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Splitting Dose In Half, Taking It Twice A Day


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#1 ittybittysmitty

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Posted 08 July 2014 - 09:21 AM

Hi everyone,

My pdoc came up with a plan for me to prevent intense rage...maybe a combo of bipolar and discontinuation ...he told me to buy gelcaps and pour half the beads into the gelcap and take it at lunchtime...this is my first day...So far so good. The beads are tricky to deal with..

I'm wondering if anyone has tried this if your dose makes your symptoms intense?

#2 FiveNotions

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Posted 08 July 2014 - 09:31 AM

Ummm, no.... we'll need fishinghat and thismoment to weigh in on this...

One thing that comes to mind is this... you'll need to be careful, very careful, that you divide the beads into two equal amounts... messing with the beads, even a little, might be unwise...just not sure...

Also, remind me please...what dose are you on right now?

Oops...I checked ... you're on 30 mg...

Edited by FiveNotions, 08 July 2014 - 09:33 AM.

#3 FiveNotions

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Posted 08 July 2014 - 09:36 AM

IBS, you're on 30 mg crapalta... but I didn't find in your previous posts what you're doing with the Paxil...are you still on it? What dose? Are you switching over to, or taking, anything else?

You've got a lot going on with managing the bi polar....was the Cymbalta for that, or depression, or something else?

I apologize, I should remember these things, but I've got swiss cheese brain this morning ;-%

#4 fishinghat

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Posted 08 July 2014 - 10:16 AM

IBS

 

I don't see anything wrong with splitting the dose but if your Cymbalta is causing this rage wouldn't it be better to get on a different medicine?


#5 ittybittysmitty

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Posted 10 July 2014 - 10:06 AM

It's taken me awhile to get back to y'all because I've been in a flare...

I'm no longer on Paxil...I'm taking 30 mg of Crapalta split into 2 capsules a day and 40 mg Celexa split into 20s twice a day because of dizziness..

There are no more rage episodes...

My pdoc still hasn't started tapering because i've been so unstable...my next appointment is tomorrow...I really could use some advise on what i should say.

#6 FiveNotions

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Posted 10 July 2014 - 10:30 AM

Hi IBS, excellent news on the absence of the rage episodes! Also good that your pdoc is holding off on the tapering until you've gotten back to being stable...

As to what to say to him tomorrow.... well, that depends.... how 'bout I ask you "20 questions" ? :-)

remind me, when was your last appointment? And what did you and he discuss then?

Since that time, what/how have you been feeling...have you seen/felt progress forward? How do you think you're responding to the celexa, and being off the paxil... if no rages, that's great ... and it sounds like the split dosing is working better, yes? How about anxiety level? How are you sleeping? How's the stress level with taking care of your mother, and do you have any back-up help with that?

And how are you feeling today, right now?

#7 fishinghat

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Posted 10 July 2014 - 11:03 AM

IBS - Just my opinion but I think your dr is right. More than likely he is waiting for the Celexa to kick in (4 to 6 weeks). At that point you should settle down and can begin tapering the Cymbalta. I like the split dosage routine as this minimizes ups and downs in blood levels and minimizes swings in mood until things stabilize.


#8 thismoment

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Posted 10 July 2014 - 12:02 PM

IBS

 

Are you taking brand name Cymbalta or a generic? 

 

It seems to me you are using the brand name. Anyway I've often wondered why a drug of short half-life (like duloxetine) isn't administered in a two, or three-times-a-day regimen to keep it from bottoming out and spiking up.

 

Fishinghat

 

You know more about this than I, but I found this interesting: When a drug goes generic, only the base formulation is let go for copy. The formulation of release (the rate at which the active ingredients are released) is often proprietary and therefore the generic doesn't always perfectly emulate the brand name. 


#9 ittybittysmitty

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Posted 10 July 2014 - 12:30 PM

remind me, when was your last appointment? And what did you and he discuss then?

Since that time, what/how have you been feeling...have you seen/felt progress forward? How do you think you're responding to the celexa, and being off the paxil... if no rages, that's great ... and it sounds like the split dosing is working better, yes? How about anxiety level? How are you sleeping? How's the stress level with taking care of your mother, and do you have any back-up help with that?

FN...my last appt was last Thursday We discussed the plan i'm on and keeping a mood diary...he also told me to double my Zyprexa dose and that has stabilized my mood...I'm feeling MUCH better with my mood...I stopped taking Adderall because it makes me too anxious...stopped that on Monday...since then i've noticed a great lack of motivation...perhaps because of the split dose or withdrawal from Adderall. who knows...yes, my anxiety level is WAY WAY down...Yay!

I've taken time off indefinitely until I feel my brain is recovered enough...Thank God my father left us well financially so we can afford the help...

This Moment...I'm on the generic of both cymbalta and celexa...you guys amaze me with your insight...thanks very much for your support...

Have an amazing day!

IBS

#10 ittybittysmitty

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Posted 10 July 2014 - 12:38 PM

do any of you experience sudden fatigue?

I'm over my 2-day flare and felt fine until about 11 this morning and had to lay down...must be the Crapalta..

Social life: Do any of you feel disinterested in socializing? my body and mind arent' up to it...know what I mean?

Sorry for the fragments...that's my brain at work. LOL

#11 FiveNotions

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Posted 10 July 2014 - 12:57 PM

"You know more about this than I, but I found this interesting: When a drug goes generic, only the base formulation is let go for copy. The formulation of release (the rate at which the active ingredients are released) is often proprietary and therefore the generic doesn't always perfectly emulate the brand name."


TM and FH... and that key difference between the mfg process for the brand and the generic is why I, and so many others, have had horrendous adverse reactions to the old (Teva, taken off the market last fall) generic wellbutrin, the newer generics of Welbutrin, and the generics of Cymbalta.... we react to the differences in release... also, the ingredients and mfg process of the capsules/outer shell coatings are all different....

Total crapshoot... esp. if the generics are coming in from India, Mexico or China... quality control zilch....

#12 fishinghat

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Posted 10 July 2014 - 01:03 PM

Fishinghat

 

You know more about this than I, but I found this interesting: When a drug goes generic, only the base formulation is let go for copy. The formulation of release (the rate at which the active ingredients are released) is often proprietary and therefore the generic doesn't always perfectly emulate the brand name. 

 

You are right TM. Some medications have a patent on the delivery system and some don't. Cymbalta not only has a patent on their delivery system but also it is proprietary (trade secret). This is a way to extend the profit on a drug. The generics just can't compete with Cymbalta with the delivery system. With time Dr quickly learn this and many will only prescribe the brand name. More money in the pocket.


#13 fishinghat

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Posted 10 July 2014 - 01:05 PM

do any of you experience sudden fatigue?

I'm over my 2-day flare and felt fine until about 11 this morning and had to lay down...must be the Crapalta..

Social life: Do any of you feel disinterested in socializing? my body and mind arent' up to it...know what I mean?

Sorry for the fragments...that's my brain at work. LOL

IBS   Are you on any benzos (Ativan, Xanax, etc,) They can cause this also.


#14 ittybittysmitty

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Posted 11 July 2014 - 11:22 PM

FH,

Thank you, Yes I'm taking klonopin...makes sense looking back why I crash after taking it.

my doctor's plan from today's visit..He said I'm PAST withdrawal (???) so next Monday, he wants me to start taking 20 mg capsules split into 10 mg, twice a day...

He wants me off the Cymbalta because it clearly has been dragging me into bipolar misery. Case in point, is today's near nervous breakdown...a disappointment triggered my bipolar mixed state...he said my nervous system is really raw, like a burn, and this triggered it...so bottom line, is that he wants to start tapering me off the Cymbalta because it is making me miserable...


your thoughts on this?

#15 fishinghat

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Posted 12 July 2014 - 07:34 AM

You are past withdrawal?11 Are you kidding me? You are still taking cymbalta. How could you be past withdrawal. Idiot dr.

 

Between the Celexa and klonopin you can probably handle things. The Celexa should be kicking in soon. (If I remember right you are now on 40 mg?) Even though the Klonopin may be causing the fatigue, you need it right now. Once every thing gets straightened out you can deal with it.


#16 ittybittysmitty

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Posted 12 July 2014 - 09:17 AM

I know, right? there is a shortage of Psychiatrists in MN so i'm stuck with him...

Thanks for your help FH, as always!!

#17 FiveNotions

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Posted 12 July 2014 - 10:13 AM

IBS, yep, the doc's an idiot wrt the Cymbalta dosing and withdrawal.... but I do think he's right about one thing... your nervous system is, indeed raw, like a burn, right now .... which is exactly why you need to continue with the slow tapering off the poison ... if you keep doing these big jumps down in dose, it'll be like yanking the bandaid off the burn each time ... worsens the pain ...

 

I read somewhere the other day that in addition to the current, and projected worsening, shortage of GPs, there's an even worse shortage of shrinks happening ... fewer kids are going to med school in general, and fewer of those few are entering "shrink-age" specialties ....

 

We're going to be "on our own" more and more as time goes by ....


#18 thismoment

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Posted 12 July 2014 - 11:52 AM

IBS

 

I don't think there's a problem splitting the daily dosage into two. Tapering off the dosage is another matter. You will have to decide how long to taper off the remaining Cymbalta. Go slow with a gentle slope in the reduction. Do you have a timeframe in mind?





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