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Family Physician
Family Physician, Doctor
Category: Medical
Satisfied Customers: 2592
Experience:  Emergency Medicine and Family Practice for over 26 years
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Can Welbutrin 150mg be scored or cut in half. I am having

Customer Question

Can Welbutrin 150mg be scored or cut in half. I am having increasing side effects since I was prescribed & I want slow reduction
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: Celexa 40mg ad, Norvase 2.5 mg just recently started, increased Welbutrin 75mg to Welbutrin 150mg XL maybe month & half ago then my blood pressure started rising which caused me to be put on Norvase, Estradiol 1mg BID, Just started Trazodone .25mg qHS in exchange of Ambien for Insomnia (started 12/22/16, along with Trazodone 50mg), Alene PM for sleep & leg pain during night, Aspirin 81mg ad, Xanax 0.5mg and 0.25mg qhs
JA: What seems to make the symptoms worse or better? Any redness or swelling in the leg?
Customer: Calm quiet environment helps racing thoughts, restlessness, excessive talking. Minimal swelling ankle area by late evening, however I walk 5 + miles per day & it helps. My D.C.: chronic depression major reoccurring, anxiety, myopathy, allergic to Penicillin, bandaids, nickel.
JA: Anything else in your medical history you think the psychologist should know?
Customer: I have seen psychologist but she thinks I'm ok. However, it was before I changed any of my medications or started new ones in last month & half
Submitted: 8 months ago.
Category: Medical
Customer: replied 8 months ago.
Major changes in my life over last 3-4 years: (moved to California for 7 month nursing job, resigned unable to adjust), (cared for dying mother for 2 years c Cancer, died 6 months), 2 other deaths in family, Father mentally and physically declining, got married 5 months ago, moved 5 times in 3-4 years, daughter's spouse killed his step-father & placed in prison, same daughter raising only grandchild on shoe-string income, and many other things I can't remember. My mental condition has been very fragile over a year. My cognitive abilities seem to be deteriorating more everyday. I'm not working and very happy in my marriage.
Customer: replied 8 months ago.
I would like a phone call and explanation sent bc I need to read over things several times to understand.
Customer: replied 8 months ago.
The medications for sleep are not working for 3-4 hours or later.
Expert:  Dr. Captain replied 8 months ago.

Hello!

Welcome to the JustAnswer.com question/answer interface.

I am a Family Medicine doctor, board certified with active licenses and certification in Internal Medicine, Pediatrics, Obstetrics and Gynecology, as well as Integrative Medicine & Naturopathy, with advanced training in Neurology, Cardiovascular Medicine, Gastroenterology, Endocrinology, and Psychiatry. I am also well-trained in Functional Medicine. — For your review, here is my direct link with my current ratings: http://www.justanswer.com/medical/expert-familydoctor/

— I have read your post and observations. Would you prefer a summary response to your question, or would you prefer more back-and-forth, where there will be a series of more questions and more details clarified? There is no difference in charges for your preference. You can continue to ask questions and receive answers without additional charges.

Either way, the goal is for your satisfaction, and I’ll do my best to take the appropriate time to help you.

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Customer: replied 8 months ago.
texting is good way for me to review questions & anwers. I am also a nurse. I'm under the care of MD, who choose to d/c Welbutrin 150 XL, return to prior med Welbutrin 75 BID, d/c Xanax 0.75 ad, return to Xanex 0.5 BID, d/c Topamax 50mg half qhs, return to Ambien 0.5 BID. What are your thoughts?
Customer: replied 8 months ago.
No, I can't afford additional cost. I understood we could text for one charge of $26
Expert:  Dr. Captain replied 8 months ago.

What you're describing an unusual way to taper medications... is that the goal?

Expert:  Dr. Captain replied 8 months ago.

just so I can understand and better direct my thoughts...

Customer: replied 8 months ago.
I want to get off some of meds that are causing new onset of symptoms
Expert:  Dr. Captain replied 8 months ago.

I see. It's certainly appropriate to taper the Wellbutrin. And moving to 75 BID makes sense... at least that way you can slowly add a day here or there, until you're tapered completely off of it. The xanax is also wise to taper off... and small increments, such as the 0.25 proposed, seem wise to me. That can actually be dangerous to stop abruptly. I agree with that one there... Topamax has a very long half life, and 40% of the medicine is protein-binding, so this one could probably be tapered more quickly, but it also depends on the indication (seizures vs headache). Ambien is not among the medications I typically recommend. In my personal view, it falls under the benzodiazepine category, in the sense that there are often better alternatives for long-term insomnia management, but it can be helpful in the short-run.

Customer: replied 8 months ago.
I am on my walk and headed home. I'm texting while traffic flying by, don't like ant to be killed, will resume conversation in about 20 minutes. Is that ok?
Expert:  Dr. Captain replied 8 months ago.

of course! At your lesiure. Please be safe :)

Customer: replied 8 months ago.
Sorry, settled at home now. I am not on Topomax. Error, it'S wasTrazadone 50 qhs
which is now d/maecqr
Expert:  Dr. Captain replied 8 months ago.

I see. Trazodone is a wonderfully benign medication. that one can be used basically as needed, and up to high doses.

Expert:  Dr. Captain replied 8 months ago.

what are the symptoms you're having, for which you're changing these medicines to help?

Customer: replied 8 months ago.
Well, no improvement in my sleep, in fact, sleeping got worse. I would take it, along with Aleve pm, and Zanax 0.5 mg. The Trazadone 50mg half at q hs & Norvase started 12/22/16. Sleeping problems got much worse.
Expert:  Dr. Captain replied 8 months ago.

Do you have difficulty getting to sleep or staying asleep?

Customer: replied 8 months ago.
Lots of problems getting to sleep. I developed problems staying asleep with Ambien, got off and replaced with Trazadone. Worked great 1st night, p sleeping problems returned. One I could not fall asleep til 2am. Now it's usually 1am and took pills 3-4 hours before going to sleep.
Expert:  Dr. Captain replied 8 months ago.

is it safe to assume you've dedicated good time and energy to making sure your sleep environment and sleep habits are ideal?

Expert:  Dr. Captain replied 8 months ago.

For instance...

Establish a regular bedtime and wake-up time and stick to them, even on weekends.

Avoid taking naps if you want to sleep more at night, but naps are great if you have less trouble sleeping at night. The more sleep, including naps, the better!

Exercise regularly during the day. Avoid exercising in the evening.

Keep light levels very low after sunset and keep the bedroom very dark.

Keep the bedroom at a cool temperature.

Use the bed only for sleep and sex, not for reading, using the computer, or watching television.

Go to bed when you are drowsy and get up when you are wide awake.

Avoid caffeine, other stimulants, cigarettes, and alcohol. Do not drink alcohol within 6 hours of bedtime. If you smoke, try to quit smoking entirely. Cutting back on smoking without quitting may lead to nicotine withdrawal in the middle of the night that awakens you.

Eat lightly at the evening meal and avoid snacks after supper.

Lose weight if you are overweight.

Learn to use relaxation exercises.

Meditate for 20 minutes before you go to bed.

Read something light or entertaining ust before you go to bed, to get your mind off the day’s troubles.

Consider having white noise in the background, such as a fan blowing.

Try not to focus on falling asleep. For example, don’t keep checking the clock and worry about why you are not asleep yet. If you are awake for more than 20 minutes, leave the bed and do not go back to bed until you feel ready to sleep.

Try to reduce stress in your life by changing the things that cause stress.

Keep a “to do” journal. Before you go to bed, write down all the things you are worrying about. Then write down what you can do tomorrow. Mark the other things as things to do later in the week. This will help clear your mind of worry.

Consider trial of Chamomile tea or Melatonin, at increasing doses over time, at bedtime.

Consider trial of Benadryl, between 25 mg and 50 mg per night, depending on the effect.

Customer: replied 8 months ago.
I have tried a lot of the recommendations and will try others to help sleep. Sorry, I feel asleep talking to you. May I notify you by this text?
Expert:  Dr. Captain replied 8 months ago.

aww! you should sleep! Maybe all you need is boring doctor talk? :)

Expert:  Dr. Captain replied 8 months ago.

sure, we can carry on tomorrow

Customer: replied 8 months ago.
Doc, sleeping was better last night. BP up some and woke up with HA before getting up & at least 2h. Not near as restless today. Stopped Welbutrin XL 150mg q a.m.
Expert:  Dr. Captain replied 8 months ago.

Wow, congrats on the better sleep! Maybe it's the start of something longer term! I'm hopeful. Congrats on stopping the Wellbutrin as well.

Customer: replied 8 months ago.
Well, I did not go pick up regular Welbutrin 75mg BID. Thanks! I will keep you in touch. I still have HA off & on, which is unusual for me.
Expert:  Dr. Captain replied 8 months ago.

Make sure you're drinking plenty of water... and maintaining a regular use of caffeine