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How To Read My Drug Information Pages
You should take a moment to learn how to read this information. Some of it is pretty obvious, but some of it isn't.
Just as the drug companies don't have a single format for their PI Sheets, we don't yet have a single format for the drug pages. That's the wonderful thing about standards, there are so many of them from which to choose.
Here is my new & improved format for side effects information. Eventually all meds will be converted to look like this. Many of the meds still have most of this information on one page. This multi-page format is my current goal.
Here's what the dosage & discontinuation & half-life page for a med will look like:
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Dosage: This is how much the drug companies think you should take, and how
much I think you should be taking. What?!? Who the hell am I to be second-guessing your
doctor about dosages? I never even finished high school. Here's the deal - most of the
time there's not going to be a conflict between what's in the
PDR and what I think.
You're going to get a prescription and that's that. However, a lot of meds are for
off-label use, especially in Bipolarland, where only medication has been specifically
developed to treat the disorder -
Symbyax, and it's a hybrid
of two previous existing meds -
Zyprexa and Prozac.
Even lithium, it was originally used for gout.
Practically every drug has been tried (there are over 70 drugs in the US pharmacopoeia
used to treat bipolar disorder, not counting the really experimental ones). Off-label usage
doesn't always follow the same dosage guidelines published for the medication. In some
cases it does, when someone with bipolar disorder is being treated with an
anticonvulsant,
the titration schedule and standard maximum dosage follows that of epilepsy. But if you're
treating bipolar disorder with an atypical antipsychotic you
wouldn't necessarily follow the same titration
schedule as you would with schizophrenia, especially if you're combining the antipsychotic
with an antidepressant. Sure, if
someone is really flipping out, give them a buttload of antipsychotics to calm
them the hell down so they don't do any more damage. But if they came into
the shrink's office under their own power, more or less, is that much Zyprexa
really necessary? When a medication is approved for multiple conditions for adults, I'll list the dosages for all of them. I seldom cover pediatric conditions. I'll list both the drug company recommendations and my own, and clearly distinguish between the two.
How Long it Takes to Work: This comes from the PI Sheet / PDR reports of the efficacy of the clinical trials combined with whatever studies I can find on this matter, along with data noted in Dr. Diamond's Instant Psychopharmacology, Dr. Drummond's The Complete Guide to Psychiatric Drugs , Preston et al.'s Consumer's Guide To Psychiatric Drugs, Mitzi Waltz's Partial Seizure Disorders, Dr. Amen's Healing Anxiety and Depression and Dr. Devinsky's Epilepsy: Patient & Family Guide. Again this is mainly opinion of users, filtered through me. A.k.a. anecdotal evidence. Either sent to me directly in e-mail, posted to the Crazy Talk forum, on Remedy Find or posted on other support groups around the net. Sometimes this is the same as the days to reach a steady state. Sometimes not. It all depends on the med. As always, your mileage may vary.
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| How to Stop Taking a Med: For basic information, please see the page on how to safely stop taking these crazy meds. Sometimes the drug companies provide discontinuation information in the PI Sheet / PDR. Sometimes this just has to be extrapolated from the pharmacokinetic data (see below). I'll note if and when there's official discontinuation information. If you've worked your way up to a particular dosage, it's usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them. With severe allergic reactions and the like you'll just have to stop taking it and deal with cold-turkey withdrawal. Let's take Effexor (venlafaxine) for example, as it's the drug best known for having one of the worst discontinuation effects. Effexor (venlafaxine) has a total half-life (since it does one of those weird double metabolisms) of 20 hours (per its PI sheet and the folks at Wyeth didn't tell us otherwise), so the average time to clear it out of your system is 80 to 100 hours, or four to five days to round it up for safety. The titration (or increasing the dosage) for Effexor (venlafaxine) should be 37.5mg. So the least suck-ass way to stop taking Effexor (venlafaxine) is to step-down the dosage by 37.5mg every four to five days, preferably every week. If anyone tells you to do it any faster than that if you're not having a life-threatening or truly nasty mental health reaction to the drug, they need to have their license to practice medicine revoked. I don't care how much donkey dong Effexor (venlafaxine) sucks at this moment, believe me, quitting it cold turkey could be like having the red-hot poker rammed up your ass by comparison. That's all from anecdotal evidence, but there's plenty out there to support that.
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Here are some of the pharmacokinetic data. In English, what your stomach, liver and other organs of digestion and metabolism do to the meds. This is important to understand how the meds are processed in your body. For the most part these data come from the PI Sheets / The PDR or Mosby's 2004 Drug Guide. Every now and then if I find something different from a better source, such as one of Dr. Stahl's or Dr. Julien's books, a study, or a particularly trustworthy research site (e.g. Dr. Preskorn's site for all things antidepressant) I'll note it. Half-Life: The half-life is an obscure bit of datum to help you figure out a discontinuation schedule if you need to stop taking a particular medication. Since the way you stop taking a med and getting it out of your system are based on it, this is the one piece of pharmacokinetics that everyone asks me about. Instead of just looking it up. The half-life is usually published in the PI Sheets / The PDR. If not, I'll find it somewhere. If I've been a good boy I'll note my source.If you're lucky enough to get an explanation from your doctor, the half-life of a neurological / psychiatric medication is often explained like this, "It's out of your body in that many hours, but it's still in your brain." That's a gross oversimplification, but it'll do. Here's a way to picture the half-life in action. Take a glass and fill it half full with some tasty beverage. Now fill it the rest of the way with water. OK, now empty it half of the mixture out and top it off with water. Keep doing that until you have something you'd drink and that could pass as water. The number of times it took to do that is the half-life, expressed in a quantity of water, of a particular tasty beverage. Try it with a different beverage and you'd get a different half-life. Half-life means how long it takes for half of the metabolites to get flushed out of your system. The half-lives of meds are expressed in time because the process of adding water to the glass, as it were, is more-or-less constant in your body. The same would be true in the environment for the half-lives of radioactive materials.
So using Effexor (venlafaxine) as an example, if you're down to your last 37.5mg dose after 20 hours you'll have 18.75mg left in your body. Twenty hours after that you'll have about 9.4mg left. And so forth until it's gone, about 80-100 hours after your final 37.5mg tablet. Please, don't get all Xeno's Paradoxical on me, after four or five passes, analogous to the water glass, a med is so broken down that the effects shouldn't be noticeable. The only real variable is not if it's four or five times the length of the half-life, but if you metabolize the med quickly or slowly. These half-life numbers are the based on the arithmetic mean averages from clinical trials and studies. Read the pharmacokinetics section of a PI sheet carefully to see what the known range of a drug's half-life is. All right so where does this "In your brain but out of your body" come from? Well when they measure half-life in humans during the clinical trials it's by blood tests. With critters in earlier tests it's a different story. Anyway, the drugs do clear out of your blood a lot faster than they do from your brain. But they hang around other organs, usually your liver and kidneys, maybe others, for four to five times the period of the half-life. So while they do all their work in your brain and that's where they like to hang out, there are other parts of your body that the meds might be hanging around as well. It all depends on the med, your body and a host of other factors. So "Out of your body but still in your brain" is mostly true and covers much of the concept neatly in the time allowed in a typical doctor's appointment.
Average Time to Clear Out of Your System: The formula of half-life times four or five as being practically clear of a med's dosage comes from Dr. Stahl and a few other sources. Dr Julien's A Primer of Drug Action would have you do six half-lives. I've just rounded up five times the half-life to the nearest day and called it close enough for government work. There, I did the math for you.
Days to Reach a Steady State: This is the
average time it takes to reach a state when you're fully saturated with the
medication and less prone to peaks and valleys of effects. You still might have
peaks of effect after taking many meds, but with a lot of the meds you'll have
fewer valleys after this point. In theory anyway. This is for when you
first start to take a medication as well as when you change the dosage.
This comes from the PI Sheets /
The PDR or Mosby's 2004 Drug Guide. Unless it wasn't published
there. If I find it elsewhere I'll note it. If all else fails it's
six times the half-life as noted in Dr Julien's
A Primer of Drug Action.
Peak Time: Dude, I can like, really feel it now. Even when you reach a steady state, you're still going to have peak times with some meds. That can make a huge difference with some of them and can really influence what time of day you should be taking them for certain effects. E.g. do you want to be more awake or do you want them to knock you out so you can get some freaking sleep? This is a new section to answer the sort of question I get in e-mail all the time. The data will come from usually come from the PI Sheets / The PDR or Mosby's 2004 Drug Guide unless otherwise noted.
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Here are the links to other pages about a med:
Basic Information Page
Side Effects Page
Dosage, Discontinuation and
Half-Life Page Effectiveness, Comparison with Other Meds and Ratings
Pages How it Works in Your Brain Page Buying, Pricing
& PI Sheets Page Special effects &
Issues page
Comments
Check for Drug-Drug Interactions This is the link to another great site, just to check drug-drug interactions. I use this site because they include drug-food interactions and interactions with non-prescription medications. They also differentiate between sustained release and immediate release version of meds. It's the most comprehensive drug interaction site I've seen. Don't freak out over the AIDS thing. Yes, it's owned and operated by HIV+ people. So what? It's not like you're going to get HIV through your computer. Practically every freaking drug on the planet is in their database, that's all that matters. No matter what sort of wacky combination of drugs you take, if a drug-drug interaction has been published, it finds its way into their database. Eventually. Hey, nobody's perfect. If you want omniscience, take it up with some deity or another. Because of the HIV issue, they cover food interactions, and that's something too many doctors and pharmacists won't even think of. Maybe the grapefruit thing will come up, but there's a lot more than that. Anticonvulsants, commonly known as "mood stabilizers," are especially sensitive to what types of foods you eat or if you take your meds with food or not.