Archive for December 29th, 2005

How To Take Wellbutrin (Bupropion)

Thursday, December 29th, 2005

WELLBUTRIN SR and XL (Bupropion)

Wellbutrin SR comes in two strengths: 100mg blue tablets and 150mg purple tablets. Wellbutrin XL comes in 150mg and 300mg tablets.

Wellbutrin enhances the brain’s natural stimulants, dopamine and norepinephrine. These help increase mental energy and motivation/interest. Wellbutrin also helps to control addictions, increase sexual functioning (especially libido and orgasm), and aids in weight reduction.  Wellbutrin works just as effectively as the Serotonin Reuptake Inhibitors (SSRI’S) for anxiety symptoms associated with depression. 

HOW TO TAKE FOR DEPRESSION

WELLBUTRIN XL

Do not break tablets.


Starting dose
 150mg in the morning for one week
After one week Increase dose to 300 mg in morning.
Sometimes dose needs to be increased to 450mg, and rarely to 600mg.

WELLBUTRIN SR

Starting dose One 150 mg tablet in the morning. 

If any significant side effects, decrease dose by cutting the tablet in half or switch to 100mg tablet. (Only about 10% of the slow release action is lost when the tablet is cut.)

After 3 – 7 days
 Add a 2nd tablet at lunch

After 1 week on 2 tablets per day
 Take both tablets in the morning if tolerated
After 3 – 4 weeks of 2 tablets per day If dose is not strong enough, add a 3rd tablet per day and take in divided doses of 2 in the morning and 1 at lunch.
(A total of four tablets per day can be used in divided doses but this is rarely needed by most people.)

OTHER TREATMENTS

SMOKING

300mg of Wellbutrin SR is usually the most effective dose to help quit or decrease smoking. It’s is even more effective when combined with nicotine replacement. (Nicotrol inhaler is best-tolerated form) 

A smoker does not have to be motivated to decrease or discontinue smoking. They just need to try the drug along with the smoking. Most people find that after taking the medication they no longer crave nicotine, and the need to smoke decreases.

SEXUAL DYSFUNCTION

Wellbutrin is effective for treatment of low sexual interest. It can also help primary orgasmic dysfunction or secondary orgasmic problems caused by other medications, especially SSRI’s. Treatment success is usually 40-50% for orgasmic dysfunction on an “as needed” basis.

WEIGHT REDUCTION

Wellbutrin has recently been found in studies to improve weight loss in obese patients. It is also an effective treatment for sluggishness and weight gain secondary to medications.

ADD and BOREDOM

Often respond well to Wellbutrin.

ANTIDEPRESSANT AUGMENTATION

Wellbutrin works well as a complementary drug with other antidepressants to achieve a more effective response in some patients.

SIDE EFFECTS

Side effects are usually mild and controllable with a dose adjustment or by adding a second medication to control side effects until they subside.

Most common side effects are:

  • Insomnia
  • Dry Mouth
  • Nervousness
  • Irritability

For full information, see package insert or prescribing information.

Posted in Addiction, Depression, Generalized Anxiety Disorder (GAD), Love And Sex, Medication: How To Take | 1 Comment »

How To Take Effexor (Venlafaxine)

Thursday, December 29th, 2005

EFFEXOR XR (Venlafaxine)

EFFEXOR XR (Venlafaxine) is a slow release capsule and comes in 37.5, 75, and 150mg sizes.  It is a broad spectrum medication, which means it works by blocking reuptake of Serotonin (at 37.5 to 75mg) and norepinephrine (at 150mg+). Serotonin and norephinephrine are the two primary stress neuromodulators. Because Effexor XR works on both these neuromodulators, it is effective in treating anxiety and depression. When Effexor XR is taken, the brain levels of Serotonin and Norepinephrine are lowered if too high (as in anxiety), or raised if too low (as in depression).

Effexor XR has no significant drug/drug interactions and does not require dose decreases for the elderly.

HOW TO TAKE FOR ANXIETY/DEPRESSION

For mild to moderate symptoms
Week 1 37.5 mg in a.m. (after breakfast)
Week 2 75 mg in a.m.
Week 3+ 75 mg in a.m. if improving, if not, take 150 mg

For moderate to severe symptoms
Day 1 37.5mg in am
Day 2 & 3 37.5mg in am and at suppertime
Day 4+ 75mg in am and at suppertime

For severe symptoms
Day 1 37.5 mg in a.m. and at suppertime
Day 2 75 mg in a.m. and at suppertime
Day 3+ 150mg in a.m. and 75 mg at suppertime

PARTIAL DOSING

During transition, (if less than 37.5 or between 37.5 and 75mg is needed), capsules may be opened and used as a sprinkle form on any soft food. Sprinkled granules remain slow release unless bitten into.

PANIC PATIENTS NOTE: 

This step is especially important in panic disorder where initial doses as small as 9mg may be needed. It is essential to minimize side effects with panic patients because of extreme sensitivity to side effects. The dose can usually be gradually increased.

DO NOT abruptly stop the medication.  This can cause rebound symptoms such as muscle aches and nausea. When tapering the dose decrease by 37.5mg every 3 days. 

WHAT IS THE BEST DOSE TO TAKE FOR ME?

Take enough, not too much!  How much is that?  I don’t know.  Each person has to find the dose for him/her that achieves the goal of remission (completely back to normal functioning).

  • If you have some side effects but they are mild – remain on dose schedule
  • If side effects are bothering you - shift the dose time, split the dose or decrease the dose for 3-4 days, then try to go back up
  • If you have taken it for 1-2 weeks and not seeing significant benefit - increase the dose

SIDE EFFECTS

Possible side effects and suggestions for management.
Fatigue, Sluggishness First, shift the dose to evening meal. If still a problem, decrease the dose.
Delayed Orgasm Change dosing time to right after sex.
Nervousness Decrease or divide the dose, decrease caffeine intake.
Nausea Take with food, decrease dose or split dose for 3-4 days.
Sweating Take medication at suppertime, or decrease dose.  Adding Cardura (a mild blood pressure medication) may help.
Increased blood pressure This occurs occasionally in susceptible patients and is usually higher doses. Is easily managed by lowering dose, splitting dose, or adding Cardura. 

HOW DO I SWITCH FROM ANOTHER ANTIDEPRESSANT TO EFFEXOR XR?

Note: The most important rule of changeover is make only ONE change at a time. In other words don’t change the Effexor XR dose and SSRI dose both on the same day.

Use a “stagger” changeover schedule for 2½ weeks:
Days 1-4 37.5 mg Effexor XR in a.m. and current dose of SSRI in evening
Days 5-8 37.5 mg Effexor XR in a.m. and decrease SSRI by ¼ - ⅓
Days 9-12 75 mg Effexor XR in a.m. and SSRI dose not change
Days 13-16 75 mg Effexor XR in a.m. and decrease SSRI another ¼ - ⅓
2½ weeks Re-evaluate - if all is going well, discontinue current SSRI and consider going up on the Effexor XR if needed for symptoms.

Posted in Depression, Generalized Anxiety Disorder (GAD), Medication: How To Take | No Comments »

How To Take Sonata (Zaleplon)

Thursday, December 29th, 2005

SONATA (Zaleplon)

Sonata, available in 5mg and 10mg capsules, is a sleeping medication from a class of drugs known as nonbenzodiazepine hypnotics.  Insomnia is usually due to hyperarousal.  Sonata works by enhancing the brain’s natural tranquilizer called GABA.

GETTING STARTED

Take one 10mg capsule after going to bed if unable to sleep using good sleep habits.

Note: Take 1-2 hours after eating, or 3 hours after eating a fatty meal.

20mg may be needed initially if:

  • Switching from another hypnotic
  • Under very high stress
  • High tolerance to medications

Most patients can decrease to 10mg after 4-7 days.

SONATA MAY NOT BE NEEDED EVERY NIGHT

  • There is no “rebound insomnia”
  • It can be taken up to 4 hours before rising

Note: A common complaint is that some people wake up after 4 hours. If this occurs, the dose can be repeated. This is usually due to hyperarousal and after a few good due nights of sleep, repeat dosing is not needed.

Posted in Medication: How To Take, Sleep Disorders | No Comments »