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    Medication questions
    ssmiddy posted:
    2 questions....

    I'm taking 6mg/day of klonpin ... is that a lot?

    What is the max dose per day for Lamictal? I've read up to 400mg, but nothing definitive.

    Height 6''1.5"
    Weight: 302

    Oh wait!!!!!! One more questions for the guys.....anyone had trouble "finishing" while on Latuda and/or Prozac? It took me 45 minutes to wear myself out and give up last evening...........nuff said......
    ssmiddy responded:
    follow up......guys.....I'm talking about extremely vigorous to wear myself out. I think I hurt us both....
    ddnos responded:
    Re the dosage of your meds - what does your doctor say?

    Re Lamictal, I pasted the following, but I assume that you are under a doctor's care and would know how to dose you. Sometimes the dosage could be higher or lower depending on if you are taking other meds with it and other factors.Bipolar DisorderThe goal of maintenance treatment with LAMICTAL is to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy. The target dose of LAMICTAL is 200 mg/day (100 mg/day in patients taking valproate, which decreases the apparent clearance of lamotrigine, and 400 mg/day in patients not taking valproate and taking either carbamazepine, phenytoin, phenobarbital, primidone, or other drugs such as rifampin that increase the apparent clearance of lamotrigine). In the clinical trials, doses up to 400 mg/day as monotherapy were evaluated; however, no additional benefit was seen at 400 mg/day compared with 200 mg/day [see Clinical Studies (14.2)>. Accordingly, doses above 200 mg/day are not recommended. Treatment with LAMICTAL is introduced, based on concurrent medications, according to the regimen outlined in Table 5. If other psychotropic medications are withdrawn following stabilization, the dose of LAMICTAL should be adjusted. For patients discontinuing valproate, the dose of LAMICTAL should be doubled over a 2-week period in equal weekly increments (see Table 6). For patients discontinuing carbamazepine, phenytoin, phenobarbital, primidone, or other drugs such as rifampin that induce lamotrigine glucuronidation, the dose of LAMICTAL should remain constant for the first week and then should be decreased by half over a 2-week period in equal weekly decrements (see Table 6). The dose of LAMICTAL may then be further adjusted to the target dose (200 mg) as clinically indicated.
    If other drugs are subsequently introduced, the dose of LAMICTAL may need to be adjusted. In particular, the introduction of valproate requires reduction in the dose of LAMICTAL
    To avoid an increased risk of rash, the recommended initial dose and subsequent dose escalations of LAMICTAL should not be exceeded
    [a id="_Refid_d7de18a6-fb02-4783-a1e3-d38626f35" style="color: rgb(17, 153, 221); text-decoration: underline; font-family: Helvetica, Arial, 'Nimbus Sans L', sans-serif; font-size: 13.63636302947998px; line-height: 17.81818199157715px; background-color: rgb(255, 255, 255);"> Table 5. Escalation Regimen for LAMICTAL for Patients With Bipolar DisorderFor Patients TAKING Valproatea
    For Patients NOT TAKING Carbamazepine, Phenytoin, Phenobarbital, Primidone,b or Valproatea
    For Patients TAKING Carbamazepine, Phenytoin, Phenobarbital, or Primidoneb and NOT TAKING Valproatea
    Weeks 1 and 2
    25 mg every otherday
    25 mg daily
    50 mg daily
    Weeks 3 and 4
    25 mg daily
    50 mg daily
    100 mg daily, in divided doses
    Week 5
    50 mg daily
    100 mg daily
    200 mg daily, in divided doses
    Week 6
    100 mg daily
    200 mg daily
    300 mg daily, in divided doses
    Week 7
    100 mg daily
    200 mg daily
    up to 400 mg daily, in divided doses
    aValproate has been shown to inhibit glucuronidation and decrease the apparent clearance of lamotrigine [see Drug Interactions (7), Clinical Pharmacology (12.3)>.
    bThese drugs induce lamotrigine glucuronidation and increase clearance [see Drug Interactions (7), Clinical Pharmacology (12.3)>. Other drugs that have similar effects include estrogen-containing oral contraceptives [see Drug Interactions (7), Clinical Pharmacology (12.3)>. Dosing recommendations for oral contraceptives can be found in General Dosing Considerations [see Dosage and Administration (2.1)>. Patients on rifampin, or other drugs that induce lamotrigine glucuronidation and increase clearance, should follow the same dosing titration/maintenance regimen as that used with anticonvulsants that have this effect
    Re Klonopin, it appears that 4 mg is the recommended max daily dose, but don't quote me on that. lol Again, I'm sure that can be varied depending on individual as long as under doctor care. Another thing that Im sure you doc mentioned is that klonopin is addictive, so need to watch out for that.
    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    Joseph F Goldberg, MD responded:
    Dear ssmiddy,
    6 mg/day of Klonopin is a fairly substantial dose.
    In the studies done by the manufacturer or Lamictal, 200 mg/day was better than 50 mg/day, and 400 mg/day wasn't any better than 200 mg/day, in preventing relapses. Now and then clinicians dose Lamictal above 200 mg/day, though outside of its use in epilepsy I know no evidence that doses above 400 mg/day produce anything more than added side effects.
    Latuda isn't especially known to cause sexual side effects, although at very high doses (e.g., 120-160 mg/day) it's possible that it could more meaningful raise levels of a hormone called prolactin that could interfere with sexual functioning. Prozac is well-known to cause delayed ejaculation or loss of orgasm intensity/satisfaction in men (and is therefore often used to treat premature ejaculations).

    Dr. G.
    ssmiddy replied to Joseph F Goldberg, MD's response:
    Thanks to the last two who replied. Yes, I am under the care of a clinician, I'm just curious cuz 200 calms me very well at night, I just wondered if perhaps 100 during the day might be a good thing to ask my clinician about.

    Any input on the sex question anyone? It concerns me that I can essentially go full bore for 45 minutes and not achieve orgasm, regardless of the pleasure. Could this be med related? Diabetes related perhaps (although it's controlled by 2000mg/day of Metformin with good numbers) about Latuda or Prozac---can they cause this. I had a similar problem with a fibromyalgia med that they used on me for pain one time who's name I forget.

    Okies. Thanks again.

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