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What Is The Effective Dose Of Buspar?

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Posted on Wed, 19 Oct 2016
Question: I am having GAD for 24 Years after a job loss. I have used low dose alprazolam-0.25mg b.i.d for 18 years with sensibly and with off and on few days in between to avoid addiction and finally changed to Nexito-10mg for the last 6 years by my Psychiatrist. Nexito also helped to control my anxiety but weaned off and stopped 4 months ago as I have gynaecomatia as its side effect. After stopped this, my anxiety symptoms came back with chest tightness, body tension, irrational & uncontrolled thoughts and mild insomnia etc. I have tried some herbal supplements like St John's wort, 5-htp etc for last 4 months and still no improvement. As I feel very scared to use another anti dep due to side effects and withdrawl symptoms etc, I just started to use Buspar-7.5 mg b.i.d for last 10 days as per my own decision based on web site info( I am now staying out of XXXXXXX and I cannot contact easily my psychiatrist). I am asking your suggestion on following matters:
(1) Buspar did not give any relief so far . I am still using till 4-5 weeks to see any improvement in my symptoms. I used buspar -5mg b.i.d for 1 month after stopped Nexito , 4 moths ago. But stopped it as not feel effective. Now I give a second chance with 15 to 20 mg per day for 4-5 weeks to see if it can work with higher dose. I prefer Buspar bcos I heard it is safe and non-addictive. Is that true Dr ? If it is not working, what should I do next ? Go back to another SSRI ?
(2) I also heard anti hypertensive drug Clonidine is also good for anxiety relief. As I already have high BP and using Cilacar-T (Cilnidipine-10mg plus Telmesartan-40mg) for last 1 year, can I try Clonidine for both my GAD and BP together? What do you suggest ? Is clonidine also help for my sleep? Can I give it a try along with Buspar?
Is there any interaction if I use Cilacar-T reduced dosage by half and add Clonidine in the night?

doctor
Answered by Dr. Ashok Kumar (24 minutes later)
Brief Answer:
Clonidine is never recommended as anti anxiety medication

Detailed Answer:
Dear XXXXXXX
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

First regarding Buspar- The effective dose of Buspar in most Asians is around 30 mg and western people need around 30-45 mg. The dose tried is never adequate and I do not think it can bet blamed.

Before we says it is effective for not the dose should be at least 10 mg three times a day. In addition Buspar acts every slowly and may take two to four weeks before showing any positive response. So I think you need to give a fair trial before saying it is not effective. Secondly if it not show response and you already think SSRI may not suit you I feel pristiq can be better option for you.

Regarding clonidine I do not think there is rational for using it in your case. I understand it have anti anxiety properties but it is never more safe than SSRI or SNRI, mainstay of treatment for GAD.

You may get severe postural hypotension on using both them together and if you prefer to discontinue clonidine it may cause rebound hypertension sufficient enough to cause stroke. It will not be wrong to say that Clonidine is never recommended as anti anxiety medication as there are better alternative available.

My advice is to talk to any local doctor before taking such major but irrational decisions.

I hope this helps you.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ashok Kumar (7 hours later)
Dear Dr,
Thanks for the advise. I am not planning to use Clonidine then. As per you advised, I try to continue use Buspar with 30 mg per day. I recently increased it from 15mg per day to 20mg just 2 days ago. Today 10th day and I am having many side effects like drowziness, blurry vision, dizziness, increased sweating, body and chest tightness, dry mouth, lack of quality sleep(wake up many times) etc. So if I increase to 30 mg suddenly, don't these side effect get worse? Is there any slow increase required?
I am also anxious to know if it seems workable with the dose you prescribed, is it SAFE to use Buspar continuously for long years without any long term side effects like SSRI/SNRI (Based on my Psy-Dr on last year, I may need the medicine for life long for my GAD )
I am very reluctant to use SNRIs like Pristiq due to its worse withdrawl symptom compared to Nexito and similar SSRIs and it also caused gynacomastia(0,06% from ehealth.me info) than even nexito(0.02%). So what else you suggest if Buspar is unsuccesful? I am looking for one (SSRI/SNRI or anything else) with least long term side effects and very LESS WITHDRAWL symptoms than Nexito and Pristiq. Thanks for your understanding.
doctor
Answered by Dr. Ashok Kumar (40 minutes later)
Brief Answer:
CBT could be safe option provided therapist is available

Detailed Answer:
Dear XXXX,
Thanks for writing back to me.

First regarding buspar. We can increase five to 10 mg per week and any such increase should be halted when were are faced with side effects. In current scenario I do not think you should increase to 30 mg from current 20 mg as there are intolerable side effects on the current dose and it is possible that with increased dose there might be increased severity of side effects.

So in this regard my request is to continue 20 mg dose if the current side effects are tolerable. In case no, revert back to 15 mg and wait for one week before increasing further. Alternatively a small dose of benzodiazepines like 0.25 mg xanax twice a day can be used along with buspar to tackle side effects.


If you tolerate well it can be used for long term without any significant adverse effects as it is quite safe and do not have any problem of addiction.

Regarding SSRI/SNRI I feel they are more effective in compare to Buster and to be XXXXXXX other medications used for GAD have more side effects than SSRI and SNRI group of medications. Although your decision to not use pristiq is respected wholeheartedly but I must acknowledge that out of more than 1000 prescriptions I have never encountered a person with gynecomastia with pristiq. I mean to say that it is very rare side effect and very common to see.

In case it happens the dopamine agonists can be used to reverse the gynecomastia.

As I said above SSRI have best side effect profile among definite treatment for GAD followed by SNRI. If they do not work there are other options like TCA, Mirtazapine and benzodiazepines which has more severe side effect profile.

The other option is cognitive behavior therapy provided there is therapist available in country where you live. This is completely side effect free and have long term effects once completed.

I hope this helps you further.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar (16 hours later)
Dear Dr,
Thanks again for your detailed answer.
I have some more queries before close this discussion..
1)Now I am using Buspar 10mgX2 without much side effect for last 2 days except insomnia. For insomnia, is it helpful if I use 10mg at morning and other 10mg at noon or evening rather than in night? Is insomnia also go away after some times?
2) If Buspar not working after 2 more weeks(that's enough time to see result! right?) and if I plan to switch in Pristiq, what dose and time to start with and how much the final dose to continue? Can I use immediately after stop Buspar?
3) This is my personal Q to clear one of my doubts. I heard SNRI is more side effect than SSRI and also more withdrawl symptom if want to stop in future.
In that case what is your opinion about zoloft(sertraline) for my case? Can I assume it is more tolerant than Pristiq in terms of withdrawl and side effects? Please enlighten me. Thank you..
doctor
Answered by Dr. Ashok Kumar (2 hours later)
Brief Answer:
Buspar does not help in sleep

Detailed Answer:
Dear XXXXXXX
Thanks for follow up.

Buspar is generally sedation neutral and do not affect sleep pattern directly although it helps it indirectly by controlling anxiety. I mean to say that morning and noon schedule unlikely to alter your sleep problem in short term but likely to resolve over time.

Buspar generally shows good result between two to six weeks and even if you get partial relief at the end of two weeks it should be continued provided there are no intolerable sude effects. Regarding the pristiq the starting dose as well as effective dose is 50 mg for most persons. Few of us may require 100 mg which can be increased after two weeks of 50 mg dose.

Side effect profile varies from person to person and I do not think it can be assumed that particualr medication have more or less side effects. Yes the chances are more with pristiq in compare to zoloft but they are population data and nothing to do with infividual patient. Having said this with 50 mg pristiq the sideeffects profile is very mild.

I hope this answers you further.
Thanks and regards.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar (1 hour later)
Dear Dr,
Thank you for your instructions.
I am happy and contended with all your answers for my questions.
doctor
Answered by Dr. Ashok Kumar (3 hours later)
Brief Answer:
You are always welcome

Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.

I am glad to know that information was useful and satisfactory for you.

Please close the thread if you do not have more questions.

Thanks again.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ashok Kumar (12 days later)
Dear Dr,
I am again here. As per our previous discussions, I have been trying Buspar 10mgX2 for 2 weeks followed by 10mgX3 for last 10 days. But still my general condition is not much improved. I am having very "blurry" vision(severe for 4 to 5 hours after use tablet) like "just awake from sleep" and a bit occasional sad mood. Seems like I have mild depressive feeling and not so energetic to go out or perform any enjoyable things. I even cannot face my Boss or colleagues in the office due to my "blurred eyes" & low feeling and feel like hide from them and not even concentrate on talking with them or in my work. Sometimes, I feel like anxiety is bit improved (about 40%) but overall internal feeling is very bad and feel tired even after I do 1 hour morning jogging every day & 20 minute meditation etc. I always think and looking inside of my mind and worrying when I can feel happy and cheerful.
I am also doing some online CBT with a well known clinical psychologist for the last one month and diligently doing all worksheets, exercise, diary writing etc, but no sign of improvement yet (My psych Dr told me 20 years ago that that I am not a right candidate for CBT as I already know many things about positive self-talk etc etc ). Frankly, I cannot sustain a positive thought pattern permanently yet with self help books, positive thinking, auto-suggestion, CBT etc and I back to my old negative habit and start worry due to this 26 years old GAD.
So questions are (1) Do I expect any more cure from Buspar and any hope if I continue with it or do I just stop and try SSRI?
(2) Even though I have some "gynacomstia" which is a rare side effect from Nexito-10mg for last 7 years use, is such issue happen in future if I use another SSRIs like Sertraline for long years ? Can I hope it is still a rare chance due to Nexito & Setraline are different chemicals eventhough both are SSRIs ? Is gynacomastia SSRI class related or chemical content related?
(3) Dr, I have about 100 tablets of Setraline-50mg with me from XXXXXXX which I bought myself from pharmacy for a try because my Psyc-Dr prescribed be Imipramine trycyclic , 4 moths ago when I told him to change Nexito-10mg to another less side effective drug , but I am unhappy and didn't use it as I know tricyclic is more dangerous side effect than SSRI. So my Q is , if you think Buspar is not effective any more for me, can start use Setraline 50mg tablet per day ?
As I almost know that I might need medication for rest of my life and my GAD condition is not so bad like many people described in this website, I am thinking to start with a low doze of it and do more exercise, meditation, continue CBT , diet modification, vitmain supplementation etc. Then what is the best lowest doze to start with and maintain ?
thanks


doctor
Answered by Dr. Ashok Kumar (8 hours later)
Brief Answer:
Sertraline can be used

Detailed Answer:
Dear XXXX,
Thanks for reverting back to me.

I am little glad that there is some improvement and I feel if it is 40% over the last 25 days we need to preserve it. However I feel there is need to review diagnosis as most symptoms (current symptoms) indicate toward mixed picture of anxiety as well as depression. Having said this we need to rethink about the treatment choice as Buspar is unlikely to help in depression.

To answer your questions

1. Yes you can expect more positive changes with buspar as there is good improvement across last three - four weeks. But the change will be most probably limited to GAD part and we can expect little help in respect of depression. I feel we need to preserve the effects achieved till date before switching to SSRI as it will be foolish to loss 40% improvement. It is better we can give a small dose of SSRI along with buspar to reduce dose related side effects and achieve remission in respect to depression as well as anxiety.


Sertraline is less likely to cause this side effects as it helps in increasing dopamine which acts against Gynecomastia. The nexito and sertraline are different at the minor neurotransmitter level although at the major level they act similarly. The side effect is not related with class and varies from drug to drug.

As I said above you can start with 25 mg a day and than increase to 50 mg after one week. I must inform you that talk to local doctor before changing any medication as it is always better to have health care provider a call away.

I hope this helps you.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ashok Kumar (3 hours later)
Dear Dr,
Thanks. I just took 25 mg setraline as my wife also telling that my mood is bad and less energy and almost unhappy with no interest in speaking with anybody. I also had same depressive feeling 7 years ago together with GAD. That was the reason my Psy Dr changed from alprzolam to nexito 10 mg which drastically made me happy and no anxiety for 7 years until stopped 4 months ago due to the mentioned side effect. I was really GAD free and very happy and energetic under Nexito. During the last 4 months, I had tried St johns wort 300mgx2 , sam-e 200mg x1 and 5-htp 50mgx2 for 2 months but only a mild help but still had anxiety and bad mood. So stopped it and then I started to use Buspiron as per the dose that u recommended.
Even though I feel bit improved in my anxiety under buspin, I still cannot tolerate its side effect like double vision (cannot read books or computer, very blurry and eye pain) , flue and nose running , back pain, constipation ,sleeplessness, feeling like a lump in throat and dizziness which all still persisting like the beginning days. So I am very worried with these side effects.
My Q1 is if nexito 10 mg only made me anxiety & depression free for 7 years, can I assume setraline only use can make me with same positive effect without Buspar together? Because I still scare to use both together due to additive side effect of both drugs make me intolerable. Moreover 40% improvement that i mentioned means 60% time still I am anxious and worried with bad, irritable and zombie like mood which is not very good also. My wife told me I look more worse after use Buspar based on my behaviour.
(2) So is it still required to use both or just use setraline?
(3) If u think both combination can work together better than only setraline, then any serotonine syndrome possibility as I scare about it. Do I need any dose adjustment for buspirone to avoid such unwanted effects in case you still suggest to use both together?
(4) What is your advise about herbals like 5htp ,sam-e & sjw for Gad & depression in my case. Any long term use with right dosage is helpful for me if they use alone or with buspar or setraline ? Are they really safe for long term and least side effects?
Anyway, I am waiting for all your suggestions for my betterness but still with tolerable side effects in long term.
Thank you


doctor
Answered by Dr. Ashok Kumar (3 minutes later)
Brief Answer:
Start with combination and than cross titrate

Detailed Answer:
Dear XXXXXXX
Thanks for reverting back tome.


I think we need to start with both (20 mg buspar and 25 mg serta) but over a period of time the buspar can be reduced and sertraline can be increased (5 mg decrease and 25 mg increase per week) to optimal dose. This is because sertraline or any SSRI will take weeks to show some effect and I do not think the currently response should be thrown away with start of sertraline itself.

There is good possibility that sertraline will work for you as they act similarly from the main neurotransmitter point of view. So it can be assumed that it will work.

Buspar have nothing to do with serotonin syndrome in compare to SSRI and I think this side effect can be ignored as we will decrease the dose of buspar with increase of sertraline dose.

I am totally against herbals as they help those who have very mild anxiety and not better than placebo if used alone.

I hope this answers you.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar (39 hours later)
Dear Dr,
Thanks for the suggestion. I am now using 25mg serta & 10mg x2 buspar daily. Today 3rd day of serta use. No problem yet. Yesterday I felt very energetic,happy and reduced anxiety with a kind of confident to do most of the things. I know serta will take weeks to show effect. Today bit less energetic but still better than before start serta. Is my feeling just psychological or due to serta's initial effect ?
Please suggest me the final dose of buspar and serta to be maintained to get the optimal effect? I still need a minimum possible dose of serta due to worry about long term side effect if want use years.
Also would like to know any liver or kidney profile blood test required after few months to see any change in liver/kidney function, because I read somewhere a Dr told one patient to do blood test after some time of serta use to see any impact on organs. So bit worried about it. Please advise.
Thanks
doctor
Answered by Dr. Ashok Kumar (9 hours later)
Brief Answer:
Yes the investigations are required

Detailed Answer:
Dear XXXX,
Thanks for reverting back to me.

I think what you experienced last three days is just placebo effect but it is good sign of recovery in future.

Regarding final dose we need to calibrate according to response. Increase to 50 mg next week and stay there for two weeks. If at the end of two weeks you feel ok than it is fine to continue 50 mg. In case no than you may need to increase the dose.


Regarding blood investigations before starting SSRI, you should undergo all routine tests and should be repeated after six months.

I hope this assists you further.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Ashok Kumar (7 hours later)
Dear Dr,
I am still bit confused about Buspar use. After increase serta to 50 mg next week and maintain it for 2 weeks and if feel ok , I can continue 50 mg ..right? So can I then stop Buspar gradually and use only serta 50mg or still need to continue Buspar parallel with serta? If need to use buspar along with serta, what the dosage and how long?
I prefer to only use serta just like my nexito-10mg last time use for 7 years without any big concern,becasue buspar still giving me side effects like blurred vision and flue symptoms, so I concern both combination add up side effects without much therauptic effect. but I still respect your suggestion and like to follow your advise.
I had done my kidney & liver profile and all other routine blood test 3 months ago while I visited XXXXXXX and all good results. So do I still need to test now or later after 6 moths ? Can I check 3 moths later instead of 6 months as I am very anxious about to know my liver/kidney impact with serta ?
Thanks and waiting for your reply,
Dileep

doctor
Answered by Dr. Ashok Kumar (16 hours later)
Brief Answer:
You need to continue serta only in future

Detailed Answer:
Dear XXXX,
Thanks for follow up.

First of all I am sorry for delayed reply due to unavoidable circumstances.

You need to cross titrate. Decrease the 5 mg of buster with every increase of 25 mg at the end of week. In addition if you feel there is great improvement in the week period (post 50 mg of sertaline) you can stop increasing dose of sertraline while continue reducing dose of buspar.

I do not think you need to subject yourself for combination of side effects as it is possible that you will feel better over time as there is history of good response to nexito (similar kind of medication).

Regarding the tests as you have base line you can repeat them after six months from now as there is no point repeating them before that.

Please remember the side effect profile of sertraline is not that bad and with regular monitoring I do not think you will risk your kidney or liver function.

I hope this helps you further.
Thanks and regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ashok Kumar (5 days later)
Dear Dr,
I feel like I need to get more advise from you again as I am not able to get my Ps-Dr to talk directly. Moreover , I respect your opinion which is more valuable and genuine than him.
Sorry Dr, I created a strong fear about SSRI use after I come across many websites about the hell of withdrawl/ discontinuation symptoms whenever want wean off and stop this drug and those still struggling for months and years with more anxiety,depression & other symptoms worst than before start ssri . For eg, I read this in Mad XXXXXXX com" by a well known psychiatrist XXXXXXX SHIPKO, MD with link http://www.madinamerica.com/2013/08/ssri-discontinuation-is-even-more-problematic-than-acknowledged/
I also read similar and more terrific ssri discontinuation symptoms from many other reliable psychiatrists. So I am very scary now to continue my serta which I used 8 days with 25mg dose till yestreday. Today not yet taken as I am waiting to get an answer from you. I request a VERY HONEST OPINION from you by considering me like your best friend or relative.
If SSRI really giving such a terrific problem whenever need to stop in future due to any crippling side effects or due to other age related illness , I am forsee and worry about how scary and discomfort it then . If I definitely need to suffer it any time in future after start use this ssri , I am thinking now , I don't want use it and just try something else.
So, if I don't continue to use serta after 8 days 25mg dose, do I get any withdrwal symptoms?
Still I am using 10mgX2 Buspar which reduced from 30 mg when I strated Serta 1 week ago. What do you think, if I stop serta from today and slowly increase and reinstall back Buspar to 30mg and give it another chance for few more weeks? If Buspar can work at least 50%, I feel like I can manage my anxiety with occasional "as if needed" use of benzos like xanax or clonazep in lowest doze without giving any chance of giving addiction.Does it work?
Now , I am also wondering, my current high anxiety symptoms which developed after stopped 7 years use of Nexito on 4 months ago was also a part of withdrawl symptom rather than relapse of anxiety(GAD)? what is your opinion?
Any other class of medicine is avaialble to at least try for my anxiety , just a thought?
Thanks Dr if you can advise me by considering my worries of SSRI withdrawl which I face one day , if I continue use it.
doctor
Answered by Dr. Ashok Kumar (7 hours later)
Brief Answer:
I will recommend you to use sorta if it is helping

Detailed Answer:
Dear XXXX,
Thanks for reverting back to me.

I understand your fears and concerns and like to acknowledge that they have basis but strong one.

First regarding my own experience with SSRI on prescribing to close friends and family members I am yet to observe any debilitating withdrawal symptoms with SSRI use (Almost one decade of experience).

I do agree there are withdrawal effects but never to the tune which can cause relapse. In addition relapse will continue indefinitely while withdrawals never goes beyond one month and less than 15 days in case of Nexito or less than three weeks in case of sorta.
It can be inferred that it was relapse rather than withdrawal of nextito.

I will still ask you to go with SSRI as they are the most effective and tolerable agent on the current day for anxiety. Unfortunately buspar, most of XXXXXXX patients do not tolarate 45 mg per day which is often prescribed in westerners.

I understand that you got from many websites but I will request you to go on any of the psychiatrist office and interview real patients there. I guess they will give you real experience than the animated one which is available on many websites.

If you are still like to discontinue sorta I respect your opinion and like to assure you that there is almost nil chance of discontinuation at this stage.

I hope this helps you further.
Thanks and regards.



Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
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Follow up: Dr. Ashok Kumar (20 hours later)
Dear Dr,
Thanks for the advice. But I didn't get the meaning of your first sentence
"I understand your fears and concerns and like to acknowledge that they have "basis but strong one." What do you mean by "they have basis but strong one"? Does it mean stronger withdrawl effect is possible from setra?
I had almost managed with Nexito withdrawl without much terrible symptoms . So can I expect more or less same withdrawl symptoms only from setra, when need to stop in future?
Anyway, based on your assurance, I plan to continue serta with the hope of getting better.
But would like to ask you some more due to my worries..sorry
" Is my condition of GAD curable or need life long ssri use ? because I didn't get a cure yet even after 27 years of medication.
If need life long use of ssri, is it okay to continue that long? is there any point where normally need to increase dosage to maximum and finally drug stop working and all end in tragedy?
Also how can I know , I am cured and it is time to stop ssri?
Thank you Doctor & sorry for all my worry questions.
doctor
Answered by Dr. Ashok Kumar (1 hour later)
Brief Answer:
Sorry for typo

Detailed Answer:
Dear XXXXX,
Thanks for follow up and pointing out my mistake.

I mean to say that "I understand your fears and concerns and like to acknowledge that they have "basis but NOT strong one." As you can see the not was missing and that lead to confusion.

As you know from your experience with nexito withdrawal the withdrawal with serta is almost similar and and withdrawal effect is often mild with sertraline. I mean to say that you do not need to worry to the extent at which you are concerned with withdrawal effects.

Regarding your question about curability of GAD I am sorry to inform you that it is treatable but not curable. It means that the symptom can be controlled with medication or therapy but often a person with GAD needs long term treatment and sometimes for life.

With continued use most patients settle with 50-80% of original effective dose so it can be said that with regular treatment it is possible to reduce dose to either one half or three fourth of first effective dose. It is rare that patient need more dose that the first effective dose.

After 27 years of GAD I do not think we can say I am cured but as suggested above a dose reduction can be attempted after at least two years of use.

I hope this answers all the points raised by you to the optimum level.
Thanks and regards.






Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ashok Kumar (48 hours later)
Thank you Dr for all the clarifications.
Today is 13th day in setra of which 5th day with 50mg. I feel very tired , sleepy mood and occasional anxitety. I takes every morning . After an hour or two, feel drowsy and tired. Now evening , I feel anxiety symptoms like body,chest tightness, shortness of breath and so feel worried and bit sad. Is it the normal initial side effect? How long will take to see real effect?
Do I need to reduce dose back to 25mg? What is the dose I can maintain?
If drowsy, is it better try night?
Can I use clonazepam 0.5 mg to reduce worry and anxiety till side effect of setra over? I have reduced and stopped Buspar 2 days ago.
As I have BP, I am using cilacar-T (clindipine 10mg plus telmisartan 40mg) 1× night. Is there any interaction with setra? Can use together or 1 in day and other in night?
Besides, I am daily using supplements like B complex, vitaminC, Ca & Mg tablet, fish oil tablet. Can I continue to use them without interaction?
Thank you.
doctor
Answered by Dr. Ashok Kumar (16 minutes later)
Brief Answer:
I think it is better to shift for night

Detailed Answer:
Dear XXXXX,
Thanks for follow up.

The anxiety, shortness of breath, tiredness and drowsy feeling can be due to rapid withdrawal of Buspar or early side effect of Sertraline.

As you said the drowsy feeling occurs it is most likely secondary to serta. In that scenario it will be better to shift to night dose only. This is not surprising as 20-30% of patients feel drowsy after serta specially during first few weeks.I mean to say that complete 50 mg can be taken in the night itself and avoid serta intake during morning.

For the positive effect on anxiety it takes around two weeks on the effective dose. Since the effective dose ranges between 50-200 mg so we can say that still there is time to see positive changes.


Since you already stopped buspar and serta is going to take time clonazepam can be taken on need basis. Please remember to limit yourself to 0.25 OD to three times a day and never exceed beyond one mg.

Regarding Cilacar T there is no significant interactions and can be taken together.

I hope this assists you further.
Thanks and regards.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ashok Kumar (2 days later)
Dear Dr,
Thanks again.
I have started serta in the night due to drowsiness. Still I am drowsy in the day and occasional bad anxiety symptoms & sad mood as I mentioned in our previous discussion.
I use clonazep 0.5 mg in the evening(one time only) . Sleeping is not an issue.
yesterday night(15th day) I increased the dose to 75mg. Today morning I didn't feel much anxiety or drowsiness and so did jogging etc. But after an hour , I start feel more drowsiness and anxiety. My eyes looks so sad (as per my wife) and my feeling also sad. Then I took 0.25mg clonazep in the morning which made me more drowsy till in the evening . Now in the evening, I feel slightly better, less drowsy and less anxious but still look sad in my eyes .
Is my sad mood a part of not working the medicine? or will it go away as well as my drowsiness after some days?
Can I continue 75mg one more week and then increase 100 mg next week, if no improvement in anxiety? I only scare it make me more drowsy and depressed.
Nexito 10 mg dose gave me relief last time. What is the equivalent dose of serta? Can I assume that equivalent dose will probably work for me?
Anyway, this is our last discussion in this payment . If I feel no improvement or any other issues arises, I will recharge and contact you for more advise.
Thank you for your valuable suggestions so far. I am happy with your service and my doubts are always get cleared by you. Keep it up. Thanks


doctor
Answered by Dr. Ashok Kumar (3 hours later)
Brief Answer:
100 mg will be equivalent to 10 mg next

Detailed Answer:
Dear XXXXX,
Thanks for follow up.

I am glad to know that you are satisfied with my responses across the last one month and will try my best to answer you.

Regarding your current question although we do not have any exact equivalent dose of Nexito and sorta but the dose of nextito is 5-20 mg and dose of sertraline is 50-200 mg. From the above knowledge it can be inferred that equivalent dose of sorta will be 10o mg for 10 mg nexito.

Regarding drowsiness, other than the shifting dose of sorta at bedtime we can go for decreasing the dose of clonazepam. Since sleep is fine and anxiety is also under little control we can slightly decrease the dose of clonazepam. I will request you to take three fourth of clonazepam and than one half after one week. So in this way we can go for 0.25 mg of clonazepam in next one to two weeks.

In addition I will suggest you to not to supplement clonazepam for drowsiness sin future as it is likely to cause more sedation. In case it is required for anxiety purpose limit yourself to half tablet of .25mg clonazepam.

Regarding dose increase if you feel there is at least one third improvement in your anxiety symptoms at the end of this week (75 mg), it is better to hold on before increasing the dose. This will give more time for low dose sorta to act and we will be avoiding further side effects.

Regarding your question about sadness I like to clarify that sorta helps in this regard and we can hope for improvement in next few weeks time.

I hope this again answers your each and every concern.
Wish you great health ahead.
Thanks and regards.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar (9 days later)
Dear Dr,
I am back again for your help.
Today is 26th day & last 12 days with 75 mg Serta. My anxiety symptoms are really very bad now than before start use it. During high anxiety period, I have extreme muscle tightness especially on chest and back, dry mouth, shallow breathing and blurry vision etc (This much sever symptoms I experienced only 23 years ago when I got GAD at first time) . Since last 2 weeks it was very high off and on daily basis. Many days I wake up in the morning with anxiety symptoms like tight muscles. It gets better after morning exercise and sometimes quite ok for 4-6 hours in the day. Then later afternoon, anxiety symptoms slowly come back and by night before sleep it become worse and difficult to relax. then I must use clonazep or alprax to calm down.
I use XXXXXXX clonazep 0.25mg , 2 times daily or some days 0.25 clonazep one time and 0.25 alprax another time. For last 1 week I don't have any drowsiness from setra and have good sleep , only high anxiety. Clonazep or alprax give some relax for few hours but again anxiety and muscle tightness come back. I think the dosage for clonazep or alprax is not enough to relax at this high anxious period.
Since every day I feel no or very less anxiety for 4 to 6 hours, bit energetic & good mood ,then I feel like setra may be working , but when later I get extreme anxiety , I feel sertra is not working . I am confused.
So I don't know what to do next. Please advise about any increase in dose required for setra, clonazep or alprax ?
doctor
Answered by Dr. Ashok Kumar (2 hours later)
Brief Answer:
I think sorta dose increase is our first option

Detailed Answer:
Dear XXXXX,
Thanks for reverting back to me.

I am glad that things are better for certain period of time but slightly disappointed to know that things are pretty worse especially in the morning and evening. The another positive thing is good tolerance and lack of side effects

For the current problem first I feel we need to go up as we have allowed enough time for 75 of sertraline. Considering the good response to 10 mg of escitalopram we may need at least 100 mg of sertraline and it is time to up the dose.

On this occasion I will request you to keep 100 mg for one week and than if there is still lag in response go to 125 mg per day after one week.

Regarding Alprax and Clonazepam I think first we need to choose one only and clonazepam is better option when it comes to round the clock cover. I understand that alprax have better efficacy but it acts just for 7-10 hours and than causes rebound anxiety thus complicating picture. So use clonazepam only and limit the dose to 0.25 mg twice a day.

I hope this clarifies at this juncture.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Ashok Kumar (2 days later)
Dear Dr,
Thanks. I increased sorta to 100mg since Friday.
How long will it take to know 100mg is an effective dose? because today night going to be 4th day and don't feel any improvement due to increase in dosage yet. Still I have anxiety at some times of the day like before increase dose, but don't feel any lazy to do home help or physical activities , but l had laziness and don't want do much things before start sorta.
I am using clonazep 0.25mg morning & night to alleviate stress and body/chest tightness due to anxiety. Is there any problem (addiction) if I continue clonazep daily till anxiety improved by sorta?
I heard sorta become full effective in some persons after 5 or 6 weeks. Is it true? Can I still hope for a full cure with sorta?
thanks

doctor
Answered by Dr. Ashok Kumar (3 hours later)
Brief Answer:
Takes 4-6 weeks after the optimum dose is reached

Detailed Answer:
Dear XXXXX,
Thanks for reverting back to me.

It is true that serta takes around 4-6 weeks to show complete effectiveness but indicator to its effectiveness are evident in first two weeks itself. In other words the effect start within two weeks and mostly in one week itself but complete response takes time of 4-6 weeks and in rare cases 12 weeks.

So it can be said that you need to wait atleast one week and preferably two weeks to see the definite effect of serta on anxiety.

Regarding clonazepam yes there is definite risk of addition if continued for long duration. The standard guidelines state that Benzodiazepines should be lowered within three months and ideally around one month. Having said this if the lowest possible dose is used the risk remains minimal and same is applicable in your case.

I hope this answers your question.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar (2 days later)
Dear Dr,
I still feel daily anxiety with extremely tight chest, back and stomach with breathless. It remains for 1 to 3 hours and after some breathing relaxation excercise , it gradually subside. It may happen any time of the day and happen 1 or 2 times per day. Except that I am active than before and happy. No any sad mood in my face. During this anxiety period, very difficult to control the worry . Stomach tightness & back tightness is first time happening since 23 years. I only had chest tightness and breathless feeling last time. What I mean, anxiety at this time is at its peak. I also feel worry about increasing dose from 100 to 125mg bcos I thought 75 mg or 100 XXXXXXX enough. Today 1 week with 100mg. Can I continue with 100mg for 1 more week to see its effect or still need to increase to 125mg?
In case if I need to increase 125 mg, is it a high dose causing more long term side effects?
If need to increase, can I reduce later after full therauptic effect?
I feel like need to take an additional clonazep of 0.25 mg during extreme tensed anxious period as needed basis( XXXXXXX then 0.75 mg per day). Can take if needed?
Based on my experience when i take 0.25 mg alprax 1or 2 time duing this high stress, i feel an immediate relax than clonazep. So is it good to try 0.25 alprax 1 or 2 time daily as needed basis during peak anxiety time and stop clonazep totally. I know alprax more addictive and so I use causiously till serta get full therauptic effect.
Btw, Is really serta working or will for me...just anxious?
Thanks and waiting your advice.
doctor
Answered by Dr. Ashok Kumar (6 hours later)
Brief Answer:
It is likely to effective for you

Detailed Answer:
Dear XXXXX,
Thanks for reverting back to me.

First of all I am glad to know that despite having park anxiety this time you are working well and having no sadness. I understand your expectation to get full response at 75-100 mg of sertraline but every medication responds differently and no body can assure you the final dose. Having said this I feel we need to wait for another week before increasing dose of sertraline. This is important as impatience to get earliest benefit will cause more side effects than any benefits.


From your description I understand that you are having intense anxiety and clonazepam is not helping you adequately. In such situation I feel you can opt for xanax with informed decision to cut it down as soon as possible. It is not something unusual as sometime I face patients who need benzodiazepines unto three months. So I mean to say that there is no point in suffering and manx can be replaced for clonazepam.

Regarding effectiveness of sertraline I do not think it will not work for you as there is good evidence of SSRI working for you in past (escitaopram) and sertraline belongs to same category.

I hope this assists you further.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar (2 days later)
Dear Dr,
This is my last chance of asking question with this recharge.
I am still having anxiety off and on. How long this parking anxiety remains normaly?
If my anxiety still continue like this, do I need to increase to 125mg this Friday( Friday will be 2 weeks with 100mg)
If my anxiety intensity and frequency reduced by this Friday and having only minor traces of anxiety do I still go to 125mg or try 100mg another 1 more week to see whether fully recovered with 100mg?
Only this parking anxiety is the current problem, apart that sleeping, activity level etc fine .
Just curious to know, if I change setra from night to morning, is there any possibility to get more better result?
I will monitor 2 more weeks and if still anxiety persists, I will seek again for your furthur guidance.
Thanks again for your help so far..
doctor
Answered by Dr. Ashok Kumar (3 hours later)
Brief Answer:
No change required if only traces of anxiety remain

Detailed Answer:
Dear XXXXX,
Thanks for reverting back to me.

Generally the parking anxiety may remain for six weeks but it does not cause much difference in working and even the suffering remain mild or moderate.

As we have discussed in the past the medication tend to improve things over weeks (mostly six weeks but sometime unto 12 weeks) if you feel better and there is no functional impairment my advice will be with same dose. I think in that scenario we should allow maximum possible time to the medication.

In case there is limited improvement and you suffer alike in past like chest tightness and others I think we can raise the dose to 125 mg after the completion of two weeks with current dose.

In my view current dose may be either enough or just marginally low from the required dose as there is improvement in many of the affected areas and especially the normal functioning.

Regarding changing in schedule there is no rationale to shift in morning if you have adequate sleep. Few of the patients with sertraline feel activated and find it difficult to sleep and in that situation it is recommended for morning dose. If there is no activation it can be taken any time of the day. I must clarify that sertraline have half life of 35 hours and remains in the system for 24 hours or more after a single dose.

I hope this helps you further.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

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What Is The Effective Dose Of Buspar?

Brief Answer: Clonidine is never recommended as anti anxiety medication Detailed Answer: Dear XXXXXXX Thanks for using Healthcaremagic. I read your query and understand your concerns. First regarding Buspar- The effective dose of Buspar in most Asians is around 30 mg and western people need around 30-45 mg. The dose tried is never adequate and I do not think it can bet blamed. Before we says it is effective for not the dose should be at least 10 mg three times a day. In addition Buspar acts every slowly and may take two to four weeks before showing any positive response. So I think you need to give a fair trial before saying it is not effective. Secondly if it not show response and you already think SSRI may not suit you I feel pristiq can be better option for you. Regarding clonidine I do not think there is rational for using it in your case. I understand it have anti anxiety properties but it is never more safe than SSRI or SNRI, mainstay of treatment for GAD. You may get severe postural hypotension on using both them together and if you prefer to discontinue clonidine it may cause rebound hypertension sufficient enough to cause stroke. It will not be wrong to say that Clonidine is never recommended as anti anxiety medication as there are better alternative available. My advice is to talk to any local doctor before taking such major but irrational decisions. I hope this helps you. Thanks and regards.