Diplopia Treatment: Does Dali Pill Work Immediately?

Double vision and taking a strong pill?

Hello, doctor.
I have been experiencing double vision for about five years.
A year ago, I had an eye examination with no issues and was prescribed prism glasses.
Recently, when I feel more fatigued, I still experience double vision even while wearing the prism glasses.
I visited a neurologist who prescribed me a medication called "Dali Pill" (likely referring to a specific medication, possibly a muscle relaxant or similar).
I take one pill at 9 AM and another at 5 PM.
However, after taking the medication, I still experience double vision without wearing the prism glasses.

Could you please tell me if the Dali Pill works immediately after taking it, or does it require a few days of continuous use to become effective? If I continue to experience double vision after a few days of taking the medication, is it advisable to stop taking it? Thank you.

KH, 20~29 year old female. Ask Date: 2017/03/06

Dr. Jiang Junyi reply Neurology

Hello, based on your description, you mentioned that the neurologist suspects myasthenia gravis, and the treatment involves the use of acetylcholinesterase inhibitors (commonly known as Mestinon).
This medication prevents the enzyme from rapidly breaking down acetylcholine, thereby prolonging the interaction time between acetylcholine and its receptors.
In Taiwan, the most commonly used oral formulation is Mestinon.
At appropriate therapeutic doses, clinical symptoms often show significant improvement.
Patients may notice a reduction in eyelid drooping, improvement or resolution of double vision, better swallowing, and increased strength in the limbs, allowing them to comb their hair and walk longer distances, among other benefits.
However, it is important to be cautious about dosage.
Overuse of these medications can lead to numerous adverse side effects, which can be categorized into three main types, as shown in Table 2.
The most common side effects are gastrointestinal, where excessive smooth muscle contraction can cause cramping, discomfort, vomiting, and diarrhea.
In terms of glandular effects, there may be increased salivation and sweating.
Therefore, anticholinergic drugs are often used concurrently to minimize these side effects.
Currently, Mestinon is the first-line medication for treating myasthenia gravis.
Its effects typically begin around thirty minutes after administration, with peak effects occurring approximately two hours later, gradually diminishing thereafter.
The dosage and timing should be tailored to the individual patient's needs, with a maximum effective dose of 120 mg every three hours.
I recommend discussing and managing your treatment with a neurologist.
Wishing you good health and happiness.

Reply Date: 2017/03/06

More Info

Diplopia, or double vision, can be a frustrating and complex condition to manage. It can arise from various underlying causes, including neurological issues, muscle imbalances, or even refractive errors. In your case, it seems that you have been experiencing diplopia for about five years, and despite wearing prism glasses, you still encounter issues, especially when fatigued. Recently, your neurologist prescribed Dali Pill (likely referring to a medication like Dexamethasone or a similar corticosteroid), which is often used to reduce inflammation and swelling in various conditions.

To address your question about the effectiveness of Dali Pill: medications like corticosteroids typically do not provide immediate relief for symptoms like diplopia. Instead, they may take several days to weeks to exert their full therapeutic effects, depending on the underlying condition being treated. The mechanism of action involves reducing inflammation, which can help alleviate symptoms over time. Therefore, it is unlikely that you will notice an immediate improvement in your diplopia after taking the medication.

If you have taken the Dali Pill for a few days and still experience diplopia, it is essential to consult your prescribing physician before making any decisions about discontinuing the medication. Stopping a medication abruptly can sometimes lead to a rebound effect or worsen the underlying condition. Your doctor may want to reassess your symptoms, consider alternative treatments, or adjust your dosage based on your response to the medication.

In addition to medication, it may be beneficial to explore other therapeutic options for managing diplopia. These can include:
1. Vision Therapy: This is a structured program of eye exercises designed to improve coordination and focusing abilities. It can be particularly helpful for patients with muscle imbalances or convergence insufficiency.

2. Prism Glasses: As you mentioned, you are already using prism glasses. These can help align the images seen by each eye, reducing the perception of double vision. If your symptoms persist, it may be worth revisiting your eye care professional to see if your prescription needs adjustment.

3. Botulinum Toxin Injections: In some cases, injections of botulinum toxin into specific eye muscles can help temporarily weaken overactive muscles, improving alignment and reducing diplopia.

4. Surgery: For certain structural issues or severe muscle imbalances, surgical intervention may be necessary to correct the alignment of the eyes.

5. Lifestyle Modifications: Managing fatigue, ensuring adequate rest, and reducing stress can also play a role in alleviating symptoms. Fatigue can exacerbate diplopia, so it is essential to listen to your body and take breaks when needed.

In summary, while Dali Pill may not provide immediate relief for your diplopia, it is crucial to follow up with your healthcare provider to monitor your progress and discuss any ongoing symptoms. They can provide guidance on the best course of action, whether that involves continuing the medication, adjusting your treatment plan, or exploring additional therapies. Remember, managing diplopia often requires a multifaceted approach, and working closely with your healthcare team will yield the best outcomes.

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