Brief Answer:
Not a good combination of drug to take

Detailed Answer:
Good evening.

Sorry you had to go through that experience. Your example is just one of the reasons I really dislike the concept of treating people with these medications BEFORE making some concerted efforts at finding other (more conservative) ways to improve their abilities to concentrate or focus on tasks.

The other thing I would've taken as a warning sign of potential problems is that at age 57 you are trying (at least the STRATTERA) this drug for what appears to be the first time. Perhaps, you've been on Paxil in the past...it's a common antidepressant. However, taking Strattera for the 1st time IF it were even the case that I believed you should've been given medication right out of the gate (which I don't) I typically start at the LOWEST dose possible and titrate upward over a period of weeks to find the minimum amount of medication that treats the symptoms. Make sense?

I can also tell you that the combination of PAXIL and STRATTERA is known to potentially cause a significant drug to drug reaction which would INCREASE the side effect profiles of the STRATTERA and if you'd like a small list of the potential consequences you were looking at by taking the drug with PAXIL well, then, strap in while your head goes on a roller coaster ride through the following PARTIAL LIST OF symptoms:

Adverse Effects
>10%

Xerostomia (dry mouth) (21%), Headache (2-19%), Abdominal pain (7-18%),
Decreased appetite (11-16%), Insomnia (2-15%), Cough (11%), Somnolence (11%), Vomiting (3-11%),

1-10%

Nausea (10%), Increases in blood pressure (BP; ≥15-20 mm Hg) and heart rate (HR; ≥20 beats/min) (5-10%), Erectile dysfunction (9%), Hot flashes (8%), Dizziness (5-8%), Urinary hesitation or retention (7%), Decreased weight (4-7%), Depression (4-7%), Irritability (<6%), Dyspepsia (4%),
Ejaculation disorder (3%), Sinus headache (3%), Constipation (2%), Dermatitis (2%), Menstrual disorder (2%), Mood swings (1-2%)

Postmarketing Reports

Cardiovascular: QT prolongation, syncope

Peripheral vascular: Raynaud phenomenon

General: Lethargy

Neurologic: Hypesthesia, paresthesia in children and adolescents, sensory disturbances, tics

Psychiatric: Depression and depressed mood, anxiety

Seizures: Cases include patients with preexisting seizure disorders and those with identified risk factors for seizures, as well as patients with neither history of nor identified risk factors for seizures; exact relation between atomoxetine and seizures is difficult to evaluate because of uncertainty about background risk of seizures in patients with attention-deficit/hyperactivity disorder (ADHD)

Skin and Hair: Hyperhidrosis, Alopecia

Musculoskeletal: Rhabdomyolysis

Of the list above I believe you EITHER suffered from a generalized form of epileptic seizure due to INCREASED activity of the STRATTERA or you suffered a CARDIAC ARRHYTHMIA of a major type OR electrical depolarization problem that resulted in passing out (explains the eye and other things you felt upon awakening up).

We could literally go on the rest of the night talking about these drugs, about why you probably could've done just as well without these drugs (maybe better) but you wanted some advice on how to get off these agents. This is a very reasonable question and luckily it's not terribly complex or involved. You just have to be patient and PROACTIVELY involved in keeping up with your appointments so that can step you through the actual protocol.

And so we are faced with getting you off of 40mg. STRATTERA and 10mg. PAXIL....right?

First look at the PAXIL (paroxetine). You'll see that the 10mg. tablet/pill is the smallest dose on the market at this time in pill/tablet form. Typically, weaning off a medication when it is already at its lowest dose possible is very easy and the way I would accomplish this would be:

10mg. taken EVERY OTHER DAY for 2 weeks at bedtime followed by 10mg. EVERY 3rd day for another 2 weeks followed by once weekly at bedtime for 2 weeks getting to ZERO mg.....one down!

On the strattera side I educate patients on the fact that this is a rare instance of a medication that as a stimulant DOES NOT REQUIRE any type of tapering down and this is due to the way it works in the body. At any rate, some patients don't feel comfortable because they're habituated into believing that medications should be tapered and not just abruptly stopped. Therefore, if you feel better weaning the medication here is the protocol I've found works well for most people and I've never once seen any case of withdrawal, relapse, or paroxysmal behaviors.

I would recommend you start taking the 40mg. every other day for 2 weeks followed by 18mg. daily x 1 week followed by 10mg. for another week then, OFF.

It doesn't matter if you're not terminating both drugs at the same time. As a matter of fact, it's a good thing that you're NOT finishing at the same time....it artificially extends your wean period a bit longer and there's nothing wrong with that strategy.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. I'm also very interested in knowing how things evolve for you so drop me a line please :0

This query has utilized a total of 75 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

P.S. Say "Hello" to my sister-in-law down there is you run into each other....she lives in Mesa as well! LOL!

---

Brief Answer:
Not a good combination of drug to take

Detailed Answer:
Good evening.

Sorry you had to go through that experience. Your example is just one of the reasons I really dislike the concept of treating people with these medications BEFORE making some concerted efforts at finding other (more conservative) ways to improve their abilities to concentrate or focus on tasks.

The other thing I would've taken as a warning sign of potential problems is that at age 57 you are trying (at least the STRATTERA) this drug for what appears to be the first time. Perhaps, you've been on Paxil in the past...it's a common antidepressant. However, taking Strattera for the 1st time IF it were even the case that I believed you should've been given medication right out of the gate (which I don't) I typically start at the LOWEST dose possible and titrate upward over a period of weeks to find the minimum amount of medication that treats the symptoms. Make sense?

I can also tell you that the combination of PAXIL and STRATTERA is known to potentially cause a significant drug to drug reaction which would INCREASE the side effect profiles of the STRATTERA and if you'd like a small list of the potential consequences you were looking at by taking the drug with PAXIL well, then, strap in while your head goes on a roller coaster ride through the following PARTIAL LIST OF symptoms:

Adverse Effects
>10%

Xerostomia (dry mouth) (21%), Headache (2-19%), Abdominal pain (7-18%),
Decreased appetite (11-16%), Insomnia (2-15%), Cough (11%), Somnolence (11%), Vomiting (3-11%),

1-10%

Nausea (10%), Increases in blood pressure (BP; ≥15-20 mm Hg) and heart rate (HR; ≥20 beats/min) (5-10%), Erectile dysfunction (9%), Hot flashes (8%), Dizziness (5-8%), Urinary hesitation or retention (7%), Decreased weight (4-7%), Depression (4-7%), Irritability (<6%), Dyspepsia (4%),
Ejaculation disorder (3%), Sinus headache (3%), Constipation (2%), Dermatitis (2%), Menstrual disorder (2%), Mood swings (1-2%)

Postmarketing Reports

Cardiovascular: QT prolongation, syncope

Peripheral vascular: Raynaud phenomenon

General: Lethargy

Neurologic: Hypesthesia, paresthesia in children and adolescents, sensory disturbances, tics

Psychiatric: Depression and depressed mood, anxiety

Seizures: Cases include patients with preexisting seizure disorders and those with identified risk factors for seizures, as well as patients with neither history of nor identified risk factors for seizures; exact relation between atomoxetine and seizures is difficult to evaluate because of uncertainty about background risk of seizures in patients with attention-deficit/hyperactivity disorder (ADHD)

Skin and Hair: Hyperhidrosis, Alopecia

Musculoskeletal: Rhabdomyolysis

Of the list above I believe you EITHER suffered from a generalized form of epileptic seizure due to INCREASED activity of the STRATTERA or you suffered a CARDIAC ARRHYTHMIA of a major type OR electrical depolarization problem that resulted in passing out (explains the eye and other things you felt upon awakening up).

We could literally go on the rest of the night talking about these drugs, about why you probably could've done just as well without these drugs (maybe better) but you wanted some advice on how to get off these agents. This is a very reasonable question and luckily it's not terribly complex or involved. You just have to be patient and PROACTIVELY involved in keeping up with your appointments so that can step you through the actual protocol.

And so we are faced with getting you off of 40mg. STRATTERA and 10mg. PAXIL....right?

First look at the PAXIL (paroxetine). You'll see that the 10mg. tablet/pill is the smallest dose on the market at this time in pill/tablet form. Typically, weaning off a medication when it is already at its lowest dose possible is very easy and the way I would accomplish this would be:

10mg. taken EVERY OTHER DAY for 2 weeks at bedtime followed by 10mg. EVERY 3rd day for another 2 weeks followed by once weekly at bedtime for 2 weeks getting to ZERO mg.....one down!

On the strattera side I educate patients on the fact that this is a rare instance of a medication that as a stimulant DOES NOT REQUIRE any type of tapering down and this is due to the way it works in the body. At any rate, some patients don't feel comfortable because they're habituated into believing that medications should be tapered and not just abruptly stopped. Therefore, if you feel better weaning the medication here is the protocol I've found works well for most people and I've never once seen any case of withdrawal, relapse, or paroxysmal behaviors.

I would recommend you start taking the 40mg. every other day for 2 weeks followed by 18mg. daily x 1 week followed by 10mg. for another week then, OFF.

It doesn't matter if you're not terminating both drugs at the same time. As a matter of fact, it's a good thing that you're NOT finishing at the same time....it artificially extends your wean period a bit longer and there's nothing wrong with that strategy.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. I'm also very interested in knowing how things evolve for you so drop me a line please :0

This query has utilized a total of 75 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

P.S. Say "Hello" to my sister-in-law down there is you run into each other....she lives in Mesa as well! LOL!

---

Brief Answer:
Always best to get to the root of a problem IF POSSIBLE

Detailed Answer:
Hello again young lady....I'm glad we're on the same page and you are too kind with your compliments...honestly, I'm finding more and more that using more common sense than medication can go a VERY VERY LONG way...no matter illness or condition you're talking about....oh, forgot to add EDUCATION to the common sense. I typically spent quite a bit of time outlining for patients what is going on with them so they can hear (at least once) the actual mechanism of the WHY what's happening is happening. Make sense?

In the case of ADD or ADHD....I was recently reading on some of the more recent views that talk about an actual BIOCHEMICAL AS WELL AS BIOPHYSICAL substrate that researchers believe occurs that either triggers/precipitates or is associated to the condition. Now, whether these changes that have been detected come BEFORE and actually CAUSE development of the condition of ADD....or whether the person's MANIFEST ADD results over time in the biochemical and biophysical changes that we see is not clearly known.

But whatever the actual mechanism of the disease and whether or not medication actually functions to alter biochemical changes or some other explanation exists for how these medications work....I believe that looking for a different solution and to avoid the use of stimulants is always in the patient's interest since in some people (as yourself) very different from expected results may suddenly occur and these can be VERY PROBLEMATIC...maybe even downright dangerous .... especially if other drugs become involved or alcohol, or other drugs that could be illicit, etc. etc.

Therefore, I believe it is always the better part of valor to do an inventory on the patient from a neurological, neuropsychological, and neuropsychiatric perspective to find out what might be there as far as brain abnormalities, biochemical/hormonal abnormalities, or behavioral aberrations or constraints to see if any modifications to these regimens can be made first before launching into any type of committed treatment modality.

I am wholly in support of your desire to look for more NON-PHARMACOLOGICAL ways to combat this problem. I wish I had a XXXXXXX answer...I don't.....treating ADD is not really a primary sort of issue neurologists tend to deal with, however, truth be told....I feel more than qualified to carry out appropriate workups and background checking for any patient who may be suspected as having the diagnosis and could be looking for alternative methods of opening themselves up to treatment options OTHER than Big pharma drugs.

You must have been a daydreamer in school! HAHA! I am going to assume you have a very CREATIVE AND ARTSY type of outlook on life....that's why you like the violin......that's why I PLAY the violin....and by the way, I take it down with me every year to the Headache Symposium in November in XXXXXXX AZ.....just a hop, skip, and Cactus throw from MESA, right? LOLOLOL! How coincidental that you should mention the possibility of coming down there...because I do just about every year.

I was there last year...but it was a bit chillier than most years....I'm hoping this year will be a bit warmer....My brother also has a condo down there in XXXXXXX that he has offered me to use if would like to....I was thinking that this year I might take him up on that!

And what about your chance of coming up to XXXXXXX OHIO where the sun almost never shines outside of the summer! HOW AWFUL is that to tell a person who comes from the LAND OF SUN, right? But, honestly, I think XXXXXXX and Arizona (any part of the state) are virtually polar opposites when it comes to XXXXXXX days, right?

I don't think you need to worry about long lasting effects of the drugs....I would want to take a look at things in you though from a neuropsychological al perspective and see what we might have to work with when trying to get you to adapt and reorganize lifestyle patterns that can really and truly lead to a change of HABIT that can remain ingrained.....it does happen at times....need persistence, discipline, and the desire to get to a higher playing level.

My sis-IL is not a doctor. She is retired at this time....at the tender young age of about 47 years old (geez...must be NICCCCEEEE) from a manufacturer called ONSEMI. She was a systems analyst (whatever those are! HA!) and her husband travels all over the world for them (he's not retired yet) and is gone from home at least 6 months out of each year! WOW!

Who knows how many times you've walked past each other in a Trader Joe's or Whole Foods store down there! TOO FUNNY!~!

Look up the XXXXXXX HEADACHE SOCIETY's Annual Headache Symposium in November and you'll find me roaming around the Camelback for sure....of course, that's in XXXXXXX ...but MESA is literally a small bit of desert away, right?

If you ever found yourself passing through XXXXXXX any time in the near future...or if you wanted to set up an appointment when you're here admiring the ROCK 'N ROLL HALL OF FAME, The XXXXXXX Orchestra, or the Metro Parks system referred to as the EMERALD NECKLACE.....you can't even imagine something like that down in Arizona....I mean they paint their front yards green....but come on....not the same as Kentucky Blue Sod! HAHA!

The phone number for Parma Neurology just so you have it on hand young lady (cuz I'd sure like to keep in touch with how you're doing) is 440.842.3816.

Many thanks again for your question.....I hope I've provided some useful and FUN information and perhaps you can point yourself out to me at the Camelback when we convene the meeting and you'll have the problem LICKED by the point! I'll be the guy with violin leaning up against the reception desk in the lobby! LOLOLOL.

I really do think you can do much better without using Big pharma drugs and medications......

Well, will you look at that my dear one...where the heck has the time gone! ?? LOL.....

This query has utilized a total of 125 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---

Brief Answer:
Always best to get to the root of a problem IF POSSIBLE

Detailed Answer:
Hello again young lady....I'm glad we're on the same page and you are too kind with your compliments...honestly, I'm finding more and more that using more common sense than medication can go a VERY VERY LONG way...no matter illness or condition you're talking about....oh, forgot to add EDUCATION to the common sense. I typically spent quite a bit of time outlining for patients what is going on with them so they can hear (at least once) the actual mechanism of the WHY what's happening is happening. Make sense?

In the case of ADD or ADHD....I was recently reading on some of the more recent views that talk about an actual BIOCHEMICAL AS WELL AS BIOPHYSICAL substrate that researchers believe occurs that either triggers/precipitates or is associated to the condition. Now, whether these changes that have been detected come BEFORE and actually CAUSE development of the condition of ADD....or whether the person's MANIFEST ADD results over time in the biochemical and biophysical changes that we see is not clearly known.

But whatever the actual mechanism of the disease and whether or not medication actually functions to alter biochemical changes or some other explanation exists for how these medications work....I believe that looking for a different solution and to avoid the use of stimulants is always in the patient's interest since in some people (as yourself) very different from expected results may suddenly occur and these can be VERY PROBLEMATIC...maybe even downright dangerous .... especially if other drugs become involved or alcohol, or other drugs that could be illicit, etc. etc.

Therefore, I believe it is always the better part of valor to do an inventory on the patient from a neurological, neuropsychological, and neuropsychiatric perspective to find out what might be there as far as brain abnormalities, biochemical/hormonal abnormalities, or behavioral aberrations or constraints to see if any modifications to these regimens can be made first before launching into any type of committed treatment modality.

I am wholly in support of your desire to look for more NON-PHARMACOLOGICAL ways to combat this problem. I wish I had a XXXXXXX answer...I don't.....treating ADD is not really a primary sort of issue neurologists tend to deal with, however, truth be told....I feel more than qualified to carry out appropriate workups and background checking for any patient who may be suspected as having the diagnosis and could be looking for alternative methods of opening themselves up to treatment options OTHER than Big pharma drugs.

You must have been a daydreamer in school! HAHA! I am going to assume you have a very CREATIVE AND ARTSY type of outlook on life....that's why you like the violin......that's why I PLAY the violin....and by the way, I take it down with me every year to the Headache Symposium in November in XXXXXXX AZ.....just a hop, skip, and Cactus throw from MESA, right? LOLOLOL! How coincidental that you should mention the possibility of coming down there...because I do just about every year.

I was there last year...but it was a bit chillier than most years....I'm hoping this year will be a bit warmer....My brother also has a condo down there in XXXXXXX that he has offered me to use if would like to....I was thinking that this year I might take him up on that!

And what about your chance of coming up to XXXXXXX OHIO where the sun almost never shines outside of the summer! HOW AWFUL is that to tell a person who comes from the LAND OF SUN, right? But, honestly, I think XXXXXXX and Arizona (any part of the state) are virtually polar opposites when it comes to XXXXXXX days, right?

I don't think you need to worry about long lasting effects of the drugs....I would want to take a look at things in you though from a neuropsychological al perspective and see what we might have to work with when trying to get you to adapt and reorganize lifestyle patterns that can really and truly lead to a change of HABIT that can remain ingrained.....it does happen at times....need persistence, discipline, and the desire to get to a higher playing level.

My sis-IL is not a doctor. She is retired at this time....at the tender young age of about 47 years old (geez...must be NICCCCEEEE) from a manufacturer called ONSEMI. She was a systems analyst (whatever those are! HA!) and her husband travels all over the world for them (he's not retired yet) and is gone from home at least 6 months out of each year! WOW!

Who knows how many times you've walked past each other in a Trader Joe's or Whole Foods store down there! TOO FUNNY!~!

Look up the XXXXXXX HEADACHE SOCIETY's Annual Headache Symposium in November and you'll find me roaming around the Camelback for sure....of course, that's in XXXXXXX ...but MESA is literally a small bit of desert away, right?

If you ever found yourself passing through XXXXXXX any time in the near future...or if you wanted to set up an appointment when you're here admiring the ROCK 'N ROLL HALL OF FAME, The XXXXXXX Orchestra, or the Metro Parks system referred to as the EMERALD NECKLACE.....you can't even imagine something like that down in Arizona....I mean they paint their front yards green....but come on....not the same as Kentucky Blue Sod! HAHA!

The phone number for Parma Neurology just so you have it on hand young lady (cuz I'd sure like to keep in touch with how you're doing) is 440.842.3816.

Many thanks again for your question.....I hope I've provided some useful and FUN information and perhaps you can point yourself out to me at the Camelback when we convene the meeting and you'll have the problem LICKED by the point! I'll be the guy with violin leaning up against the reception desk in the lobby! LOLOLOL.

I really do think you can do much better without using Big pharma drugs and medications......

Well, will you look at that my dear one...where the heck has the time gone! ?? LOL.....

This query has utilized a total of 125 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---