Home Forums General Discussion Need Advice on Changing Generics

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  • #308819
    CurlyinNC
    Participant

    I’ve been using the Watson mino capsules for about 8 month now. After 3 1/2 months I started to see small improvements which continued for a couple of months, then leveled off. My doctor wanted me to increase to 100 mg bid, but the herxing convinced me to go back to once daily on MWF.

    I’ve been thinking for some time that perhaps a change in generics could be in order. Additionally, I’ve recently developed an altered sense of taste. I can detect some flavors, but most foods just taste bland. I’m not certain if the mino is the culprit since I only found one post on this forum regarding this, and found very little on the Internet at large. It’s possible that a different generic would not produce the same side effects.

    I’ve read some posts about generics that some folks prefer, but I’d like to put the request out for not only recommended manufacturers, but also those that are not recommended.

    Also, would I need to do a wash out or slowly introduce the new generic? Does anyone have opinions on the efficacy of tablets versus capsules? I have found that 50 mg capsules are cheaper than 100 mg capsules even considering that you need twice as many 50 mg capsules. Also capsules are cheaper than tablets.

    I want to give AP the best chance of working because the alternative is unthinkable to me. Thanks in advance for your input.

    Karen

    Diagnosed with RA 10/2014 with very positive anti-CCP. Rheumatoid factor was negative and continues to be negative.
    Began abx treatment 12/2014.
    Currently taking minocycline 100 mg bid M-F, diclofenac 75 mg as needed, probiotics, various other supplements.

    #375425
    PhilC
    Participant

    Hi Karen,
    @CurlyinNC wrote:

    My doctor wanted me to increase to 100 mg bid, but the herxing convinced me to go back to once daily on MWF.

    How, exactly, did you do that? Did you just suddenly start taking 100 mg twice a day, seven days a week?

    @CurlyinNC wrote:

    Additionally, I’ve recently developed an altered sense of taste. I can detect some flavors, but most foods just taste bland.

    How much vitamin B12 are you taking?

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #375426
    CurlyinNC
    Participant

    Hi, Phil. I initially started with an additional 100 mg on only 1 additional day per week which I continued for only 6 weeks. Prior to this I had been increasing my thrice-weekly dosage by 50 mg at a time, and stabilizing each time for a few weeks. I knew better than to go too fast, but wanted to follow my doctor’s advice.

    I’ve just been hesitant to start the slow ramp-up a second time daily due to the difficulty of trying to work around the dosing of all my other supplements/drugs.

    I’m taking 5000 mcg daily of Methyl B12 based on the recommendation from my doctor.

    Karen

    Diagnosed with RA 10/2014 with very positive anti-CCP. Rheumatoid factor was negative and continues to be negative.
    Began abx treatment 12/2014.
    Currently taking minocycline 100 mg bid M-F, diclofenac 75 mg as needed, probiotics, various other supplements.

    #375427
    PhilC
    Participant

    Hi Karen,
    @CurlyinNC wrote:

    I initially started with an additional 100 mg on only 1 additional day per week which I continued for only 6 weeks. Prior to this I had been increasing my thrice-weekly dosage by 50 mg at a time, and stabilizing each time for a few weeks. I knew better than to go too fast, but wanted to follow my doctor’s advice.

    My approach to the problem would be to make 100 mg every day the first step up. If someone has been taking 100 mg MWF for at least three months and is tolerating it fairly well, then a dose increase to 100 mg daily is also likely to be well tolerated (based on my own experience). So, even if you find that you’re unable to follow your doctor’s advice right away, it may be possible to quickly get yourself half way there.

    @CurlyinNC wrote:

    I’m taking 5000 mcg daily of Methyl B12 based on the recommendation from my doctor.

    That’s a rather high dose, and my experience is that overdosing on vitamin B12 is possible. I developed a burning sensation in my mouth (I believe that mainly my tongue was affected) when I was taking only 2000 mcg of vitamin B12 daily. The burning sensation went away within a few days after I discontinued the vitamin B12.

    Obviously, the nerves in my tongue were adversely affected by the high dose of vitamin B12 that I was taking. Perhaps your sense of taste is being affected in a similar way.

    Keep in mind that none of the above is medical advice. I am just passing along what experience has taught me with the hope that the information may be helpful in some way. What you do with the information is totally up to you.

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #375428
    CurlyinNC
    Participant

    Hi, Phil. I’m thinking I wasn’t clear regarding my doctor’s advice. She wanted me to go to 100 mg bid MWF, not every day. That is what I was attempting to work up to by adding 100 mg on one additional day when the herxing started. I feel like if I couldn’t tolerated an additional 100 mg on one additional day, I certainly couldn’t tolerate 100 mg every day. Besides, I thought that the pulsed dosing was preferred.

    I appreciate the heads up on the B12. I couldn’t find any information that B12 could cause such problems, but that doesn’t mean it isn’t the cause. I believe I’ll discontinue for a few days and see what happens. I’ll let you know if it works.

    Karen

    Diagnosed with RA 10/2014 with very positive anti-CCP. Rheumatoid factor was negative and continues to be negative.
    Began abx treatment 12/2014.
    Currently taking minocycline 100 mg bid M-F, diclofenac 75 mg as needed, probiotics, various other supplements.

    #375429
    PhilC
    Participant

    Hi Karen,
    @CurlyinNC wrote:

    I feel like if I couldn’t tolerated an additional 100 mg on one additional day, I certainly couldn’t tolerate 100 mg every day.

    Not quite. When you take an additional 100 mg on the same day, the level of minocycline in your blood will spike much higher than if you waited and took it the following day. That spike will help push the mino further into your tissues and hit the “bugs” harder. Your immune system then starts attacking the sick bacteria and you experience an increase in inflammation as a result.

    @CurlyinNC wrote:

    Besides, I thought that the pulsed dosing was preferred.

    I can see how you could get that impression, but I believe that the opposite is true — daily dosing is preferred. However, at the start of treatment it is often necessary to use pulsed dosing for tolerability sake. So, rather than being preferred, I would say that it is prudent to use pulsed dosing during the early part of treatment for rheumatic diseases that have an inflammatory component.

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #375430
    lynnie_sydney
    Participant

    I can see how you could get that impression, but I believe that the opposite is true — daily dosing is preferred. However, at the start of treatment it is often necessary to use pulsed dosing for tolerability sake. So, rather than being preferred, I would say that it is prudent to use pulsed dosing during the early part of treatment for rheumatic diseases that have an inflammatory component.

    That’s not quite true Phil. Regimes vary. Many AP Doctors (mine included) prefer pulsed dosing for longterm treatment. From the infectious trigger point of view, pulsed dosing is still often the preferred way to go. Reason? To allow the patient

    Be well! Lynnie

    Palindromic RA 30 yrs (Chronic Lyme?)
    Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
    rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
    Diet: no gluten, dairy, sulphites, low salicylates
    Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

    #375431
    PhilC
    Participant

    Hi Lynnie,

    I’ll try to explain what I mean a little more clearly. Regarding what any particular doctor prefers, I don’t really care because I see it as being largely irrelevant. As for your situation, I see it as being totally different because you are taking multiple antibiotics. That really complicates matters, and makes it much harder to assess the risks/benefits of pulsed dosing vs. daily dosing.

    What matters most is what works best for the patient. Surely, for some it will be pulsed dosing. In those cases, I see it as being used out of necessity. Pulsed dosing is not being used because it is somehow inherently better or superior, it is being used because the patient’s current condition or situation requires a dosing schedule with better tolerability than daily dosing can provide. The way I see it, using pulsed dosing in these cases is not the ideal, but it’s the next best thing.

    From my point of view, daily dosing is the ideal. I will try to explain what I mean by that by using my own situation as an example. When I first started taking doxycycline, I had to reduce my dose to 100 mg MWF because daily dosing was causing unpleasant symptoms (possibly due, in part, to the release of toxins). Later, when I started taking minocycline, I had an even stronger reaction which caused me to reduce my dose to 25 mg MWF. However, by slowly increasing my dose I was able to eventually increase my dose of minocycline to 100 mg MWF. Not long after reaching that dose, I was taking 100 mg every day of the week. I didn’t stop there, though, I continued slowly increasing my dose until I was taking 200 mg of minocycline every day.

    Did I experience any discomfort while increasing my dose of minocycline? Yes, of course. But it was easily tolerated because I increased my dose slowly. And now I can take 200 mg of minocycline every day with no problems whatsoever. Now that I’ve reached my goal, are there any good reasons why I should switch to pulsed dosing? Although I can think of some reasons, I can’t think of any good reasons, so the answer is “no.” There is nothing inherently better or superior about pulsed dosing that would make me choose it over daily dosing. When I used pulsed dosing, I did so only out of necessity.

    There is a very good reason why I think daily dosing is preferable (as soon as one is able to tolerate it). Anyone who has spent time over at cpnhelp.org knows that the people on that site are adamant about not pulsing bacteriostatic antibiotics like the tetracyclines and macrolides because it encourages bacterial antibiotic resistance. I know from personal experience that it can happen, but I also know that months or even years could pass before antibiotic resistance finally does develop, so I don’t think it is reason enough to abandon pulsed dosing. However, I do think it is unwise to stay on pulsed dosing any longer than necessary, especially if one is only taking a single antibiotic.

    Well, that post is a bit more long-winded than I would prefer. Unfortunately, I don’t have time to edit it and make it more concise, so for now it will have to do.

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #375432
    jasregadoo
    Moderator

    I’ve been following this conversation with interest, as clearly there are differences in opionion on whether the 100mg bid is actually better than the much lower 100 mg MWF or not.

    Clearly none of us here are doctors, and so we are going off of what we have experienced, what our doctors have advised, and what we have discovered via research. We’re all doing our best to figure this out. On one hand, it’s a little confusing to see varied opinions on what is the best method. On the other hand, it’s helpful to give us newbies a more varied idea of the philosophies behind the different approaches.

    I do wish it were cut and dry and simple, and that everyone were easily cured by a set regimine.

    I have a question for PhilC….once one is on the MWF dose, and tolerating it well, it’s generally not too difficult to increase to 100mg daily. That has been my experience as well. How difficult was it for you to increase to the 2x daily dosage, once you had gotten to the 100mg daily dosage? I want to take it slowly, but I’m not sure how slowly is a good idea. Did you increase by 100mg a week, or a month, or how? In other words, once you were (somewhat) comfortably at 100mg a day, how did you go about adding that second dose? One extra day one week, or two…or only one extra day per week, once a month?

    #375433
    PhilC
    Participant

    Hi Julie,
    @jasregadoo wrote:

    How difficult was it for you to increase to the 2x daily dosage, once you had gotten to the 100mg daily dosage? I want to take it slowly, but I’m not sure how slowly is a good idea.

    It wasn’t difficult at all. Because of how the higher doses were spaced, increases in joint pain were short-lived and easily tolerated. However, I have been almost 100% free of joint pain for a long time now, so it’s possible that some people may not be able to go as quickly as I did.

    You can find more details here:
    https://www.roadback.org/forum/viewtopic.php?p=80812#p80812

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

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