Thanks to all who replied to my question about Advair. We were very careful to keep the Flovent the same level (she used the Flovent inhaler in addition to the Advair to keep it equal) and she switched from a Serevent diskus, so all things should have been the same. However, I left the choice to her, and she decided to go back to the Serevent diskus and Flovent MDI. She hasn’t been having any problem since. I guess it’s a case of "different strokes for different folks." sue — Susan Hartman/Dirty Linen The Magazine of Folk and World Music http://www.dirtylinen.com
Does Advair have the same compounds as Pulmicort. Check with your doctor. Lane – Hide quoted text — Show quoted text – Hello. I’ve read lots of posts about Advair and seen that most people like it. But I’m still slightly concerned. My 13-y.o. daughter has severe asthma and takes Accolate, Serevent, Flovent, and Zyrtec. She’s been well controlled over the summer. In the past she has tried Pulmicort Turbohaler and had disastrous results. She couldn’t sleep at night, couldn’t wake in the morning, and had awful nightmares and almost "psychotic" dreams/nighttime episodes. This occured between 1-3 weeks after starting Pulmicort, and when we made the connection we put her back on Flovent and she was fine. (And this has happened twice, at 18-mo intervals). Well, she just started Advair about a week and a half ago and is starting to have trouble sleeping and waking. This morning she mentioned that she thinks it might be similar to the Pulmicort experience. But since it’s just the first couple of weeks of school, it’s hard to say whether it’s Advair-related or normal teen adjustment to a daytime schedule! Though she did also just yesterday have her first asthma flare in a long while – several weeks at least (used the neb for the first time since the beginning of summer). So my question is, has anyone had similar problems with Pulmicort Turbohaler, and what is the experience of those "sensitive" people to Advair? Is there something related to the delivery method? Or was the Pulmicort/Flovent difference related to the drug involved? I should also mention that’s she’s one of those unfortunate people who responds "over the top" to prednisone…every bad side effect known to woman! Munchies, water retention, screaming meanies, etc. Thanks for any light you can shed. Sue — Susan Hartman/Dirty Linen The Magazine of Folk and World Music http://www.dirtylinen.com
Her reaction to Advair shouldn’t be any different than her reaction to Flovent and Serevent since Advair is the combination of the 2 drugs in a more convenient form. What dose is she on? And did she increase her dose? For example if she was on Flovent 220 is her Advair 250/50? Or higher?
Well, she just started Advair about a week and a half ago and is starting to have trouble sleeping and waking. This morning she mentioned that she thinks it might be similar to the Pulmicort experience.
It may be an issue of dose. It is possible that her technique with the MDI is not optimal so what the doctor thinks is an equivalent dose of the dry powder inhalers is actually an increase. Advair comes in three different strengths so it may be possible to reduce her dose safely. — CBI, MD
I took Advair for about six weeks and finally decided to take a break inasmuch as my nasal passges have been very sore deuring that time. I don’t know if there’s a connection, thus the break to see what happens. If it clears up then reappears when I resume the Advair, then I’ve resolved the problem. I did find that the NIH resume was most helpful … I don’t have it in front of me, but loss of sleep might’ve been one of the side effects. Hope this helps … Al Fisher
Hello. I’ve read lots of posts about Advair and seen that most people like it. But I’m still slightly concerned.
I loved Advair. I was down to one puff a day, and was off my ventolin inhalers completely. <I am one ofthose people who has cats, sleeps with them – and is allergic However, I also had a concern – I began having heart palpitaitons. I checked the web for side effects, asked the doctor – and my concerns were dismissed. I ended up in the hospital with Ventricular Tachycardia (VT). Normally a very healthy (other than the asthma) adult who hikes, bikes and climbs stairs, my energy level was dropping off the bottom. I have since read that the Advair guys had done some tests on VT and Advair, but I don’t know what the results were. Why would they do the tests if there was no concern? If you do develop VT from using Advair – does it disappear after you stop using it? Does anyone have any anecdotal evidence on this? Connie
I found on a switch from Aerobid to Flovent, that the switch itself caused me to be extremely sensitive for about 3 weeks. It wasn’t that the new drug didn’t work, I think it was that the old one quit before the new one built up. Time may help? LA – Hide quoted text — Show quoted text – Hello. I’ve read lots of posts about Advair and seen that most people like it. But I’m still slightly concerned. My 13-y.o. daughter has severe asthma and takes Accolate, Serevent, Flovent, and Zyrtec. She’s been well controlled over the summer. In the past she has tried Pulmicort Turbohaler and had disastrous results. She couldn’t sleep at night, couldn’t wake in the morning, and had awful nightmares and almost "psychotic" dreams/nighttime episodes. This occured between 1-3 weeks after starting Pulmicort, and when we made the connection we put her back on Flovent and she was fine. (And this has happened twice, at 18-mo intervals). Well, she just started Advair about a week and a half ago and is starting to have trouble sleeping and waking. This morning she mentioned that she thinks it might be similar to the Pulmicort experience. But since it’s just the first couple of weeks of school, it’s hard to say whether it’s Advair-related or normal teen adjustment to a daytime schedule! Though she did also just yesterday have her first asthma flare in a long while – several weeks at least (used the neb for the first time since the beginning of summer). So my question is, has anyone had similar problems with Pulmicort Turbohaler, and what is the experience of those "sensitive" people to Advair? Is there something related to the delivery method? Or was the Pulmicort/Flovent difference related to the drug involved? I should also mention that’s she’s one of those unfortunate people who responds "over the top" to prednisone…every bad side effect known to woman! Munchies, water retention, screaming meanies, etc. Thanks for any light you can shed. Sue — Susan Hartman/Dirty Linen The Magazine of Folk and World Music http://www.dirtylinen.com
Hello. I’ve read lots of posts about Advair and seen that most people like it. But I’m still slightly concerned. My 13-y.o. daughter has severe asthma and takes Accolate, Serevent, Flovent, and Zyrtec. She’s been well controlled over the summer. In the past she has tried Pulmicort Turbohaler and had disastrous results. She couldn’t sleep at night, couldn’t wake in the morning, and had awful nightmares and almost "psychotic" dreams/nighttime episodes. This occured between 1-3 weeks after starting Pulmicort, and when we made the connection we put her back on Flovent and she was fine. (And this has happened twice, at 18-mo intervals). Well, she just started Advair about a week and a half ago and is starting to have trouble sleeping and waking. This morning she mentioned that she thinks it might be similar to the Pulmicort experience. But since it’s just the first couple of weeks of school, it’s hard to say whether it’s Advair-related or normal teen adjustment to a daytime schedule! Though she did also just yesterday have her first asthma flare in a long while – several weeks at least (used the neb for the first time since the beginning of summer). So my question is, has anyone had similar problems with Pulmicort Turbohaler, and what is the experience of those "sensitive" people to Advair? Is there something related to the delivery method? Or was the Pulmicort/Flovent difference related to the drug involved? I should also mention that’s she’s one of those unfortunate people who responds "over the top" to prednisone…every bad side effect known to woman! Munchies, water retention, screaming meanies, etc. Thanks for any light you can shed. Sue — Susan Hartman/Dirty Linen The Magazine of Folk and World Music http://www.dirtylinen.com
Hi all… A week ago Tues I saw my specialist who said to reduce my FloVent to 500 mcg per day and see how it goes. So Tues I had the reduced dose and Wed I woke with that familar tiggle and congestion in the back of my throat. I posted a message about this being related to reduced FloVent so fast but no one replied. Then Wed afternoon my PEF dropped into my yellow zone where it has remained (9 1/2 days total). During this time, I returned to 1000 mcg (last Fri). Since I was taking my Bricanyl more frequently, I called my doctor who said to up the dose to 2000 mcg until things calm down then gradually reduce to my regular 1000 mcg. I can’t figure out what caused this drop in PEF; I’m still very close to my red zone so I’m taking it easy, staying indoors and close to the phone incase my PEF drops to the red zone. I’m drinking lots of tea and water. At first I thought I may have a cold but no real cold symptoms have appeared other than feeling quite run down and sluggish. I don’t have any nasal congestion, excessive coughing, sneezing. I did notice a low grade transient fever that didn’t last very long. Does anyone have any ideas what may have caused this? I sure would like to find out so I can prevent it from happening again. — Janine
- Hide quoted text — Show quoted text – A week ago Tues I saw my specialist who said to reduce my FloVent to 500 mcg per day and see how it goes. So Tues I had the reduced dose and Wed I woke with that familar tiggle and congestion in the back of my throat. I posted a message about this being related to reduced FloVent so fast but no one replied. Then Wed afternoon my PEF dropped into my yellow zone where it has remained (9 1/2 days total). During this time, I returned to 1000 mcg (last Fri). Since I was taking my Bricanyl more frequently, I called my doctor who said to up the dose to 2000 mcg until things calm down then gradually reduce to my regular 1000 mcg. I can’t figure out what caused this drop in PEF; I’m still very close to my red zone so I’m taking it easy, staying indoors and close to the phone incase my PEF drops to the red zone. I’m drinking lots of tea and water. At first I thought I may have a cold but no real cold symptoms have appeared other than feeling quite run down and sluggish. I don’t have any nasal congestion, excessive coughing, sneezing. I did notice a low grade transient fever that didn’t last very long. Does anyone have any ideas what may have caused this? I sure would like to find out so I can prevent it from happening again. —
Janine (in Canada), I would guess your exacerbation is caused by a virus, this happens often; external symptoms may be minimal but the lung function gets knocked down; another possibility is its one of your other triggers. Have your triggers been identified and exposure to them minimized? Per US Guidelines, fluticasone use above 660 mcg/day, or 3 puffs/day of Flovent 220 constitutes a High Dose. I believe in Canada you use the same MDI inhaler but labeled Flovent 250 since you measure dose at the nozzle whereas in the US its measured at the holder opening; so this translates to 750 mcg/day is a High Dose. It would be desireable to get your dose down to 500 mcg/day per your doctor’s suggestion, after you are over the exacerbation. Are you using any steroid-sparing meds; a long acting bronchodilator is usually recommended, Serevent, 2 pf twice a day; or TheoDur tablets. [I take both.] Another possibility is Accolate. Do you have Sinusitis or Gastroesophageal Reflux, that could be contributing to asthma? If so it needs to be treated. Do you breathe thru your nose most of the time (filters & humdifies air) Here are links on Asthma Triggers: ASTHMA TRIGGERS http://www.aaaai.org/patpub/resource/publicat/tips/tip04.html TRIGGERS OF ASTHMA http://www.njc.org/MFhtml/TRI_MF.html Identifying Triggers of Asthma, 1994 http://www.ama-assn.org/special/asthma/treatmnt/updates/identify.htm Identifying Asthma Triggers http://www.mayohealth.org/mayo/9602/htm/trigg_sb.htm Trigger-proofing your environment http://www.lungusa.org/learn/asthma/astastrig.html Asthma Triggers http://www.lungusa.org/global/news/medical/medfebaf.html Ozone Air Pollution, Particulates Ellis
snip I would guess your exacerbation is caused by a virus, this happens often; external symptoms may be minimal but the lung function gets knocked down
There’s a nasty respiratory bug going around right now. My son, who is normally a Mild Persistant asthmatic, had a horrible time of it last week. He dropped into his red zone fairly quickly, and when we got to the doctor, he was in bad shape. He had to go onto oral prednisone for five days–and two days later, had a coughing fit so bad he had problems catching his breath and we did the 911/emergency room run, ending up with another breathing treatment (and a verdict of clear lungs) and a diagnosis of a virus-caused cough triggering bronchospasm. So he got codeine to go with the prednisone. That same day he had a brief, but intense fever, going from normal to 103 degrees back down to normal in the space of five hours. We visited the doctor, had x-rays done, because the doctor was worried about the possibility of pneumonia. Lungs looked good, with only a few mucus plugs remaining in his lungs (the doctor pointed them out to me, saying "this is what an asthmatic’s lung looks like on x-rays)…it’s just an ugly, ugly virus causing coughing which irritates the bronchial tubes. I’m hoping we don’t have to go back on prednisone, because he’s now off–but he’s still blowing in his yellow zone. It’s borderline yellow/green–but I’d like him to get back to Intal only, not Intal and Ventolin, as we’ve been doing to manage the attack. jrw
280 is panic time??? Wow, I don’t get worried until I am down below 200. Sharre T.
It depends on what your personal best is. Obviously if your personal best is 600, your normal lung capicity is more than someone whose personal best is 400. Kim
- Hide quoted text — Show quoted text – I went to the doctor’s again today since I have been in my yellow zone since the 7th despite increased FloVent (from 1000 mcg to 2000 mcg daily). A side effect of the FloVent has been thrush 
so he prescribed medication for that and Prednisone. Funny, I was rinsing after each FloVent inhalation, using tea tree oil toothpaste and using my spacer but still developed thrush! Perhaps I’m a little run down? I mentioned this to the doctor and he said I should call him Thurs to let him know how I was doing and if things were not improving then he would run some blood tests. Isn’t asthma fun? Even when you do everything you are supposed to, things can still go wrong. Janine
Yep, that’s true. I would suggest that instead of using a tea tree oil toothpaste you use a tea tree oil mouth wash. You can gargle with it and get the areas of your throat that a toothpast will miss. Also swishing it around your mouth will cover areas the toothpaste would miss. Hang in there. Sometimes, as you said, you do everything right and things still go wrong. Loki
I would suggest that instead of using a tea tree oil toothpaste you use a tea tree oil mouth wash. You can gargle with it and get the areas of your throat that a toothpast will miss. Also swishing it around your mouth will cover areas the toothpaste would miss.
I’m not familiar with tea tree oil. Is it an antispetic of some sort? Anyway, I use a standard antispetic mouthwash for the same purpose. It may not be ‘natural’ but it seems to do the job just fine (and is probably a lot less expensive).
I would suggest that instead of using a tea tree oil toothpaste you use a tea tree oil mouth wash. You can gargle with it and get the areas of your throat that a toothpast will miss. Also swishing it around your mouth will cover areas the toothpaste would miss. I’m not familiar with tea tree oil. Is it an antispetic of some sort?
It is an essential oil that has antiseptic and antifungal properties. As an antiseptic it’s ok. I use it on minor things like paper cuts. As an antifungal it is extremely good. Anyway, I use a standard antispetic mouthwash for the same purpose. It may not be ‘natural’ but it seems to do the job just fine (and is probably a lot less expensive).
As long as it works, that’s all that matters. I used just plain water for a long time. I’ve started using the tea tree oil mouthwash mostly because I had begun to get thrush no matter how thoroughly I rinsed. It seems to be doing the job (at least for now). I’m sure your mouthwash tastes better than mine anyway. Tea tree oil isn’t exactly the most appetizing thing in the world even when masked with spearmint oil (as mine is). Oh, I do believe you are correct about the cost. Someone who is adventurous might try just adding a drop of tea tree oil to their regular mouthwash but I’m uncertain of the correct dilution for that purpose so I wouldn’t. (I could go do the research but I’m in a hurry.) Now, if you need the dilution for shampoo (dandruff), that I can give you. <chuckle Loki
One more note about tea tree–as with any herbal remedy, be cautious with it. My niece is allergic to it, as she discovered to her horror when she used it on a skin inflammation and made it WORSE. I may be a bit sensitive to it as well, as I’ve found it irritating to some of the things I’ve tried to treat with it, and pretty much ineffective for me. Your mileage may vary, but do be careful in testing it. Tea tree oil is also sometimes called "ti tree oil". I understand the tree itself, which was imported into Florida, has become a pest there and is displacing native plants. Maybe if someone turned Floridians on to the market for the stuff, they’d harvest the interloper trees and the price would go down. ;-) My sympathies for those who get thrush from Azmacort or other inhalers. Apparently following my doctor’s recommendation of rinsing my mouth (or just drinking something) after use has been enough to prevent it in my case. Kiwi Carlisle
280 is panic time??? Wow, I don’t get worried until I am down below 200. I only use ventolin, and five mgs methylprenisolone with an antibiotic if I get an infection. I have never really understood peak flow numbers. I didn’t even own one for the first three years of my asthma. Once when I got an infection that went too long before I got my refill for prednisone, I blew 95. THEN I was panicked. I am a half an hour from the hospital. The doctor keeps telling me that there are no definite numbers. I keep wondering why the hell I have the meter. – Hide quoted text — Show quoted text – Hi all… I talked to my doctor on Thursday after trying to get my PEFs up out of the yellow for the past two weeks. Despite prednisone, they were still in the yellow. He referred me back to my specialist who I saw this afternoon at the end of his day. The first few minutes of the visit were disasterous! I told him that my peak flows were down and he commented that "You are obsessed with you peak flows, we have worse cases of asthma than this…go down to spirometry." I was stunned, since any other time I had dealt with him there had been no problem. I went down to spirometry, and the first try produced severe chest tightness and pain. The respirologist immediately left to talk to the specialist, then came back and asked if I would be ok to try again. I managed to get through two more tries. The last two loops could easily fit within the first loop as they were quite a bit smaller. This was under the influence of prednisone and Bricanyl (within 1 hr of the test). I headed back to the examining room while he looked over my results. When he returned, his attitude was significantly changed. Now he was extremely interested in my peak flow chart and commented that he hadn’t realized that I had been this bad for this long. He said that the FloVent was not depositing in my lungs so he has now put me on Pulmicort turbuhaler (400 ug) and he replaced my SereVent with Foradil aerolizer. He also gave me a renewable prescription for prednisone (5 mg) with instructions to use 4 tablets if my PEF drops to 280. I now have to go back in three weeks, sooner if things don’t settle down. He said I definitely had a viral infection which caused my peak flows to drop but I didn’t feel "sick" so I’m still wondering about this. What I found so interesting was his change in attitude and I am left wondering why the change. I definitely will make sure that my next visit with him is not at the end of the day though. — Janine
Sharre T. Truth is infinite; therefore, Truth cannot be known in finite terms – Joel Goldsmith
Hi all… <snip if things don’t settle down. He said I definitely had a viral infection which caused my peak flows to drop but I didn’t feel "sick" so I’m still wondering about this.
<snip I feel that quite a low-grade viral infection which I wouldn’t have noticed before asthma, or which would have lead to a slight drippy nose, can affect my chest or possibly increase my sensativity to chemical smells, such as toilet cleaner, which seem to make my asthma worse. — Surfer! http://www.nevis-vieww.demon.co.uk Hopeful anti-spam: alter double ‘w’ to single ‘w’ to view site & send Email.
At 3 puffs of Flovent 110 daily (i.e. daily dose of 330 mcg.), I experience significant dysphonia ( hoarseness) At 2 puffs of Flovent 220 daily (i.e. daily dose of 440 mcg.), I experience no dysphonia I have observed this repeatedly over 2 years of daily use. Has anyone else had this experience? Perhaps others with dysphonia on Flovent 110 might try the 220. —–= Posted via Newsfeeds.Com, Uncensored Usenet News =—– http://www.newsfeeds.com – The #1 Newsgroup Service in the World! —–== Over 80,000 Newsgroups – 16 Different Servers! =—–
Hi, that certainly is a very interesting piece of information, and I am eager to try this "experiment". Thanks for sharing.
I know it’s way too early to tell, but I swear I’m getting relief from Sinulair… I’m a mild asthmatic and finally wenr to the doctors after a cold kept me weezing for an entire week (prior episodes were confined to 1-2x month)… after an in-office test he prescribed everything – Flo-Vent + Singulair + Albuterol for weezing… I am a borderline health "nut" and avoid drugs if at all possible… I told him I would not take the full regiment to start, but instead would try just the singulair and see how it goes… well it’s been a week and my night’s have been wonderful! Clear, full breaths with no effort! Keep in mind, I wasn’t moderate or severe prior to taking the Singulair… but my relief is self-evident nonetheless… We’ll see if it keeps up. Brad
- Hide quoted text — Show quoted text – I know it’s way too early to tell, but I swear I’m getting relief from Sinulair… I’m a mild asthmatic and finally wenr to the doctors after a cold kept me weezing for an entire week (prior episodes were confined to 1-2x month)… after an in-office test he prescribed everything – Flo-Vent + Singulair + Albuterol for weezing… I am a borderline health "nut" and avoid drugs if at all possible… I told him I would not take the full regiment to start, but instead would try just the singulair and see how it goes… well it’s been a week and my night’s have been wonderful! Clear, full breaths with no effort! Keep in mind, I wasn’t moderate or severe prior to taking the Singulair… but my relief is self-evident nonetheless… We’ll see if it keeps up. Brad
Glad to see the singulair works for you but as with any drug, keep an Eye on other side effects it may bring. It is a new drug and I have had some things happen that greatly concern me, since starting the singulair. I will not mention what, as i don’t want to influence your judgement. If you have been reading other peoples posting about singullair you probably know what might happen. The drug helped bring up my peak flow readings as well, but I think the other side effects far outway the 20 points higher on my readings. So i am not on the drug any more. Dont forget to look at possible food/allergies etc. that might be causing problems during sleep, also have you had reflux ruled out. No eating after 8pm!!! Take care,, Mountain Mama
Is there any research indicating that Singulair can have a beneficial effect for people with Chronic Obstructive Pulmonary Disease? I’ve asked my doctor, an internist with a subspecialty in pulmonology, about this, and he was doubtful that the drug would be helpful to me. Since the various "classic" asthma meds are used in treating COPD symptoms, it seems strange that the anti-leukotrienes (and Singulair, in particular) have not been recommended by the drug mfrs. [I posted this question to this list several months ago. I'm asking it again, on the outside chance that there is possibly some new data available.] — Neal Blank http://p3.net/~nealb/
I am just taking a guess from what I know about Singulair. I am sure If I am way off base here aleast one of you will correct me. Singulair, goes after the chemical that at the root of the problem causes the bronchial spasms. By stopping the spasms there will be less inflammation, in turn lessing the asthma attacks. Bronchistis, and emphysema are due to inflamed bronchial tubes, but are not caused by the spasms that causes the inflammations of asthma, so Singulair will not help. I am not sure if I am right but, this may (or may not)help.
Is there any research indicating that Singulair can have a beneficial effect for people with Chronic Obstructive Pulmonary Disease? I’ve asked my doctor, an internist with a subspecialty in pulmonology, about this, and he was doubtful that the drug would be helpful to me. Since the various "classic" asthma meds are used in treating COPD symptoms, it seems strange that the anti-leukotrienes (and Singulair, in particular) have not been recommended by the drug mfrs. [I posted this question to this list several months ago. I'm asking it again, on the outside chance that there is possibly some new data available.]
No I don’t think there is any data available. I note that in the UK the drug is only licensed for asthma. However, I have COPD with a ‘reversible componant’, which means that I respond to corticosteroid therapy with an improvement in PF and FEV1. I also respond to bronchodilators. Call this asthma if you like, and yes I have been perscribed Singulair and yes it seems to have definitely improved things for me. I have now just finished the first months treatment and the improvement I felt within days of taking it seems to have been maintained. Yesterday was the *first day for over ten years* that I have not used a single puff of Ventolin 
If you can persuade them to let you have it I would say it is worth a try. Regards Rob Remove the spam from address if replying by email
I am just taking a guess from what I know about Singulair. I am sure If I am way off base here aleast one of you will correct me. Singulair, goes after the chemical that at the root of the problem causes the bronchial spasms. By stopping the spasms there will be less inflammation, in turn lessing the asthma attacks. Bronchistis, and emphysema are due to inflamed bronchial tubes, but are not caused by the spasms that causes the inflammations of asthma, so Singulair will not help. I am not sure if I am right but, this may (or may not)help.
Not wrong, but an oversimplification. Yes, LTD is a potent broncho-constrictor. BUt it appears to be having at least mild anti-inflammatory effects at least in mild to moderate asthmatics. THe reasons arent clear yet, but bronchospasm can lead to secondary release of mediators (prostaglandin D, Thromboxane A, cytokines, etc) which ARE inflammatory. If LTD even partially inhibits the release of such mediators from mast cells, eosinophils etc, it would have anti-inflammatory effects. BUT – *I* don’t know of any evidence that LTD is a precipitating agent in COPD. If it’s not a major player in that disease, SIngulair/Accolate’s impact is likely to be far less than in asthma. To date, there are no scientific studies of the question. Both LTE and LTB (a leukotriene NOT targeted by Accolate/Singulair) have been shown to be elevated in COPD, but whether reducing that elevation has any effect in the disease doesnt appear to have been studied. IF LTB is importand, COPD may be better treated with Zyflo than with the LT-RAs.
Hi all! Just came from Dr, now we have 2 inhalers (Flovent and Albuterol) plus ventolin to add to the albuterol nebulizer. We also have the Steroids (Predinisone) for 5 days and another allergy medicine to try (Claritin didn’t help)….. Thanks everyone who posted and emailed me, we have an action plan now and the Doctor talked to me for a long time today about what to look for – in order to know to take her to the ER, signs like some of the ones mentioned… Finding the trigger I’m thinking will be next to impossible since she only gets it 2x per year, we are thinking it’s pollen or something seasonal. I tried to respond via dejanews about the environment suggestions, it’s not showing up here now but anyway, the possibility of eliminating dust mold etc are pretty remote, if it’s the house, carpet, furniture…. Thanks again all, Kathleen | Hi Steve and Kathleen, | | I have a daughter 6 1/2 years of age and a son 4 years of age. Both have | had asthma since they were 3 months old. | | I have two nebulizers at home and I give the kids ventolin when they are | coughing. They also have taken preventative medication Intal (didn’t work) | and Pulmicort. They are now on 2 other preventative treatments Flixatide | (which is like Pulmicort) and Serevent (which is a preventative ventolin). | | I have them under the control of a pediatric respritory doctor who is | superb. I can give my kids Ventolin every 1 – 2 hours. My asthma plan is | they have 2 machines close together 1/2 hour apart. Wait an 1hr give | another and wait an 1 hr and give another, if they don’t settle I take them | up to the hospital or start a 3 day course of prednisolone. | | Take a good close look at their chest. If their chest is suken when you | lift their shirt then they need oxygen immediately. | | If she needs prednisolone, I feel she needs a preventative. My children | have not been able to stop preventative medication for more than 3 months at | a time. | | Are you in Australia? | | LA
Barry is a salesman. He sells air cleaners.
I am glad that you asked this question as it was the first thing I thought when I read the posting.
Hi ! First let me say that I can not help you but before you toss this you might be able to help me… I am a preschool teacher ( 4 and 5 year olds) and more of my students are being diagnosed with asthma. One of my students was hospilatized theis weekend. ( he’s fine now but it got me thinking) I have taken courses in Health, Safety and Nutrition as well as CPR and First Aid and yet I too, do not know much about the early signs of a problem. I hope I would recognize a child in a severe condition and could respond accordingly but I’m not sure I could detect the early signs…. Can you help educate me? Can you share some information? Do you know of any helpful books or brochures. I would hate to think I could overlook sign until a distressful situation developed. I probably won’t remember how I got to this board so can you respond in a
Tough call. If your child is mature enough to understand how to use a peak flow meter then I would get one. It is a little plastic device that they blow into as hard as they can. Asthmatics have a hard time getting air out of their lungs quickly. If there is an asthma attack it will show up on the peak flow. Have your child do three blows twice a day and record the results. Know what her best is. If she is 80-100% of her best, she is ok. If she is 60-80% of her best she is having some trouble, needs albuterol, but you don’t need to rush to the ER. Just see your doctor as quickly as possible. Under 60% then an ER visit is indicated. Remember, asthma is a desease of inflammation, not bronchoconstriction. Albuterol is a bronchodilator and steroids are antiinflammatories. Although you cannot overdose albuterol you may get to a point were it’s not effective anymore because you need that steroid. Also, is your child on a preventative medicine? I hope that helps. For more information on asthma you can check out my website at www.ibabydoc.com. No spam I just love being a pediatrician and helping children. Dr. Michael Bornstein, M.D. F.A.A.P. www.ibabydoc.com
My daughter has had asthma since she was around 2yo, just ‘officially’ diagnosed early this year. We have a nebulizer at home and I have been instructed to use it when she starts coughing, with albuterol & saline solution. About 2x a year it isn’t enough and she has had to take Pedipred/predinisone (spelling?) for 10 days and that has always cleared it up. My question is, how do I know she needs to go to the hospital?
The Expert Panel Report 2 has a figure classifying severity of asthma exacerbations [Fig 3-9]. Some of the symptoms for a severe exacerbation are: Breathlessness–while at rest Talks in words, rather than phrases or sentences. Agitated Repiratory rate often 30/min Wheeze–usually loud; throughout inhale & exhale Pulse–120/min Peak flow <50% personal best [a 5 yr old should be able to use a peak flow meter] Note: The presence of several parameters, but not necessarily all, indicates the general classification of the exacerbation. Her appetite is better today than yesterday, she is wanting to get around today (yesterday she slept on and off all day) but I can feel the wheezing in her chest. I have been giving her breathing treatments at least every three hours. This started up Friday morning and I let her go to school, however the nebulizer does not seem to be helping, not more than for a couple hours anyway. Is it possible to overdose on Albuterol??
Ask your doctor; albuterol is a fairly safe drug. Current asthma guidelines are to have an Action Plan to increase drugs when peak flow decreases or symptoms increase; typically a steroid inhaler is added or increased and albuterol used as needed, when peak flows drop below 80% personal best or symptoms increase. Such an Action Plan may help avoid the need to go on oral steroids like Pedipred or make a trip to ER. http://www.ama-assn.org/special/asthma/treatmnt/updates/patient.htm Patient Asthma Action Plans Ellis – Hide quoted text — Show quoted text – We have had a great doctor since she was born, and will go see her tomorrow but it would be nice if I could converse with others who have dealt with this type of asthma….. It never seems particularly severe to me but her doctor is always very concerned by the time I take her in. I tend to worry about it a lot when she gets like this and fear the worst.. that I will under-react and it will be TOO LATE. Thanks, Kathleen
My daughter has had asthma since she was around 2yo, just ‘officially’ diagnosed early this year. We have a nebulizer at home and I have been instructed to use it when she starts coughing, with albuterol & saline solution. About 2x a year it isn’t enough and she has had to take Pedipred/predinisone (spelling?) for 10 days and that has always cleared it up. My question is, how do I know she needs to go to the hospital? Her appetite is better today than yesterday, she is wanting to get around today (yesterday she slept on and off all day) but I can feel the wheezing in her chest. I have been giving her breathing treatments at least every three hours. This started up Friday morning and I let her go to school, however the nebulizer does not seem to be helping, not more than for a couple hours anyway. Is it possible to overdose on Albuterol?? We have had a great doctor since she was born, and will go see her tomorrow but it would be nice if I could converse with others who have dealt with this type of asthma….. It never seems particularly severe to me but her doctor is always very concerned by the time I take her in. I tend to worry about it a lot when she gets like this and fear the worst.. that I will under-react and it will be TOO LATE. Thanks, Kathleen I am not looking for treatment or medical gagets, just people who are familiar with this scenario — "If you think you are too small to be effective then you have never been in bed with a mosquito."
Barry here of http://www.aircleaners.com I know that your against medical devices, but if the drugs arent working then mabe its an environmental problem that products such as HEPA air cleaners, DustMite Proof mattress and pillow encasings Ect.. may help. Mabe your homes indoor environment needs to be cleaned up. Do you have any carpet that is less then two years old ? Have you had any roof leaks in the past? You could have a chemical outgassing problem or a mold problem in your home that could cause chronic health problems.Also have you had much pest control ? If you dont get rid of the triggers first, the drugs wont always do a good job.You need to look at the big picture for possible environmental problems.Both at home and at school. The drugs are just a part of it. – Hide quoted text — Show quoted text – My daughter has had asthma since she was around 2yo, just ‘officially’ diagnosed early this year. We have a nebulizer at home and I have been instructed to use it when she starts coughing, with albuterol & saline solution. About 2x a year it isn’t enough and she has had to take Pedipred/predinisone (spelling?) for 10 days and that has always cleared it up. My question is, how do I know she needs to go to the hospital? Her appetite is better today than yesterday, she is wanting to get around today (yesterday she slept on and off all day) but I can feel the wheezing in her chest. I have been giving her breathing treatments at least every three hours. This started up Friday morning and I let her go to school, however the nebulizer does not seem to be helping, not more than for a couple hours anyway. Is it possible to overdose on Albuterol?? We have had a great doctor since she was born, and will go see her tomorrow but it would be nice if I could converse with others who have dealt with this type of asthma….. It never seems particularly severe to me but her doctor is always very concerned by the time I take her in. I tend to worry about it a lot when she gets like this and fear the worst.. that I will under-react and it will be TOO LATE. Thanks, Kathleen I am not looking for treatment or medical gagets, just people who are familiar with this scenario — "If you think you are too small to be effective then you have never been in bed with a mosquito."
Barry here of http://www.aircleaners.com I know that your against medical devices, but if the drugs arent working then mabe its an environmental problem that products such as HEPA air cleaners, DustMite Proof mattress and pillow encasings Ect.. may help. Mabe your homes indoor environment needs to be cleaned up. Do you have any carpet that is less then two years old ? Have you had any roof leaks in the past? You could have a chemical outgassing problem or a mold problem in your home that could cause chronic health problems.Also have you had much pest control ? If you dont get rid of the triggers first, the drugs wont always do a good job.You need to look at the big picture for possible environmental problems.Both at home and at school. The drugs are just a part of it.
This in no way remotely addresses the questions she was answering. I don’t understand you people.
Barry here of http://www.aircleaners.com I know that your against medical devices, but if the drugs arent working then mabe its an environmental problem that products such as HEPA air cleaners, DustMite Proof mattress and pillow encasings Ect.. may help. Mabe your homes indoor environment needs to be cleaned up. Do you have any carpet that is less then two years old ? Have you had any roof leaks in the past? You could have a chemical outgassing problem or a mold problem in your home that could cause chronic health problems.Also have you had much pest control ? If you dont get rid of the triggers first, the drugs wont always do a good job.You need to look at the big picture for possible environmental problems.Both at home and at school.
That is assuming that there is an ‘environmental problem.’ Generally, in the case of asthma the problem will be allergy. Identifying the allergen in question is a must before you try to spend any money controlling things that usually are not causing problems. "Being responsible sometimes means pissing people off." General Colin Powell
Barry here of http://www.aircleaners.com I know that your against medical devices, but if the drugs arent working then mabe its an environmental problem that products such as HEPA air cleaners, DustMite Proof mattress and pillow encasings Ect.. may help. Mabe your homes indoor environment needs to be cleaned up. Do you have any carpet that is less then two years old ? Have you had any roof leaks in the past? You could have a chemical outgassing problem or a mold problem in your home that could cause chronic health problems.Also have you had much pest control ? If you dont get rid of the triggers first, the drugs wont always do a good job.You need to look at the big picture for possible environmental problems.Both at home and at school. The drugs are just a part of it. This in no way remotely addresses the questions she was answering. I don’t understand you people.
Barry is a salesman. He sells air cleaners. PS Barry, are you still selling Alpine products? "Being responsible sometimes means pissing people off." General Colin Powell
: : Barry here of http://www.aircleaners.com I know that your against medical : devices, but if the drugs arent working then mabe its an environmental : problem that products such as HEPA air cleaners, DustMite Proof mattress and : pillow encasings Ect.. may help. Mabe your homes indoor environment needs to : be cleaned up. Do you have any carpet that is less then two years old ? Have : you had any roof leaks in the past? You could have a chemical outgassing : problem or a mold problem in your home that could cause chronic health : problems.Also have you had much pest control ? If you dont get rid of the : triggers first, the drugs wont always do a good job.You need to look at the : big picture for possible environmental problems.Both at home and at school. : : That is assuming that there is an ‘environmental problem.’ : : Generally, in the case of asthma the problem will be allergy. : Identifying the allergen in question is a must before you try to spend : any money controlling things that usually are not causing problems. I do have asthma triggered by environmental problems and the air cleaners don’t help much if any. If you have an environmental trigger you get away from it or clean it up. At best a room sized air filter help me a very little bit. Cleaning the airconditioner ducts and sealing the leak between the cloths dryer and the return air and putting a decent filtering set helped a lot. The fabric softener in laundry products causes me problems if I get in in my lungs. I don’t use the crap on my cloths and we had changed for the one that caused me trouble but there was still enough in the ducts to cause problems. I am not cured but I am a lot better. Before you spend money fixing problems find out what triggers the asthma. An allergy test is a good start. Baring that some commons sense things that don’t cost anything are don’t run the vacuum while your child is in the house. Do it when she will be at school or a friends for a few hours. Make sure some fresh air gets in the house don’t live on recycled air. Wash the bed clothes in hot 150 degree water and dry them on high heat or dry them on a line in the sun shine. Both hard on dust mites. Keep the humidity between 30 and 50% if possible. Higher than this dust mites an molds are a problem lower than this air way irritation is a problem. Use ivory soap and avoid perfumed stuff for her in particular. They may or may not cause her a problem but they don’t help. Don’t use perfumed products when you can get a better cheaper plain product. Make your house smell clean by being clean not by deodorizers. Don’t use fabric softener on her clothes or bedding. It may not be a problem but it won’t help her asthma. One thing Barry is right on about is roof leaks and black slimy mold. If you have black slimy mold in the house you need to find out what it is and get rid of it. Some of them are very very bad news. They are also very rare. The seem to like to grow on the paper on sheet rock in the walls. Mildew is a lesser problem that should be dealt with by lowering the humidity until it is not much of a problem except at the corners of the bath tube and so on. Keeping molds out of carped bath rooms is hard to do. If you must have carpeted bathrooms make sure the shower curtain is tight and run the exhaust fan a lot and make sure the male members of the family have good aim. If you have animals move them outside or get rid of them. Don’t use a lot of Clorox or other cleaners that irritate the airways while she is in the house. Until you find the triggers or she grows enough that the asthma no longer causes attacks because the air ways get big enough the don’t close off you are running blind on trying to find relief by avoiding triggers. An allergist and pulmunolgist are your best bets for finding triggers and developing a plan to treat the asthma. Your daughter may be able to tell you what makes her feel bad. Sometimes they are right. — Gordon W5RED
– Hide quoted text — Show quoted text -I am hoping someone may have some suggestions/advice for me. I have been diagnosed with ADD for which I take Concerta (36 mgs at 6:00 am). This has helped me quite a bit. I however start to feel tense and anxious in the afternoon which will build up until I take 100 mg Seroquel about 1/2 hour before sleeping. I work in the computer field which I enjoy very much. I can’t seem to let my work go and am constantly studying and extremely curious about computers/networks in general. It seems I am always thinking out scenarios in my head about various ways to do things. The problem is that this compulsive thinking is leading to my anxious state. My dr. has tried me on numerous meds such as paxil, zoloft, effexor, luvox, depakote, lithium, remeron, wellebutrin, etc. I am not depressed, I just am (and have always been) somewhat hyper and cannot relax. It seems any med that works with serotonin just gives me bad headaches. I respond easily to Klonipin, not so well with Antivan. I guess I have ADD and am somewhat obsessive/compulsive. Erv
ever try strattera? or good old tca meds like imipramine? LM — The charter is available at:
Went fine I think. PDoc recommended Lexpro instead of Celexa – said less side effects I started yesterday and continued today. No bad stuff yet. :) Hope there isn’t any to come….. He said 3-4 days 1/2 lex pill = 5mg. with 1/2 my zoloft dosage Then go up to 10mg. almost 2 days down already! thanks,
– Hide quoted text — Show quoted text – :I meed with the doc tomorrow. Called this morning and got an appt. – what :luck How did your appt go? I hope well. Tell us about it Jackie ~*~I wanted you to see what real courage is, instead of getting the idea that courage is a man with a gun in his hand. It’s when you know you’re licked before you begin but you begin anyway and you see it through no matter what~*~ ~Harper Lee~ ~~To Kill a Mockingbird~~ — The charter is available at: http://readystump.algebra.com/~asapm
– The charter is available at: http://readystump.algebra.com/~asapm
:I started yesterday and continued today. No bad stuff yet. :) Hope there :isn’t any to come….. : :He said 3-4 days 1/2 lex pill = 5mg. with 1/2 my zoloft dosage :Then go up to 10mg. : :almost 2 days down already! Glad it`s going well. Good luck with the lexapro, I hope it works out for you Jackie ~*~Every time you are tempted to react in the same old way, ask if you want to be a prisoner of the past or a pioneer of the future~*~ ~ Deepak Chopra ~ — The charter is available at: http://readystump.algebra.com/~asapm
I meed with the doc tomorrow. Called this morning and got an appt. – what luck
Hope the appointment is productive! Let us know how it goes. xxoo Anne — The charter is available at: http://readystump.algebra.com/~asapm
:I meed with the doc tomorrow. Called this morning and got an appt. – what :luck How did your appt go? I hope well. Tell us about it Jackie ~*~I wanted you to see what real courage is, instead of getting the idea that courage is a man with a gun in his hand. It’s when you know you’re licked before you begin but you begin anyway and you see it through no matter what~*~ ~Harper Lee~ ~~To Kill a Mockingbird~~ — The charter is available at: http://readystump.algebra.com/~asapm
Thanks Anne and Jacqueline for the followups. I meed with the doc tomorrow. Called this morning and got an appt. – what luck Hope you are well.
– Hide quoted text — Show quoted text – :I went to sleep and was startled awake probably 10 times the first hour. I :kept startling MYSELF awake. When my anxiety and panic is really bad, this is what happens to me. Some nights it was so bad that I couldn`t sleep at all. It was like my body just couldn`t relax, it was so use to being tense. :The funny thing is that there really isn’t :anything stressful going on in my life right now. Things are looking up, :got some nice trips planned with my wife. Makes no sense, huh 
I`ve had times in my life where there was no reason to be anxious or panicky, I just was. Then times…. when I should have been paralyzed by anxiety due to lifes stressors, that it didn`t rear it`s ugly head. :It just feels like lately a "grim :reaper" type of feeling keeps pecking at me, ruining all the good times – :making everything difficult. When you get to this point, changes have to be made. No need to suffer like this when something could help. :The doc said that I’d cut my zoloft dose by 50% and take a 50% dose of :celexa for a few weeks and then see what happens. : :Anyone else make this switch and have any comments? I`ve never made a switch like this, but many others have with great success. Good luck and I hope you see some positive changes soon Jackie ~*~Yes there are two paths you can go by, but in the long run, there’s still time to change the road you’re on~*~" — The charter is available at: http://readystump.algebra.com/~asapm
– The charter is available at: http://readystump.algebra.com/~asapm
:I went to sleep and was startled awake probably 10 times the first hour. I :kept startling MYSELF awake. When my anxiety and panic is really bad, this is what happens to me. Some nights it was so bad that I couldn`t sleep at all. It was like my body just couldn`t relax, it was so use to being tense. :The funny thing is that there really isn’t :anything stressful going on in my life right now. Things are looking up, :got some nice trips planned with my wife. Makes no sense, huh I`ve had times in my life where there was no reason to be anxious or panicky, I just was. Then times…. when I should have been paralyzed by anxiety due to lifes stressors, that it didn`t rear it`s ugly head. :It just feels like lately a "grim :reaper" type of feeling keeps pecking at me, ruining all the good times – :making everything difficult. When you get to this point, changes have to be made. No need to suffer like this when something could help. :The doc said that I’d cut my zoloft dose by 50% and take a 50% dose of :celexa for a few weeks and then see what happens. : :Anyone else make this switch and have any comments? I`ve never made a switch like this, but many others have with great success. Good luck and I hope you see some positive changes soon Jackie ~*~Yes there are two paths you can go by, but in the long run, there’s still time to change the road you’re on~*~" — The charter is available at: http://readystump.algebra.com/~asapm
Hi all, I wrote recently about how I’ve been on zoloft for 8 years and tried to taper off 2 times. Last year I weaned back up to my normal dose of zoloft, but still things don’t seem very good. I am doing ok during the days, but when evening comes, I start to feel the anxiety setting in. Last night I took a xanax to help with it, and it was still pretty bad. I haven’t been sleeping well lately so I’ll take a tylenol pm too. I went to sleep and was startled awake probably 10 times the first hour. I kept startling MYSELF awake. I wake up feeling about 80% ok. the other 20% is that oh-so dark feeling. The funny thing is that there really isn’t anything stressful going on in my life right now. Things are looking up, got some nice trips planned with my wife. It just feels like lately a "grim reaper" type of feeling keeps pecking at me, ruining all the good times – making everything difficult. The doc said that I’d cut my zoloft dose by 50% and take a 50% dose of celexa for a few weeks and then see what happens. Anyone else make this switch and have any comments? thanks, Phil — The charter is available at: http://readystump.algebra.com/~asapm
The doc said that I’d cut my zoloft dose by 50% and take a 50% dose of celexa for a few weeks and then see what happens.
I did that with Paxil– Celexa, Phil. I tapered down on the Paxil slowly (Verrrrry slowly!) from 30 mg per day to 10 mg. I began to feel some breakthrough depression then, so my pdoc switched me immediately to 10 mg Celexa (discontinuing the Paxil) and I weaned up to 20 mg Celexa. This worked very well for me. I did have to wait a bit longer for the Celexa to address all my issues (depression in particular) than I had with the Paxil originally, but it was worth it — a great med for me, with almost no side effects. I hope the switch will work for you. It’s definitely better than going cold turkey off the Zoloft. xxoo Anne — The charter is available at: http://readystump.algebra.com/~asapm
Was diagnosed with low testosterone after stopping Effexor, never had this problem before but believe it to be related to the drug for a whole bunch of reasons that I won’t go into here. Has this happened to anyone else? My urologist believes my pitutatary gland has some how got out of whack, now I am not only depressed but have this to deal with. Wish I had never taken the drug, Wellbutrin is much better. I read on one of these posts that a user of effexor who quit taking it was told by his doctor that the drug had completely rewired his brain. Has anyone else heard of permanent side effects from Effexor?
- Hide quoted text — Show quoted text – << Was diagnosed with low testosterone after stopping Effexor, never had this problem before but believe it to be related to the drug for a whole bunch of reasons that I won’t go into here. Has this happened to anyone else? My urologist believes my pitutatary gland has some how got out of whack, now I am not only depressed but have this to deal with. Wish I had never taken the drug, Wellbutrin is much better. I read on one of these posts that a user of effexor who quit taking it was told by his doctor that the drug had completely rewired his brain. Has anyone else heard of permanent side effects from Effexor? Sounds like bullshit to me. But when dealing with medicine and drugs, I suppose anything is possible. Its also possible that your testosterone was already low before starting Effexor, you just didnt know it yet and neither did your doctor. Low testosterone levels can cause depression all by itself. In fact, up at Columbia/Presbyterian psychiatry in NYC, there are some experimental clinical trials that use testosterone supplements (anabolic steroids) to "augment" SSRIs in refractory depressed men. Abnormally low levels of testosterone can no doubt cause depression. Anabolic steroids (testosterone) are said to have strong antidepressant effects. So you are on track..correct your low testosterone levels first, then if you still need an AD go back on the Effexor or an SSRI. Eric Steroids caused my depression…prednisone should be used conservatively http://groups.yahoo.com/group/FactsAndFallaciesOfDepression MIBS (Minimally Invasive Brain Stimulation) http://www.musc.edu/psychiatry/fnrd/tms.htm
I am really sure I never had low testosterone before effexor, the effects of having this are pretty dramatic, hot flashes, tired all the time, no libido, very erratic mood swings. After I went on Effexor I started getting these symptoms. At first I thought it was the drug so I went off of it, after a few months of being off of it and the side effects staying I realized something was really wrong. I found another person who had this happen by searching through some old postings, that makes 2, how many more are there?
"Twenty-two Medications Used for Bipolar Mood Stabilization in the US" By James D. Milton Last Updated: 8/22/99
Thanks James —
Vigabatrin – Sabrilex (severe vision problems? cocaine and nicotine addiction?)
Extreme caution should be used when taking vigabatrin! The trade name in the US is Sabril and in Europe it is Sabrilex. It is an anticonvulsant manufactured by Hoechst Marion Roussel that is unfortunately causing significant vision problems in a significant percentage of those taking it. It even appears that permanent vision damage may result. So with the next update of this article, I will omit vigabatrin. James
did i miss any info on zoloft? i do not see it mentioned. nor is there any info listed by you on tranquilizres. i just feel very suspiciose of valproic acid and some of the other meds you mention, for my own use. anyone who is allready on the meds and is benefitting good results should continue. but iam only on zoloft/xanax and would like to know you opinion on that. should i ask my doc. about some of the mood elevators??? would they help me more???,,,harpyrec
<Posted and Mailed to Bruce did i miss any info on zoloft? i do not see it mentioned. nor is there any info listed by you on tranquilizers. i just feel very suspicious of valproic acid and some of the other meds you mention for my own use. anyone who is already on the meds and is benefiting good results should continue. but i am only on zoloft/xanax and would like to know you opinion on that. should i ask my doc about some of the mood elevators??? would they help me more???,,,harpyrec
If I were to include all the antidepressants, the antianxiety meds, the antipsychotics, and all the other meds in a pdoc’s tool box, the number of meds would be several hundred long. I confined myself to those only having mood stabilizing properties. These I believe are the first line of defense for a person with BP disorder — though the others may prove to be very useful adjuncts. I personally don’t like any of the older mood stabilizers. But they work fine for some people. I am not telling you what to use. I am merely telling you what is available so you can discuss the pros and cons of each with your pdoc. My opinion is that a person with BP first needs to find a mood stabilizer (or combination of mood stabilizers) that is effective for them. Then the adjunct meds can be added later if needed. The more modern mood stabilizers (Neurontin, Lamictal, and Topamax) demonstrate strong antidepressant properties for some people. If you were taking Zoloft already and were very sensitive to these AD properties, you could wind up in a manic state if you started taking one of these mood stabilizers. I hope this answers your questions about my post. I suggest that you consult with your pdoc about your specific concerns. James D. Milton Standard Medical Disclaimer Any opinions stated should NOT be considered as medical advice! You should confirm any suggestions made with your physician who is solely responsible for prescribing ALL medications and monitoring the patient’s progress. Make NO changes in your prescribed dosages without the approval of your doctor!
"Twenty-two Medications Used for Bipolar Mood Stabilization in the US" By James D. Milton Last Updated: 8/22/99 <For best results specify that display and printing be done 80 characters/line with a fixed pitch font to avoid line wrapping. Please see below for various psychotropic meds that are presently being used as mood stabilizing meds in the United States. I have not attempted to list either all of the adverse side effects or all the potential benefits from these psychoaffective medications because they vary considerably from person to person. In addition an entire book could easily be written about the pros and cons of these meds. A person with a Bipolar (BP) disorder will just have to keep on experimenting until they find the meds that are effective for each individual with side effects that can be personally tolerated. In general most people usually find that the newer mood stabilizers will have a more benign adverse side effect profile than the older meds. Also these meds may well prove to be more effective — particularly when the traditional older mood stabilizers have failed for some reason or another. For additional most important information about the efficacy of the newer mood stabilizers please see the following article: Current Treatments in Bipolar Disorder: http://www.cme-reviews.com/supplements.html Since these newer meds have not been available as long, the long term benefits and disadvantages are not as well known as the mood stabilizers that preceded them. Each person should thoroughly discuss ALL the various medication options together with their associated pros and cons with their pdoc (psychiatrist or psychopharmacologist). I strongly advocate a collaborative team approach between the patient and their physician and therapist. You can find out a lot about the treatment of bipolar disorder by visiting the following most informative Web page compiled by Dr. Ivan Goldberg and then following the many valuable links to other educational sites about bipolar disorder: Bipolar (Manic-Depressive) Disorder: http://www.psycom.net/depression.central.bipolar.html Knowledge, Patience, Persistence, and Med Compliance IMO are vital keys to victory over our common illness. I wish you all the very best in your search for mental stability and well being! "Information Regarding BP Mood Stabilizers" Note: Only some of the potentially important effects are listed in the following tables. Since there are NO universal responses to any particular psychotropic medication, a person MAY or MAY NOT experience the positive benefits or the negative adverse side effects. YBMV (Your Brain May Vary) — and likely will! Older Primary Mood Stabilizers Lithium — Lithobid, Eskalith CR (thyroid damage? tremors? weight gain?) Divalproex Na — Depakote, Epival (liver damage? nausea? hair loss? weight gain?) Valproic acid — Depakene (similar to Depakote — including platelet decrease?) Carbamazepine — Tegretol XR, Carbatrol (rare life-threatening anemia and rash?) Newer Primary Mood Stabilizers (Anticonvulsants) Gabapentin – Neurontin (antidepressant? antianxiety med? IMPROVES COGNITION?) Lamotrigine — Lamictal (antidepressant? rashes? rare life-threatening rash?) Topiramate – Topamax (antidepressant? kidney stones? heart probs? WEIGHT LOSS?) Tiagabine — Gabatril (blocks reuptake of GABA? cognitive impairment?) Felbamate — Felbatol (possibility of developing fatal aplastic anemia?) Pregabalin – (Currently in Phase III; analgesic? antianxiety? social phobia?) Vigabatrin – Sobrilex (severe vision problems? cocaine and nicotine addiction?) Calcium Channel Blockers (to be used ONLY as Secondary Mood Stabilizers) Verapamil — Calan SR, Isoptin SR (anti-dysrhythmic/anginal/hypertensive agent) Nimodipine – Nimotop (improves cognition? aids multiple sclerosis depression?) Amlodipine – Norvasc, Lotrel (anti-hypertensive agent) Diltiazem — Cardizem CD (anti-hypertensive/anginal agent) Felodipine – Plendil (anti-hypertensive agent) Isradipine – DynaCirc (anti-hypertensive agent) Nicardipine — Cardene (anti-hypertensive agent) Nifedipine – Procardia XL (anti-hypertensive/anginal/pulmonary-edema agent) Adjunctive Medications Having Mood Stabilizing Properties Clozapine — Clozaril (older antipsychotic to be used only with anticonvulsants) Levothyroxine — Synthroid (adjust T4 level to 25% the upper limit of normal) Liothyronine sodium — Cytomel (adjust T3 level to treat refractory depression) Combining two (or more) mood stabilizers MAY be more effective than when each is taken alone. This is called "polytherapy" as opposed to the more traditional "monotherapy". One med may "potentiate" the effectiveness of another — so that the total effect becomes greater than the sum of its individual contributors. I believe that the efficacy of this approach is becoming increasingly apparent — particularly in refractory cases. It is my personal belief that polytherapy should also be utilized in nonrefractory BP cases as well. This concept is a "defense-in-depth" approach. Where one mood stabilizer is weak, hopefully another will be able to compensate for this weakness. For additional important technical information on "combination" or polytherapy please see: The Role of Complex Combination Therapy in the Treatment of Refractory Bipolar Illness: http://www.cme-reviews.com/CNS598_post.html Lithium carbonate (or another mood stabilizer) may prove helpful as a secondary adjunct to one of the newer mood stabilizers which have demonstrated powerful antidepressive properties for some people. Consequently for example I suggest that Neurontin-lithium and Lamictal-lithium combinations be considered. It is also possible that subtherapeutic dosages of lithium carbonate may be taken so as to minimize its adverse side effects. My current recommendation for optimal results is Neurontin-Lamictal. However due to the potential strong antidepressive properties of each of these meds, suggested conservative dosage titration protocols are given below. Of course only one mood stabilizer dosage should be adjusted at a time. A calcium channel blocker should at this point only be used as a secondary mood stabilizer — solely in conjunction with an effective primary mood stabilizer. There is some evidence to suggest that calcium channel blockers may be effectively used as antimanic agents — possibly as a replacement for lithium. They appear to have a much more benign side effect profile because they do not cause weight gain, do not cause tremors, and are well tolerated for gastrointestinal upsets and other adverse side effects. Of the 8 calcium channel blockers listed above, verapamil and nimodipine are the ones most commonly being used. Nimodipine is unfortunately quite expensive but shows promise under certain circumstances. Nimodipine is one of the few drugs found to increase the cerebrospinal fluid levels of somatostatin, a neuropeptide known to be permanently reduced in patients with Alzheimer’s and transiently reduced during active episodes of both depression and multiple sclerosis. Somatostatin depletion is also associated with problems of learning and memory. Subjectively, a number of patients felt more cognitively clear on nimodipine. Clozaril (clozapine) is an atypical antipsychotic medication that has some potentially rather severe adverse side effects. Nevertheless Clozaril is being successfully used in polytherapy. However the US FDA requires weekly blood tests for the first six months and biweekly thereafter. So this IMO limits the utility of Clozaril in an outpatient basis. There are many antidepressant, antianxiety, antimania, antipsychotic, and thyroid supplement (T3 and T4) meds that may prove to be very useful adjuncts to mood stabilizers in the treatment of a BP condition. My first psychiatrist, Dr. Dean Ackley, found that many of his patients needed to have their T4 levels adjusted to be in the high end of the normal T4 range. Dr. Peter Whybrow (Executive Chair of Psychiatry and Biobehavioral Sciences at UCLA) advocates raising the T4 level even further to 25% beyond the upper limit of the normal range. Combinations of synthetic T3 (triiodothyronine) and T4 (thyroxine) are being used to successfully treat refractory depression. Headaches commonly result if too much supplementary T4 and/or T3 is taken. A Neurontin-Topamax* or Lamictal-Topamax* combination may well prove effective for those wishing to lose weight. Topamax* exhibits very powerful appetite suppression effects for some people. * It has recently come to my attention that several people with BP disorder have experienced potentially serious cognitive and physical difficulties when taking Topamax. It is possible that these were a result of too rapid dosage loading. The suggested bipolar protocol for Topamax given below is one half the rate and amount used to treat seizure disorder. Consequently very careful monitoring is advised when Topamax is prescribed. I suggest a maximum of 100 mg BID until there is more information known about adverse side effects. One known adverse side
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