Common use Consumer ratings reports for CYMBALTA. Includes 2458 patient rankings on scale of 1-5, comments, side effects, dosage, sex, age, time taken. Page 1 of 41. A happy yarn shop in Portland, OR and online. We love unique and natural fiber yarns and making pretty things with string. The following information is NOT intended to endorse drugs or recommend therapy. While these reviews might be helpful, they are not a substitute for the expertise, skill, knowledge and judgement of healthcare practitioners in patient care. 160 Ratings with 133 User Reviews What next.Compare all 192 medications used in the treatment of Anxiety. Reviews for Cymbalta to treat Anxiety Was prescribed for depression, but it affected my panic disorder very much. I went from 6-7 panic attacks a day to 1-2 a week/month. It really really helped with my anxiety. The initial 2 weeks were horrible though, increased anxiety, hot flashes. And it interacts with a lot of medications including vitamin d supplements 1 users found this comment helpful. Changed my life. I had been experiencing slight bouts of anxiety starting at around age 19. Hitting me hard, randomly of course, only a few times a year. Then when I was 24 something changed with my anxiety and I became completely crippled by it. I was being consumed by constant anxiety, worry, fear, etc every single minute of everyday including when I slept. I was out of control emotionally and mentally. I had to take a box of tissues with me everywhere because the anxiety was so severe I would burst out into tears even during the happiest of times. Finally after suffering for months I decided to give Cymbalta a try, reluctantly though. After a week of relatively mild side effects it had changed my life and saved my life. XYY DD taken for 6 months to 1 year April 2, 2016 9 users found this comment helpful. I was experiencing awful panic attacks and anxiety that wouldn t let up, I tried so many medications but Cymbalta was the one that worked best for me. Started at 30 mg for a week then went up to 60, then up to 90 mg where Im at now. Only down side was it seemed like it took a long time to get here almost back to normal after almost 2 months but I m glad I m here, have not had a panic attack in weeks, anxiety is down and I m off all benzos. Stick with this medication it did wonders for me and I m very sensitive to medications. 12 users found this comment helpful. I m Taking Cymbalta for Anxiety And Depression It Makes Me A Little Jittery And If I Don t Eat With It I Get Sick to My Stomach But I Feel Better Than I Have In A Long Time And Where I Was Using Food To Cope With The Depression This Actually Regulated My Eating So Now I m Eating Less With More Energy And Feeling Like A Million Bucks AwesomeStuf taken for less than 1 month March 13, 2016 I was hesitant to start on an antidepressant. However, while always prone to depression, the episodes had become more severe and lasted longer. I had terrible anxiety. Often even waking up in the middle of the night gasping for breath. Went on cymbalta. It took maybe 2 wks till I tentatively began to acknowledge that it might be working. Plus one evening I went downstairs to get ice for my neck I had neck surgery last year and realized I hadn t done that in weeks. Wasn t even taking It for pain. Ive been on it for 3 mos now. I have experienced extreme fatigue like if I didn t have to get out of bed I could sleep for 12 hrs. But that seems to be getting better. This drug has been subtle yet miraculous and improved my quality of life. Caligrl949 taken for 1 to 6 months March 6, 2016 10 users found this comment helpful. I began taking cymbalta six weeks ago for generalized anxiety disorder. Although the initial side effects of disrupted sleep was difficult, it disappeared after about three weeks. I began on 30 mg and increased to 60 mg after one week. The results have been incredible. For the first time ever, I can sit quietly without a million thoughts running through my head. I no longer feel stuck on certain thoughts. I feel calmer, more relaxed and happier. I also find that my thinking is very clear. Overall, feeling very, very good. Highly recommend cymbalta. Traceygirl taken for 1 to 6 months February 14, 2016 36 users found this comment helpful. I took this drug awhile back, I was on it for 3 years. I don t recall ever having side effects while initially starting or during taking it over time. This drug seemed to help my depression and anxiety significantly, probably more than I actually realized at the time. Only problem I had was, if I missed a dose I d be hit with massive emotional distress. Crying over the stupidest things rather it was positive or negative crying. My emotions were intense. After a long time without medicine now, trying to beat depression and anxiety on my own and being somewhat successful for an extended period of time I ve been contemplating using it again. I ve tried almost all of these meds, and this is the one that s worked for me the most. nickname12345 December 11, 2015 33 users found this comment helpful. I have used Prozac gained a lot of weight Now I am on a combination of Wellbutrin and Cymbalta. What a difference. No foggy brain. My emotions are back. Don t feel like a zombie any more. Feel a little dizzy at times, but the benefits outweigh the side effects. I lost 10 kg Look and feel great. Will stay on this combination. Great for depression. 29 users found this comment helpful. I have Generalized Anxiety Disorder. It got so bad I couldn t function and my Dr took me off work for 5 weeks and gave me 30mg of cymbalta generic. By day 10 I noticed a big improvement..about 60 better. I see Dr in 2 weeks and she will decide if I should take 60mg. I really don t want to and I m hoping I will continue to get better on the 30mg. I guess I will wait and see how I feel. I think therapy is a must for people with anxiety so we can learn ways to help stop the negative thoughts and not let them ruminate on a repeat reel in our head. I have found that there are things we can learn to help with that along with the meds. AnnaDell taken for less than 1 month November 3, 2015 43 users found this comment helpful. I tried cymbalta right after I gave birth and I noticed a difference within days. My.mood swings before my period get very bad and I thought the medicine wasn t working anymore so I switched to prozac. Big.mistake. I couldn t get out of bed. I switched back to cymbalta and am on day 2 and feel good. Never had side effects or anything like that. This has always been fast acting and an overall good medicaton for depression and my anxiety. I took this for both anxiety and pain. It did not work as well as Effexor for anxiety but it helped keep away the bad anxiety attacks. I had to take ativan several times a week where as on the Effexor I took it once or twice a week. I changed to the Cymbalta hoping it would help with my chronic pain and it did significantly. The only bad side effect I have had is higher body temperature and sweating. I am currently researching other medications just because of this side effect. If you anxiety is mild to moderate and you have chronic pain I think this is a good option if you dont experience the sweating. My anxiety was a little to much for this drug to handle alone and I cant handle the sweating and hot flashes Anonymous taken for 6 months to 1 year October 9, 2015 26 users found this comment helpful. I ve only been on it for 7 days at 30 mg. My Dr said to increase to 60 mg after a week. I feel it s working for my anxiety at this level so I don t think I should go up. Thoughts. angiesmith taken for less than 1 month September 12, 2015 19 users found this comment helpful. I took my first and last 30mg dose of Cymbalta yesterday. The side effects were just unbearable. Dry mouth, blurred vision, tremors, panic attacks, vomiting. I will never take it again. And now today, after only having took one pill and discontinuing, I am having body aches and extreme fatigue. There has to be a better way to beat this anxiety than poisoning ourselves. LettyMachete September 1, 2015 20 users found this comment helpful. At 25 i started taking celexia. When I became pregnant less then a year later I noticed it not working any more. Then after my daughter was born I noticed a huge difference. My doctor perscribed my cymbalta, starting at 30mg and finally leveling out at 90mg. This is the best I have ever felt and have now been taking it for almost 5 years. A year ago I tried to lower my dosage through my doctor of course and with in the week noticed a huge difference, I was more irritable, less patient, and more anxiety. And when I dont take it for a few days my head pounds, I feel nausious, and not like my self at all. At the end of the day the good out ways the bad. Although I do wish they were not so expensive but how can you put a price on feeling normal. 38 users found this comment helpful. I took Cymbalta for anxiety and depression. Over the years, I took anywhere from 30-120 mg. I think around 60 mg was most effective with fewest side effects, but I still experienced tons of anxiety while on it. At 120 mg, I had bizarre psychomotor symptoms - for example, in order to fall asleep, I had to rock back and forth. The same day that I decreased from 60 mg to 30 mg, I noticed the return of an OCD-style facial tic I hadn t had since middle school I m 25. Side effects included drastically increased sweating, brain zap headaches, and difficulty finding the right words which may be permanent, as I ve been off Cymbalta for 3 weeks and continue to experience it. lou3 taken for 2 to 5 years July 31, 2015 23 users found this comment helpful. After several years of Zoloft use for GAD, I went off of it, under my dr s supervision. Felt Ok, then last year, had a lot of chronic pain, back arthritisheard that Cymbalta was good for all those--pain, depression and anxiety. Psych doc gave me samples, seemed to kick in pretty well quickly. I have gone through 3 major surgeries in the last 18 months--and went off the Cymbalta b/c I thought I could handle itNope, I m a mess. Needed daily clonazepam to cope. I just went though a 3rd and Hopefully.. final surgery 5 weeks ago. Hadn t taken any Cymbalta for months. I am going back on. Just got thru the worst anxiety attacks in my life following the 3rd surgery. I think the dose for me was 60mgs, and I will start it up again. MidKid taken for 1 to 2 years July 20, 2015 24 users found this comment helpful. Started on Cymbalta for anxiety depression fall 2014. It was the first anti-depressant that I d ever tried aside from St. John s Wort. Side effects during the first week of taking it were SO terrible that I had to stop. I was constantly dizzy. I couldn t focus on anything. It made my body so tense, I d catch myself clenching my teeth and fists. Insomnia was terrible; I d wake up 5x per night. I work in healthcare and I felt like I couldn t do my job with all of these side effects, so I stopped. The side effects were really worse than my anxiety and depression. I have no doubt that they would have eventually decreased, but I couldn t wait for that to happen. Obviously, the side effects will be different for everybody but that s my story AliceBB taken for less than 1 month May 29, 2015 34 users found this comment helpful. This medications helped with my arthritis a little but did nothing for anxiety 17 users found this comment helpful. I was prescribed Cymbalta for anxiety, it has had a major positive impact. I was a competitive distance runner for about 25 years and sprained both ankles and wore out my knees. I was so achy in my joints all weekend and realized I did not take my medicine Saturday or Sunday because I put my pill case away when the cleaning lady came--HA HA. It helps anxiety and joint pain. I am very pleased with the results. 53 users found this comment helpful. I have GAD, tried celexa, worked for a while, mental fog. I then tried Lexapro which worked but I decided to try Cymbalta for its chronic low back pain effectiveness. I have a bulged disc, arthritis from homecare for many years. I will not even consider Narcotics for pain Cymbalta has been a life saver, I too have dry mouth night sweats, increased weight of 10lbs. But I feel calmer, I started off on 30 mg for 2 wks the increased the dose per my HCP. I can tell when I don t take it. Chronic low back pain, dizziness as well and anxiety symptoms return I am a nurse and I hate taking medicine but this is one medicine I don t mind taking. The benefits out weigh the everything else. 57 users found this comment helpful. I had been using Cymbalta for 3 years and all was great until the generic one appeared and I took it for several weeks and started getting a metallic taste in my mouth and got cyst in my mouth and on both sides of my tongue; nothing tasted right. I had my doc write a script for use of only the original Cymbalta because I saw on another forum that this was a reaction of the generic. All the cyst cleared up and gone and everything is normal after 2 weeks of original Cymbalta. Sly4 taken for 2 to 5 years February 12, 2015 Took it for 6 months and it got me through the worst of my symptoms 46 users found this comment helpful. I have been on several medications citalopram after 6 years it simply stopped helping my anxiety. It made me tired, foggy spacey anyways. I had a hard time being sharp at my corporate job. I then got off of anything and was just ok for 7 months. Then my spouse almost died and it sent me reeling into depression severe anxiety. I was paralyzed with fear. I couldn t get my work done, cried all the time, had major anxiety. I was afraid to try anything due to the fear of being tired, foggy or dull. Started 30mg Cymbalta. It helped me within 3 days. First 3 days was nauseous. After 2 weeks I was no longer depressed, no catastrophic thinking or panic attacks. Wish I had tried 10-20 years ago. It has turned me around. Not foggy or tired. WorkingMommyof 2 taken for 1 to 6 months November 29, 2014 114 users found this comment helpful. I started taking Cymbalta earlier this year for my anxiety. I found it really helped, but I didn t want to stay on it for long. I had a few side effects while being on Cymbalta such as night sweats, trouble sleeping and electric pulses through my body. Whilst gradually lowering my doses of Cymbalta these side effects did get a little worse, however they have completely gone now. I started lowering my doses in June, and now by the end of August the night sweats have completely stopped, my sleeping is back to normal, and the electric pulses are very rare. When I think about getting worried or anxious now, I just remember that its not a big deal and that if I was on Cymbalta I wouldn t have even thought about it. 82 users found this comment helpful. I m 5 weeks into taking Duloxetine for depression and anxiety and have had an overall positive experience. My anxiety was greatly reduced after only 4 days on 40mg per day including stopping negative thoughts, no more panic attacks at night etc. The second week I was very tired and depressed without the anxiety, sleeping many hours each day. But by the third week both depression and anxiety were greatly reduced. However by the end of the month the anxiety had started to return slightly and my doctor has now increased the dose to 80mg per day. I had slight nausea, dry mouth and loss of appetite, and some indigestion during the first week or so and now again since I have upped the dose but I imagine these will disappear again soon. 87 users found this comment helpful. Drugs.com Health Center:Mental HealthAnxietyBenzodiazepines Mayo Clinic Reference:AnxietyMore about Cymbalta duloxetine Side EffectsDuring Pregnancy or BreastfeedingDosage InformationDrug ImagesDrug InteractionsSupport GroupPricing CouponsEn Espanol965 Reviews - Add your own review/ratingGeneric Availability Consumer resourcesCymbaltaCymbalta delayed-release capsulesCymbalta Advanced Reading Other brands: Irenka Professional resourcesCymbalta AHFS Monograph Cymbalta FDA Related treatment guidesFibromyalgiaChronic PainBack PainAnxietyDepressionMore 4 Availability Rx Prescription only Pregnancy Category C Risk cannot be ruled out CSA Schedule N Not a controlled drug Approval History Calendar Drug history at FDA Fighting Allergy Season with Medications Medications for High Blood Pressure Irritable Bowel Syndrome Treatments Aren t One-Size-Fits-All Fighting Diabetes Deadly Impact on Minorities Serotonin-norepinephrine reuptake inhibitors SNRIs Previous Mental Distress May Slow Concussion Recovery Sexual Trauma in Military May Lead to Homelessness: Study Talk Therapy May Help Depressed Teens Who Shun Antidepressants What is the correct way to discontinue use of Cymbalta. Should I increase my dosage of Cymbalta. Generic Cymbalta - Is it available. I need to know how long CYMBALTA 60mg will stay in my system for i have a job interview. Fibromyalgia - I have been prescribed Cymbalta for my firbromyalgia. I am concerned with the side. Didn t work for me. Felt pretty barfy and crummy first several days. Seemed to make me agitated. Only on it for a week; withdrawal was unpleasant. Just my experience, however. king bean taken for 1 to 6 months August 4, 2014 50 users found this comment helpful. I just started taking this medication last night and ALREADY feel so much better. I ve tried Prozac, Celexa, Zoloft, Buspar, Abilify, and countless others to help with my anxiety and none of them worked. This medication is a miracle in my opinion. I can t believe how quickly it works too. I m taking this along with Atarax to help anxiety and panic attacks. I like the Atarax too and have not needed to take clonazepam today. Very happy. Only problem was that I couldn t sleep last night. I was physically exhausted and couldn t open my eyes or move but my mind was active. Hopefully this will pass. I ve also had an upset stomach today with diarrhea but it beats anxiety any day. 98 users found this comment helpful. I was quick to anger, severe mood swings would yell at my kids for the slightest things. I was ready to punch anybody that would make me mad and it didn t take much. I started with Cymbalta 30mg and I noticed a slight difference I was increased to 60 mg and I felt the change right away. I m so calm and I m back to being a happy mom. I take it at night because it would get me sleepy during the day if I take in the morning some of the side effects I ve experienced have been dry mouth, lack of appetite, hot flashes, tiredness. I love this medicine it has changed my life. The relationship with my children is much much better too. I no longer have crying spells and I m a much nicer person. Try Cymbalta. danimom80 taken for 1 to 6 months July 2, 2014 219 users found this comment helpful. After trying two other medicines with horrible side effects and no results, Cymbalta finally did the trick. The side effects were mild hot flashes, some shakiness, etc have mostly subsided and I m sleeping better. tiggergal taken for less than 1 month June 9, 2014 This medication was a life saver for me as it helped me to overcome anxiety at work and allowed me to regain my focus. This also helped a lot with my irritable bowel syndrome issues. Only downfall was the first few weeks where I lost a lot of weight due to having no desire to eat and I had to switch to taking it at night because when I took it in the morning it made me dizzy and tired all day. I am taking 30mg once a day and have been on this for about 8 months. Hang in there if you just started the medication because it takes about a month to really kick in. Office Executive taken for 6 months to 1 year April 23, 2014 161 users found this comment helpful. I started this medication after I basically had a nervous breakdown in June 2013. I couldn t function as a mother, I felt scared nervous all the time, lights were too bright, sounds were too loud. I couldn t deal with all of the things that needed to be done around the house. Started out at 30mg for 2 weeks then went up to 60mg. Made me super tired in the afternoons at first. take around 7am. Cymbalta slowly brought me out of the fog I was in, it took about 6-8 weeks before I could say I felt normal again; whatever that is, right. Lala- age 30 taken for 6 months to 1 year March 13, 2014 155 users found this comment helpful. The medication helps but if I take too much at once or not at the right time thing dont feel right other wise It has greatly helped my mood huntergirl214 taken for less than 1 month February 8, 2014 42 users found this comment helpful. Cymbalta worked somewhat on my obsessive compulsive disorder, anxiety and depression better than other medicines. However, I felt like I couldn t do much. I had zero energy even though I took my dose 60mgs at night. It became too tiring to even make myself something to eat. I did not want to go anywhere or do anything because I didn t have the energy. At higher doses 90 mgs, I had stomach upset and pains if I did not take my dose with food. I would also have diarrhea/loose stools at the higher dose. Sexual side effects were decreased interest and desire in sex. Could be attributed to just not having the energy to enjoy it. It did help with my OCD and lowered my anxiety but did not help my depression. OCD/Anxiety/Depression taken for 1 to 2 years December 2, 2013 54 users found this comment helpful. Cymbalta saved my sanity. I was under incredible work pressure and stress for three solid months new job covering for one coworker on maternity leave another coworker having a sudden heart attack and Crohn s flare up. Me running the office for three months, even though I d just been hired. I had a doctor s appointment and broke down on the table. He prescribed Celexa first, which gave me severe panic attacks. Then he switched me to Cymbalta, and I was back to normal within days. The downside: It is extremely hard to stop taking it. I was intended to take it only for the short term, until things calmed down at work. Two years later, I m still on it because going off was WEIRD. Numbness, tingling, weird sensory inputs, distraction. 120 users found this comment helpful. I have been on Cymbalta for almost 5 years after a very difficult 4 years of PND/PSTD. Other medications got me to a point of about 50 percent improvement. This was far from ideal/adequate. Cymbalta worked for me like no other antidepressant. My anxiety reduced to the point where I can function at a pretty high level. I still have bouts of anxiety and occasional dark moods but they pass and even now are fewer and further between. I have tried to come off of it a few times but at 30mg the cogs begin to turn faster and I can feel my anxiety levels significantly increasing. I am concerned that my emotions are a bit blunted and like someone else said, I cannot cry, which I miss. I used to like a good, therapeutic cry. I also have no sex drive. Little ole me September 29, 2013 108 users found this comment helpful. Have been on this medication for 4 yrs for Anxiety Disorder Fibromyalgia. Cymbalta has definitely helped with both conditions. Without it, I d be in an almost constant state of Anxiety the Fibromyalgia flare-ups would be much worse. Found this out when I reduced the dose from 60 mgs a day to 30mgs every other day, after hitting the expensive Medicare donut hole last year. That reduction also caused severe depression within a month and I ve never been diagnosed with depression.. My side effects include some gastrointestinal problems 30 lb. weight gain, despite daily exercise/diet. All SSRI s cause weight gain for me. Hate the extra weight gain, but it s better than having Anxiety/Fibromyalgia pain. Female 50 yrs of age September 12, 2013 73 users found this comment helpful. I was started on Cymbalta 30mg about 6 months ago. I was increasingly anxious and irritable and quick to start arguments. My presenting complaint was however tinnitus due to jaw clenching. Cymbalta almost immediately calmed me down. I feel less guilt feelings about everything. I can walk away from arguments unless really pushed - and then just watch out. My spouse thinks I am better for it. However I do feel rather fatigued and now find it difficult to exercise but once I start I have no problem. I can focus and work with a less antagonistic attitudes. Sleep is better. Sex is better. No weight problem. I do drink very moderately with no problem. Missing doses is a major problem: headaches, dizziness, nightmares. 133 users found this comment helpful. The only real way to see if medication works is to ask the people you live with. I ve been on Cymbalta for over a month and have had no side effects. My family can testify that I am a so much more calmer and less reactive. In fact my 18 year old daughter happened to be with me when I went to the doctor and he asked how I was going. My daughter replied for me and told him, I don t know if it s all in her head, but she is amazing now. She used to be so irritable and grumpy. Now she s really nice. How s that for honesty. Like they say, Out of the mouth of babes. I really, really do feel happier and it s great knowing my family can see the difference. I remember saying to my doctor I m not coping, but I truly don t feel that way anymore. I have suffered from anxiety problems my whole life, but it was easily managed until I turned 23 2.5 years ago when it blew up and every month got much worse. In Dec 2012, I was diagnosed with severe generalized anxiety disorder, moderate panic disorder, and moderate agoraphobia. I also have Irritable Bowel Syndrome-D, and combined with anxiety, I always had to be near a bathroom - any time I left the house I had diarrhea. Couldn t go shopping alone, do drive throughs, etc. Started this and almost immediately felt a bit better, minimal side effects insomnia/headache 1st 3 days, itchy armpits 1st week and it has taken the edge off lots. Have done many things I couldn t. No weight gain so far, very happy. Only big anxiety triggers bother me a bit, and Imodium use decreased LOTS. No mental fog. mo15 taken for 1 to 6 months July 13, 2013 77 users found this comment helpful. I have been taking Cymbalta for 15 months now. First 30mg and then six months later up it to 60mgs/day. It was prescribed to me for clinical depression. It works for the depression and I also noticed it has worked very well for anxiety also. My MD and I have discussed that I probably have had this anxiety disorder for some time and curtailed with the depression, Cymbalta has done well for both. Side effects are weight gain 5-10 lbs, and bad withdrawal effects if you miss a day or two - headaches. Otherwise, the medication has worked very well and I feel like I can live my life again. Tiger6933 taken for 1 to 2 years June 10, 2013 84 users found this comment helpful. I ve been taking 120mg of Cymbalta for 6 months now have found the benefits to be: decreased anxiety; increased social confidence; and 10kg 22.2 pounds weight loss.. The negatives have been: irregular insomnia; slightly manic personality when really comfortable in my social surroundings; dry mouth; mild occasional nausea that s about it. I m under the watchful eye of a great Psychiatrist think Cymbalta is much better than Prozac Zoloft which I ve been on for 5 years prior at alternate times. Also, I strongly recommend reducing your alcohol intake - Cymbalta increases side effects makes you feel embarrassingly drunk tired much earlier than others. Good luck. Batgirl516 taken for 6 months to 1 year June 7, 2013 I have been on Cymbalta for about 4 months now, and finally can say that it is worth going through some of the beginning side effects. We must be careful though, to listen to our bodies first. Side effects can be bothersome but should not be unbearable, so if this is your case with Cymbalta or any other medication, you must consult your physician. When I first started Cymbalta, which I did twice before finally staying on it I could not sleep, had headaches, and could not even drink a cup of coffee without feeling as if I was hyper. Eventually, things got better and I was able to stop the additional medication that was prescribed to help me sleep. Switching Cymbalta to bedtime helped tremendously. No pain and/or anxiety. NinaEnid taken for 1 to 6 months June 2, 2013 103 users found this comment helpful. For years, I struggled with anxiety but my understanding and how I was raised was to suck it up and fight through it. Finally, after many sleepless nights, I went to the GP and she advised me to take Cymbalta. I started on 30 mg s but my tolerance to these types of medicines pushed me to take 120mg s for a month or so. After that month I got back to the old me, the one that didn t care what people thought or how I should act in front of people. I would definitely recommend this for anyone with social or general anxiety. therealme taken for 1 to 2 years April 27, 2013 105 users found this comment helpful. Cymbalta changed my life. Initially, for the worst - I was vomiting and felt like I was dying for the first few days. Then gradually, the side effects lessened. The vomiting stopped after 2 days, the foggy head and ill stomach cleared after a week or 2. Then it changed my life for the better - to my shock and my doctor s amazement, the lowest dose 30mg worked. No need to experience the side effects of moving to a higher dosage thank goodness.. I was previously unable to socialise and frequently had a fight or flight response that was way over-reactive. Now, although not perfect, it s way more under control. I ve used Cymbalta for almost a year. I would definitely recommend Cymbalta. Sars taken for 6 months to 1 year April 23, 2013 115 users found this comment helpful. On it for a month, became extremely depressed and had suicidal thoughts. I absolutely love Cymbalta; it s a miracle for me. My anxiety, depression, and spinal pain have all been reduced or gone away. I also lost weight and could eat anything I wanted. After 6 months, I switched to Celexa to save money. Big Mistake. I started gaining weight, and it didn t have much effect on anxiety or depression. I switched back to Cymbalta, and am happy again. michellemybelle April 21, 2013 109 users found this comment helpful. I ve been on Cymbalta for about 8 months now. I never had major side effects to begin with but the last 3 months I ve been experiencing nightmares or crazy dreams, I m tired a lot, I sweat at night, I feel as if I m in one mood and the only major emotion I get is anger. It s hard to laugh at things that I used to and I can t cry anymore. Sometimes I just want to feel frustrated when I know I should, and sad, but I feel stuck and emotionless. I don t think Cymbalta has helped me. I think the only progress I ve made with my anxiety, OCD, and depression has been on my own. Anonymoussssssss February 10, 2013 45 users found this comment helpful. I have been on Cymbalta 30mg for just under 2 weeks. After the first 3 days I started feeling a lot better. It was slightly scary actually to go from feeling like your world is imploding to feeling like you want to smell and see every flower on the planet. It happened so fast. Yes there were a lot of initial side effects from getting used to the medicine. I had the shakes, weird slowing down, odd feelings, nausea, etc. but I am doing very well on it. I went on diet again having gained 25kg from being in Lexapro and Seroquel for over a 18 months. But I now have a low dose of Seroquel every night and Cymbalta every morning and I am back to feeling great. Chrissyjels taken for less than 1 month January 28, 2013 Was on Cymbalta for 2 years. Worked fabulous for anxiety and panic. Unfortunately I was diagnosed with Gastritis so me and my doctor felt it was best to switch to something else because this medicine has been found to cause stomach issues. razz2012 taken for 2 to 5 years January 8, 2013 52 users found this comment helpful. I am a 23 year old girl and I have suffered from anxiety for as long as I can remember. I had tried so many different medicines from Paxil, Zoloft, Prozac and Celexa nothing worked. I would get a little better but once again, I would suffer a horrible bout of anxiety attacks. The first day I started Cymbalta I felt a rush of calmness over me. I immediately felt at ease and not as ansy and nervous as I always was. I could finally relax and do everyday normal things without worrying about when I would suffer another attack and would ruin my day. I have not had an attack in about 3 months now and feel so great. I do not feel zoned out like I did on the other medicines. I am happy and confident and overall have a better sense of well being. karkarrrr taken for 1 to 6 months December 28, 2012 119 users found this comment helpful. I have been diagnosed with generalized anxiety disorder. My doctor prescribed Cymbalta. It cured my anxiety, but came at a price it s an expensive medicine, and I hope that mediation and relaxation will help me get off of Cymbalta one day : Short term, it has been extremely effective in my recovery of anxiety and Post Traumatic Stress Disorder. 51 users found this comment helpful. I am a RN who suffers from severe social anxiety and moderate depression. Symptoms associated with SAD have included inability to write in front of others, eat in public, public speaking. Even drinking in front of others was difficult for me. I hated the shaking, heart racing/pounding, and everything else that went along with this horrible affliction. I remember it all starting around 15 years old but never could understand why. I m 41 yrs old today and my anxieties have affected my life negatively and held me back in so many ways. I never felt normal. Many years and meds later, I came to believe my life would never change. That I would never feel normal around people. Then I found Cymbalta..changed my life. 151 users found this comment helpful. I have been taking this medication for a little over 6 years and was started off on the 60mg dosage. In the beginning it worked great. I m now on 90mg sometimes 160mg of Cymbalta, and I feel anxious all the time and also extreme fatigue. Anonymous taken for 5 to 10 years September 6, 2012 35 users found this comment helpful. I ve been on Cymbalta for 2 days and it is great. My daily high anxiety is completely diminished. I can make decisions without anxiety. I am having trouble with sleepiness however, I know this will subside. I got back on antidepressants because I ve had a tough time dealing with moms death in May and currently going through divorce. bolderdash taken for less than 1 month August 21, 2012 55 users found this comment helpful. I went from being extremely angry and so anxious I couldn t leave the house, to now being able to go out in public, socialize with others, and live life. I feel much happier, have more energy, and am MUCH more pleasant to be around. Cymbalta did nothing to lessen my anxiety. Anonymous taken for 1 to 6 months July 16, 2012 I took Cymbalta for 4 days for anxiety, panic attacks and mild depression. I read many reviews and wondered whether I should stick with it despite the side effects, but in the end I just couldn t. I ve been on Lexapro and Effexor before and I was expecting the same type of side effects: dry mouth, nausea, headaches. But this was a lot worse. I was sleeping ok before, and started having insomnia from Cymbalta. My heart was also racing, which for a panic attack sufferer, is the worst thing that can happen. I almost stopped eating, no appetite at all. I also started feeling really low, super anxious and depressed, and could only go through the day with the use of alprazolam. In the end I spoke to my doctor and I will now start on Pristiq catotamartins taken for less than 1 month May 16, 2012 I love this medicine. My anxiety started off as mild and as years past slowly got worse. I went from having social anxiety to generalized anxiety and then major depression. It took me 7 years to find this medicine but once I found it I gained my life back. Still have a little anxiety but most is gone. This medicine was great for my major depression. Yes it does have some side effects but most will disappear with time and like most other users will vouch, the benefits far outweigh the side mild side effects. Stefan From Australia April 5, 2012 60 users found this comment helpful. I ve been taking Cymbalta for 2-3 months. I had been taking 30 mg. a day, but my doctor told me I could try 60 mg. a day, i.e. 30 mg. twice a day, and since I ve been taking 60 mg., which is about a month ago, something weird has happened: I feel ecstatic all the time, and as though I ve returned to my true self, i.e. ways I used to be, and liked, decades ago, but have been out of touch with for a long time. I m much more productive and creative, and don t feel overwhelmed the way I used to. 96 users found this comment helpful. Worked great on the anxiety. Was TERRIBLE for weight gain. I gained 30 lbs in 3 months and this was the only change to my routine. I was not eating more or differently. I was doing more because my arthritis hurt less. So, as far as I am concerned it was the Cymbalta. So if feeling calmer and more able to handle stressful events is worth the extra weight, then this is a good pill. For me, the extra 30 lbs was not OK, and it is a new experience for me. I have never had a weight gain problem before. 30 users found this comment helpful. Helped for several years but effect stopped recently and I had to switch 15 users found this comment helpful. This is my second week. I m extremely tired, moody and emotional and constipated. My doctor took me off of Celexa. I m not sure if I want to continue taking this since it seems as though I m worse. I ve experienced more anxiety and I m a mess now. 16 users found this comment helpful. 4 weeks on Cymbalta at 60mg. I came off because they made me feel ill, and I am used to medication as I have tried a few. I spent 3 years on a high dose of Citalopram and never went through anything like I have done with coming off Cymbalta. My GP decided to slowly taper me off and this is when hell started. Never on any medication that I have taken have the withdrawals been as bad. I have constant nausea, have been sick, stomach aches and pains, diarrhea, dizziness, leg ache, restless sleep, bad dreams, chills, and now my anxiety is back. I am crying on/off and having panic attacks. It s just awful. I can t sleep, I am talking to fast and my heart feels like its going to fly out of my chest at anytime. They were trying to slow it down and all they did was speed it up. When I started taking Cymbalta it took only a few days for it to kick in. It worked great for my anxiety and depression, but did nothing for arthritis pain. The only side effect I had was extremely difficult urination. I had to discontinue the medication. 14 users found this comment helpful. I have been treated with Lexapro, Zoloft, Pristiq, Klonopin and lamictal and none were effective. I have been taking Cymbalta for about one week now, and still don t feel any different. I wake up every day feeling 100 anxious and find it extremely hard to get out of bed. It has been this severe for about two months now where I feel totally incapable of living. Doctor said to stay on Cymbalta and see if it changes anything. Feeling hopeful. Never thought I would have my life back. I can think clearer, my mind isn t racing as often, and I m not agoraphobic. I used to have a severe phobia of driving and now I can get behind the wheel and even look forward to driving. I have tried everything, Prozac, Wellbutrin, Paxil, Zoloft, and none of them have worked for me. I have lost 9 pounds and counting, because I m not eating out of depression and anxiety and I m able to think about myself in a healthy light. I was prescribed Klonopin for severe attacks and found after 4 weeks of Cymbalta find no need for them. I am so grateful for this medicine. 78 users found this comment helpful. This medication did amazing things for me after being diagnosed with an anxiety disorder. I suffered panic attacks, inability to control my emotions, crying to bouts of anger along with other symptoms. Within 2 weeks there was a huge change. I am now laughing and joking again, I have no mood swings, no more crying, I have no anger issues now, just incredible. I did suffer side effects for the first 17 days and was very nauseous. First few days are the worst and then it eases off, some minor headaches, a small amount of fever, a little more sweating, some dizziness, but overall it was worth it. Back to a happy go lucky girl. 44 users found this comment helpful. I have been on Cymbalta for 6 years. It was a life saver for me as I was unable to take the SSRIs due to retinal detachment, and the older type of medicines did little for me. During the first 2 weeks of Cymbalta, nausea was the most common side effect but that only lasted for approx 3-4 weeks. This medicine gave me my life back after suffering for years from fear and anxiety. Thanks Eli Lilly. This didn t agree with my body at all. After only 2 or 3 days I was convulsing, vomiting, diarrhea and was very lethargic. I was on a very low dosage. 10 mg 11 users found this comment helpful. I was having panic attacks so bad I would have to pull off the road while driving. My husband was waiting on a double lung transplant when these attacks started. After the transplant the care giving made these attacks become worse. I couldn t breathe, I wanted to cover up under something and not come out. My doctor gave me Lexapro and one dose made me worse. He ask me to try Cymbalta and after one dose I became immediately better. I ve been on Cymbalta for 4 years, and would hate to go back to the times when I had those attacks. It obviously was the medicine I needed. I wouldn t go as far to say Cymbalta has given me my life back but I will say it improved my quality of life immensely and has kept working. I have moderate to severe generalized anxiety disorder and I felt like I was living a nightmare - highly uncomfortable and muscle tension so bad I could barely breath at times, constant worry and stress. I have been off and on Lexapro for this very reason because I hated the stigma. Lexapro helped but the sexual side effects were horrible and I felt emotionless. A Nurse practitioner suggested Cymbalta. I stuck with low dose 30 mg every morning and what a difference. I can breath easier, sex is better still not back to where it was before antidepressants but the debilitating anxiety is mostly gone. I started take this at 30mg a week ago. I have been on so many different medicines none of them work but after only a couple of days I was feeling much better. I drove my car for an hour last night for the first time. 2 years ago I got electrocuted on 440 and I started getting the worse panic attacks. I could not get out of bed most days. I have been on every medicine they make for this. None of them worked but in a week on Cymbalta I feel like I m almost my old self again. I just turned 25 and I have a 2year old son. So thank you Cymbalta. The only side effect is I can not sleep at all. Maybe an hour here or there but I have not been tired. I was on Cymbalta for up to just under two weeks ago. At one point, I was on 90mg for a short period of time. Last December, I dropped it. Only because it, meaning Cymbalta, left me mostly feeling fatigued. The anxiety came back and last month, April/2011 restarted it again back on 60mg. Everything was going fairly well, then I experienced a rash on my forehead, itching. My throat felt as if it was closing up on me. Stopped it cold turkey and went through a roller coaster of mostly aggressive moods. It was an allergic/adverse reaction. 13 users found this comment helpful. I am taking 60 mg of Cymbalta for anxiety and depression. Previously I had been on Lexapro which gave me nightmares and Paxil, which worked for a time but sent me into a relapse when I was weaned off of it. I have noticed a few side effects - the most predominant one is that it makes me very tired. I don t have much of an appetite, but when I do, I crave sweets and have put on a few pounds as a result. Very little sex drive, though it was low to begin with. Although the medication has helped to keep my anxiety at a manageable level, my general mood has been very blank - I feel very little in the way of happiness or sadness. My doctor has suggested either switching to a higher dose 120 mg of Cymbalta, or changing to Zoloft or Paxil. Cymbalta has changed my life. I suffer from anxiety and trichotillomania which is an obsessive hair pulling disorder which stems from the anxiety. I ve tried many different medications such as Prozac and Zoloft etc. I had bad luck with those. The first two weeks on Cymbalta was rough. I was very very dizzy, felt sick and did not want to eat. I was very tired and would sweat. I started to take the medication at night because the dizziness was too much. After a week they upped the dosage and it got a little better. Three weeks I felt relieved and by week five, I felt amazing. I feel like a normal person, my mind is clear, I m not anxious and I stopped pulling my hair. The side effects went away except for being slightly tired. Started off with 30 mg dosage. Symptoms started out blurred vision, fogged feeling, mental confusion, mild anxiety, mild depression. Also clenched my jaw and was diagnosed with TMJ. After one week bumped up to 60 mg. Side effects in first week or two..tired and drowsy, which went away completely. Stick with it and you ll see it works wonders. You will be left with clarity and peace of mind. 40 users found this comment helpful. Cymbalta works for me, I have symptoms of PTSD and have tried other medications for my anxiety such as: PAXIL, CELEXA, and PROZAC with no good results. So far so good with Cymbalta with minimal sexual side effects for me. Psychotherapy and Physical Fitness is recommended if you use this medication. My Dr. prescribed me 60 MG Cymbalta 2 weeks ago to take everyday along with a 25MG Antihistamine for anxiety. Honestly, there seems to be more good than bad reviews so I m guessing I m a part of the small percent chance that it will have bad or little to no effect. The only thing Cymbalta does for me is make me exaggerate a smile. I still feel exactly the same and my anxiety is still there. The Antihistamine mainly takes care of the physical effects of anxiety but mentally I m still suffering. Try it if you need to, I say it s worth a shot. I have been on Cymbalta for about four months. My doctor switched me from Zoloft to Cymbalta after I continued to experience panic attacks. Fortunately, Cymbalta worked great. My panic attacks went away and my mood swings seemed to calm down. But, about a month ago I decided that I wanted to come off of Cymbalta because my husband and I are trying to get pregnant. That s when things went down hill. Instead of tapering off of the medicine which is not what my doctor said I would have to do I just stopped cold turkey. I began to experience severe headaches, insomnia, nausea, tingling in my hands and face, I also began to hallucinate and the worst part has been the brain zaps. Been on this medicine for almost 2 years. Went to max dose of 60mg. Did NOTHING for my depression, anxiety, back pain, or Fibromyalgia. Completely useless medication. And whats worse. You got it- WITHDRAWAL. I have been to the ER 4 times now since withdrawing from 60mg down to 30mg, so I am only half way weened off as of now. Extreme vertigo, nausea, dizziness, brain zaps, edge of panic all day into night. Worst experience I have every had after trying different anti-depressants for the last 7 years. Gave this medicine the last chance. After I get off it, may take me a year or more to ween the rest of the way down. I have been on Cymbalta for almost 4 years now and it has been a lifesaver for me. The first few weeks I had some loose stools, but that subsided. The only problem I have with it now is keeping weight off. I have trouble loosing weight and I think it is due to the Cymbalta. I eat a well balanced diet and exercise. However, due to the numerous medicines I had tried before that failed me for anxiety and depression, I will keep taking the Cymbalta. I d rather be fat then feel the way I felt before. I ve been taking Cymbalta 60mg for around 6 months now and it seems to be really helping me with my anxiety and depression. I don t panic over little things anymore which is great and my friends and family have really seen an improvement in my mood. Decreased my appetite and emotional eating and I ve lost 17 kilos 37 pounds. Negative but bearable side effects would be moderate fatigue, the occasional headache if I take my dose late, weird dreams every night, twitching, dizziness when I stand up. The worst thing I ve noticed is memory problems, I sometimes can t remember simple words and get a little confused. My issue is anxiety. I have tried Effexor, Lexapro, Prozac, and finally Cymbalta. Last month, I told my doctor I was done with these medications. I was willing to live with the anxiety because the uncontrollable weight gain was making me depressed. He listened and prescribed a very low dose of Cymbalta. Thank you so MUCH. I feel so much better. I am finally able to lose weight without trying. Before, I could not convince myself to even diet for one day. It was impossible. Never an issue prior and now thankfully I have control over my eating. I was always ambivalent about everything. Now things impact me within reason. I don t obsess but I still care. I have been on Cymbalta for about 3 months for anxiety. Started at 30mgs for the first two weeks then up to 60. My doctor also prescribed me Lorazepam for the occasional melt down. Before Cymbalta I was anxious about everything, whether it made sense or not. Had melt downs at least three times a week. I have noticed a huge change, my family has as well. I feel like myself, not afraid or anxious. But I missed two doses just two and am now experiencing some not so fun withdrawal symptoms. I m extremely nauseous, dizzy, brain feels muddled and I m feeling a bit depressed/emotional. Now, I seem to be questioning this miracle drug and think I may need to find another way to deal with my anxiety issues. Prescribed via a Psychiatrist for severe Panic attacks for 2 years. If I take dosage late or forget to take it the withdrawal symptoms kick in. Gnawing physical pain, breathlessness, disorientation to time, difficulties in word finding while speaking, severe muscle pain and stiffness, nausea, labile emotions and panic. 25 users found this comment helpful. I have been off and on Cymbalta for over a year now. During a really stressful time in my life I was started on Zoloft and then Klonopin. The Zoloft gave me restless legs and Klonopin made me severely depressed. After a period of nothing my Doctor suggested Cymbalta. After just a few days things got so much better. I relaxed and was able to eat and sleep normally again. The side effects were very minimal and lasted less than a week. After hearing horror stories of stopping Zoloft. I quit by counting the granules and tapering down over a couple of months. It worked fine for me. I usually try to take it around noon with lunch for the best sleep at night. 27 users found this comment helpful. I have been on Cymbalta 30mg for a three week trial for treating my anxiety, depression and fibromyalgia. Thought it sounded like a miracle pill since I m only 21 years old, but this has caused everything from headaches to stomach pain to diarrhea. I figured I could live with that and let it run its course but things got worse. I noticed my anxiety attacks got much worse and became more frequent, had to go the ER last night because my hands, feet, tongue, ears, face went numb and swelled. Now I m on steroids and Benadryl to bring it down. Did not work for me. Was having some side effects from Zoloft, so I went to my MD to change things around a bit. Zoloft was the only thing I had ever been on, but the tiredness and no libido was getting in the way of my children and marriage. My doctor put me on Cymbalta and at first I thought that I was really going to like it. I felt more energetic and definitely more patient with my husband and children. BUT then I started getting anxious off and on, which gradually got worse until I couldn t stand it any more. Now I m trying a different SNRI, Pristiq. Time will tell, but Cymbalta was definitely not for me. Being 32 and having cancer four times, I realized that I had a serious anxiety disorder. I did not believe in a pill but eventually, I realized that something had to change. I tried Welbutrin for a while, which made me feel bipolar and then I switched to Lexapro for several years. The problem with Lexapro was that I didn t feel anything good or bad. I know that you might think that s a blessing, but it s truly not. After gaining over 20 pounds, my doctor suggested that I switch to Cymbalta, which I was very nervous about, but I knew something had to change. I have been on Cymbalta for 3 months now and it is working. I think the worst part is the constipation. I also have broken out in several rashes on my face while drinking. I have been taking this medicine for 1.5 years, and it has been a life changer. I have generalized anxiety and fibromyalgia, both of which affected my daily life. I began noticing mood changes immediately, and the pain subsided within a month or so. I am myself again, relaxed, level headed, and able to cope with everyday stress. The only side effect I have experienced was extreme night sweats. This has subsided, as most of Cymbalta s side effects do. I ask if you are questioning whether or not to stay on the Cymbalta or to wait it out, because the side effects fade and the positive effects increase. 39 users found this comment helpful. I ve been on Cymbalta for about 13 months but after reading many of the posts, I m thinking I should add this little self-evaluation. I was diagnosed with autism, dyslexia and hyper-activity in the mid-1960 s when research was still in its infancy. Anxiety was a continuous battle and after failing the 4th grade, all I remember was being in a fog. Cymbalta has cut through the anxiety even though the autism and dyslexia are hard-wired as part of my disorder. I was recently pushed to 60 mg with improvement from my 30 mg dose. As part of anxiety, you can feel the adrenaline flowing through you at the slightest distraction or obstacle, but Cymbalta has done miracles to cut the amount of adrenaline released. Coffee puts me to sleep. 31 users found this comment helpful. I have been taking Cymbalta for about 10 months now. At first the side effects were difficult because I felt nauseous, dizzy, had brain zaps, constipation, and my dreams were crazy. Luckily I did not quit within the first 2 weeks and the side effects mostly subsided. Cymbalta has really helped with my anxiety and depression. I was on 30mg then 60mg. The first couple months were the best with no anxiety at all but slowly it started to come back. My dose has just been raised to 90mg and am also on Wellbutrin. Not perfect and I don t want to keep raising the dose but Cymbalta has really improved my daily life and relationships with others. I was prescribed this medicine after failed attempts on Effexor, Lexapro, Zoloft and Pristq. I ve been trying different medicines and have been having panic attacks ever since I can remember, even when I was a child in school, after my son was born it got WORSE. I am currently taking Xanax, two 0.5mgs a day and clonazepam two 1mg s a day and also a Beta Blocker for fast heart rate. I ve been on the Beta Blocker for 6 years. I have been taking Xanax and clonazepam for 3 years. They do not help my anxiety 100. I still get attacks, but not full blown panic attacks like I used to. I took my first Cymbalta last night. I m supposed to take 20mg in the morning and another 20mg at night. No side effects yet. I m hoping this will be the pill that works for me. This medicine has been truly life changing. My anxiety and depression were severe, and no other medicine had shown promising results. After about 3 months on this medicine Only 30mg I had remarkable results. I am an 18 year old male. I started Cymbalta 3 weeks ago for Generalized Anxiety. My anxiety got to a point where I couldn t even sit down and watch T.V or surf the internet without getting stressed. My stress started to control me. It was controlling simple decisions, it controlled what I did. I started to avoid everything that would possibly stress me out. It became a viscous cycle. Even things like simply playing my guitar or attending my college classes was becoming difficult to do without getting anxious. NOW after taking Cymbalta I feel like I have the opportunity to be myself again, and without worrying about getting anxious or stressed. Now I control my anxiety, instead of it controlling me. Only side effect is delayed orgasm. 47 users found this comment helpful. Cymbalta is the best med I have ever taken for my panic attacks and depression. It has fixed my mood and is very tolerable. This medication is excellent for anxiety, depression, bipolar type 2 disorder and also helps with any pain that the patient my be suffering from from pain from depression and/or chronic pain. However this medication will not cure your pain if it s chronic, but it will alleviate it a lot and you wont have to take so much prescription pain killers. I m speaking from personal experience and from the experiences of others. The only problem is that this medication is very expensive especially if you don t have prescription drug insurance and there s no generic for this yet. I have been on Cymbalta for one month for relentless anxiety and depression, after trying Paxil, Wellbutrin, Prozac and many others I can not even remember the names of. There has been a loss of appetite for a few weeks but it has mostly gone away. It caused panic in the beginning but Ativan helped a little with that. After a week I felt really good 20 mg and have been up and down ever since. It has helped a lot but so far it is not the answer. jmharrington42 January 25, 2010 I took this drug for a couple years. At first I was very tired all the time but that passed. It did help with the anxiety for the first 6 months or so but I always had the brain zaps everyone talks about. They were very frustrating and after the 6 months it was not effective. I didn t like the way I felt and quit taking it. 22 users found this comment helpful. I am 42 and began taking Cymbalta 4 weeks ago. I started with 30mg for 2 weeks, and am currently taking 60mg a day. I began taking this drug due to the advice of my doctor after approaching him about my uncontrolable anger issues that have plagued me my entire adult life. I have to say that it has been a lifesaver. I have never gone 1 week, never mind 4 weeks without an anger outburst or stress related outburst. My family is happier..I am happierI have never felt this greatonly side effects are some dry mouth at night and occasional tiredness during the dayan easy trade off for a drug that has given me my life back Usedtobeangry January 17, 2010 My Doctor diagnosed me with Generalized Anxiety Disorder and put me on Cymbalta. The first couple of weeks were a little rough with the nausea, but nothing unbearable. I did lose a bit of weight too. It did help with my anxiety and depression a lot. I was on 60mg. Now 2 years later I was in a different place in my life, did not want to be dependent on a pill, so started weaning off. Went from 60mg to 30mg. Then taking it every other day. then down to 20mg. Now is the hard part. Dr told me from there just quit taking it - yah right. All the blogs you read about the brain zaps are so true. First couple of weeks where quite bad with nausea, yawning, panic attacks but then quite suddenly I was able to leave my house go for walks without anxiety, all was good for about 4-5 months on 60 mg, then anxiety came back, now I m on 90mg and it s better yet again. i got severe backpains, and was given tramadol.not a good idea, i had some intestinal bleeding and severe mood swings, vicodin seems fine, so does codein taken with tylanol 21 users found this comment helpful. This medicine was the 1st thing in YEARS that made me feel like myself again. It started working within a few days. The panic attacks subsided almost immediately and the depression lifted. The side effects I experienced although annoying were nothing compared to the benefits it gave me. The 1st 2 weeks I was nauseous and tired, felt out of it but my head was clearer and thoughts focused after that. I did lose like 20 pounds, it stopped my emotional eating. The worst part was the night sweats I had for about 2 months or so. I was on it for about 5 months but had to wean off due to lack of insurance. Coming off was terrible though total withdrawal, brain zaps, confusion etc. I ll get back on it as soon as I can because I know it did wonders. 32 users found this comment helpful. I was prescribed this for mild anxiety after I was in a car accident and the headaches I got as a result. I took ONE 20 mg at night and woke up four hours later with the most horrible panic attack that s what the doctor said. I ve never had that happen in my life. My heart was racing and pounding, I would get hot then cold and back again, I was shaking so bad I could hardly type. I wanted to cry but couldn t, scream or something. I felt like all of a sudden I had a different personality. My heart raced for 4 days after that. I never took another after that first one. I ve been having heart pounding sensations for days in the last three weeks since taking the Cymbalta. I started this pill 3 weeks ago and it is really working for me. I am much happier and my attacks are gone. The first night I had terrible pains in my stomach but after that night no more problems. I am on 60mgs and the only negative thing I have noticed about it is that if I forget to take it I get a really bad headache in the morning and feel hung over. Overall I love it. I took Cymbalta for 7 weeks for post-partum anxiety/depression. After the initial week of feeling nausea and fatigue, I started to feel better. I stayed on 30 mg, but found after 5 weeks I was having vivid, disturbing dreams, insomnia, sweating, and the anxiety came back. I started tapering off, and even at the low dose the withdrawls are quite uncomfortable - after tapering and stopping the drug I still get a buzz/pulse/shock like sensation in my head almost constantly after a week. Great if it helps, but hard to get off. I suffer from medical anxiety. I first tried Paxil - itched like crazy. Then lexapro - shook all the time. Cymbalta has changed my life. I feel so much better now, and almost back to normal after 5 weeks on the medication. I have a little insomnia, and have lost a few pounds, but other than that I feel like I m 30 again, instead of 50. 56 users found this comment helpful. Cymbalta and lots of prayers saved my marriage. I m so thankful that my husband is taking it. thankful wife September 26, 2009 28 users found this comment helpful. After years of knowing something was wrong, I went to the doctor and he prescribed Cymbalta. I have been on it for 6 months. I love it. I will be married a year in October and my husband and I were already talking divorce until I started Cymbalta. I did have VERY violent and goury dreams when I took it right before bed. Now I take it in the morning, my dreams are back to normal. I am currently taking 60mg, but am going to request to take a lower dosage as I am now starting to experience headaches and nausea. I feel like I am finally the person I always knew I was and not the bitter, angry, weepy person other people saw. I was on Wellbutrin, Prozac and Zoloft trying each per my doctors orders, waiting about 6 weeks, repeat with next for anxiety. I stopped even trying instant anti-anxiety drugs Xanax, Valium years ago because they zombified me too much. Cymbalta is AMAZING. After about 2 weeks the side effects disappeared entirely. I can concentrate better, I sleep VERY soundly, and no panic attacks. For those having insomnia issues some people here say take it at night. I had exactly the OPPOSITE experience. Taking Cymbalta at night/dinner time would make sleep nearly impossible/restless. Taking it first thing in the morning I get a little tired in the afternoon, but nothing a latte won t fix. I sleep like a BABY now; which I haven t done ever. For those of you experiencing fatigue, it would make sense to take Cymbalta at night. This is how I have dealt with fatigue with many medications and was also the advice of my doctor. ALSO, for those with side effects that are bothersome, I was advised to give it more than a week because they usually dissipate. Don t stop taking it after only a few days. I ve been taking this medication for 3 weeks. First week I was on 30 mg, I felt almost immediate relief from my anxiety/depression. The first six days I experienced fatigue and slept 12 hours a day. By 7th day I was sleeping less and feeling more emotionally balanced. Second week, my dosage was increased to 60 mg and the same thing happened. I slept 12 for about 6 days and by the 7th day I felt good and was sleeping normally. I do have some clenching of my jaw and dry mouth, but a glass of water seems to help. I take my medication at the same time every morning after eating and drink lots of water throughout the day. I m not taking any other drugs. I ve found great relief with Cymbalta. My husband is thrilled with the calmer, happier me. Me too. 91 users found this comment helpful. Previously was on Prozac for anxiety and while that worked really really well for 2 years, it sort of stopped working, and nothing helped again until I got on Cymbalta and 1 small dose of clonezapam at night. Now, I m virtually anxiety free, with just a rare panic attack here and there, treated with other medicines. Cymbalta keeps me pretty even. I m on the 60mg once daily. I ve been taking Cymbalta for ten weeks 60mg per day. If this is as good as it gets, I d hate to see what it s like without it. I can t tell or feel any effects at all. Not even side effects. I was on Cymbalta for 5 days. It helped my anxiety, but I couldn t handle the side effects: nausea, extreme sleepiness and yawning for the better part of the day, feeling zombie-like, chills, clenching my jaw, headache. I stopped taking it after 5 days, and the withdrawal was terrible. I felt like I d been hit my a truck: terrible headache and clenching of jaw. And I d only been on 30 mg for 5 days. Even if I could have tolerated the side effects, I would have been worried about the withdrawal. I have been taking Cymbalta for two months. It works great for my anxiety and chronic pain. I feel great, like a new person. The only side effect for me is insomnia. I will be checking back with Doctor on that. Many side effects. I have been trying to ween off this medication for over a month and have been unsuccessful. I received no benefits from this medication. Made me feel better mentally, but the severe diahrrea would not go away. So, I had to quit. I was prescribed Cymbalta over a year ago, after a crippling anxiety attack and I will have to say, it s helped me quite a bit. I was skeptical on taking it, because I had no positive outcomes with Wellbutrin or Zoloft, but this drug helped me with amazing results. The only thing I ve found probably like with any other drug of this type is that you NEED to take it on a scheduled basis. I have forgotten to take it or not been able to take it until 6 to 8 hours past my regular time and have to spend a few days readjusting to it. The only reason I gave Cymbalta a 9 instead of ten is for that reason and that weaning off this medicine may prove to be difficult. This has caused multiple sexual side effects, urinary retention, almost constant hot flashes and sleep problems. It did nothing for my anxiety. There were no benefits to me from this drug. Anxiety disorder and panic attacks run in my family. I have loved this drug - I am a happy, calm, relaxed me. I am so glad I have this tool to improve my life. 58 users found this comment helpful. Weight loss, more energy, much less anxiety and stress, no mood swings. I do feel shaky in the morning and at night and don t sleep quite as soundly. 64 users found this comment helpful. I have just started taking the medication and have noticed a considerable change in my mood. I am not jumpy anymore. The only thing that I don t like about it is the bad taste I get in my mouth and some insomnia. mbroussard61 December 22, 2008 Cymbalta is a god send for me and all those people out there who suffer from depression, anxiety, bipolar disorder, diabetic nerve damage, fibromyalgia, pain or what ever else it is used for. I myself have s. A. D social anxiety disorder and at times depression. I was taking zoloft and I still felt the anxiety so my doctor prescribed cymbalta and it took about a week 2 actually kick in and when it did I felt it and loved it and would recommend this medication to those who are trying to find a way to help them live there life with ease. It s not a cure but it is very helpful as long as you take it when you are supposed to. Cymbalta is the best. Thanks. 106 users found this comment helpful. I took Cymbalta for 3 months and it worked great. Then over time it didn t work as well and I quit. I hit rock bottom. rosspaige2007 November 19, 2008 Have been on cymbalta for a little over 3 months. It has changed my life for the better. My anxiety had gotten to the point that I was hiding in the restroom at work during episodes almost everyday. I am able to communicate what I am thinking more clearly. I don t break out in a sweat if something isn t going the way I think it should. I feel like myself before the panic/anxiety attacks started several years ago. I was dieting when I started taking cymbalta and lost more weight than I had been averaging. Didn t have as much appetite as usual, which wasn t a bad thing. The irritability is gone and I am a lot more pleasant to be around. I am me again. 165 users found this comment helpful. I ve been taking Cymbalta for anxiety and dysthymia for 3 months. It is the best medication I have tried in 10 years of treatment. No weight gain, not as lethargic, and my attitude has been much better towards life in general. Right now I am on 60mg a day. I m not sure if I can go up from here but even if I don t, the way I feel now is better than anything else I have tried including prozac, lexapro, welbutrin and several others. I do have some dry mouth and sweating but it is tolerable. 74 users found this comment helpful. I was on Cymbalta for two years. I had no side effects and it worked really well for my anxiety. I had no sexual side effects which was great. I decided to go off of it thinking that I didn t need it anymore. I thought that I tapered it by taking 20mg for a month. Once I started taking 20mg every other day it was like experiencing the withdrawal symptoms over again each time. I finally just stopped taking it and had awful withdrawal symptoms.- more monitoring would have helped. I haven t felt this good since childhood. So thankful they make this drug to help with my chronic anxiety. My entire outlook has changed, as well as my concentration. 132 users found this comment helpful. I have been on this medication for 1.5yrs it has been GREAT. Was on Paxil for 3 yrs prior to switching to Cymbalta. It worked in about 3 days and i havent had any abnormal feelings of anxiety since I started this med. I haven t had any side effects from taking it. I had experienced some weight gain from Paxil, but none on Cymbalta. The only thing is that if you miss a dose, your terrible headache will remind u that u forgot to take it. Other than that, it s been great. 174 users found this comment helpful. I have been on Cymbolta for 8 weeks, I suffer from medical anxiety. I have not felt this good in years. the first 2 weeks I did have a lot of side effects swetting, dizziness, insomnea, upset stomach, but after that I started feeling better. I have lost 20 lbs because I no longer feel hunger all the time. I feel like I did 20 years ago so much happier. I can t rave enough about it. 238 users found this comment helpful. I m 29 been on Cymbalta 1 week, prior to taking, couldnt sleep 4 hrs on average, panic attacks, acne break outs, hair falling out, highly stressed, now a little disoriented at times, loss of appetite not a bad thing, great sleep much needed and Im much calmer. The doctor wants to add Wellbutrin in 30 days but I am not going that route. I am very pleased with the direction we are going in now it is just taking some time to adjust to the side effects and new routine of actually resting.. xxoolostooxx November 18, 2007 Learn about clinical pharmacology for the drug Cymbalta Duloxetine Hcl. Below are Cymbalta Duloxetine reviews, ratings, comments submitted by patients and caregivers. Based on a total of 42 ratings/reviews, Cymbalta has an overall. Detailed dosage guidelines and administration information for Cymbalta duloxetine hydrochloride. Includes dose adjustments, warnings and precautions. Learn about indications, dosage and how it is supplied for the drug Cymbalta Duloxetine Hcl.
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Common use Suicidality and Antidepressant Drugs Antidepressants increased the risk compared to placebo of suicidal thinking and behavior suicidality in children, adolescents, and young adults in short-term studies of major depressive disorder MDD and other psychiatric disorders. Anyone considering the use of Celexa or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Celexa is not approved for use in pediatric patients. See WARNINGS: Clinical Worsening and Suicide Risk, PRECAUTIONS: Information for Patients, and PRECAUTIONS: Pediatric Use. Celexa citalopram HBr is an orally administered selective serotonin reuptake inhibitor SSRI with a chemical structure unrelated to that of other SSRIs or of tricyclic, tetracyclic, or other available antidepressant agents. Citalopram HBr is a racemic bicyclic phthalane derivative designated -1- 3-dimethylaminopropyl -1- 4-fluorophenyl -1,3-dihydroisobenzofuran-5-carbonitrile, HBr with the following structural formula: Slideshow: Flashback: FDA Drug Approvals 2013 The molecular formula is C20H22BrFN2O and its molecular weight is 405.35. Citalopram HBr occurs as a fine, white to off-white powder. Citalopram HBr is sparingly soluble in water and soluble in ethanol. Celexa citalopram hydrobromide is available only in tablet dosage form. Celexa 10 mg are film-coated, oval tablets containing citalopram HBr in strengths equivalent to 10 mg citalopram base. Celexa 20 mg and 40 mg are film-coated, oval, scored tablets containing citalopram HBr in strengths equivalent to 20 mg or 40 mg citalopram base. The tablets also contain the following inactive ingredients: copolyvidone, corn starch, crosscarmellose sodium, glycerin, lactose monohydrate, magnesium stearate, hypromellose, microcrystalline cellulose, polyethylene glycol, and titanium dioxide. Iron oxides are used as coloring agents in the beige 10 mg and pink 20 mg tablets. Celexa - Clinical Pharmacology The mechanism of action of citalopram HBr as an antidepressant is presumed to be linked to potentiation of serotonergic activity in the central nervous system CNS resulting from its inhibition of CNS neuronal reuptake of serotonin 5-HT. In vitro and in vivo studies in animals suggest that citalopram is a highly selective serotonin reuptake inhibitor SSRI with minimal effects on norepinephrine NE and dopamine DA neuronal reuptake. Tolerance to the inhibition of 5-HT uptake is not induced by long-term 14-day treatment of rats with citalopram. Citalopram is a racemic mixture 50/50, and the inhibition of 5-HT reuptake by citalopram is primarily due to the S -enantiomer. Citalopram has no or very low affinity for 5-HT1A, 5-HT2A, dopamine D1 and D2, α1-, α2-, and β-adrenergic, histamine H1, gamma aminobutyric acid GABA, muscarinic cholinergic, and benzodiazepine receptors. Antagonism of muscarinic, histaminergic, and adrenergic receptors has been hypothesized to be associated with various anticholinergic, sedative, and cardiovascular effects of other psychotropic drugs. The single- and multiple-dose pharmacokinetics of citalopram are linear and dose-proportional in a dose range of 10-60 mg/day. Biotransformation of citalopram is mainly hepatic, with a mean terminal half-life of about 35 hours. With once daily dosing, steady state plasma concentrations are achieved within approximately one week. At steady state, the extent of accumulation of citalopram in plasma, based on the half-life, is expected to be 2.5 times the plasma concentrations observed after a single dose. Following a single oral dose 40 mg tablet of citalopram, peak blood levels occur at about 4 hours. The absolute bioavailability of citalopram was about 80 relative to an intravenous dose, and absorption is not affected by food. The volume of distribution of citalopram is about 12 L/kg and the binding of citalopram CT, demethylcitalopram DCT and didemethylcitalopram DDCT to human plasma proteins is about 80. Following intravenous administrations of citalopram, the fraction of drug recovered in the urine as citalopram and DCT was about 10 and 5, respectively. The systemic clearance of citalopram was 330 mL/min, with approximately 20 of that due to renal clearance. Citalopram is metabolized to demethylcitalopram DCT, didemethylcitalopram DDCT, citalopram-N-oxide, and a deaminated propionic acid derivative. In humans, unchanged citalopram is the predominant compound in plasma. At steady state, the concentrations of citalopram s metabolites, DCT and DDCT, in plasma are approximately one-half and one-tenth, respectively, that of the parent drug. In vitro studies show that citalopram is at least 8 times more potent than its metabolites in the inhibition of serotonin reuptake, suggesting that the metabolites evaluated do not likely contribute significantly to the antidepressant actions of citalopram. In vitro studies using human liver microsomes indicated that CYP3A4 and CYP2C19 are the primary isozymes involved in the N-demethylation of citalopram. Age - Citalopram pharmacokinetics in subjects 60 years of age were compared to younger subjects in two normal volunteer studies. In a single-dose study, citalopram AUC and half-life were increased in the subjects 60 years old by 30 and 50, respectively, whereas in a multiple-dose study they were increased by 23 and 30, respectively. 20 mg/day is the maximum recommended dose for patients who are greater than 60 years of age see WARNINGS and DOSAGE AND ADMINISTRATION, due to the risk of QT prolongation. Gender - In three pharmacokinetic studies total N 32, citalopram AUC in women was one and a half to two times that in men. This difference was not observed in five other pharmacokinetic studies total N 114. In clinical studies, no differences in steady state serum citalopram levels were seen between men N 237 and women N 388. There were no gender differences in the pharmacokinetics of DCT and DDCT. No adjustment of dosage on the basis of gender is recommended. Reduced hepatic function - Citalopram oral clearance was reduced by 37 and half-life was doubled in patients with reduced hepatic function compared to normal subjects. 20 mg/day is the maximum recommended dose for hepatically impaired patients see WARNINGS and DOSAGE AND ADMINISTRATION, due to the risk of QT prolongation. CYP2C19 poor metabolizers -– In CYP2C19 poor metabolizers, citalopram steady state Cmax and AUC was increased by 68 and 107, respectively. Celexa 20 mg/day is the maximum recommended dose in CYP2C19 poor metabolizers due to the risk of QT prolongation see WARNINGS and DOSAGE AND ADMINISTRATION. CYP2D6 poor metabolizers - Citalopram steady state levels were not significantly different in poor metabolizers and extensive metabolizers of CYP2D6. Reduced renal function - In patients with mild to moderate renal function impairment, oral clearance of citalopram was reduced by 17 compared to normal subjects. No adjustment of dosage for such patients is recommended. No information is available about the pharmacokinetics of citalopram in patients with severely reduced renal function creatinine clearance In vitro enzyme inhibition data did not reveal an inhibitory effect of citalopram on CYP3A4, -2C9, or -2E1, but did suggest that it is a weak inhibitor of CYP1A2, -2D6, and -2C19. Citalopram would be expected to have little inhibitory effect on in vivo metabolism mediated by these enzymes. However, in vivo data to address this question are limited. CYP3A4 and CYP 2C19 inhibitors: Since CYP3A4 and CYP 2C19 are the primary enzymes involved in the metabolism of citalopram, it is expected that potent inhibitors of CYP3A4 e.g., ketoconazole, itraconazole, and macrolide antibiotics and potent inhibitors of CYP2C19 e.g., omeprazole might decrease the clearance of citalopram. However, coadministration of citalopram and the potent CYP3A4 inhibitor ketoconazole did not significantly affect the pharmacokinetics of citalopram. Celexa 20 mg/day is the maximum recommended dose in patients taking concomitant cimetidine or another CYP2C19 inhibitor, because of the risk of QT prolongation see WARNINGS and DOSAGE AND ADMINISTRATION. CYP2D6 Inhibitors: Coadministration of a drug that inhibits CYP2D6 with Celexa is unlikely to have clinically significant effects on citalopram metabolism, based on the study results in CYP2D6 poor metabolizers. The efficacy of Celexa as a treatment for depression was established in two placebo-controlled studies of 4 to 6 weeks in duration in adult outpatients ages 18-66 meeting DSM-III or DSM-III-R criteria for major depression. Study 1, a 6-week trial in which patients received fixed Celexa doses of 10, 20, 40, and 60 mg/day, showed that Celexa at doses of 40 and 60 mg/day was effective as measured by the Hamilton Depression Rating Scale HAMD total score, the HAMD depressed mood item Item 1, the Montgomery Asberg Depression Rating Scale, and the Clinical Global Impression CGI Severity scale. This study showed no clear effect of the 10 and 20 mg/day doses, and the 60 mg/day dose was not more effective than the 40 mg/day dose. In study 2, a 4-week, placebo-controlled trial in depressed patients, of whom 85 met criteria for melancholia, the initial dose was 20 mg/day, followed by titration to the maximum tolerated dose or a maximum dose of 80 mg/day. Patients treated with Celexa showed significantly greater improvement than placebo patients on the HAMD total score, HAMD item 1, and the CGI Severity score. In three additional placebo-controlled depression trials, the difference in response to treatment between patients receiving Celexa and patients receiving placebo was not statistically significant, possibly due to high spontaneous response rate, smaller sample size, or, in the case of one study, too low a dose. In two long-term studies, depressed patients who had responded to Celexa during an initial 6 or 8 weeks of acute treatment fixed doses of 20 or 40 mg/day in one study and flexible doses of 20-60 mg/day in the second study were randomized to continuation of Celexa or to placebo. In both studies, patients receiving continued Celexa treatment experienced significantly lower relapse rates over the subsequent 6 months compared to those receiving placebo. In the fixed-dose study, the decreased rate of depression relapse was similar in patients receiving 20 or 40 mg/day of Celexa. Analyses of the relationship between treatment outcome and age, gender, and race did not suggest any differential responsiveness on the basis of these patient characteristics. Comparison of Clinical Trial Results Highly variable results have been seen in the clinical development of all antidepressant drugs. Furthermore, in those circumstances when the drugs have not been studied in the same controlled clinical trial s, comparisons among the results of studies evaluating the effectiveness of different antidepressant drug products are inherently unreliable. Because conditions of testing e.g., patient samples, investigators, doses of the treatments administered and compared, outcome measures, etc. vary among trials, it is virtually impossible to distinguish a difference in drug effect from a difference due to one of the confounding factors just enumerated. Indications and Usage for Celexa Celexa citalopram HBr is indicated for the treatment of depression. The efficacy of Celexa in the treatment of depression was established in 4-6 week, controlled trials of outpatients whose diagnosis corresponded most closely to the DSM-III and DSM-III-R category of major depressive disorder see CLINICAL PHARMACOLOGY. A major depressive episode DSM-IV implies a prominent and relatively persistent nearly every day for at least 2 weeks depressed or dysphoric mood that usually interferes with daily functioning, and includes at least five of the following nine symptoms: depressed mood, loss of interest in usual activities, significant change in weight and/or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, a suicide attempt or suicidal ideation. The antidepressant action of Celexa in hospitalized depressed patients has not been adequately studied. The efficacy of Celexa in maintaining an antidepressant response for up to 24 weeks following 6 to 8 weeks of acute treatment was demonstrated in two placebo-controlled trials see CLINICAL PHARMACOLOGY. Nevertheless, the physician who elects to use Celexa for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient. The use of MAOIs intended to treat psychiatric disorders with Celexa or within 14 days of stopping treatment with Celexa is contraindicated because of an increased risk of serotonin syndrome. The use of Celexa within 14 days of stopping an MAOI intended to treat psychiatric disorders is also contraindicated see WARNINGS and DOSAGE and ADMINISTRATION. Starting Celexa in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome see WARNINGS and DOSAGE AND ADMINISTRATION. Concomitant use in patients taking pimozide is contraindicated see PRECAUTIONS. Celexa is contraindicated in patients with a hypersensitivity to citalopram or any of the inactive ingredients in Celexa. WARNINGS-Clinical Worsening and Suicide Risk Clinical Worsening and Suicide Risk Patients with major depressive disorder MDD, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior suicidality or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Pooled analyses of short-term placebo-controlled trials of antidepressant drugs SSRIs and others showed that these drugs increase the risk of suicidal thinking and behavior suicidality in children, adolescents, and young adults ages 18-24 with major depressive disorder MDD and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older. The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive compulsive disorder OCD, or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4400 patients. The pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trials median duration of 2 months of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied. There were differences in absolute risk of suicidality across the different indications, with the highest incidence in MDD. The risk differences drug vs. placebo, however, were relatively stable within age strata and across indications. These risk differences drug-placebo difference in the number of cases of suicidality per 1000 patients treated are provided in Table 1. No suicides occurred in any of the pediatric trials. There were suicides in the adult trials, but the number was not sufficient to reach any conclusion about drug effect on suicide. It is unknown whether the suicidality risk extends to longer-term use, i.e., beyond several months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression. All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessness, hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality. Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient s presenting symptoms. If the decision has been made to discontinue treatment, medication should be tapered, as rapidly as is feasible, but with recognition that abrupt discontinuation can be associated with certain symptoms see PRECAUTIONS and DOSAGE AND ADMINISTRATION Discontinuation of Treatment with Celexa, for a description of the risks of discontinuation of Celexa. Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for Celexa should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose. QT-Prolongation and Torsade de Pointes Citalopram causes dose-dependent QTc prolongation, an ECG abnormality that has been associated with Torsade de Pointes TdP, ventricular tachycardia, and sudden death, all of which have been observed in postmarketing reports for citalopram. Individually corrected QTc QTcNi interval was evaluated in a randomized, placebo and active moxifloxacin 400 mg controlled cross-over, escalating multiple-dose study in 119 healthy subjects. The maximum mean upper bound of the 95 one-sided confidence interval difference from placebo were 8.5 10.8 and 18.5 21.0 msec for 20 mg and 60 mg citalopram, respectively. Based on the established exposure-response relationship, the predicted QTcNi change from placebo upper bound of the 95 one-sided confidence interval under the Cmax for the dose of 40 mg is 12.6 14.3 msec. Because of the risk of QTc prolongation at higher citalopram doses, it is recommended that citalopram should not be given at doses above 40 mg/day. It is recommended that citalopram should not be used in patients with congenital long QT syndrome, bradycardia, hypokalemia or hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure. Citalopram should also not be used in patients who are taking other drugs that prolong the QTc interval. Such drugs include Class 1A e.g., quinidine, procainamide or Class III e.g., amiodarone, sotalol antiarrhythmic medications, antipsychotic medications e.g., chlorpromazine, thioridazine, antibiotics e.g., gatifloxacin, moxifloxacin, or any other class of medications known to prolong the QTc interval e.g., pentamidine, levomethadyl acetate, methadone. The citalopram dose should be limited in certain populations. The maximum dose should be limited to 20 mg/day in patients who are CYP2C19 poor metabolizers or those patients who may be taking concomitant cimetidine or another CYP2C19 inhibitor, since higher citalopram exposures would be expected. The maximum dose should also be limited to 20 mg/day in patients with hepatic impairment and in patients who are greater than 60 years of age because of expected higher exposures. Electrolyte and/or ECG monitoring is recommended in certain circumstances. Patients being considered for citalopram treatment who are at risk for significant electrolyte disturbances should have baseline serum potassium and magnesium measurements with periodic monitoring. Hypokalemia and/or hypomagnesemia may increase the risk of QTc prolongation and arrhythmia, and should be corrected prior to initiation of treatment and periodically monitored. ECG monitoring is recommended in patients for whom citalopram use is not recommended see above, but, nevertheless, considered essential. These include those patients with the cardiac conditions noted above, and those taking other drugs that may prolong the QTc interval. Citalopram should be discontinued in patients who are found to have persistent QTc measurements 500 ms. If patients taking citalopram experience symptoms that could indicate the occurrence of cardiac arrhythmias, e.g., dizziness, palpitations, or syncope, the prescriber should initiate further evaluation, including cardiac monitoring. Screening Patients for Bipolar Disorder: A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed though not established in controlled trials that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that Celexa is not approved for use in treating bipolar depression. The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including Celexa, alone but particularly with concomitant use of other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, trytophan, buspirone, and St. John s Wort and with drugs that impair metabolism of serotonin in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue. Serotonin syndrome symptoms may include mental status changes e.g., agitation, hallucinations, delirium, and coma, autonomic instability e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia, neuromuscular symptoms e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination, seizures and/or gastrointestinal symptoms e.g., nausea, vomiting, diarrhea. Patients should be monitored for the emergence of serotonin syndrome. The concomitant use of Celexa with MAOIs intended to treat psychiatric disorders is contraindicated. Celexa should also not be started in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue. All reports with methylene blue that provided information on the route of administration involved intravenous administration in the dose range of 1 mg/kg to 8 mg/kg. No reports involved the administration of methylene blue by other routes such as oral tablets or local tissue injection or at lower doses. There may be circumstances when it is necessary to initiate treatment with an MAOI such as linezolid or intravenous methylene blue in a patient taking Celexa. Celexa should be discontinued before initiating treatment with the MAOI see CONTRAINDICATIONS and DOSAGE AND ADMINISTRATION. If concomitant use of Celexa with other serotonergic drugs including, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, trytophan and St. John s Wort is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome particularly during treatment initiation and dose increases. Treatment with Celexa and any concomitant serotonergic agents should be discontinued immediately if the above events occur and supportive symptomatic treatment should be initiated. Discontinuation of Treatment with Celexa During marketing of Celexa and other SSRIs and SNRIs serotonin and norepinephrine reuptake inhibitors, there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances e.g., paresthesias such as electric shock sensations, anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms. Patients should be monitored for these symptoms when discontinuing treatment with Celexa. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate see DOSAGE AND ADMINISTRATION. SSRIs and SNRIs, including Celexa, may increase the risk of bleeding events. Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, warfarin, and other anticoagulants may add to the risk. Case reports and epidemiological studies case-control and cohort design have demonstrated an association between use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Bleeding events related to SSRIs and SNRIs use have ranged from ecchymoses, hematomas, epistaxis, and petechiae to life-threatening hemorrhages. Patients should be cautioned about the risk of bleeding associated with the concomitant use of Celexa and NSAIDs, aspirin, or other drugs that affect coagulation. Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including Celexa. In many cases, this hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion SIADH, and was reversible when Celexa was discontinued. Cases with serum sodium lower than 110 mmol/L have been reported. Elderly patients may be at greater risk of developing hyponatremia with SSRIs and SNRIs. Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk see Geriatric Use. Discontinuation of Celexa should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted. Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. Signs and symptoms associated with more severe and/or acute cases have included hallucination, syncope, seizure, coma, respiratory arrest, and death. In placebo-controlled trials of Celexa, some of which included patients with bipolar disorder, activation of mania/hypomania was reported in 0.2 of 1063 patients treated with Celexa and in none of the 446 patients treated with placebo. Activation of mania/hypomania has also been reported in a small proportion of patients with major affective disorders treated with other marketed antidepressants. As with all antidepressants, Celexa should be used cautiously in patients with a history of mania. Although anticonvulsant effects of citalopram have been observed in animal studies, Celexa has not been systematically evaluated in patients with a seizure disorder. These patients were excluded from clinical studies during the product s premarketing testing. In clinical trials of Celexa, seizures occurred in 0.3 of patients treated with Celexa a rate of one patient per 98 years of exposure and 0.5 of patients treated with placebo a rate of one patient per 50 years of exposure. Like other antidepressants, Celexa should be introduced with care in patients with a history of seizure disorder. Interference with Cognitive and Motor Performance In studies in normal volunteers, Celexa in doses of 40 mg/day did not produce impairment of intellectual function or psychomotor performance. Because any psychoactive drug may impair judgment, thinking, or motor skills, however, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that Celexa therapy does not affect their ability to engage in such activities. Use in Patients with Concomitant Illness Clinical experience with Celexa in patients with certain concomitant systemic illnesses is limited. Due to the risk of QT prolongation, citalopram use should be avoided in patients with certain cardiac conditions, and ECG monitoring is advised if Celexa must be used in such patients. Electrolytes should be monitored in treating patients with diseases or conditions that cause hypokalemia or hypomagnesemia. see WARNINGS. In subjects with hepatic impairment, citalopram clearance was decreased and plasma concentrations were increased. The use of Celexa in hepatically impaired patients should be approached with caution and a lower maximum dosage is recommended see DOSAGE AND ADMINISTRATION. Because citalopram is extensively metabolized, excretion of unchanged drug in urine is a minor route of elimination. Until adequate numbers of patients with severe renal impairment have been evaluated during chronic treatment with Celexa, however, it should be used with caution in such patients see DOSAGE AND ADMINISTRATION. Physicians are advised to discuss the following issues with patients for whom they prescribe Celexa. Patients should be cautioned about the risk of serotonin syndrome with the concomitant use of Celexa and triptans, tramadol or other serotonergic agents. Although in controlled studies Celexa has not been shown to impair psychomotor performance, any psychoactive drug may impair judgment, thinking, or motor skills, so patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that Celexa therapy does not affect their ability to engage in such activities. Patients should be told that, although Celexa has not been shown in experiments with normal subjects to increase the mental and motor skill impairments caused by alcohol, the concomitant use of Celexa and alcohol in depressed patients is not advised. Patients should be advised to inform their physician if they are taking, or plan to take, any prescription or over-the-counter drugs, as there is a potential for interactions. Patients should be cautioned about the concomitant use of Celexa and NSAIDs, aspirin, warfarin, or other drugs that affect coagulation since combined use of psychotropic drugs that interfere with serotonin reuptake and these agents has been associated with an increased risk of bleeding. Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy. Patients should be advised to notify their physician if they are breastfeeding an infant. While patients may notice improvement with Celexa therapy in 1 to 4 weeks, they should be advised to continue therapy as directed. Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with Celexa and should counsel them in its appropriate use. A patient Medication Guide about Antidepressant Medicines, Depression and other Serious Mental Illness, and Suicidal Thoughts or Actions is available for Celexa. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document. Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking Celexa. Clinical Worsening and Suicide Risk: Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessness, hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient s prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient s presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication. There are no specific laboratory tests recommended. Triptans: There have been rare postmarketing reports of serotonin syndrome with use of an SSRI and a triptan. If concomitant treatment of Celexa with a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases see WARNINGS - Serotonin Syndrome. CNS Drugs - Given the primary CNS effects of citalopram, caution should be used when it is taken in combination with other centrally acting drugs. Alcohol - Although citalopram did not potentiate the cognitive and motor effects of alcohol in a clinical trial, as with other psychotropic medications, the use of alcohol by depressed patients taking Celexa is not recommended. Drugs That Interfere With Hemostasis NSAIDs, Aspirin, Warfarin, etc. - Serotonin release by platelets plays an important role in hemostasis. Epidemiological studies of the case-control and cohort design that have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding have also shown that concurrent use of an NSAID or aspirin may potentiate the risk of bleeding. Altered anticoagulant effects, including increased bleeding, have been reported when SSRIs and SNRIs are coadministered with warfarin. Patients receiving warfarin therapy should be carefully monitored when Celexa is initiated or discontinued. Cimetidine - In subjects who had received 21 days of 40 mg/day Celexa, combined administration of 400 mg twice a day cimetidine for 8 days resulted in an increase in citalopram AUC and Cmax of 43 and 39, respectively. Celexa 20 mg/day is the maximum recommended dose for patients taking concomitant cimetidine because of the risk of QT prolongation see WARNINGS and DOSAGE AND ADMINISTRATION. Digoxin - In subjects who had received 21 days of 40 mg/day Celexa, combined administration of Celexa and digoxin single dose of 1 mg did not significantly affect the pharmacokinetics of either citalopram or digoxin. Lithium - Coadministration of Celexa 40 mg/day for 10 days and lithium 30 mmol/day for 5 days had no significant effect on the pharmacokinetics of citalopram or lithium. Nevertheless, plasma lithium levels should be monitored with appropriate adjustment to the lithium dose in accordance with standard clinical practice. Because lithium may enhance the serotonergic effects of citalopram, caution should be exercised when Celexa and lithium are coadministered. Pimozide - In a controlled study, a single dose of pimozide 2 mg co-administered with citalopram 40 mg given once daily for 11 days was associated with a mean increase in QTc values of approximately 10 msec compared to pimozide given alone. Citalopram did not alter the mean AUC or Cmax of pimozide. The mechanism of this pharmacodynamic interaction is not known. Theophylline - Combined administration of Celexa 40 mg/day for 21 days and the CYP1A2 substrate theophylline single dose of 300 mg did not affect the pharmacokinetics of theophylline. The effect of theophylline on the pharmacokinetics of citalopram was not evaluated. Sumatriptan - There have been rare postmarketing reports describing patients with weakness, hyperreflexia, and incoordination following the use of a SSRI and sumatriptan. If concomitant treatment with sumatriptan and an SSRI e.g., fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram is clinically warranted, appropriate observation of the patient is advised. Warfarin - Administration of 40 mg/day Celexa for 21 days did not affect the pharmacokinetics of warfarin, a CYP3A4 substrate. Prothrombin time was increased by 5, the clinical significance of which is unknown. Carbamazepine - Combined administration of Celexa 40 mg/day for 14 days and carbamazepine titrated to 400 mg/day for 35 days did not significantly affect the pharmacokinetics of carbamazepine, a CYP3A4 substrate. Although trough citalopram plasma levels were unaffected, given the enzyme-inducing properties of carbamazepine, the possibility that carbamazepine might increase the clearance of citalopram should be considered if the two drugs are coadministered. Triazolam - Combined administration of Celexa titrated to 40 mg/day for 28 days and the CYP3A4 substrate triazolam single dose of 0.25 mg did not significantly affect the pharmacokinetics of either citalopram or triazolam. Ketoconazole - Combined administration of Celexa 40 mg and ketoconazole 200 mg decreased the Cmax and AUC of ketoconazole by 21 and 10, respectively, and did not significantly affect the pharmacokinetics of citalopram. CYP2C19 Inhibitors - Celexa 20 mg/day is the maximum recommended dose for patients taking concomitant CYP2C19 inhibitors because of the risk of QT prolongation see WARNINGS, DOSAGE AND ADMINISTRATION, AND CLINICAL PHARMACOLOGY. Metoprolol - Administration of 40 mg/day Celexa for 22 days resulted in a two-fold increase in the plasma levels of the beta-adrenergic blocker metoprolol. Increased metoprolol plasma levels have been associated with decreased cardioselectivity. Coadministration of Celexa and metoprolol had no clinically significant effects on blood pressure or heart rate. Imipramine and Other Tricyclic Antidepressants TCAs - In vitro studies suggest that citalopram is a relatively weak inhibitor of CYP2D6. Coadministration of Celexa 40 mg/day for 10 days with the TCA imipramine single dose of 100 mg, a substrate for CYP2D6, did not significantly affect the plasma concentrations of imipramine or citalopram. However, the concentration of the imipramine metabolite desipramine was increased by approximately 50. The clinical significance of the desipramine change is unknown. Nevertheless, caution is indicated in the coadministration of TCAs with Celexa. Electroconvulsive Therapy ECT - There are no clinical studies of the combined use of electroconvulsive therapy ECT and Celexa. Carcinogenesis, Mutagenesis, Impairment of Fertility Citalopram was administered in the diet to NMRI/BOM strain mice and COBS WI strain rats for 18 and 24 months, respectively. There was no evidence for carcinogenicity of citalopram in mice receiving up to 240 mg/kg/day, which is equivalent to 20 times the maximum recommended human daily dose MRHD of 60 mg on a surface area mg/m2 basis. There was an increased incidence of small intestine carcinoma in rats receiving 8 or 24 mg/kg/day, doses which are approximately 1.3 and 4 times the MRHD, respectively, on a mg/m2 basis. A no-effect dose for this finding was not established. The relevance of these findings to humans is unknown. Citalopram was mutagenic in the in vitro bacterial reverse mutation assay Ames test in 2 of 5 bacterial strains Salmonella TA98 and TA1537 in the absence of metabolic activation. It was clastogenic in the in vitro Chinese hamster lung cell assay for chromosomal aberrations in the presence and absence of metabolic activation. Citalopram was not mutagenic in the in vitro mammalian forward gene mutation assay HPRT in mouse lymphoma cells or in a coupled in vitro/in vivo unscheduled DNA synthesis UDS assay in rat liver. It was not clastogenic in the in vitro chromosomal aberration assay in human lymphocytes or in two in vivo mouse micronucleus assays. When citalopram was administered orally to 16 male and 24 female rats prior to and throughout mating and gestation at doses of 32, 48, and 72 mg/kg/day, mating was decreased at all doses, and fertility was decreased at doses 32 mg/kg/day, approximately 5 times the MRHD of 60 mg/day on a body surface area mg/m2 basis. Gestation duration was increased at 48 mg/kg/day, approximately 8 times the MRHD. In animal reproduction studies, citalopram has been shown to have adverse effects on embryo/fetal and postnatal development, including teratogenic effects, when administered at doses greater than human therapeutic doses. In two rat embryo/fetal development studies, oral administration of citalopram 32, 56, or 112 mg/kg/day to pregnant animals during the period of organogenesis resulted in decreased embryo/fetal growth and survival and an increased incidence of fetal abnormalities including cardiovascular and skeletal defects at the high dose, which is approximately 18 times the MRHD of 60 mg/day on a body surface area mg/m2 basis. This dose was also associated with maternal toxicity clinical signs, decreased body weight gain. The developmental, no-effect dose of 56 mg/kg/day is approximately 9 times the MRHD on a mg/m2 basis. In a rabbit study, no adverse effects on embryo/fetal development were observed at doses of up to 16 mg/kg/day, or approximately 5 times the MRHD on a mg/m2 basis. Thus, teratogenic effects were observed at a maternally toxic dose in the rat and were not observed in the rabbit. When female rats were treated with citalopram 4.8, 12.8, or 32 mg/kg/day from late gestation through weaning, increased offspring mortality during the first 4 days after birth and persistent offspring growth retardation were observed at the highest dose, which is approximately 5 times the MRHD on a mg/m2 basis. The no-effect dose of 12.8 mg/kg/day is approximately 2 times the MRHD on a mg/m2 basis. Similar effects on offspring mortality and growth were seen when dams were treated throughout gestation and early lactation at doses 24 mg/kg/day, approximately 4 times the MRHD on a mg/m2 basis. A no-effect dose was not determined in that study. There are no adequate and well-controlled studies in pregnant women; therefore, citalopram should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Pregnancy-Nonteratogenic Effects Neonates exposed to Celexa and other SSRIs or serotonin and norepinephrine reuptake inhibitors SNRIs, late in the third trimester, have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Such complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. These features are consistent with either a direct toxic effect of SSRIs and SNRIs or, possibly, a drug discontinuation syndrome. It should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome see WARNINGS: Serotonin Syndrome. Infants exposed to SSRIs in pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn PPHN. PPHN occurs in 1- 2 per 1,000 live births in the general population and is associated with substantial neonatal morbidity and mortality. Several recent epidemiologic studies suggest a positive statistical association between SSRI use including Celexa in pregnancy and PPHN. Other studies do not show a significant statistical association. Physicians should also note the results of a prospective longitudinal study of 201 pregnant women with a history of major depression, who were either on antidepressants or had received antidepressants less than 12 weeks prior to their last menstrual period, and were in remission. Women who discontinued antidepressant medication during pregnancy showed a significant increase in relapse of their major depression compared to those women who remained on antidepressant medication throughout pregnancy. When treating a pregnant woman with Celexa, the physician should carefully consider both the potential risks of taking an SSRI, along with the established benefits of treating depression with an antidepressant. This decision can only be made on a case by case basis see DOSAGE AND ADMINISTRATION. The effect of Celexa on labor and delivery in humans is unknown. As has been found to occur with many other drugs, citalopram is excreted in human breast milk. There have been two reports of infants experiencing excessive somnolence, decreased feeding, and weight loss in association with breastfeeding from a citalopram-treated mother; in one case, the infant was reported to recover completely upon discontinuation of citalopram by its mother and in the second case, no follow-up information was available. The decision whether to continue or discontinue either nursing or Celexa therapy should take into account the risks of citalopram exposure for the infant and the benefits of Celexa treatment for the mother. Safety and effectiveness in the pediatric population have not been established see BOXED WARNING and WARNINGS Clinical Worsening and Suicide Risk. Two placebo-controlled trials in 407 pediatric patients with MDD have been conducted with Celexa, and the data were not sufficient to support a claim for use in pediatric patients. Anyone considering the use of Celexa in a child or adolescent must balance the potential risks with the clinical need. Decreased appetite and weight loss have been observed in association with the use of SSRIs. Consequently, regular monitoring of weight and growth should be performed in children and adolescents treated with Celexa. Of 4422 patients in clinical studies of Celexa, 1357 were 60 and over, 1034 were 65 and over, and 457 were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Most elderly patients treated with Celexa in clinical trials received daily doses between 20 and 40 mg see DOSAGE AND ADMINISTRATION. SSRIs and SNRIs, including Celexa, have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse event see PRECAUTIONS, Hyponatremia. In two pharmacokinetic studies, citalopram AUC was increased by 23 and 30, respectively, in subjects 60 years of age as compared to younger subjects, and its half-life was increased by 30 and 50, respectively see CLINICAL PHARMACOLOGY. 20 mg/day is the maximum recommended dose for patients who are greater than 60 years of age see WARNINGS and DOSAGE AND ADMINISTRATION. The premarketing development program for Celexa included citalopram exposures in patients and/or normal subjects from 3 different groups of studies: 429 normal subjects in clinical pharmacology/pharmacokinetic studies; 4422 exposures from patients in controlled and uncontrolled clinical trials, corresponding to approximately 1370 patient-exposure years. There were, in addition, over 19,000 exposures from mostly open-label, European postmarketing studies. The conditions and duration of treatment with Celexa varied greatly and included in overlapping categories open-label and double-blind studies, inpatient and outpatient studies, fixed-dose and dose-titration studies, and short-term and long-term exposure. Adverse reactions were assessed by collecting adverse events, results of physical examinations, vital signs, weights, laboratory analyses, ECGs, and results of ophthalmologic examinations. Adverse events during exposure were obtained primarily by general inquiry and recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories. In the tables and tabulations that follow, standard World Health Organization WHO terminology has been used to classify reported adverse events. The stated frequencies of adverse events represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation. Adverse Findings Observed in Short-Term, Placebo-Controlled Trials Adverse Events Associated with Discontinuation of Treatment Among 1063 depressed patients who received Celexa at doses ranging from 10 to 80 mg/day in placebo-controlled trials of up to 6 weeks in duration, 16 discontinued treatment due to an adverse event, as compared to 8 of 446 patients receiving placebo. The adverse events associated with discontinuation and considered drug-related i.e., associated with discontinuation in at least 1 of Celexa-treated patients at a rate at least twice that of placebo are shown in TABLE 2. It should be noted that one patient can report more than one reason for discontinuation and be counted more than once in this table. Adverse Events Occurring at an Incidence of 2 or More Among Celexa -Treated Patients Table 3 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse events that occurred among 1063 depressed patients who received Celexa at doses ranging from 10 to 80 mg/day in placebo-controlled trials of up to 6 weeks in duration. Events included are those occurring in 2 or more of patients treated with Celexa and for which the incidence in patients treated with Celexa was greater than the incidence in placebo-treated patients. The prescriber should be aware that these figures cannot be used to predict the incidence of adverse events in the course of usual medical practice where patient characteristics and other factors differ from those which prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators. The cited figures, however, do provide the prescribing physician with some basis for estimating the relative contribution of drug and non-drug factors to the adverse event incidence rate in the population studied. The only commonly observed adverse event that occurred in Celexa patients with an incidence of 5 or greater and at least twice the incidence in placebo patients was ejaculation disorder primarily ejaculatory delay in male patients see TABLE 3. Dose Dependency of Adverse Events The potential relationship between the dose of Celexa administered and the incidence of adverse events was examined in a fixed-dose study in depressed patients receiving placebo or Celexa 10, 20, 40, and 60 mg. Jonckheere s trend test revealed a positive dose response p Male and Female Sexual Dysfunction with SSRIs Although changes in sexual desire, sexual performance, and sexual satisfaction often occur as manifestations of a psychiatric disorder, they may also be a consequence of pharmacologic treatment. In particular, some evidence suggests that SSRIs can cause such untoward sexual experiences. Reliable estimates of the incidence and severity of untoward experiences involving sexual desire, performance, and satisfaction are difficult to obtain, however, in part because patients and physicians may be reluctant to discuss them. Accordingly, estimates of the incidence of untoward sexual experience and performance cited in product labeling, are likely to underestimate their actual incidence. The table below displays the incidence of sexual side effects reported by at least 2 of patients taking Celexa in a pool of placebo-controlled clinical trials in patients with depression. In female depressed patients receiving Celexa, the reported incidence of decreased libido and anorgasmia was 1.3 n 638 females and 1.1 n 252 females, respectively. There are no adequately designed studies examining sexual dysfunction with citalopram treatment. Priapism has been reported with all SSRIs. While it is difficult to know the precise risk of sexual dysfunction associated with the use of SSRIs, physicians should routinely inquire about such possible side effects. Celexa and placebo groups were compared with respect to 1 mean change from baseline in vital signs pulse, systolic blood pressure, and diastolic blood pressure and 2 the incidence of patients meeting criteria for potentially clinically significant changes from baseline in these variables. These analyses did not reveal any clinically important changes in vital signs associated with Celexa treatment. In addition, a comparison of supine and standing vital sign measures for Celexa and placebo treatments indicated that Celexa treatment is not associated with orthostatic changes. Patients treated with Celexa in controlled trials experienced a weight loss of about 0.5 kg compared to no change for placebo patients. Celexa and placebo groups were compared with respect to 1 mean change from baseline in various serum chemistry, hematology, and urinalysis variables, and 2 the incidence of patients meeting criteria for potentially clinically significant changes from baseline in these variables. These analyses revealed no clinically important changes in laboratory test parameters associated with Celexa treatment. In a thorough QT study, Celexa was found to be associated with a dose-dependent increase in the QTc interval see WARNINGS - QT-Prolongation and Torsade de Pointes. Electrocardiograms from Celexa N 802 and placebo N 241 groups were compared with respect to outliers defined as subjects with QTc changes over 60 msec from baseline or absolute values over 500 msec post-dose, and subjects with heart rate increases to over 100 bpm or decreases to less than 50 bpm with a 25 change from baseline tachycardic or bradycardic outliers, respectively. In the Celexa group 1.9 of the patients had a change from baseline in QTcF 60 msec compared to 1.2 of the patients in the placebo group. None of the patients in the placebo group had a post-dose QTcF 500 msec compared to 0.5 of the patients in the Celexa group. The incidence of tachycardic outliers was 0.5 in the Celexa group and 0.4 in the placebo group. The incidence of bradycardic outliers was 0.9 in the Celexa group and 0.4 in the placebo group. Other Events Observed During the Premarketing Evaluation of Celexa citalopram HBr Following is a list of WHO terms that reflect treatment-emergent adverse events, as defined in the introduction to the ADVERSE REACTIONS section, reported by patients treated with Celexa at multiple doses in a range of 10 to 80 mg/day during any phase of a trial within the premarketing database of 4422 patients. All reported events are included except those already listed in Table 3 or elsewhere in labeling, those events for which a drug cause was remote, those event terms which were so general as to be uninformative, and those occurring in only one patient. It is important to emphasize that, although the events reported occurred during treatment with Celexa, they were not necessarily caused by it. Events are further categorized by body system and listed in order of decreasing frequency according to the following definitions: frequent adverse events are those occurring on one or more occasions in at least 1/100 patients; infrequent adverse events are those occurring in less than 1/100 patients but at least 1/1000 patients; rare events are those occurring in fewer than 1/1000 patients. Cardiovascular - Frequent: tachycardia, postural hypotension, hypotension. Infrequent: hypertension, bradycardia, edema extremities, angina pectoris, extrasystoles, cardiac failure, flushing, myocardial infarction, cerebrovascular accident, myocardial ischemia. Rare: transient ischemic attack, phlebitis, atrial fibrillation, cardiac arrest, bundle branch block. Central and Peripheral Nervous System Disorders - Frequent: paresthesia, migraine. Infrequent: hyperkinesia, vertigo, hypertonia, extrapyramidal disorder, leg cramps, involuntary muscle contractions, hypokinesia, neuralgia, dystonia, abnormal gait, hypesthesia, ataxia. Rare: abnormal coordination, hyperesthesia, ptosis, stupor. Endocrine Disorders - Rare: hypothyroidism, goiter, gynecomastia. Gastrointestinal Disorders - Frequent: saliva increased, flatulence. Infrequent: gastritis, gastroenteritis, stomatitis, eructation, hemorrhoids, dysphagia, teeth grinding, gingivitis, esophagitis. Rare: colitis, gastric ulcer, cholecystitis, cholelithiasis, duodenal ulcer, gastroesophageal reflux, glossitis, jaundice, diverticulitis, rectal hemorrhage, hiccups. General - Infrequent: hot flushes, rigors, alcohol intolerance, syncope, influenza-like symptoms. Rare: hayfever. Hemic and Lymphatic Disorders - Infrequent: purpura, anemia, epistaxis, leukocytosis, leucopenia, lymphadenopathy. Rare: pulmonary embolism, granulocytopenia, lymphocytosis, lymphopenia, hypochromic anemia, coagulation disorder, gingival bleeding. Metabolic and Nutritional Disorders - Frequent: decreased weight, increased weight. Infrequent: increased hepatic enzymes, thirst, dry eyes, increased alkaline phosphatase, abnormal glucose tolerance. Rare: bilirubinemia, hypokalemia, obesity, hypoglycemia, hepatitis, dehydration. Musculoskeletal System Disorders - Infrequent: arthritis, muscle weakness, skeletal pain. Rare: bursitis, osteoporosis. Psychiatric Disorders - Frequent: impaired concentration, amnesia, apathy, depression, increased appetite, aggravated depression, suicide attempt, confusion. Infrequent: increased libido, aggressive reaction, paroniria, drug dependence, depersonalization, hallucination, euphoria, psychotic depression, delusion, paranoid reaction, emotional lability, panic reaction, psychosis. Rare: catatonic reaction, melancholia. Reproductive Disorders/Female - Frequent: amenorrhea. Infrequent: galactorrhea, breast pain, breast enlargement, vaginal hemorrhage. based on female subjects only: 2955 Respiratory System Disorders - Frequent: coughing. Infrequent: bronchitis, dyspnea, pneumonia. Rare: asthma, laryngitis, bronchospasm, pneumonitis, sputum increased. Skin and Appendages Disorders - Frequent: rash, pruritus. Infrequent: photosensitivity reaction, urticaria, acne, skin discoloration, eczema, alopecia, dermatitis, skin dry, psoriasis. Rare: hypertrichosis, decreased sweating, melanosis, keratitis, cellulitis, pruritus ani. Special Senses - Frequent: accommodation abnormal, taste perversion. Infrequent: tinnitus, conjunctivitis, eye pain. Rare: mydriasis, photophobia, diplopia, abnormal lacrimation, cataract, taste loss. Urinary System Disorders - Frequent: polyuria. Infrequent: micturition frequency, urinary incontinence, urinary retention, dysuria. Rare: facial edema, hematuria, oliguria, pyelonephritis, renal calculus, renal pain. Other Events Observed During the Postmarketing Evaluation of Celexa citalopram HBr It is estimated that over 30 million patients have been treated with Celexa since market introduction. Although no causal relationship to Celexa treatment has been found, the following adverse events have been reported to be temporally associated with Celexa treatment, and have not been described elsewhere in labeling: acute renal failure, akathisia, allergic reaction, anaphylaxis, angioedema, choreoathetosis, chest pain, delirium, dyskinesia, ecchymosis, epidermal necrolysis, erythema multiforme, gastrointestinal hemorrhage, glaucoma, grand mal convulsions, hemolytic anemia, hepatic necrosis, myoclonus, nystagmus, pancreatitis, priapism, prolactinemia, prothrombin decreased, QT prolonged, rhabdomyolysis, spontaneous abortion, thrombocytopenia, thrombosis, ventricular arrhythmia, torsade de pointes, and withdrawal syndrome. Celexa citalopram HBr is not a controlled substance. Physical and Psychological Dependence Animal studies suggest that the abuse liability of Celexa is low. Celexa has not been systematically studied in humans for its potential for abuse, tolerance, or physical dependence. The premarketing clinical experience with Celexa did not reveal any drug-seeking behavior. However, these observations were not systematic and it is not possible to predict, on the basis of this limited experience, the extent to which a CNS-active drug will be misused, diverted, and/or abused once marketed. Consequently, physicians should carefully evaluate Celexa patients for history of drug abuse and follow such patients closely, observing them for signs of misuse or abuse e.g., development of tolerance, incrementations of dose, drug-seeking behavior. In clinical trials of citalopram, there were reports of citalopram overdose, including overdoses of up to 2000mg, with no associated fatalities. During the postmarketing evaluation of citalopram, Celexa overdoses, including overdoses of up to 6000 mg, have been reported. As with other SSRIs, a fatal outcome in a patient who has taken an overdose of citalopram has been rarely reported. Symptoms most often accompanying citalopram overdose, alone or in combination with other drugs and/or alcohol, included dizziness, sweating, nausea, vomiting, tremor, somnolence, and sinus tachycardia. In more rare cases, observed symptoms included amnesia, confusion, coma, convulsions, hyperventilation, cyanosis, rhabdomyolysis, and ECG changes including QTc prolongation, nodal rhythm, ventricular arrhythmia, and very rare cases of torsade de pointes. Acute renal failure has been very rarely reported accompanying overdose. Establish and maintain an airway to ensure adequate ventilation and oxygenation. Gastric evacuation by lavage and use of activated charcoal should be considered. Careful observation and cardiac and vital sign monitoring are recommended, along with general symptomatic and supportive care. Due to the large volume of distribution of citalopram, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be of benefit. There are no specific antidotes for Celexa. In managing overdosage, consider the possibility of multiple-drug involvement. The physician should consider contacting a poison control center for additional information on the treatment of any overdose. Celexa Dosage and Administration Celexa should be administered once daily, in the morning or evening, with or without food. Celexa citalopram HBr should be administered at an initial dose of 20 mg once daily, with an increase to a maximum dose of 40 mg/day at an interval of no less than one week. Doses above 40 mg/day are not recommended due to the risk of QT prolongation. Additionally, the only study pertinent to dose response for effectiveness did not demonstrate an advantage for the 60 mg/day dose over the 40 mg/day dose. 20 mg/day is the maximum recommended dose for patients who are greater than 60 years of age, patients with hepatic impairment, and for CYP2C19 poor metabolizers or those patients taking cimetidine or another CYP2C19 inhibitor. see WARNINGS No dosage adjustment is necessary for patients with mild or moderate renal impairment. Celexa should be used with caution in patients with severe renal impairment. Treatment of Pregnant Women During the Third Trimester Neonates exposed to Celexa and other SSRIs or SNRIs, late in the third trimester, have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding see PRECAUTIONS. When treating pregnant women with Celexa during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. It is generally agreed that acute episodes of depression require several months or longer of sustained pharmacologic therapy. Systematic evaluation of Celexa in two studies has shown that its antidepressant efficacy is maintained for periods of up to 24 weeks following 6 or 8 weeks of initial treatment 32 weeks total. In one study, patients were assigned randomly to placebo or to the same dose of Celexa 20-60 mg/day during maintenance treatment as they had received during the acute stabilization phase, while in the other study, patients were assigned randomly to continuation of Celexa 20 or 40 mg/day, or placebo, for maintenance treatment. In the latter study, the rates of relapse to depression were similar for the two dose groups see Clinical Trials under CLINICAL PHARMACOLOGY. Based on these limited data, it is not known whether the dose of citalopram needed to maintain euthymia is identical to the dose needed to induce remission. If adverse reactions are bothersome, a decrease in dose to 20 mg/day can be considered. Symptoms associated with discontinuation of Celexa and other SSRIs and SNRIs have been reported see PRECAUTIONS. Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate. Switching a Patient To or From a Monoamine Oxidase Inhibitor MAOI Intended to Treat Psychiatric Disorders At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with Celexa. Conversely, at least 14 days should be allowed after stopping Celexa before starting an MAOI intended to treat psychiatric disorders see CONTRAINDICATIONS. Use of Celexa with Other MAOIs, Such as Linezolid or Methylene Blue Do not start Celexa in a patient who is being treated with linezolid or intravenous methylene blue because there is an increased risk of serotonin syndrome. In a patient who requires more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should be considered see CONTRAINDICATIONS. In some cases, a patient already receiving Celexa therapy may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Celexa should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with Celexa may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue see WARNINGS. The risk of administering methylene blue by non-intravenous routes such as oral tablets or by local injection or in intravenous doses much lower than 1 mg/kg with Celexa is unclear. The clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin syndrome with such use see WARNINGS. 10 mg Bottle of 100 NDC 0456-4010-01 Imprint on one side with FP. Imprint on the other side with 10 mg. 20 mg Bottle of 100 NDC 0456-4020-01 10 x 10 Unit Dose NDC 0456-4020-63 Pink, oval, scored, film-coated. Imprint on scored side with F on the left side and P on the right side. Imprint on the non-scored side with 20 mg. 40 mg Bottle of 100 NDC 0456-4040-01 10 x 10 Unit Dose NDC 0456-4040-63 White, oval, scored, film-coated. Imprint on the non-scored side with 40 mg. Store at 25 C 77 F ; excursions permitted to 15 - 30 C 59-86 F. Pathologic changes degeneration/atrophy were observed in the retinas of albino rats in the 2-year carcinogenicity study with citalopram. There was an increase in both incidence and severity of retinal pathology in both male and female rats receiving 80 mg/kg/day 13 times the maximum recommended daily human dose of 60 mg on a mg/m2 basis. Similar findings were not present in rats receiving 24 mg/kg/day for two years, in mice treated for 18 months at doses up to 240 mg/kg/day, or in dogs treated for one year at doses up to 20 mg/kg/day 4, 20, and 10 times, respectively, the maximum recommended daily human dose on a mg/m2 basis. Additional studies to investigate the mechanism for this pathology have not been performed, and the potential significance of this effect in humans has not been established. Cardiovascular Changes in Dogs In a one-year toxicology study, 5 of 10 beagle dogs receiving oral doses of 8 mg/kg/day 4 times the maximum recommended daily human dose of 60 mg on a mg/m2 basis died suddenly between weeks 17 and 31 following initiation of treatment. Although appropriate data from that study are not available to directly compare plasma levels of citalopram CT and its metabolites, demethylcitalopram DCT and didemethylcitalopram DDCT, to levels that have been achieved in humans, pharmacokinetic data indicate that the relative dog-to-human exposure was greater for the metabolites than for citalopram. Sudden deaths were not observed in rats at doses up to 120 mg/kg/day, which produced plasma levels of CT, DCT, and DDCT similar to those observed in dogs at doses of 8 mg/kg/day. A subsequent intravenous dosing study demonstrated that in beagle dogs, DDCT caused QT prolongation, a known risk factor for the observed outcome in dogs. This effect occurred in dogs at doses producing peak DDCT plasma levels of 810 to 3250 nM 39-155 times the mean steady state DDCT plasma level measured at the maximum recommended human daily dose of 60 mg. In dogs, peak DDCT plasma concentrations are approximately equal to peak CT plasma concentrations, whereas in humans, steady state DDCT plasma concentrations are less than 10 of steady state CT plasma concentrations. Assays of DDCT plasma concentrations in 2020 citalopram-treated individuals demonstrated that DDCT levels rarely exceeded 70 nM; the highest measured level of DDCT in human overdose was 138 nM. While DDCT is ordinarily present in humans at lower levels than in dogs, it is unknown whether there are individuals who may achieve higher DDCT levels. The possibility that DCT, a principal metabolite in humans, may prolong the QT interval in dogs has not been directly examined because DCT is rapidly converted to DDCT in that species. Subsidiary of Forest Laboratories, Inc. 2009, 2011, 2012, 2013 Forest Laboratories, Inc. Read the Medication Guide that comes with Celexa before you start taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking to your healthcare provider about your medical condition or treatment. Talk with your healthcare provider if there is something you do not understand or want to learn more about. What is the most important information I should know about Celexa. Celexa and other antidepressant medicines may cause serious side effects, including: 1. Suicidal thoughts or actions: Celexa and other antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, or young adults within the first few months of treatment or when the dose is changed. Depression or other serious mental illnesses are the most important causes of suicidal thoughts or actions. Watch for these changes and call your healthcare provider right away if you notice: New or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe. Pay particular attention to such changes when Celexa is started or when the dose is changed. Keep all follow-up visits with your healthcare provider and call between visits if you are worried about symptoms. Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency, especially if they are new, worse, or worry you: thoughts about suicide or dying new or worse anxiety or panic attacks feeling agitated, restless, angry or irritable an increase in activity or talking more than what is normal for you other unusual changes in behavior or mood Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency. Celexa may be associated with these serious side effects: 2. Changes in the electrical activity of your heart QT prolongation and Torsade de Pointes. This condition can be life threatening. The symptoms may include: 3. Serotonin Syndrome. This condition can be life-threatening and may include: agitation, hallucinations, coma or other changes in mental status coordination problems or muscle twitching overactive reflexes racing heartbeat, high or low blood pressure swelling of the face, tongue, eyes or mouth rash, itchy welts hives or blisters, alone or with fever or joint pain 5. Abnormal bleeding: Celexa and other antidepressant medicines may increase your risk of bleeding or bruising, especially if you take the blood thinner warfarin Coumadin, Jantoven, a non-steroidal anti-inflammatory drug NSAIDs, like ibuprofen or naproxen, or aspirin. excessive happiness or irritability talking more or faster than usual 8. Changes in appetite or weight. Children and adolescents should have height and weight monitored during treatment. 9. Low salt sodium levels in the blood. Elderly people may be at greater risk for this. Symptoms may include: confusion, problems concentrating or thinking or memory problems Do not stop Celexa without first talking to your healthcare provider. Stopping Celexa too quickly may cause serious symptoms including: anxiety, irritability, high or low mood, feeling restless or changes in sleep habits headache, sweating, nausea, dizziness electric shock-like sensations, shaking, confusion Celexa is a prescription medicine used to treat depression. It is important to talk with your healthcare provider about the risks of treating depression and also the risks of not treating it. You should discuss all treatment choices with your healthcare provider. Celexa is also used to treat: Talk to your healthcare provider if you do not think that your condition is getting better with Celexa treatment. are allergic to citalopram hydrobromide or escitalopram oxalate or any of the ingredients in Celexa. See the end of this Medication Guide for a complete list of ingredients in Celexa. take a monoamine oxidase inhibitor MAOI. Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid. Do not take an MAOI within 2 weeks of stopping Celexa unless directed to do so by your physician. Do not start Celexa if you stopped taking an MAOI in the last 2 weeks unless directed to do so by your physician. People who take Celexa close in time to an MAOI may have serious or even life-threatening side effects. Get medical help right away if you have any of these symptoms: rapid changes in heart rate or blood pressure loss of consciousness pass out take the antipsychotic medicine pimozide Orap because this can cause serious heart problems. have a heart problem including congenital long QT syndrome What should I tell my healthcare provider before taking Celexa. Ask if you are not sure. Before starting Celexa, tell your healthcare provider if you Are taking certain drugs such as: Medicines that lower your potassium or magnesium levels in your body Triptans used to treat migraine headache Medicines used to treat mood, anxiety, psychotic or thought disorders, including tricyclics, lithium, SSRIs, SNRIs, or antipsychotics Over-the-counter supplements such as tryptophan or St. John s Wort have or had seizures or convulsions have bipolar disorder or mania have low sodium levels in your blood are pregnant or plan to become pregnant. It is not known if Celexa will harm your unborn baby. Talk to your healthcare provider about the benefits and risks of treating depression during pregnancy are breast-feeding or plan to breast-feed. Some Celexa may pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while taking Celexa. Tell your healthcare provider about all the medicines that you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Celexa and some medicines may interact with each other, may not work as well, or may cause serious side effects. Your healthcare provider or pharmacist can tell you if it is safe to take Celexa with your other medicines. Do not start or stop any medicine while taking Celexa without talking to your healthcare provider first. Take Celexa exactly as prescribed. Your healthcare provider may need to change the dose of Celexa until it is the right dose for you. Celexa may be taken with or without food. If you miss a dose of Celexa, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of Celexa at the same time. If you take too much Celexa, call your healthcare provider or poison control center right away, or get emergency treatment. What should I avoid while taking Celexa. Celexa can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how Celexa affects you. Do not drink alcohol while using Celexa. What are the possible side effects of Celexa. Celexa may cause serious side effects, including: See What is the most important information I should know about Celexa. Common possible side effects in people who take Celexa include: Other side effects in children and adolescents include: abnormal increase in muscle movement or agitation possible slowed growth rate and weight change. Your child s height and weight should be monitored during treatment with Celexa. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of Celexa. For more information, ask your healthcare provider or pharmacist. CALL YOUR DOCTOR FOR MEDICAL ADVICE ABOUT SIDE EFFECTS. YOU MAY REPORT SIDE EFFECTS TO THE FDA AT 1-800-FDA-1088. Store Celexa at 25 C 77 F, between 15 C to 30 C 59 F to 86 F. Keep Celexa bottle closed tightly. Keep Celexa and all medicines out of the reach of children. General information about Celexa Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Celexa for a condition for which it was not prescribed. Do not give Celexa to other people, even if they have the same condition. It may harm them. This Medication Guide summarizes the most important information about Celexa. If you would like more information, talk with your healthcare provider. You may ask your healthcare provider or pharmacist for information about Celexa that is written for healthcare professionals. For more information about Celexa call 1-800-678-1605 or go to www.Celexa.com. What are the ingredients in Celexa. Active ingredient: citalopram hydrobromide Tablets: copolyvidone, corn starch, crosscarmellose sodium, glycerin, lactose monohydrate, magnesium stearate, hypromellose, microcrystalline cellulose, polyethylene glycol, titanium dioxide and iron dioxide for coloring. This Medication Guide has been approved by the U.S. Food and Drug Administration. 2010, 2011, 2012, 2013 Forest Laboratories, Inc. Principal Display Panel – 10mg/5ml Bottle Label - Oral Solution Principal Display Panel – 10mg Bottle Label Equivalent to 10 mg citalopram Principal Display Panel – 20mg Bottle Label Equivalent to 20 mg citalopram Principal Display Panel – 40mg Bottle Label Equivalent to 40 mg citalopram citalopram hydrobromide tablet, film coated citalopram hydrobromide suspension Kerxton Insurance Agency has been helping businesses and families in Washington, D.C., Maryland, Virginia and nationwide with their insurance needs since 1964. Farmer s Copper Ltd. maintains an extensive inventory of pure copper, bronze, and brass in sheet, plate, rod, bar, tube, pipe and fittings. We thank your company for a wonderful job. Our patio and landscaping are beautiful and we are very happy with the outcome. You were is great. Expect Green was. Who We Are. Eli was a man who stood for tradition, strength and the value of relationships. Henry is a man who is passionate about possibilities, working hard to. Random width plank flooring in country and select grades. Located in Woodstock, MD. Convenient Dining Locations In the Heart of Branson. Welcome to Branson s Best Restaurants We own and operate several restaurant in Branson that are conveniently. Alpha dot net provides a range of IT solutions to Australia including website hosting, connectivity plans, managed IT solutions, strategy and planning. Hello bhouse. It truly varies in as much as a individuals dose. Old tale, we all respond differently. As we age, our bodies are more in tune to the various drugs. More so in regards to psychiatric ones, because they work on the brain and as we age, this organ also ages. Your dose is high bit not uncommonly so. I know of where people are over often almost double or near, close to the FDA/manufacturers recommendations. I believe that once your depression eases, your doctor will decide what adjustment, if any she/he will perscribe. Just to add if you are feeling comfortable on the dose, and no side effects that are bothersome to the point of not wanting, willing to take the Celexa, I believe you will be fine. Regards pledge. Celexa official prescribing information for healthcare professionals. Includes: indications, dosage, adverse reactions, pharmacology and more. I am on 80mg of Celexa & I am 66yrs old. Is anyone else taking that amount of mg? JewelCode Corporation is the maker of CareComplete, a full service aging life, geriatric, and guardianship care management software solution that includes full. Common use Suhagrat: - Khwatin am tor se bhut sharmili hoti ha. Suhagrat ka name sunte hi sharm k mare chera Surkh ho jata ha. Suhagraat me ek ladki kya kare and kya na kre is bare me her ladki yani naidulhan janna chati ha. hum apni samajh se kuch tips is bare me de rahe ha but aap apni samajhdari se zaroor kam le. Rat her mard and Aurat ki life me ek Important Rat hoti ha. is rat ko yadgar rat bnaye. Suhagrat ki rat me biwi ko chaiye k wo apne shohar ki her bat ko taslim kare. Hesitation Sharm o hya k sath sath apne shohar ki her bat ka nai Dulhan ko zyada kuch nahi karna hota ha sirf apne husband ka sath dena ha. husband aap k jism se muhbbat karta ha to use karne de. Wo aap ke pistan ko hath lagyega aur use choose ga, dress ko utarega to aap use roke nahi mana nahi kare use apke jism ke har hisse se pyar karne de. biwi apne shohar ko her bat par tock ti ha to shohar ka mood sex se hat jata ha aur use ghussa ata ha, is lye apne shohar ko pyar kane me rok tok na kre. aap apne makeup I mean sajne swarne par khas dhyan de. Best dress and best makeup kare koi haraj ki bat nahi ha aur apni sharmgah ke hair ko remove zaror - First Impression good and best hona chaiye is k liye aap apni samajhdari se kam le. Achcchi dress ke sath sath under k cloth bhi behtar hona chaiye. me dulha dulhan sex karege to humbistari k bad mani bahar nikalti ha is ke lye mubashrat karne me biwi ko dard hot ha, but is pain me enjoy ka tadka bhi hota ha I mean ye pain aisa hota ha jisme lutf aur maza bhi hota ha is me masti bhi hoti ha is lye first time mubashrat ke dard se dare nahi aur apni suhagraat ko enjoy kare lakin sharm o haya ka damn na chode. Suhagraat In, Urdu, Hindi Suhagraat manane ka Tarika How to make sohagrat An important bat yeah ha ke agar first time suhagraat me aap ka husband aap. Woman Xxx suhagraat manane ka tarika hindi me. Bu kimi saytların sayı her gün artmaqdadır. Artisteer is the first and only Web design automation product that instantly. Suhagraat manane ka Tarika How to make sohagrat In Urdu Suhagraat manane ka Tarika How to make Suhagraat mean shadi ki pehli raat tips in Hindi, first time suhagraat me Dulha Suhagrat story: Her ek ki kahani. Suhagraat Manane ka Tarika Hindi SMS. suhagraat ka tarika. suhagraat ka tarika. Suhagraat Manane ka Tarika Hindi SMS. Fahrspaß pur mit dem Ford Ka. Dec 22, 2013 Suhagraat manane ka Tarika How to make sohagrat In Urdu. What is Answer these question In Hindi and Urdu language Blog. A question ling ki size. Wedding ke bad pehli raat I mean Suhagraat me jab first time Dulha Dulhan ak single room me single milte hain to Dulhan bhi dari si rehti ha and Dulha bhi kuch dara sa rehta ha but yeah her ak ki story nahi ha expert ke according 80 to 90 newly Dulha Dulhan Suhagraat me thik se sambhog nahi kar pate. Suhagraat Shadi ki pehli raat it mean first night main kuch boys, ladko ki yeah kahani hoti ha keh un ka ling sambhog ke lye khade nahi ho pata ha. saaf wording me yeah ke suharaat ki raat land sahi khada na hone ki problem kai logo ko face karna padti ha. so is condition me first kam yeah ha ke is bat ko dil par an le and mayoos na ho. Safal Suhagrat, kamyab suhagraat It mean successful suhagraat mana ne ke lye and sambhog sex me kisi tarha ki problem se bachne k lye aap ko apne man se heart se her type ka Dar nikal dena chaiye. Suhagraat me ling khada ho ya na ho is bat ko importance na dete hue aap pehle apni newly Dulhan wife se friendship kare. Jab new pati patni ke beech dostana friendship mahol paida ho jayega to is condition me automatic sambhog ki feelings paida hogi. And ling land natural tarike se khada ho kar lamba ho jayega. Suhagraat me sambhog sex ko start karne se pehle aap ko some time tak apni patni wife ko khoob excite karna chaiye, is k lye aurat ki body ke sensitive part jaise istan jise urdu me Pistan boobs kehte ha is ko dbane se larki sex ke lye tyyar ho jati ha and husband ka bhi mood sambhog mubashrt ke lye ready ho jata ha. Suhagraat wedding ke bad first time apni biwi se khoob romance bhari bate kare, romantic bato ke bad apni Dulhan ki dress ko utare and phir istan ko choose and body sharir, jism ke her ang hisse par kiss kare, der tak wife se is tarha kiss karne se shohar Husband ka mood sambhog ke lye ready ho jayega. Agar in sab bato ke bad bhi mard ka ling sambhog mubashrat ke lye suhagraat ke din khada na ho to is ka dosra ak reason shadi ki thkan bhi ho sakti ha matlab yeah ke wedding ki bhag-dord me neend sleeping puri na ho na and many tensions ki wajah se jism thak jata ha to is condition me pati patni ka mood sambhog sex ke lye nahi ho pata ha. Is lye agar suhagraat ki rat first time aap sambhog sex na kar paye to Don t worry, next day fresh ho kar tray kare easy tarike se aap apni patni ki yoni me apna ling dal sake ge. Best of luck for best suhagraat. Good luck for wedding. enjoy your wedding and your wedding life. Suhagraat manane ka Tarika How to make sohagrat In Urdu Suhagraat story and Suhagraat me wife se sax kaise kya Suhagraat ki Suhagraat Manane ka Tarika Hindi. Suhagraat manane ka Tarika How to Suhagraat mean shadi ki pehli raat tips in Hindi, first time suhagraat me suhagrat ki masti our is raat ka maza kaise. Oct 31, 2013 - in Suhagraat manane ka matlab ye uske boobs jise urdu me Pastan aur hindi me Istan kehte he ko choomna aur How to make suhagraat Top. Use that is common WILMINGTON NC S ORIGINAL PLACE TO SHOP. Hanover Center is a 320,000 square foot community shopping center, located in the geographical center of Wilmington. Sildenafil Citrate tablet What is this medicine. Generic Viagra is used to treat male Impotence also known as Erectile Dysfunction. Also, it has been approved by US. Convenient Dining Locations In the Heart of Branson. Welcome to Branson s Best Restaurants We own and operate several restaurant in Branson that are conveniently. Breeds. 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One of the premier Calgary hotels, located in the South, this full service hotel features 188 deluxe guest rooms, a conference center for. Welcome to the website for the EMBO Practical Course on Phylogenetics in the -omics era 10th – 17th January 2016. Common use Below are Topamax Topiramate reviews, ratings, comments submitted by patients and caregivers. Based on a total of 35 ratings/reviews, Topamax has an overall score. I took topamax for a couple of months and I can honeslty say it was the best thing that ever happened to me. I am 5 1 and i weighted 207; I now weigh 140. Madeleine Carter 18 Caradon Hill Ugley CM22 9ZQ 079 4521 6389 M.Carter highhouseproductionpark.co.uk. I took tompamax for awhile to lose weight and to control migranes. I only took 25mg though. I did lose a little weight because I could no longer drink pops or eat anything that was sweet. Things like that just had a horrible taste to it. My appetite didn t seem to decrease but maybe because of the small dose. I had a problem with balance and dizziness while on the med to the point that I could no longer that the medicine. My balance would get so bad that it was hard to be in a sitting position let along walking. Now I take Atenolol to control migranes it seems to work better than the tompamax. I took topamax for a couple of months and I can honeslty say it was the best thing that ever happened to me. I am 5 1 and i weighted 207; I now weigh 140. But I only took topamax for I would say 5 months. I was only 100 each day and it took everything away my appetite my sense of taste for any cola drink. It was awesome and it took away all my headaches. The remainder of the months I did by myself by exercising and just sticking with a 2000 calories intake. My goal is 130. Probably by next year in Feb. But thats ok it was a long road to get where I am. I Love it. i have been on topamx on and off for two years for migrains.i had just had my third child and within 5 weeks i was down 40lbs-but i did have alot of side effects-tingling, throwing up and severe stomache pains-but i didnt have any migairns-over the years i have figured out how to take this without having as many side effects-1 make sure to drink alot of water w/ it 2take it at night 3.stay away from dairy products-4 take a topomax vacation 1-2 weeks the one problem i can not get rid of is the fact that soda taste awful-so i just stay away from it I started Topamax in November of this year at 25mg a week and have been increasing the dose by 25mg per week and will reach 200mg next week to reach my limit. My doctor prescribed it for my migraines as I had requested it since all the other treatments seemed to have weight gain as a side effect while this one was the opposite with weight loss as a possibility. A year ago I tried Sibelium for 3 months and it worked but I gained 12 pounds in a month and a year later those pounds have not budged. I am now almost 6 weeks into topamax and as far as the migrains go nothing is happening yet, but it can take a few months to work so I will wait and see before I give up. As far as weight loss, I only have 10-15 pounds to lose, but I have not even lost a pound- yet my appetite has decreased significantly right from the start and my cravings are gone-go figure. I see someone wrote that their doctor said that weight doesn t start to come off until they get into 150-200mg, well I just started 175 so maybe I m not there yet, got my fingers crossed. As far as side effects go, they are definitely there. Tingly fingers and feet. My memory SUCKS. Just today someone asked me for my postal code i m canadian and I became tongue tied and couldn t say it and I m usually a somewhat intelligent person. I ve read that the side effects can subside if you reach the correct dose for your body so I m hoping that happens because giving up one s brains is really not worth anything. But like I said I ll wait this out for a bit and see what happens, probably two more months I think. i just started topamax last month im taking 75 mg a day i have noticed a decrease in my hunger i was having very bad headaces with meridia so the doc wanted to try this and i love it already im 5 4 and started at 189 i go to doc on the 9th im gointo see then how it has done good luck sallie I have had a wild ride with Topamax. I take it for depression as a mood stabilizer and started over a year ago, I am also quite obese and it immediately had a profound impact on my weight. I am, myself, a Family Physician and had never prescribed Topamax so I was quite interested in its effects on me. My psychiatrist rapidly increased my dose and I have to say that I also somewhat anxiously would occassionally take more than I was supposed to because I was hoping to lose more weight and I thought that if a little bit helped then a lot would help even more I was being stupid. Last year at this time I was taking 100mg a day of Prozac and 600mg a day of Topamax and occassionally even more. I started to become very manic, which I had never been before in my life, I was not sleeping and hardly eating anything and I was having magical thinking. I started to think that I had a special understanding of the universe that only a few people shared and that I could heal people by merely laying my hands on them. Then one night I completely flipped out, I went into a trance like state and I thought I was a messiah and the end of the world was coming and I was the savior, not Jesus mind you but on par with him. At first we didnt realize it was the topamax and thought I was just having a psychotic break. But eventually we realized that I was toxic on the topamax and that what had happened was that I had actually had a Partial complex seizure or a temporal Lobe seizure, that what the trance was. I stopped the topamax and all of that went away completely. I was back to normal-but slightly depressed. After several months I slowly started back on topamax at a lower dose this time sticking strictly to my Doctors instruction. I have occassionally had small episodes of partial complex seizures again usually after an increase in dose or if I forget a few doses and then start up again at the same dose. I also get the weird usual side effects of trouble with word finding and what not but I kind of get a kick out of those side effects, for the most part I really like Topamax, it has really helped me as long as I am careful with it but it can really pack a wallop. i went to the doc this morning,and i m down to 176. thats 13 lbs gone i think thats great. i realy like topamax.plus no more headaces.is anyone else haveing luck. I reached my maximum dose of 200mg Jan.6 and just recently it ll be 2 months since I started my initial dose of 25mg on Jan.18 I ve noticed a decrease in my migraines which is great. As well, since 175mg and up, I ve noticed a decrease in the stupid side effects, ie. my brain is functioning a little better which is nice as well. Unfortunately for me, no weight loss to speak of as of yet, but maybe it s because I only have about 15lbs to lose and possibly it only works when there s more to lose Or maybe it will start to kick in soon I m hoping. Good luck to everyone else. I was placed on Topomax for severe migraines. My migraines started when placed on Toprol Xl 75mg for a heart condition. I am now at 275mg. and have not had ANY WEIGHT LOSS. Everyone else that I have spoke to has had weight loss with the drug. I had a series of blood tests done and of course everything has come back normal. The only good that came from it, is I don t crave soda pop any more, but then again I hardly drank it anyway. I am not severly overweight anyway, but it would have been nice to drop about 20lbs. All my life I never had a problem with weight until I hit 25. Now I am 35 and can t seem to shed any weight. The topomax has done wonders for my migraines, and I am not that tired from it either, except for when I take it at bedtime. Any suggestions. Not complaining, but it sure would have been a nice little side effect. I know others have had more severe, and I just can t say enough about what it has been like to be migraine free. It s been 20 days since your previous post. Anymore effects to share. How about your weight loss progress. I would love to hear an update. Your post has me feeling hopeful about this medication. yes im still lossing weight. im not checking my weight at home im going to wait tell i go to my doc. everyone can tell now. i realy like this med. it has taken my heahaces away, and my mood is so much better. i feel like myself for the first time in a year1/2. and loveing the weight loss. are you on the med. I am not on the med yet. I have been on Cymbalta for a little over a year for depression. I have since gained about 15 pounds in addition to the other weight I had gained on prozac years earlier. After complaining about this common side effect of antidepressants, my doctor said he normally recommends 1 of 2 meds to help combat the weight gain. One is Glucophage normally prescribed to diabetics to control sugar absorbtion or Topomax. He gave me Glucophage last month, but I ve noticed no weight change. I have another appointment this week, and I m going to ask to try his second choice the topomax. Now, I must say that I am not majorly overweight, but the 25-30 pounds that I gained over these antidepressant years is miserable in it s own way. I ve even trained for and run a marathon and can t lose the weight. I m a bit afraid of the confusion that the drug may cause, but I m willing to try it. I do not have migraines or seizures. I only have night time twitches that my doctor doesn t even know I about becasue I always forget to tell him. I like this site very much. It is the best site that I have been on regarding ANY medication. Everyone is full of great advice and the sharing of stories is so appreciated. seems like your experience is the same as mine it s working great for my migraines, but I have yet to shed an ounce and I have now accepted that that is the way it is going to be. Like you, I only have 12-18 lbs to lose and I never did have a weight problem growing up, quite the opposite, just put the pounds on in this past year-I turn 30 in 2 weeks. When the doctor and I were deciding which prophylactic to try next for my migraines topamax was the obvious choice since every other med had weight gain as a side effect which is where I had gained my weight that I wanted to lose-such a viscious circle.. I have read that not everyone does lose weight so maybe we are two of the unlucky few One good thing for myself, though, is pretty much all of the side effects are gone and most days I don t even think about the fact that I m on the med. my mom is on a vaction in d.c. to see my new cousin.we are a family of 6 and could not all go. we sent her to a day and night to poplar spings inn and spa she is haveing a great time.my mom also owns her own daycare and preschool and runs it all she does not stop im sure she will get back to you when she come home on the 10th im responding for my mother she asked me to watch some things Karisa. I think you may be right about us being the only two. I have to say the side effects that I had with the tingling in my feet and stuff are gone. And my migraineswell no more. I have a follow with the neurologist in another month and I have had just a couple of break through headaches and some other people I know who are on it say he may bump me up to 300 which freaks me a little, because I don t feel so tired anymore on the 275 dose. Anyway, the good news is at least I can eat what I want and just maintain where I am at, but it would have been nice to lose the pesky 18-20 I have gained in the last 5 yrs. Good luck. I am just so happy not to have the migraines i am a 5 1 29 year old female who is 199lbs and currently takeing welbutrin. I have been for about 6mos. I was prevoiusly on effexor, and that med was a nightmare for me. I was very emotionless on effexor, and before i started effexor, i was a member of weight watchers and lost 40lbs, all of which i put on after starting effexor. Before starting weight watchers i was 212lbs. can you imagine. Anyhow, i am very depressed most of the time. I have to be fake alot around family and co-workers. But every once-n-awhile how i truely feel cannot help but peek its ugly self out to display for all to see, and i look a fool. I come from a family with mental illnesses. My mom has ocd,ptsd,who knows what else, my dad is bi-polar so i am bound to be effective somehow, right. lol My biggest issue in my life is my weight. I HATE HOW I LOOK IT S KILLING MY SOCIAL LIFE. IT S RUINING ME MENTALLYalong with other issues so, my doctor took me off the effexor put me on the welbutrin, and i initially lost over a year after being on no med at all, and 6 mos. of welbutrin 27lbs. NOTHING to be proud of. I tried every weight loss plan in the book. I even tried to be a contestant on the television show called The Biggest Looser. sent in a tape, must not have appealed to them as being needy enough nothing has helped. Welbutrin has curbed my appitite, but.. i do nothing in the form of dietor exercise. so i am back up to 199lbs. I slowly crept back to that weight. I do not blame Welbutrin for that. I blame my depression for that. So, now i have been having these headaches lately, god awful ones I go to see the doctor 2 days ago and she gave me this Topamax to start. I am kinda excited to hear about the weight loss side affect, although i will not hold my breath to it having that affect on me, my doctor put me on welbutrin for that reason, and look i am still obease. Ha Ha The joke is on me, Right. Maybe i am just destined to remain fat all my life.. i don t know. I read all these entries and see that it has helped most of you, but not all of you. Some of the side effects sound crappy, but i am gonna give this med a shot. What have i got to loose. lets seeMy mind, a few pounds, some headaches. lol I just took my first 25mg. tablet last night, so we will see what this tiny little pill is gonna do for me. Any words of support or advice are welcome. I am 61 yo female, heavy for many years. I started taking topamax about five weeks ago. I started with 25 mg one week, increased to 50mg second week, then 75mg third week, 100mg fourth week. Visited the doctor after the 4th week. I had lost 5 lbs by his scale. Then he increased my dosage to 200 mg. He said to increase 100 mg each week, but stop increasing or drop back the dosage if side effects bothered me. I have actually stayed at either 100 or 150 mg. I think I ve lost about ten to 12 lbs by my scale. I don t know if this is going to work as well as the doctor seems to think. He says most patients lose 10 lbs a month. If I lose that it would be great. I have not been exercising because I am recuperating from a double total knee replacement, but hope to start on a treadmill soon. I am faithful about drinking the water each day to avoid the kidney stones that are a very real side effect. I don t think I am going to be able to take a much larger dose than what I am presently taking. Anyone else have a comment on their dosage. I presently weight 218 lbs and I am 5 3. I would like to get down to about 160 to be healthy. Today is day two outta the way, on to third pill tonight. Can hardly believe that after only one dosage soda tastes like . I just bought a bunch of diet soda too. lol Oh well, the family can have it. So far there is no change in how any of the foods i have consumed have tasted, and i have not had any weird side effects yet either. Yippie.. But, i wont hold my breath, i am sure i am not one of the lucky ones to not have any side effects at all. And if i experience any side effects, and then have some that i do not experience, well, my luck says it will be the weight loss side effect that i will not experience, and i will experience all of the wacky ones. Oh well, right. At least the headaches will be gone. if i am lucky, which i am usually not. Well, i like this web page here, and i like to hear what this drug has done, and is doing for others, so please continue to post.. I will continue too. I will continue to update. not on a daily basis though, not to worry.lol. Take care Its amazing how Drs prescribe the dosage differently. My neurologist only did 15 mg increments because the side effects could be so dramatic for some people. I know its a touchy drug for some. As far as soda tasting like , it does. However yesterday home with an upset stomach, I drank Coke just to calm it. I did not care if tasted bad or not. I have been on it for 7 months and I my weight is maintained. I only go up and down between 5 s. I eat whatever I want. I am sure if I tried to diet I could probably lose the pesky 20 that plague me. I think its because I don t have that much to lose and that s why I don t. I truly haven t seen that much of change in my appetiteanyone else. I am actually more hungry which is strange. I guess everyone is different. LOL everyone. I must be that weird percentile, all I know is not having headaches is worth it though. Hope everyone had a good valentines day. I have been on Topamax for 18 mos. for migraine. I m 57 y/o have suffered from migraines for about 40 yrs. The Topamax has been amazing in the help it has given me: only 2 severe HA s since starting on the meds. But side effects have begun. At first I was constipated. I solved that w/ stool softeners. I have lost about 30 lbs. but my weight is now stable to within 1-2 lbs. It changes your metabolism as well as suppresses your appetite. The weight loss was good as I needed to lose just about that much. My regular dr. is very happy. Now a new problem: In the last 2 mos. I have started tearing excessively to the point that my eyes stay very red. My ophthalmologist has no answer other than to stop the meds. For me, that is the last option. I am taking only 50mg bid so I am going to start decreasing to 25mg bid gradually to see if that will help. Has anyone else had this problem and if so, how did you handle it. hello everyone.im wondering about the pins and needles feeling that goes all my body every once and awhile. does any one have side effects like that. im on 100 mg now. RE:hello everyone.im wondering about the pins and needles feeling that goes all my body every once and awhile. does any one have side effects like that. im on 100 mg now. Yes. I was given Topamax for migraine control after I stopped taking Nadolol. I started taking Topamax a little more than 7 days ago, 25mg at night before bed. I ve had all sorts of side effects, some I tried to ignore and blame on the recent beta blocker withdrawal I had from Nadolol. Now on my first day off of it. What really convinced me to get off Topamax was the 7th day dose when I went to 50mg at night. I woke up three hours later having a small anxiety attack and couldn t get back to sleep. So the side effects for me are the light headiness, tight back/kidney, difficulty concentrating, lack of sleep, dizziness, shivers, and anxiety. This medicine is not for everyone. Besides the Beta-Blocker withdrawals, Topamax is the only drug I Yes, I still get the pins needles effect but only in my feet. I notice it mostly if I sit for very long periods of time. It used to be very noticeable when I first started it then it went away. Now I only it get it when I am sitting around. LOL. I usually just get up and move around. That is a very common side effect and the first thing I asked the dr. about. Hope it gets tolerable for you. Good luck. This is a really good sounding board. A lot of the questions and concerns I had with the drug seems to be what everyone else has. I see my dr. in 3weeks. I have tons of questions again for him. Just glad the migraines are under control. So people say it suppresses your appetite huh Gosh, why can t that happen to me. Must be a mind thing for me. I need to ask my dr. about that one too because I sure haven t had that happen. Good luck all. I am new to this forum and thought I would share my story. I am on Wellbutrin XL 300 mg and Topamax 25 mg going up to 50 next week once a day for depression/anxiety. I was on Wellbutrin and Lexapro for two months, but that combination made me GAIN 10 pounds in a month. I felt like eating all the time, and it didn t make sense to me since Wellbutrin is supposed to cause weight loss. So the doctor suggested we pull me off of Lexapro those darn ssri s and try Topamax for mood stabilization and to help curb my appetite as you all know one of it s side effects is possible weight loss. Well I ve only been on the Topamax for 3 days and I can tell you right now it s working I have no desire to snack at all, until the afternoon I take it the night before, so the next day in the afternoon it s probably wearing off. I ll be bumping it up to 50 mg next week so I m sure that will help me in the afternoons. Anyway, that s my experience so far. I haven t noticed any other side effects except that I feel a bit drowsy right after I take it. No pins and needles yet, but I ll let you know if I get them down the road. Thanks for sharing all your experiences. It really helps knowing there s others out there you can relate to. Hi. I m new to the forum. I ve been reading it for a while and it s been very been very helpful for me. I ve been taking Topamax for a little over a month,100 mg a day I am also on Prozac 20mg for depression. I am 37 yrs old and have been dealing with daily migraines for over 25yrs. Finally some relief.. I love it.I have had very few side effects, some tingling in my heels, and coke tastes really bad. I have had some weight issues over the last several years, so I a hoping that losing weight will be an added bonus. My question is, does Topamax decrease your appetite or increase your metabolism. I ve been obsessing over this. I want to lose weight now. yes, I have OCD tendencies. Because I know that Topamax can cause you to lose weight, I find myself trying to eat less, but feeling hungry. I can t tell if my appetite has decreased or not because I am obsessing over it. Can someone please help calm my crazy mind, talk me through this. I have read that usually the dosage needs to be at least 150mg to to lose weight, is that what is really what is going on with me. My dosage would need to be higher before I would really notice it. Thanks for listening.. I was prescribed Topamax several weeks ago for depression. I specifically requested something that wouldn t cause weight gain due to the fact that I have about 50 pounds to lose. He started me on 100 mg to be taken at bedtime. I ended up quitting the Topamax after three days. I was so paranoid that I was afraid to drive. I had to pull over one morning to let my 16 yr old son drive I was so scared. At some point during the day, it does wear off because driving home from work is uneventful. I m thinking about starting them again but taking them earlier in the evening in hopes the paranoid feeling will be worn off before work time. I m nervous though because of some of the things I ve read. A plus is the loss of appetite side effect. I can definitely see why people lose weight on this. Has anyone else on Topamax had feelings of being paranoid and if so, did it improve. ive now been takeing Topamax for a total of 14 days 50mgs. I take my last 50mg tonight, and ten i start my 75 mg week tomorrow. 25mg in am, and 50mg in pm. My only side affects so far have been ones i can live with, i have a tingling sensation in some of my toes both feet once-n-awhile, ans the samealmost a numbness feeling in the tips of my fingers every once-n-awhile. But it is so very little, and does not last for very long, that i can handle it. Mentally, I FEEL GREAT.. i have not had a headache yet, pop tastes like . but it has not been that long for me to be on topamax, and the other thing i can live with, for sure i have very little appitite. I pretty much make myself eat 3 meals a day. I could care less to eat at all. That is great, cause it cut out ALL the snacking which before,i did ALOT OF I have lost a total of 6lbs in 2weeks. I am not sure if i posted what i weighed in the beginning, but, i am 5 1 was 199 2 weeks ago and now i weigh 193. I have boo hooed for too long about my weight, it has been the main source for my depression. I am done boo-hooing about it. Done being embarrased. gonna do something about it, and so what if a pill helps me, it is better than surgery risking death, just to be thin-not worth it. I know a mother/daughter who went to have gastric bypass done toghether, daughter made it everthing went fine for her, mother got some sort of infection from the surgery, never left the hosptial- died there. So if this pill helps me great. I will hold no shame in it. I also benefit two other ways mentally moods and medically headaches thanks to all for posting/reading.. this is a nice place to journal/get advice/just comment about how things are going for ya on the med. I enjoy reading. Oh and. itslaw ask to be started on a lower dosage, maybe that was too much for you initally to handal. You shaoud start out slow, and work your way up to 100mgs.. talk to your doctor. First off miketish congrats on the weightloss.. That is really good news for you. Second I agree with what you said for Itslaw, 100mg seems like a pretty high dose to start out with. I too would check with your dr. Does anyone do any diet restrictions while on topomax or do you just eat when you are hungry. I am very curious. I know that I don t have as much to lose as others and I am not on it for weight loss, but like I have mentioned I would not mind dropping 20. Also, I too am curious if topomax affects your metabolism or your appetite. Does anyone know. If not, I know I see the dr. for a visit in a few weeks. Also, does anyone experience on the higher dosage at bedtime which is when I assume you take itabout 30 minutes after I take it, I am in lalala land. Is that the norm. I mean I don t wake up until the alarm goes off. I have no answer to your question, but if you get an answer, please share. i am eager to find out too. i do not get the la la land feelings honestly, it is the other way around, i cannot sleep very well. Which i am none to thrilled about. But, i have not had any other side affects oh. i lie. today, i am realy gassy lol and, i have no idea why, i do not eat much. What i eat is not all that bad, and it is not in a big quanity. I have lost MUCH of my appitite. I think it the gas may be a side affect, but if it is not, i just embarrassed myself here lol oh well. Keep me posted on how you re doing, and what your doctor has to say about the whole metabolism thing. Good luck oh, and just like you, i am not on it for weight loss, but would love to loose some weight. I am gonna not be so bashful and out loud hope for a loss of about 50lbs.. Hi. I ve been using topamax for about 3 months and I ve had great results. However, the side- effects are great I ve dealt with pins and needles in my hands and lips, shivers, back pain, being tongue tied and the best of all weight loss. I found if I drink all of H20 it decreaces the tingling in my hands and lips and I mean alot of water. Since being on Topamax I ve lost 25 pounds. It s a bit frustrating becauce my taste buds have changed and soda taste terrible along with coffee,mint toothpaste and orange juice. But I ll give up anything to get to my pre-pregancy weight. I ve enjoyed reading everyones challenges with topamax it makes me feel like I m not alone. Thanks to you all. This is my second time with Topamax. I was diagnosed some time ago with bi-polar - still not quite sure if I agree with them on that. I do however agree that I have mood swings. The first time around I was on Epival used as a mood stabilizer but is also an anti-convulsant as is Topamax and had Topamax added while going through difficult times with a live in boyfriend. Without going through a long story of the cheating , I was placed on topomax to help me with my mood swings and depression. I can not say if it was the topomax, the situation, the lack of eating or the combination that made me spin out of control. I was definitely paranoid without question. When I look back on it now, I think that I should have started out with 25 mg and worked my way up, even though I believe I only started on 50mg. My body is really touchy to anything I put in it. I eventually leveled off. I went from 145lbs to 118 I looked anorexic, but again, this had much to do with the situation I was in. I stayed on Topamax for nearly 3 years and weaned myself off. I kept thinking about one day having children and how it might affect me. My weight crept back and I got myself into a number of other situations that need to be dealt with once again - the story of my life. So here I find myself in the worst shape of my life - oh, did I mention I was a personal trainer. - needing to lose the weight, as it rules my life or I allow it to and get the rest of my life back on track. I started with 25 mg last Wednesday night 1 week ago and pushed it to 50 mg last night. Definitely have the numbing head sensation, a little tingling and anxiety. Has not helped my appetite . yet, I am really hoping it does, as that is the main reason I went back on it. I am also trying to watch what I eat again. Back to protein and veggies and fruit. Have to up the water. NOTE: Something that I found strange that no one has mentioned is how to alleviate some of the side effects. The dumbing effect, can be alleviated by taking 3-5 mg of Folic Acid, which anyone taking anti-convulsants for something OTHER than epilepsy should be taking anyhow. Add Salmon Oil 1,000 mg - 2,000 mg and 1,000 - 2,000 mg Vit C. The folic acid is the key. I will keep you posted on my weight loss. I also want to get back into my fitness modeling so lets hope this works. All the best to everyone and I am glad that T-max is working for many of you. hello every one went to doc this morning. he wants me to start taking 200mg now, ill start today. ill let everyone know how its going. the numbness,pin,and needles feeling was just starting to get better. Hi.again everyone. I went to see Dietitian the other day and she is so pleased on the results of the topamax. Let me back track a little I promise It ll be a short one. I was sent to my Dietitian from my Endrconologist for my thyroid;they found that I had high sugar so they had to put me on a low-carb diet like that helped. anyway, my Dietition found out that I had been on Depakot for 9 years and to my surprise the main side-effect is weight gain and of course, my dr. had faild to tell me that so here I am my last visit at neuro. I demanded new meds. and by golly I got it. To make a small story short the reason why I m sending this note is I have some imfo. from my Dietition on topamax she says that it can cause Anemia and it can decrease white blood cells if you all don t know. Talk to your dr. because I had blood work done for my thyroid and it should that I was on the low end of being Anemic. Take care Thought I d give you an update. If you are recently new, I am on Wellbutrin XL 300 mg 1/day and topomax; current scrip is 50 mg 1/day I take 1 25 mg in morning and 1 at night. Although I am overweight, my main reason why I am on Topomax is because of my depression/anxiety, or maybe bi-polar the doc and I am in the middle of figuring out which one I am, ha ha... I will be moving up to 100 mg of t-max next week. I have been dealing with depression or something of the sort for 6 years right after my second child was born i couldn t snap out of PPD. I am a married, stay at home mom of 3 children ages 2, 6 and 9; one of which is ADHD, AND my husband is also ADD wow that enough would make a normal person crazy, right. I love all of them dearly and that is why I am so desperate to get the right dosage so my sweet family can have their loving mommy and wife BACK. They have been real troopers through all this, God love em. Like many of you, I ve tried almost everything the pharmaceutical companies can dish out for depression, but I never felt 100. It knocked out the depression, but I still had feelings of rage, anxiety, then euphoria, and at times I could conquer the world give me a break.. Does that sound just conceeded or what.. Finally I decided to dump my old doc and shop for a new one, and boy am I glad I did. Now I am in a whole new ball gameI didn t even THINK that maybe, just maybe.I may be bi-polar it wouldn t surprise me, since after some research into my roots I found several ancestors who had mental disorders. For 6 years I wasted my time and on SSRI s that just gave me headaches and a weight gain of 50 pounds. That could give you depression just in itself. All this time I thought I d developed really bad eating habits, but now I know better. I at least walked 2x/week and made nutritious meals for my family and even though we ate out once in awhile, it s not like we stopped at McDonald s 5 times a week. No wonder most of us here who ve tried other drugs are elated to see that Topomax is helping us reclaim the bodies we had before taking those other drugs. Okay..I m off the soapbox now. Oh, and by the wayI ve been on Topomax for 2 weeks, and I ve lost 3 pounds. Whoopie. I have also noticed that my moods are so much better, just in a matter of a few weeks. My husband has too. We went out with some friends last night and he couldn t believe how happy I was. I couldn t stop laughingI had such a great time and hey guys, I don t even drink alcohol. Don t get me wrong; there have been some bad days. You re going to have those days while your body adjusts, especially if you ve been on one kind of medication for years. Remember-- I was on SSRi s for 6 years and then switched to Wellbutrin and Topomax that control two different areas of the brain. Believe me your brain is going to go uh..what happened here. where s my ssri..I m crabby. I want my ssri I can t wait to tell my doctor about last night. He is going to be so excited. I asked my husband this morning if I was too crazy on our date like to the point of embarrassing him and with tears in his eyes, he told me, No wayI am so happy to see you this way honeyI can t remember the last time seeing you this joyfulit s wonderful. sniff sniff. . Okay I ve babbled enough. I am just so happy today that I can t get it out fast enough. I hope it stays and it s not just a fluke.not just for my benefit, but for yours, too. We all need some faith promoting stories to keep us going, right. Until next time. after I go to 100 mg well i went to the doc yesterday. i have only lost 1 lbs im looking at it in a positive way. i went on vacation for 2 weeks, ate what ever i wanted, iv been under alote of stress too. i had to leave my dad in the hospital in d.c.on our vacation and he is still there in te hospital and im back homein IN. so 1 lb is ok. im now on 200 mg a day. well I met w/ my dr. on Mon. and everything went pretty well. I am pretty well stable at 275mg. We agreed not to change the dose even though I have had a few break threw headaches. As far as the appetite goes he thinks its related to the toprol I take for my heart arhtymia sp. At least I can eat pretty much what I want and not gain anything so I guess I should be happy with that. Once the weather warms up in my area, I agreed to start walking a little bit more and he thinks that will help with getting a few pounds off. Other than that I really don t have any other adverse side effects accept when I take the drug I can pretty much say that within 30 minutes I am so ready for bed. Sallie sorry to hear about your dad hopefully nothing too serious. And what a positive attitude about losing 1. The rest will come off. I am sure of it. Good luck. Hello everyone. I have found this site to be so helpful and comforting. Everyone s comments about Topamax have been honest and supportive. I will start Topamax at the end of the week mainly for weight loss, but I have been on several anti depressant meds for 3 years and like many of you have gained about 50lbs. I can t stand myself anymore I am saying a lot of prayers hoping I will be one of the lucky ones that will experience weight loss. I m really nervous about the side effects and with my job I can t afford the memory problems and mind foggyness. I will return to the site as soon as I get started and share my experience. Hang in there everyone. I been reading your posts and think it s wonderful how you support eachother. Last night was my first night of taking topamax. I am taking it because the medications I was on were making me gain too much weight and the weight has been physically hurting my back and bone structure. I think it was too fast and my bones and muscles didn t have the time to develop to hold it. I was taking seroquel and still am taking cymbalta but i ll slowly taper off of that. I m so glad. This topamax is also supposed to help w/ sleep. I hope so. My first impression this morning, was lots of nasea and no desire to eat. Also overwhelming fatigue. But I moved a truckload of boxes w/ my boyfriend up 4 flights of stairs and I have Fibromyalgia so who knows what is what. I am very glad that I a will have a place where I can be w/ others that are taking the same medication I am. I have been on Topamax for about 4 months now for migraines. It has helped tremendously.. I had put on some weight since I had my last child which was 2-1/2 years ago. I am now 42 years old. I must say it has been a bugger getting the weight off, but since being put on the Topamax, the weight has all but fallen off pretty much effortlessly. I do exercise a bit about 3 times a week on my elliptical machine and I watch what I eat. I try to stick to a low-carb, high-protein diet. When I was put on the Topamax I weighed in at 170 pounds and I am 5 feet 3 inches, so I was definitely overweight for my height. I know weigh in at 148 pounds. Plus, I am pretty much headache free besides. I love this medication.. It is the best. I hope they do not take it off the market because if they do, I will just CRY MY EYES OUT FIRST AND FOREMOST because it has helped me for my migraines which I have suffered from for over 20 years now I have had them chronically for 7 to 10 days out of every single month which put me bedridden. It was a nightmare. I began at the 25 mg mark and it took me about 3 months or so to get up to 75 mg twice a day so I now take 150 mg total and that dosage seems to be working for me. My question is how long can one stay on this medication.. I think my doctor told me indefinitely.. I am just wondering.. if you stay on it forever.. does your weight start to stabilize or do you continue to keep on losing weight.. That kind of scares me.. because I know one can get too thin I have been at that point in my life and it is scary.. Any comments would be appreciated. Have you heard they are going take Topamax off the market. That worries me. I just went back on it after being off of it for 5 months, during which time I began obsessing about food again and other things. I lost weight about ten pounds last time but stabilized when I hit the mid 130s, so I don t think you ll just keep losing as long as you re still eating. I always found that I still eatI just don t crave the extra. Although, sometimes I find that I am hungry but crave nothing. I think it takes you re appetite away but not you re hunger. I am pretty sure you can stay on it forever, as long as the side effects don t bother you. I finally felt the tingaling this morning after five days and was relieved to know the pill was working --- I was worried because I felt nothing. I don t have the cognitive effects though. Has any one had hair loss. My headaches came back now I think they are under control again.this post started in dec of 05. I m now 115 from 189.I have lost alote of hair in the year. I have filled a gallen and 1/2 baggy. I was just prescribed topamax today with a dosage of 50mg daily for the next month. My doc said he will increase it monthly. I have been taking depression meds for years. I started on prozac, which had too many sexual side effects. Then I took paxil for two years and gained 70lbs. I got so mad one month and quit the meds cold turkey and lost 50lbs in one year. Then I got pregnant and gained back the 50lbs. I got severely depressed after my son was born and was put on wellbutrin. I currenlty take 400mg a day. I also take. 5mg of xanax as needed. Wellbutrin helped, but did not take all the depression away. My doctor decided to put me on a low dose of celexa to supplement the wellbutrin. I gained 30lbs in two months. Today he gave me topamax to see if it helps me lose some weight. I currently weigh 210lbs. I really hope it works. I am so depressed without the meds, but the weight gain depresses me in a whole new way. I used to weigh 118 before I ever had a baby i actually have two children or took any medicine. I am currently taking Seroquel for sleep and anxiety. I have gained 18 pounds in 4 months. I am 6 tall and now weigh a wopping 215 lbs. That is an all-time record for me. Anyway, my doctor is suggesting prescribing topamax to suppress my appetite, since the benefits of the seroquel are so great for taming my underlying anxiety and mood swings. I also take focalin for ADHD, which has typically suppressed my appetite at least a little in the past, so the constant hunger pains are a new feeling with the addition of seroquel. My question is has anyone else taken the combination of seroquel, topamax and focalin or any combo therein. I am curious as to what your experience has been. Thanks. Hi, I have been taking topamax for migraine for a little almost three weeks, will increase to 75ml tomorrow. I ve noticed I have no desire for alcohol and I used to drink daily, so I guess this is a good this. Soda or anything carbonated tastes horrible. My appetite has decreased and I ve losts a couple pounds 2 or 3. I m thirsty all the time. I m having a little short term memory problem, but not too bad. And Im experiencing some sleep issues some nights and others nights I sleep really well, but have really strange dreams. I m hoping to lose about 20 lbs, but it s not just falling off, that s for sure. It will start to come off nowthat is the way mine started. I was put on topamax in late April for migraines. At first the only thing I noticed was a few pounds and that I was not drinking my constant Dr. Pepper anymore because I could not tolerate the taste. My dr. started me low and at this point I am up to 300 mg. a day that I take at night and have lost a total of 57 lbs. It continues to come off and I am very happy with it. I do notice the short-term memory fuzziness usually when we change my dosage and then it levels out. Overall, I am very happy with this medication. I had put on a lot of extra weight with my three pregnancies and that is almost all gone. My migraines are not running my life. 4 Years ago I was prescribed xanax,lexapro,Welbutrin for PDA panic attact disorder and despression. I am 5 2 and weighted 115. Then 3 years later I was put on topamax for migrains. I now weigh 200lbs. and have just weined myself off the xanax lexapro and welbutrin. I am praying that as soon as the medication gets out of my system the topamax will kick in. I eat very healthy take walks. From what I have read lexapro and most anti depressants slows down a persons metabolism. I also am going to talk to my dr. about a low dose diet pill for 1 month to jump start me into losing the weight. I will keep everyone posted. I wish you all the best. I have been on a 100 mg/day dose of topamax for several years to control my migraines. I am 5 2 and weighed about 115 pounds when I started taking topamax. While the headaches were reduced in both frequency and severity almost immediately, I didn t notice any change in weight or appetite. Then about four years ago, my metabolism seemed to change and I dropped to 97 pounds in about 6 months. I attribute this to the topamax since I am otherwise in good health. My weight has stayed constant at 97 pounds so I don t think those who are losing weight on topamax need to fear getting too thin. Background: 42 yr old male..Killer migraines started a few years ago and have been getting worse, Doc put s me on Prozac and all was fine for a while, then they start again. Up dose, doesn t help. Pharmacist sis-in-law talks to me about Topamax and I begin to research. I am very overweight 300 and like the idea of losing migraines AND weight. Most people comment on how bad soda tastes, implying many of you drank lots of soda before taking Topamax which I don t drink which could account for a serious drop in water weight from not drinking soda alone.. Does the drug affect the taste of sugar in general. Could weight loss be due to not liking the taste of certain foods or do you feel it s a metabolism issue. Who has been using it the longest. I will go to my Doc as soon as I am convinced it will really benefit me. If this drug can kill two birds with one stone I would be soo relieved. Topamax has truly been a wonder drug for me. My migraines had progressed to daily episodes for 5 weeks and it took being on Topamax for 1 1/2 weeks before it stopped almost completely. I have breakthrough headaches, but nothing like the migraines. I ve lost a little weight. I m at 50mg and holding. My dr. told me I could go as high as I wanted to. To just stop at whatever level worked. My question is: Do you experience more weight loss/better results at higher doses. or just worse side effects. My side effects are occasional tingling of hands/feet. I ve had an occasional cramp in the leg. I did have some mood swings in the beginning but those stabilized. I haven t noticed anything else. Great relief from debilitating migraines. So happy not to have to go down the opiate road. But I do miss my Cokes. yes i been on topamax for 6 mos foe mood and wellbutrn xl i take both and i lost 14lbs in 5 mons I ve been on 200mg of Topamax per day for the last six months. I think it is a wonder drug because I have been migraine free AND I have dropped over 20 pounds. is anyone taking topomax just for weight loss and no other reason. i am interested in trying it and would like to know how it affects healthly adults age 50-60 years of age. I am 5 2 i weighed 138 about 3 months ago i am now down to 112. What happens if you drink while on it. I just took the first dose of 50mg tonight and will continue with 50mg twice daily tomorrow. Soda tastes horrible and some foods are taste bad but I still have my hearty appetite. I am drinking a lot of water, taking stool softeners, and a multivitamin but I am getting horrible heartburn since starting Topamax. When did most of you notice your appetite reduction higher doses. I started Topamax for migraines 3 evenings ago. I am taking 25mg every night before bed for 7 days, then will increase to 50mg for one month, then to 100mg for a couple months, then take it from there. I am 5 2 and weigh140, which may not sound like a lot but I am very small framed so I m not built to be a heavy-set woman but gained weight after starting Lexapro. I would be happy to drop 20lbs but it doesn t seem to be happening no matter what I do with Lexapro. I also take Wellbutrin and have taken Wellbutrin since I quit smoking in 2006. I experienced no weight gain at all with Wellbutrin but Lexapro was another story. With the topamax, I really haven t noticed any side effects, I have had some mild diarrhea and stomach problems, but I m lactose intolerant and have a VERY touchy stomach so that may not necessarily be the medication - it could be anything. I have not noticed any difference in tastes, smells, or any difference in appetite at all. Is it only in higher doses. Does it take a while. Oh, and I take Topamax for severe migraines. it has been a little over a week now since I started Topamax. I increased my dosage to 50mg daily a couple days early because I wasn t really having any bad side effects that other people were talking about. I have NO loss in appettite yet, so again, maybe that will come in the higher doses.. Who knows. But, I haven t had any migraines. But, I have had headaches since I have started on Lexapro, since then I have tapered myself off and been off for a couple days now, and starting to feel good again. Still on my Wellbutrin, have no need to stop that. I have Tourette s Syndrome and just started taking Topomax on top of Klonopin and immediately can tell the difference that it it helping with the sniffling and snorting from the Tourette s - I am at 25 mg and will go up from there soon - am also interested in losing weight - My neurologist put me on it and told me if I get the tingling in my fingers that Gaterade will take it away - a TON of water MUST be drunk every day or it will cause kidney stones and for me, very SEVERE leg cramps at night - thought I was going to die the first night I took my first pill - couldn t straighten up even. Hope I lose some weight, but noticed immediately that I have very little desire for sweets and am just generally in a much better mood with more energy.. Love it.. I m 24 and have been struggling with migraines since I was about 16 or 17. They got much worse when i hit 20 just like my mother and then really really bad when I got pregnant July of last year. I had migraines for weeks at a time and there wasn t much I could take because I was pregnant. My OB would prescribe me percocet because it was the only thing that would give me any kind of relief. I gave birth March 21 of this year and since then they have gotten a little better but I still get them. I ve tried a few different things but nothing seemed to work. I just started Topomax on 2 days ago this evening will be my 3rd, just 25mg a day for the first week, then 50mg a day for a week, then I call the dr. and we ll either increase it or keep it the same depending on the effects. I had a little bit of tingling but nothing major. I m excited to hear about the weight loss thing though because I gained 70lbs with my pregnancy. I m 5 8 and before i got pregnant i weighed 135lbs and when I gave birth I weighed 205lbs. I am down to 145 so I d like to get rid of the last 10lbs. I hope this works. Topomaz I ve slowly lost a few lbs. a month over the last few years. A total weight loss of 55 lbs I ve been on 50mg morning and 100mg night. but I have not lost any weight for a year now and have a few breakthrough headaches maybe I need a dose increase. I have been so happy with the Topomax for severe headaches and neck pain after fusion of my neck I was in agony. The weight loss was an added blessing I m in a wheelchair and can t exercise much. It does affect your appetite and interest in food it s a great side effect to a great medication. I ve been taking 100mg/day for about 7 months and not only am I mostly headache free occasionally a migraine can be triggered by a sinus headache I have lost 22lbs. I still experience the occasional tingling in my hands and feet but overall had very few negative side effects after the first month of slowly weaning onto the full dose. I never had an issue with memory loss. It s true soda tastes flat but I deal with it and I do notice that I still eat far less than I used too. I m just not as interested in food. The only thing I didn t like was the way it effected my energy levels. I used to work out 2 hrs/day with minimal weight loss results, mind you and within days of starting on topomax I could barely make 3 steps without feeling completely fatigued and to this day I have little motivation to do more than walk a few miles, but the weight came off and at least I am working my heart. I love topomax. It s given me my life back. The migraines were debilitating, the weight loss was a pleasant side effect : My physician just prescribed me Topamax to fight my ongoing headaches not migraines but chronic sinus/tension headaches that have not even alleviated after surgery and nasal steroids, my generally high level of l moodiness and anxiety, and the negative and related issue of chronic insomnia. I ve read competing reports, however, regarding the effective use of Topamax in the realms of the treatment of anxiety and insomnia--indeed, some patients report that Topamax actually increases rather markedly the experience of both, usually in diametric accordance with increases in medication. While Topamax seems to be fantastic in terms of treating headaches-migraines as well as simultaneously granting most patients some weight-loss potential, it seems as though many patients also express concerns regarding brain fog/short-term memory loss and mild-to-severe bouts of anxiety or paranoia. Physiological side-effects that appear to have caused intermittent cause for concern also include various levels of tingling sinsations throughout the body, usually within the extremities, as well as worries over kidney stones, digestive system pain and associated problems, and reported cases of hair loss. My doctor informed me I will only be only a very low dose, topping off at only 50 mg a day. Does anyone know what side effects I should expect to experience at this dosage. I typically have a very strong stomach but worry a great deal about any reports that Topamax exaggerates or causes anxiety or insomnia as I am already accomplished in both arenas. I also do not have the patience to deal with the Stupimax -Memory Fog effect or hair loss issues so hope those who have taken Topamax might comment on their experiences so that I might have a more enlightened view of this medication and its effects or non-effects in these areas. Thanks so much for your time. And thanks so much for this open dialogue--it s so much better than the crazy drug blogs I ve stumbled across online the supportive vibe is really positive a great standard other websites should try to replicate. I have been using topamax starting at 50 mg first week then 100 mg 2nd week my orders not doctors LOL tomorrow I go to doctor appt for follow up - he needs to increase me as the migraines are coming back slowly. Had a big one yesterday. Weight loss I know a week ago I had lost 10 lbs. this week I dont know yet. but yes I feel alot of pins and needles and mental fogness. My husband calls it my dummy pill lol you just have to stop and concentrate a little harder, but the bad side effects do fade away little by little,week 2 is better than week 1, so I assume it gets better. I am looking to lose 40 unwanted lbs I gained on anti-depressants, NEVER AGAIN will I take that junk-o-pills..waste of time and I can t take the weight off for my life, so this not only will help, it will take away 25 years of migraine suffering. My doctor calls it MY MIRACLE PILL.I will check in tomorrow with weight results. I started at 171 lbs 5 5 FT tall It sounds like I m having a situation similiar to yours. I ve taken topamax 100 50 twice a day for 3 and a half weeks and haven t lost a pound. I feel as hungry as usual. Guess that means the drug doesn t give me that great side effect. Do you agree. Oh well. I am now on 150 mg twice a day 300 mg a day. because of summer approaching the migraines seems to be getting a bit stronger so doctor increased it. Weight loss has been about nomore than 15 lbs in total. nothing major and its been what. 3 months I ve been on it. So I decided to go back to the gym which is helping a great deal. pins needles I still experience frequently but the mental fogness is wearing off a lot. I do loss the word I am about to say quite a lot, but it comes to me. concentrate is the key word people I love this medication and after years and years of every over the counter migraine medication and every prescription given to me - this has been the only relieve I ve had. Since I was 6 years old I ve been having migraine headaches. Im a 35 year woman now and I can finally live a normal life. I will live thorugh the side effects before going back to migraine headaches anyday I started taking Topamax 50mg twice daily then moved up to 100mg to control seizures. I have to say that the difficulty concentrating did play a big part in my reluctance to try the drug. Im a college student and I really didnt want to have anything hindering my chances of me finishing school. I suffered from depression and had gained quite a bit of weight since highschool. I was up to around 200 lbs which isnt extremely bad, but when I looked at the BMI calculator and I saw that I was officially classified as obese I just sortof lost it. Its hard to lose that weight when you are already doing everything that you think you are able to do. Im not some health nut that can run a marathon every morning before work and still be okay to do everything else too. Ive been on Topamax now for about two school semester now. To be honest it was a slow start and then it picked ut. But I didnt change anything extra. I havent had time to hit the gym because all my time has been used up at work or at school. People have said that they arent as hungry on topamax, but Im actually hungrier Somehow Im still losing weight. The only thing that changed is I dont drink soda now. Only because I cant taste the carbonation. Now I just drink water, because frankly I might as well. It kindof urks me when my friends are around me and they all drink sodas and they they order me a water like Im too good for a soda, because god, sometimes I REALLY want one but yeah thats the way the cookie crumbles I guess. I ve lost 60 pounds since the fall. Thats not some inflated number to give people hope. I have lost over 10 inches off my waist. Ive gone from wearing a 40 waistline to having a 28 waistline. The weightloss is great, but I will warn you that it went really really quick like the skin has no where to go and although I feel lighter and a bit less ashamed about my weight. I still wont go off showing my body because I think my skin looks gross. Once I noticed how quickly I was losing weight I started using lotion that pregnant women use for their skin, but still. Its something to watch out for Hi, I m Jenny. Just had my third dose of 50mg Topamax last night and tonight will be number four. I ll increase to 100mg in 2 weeks. Started on it for both bipolar disorder and bulimia. So far I ve got pins and needles in my fingers and face and trouble sleeping. A little tired during the day. Havent tried soda. Food tastes ok, but I just don t want to eat. I m physically hungry but no appetite. According to the scale I m down about 3 pounds. Started at 132 so my weight really isnt a problem either way. Have had a tiny bit of memory loss but it hasnt been bad. Just hope the side effects not the weight loss don t get worse. I ll keep ya updated. I have been on Topamax for about 10 weeks. It has been kind of a crazy ride for me. I am attempting to stick it out however. I am having quite a few side effects from it and still waiting for the migraines to improve more. I have to put one warning out there though. For those of you that do experience the loss of appetite from it. PLEASEmake yourself eat. I am starting out very obese myself. I started 10 weeks ago at 264 pounds. I am one person that is very greatful for the weightloss. As of this morning, i am down to 222. Yes, that is 42 pounds. BUT, let me warn you, my body is starving itself. Even if you don t feel like eating, force yourself. If you don t feel like drinking, force yourself. This is a wee bit scarey. Weight loss is nice, but don t sacrifice yourself and your health. I m relieved I found this forum. I started 25 mg. 1x day working up to 100 mg 1x day Topomax last Sun. 5 days ago and feel soooo tired, but no migraines. My appetite has about vanished, which is a great side effect, but my family is freaked out about my having to force myself to eat and not enjoying much of anything. They think it s odd because I m 265 lbs/ 5 7 and normally love to cook eat and not crazy about exercising. I have tingly feet and hands, but sounds like a common side effect, that I hope disappears along with the diarrhea all day long. Did I read avoiding dairy helps. I will try that. It would be a double blessing to have the migraines that have plaugued most of my life go away and well as lose about 100 lbs, but I hope to combat the awful tiredness and lack of concentration. Maybe coffee instead of diet colas. which I was addicted to and taste kinda crappy now. Best wishes to all topomax buddies. so ive started topamax recentlyonly 1 week agoi am taking 25mg 3X per day for a few different reasons1:bipolar disorder 2:migrains 3:Anxiety 4:Depression 5:obeseity. i have not noticed any symptoms like loss of appetite or numbness or tinglingi know it works wonders for my migrains and im definitely less snappy but im aa little concerned with the confusion, weather it ever goes away or gets better after body gets adjusted to the medsi dont know how i feel one minute to the next or what i want and its funny that i have found everyone posting about the pop tastes, i had fountain pop today, something i usually enjoy and it was awful. my mother said it was actually better then normal.something is wrong there, lolim not complaining though, i do need to back away from sweets ive struggled with my weight fom all my life and when i found out this drug will also help me lose weight i couldnt wait to get startednow i cant wait to see some results, most my depression comes from lack of self love, i despise my body view and cant wait for a new mirror.im just wondering, does this work for everyone I recently started taking Topomax for Migraines. It has been one month. I started with 25mg once daily. No headaches..only pressure and throbbing in my head 3 times this month but NO pain.. So doc and I decided to increase dose to 25 mg 3 times daily. I have lost 5 pounds on the low dosage and hope to lose more could stand to lose 30 more actually. I have cut out all carbonated beverages do to the change of taste side effect. All carbonated drinks taste like flat metal. My Dr. put my on Topamax last summer to prevent my migraines, which it has done wonderfully. In a little under a year I lost 145 pounds. I am no longer pre-diabetic and feeling alot better about myself. There are some side effects that I have noticed like tingeling sensation running up and down my arms this doesn t happen often and it last a short period every once in a while, and I sometimes have trouble recalling words I know as well as my own name. However, in my book, these side effects are worth dealing with for all the benefits that I have received from taking Topamax. THANK YOU TOPAMAXYOU SAVED MY LIFE. I have recognized that I am depressed, over weight suffer stupidly with irritability and anxiety and wanted to take topamax Im also over weight I have been to the GP who prescribed me a medication, I haven t taken as I don t want to gain weight plus it states I cant drive. I would love to take a medication that enhances my mood makes me lose weight, I have never taken any medication at all before for depression, I wanted to take 15mg and just stay at that dose I don t want to increase it. whats ur advice on me taking these topamax. hello everyone, I am a severe migraine sufferer have been since the age of 15, my attacks are very intense usually end up in the hospital on an ivy, my days consist of worrying about my next attack and wondering when the next one will come, my boyfriend seems to think that they arent as bad as they truely are. I have been prescribed many medications to help reduce or prevent my migraines but so far nothing has helped. My Dr. decided to see how I would do on topamax topiramate generic name, but I am so nervous that I may have an adverse reaction, does any one have any good advice the mg is 50mgs at bedtime, today i am trying my first dose hoping to shed some weight not concentrate on my migraines as much. Tonight is exactly a week since I started on Topamax for migraines. I am 54 and have migraines for the last 40 years. Life before zoning nasal spay was so miserable. I resisted my neurologist s recommendation re. topamax for a long time because of possible side effects. Guess what. So far the only side effects are: not very pleasant taste in my mouth and reduced appetite. I was on 25 mg for a week. Today I took 50 mg for the first time. Hopefully next Wednesday will be 75 and Wednesday after that the final dose- 100mg. I was on amitriptyline for a year, it did not do it for migraines but I gained 18 lb. Hopefully now I ll kill two birds with one stone. Will be back in a week with the update. Hello I am new to the community, My name is Lisa I am 36 and have had chronic migraines since my teenage years. I get at least 3 -4 a week and have been on topamax for hmmmmmmmmmm over 15 years. I ve been off and on of it and other meds in these past years and also have been up to my highest weight. I am 5 foot and was 215. I have had neck surgery and low back surgery so I have chronic back pain and fibromyalgia. So I am on Cymbalta and they had also put me on Lyrica. The the Lyrica just put weight on me but really didn t seem to help me. So once I convinced my doctor that it wasn t helping and it was just adding the pounds he took me off. My migraines are getting worse so I am now increased to 150mg of course I have been higher and lower throughout the years and I have been reading on here and I have had to force myself to eat I never knew which meds it was and sometimes I can drink soda and sometimes I don t want it and it does taste horrible and I never knew why and it s so funny all this time I am just finding out why. Im finally cut out the Lyrica and cut stop eating alot of the sweets and really all I drink is one mild flavor gatorade and sweet tea about one cup of coffee and not much a day enough and I am at 180 and that is from last July. So 35 pounds I guess I don t know if it is just the topamax bjt you do have to watch the other meds your on and what else your eating. I can t really do much in exercise so this is what I can do. Good Luck. I was on Topamax 5 yrs. ago and had to stop because of the hair loss. It was awful. I had thick curly hair and all of a sudden it was falling out everywhere. I tried Nioxin Shampoo and it helped a little. I gradually went off it and my hair grew back. It also made me extremely nauseas 24 hours a day. I was put on Topamate for migraines on July 3rd I started at 25 mg and am now at 25 twice a a once in the am and once in the am. I hate soda. it is really gross. I took a sip of soda after my second dose and it felt like I set my mouth on fire it blistered the roof of my mouth Did this happen to anyone else. I start 75 mg in a few days. I have noticed a small weight loss I am hoping I lose weight. The only side effects I have so far is a little bit of tingling in my heels, and finger tips. I don t get dopy, or dizzy, or forget things. I can live wit that. My migraine are gone I haven t had one since starting this med. I do have the loss of appetite I don t mind though I am over weight and a bad beige eater. Does anyone know when you start to lose weight. Now that my migraines are under control I would like to get control of my weight and a nice side effect like that would help. The weight will come off not the first month but wait until month 2 or 3 then it starts. I was 189, month 1 189, month 2 185, month 3 165, month 4 140 month 5 120 now it s month 6 and I weigh 110, a dim scared. Never so thin I my life need to get off this med, but the withdrawal is horrible I m told, so be careful you will lose weight a lot of it. Then what it doesn t stop like me you will be so thin it s a little scary email me if u want to talk. Topamax 25 mg Tablets - Summary of Product Characteristics SPC by Janssen-Cilag Ltd. I have digenerative disc disease and my neirologist just prescribed topamax, he said it would help with the pain and tingling but could result in weight loss. I am. Use that is common Stark canada pharmacy tadacip 10mg paypal canada pharmacy tadacip 10mg paypal assessments highlight. Empiric tuberculosis infection relapse rate and caregivers. Cialis Buy Cheap Tadacip cipla 20, 10 mg. Tadacip official Pharmacy from Canada Best Place to Buy OnLine 1.07 per pill - your most reliable online pharmacy. Cialis Canada Lilly: 10 mg: 8: 175.00: Cialis 10 mg: 8: 35.00: Tadalafil Tagra-Cipla Generic: Canadian Pharmacy Cialis. 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Sildenafil joins bosentan and prostacyclin-based therapies for this condition. 7 Sildenafil has been shown to be useful for the prevention and treatment of high-altitude pulmonary edema associated with altitude sickness such as that suffered by mountain climbers. 8 9 While this effect has only recently been discovered, sildenafil is already becoming an accepted treatment for this condition, in particular in situations where the standard treatment of rapid descent has been delayed for some reason. 10 Viagra pills are blue and diamond-shaped with the word Pfizer engraved on one side, and VGR xx where xx stands for 25, 50 or 100, the dose of that pill in milligrams engraved on the other. It is taken not more than once per day between 30 minutes and 4 hours prior to sexual intercourse. The dosage for pulmonary arterial hypertension Revatio is three times a day. 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In July 2005, the FDA found that sildenafil could lead to vision impairment in rare cases 14 and a number of studies have linked sildenafil use with nonarteritic anterior ischemic optic neuropathy. 15 Rare but serious adverse effects found through postmarketing surveillance include priapism, severe hypotension, myocardial infarction heart attack, ventricular arrhythmias, stroke, increased intraocular pressure, and sudden hearing loss. 12 As a result of these postmarketing reports, in October 2007, the FDA announced that the labeling for all PDE5 inhibitors, including sildenafil, required a more prominent warning of the potential risk of sudden hearing loss. 16 Care should be exercised by patients that are also taking protease inhibitors for the treatment of HIV. Protease inhibitors inhibit the metabolism of sildenafil, effectively multiplying the plasma levels of sildenafil, increasing the incidence and severity of side effects. It is recommended that patients using protease inhibitors limit their use of sildenafil to no more than one 25 mg dose every 48 hours. 17 Other drugs that interfere with the metabolism of sildenafil include erythromycin and cimetidine, both of which can also lead to prolonged plasma half life levels. Concomitant use of sildenafil and an alpha blocker may lead to low blood pressure, but this effect does not occur if they are taken at least four hours apart. 18 Contraindications include: 12 p11 When taking nitric oxide donors, organic nitrites and nitrates, such as glyceryl trinitrate nitroglycerin, sodium nitroprusside, amyl nitrite poppers 19 In men for whom sexual intercourse is inadvisable due to cardiovascular risk factors Severe hepatic impairment decreased liver function Severe impairment in renal function Hypotension low blood pressure Hereditary degenerative retinal disorders including genetic disorders of retinal phosphodiesterases Sildenafil s popularity with young adults has increased over the years. 20 Sildenafil s trade name Viagra is widely recognized in popular culture, and the drug s association with treating erectile dysfunction has led to its recreational use. 21 The reasons behind such use include the belief that the drug increases libido, improves sexual performance, 21 or permanently increases penis size. 22 Studies on the effects of viagra when used recreationally are limited, but suggest that it has little effect when used by those not suffering from erectile dysfunction. In one study, a 25 mg dose was shown to cause no significant change in erectile quality, but did reduce the post-ejaculatory refractory time. 23 This study also noted a significant placebo effect in the control group. 23 Unprescribed recreational use of sildenafil and other PDE5 inhibitors is noted as particularly high among users of illegal drugs. 24 25 Sildenafil is sometimes used to counteract the effects of other substances, often illicit. 21 Some users mix it with methylenedioxymethamphetamine MDMA, ecstasy, other stimulants, or opiates in an attempt to compensate for the common side effect of erectile dysfunction, a combination known as sextasy, rockin and rollin, or trail mix. 21 Mixing with amyl nitrite is particularly dangerous and potentially fatal. 21 The 2007 Ig Nobel Prize in Aviation went to Patricia V. Agostino, Santiago A. Plano, and Diego A. Golombek of Universidad Nacional de Quilmes, Argentina for their discovery that Viagra helps treat jet lag recovery in hamsters. 26 Their research was published in the Proceedings of the National Academy of Sciences. 27 Professional athletes have been documented using sildenafil, believing the opening of their blood vessels will enrich their muscles. In turn, they believe that it will enhance their performance. 28 29 Israeli and Australian researchers discovered that 1 mg of the drug dissolved in a vase of water can extend the shelf life of cut flowers, making them stand up straight for up to a week beyond their natural life span. The drug also slows down plant ripening; tests were done strawberries, legumes, roses, carnations, broccoli, and other perishables. Viagra increases the vase life of the flowers by slowing the breakdown of cGMP by cGMP-specific phosphodiesterase type 5. The Viagra acts on the cGMP in a fashion similar to nitric oxide which also slows down the ripening process, but was found to be easier to use with cut flowers. 30 31 Acetildenafil is a structural analog of sildenafil, one of the PDE5 inhibitors found in a number of herbal aphrodisiac products sold over-the-counter. This class of analogs has not undergone any of the rigorous testing that drugs like sildenafil have passed, and, thus, has an unknown side-effect profile. 32 Some attempts have been made to ban these drugs, but progress has been slow so far, as, even in those jurisdictions that have laws targeting designer drugs, the laws are drafted to ban analogues of illegal drugs of abuse, rather than analogues of prescription medicines. However, at least one court case has resulted in a product being taken off the market. 33 The United States FDA has banned numerous products claiming to be Eurycoma longifolia that, in fact, contain only analogs of sildenafil. 34 35 36 Peddlers of such fake herbals typically respond by just changing the names of their products. Detection in biological fluids Sildenafil and/or N-desmethylsildenafil, its major active metabolite, may be quantitated in plasma, serum or whole blood to assess pharmacokinetic status in those receiving the drug therapeutically, to confirm the diagnosis in potential poisoning victims or to assist in the forensic investigation in a case of fatal overdosage. 37 Crystal structure of human PDE5 with bound sildenafil. PDB entry 1udt 38 The mechanism of action of sildenafil involves the protection of cyclic guanosine monophosphate cGMP from degradation by cGMP-specific phosphodiesterase type 5 PDE5 in the corpus cavernosum. Nitric oxide NO in the corpus cavernosum of the penis binds to guanylate cyclase receptors, which results in increased levels of cGMP, leading to smooth muscle relaxation vasodilation of the intimal cushions of the helicine arteries. This smooth muscle relaxation leads to vasodilation and increased inflow of blood into the spongy tissue of the penis, causing an erection. 39 Robert F. Furchgott, Ferid Murad and Louis Ignarro won the Nobel Prize in Physiology or Medicine in 1998 for their independent study of the metabolic pathway of nitric oxide in smooth muscle vasodilation. Sildenafil is a potent and selective inhibitor of cGMP-specific phosphodiesterase type 5 PDE5, which is responsible for degradation of cGMP in the corpus cavernosum. The molecular structure of sildenafil is similar to that of cGMP and acts as a competitive binding agent of PDE5 in the corpus cavernosum, resulting in more cGMP and better erections. 39 Without sexual stimulation, and therefore lack of activation of the NO/cGMP system, sildenafil should not cause an erection. Other drugs that operate by the same mechanism include tadalafil Cialis and vardenafil Levitra. Sildenafil is broken down in the liver by hepatic metabolism using cytochrome p450 enzymes, mainly CYP450 3A4 major route, but also by CYP2C9 minor route hepatic isoenzymes. The major product of metabolisation by these enzymes is N-desmethylated sildenafil, which is metabolised further. This metabolite also has an affinity for the PDE receptors, about 40 of that of sildenafil. Thus, the metabolite is responsible for about 20 of sildenafil s action. Sildenafil is excreted as metabolites predominantly in the feces approximately 80 of administered oral dose and to a lesser extent in the urine approximately 13 of the administered oral dose. If taken with a high-fat meal, absorption is reduced; the time taken to reach the maximum plasma concentration increases by around one hour, and the maximum concentration itself is decreased by nearly one-third. 40 The preparation steps for synthesis of sildenafil are as follows: 41 Methylation of 3-propylpyrazole-5-carboxylic acid ethyl ester with hot dimethyl sulfate Hydrolysis with aqueous NaOH to free acid Nitration with oleum/fuming nitric acid Carboxamide formation with refluxing thionyl chloride/NH4OH Reduction of nitro group to amino Acylation with 2-ethoxybenzoyl chloride Sulfonation to the chlorosulfonyl derivative Condensation with 1-methylpiperazine. Sildenafil compound UK-92,480 was synthesized by a group of pharmaceutical chemists working at Pfizer s Sandwich, Kent, research facility in England. It was initially studied for use in hypertension high blood pressure and angina pectoris a symptom of ischaemic heart disease. The first clinical trials were conducted in Morriston Hospital in Swansea. 42 Phase I clinical trials under the direction of Ian Osterloh suggested that the drug had little effect on angina, but that it could induce marked penile erections. 2 43 Pfizer therefore decided to market it for erectile dysfunction, rather than for angina. The drug was patented in 1996, approved for use in erectile dysfunction by the FDA on March 27, 1998, becoming the first oral treatment approved to treat erectile dysfunction in the United States, and offered for sale in the United States later that year. 44 It soon became a great success: annual sales of Viagra peaked in 2008 at US 1,934 million. 45 The British press portrayed Peter Dunn and Albert Wood as the inventors of the drug, however only Andrew Bell, David Brown, and Nicholas Terrett are listed on the original composition of matter patent. 1 Bulk bag of counterfeit Viagra Even though sildenafil is available only by prescription from a doctor, it was advertised directly to consumers on U.S. TV famously being endorsed by former United States Senator Bob Dole and football star Pelé. Numerous sites on the Internet offer Viagra for sale after an online consultation, often a simple web questionnaire. 46 47 The Viagra name has become so well known that many fake aphrodisiacs now call themselves herbal viagra or are presented as blue tablets imitating the shape and colour of Pfizer s product. Viagra is also informally known as Vitamin V, the Blue Pill, Blue Diamond as well as various other nicknames. 48 In 2000, Viagra sales accounted for 92 percent of the global market for prescribed erectile dysfunction pills. 49 By 2007, Viagra s global share had plunged to about 50 percent 50 due to several factors, including the entry of Cialis and Levitra, along with several counterfeits and clones, and reports of vision loss in people taking PDE5 inhibitors. 51 52 In February 2007, it was announced that Boots, the UK pharmacy chain, would try over-the-counter sales of Viagra in stores in Manchester, England. Men between the ages 30 and 65 would be eligible to buy four tablets after a consultation with a pharmacist. 53 On May 6, 2013, Pfizer, who manufacturers Viagra, told The Associated Press that they will begin selling the drug directly to patients on its website. 54 In 2008/9, reports 55 emerged of police and other authorities in Malaysia seizing sachets of coffee laced with sildenafil. Numerous brands tested were found to contain it, and were removed from sale. Pfizer s patent on sildenafil citrate expired in some member countries of the EU, Austria, Denmark, France, Germany, Ireland, Italy, The Netherlands, Spain, Sweden, United Kingdom as well as Switzerland on 21 June 2013. 56 57 58 A UK patent held by Pfizer on the use of PDE5 inhibitors see below as treatment of impotence was invalidated in 2000 because of obviousness; this decision was upheld on appeal in 2002. 59 60 In 1992 Pfizer filed a patent covering the substance sildenafil and its use to treat cardiovascular diseases. 61 This patent was published in 1993 and expired in 2012. In 1994 Pfizer filed a patent covering the use of sildenafil to treat erectile dysfunction. 62 This patent was published in 2002 and will expire in 2019. Teva sued to have the latter patent invalidated, but Pfizer prevailed in an August 2011 federal district court case. 63 The patent on Revatio indicated for pulmonary arterial hypertension rather than erectile dysfunction expired in late 2012. Generic versions of this low-dose form of sildenafil have been available in the U.S. from a number of manufacturers including Greenstone, Mylan and Watson, since early 2013. 64 There is no legal barrier to doctors prescribing this form of sildenafil off label for erectile dysfunction, although the dosage typically required for treating ED requires patients to take multiple pills. In Canada, Pfizer s patent 2,324,324 for Revatio sildenafil used to treat pulmonary hypertension was found invalid by the Federal Court in June 2010, on an application by Ratiopharm Inc. 65 66 On November 8, 2012 the Supreme Court of Canada ruled that Pfizer s patent 2,163,446 on Viagra was invalid from the beginning because the company did not provide full disclosure in its application. The decision, Teva Canada Ltd. v. Pfizer Canada Inc., pointed to section 27 3 b of The Patent Act which requires that disclosure must include sufficient information to enable any person skilled in the art or science to which it pertains to produce it. It added further: As a matter of policy and sound statutory interpretation, patentees cannot be allowed to game the system in this way. This, in my view, is the key issue in this appeal. 67 Teva Canada launched Novo-Sildenafil, a generic version of Viagra, on the day the Supreme Court of Canada released its decision. 68 69 70 To remain competitive, Pfizer then reduced the price of Viagra in Canada. 71 However, on November 9, 2012, Pfizer filed a motion for a re-hearing of the appeal in the Supreme Court of Canada, 72 on the grounds that the court accidentally exceeded its jurisdiction by voiding the patent. 73 Finally, on April 22, 2013, The Supreme Court of Canada invalidated Pfizer s patent altogether. 74 Manufacture and sale of sildenafil citrate drugs known as generic viagra is common in India, where Pfizer s patent claim does not apply. Trade names include Kamagra Ajanta Pharma, Silagra Cipla, Edegra Sun Pharmaceutical, Penegra Zydus Cadila, and Zenegra Alkem Laboratories. Manufacture and sale of sildenafil citrate drugs known as generic viagra is common in China, where Pfizer s patent claim is not widely enforced. Egypt approved Viagra for sale in 2002, but soon afterwards allowed local companies to produce generic versions of the drug, citing the interests of poor people who would not be able to afford Pfizer s price. 75 Pfizer s patent on sildenafil citrate expired in Brazil in 2010. 76 a b Patent US5250534 - Pyrazolopyrimidinone antianginal agents - Google Patents. a b Boolell M, Allen MJ, Ballard SA, Gepi-Attee S, Muirhead GJ, Naylor AM, Osterloh IH, Gingell C June 1996. Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int. J. Impot. Res. 8 2 : 47–52. PMID 8858389. Vardi M, Nini A 2007. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. In Vardi, Moshe. 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Sildenafil inhibits altitude-induced hypoxemia and pulmonary hypertension. Am. J. Respir. Crit. Care Med. 171 3 : 275–81. doi:10.1164/rccm.200406-804OC. PMID 15516532. Perimenis P 2005. Sildenafil for the treatment of altitude-induced hypoxaemia. Expert Opin Pharmacother 6 5 : 835–7. doi:10.1517/14656566.6.5.835. PMID 15934909. Fagenholz PJ, Gutman JA, Murray AF, Harris NS 2007. Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Alt. Med. Biol. 8 2 : 139–46. doi:10.1089/ham.2007.3055. PMID 17584008. Pill Identifier. Drugs.com. Retrieved 2009-02-10. This site is intended for viewing by the USA audience only. If you are in another country, local laws may not permit access to the medical information contained in this site. a b c Viagra Prescribing Information PDF. Pfizer. October 2007. Archived from the original on 14 November 2012. Retrieved 14 November 2012. Viagra and vision. VisionWeb. 29 October 2001. Retrieved 2009-02-10. FDA Updates Labeling for Viagra, Cialis and Levitra for Rare Post-Marketing Reports of Eye Problems. United States Food and Drug Administration. 8 July 2005. Archived from the original on February 23, 2008. Retrieved 2009-02-10. Laties AM 2009. Vision disorders and phosphodiesterase type 5 inhibitors: a review of the evidence to date. Drug Saf 32 1 : 1–18. PMID 19132801. FDA Announces Revisions to Labels for Cialis, Levitra and Viagra. United States Food and Drug Administration. 18 October 2007. Archived from the original on 11 July 2007. Retrieved 10 February 2009. Viagra sildenafil citrate tablets. page 29: Pzifer. October 2007. Retrieved 2009-10-25. Kloner RA 2005. Pharmacology and drug interaction effects of the phosphodiesterase 5 inhibitors: focus on alpha-blocker interactions. Am J Cardiol 96 12B : 42M–46M. doi:10.1016/j.amjcard.2005.07.011. PMID 16387566. Cheitlin MD, Hutter AM Jr, Brindis RG, Ganz P, Kaul S, Russell RO Jr, Zusman RM 1999. ACC/AHA expert consensus document. Use of sildenafil Viagra in patients with cardiovascular disease. American College of Cardiology/American Heart Association. Journal of the American College of Cardiology 33 1 : 273–82. doi:10.1016/S0735-1097 98 00656-1. PMID 9935041. Peterson K 2001-03-21. Young men add Viagra to their drug arsenal. USAToday. a b c d e Smith KM, Romanelli F 2005. Recreational use and misuse of phosphodiesterase 5 inhibitors. J Am Pharm Assoc 2003 45 1 : 63–72; quiz 73–5. doi:10.1331/1544345052843165. PMID 15730119. Sildenafil Will Not Affect Libido - Fact. a b Mondaini N, Ponchietti R, Muir GH, Montorsi F, Di Loro F, Lombardi G, Rizzo M June 2003. Sildenafil does not improve sexual function in men without erectile dysfunction but does reduce the postorgasmic refractory time. Int. J. Impot. Res. 15 3 : 225–8. doi:10.1038/sj.ijir.3901005. PMID 12904810. McCambridge J, Mitcheson L, Hunt N, Winstock A March 2006. The rise of Viagra among British illicit drug users: 5-year survey data. Drug Alcohol Rev 25 2 : 111–3. doi:10.1080/09595230500537167. PMID 16627299. Eloi-Stiven ML, Channaveeraiah N, Christos PJ, Finkel M, Reddy R November 2007. Does marijuana use play a role in the recreational use of sildenafil.. J Fam Pract 56 11 : E1–4. PMID 17976333. The 2007 Ig Nobel Prize Winners. Improbable Research. 4 October 2007. Retrieved 2009-02-10. Agostino PV, Plano SA, Golombek DA June 2007. Sildenafil accelerates reentrainment of circadian rhythms after advancing light schedules. Proc. Natl. Acad. Sci. U.S.A. 104 23 : 9834–9. doi:10.1073/pnas.0703388104. PMC 1887561. PMID 17519328. Teri Thompson, Christian Red, Michael O Keefffe, and Nathaniel Vinton 10 June 2008. Source: Roger Clemens, host of athletes pop Viagra to help onfield performance. Daily News Daily News. Retrieved 2009-02-10. Busbee J 2012-11-28. Bears Brandon Marshall says some NFL players use Viagra ON THE FIELD. Yahoo. Sports. Retrieved 2012-11-28. Siegel-Itzkovich J July 1999. In brief: Viagra makes flowers stand up straight. BMJ 319 7205 : 274B. doi:10.1136/bmj.319.7205.274a. PMC 1126921. PMID 10426724. Prolongation of the shelf life of fruits and flowers. Biology Department, University of Hamburg. Retrieved 28 November 2012. Oh SS, Zou P, Low MY, Koh HL. Detection of sildenafil analogues in herbal products for erectile dysfunction 2006. Detection of sildenafil analogues in herbal products for erectile dysfunction. Journal of Toxicology and Environmental Health Part A 69 21 : 1951–1958. doi:10.1080/15287390600751355. PMID 16982533. Venhuis BJ, Blok-Tip L, de Kaste D 2008. Designer drugs in herbal aphrodisiacs. Forensic Science International 177 2–3 : 25–27. doi:10.1016/j.forsciint.2007.11.007. PMID 18178354. FDA letter to Libidus distributor FDA Warns Consumers About Dangerous Ingredients in Dietary Supplements Promoted for Sexual Enhancement Hidden Risks of Erectile Dysfunction Treatments Sold Online R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 9th edition, Biomedical Publications, Seal Beach, CA, 2011, pp. 1552–1553. Sung, B. J.; Hwang, K.; Jeon, Y.; Lee, J. I.; Heo, Y. S.; Kim, J.; Moon, J.; Yoon, J.; Hyun, Y. L.; Kim, E.; Eum, S.; Park, S. Y.; Lee, J. O.; Lee, T.; Ro, S.; Cho, J. 2003. Structure of the catalytic domain of human phosphodiesterase 5 with bound drug molecules. Nature 425 6953 : 98–102. doi:10.1038/nature01914. PMID 12955149. edit a b Webb, D.J.; Freestone, S.; Allen, M.J.; Muirhead, G.J. March 4, 1999. Sildenafil citrate and blood-pressure-lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist. Am. J. Cardiol. 83 5A : 21C–28C. doi:10.1016/S0002-9149 99 00044-2. PMID 10078539. Viagra Clinical Pharmacology. RxList.com. 2008. Retrieved 2008-08-20. Dunn PJ 2005. Synthesis of Commercial Phosphodiesterase V Inhibitors. Org Process Res Dev 2005 1 : 88–97. doi:10.1021/op040019c. Research. ABM. Abertawe Bro Morgannwg University Health Board. 4 July 2008. Archived from the original on 26 September 2008. Retrieved 6 August 2008. Our clinicians regularly offer patients the opportunity to take part in trials of new drugs and treatments. Morriston Hospital in Swansea, was the first in the world to trial Viagra. Terrett NK, Bell AS, Brown D, Elllis P 1996. Sildenafil Viagra, a potent and selective inhibitor of Type 5 cGMP phosphodiesterase with utility for the treatment of male erectile dysfunction. Bioorg Med Chem Lett 6 15 : 1819–1824. doi:10.1016/0960-894X 96 00323-X. Kling J 1998. From hypertension to angina to Viagra. Mod. Drug Discov. 1: 31–38. ISSN 1532-4486. OCLC 41105083. Viagra sales peak at 1,934m in 2008 Ciment, J 1999. Missouri fines internet pharmacy. BMJ British Medical Journal 319 7221 : 1324. doi:10.1136/bmj.319.7221.1324g. PMC 1174637. PMID 10567131. Devine, Amy September 29, 2008. Chemists plan to sell Viagra on the internet. Daily Record. Retrieved 2012-04-30. Urban Dictionary: Vitamin V. Urban Dictionary. January 16, 2009. Retrieved 2013-12-27. Keith A 2000. The economics of Viagra. Health Aff Millwood 19 2 : 147–57. doi:10.1377/hlthaff.19.2.147. PMID 10718028. McGuire S 2007-01-01. Cialis gaining market share worldwide. Medical Marketing Media. Haymarket Media. Archived from the original on 2009-01-03. Retrieved 2009-02-10. Mullin, Rick June 20, 2005. Viagra. Chemical Engineering News 83 25. Retrieved 2008-08-20. Berenson, Alex December 4, 2005. Sales of Impotence Drugs Fall, Defying Expectations. The New York Times. Retrieved 2013-12-27. Over-the-counter Viagra piloted. BBC News. BBC News. 11 February 2007. Retrieved 2009-02-10. Pfizer to sell Viagra online, in first for Big Pharma: AP. CBS News. Retrieved 6 May 2013. Malaysian authorities seize Viagra coffee, report, phys.org, 5 July 2009, accessed 8 February 2014 Actavis Launches Generic Viagra in Europe as Patents Expire. Retrieved 2013-10-25. Jim Edwards October 21, 2009. What Will Happen When Viagra Goes Generic.. AccessRx.com. Retrieved 2013-12-27. Is Viagra about to lose its pulling power in the UK.. The Guardian. Retrieved 13 June 2013. Murray-, Rosie 23 January 2002. Viagra ruling upsets Pfizer. London: Telegraph Media Group Limited. Archived from the original on 22 August 2009. Retrieved 10 February 2009. Pfizer Loses UK Battle on Viagra Patent. UroToday. Thomson Reuters. 17 June 2002. Archived from the original on 25 June 2007. Retrieved 10 February 2009. Pfizer Wins Viagra Patent Infringement Case Against Teva Pharmaceuticals. Bloomberg. August 15, 2011. Retrieved 2012-04-01. Pfizer s Revatio Goes Generic. Zacks Equity Research. November 15, 2012. Retrieved 2013-10-05. Revation patent ruled invalid for lack of sound prediction and obviousness. Canadian Technology IP Law. Stikeman Elliott. 2010-06-18. Retrieved 2012-11-14. Pfizer Canada Inc. v. Ratiopharm Inc., 2010 FC 612. CanLII. Teva Canada Ltd. v. Pfizer Canada Inc. 2012 SCC 60 at par. 80 8 November 2012 John Spears 2012-11-08. Supreme Court ruling could lead to cheaper versions of Viagra. The Toronto Star. Retrieved 2012-11-14. Ken Hanly 2012-11-08. Canadian Supreme court rules Viagra patent invalid. Digital Journal. Retrieved 2012-11-14. Viagra patent tossed out by Supreme Court: Decision allows generic versions of drug to be produced. CBC News. 2012-11-08. Retrieved 2012-11-14. Pfizer Canada drops Viagra price after generic versions get Supreme Court green light. Financial Post. 2012-11-22. Retrieved 2013-12-27. SCC Case Information, Docket No. 33951. Retrieved 2012-11-14. Kirk Makin 2012-11-15. In rare move, Pfizer asks Supreme Court to reconsider ruling that killed Viagra patent. The Globe and Mail. Retrieved 2012-11-15. Gowling Lafleur Henderson LLP, Hélène D Iorio 2013-04-22. The Supreme Court of Canada holds Pfizer s Viagra patent invalid. Lexology. Retrieved 2013-12-27. Allam, Abeer October 4, 2002. Seeking Investment, Egypt Tries Patent Laws. New York Times. Retrieved 2013-12-27. Viagra patent expires in June, says Brazilian court prescribing information for Viagra and prescribing information for Revatio from Pfizer MedlinePLUS information, including side effects U.S. National Library of Medicine: Drug Information Portal – Sildenafil Viagra at The Periodic Table of Videos University of Nottingham Retrieved from Sildenafil oldid 609769584 Categories: PDE5 inhibitorsCitratesPfizerPiperazinesPhenol ethersPyrazolopyrimidinesLactams1998 introductions. Robot: Complete Control Mk V Type: Grappling Lifter with Flame Torch Team: Mission Destruction Derek Young, Ronen Sarig, Zacky Rubin, Danny Haeg Hometown: San. Buy Cialis Online at USA Online Pharmacy Sildenafil, sold as Viagra and other trade names, is a medication used to treat erectile dysfunction and pulmonary arterial hypertension. Its effectiveness for. Common use Welcome to Advisorpod.com. Our mission at Advisorpod.com is to provide financial services professionals with relevant best widget-practices and actionable tools to. silagra manufactured by cipla in india silagra potenzmittel sildenafil where to buy silagra in pattaya silagra 100 sildenafil citrate silagra kamagra caverta oder penegra zenegra caverta silagra kamagra edegra penegra what are the side effects of silagra silagra versand aus deutschland silagra per nachnahme bestellen how much silagra should i take silagra potenzmittel sildenafil 20 what is the difference between suhagra and silagra difference between silagra and suhagra is silagra better than kamagra which is better silagra or kamagra Here at I Am Creative, we are always amazed by the quality of the work uploaded to the I Am Creative Gallery. We wanted to come up with a way to ensure that we capture the amazing creative potential of the best rated work, and thus, we came up with the concept of the The Ladder The Ladder is the Ideas Foundation s new and exclusive progression group and every member of every team that wins a brief, or is rated Highly Commended by our panel of judges, will get a place on it. The members of the Ladder team are offered an array of opportunities news and information so that they get a head-start to getting into the creative industries, beginning with an all-expenses paid Progression Day hosted in London. Check out the current members of The Ladder below. Idea: An app on which people can upload their version of their favorite Sony film scenes My inspiration: Music is quite a big one, and so are webcomics Idea: To have an art museum where the visitors can interact with the artwork. The walls are electronic and people are able to talk to the art My inspiration: Studio Ghibli, music, nature, people, video games, cartoons, creepy pasta stories, friends, animals, mythical/ancient stories, my childhood Idea: Our group created an app tailored to your personal revision needs as part of IBM s 5 in 5 campaign My inspiration: My area. Nottingham is the 4th most creative city in England. It is all around me. My media teachers too, because they let me be creative Idea: An app for Generation C to participate by re-enacting a film scene to which they receive a discount form from Sony My inspiration: A film or a short clip that plays with editorial techniques, also music is a big part of me being creative The One With The Most To Give, 17 Idea: Consumer will pick a scene from a Sony film and finish the scene in an interesting way. My inspiration: I get inspiration from the environment around, quotes and social media like pinterest Idea: My idea was to create an app using augmented reality experience. My inspiration: My creative inspiration is Renzo Piano. His work really inspires me and how he got inspired to design the shard by drawing on a napkin. Idea: My idea was an app to encourage people to buy more Sony movies My inspiration: My inspiration is street art, which always has a secret message. The One With Artistic Taste, 15 Idea: Sony Sofa Sync, where users can buy a Sony movie and sync with their friends or family who are far apart to watch movies together. My inspiration: Mainly nature and the surrounding feels and emotions at the time. I use he surroundings to give inspiration to create and design things. The One With Innovative Thinking, 17 Idea: Sofa Sync. It s a Sony application that streams only Sony movies. 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Gabapentin was initially synthesized to mimic the structure of GABA for the treatment of epilepsy. Nowadays, gabapentin has been widely used. R D is at the heart of fulfilling Pfizer s purpose as we work to translate advanced science and technologies into the therapies that matter most. Neurontin official prescribing information for healthcare professionals. Includes: indications, dosage, adverse reactions, pharmacology and more. Learn about the prescription medication Neurontin Gabapentin, drug uses, dosage, side effects, drug interactions, warnings, reviews and patient labeling. Gabapentin is the generic name of Neurontin, a prescription drug used to treat epilepsy, seizures, RLS, and pain from shingles. Read about the medication gabapentin Neurontin, Gralise, Horizant, Fanatrex FusePag, a drug used for treating seizure disorders, shingles, fibromyalgia, neuropathy. Gabapentin is used with other medications to prevent and control seizures. It is also used to relieve nerve pain following shingles a painful rash due to herpes zoster infection in adults. Gabapentin is known as an anticonvulsant or antiepileptic drug. OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. Gabapentin may also be used to treat other nerve pain conditions such as diabetic neuropathy, peripheral neuropathy, trigeminal neuralgia and restless legs syndrome.How to use Neurontin Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking gabapentin and each time you get a refill. If you have any questions, ask your doctor or pharmacist. Take this medication by mouth with or without food as directed by your doctor. Dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight. If you are taking the tablets and your doctor directs you to split the tablet in half, take the other half-tablet at your next scheduled dose. Discard half tablets if not used within several days of splitting them. If you are taking the capsules, swallow them whole with plenty of water. It is very important to follow your doctor s dosing instructions exactly. During the first few days of treatment, your doctor may gradually increase your dose so your body can adjust to the medication. To minimize side effects, take the very first dose at bedtime. Take this medication regularly to get the most benefit from it. This drug works best when the amount of medicine in your body is kept at a constant level. Therefore, take gabapentin at evenly spaced intervals at the same time s each day. If you are taking this medication 3 times a day to control seizures, do not let more than 12 hours pass between doses because your seizures may increase. Do not take this medication more often or increase your dose without consulting your doctor. Your condition will not improve any faster and the risk of serious side effects may increase. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased. Antacids containing aluminum or magnesium may interfere with the absorption of this medication. Therefore, if you are also taking an antacid, it is best to take gabapentin at least 2 hours after taking the antacid. Different forms of gabapentin such as immediate-release, sustained-release, enacarbil sustained-release are absorbed in the body differently. Do not switch from one form to the other without consulting your doctor. 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