Generic name: Acyclovir
Brand name: Zovirax

Pronounced: zoh-VIGH-racks

Full Zovirax Prescribing Information

Why is this Zovirax (acyclovir) prescribed?

Zovirax liquid, capsules, and tablets are used in the treatment of certain infections with herpes viruses. These include genital herpes, shingles, and chickenpox. This drug may not be appropriate for everyone, and its use should be thoroughly discussed with your doctor. Zovirax ointment is used to treat initial episodes of genital herpes and certain herpes simplex infections of the skin and mucous membranes. Zovirax cream is used for herpes cold sores on the lips and face only.

Some doctors use Zovirax, along with other drugs, in the treatment of AIDS, and for unusual herpes infections such as those following kidney and bone marrow transplants.

Most important fact about Zovirax

Zovirax does not cure herpes. However, it does reduce pain and may help the sores caused by herpes to heal faster. Genital herpes is a sexually transmitted disease. To reduce the chance of infecting your partner, forgo intercourse and other sexual contact while you have sores or any other symptom.

How should you take Zovirax?

Your medication should not be shared with others, and the prescribed dose should not be exceeded. You can take Zovirax with or without food.

Zovirax ointment should not be used in or near the eyes. To reduce the risk of spreading the infection, use a rubber glove to apply the ointment.

Zovirax cream should not be used in or near the eyes, or inside the nose or mouth. The medication can, however, be applied on the outside of the lips. Apply the cream with your fingers to clean, dry skin. Be sure to wash your hands before and after applying Zovirax cream, and avoid bathing or swimming afterward to prevent it from washing off. Do not cover the cold sore with a bandage or make-up unless your doctor approves.

--If you miss a dose...

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

 

If you are using the ointment, apply it as soon as you remember and continue your regular schedule.

--Storage instructions...

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Store Zovirax at room temperature in a dry place.

What side effects may occur when taking Zovirax?

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

• More common side effects may include: Diarrhea, general feeling of bodily discomfort, nausea, vomiting
• Side effects of Zovirax ointment may include: Burning, itching, mild pain, skin rash, stinging, vaginal inflammation
• Side effects of Zovirax cream may include: Allergic reactions, burning, dry or cracked lips, dry or flaky skin, eczema (inflamed, irritated patches of skin), hives, inflammation, itchy spots, stinging

Why should Zovirax not be prescribed?

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

Special warnings about Zovirax

If you are being treated for a kidney disorder, consult your doctor before taking Zovirax. The drug has been known to cause kidney failure.

If you develop unusual bruising or bleeding under the skin, be sure to alert your doctor. It could signal a dangerous blood disorder.

Possible food and drug interactions when taking Zovirax

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

Cyclosporine (Sandimmune, Neoral)
Interferon (Roferon-A)
Probenecid (Benemid)
Zidovudine (Retrovir)

Special information if you are pregnant or breastfeeding

Zovirax seems relatively safe during pregnancy. Nevertheless, it should be used only if its benefits outweigh the potential risk to the baby. If you are pregnant or plan to become pregnant, inform your doctor immediately. Zovirax appears in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding your baby until your treatment with Zovirax is finished.

Recommended dosage for Zovirax

ADULTS

For Genital Herpes

The usual dose is one 200-milligram capsule or 1 teaspoonful of liquid every 4 hours, 5 times daily for 10 days. If the herpes is recurrent, the usual adult dose is 400 milligrams (two 200-milligram capsules, one 400-milligram tablet or 2 teaspoonfuls) 2 times daily for up to 12 months.

If genital herpes is intermittent, the usual adult dose is one 200-milligram capsule or 1 teaspoon of liquid every 4 hours, 5 times a day for 5 days. Therapy should be started at the earliest sign or symptom.

Ointment: Apply ointment to affected area every 3 hours, 6 times per day, for 7 days. Use enough ointment (approximately one-half inch ribbon of ointment per 4 square inches of surface area) to cover the affected area.

For Herpes Cold Sores

Apply Zovirax cream to the affected area 5 times a day for 4 days. Therapy should begin as soon as possible after the first sign of a cold sore such as a bump, tingling, redness, or itchiness.

For Herpes Zoster (Shingles)

The usual adult dose is 800 milligrams (one 800-milligram tablet or 4 teaspoonfuls of liquid) every 4 hours, 5 times daily for 7 to 10 days.

For Chickenpox:

The usual adult dose is 800 milligrams 4 times a day for 5 days.

If you have a kidney disorder, the dose will need to be adjusted by your doctor.

CHILDREN

The usual dose for chickenpox in children 2 years of age and older is 20 milligrams per 2.2 pounds of body weight taken orally 4 times daily, for a total of 80 milligrams per 2.2 pounds, for 5 days. A child weighing more than 88 pounds should take the adult dose.

The safety and effectiveness of oral Zovirax have not been established in children under 2 years of age. However, your doctor may decide that the benefits of this medication outweigh the potential risks. The safety and effectiveness of Zovirax ointment in children have not been established. Zovirax cream has not been studied in children less than 12 years old.

OLDER ADULTS

Your doctor will start you at the low end of the dosage range, since older adults are more apt to have kidney problems or other disease, or to be taking other medications.

Overdosage of Zovirax

Zovirax is generally safe. However, any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Zovirax overdose may include: Agitation, kidney failure, lethargy, coma, seizures

Patients are instructed to consult with their physician if they experience severe or troublesome adverse reactions, they become pregnant or intend to become pregnant, they intend to breastfeed while taking orally administered ZOVIRAX, or they have any other questions. Patients should be advised to maintain adequate hydration.

Herpes Zoster: There are no data on treatment initiated more than 72 hours after onset of the zoster rash. Patients should be advised to initiate treatment as soon as possible after a diagnosis of herpes zoster.

Genital Herpes Infections: Patients should be informed that ZOVIRAX is not a cure for genital herpes. There are no data evaluating whether ZOVIRAX will prevent transmission of infection to others. Because genital herpes is a sexually transmitted disease, patients should avoid contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners. Genital herpes can also be transmitted in the absence of symptoms through asymptomatic viral shedding. If medical management of a genital herpes recurrence is indicated, patients should be advised to initiate therapy at the first sign or symptom of an episode.

Chickenpox: Chickenpox in otherwise healthy children is usually a self-limited disease of mild to moderate severity. Adolescents and adults tend to have more severe disease. Treatment was initiated within 24 hours of the typical chickenpox rash in the controlled studies, and there is no information regarding the effects of treatment begun later in the disease course.

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Last updated: 06/2007

Full Zovirax Prescribing Information

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

back to: Psychiatric Medication Patient Information Index

Brand Name: Lyrica
Generic Name: pregabalin capsules, CV

Pronunciation: (LEER- i- kah)

Lyrica Full Prescribing Information

Read the Patient Information that comes with LYRICA before you start taking it and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your doctor about your condition or treatment. If you have any questions about LYRICA, ask your doctor or pharmacist.

What Is the Most Important Information I Should Know About LYRICA?

1. LYRICA may cause serious allergic reactions.

• Call your doctor right away if you think you have any of the following symptoms of a serious allergic reaction:
  • swelling of the face, mouth, lips, gums, tongue or neck
  • have any trouble breathing
• Other allergic reactions may include rash, hives and blisters.

2. LYRICA may cause dizziness and sleepiness.

• Do not drive a car, work with machines, or do other dangerous activities until you know how LYRICA affects how alert you are. Ask your doctor when it is okay to do these activities.

3. LYRICA may cause problems with your eyesight, including blurry vision.

• Call your doctor if you have any changes in your eyesight.

What is LYRICA?

LYRICA is a prescription medicine used in adults, 18 years and older, to treat:

• pain from damaged nerves (neuropathic pain) that happens with diabetes
• pain from damaged nerves (neuropathic pain) that follows healing of shingles (a painful rash that comes after a herpes zoster infection)
• partial seizures when taken together with other seizure medicines
• fibromyalgia

LYRICA has not been studied in children under 18 years of age.

Pain from Damaged Nerves (neuropathic pain)

 

Diabetes and shingles can damage your nerves. Pain from damaged nerves may feel sharp, burning, tingling, shooting, or numb. If you have diabetes, the pain can be in your arms, hands, fingers, legs, feet, or toes. If you have shingles, the pain is in the area of your rash. You may experience this kind of pain even with a very light touch. LYRICA can help relieve the pain. Some people taking LYRICA had less pain by the end of the first week of LYRICA therapy. LYRICA may not work for everyone.

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Partial Seizures

Partial seizures start in one part of the brain. A seizure can make you fearful, confused, or just feel "funny". You may smell strange smells. A seizure may cause your arm or leg to jerk or shake. It can spread to other parts of your brain, make you pass out, and cause your whole body to start jerking.

LYRICA can lower the number of seizures for people who are already taking seizure medicine.

Fibromyalgia

Fibromyalgia is a condition which includes widespread muscle pain and difficulty performing daily activities. LYRICA can help relieve the pain and improve function. Some people taking LYRICA had less pain by the end of the first week of LYRICA therapy. LYRICA may not work for everyone.

Who Should Not Take LYRICA?

Do not take LYRICA if you are allergic to any of its ingredients. The active ingredient is pregabalin. See the end of this leaflet for a complete list of ingredients in LYRICA.

What Should I Tell My Doctor Before Taking LYRICA?

Tell your doctor about all your medical conditions, including if you:

• have any kidney problems or get kidney dialysis
• have heart problems including heart failure
• have a bleeding problem or a low blood platelet count
• are pregnant or plan to become pregnant. It is not known if LYRICA may harm your unborn baby. You and your doctor will have to decide if LYRICA is right for you while you are pregnant.
• are breastfeeding. It is not known if LYRICA passes into breast milk and if it can harm your baby. You and your doctor should decide whether you should take LYRICA or breastfeed, but not both.

Tell your doctor about all the medicines you take including prescription or non- prescription medicines, vitamins or herbal supplements. LYRICA and other medicines may affect each other. Especially tell your doctor if you take:

• angiotensin converting enzyme (ACE) inhibitors. You may have a higher chance for swelling and hives if these medicines are taken with LYRICA. See "What is the most important information I should know about LYRICA?"
• Avandia®(rosiglitazone) or Actos®(pioglitazone) for diabetes. You may have a higher chance of weight gain or swelling if these medicines are taken with LYRICA. See "What are the possible side effects of LYRICA."
• any narcotic pain medicine (such as oxycodone), tranquilizers or medicines for anxiety (such as lorazepam). You may have a higher chance for dizziness and sleepiness if these medicines are taken with LYRICA. See "What is the most important information I should know about LYRICA?"
• any medicines that make you sleepy

Know all the medicines you take. Keep a list of them with you to show your doctor and pharmacist each time you get a new medicine.

Tell your doctor if you plan to father a child. Animal studies showed that pregabalin, the active ingredient in LYRICA, made male animals less fertile and caused sperm abnormalities. Also, in animal studies, birth defects occurred in the offspring of male animals who were treated with pregabalin. It is not known if these effects would happen in people.

How Should I Talke LYRICA?

• Take LYRICA exactly as prescribed. Your doctor may adjust your dose during treatment. Do not change your dose without talking to your doctor.
• Do not stop taking LYRICA suddenly without talking to your doctor. If you stop taking LYRICA suddenly, you may have headaches, nausea, diarrhea or trouble sleeping. Talk with your doctor about how to slowly stop LYRICA.
• LYRICA is usually taken 2 or 3 times a day, depending on your medical condition. Your doctor will tell you how much LYRICA to take and when to take it. Take LYRICA at the same times each day.
• LYRICA may be taken with or without food.
• If you miss a dose by a few hours, take it as soon as you remember. If it is close to your next dose, just take LYRICA at your next regular time. Do not take two doses at the same time.
• If you take too much LYRICA, call your doctor or poison control center or go to the nearest emergency room right away.

What Should I Avoid While Taking LYRICA?

• Do not drive a car, work with machines, or do other dangerous activities until you know how LYRICA affects how alert you are. See "What is the most important information I should know about LYRICA?"
• Do not drink alcohol while taking LYRICA. LYRICA and alcohol can affect each other and increase side effects such as sleepiness and dizziness. This can be dangerous.

Do not drive a car, work with machines, or do other dangerous activities until you know how LYRICA affects how alert you are. See "What is the most important information I should know about LYRICA?" Do not drink alcohol while taking LYRICA. LYRICA and alcohol can affect each other and increase side effects such as sleepiness and dizziness. This can be dangerous.

What Are the Possible Side Effects of LYRICA?

LYRICA may cause side effects including:

• allergic reactions. See "What is the most important information I should know about LYRICA?"
• weight gain and swelling of the hands and feet (edema). Weight gain may affect the management of diabetes. Weight gain and swelling can also be a serious problem for people with heart problems.
• dizziness and sleepiness. See "What is the most important information I should know about LYRICA?"
• eyesight problems. See "What is the most important information I should know about LYRICA?"
• unexplained muscle problems, such as muscle pain, soreness, or weakness. If you develop these symptoms, especially if you also feel sick and have a fever, tell your doctor right away.

The most common side effects of LYRICA are:

• dizziness
• blurry vision
• weight gain
• sleepiness
• trouble concentrating
• swelling of hands and feet
• dry mouth

LYRICA caused skin sores in animals. Although skin sores were not seen in studies in people, if you have diabetes, you should pay extra attention to your skin while taking LYRICA and tell your doctor of any sores or skin problems.

LYRICA may cause some people to feel "high." Tell your doctor, if you have abused prescription medicines, street drugs, or alcohol in the past.

Tell your doctor about any side effect that bothers you or that does not go away.

These are not all the side effects of LYRICA. For more information, ask your doctor or pharmacist.

How Should I Store LYRICA?

• Store LYRICA at room temperature, 59 to 86° F (15 to 30° C) in its original package.
• Safely throw away LYRICA that is out of date or no longer needed.
• Keep LYRICA and all medicines out of the reach of children.

General information about LYRICA

Medicines are sometimes prescribed for conditions other than those listed in patient information leaflets. Do not use LYRICA for a condition for which it was not prescribed. Do not give LYRICA to other people, even if they have the same symptoms you have. It may harm them.

This leaflet summarizes the most important information about LYRICA. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about LYRICA that is written for health professionals.

You can also visit the LYRICA website at www. LYRICA. com or call 1- 866-4LYRICA.

What are the ingredients In LYRICA?

Active ingredient: pregabalin

Inactive ingredients: lactose monohydrate, cornstarch, talc;

Capsule shell: gelatin and titanium dioxide; Orange capsule shell: red iron oxide; White capsule shell: sodium lauryl sulfate, colloidal silicon dioxide. Colloidal silicon dioxide is a manufacturing aid that may or may not be present in the capsule shells.

Imprinting ink: shellac, black iron oxide, propylene glycol, potassium hydroxide.

Avandia is a registered trademark of GlaxoSmithKline. Actos is a registered trademark of Takeda Chemicals Industries, Ltd. and used under license by Takeda Pharmaceuticals of America, Inc. and Eli Lilly and Co. June 2007

PATIENT COUNSELING INFORMATION

Patient Package Insert

Patients should be informed of the availability of a patient information leaflet, and they should be instructed to read the leaflet prior to taking LYRICA.

Angioedema

Patients should be advised that LYRICA may cause angioedema, with swelling of the face, mouth (lip, gum, tongue) and neck (larynx and pharynx) that can lead to life-threatening respiratory compromise. Patients should be instructed to discontinue LYRICA and immediately seek medical care if they experience these symptoms [ see Warnings and Precautions].

Hypersensitivity

Patients should be advised that LYRICA has been associated with hypersensitivity reactions such as wheezing, dyspnea, rash, hives, and blisters. Patients should be instructed to discontinue LYRICA and immediately seek medical care if they [see Warnings and Precautions] experience these symptoms

Dizziness and Somnolence

Patients should be counseled that LYRICA may cause dizziness, somnolence, blurred vision and other CNS signs and symptoms. Accordingly, they should be advised not to drive, operate complex machinery, or engage in other hazardous activities until they have gained sufficient experience on LYRICA to gauge whether or not it affects their mental, visual, and/or motor performance adversely. [see Warnings and Precautions].

Weight Gain and Edema

Patients should be counseled that LYRICA may cause edema and weight gain. Patients should be advised that concomitant treatment with LYRICA and a thiazolidinedione antidiabetic agent may lead to an additive effect on edema and weight gain. For patients with preexisting cardiac conditions, this may increase the risk of heart failure. [see Warnings and Precautions].

Abrupt or Rapid Discontinuation

Patients should be advised to take LYRICA as prescribed. Abrupt or rapid [see discontinuation may result in insomnia, nausea, headache, or diarrhea. Warnings and Precautions].

Ophthalmological Effects

Patients should be counseled that LYRICA may cause visual disturbances. Patients should be informed that if changes in vision occur, they should notify their physician [see Warnings and Precautions].

Creatine Kinase Elevations

Patients should be instructed to promptly report unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. [see Warnings and Precautions].

CNS Depressants

Patients who require concomitant treatment with central nervous system depressants such as opiates or benzodiazepines should be informed that they may experience additive CNS side effects, such as somnolence.

Alcohol

Patients should be told to avoid consuming alcohol while taking LYRICA, as LYRICA may potentiate the impairment of motor skills and sedating effects of alcohol.

Use in Pregnancy

Patients should be instructed to notify their physician if they become pregnant or intend to become pregnant during therapy, and to notify their physician if they are breast feeding or intend to breast feed during therapy [see Use In Specific Populations].

Male Fertility

Men being treated with LYRICA who plan to father a child should be informed of the potential risk of male-mediated teratogenicity. In preclinical studies in rats, pregabalin was associated with an increased risk of male-mediated [see Nonclinical teratogenicity. The clinical significance of this finding is uncertain Toxicology] .

Dermatopathy

Diabetic patients should be instructed to pay particular attention to skin integrity while being treated with LYRICA. Some animals treated with pregabalin developed skin ulcerations, although no increased incidence of skin lesions associated with LYRICA was observed in clinical trials [see Nonclinical Toxicology.]

Manufactured by:
Pfizer Pharmaceuticals LLC
Vega Baja, PR 00694

LAB-0294-14.0

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Last revised 06/2007

Lyrica Full Prescribing Information

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

back to: Psychiatric Medication Patient Information Index

Brand Name: Caltrex, Citracal
Generic Name: Calcium Carbonate

other names: Os-Cal, Oyster Shell, Tums, Titralac, Posture

Contents:

Description
Precautions
Drug Interactions
Adverse Reactions
Dosage
How Stored

Description

Calcium supplements are used to ensure an adequate intake of calcium during important periods of bone growth such as in childhood, during pregnancy and while breast-feeding. In adults, calcium is used to prevent osteoporosis (deterioration of bone).

Precautions

Information for the Patient
If you have any of the following health problems, consult your doctor before using this medication: diarrhea, stomach trouble, parathyroid disease, lung disease (sarcoidosis) or kidney stones. Tell your doctor if you are pregnant before using this medication. Some forms of calcium are known to be excreted into breast milk. Though there have been no reports (to date) of harm to nursing infants, consult your doctor before breast-feeding.

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Drug Interactions

BEFORE USING THIS MEDICINE: INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking, especially of vitamins, tetracycline, quinolone antibiotics (e.g. ciprofloxacin), gallium nitrate, cellulose sodium phosphate, etidronate, magnesium sulfate, calcium channel blockers (e.g., diltiazem, verapamil) and phenytoin.

Do not eat large amounts of bran or whole grain cereals and breads. They may reduce absorption of calcium. Also, consuming alcohol, large amounts of caffeine, and tobacco smoking may affect absorption of calcium. Do not start or stop any medicine without doctor or pharmacist approval.

 

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Adverse Reactions

Calcium is generally well tolerated. High levels of calcium can cause nausea, vomiting, loss of appetite, constipation, stomach pain, thirst, dry mouth, increased urination. Notify your doctor if your experience any of these effects. If you notice other effects not listed above, contact your doctor or pharmacist.

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Dosage

HOW TO USE THIS MEDICINE:

Take with a large glass of water during or after a meal. Chewable tablets must be chewed well before swallowing. Effervescent tablets must be diluted in a glass of cold water or juice before taking. Allow the tablet to stop fizzing before drinking. Drink slowly. Because calcium can interfere with the absorption of other drugs, do not take other medications within 2 hours of taking calcium.

If you have missed a dose, take the missed dose as soon as possible but not if it is almost time for the next dose. If it is time for the next dose, skip the missed dose and resume your regular schedule. Do not double the dose.

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How Stored

Keep out of the reach of children in a container that small children cannot open.

Store at room temperature between 15 and 30°C (59 and 86°F). Throw away any unused medicine after the expiration date.

NOTE:: This information is not intended to cover all possible uses, precautions, interactions, or adverse effects for this drug. If you have questions about the drug(s) you are taking, check with your health care professional.

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

Copyright © 2007 Healthyplace Inc. All rights reserved.

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back to: Psychiatric Medications Pharmacology Homepage

Brand Name: Temposil
Generic Name: Calcium Carbimide

Temposil (Calcium Carbimide) is used for alcoholism therapy; medical treatment of alcoholism. Usage, dosage, side effects of Temposil.

Contents:

Pharmacology
Indications and Usage
Precautions
Adverse Reactions
Overdose
Dosage
Supplied

Pharmacology

Calcium Carbimide is used for alcoholism therapy.

Indications and Usage

As an adjunct to the medical treatment of alcoholism. Following ingestion of calcium carbimide, an alcohol challenge reaction will still occur on an average of 12 hours up to 24 hours after dosing.

However, beyond 15 hours, reactions are of a mild nature and it is necessary to administer doses every 12 hours for secure coverage. Signs of reaction to alcohol challenge may include: conjunctival injection, flushing, headache, dyspnea, palpitation, tremor, vertigo, drowsiness, nausea and vomiting, increase in pulse rate and mild blood pressure changes.

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Precautions

White blood count may be increased by 2000 white cells. On discontinuance of the drug, count returns to normal. Use with caution in asthma, in coronary artery or myocardial disease and whenever a reaction of the nature of alcohol challenge might be undesirable.

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Adverse Reactions

Drowsiness, giddiness, fatigue, rash, tinnitus, dullness, slight depression, impotence, urinary frequency. In the presence of severe reactions or idiosyncrasies, the drug should be discontinued and appropriate measures taken.

 

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Overdose

Symptoms and Treatment

A reaction may be rapidly terminated by the administration of 100% oxygen by mask, or by the use of I.V. antihistamines.

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Dosage

HOW TO USE THIS MEDICINE:

DO NOT EXCEED THE RECOMMENDED DOSE or take this medicine for longer than prescribed.

Additional Information:: 50 or 100 mg every 12 hours. The drug should never be administered to a patient in a state of intoxication, nor probably any sooner than 36 hours after the last consumption of alcohol. Do not administer the drug under any circumstances without the patient's knowledge.

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How Supplied

Each round, white tablet, engraved "LL" and "U13", contains: Calcium carbimide 50 mg; tartrazine-free. Bottles of 50.

NOTE:: This information is not intended to cover all possible uses, precautions, interactions, or adverse effects for this drug. If you have questions about the drug(s) you are taking, check with your health care professional.

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

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

Copyright © 2007 Healthyplace Inc. All rights reserved.

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back to: Psychiatric Medications Pharmacology Homepage

We are set up to fail to get our needs met in Romantic Relationships in the same way that we are set up to fail in life - by being taught false beliefs about who we are and why we are here in human body, false beliefs about the meaning and purpose of this dance of life.

Facet # 3 - Shame Core - Inner Child Healing

"The dance that we learn as children - the repression and distortion of our emotional process in reaction to the attitudes and behavior patterns we adopt to survive in an emotionally repressive, Spiritually hostile environment - is the dance we keep dancing as adults.

We are driven by repressed emotional energy. We live life in reaction to childhood emotional wounds. We keep trying to get the healthy attention and affection, the healthy love and nurturing, the being-enhancing validation and respect and affirmation, that we did not get as children.

This dysfunctional dance is Codependence. It is Adult Child Syndrome. It is the tune that humans have been dancing to for thousands of years. Vicious, self-perpetuating cycles of self-destructive behavior"

*

"That shame is toxic and is not ours - it never was! We did nothing to be ashamed of - we were just little kids. Just as our parents were little kids when they were wounded and shamed, and their parents before them, etc., etc. This is shame about being human that has been passed down from generation to generation.

There is no blame here, there are no bad guys, only wounded souls and broken hearts and scrambled minds"

*

"If we are reacting out of what our emotional truth was when we were five or nine or fourteen, then we are not capable of responding appropriately to what is happening in the moment; we are not being in the now.

When we are reacting out of old tapes based on attitudes and beliefs that are false or distorted, then our feelings cannot be trusted.

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When we are reacting out of our childhood emotional wounds, then what we are feeling may have very little to do with the situation we are in or with the people with whom we are dealing in the moment.

In order to start be-ing in the moment in a healthy, age-appropriate way it is necessary to heal our "inner child". The inner child we need to heal is actually our "inner children" who have been running our lives because we have been unconsciously reacting to life out of the emotional wounds and attitudes, the old tapes, of our childhoods".

Codependence is a dis-ease of reaction. As long as we are in reaction we are being a victim. We are not owning our power if we are reacting. Many of us have reacted to being hurt in Romantic Relationships by going to the other extreme - overreacting to the point where we spent many years out of relationship. Then we try a relationship again and have another disaster because we are reacting to our childhood programming and we again react to our reaction by overreacting to the other extreme. In Recovery we are working on getting the pendulum swing smaller and smaller - finding the middle ground, the place of balance.

Overreacting to our patterns is just as dysfunctional as reacting to the wounds that caused the patterns. If we discover a pattern - say, that we leave relationships before we can be left - and we overreact and decide to stick it out in the next relationship no matter what, that can lead to us accepting a lot of abuse in the name of recovery. If we are in reaction and trying to figure out what is right and wrong - we are giving power to the disease.

There are no mistakes only lessons - which are painful but not that painful if we are not judging and shaming ourselves. What makes lessons so painful is the shame the disease lays on us - in other words - the disease creates all of this fear about getting hurt until we are terrified of being hurt - but what is so painful about being hurt is the shame that the disease beats us up with after we get hurt.

The hurt itself passes - the shame and judgment the disease abuses us with is what is most painful.

We are programmed to believe that making a "mistake" is horribly shameful. We are programmed to believe that if we do not find "Happily-ever-after" in a Romantic Relationship then we have made a mistake, or something is wrong with us.

When a relationship doesn't work our we torture ourselves with recriminations about what we did "wrong" or what is "wrong" with us. We rip ourselves for the shame of "failing".

"Our intuition/gut/heart tells us the Truth - it's our head that screws things up. I understand perfectly why my friend is in reaction the way she is - I am just very sad that it means she can't be in my life. She and I both come from a place of having so much terror of intimacy that we were relationship phobic - sometimes what is necessary for someone with a relationship phobia is to jump right in, that may be the only way past the fear.

I am happy to say that I don't have a relationship phobia anymore - I welcome another chance to explore a relationship now that I know that my worst fear can come true and it can make me stronger and better and happier. The reason for that is that I did not give power to the shame - what a miracle! What a gift! I am so grateful." An Adventure in Romance by Robert Burney

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"Codependence causes us to have a distorted and repressed emotional process, and the only way out is through the feelings. Codependence gives us a scrambled mind, a reversed dysfunctional way of looking at ourselves and the world, and we have to be able to use the wonderful tool that is our mind while changing our attitudes and reprogramming our thinking.

It seems awfully complicated, doesn't it?

That is because it is!

On another level it is also very simple. It is a Spiritual Dis-ease. It can only be healed through a Spiritual Cure. It cannot be healed by only looking at the symptoms. That is backwards.

The cure is available through surrendering control to a Higher Power. We cannot do this healing by ourselves. We need a Loving Higher Power in our lives. We need other Recovering people in our lives.

We are powerless out of human ego-self to get out of this quagmire. That is the bad news. It is also the good news.

Once you let go enough times, once you becoming willing to go to any length, to do whatever it takes, once you become willing to make healing the number one priority in your life, then you will be guided all the way. You will get the tools you need when you need them. You will get the help you need when you need it. You will have Loving, supportive people come into your life when you need them. You will start making rapid, discernible progress in your healing transformation.

On the other side of powerlessness is all the power in the Universe. On the other side of powerlessness is freedom, happiness, and peace within. On the other side of powerlessness is Joy and Love!

The answer is to stop fighting it, to surrender to the Spiritual Forces at work. Surrender to the possibility that maybe, just maybe, you do deserve to be happy and Loved."

Codependence Recovery is not self-help. We are being guided. The Force is with us!

Romantic Relationships are part of the curriculum in this school of Spiritual Evolution - not the place we find happily ever after. Life is a journey - it is not about reaching a destination.

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"As I said, the goal of healing is not to become perfect, it is not to "get healed". Healing is a process, not a destination - we are not going to arrive at a place in this lifetime where we are completely healed.

The goal here is to make life an easier and more enjoyable experience while we are healing. The goal is to LIVE. To be able to feel happy, Joyous, and free in the moment, the majority of the time.

To get to a place where we are free to be happy in the moment most of the time, we need to change our perspectives enough to start recognizing Truth when we see or hear it. And the Truth is that we are Spiritual Beings having a human experience that is unfolding perfectly and always has been, there are no accidents, coincidences, or mistakes - so there is no blame to be assessed.

The goal here is to be and enjoy! We can't do that if we are judging and shaming ourselves. We can't do that if we are blaming ourselves or others.

We must start recognizing our powerlessness over this disease of Codependence.

As long as we did not know we had a choice we did not have one.

If we never knew how to say "no", then we never really said "yes".

We were powerless to do anything any different than we did it. We were doing the best we knew how with the tools that we had. None of us had the power to write a different script for our lives.

We need to grieve for the past. For the ways in which we abandoned and abused ourselves. For the ways we deprived ourselves. We need to own that sadness. But we also need to stop blaming ourselves for it. It was not our fault!

We did not have the power to do it any differently.

*

"It is when we start understanding the cause and effect relationship between what happened to the child that we were, and the effect it had on the adult we became, that we can Truly start to forgive ourselves. It is only when we start understanding on an emotional level, on a gut level, that we were powerless to do anything any differently than we did that we can Truly start to Love ourselves.

The hardest thing for any of us to do is to have compassion for ourselves. As children we felt responsible for the things that happened to us. We blamed ourselves for the things that were done to us and for the deprivations we suffered. There is nothing more powerful in this transformational process than being able to go back to that child who still exists within us and say, "It wasn't your fault. You didn't do anything wrong, you were just a little kid".

*"It is necessary to own and honor the child who we were in order to Love the person we are. And the only way to do that is to own that child's experiences, honor that child's feelings, and release the emotional grief energy that we are still carrying around."

next: The Heart Break of Romantic Relationship Facet # 4

Hello Dr. Peele,

I very much enjoy reading your pages and the honest stand you seem to take in what I see as a less than honest business.

I have been mentioning some of your writings lately on some lists. One fellow wrote back to say he thought you were sponsored by some wine company and were a consultant to an insurance company.

Is this true?

He feels it could bring your work into question.

What do you think of that?

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Thank you very much for the compliment and support.

My résumé (listed at my web site as my curriculum vitae) describes my activities.

I have been virtually unfunded by American government and academic institutions after leaving the Harvard Business School faculty in 1975. For the next 20 years of my career, I earned my living by writing about, lecturing on, and treating addiction as an independent scholar/psychologist, supplemented by nonaddiction-related commercial consulting. My antagonism to the disease theory, which I have always thought was a dangerous concept, made it quite hard for me to get chances to present my views on addiction.

At times I have felt like I am the only free person in America. When disease diehards attacked behavioral treatments and practitioners of controlled-drinking therapy (particularly the Sobells), I rushed to defend them, even though many of their colleagues who were safely supported by academic institutions and government grants remained securely on the sidelines. My career and financial situation suffered dramatically. (These episodes are described in "Denial—of reality and freedom—in addiction research and treatment".)

When I finally accused a leading behaviorist of jettisoning controlled-drinking therapy to gain grants, he and his colleagues attacked me as profiting from my iconoclastic views through popular writing. Believe me, you lose more than you gain from taking a widely disapproved position that better-situated people are afraid to defend.

In the late 1980s, after my third child was born, my wife left her job and I couldn't get an academic position. I was forced to take on more commercial work. I succeeded at that work and became a successful market research and strategic consultant with several insurance companies, most prominently the branch of Prudential that underwrote the group insurance plan for the AARP. This insurance consulting work had nothing to do with alcohol/drug treatment and had no relation to my writing. (Years later, I served as an advisor—the only psychologist along with three psychiatrists—for Prudential's psychiatric managed care treatment protocols.)

In 1993, I wrote an article for the American Journal of Public Health in which I described the health benefits from alcohol and the resistance in America to accepting this information. This paper expressed my long-held belief that our culture is terribly mixed up about alcohol. The paper was completely unfunded. Nor did I receive any support for any articles I had previously done, like that in 1987 questioning the control-of-supply approach to alcohol problems ("The limitations of control-of-supply models of alcoholism and other addictions," which won the Mark Keller Award from the Rutgers Center for Alcohol Studies).

Only following this article was I contacted by alcohol producers. I received a few small stipends for presentations and research and writing, which I fully acknowledge, but not a significant amount of my income. Only since last year have I begun to receive consulting work from organizations funded by alcohol manufacturers, based on the unremunerated work I did for two decades expressing my own convictions.

I did not develop my views to get such funding; I did not even seek such funding. I believe what I believe and no one can say otherwise. When some high-flown academic or government employee (such as the vice president of research at Canada's Addiction Research Foundation, Robin Room) mentions that I work with the alcohol industry now, I always joke — "I'll quit right away if you give me a job at your institution." So far, no one has taken me up on it.

Best regards,

Stanton

P.S.: There has certainly been no funding for my work showing that most heroin and cocaine users do not lose control of their drug use. (Although, 20 years into my career, I received some small writing and speaking stipends from Ethan Nadelmann's groups—The Lindesmith Center and the Smart Foundation Drug Policy Reform Group. So too, however, has Room.) In sum, I have never received a living salary in my life from my work on addiction, alcohol, and drugs. Don't you think the U.S. government should be supporting a national treasure like me?

next: Stop Making Excuses for Drug Addiction
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

The problem of childhood obesity in the United States has grown considerably in recent years. Between 16 and 33 percent of children and adolescents are obese. Obesity is among the easiest medical conditions to recognize but most difficult to treat. Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 300,000 deaths each year. The annual cost to society for obesity is estimated at nearly $100 billion. Overweight children are much more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise.

What is obesity?

A few extra pounds do not suggest obesity. However they may indicate a tendency to gain weight easily and a need for changes in diet and/or exercise. Generally, a child is not considered obese until the weight is at least 10 percent higher than what is recommended for the height and body type. Obesity most commonly begins in childhood between the ages of 5 and 6, and during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.

What causes obesity?

The causes of obesity are complex and include genetic, biological, behavioral and cultural factors. Basically, obesity occurs when a person eats more calories than the body burns up. If one parent is obese, there is a 50 percent chance that the children will also be obese. However, when both parents are obese, the children have an 80 percent chance of being obese. Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems. Obesity in childhood and adolescence can be related to:

• poor eating habits
• overeating or binging
• lack of exercise (i.e., couch potato kids)
• family history of obesity
• medical illnesses (endocrine, neurological problems)
• medications (steroids, some psychiatric medications)
• stressful life events or changes (separations, divorce, moves, deaths, abuse)
• family and peer problems
• low self-esteem
• depression or other emotional problems

What are risks and complications of obesity?

There are many risks and complications with obesity. Physical consequences include:

• increased risk of heart disease
• high blood pressure
• diabetes
• breathing problems
• trouble sleeping

Child and adolescent obesity is also associated with increased risk of emotional problems. Teens with weight problems tend to have much lower self-esteem and be less popular with their peers. Depression, anxiety, and obsessive compulsive disorder can also occur.

How can obesity be managed and treated?

Obese children need a thorough medical evaluation by a pediatrician or family physician to consider the possibility of a physical cause. In the absence of a physical disorder, the only way to lose weight is to reduce the number of calories being eaten and to increase the child's or adolescent's level of physical activity. Lasting weight loss can only occur when there is self-motivation. Since obesity often affects more than one family member, making healthy eating and regular exercise a family activity can improve the chances of successful weight control for the child or adolescent.

Ways to manage obesity in children and adolescents include:

• start a weight-management program
• change eating habits (eat slowly, develop a routine)
• plan meals and make better food selections (eat less fatty foods, avoid junk and fast foods)
• control portions and consume less calories
• increase physical activity (especially walking) and have a more active lifestyle
• know what your child eats at school
• eat meals as a family instead of while watching television or at the computer
• do not use food as a reward
• limit snacking
• attend a support group (e.g., Weight Watchers, Overeaters Anonymous)

Obesity frequently becomes a lifelong issue. The reason most obese adolescents gain back their lost pounds is that after they have reached their goal, they go back to their old habits of eating and exercising. An obese adolescent must therefore learn to eat and enjoy healthy foods in moderate amounts and to exercise regularly to maintain the desired weight. Parents of an obese child can improve their child's self esteem by emphasizing the child's strengths and positive qualities rather than just focusing on their weight problem.

When a child or adolescent with obesity also has emotional problems, a child and adolescent psychiatrist can work with the child's family physician to develop a comprehensive treatment plan. Such a plan would include reasonable weight loss goals, dietary and physical activity management, behavior modification, and family involvement.

next: Obesity: Is It An Eating Disorder?
~ eating disorders library
~ all articles on eating disorders

Brand name: Restoril

Pronounced: RES-tah-rill

Generic name: Temazepam

Restoril Full Prescription Information

Why is Restoril prescribed?
Restoril is used for the relief of insomnia (difficulty in falling asleep, waking up frequently at night, or waking up early in the morning). It belongs to a class of drugs known as benzodiazepines.

Most important fact about Restoril
Sleep problems are usually temporary, requiring treatment for only a short time, usually 1 or 2 days and no more than 2 to 3 weeks. Insomnia that lasts longer than this may be a sign of another medical problem. If you find you need this medicine for more than 7 to 10 days, be sure to check with your doctor.

How should you take Restoril?
Take this medication exactly as directed; never take more than the prescribed amount.

--If you miss a dose...

Take only as needed.

--Storage instructions...

Keep this medication in the container it came in, tightly closed, and out of the reach of children. Store it at room temperature.

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

More common side effects may include:
Dizziness, drowsiness, fatigue, headache, nausea, nervousness, sluggishness
Side effects due to rapid decrease in dose or abrupt withdrawal from Restoril:
Abdominal and muscle cramps, convulsions, feeling of discomfort, inability to fall asleep or stay asleep, sweating, tremors, vomiting

Why should Restoril not be prescribed?
If you are pregnant or plan to become pregnant, you should not take this medication. It poses a potential risk to the developing baby.

 

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Special warnings about Restoril
When you take Restoril every night for more than a few weeks, it loses its effectiveness to help you sleep. This is known as tolerance. You can also develop physical dependence on this drug, especially if you take it regularly for more than a few weeks, or take high doses.

When you first start taking Restoril, until you know whether the medication will have any "carry over" effect the next day, use extreme care while doing anything that requires complete alertness such as driving a car or operating machinery.

If you are severely depressed or have suffered from severe depression, in the past, consult your doctor before taking this medication.

If you have kidney or liver problems or chronic lung disease, make sure your doctor is aware of it.

After you stop taking Restoril, you may have more trouble sleeping than you had before you started taking it. This is called "rebound insomnia" and should clear up after 1 or 2 nights.

Possible food and drug interactions when taking Restoril
Restoril may intensify the effects of alcohol. Do not drink alcohol while taking this medication.

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

Antidepressant drugs such as Elavil, Nardil, Parnate, and Tofranil
Antihistamines such as Benadryl
Barbiturates such as phenobarbital and Seconal
Major tranquilizers such as Mellaril and Thorazine
Narcotic pain relievers such as Percocet and Demerol
Tranquilizers such as Valium and Xanax

Special information if you are pregnant or breastfeeding
Do not take Restoril if you are pregnant or planning to become pregnant. There is an increased risk of birth defects. This drug may appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with this medication is finished.

Recommended dosage

ADULTS

The usual recommended dose is 15 milligrams at bedtime; however, 7.5 milligrams may be all that is necessary, while some people may need 30 milligrams. Your doctor will tailor your dose to your needs.

CHILDREN

The safety and effectiveness of Restoril have not been established in children under 18 years of age.

OLDER ADULT

The doctor will prescribe the smallest effective amount in order to avoid side effects such as oversedation, dizziness, confusion, and lack of muscle coordination. The usual starting dose is 7.5 milligrams.

Overdosage

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

The symptoms of Restoril overdose may include:

Coma, confusion, diminished reflexes, low blood pressure, labored or difficult breathing, sleepiness

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Restoril Full Prescription Information

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

back to: Psychiatric Medication Patient Information Index

It's not easy for non-ADHD adult and an ADHD adult to have a successful long-term relationship. The author has some suggestions on how to make it work.

As any adult with AD/HD knows, it is very difficult to cope in the non AD/HD world we live in. A relationship with a significant other can further compound these difficulties. If the respective other does not have AD/HD or understand the way we think, these difficulties can be magnified tenfold. As much as our respective others try to educate themselves about AD/HD, the differences in brain chemistry can push a relationship to its limits and in many cases beyond. All good intentions aside, short of crawling into our skin and seeing the world through our eyes, it is close to impossible to truly understand.

I am not a marriage counselor, nor a psychologist, but I am an adult with AD/HD and have been married for nearly eleven years to the most NON of the non-AD/HD spouses. Making a mixed marriage like ours work isn't always easy. But, I can honestly say it is well worth every challenge we face. I also firmly believe that we sought each other out because of our differences. Here are some rules that you may find useful if your relationship faces these pressures.

Educate Yourselves

The most important thing for an adult diagnosed with AD/HD and their respective other, is to educate themselves. Being diagnosed is helpful, but AD/HD is a very complex disorder. It effects adults differently than children. There are many co-morbidities that are present in those with AD/HD, that can either mask symptoms or make them worse.

It is extremely important for the AD/HD adult to understand themselves and why they do the things that they do. This is equally important for the non AD/HD spouse or partner. Reading about this neurological disorder will help to understand the actions, and reactions, of their partner. Understanding this is also the first step in bridging the gap between diametrically opposed thought processes. This education will also help in understanding that inappropriate conduct, while clearly inappropriate, is not present due to a lack of caring about a partner or the relationship itself.

One of the problems that was recurring in my marriage was the distribution of household chores. This was, and still can be, the source of much resentment. My wife often felt, and rightly so, that I wasn't contributing as much effort as she was. When we would discuss it, even before my diagnosis, I would often ask her to make me a list of what she needed of me. I thought that a list would make it tangible and I could work through it. What followed, was even more resentment. Her response was that we were adults and she didn't need anyone to make a list for her. Why should I need that? Understandably, it didn't seem fair to her. After my diagnosis, I began to understand why I needed the list.

When I asked for, and got one, things were much simpler and the list got done. I needed something visual and tangible to work through. This is especially true since it is often difficult to please someone when you aren't completely sure what they want. Add to this, a tendency to hyper focus or daydream and the prognosis is not good. There are still times of resentment, but they are much fewer. We both have seen that I can accomplish things, it just may be in a different way. I also think that seeing my willingness to help went a long way in reinforcing that I wasn't taking her for granted or being lazy.

Don't Hide Behind Your Disability

It is extremely important for both the AD/HD adult and their respective other to understand that AD/HD is NOT an excuse for inappropriate behavior. When lateness or impulsivity occurs to disrupt the flow of a relationship, it is important that the AD/HD adult not hide behind their condition and their partner not get that impression. Understanding how this neurological disorder effects behavior is useful in trying to prevent or avoid it in the future.

This issue is one of the central issues that people with AD/HD, both child and adult face on a daily basis. Unfortunately, no matter what we say or do, there are those who believe that the whole concept of AD/HD is nothing but an excuse for inappropriate behavior. Any appearance that a disability is being used as an excuse is like throwing gasoline on a fire. This issue is central to the raging debate in this country with respect to discipline for special needs children in school.

In truth, there is no excuse for inappropriate behavior. What the Adult with AD/HD and the non AD/HD partner must remember is to try to constructively concentrate on why the behavior occurred and how to avoid it in the future. It is also important when a disability is involved, for the non-disabled partner to understand that the conduct, although clearly inappropriate, is not a reflection on their partner's feelings about them or the relationship. Understanding the disability is crucial in understanding why the behavior occurs and what can be done to effect positive change in the future. Changes that both partners can effect together. If this can be accomplished successfully, the relationship will be stronger because of it.

Another thing that is often overlooked by the non AD/HD partner is the pain and anguish that their partner goes through in trying to do the right thing at times and despite their efforts, things do happen. I can honestly say that I usually start out with hope at getting where I am supposed to be on time. That hope can get destroyed quickly when hyperfocus, or guilt at not being more productive, interfere with my ability to leave point A to get to point B. I get very angry with myself. My conduct is inappropriate and wrong. I know that and beat myself up over it. That doesn't mean it is excusable by any means. This is something that is never seen on the other side. There is somehow this belief that we take pleasure at being late, being irresponsible or otherwise acting inappropriately. I have yet to meet the adult with AD/HD who has expressed this mythical pleasure. I can honestly say that if we could "just do it" as we are often told, we would.

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ADHD Medication Helps

Medication can help situations like this in many ways. First, the ADHD medication can go a long way as a tool to help an individual effect positive change in their life. Second, medication for ADHD helps remarkably in showing the non- AD/HD partner how different their counterpart can be under medication. It is an effective way to help them understand that AD/HD is a medical condition and not an excuse. They are in a better position than the disabled adult to assess the difference between their partner on medication and off. The differences in behavior are usually much clearer to another.

I can't tell you how many times this conversation has taken place on a weekend in my house. "Rob, your not medicated are you?", "actually, I am not honey, how can you tell?" There was one time that I ran out of medication and my prescription had to be ordered. I had none for several days. That weekend, I thought my wife was going to throw me out a window. The interesting part of it is that we were married for many years before I was diagnosed. I think it showed her how far we both had come in dealing with many of these issues. There are also times when she will ask me whether or not I plan to take medication, depending on whether or not we are going to a social function or something. It helps her be prepared for the evening.

The important thing to remember about ADHD medication is that it is not a cure and it may not address all of your symptoms. The benefit of medication is that it can be an effective tool for an individual with AD/HD to make positive changes in their life. With the help of a supportive partner, these changes may be more effective and strengthen your relationship.

Conclusion

I certainly don't have all the answers, but I have spent a lot of time thinking about and trying to resolve the issues in my relationship with my family, because it is so important to me. I also think it may be helpful for both the adult with AD/HD and their partner to know that there are others out there who have the same struggles in their relationships. It also may help in understanding that common concerns reinforce the notion that my husband or girlfriend isn't doing this because they don't care about me or our relationship. Relationships are very difficult to maintain, especially when a disability is involved. But, to borrow from the Venus and Mars theory, it is helpful to understand that there are differences in the way that people with AD/HD, and those without, think and perceive the world around them. That understanding can go a long way to making things better.

So good luck in your relationships and tell your non AD/HD partners that there are many others out there just like them too.

About the author: Robert M. Tudisco is a practicing attorney and freelance writer. He is an adult diagnosed with AD/HD and is a member of the National Board of Directors of ADDA and the Board of Directors of the Westchester County Chapter of CHADD in New York. Robert lives with his wife and young son in Eastchester, New York.

Re-printed with permission, 2002 FOCUS Magazine, ADDA www.add.org

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Considering Strattera for your ADHD treatment? Learn how Strattera works, Strattera side effects and how it fits into an overall ADHD treatment plan.

Atomoxetine, brand name, Strattera, was approved by the FDA for distribution in November 2002. It became available in US pharmacies in early 2003. Despite its hefty price tag, it is becoming widely used for adults and children with Attention Deficit Hyperactivity Disorder. (AD/HD) It is a non-stimulant medication approved for the treatment of AD/HD in both children and adults. The stimulants include methylphenidate (Ritalin, Concerta and Metadate CD) and Amphetamine (Dexedrine, Dexedrine Spansules, and Adderall XR). Stimulants are FDA approved for the treatment of AD/HD in children and adolescents, but most physicians consider them the first line medication treatment for AD/HD in adults too.

How Does Strattera Work?

Atomoxetine is a selective norepinephrine reuptake inhibitor. This means that it strengthens the chemical signal between those nerves that use norepinephrine to send messages. Atomoxetine does not appear to affect the dopamine systems as directly as do the stimulants. Atomoxetine does not seem to cause an increase in brain dopamine levels in the nucleus accumbens or the striatum areas of the brain. The stimulants appear to cause an increase in the availability of dopamine in these areas. The effect on the nucleus accumbens is believed to cause euphoria and to be responsible for the stimulants' abuse liability. Dopamine increases in the striatum may be associated with the risk of motor tics. (1)

Although Atomoxetine's direct effect only seems to be with norepinephrine, it appears to cause a secondary increase in dopamine levels in the prefrontal cortex area of the brain. (the brain area behind the eyes.) This part of the brain is associated with the ability to mentally rehearse responses, and inhibit impulsivity. The area is also associated with working memory.

Atomoxetine's chemical structure bears some similarities to the tricyclic antidepressants although it is actually a phenylpropanolamine derivative. The tricyclic antidepressants include desipramine and imipramine. These two medications have been shown to be effective treatments for AD/HD in adults and children but do not have FDA approval for this use. The tricyclics affect norepinephrine but are not as specific as atomoxetine. It is the tricyclics' effect on neurotransmitters other than dopamine and norepinephrine that appear to cause their drawbacks. Their anticholinergic effects can cause constipation, dry mouth and dry eyes. Their antihistaminergic effects can cause weight gain and tiredness. Their alpha adrenergic effects can cause tremor and changes in blood pressure. The tricyclics can cause a delay in cardiac conduction. This effect can cause minor—and in rare cases—serious changes in heart rhythm. Investigators have evaluated atomoxetine carefully for cardiac rhythm and blood pressure changes. Minor, but insignificant, increases in pulse and blood pressure were noted. Atomoxetine did not appear to cause changes in cardiac conduction. (2)

Can you abuse Strattera?

Some physicians have been reluctant to prescribe stimulants for adults because they are Schedule II and are officially listed as having a significant potential for addiction. Although stimulants can indeed be abused, their use does not seem to cause abuse individuals who do not already have a substance abuse problem. (3) However there are other ways in which stimulants can be abused. Because they decrease sleepiness and cut appetite, individuals might use them to cram for exams or lose weight. Atomoxetine appears to have minimal abuse potential. Thus, it is not as highly controlled as the stimulants. It can inhibit sleep or appetite but does so much less than the stimulants. Thus, it is less likely to be passed around.

Does Strattera have side effects?

The side effects of atomoxetine may include many of the side effects seen with stimulants. These common effects include appetite suppression, sleep disturbance jitteriness and irritability. Since there is a small increase in pulse and blood pressure, these should be monitored in patients with cardiac disease. However, these effects are often milder than those of the stimulants. Atomoxetine can cause a significant problem with nausea. In my experience, this is the most common reason for individuals stopping the drug. Taking it with meals or splitting the dose may help. Atomoxetine is most commonly given as a single dose in the morning. However there are some individuals who cannot tolerate this because they actually find the medication to be sedating. Atomoxetine can lead to urinary retention in some individuals. It can also cause problems with sexual functioning. Some individuals experience sexual side effects. such as impotence, erectile difficulties and difficulty achieving orgasm. (4) Stimulants often cause the individual to feel more alert and less sleepy. Atomoxetine can occasionally do this to a milder degree. In many individuals, individuals, however, Atomoxetine can actually cause sleepiness. I have several patients who prefer to take it at night. Atomoxetine does not usually have a rebound effect. Although the compound is metabolized quickly, the clinical effects appear to last all day and even into the following morning. This can be a good thing for individuals who find that stimulants make them feel irritable in the evenings. However, people who need to stimulant "kick" to help them focus may be disappointed in the new drug.

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In December 2004, Lilly Pharmaceuticals announced that it was adding a warning about atomoxetine (Strattera) and hepatitis. Two cases of severe hepatitis were reported associated with the use of this medication. Both cases resolved after the medication was stopped. Patients should contact their physician if they notice signs of possible hepatitis: Dark urine, yellowing of skin or eyes, or upper abdominal pain. It should be noted that only 2 cases have been reported and over 2 million people have taken atomoxetine.

How Strong and How Fast?

Stimulants start to work in less than an hour. Because of this, one can rapidly determine the best dose. Atomoxetine has a more subtle, gradual onset. One must increase the dose over several days or weeks. One may not see the maximum effect of a given dose for about three weeks. In some cases, I may do a cross over in which the individual takes a lower dose of the stimulant while waiting for the atomoxetine to take its full effect. Limited studies have suggested that atomoxetine is equally effective to methylphenidate (Ritalin) for a variety of AD/HD symptoms. (2) In my own experience, this is not always true. Some individuals experience even the highest recommended doses of the drug as less effective than the conventional stimulants.

Atomoxetine is metabolized through the cytochrome P-450 2D6 pathway. However the major metabolite is also active. The activity of the CYP 2D6 system can vary widely in perfectly healthy people. Individuals who metabolize it slowly will build up a higher level faster than those who metabolize it rapidly. Because of this, we may not be able to achieve an effective dose in some individuals within the FDA dosage guidelines. Fluoxetine (Prozac) and Paroxetine (Paxil), as well as other drugs affect the metabolism of atomoxetine. If one is taking atomoxetine it is important to check with the doctor or pharmacist to make sure that the atomoxetine does not interfere with other medications that the individual is taking.

Strattera: A Double Edged Sword?

Some of the advantages of Strattera may be a double edged sword. Its lower abuse potential might make us more willing to prescribe it for individuals with a substance abuse problem. Its weak antidepressant effect might make us more comfortable prescribing it for individuals who might have co-morbid depression. However this should not relieve clinicians from the responsibility for assessing and treating co-morbid substance abuse and mood problems. Atomoxetine is more convenient because you can call in refills. However, one of the major reasons for failure for AD/HD medication treatment failure is inadequate follow up with infrequent dosage monitoring and adjustments. Medication management visits can be therapeutic. Frequent visits also help pick up changes in the patient's clinical condition.

So, Where Does Strattera Fit In?

I still recommend the stimulants as the first-line drugs for AD/HD. They have stood the test of time. We are familiar with their strengths and their side effects. Their quick onset enables the clinician to more rapidly adjust the dose. The stimulants—even the newer ones—are less expensive than atomoxetine. I have found a number of patients who feel that even the higher doses of atomoxetine are not as effective as the stimulants. However there are many people who do not respond to stimulants or who cannot tolerate the side effects. I have achieved excellent results in a number of individuals who felt jumpy or irritable on stimulants. For these people, atomoxetine can be an excellent medication.

About the author: Carol Watkins, M.D. is Board Certified in Child, Adolescent & Adult Psychiatry and in private practice in Baltimore, MD.

Sources:

1. Bymaster FP, Katner JS, Nelson DL, et al. Atomoxetine increases extracellular levels of norepinephrine and dopamine in prefrontal cortex of rat: A potential mechanism for efficacy in attention deficit/hyperactivity disorder. Neuropsychopharmacology 2002; 27:699-711.
2. Kratochvil CJ, Heiligenstein JH, Dittmann R, et al. Atomoxetine and methylphenidate treatment in children with ADHD: A prospective, randomized, open-label trial. J Am Acad Child Adolesc Psychiatry 2002;41:776-84.
3. Biederman, J, WIlens, T, Mick, E, Spencer, T, Faraone, SV, Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder Reduces Risk for Substance Use Disorder, Pediatrics, 104:2 1999 pe20.
4. Michelson D, Adler I, Spencer T, et al. Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Biol Psychiatry 2003;53:112-20.
5. Michelson, D, Faries, D, Wernicke, J, Kelsey, D, Kendrick, K, Sallee, FR, Spencer, T., Atomoxetine in the Treatment of Children and Adolescents with Attention-Deficit Disorder: A Randomized, Placebo-Controlled, Dose-Response Study, Pediatrics 2001, 108:5.

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