Pregnantandpanicking: adverse reaction to restarting duloxetine - anxiety, insomnia and anhedonia

August 5, 2019

Please put ALL the drugs you are currently taking (including melatonin) into the Drug Interactions Checker and copy and paste the results here in your introduction topic.

Edited August 5, 2019 by ChessieCat

August 5, 2019

Interactions between your drugs

Major

Using propranoloL and cloNIDine together may lower your blood pressure and slow your heart rate. Using these medications together can cause a slow heartbeat, headaches, dizziness, or feeling like you might pass out. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or need your blood pressure checked more often to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Major

Ask your doctor before using LORazepamtogether with OLANZapine. This can cause low blood pressure, shallow breathing, weak pulse, muscle weakness, drowsiness, dizziness and slurred speech. This may be more likely to occur in older adults or those with a debilitating condition. You should be counseled to avoid activities requiring mental alertness until you know how these medications will affect you. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safely use these medications together. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

OLANZapine and cloNIDine may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

August 5, 2019

This report displays the potential drug interactions for the following 6 drugs:

Nardil (phenelzine)
olanzapine
pregabalin
zolpidem
Ativan (lorazepam)
melatonin

Interactions between your drugs

Major

LORazepam OLANZapine

Applies to: Ativan (lorazepam), olanzapine

Ask your doctor before using LORazepam together with OLANZapine. This can cause low blood pressure, shallow breathing, weak pulse, muscle weakness, drowsiness, dizziness and slurred speech. This may be more likely to occur in older adults or those with a debilitating condition. You should be counseled to avoid activities requiring mental alertness until you know how these medications will affect you. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safely use these medications together. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

LORazepam phenelzine

Applies to: Ativan (lorazepam), Nardil (phenelzine)

Using LORazepam together with phenelzine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

zolpidem pregabalin

Applies to: zolpidem, pregabalin

Using zolpidem together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

phenelzine pregabalin

Applies to: Nardil (phenelzine), pregabalin

Using phenelzine together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

LORazepam pregabalin

Applies to: Ativan (lorazepam), pregabalin

Using LORazepam together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

OLANZapine pregabalin

Applies to: olanzapine, pregabalin

Using OLANZapine together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

zolpidem OLANZapine

Applies to: zolpidem, olanzapine

Using zolpidem together with OLANZapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

phenelzine OLANZapine

Applies to: Nardil (phenelzine), olanzapine

Using phenelzine together with OLANZapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

phenelzine zolpidem

Applies to: Nardil (phenelzine), zolpidem

Using phenelzine together with zolpidem may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

LORazepam zolpidem

Applies to: Ativan (lorazepam), zolpidem

Using LORazepam together with zolpidem may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Minor

zolpidem melatonin

Applies to: zolpidem, melatonin

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

For clinical details see professional interaction data.

Minor

LORazepam melatonin

Applies to: Ativan (lorazepam), melatonin

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

For clinical details see professional interaction data.

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist.

Drug and food interactions

Major

phenelzine food

Applies to: Nardil (phenelzine)

During and within two weeks after treatment with phenelzine, you must not consume any foods or beverages that are high in tyramine content. Doing so can raise your blood pressure to dangerous levels, a condition known as hypertensive crisis. The condition is potentially fatal and may cause symptoms such as severe headache, confusion, blurred vision, problems with speech or balance, nausea, vomiting, chest pain, convulsions, and sudden numbness or weakness (especially on one side of the body). You should seek immediate medical attention if you have any of these symptoms. Foods that are high in tyramine include, but are not limited to, air dried meats; aged or fermented meats; sausage or salami; pickled herring; anchovies; liver; red wine; beer; aged cheeses, including blue, brick, brie, cheddar, parmesan, romano, and swiss; sour cream; sauerkraut; canned figs; raisins; bananas or avocados (particularly if overripe); soy beans; soy sauce; tofu; miso soup; bean curd; fava beans; or yeast extracts (such as Marmite). You should avoid the use of alcohol while being treated with phenelzine, as alcohol may increase some of the nervous system side effects such as dizziness, drowsiness, and difficulty concentrating. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

LORazepam food

Applies to: Ativan (lorazepam)

Alcohol can increase the nervous system side effects of LORazepam such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with LORazepam. Do not use more than the recommended dose of LORazepam, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

zolpidem food

Applies to: zolpidem

You should avoid the use of alcohol while being treated with zolpidem. Alcohol can increase the nervous system side effects of zolpidem such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Taking zolpidem with food may delay the onset of sleep. For faster sleep onset, zolpidem should not be taken with or immediately after a meal. This will make it easier for your body to absorb the medication. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

OLANZapine food

Applies to: olanzapine

Alcohol can increase the nervous system side effects of OLANZapine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with OLANZapine. Do not use more than the recommended dose of OLANZapine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

pregabalin food

Applies to: pregabalin

Alcohol can increase the nervous system side effects of pregabalin such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with pregabalin. Do not use more than the recommended dose of pregabalin, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Minor

melatonin food

Applies to: melatonin

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

For clinical details see professional interaction data.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes five medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

Nardil (phenelzine)
olanzapine
pregabalin
zolpidem
Ativan (lorazepam)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication

Psychotropic agents

Therapeutic duplication

The recommended maximum number of medicines in the 'psychotropic agents' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'psychotropic agents' category:

Nardil (phenelzine)
olanzapine
zolpidem
Ativan (lorazepam)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

August 6, 2019

@Altostrata, @Shep

April 2018 - reinstated duloxetine 60mg - within 3 days severe anxiety, insomnia and depression - still ongoing

Jun 2018 pregnant by IVF due Mar 2019

Tried sertraline and Amitriptyline- worse

Psych kept me on quetiapine 500mg

Sam born February 2019

Started Nardil 60mg

Started olanzapine 15mg now down to 5mg since end of June 2019

Also on pregabalin 200mg morning 225mg night, Zolpidem 10mg, Ativan 0.5mg, Melatonin 6mg

Still sleeping badly - 4-5 hours

Hi Pregnant

Sorry to see you have arrived back here and apologise for the delay in responding

Your taper of Olanzapine may have been too fast but I know very little about antipsychotics.

I do know that for the moment you should make no further changes including cuts to your meds, until a moderator with the appropriate knowledge has a chance to review your current situation.

Please amend your drug signature with the start dates for Nardil and olanzapine.

Sassenach

August 6, 2019

On 8/5/2019 at 1:57 AM, Pregnantandpanicking said:

Topic title: Trying to come off olanzapine

Basically I had a severe kindling reaction to restarting cymbalta. I am now on Nardil 60mg, pregabalin 200mg am 225mg pm, olanzapine 5mg, melatonin 6mg and Ativan 0.5mg and zolpidem 10mg. I got better in April and almost felt back to normal but now my mood and sleep have deteriorated again before I changed any of these meds. I sleep for about 4-5 hours. I have put on 20kg on olanzapine and want to come off. I have been on 15mg since Feb 2019 (switched from quetiapine since July 2018). I am now down to 5mg (for 2 weeks) and plan to go down to 2.5mg on 14th August, then to 1.25mg then to 0.625 then stop. I am terrified I will not sleep without this drug as I no longer feel sleepy naturally.

Who designed this cocktail for you, and what is it supposed to do? While you're taking an absurd collection of drugs and probably feel awful, 4-5 hours of sleep is not too bad. What result are you aiming for?

You must have an iron constitution, or be a fast metabolizer -- doctors will load fast metabolizers up with drugs until their livers or kidneys finally break down.

Dating back to last November:

On 11/17/2018 at 1:12 PM, Altostrata said:

....

You are taking too much of all your drugs, and your nervous system is fighting against that, producing paradoxical reactions. The drugs might be interacting in a bad way as well. Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

...

On 11/17/2018 at 2:20 PM, Altostrata said:

Yes, that's because all the drugs do the same thing -- press your nervous system down, and your nervous system doesn't like that. You're taking too much of everything and getting a paradoxical reaction -- paradoxical because it's opposite of what you'd expect.

We need to reduce all your drugs.

....

As your interaction reports show, your drug cocktails have been excessive all along.

While quetiapine may have caused a great deal of weight gain, it may be that interactions among your drugs are causing your problems. We need more information about your daily drug schedule and symptom pattern, in this format:

On 11/17/2018 at 1:15 PM, ChessieCat said:

This is an example:

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

As this is a site for going off drugs, what we work on is reducing adverse effects and drug burden while attempting to minimize withdrawal symptoms.

If you keep on adding drugs, you are working against our efforts. If you believe you need a psychiatric drug cocktail to get by and cannot deal with the uncertainty of reducing your drugs yourself, we probably can't help you.

August 8, 2019

@Altostrata once my baby was born I was so suicidal, anxious and depressed that more drugs kept being added. Ideally I would love to be on no drugs but I know this is going to be a long journey. I don’t know where to start.

Diary for yesterday

09.30 woke up and fed and changed baby

10.00 took 200mg lyrica, 80mg slow release propranolol, first dose Nardil

11.00 felt low and anxious got back into bed, lay but did not sleep

12.30 second dose Nardil

2.30 third dose Nardil

16.00 got up and showered

17.00 dinner at in laws, anxious and down

21.00 back home still low and anxious

22.00 watched tv

23.00 took olanzapine, ambien, Ativan, pregabalin, clonidine, melatonin

00.00 went to bed

05.00 woke up

09.00 dozed til baby woke up

Edited August 8, 2019 by Sassenach
Altostrata to @Altostrata

August 8, 2019

Updated report which includes clonidine and propranolol which were not included in the first report.

Drug Interaction Report

This report displays the potential drug interactions for the following 8 drugs:

clonidine
propranolol
Nardil (phenelzine)
olanzapine
Ambien (zolpidem)
Ativan (lorazepam)
pregabalin
melatonin

Major (2)

Moderate (17)

Minor (3)

Food (7)

Therapeutic Duplication (2)

Interactions between your drugs

Major

propranoloL cloNIDine

Applies to: propranolol, clonidine

Using propranoloL and cloNIDine together may lower your blood pressure and slow your heart rate. Using these medications together can cause a slow heartbeat, headaches, dizziness, or feeling like you might pass out. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or need your blood pressure checked more often to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Major

LORazepam OLANZapine

Applies to: Ativan (lorazepam), olanzapine

Ask your doctor before using LORazepam together with OLANZapine. This can cause low blood pressure, shallow breathing, weak pulse, muscle weakness, drowsiness, dizziness and slurred speech. This may be more likely to occur in older adults or those with a debilitating condition. You should be counseled to avoid activities requiring mental alertness until you know how these medications will affect you. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safely use these medications together. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

cloNIDine OLANZapine

Applies to: clonidine, olanzapine

OLANZapine and cloNIDine may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

phenelzine OLANZapine

Applies to: Nardil (phenelzine), olanzapine

Using phenelzine together with OLANZapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

zolpidem OLANZapine

Applies to: Ambien (zolpidem), olanzapine

Using zolpidem together with OLANZapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

cloNIDine pregabalin

Applies to: clonidine, pregabalin

Using cloNIDine together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

LORazepam pregabalin

Applies to: Ativan (lorazepam), pregabalin

Using LORazepam together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

phenelzine pregabalin

Applies to: Nardil (phenelzine), pregabalin

Using phenelzine together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

zolpidem pregabalin

Applies to: Ambien (zolpidem), pregabalin

Using zolpidem together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

propranoloL OLANZapine

Applies to: propranolol, olanzapine

OLANZapine and propranoloL may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

phenelzine zolpidem

Applies to: Nardil (phenelzine), Ambien (zolpidem)

Using phenelzine together with zolpidem may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

cloNIDine LORazepam

Applies to: clonidine, Ativan (lorazepam)

Consumer information for this interaction is not currently available.

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Moderate

propranoloL phenelzine

Applies to: propranolol, Nardil (phenelzine)

Phenelzine may increase the effects of propranoloL on your blood pressure and heart rate. Contact your doctor if you experience dizziness, lightheadedness, fainting, a slow pulse or heart rate, chest pain, shortness of breath, difficulty breathing, and/or swelling of the legs, ankles, or feet. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

cloNIDine phenelzine

Applies to: clonidine, Nardil (phenelzine)

Phenelzine and cloNIDine may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

OLANZapine pregabalin

Applies to: olanzapine, pregabalin

Using OLANZapine together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

LORazepam phenelzine

Applies to: Ativan (lorazepam), Nardil (phenelzine)

Using LORazepam together with phenelzine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

propranoloL zolpidem

Applies to: propranolol, Ambien (zolpidem)

PropranoloL and zolpidem may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

cloNIDine zolpidem

Applies to: clonidine, Ambien (zolpidem)

CloNIDine and zolpidem may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

LORazepam zolpidem

Applies to: Ativan (lorazepam), Ambien (zolpidem)

Using LORazepam together with zolpidem may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Minor

LORazepam melatonin

Applies to: Ativan (lorazepam), melatonin

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

Minor

propranoloL LORazepam

Applies to: propranolol, Ativan (lorazepam)

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

Minor

zolpidem melatonin

Applies to: Ambien (zolpidem), melatonin

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

Drug and food interactions

Major

phenelzine food

Applies to: Nardil (phenelzine)

During and within two weeks after treatment with phenelzine, you must not consume any foods or beverages that are high in tyramine content. Doing so can raise your blood pressure to dangerous levels, a condition known as hypertensive crisis. The condition is potentially fatal and may cause symptoms such as severe headache, confusion, blurred vision, problems with speech or balance, nausea, vomiting, chest pain, convulsions, and sudden numbness or weakness (especially on one side of the body). You should seek immediate medical attention if you have any of these symptoms. Foods that are high in tyramine include, but are not limited to, air dried meats; aged or fermented meats; sausage or salami; pickled herring; anchovies; liver; red wine; beer; aged cheeses, including blue, brick, brie, cheddar, parmesan, romano, and swiss; sour cream; sauerkraut; canned figs; raisins; bananas or avocados (particularly if overripe); soy beans; soy sauce; tofu; miso soup; bean curd; fava beans; or yeast extracts (such as Marmite). You should avoid the use of alcohol while being treated with phenelzine, as alcohol may increase some of the nervous system side effects such as dizziness, drowsiness, and difficulty concentrating. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

propranoloL food

Applies to: propranolol

Food can enhance the levels of propranoloL in your body. You shoud take propranoloL at the same time each day, preferably with or immediately following meals. This will make it easier for your body to absorb the medication. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking propranoloL. PropranoloL is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

Moderate

LORazepam food

Applies to: Ativan (lorazepam)

Alcohol can increase the nervous system side effects of LORazepam such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with LORazepam. Do not use more than the recommended dose of LORazepam, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

zolpidem food

Applies to: Ambien (zolpidem)

You should avoid the use of alcohol while being treated with zolpidem. Alcohol can increase the nervous system side effects of zolpidem such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Taking zolpidem with food may delay the onset of sleep. For faster sleep onset, zolpidem should not be taken with or immediately after a meal. This will make it easier for your body to absorb the medication. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

OLANZapine food

Applies to: olanzapine

Alcohol can increase the nervous system side effects of OLANZapine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with OLANZapine. Do not use more than the recommended dose of OLANZapine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

pregabalin food

Applies to: pregabalin

Alcohol can increase the nervous system side effects of pregabalin such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with pregabalin. Do not use more than the recommended dose of pregabalin, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Minor

melatonin food

Applies to: melatonin

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes five medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

Nardil (phenelzine)
olanzapine
Ambien (zolpidem)
Ativan (lorazepam)
pregabalin

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication

Psychotropic agents

Therapeutic duplication

The recommended maximum number of medicines in the 'psychotropic agents' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'psychotropic agents' category:

Nardil (phenelzine)
olanzapine
Ambien (zolpidem)
Ativan (lorazepam)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

August 9, 2019

Pregnant, have you ever discussed these drug interactions reports with your doctors?

It's not right that they get you into this fix and you have go to peer support Web sites to find out how to unravel these messes.

What are your worst symptoms now, when do they appear? We have to see if they're better or worse after you take any of these drugs. Please include your symptom pattern in your daily notes.

Olanzapine is a very destructive drug, it can not only cause you to gain weight but develop diabetes and movement disorders. On the other hand, you're taking 3 gaba-ergic drugs that can make you sluggish and unable to focus (olanzapine contributes to this).

What is it you want to accomplish here?

August 9, 2019

Since my adverse reaction to restarting cymbalta after weaning off I have had insomnia anxiety and loss of emotion. Also constant agitation. Ideally I want off all meds but know this is a long journey. However I want to get off olanzapine as I have put on 20kg with it. The problem is my body will not fall asleep without it now and this scares me.

August 11, 2019

I was on cymbalta for 5 years following a relationship break up and depression and did brilliantly on it, managed a high stress job and did lots of travelling and enjoyed life. I came off it to get pregnant, very gradually over 6 month period (completely off by Jan 2018. After 3 months had passed work was becoming stressful and I decided to go back on at 60mg and had the severest adverse reaction - at first GI symptoms then anxiety insomnia and panic attacks which still haven’t gone a year on although have improved. My GP gave me valium to get through it but it wasn’t enough and I stopped after 5 days. Since then I have tried numerous antidepressants - mirtazapine (8 weeks), amitriptyline (10 weeks) and Nardil (6 months). I am still on Nardil. Will it ever be safe for me to try cymbalta again and get back to how well I was on it?

August 11, 2019

It seems from what you have posted above that in the past you have turned to a drug solution for situational stress instead of learning and using non drug coping skills.

You already have 2 major interactions. See the new interactions below. Adding Cymbalta would have a 3rd major drug interaction.

Below are the additional drug interactions just for adding Cymbalta to your currrent drug cocktail.

______________________________________________________________________________________________

From https://reference.medscape.com/drug-interactioncheckermedscape

Contraindicated

phenelzine + duloxetine

phenelzine and duloxetine both increase serotonin levels. Contraindicated.

Monitor Closely

duloxetine + propranolol

duloxetine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

______________________________________________________________________________________________

From Drug Interactions Checker

Note that adding Cymbalta increases both the CNS drugs (3 --> 6) and Psychotropic drugs (3 --> 5)

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes six medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

Nardil (phenelzine)
Cymbalta (duloxetine)
olanzapine
Ambien (zolpidem)
Ativan (lorazepam)
pregabalin

Duplication

Psychotropic agents

Therapeutic duplication

The recommended maximum number of medicines in the 'psychotropic agents' category to be taken concurrently is usually three. Your list includes five medicines belonging to the 'psychotropic agents' category:

Nardil (phenelzine)
Cymbalta (duloxetine)
olanzapine
Ambien (zolpidem)
Ativan (lorazepam)

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

Nardil (phenelzine)
Cymbalta (duloxetine)

Major

phenelzine DULoxetine

Applies to: Nardil (phenelzine), Cymbalta (duloxetine)

Using phenelzine together with DULoxetine is not recommended. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. In general, you should wait at least 14 days after stopping phenelzine before you start treatment with DULoxetine. Conversely, if you have recently been on DULoxetine and are now starting treatment with phenelzine, you should check with your doctor or pharmacist to see how long you should wait before it is safe for you to use phenelzine, as some medications can take a while to clear from your body. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

propranoloL DULoxetine

Applies to: propranolol, Cymbalta (duloxetine)

DULoxetine may increase the blood levels and effects of propranoloL. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your condition changes or you experience increased side effects. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

cloNIDine DULoxetine

Applies to: clonidine, Cymbalta (duloxetine)

DULoxetine may reduce the effects of cloNIDine. You may need a dose adjustment or more frequent monitoring of your blood pressure if you have been taking cloNIDine and are starting treatment with DULoxetine. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

LORazepam DULoxetine

Applies to: Ativan (lorazepam), Cymbalta (duloxetine)

Using LORazepam together with DULoxetine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

zolpidem DULoxetine

Applies to: Ambien (zolpidem), Cymbalta (duloxetine)

Using zolpidem together with DULoxetine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

OLANZapine DULoxetine

Applies to: olanzapine, Cymbalta (duloxetine)

Using OLANZapine together with DULoxetine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

DULoxetine pregabalin

Applies to: Cymbalta (duloxetine), pregabalin

Using DULoxetine together with pregabalin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

DULoxetine food

Applies to: Cymbalta (duloxetine)

DULoxetine may cause liver damage, and taking it with alcohol may increase that risk. You should avoid or limit the use of alcohol while being treated with DULoxetine. Call your doctor immediately if you have fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, dark colored urine, or yellowing of the skin or the whites of your eyes, as these may be symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

August 12, 2019

On 8/8/2019 at 6:35 PM, Pregnantandpanicking said:

Diary for yesterday

Do you have any more daily symptom notes? We need to see at least 3 consecutive days of notes so that they can be assessed.

It is most likely the large number of drugs that you are taking which is contributing to the way you are feeling.

Notes can help the mods to try and work out a plan to reduce/get off your drugs.

August 13, 2019

9.30am woke up shaking

10am got up to feed baby

10.15am took pregabalin 200mg propranolol slow release 80mg and progesterone only pill and Nardil 15mg

11am went shopping with mother in law and had a scone

12.30 Nardil 15mg

2.30 Nardil 15mg

3pm managed to do some baking with mother in law

5pm watched tv

6pm made dinner

8pm watched tv but felt anxious and couldn’t settle or concentrate

11pm took melatonin, olanzapine, zolpidem, Ativan and clonidine

1am fell asleep

5am woke up

Fell back asleep

August 13, 2019

On 8/9/2019 at 1:18 PM, Altostrata said:

Please include your symptom pattern in your daily notes.

We need more information about what symptoms you got throughout the day and when they occurred. See below:

On 9/28/2016 at 4:49 AM, Altostrata said:

you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs.

August 13, 2019

10 hours ago, Pregnantandpanicking said:

10.15am took pregabalin 200mg propranolol slow release 80mg and progesterone only pill and Nardil 15mg

How long have you been taking progesterone and why? This needs to be included in your drug interactions chart.

Do you feel better or worse after you take this cocktail in the morning? Why are you taking all these drugs at the same time?

10 hours ago, Pregnantandpanicking said:

11pm took melatonin, olanzapine, zolpidem, Ativan and clonidine

Do you feel better or worse after you take this cocktail in the evening? Why are you taking all these drugs at the same time?

You're taking propranolol slow release AND clonidine? How long have you been taking these together? Why are you taking both? Do you often feel faint and dizzy?

Has one doctor prescribed all these drugs? Is this person in her or his right mind?

August 20, 2019

Hi P and P,

How are you faring today? I just read a bit of your introduction and thought I'd stop by.

I can relate a bit, as I am a Nardil(phenelzine) survivor and Mom. Me boy is grown now, however.......still a Mum and parent however.

How old is your little one now?

Are you able to attend to the questions asked above and do some more notes?

Don't panic......I know, I know.......easier said than done........

(((((butterfly hugs)))))))

Love, peace, healing, and growth,

mmt

Pregnantandpanicking: adverse reaction to restarting duloxetine - anxiety, insomnia and anhedonia

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