![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by fachad on June 27, 2002, at 20:05:02
The next pdoc appointment is coming up in a few weeks and I think I need to discontinue Dexedrine.
It has way too many sympathomemetic side effects (racing heart, sweating, and dry mouth) for me. It's definitely a big improvement over Adderall, but I can still feel it in my body, which I do not like.
Anyway, it's back to methylphenidate. I'll probably go with the plain generic immediate release MPH. Concerta is smooth, but my insurance copay is very high, and they will only cover 1 tablet per day (any strength, but only one tablet).
But I'm wondering if I should consider Focalin (dextro-methylphenedate). It will also have high copay like Concerta, and will be short acting.
Is it worth it?
Has anyone had experience with both? How is Focalin different than MPH?
Also, how much Focalin are people taking? I am taking 40mg/day of Dexadrine, and I used to take 54mg Concerta. The Focalin monograph is written like never more than 20mg/day will be taken. What is the typical adult dose?
Thanks
Posted by BekkaH on July 2, 2002, at 19:18:53
In reply to Focalin vs. Ritalin? (and Focalin Dose Questions), posted by fachad on June 27, 2002, at 20:05:02
> But I'm wondering if I should consider Focalin (dextro-methylphenedate). It will also have high copay like Concerta, and will be short acting.
> Is it worth it?
> Has anyone had experience with both? How is Focalin different than MPH?
> Also, how much Focalin are people taking? I am taking 40mg/day of Dexadrine, and I used to take 54mg Concerta. The Focalin monograph is written like never more than 20mg/day will be taken. What is the typical adult dose?
*************************************************Hi Fachad,
I don't know whether this reply will work. I've been having some problems with my registration.I tried Focalin briefly right after it was marketed several months ago. I will probably try it again at some point. The number of milligrams is supposed to be HALF the number of mg that you'd take if you were on Ritalin/regular methylphenidate because Focalin is supposed to be twice as potent. I found it to be very intense! I took 1/4 the amount (rather than 1/2), and I thought it was a bit much. I think it's definitely worth a try for you, especially since you have had such long term success with Ritalin.
Once problem I had on Focalin was a complete lack of appetite. I think this would be very bad for children who are put on the medicine.
By the way, how is your Surmontil trial coming along? Are you still on it? How much do you take, and are you still on Dexedrine? How much Dexedrine are you able to combine with the Surmontil? Have you ever taken Ritalin with Surmontil?
Good luck on your Focalin trial.
Bekka
Posted by fachad on July 2, 2002, at 21:52:26
In reply to Re: Focalin vs. Ritalin? (and Focalin Dose Questions), posted by BekkaH on July 2, 2002, at 19:18:53
Hi Bekka,
Thanks for the response. My post was there all alone for quite awhile! I was beginning to doubt anyone would respond.
> By the way, how is your Surmontil trial coming along?
Still taking it in tiny doses. I'm seeing my pdoc in a few weeks and I'm going to ask then for the custom 2.5 mg capsules. (They can be made at a compounding pharmacy.) Till then, it's just open the capsule and take a "little bit". Maddeningly unscientific, but the best I can do for now.
>are you still on Dexedrine?
Yes, I'm still on dex. I had an uncomfortable visit with my primary care doc today; I don't think he approves of the dex, but it could be just my imagination.
>How much Dexedrine are you able to combine with the Surmontil?
Well, I take 40mg/day of Dex.
The Surmontil is a unique TCA in that it does not affect either NE or 5-HT reuptake, so it should not potentate the pressor effects of dex. I limit the Surmontil dose because of other side effects like dry mouth, constipation and possibility of weight gain, not because of interactions with dex.
>Have you ever taken Ritalin with Surmontil?
No, but it should be even gentler than dex + Surmontil.
I'm encouraged that you found Focalin so potent. How much Ritalin do you take? How much Focalin did you take?
Thanks.
fachad
Posted by BekkaH on July 3, 2002, at 23:41:57
In reply to Re: Focalin vs. Ritalin? (and Focalin Dose Questions) » BekkaH, posted by fachad on July 2, 2002, at 21:52:26
> > By the way, how is your Surmontil trial coming along?
>
> Still taking it in tiny doses. I'm seeing my pdoc in a few weeks and I'm going to ask then for the custom 2.5 mg capsules. (They can be made at a compounding pharmacy.) Till then, it's just open the capsule and take a "little bit". Maddeningly unscientific, but the best I can do for now.Very interesting. Can any pharmacy make them up? I've never heard of this. It sounds like a good idea since I have so much trouble combining meds. I usually need to take teensy tiny doses of any 2nd or 3rd meds. Usually I can't even try a third med due to adverse interactions.
When opening up capsule medicines, as long as they are not time release, you can also try this: Mix the contents of the capsule with 4 oz or 8 oz (or however much you want) of applesauce. Mix it very well so the medicine is well distributed. Then take the number of ounces that should contain the number of milligrams of the medicine you mixed in. Of course, this assumes that the medicine is well distributed and that it dissolves well, etc. Again, it's not very scientific, but it's better than taking the whole capsule.
> >How much Dexedrine are you able to combine with the Surmontil?
>
> Well, I take 40mg/day of Dex.Do you take Dex immediate release or SR? So, would you say that you're taking approximately 2.5-3 mg of Surmontil a day?
> The Surmontil is a unique TCA in that it does not affect either NE or 5-HT reuptake, so it should not potentate the pressor effects of dex. I limit the Surmontil dose because of other side effects like dry mouth, constipation and possibility of weight gain, not because of interactions with dex.
>
> I'm encouraged that you found Focalin so potent. How much Ritalin do you take? How much Focalin did you take?Well, I tried Focalin only briefly. I don't think I took more than 10 mg, but I know someone who took 10 mg twice a day and liked it much bettter than Ritalin (fewer side effects). I am currently on Dexedrine, but when I do take Ritalin, I take approximately 30-40 mg. When I take Concerta, I take 54 mg. I have been told that the Methylphenidate dosing is supposed to be twice the number of milligrams that you'd take of Dexedrine. I take 25-30 mg of Dex per day, but for some reason, I've never been able to tolerate 50-60 mg of Ritalin immediate release. I will try Focalin again some time. It takes a while to get used to any of these meds, and I didn't give Focalin enough time to work.
Bekka
Posted by Ken on July 4, 2002, at 13:42:59
In reply to Re: Focalin vs. Ritalin? (and Focalin Dose Questions) » BekkaH, posted by fachad on July 2, 2002, at 21:52:26
[...]
> Still taking it in tiny doses. I'm seeing my pdoc in a few weeks and I'm going to ask then for the custom 2.5 mg capsules. (They can be made at a compounding pharmacy.) Till then, it's just open the capsule and take a "little bit". Maddeningly unscientific, but the best I can do for now.
If I may interject here... I take 0.5 mg Navane (a neuroleptic) to control the jitters I otherwise get from Dexedrine. Problem is the smallest 'denomination' of Navane is a 2 mg capsule. What I do is empty the whole Navane capsule onto a clean piece of paper, then by manipulating the piece of paper I gently shape the powder into an even, circular pile. I simply then 'cut' that circular pile into quarters and take away one quarter (throwing away the rest). I admit though, going through this procedure every evening is a real inconvenience and I would like to turn to a compounding pharmacy to go to this trouble for me. However, it seems to me that the 'inconvenience' of paying what a compounding pharmacy would charge me to do this, would be greater than the inconvenience of doing it myself (plus, I'm almost certain my insurance won't help pay).
Ken
Posted by BekkaH on July 4, 2002, at 16:38:15
In reply to Re: Focalin vs. Ritalin? (and Focalin Dose Questions) » fachad, posted by Ken on July 4, 2002, at 13:42:59
Hi Ken,
Thanks for your tips on dealing with tiny doses. If you don't mind telling us, I'm interested to know how much Dex you take, and whether you take sustained release or immediate release. I have some trouble deciding which is best for me, so I usually take the immediate release. It's easier to control, and the SR takes so long to kick in, but I really dislike taking meds with me throughout the day!I gather that the Navane is quite helpful to you. That's one of the older medicines, isn't it? Have you ever tried any of the newer ones (Geodon, etc)? Does the Navane help you sleep?
Bekka
Posted by fachad on July 4, 2002, at 17:07:05
In reply to Re: Focalin vs. Ritalin? (and Focalin Dose Questions), posted by BekkaH on July 3, 2002, at 23:41:57
Bekka,
Answers to your questions below.
Bekka: Can any pharmacy make them (custom strength caps) up? I've never heard of this...fachad: No, regular pharmacies like grocery store or chain drug store pharmacies do not do any compounding or custom meds. All they do is count pre-made pills from big bottles and put the correct number into little bottles, which IMHO, is an awful waste of the specialized skills and training of a pharmacist.
In contrast, a compounding pharmacy can make custom strengths, or custom combination meds, or custom delivery systems like liquids or lozenges or topical creams or whatever. The possibilities are endless.
Most insurance won't pay for this - but the two compounding pharmacies I contacted have very reasonable prices, which was really a surprise to me.
It's something you may want to look into if you have problems with adverse effects due to too high standard dosages.
Bekka: Mix the contents of the capsule with 4 oz or 8 oz (or however much you want) of applesauce.
Regarding the applesauce thing, I just open the capsule into water and stir vigourlsy until it looks completely dissolved and equally mixed. Then I drink the amount that has the right amount of milligrams. I don't know how you could ensure equal mixing in applesauce.
Bekka: Do you take Dex immediate release or SR?
fachad: I take immediate release 10 mg Dextrostat generic tablets. It's far less expensive than the Dexedrine Spansules. Besides, it lasts a long time for me, not like Ritalin which wears off in less than 2 hrs.
Bekka: So, would you say that you're taking approximately 2.5-3 mg of Surmontil a day?
fachad: Yikes, it's hard to guess, but I'd guess more like 5 - 10mg of Surmontil. I had the Compounding Pharmacy call my pdoc for the RX for the 2.5 mg caps, I'll know soon what the optimum dose is for me.
Bekka: when I do take Ritalin, I take approximately 30-40 mg. When I take Concerta, I take 54 mg.
fachad: I took Ritalin 30 mg a day for a quite a while. When Concerta came out, 36mg seemed a lot less than 30 mg Ritalin, so I took 54mg.
Bekka: I have been told that the Methylphenidate dosing is supposed to be twice the number of milligrams that you'd take of Dexedrine.
fachad: I've heard the same rule of thumb. I think I should have been taking more Concerta all along, but my insurance will only pay for one pill per day, period.
Since I am taking 40mg of Dex, that would imply that I should take 80mg Ritalin. Since Focalin is supposed to be half the Ritalin dose, I'm guessing it should be the same as dex, 40mg. But the package insert talks like the FDA prescribing limit is 20 mg per day. That's why I was wondering if anyone had been RX'd more than 20 mg/day.
Take care,
fachad.
> > > By the way, how is your Surmontil trial coming along?
> >
> > Still taking it in tiny doses. I'm seeing my pdoc in a few weeks and I'm going to ask then for the custom 2.5 mg capsules. (They can be made at a compounding pharmacy.) Till then, it's just open the capsule and take a "little bit". Maddeningly unscientific, but the best I can do for now.
>
> Very interesting. Can any pharmacy make them up? I've never heard of this. It sounds like a good idea since I have so much trouble combining meds. I usually need to take teensy tiny doses of any 2nd or 3rd meds. Usually I can't even try a third med due to adverse interactions.
>
> When opening up capsule medicines, as long as they are not time release, you can also try this: Mix the contents of the capsule with 4 oz or 8 oz (or however much you want) of applesauce. Mix it very well so the medicine is well distributed. Then take the number of ounces that should contain the number of milligrams of the medicine you mixed in. Of course, this assumes that the medicine is well distributed and that it dissolves well, etc. Again, it's not very scientific, but it's better than taking the whole capsule.
>
> > >How much Dexedrine are you able to combine with the Surmontil?
> >
> > Well, I take 40mg/day of Dex.
>
> Do you take Dex immediate release or SR? So, would you say that you're taking approximately 2.5-3 mg of Surmontil a day?
>
> > The Surmontil is a unique TCA in that it does not affect either NE or 5-HT reuptake, so it should not potentate the pressor effects of dex. I limit the Surmontil dose because of other side effects like dry mouth, constipation and possibility of weight gain, not because of interactions with dex.
> >
> > I'm encouraged that you found Focalin so potent. How much Ritalin do you take? How much Focalin did you take?
>
> Well, I tried Focalin only briefly. I don't think I took more than 10 mg, but I know someone who took 10 mg twice a day and liked it much bettter than Ritalin (fewer side effects). I am currently on Dexedrine, but when I do take Ritalin, I take approximately 30-40 mg. When I take Concerta, I take 54 mg. I have been told that the Methylphenidate dosing is supposed to be twice the number of milligrams that you'd take of Dexedrine. I take 25-30 mg of Dex per day, but for some reason, I've never been able to tolerate 50-60 mg of Ritalin immediate release. I will try Focalin again some time. It takes a while to get used to any of these meds, and I didn't give Focalin enough time to work.
>
> Bekka
Posted by BekkaH on July 4, 2002, at 18:47:55
In reply to Re: Focalin vs. Ritalin? (Compounding Meds etc.) » BekkaH, posted by fachad on July 4, 2002, at 17:07:05
Fachad: Regarding the applesauce thing, I just open the capsule into water and stir vigourlsy until it looks completely dissolved and equally mixed. Then I drink the amount that has the right amount of milligrams. I don't know how you could ensure equal mixing in applesauce.
Bekka: Yes, you're right, and I probably won't bother to check in a Chemistry handbook on the solubilities of these meds!
Fachad re: Dextrostat: Besides, it lasts a long time for me, not like Ritalin which wears off in less than 2 hrs.
B: Oh, so you've experienced that, too? Regular immediate release ritalin is awful for me!! For me, it feels as if it wears off before it ever peaks! The rebound is horrendous. I wonder how so many children can tolerate that. Perhaps they metabolize it differently.
> fachad: I took Ritalin 30 mg a day for a quite a while. When Concerta came out, 36mg seemed a lot less than 30 mg Ritalin, so I took 54mg.
B: I haven't verified this yet, but I read somewhere that Concerta is now available in 27 mg capsules, as well as 18 mg. That would allow for more flexible dosing. 36mg isn't enough for me, and 54 feels like too much.
> Bekka: I have been told that the Methylphenidate dosing is supposed to be twice the number of milligrams that you'd take of Dexedrine.
>
F:> Since I am taking 40mg of Dex, that would imply that I should take 80mg Ritalin. Since Focalin is supposed to be half the Ritalin dose, I'm guessing it should be the same as dex, 40mg. But the package insert talks like the FDA prescribing limit is 20 mg per day. That's why I was wondering if anyone had been RX'd more than 20 mg/day.B: Well, as with most stimulants, I think the best thing is to start with the smallest dose you can manage on, and then work up from there, if you need to. As I said, I found Focalin to be VERY intense, and perhaps you will, too. If that's the case, you may not need that much. I don't know of anyone who has gone above 20 mg on Focalin, but I know very few people who have been on it. It's still so new.
Thanks for your help and ideas! Good luck with the compounding and with Focalin!
Bekka
Posted by Seamus2 on July 4, 2002, at 21:53:20
In reply to Re: Focalin vs. Ritalin? (and Focalin Dose Questions) » fachad, posted by Ken on July 4, 2002, at 13:42:59
My, that's an interesting combination!
Who came up with that idea and how well does it work? Did you try Xanax or another BZD first?
How much Dexedrine are you taking per day?
Thanks,Seamus
Posted by fachad on July 4, 2002, at 22:24:37
In reply to Re: Focalin vs. Ritalin? (and Focalin Dose Questions) » fachad, posted by Ken on July 4, 2002, at 13:42:59
>If I may interject here... I take 0.5 mg Navane (a neuroleptic) to control the jitters I otherwise get from Dexedrine.
How much Dex do you take?
I have often wondered if the mild DA blockade of trimipramine is helpful to offset my dex when it's time to sleep.
Surmontil is 400 times less potent than Navane at D2 blockade. (trimip = 0.56; Navane= 222.0)
I'd have to take 200 mg of Surmontil to get the same D2 blockade as your 0.5 mg Navane! (Yes, I know that came out sounding like a "Total" cerial commercial.)
>Problem is the smallest 'denomination' of Navane is a 2 mg capsule.
Ask your (regular chain store) pharmacist about that.
I know that Mylan generics makes a 1 mg THIOTHIXENE capsule; other generic manufacturers also make 1 mg capsules.
And the Pfizer branded Navane comes in 1 mg capsules and even better, a 5mg/ml liquid form.
>However, it seems to me that the 'inconvenience' of paying what a compounding pharmacy would charge me to do this, would be greater than the inconvenience of doing it myself (plus, I'm almost certain my insurance won't help pay).
No, most insurance will not cover compounding.
My insurance (sort of) covers the standard 25 mg Surmontil capsules. My copay is $40/month for brand name meds, regardless of quantity or strength.
The compounding pharmacy quoted me $45 for 100 of the 2.5 mg custom tablets. And next month if I want 100 5mg or 7.5 mg tablets, it would be only $47.50. So it's not really that much more expensive, unless you have good insurance with a low copay.
Posted by BekkaH on July 4, 2002, at 22:33:40
In reply to Navane + Dexedrine and Compounding Costs, etc. » Ken, posted by fachad on July 4, 2002, at 22:24:37
Surmontil is 400 times less potent than Navane at D2 blockade. (trimip = 0.56; Navane= 222.0)
>Hi Fachad, May I ask where you get those values? Do you look it up online or do you have a psychopharmacology text at home?
Thanks,
Bekka
Posted by jrbecker on July 5, 2002, at 1:58:31
In reply to Re: Focalin vs. Ritalin? (and Focalin Dose Questions), posted by BekkaH on July 3, 2002, at 23:41:57
Focalin was definitely a better option for me. Ritalin, even at a low dose had such a strong onset, it seemed to actually increase my hyperactivity and sense of distraction. And worse was the fact that after the first dosing, I would crash pretty bad in coming off of it. So much so that I felt fairly sleep. Taking a second dose for the day with Ritalin never helped either. It never worked as good as the first dosing, making me only more irritable instead (a common issue with others as well I'm sure).
Focalin was definitely an improvement. The main seller for me is that it has a smoother onset and withdrawal so the cycle isn't as rough as Ritalin can be for some people. On Ritalin, it seemed like I'd have to plan my day around taking just one dose and gettng the most out of it. But not with Focalin, it's not as jarring in it's cycling. So in summary, it packs a slightly softer punch and I guess that's good for some people like me who are fairly sensitive to the stimulants.
Posted by fachad on July 5, 2002, at 13:20:15
In reply to Re: Navane + Dexedrine and Compounding Costs, etc., posted by BekkaH on July 4, 2002, at 22:33:40
Bekka,
> Hi Fachad, May I ask where you get those values? Do you look it up online or do you have a psychopharmacology text at home?
>Those values were not easy to find. Most psychopharmacology texts and online resources give values in little "+" or "-" signs, roughly comparative, but not at all quantitative.
The values I get come from journal articles written by a researcher named Elliott Richelson, MD.
He does research on ADs and APs, and publishes receptor affininty data for H1, H2, cholenergic, alpha-1, alpha-2, 5HT subtypes, 5HT reuptake blockade, NE reptake blockade, Dopamaine reuptake, D2 blockade, etc.
He has published dozens of such articles over a span of 20 years in many different medical journals.
I'll start a new thread in a day or two with a beginning bibliography of where to find that stuff.
No single article contains all the data, but the scales used in all of Richelson’s publications are always the same so the data can be collated meaningfully.
Someday, I plan to compile all the data into a comprehensive spreadsheet.
That quantitative data by receptor is really fascinating to me and I've always been frustrated by how difficult it is to get.
Posted by BekkaH on July 5, 2002, at 22:52:57
In reply to Re: Nav+ Dex (Med / Receptor Affinity Values) » BekkaH, posted by fachad on July 5, 2002, at 13:20:15
> Hi Fachad, May I ask where you get those values? Do you look it up online or do you have a psychopharmacology text at home?
> >
> Those values were not easy to find. Most psychopharmacology texts and online resources give values in little "+" or "-" signs, roughly comparative, but not at all quantitative.
>
> The values I get come from journal articles written by a researcher named Elliott Richelson, MD.
>
*********************************************Which journals do you read? The JOURNAL OF CLINICAL PSYCHIATRY often has good articles; unfortunately, many of those studies are sponsored by the pharmaceutical companies, so we're not getting unbiased reports.
Posted by Ken on July 8, 2002, at 2:59:26
In reply to Tiny doses - Ken, posted by BekkaH on July 4, 2002, at 16:38:15
Sorry Bekka for the delay in responding here... I did, in fact, reply three days ago. But for some unknown reason it didn't show up on the board.
You wrote...> [...] If you don't mind telling us, I'm interested to know how much Dex you take, and whether you take sustained release or immediate release.
I take 55 mg/day Dexedrine (immediate release).
> [...]
> I gather that the Navane is quite helpful to you.
It takes just enough of the harsh edge off the Dexedrine so I can 'live with it'.
> That's one of the older medicines, isn't it?
Yes. I first became acquainted with Navane way back in 1985, when my pdoc gave me a low dose trial of it in response to my complaints of anxiety from Merital (i.e. nomifensine - an antidepressant with amphetamine-like properties; Hoescht voluntarily withdrew Merital from the market in 1986).
> Have you ever tried any of the newer ones (Geodon, etc)?
No I haven't. My pdoc tacitly made inference once that it might be interesting to try Zyprexa. But I declined to 'return the serve' (as it were) as a main side effect of Zyprexa is strong sedation (something which would, in large part, only counteract the therapeutic effects of [and for which I am prescribed] Dexedrine).
Does the Navane help you sleep?No I can't say I notice any effect of Navane on my ability to get to sleep (which is not a problem area for me anyway).
Take care,
Ken
Posted by Ken on July 8, 2002, at 3:44:05
In reply to Re: Navane + Dexedrine -- questions » Ken, posted by Seamus2 on July 4, 2002, at 21:53:20
> My, that's an interesting combination!
> Who came up with that idea and how well does it work? [...]
> How much Dexedrine are you taking per day?
>See my response to Bekka in this thread.
> Did you try Xanax or another BZD first?
Yes, I have tried 'tiny dose' benzos (e.g. Ativan, Xanax) These have worked (and I still do receive a small supply for very occasional use only) but they are not that popular with my pdoc. (He's very protective of the esteem he enjoys of his colleagues and/or others in the health care system. Dexedrine, being one of the drugs our society has sought to demonize, my pdoc wishes to avoid adding yet another demonized drug to a cocktail, which by some zealot among anti-drug-abuse faithful, could be aggressively misconstrued and misrepresented. An old anti-drug catch-phrase easily slips across one's imagination in this instance, "...uppers to bring them up! And downers to bring them back down! <gasp>".)
Regards,
Ken
Posted by GIANA on April 7, 2004, at 18:35:51
In reply to Re: Focalin vs. Ritalin? (Compounding Meds etc.) » BekkaH, posted by fachad on July 4, 2002, at 17:07:05
I have read that the way Ritalin works, is to stimulate the brain stem but they are not sure really how it works.
The Focalin, which is newer and suppost to be a more active form of Ritalin? Works by preventing the reuptake of Norepinephrine & Dopamine and releases them?
Is this true? so what is the difference between Ritalin & Focalin? Do they both do the same thing?
and if Focalin does do this wouldn't this be the same as taking Wellbutrin?
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.