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April 11, 2007


Dr. Black Kitty

Jim, Great posting. I totally agree. Another example of bad design is Cymbalta. It is a SSNRI that needs to be titrated up to a tolerable dose, due to a very bad side effect profile. Its great new indication is PAIN, therefore it is the new Effexor.

This medication needs to be titrated VERY SLOWLY in order to make sure that patients don't go into breakthrough hypomania, if they have bipolar rather than unipolar depression or adjustment disorders. But alas, the BRILLIANT designers of this medication, make it a gelatin CAPSULE FULL OF SMALL TINY LITTLE BALL BEARINGS, RATHER THAN A PILL THAT COULD BE BROKEN EASILY. Better yet,providing varying dosages would allow providers options in dosing and medication management??

Additionally, in the time release version, they are tiny VERY BITTER BALLS are of different sizes. How does the MD expect patients to get any kind of consistent dosages?

Patients are told by the LABEL and the INFORMATION provided by the pharmacists to NOT OPEN THE PILLS however, hundreds of patients are being told by their providers to open the pill, and try to take a half or a quarter of the ball bearings at a time.

So here is the provider dilemma, how do I administer this NEW and GREAT FOR PAIN drug to make my rep happy, but not violate my ethics? I ASSUME that MDs KNOW that the pharmacists TELL patients NOT to open the pills, but, then again, who really knows?

I give a huge BOW to both Furious Seasons and Clinical Psychology BLOGS for starting to discuss Cymbalta. This is a good place for you to throw your hat into the ring, Jim. Cymbalta is being used very badly. Many people are getting hypomanic, and nothing is in the literature. It is my SINCERE wish, that you, Peter, and Health Care Renewal, along with the other bloggers CATCH UP to Clinical Psych and Furious Seasons on this issue.

Thank you so much for allowing me this opportunity.

Dr. BK


I like your hearing aid suggestion. Far from wanting to hide the fact that I wear hearing aids, I'd like them to be evident (yet attractive) so people will be alerted to speak clearly to me, not address me while turning their backs, etc.


It's great that Amy got the discussion going. But as a person with Type 1 diabetes who has to carry around a bulky assortment of test strips, needles, lancets and meters, a hearing aid is one of the most discreet medical devices around. My blood glucose meter is larger than an iPod nano and is QUITE noticeable.

pain relief

Celebrex medication is a nonsteroidal anti-inflammatory drug (NSAID) which relieves pain and inflammation (swelling). It is used to treat

pain, swelling and stiffness due to arthritis. This drug works by blocking the enzyme in your body that makes prostaglandins. Decreasing

prostaglandins helps to reduce pain and swelling.


GELONIDA is a narcotic analgesic used to treat or prevent moderate to severe pain. It may also be used to treat other conditions as determined

by your doctor. DO NOT TAKE THIS MEDICINE IF YOU HAVE HAD A SEVERE ALLERGIC REACTION to codeine, hydrocodone, dihydrocodeine, or oxycodone

(such as Tylox, Tylenol with Codeine, Vicodin). A severe allergic reaction includes a severe rash, hives, breathing difficulties, or



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