Thank You Doctor. For Little Anxiety That Is Left, I

Posted on Mon, 28 Jan 2019

Question: Thank you doctor. For little anxiety that is left, I consulted my doctor and asked him following questions:
- can I increase mirtazipine? To which he said no
- can I increase duolextine? He said no, as the higher doses have not helped me in the past
Can I increase amitryn? He said no as amitryn at 300 mg has done its job and increase in amitryn will not help
According to him, adding imipramine 25 in the morning along with amitryn 300 may help better
Also, according to him, though the theory says that amitryn should not be increased beyond 300 but in practical he said one can go up to 350
He said increasing amitryn to 325 will also help but imipramine 25 along with 300 amitr. May help better?
The side effects of amitryn are not really bothering me, what ever little I have am ok to live with them
What do you think I tweak among amitryn, mirtaz and duolextine?

What would pls let me know your view on the above options?

Answered by Dr. Seikhoo Bishnoi (3 hours later)

Brief Answer:
If you are feeling good then no need to make changes in prescription.

Detailed Answer:
Hello again,

Increasing the dose of Amitriptyline is a better option than adding Imipramine because addition of Imipramine will add a new medicine and consequent risk of side effects.

Over all if you are good with these medicines then please don't make much changes in medicines. The prescription is good and is resulting in good effects.

For episodes of anxiety and slight anxiety which is left you can take drugs like low dose Propranolol or Clonazepam on SOS basis. This will help in reducing the anxiety.

But still if you want to make changes in medicines then in my opinion either you can increase dose of Mirtaz or Amitriptyline.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (1 hour later)

Thank you doctor. What is the maximum dose of amitryn one can take in theory and in practice?

Answered by Dr. Seikhoo Bishnoi (5 hours later)

Brief Answer:
300 mg is maximum dose

Detailed Answer:
Hello again

Considering XXXXXXX population the maximum dose is roughly 200 mg. In theory the dose of 300 mg is maximum dose.

I haven't used the drug at such high dose. But the doses of 300-325 mg can be used for resistant cases.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (50 minutes later)

Thank you doctor. I am taking flatuna tablet
( that contains activated charcoal), for the flatulance prescribed by a gastroenterologist, read on the net that it is given for the toxicity of amitryn, does it also mean that it can reduce the effectiveness of amitryn?

Answered by Dr. Seikhoo Bishnoi (11 hours later)

Brief Answer:
No a single tablet will not effectiveness of Amitriptyline.

Detailed Answer:
Hello again

Flatuna consists of Simethicone as main constituent and activated charcoal. Activated charcoal is used in Amitriptyline toxicity in order to reduce absorption. The amount in a single tablet should be very low to reduce the effectiveness of Amitriptyline. So no need to get worried for that.

You can keep a couple of hours gap between medicines.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (3 hours later)

Thank you doctor. I am a bit confused between increasing amitryn or mirtaz.
Amitryn because I don’t know how more then 300 will behave in the long run. Also, I am taking flatuna thrice a day, therefore, worried about its effectiveness. I have increased it 300 from 295 about 10 days back, thinking I should give it some more time. Do you think it’s effectiveness will increase with time or 10 days are enough for extra 5 mg to show full effect. Also, because of urinary and ejaculation side effects, don’t know whether it’s a good idea to go beyond 300 mg. I started feeling better after making it 300
Mirtazipine because it helps with sexual side effects and it has no relation with flatuna. I am on 37.5, do you think making it 37.5+1/2 or 7.5 will help better as compared to amitryn. When I upped from 30 to 37.5, didn’t feel any change in the anxiety. Therefore, not sure if increasing it further will help
Also, thinking if making duolextine 70 from 60 is an option. I was on 120 some time back and the would not get erection and would not feel sexually excited. My doctor brought it down to 60. Now with amitryn 300 and mirtaz 37.5, do you think increasing duolextine to 70 will help without any sexual side effects
What would be your final word between amitryn, mirtaz and duolextine and the reason for doing so?

Answered by Dr. Seikhoo Bishnoi (48 minutes later)

Brief Answer:
Mirtazapine you can increase to 45 mg.

Detailed Answer:
Hello again

Yes increasing the Amitriptyline will increase the risk of sexual side effects. This will increase the ejaculation time and might reduce the libido.

In coming days you will see more control of anxiety with 300 mg Amitriptyline. No need to get worried for that.

Yes you can increase the Mirtazapine to 45 mg. This will make sleep better and will not add to sexual side effects. This should control anxiety too.

Please don't increase Duloxetine. This will not cause much benefits. This will increase the side effects too and you might have gastric issues at high dose.

Thanks.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar