Brotizolam with Lamotrigine

[AmZ]

Does anyone know which website I can use to see about possible interactions with Brotizolam (Lendormin) and Lamotrigine (Lamictal)?

As Brotizolam is not approved and offered in the US/North America, it's therefore not on drugs.com in order to check.

It's too late to call a pharmacy now or anything else to check.

Thanks in advance.

 

[Retired]

Try this: http://www.medscape.com/druginfo/druginterchecker

Just going out the door

 

[AmZ]

Thanks Steve.

Brotizolam is not on there unfortunately.

Can't seem to find it on any of these sites.

Just want to sleep this weekend... Will see about taking the Brotizolam and hopefully that won't go wrong with the Lamictal. One thing I do know is that Brotizolam does not go well with alcohol. So lucky I have no alcohol in my apartment. Don't want to drink anyway.

 

[Yuray]

Hope this helps

Brotizolam - Wikipedia, the free encyclopedia

Brotizolam Drug Metabolism, Genetics, Side Effects, and Drug Interactions

 

[Retired]

Reliable scientific information for brotizolam is difficult to find, although one of my sources, a Medscape table of comparison for benzodiazepines shows this particlar medication as having a short half life of 5 hours, and that it posesses active metabolites.

Unfortunately a monograph for this product cannot be located in order to evaluate its kinetics and how it might interact with other medications.

Having a short half life suggests that if this medication is taken as directed on a daily basis, steady state should be achieved (where the amount ingested equals the amount excreted) in less than a week; the corollory to that is if this medication is taken for several weeks, it needs to be tapered to avoid withdrawl symptoms. The significance of its active metabolites are not clear, as further information is not available.

On a potentially positive note, Lamotrigine (Lamictal) does not appear to interact adversely with other benzodiazepines, even others that are known to posses active metabolites.

I would have to stress that my comments are speculative based on limited available information, and your prescribing doctor along with your pharmacist should be in a better position to guide you on the valid questions you raised.

My question would be, why have you been prescribed brotizolam when you were previously prescribed lorazepam (Ativan). Lorazepam clearly does not interact with any other medication, is relatively short acting, can be used only when required, if that's what is required and has no active metabolites.

 

[AmZ]

Thanks for the information.

I was prescribed the brotizolam after I had been taking the Lorazepam for a few months and was stopping to take that as we wanted to focus on the anti-depressant. Then I still had the same sleep issues (the Lorazepam never helped my sleep even though I was taking 1mg at night) so the psychiatrist prescribed the brotizolam specifically for the insomnia.
I took it a couple of times, as prescribed and it did nothing, I was still awake after 3 hours of sleep or so. Then she prescribed me with Melatonin the other day and I went to my family doctor to get the prescription written up and she said that I can't get the Melatonin as it's only given to over 55s. So I have to speak with the psychiatrist and see what we're going to do now.

I took it the brotizolam last night and even though I am OK today, and had an amazing 14 hour sleep, I took a few too many to be honest so I'm going to have to dispose of the rest before I accidentally do something stupid.

 

[Retired]

You may want to ask your doctor why she prefers to prescribe a benzodiazepine for sleep when more recent non-benzodiazepine medications have been developed specifically for sleep. Some examples would be LUNESTA (eszopiclone), Ambien or Edluar (zolpidem) and Sonata (zaleplon). (generic names in parentheses which may help to identify which brand name is available in your Country, as brand names may vary from Country to Country)

One of the original medication sof this type is Imovane (zopliclone) and may not be avaialble any longer.

They work by slowing activity in the brain to allow sleep. Many people taking these medications report having an excellent quality of sleep with no morning hangover, a side effect sometimes experienced with some benzodiazepines when they are used for sleep.

For your information, when doctors refer to these medications, they usually call them hypnotics. These medications are generally compatible with SSRI/SNRI.

You can read about this type of medication HERE

 

[AmZ]

Thanks for the information Steve. Much appreciated.

The previous psychiatrist had prescribed me with the Brotizolam a couple of months ago but like I had experienced with the Lorazepam and Clonazepam, the short-half life was a problem. Especially when the problem isn't me falling asleep, of which I have no problem with on most occasions, but the problem is staying asleep. Even when I was taking the Brotizolam for a couple of nights and the Lorazepam before for a few months each night (and half in the morning), I still woke up after 2-4 hours sleep max and several times in the night and wake up early. Even taking two Brotizolam last night, (was prescribed 1 pill before bed time), I still woke up 3 hours later. Then I took another one and woke up 2 hours later, then I took 2 and, well, that kinda did the trick eventually.

I don't know why this new psychiatrist tried to prescribe me the Melatonin instead of the medications you had mentioned. Anyway I am going to ask her about stopping the Lamictal because I'd rather focus on the Effexor for now and if that is working enough, then maybe add on a second for the sleep. I don't want the Effexor, Lamictal and then a third for sleep.

I'll be honest, and maybe it's something I have to be honest with myself and the psychiatrist about... I don't really think it's good for me to have any medications around that are sleep-inducing or alike. Like with the Brotizolam last night, I had been prescribed to take one at night and over the space of a few hours, I took 5 in total... Even though it's not like an attempt to do something 'worse' to myself, other than to just be knocked out and sleep, I know it's still dangerous and something could go wrong which I wasn't planning on happening.

I'm a bit of a mess, yikes.

 

[Retired]

As you well know I am not a health professional, but have had the opportunity to learn some aspects of treating mental health disorders. From my understanding of the illness of depression, your early morning awakening may be related to the depression, which is why the combination of an effective antidepressant along with an equally effective hypnotic may help in alleviating symptoms. It's difficult to deal with the symptoms of depression if you cannot get a good night's sleep, which is why I feel you might want to pursue a conversation with your doctor about finding a better way for you to get good quality sleep.

Continue your research as you are doing now, so that when you have this conversation, you will have enough background knowledge to ask the right questions.

In doing so, you become a partner in your health care, as an empowered patient.

 

[AmZ]

I totally agree with you Steve.

From my understanding of the illness of depression, your early morning awakening may be related to the depression

For sure, it was like this from day one and is still the same. I've never had problems sleeping before in my life.

I know that I feel a bit better once I have had a better night sleep. I've really had patience here, and I know that things take time, but 7 months of the same sleep pattern day in day out doesn't make anything easier. It's been a constant thing which hasn't changed over the last 7 months. Of course, asides from a couple of better nights sleep I had a couple of weeks ago (but had still woken up during the night) and last night after taking the Brotizolam, lol and still woke up during the night after taking double the dosage and then another 3 on top!

I'm a bit pi**ed off to be honest. I still don't feel like things are getting sorted out, whatever I do. Now I go and pay a fortune for this private psychiatrist and my therapist and her had spoken beforehand and they discussed me and what's going on, blah blah, great, sounds like a good idea and something which can really help... then I go there and she prescribes me with something that I can't even darn get as it's only prescribed to patients over 55 years old. Now I have to tell her this and say about the Lamictal and even the Effexor has it's issues also, and I'm still not sleeping better.... So... Yeah, sorry, I'm just rather peed off and don't think it's that unreasonable for me to feel like this. Then I just feel like I don't care and all I want to do is sleep, so take 5 of those Brotizolam because I've just had enough.

 

[David Baxter PhD]

I am going to ask her about stopping the Lamictal because I'd rather focus on the Effexor for now and if that is working enough, then maybe add on a second for the sleep. I don't want the Effexor, Lamictal and then a third for sleep.

That really makes little sense, AmZ. You really should do yourself a favor and stop self-prescribing. The Lamictal is a mood stabilizer prescribed to limit your mood swings - and if you doubt that you have mood swings just read through some of your own threads here.

What difference does it make how many medications you vare taking? The important thing is to find some combinations of medications that work to manage your symptoms. For some people, that may be one; for others it may be three, four, five, or six.

I'll be honest, and maybe it's something I have to be honest with myself and the psychiatrist about... I don't really think it's good for me to have any medications around that are sleep-inducing or alike. Like with the Brotizolam last night, I had been prescribed to take one at night and over the space of a few hours, I took 5 in total... Even though it's not like an attempt to do something 'worse' to myself, other than to just be knocked out and sleep, I know it's still dangerous and something could go wrong which I wasn't planning on happening.

On the other hand, you don't appear to be suicidal and if you were given an actual sedative/hypnotic which is designed to help you sleep instead of a short-acting tranquilizer there'd be no need for you to wake up and take more, right?

I'm a bit pi**ed off to be honest. I still don't feel like things are getting sorted out, whatever I do. Now I go and pay a fortune for this private psychiatrist and my therapist and her had spoken beforehand and they discussed me and what's going on, blah blah, great, sounds like a good idea and something which can really help... then I go there and she prescribes me with something that I can't even darn get as it's only prescribed to patients over 55 years old. Now I have to tell her this and say about the Lamictal and even the Effexor has it's issues also, and I'm still not sleeping better.... So... Yeah, sorry, I'm just rather peed off and don't think it's that unreasonable for me to feel like this.

Perhaps not, but in this case it's the pharmacist you should be angry with, not your doctor. It is simply not true that melatonin is only prescribed for people over 55. On the other hand, any benefits of melatonin are likely to be short-lived; most people find it works for a week or two and then stops working.

I just feel like I don't care and all I want to do is sleep, so take 5 of those Brotizolam because I've just had enough.

Yes, but you are aware that that's pretty dangerous and stupid so why are you doing it?

 

[AmZ]

Thanks Dr Baxter.

That really makes little sense, AmZ. You really should do yourself a favor and stop self-prescribing. The Lamictal is a mood stabilizer prescribed to limit your mood swings - and if you doubt that you have mood swings just read through some of your own threads here. What difference does it make how many medications you vare taking? The important thing is to find some combinations of medications that work to manage your symptoms. For some people, that may be one; for others it may be three, four, five, or six.

My point, since the beginning has been that as long as I could see that the Effexor was doing 'enough' then I would be satisfied in taking a second medication. I am not denying that the Effexor has helped me in some aspects such as having less physical anxiety, but asides from that, it's clear to see that it's not 'quite there' enough to warrant me me taking it. I'd told the psychiatrist about the 4 days I'd had with the Effexor the other week where it felt like 'too much' and that I was over-energized and racing inside. She asked several questions about how I felt and some other things and said that it definitely sounds like the dosage of the Effexor is probably too high. But then what does she do? She says to carry on with the Lamictal and that should 'snip both ends off' of the good and bad that I am experiencing. 1. The 'good' that needed 'snipping' was not due to bipolar or general something-else-ness. It was 4 days of a dry mouth, racing inside, constipation and a lot of things which point to being side-effects from the Effexor, hence the dosage possibly being too high. 2. I truly think that the 'bad' that needs snipping should be best 'snipped off' by the original anti-depressant, fine, not fully, but at least in general it should be noticeable that I'm having less bad days, rather than just less anxiety and with everything else being the same pretty much.
Does this make sense at all? Basically, I feel like the Lamictal is being added to do the work that the Effexor is not doing. Honestly, if I felt like the Effexor was doing enough, and I was still having the mood swing issue, then I'd take a second, but the 'ups' are not a problem, because it happened once for 4 days (and it's been said that it is def not a bipolar issue and is most likely a high-dosage issue!), it is the downs that are a problem... I don't want to add on a second and third medication without at least seeing that the first is worthwhile taking.

On the other hand, you don't appear to be suicidal and if you were given an actual sedative/hypnotic which is designed to help you sleep instead of a short-acting tranquilizer there'd be no need for you to wake up and take more, right?

Yep. I wouldn't have taken 5 in the first place. I just would have taken the 2 and slept the whole night.

Yes, but you are aware that that's pretty dangerous and stupid so why are you doing it?

But that is the problem. Even though I am not feeling actively suicidal, the thoughts about it have been going around in my head especially over the last couple of days. It's not making me want to do such a thing, but I feel like I'm a bit 'pushed over the edge' of generally caring to be honest. All I think is 'it will most likely be fine' and then unbolt my door in the case of someone not being able to get in my apartment from the outside with me in it. I'm still doing it with the knowledge that something could happen and like I say, I feel like I want to sleep (in this example) so much, plus get the lonely weekend over and done with as quick as I can, I don't care so much to take that risk when I already feel like I want to hurt myself anyway to be honest.

Perhaps not, but in this case it's the pharmacist you should be angry with, not your doctor. It is simply not true that melatonin is only prescribed for people over 55. On the other hand, any benefits of melatonin are likely to be short-lived; most people find it works for a week or two and then stops working.

The private psychiatrist had prescribed me this. I then went to my family doctor as she needed to write up the prescription in order for me to get it. She said that it's only given to over 55s so she doesn't think any pharmacist will give me it. So I tried two different pharmacists and neither would. It's OK, I'm over it. I'll speak with the psychiatrist tomorrow and we'll sort something out. But I am not paying again to go see her in order to do so.

 

[David Baxter PhD]

I am not denying that the Effexor has helped me in some aspects such as having less physical anxiety, but asides from that, it's clear to see that it's not 'quite there' enough to warrant me me taking it.

Why are you going to doctors if you think you know more than they do?

I'd told the psychiatrist about the 4 days I'd had with the Effexor the other week where it felt like 'too much' and that I was over-energized and racing inside. She asked several questions about how I felt and some other things and said that it definitely sounds like the dosage of the Effexor is probably too high. But then what does she do? She says to carry on with the Lamictal and that should 'snip both ends off' of the good and bad that I am experiencing. 1. The 'good' that needed 'snipping' was not due to bipolar or general something-else-ness.

Again, how do you know this?

I truly think that the 'bad' that needs snipping should be best 'snipped off' by the original anti-depressant, fine, not fully, but at least in general it should be noticeable that I'm having less bad days, rather than just less anxiety and with everything else being the same pretty much.

You are not a physician, or a psychiatrist, or a psychopharmacologist. You need to stop pretending to be any of these things and work WITH your doctors.

Basically, I feel like the Lamictal is being added to do the work that the Effexor is not doing.

No. Effexor is used to treat depression and/or anxiety disorders. Lamictal is prescribed as a mood stabilizer. Two different things.

Honestly, if I felt like the Effexor was doing enough, and I was still having the mood swing issue, then I'd take a second, but the 'ups' are not a problem, because it happened once for 4 days (and it's been said that it is def not a bipolar issue and is most likely a high-dosage issue!), it is the downs that are a problem...

Said by whom? And by the way every patient with bipolar disorder will tell you the same thing: The highs are not a problem; only the lows are a problem. Then ask anyone who knows or lives with someone with bipolar disorder and what do you think they will say?

None of this should be taken to mean that I am suggesting you have or do not have bipolar disorder. My point is that, first, you are not in a position to know that, and, second, that there are conditions other than bipolar disorder that could result in mood swings and either way those still need to be managed - and Effexor alone will not manage them.

I don't want to add on a second and third medication without at least seeing that the first is worthwhile taking.

If your symptoms include mood swings and insomnia, it is very likely that there is no single medication that will work for you. Your psychiatrist and your physician spent several years learning about medical and psychiatric disorders and about medications to treat those. You do not have that background.

You're going to experts and then saying, "I disagree. I know better than they do. I want to do it my way."

But that is the problem. Even though I am not feeling actively suicidal, the thoughts about it have been going around in my head especially over the last couple of days. It's not making me want to do such a thing, but I feel like I'm a bit 'pushed over the edge' of generally caring to be honest.

But you're doing this to yourself. There is so much distorted thinking, faulty logic, and faulty assumptions leading to this point. You need to be working more on these, in my opinion.

In this country, melatonin is certainly given to people under the age of 55 (I've had clients in their 20s taking it) so I have no idea where that's coming from. I'm not sure one even needs a prescription to get melatonin here.

 

[AmZ]

Sorry, I don't like having these 'banging heads with a brick wall' type conversations. I am really tying my best to be reasonable and to as clear-headed as I can.

I still totally agree about the depression causing the distorted thinking etc, but on the other, both I and with the opinion of the therapist that I have been seeing for 4 months twice a week, even taking me out of it, she has totally confirmed what I have been saying about the Effexor. She has not said it in such words, like I go and blab about. And I know that I should say less than I do and keep it simple, but the therapist, is, in the end, a trained professional, so whether I am seeing things wrongly or not, she is the unbiased and clear-headed one who has been sitting in front of me twice a week for 4 months.

I'm not trying to put all the emphasis on her or the 'facts' which I explain which I know, can be seen as distorted or in fact all distorted... I just honestly want to feel better and am really struggling. Like I say, take all of my words and feelings out of this and the therapist should be the one to listen to. I don't want to also cling on to the words of others, but when I went to the private psychiatrist, she'd said that if I feel like I want to hurt myself (which at the time, I did) amongst some other things, which I feel now also, and more... then the medication (Effexor) needs to be adjusted or changed to something else. Now because me having those weird 4 days, even though she's said that it's not bipolar etc, and me saying that I still see a little improvement, she said to carry on with the Lamictal... So what, now I want to hurt myself again and have no care for my life even to be honest and have had 5 days of so in a row of a big down... so now what? I'd honestly like to stop everything asides from the Effexor and go with it for now and see if we can see a gradual change and if so, then fine, maybe add something else. I'm not trying to make this more difficult for myself, I just don't want to be on a whole list of medications unnecessarily.

 

[David Baxter PhD]

Then your course of action should be clear: You need to go back to the psychiatrist. Your psychologist does not have the necessary background in psychopharmacology; that's why she sent you to the psychiatrist.

So make an appointment with the psychiatrist. Soon.

 

[AmZ]

And by the way every patient with bipolar disorder will tell you the same thing: The highs are not a problem; only the lows are a problem. Then ask anyone who knows or lives with someone with bipolar disorder and what do you think they will say?

I'm not loony enough to not remember 'high days' which I've had throughout this, trust me! I had those 4 days of 'high' which the psychiatrist had confirmed def sounds like the Effexor needs to be decreased and if the dry mouth and constipation carries on for a few more days, to call her and we'll decrease the Effexor. I have had no other days like this. The better hours/days I have had were me feeling 'OK' enough to do some extra small things.. not me going around feeling great or even much above 'good'. I am not in denial or something here.

If your symptoms include mood swings

Right. Maybe we can simplify this a bit. What is classed as a mood swing? Because I don't think that is what I am experiencing. If someone has depression, they are not feeling the same day in day out necessarily? Say that 0 is feeling the worst and 100 feeling the best, would it not be normal for the person to one day feel at 10, then 20, then 15, then 0...? If we use this scale to explain how I am feeling, if 50 is OK, that is the max I have felt throughout all of this... so one day 10, then 20 the next, 15 the next, 5 the next... and not having much jumps in-between... which I would take it, would be classed as a mood swing. i.e. going from 0 to 50, then 50 to 10, and 10 to 50, etc.

---------- Post added at 11:51 PM ---------- Previous post was at 11:47 PM ----------

Then your course of action should be clear: You need to go back to the psychiatrist. Your psychologist does not have the necessary background in psychopharmacology; that's why she sent you to the psychiatrist.

So make an appointment with the psychiatrist. Soon.

Thanks. I agree. I know that the psychologist doesn't have a background in medications, and she doesn't make out to have one either. At least from her education and experience, she has explicitly said that the medication, regardless of what and how much etc, is not where it needs to be. That we can't of course expect it to do everything, or even half of everything, and we have a lot of work to do, but it's still not right.
I called the psychiatrist on Thursday and left a message.. but the I went AWOL and switched my phone off including other things and only turned it on at midnight with a message from her asking to call her back. That wasn't helping myself, I know. But I will definitely be calling her in the morning and leave a message for her to call me back (only a voicemail service) and ask to re-meet with her. Her schedule seems very tight and busy, I don't think she works in the city in a daily basis, but maybe a couple of days a week perhaps, but without sounding like I am the only one that exists in this world, she'll need to find the time to see me, like, this week coming

---------- Post added at 11:58 PM ---------- Previous post was at 11:51 PM ----------

Thank you everyone for sticking with me and helping me out

---------- Post added January 2nd, 2011 at 12:31 AM ---------- Previous post was January 1st, 2011 at 11:58 PM ----------

I just wanted to say that I'm not persisting on here in order for me to be 'right' and everyone else 'wrong'. I just want to be understood fully and reply to comments and questions where needs be. I know that I still have a lot of things to work on and that this situation isn't all black & white (even though I make it sound like that).

Some things that have happened have been because of my own failures and lack of clearness - so I am not blaming it all on the psychiatrist in this case.
I'm finding this process very frustrating, especially because the lack of support from others (of course, meaning outside this forum )
I'm frustrated with myself amongst other things and people and trying to retain level-headed and fully rational hasn't been one of my fort?s in the last several months.

Things are sometimes tough enough in life and doing them by yourself certainly doesn't make things any easier. I like to think of myself as brave, but this experience has truly shown me that we can't be brave and strong enough with all things in life when not having support, care and love from others.
That's pretty upsetting enough for me.

 

[Retired]

I like to think of myself as brave

I for one think of you as being courageous and persistent, because those are the qualities required to pursue treatment for the illness in question. It's not an easy task, and being the intelligent and perceptive person you are, you are questioning and challenging the information you are provided.

Hopefully, through your persistence and questioning, you will form a strategy that might eventually get the relief you're looking for.

Ask away, and vent away. With the support we hope we can provide, with time success should come.

You are a brave person.

 

[AmZ]

What lovely people you all are... really.

I just need one or two of you in my life and things would be much easier.

I know that I don't make things easy on myself and I am often my own worst enemy, but we've all got things to work on, right?

I wish that I had that enthusiasm back that I had only a couple of months ago. Now I am just feeling really hopeless and I feel like putting my hands up and saying "fine, I give in".
It scares me to have such thoughts and I feel so much guilt because of how it would affect others if I gave up. But I don't really care for myself because I feel so far gone, worthless and a lost cause. If it wasn't for my dad, sister and baby niece, I wouldn't be here with all of this persistance and patience right now.
Still, I feel close enough to losing it somewhat.

 

[Yuray]

If at this time there is no personal valid reason for continuing on with the 'good fight', then I am grateful that your dad, sister, and baby niece all have a presence in your thoughts and decisions.

 

[AmZ]

Me too.

Thx.