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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Sheilac on October 12, 2013, at 13:25:57
The neuro/psych said he didn't like the use of benzos. He said they're hard on the liver and didn't write me an Rx for my Klonopin I've been on for 10 years! How can Klonopin be hard on the liver and not all the other meds?!
I don't consider Klonopin a benzo. I mean, originally it was an anti-seizure med. Xanax is a benzo. I personally think he doesn't like writing a script for a now controlled substance. So what am I supposed to do? I can taper down, but I don't think 3mg is that bad.
No Klonopin?!!
Then, he wanted me to take a med that is not covered by my insurance yet called Oxtellar XR, it's a long acting version of 600mg Trileptal. It's a good idea, I guess, but for $600, I can just take the generic Trileptal just fine.
Anyone have any thoughts on the Klonopin thing?
Anyone use or heard of Oxtellar XR?
So far, 5mg Abilify gave me some akathesia, for which, ironically, I took some Klonopin! I'm thinking of calling his office to let them know!
Posted by linkadge on October 12, 2013, at 14:15:46
In reply to Oxtellar XR + no Klonopin?!, posted by Sheilac on October 12, 2013, at 13:26:14
I've never heard of benzos being hard of the liver (although I could be wrong). OTOH certain anticonvulsants like depakote are.
Linkadge
Posted by gadchik on October 12, 2013, at 14:34:51
In reply to Re: Oxtellar XR + no Klonopin?!, posted by linkadge on October 12, 2013, at 14:15:46
one gp that I saw mentioned it being hard on the kidneys but I never heard that either. Another gp, an internal med dr, said u could stay on klonopin for life, as long as ur liver and kidneys functioned normally. I do hear a diff story on benzos from every dr Ive seen...
Posted by Phillipa on October 12, 2013, at 15:04:53
In reply to Re: Oxtellar XR + no Klonopin?!, posted by gadchik on October 12, 2013, at 14:34:51
Well look at it this way after 43 years on benzos wouldn't my liver function tests be off? They are perfect. So I disagree with that doc. $600 is a lot of money for a med. I'd call back also. Phillipa
Posted by Sheilac on October 12, 2013, at 15:07:51
In reply to Re: Oxtellar XR + no Klonopin?!, posted by Phillipa on October 12, 2013, at 15:04:53
Or I could just stick with my current shrink and get her to change me to Abilify!
I wonder how long it will take me to get past the Abilify akathesia?
Posted by ed_uk2010 on October 12, 2013, at 15:20:08
In reply to Oxtellar XR + no Klonopin?!, posted by Sheilac on October 12, 2013, at 13:25:57
>He said they're hard on the liver and didn't write me an Rx for my Klonopin I've been on for 10 years! How can Klonopin be hard on the liver and not all the other meds?!
Liver toxicity is rare with benzos. I don't know why he would bring that up.
>I don't consider Klonopin a benzo.
Clonazepam is absolutely a benzo, a very potent benzo.
>I mean, originally it was an anti-seizure med.
It was originally marketed as an anti-seizure med, partly because Roche already marketed various other benzos for anxiety and insomnia. Other benzos such as Ativan and Valium are also anti-seizure. In fact, all currently used benzos are believed to be anti-seizure.
>I personally think he doesn't like writing a script for a now controlled substance.
Yes, that's probably got a lot to do with it!
>So what am I supposed to do? I can taper down, but I don't think 3mg is that bad.
Klonopin is very potent, so 3mg isn't low. Although much higher doses can theoretically be used in epilepsy, this is very uncommon. Few people take more than 4mg per day on a long-term basis. You could taper down, but if you've taken it regularly for a long time this needs to be very gradual. Stopping abruptly is a very bad idea.
>Then, he wanted me to take a med that is not covered by my insurance yet called Oxtellar XR, it's a long acting version of 600mg Trileptal. It's a good idea, I guess, but for $600, I can just take the generic Trileptal just fine.
If you can take generic Trileptal, Oxtellar XR sounds like a ludicrous waste of money. I cannot think of any reason why you would need it.
I think you need to talk to this doctor again. I must admit, I'm not getting a great impression of him so far!
Posted by baseball55 on October 12, 2013, at 19:36:56
In reply to Re: Abilify akathesia?, posted by Sheilac on October 12, 2013, at 15:07:51
Why are you seeing a new p-doc? I thought you were feeling stable on geodon, trileptal and klonopin? Why do you want to change to ability if geodon is working? Especially if abilify causes akathesia at such a low dose?
Also, what kind of doctor would take you cold-turkey off a benzo? Sudden cessation of benzos can cause life-threatening seizures. Insurance companies won't pay for inpatient detox from opiates because, hard as withdrawal is, it won't kill you. They will pay for inpatient detox from benzos because of the danger of seizures.
Then there's his pushing a needlessly expensive patented drug to replace a perfectly serviceable generic. You should ask him how much money he takes from drug companies in a year. I live in MA and they actually make doctors report this and publish the info on line.
I would stick with your current p-doc if I were you.
Posted by Sheilac on October 13, 2013, at 12:38:50
In reply to Re: Abilify akathesia?, posted by baseball55 on October 12, 2013, at 19:36:56
Baseball55...I agree with you. I had this long standing appt scheduled with this neuro/psych doc to see if he had any different ideas about what I should be taking or what doses I should be on. Unfortunately, he did not. I thought because he was a neurologist as well as a psychiatrist, he would, but nope. He just wanted to push a med that I already take a generic of and change me from Geodon, which does work, to Abilify, which I'm not sure about.
Also, he may be compensated from the drug companies as he does speaking engagements for them on certain meds they push. So it does make you wonder. My neighbor is a drug rep and she told me another doc in his office is their speaker on an Alzheimer's med.
After 3 days on Abilify, I honestly feel better on just Geodon. And, I can't imagine stopping my Klonopin. It is my emergency go to med and I do use it nightly and during the day IF I need it. I've never had a doc tell me to stop taking it. I think it's PROBABLY the SAFEST med I take! Geez. Geodon has more issues than Klonopin, I would think.
So, in actuality, the neuro/psych doc had no bright ideas.
I see my regular pdoc and will discuss my meds with her. I'm sure she will fully understand me going back to Trileptal given my recent steroid shots.
So, basically, no change, just my insurance got charged a lot of money for seeing a special specialist.
Posted by SLS on October 13, 2013, at 13:45:02
In reply to Re: Neuro doc..., posted by Sheilac on October 13, 2013, at 12:38:50
> After 3 days on Abilify,
Do you honestly think that you can evaluate a drug after only 3 days?
The akathisia-like side effects that some people experience at the beginning of treatment with Abilify often disappears within a week.
You keep changing drugs and dosages on a daily basis, even when you are feeling better. Why?
- Scott
Posted by Sheilac on October 13, 2013, at 14:27:03
In reply to Re: Neuro doc... » Sheilac, posted by SLS on October 13, 2013, at 13:45:02
Actually, I've been taking 80mg Geodon for a while now. I did try lowering it for a night here and there to see if it would help with sleep, but 80mg is my dose.
I have had to raise Trileptal due to the steroid shots.
No, I don't think 3 days of Abilify is a fair trial. But is Abilify better than Geodon? People tell me I'll gain weight with Abilify, so why change?
Right now, I haven't stopped any meds, only added 5mg Abilify.
I see your point. That's a huge problem for me since July when I stopped my meds - as people stupidly do. I've been trying to get back to my base of Trileptal, Klonopin and Geodon. The only thing the doc wanted to change - in time - is going off Geodon and he started me on Abilify 3 days ago.
What are your thoughts on Abilify vs Geodon? Weight gain?
Posted by SLS on October 13, 2013, at 15:07:10
In reply to Re: Neuro doc... » SLS, posted by Sheilac on October 13, 2013, at 14:27:03
Hi Sheila.
> Actually, I've been taking 80mg Geodon for a while now. I did try lowering it for a night here and there to see if it would help with sleep, but 80mg is my dose.
I'm glad you found your optimum dosage of Geodon. I do think that it would be worth considering staying on Trileptal 1200 mg/day long-term in order to stabilize your psychobiology and perhaps prevent drug-induced mania. Do you think that you would be able to take Lamictal with the higher dosage of Trileptal? Just a thought.
Between Abilify and Geodon, I would use the one you like best. It is that simple. That will, of course, take some experimentation and adherence to a treatment plan.
One can gain weight with Abilify. I have. However, the improvement in my condition is worth the extra pounds. For me, the ideal dosage of Abilify is 10 mg/day.
Honestly, can you say that you were in complete remission with the Geodon? If so, why change? If not, it would be interesting to see how the Abilify treats you. It sounds like you have a good doctor.
- Scott
Posted by Sheilac on October 13, 2013, at 15:29:19
In reply to Re: Neuro doc... » Sheilac, posted by SLS on October 13, 2013, at 15:07:10
The only issue so far with the higher dose of Trileptal is my vision is terrible, even with glasses. Just awful.
No, I don't think Geodon has stabilized me. I was using it for depression. It works for me on my depression, but so did a simple drug like Buspar, believe it or not. Unfortunately, I wasn't taking Trileptal at the time of trying Buspar. Trileptal is the med that keeps me stable. I also lost weight with Buspar.
Honestly, I'm already overweight (which my family doc isn't happy about), and if Abilify caused me to gain even more weight - no, I honestly could tell you I wouldn't stick with it. So far, after 3 doses it has caused some water retention and I can't get my rings on, but I think I remember that about Abilify & Rispetdal with me.
For me, complete remission from mania can only come from the Trileptal.
Addressing the depression could be as simple as Buspar, or as complicated as Geodon.
Posted by SLS on October 13, 2013, at 15:53:05
In reply to Re: Neuro doc... » SLS, posted by Sheilac on October 13, 2013, at 15:29:19
Bummer. I'm sorry your vision is so impaired. Obviously, you are not such an easy case to treat.
Have you considered Saphris (asenapine)? It is an antipsychotic with antidepressant effects, but without the agitation, insomnia, anxiety, and overstimulation that Geodon can produce. Saphris is weight-neutral. You might not need Trileptal if you are able to discontinue the Geodon and replace it with Saphris.
If Buspar helped for depression, so might velazodone or vortioxetine. How have you reacted to SSRIs in the past?
Keep Topamax and Keppra in mind as mood-stabilizers to replace Trileptal. Most doctors will pass on these two drugs for lack of evidence of efficacy, but I have seen them work very well to treat mania and agitated mixed states.
How do you react to lithium?
One day at a time...
- Scott
Posted by Sheilac on October 13, 2013, at 16:27:07
In reply to Re: Neuro doc... » Sheilac, posted by SLS on October 13, 2013, at 15:53:05
Yea, I'm fairly hard to treat. I think side effect is my middle name!
Lithium grew a nodule on my thyroid that had to be biopsied. Scary.
Antidepressants cause hypomania in me. Wellbutrin caused full blown mania. Viibryd caused binge eating -as do most ADs with me. Terrible. Even in low dose. I refuse to pack on 50 lbs. again!
Topamax made me so stupid it wasn't funny.
Doc has never mentioned Saphris or Keppra.
There you have it. One hard to treat gal.
Blindness from Trileptal sucks, but what can I do? My doc did make note of that last time. Also, my vision got worse the higher I went on Geodon. My vision wasn't effected at 40mg Geodon.Side effects are no fun.
This is the end of the thread.
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