headachy, jittery. Hopefully not with you. I am sensitive.
Anyway, inside a capsule are hundreds of tiny beads. Each one is enteric coated, so they dissolve in your intestines. Stomach acid would destroy them without the enteric coating. They need to get past the stomach and into the intestines where they then absorb. The capsule itself is not enteric coated, just the beads.
Approximately 10 beads equals 1mg. Or you can just roughly divide them up on a plate. Reload the desired beads into an empty gel cap, or sprinkle them on applesauce or yogurt and swallow without chewing. For example, you could do 45mg as a stepping stone down to 30mg.
Posted by Zoomzoom on December 1, 2008, at 1:34:17
In reply to Re: Cymbalta overdose/rejection? » Zoomzoom, posted by bleauberry on November 30, 2008, at 14:59:51
VERY HELPFUL, THANK YOU.
Posted by Racer on December 6, 2008, at 11:13:22
In reply to Re: Cymbalta overdose/rejection?, posted by Zoomzoom on November 30, 2008, at 13:39:19
> If I go down to 30mg, should i begin immediately at my next dose time? Is there any point in skipping one day so the excess can dissipate?
No, you don't want to skip a day. The shortish half-life of Cymbalta means that it's best to take it every day -- skipping a day can lead to some discomfort from the "discontinuation syndrome." (That's the euphemism for withdrawal. ;-) Sounds much more scientific, you know.)
> The reason why I would or did consider continuing with the 60's is to explore the optimal result. At this stage, and considering everything you all have said, would you say my persistence and my concept of "optimal result," is just erroneous?
>Erroneous in the sense that more is not necessarily better. Many of these drugs have a pretty distinct therapeutic window, and too much can be as ineffective as too little. It's hard to know sometimes whether your lack of adequate response is caused by too low a dose, too short a trial, or just the wrong drug. That's the frustration of a lot of these drugs -- it's all trial and error, and it's best to extend a trial to at least 6 weeks.
Your optimal dose of Cymbalta may be 30mg, it may be higher, it may even be lower. The only way to know is to experiment -- but don't make a lot of changes. Stick with a dose for about 6 weeks before changing. If you felt the 30mg was starting to do something for you, then it's worth going back to revisit that dose and see what happens.
Also, if it turns out you do need to raise the dose, you might ask your doctor about raising in stages -- 1-30mg capsule, to 2-20mg capsules, to 1-30mg and 1-20mg, etc. Again -- it's all pretty individual, and sometimes a lower dose is optimal.
Best luck to you!
Posted by Zoomzoom on December 14, 2008, at 22:06:26
In reply to Re: Cymbalta overdose/rejection? » Zoomzoom, posted by bleauberry on November 30, 2008, at 14:59:51
Thank you Racer, that was VERY helpful.
Although I have new questions. I will start a new thread called "Is cymbalta working for me?" I'm not exactly sure what is the best way to post so that others - not just people linked with this thread can read things??? I'm very much looking forward to your response tho, thanks again.....
> You kind of have to follow your gut instincts on whether to stay at 60mg or return to 30mg. Even the doctor and pharmacist gave you that option, so it's up to you.
>
> If going back down to 30mg, yes, you can split capsules. It might make the transition smoother. I mean, in my experience, even a couple days on cymbalta lowered to a lower dose can feel lousy. Kind of flu-like, headachy, jittery. Hopefully not with you. I am sensitive.
>
> Anyway, inside a capsule are hundreds of tiny beads. Each one is enteric coated, so they dissolve in your intestines. Stomach acid would destroy them without the enteric coating. They need to get past the stomach and into the intestines where they then absorb. The capsule itself is not enteric coated, just the beads.
>
> Approximately 10 beads equals 1mg. Or you can just roughly divide them up on a plate. Reload the desired beads into an empty gel cap, or sprinkle them on applesauce or yogurt and swallow without chewing. For example, you could do 45mg as a stepping stone down to 30mg.
This is the end of the thread.
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