Find out why Prozac is prescribed, side effects of Prozac, Prozac warnings, effects of Prozac during pregnancy, more - in plain English.

Generic name: Fluoxetine hydrochloride
Brand names: Prozac, Sarafem

Pronounced: PRO-zak

Prozac (fluoxetine) Full Prescribing Information
Prozac Medication Guide: A Warning About Children and Adolescents Taking Antidepressants

Why is Prozac prescribed?

Prozac is prescribed for the treatment of depression--that is, a continuing depression that interferes with daily functioning. The symptoms of major depression often include changes in appetite, sleep habits, and mind/body coordination; decreased sex drive; increased fatigue; feelings of guilt or worthlessness; difficulty concentrating; slowed thinking; and suicidal thoughts.

Prozac is also prescribed to treat obsessive-compulsive disorder. An obsession is a thought that won't go away; a compulsion is an action done over and over to relieve anxiety. The drug is also used in the treatment of bulimia (binge-eating followed by deliberate vomiting). It has also been used to treat other eating disorders and obesity.

In addition, Prozac is used to treat panic disorder, including panic associated with agoraphobia (a severe fear of being in crowds or public places). People with panic disorder usually suffer from panic attacks--feelings of intense fear that develop suddenly, often for no reason. Various symptoms occur during the attacks, including a rapid or pounding heartbeat, chest pain, sweating, trembling, and shortness of breath.

In children and adolescents, Prozac is used to treat major depression and obsessive-compulsive disorder.

Under the brand name Sarafem, the active ingredient in Prozac is also prescribed for the treatment of premenstrual dysphoric disorder (PMDD), formerly known as premenstrual syndrome (PMS). Symptoms of PMDD include mood problems such as anxiety, depression, irritability or persistent anger, mood swings, and tension. Physical problems that accompany PMDD include bloating, breast tenderness, headache, and joint and muscle pain. Symptoms typically begin 1 to 2 weeks before a woman's menstrual period and are severe enough to interfere with day-to-day activities and relationships.

Prozac is a member of the family of drugs called "selective serotonin re-uptake inhibitors." Serotonin is one of the chemical messengers believed to govern moods. Ordinarily, it is quickly reabsorbed after its release at the junctures between nerves. Re-uptake inhibitors such as Prozac slow this process, thereby boosting the levels of serotonin available in the brain.

 

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Most important fact about Prozac

Most important fact about this drug

Serious, sometimes fatal, reactions have been known to occur when Prozac is used in combination with other antidepressant drugs known as MAO inhibitors, including Nardil and Parnate; and when Prozac is discontinued and an MAO inhibitor is started. Never take Prozac with one of these drugs or within at least 14 days of discontinuing therapy with one of them; and allow 5 weeks or more between stopping Prozac and starting an MAO inhibitor. Be especially cautious if you have been taking Prozac in high doses or for a long time.

If you are taking any prescription or nonprescription drugs, notify your doctor before taking Prozac.

How should you take Prozac?

How should you take this medication?

Prozac should be taken exactly as prescribed by your doctor.

Prozac usually is taken once or twice a day. To be effective, it should be taken regularly. Make a habit of taking it at the same time you do some other daily activity.

It may be 4 weeks before you feel any relief from your depression, but the drug's effects should last about 9 months after a 3-month treatment regimen. For obsessive-compulsive disorder, the full effect may take 5 weeks to appear.

--If you miss a dose...

Take the forgotten dose as soon as you remember. If several hours have passed, skip the dose. Never try to "catch up" by doubling the dose.

--Storage instructions...

Store at room temperature.

What side effects may occur when taking Prozac?

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Prozac.

• More common side effects of Prozac may include: Abnormal dreams, abnormal ejaculation, abnormal vision, anxiety, diminished sex drive, dizziness, dry mouth, flu-like symptoms, flushing, gas, headache, impotence, insomnia, itching, loss of appetite, nausea, nervousness, rash, sinusitis, sleepiness, sore throat, sweating, tremors, upset stomach, vomiting, weakness, yawning

• Less common side effects may include: Abnormal taste, agitation, bleeding problems, chills, confusion, ear pain, emotional instability, fever, frequent urination, high blood pressure, increased appetite, loss of memory, palpitations, ringing in the ears, sleep disorders, weight gain

• In children and adolescents, less common side effects may also include: Agitation, excessive menstrual bleeding, frequent urination, hyperactivity, mania or hypomania (inappropriate feelings of elation and/or rapid thoughts), nosebleeds, personality changes, and thirst A wide variety of other very rare reactions have been reported during Prozac therapy. If you develop any new or unexplained symptoms, tell your doctor without delay.

Why should this drug not be prescribed?

Why should this drug not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Prozac or similar drugs such as Paxil and Zoloft, you should not take this medication. Make sure that your doctor is aware of any drug reactions that you have experienced.

Do not take this drug while using an MAO inhibitor. (See "Most important fact about this drug.") You should also not use Prozac if you are taking Mellaril (thioridazine). Likewise, do not start taking Mellaril within 5 weeks of stopping Prozac.

Special warnings about Prozac

Special warnings about this medication

Unless you are directed to do so by your doctor, do not take this medication if you are recovering from a heart attack or if you have liver disease or diabetes.

Prozac may cause you to become drowsy or less alert and may affect your judgment. Therefore, driving or operating dangerous machinery or participating in any hazardous activity that requires full mental alertness is not recommended.

While taking this medication, you may feel dizzy or light-headed or actually faint when getting up from a lying or sitting position. If getting up slowly doesn't help or if this problem continues, notify your doctor.

If you develop a skin rash or hives while taking Prozac, discontinue use of the medication and notify your doctor immediately.

Prozac should be used with caution if you have a history of seizures. You should discuss all of your medical conditions with your doctor before taking this medication.

Prozac can occasionally cause decreased appetite and weight loss, especially in depressed people who are already underweight and in those with bulimia. If you notice changes in your weight or appetite, tell your doctor.

Possible food and drug interactions when taking Prozac

Possible food and drug interactions when taking this medication

Combining Prozac with MAO inhibitors or Mellaril (thioridazine) is dangerous.

Do not drink alcohol while taking this medication.

If Prozac is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Prozac with the following:

Alprazolam (Xanax)
Carbamazepine (Tegretol)
Clozapine (Clozaril)
Diazepam (Valium)
Digitoxin (Crystodigin)
Drugs that impair brain function, such as sleep aids and narcotic painkillers
Flecainide (Tambocor)
Haloperidol (Haldol)
Lithium (Eskalith)
Other antidepressants (Elavil)
Phenytoin (Dilantin)
Pimozide (Orap)
Tryptophan
Vinblastine (Velban)
Warfarin (Coumadin)

Special information if you are pregnant or breastfeeding

Special information if you are pregnant or breastfeeding

The effects of Prozac during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. This medication appears in breast milk, and breastfeeding is not recommended while you are taking Prozac.

Recommended dosage for Prozac

ADULTS

The usual starting dose is 20 milligrams per day, taken in the morning. Your doctor may increase your dose after several weeks if no improvement is observed. People with kidney or liver disease, the elderly, and those taking other drugs may have their dosages adjusted by their doctor. Dosages above 20 milligrams daily should be taken once a day in the morning or in 2 smaller doses taken in the morning and at noon.

The usual daily dose for depression ranges from 20 to 60 milligrams. For obsessive-compulsive disorder the customary range is 20 to 60 milligrams per day, though a maximum of 80 milligrams is sometimes prescribed. For bulimia nervosa, the usual dose is 60 milligrams, taken in the morning. Your doctor may have you start with less and build up to this dosage. The usual dose for premenstrual dysphoric disorder is 20 milligrams a day.

For depression, it may take up to 4 weeks before the full effects of the medication are seen. For obsessive-compulsive disorder, treatment can take 5 weeks or more to be effective.

If you are taking a 20-milligram daily dose of Prozac for depression, the doctor may switch you to a delayed-release formulation called Prozac Weekly. To make the change, you'll be asked to skip your daily dose for 7 days, then take your first weekly capsule.

CHILDREN

The usual starting dose for depression is 10 or 20 milligrams a day. After 1 week at 10 milligrams a day, the doctor may increase the dose to 20 milligrams. It may take up to 4 weeks before the full effects of the medication are seen. For obsessive-compulsive disorder, the usual starting dose is 10 milligrams a day. After 2 weeks, the doctor may increase the dose to 20 milligrams. If no improvement is seen after several weeks, the dosage may be increased as needed, up to a maximum of 60 milligrams a day. Treatment may take 5 weeks or more to be effective.

Children who are underweight, have kidney or liver problems, or are taking multiple medications may need their dosages adjusted by their doctor.

Overdosage

Any medication taken in excess can have serious consequences. An overdose of Prozac can be fatal. In addition, combining Prozac with certain other drugs can cause symptoms of overdose. If you suspect an overdose, seek medical attention immediately.

• Common symptoms of Prozac overdose include: Nausea, rapid heartbeat, seizures, sleepiness, vomiting

• Other symptoms of Prozac overdose include: Coma, delirium, fainting, high fever, irregular heartbeat, low blood pressure, mania, rigid muscles, sweating, stupor

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Prozac (fluoxetine) Full Prescribing Information
Prozac Medication Guide: A Warning About Children and Adolescents Taking Antidepressants

Detailed Info on Signs, Symptoms, Causes, Treatments of Depression

Detailed Info on Signs, Symptoms, Causes, Treatments of OCD

Detailed Info on Signs, Symptoms, Causes, Treatments of Eating Disorders

Detailed Info on Signs, Symptoms, Causes, Treatments of Anxiety Disorders

back to: Psychiatric Medication Patient Information Index

Find out why Depakote is prescribed, side effects of Depakote, Depakote warnings, effects of Depakote during pregnancy, more - in plain English.

Generic name: Divalproex sodium (Valproic acid)
Brand name: Depakote

Pronounced: DEP-uh-coat

Depakote (divalproex sodium) Full Prescribing Information

Why is Depakote prescribed?

Depakote, in both delayed-release tablet and capsule form, is used to treat certain types of seizures and convulsions. It may be prescribed alone or with other epilepsy medications.

The delayed-release tablets are also used to control the manic episodes--periods of abnormally high spirits and energy--that occur in bipolar disorder (manic depression).

An extended-release form of this drug, Depakote ER, is prescribed to prevent migraine headaches. The delayed-release tablets are also used for this purpose.

Most important fact about Depakote

Depakote can cause serious or even fatal liver damage, especially during the first 6 months of treatment. Children under 2 years of age are the most vulnerable, especially if they are also taking other anticonvulsant medicines and have certain other disorders such as mental retardation. The risk of liver damage decreases with age; but you should always be alert for the following symptoms: loss of seizure control, weakness, dizziness, drowsiness, a general feeling of ill health, facial swelling, loss of appetite, vomiting, and yellowing of the skin and eyes. If you suspect a liver problem, call your doctor immediately.

Depakote has also been known to cause life-threatening damage to the pancreas. This problem can surface at any time, even after years of treatment. Call your doctor immediately if you develop any of the following warning signs: abdominal pain, loss of appetite, nausea, or vomiting.

How should you take Depakote?

Take the tablet with water and swallow it whole (don't chew it or crush it). It has a special coating to avoid upsetting your stomach.

 

If you are taking the sprinkle capsule, you can swallow it whole or open it and sprinkle the contents on a teaspoon of soft food such as applesauce or pudding. Swallow it immediately, without chewing. The sprinkle capsules are large enough to be opened easily.

Depakote can be taken with meals or snacks to avoid stomach upset. Take it exactly as prescribed.

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--If you miss a dose...

If you take Depakote once a day, take your dose as soon as you remember. If you don't remember until the next day, skip the missed dose and return to your regular schedule. Never take 2 doses at the same time.

If you take more than one dose a day, take your dose right away if it's within 6 hours of the scheduled time, and take the rest of the day's doses at equal intervals during the day. Never take 2 doses at the same time.

--Storage instructions...

Store at room temperature.

What side effects may occur when taking Depakote?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Because Depakote is often used with other antiseizure drugs, it may not be possible to determine whether a side effect is due to Depakote alone. Only your doctor can determine if it is safe for you to continue taking Depakote.

• More common side effects of Depakote may include: Abdominal pain, abnormal thinking, breathing difficulty, bronchitis, bruising, constipation, depression, diarrhea, dizziness, emotional changeability, fever, flu symptoms, hair loss, headache, incoordination, indigestion, infection, insomnia, loss of appetite, memory loss, nasal inflammation, nausea, nervousness, ringing in the ears, sleepiness, sore throat, tremor, vision problems, vomiting, weakness, weight loss or gain

• Less common or rare side effects may include: Abnormal dreams, abnormal milk secretion, abnormal walk, aggression, anemia, anxiety, back pain, behavior problems, belching, bleeding, blood disorders, bone pain, breast enlargement, chest pain, chills, coma, confusion, coughing up blood, dental abscess, drowsiness, dry skin, ear inflammation, excessive urination (mainly children) or other urination problems, eye problems, feeling of illness, gas, growth failure in children, hallucinations, hearing problems, heart palpitations, high blood pressure, hostility, increased appetite, increased cough, involuntary rapid movement of eyeball, irregular or painful menstruation, itching, jerky movements, joint pain, lack of muscular coordination, leg cramps, liver problems, loss of bladder or bowel control, muscle or joint pain, muscle weakness, muscle pain, neck pain, nosebleed, overactivity, pneumonia, rapid heartbeat, rickets (mainly children), sedation, seeing "spots before your eyes", sensitivity to light, sinus inflammation, skin eruptions or peeling, skin rash, speech difficulties, stomach and intestinal disorders, swelling of arms and legs due to fluid retention, swollen glands, taste changes, tingling or pins and needles, twitching, urinary problems, vertigo, vision problems

Why should this drug not be prescribed?

You should not take this medication if you have liver disease or your liver is not functioning well, or if you have a genetic abnormality known as urea cycle disorder (UCD).

If you are sensitive to or have ever had an allergic reaction to Depakote, you should not take this medication.

Special warnings about Depakote

This medication can severely damage the liver (see "Most important fact about this drug"). Your doctor will test your liver function before you begin taking this medication and at regular intervals thereafter.

Also remember that the drug can damage the pancreas (see "Most important fact about this drug"). This problem can worsen very rapidly, so be sure to contact your doctor immediately if you develop any symptoms.

In people with a rare set of genetic abnormalities called urea cycle disorders, Depakote may adversely effect the brain. Signs of a developing problem include lack of energy, repeated attacks of vomiting, and mental changes. If you suspect a problem, see your doctor immediately. Depakote may have to be discontinued.

Depakote causes some people to become drowsy or less alert. You should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you are certain the drug does not have this effect on you.

Do not abruptly stop taking this medicine without first consulting your doctor. A gradual reduction in dosage is usually required.

Depakote prolongs the time it takes blood to clot, which increases your chances of serious bleeding.

This drug can also increase the effect of painkillers and anesthetics. Before any surgery or dental procedure, make sure the doctor knows you are taking Depakote.

If you are taking Depakote to prevent migraine, remember that it will not cure a headache once it has started.

Some coated particles from the capsules may appear in your stool. This is to be expected, and need not worry you.

Possible food and drug interactions when taking Depakote

Depakote depresses activity of the central nervous system, and may increase the effects of alcohol. Do not drink alcohol while taking this medication.

If Depakote is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Depakote with the following:

Amitriptyline (Elavil)
Aspirin
Barbiturates such as phenobarbital and Seconal
Blood thinners such as Coumadin
Cyclosporine (Sandimmune, Neoral)
Notriptyline (Pamelor)
Oral contraceptives
Other seizure medications, including carbamazepine (Tegretol), clonazepam (Klonopin), ethosuximide (Zarontin), felbamate (Felbatol), lamotrigine (Lamictal), phenytoin (Dilantin), and Primidone (Mysoline)
Rifampin (Rifater)
Sleep aids such as Halcion
Tolbutamide (Orinase)
Tranquilizers such as Valium and Xanax
Zidovudine (Retrovir)

Special information if you are pregnant or breastfeeding

Depakote may produce birth defects if it is taken during pregnancy. If you are pregnant or plan to become pregnant, inform your doctor immediately. Depakote appears in breast milk and could affect a nursing infant. If Depakote is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with this medication is finished. Read more about taking Depakote during pregnancy or breastfeeding.

Recommended dosage for Depakote

Recommended dosage

EPILEPSY

Dosage for adults and children 10 years of age or older is determined by body weight. The usual recommended starting dose is 10 to 15 milligrams per 2.2 pounds per day, depending on the type of seizure. Your doctor may increase the dose at 1-week intervals by 5 to 10 milligrams per 2.2 pounds per day until your seizures are controlled or the side effects become too severe. The most you should take is 60 milligrams per 2.2 pounds per day. If your total dosage is more than 250 milligrams a day, your doctor will divide it into smaller individual doses. Older adults usually begin taking this medication at lower dosages, and the dosage is increased more slowly.

MANIC EPISODES

The usual starting dose for those aged 18 and over is 750 milligrams a day, divided into smaller doses. Your doctor will adjust the dose for best results.

MIGRAINE PREVENTION

Delayed-Release Tablets The usual starting dose for those aged 16 and over is 250 milligrams twice a day. Your doctor will adjust the dose, up to a maximum of 1,000 milligrams a day.

Extended-Release Tablets

The usual starting dose is 500 milligrams once a day for 1 week. The dose may then be increased to 1,000 milligrams once a day.

Depakote delayed-release and extended-release tablets work differently, so you cannot substitute one type for the other.

Researchers have not established the safety and effectiveness of Depakote for prevention of migraines in children or in adults over 65.

Overdosage

Any medication taken in excess can have serious consequences. An overdose of Depakote can be fatal. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Depakote overdose may include: Coma, extreme sleepiness, heart problems

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Depakote (divalproex sodium) Full Prescribing Information

Detailed Info on Signs, Symptoms, Causes, Treatments of Bipolar Disorder

back to: Psychiatric Medication Patient Information Index

Things parents can do to help prevent your child from developing an eating disorder.

Parents are the key players in preventing eating disorders, according to ANRED (Anorexia Nervosa and Related Eating Disorders), a non-profit organization educating the public about eating disorders.

The group maintains that "almost all effective eating disorder prevention strategies will be carried out in the context of the family, not in organized school or community programs." If you are a parent, keep in mind that what you do is a much more powerful message than what you say.

• Examine your own attitudes and behaviors regarding weight and appearance. Talk with your children about genetic differences in body types and the devastating effects of irrational prejudice.
• Examine what you are modeling. Do you exhibit acceptance of yourself and take appropriate measures to deal with your body function and size, or do you practice self-condemnation, criticism of your spouse's body, extreme dieting, etc.?
• Examine your dreams and goals for your children and other loved ones. Are you overemphasizing physical appearance and body shape, especially for girls?
• Don't shame or ridicule your child (verbally or nonverbally). Parents who do can send your child careening toward an eating disorder. Children need to know they are loved unconditionally. And since feeling helpless and out of control is common among eating-disordered individuals, stability and healthy relationships within families are extremely importance.
• Be aware of the messages you send about the "chubby child" in your family. Do you communicate, through words and action, positive or negative feelings about his or her value, talents, and lovability?
• Don't encourage or force your children to diet. It can actually push your kids toward unhealthy eating patterns that last a lifetime. The best approach is to simply provide balanced, nutritious meals.
• Be involved and offer appropriate direction. Abdicating your parental role by offering your children too little direction can also be just as damaging as controlling to tightly. It can leave children feeling left adrift.
• Don't say things that make your child feel responsible for your well-being or the well-being of others in the family.
• Help to develop your teen's critical thinking skills by talking about celebrities whose lives are dysfunctional and filled with problems in spite of having the "perfect" body. Or do some research on how magazine photos are airbrushed and how movies use "body doubles." Young people who realize that "perfection" is not always what it seems are better able to establish realistic standards for themselves.
• Avoid categorizing foods as "good" or "bad."
• Be a good role model by eating sensibly, using exercise as a path to good health and enjoyment.
• Do not avoid activities (such as swimming, water skiing, etc.) because they call attention to your size and shape.
• Do whatever you can to encourage your teenager's self-respect based on intellectual, spiritual, athletic and social endeavors.
• Practice complimenting people for what they say, feel and do—not for how thin they are.
• Help your family become discerning regarding media messages that imply a slender body means happiness and success.
• Look at what's wrong with the message "thin is best" rather than focusing on what's wrong with your body.
• Use caution when exposing high-risk teens to anti-eating disorder materials. Books, documentaries and pamphlets warning against disordered eating have often been used by anorexics and bulimics as how-to guides.

If you suspect your teen is already developing an eating disorder, seek help immediately. Early detection and treatment can be very important, so consult with a qualified medical or mental health professional right away.

Sources:

• ANRED (Anorexia Nervosa and Related Eating Disorders)

Find out why Valium is prescribed, side effects of Valium, Valium warnings, effects of Valium during pregnancy, more - in plain English.

Generic name: Diazepam
Brand name: Valium

Pronounced: VAL-ee-um

 

Why is Valium prescribed?

Valium is used in the treatment of anxiety disorders and for short-term relief of the symptoms of anxiety. It belongs to a class of drugs known as benzodiazepines.

It is also used to relieve the symptoms of acute alcohol withdrawal, to relax muscles, to relieve the uncontrolled muscle movements caused by cerebral palsy and paralysis of the lower body and limbs, to control involuntary movement of the hands (athetosis), to relax tight, aching muscles, and, along with other medications, to treat convulsive disorders such as epilepsy.

Most important fact about Valium

Valium can be habit-forming or addictive. You may experience withdrawal symptoms if you stop using this drug abruptly. Discontinue or change your dose only on your doctor's advice.

How should you take Valium?

Take this medication exactly as prescribed. If you are taking Valium for epilepsy, make sure you take it every day at the same time.

 

--If you miss a dose...

Take it as soon as you remember if it is within an hour or so of the scheduled time. If you do not remember until later, skip the dose you missed and go back to your regular schedule. Never take 2 doses at the same time.

--Storage instructions...

Store away from heat, light, and moisture.

What side effects may occur when taking Valium?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Valium.

• More common side effects of Valium may include: Drowsiness, fatigue, light-headedness, loss of muscle coordination

• Less common or rare side effects may include: Anxiety, blurred vision, changes in salivation, changes in sex drive, confusion, constipation, depression, difficulty urinating, dizziness, double vision, hallucinations, headache, inability to hold urine, low blood pressure, nausea, overstimulation, rage, seizures (mild changes in brain wave patterns), skin rash, sleep disturbances, slow heartbeat, slurred speech and other speech problems, stimulation, tremors, vertigo, yellowing of eyes and skin

• Side effects due to rapid decrease in dose or abrupt withdrawal from Valium: Abdominal and muscle cramps, convulsions, sweating, tremors, vomiting

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Why should this drug not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Valium, you should not take this medication.

Do not take this medication if you have the eye condition known as acute narrow-angle glaucoma.

Anxiety or tension related to everyday stress usually does not require treatment with such a powerful drug as Valium. Discuss your symptoms thoroughly with your doctor.

Valium should not be prescribed if you are being treated for mental disorders more serious than anxiety.

Special warnings about Valium

Valium may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how this drug affects you.

If you have liver or kidney problems, use this medication cautiously.

Possible food and drug interactions when taking Valium

Valium slows down the central nervous system and may intensify the effects of alcohol. Do not drink alcohol while taking this medication.

If Valium is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Valium with any of the following:

Antiseizure drugs such as Dilantin
Antidepressant drugs such as Elavil and Prozac
Barbiturates such as phenobarbital
Cimetidine (Tagamet)
Digoxin (Lanoxin)
Disulfiram (Antabuse)
Fluoxetine (Prozac)
Isoniazid (Rifamate)
Levodopa (Larodopa, Sinemet)
Major tranquilizers such as Mellaril and Thorazine
MAO inhibitors (antidepressant drugs such as Nardil)
Narcotics such as Percocet
Omeprazole (Prilosec)
Oral contraceptives
Propoxyphene (Darvon)
Ranitidine (Zantac)
Rifampin (Rifadin)

Special information if you are pregnant or breastfeeding

Do not take Valium if you are pregnant or planning to become pregnant. There is an increased risk of birth defects.

If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.

Recommended dosage for Valium

ADULTS

Treatment of Anxiety Disorders and Short-Term Relief of the Symptoms of Anxiety

The usual dose, depending upon severity of symptoms, is 2 milligrams to 10 milligrams 2 to 4 times daily.

Acute Alcohol Withdrawal

The usual dose is 10 milligrams 3 or 4 times during the first 24 hours, then 5 milligrams 3 or 4 times daily as needed.

Relief of Muscle Spasm

The usual dose is 2 milligrams to 10 milligrams 3 or 4 times daily.

Convulsive Disorders

The usual dose is 2 milligrams to 10 milligrams 2 to 4 times daily.

CHILDREN

Valium should not be given to children under 6 months of age. The usual starting dose for children over 6 months is 1 to 2.5 milligrams 3 or 4 times a day. Your doctor may increase the dosage gradually if needed.

OLDER ADULTS

The usual dosage is 2 milligrams to 2.5 milligrams once or twice a day, which your doctor will increase as needed. Your doctor will limit the dosage to the smallest effective amount because older people are more apt to become oversedated or uncoordinated.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect a Valium overdose, seek medical attention immediately.

• Symptoms of Valium overdose may include: Coma, confusion, diminished reflexes, sleepiness

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Detailed Info on Signs, Symptoms, Causes, Treatments of Anxiety Disorders

Detailed Info on Signs, Symptoms, Causes, Treatments of Addictions

back to: Psychiatric Medication Patient Information Index

Quest for Freedom!

~ An insight into OCD ~ Obsessive Compulsive Disorder

Dear Diary,
AAAtttiiissshhhooo! Ha, well apart from a rotten cold I'm doing ok-ish. 'Tis the season to be merry and all that. The site's getting some great response and I've had some lovely emails from fellow caring and lovely OCD'ers. We are definitely a caring community!

I'm doing well on the OCD front except for when that voice creeps up on me and whispers uncertainty into my ear. Actually, because of the cold I think my resistance to it isn't as strong as it should be and the floor defiantly still feels dodgy to me. However, my determination is staying strong. As you know, I'm staying at my friends house and it seems like I shall be for a little while... Hubby is at a low point and needs a break from the OCD. He keeps catching colds and is feeling very down at the moment. I guess doing so much for me over the years has taken it's toll on him too, and he feels mentally exhausted, plus I think he's scared of me returning to how I was OCD-wise at home. Now that he's seen what I can live like here he doesn't want that for me. We're seeing each other every week though, and talk everyday.

I'm a person who hates change. I like everything that I know and love to stay constant and the same. Unfortunately, at the moment nothing much in my life feels very familiar to me, and I don't like the feeling very much at all. It seems like on the one hand I'm doing really well and it has to be better to be living in a more normal way instead of hibernating in one room, but on the other hand I can't help feeling a bit lost. I suppose I'm scared too. I've had this illness for so long and everything has been so controlled and ordered in my day to day life, and now it isn't. I've been doing some Christmas shopping, not keen on the crowds though. Oh, and that's another thing - Christmas! Me and Hubby - I'll call him Phil although that's not his real name - well Phil and I absolutely LOVE Christmas. Anyone who knows us would tell you that. Both of us always have. We have our own little traditions and schedule, and because I shall, more than likely, be spending Christmas here (for the reasons I mentioned before) it is going to feel very unfamiliar and strange too! Oh well, never mind.. Enough of my moaning, hee hee.

I hope everyone reading this has a lovely Christmas and an OCD FREE year as much as possible. Eat drink and be merry... hic! Not too merry though, if you're on medication, Ha. Talk to you next month, keep smiling!

Love,

Sani.xx

next: My Obsessively Clean Diary: March, 2001
~ ocd library articles
~ all ocd related disorders articles

Find out why Dexedrine is prescribed, side effects of Dexedrine, Dexedrine warnings, effects of Dexedrine during pregnancy, more - in plain English.

Generic name: Dextroamphetamine sulfate
Brand name: Dexedrine, Dextrostat

Pronounced: DEX-eh-dreen

Dexedrine (dextroamphteamine) Full Prescription Information

Why is Dexedrine prescribed?

Dexedrine, a stimulant drug available in tablet or sustained-release capsule form, is prescribed to help treat the following conditions:

1. Narcolepsy (recurrent "sleep attacks")
2. Attention Deficit Hyperactivity Disorder. (The total treatment program should include social, psychological, and educational guidance along with Dexedrine.)

Most important fact about Dexedrine

Because it is a stimulant, this drug has high abuse potential. The stimulant effect may give way to a letdown period of depression and fatigue. Although the letdown can be relieved by taking another dose, this soon becomes a vicious circle.

If you habitually take Dexedrine in doses higher than recommended, or if you take it over a long period of time, you may eventually become dependent on the drug and suffer from withdrawal symptoms when it is unavailable.

How should you take Dexedrine?

Take Dexedrine exactly as prescribed. If it is prescribed in tablet form, you may need up to 3 doses a day. Take the first dose when you wake up; take the next 1 or 2 doses at intervals of 4 to 6 hours. You can take the sustained-release capsules only once a day.

Do not take Dexedrine late in the day, since this could cause insomnia. If you experience insomnia or loss of appetite while taking this drug, notify your doctor; you may need a lower dosage.

It is likely that your doctor will periodically take you off Dexedrine to determine whether you still need it.

Do not chew or crush the sustained-release form, Dexedrine Spansules.

 

Do not increase the dosage, except on your doctor's advice.

Do not use Dexedrine to improve mental alertness or stay awake. Do not share it with others.

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--If you miss a dose...

If you take 1 dose a day, take it as soon as you remember, but not within 6 hours of going to bed. If you do not remember until the next day, skip the dose you missed and go back to your regular schedule.

If you take 2 or 3 doses a day, take the dose you missed if it is within an hour or so of the scheduled time. Otherwise, skip the dose and go back to your regular schedule. Never take 2 doses at once.

--Storage instructions...

Store at room temperature in a tightly closed container, away from light.

What side effects may occur when taking Dexedrine?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Dexedrine.

• More common side effects of Dexedrine may include: Excessive restlessness, overstimulation

• Other side effects may include: Changes in sex drive, constipation, diarrhea, dizziness, dry mouth, exaggerated feeling of well-being or depression, headache, heart palpitations, high blood pressure, hives, impotence, loss of appetite, rapid heartbeat, sleeplessness, stomach and intestinal disturbances, tremors, uncontrollable twitching or jerking, unpleasant taste in the mouth, weight loss

• Effects of chronic heavy abuse of Dexedrine may include: Hyperactivity, irritability, personality changes, schizophrenia-like thoughts and behavior, severe insomnia, severe skin disease

Why should this drug not be prescribed?

Do not take Dexedrine if you are sensitive to or have ever had an allergic reaction to it.

Do not take Dexedrine for at least 14 days after taking a monoamine oxidase inhibitor (MAO inhibitor) such as the antidepressants Nardil and Parnate. Dexedrine and MAO inhibitors may interact to cause a sharp, potentially life-threatening rise in blood pressure.

Your doctor will not prescribe Dexedrine for you if you suffer from any of the following conditions:

Agitation
Cardiovascular disease
Glaucoma
Hardening of the arteries
High blood pressure
Overactive thyroid gland
Substance abuse

Special warnings about Dexedrine

Be aware that one of the inactive ingredients in Dexedrine is a yellow food coloring called tartrazine (Yellow No. 5). In a few people, particularly those who are allergic to aspirin, tartrazine can cause a severe allergic reaction.

Dexedrine may impair judgment or coordination. Do not drive or operate dangerous machinery until you know how you react to the medication.

There is some concern that Dexedrine may stunt a child's growth. For the sake of safety, any child who takes Dexedrine should have his or her growth monitored.

Possible food and drug interactions when taking Dexedrine

If Dexedrine is taken with certain foods or drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Dexedrine with the following:

• Substances that dampen the effects of Dexedrine:

  Ammonium chloride
  Chlorpromazine (Thorazine)
  Fruit juices
  Glutamic acid hydrochloride
  Guanethidine
  Haloperidol (Haldol)
  Lithium carbonate (Eskalith)
  Methenamine (Urised)
  Reserpine
  Sodium acid phosphate
  Vitamin C (as ascorbic acid)

• Substances that boost the effects of Dexedrine:

  Acetazolamide (Diamox)
  MAO inhibitors such as Nardil and Parnate
  Propoxyphene (Darvon)
  Sodium bicarbonate (baking soda)
  Thiazide diuretics such as Diuril

• Substances that have decreased effect when taken with Dexedrine:

  Antihistamines such as Benadryl
  Blood pressure medications such as Catapres, Hytrin, and Minipress
  Ethosuximide (Zarontin)
  Veratrum alkaloids (found in certain blood pressure drugs)

• Substances that have increased effect when taken with Dexedrine:

  Antidepressants such as Norpramin
  Meperidine (Demerol)
  Norepinephrine (Levophed)
  Phenobarbital
  Phenytoin (Dilantin)

Special information if you are pregnant or breastfeeding

If you are pregnant or plan to become pregnant, inform your doctor immediately. Babies born to women taking Dexedrine may be premature or have low birth weight. They may also be depressed, agitated, or apathetic due to withdrawal symptoms. Since Dexedrine appears in breast milk, it should not be taken by a nursing mother.

Recommended dosage for Dexedrine

Take no more Dexedrine than your doctor prescribes. Intake should be kept to the lowest level that proves effective.

NARCOLEPSY

Adults

The usual dose is 5 to 60 milligrams per day, divided into smaller, equal doses.

Children

Narcolepsy seldom occurs in children under 12 years of age; however, when it does, Dexedrine may be used. .

The suggested initial dose for children between 6 and 12 years of age is 5 milligrams per day. Your doctor may increase the daily dose in increments of 5 milligrams at weekly intervals until it becomes effective.

Children 12 years of age and older will be started with 10 milligrams daily. The daily dosage may be raised in increments of 10 milligrams at weekly intervals until effective. If side effects such as insomnia or loss of appetite appear, the dosage will probably be reduced.

ATTENTION DEFICIT HYPERACTIVITY DISORDER

This drug is not recommended for children under 3 years of age. Children from 3 to 5 Years of Age e

The usual starting dose is 2.5 milligrams daily, in tablet form. Your doctor may raise the daily dosage by 2.5 milligrams at weekly intervals until the drug becomes effective.

Children 6 Years of Age and Older

The usual starting dose is 5 milligrams once or twice a day. Your doctor may raise the dose by 5 milligrams at weekly intervals until he or she is satisfied with the response. Only in rare cases will the child take more than 40 milligrams per day.

Your child should take the first dose when he or she wakes up; the remaining 1 or 2 doses are taken at intervals of 4 to 6 hours. Alternatively, the doctor may prescribe "Spansule" capsules that are taken once a day. Your doctor may interrupt the schedule occasionally to see if behavioral symptoms come back enough to require continued therapy.

Overdosage

An overdose of Dexedrine can be fatal. If you suspect an overdose, seek medical attention immediately.

Symptoms of an acute Dexedrine overdose may include: Abdominal cramps, assaultiveness, coma, confusion, convulsions, depression, diarrhea, fatigue, hallucinations, high fever, heightened reflexes, high or low blood pressure, irregular heartbeat, nausea, panic, rapid breathing, restlessness, tremor, vomiting.

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Dexedrine (dextroamphteamine) Full Prescription Information

Detailed Info on Signs, Symptoms, Causes, Treatments of ADHD

back to: Psychiatric Medication Patient Information Index

Brand Name: Ludiomil
Generic Name: Maprotiline

Maprotiline (Ludiomil) is an antidepressant used to treat depression with or without anxiety. Uses, dosage, side effects of Ludiomil.

Outside U.S., Brand Names also known as: Deprilept, Psymion

Maprotiline (Ludiomil) Full Prescribing Information (PDF)

Contents:

Description
Pharmacology
Indications and Usage
Contraindications
Warnings
Precautions
Drug Interactions
Adverse Reactions
Overdose
Dosage
Supplied

Description

Maprotiline (Ludiomil) is an antidepressant used to treat depression with or without anxiety.

Pharmacology

Maprotiline has been shown to exhibit an antidepressant action. It strongly inhibits the uptake of noradrenaline in the brain and peripheral tissues, though it is notable in its lack of inhibition of serotonergic uptake. Maprotiline also exerts a sedative effect on the anxiety component of depressive illness.

Similar to other tricyclic antidepressants, maprotiline lowers the convulsive threshold.

Following repeated daily doses of maprotiline, a plasma steady state concentration was reached in the second week, with the majority of subjects receiving daily doses of 150 mg attaining steady state blood levels between 100 and 400 ng/mL.

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Indications and Usage

Ludiomil is used to treat depression, including the depressed phase of manic-depressive illness (bipolar disorder), psychotic depression (unipolar depression), and involutional melancholia. It might also be useful in selected patients suffering severe depressive neurosis.

 

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Contraindications

Maprotiline should not be given in conjunction with, or within 14 days of treatment with a MAO inhibitor. Combined therapy of this type could lead to the appearance of serious interactions such as hyperpyrexia, tremors, generalized clonic convulsions, delirium and possible death.

Contraindicated in patients with a history of hypersensitivity to Maprotiline.

Maprotiline is contraindicated during the acute recovery phase following myocardial infarction in the presence of acute congestive heart failure, and in patients with conduction defects.

Should not be used in patients with known or suspected convulsive disorders. Maprotiline lowers the seizure threshold.

Patients with narrow angle glaucoma should not be given maprotiline.

Patients with urinary retention due to prostatic disease should not receive maprotiline.

Maprotiline should be withdrawn in cases of acute poisoning with alcohol, hypnotics, analgesics or psychotropic drugs.

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Warnings

Cardiovascular: Tricyclic and tetracyclic antidepressants, particularly in high doses, have been reported to produce arrhythmias. A few instances of unexpected death have been reported in patients with cardiovascular disorders. Myocardial infarction and stroke have also been reported with these drugs. Therefore, extreme caution should be used when maprotiline is given to elderly patients, or those with known cardiovascular disease including those with a history of myocardial infarction, arrhythmias and/or ischemic heart disease.

Maprotiline should be used with caution in hyperthyroid patients and in those on thyroid medication because of the possibility of cardiovascular toxicity.

Maprotiline should be used with caution in patients receiving guanethidine or similar sympatholytic antihypertensive agents (bethanidine, reserpine, alpha-methyldopa, clonidine) since it may block the effects of these drugs with subsequent loss of blood pressure control.

Seizures: Seizures have been reported in patients without a known history of seizures who were treated with maprotiline at therapeutic dose levels.

The risk of seizures may be increased when maprotiline is taken concomitantly with phenothiazines, when the dosage of benzodiazepines is rapidly tapered in patients receiving maprotiline, or when the recommended dosage of maprotiline is rapidly exceeded.

The risk of seizures may be reduced by: initiating therapy at a low dosage; maintaining the initial dosage for 2 weeks before raising it gradually in small increments.

Because of its anticholinergic properties, maprotiline should be used with caution in patients with a history of increased intraocular pressure or history of urinary retention, particularly in the presence of prostatic hypertrophy.

Psychosis: An activation of psychosis has occasionally been observed in schizophrenic patients administered tricyclic antidepressant drugs and must be considered as a possibility when administering maprotiline.

Hypomanic or manic episodes: in patients with cyclic disorders have been known to occur during treatment of a depressed phase with a tricyclic antidepressant. These 2 conditions, should they occur, may require a reduction in the dosage of maprotiline, discontinuation of the drug, and/or administration of an antipsychotic agent.

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Precautions

Suicide: The possibility of suicide in seriously depressed patients is inherent in their illness and may persist until significant remission occurs. Therefore, patients must be carefully supervised during all phases of treatment with maprotiline and prescriptions should be written for the smallest amount consistent with good management.

Cardiovascular: Particularly in patients with heart diseases, as well as in elderly subjects, cardiac function should be monitored and ECG examinations performed during long-term treatment with high doses. Regular measurements of the blood pressure are called for in patients susceptible to postural hypotension.

Constipation: Tricyclic antidepressants may give rise to paralytic ileus, particularly in the elderly and in hospitalized patients. Therefore, since maprotiline has similar anticholinergic properties, appropriate measures should be taken if constipation occurs.

Usage in Children: The drug is not recommended for use in children.

Pregnancy and Withdrawl: Safe use of Maprotiline during pregnancy or lactation has not been established; therefore, its use in pregnancy, in nursing mothers or in women of childbearing potential requires that the benefits of treatment be weighed against the possible risks to mother and child.

Interference with Cognitive or Motor Performance: Since Maprotiline may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as operating an automobile or machinery, the patient should be cautioned accordingly.

Prior to elective surgery: Little is known about the interaction between maprotiline and general anesthetics. Maprotiline should be discontinued for as long as clinically feasible.

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Drug Interactions

Maprotiline should not be given in conjunction with, or within 14 days of treatment with a MAO inhibitor. Combined therapy of this type could lead to the appearance of serious interactions such as hyperpyrexia, tremors, generalized clonic convulsions, delirium and possible death.

While taking maprotiline, responses to alcoholic beverages, barbiturates, and other CNS depressants may be exaggerated.

Maprotiline may diminish or abolish the antihypertensive effects of adrenergic neuron blocking drugs, such as guanethidine, bethanidine, reserpine, clonidine and alpha-methyldopa. Therefore, patients requiring concomitant treatment for hypertension should be given antihypertensives of a different type (i.e., diuretics, vasodilators, or beta-blockers which do not undergo pronounced biotransformation).

Maprotiline may potentiate the cardiovascular effects of indirect and directly acting sympathomimetic drugs such as noradrenaline, adrenaline, and methylphenidate. Maprotiline may also potentiate the effects of anticholinergic drugs (atropine, biperiden) and levodopa. Therefore, close supervision and careful adjustment of dosage is required when administering maprotiline with anticholinergic or sympathomimetic drugs because of the possibility of additive effects.

Drugs that activate hepatic microsomal enzymes, such as barbiturates, phenytoin, oral contraceptives and carbamazepine, may accelerate the metabolism of maprotiline resulting in decreased antidepressant efficacy. If necessary, the dosage should be adapted accordingly.

Concomitant treatment with maprotiline and major tranquilizers may result in increased plasma levels of maprotiline, a lowered convulsion threshold, and seizures.

The combination of maprotiline and benzodiazepines may cause increased sedation.

Concurrent use of parenteral magnesium sulfate and maprotiline may result in serious potentiation of CNS depressant effects.

BEFORE USING THIS MEDICINE: INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. This includes other medicines to treat depression. Inform your doctor of any other medical conditions including a recent heart attack, epilepsy, allergies, pregnancy, or breast-feeding.

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Adverse Reactions

This medicine may cause blurred vision, especially during the first few weeks of treatment.

Adverse reactions with maprotiline have been mild and transient, usually disappearing with continued treatment or following a reduction in the dosage.

Check with your doctor as soon as possible if any of the following side effects occur: More common: Skin rash, redness, swelling, or itching.

Less common: Constipation (severe); nausea or vomiting; shakiness or trembling; seizures (convulsions); unusual excitement; weight loss.

Rare: Breast enlargement - in males and females; confusion (especially in the elderly); difficulty in urinating; fainting; hallucinations (seeing, hearing, or feeling things that are not there); inappropriate secretion of milk - in females; irregular heartbeat (pounding, racing, skipping); sore throat and fever; swelling of testicles; yellow eyes or skin.

Other common side effects are: Blurred vision; decreased sexual ability; dizziness or lightheadedness (especially in the elderly); drowsiness; dryness of mouth; headache; increased or decreased sexual drive; tiredness or weakness; constipation (mild); diarrhea; heartburn; increased appetite and weight gain; increased sensitivity of skin to sunlight; increased sweating; trouble in sleeping; weight loss.

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Overdose

Signs and Symptoms

Symptoms of an overdose are convulsions (seizures); dizziness (severe); drowsiness (severe); fast or irregular heartbeat; fever; muscle stiffness or weakness (severe); restlessness or agitation; trouble in breathing; vomiting; and dilated pupils.

Treatment

If you or someone you know may have used more than the recommended dose of this medicine, contact your local poison control center or emergency room immediately.

No specific antidote is known.

Maintain adequate airway, empty stomach contents, and treat symptomatically.

Cardiac arrhythmias and CNS involvement pose the greatest threat and may occur suddenly even when initial symptoms appear to be mild. Therefore, patients who may have ingested an overdosage of maprotiline, particularly children, should be hospitalized and kept under close surveillance.

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Dosage

Several days to weeks may pass before you feel the full benefit of this medicine. Do not stop taking this medicine without checking with your doctor.

• Follow the directions for using this medicine provided by your doctor.
• Store this medicine at room temperature, in a tightly-closed container, away from heat and light.
• Continue to take this medicine even if you feel better.
• Do not miss any doses. If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Additional Information:: Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children.

Patients should be kept under medical surveillance during treatment with maprotiline. The dosage of maprotiline should be individualized according to the requirements of each patient.

Sometimes this medicine must be taken for up to 2 or 3 weeks before you begin to feel better.

Adults: At first, 25 milligrams (mg) taken one to three times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 150 mg a day, unless you are in the hospital.

Some hospitalized patients may need higher doses. (a higher initial dose of 100 mg daily in 2 or 3 divided doses may be indicated. The usual optimal dose in these patients is 150 mg daily, but some patients may require up to 225 mg in divided doses).

When these higher doses are used, it is essential to exclude a history of convulsive disorders.

Elderly and Debilitated Patients: In general, lower dosages are recommended for these patients, and doses should only be increased in gradual increments. Initially, 10 mg 3 times daily is suggested, with very gradual increments, depending on tolerance and response, up to 75 mg daily in divided doses.

Children: This medicine is not recommended for use in children.

Discontinuation: After you stop taking this medicine, your body will need time to adjust. This usually takes about 3 to 10 days. Continue to follow the precautions listed above during this period of time.

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How Supplied

Tablets:: available in 25 mg, 50 mg, 75 mg.

IF YOU WILL BE USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, be sure to obtain necessary refills before your supply runs out.

Detailed Info on Signs, Symptoms, Causes, Treatments of Depression

Detailed Info on Signs, Symptoms, Causes, Treatments of Bipolar Disorder

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The information in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse. Last updated 3/03.

Copyright © 2007 Healthyplace Inc. All rights reserved.

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Maprotiline (Ludiomil) Full Prescribing Information (PDF)

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J. Jaffe (Ed.), Encyclopedia of Drugs and Alcohol, New York: Macmillan, pp. 92-97 (written in 1991, references updated 1993)

Abstinence is the total avoidance of an activity. It is the dominant approach in the United States to resolving alcoholism and drug abuse (e.g., "Just Say No"). Abstinence was at the base of Prohibition (legalized in 1919 with the Eighteenth Amendment) and is closely related to prohibitionism—the legal proscription of substances and their use.

Although temperance originally meant moderation, the nineteenth-century TEMPERANCE MOVEMENT'S emphasis on complete abstinence from alcohol and the mid-twentieth century's experience of the ALCOHOLICS ANONYMOUS movement have strongly influenced alcohol- and drug-abuse treatment goals in the United States. Moral and clinical issues have been irrevocably mixed.

The disease model of alcoholism and drug addiction, which insists on abstinence, has incorporated new areas of compulsive behavior—such as overeating and sexual involvements. In these cases, redefinition of abstinence to mean "the avoidance of excess" (what we would otherwise term moderation) is required.

Abstinence can also be used as a treatment-outcome measure, as an indicator of its effectiveness. In this case, abstinence is defined as the number of drug-free days or weeks during the treatment regimen—and measures of drug in urine are often used as objective indicators.

Bibliography

HEATH, D.B. (1992). Prohibition or liberalization of alcohol and drugs? In M. Galanter (Ed.), Recent developments in alcoholism Alcohol and cocaine. New York: Plenum.

LENDER, M. E., & MARTIN, J. K. (1982). Drinking in America. New York: Free Press.

PEELE, S., BRODSKY, A., & ARNOLD, M. (1991). The truth about addiction and recovery. New York: Simon & Schuster.

Controlled Drinking versus Abstinence

Stanton Peele

The position of ALCOHOLICS ANONYMOUS (AA) and the dominant view among therapists who treat alcoholism in the United States is that the goal of treatment for those who have been dependent on alcohol is total, complete, and permanent abstinence from alcohol (and, often, other intoxicating substances). By extension, for all those treated for alcohol abuse, including those with no dependence symptoms, moderation of drinking (termed controlled drinking or CD) as a goal of treatment is rejected (Peele, 1992). Instead, providers claim, holding out such a goal to an alcoholic is detrimental, fostering a continuation of denial and delaying the alcoholic's need to accept the reality that he or she can never drink in moderation.

In Britain and other European and Commonwealth countries, controlled-drinking therapy is widely available (Rosenberg et al., 1992). The following six questions explore the value, prevalence, and clinical impact of controlled drinking versus abstinence outcomes in alcoholism treatment; they are intended to argue the case for controlled drinking as a reasonable and realistic goal.

1. What proportion of treated alcoholics abstain completely following treatment?

At one extreme, Vaillant (1983) found a 95 percent relapse rate among a group of alcoholics followed for 8 years after treatment at a public hospital; and over a 4-year follow-up period, the Rand Corporation found that only 7 percent of a treated alcoholic population abstained completely (Polich, Armor, & Braiker, 1981). At the other extreme, Wallace et al. (1988) reported a 57 percent continuous abstinence rate for private clinic patients who were stably married and had successfully completed detoxification and treatment—but results in this study covered only a 6-month period.

In other studies of private treatment, Walsh et al. (1991) found that only 23 percent of alcohol-abusing workers reported abstaining throughout a 2-year follow-up, although the figure was 37 percent for those assigned to a hospital program. According to Finney and Moos (1991), 37 percent of patients reported they were abstinent at all follow-up years 4 through 10 after treatment. Clearly, most research agrees that most alcoholism patients drink at some point following treatment.

2. What proportion of alcoholics eventually achieve abstinence following alcoholism treatment?

Many patients ultimately achieve abstinence only over time. Finney and Moos (1991) found that 49 percent of patients reported they were abstinent at 4 years and 54 percent at 10 years after treatment. Vaillant (1983) found that 39 percent of his surviving patients were abstaining at 8 years. In the Rand study, 28 percent of assessed patients were abstaining after 4 years. Helzer et al. (1985), however, reported that only 15 percent of all surviving alcoholics seen in hospitals were abstinent at 5 to 7 years. (Only a portion of these patients were specifically treated in an alcoholism unit. Abstinence rates were not reported separately for this group, but only 7 percent survived and were in remission at follow-up.)

3. What is the relationship of abstinence to controlled-drinking outcomes over time?

Edwards et al. (1983) reported that controlled drinking is more unstable than abstinence for alcoholics over time, but recent studies have found that controlled drinking increases over longer follow-up periods. Finney and Moos (1991) reported a 17 percent "social or moderate drinking" rate at 6 years and a 24 percent rate at 10 years. In studies by McCabe (1986) and Nordström and Berglund (1987), CD outcomes exceeded abstinence during follow-up of patients 15 and more years after treatment (see Table 1). Hyman (1976) earlier found a similar emergence of controlled drinking over 15 years.

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4. What are legitimate nonabstinent outcomes for alcoholism?

The range of nonabstinence outcomes between unabated alcoholism and total abstinence includes (I) "improved drinking" despite continuing alcohol abuse, (2) "largely controlled drinking" with occasional relapses, and (3) "completely controlled drinking." Yet some studies count both groups (1) and (2) as continuing alcoholics and those in group (3) who engage in only occasional drinking as abstinent. Vaillant (1983) labeled abstinence as drinking less than once a month and including a binge lasting less than a week each year.

The importance of definitional criteria is evident in a highly publicized study (Helzer et al., 1985) that identified only 1.6 percent Of treated alcoholism patients as "moderate drinkers." Not included in this category were an additional 4.6 percent of patients who drank without problems but who drank in fewer than 30 of the previous 36 months. In addition, Helzer et al. identified a sizable group (12%) of former alcoholics who drank a threshold of 7 drinks 4 times in a single month over the previous 3 years but who reported no adverse consequences or symptoms of alcohol dependence and for whom no such problems were uncovered from collateral records. Nonetheless, Helzer et al. rejected the value of CD outcomes in alcoholism treatment.

While the Helzer et al. study was welcomed by the American treatment industry, the Rand results (Polich, Armor, & Braiker, 1981) were publicly denounced by alcoholism treatment advocates. Yet the studies differed primarily in that Rand reported a higher abstinence rate, using a 6-month window at assessment (compared with 3 years for Helzer et al.). The studies found remarkably similar nonabstinence outcomes, but Polich, Armor, and Braiker (1981) classified both occasional and continuous moderate drinkers (8%) and sometimes heavy drinkers (10%) who had no negative drinking consequences or dependence symptoms in a nonabstinent remission category. (Rand subjects had been highly alcoholic and at intake were consuming a median of 17 drinks daily.)

The harm-reduction approach seeks to minimize the damage from continued drinking and recognizes a wide range of improved categories (Heather, 1992). Minimizing nonabstinent remission or improvement categories by labeling reduced but occasionally excessive drinking as "alcoholism" fails to address the morbidity associated with continued untrammeled drinking.

5. How do untreated and treated alcoholics compare in their controlled-drinking and abstinent-remission ratios?

Alcoholic remission many years after treatment may depend less on treatment than on posttreatment experiences, and in some long-term studies, CD outcomes become more prominent the longer subjects are out of the treatment milieu, because patients unlearn the abstinence prescription that prevails there (Peele, 1987). By the same token, controlled drinking may be the more common outcome for untreated remission, since many alcohol abusers may reject treatment because they are unwilling to abstain.

Goodwin, Crane, & Guze (1971) found that controlled-drinking remission was four times as frequent as abstinence after eight years for untreated alcoholic felons who had "unequivocal histories of alcoholism" (see Table 1). Results from the 1989 Canadian National Alcohol and Drug Survey confirmed that those who resolve a drinking problem without treatment are more likely to become controlled drinkers. Only 18 percent of 500 recovered alcohol abusers in the survey achieved remission through treatment. About half (49%) of those in remission still drank. Of those in remission through treatment, 92 percent were abstinent. But 61 percent of those who achieved remission without treatment continued drinking (see Table 2).

6. For which alcohol abusers is controlled-drinking therapy or abstinence therapy superior?

Severity of alcoholism is the most generally accepted clinical indicator of the appropriateness of CD therapy (Rosenberg, 1993). Untreated alcohol abusers probably have less severe drinking problems than clinical populations of alcoholics, which may explain their higher levels of controlled drinking. But the less severe problem drinkers uncovered in nonclinical studies are more typical, outnumbering those who "show major symptoms of alcohol dependence" by about four to one (Skinner, 1990).

Despite the reported relationship between severity and CD outcomes, many diagnosed alcoholics do control their drinking, as Table 1 reveals. The Rand study quantified the relationship between severity of alcohol dependence and controlled-drinking outcomes, although, overall, the Rand population was a severely alcoholic one in which "virtually all subjects reported symptoms of alcohol dependence" (Polich, Armor, and Braiker, 1981).

Polich, Armor, and Braiker found that the most severely dependent alcoholics (11 or more dependence symptoms on admission) were the least likely to achieve nonproblem drinking at 4 years. However, a quarter or this group who achieved remission did so through nonproblem drinking. Furthermore, younger (under 40), single alcoholics were far more likely to relapse if they were abstinent at 18 months than if they were drinking without problems, even if they were highly alcohol-dependent (Table 3). Thus the Rand study found a strong link between severity and outcome, but a far from ironclad one.

Some studies have failed to confirm the link between controlled-drinking versus abstinence outcomes and alcoholic severity. In a clinical trial that included CD and abstinence training for a highly dependent alcoholic population, Rychtarik et al. (1987) reported 18 percent controlled drinkers and 20 percent abstinent (from 59 initial patients) at 5 to 6 year follow-up. Outcome type was not related to severity of dependence. Nor was it for Nordström and Berglund (1987), perhaps because they excluded "subjects who were never alcohol dependent."

Nordström and Berglund, like Wallace et al. (1988), selected high-prognosis patients who were socially stable. The Wallace et al. patients had a high level of abstinence; patients in Nordström and Berglund had a high level of controlled drinking. Social stability at intake was negatively related in Rychtarik et al. to consumption as a result either of abstinence or of limited intake. Apparently, social stability predicts that alcoholics will succeed better whether they choose abstinence or reduced drinking. But other research indicates that the pool of those who achieve remission can be expanded by having broader treatment goals.

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Rychtarik et al. found that treatment aimed at abstinence or controlled drinking was not related to patients' ultimate remission type. Booth, Dale, and Ansari (1984), on the other hand, found that patients did achieve their selected goal of abstinence or controlled drinking more often. Three British groups (Elal-Lawrence, Slade, & Dewey, 1986; Heather, Rollnick, & Winton, 1983; Orford & Keddie, 1986) have found that treated alcoholics' beliefs about whether they could control their drinking and their commitment to a CD or an abstinence-treatment goal were more important in determining CD versus abstinence outcomes than were subjects' levels of alcohol dependence. Miller et al. (in press) found that more dependent drinkers were less likely to achieve CD outcomes but that desired treatment goal and whether one labeled oneself an alcoholic or not independently predicted outcome type.

Summary

Controlled drinking has an important role to play in alcoholism treatment. Controlled drinking as well as abstinence is an appropriate goal for the majority of problem drinkers who are not alcohol-dependent. In addition, while controlled drinking becomes less likely the more severe the degree of alcoholism, other factors—such as age, values, and beliefs about oneself, one's drinking, and the possibility of controlled drinking—also play a role, sometimes the dominant role, in determining successful outcome type. Finally, reduced drinking is often the focus of a harm-reduction approach, where the likely alternative is not abstinence but continued alcoholism.

(SEE ALSO: Alcohol; Disease Concept of Alcoholism and Drug Abuse; Relapse Prevention; Treatment)

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Table 1. Selected Alcoholism Outcome Studies

Study	Years of Follow-up	No. of Assessed Subjects	Percent Abstinent	Percent Controlled Drinking	Percent Remission Survivors (a)
Untreated
Goodwin, Crane, & Guze (1971)	8	93	8	33 (b)	41
1989 Canadian National Survey	>=1	497	49	51	100 (c)
Treated
Rand (Polich, Armor, & Braiker 1981)	4	548	28	18 (d)	46
Vaillant (1983)	8	100	39	6	45
Helzer et al. (1985) (e)	5-7	387	15 (f)	18 (g)	33
McCabe (1986)	16	31	26	35	61
Nordström & Berglund (1987)	18-24	55	20	38	58
Rychtarik et al. (1987)	5-6	43	23	21	44
Wallace et al. (1988)	0.5	169	68 (h)	-(h)	68 (h)
Finney and Moos (1991)	10	83	54	24	78
Walsh et al. (1991)	2	200	23 (37) (i)	10 (7) (i)	33 (44) (i)
a Since only survivors are included, successful remission rates are overstated. b Nonabstinence remission included 18 percent "moderate drinkers," 9 percent getting "drunk about once a week," 6 percent "switched from whiskey to beer, . . . drank almost daily and sometimes excessively, [but] had experienced no problems from drinking since making the change." c The Canadian National Survey data concern only recovered alcohol abusers. d Defined as nonproblem drinking, with either low quantities of consumption (8%) or some heavy drinking (10%). e Although all subjects in this study were hospital patients, only one group was treated in an alcohol unit. This group had the worst outcomes of any group, but these outcomes were not reported separately. f Reported data were weighted by Helzer et al. g Controlled drinking outcomes include occasional drinkers (4.6%), moderate drinkers (1.6%), and heavy, nonproblem drinkers (12%). h Wallace et al. reported 57 percent continuous abstinence over 6 months and an additional 11 percent currently abstinent. Although Wallace et al. reported no controlled drinking, a small group (4%) had "one brief contained return to drinking or drug use" in the 180-day period. i Figures are for all treated groups, with assigned hospital patients in parentheses. No controlled-drinking category was included, but this column comprises those in the study who drank without ever becoming intoxicated during the 2-year follow-up (the latter data are not fully reported in the published article).

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Table 2. Controlled Drinking and Abstinence in Relation to Treated and Untreated Remission: The 1989 Canadian National Alcohol and Drug Survey
(Data Weighted to Represent National Population)

	Treated Remission (n = 89)	Untreated Remission (n = 408)
Abstinent (51%)	92	39
Nonabstinent (49%)	8	61
Data presented by L. C. Sobell & M. B. Sobell (November 1991). Cognitive mediators of natural recoveries from alcohol problems: Implications for treatment. Paper presented as part of a symposium, "Therapies for Substance Abuse: A View towards the Future," 25th Annual Meeting of the Association for the Advancement of Behavior Therapy, New York.

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Table 3. Relapse Rates at 4-Year Follow-up According to Remission Category at Eighteen Months, by Alcohol Dependence Category, Marital Status, and Age

	Age < 40 at Admission		Age > 40 at Admission
	Abstaining 18 Months	Nonproblem Drinking 18 Months	Abstaining 18 Months	Nonproblem Drinking 18 Months
High Dependence Symptoms Married	12	17	14	50
Single	21	7	24	28
Low Dependence Symptoms Married	16	7	19	28
Single	29	3	32	13
J. M. Polich, D. J.. Armor, & H. B. Braiker (1981). The course of alcoholism: Four years after treatment. New York: Wiley.

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Bibliography

BOOTH, P. G., DALE, B., & ANSARI, J. (1984). Problem drinkers' goal choice and treatment outcomes: A preliminary study. Addictive Behaviors, 9, 357-364.

EDWARDS, G., ET AL. (1983). What happens to alcoholics? Lancet, 2, 269-271.

ELAL-LAWRENCE, G., SLADE, P. D., & DEWEY, M. E. (1986). Predictors of outcome type in treated problem drinkers. Journal of Studies on Alcohol, 47, 41-47.

FINNEY, J. W., & MOOS, R. H. (1991). The long-term course of treated alcoholism: 1. Mortality, relapse and remission rates and comparisons with community controls. Journal of Studies on Alcohol, 52, 44-54.

GOODWIN, D. W., CRANE, J. B., & GUZE, S. B. (1971). Felons who drink: An 8-year follow-up. Quarterly Journal of Studies on Alcohol, 32, 136-47.

HEATHER, N. (1992). The application of harm-reduction principles to the treatment of alcohol problems. Paper presented at the Third International Conference on the Reduction of Drug-Related Harm. Melbourne Australia, March.

HEATHER, N., ROLLNICK, S., & WINTON, M. (1983). A comparison of objective and subjective measures of alcohol dependence as predictors of relapse following treatment. Journal of Clinical Psychology, 22, 11-17.

HELZER, J. E. ET AL., (1985). The extent of long-term moderate drinking among alcoholics discharged from medical and psychiatric treatment facilities. New England Journal of Medicine, 312, 1678-1682.

HYMAN, H. H. (1976). Alcoholics 15 years later. Annals of the New York Academy of Science, 273, 613-622.

McCABE, R. J. R. (1986). Alcohol-dependent individuals 16 years on. Alcohol & Alcoholism, 21, 85-91.

MILLER, W. R. ET AL., (1992). Long-term follow-up of behavioral self-control training. Journal of Studies on Alcohol, 53, 249-261.

NORDSTRÖM, G., & BERGLUND, M. (1987). A prospective study of successful long-term adjustment in alcohol dependence. Journal of Studies on Alcohol, 48, 95-103.

ORFORD, J., & KEDDIE, A. (1986). Abstinence or controlled drinking: A test of the dependence and persuasion hypotheses. British Journal of Addiction, 81, 495-504.

PEELE, S. (1992). Alcoholism, politics, and bureaucracy: The consensus against controlled-drinking therapy in America. Addictive Behaviors, 17, 49-61.

PEELE, S. (1987). Why do controlled-drinking outcomes vary by country, era, and investigator?: Cultural conceptions of relapse and remission in alcoholism. Drug and Alcohol Dependence, 20, 173-201.

POLICH, J. M., ARMOR, D. J., & BRAIKER, H. B. (1981). The course of alcoholism: Four years after treatment. New York: Wiley.

ROSENBERG, H. (1993). Prediction of controlled drinking by alcoholics and problem drinkers. Psychological Bulletin, 113, 129-139.

ROSENBERG, H., MELVILLE, J., LEVELL., D., & HODGE, J. E. (1992). A ten-year follow-up survey of acceptability of controlled drinking in Britain. Journal of Studies on Alcohol, 53, 441-446.

RYCHTARIK, R. G., ET Al., (1987). Five-six-year follow-up of broad spectrum behavioral treatment for alcoholism: Effects of training controlled drinking skills. Journal of Consulting and Clinical Psychology, 55, 106-108.

SKINNER, H. A. (1990). Spectrum of drinkers and intervention opportunities. Journal of the Canadian Medical Association, 143, 1054-1059.

VAILLANT, G. E. (1983). The natural history of alcoholism. Cambridge: Harvard University Press.

WALLACE, J., ET AL., (1988). 1. Six-month treatment outcomes in socially stable alcoholics: Abstinence rates. Journal of Substance Abuse Treatment, 5, 247-252.

WALSH, D. C., ET AL., (1991). A randomized trial of treatment options for alcohol-abusing workers. New England Journal of Medicine, 325, 775-782.

 

Find out why Desoxyn is prescribed, side effects of Desoxyn, Desoxyn warnings, effects of Desoxyn during pregnancy, more - in plain English.

Generic name: Methamphetamine hydrochloride
Brand name: Desoxyn

Pronounced: des-OK-sin

Desoxyn (methamphetamine) Full Prescribing Information

Why is Desoxyn prescribed?

Desoxyn is used to treat Attention Deficit Hyperactivity Disorder (ADHD). This drug is given as part of a total treatment program that includes psychological, educational, and social measures. Symptoms of ADHD include continual problems with moderate to severe distractibility, short attention span, hyperactivity, emotional instability, and impulsiveness.

Desoxyn also may be used for a short time as part of an overall diet plan for weight reduction. Desoxyn is given only when other weight loss drugs and weight loss programs have been unsuccessful.

Most important fact about Desoxyn

Excessive doses of this medication can produce addiction. Individuals who stop taking this medication after taking high doses for a long time may suffer withdrawal symptoms, including extreme tiredness, depression, and sleep disorders. Signs of excessive use of Desoxyn include severe skin inflammation, difficulty sleeping, irritability, hyperactivity, personality changes, and psychiatric problems.

Desoxyn can lose its effectiveness in decreasing the appetite after a few weeks. If this happens, you should stop taking the medication. Do not take more than the recommended dose in an attempt to increase its effect.

How should you take Desoxyn?

Follow your doctor's directions carefully. Your doctor will prescribe the lowest effective dose of Desoxyn; never increase it without approval Do not take this medication late in the evening; it can cause difficulty sleeping.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for the next dose, skip the one that you missed and go back to your regular schedule. Never take 2 doses at the same time.

 

--Storage instructions...

Store at room temperature.

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What side effects may occur when taking Desoxyn?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe to continue taking Desoxyn.

• Side effects of Desoxyn may include: Changes in sex drive, constipation, diarrhea, dizziness, dry mouth, exaggerated feeling of well-being, feeling of unwellness or unhappiness, headache, hives, impaired growth, impotence, increased blood pressure, overstimulation, rapid or irregular heartbeat, restlessness, sleeplessness, stomach or intestinal problems, tremor, unpleasant taste, worsening of tics and Tourette's syndrome (severe twitching)

Why should this drug not be prescribed?

You should not take Desoxyn if you are also taking a monoamine oxidase (MAO) inhibitor drug such as Nardil or Parnate. Allow 14 days between stopping an MAO inhibitor and beginning therapy with Desoxyn.

You should not take Desoxyn if you have glaucoma, advanced hardening of the arteries, heart disease, moderate to severe high blood pressure, thyroid problems, or sensitivity to this type of drug. This medication should not be taken by anyone who suffers from tics (repeated, involuntary twitches) or Tourette's syndrome or who has a family history of these conditions.

People who are in an agitated state or who have a history of drug abuse should not take this medication.

Desoxyn should not be used to treat children whose symptoms may be caused by stress or a psychiatric disorder.

Special warnings about Desoxyn

Desoxyn is not appropriate for all children with symptoms of ADHD. Your doctor will do a complete history and evaluation before prescribing this medication. The doctor will take into account the duration and severity of the symptoms as well as your child's age.

This type of medication can affect the growth of children, so your doctor will watch your child carefully while he or she is taking this drug. The long-term effects of this type of medication in children have not been established.

Desoxyn should be used with caution if you have mild high blood pressure.

Desoxyn may affect your ability to perform potentially hazardous activities, such as operating machinery or driving a car.

Desoxyn should not be used to combat fatigue or to replace rest.

Possible food and drug interactions when taking Desoxyn

If Desoxyn is taken with certain other drugs, the effects of either could be increased, decreased, or changed. It is especially important to check with your doctor before combining Desoxyn with the following:

Antidepressants classified as "tricyclics," such as Elavil, Pamelor, and Tofranil
Drugs classified as monoamine oxidase (MAO) inhibitors, such as the antidepressants Nardil and Parnate
Drugs classified as phenothiazines, such as the antipsychotic medications Compazine and Thorazine
Guanethidine
Insulin

Special information if you are pregnant or breastfeeding

Infants born to women taking this Desoxyn have a risk of prematurity and low birth weight. Drug dependence may occur in newborns when the mother has taken this drug prior to delivery. If you are pregnant or plan to become pregnant, tell your doctor immediately.

Desoxyn makes its way into breast milk. Do not breastfeed while taking this medication.

Recommended dosage for Desoxyn

ATTENTION DEFICIT HYPERACTIVITY DISORDER

For children 6 years and older, the usual starting dose is 5 milligrams of Desoxyn taken once or twice a day. Your doctor may increase the dose by 5 milligrams a week until the child responds to the medication. The typical effective dose is 20 to 25 milligrams a day, usually divided into two doses. Your doctor may periodically discontinue this drug in order to reassess the child's condition and see whether therapy is still needed.

Desoxyn should not be given to children under 6 years of age to treat attention deficit disorder; the safety and effectiveness in this age group have not been established.

WEIGHT LOSS

For adults and children 12 years and older, the usual starting dose is 5 milligrams taken one-half hour before each meal. Treatment should not continue for longer than a few weeks. The safety and effectiveness of Desoxyn for weight loss have not been established in children under age 12.

Overdosage

Any drug taken in excess can have dangerous consequences. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Desoxyn overdose may include: Abdominal cramps, agitation, blood pressure changes, confusion, convulsions (may be followed by coma), depression, diarrhea, exaggerated reflexes, fatigue, hallucinations, high fever, irregular heartbeat, kidney failure, muscle aches and weakness, nausea, panic attacks, rapid breathing, restlessness, shock, tremor, vomiting

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Desoxyn (methamphetamine) Full Prescribing Information

Detailed Info on Signs, Symptoms, Causes, Treatments of ADHD

Detailed Info on Signs, Symptoms, Causes, Treatments of Eating Disorders

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Find out why Norpramin is prescribed, side effects of Norpramin, Norpramin warnings, effects of Norpramin during pregnancy, more - in plain English.

Generic name: Desipramine hydrochloride
Brand name: Norpramin

Pronounced: NOR-pram-in

Norpramin (desipramine) Full Prescribing Information

Why is Norpramin prescribed?

Norpramin is used in the treatment of depression. It is one of a family of drugs called tricyclic antidepressants. Drugs in this class are thought to work by affecting the levels of the brain's natural chemical messengers (called neurotransmitters), and adjusting the brain's response to them.

Norpramin has also been used to treat bulimia and attention deficit disorders, and to help with cocaine withdrawal.

Most important fact about Norpramin

Serious, sometimes fatal, reactions have been known to occur when drugs such as Norpramin are taken with another type of antidepressant called an MAO inhibitor. Drugs in this category include Nardil and Parnate. Do not take Norpramin within two weeks of taking one of these drugs. Make sure your doctor and pharmacist know of all the medications you are taking.

How should you take Norpramin?

Norpramin should be taken exactly as prescribed.

Do not stop taking Norpramin if you feel no immediate effect. It can take up to 2 or 3 weeks for improvement to begin.

Norpramin can cause dry mouth. Sucking hard candy or chewing gum can help this problem.

--If you miss a dose...

If you take several doses per day, take the forgotten dose as soon as you remember, then take any remaining doses for the day at evenly spaced intervals. If you take Norpramin once a day at bedtime and don't remember until morning, skip the missed dose. Never try to "catch up" by doubling the dose.

--Storage instructions...

Norpramin can be stored at room temperature. Protect it from excessive heat.

What side effects may occur when taking Norpramin?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Norpramin.

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• Side effects of Norpramin may include: Abdominal cramps, agitation, anxiety, black tongue, black, red, or blue spots on skin, blurred vision, breast development in males, breast enlargement in females, confusion, constipation, delusions, diarrhea, dilated pupils, disorientation, dizziness, drowsiness, dry mouth, excessive or spontaneous flow of milk, fatigue, fever, flushing, frequent urination or difficulty or delay in urinating, hallucinations, headache, heart attack, heartbeat irregularities, hepatitis, high or low blood pressure, high or low blood sugar, hives, impotence, increased or decreased sex drive, inflammation of the mouth, insomnia, intestinal blockage, lack of coordination, light-headedness (especially when rising from lying down), loss of appetite, loss of hair, mild elation, nausea, nightmares, odd taste in mouth, painful ejaculation, palpitations, purplish spots on the skin, rapid heartbeat, restlessness, ringing in the ears, seizures, sensitivity to light, skin itching and rash, sore throat, stomach pain, stroke, sweating, swelling due to fluid retention (especially in face or tongue), swelling of testicles, swollen glands, tingling, numbness and pins and needles in hands and feet, tremors, urinating at night, visual problems, vomiting, weakness, weight gain or loss, worsening of psychosis, yellowed skin and whites of eyes

Why should this drug not be prescribed?

Norpramin should not be used if you are known to be hypersensitive to it, or if you have had a recent heart attack.

People who take antidepressant drugs known as MAO inhibitors (including Nardil and Parnate) should not take Norpramin.

Special warnings about Norpramin

Before using Norpramin, tell your doctor if you have heart or thyroid disease, a seizure disorder, a history of being unable to urinate, or glaucoma.

Nausea, headache, and uneasiness can result if you suddenly stop taking Norpramin. Consult your doctor and follow instructions closely when discontinuing Norpramin.

This drug may impair your ability to drive a car or operate potentially dangerous machinery. Do not participate in any activities that require full alertness if you are unsure about your ability.

Norpramin may increase your skin's sensitivity to sunlight. Overexposure could cause rash, itching, redness, or sunburn. Avoid direct sunlight or wear protective clothing.

If you are planning to have elective surgery, make sure that your doctor is aware that you are taking Norpramin. It should be discontinued as soon as possible prior to surgery.

Tell your doctor if you develop a fever and sore throat while you are taking Norpramin. He may want to do some blood tests.

Possible food and drug interactions when taking Norpramin

People who take antidepressant drugs known as MAO inhibitors (including Nardil and Parnate) should not take Norpramin.

If Norpramin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Norpramin with the following:

Cimetidine (Tagamet)
Drugs that improve breathing, such as Proventil
Drugs that relax certain muscles, such as Bentyl
Fluoxetine (Prozac)
Guanethidine (Ismelin)
Paroxetine (Paxil)
Sedatives/hypnotics (Halcion, Valium)
Sertraline (Zoloft)
Thyroid medications (Synthroid)

Extreme drowsiness and other potentially serious effects can result if Norpramin is combined with alcohol or other depressants, including narcotic painkillers such as Percocet and Demerol, sleeping medications such as Halcion and Nembutal, and tranquilizers such as Valium and Xanax.

Special information if you are pregnant or breastfeeding

Pregnant women or mothers who are nursing an infant should use Norpramin only when the potential benefits clearly outweigh the potential risks. If you are pregnant or planning to become pregnant, inform your doctor immediately.

Recommended dosage for Norpramin

Your doctor will tailor the dose to your individual needs.

ADULTS

The usual dose ranges from 100 to 200 milligrams per day, taken in 1 dose or divided into smaller doses. If needed, dosages may gradually be increased to 300 milligrams a day. Dosages above 300 milligrams per day are not recommended.

CHILDREN

Norpramin is not recommended for children.

OLDER ADULTS AND ADOLESCENTS

The usual dose ranges from 25 to 100 milligrams per day. If needed, dosages may gradually be increased to 150 milligrams a day. Doses above 150 milligrams per day are not recommended.

Overdosage

Any medication taken in excess can have serious consequences. An overdosage of Norpramin can be fatal. If you suspect an overdose, seek medical help immediately.

• Symptoms of Norpramin overdose may include: Agitation, coma, confusion, convulsions, dilated pupils, disturbed concentration, drowsiness, extremely low blood pressure, hallucinations, high fever, irregular heart rate, low body temperature, overactive reflexes, rigid muscles, stupor, vomiting

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Norpramin (desipramine) Full Prescribing Information

Detailed Info on Signs, Symptoms, Causes, Treatments of Depression

Detailed Info on Signs, Symptoms, Causes, Treatments of Eating Disorders

Detailed Info on Signs, Symptoms, Causes, Treatments of ADHD

back to: Psychiatric Medication Patient Information Index