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Non-compliance out of necessity


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Hi,

Okay. The new pdoc started me out on 100mg of Topamax last Friday. That was my starting dose. I've been feeling increasingly anxious lately--a weird kind of anxiety. I hardly slept last night, and my heart was just pounding. I'm an anxious person, but this was an overmedicated type of pouding.

The Topamax has helped the mood swings big-time, but now I just get the feeling that I am overmedicated. It's just a gut-instinct kind of thing. You just know. I suppose it's the same way you know that jumping into the Atlantic in December probably isn't a good idea.

But just to make sure I had all bases covered, I called the pdoc, who had decreased my Seroquel from 150 to 100mg. (This helps with anxiety, depression, sleep, etc.)

Well, I just talked to him, and we're upping the Seroquel back to 150mg, but here's the scary part...(Here's the conversation):

Me: I've read that it's the norm to start a patient out at 25mg, and

increase the dose by 25 mg every week

Pdoc: It doesn't have to be done that way

Me: So, how will I know if I'm on too much?

Pdoc: You won't.

WTF? Okay. I'm not taking 100mg tonight. I'm just not. I'm going down to 50mg. Or, do you think I should opt for 25mg? I'd have to be the world's biggest ass to feel my racing heart and still take 100mg.

In no way am I advocating non-compliance, but I feel like I'm literally fighting for my life here!

Please help!

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Hi!  I was started on 200mg Topamax and told I could cut the pills in half "if you want to"!  So I cut 'em in half.  I was taking 50mg in the morning and 50mg at night and it was too much.

I was getting a lot of tingling and it was really bad when I laid down.  Trying to sleep was an adventure.

If you go to the Topamax site you'll see that they recommend starting slow (25mg once per day, at night) for migraine treatment. 

I stopped for a few days and restarted at 25mg and had a much better time.

Go to the Topamax site and look at the chart and you'll see that they don't have you taking 100mg until you titrate up for a month or so.

Use a pill cutter or whatever and do 25!

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Hi Jill:

Did you ask your pdoc about splitting your dose, so that you don't have to take it all before bed?

I am glad to hear that the Topamax is helping. I think that's the important part, as everything else can be sorted rather easily.

Todd.

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Hi Jill:

Did you ask your pdoc about splitting your dose, so that you don't have to take it all before bed?

I am glad to hear that the Topamax is helping. I think that's the important part, as everything else can be sorted rather easily.

Todd.

<{POST_SNAPBACK}>

Thanks, Todd. Yes, I did ask him about splitting the dose, especially when he handed me the script. He's all about taking it all at night. (sigh) I agree with you; at least I'm on the stuff. I don't want to have a heart attack, though. I'm relieved that I'm lowering it tonight (disclaimer: do not do this at home...)

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Hi,

Some pdocs are really stupid. They look at us like we're car engines and not living organisms!

I'd keep the Seroquel at whereever you like it (150 or whatever) and increase the Dopeamax slowly, at the rate you want to. You know how you feel.

I am NOT advocating non-compliance. I am advocating emergency med safety. It doesn't hurt in a non-emergency situation to be careful.

You may want to take a benzo like Klonopin when you take the Dope, so the cardiovascular shit goes away. Cardiovascular symptoms are a reason to call the pdoc as an emergency, call the pharmacist, CALL THE PRESIDENT!

-- loonier than usual---

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and increase the Dopeamax slowly, at the rate you want to. You know how you feel.

-- loonier than usual---

<{POST_SNAPBACK}>

Loony, please tell me you meant "decrease" the Dopeamax, not "increase." I don't think it's making me too stupid as yet, but perhaps stoopid enough to read that and write it down as my instructions for the evening. He he. :-)

How can a pdoc not know how to prescribe a drug? I mean, if you don't know how, you can always look it up! All he had to do was come to Crazy Boards!

I'm actually really scared. I'm not taking 100mg tonight, but don't know what awaits me.

Plus, what if all I need to be okay is 50mg? Well, by starting me on 100mg, the pdoc skipped both 25mg and 50mg. I'm feeling so frustrated.

I'm glad I made a "back up" appointment with another pdoc for January.

Keep the suggestions coming! I'm sitting at the computer, paralyzed by fear.  ;)

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Or maybe she did mean to increase the Topa, but from a lower level?  Like, to cut back to 25 or whatever, then gradually go up?  Perhaps 100 is the right number for you, but the shock's a bit much for your system to take.  Be cautious, but also keep in mind the sorts of benefits you're looking for, namely stability.  Undepressed stability. 

From what you've shared over the past weeks, that backup appointment in January might be a good idea.... 

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Want to make sure you saw my post re: titration at your other thread "What's your Topamax dose?" so I'm cutting and pasting it here:

-----------------------------------------------------------------------------------------------

Hi,

I've never taken Topamax, so I can't speak from personal experience. However, I can give you some links with detailed info:

1) http://www.crazymeds.us is always a good place to start. Topamax is listed under the "Miscellaneous Anticonvulsants" category in the left menu. Once you get to the Topamax page, they have some info regarding titration. They also have a link to the full 35-page PI sheet: http://www.crazymeds.us/topamaxpi.pdf

2) If you go to http://www.topamax-epilepsy.com/utilities/...information.jsp there is a link to the 7-page prescribing info -- or here's the direct link: http://www.topamax-epilepsy.com/utilities/...ax.pdf#zoom=100. Page 7 of this has a chart with a detailed titration schedule.

Good luck!

revlow

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