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Old 04-15-2012, 10:01 PM
Location: Cambridge, MA
156 posts, read 606,241 times
Reputation: 130


Originally Posted by steel7 View Post
Which meds work best to help sleep. Trazadone or quietiapine fumarate ? One of the side effects of quietiapine is weight gain (10 lbs in 6 weeks).
Depends, of course.

Are you having trouble falling asleep or staying asleep once you fall asleep. If the latter, how often do you wake up at night? How long until you can fall back asleep?

Are you tired, or do you have trouble staying awake during the day?

Have you seen a neurologist relating to this problem?

Regarding the two medications you listed:

Trazadone can also cause weight gain. Trazadone is a first line tx for insomnia, however, more doctors (especially GPs)--when not concerned with addiction--will go straight to nonbenzodiazepine hypnotics or straight to benzodiazepines. There are problems beyond addiction with these two types of medications, however, in my experience, benzos (e.g. Ativan, Valium) are preferably to nonbenzodiazepine medications (e.g. Ambien IR or CR, Lunesta et al.)
Seroquel is very effective, at low doses, e.g. either 25 or 50 mg. Seroquel has a considerable side effect profile and is typically not rx'ed for insomnia.

Having said that, I would stay away from Valium due to the incredibly long half-life of the medication. Ativan, in my opinion, is the best benzodiazepine for trouble falling asleep.

Please don't walk into the doctor's office asking for xyz drug by name. Please have a conversation with your GP and be patient, it may take several weeks to find a suitable medication for you. That is to say, because it worked for your friend doesn't mean it will work for you.

If you have any questions, feel free to ask and I will try to help.

NB: I am a doctor but this should not be construed as medical advice. I am not your doctor.
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Old 04-15-2012, 10:25 PM
Location: Cambridge, MA
156 posts, read 606,241 times
Reputation: 130
I wanted to respond to this because, I, as a physician, understand where you are coming from. I see several patients a week--although for different reasons, I am an anesthesiologist--that have had similar exchanges with their doctors, who in turn, send them to me for a medication evaluation.

Originally Posted by AnonChick View Post
So the PA says I will need to start weaning off the Ambien, because it's habit forming and I can develop a tolerance to it and require more to get the same effect as before. I'm like - yeah weaning off isn't gonna work so good, because when I stop taking it, I can't sleep. I started taking it, because I couldn't sleep. Now that I'm taking it, I sleep great. No need to wean off, it's doing exactly what it's supposed to be doing.
The PA was inappropriate. They should not be making tx decisions as you have a long-standing order written by your MD.

It is true that tolerance can occur. It isn't necessarily a bad thing.

She said she'd give me a 30 day scrip of the ambien, but no refills, since it's a schedule IV narcotic.
Narcotic is a legal term.

I told her no, it's not a narcotic. She said oh well it's a non-opiate narcotic.
Opiate/opioid is a medical term, viz. drugs that are used for pain relief.

She said oh well since it's schedule IV, then she can't prescribe more than 30 days worth. I said no, schedule IV means she can prescribe up to 90 days, with 1 refill, or 30 days, with 5 refills. You can have up to 6 months worth of prescription, after which you have to get a new scrip.
You are correct, refills are allowed at the doctor's discretion for Schedule IV medications.

That's how the Schedule IV law works. She just kind of stared at me like I didn't know anything. Really pissed me off.
I'm sorry you had to deal with an uncaring and disrespectful medical professional. I understand your frustration and it is valid.

So she tells me I should go to a shrink and get on Seroquel. I'm all uh - wtf? Really? An anti-psychotic, for a sleeping problem? She says yeah it's also used for sleeping. I said well that's really lovely but why would I want that? I'm not psychotic. I'm not even depressed. If it's used for depression and psychosis, then it's going to cause side-effects in people who are -not- depressed or psychotic, because it is doing something to the brain, that is -intended- to do something for depressed people and psychotics.
The dosage of Seroquel that is effective for psychosis is much higher than the dosage used for insomnia. In fact, there is a paradoxical reaction: Only low doses of Seroquel works for insomnia-- higher dosages, which are rx'ed for psychosis, does not work well at all for insomnia. So the PA offered a valid alternative, just one you weren't in favor of.

Plently of medications are used off label every day. You know about Aspirin, right? W.r.t neurology and psychiatry, I would guestimate that over 40% of rx'es made in the doctor's office are for off-label uses.

My doctor then prescribed me the full 6-month prescription and apologized for the inconvenience. She also told me I wouldn't need to wean off until and unless she and I agreed together that I was feeling the need for close to the max recommended nightly dosage.
Happy ending! There are other sleeping medications that you can switch to, if indeed this day comes. And if you do ween off Ambien to another sleeping pill, in the future, Ambien could be fully effective again at lower dosages. This is called "medication rotation".

Fortunately this refill, the pharmacy gave me the elongated pills instead of the UNscored round ones, so I can break off the end of it, and take the bigger portion, and store the tiny portion for when I run low on the big ones. So that means, my 90-day prescription, at 10mg/night, will now become a 100-day prescription, at around 8mg/night. I'm already taking -less- than what is prescribed for me, because really, I only need around 8mg/night. But the previous refills only came round, and unscored, and as anyone who's tried knows, trying to break up those tiny little _round_ pills into tinier little segments is a study in futility.
You really shouldn't break unscored or scored tablets. Even scored tablets may not be even on both sides. It is common knowledge that scored tablets contain the same amount of medication on each side, but this is not the case (many doctors incorrectly advise their patients it is okay). But if it's working for you, and you have told your doctor so he is aware then wonderful!
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Old 04-16-2012, 07:23 PM
Location: In a house
13,258 posts, read 34,604,245 times
Reputation: 20198
She, but yes she's aware of it. My -original- prescription, over 6 years ago, was written by a previous physician in a different office. He has since moved to Hawaii, which was why I had to change physicians in the first place. The original prescription was for .5 Ambien. But the cost for me of the prescription was the same, regardless of the dosage, because of my insurance. So I asked if he'd let me have the 1mg and split it in half. He was fine with that.

And then the insurance company decided it wasn't going to cover brand names if generics were availble. Eventually I grew somewhat of a tolerance to .5, and upped it to .75, with the blessing of my physician. He changed my prescription to 1mg, with instructions to me to break off an end, because that would save me money (since instead of paying for 30 days worth of .5 pills, I was now paying the same amount for 45 days worth of 1mg pills, at 3/4 pill per day).

How the pharmacist (who I trust with regards to "how pills are made" more than an anasthesiologist) explained it: They mix the ingredients into a soupy stew and blend it, and THEN pour it into pill molds.

Your odds of having one half of a pill being a different dosage than the other half, are the same as the odds of one pill being a different dosage than another pill. Yes, it can happen. But the odds are low to begin with, and no more than any other time you blend several powders in a big soup vat, mix it all up good, add a liquid, turn it into a thick pulpy consistency, whip it some more, whip it even more, shake it around for 20 minutes, and pour it into a mold.

Also, opiod/opiates aren't "medical" terms. They're scientific terms, not limited to medicine. Opiates refer to the specific type of narcotic derived from opium poppy. The term Opioid refers to all drugs that have the activity of opium/morphine drugs, whether they are derived from poppy, or fully synthesized. Opioid, is actually a chemical term, not a "medical" term.

The word narcotic is historically a medical term. It is -also- a legal term.

Also, I don't believe they even manufacture .75 mg of Ambien, generic or brand. So it'd be impossible to take it - without either taking 1 .5mg and breaking a second one in half.. or taking 3/4 of 1mg, thus - breaking it. And they aren't scored.
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