Gabatril for anxiety

Discussion in 'Fibromyalgia Main Forum' started by Applyn59, Jul 8, 2003.

  1. Applyn59

    Applyn59 New Member

    Hi,

    I am wondering if I should ask for Gabatril.
    I would love it to help me sleep but I also
    need something for anxiety.

    Does anyone take it for that?
    During the day?

    I find xanax too sedating during the day time.

    Lynn
  2. Applyn59

    Applyn59 New Member

  3. zggygirl

    zggygirl New Member

    Hi!
    The first med I was put on for anxiety was xanax. I think it was .5mg. Anyway I complained to my psychiatrist that it was too sedating. He said I was taking too much if I was feeling the effects other than lack of anxiety.
    He is a BIG believer in the lowest possible dose thoough he always prescribes more than enough.
    He told me to get the book "How to make your medicines safe".
    It is all about how you can usually take half or less than what is the prescibed dose by the manufacturer.
    Anyway just a thought that it might work for you if you cut it up and take just a tiny bit.
    Ziggy
  4. zggygirl

    zggygirl New Member

    Hi again :)
    I just got some samples of gabatril and I am afraid to take it! I think I will cut one in half the fist time around.
    Madwolf recommended 2- 8 at bedtime for someone. So I would think 1mg would be a good place to start for the daytime or even less for anxiety. Just my opinion. I am just scared to take anything. But I always give in cause I can't take it anymore :p
    PS Ativan is also for anxiety and to me is less sedating than xanax. Klonipin is also for anxiety but I find it pretty "heavy". Though that may be what you need right now.
    Gosh so much trial and error.
    Hang in there,
    Ziggy
  5. zggygirl

    zggygirl New Member

    Lynn,
    After posting all that about low doses i realized that I should be more careful about what I say.
    A lot of pills can be divided. I had a pharmasist even suggest it to me.
    BUT I am sitting here with a med. that is sustained release and very potent and I don't think it should be cut.
    You may already know all this but I figured I better clarify what I wrote in case it was misleading.
    Sorry,
    Ziggy
  6. Applyn59

    Applyn59 New Member

    Yes, I know about the pill splitting etc and that
    not all can be split.

    Was it difficult for you to get your dr. to prescribe
    Gabatril? What kind of dr. did it.

    I believe Maddwolf said 2 to 4 mg but I could
    be wrong. I was just reading it today.

    I would love to try some and I want my mother
    to get it as well. She is much worse than I am.

    I was hoping to get some of this resolved
    today but the dr. wasn't very cooperative.

    Maybe I will ask my endocrinologist. He is
    usually nice to me.

    So sick of drs and everything else.

    Lynn

    Thanks for suggestions. I have xanax and so does
    my mother. I have tired klonopin and didn't really
    like it. I was only taking for sleep though. My mother
    also has Ativan but claims it is too strong.

    I really need to get her better but it's hard when
    I have 1000 health problems all at the same time!
  7. Applyn59

    Applyn59 New Member

    Where are you getting this information?
    I have just read two articles that say it is the
    safest drug for anxiety.

  8. Dorothy45

    Dorothy45 New Member

    This is terrible, but I can't remember the dosage. I think I am on 4mg twice a day. My psychiatrist prescribed it and other medication to treat me for bipolar. He commented that the Gabitril would help with anxiety. I have taken buspar and xanax for anxiety too, and prefer Gabitril. I don't care for the "doped up" feeling I get with Xanax. In regards to Jaci's comment...I think I read an article somewhere regarding the saftey of Gabitril. I think it referred to Gab as a catalyst for cancer growth. I will try to see if I can find it again. I still take it. I have been suicidal, and that's dangerous too. I decide which is the lessor of two evils.
  9. Shirl

    Shirl New Member

    Ziggy is right about the Xanax, I take .25 milligrams at 7pm for racing brain syndrome. Have taken this same dosage now for 16 years. It never did make me feel 'sedated'. The only thing that I feel 'differnt' about is the 'anxiety' feeling is gone, or at night my 'brain' stops racing. Nothing else.

    If I need it for anxiety during the day, I take half of that amount. I just put it under my tongue, and in a short time the anxiety is gone. No sedated feeling at all.

    You must be taking way too much if you feel that way.

    Most people with FM/CFS are very sensitive to meds, we usually need way less then normal people for the same effect.

    Good luck............

    Shalom, Shirl
  10. Shirl

    Shirl New Member

    This is from Medscape...............

    GABITRIL ORAL
    Uses & Dosage





    Labeled Uses


    Complex-Partial Epilepsy
    Simple-Partial Epilepsy

    Unlabeled Uses



    Uses from AHFS DI™

    Partial Seizures
    Tiagabine hydrochloride is used in combination with other anticonvulsant agents in the management of partial seizures. In controlled clinical studies, adjunctive therapy with tiagabine was effective in reducing seizure frequency in patients with simple and/or complex partial seizures refractory to therapy with one or more conventional anticonvulsant drugs (e.g., carbamazepine, phenytoin, valproate).In 2 multicenter, parallel-group studies conducted in the US, patients received tiagabine or placebo in addition to their existing anticonvulsant regimen, and efficacy of the drug was evaluated principally in terms of the median decrease (from baseline) in the frequency of complex partial seizures per 4-week period during adjunctive treatment;|the median frequency of all partial seizures per 4-week period also was recorded in these studies.In the first US study, patients were randomized to receive adjunctive therapy with placebo or 16, 32, or 56 mg of tiagabine hydrochloride administered in 4 divided doses daily for 12 weeks (after a 4-week titration period to achieve the assigned daily dosage).In patients receiving adjunctive tiagabine therapy, a reduction from baseline of 2.2 or 2.9 in the median 4-week frequency of complex partial seizures occurred with tiagabine hydrochloride dosages of 32 or 56 mg daily, respectively, while the median reduction in the 4- week frequency of all partial seizures in patients receiving adjunctive tiagabine was 2.7 or 3.5, respectively.Seizure frequency did not decrease substantially in patients receiving adjunctive therapy with placebo or tiagabine hydrochloride 16 mg daily.To determine the potential for tiagabine to induce withdrawal seizures, the dosage of tiagabine hydrochloride was gradually reduced and the drug discontinued over a 4-week period in this study.An increased frequency of seizures was noted for each type of partial seizure, for all types of partial seizures combined, and for secondarily generalized tonic-clonic seizures in patients receiving tiagabine; the increase in seizure frequency was similar regardless of tiagabine hydrochloride dosage.In a second US study, patients were randomized to receive tiagabine hydrochloride 16 mg twice daily, 8 mg 4 times daily, or placebo for 8 weeks as an adjunct to existing anticonvulsant therapy after a 4-week dosage titration period.Patients receiving tiagabine hydrochloride 8 mg 4 times daily experienced a median reduction of 1.3 in the 4-week frequencies of both complex partial and all partial seizures, although the difference in seizure frequency reduction for all partial seizures was not statistically significant.Patients receiving tiagabine hydrochloride 16 mg twice daily or placebo did not experience a substantial reduction in 4-week seizure frequency for either complex partialor all partial seizures.In a multicenter, parallel-group study conducted in Europe, patients were randomized to receive adjunctive therapy with 10 mg of tiagabine hydrochloride or placebo 3 times daily for 12 weeks after a 6-week dosage titration period.Efficacy of tiagabine was evaluated principally in terms of the proportion of patients achieving at least a 50% reduction from baseline (i.e., on existing anticonvulsant therapy) in the 4-week frequency of all partial seizures during treatment with tiagabine or placebo; however, the difference in the median decrease of seizure frequency between patients receiving tiagabine or placebo was insubstantial.Secondary analyses were performed using evaluation criteria similar to those used in the US studies (i.e., median decrease from baseline in the 4-week frequency of complex partial or all partial seizures).In these analyses, patients receiving tiagabine experienced a substantial median decrease from baseline of 1.3 or 1.1 in the 4- week frequency of complex partial or all partial seizures, respectively,but patients receiving placebo tended to have a median increase in the 4- week frequency of complex partial or all partial seizures.In 2 other small, placebo-controlled crossover studies, which consisted of a dosage titration period of at least 4 weeks followed by two 7-week treatment periods with a 3-week washout period between treatments (tiagabine followed by placebo, or placebo followed by tiagabine), median within-patient reductions in the frequency of complex partial and all partial seizures per 4-week period during administration of tiagabine were greater than those reported during placebo administration.Dosage and Administration from AHFS DI™

    Administration
    Tiagabine hydrochloride is administered orally. Food delays but does not decrease the extent of tiagabine absorption. The manufacturer states that tiagabine should be taken with food.
    Dosage
    Safety and efficacy of tiagabine in children younger than 12 years of age have not been established.In addition, the manufacturer states that clinical trials have not included sufficient numbers of patients older than 65 years of age to determine whether they respond differently than do younger patients, and safety and efficacy of tiagabine in geriatric patients have not been established.However, the pharmacokinetic profile of tiagabine in healthy geriatric adults was similar to that in healthy young adults in clinical trials.The manufacturer states that a therapeutic range of plasma tiagabine concentrations has not been established;however, because of the potential for altered tiagabine clearance during concurrent administration of hepatic microsomal enzyme-inducing or -inhibiting drugs, it may be useful to determine plasma tiagabine concentrations before and after changes are made to the patient’s drug regimen.Tiagabine undergoes extensive hepatic metabolism,and the plasma half-life of the drug is decreased from 7–9 hours to 4–7 hours in patients concomitantly receiving an anticonvulsant drug that induces hepatic microsomal enzymes (e.g., carbamazepine, phenobarbital, phenytoin, primidone).Because all clinical trials of tiagabine therapy were conducted in patients receiving at least one enzyme-inducing anticonvulsant drug, patients receiving only non-enzyme- inducing anticonvulsants (e.g., gabapentin, lamotrigine, valproic acid) should receive a reduced dosage of tiagabine hydrochloride or slower dosage titration.Patients receiving a combination of enzyme-inducing and non- enzyme-inducing anticonvulsant drugs (e.g., carbamazepine and valproate) should be considered to have induced hepatic microsomal enzymes.Tiagabine does not appear to induce or inhibit hepatic microsomal enzymesnor does it appear to have any clinically important interactions with other anticonvulsants.Therefore, unless clinically indicated, modification of concomitant anticonvulsant therapy is not necessary when tiagabine is added to an existing anticonvulsant regimen.Because of the possibility of increasing seizure frequency, anticonvulsant drugs, including tiagabine, should not be discontinued abruptly.The manufacturer states that withdrawal of tiagabine has been associated with increased seizure frequency and that the drug should be withdrawn gradually unless more rapid withdrawal is required for the safety of the patient.(See Uses.)Because tiagabine is highly (96%) protein bound, it may be displaced from plasma protein binding sites or may displace other protein-bound drugs from such binding sites.In vitro, valproic acid reduces tiagabine plasma protein binding from 96.3 to 94.8%, which results in a 40% increase in free plasma tiagabine concentrations;however, the clinical relevance of tiagabine displacement from plasma proteins by valproic acid has not been established.Dosages of tiagabine hydrochloride exceeding 4 mg daily should be administered as 2–4 divided doses daily.
    Adult Dosage
    For adjunctive therapy in the management of partial seizures in adults 18 years of age and older, the initial dosage of tiagabine hydrochloride is 4 mg once daily for the first week of therapy.Beginning with the second week of treatment, the total daily dosage of tiagabine hydrochloride (administered as 2–4 divided doses) may be increased by 4–8 mg at weekly intervals until a clinical response is achieved or a total daily dosage of 56 mg is reached.The usual maintenance dosage of tiagabine hydrochloride in adults is 32–56 mg daily. The manufacturer states that dosages exceeding 56 mg daily have not been evaluated systematically in controlled clinical studiesand that limited experience exists in adults receiving tiagabine hydrochloride twice daily at daily dosages exceeding 32 mg.
    Adolescent Dosage
    The usual initial dosage of tiagabine hydrochloride in adolescents 12–18 years of age is 4 mg once daily for the first week of therapy.Daily dosage may be increased to 4 mg twice daily beginning with the second week of treatment; thereafter, the total daily dosage (administered in 2–4 divided doses) may be increased by 4–8 mg at weekly intervals until a clinical response is achieved or a total daily dosage of 32 mg is reached. The manufacturer states that daily dosages exceeding 32 mg have been tolerated in a limited number of adolescents for a relatively short duration.
    Dosage in Renal and Hepatic Impairment
    The manufacturer states that the pharmacokinetics of total and unbound tiagabine are similar among patients with normal renal function (creatinine clearance greater than 80 mL/minute); those with mild, moderate, or severe renal impairment (creatinine clearance of 40–80, 20–39, or 5–19 mL/minute, respectively);and patients with renal failure undergoing hemodialysis.Tiagabine clearance is decreased in patients with hepatic impairment,and the manufacturer states that such patients may require decreased initial and maintenance dosages of tiagabine and/or longer dosing intervals than patients who have normal hepatic function.However, the manufacturer makes no specific recommendations for dosage adjustment in such patients.Description from AHFS DI™
    Tiagabine, a nipecotic acid derivative, is an anticonvulsant agent.The drug is commercially available as the hydrochloride salt and differs structurally from other currently available anticonvulsant agents.Although the precise mechanism of action of tiagabine is unknown, the drug enhances inhibitory neurotransmission mediated by γ- aminobutyric acid (GABA).Tiagabine increases the amount of GABA available in extracellular spaces of the globus pallidus, ventral pallidum, and substantia nigra,suggesting a GABA-mediated anticonvulsant mechanism of action (i.e., inhibition of neural impulse propagations that contribute to seizures).Tiagabine inhibits presynaptic neuronal and glial GABA reuptake,and increases the amount of GABA available for postsynaptic receptor binding.The drug does not stimulate GABA release, and does not have activity at other receptor binding and uptake sites at concentrations that inhibit the uptake of GABA.Tiagabine selectively blocks presynaptic GABA uptake by binding reversibly and saturably to recognition sites associated with GABA transporter protein in neuronal and glial membranes.Tiagabine exhibits anticonvulsant activity in several animal seizure models.Although the drug is effective against tonic seizures induced in some animals by subcutaneous administration of pentylenetetrazole (PTZ),tiagabine is only partially effective against PTZ-induced clonic seizures in some animals,indicating that it may not have substantial activity against absence seizures in humans.Tiagabine decreases seizure severity and aftercharge duration in animals with amygdala-kindled seizures,indicating potential anticonvulsant activity against partial seizures in humans.Tiagabine exhibits a dose-dependent effect against clonic seizures induced by proconvulsant methyl-6,7-dimethyoxy-4-ethyl-β-carboline-3-carboxylate (DMCM), with diminished effectiveness at higher dosages,and is effective against audiogenic seizures in genetically epilepsy-prone animals.Tiagabine is partially effective against picrotoxin- induced seizures,bicuculline-induced seizures,photic seizures,and is minimally effective against maximal electroshock seizures (MES) in animals.In vitro binding studies indicate that tiagabine does not inhibit substantially the uptake of dopamine, norepinephrine, serotonin, glutamate, or choline,and does not bind substantially to dopamine D1 or D2;cholinergic muscarinic;serotonergic type 1A, type 2, or type 3 (5HT1A, 5HT2, or 5HT3, respectively);α1- or α2-adrenergic; β1- or β2-adrenergic;histamine H2 or H3;adenosine A1 or A2;opiate µ or κ1;glutamate N-methyl-d- aspartate (NMDA);or GABAA receptors.Also, tiagabine has little or no affinity for sodium or calcium channels.Tiagabine binds to histamine H1, serotonergic type 1B (5HT1B), benzodiazepine, and chloride channel receptors at concentrations 20–400 times those that inhibit the uptake of GABA.SumMon® (see Users Guide). For additional information on this drug until a more detailed monograph is developed and published, the manufacturer’s labeling should be consulted. It is essential that the labeling be consulted for detailed information on the usual cautions, precautions, and contraindications.




    ------------------------------------------------------------


    GABITRIL ORAL
    Patient Handout


    TIAGABINE - ORAL

    The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug.

    Common Brand Name(s):
    Gabitril


    Uses
    This medication is used to control certain types of seizures (epilepsy).



    How to Take this Medication
    Use exactly as directed by mouth with food, usually beginning at 4 mg once daily, and usually in addition to other anti-epilepsy drugs. The dose will be increased based on age and medical condition, up to 2 to 4 times daily. Do not interrupt or discontinue treatment without consulting your doctor or pharmacist. If told to stop this medication, it should be discontinued gradually.



    Side Effects
    Dizziness, weakness, drowsiness, shakiness, trouble sleeping, nausea, diarrhea or vomiting may occur. If these persist or worsen, notify your doctor. Report promptly any: difficulty breathing. Unlikely but report promptly: mental/mood changes, rash, easy bruising or bleeding, stomach pain, speech problems, unsteadiness, fainting, tingling hands or feet. Very unlikely but report promptly: bloody or black/tarry stools, chest pain, eye problems, persistent sore throat or fever. If you notice other effects not listed above, contact your doctor or pharmacist.



    Precautions
    Before using this drug, tell your doctor your medical history, including: any allergies (especially drug allergies), liver disease. Limit alcohol intake, as it may enhance certain side effects of this medication. Since this drug may cause drowsiness or dizziness, use caution if operating machinery or performing hazardous tasks. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not known whether this drug is excreted into breast milk. Consult your doctor before breast-feeding.



    Interactions
    Tell your doctor of all nonprescription and prescription medication you may use, especially: drugs for sleep (e.g., triazolam), other anti-seizure drugs (e.g., phenytoin, carbamazepine, phenobarbital or primidone), sedatives, tranquilizers, anti-anxiety medications (e.g., diazepam), narcotic pain relievers (e.g., codeine), muscle relaxants, certain antihistamines (e.g., diphenhydramine). Do not start or stop any medicine without doctor or pharmacist approval.



    Overdose
    If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include drowsiness; confusion; weakness; difficulty speaking; behavioral, emotional, or mood changes; seizures; and loss of consciousness.

    Notes
    Do not share this medication with others. Report any increase in the number of seizures or changes in seizure symptoms. Laboratory tests may be done to monitor treatment.

    Missed Dose
    If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

    Storage
    Store at room temperature between 68 and 77 degrees F (20-25 degrees C) away from light and moisture.























    [This Message was Edited on 07/10/2003]
  11. zggygirl

    zggygirl New Member

    Hi,
    My doc is a regular MD who specializes in FM. He had samples and I didn't get the impression that he knew a lot about it, though maybe he just didn't want to take the time to tell me. He just seemed to think it was a good idea to try it for sleep when I asked.
    My guess it the pharmacutical reps. are just making the rounds with it. Just a hunch.
    good luck and keep asking about it to your doctors. One has got to listen!
    Ziggy
  12. JaciBart

    JaciBart Member

    I am sorry for the wrong info you guys, I had not read that info obviously, I was just going by the little bit I know about it, the symptoms that do happen to me tho are a bit scary but we do all react differently. I hope I have not caused excessive fear, pay no attn to me!!!!!

    Jaci