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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Ben on October 23, 2011, at 7:03:12
I have tremor of meds and probably essential tremor too. I can`t stand betablockers. Which meds should I try? Klonopin works but it makes my too much sedated. Whats your experiences?
I have to mention that I`m BP II with social phobia too. I`m on lithium, Lamictal, valproate and Abilify as well an Parnate. Perhaps I have to change my med regimen too!
Posted by SLS on October 23, 2011, at 7:13:40
In reply to Meds for tremor, posted by Ben on October 23, 2011, at 7:03:12
> I have tremor of meds and probably essential tremor too. I can`t stand betablockers. Which meds should I try? Klonopin works but it makes my too much sedated. Whats your experiences?
>
> I have to mention that I`m BP II with social phobia too. I`m on lithium, Lamictal, valproate and Abilify as well an Parnate. Perhaps I have to change my med regimen too!
Maybe gabapentin (Neurontin)?I'm sure you know that Lamictal, lithium, and valproate can cause hand tremors. Did you adjust your dosage of Lamictal to compensate for the valproate?
- Scott
Posted by Ben on October 23, 2011, at 7:17:56
In reply to Re: Meds for tremor » Ben, posted by SLS on October 23, 2011, at 7:13:40
Hi Scott. Thanks for your quick reply. I take 200mg Lamictal and 600mg Valproate. Both plasma levels are in range or did you mean something other? My pdoc said, that all of his patients have tremore if they take lithium and valproate together. Perhaps I have to replace the valproate with gabapentin. Is gabapentin also a mood stabilizer?
Posted by SLS on October 23, 2011, at 8:12:11
In reply to Re: Meds for tremor, posted by Ben on October 23, 2011, at 7:17:56
> My pdoc said, that all of his patients have tremore if they take lithium and valproate together.
Definitely.
> Perhaps I have to replace the valproate with gabapentin. Is gabapentin also a mood stabilizer?
It was considered to be a mood-stabilizer 10 years ago. I don't think it is used much for that purpose anymore.
When combined with valproate, Lamictal blood levels are elevated by a factor of two. 200mg with valproate equals 400mg without it. I had hand tremors when I took 300mg.
- Scott
Posted by Phillipa on October 23, 2011, at 11:05:09
In reply to Re: Meds for tremor » Ben, posted by SLS on October 23, 2011, at 8:12:11
Had two family members on lithium at one time and the hand tremors were horrible. One stopped it as was taking for anger. Don't know what happened to him as haven't seen him in years. Phillipa
Posted by Phidippus on October 23, 2011, at 17:54:54
In reply to Meds for tremor, posted by Ben on October 23, 2011, at 7:03:12
There's also Cogentin, Artane and Amantadine to treat tremor with.
Check your Lithium level, too.
Eric
Posted by jono_in_adelaide on October 23, 2011, at 19:55:29
In reply to Meds for tremor, posted by Ben on October 23, 2011, at 7:03:12
I'd sat stick with the Klonopin for a coupe of weeks and see if the sedation passes off.
You could also try orphenedrine (Norflex, Disipal)
What is it about beta blockers that you cant stand?
Posted by Ben on October 24, 2011, at 0:50:15
In reply to Re: Meds for tremor » Ben, posted by Phidippus on October 23, 2011, at 17:54:54
Lithium level is 0.7 mmol/l.
Posted by Ben on October 24, 2011, at 0:54:44
In reply to Re: Lithium level, posted by Ben on October 24, 2011, at 0:50:15
I used to take Gabapentin earlier but I had awful constipation. Should I give it a further trial? It could also be good for social phobia?!
And what about Topiramt? My pdoc says that he have only 2 patients which can take it. The rest had to give it up due to side effects.
Posted by SLS on October 24, 2011, at 5:48:35
In reply to Re: Topiramat and Gabapentin, posted by Ben on October 24, 2011, at 0:54:44
> I used to take Gabapentin earlier but I had awful constipation. Should I give it a further trial? It could also be good for social phobia?!
> And what about Topiramt? My pdoc says that he have only 2 patients which can take it. The rest had to give it up due to side effects.Cognitive side effects with Topiramate (Topamax) can be mitigated or avoided entirely by starting at a very low dosage and titrating very gradually. A few doctors have described to me that once triggered by too rapid a titration schedule, cognitive impairments appear and tend to linger. A more gradual titration is less likely to trigger cognitive and memory impairments. I managed to get up to 200mg a day without a hint of a "Dopamax" effect. I would explore 100mg first before increasing the dosage.
- Scott
Posted by Ben on October 26, 2011, at 2:20:10
In reply to Re: Topiramat and Gabapentin » Ben, posted by SLS on October 24, 2011, at 5:48:35
Is Topamax a mood stabilizer too (BP II) ? Perhaps I should give the Klonopin a second chance (0.5 mg ad bedtime ?) because I have fear to take out the Valproate. My mood is more depressive at the moment and I have social phobia as well.
Posted by Ben on October 26, 2011, at 2:21:29
In reply to Re: Topiramat and Gabapentin » Ben, posted by SLS on October 24, 2011, at 5:48:35
Is Topamax a mood stabilizer too (BP II) ? Perhaps I should give the Klonopin a second chance (0.5 mg ad bedtime ?) because I have fear to take out the Valproate. My mood is more depressive at the moment and I have social phobia as well.
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