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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Good evening doctor - i have made amitryn 310 from

Answered by
Dr.
Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5171 Questions

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Posted on Wed, 6 Feb 2019 in General Health
Question: Good evening doctor - i have made amitryn 310 from 300 mg about three days back. Anxiety is more or less the same. My sleep pattern for a long time has been bad. I wake up every two hours and use the toilet ( i sometimes dont even urinate), and then go to sleep again and everytime i wake up i rush to the toilet (i think the patter is to get out of the bed), In the process, i dont feel fresh when i wake up in the morning and at work also i am groggy. I think if my sleep improves, it will help in my anxiety also. My medication is as under : amitryn 310, qutipin 100, mirtaz 37.5 in the night
duolextine 60, betacap tr 40 in the morning
what tweaking in my medicine will help me to sleep better. And how long should i be on 310 amitryn before further increasing it. Pls help
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Good evening doctor - i have made amitryn 310 from 300 mg about three days back. Anxiety is more or less the same. My sleep pattern for a long time has been bad. I wake up every two hours and use the toilet ( i sometimes dont even urinate), and then go to sleep again and everytime i wake up i rush to the toilet (i think the patter is to get out of the bed), In the process, i dont feel fresh when i wake up in the morning and at work also i am groggy. I think if my sleep improves, it will help in my anxiety also. My medication is as under : amitryn 310, qutipin 100, mirtaz 37.5 in the night
duolextine 60, betacap tr 40 in the morning
what tweaking in my medicine will help me to sleep better. And how long should i be on 310 amitryn before further increasing it. Pls help
doctor
Answered by Dr. Seikhoo Bishnoi 16 hours later
Brief Answer:
Quetiapine can be increased

Detailed Answer:
Hello again

Please don’t increase the dose of Amitriptyline now. This could increase the side effects and will not add to therapeutic benefit.

For improvement of sleep one option that can be tried is to increase the dose of Quetiapine to 150 mg in SR form. This will help in maintaining the sleep and will prevent night time awakening.

High dose of Amitriptyline could be resulting in anti-cholinergic side effects which could be resulting in urinary hesitancy.

Drink plenty of water to stay hydrated and this will also help you in improving urine stream.

Thanks
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
Quetiapine can be increased

Detailed Answer:
Hello again

Please don’t increase the dose of Amitriptyline now. This could increase the side effects and will not add to therapeutic benefit.

For improvement of sleep one option that can be tried is to increase the dose of Quetiapine to 150 mg in SR form. This will help in maintaining the sleep and will prevent night time awakening.

High dose of Amitriptyline could be resulting in anti-cholinergic side effects which could be resulting in urinary hesitancy.

Drink plenty of water to stay hydrated and this will also help you in improving urine stream.

Thanks
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Seikhoo Bishnoi 26 minutes later
Was reading on the net and found out that lower doses of mirtaz help in better sleep. Do you think lowering mirtaz is an option too. My XXXXXXX doctor said, add 25 mg quitipin and make it 125 for better sleep. If quitipin has to be added, then it should be plain 25 or 25 sr or 50 sr! Pls help
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Was reading on the net and found out that lower doses of mirtaz help in better sleep. Do you think lowering mirtaz is an option too. My XXXXXXX doctor said, add 25 mg quitipin and make it 125 for better sleep. If quitipin has to be added, then it should be plain 25 or 25 sr or 50 sr! Pls help
doctor
Answered by Dr. Seikhoo Bishnoi 17 hours later
Brief Answer:
Mirtazapine in low dose helps in sleep.

Detailed Answer:
Hello again

Yes we discussed about this earlier too. Mirtazapine in lower doses helps in providing good sleep. Doses more than 30 mg doesn't help much in sleep. Dose of 15 mg is best for sleep.

If you are adding Quetiapine then you can add SR form which will help in refreshing long sleep.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
Mirtazapine in low dose helps in sleep.

Detailed Answer:
Hello again

Yes we discussed about this earlier too. Mirtazapine in lower doses helps in providing good sleep. Doses more than 30 mg doesn't help much in sleep. Dose of 15 mg is best for sleep.

If you are adding Quetiapine then you can add SR form which will help in refreshing long sleep.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 4 hours later
Thank you Doctor. I really value your advise. Last night, i made mirtaz 30+1/2 of 7.5. It didn't have any positive impact on the sleep, but today morning after waking up was feeling better in terms of anxiety. Do you think anxiety was better because of reduction of mirtaz? Do amitryn and mirtaz interfere with each other, what i mean is, is it better that when taking amitryn and mirtaz together, lower dose of mirtaz works better with higher dose of amitryn?
Also, in one of your advises earlier, you had mentioned that amitryn can be increased to 325 (am on 310), if residual anxiety is bothering me, do you think i can make it 325 to get over it? if yes, after how long?
Stopping quitipin 100 cold turkey and starting 150 sr, will have any withdrawal effects as 150 sr make take time to show effect? Also, do you think adding quitipin 25sr or 50 sr along with 100 plain can be a option? or else if have to switch to 150 sr from 100 plain, how do i do that?
My latest medication is as under :
Amitryn 310, quitipin 100, mirtaz 30+1/2 of 7.5 all in the night
Duolextine 60, betacap tr 20 all in the morning
Looking at my prescription and also keeping in my mind my residual anxiety, what would your revised prescription be?
I am also keen to consult you over the phone or may be through a video call, pls let me know how do i do that? Thank you
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Thank you Doctor. I really value your advise. Last night, i made mirtaz 30+1/2 of 7.5. It didn't have any positive impact on the sleep, but today morning after waking up was feeling better in terms of anxiety. Do you think anxiety was better because of reduction of mirtaz? Do amitryn and mirtaz interfere with each other, what i mean is, is it better that when taking amitryn and mirtaz together, lower dose of mirtaz works better with higher dose of amitryn?
Also, in one of your advises earlier, you had mentioned that amitryn can be increased to 325 (am on 310), if residual anxiety is bothering me, do you think i can make it 325 to get over it? if yes, after how long?
Stopping quitipin 100 cold turkey and starting 150 sr, will have any withdrawal effects as 150 sr make take time to show effect? Also, do you think adding quitipin 25sr or 50 sr along with 100 plain can be a option? or else if have to switch to 150 sr from 100 plain, how do i do that?
My latest medication is as under :
Amitryn 310, quitipin 100, mirtaz 30+1/2 of 7.5 all in the night
Duolextine 60, betacap tr 20 all in the morning
Looking at my prescription and also keeping in my mind my residual anxiety, what would your revised prescription be?
I am also keen to consult you over the phone or may be through a video call, pls let me know how do i do that? Thank you
doctor
Answered by Dr. Seikhoo Bishnoi 10 hours later
Brief Answer:
Mirtazapine can be reduced to 15-30

Detailed Answer:
Hello again

Try to make Mirtazapine in 15-30 mg dose. This will help in making sleep better without compromising its effects on anxiety and depression.

There are no significant drug interactions between Amitriptyline and Mirtazapine.

You can reach to 325 mg after a week but as mentioned earlier this might increase side effects like urinary retention or sexual side effects. This can have some effects on anxiety.

You can stop 100 mg plain cold turkey and can shift to 150 SR with no worries.

You can reduce Mirtaz to 15 in coming weeks, make Quetiapine to 150 mg and rest medicines should be same.

You can call HCM customer care for a call.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
Mirtazapine can be reduced to 15-30

Detailed Answer:
Hello again

Try to make Mirtazapine in 15-30 mg dose. This will help in making sleep better without compromising its effects on anxiety and depression.

There are no significant drug interactions between Amitriptyline and Mirtazapine.

You can reach to 325 mg after a week but as mentioned earlier this might increase side effects like urinary retention or sexual side effects. This can have some effects on anxiety.

You can stop 100 mg plain cold turkey and can shift to 150 SR with no worries.

You can reduce Mirtaz to 15 in coming weeks, make Quetiapine to 150 mg and rest medicines should be same.

You can call HCM customer care for a call.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 11 hours later
Thank you doctor. Wanted to check with you the following :
I made mirtaz 30+(1/2) 7.5 on 16th XXXXXXX along with other medicines remaining the same i.e. amitryn 310, quitipin 100 in the night and duolextine 60 and betacap tr 40 in the morning.
After making this change, i am feeling better (yesterday and today) in terms of anxiety. is it that reduced dose of mirtaz along with other night medicines (especially amitryn) is helping me or you think amiyrn 310 from 300 is helping me? I am little confused, as i dont know whether to reduce mirtaz further or to increase amitryn further for me to completely feel better?
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Thank you doctor. Wanted to check with you the following :
I made mirtaz 30+(1/2) 7.5 on 16th XXXXXXX along with other medicines remaining the same i.e. amitryn 310, quitipin 100 in the night and duolextine 60 and betacap tr 40 in the morning.
After making this change, i am feeling better (yesterday and today) in terms of anxiety. is it that reduced dose of mirtaz along with other night medicines (especially amitryn) is helping me or you think amiyrn 310 from 300 is helping me? I am little confused, as i dont know whether to reduce mirtaz further or to increase amitryn further for me to completely feel better?
doctor
Answered by Dr. Seikhoo Bishnoi 5 minutes later
Brief Answer:
Please reduce the dose of Mirtazapine

Detailed Answer:
Hello again

Most likely slight reduction of dose of Mirtazapine resulted in somewhat better sleep and this resulted in improvement of anxiety.

You should further reduce the dose of Mirtazapine and this will help you. As of now don’t increase the dose of Amitriptyline. This will help to reduce residual anxiety.

Thanks
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
Please reduce the dose of Mirtazapine

Detailed Answer:
Hello again

Most likely slight reduction of dose of Mirtazapine resulted in somewhat better sleep and this resulted in improvement of anxiety.

You should further reduce the dose of Mirtazapine and this will help you. As of now don’t increase the dose of Amitriptyline. This will help to reduce residual anxiety.

Thanks
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Seikhoo Bishnoi 27 hours later
Can’t thank you enough for the advise yesterday.
Made following changes : mirtaz 30 from 30+1/2 of 7.5, amitryn 310, quitipin 100 plain and 50 sr...in the night
Duolextine 60, betacap tr 20... in the morning
Still woke up in between but sleep was sound and felt better in the morning, anxiety is also better. Just that after waking up, there were still nagging thoughts about the meeting on Monday. Do you think is there any other tweaking I should do to get over these morning nagging thoughts? But overall, feeling much better.
Any change you suggest for today or I should stick to this combo of medicines for sometime.
Also, can I request that i routinely would like to consult you apart from HCM and icliniq as I am more comfortable with you? Pls advise
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Can’t thank you enough for the advise yesterday.
Made following changes : mirtaz 30 from 30+1/2 of 7.5, amitryn 310, quitipin 100 plain and 50 sr...in the night
Duolextine 60, betacap tr 20... in the morning
Still woke up in between but sleep was sound and felt better in the morning, anxiety is also better. Just that after waking up, there were still nagging thoughts about the meeting on Monday. Do you think is there any other tweaking I should do to get over these morning nagging thoughts? But overall, feeling much better.
Any change you suggest for today or I should stick to this combo of medicines for sometime.
Also, can I request that i routinely would like to consult you apart from HCM and icliniq as I am more comfortable with you? Pls advise
doctor
Answered by Dr. Seikhoo Bishnoi 9 hours later
Brief Answer:
You should stick with same prescription for a couple of days.

Detailed Answer:
Hello again

No need to make any changes for today. Wait till Wednesday and then you should reduce the Mirtazapine by 7.5 mg that is 22.5 mg in night. Rest of prescription should be same.

You can take Betacap TR 40 and low dose Clonazepam on SOS basis. These medicines will keep the anxiety under control during meetings if needed.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
You should stick with same prescription for a couple of days.

Detailed Answer:
Hello again

No need to make any changes for today. Wait till Wednesday and then you should reduce the Mirtazapine by 7.5 mg that is 22.5 mg in night. Rest of prescription should be same.

You can take Betacap TR 40 and low dose Clonazepam on SOS basis. These medicines will keep the anxiety under control during meetings if needed.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 18 hours later
Good evening - slight anticipatory anxiety for meetings is still there. In your notes to me, you said to add quitipin 150 sr instead of 100 plain. I have made 100 plain + 50 sr. I wake up in between still. Do you think i should made 150 sr or stick to 100plain +50 sr for sometime, if yes, after how long? I have important meetings tomorrow and day after, I should do that after that or can make it today or tomorrow, if yes, will it have any withdrawal/side effects. Also, you said i should take ativan 1 mg instead of 0.25 zapiz, should i make that change? if yes, I should do it before every meeting or i should watch and take it if anticipatory anxiety bothers me. The sudden rush which i had in the last meeting could be because of zapiz 0.25 ( any side effects of zapiz), which i took before the meeting? if i have to take zapiz 0.25 or ativan 1 mg, how long before the meeting i should i take? In stead of ativan 1 mg, can i take zapiz 0.5 instead of 0.25 as 0.25 did not help me in the last meeting? pls advise
Also, if i have to do a phone/video consultation with you, how can i do that directly with icliniq? pls suggest
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Good evening - slight anticipatory anxiety for meetings is still there. In your notes to me, you said to add quitipin 150 sr instead of 100 plain. I have made 100 plain + 50 sr. I wake up in between still. Do you think i should made 150 sr or stick to 100plain +50 sr for sometime, if yes, after how long? I have important meetings tomorrow and day after, I should do that after that or can make it today or tomorrow, if yes, will it have any withdrawal/side effects. Also, you said i should take ativan 1 mg instead of 0.25 zapiz, should i make that change? if yes, I should do it before every meeting or i should watch and take it if anticipatory anxiety bothers me. The sudden rush which i had in the last meeting could be because of zapiz 0.25 ( any side effects of zapiz), which i took before the meeting? if i have to take zapiz 0.25 or ativan 1 mg, how long before the meeting i should i take? In stead of ativan 1 mg, can i take zapiz 0.5 instead of 0.25 as 0.25 did not help me in the last meeting? pls advise
Also, if i have to do a phone/video consultation with you, how can i do that directly with icliniq? pls suggest
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Follow up: Dr. Seikhoo Bishnoi 1 minute later
i mean without icliniq and not with icliniq...
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
i mean without icliniq and not with icliniq...
doctor
Answered by Dr. Seikhoo Bishnoi 17 hours later
Brief Answer:
Make SR 150 from today.

Detailed Answer:
Hello again

I am sorry for replying late I was traveling.

You can make 150 SR from today evening. This should help in long refreshing sleep.

Ativan works rapidly and has short duration of action. You can take this with Betacap SR 40 on sos basis without worries. You can take tablets around half hour before meeting.

You can take Zapiz 0.5 too but Ativan is better in such situations in my opinion.

Yes you can contact HCM customer care for this.

Thanks

Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
Make SR 150 from today.

Detailed Answer:
Hello again

I am sorry for replying late I was traveling.

You can make 150 SR from today evening. This should help in long refreshing sleep.

Ativan works rapidly and has short duration of action. You can take this with Betacap SR 40 on sos basis without worries. You can take tablets around half hour before meeting.

You can take Zapiz 0.5 too but Ativan is better in such situations in my opinion.

Yes you can contact HCM customer care for this.

Thanks

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Seikhoo Bishnoi 9 hours later
Thank you doctor. I have an important meeting tomorrow. Do you think making 150 sr will help me or I should make it tomorrow after the meeting? In today’s meeting, thinking about giving my introduction was bothering me (in anticipation of that as I have fumbled earlier in some of the meetings) but reached a bit late (there was some confusion about the timing) and didn’t have to give introduction. But putting across my points of view during the meeting was not coming effortlessly as I was thinking about whether I will be able to convey my point of view or will I stammer etc. (threes thoughts were crossing my mind and I was preoccupied with these thoughts). My natural self is quite bindaas with a lot of confidence, and when I don’t feel that in the meetings I feel let down. But the level of effots was slightly better than the last meeting.
And also every time I need to talk to you, I should go through icliniq or as a patient I can consult you directly after fixing up the timing in advance.
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Thank you doctor. I have an important meeting tomorrow. Do you think making 150 sr will help me or I should make it tomorrow after the meeting? In today’s meeting, thinking about giving my introduction was bothering me (in anticipation of that as I have fumbled earlier in some of the meetings) but reached a bit late (there was some confusion about the timing) and didn’t have to give introduction. But putting across my points of view during the meeting was not coming effortlessly as I was thinking about whether I will be able to convey my point of view or will I stammer etc. (threes thoughts were crossing my mind and I was preoccupied with these thoughts). My natural self is quite bindaas with a lot of confidence, and when I don’t feel that in the meetings I feel let down. But the level of effots was slightly better than the last meeting.
And also every time I need to talk to you, I should go through icliniq or as a patient I can consult you directly after fixing up the timing in advance.
doctor
Answered by Dr. Seikhoo Bishnoi 37 minutes later
Brief Answer:
You can take SR150 from today.

Detailed Answer:
Hello again

Yes you can take 150 SR from today only. This will help in improving the sleep quality and you will feel refreshed in morning. Don't anticipate about tomorrow's meeting. You will do good. No need to get worried for that.

Slight anxiety which you faced today was because of anticipation only. Stop anticipating about any futuristic things. Just keep one thing in mind that you have anxiety and you have to overcome this. Make your brain realise that this is just anxiety and most of individuals have anxiety.

You can take Betacap TR 40 and Lorazepam on SOS basis.

You can contact through HCM too.

Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
You can take SR150 from today.

Detailed Answer:
Hello again

Yes you can take 150 SR from today only. This will help in improving the sleep quality and you will feel refreshed in morning. Don't anticipate about tomorrow's meeting. You will do good. No need to get worried for that.

Slight anxiety which you faced today was because of anticipation only. Stop anticipating about any futuristic things. Just keep one thing in mind that you have anxiety and you have to overcome this. Make your brain realise that this is just anxiety and most of individuals have anxiety.

You can take Betacap TR 40 and Lorazepam on SOS basis.

You can contact through HCM too.

Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Seikhoo Bishnoi 9 minutes later
Thank you doctor. Checked with HCM, they have stopped consulting over the phone/ video call. If not directly, wii route it through icliniq. Also am in XXXXXXX from 15th-19th feb, wondering if I could meet you in XXXXXXX if you have any plan to visit XXXXXXX during that time.
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Thank you doctor. Checked with HCM, they have stopped consulting over the phone/ video call. If not directly, wii route it through icliniq. Also am in XXXXXXX from 15th-19th feb, wondering if I could meet you in XXXXXXX if you have any plan to visit XXXXXXX during that time.
doctor
Answered by Dr. Seikhoo Bishnoi 6 minutes later
Brief Answer:
I will let you know about schedule.

Detailed Answer:
Hello again

In that case you can contact me.

Right now I don't have plans for XXXXXXX on 15th-19th Feb. I am in XXXXXXX for few hours on 31st XXXXXXX and also on 3rd Feb. If there is any plan I will let you know.

Thanks
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
I will let you know about schedule.

Detailed Answer:
Hello again

In that case you can contact me.

Right now I don't have plans for XXXXXXX on 15th-19th Feb. I am in XXXXXXX for few hours on 31st XXXXXXX and also on 3rd Feb. If there is any plan I will let you know.

Thanks
Above answer was peer-reviewed by : Dr. Prasad
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