Another Casualty of the Lack of Health Care Reform

Andrea writes in:

I have been taking 100 mg of Lamictal for about two years. In the last 1.5 yrs my doctor added 100 mg of Pristiq. I have recently lost my health insurance and need to get off both drugs as a result. How should I do this? I’m a full time student and a mother of 2 children. When I miss a single dose of either drug I become ill. Nausea, dizziness, irritability, etc. I can’t afford to fall apart but I can’t pay for the drugs any longer. Please advise

Ok, I’ll get down off my soap box and tend to this practical matter.  But, really, when are we as a people step up to the plate and not allow this to happen.  If someone needs medical attention to continue to be a productive member of our society, how can we look the other way???

Ok, some practical advice . . .

I know nothing of your history.  There are two issues going on here, tho:  1)  how do you stay on the medicine (or some medicine) and keep your self going;  and 2)  how do you get off of you don’t need to be on medicine.  The answer to that question comes best from your conversation with your health care professional who is prescribing the medicine.  If you need to stay on the medicine, then you either use samples (Prisitq still samples), go to the manufacturer for freebies (they have patient assistance programs . . . just go on to their website and look around), or switch to another medication that still comes in samples (in my neck of the woods, Lexapro and Cymbalta are still aggressively sampled).  If you NEED to be on medicine, the question is how to get you some medicine in a way that you can afford NOT how do I get off so I am not so uncomfortable when I crash.

If you are able to get off the medicine (again, that decision should be reached with your health care provider), you should talk to him/her about how they will get you off.  For my patients, I subscribe to the philosophy of slow being better.  While Lamictal is not too bad for most people to get off (although you will read horror stories on this site).  I would go down by 25-50 mg every two weeks or so until you are off.  As for the Pristiq, I would again go slow.  Remember, the core molecule of Pristiq is a relative of Effexor . . . one of the more difficult medicines to get off.  It will be typical for you to have discontinuation symptoms as you come off Pristiq unless you go slow.  I would drop by 25 mg at most every two weeks or so.

My biggest concern  here is that you seem disconnected from the health professional that has been prescribing this medicine.  I would get in to see that person and tell them about what is going on with you.

Good Luck.

–Dan Hartman, MD

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