Taking twice a day

[daanh]

Hi! A blood test showed that the paxil level in my blood was very low in the morning. Apparantly I have a very fast metabolism. The Psych thought it was a good idea to take it twice a day to get it more even in the blood. I started taking 5ml at breakfast (9 in the morning) and 2,5 ml at 9 in the evening. I didn't want to split it evenly at once, maybe I will gently even it out over the coming weeks/months. I heard that your metabolism is much lower at night.

Are there any other people who have experience with this? Or who maybe have an opinion on it? Perhaps that an even split is very neccesary, or that you can better take the second dose at dinner?

Thanks, Daan

[texgirl]

I don't understand the rationale for this at all. Even if you could accurately measure the level of Paxil in the blood (I have no idea whether that's medically possible), wouldn't it logically be "low" because you're tapering? I mean, isn't that the goal?

[LCrawford67]

Yeah, that makes absolutely no sense at all. The half life of Paxil is 16-21 hours anyway and, as Tex said, even if you could accurately measure the level of Paxil (which is something I've never heard of) if you're taking less Paxil, you'd have less.

What kind of doctor did this?

[texgirl]

I'd never heard of it, either. It sounds like bull**** to me.

[daanh]

OK, let me make things clearer. You CAN measure the amount of Paxil in the blood. Mine was measured in the morning, 24 hours after I took 15 mg. The amount was supposed to be between 10 and 75 (mmol/cl or something, not percent) considering the 24 hours and the dose. Mine was 12, so in range but low.

The idea is that, when I take a dose, I get a peak during the day (fast metabolism) and then it rapidly drops.

Does all this sound so stupid?

[texgirl]

I still don't get it. By what standards is Paxil "supposed to be" between 10 and 75 mmol/cl (or whatever)? Even if the level was possible to measure or quantify, how does one set a baseline for something like that?

[rangerNY]

So someone is telling you that there's a "target" level of Paxil in the bloodstream and that they can measure that? Frankly, that sounds like shenanigans to me. From antidepressantfacts.com, apparently with reference to treating possible overdose:

4.1 MONITORING PARAMETERS/LEVELS
4.1.2 SERUM/BLOOD
A. Monitor serum electrolytes in symptomatic patients. Paroxetine levels are not widely available or clinically useful.
4.1.4 OTHER
A. Institute continuous cardiac monitoring and obtain ECG.

In another thread a member was told by an alternative practitioner that the blood tests they did "isolated the chemicals that were causing her withdrawal". That wasn't even remotely true, and I'm guessing that neither is what you're being told.

[scotty]

Originally Posted by daanh

You CAN measure the amount of Paxil in the blood. Mine was measured in the morning, 24 hours after I took 15 mg. The amount was supposed to be between 10 and 75 (mmol/cl or something, not percent) considering the 24 hours and the dose. Mine was 12, so in range but low.

There is no "norm" for paxil levels, so whatever this doctor is telling you is ridiculous. Even looking at the levels that were given as normals are SO widely varied it makes no sense at all. Someone who has a supposed paxil level of 10 is normal AND so is a person with a level of 75? I have no clue where he came up with these numbers, but they mean nothing. To have a norm of any drug there has to be a level that when achieved would relieve all symptoms, and we know that is not factual at all.

If drug levels aren't used to determine efficacy, then those levels would mean nothing in withdrawal.

[daanh]

OK, forget the norm.

If my body happens to process Paxil faster than most other people, AND paxil is known to have a short half-life, wouldn't it be logical to take it twice a day? To get the amount in the blood more stable?

Nobody ever tried this??

Daan

[kj630]

The last pdoc that I saw said that they could measure levels of Tricyclics in the blood to determine if you are in the effective concentration range, but said that it can't be done with SSRIs (don't know why). I had never heard of measuring the level of any drug in the blood before this. I don't doubt that it can be performed, but I question the accuracy and the relevance to treatment. Although I have heard some ppl being dosed twice a day (I think with some of the shorter half-life drugs like Effexor and Cymbalta). When I was on Paxil, at different times during treatment I took the drug at morning, noon, or night (based on whatever was convenient with my schedule at the time) and never noticed a difference...as in I couldn't feel it running low or anything and needing my next pill like I have on some of the shorter-acting benzos. I think Paxil has a long enough half-life to be dosed once a day. But, if your doctor insists, I don't see any harm from what I know in splitting it up...just sounds unnecessary to me and easier to forget.

[scotty]

Originally Posted by daanh

If my body happens to process Paxil faster than most other people, AND paxil is known to have a short half-life, wouldn't it be logical to take it twice a day? To get the amount in the blood more stable?

First, what makes you think that you process drugs faster? And the twice a day dosing with paxil just makes it much harder to figure out a weaning schedule down the line(which dose do you lower, both doses, one dose?)

Paxil is designed to be taken once a day...take it once a day. Weaning doesn't mean reinventing the wheel. Stick to once a day dosing.

If I'm understanding your post, you're now taking 9mg in the morning and 9mg at night?

[LCrawford67]

Originally Posted by daanh

OK, forget the norm.

If my body happens to process Paxil faster than most other people, AND paxil is known to have a short half-life, wouldn't it be logical to take it twice a day? To get the amount in the blood more stable?

Nobody ever tried this??

Daan

Paxil doesn't work in your blood, it effects brain chemistry. And, as Laurie mentioned, it's made to be taken once a day. This twice a day thing, isn't beneficial and, in fact, makes it more difficult to taper. Nowhere will you see the manufacturer recommending it to be taken twice a day.