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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest dosage for Lurasid

Answered by
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Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 4802 Questions

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Posted on Thu, 30 Mar 2017 in General Health
Question: Hello doctor - my anxiety is still there, though the intensity has come down. spoke to my doctor, he asked me to take 20 mg lurasid in the morning along with 40 mg in the night. I have following questions:
will it make me drowsy if i take 20 in the morning
i was thinking of making 60 in the night instead of 20/40 mor/eve, if i do that will it bother my sleep
what is the best time to take lurasid?
what would you advise.
doctor
Answered by Dr. Seikhoo Bishnoi 1 hour later
Brief Answer:
Dose increase of 20 mg would not cause much effects on sleep.

Detailed Answer:
Hello again

No 20 mg in morning will not make you drowsy. But if you don't want even mild form of sedation then you can take its whole dose that is 60 mg in evening.

Only 20 mg increase in dose would not bother your sleep. Best time is to take after dinner.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 2 hours later
I increased the dose of amitryn to 35 from 25 two days back on my own, my stomach has started acting up with constipation and bloating and burning. it has helped me with excess salivation caused by sizopin and anxiety is lil better. now because of stomach problem i am planning to go back to 25 amitryn. am lil worried whether reducing amitryn to 25 will increase my salivation. also will increasing lurasid to 60 cause salivation problem? my doctor had prescribed glycolate for my excess salivation problem but i did not take it worrying about dry mouth. Now i am planning to do the following change in my medication:
amitryn 25 ( from 35), lurasid 60 (from 40), sizopin 25, quietiapine 50, zapiz 0.125, will the changes in dose of amitryn and lurasid cause any problem especially sleep and salivation, can i go ahead with the change. also, does glycolate help with internal shaking of the body, was checking internet, no where its mentioned that it helps with shaking/tremor? does glycolate cause any bothering side effects like amitryn especially upset stomach and constipation. does increased dose of lurasid increase my shaking? pls advise.
doctor
Answered by Dr. Seikhoo Bishnoi 6 hours later
Brief Answer:
You can try to remain on 35 mg Amitriptyline.

Detailed Answer:
Hello again

Reducing the dose of Amitriptyline would not cause any increase in salivation and you can go with this. But since your anxiety and sleep improved so I don't think reducing its dose in such a short time is a good idea. If the constipation is an issue then for that drugs like Lactulose can be used. This will soften stools and constipation will improve.

Increasing the Lurasid to 60 will not cause much side effects. I don't think this will increase the salivation.

So in my opinion you should remain on 35 Amitriptyline, 60 mg Luraside (from 40) and other drugs as you are already taking. In coming days consider reducing the dose of Quetiapine to 25 followed by stopping completely.

For salivation Glycolate is used. This helps in tremors too by reducing the EPS symptoms. Glycolate is safe to use.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 26 hours later
dear doctor - took lurasidone 60 and made amitryn 25 last night. have following queries:
my stomach is acting up a bit. today in the office, was facing excess salivation and took 1 mg glycolate. was wondering if my stomach is acting up because of reduced amitryn ( from 35 to 25) or because of glycolate or because of increased dose of lurasidone?
what should i do with amitryn? with 35 amitryn, i was feeling extra aggressive, should i keep it at 25 0r 30 or 35? will constipation and aggressiveness, settle down with time?
also, on fridays i go out for dinner and have a drink or two, on saturdays, i dont get afternoon sleep and feel very sedated and depressed and dont feel like meeting my friends? was wondering what can i take that gives me good 2-3 hours sleep on saturdays afternoon? Pls advise.
doctor
Answered by Dr. Seikhoo Bishnoi 7 hours later
Brief Answer:
This could be due to Lurasidone

Detailed Answer:
Hello thanks for asking again

Then mild gastric symptoms could be due to Lurasidone dose. If possible ignore these symptoms. Glycolate or reduced dose of Amitriptyline are not the reasons for this.

For sleep today you can use one extra Zapiz 0.25 or 0.5 in afternoon. This will help in good sleep. Avoid anticipating that you will not sleep. Just remain relaxed, try to distract yourself by watching TV or reading a book.

Continue to take 25 mg Amitriptyline as you have reduced the dose already, for a couple of days. Increase the dose again to 35 once the symptoms improve.

The mild aggressiveness or constipation will go by own in a couple of days.

Alcohol might worsen symptoms but don't think much about it. You can have one or two drink on weekends. No need to worry. Just keep a gap of 2-3 hours between Zapiz and alcohol.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 9 hours later
will these gastric symptoms because of lurasidone settle with time? how long will it take?
doctor
Answered by Dr. Seikhoo Bishnoi 3 hours later
Brief Answer:
In 5-7 days you will see improvement

Detailed Answer:
Hello again

Yes surely these will settle with time. With in next 5-7 days you will see improvement.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 6 minutes later
have got stye in the eye and doctor has put me on doxycycline, have been feeling constipated, does this happen with doxycycline? what can i take to get relief from it?
doctor
Answered by Dr. Seikhoo Bishnoi 9 minutes later
Brief Answer:
Doxycycline doesn't result in constipation normally

Detailed Answer:
Hello again

Constipation is not a common side effect of Doxycycline. Normally it is not associated with constipation.

You can try lactose suspension for relief from constipation. Also take lactic acid tabs for overall relief.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 6 days later
Dear doctor - my medication is as under:
quetiapine 50
lurasid 60 (increased from 40 about a week back)
amitryn 25
sizopin 25
zapiz 0.125
I have noticed that my tongue twists while pronouncing difficult words and also get a sense of internal shaking. at times become conscious of talking over phone or while in conversation with someone or in a group
what can i do to overcome this? is it because of increased dose of lurasid? what tweaking i can do in my medication that will help me with this?
also, can i stop zapiz as i did not take it last night and slept ok? pls advise.
doctor
Answered by Dr. Seikhoo Bishnoi 1 hour later
Brief Answer:
Dose of Quetapine can be reduced.

Detailed Answer:
Hello again

The tongue twisting like feeling along with internal shaking are probably occurring due to three antipsychotic drugs you are taking. You are on Lurasidone, Sizopin and Quetiapine and this is the reason for the shakiness like symptoms.

I don't think its because of increased dose of Lurasidone alone.

If I have to change your prescription then I'd have reduced the dose of Quetiapine completely over next 4 weeks. This will help in reducing your symptoms.

Yes you can skip the dose of Zapiz any time if your sleep is better. You can even keep the drug use on SOS basis.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 8 hours later
dear doctor - tried reaching my doctor but could not get through. on my own i have decided to reduce sizopin to 12.5mg as i salivate a lot in the night and my pillow is full of saliva. i am keeping everything same as under:
lurasid 60
quetiapine 50
amitryn 25
zapiz 0.125
my only worry is will it affect my sleep? according to you i should go ahead with the change or you will recommend change in any other medicine also to compensate for the reduced sizopin that will take care of my sleep. will this change help me with my symptoms of tongue twisting and losing control on pronouncing words. pls advise.
doctor
Answered by Dr. Seikhoo Bishnoi 4 minutes later
Brief Answer:
Yes you can reduce the dose to 12.5

Detailed Answer:
Hello again

Yes you can think of reducing Sizopin dose but that might cause problem of sleep. Sizopin is a good sedative. If you are planning to reduce to 12.5 then please in future keep in mind to stop this drug completely. You can go ahead with this if you face issues of sleep then increase the Zapiz to 0.25 for now.

Or alternatively you can think to reducing Quetiapine to 25 and then stopping completely. This will also reduce the symptoms you're having.


Thanks


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Seikhoo Bishnoi 25 minutes later
dear doctor - sizopin is given to me only for sleep or it has some antidepressant effect also. hope reducing it does not aggravate my depression!
doctor
Answered by Dr. Seikhoo Bishnoi 1 minute later
Brief Answer:
This will not worsen depression

Detailed Answer:
Hello again

No, at this dose it's working for sleep only.

Reducing the dose will not worsen the depressive symptoms.

Thanks
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Seikhoo Bishnoi 40 hours later
Dear Doctor - Getting little shakiness in the body and hands, what can be the reason:
I have reduced sizopin to 12.5, sleep is ok with 12.5. What else can i take to control the shakiness or it will go with time, if yes, how long will it take to go?
doctor
Answered by Dr. Seikhoo Bishnoi 3 hours later
Brief Answer:
In a couple of days stop the drug completely.

Detailed Answer:
Hello again

If you are sleeping good even after reducing the dose of Sizopin to 12.5 then in a couple of days stop the drug completely. This will reduce the shakiness.

I hope you are seeing improvement in shakiness after reducing the dose of Sizopin to 12.5 MG.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 45 hours later
Dear Doctor -almost had anxiety attacks in two meetings in the last one week.
My medication is as under:
Lurasid 60
amitryn 25
sizopin 12.5
zapiz 0.125
quetiapine 50
Was wondering why did it happen? can lurasidone cause it? Also feeling shakiness in the body (internal), dont have tremors though.
Went to my doctor, he made the following changes:
Amitryn 12.5 from 25
zapiz 0.25 mor/eve
betacap tr 40, rest everything same
I have fololwing questions:
do you agree with the change, will it help me with my anxiety attacks? or you would recommend some other changes?
Can zapiz 0.25 mor/eve be taken for a long time? does it develop tolerance or addiction after some time? for how long it is safe to take it at these dosages?
Will betacap tr 40 help me with shakiness and is it safe to take it in the long term?
I am not comfortable with zapiz mor/eve as the net says you develop tolerance to it after some time and need to increase the dose?
What would your advise be?
doctor
Answered by Dr. Seikhoo Bishnoi 8 hours later
Brief Answer:
Zapiz is safe to use if taken as per prescription.

Detailed Answer:
Hello thanks for asking

Lurasidone is not the reason of the panic attacks you had during meetings. Lurasidone in long term helps to control the anxiety and panic.

I agree with the changes, but I'd have reduced the dose of one antipsychotic drug out of three you are taking (Lurasidone, Sizopin and Quetiapine). I'd have reduced the dose of Sizopine to zero.

Yes for now you can continue to take Zapiz 0.25 twice a day. Short term use will not cause tolerance or addiction, no need to worry. In general the drug should not be used regularly for more than 4 weeks unless strongly indicated.

Yes Betacap 40 will help in shakiness and anxiety. The drug has no dependence potential and is safe to use for long.

No need to worry from Zapiz if you are taking it as per prescription.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 12 hours later
does it mean that i have to take zapiz only for one month or i can take longer than that as well? Also, how long the effect of zapiz 0.25 stay in your system? if after one month, i have to stop it, i am worried that my anxiety will come back, therefore, am in two minds whether to continue it or not!
doctor
Answered by Dr. Seikhoo Bishnoi 20 minutes later
Brief Answer:
Anxiety will not relapse after stopping Zapiz.

Detailed Answer:
Hello thanks for asking

Zapiz is a benzodiazepine drug. The drug doesn't has long lasting effects but the drug helps to potentiate of action of other antidepressants. This potentiation remain long lasting.

So even after you stop Zapiz after one month at that time other drugs would result in improvement and effect will last long.

Your anxiety will not come back after stopping Zapiz.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 2 hours later
do you think reducing amitryn to 12.5 by my doctor is a good idea or i should go back to 25?
doctor
Answered by Dr. Seikhoo Bishnoi 10 minutes later
Brief Answer:
Please continue on 12.5 mg dose

Detailed Answer:
Hello again

No please continue to take 12.5 mg as advised by your doctor. Zapiz and Betacap will help to compensate for it. The drugs would help to control sleep and anxiety. Slight insomnia that can occur by reducing the dose of Amitriptyline would be taken care by Zapiz.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 3 hours later
dear doctor - even after starting zapiz 0.25 mor/eve and betacap tr 40, i still feel breathless when i open a conversation. this normally happens with the people in front of whom i have had anxiety attack earlier like my boss and a colleague of mine. was wondering if its because of reduction in dose of amitryn! I am in two minds as to what to do?
- one mind tells me that i should go back to amitryn 25 instead of 12.5 and take zapiz 0.125 instead of 0.25 in the night
- other mind tells me that i should stop sizopin totally and make quetiapine 75 instead of 50 ( as i have read on the net that quetiapine helps with anxiety and panic attacks) along with 0.125 of zapiz in the night
- cant figure out why this breathlessness is there when i open a discussion.
- how long zapiz and betacap take to show effect? is it instant? i started them yesterday but today still feeling breathless, how long will it take before they show effect?
And, how long the effect of zapiz stay in your system?
What would your prescription be keeping my symptoms in mind?
Pls advise.
doctor
Answered by Dr. Seikhoo Bishnoi 1 hour later
Brief Answer:
Social anxiety is the cause of your persistent symptoms.

Detailed Answer:
Hello again

The symptoms like breathlessness which you are facing while talking to someone are part of social anxiety only. This is not due to reduction of dose of Amitriptyline, but due to persistent anxiety. So please don't think of going back to 25 mg dose again.

Please take Zapiz 0.25 bid and Betacap TR in OD doses and this will help you in some days. Though in most individuals the drugs start working from first day only but your anxiety symptoms are resistant and will take time. Just remain on same prescription for some days.

Zapiz has long actions but in about a week the drug get cleared of body. The drug helps to control symptoms for even about 24 hours.

I'd have advised you to take Zapiz 0.25 bd, Betacap TR 40 OD, have preferred to increase Quetiapine to 100 (though my first choice was Sizopin but you have already reduced the doses), I'd have stopped Sizopine and no changes in other drugs. Reducing one antipsychotic will reduce shakiness.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 22 hours later
went to c another doctor to take an opinion, according to him, lurasiodone in some patients can cause restlessness and increase anxiety and according to him, this can be the reason of my breathlessness. he has asked me to stop lurasid totally and start sizodon 1 mg (1/2 for 4 days and then full), increased amitryn to 25 from 12.5 and also increased sizopin to 25 from 12.5, rest everything same. what do you think of this prescription? my sleep has been disturbed and because of lack of sleep in the night, feel sedated through out the day. pls advise
doctor
Answered by Dr. Seikhoo Bishnoi 3 hours later
Brief Answer:
In my opinion stopping Lurasid and starting Sizodon is not a good idea

Detailed Answer:
Hello again

Yes he is right but that increase in anxiety is seen only during first 1-2 weeks of starting the treatment. You are taking Lurasidone for more than one month and I don't think this is the cause of the breathlessness you are having.

Sizodon is Risperidone and the drug can even cause side effects similar to Lurasidone. Lurasidone is considered as antipsychotic which is tolerated better.

Increasing the Sizopin to 25 again would not cause much benefit, ultimately you have to get rid of one out of three antipsychotics.

So if you want to take my opinion, then in my opinion you should at least continue to take the drugs as per prescription of your other doctor for at least a couple of weeks. This will help in better response.

Thanks.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Seikhoo Bishnoi 15 hours later
dear doctor - went to my doctor yesterday, he has made the following changes:
quetiapine 100 (increased from 50)
lurasidone 60
sizopin 12.5
zapiz 0.25 mor/eve
inderal la 40
amitryn he has stopped. quetiapine has been increased to 100 for my sleep, luckily could sleep better last night. wanted to check with you if tynept od can be added in the morning for my morning anxiety as my psychiatrist from XXXXXXX had suggested that went i met him. he had suggested the following prescription:
everything else same as my present prescription except lurasid was at 40, tynept in the morning, zapiz 0.5 in the night. What is your view of adding tynept od in the morning?
doctor
Answered by Dr. Seikhoo Bishnoi 8 hours later
Brief Answer:
Tynept can be tried.

Detailed Answer:
Hello again

Adding Tynept OD might increase restlessness at least for few days. But the drug will definitely increase day time activeness and you will function better.

You can keep this in option. Now since Quetiapine doses are increased and Lurasid is on same dose you can discuss with your doctor to stopping Sizopin completely if possible. This will reduce the burden of third antipsychotic in your prescription.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 22 hours later
dear doctor - after increased dosage of quetiapine, in my sleep i freeze sometimes and struggle to come out of it. was wondering why its happening? what would you advise?
doctor
Answered by Dr. Seikhoo Bishnoi 1 hour later
Brief Answer:
Quetiapine increases deep sleep

Detailed Answer:
Hello again

Quetiapine results in reduction of REM sleep and increase in NREM or deep sleep. This is the probable reason you are having symptoms like freezing during sleep. This is a good sign and will help you in long term.

Thanks
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Seikhoo Bishnoi 22 hours later
dear doctor - today again in the meeting breathlessness happened, intensity was less though (shivering and breathlessness was there), i have following questions:
Despite taking zapiz mor/eve and inderal la 40, why is it happening? cant understand?
Has any medication to do with it, especially lurasidone, is lurasidone 60 too high a dose for it to cause breathlessness, do you think reducing it to 40 or 50 will help?
do you think any tweaking in any other medicine will help, especially zapiz if i make it 0.5 in the morning?
do you think stopping sizopin and increasing quetiapine to 125 from 100 will help? read on the net that quetiapine helps with anxiety and anxiety attacks?
how long will tynept od take to show its full effects? what is the therapeutic dose of tynept, do you think increasing tynept will help?
I really need your sincerely advise to help me with breathlessness and sleep?
Look forward to your advise!
Regards
doctor
Answered by Dr. Seikhoo Bishnoi 47 minutes later
Brief Answer:
Zapiz can be increased in doses.

Detailed Answer:
Hello again

The breathless of less intensity that happened was due to anxiety only. I don't think Lurasidone is responsible for it. So please continue to take dose of Lurasidone without making any change.

If even with Zapiz or Inderal the symptoms are there so yes you can increase the dose of Zapiz to 0.5 mg for some days.

Sizopin can be stopped and increase the dose to Quetiapine to 100-150 mg per day. This will help in controlling the anxiety symptoms more effectively.

Tynept OD will start working in about 3-4 weeks. Normally in Tianeptine is used in doses of 12.5-50 mg per day. The drug will help in abdominal symptoms too.

Thanks. Take care. Please continue to take drugs and try to avoid mild symptoms.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 43 hours later
dear doctor - last night stopped sizopin 12.5 and increased quetiapine to 125, did not sleep well, was getting a lot of weird dreams (had been getting them on sizopin 12.5 and quetiapine 100 aslo), woke up with headache which is continuing through out the day and in the meeting today got breathlessness again. what should i do for my sleep and breathlessness? my medication is as under :
quetiapine 125
lurasid 60
zapiz 0.25 mor/eve
inderal la 40 in the morning
pls advise.
doctor
Answered by Dr. Seikhoo Bishnoi 34 minutes later
Brief Answer:
Don't make any change, continue with same prescription

Detailed Answer:
Hello again

Just don't make any change in your prescription. The headache will improve in some time. Good that you stopped Sizopin. If you feel disturbed sleep then take two Zapiz instead of one in evening.

Thanks
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Seikhoo Bishnoi 4 hours later
dear doctor - sometimes i wonder if the medication i am taking is the right one as my breathlessness, sleep and meeting phobia is still there (intensity is less ) and not completely gone. as ssris and snris dont suit me, which are known to help with my symptoms, sometimes i wonder if i will have to live with my problems for life. i am seeing a homeopath also for the last two months, his name is XXXXXXX XXXXXXX ( he is a known psychiatrist but practices homeopathy now) but homeopathy does not seem to be helping either. feeling quite helpless. is there a pill that is soothing to the stomach and at the same time helps with sleep, social anxiety and breathlessness.
pls advise, feeling quite low and helpless. the job and the position i am at, cant afford to go through this. have been avoiding client meetings, important presentations and so on and so forth, pls advise if any other pill will help.
doctor
Answered by Dr. Seikhoo Bishnoi 10 hours later
Brief Answer:
Currently you are not on any antipsychotic drug.

Detailed Answer:
Hello again

Since SSRIs and SSRIs are not getting tolerated in your case, over the time the prescription changed from anti anxiety drugs to antipsychotic drugs. Antipsychotic drugs aids in anxiety but are not first line for anxiety.

The symptoms like breathlessness, sleeplessness, meeting phobia etc are part of anxiety only. You have complete insight of illness so antipsychotics could not become first line of treatment.

If you were not able to tolerate the SSRIs or SNRIs then drugs like Bupropion can be tried. The drug is relatively better tolerated but has not very strong efficacy. The addition of this drug to your prescription would help in better symptoms control.

Since you have stopped Clozapin now our next move should be to reduce dose of Lurasidone and then to continue with only one antipsychotic that is Quetiapine. This will help in better control.

Zapiz and Propranolol can be continued as both drugs help to keep anxiety under control

Thanks. Take care


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 13 hours later
i am in XXXXXXX and went to see my psychiatrist here, he is of the view that veniz 37.5 should be added to my prescription along with librium 10 mor/eve instead of zapiz 0.25, i have following questions:
since dveniz has not suited me earlier as it gave me stomach problems like bloating, churning, gas etc., do you think veniz will suit me as they are more or less same in composition, my doctor feels that it will not give stomach issues but am skeptical to start it. pls advise if its worth giving a try at the same time keeping in mind the stomach problems i have had with dveniz and other snris and ssris? what time it should be taken, morning or evening?
is librium a better choice than zapiz? can librium be taken for long term say for 4-5 months? is it addictive? do you develop tolerance to it?
i was thinking if tynept has suited me for my stomach, can it be increased to 50 mg? do you think 50 mg will control my anxiety better? i take tynept od 37.5 in the morning, how do i make it 50? should i cut 37.5 into three parts and take one part or is there any other mechanism? pls advise
doctor
Answered by Dr. Seikhoo Bishnoi 16 minutes later
Brief Answer:
Better to increase dose of Tynept in my opinion.

Detailed Answer:
Hello again

Venlafaxine also causes side effects like nausea (even more than SSRIs) and also gastric upset. If you failed to tolerate Desvenlafaxine then I don't think starting this is a good idea. As you are tolerating Tianeptine so the dose of this drug could be increased. You can go ahead with dose increase to 50 mg. 37.5 OD in morning and 12.5 mg plain in evening or afternoon. Avoid cutting in three parts.

Librium is good for stomach issues and but for anxiety it has no added advantages to Zapiz. Librium also has addiction potential like other benzodiazepines but that doesn't mean it couldn't be taken for long.

Any benzodiazepine if taken under regular supervision of a doctor is safe to use even for long time.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 22 hours later
dear doctor - since am on leave, took veniz xr 37.5 today morning (as i wanted to give it a try, as to get completely better i think i have to be on snri or ssri) on my doctor's assurance that it would not cause stomach issues as according to him he has been prescribing it to a lot of people in XXXXXXX without any such issues and he said since i am also from XXXXXXX the same should apply to me as well. i have got slight constipation but not unbearable and slight stomach issue but bearable, i have following questions:
since it has almost suited me on day 1, are there chances that it will give me side effects later? or i'll feel better in my stomach and general well being as the days pass by? normally side effects start with first dose or they take time for the drug to build up in the body and then start acting up? or do i have reason to feel happy that veniz has suited me?
since tynept has helped me with my stomach, if stomach acts up later, can i take one tynept 12.5 along with veniz sometime in the afternoon?
what would your advise be?
doctor
Answered by Dr. Seikhoo Bishnoi 25 minutes later
Brief Answer:
You will not develop side effects later.

Detailed Answer:
Hello again

Since you haven't had any symptoms on first day of use so I don't think you will see side effects later. Yes you will feel better as days will pass. No side effects especially like nausea, epigastric distress are seen from first dose only. I don't think you will see any worsening.

Why are you thinking that stomach will act up later. Remain relaxed, as you have started Venlafaxine and didn't have any symptoms on first day so you will feel better in coming days.

Just ignore any mild symptoms if you develop. Stick to your drug therapy.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 26 minutes later
also read on the net that tynept works better on empty stomach, is it so? can i take it first thing in the morning along with pantocid d?
doctor
Answered by Dr. Seikhoo Bishnoi 8 minutes later
Brief Answer:
Drug should be taken with meals

Detailed Answer:
Hello again

As per the drug information the drug should be taken at time of meals or during meals. The absorption is marginally affected when drug is taken empty stomach compared to after meals. I prefer to advise my patients to take the drug after meals for better tolerance.

Thanks.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi 17 hours later
dear doctor - have not been sleeping well despite taking quetiapine 125mg, lurasid 60 and zapiz 0.25 in the night. my doctor in XXXXXXX feels that librium 10 should be added in the night instead of zapiz for better sleep along with one in the morning. I have following questions:
do you think i should start librium and quit zapiz? is librium ok for stomach, have read on the net that it can cause constipation. right now with veniz am already getting slight constipation, do you think adding librium will help me with sleep and stomach problem or it will aggravate my stomach problem pls advise keeping the sensitivity of my stomach in my mind.
doctor
Answered by Dr. Seikhoo Bishnoi 4 hours later
Brief Answer:
You should go with Librium if he is stressing.

Detailed Answer:
Hello again

If your doctor wants to replace Zapiz with Librium then you can go ahead. Don't fear from constipation because even Zapiz results in constipation. Librium will be good for gastric issues too and will control anxiety also.

So if he is stressing then go with Librium.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 21 hours later
dear doctor - my stomach started acting up and went to my doctor today,he made the following changes:
venlor 37.5 he has stopped
tianeptine he has increased to 50 (37.5 od +12.5 normal)
librium 10 mor/eve, he has stopped zapiz
quetiapine 150 ( from 125)
inderal la 40
lurasid 60
he has asked me to add bupron 150 xl in the morning for ist three days and then 150 xl ( mor/eve)
fulnite 2mg for sleep
i have following questions:
what is your opinion about this change?
what time should i take tianeptine? what is its half life? should i take in the morning along with od 37.5, will that work better or taking it in the afternoon/ evening or night will help better?
will increased doasge of tianeptine help?
does bupron help with social anxiety? how long does it take to work? should i start with 150 xl or 75 xl and how do i go about upping the dose? dose increase should be by 75 or 150 and after how many weeks?
i was just thinking if i should continue with venlor xr 37.5 along with increased tianeptine as extra tianeptine may take care of my stomach issue?
Is fulnite 2mg habit forming or addictive? should i give it a try? am skeptical of taking it as i may get addicted to it? whats your view?
will quetiapine 150 from 125 help me with sleep? should i first try this and see how i feel before starting fulnite?
pls advise
doctor
Answered by Dr. Seikhoo Bishnoi 3 hours later
Brief Answer:
Bupropion is better tolerated.

Detailed Answer:
Hello again

Adding Bupropion will help in control of depressive symptoms and the drug will augment the actions of Tianeptine too. This will control anxiety.

In my opinion you should take Tynept OD 37.5 in morning after meals and 12.5 mg during lunch time. Half life of OD preparation is more and even single dose can help to control the symptoms effectively. Yes increased dose of Tynept and addition of Bupron should definitely help.

Bupron has no direct effects to control social anxiety but will augment the Tianeptine and will also help to control the depressive symptoms. The drug will take time to act and at least 3-4 weeks time is needed to see improvement.

Dose of 150 mg once a day and after about a week dose of 150 mg twice a day. The drug is relatively better tolerated so no need to worry.

Taking Tiapetine, Bupron and also Venlor will increase the risk of serotonin syndrome. So its better to stop Venlor if stomach issues are there.

Fulnite is habit forming but not so strong as benzodiazepines. Yes for sleep you can try this without any worries. The drug is safe to use.

Dose increase of Quetiapine will also help in sleep. Better to take the drugs are per your prescription i.e. increase the Quetiapine doses and also take Fulnite.

Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Seikhoo Bishnoi 41 hours later
discussed the change in prescription by my XXXXXXX docor with my psychiatrist in XXXXXXX he made the following changes:
quetiapine he has brought down to 100 from 150
he has added sizopin 12.5 again as he feels i need to take it for some time for sleep
lurasid at 60 no change
tynept he has made 1/2 of 37.5 in the night along with one in the morning
he is of the view that i should stop librium and take zapiz 0.5 in the morning, but for the time being he has stopped zapiz and added librium 10 in the morning? he feels one develops tolerance to librium faster, is it true?
inderal la 40 no change
buopron he has stopped as he feels it can aggravate stomach problem,
i have following questions:
does sizopin help with anxiety and depression?
should i take tynept 12.5 in the night or stick to 1/2 of 37.5 od, which one works better?
feeling constipated today, is it because of increased tynept or adding sizopin?
do you think still i should give bupron a try? will it help with my anxiety and meeting phobia? does it cause stomach problem? or i can skip it and will feel better with increased tynept?
pls advise
doctor
Answered by Dr. Seikhoo Bishnoi 6 hours later
Brief Answer:
Clonazepam is shorter acting compared to Librium

Detailed Answer:
Hello again

Both Librium and Clonazepam have addiction potential. Librium is relatively longer acting compared to Cloazepam. But you are taking medicines under regular supervision so I don't think this makes any difference. But if he is in opinion then you can switch to Zapiz again.

Sizopin helps to augment the actions of antidepressants or anti anxiety drugs but I don't think 12.5 mg dose would have much direct benefits apart from helping in sleep.

In my opinion Tynept OD 37.5 in morning and 12.5 plain in evening would be better.

Sizopin might lead to constipation to some extent. You will develop tolerance to this with time.

Yes you should give Bupron a try. This will help to increase actions of Tianeptine. This might cause stomach issues but in most patients it is tolerated easily. You can first give a try to increased dose of Tianeptine and if in needed then Bupropion can be added later.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 21 hours later
since i am not getting sleep, my doctor has added mirtazipine 7.5 to my prescription, other medicines are :
Lurasid 60
sizopin 12.5
librium 10 mor/eve
quetiapine 100
inderal la 40
tynept 37.5, stopped evening 1/2 of 37.5 tynept , i have following questions:
should i start with mirtaz 7.5 or take 1/2 of 7.5 for few days and then make 7.5?
mirtaz has given me weird dreams earlier, do you think at this dose, it will cause dreams again?
now since mirtaz has been added, should i continue with sizopin or should i stop it?
librium tolerance keeps on playing in my mind, read on the net that its use beyond 4 months has not been assessed, is it true that it can be taken for 4 months without any worry or you develop tolerance faster than 4 months? what is the longest period you have prescribed it for? my doctor feels that it can be taken for 1 year also before you develop tolerance? pls clear this doubt specifically?
will stopping evening tynept cause any problem, i have taken it for 3-4 days only?
what is your view about adding raboxetine, read on the net that it is useful for panic attcks, is it true? does it have any stomach related side effects?
pls advise
doctor
Answered by Dr. Seikhoo Bishnoi 3 hours later
Brief Answer:
Librium causes tolerance if used for long.

Detailed Answer:
Hello again

Since you are very sensitive to side effects so in my opinion its better to start with half of tablet and then increase to one tablet of 7.5 mg after a week. I don't think 7.5 mg would give weird dreams.

In my opinion Sizopin can be stopped, no need to continue it.

I haven't prescribed Librium for such long time to my patients. But even regular use for more than 4 weeks would result in tolerance. Though a lot of my patients are on Clonazepam mono therapy for even more than 1-2 years. They are doing fine, but to get prescription they have to visit me at least once a month. But regular use of even 4 months would lead to tolerance for librium.

No you can stop evening Tianeptine without any worries. This would not cause withdrawal symptoms.

I haven't used the drug till now. But I read about this during my studies, this will cause stomach symptoms like any other serotonergic drug.

Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Seikhoo Bishnoi 18 hours later
dear doctor - after the following changes in the medication:
lurasid 60 no change
tianeptine 37.5 od, stopped 1/2 of 37.5 od in the night
sizopin 12.5 no change
librium 10 mor/eve no change
mirtazapine 3.75 ( started last night)
quetiapine 100 no change
inderal la 40 no change
i am feeling breathless while talking today. was wondering why is it happening? can addition of mirtaz cause this? what do you think why is it happening despite taking librium mor/eve and according to you what should i do? i have an important presentation tomorrow and this breathlessness is scaring and psyching me up? pls advise
doctor
Answered by Dr. Seikhoo Bishnoi 13 hours later
Brief Answer:
Propranolol can be used for anxiety.

Detailed Answer:
Hello again

No 3.75 MG of Mirtazapine is not causing these symptoms. This is more due to psychological reasons rather than side effect on any drug. For presentation you can take 5 mg of Librium about 2 hours before presentation or if you have prescription you can take Propranolol 20 mg about 2 hours before presentation. Both drugs will make you calm.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 12 hours later
dear doctor - along with my librium 10 mg and inderal la 40 which i take in the morning, i had to take zapiz 0.25 and inderal 10 for my presentation today, still it took a lot of effort to introduce myself in the beginning ( still there was slight shivering and anxiety )and took some time for me to settle down. dont know for how long will it continue, do you think giving up zapiz and starting librum is causing this ( what i mean is, is this happening because of transition from zapiz to librium). what is the equivalent dose of librium for zapiz 0.25?
by now you know my symptoms prescription well, what will be your prescription for me?
doctor
Answered by Dr. Seikhoo Bishnoi 55 minutes later
Brief Answer:
Social anxiety is causing these symptoms.

Detailed Answer:
Hello again

This has nothing to do with change in doses or change in drugs from Zapiz to Librium. These were social anxiety symptoms which are persistent in your case. To some extent you have to learn to accept this. Avoid thinking about this and try to ignore any anticipatory thoughts about presentation or group discussions.

Approx equivalent dose of Librium to Zapiz 0.25 is 25 mg.

Since last one year I am in contact with you and based upon the symptoms and history I would have advised you-

Tablet Quetiapine 100-150 mg HS

Tablet Paroxetine CR 12.5 to begin with and then to 25-37.5 mg HS

(Though it is known to cause constipation but with time tolerance to this side effect develops. The drug is safe to use in abdominal symptoms and is better tolerated, helps to regulate sleep rhythm).

Tablet Zapiz 0.25-0.5 mg BD and SOS

Tablet Propranolol 20 mg and Tablet Clonazepam 0.25 combination on SOS basis.

Capsule Pregabalin 75 mg and Methylcobalamine combination in night after dinner.

For some days on these drugs you might suffer worsening of symptoms but with time you will develop tolerance to side effects and will feel better.

Thanks, You can discuss for these options with your doctor.

Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 3 days later
have tried paroxetine and pregabalin in the past. didnt suit. my doc has put me on ventab dxt 25 to begin with but my stomach is acting up again (burning, bloating, chirning etc), thinking of stopping it. is bupron a choice for me. read on the net that it does not really help anxiety, it is mainly for depression, what is your view? is bupron worth giving try for my symptoms which are largely meetings, meeting phobias? also does librium start working immediately or it takes some days to show effect?
doctor
Answered by Dr. Seikhoo Bishnoi 8 hours later
Brief Answer:
Bupron can indirectly reduce anxiety symptoms by augmenting other drugs.

Detailed Answer:
Hello again,

Yes Bupron doesn't has much effects in anxiety but the drug has great efficacy in depressive symptoms. This will augment the actions of other antidepressant and anti anxiety drugs you are taking and thus will indirectly control the anxiety symptoms too. The drug is relatively better tolerated compared to other serotonergic drugs.

Bupron should help in social anxiety or phobias but don't expect much for first 4-6 weeks of starting treatment.

Librium starts acting from first day only, with time the effectiveness in depressive symptoms increases.

Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Seikhoo Bishnoi 32 hours later
hello doctor - started taking bupron from yesterday, stomach is more or less ok. Today my doctor said that i should try fluvoxamine 50 in the morning. read on the net that it has more gastrointestinal effects than other SSRIs, so am little skeptical to start it? whats your view keeping my stomach issues in mind?
doctor
Answered by Dr. Seikhoo Bishnoi 6 hours later
Brief Answer:
Fluvoxamine might worsen the symptoms

Detailed Answer:
Hello again

Yes Fluvoxamine will cause worsening of symptoms especially on first few days of therapy. I don't think starting this drug is a good idea.

Right now since you've started Bupropion so wait for its effects.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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