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What Could Cause Head Spinning While On Primidone?
Question: I have taken 2 50m primidone a day for about 2 years with no noticeable side effects. 2 days ago my neurologist prescribed one additional 50 m Primidone and after one week without much change in my condition, essential tremor, had suggested 2 in the morning and 2 at night - I did this for the past 2 days and this morning woke up with my bedroom spinning around - after lying back down and rising once more to less spinning it finally went away - and has not returned today - I am going back to 3 til I hear from him. Any suggestions or ideas?
Brief Answer:
Recommend having a discussion with your doctor on rationale
Detailed Answer:
I have read your information and have reservations with the decision to ADD additional primidone to a regimen which a patient feels is doing a very good job controlling their condition of ET. It does not XXXXXXX me in the least that you became vertiginous. I always tell me patients that they always have the option to return to a previous dose that did not give them side effects if what I've recommended gives them unexpected problems. However, it appears that your body has become accustomed to this new dose of primidone.
However, I still have reservations as a prescribing physician when patients use over and above necessary doses to treat any particular medical condition. My philosophy is to always try and find a dosing amount and schedule which gives the patient the LEAST amount of medication necessary in order to MAXIMALLY treat their condition WITHOUT side effects or other complications. When something like primidone gets overextended then, at some point in the future if the patient becomes tachyphylactic (tolerant to the dose) we may not have much more room to move in order to keep the tremors under control. Make sense?
And so I'm always looking to "not shoot the whole WOD if possible in the early going of something like ET because I know we're going to likely need some fire power down the road.
My best advice to you is to have a discussion with your neurologist and find out what his rationale for suddenly raising you 50% for a problem that was being otherwise well controlled according to your description. I always encourage patients to question prescriptions for the purpose of understanding WHAT they are supposed to treat of their condition, HOW they are supposed to treat their condition, and what the average dose is for most patients taking this same prescription.
If I've adequately answered your questions then, I'd greatly appreciate your CLOSING the query and assigning a 5 STAR rating to our encounter. Cheers!
20 minutes of professional time were spent in reading, researching, and formulating an analysis on behalf of this patient.
Recommend having a discussion with your doctor on rationale
Detailed Answer:
I have read your information and have reservations with the decision to ADD additional primidone to a regimen which a patient feels is doing a very good job controlling their condition of ET. It does not XXXXXXX me in the least that you became vertiginous. I always tell me patients that they always have the option to return to a previous dose that did not give them side effects if what I've recommended gives them unexpected problems. However, it appears that your body has become accustomed to this new dose of primidone.
However, I still have reservations as a prescribing physician when patients use over and above necessary doses to treat any particular medical condition. My philosophy is to always try and find a dosing amount and schedule which gives the patient the LEAST amount of medication necessary in order to MAXIMALLY treat their condition WITHOUT side effects or other complications. When something like primidone gets overextended then, at some point in the future if the patient becomes tachyphylactic (tolerant to the dose) we may not have much more room to move in order to keep the tremors under control. Make sense?
And so I'm always looking to "not shoot the whole WOD if possible in the early going of something like ET because I know we're going to likely need some fire power down the road.
My best advice to you is to have a discussion with your neurologist and find out what his rationale for suddenly raising you 50% for a problem that was being otherwise well controlled according to your description. I always encourage patients to question prescriptions for the purpose of understanding WHAT they are supposed to treat of their condition, HOW they are supposed to treat their condition, and what the average dose is for most patients taking this same prescription.
If I've adequately answered your questions then, I'd greatly appreciate your CLOSING the query and assigning a 5 STAR rating to our encounter. Cheers!
20 minutes of professional time were spent in reading, researching, and formulating an analysis on behalf of this patient.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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