nunya: trying to get off of MAOI

[nunya]

Hi everyone, I just tired to write an intro but it was awful and getting worse so I'm starting over.

 

I took Nardil/phenelzine 60mg for very close to a year. It worked better than anything else ever has for my depression, but eventually the side effects finally became intolerable and I decided to get off of it.

 

The medical literature says you can just stop taking it. My Dr and I decided instead to taper. The initial tapering attempt was to reduce dosage by half for a couple of weeks, then another half and finally nothing. I made it 3 days on the 30mg dose before I had to go right back up to 60mg because of how badly I reacted to the reduction.

 

Because of some things happening in my RL I had to put off the next taper attempt for a couple of months. I moved across the state and was in my new home a month before I tried to taper again. This time the plan was to reduce by 15mg every 2 weeks until I was off of it. (This medication comes in 15mg pills and I was taking 4 to get the 60mg.) So I went down to 45mg for two weeks. The day before I was to reduce dosage again, I had my monthly phone consultation with my doctor (who lives in the town where I used to live until recently.) The two weeks had not been at all enough for me to level out at the 45mg dosage so we decided I would stay at 45mg for at least another week.

 

By the end of that 3rd week at 45mg I was not better and not even improving. I reasoned that, if I was going to feel this awful for the whole taper, I might as well go cold turkey and tough it out for 14 days until that Dr could put me on something else. With Dr's permission, that's what I did, I stopped taking it entirely. 

 

On the 8th day of pure hell and complete dysfunction, I found out about antidepressant withdrawal symptoms and syndrome and I found this website. After reading a bunch on here yesterday (day 8), I called Dr again to get permission to go back to taking 15mg in hopes that it would help the symptoms I'm going through. So I took 15mg yesterday and today. So far I'm not better and I'm not sure how long I should give it before considering raising the dose again if I don't improve. I really don't want to go back up any higher but then I didn't want to take the 15mg either. But I can't continue like this indefinitely. It was hard enough trying to get through 2 weeks of it, in fact I couldn't do it. I'll go back up on the dose if I have to, and I'll stay there until I can start the 10% taper plan.

 

I know I'm supposed to put a signature of info but I can't think straight enough to do that right now. It's been really difficult just to make this intro make sense as it is.

[ChessieCat]

Hi nunya and welcome to SA,

 

3 hours ago, nunya said:

On the 8th day of pure hell and complete dysfunction, I found out about antidepressant withdrawal symptoms and syndrome and I found this website. After reading a bunch on here yesterday (day 8), I called Dr again to get permission to go back to taking 15mg in hopes that it would help the symptoms I'm going through. So I took 15mg yesterday and today. So far I'm not better and I'm not sure how long I should give it before considering raising the dose again if I don't improve. I really don't want to go back up any higher but then I didn't want to take the 15mg either. But I can't continue like this indefinitely. It was hard enough trying to get through 2 weeks of it, in fact I couldn't do it. I'll go back up on the dose if I have to, and I'll stay there until I can start the 10% taper plan. 

 

It's really good that the doctor made a reasonably low dose reinstatement.

 

Please be aware that it takes about 4 days for a dose to get to full level in the blood and a bit longer for it to register in the brain.  So it might take a few more days before you notice improvement.  Please keep notes on paper of your symptoms so that you can see how the reinstatement is affecting your symptoms.  Don't compare how you feel to how you felt at your best, compare how you feel to how you felt at your worst.

 

It's also important to know that it is better to increase by small amounts if needed.  The idea of reinstatement isn't to get rid of withdrawal symptoms completely but to bring them to a bearable level.  SA uses the term "lowest effective dose".  Unless your symptoms are unbearable after 7 days, it would be better to wait until 14 days and then assess the severity of your symptoms.

 

About reinstating and stabilizing to reduce withdrawal symptoms  

 

Please also note that stabilising is not linear but can happen in a windows and waves pattern.  So you might feel improvement for a while and then feel worse and then feel improvement etc.  It is important not to panic and end up increasing your dose too soon or by too much because that might make things worse:  Windows and Waves Pattern of Stabilization

 

This is your own introduction topic where you can ask questions and journal your progress.

[nunya]

Thank you, Chessie Cat, for the welcome and the information and links. I'm on day 4 at the reintroduced 15mg and am keeping track of symptoms using the list from the Glenmullen book(?) and the associated monthly chart. Yesterday I was at a count of 12 before 10am. Today I've counted 13. According to the scoring legend, both of those counts put me past the "severe" category, but I'm not sure what that means. I'm miserable and every contact with other people seems to end up making things worse between us, but I'm not having brain zaps or suicidal or homicidal thoughts, nor any of the other more serious physical symptoms that IMO might need some kind of medical intervention. 

 

My aunt suggested I go to the ER anyway but there isn't anything they can do for me because of the specific medication I am on (and trying to get off of.) They can't even give me anything effective to treat the migraine I've had all day today because of this stupid MAOI. I just have to get through it until the migraine goes away on its own, and kind of the same thing applies to the antidepressant withdrawal as far as I can tell. 

 

While I wait this out, I seem to be destroying all of my personal relationships (and it's not like there are that many to start with.) My aunt and dad seem to get what I'm dealing with better than anyone else. My brother may or may not get it. He's hard to read. I can't tell everything to my mother for fear (realistic fear) that she'll try to come here to "save" me and I just finally got away from her 2 months ago as it is.

 

My closest friend, who is also my housemate, is dealing with his own issues and has mostly been pretty great about mine but we got into it this evening over text message and I had to end the conversation because it was not going anywhere positive. I'm both terrified that he's going to leave and wondering if I'll feel relieved when I don't have to dance around his issues as well as my own. I kind of hate myself for even thinking that. We've been through so much together and have taken turns taking care of one another through some extremely gnarly shite. When our individual "issues" take turns messing with us, we can take turns taking care of each other, but when they are happening at the same time (like now, apparently) we're pretty screwed.

 

I should not have tried to get off the MAOI (again) when I did. I should have waited until we had gotten this stupid house into a livable condition and were actually settled into something of a regular life. I just wanted to be off of it so badly. I thought any withdrawal symptoms would be mild and brief I never imagined that they would be absolutely devastating. 

 

So now we are still living in a house that we can only use parts of because the rest of it is filled with crap that my other family members stored here 20+ years ago. There is still at least 1 rat that lives downstairs and which I can't seem to catch in the live trap and which does not seem to be phased by the presence of our cats. In addition to the 3 adult cats, we have 7 foster kittens occupying the bathroom and making it difficult to use because we have to be so careful that they don't escape into the mess downstairs. And everyone in my family has so much of importance going on in their own lives that we and this house are quite low in their priority lists. The house stays full of crap because I can't throw out other people's stuff and I'm too afraid of catching some rodent-borne disease to go through all of it myself. Plus so much of what is stored downstairs is an emotional minefield to go through. There are things there from the time I was born up through just a few years ago. Right now all those things do is remind me that going on and off of psychiatric drugs has robbed me of my entire adult life. It's too late for me to have a child and I'm in no shape to raise one anyway. Not to mention that I've been chronically unable to hold a job for any length of time. 

 

I quite literally cannot see life positively or optimistically or hopefully right now. I can't even imagine seeing things that way. The only hope I have is that I can outlast what I'm going through now without making everything worse. But I'm already making things worse with my closest friend. Circles and spirals and loops - it's all connected and tangled up and I can't see any way through it but to wait it out and hide in my room as long as I can.

 

Have I mentioned the agoraphobia? It's off the charts right now. I can go check the mail or take out the trash but that's the extent of my world right now. 

 

And this time, there is no escape in sleep because this time I'm having nightmares. And when they aren't nightmares they are super vivid dreams that I have trouble differentiating from real life until I've been awake for a while. 

 

Thanks for giving me space to write this. Since my breakdown in 2011, I've managed to become cut off from those who were once my closest friends and my peer support system has dwindled to only a couple of people. I guess even those people who were once your closest ride-or-die BFFs have only so much patience for you not getting better and getting back to being your old self again. Will I ever be my old self again? I've been treated with psych meds for so long I'm not even sure which of my old selves I wish I could return to being.

 

I'm just going to go ahead and post this. It's so long and so ramble-y as it is. There is no happy ending here. There's not even an ending 

 

 

Edited September 2, 2019 by ChessieCat
removed obscenity

[Altostrata]

Hello, Nunya. I don't know the Glenmullen scoring system. Are you saying you felt worse today than yesterday? What are your most prominent symptoms?

 

Since you reinstated 15mg Nardil 5 days ago, have you been feeling progressively worse? What times of day do you take your drugs, and their dosages? Do you feel better or worse after you take them?

 

You have a fairly classic case of antidepressant withdrawal syndrome. This tends to go away slowly and haltingly. Unfortunately, few doctors know anything about this. That's why this site exists.

 

It seems there is a lot of chaos in your immediate environment. I would make a safe space for yourself and let your family do whatever it is they do. Stay in your room if you need to, draw the shades, keep cool and quiet. You can talk to your aunt and dad, you should probably not try to get understanding from your brother at this time. I'd apologize to your housemate-friend. Just stay out of arguments, it's not good for your fried nervous system right now.

[WiggleIt]

Hello nunya,

Alto and ChessieCat have asked some important questions and given good tips, so I'd like to talk about some of the other stuff in your posts, like the agoraphobia and the changed relationships.

First off, withdrawal (WD) does a number on us.  Relationships might change, people might believe, people might not.  People might "get it," but they might not.  What I learned was that I figured out which friends I could really trust when I was going through WD, and it surprised me who became my closer friends versus which ones left my life.  That's not to say that every single behavior of mine was excusable during WD, but when I learned to mend bridges, I could see which friends judged me poorly versus which ones realized I had been in a tough medical situation.  Just keep doing your best, and the best friendships in your life will stick—or they'll appear from someplace you least expected it.

Family can be a tough call, though.  I have family members who still are very plainly dubious about what I went through, but I've made peace in my heart and don't hold any grudges against them, because they're family and they're good to me in the ways they know how to be.

I suffered the opposite of agoraphobia.  I suffered from intense monophobia.  I couldn't be left alone for even one minute or I'd start screaming my head off until someone came back in the room.  This would be abnormal behavior for anyone, but it was particularly odd for me, as I'm an only child and spent a lot of time in my life quite happily alone.  But being alone during WD petrified me.  And now, I'm totally back to normal from the monophobia.  I'm confident you can heal from the agoraphobia, I truly am.

Alto's advice to create a safe space is 100% right on the nose.     

  

[nunya]

Hi Altostrata,

 

I got the Glenmullen symptom checklist as a pdf from this website. I have looked for it on SA again today but I can't find it. Somewhere on here there is a post with links to download a pdf copy of an Appendix page from a book by Dr. Glenmullen which is a long checklist of withdrawal symptoms and there are also links to a spreadsheet based on that list which can be checked off. The titles of the documents I got from here are glenmullen_symptoms_AS Appendix 1.pdf and Dr Glenmullens Symptom List for Month to Print.pdf. I just can't find where they are located on this website right now. 

 

I've ordered Dr. Glenmullen's book "The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction"" and it should be here in a couple of days. 

 

The count I mentioned is counting up the symptoms I have checked off on that list each day (or at least each day since I found the list.) So far my counts are: Day3:12; D4:13; D5:13; D6:11 and today is Day 7 since reinstatement. 

 

Altostrata asked "Since you reinstated 15mg Nardil 5 days ago, have you been feeling progressively worse? What times of day do you take your drugs, and their dosages? Do you feel better or worse after you take them?" 

 

I don't think I felt worse, I think the symptoms I was experiencing stayed pretty much the same, I just became aware of different ones at different times, depending on how prominent each was. Having migraines (or a migraine) for 3 days did not help with being able to think or feel clearly what was happening. 

 

Here is a list of what I take every day and when (the "when" is just a ballpark of AM or PM. I don't have an exact time that I take things. I just take my AM handful as early in the day as I can remember to do it and I take the PM handful in the evening. It's not ideal, I know, but I am trying my best to be organized about this despite a lifetime of (mostly) untreated ADD and very few learned coping skills which is a whole other problem complicating any recovery or progress.

 

AM

• Nardil 15mg
• Metformin 500mg
• Clonazepam 1mg
• Gabapentin 300mg
• Omega3-6-9 2000mg
• A mostly Cranberry extract but with low doses of Vitamin C, Calcium, & Magnesium included
• methyl-folate 1000mcg
• CoQ10 200mg
• methyl-B12 1000mcg
• D3 5000IU/5 days per week

Midday

• 1 scoop of a powder mix that has a bunch of vegetables, fruits, fiber, and probiotics in it. (It was recommended to me because my diet is so bad. I'm ok on protein and fiber but there are far too many carbs and almost no fresh veggies in my daily intake of food. Not leaving the house and not knowing how to cook will do that to you.)

PM

• Metformin 500mg
• Clonazepam 1mg
• Gabapentin 300mg
• Omega3-6-9 2000mg
• L-Tryptophan 500mg
• Melatonin 10mg
• AREDS2 (includes Vitamins C and E, Zinc, Copper, Lutein, & Zeaxanthin)

PRN

• hydrochlorothiazide 12.5mg 
• potassium 595mg
• magnesium oxide 500mg (planning to get a different form of magnesium soon and add it to AM regimen)
• ibuprofen (dosage depends on if it's for normal pain or a migraine)
• benadryl 
• tums
• beano
• gas-x
• clonazepam (I am allowed 1mg more per day to take as needed but that is only since I started having the WD symptoms and most days I forget that I have this option available)

As far as how I feel after taking my meds - I have not noticed any different feeling or change in symptoms before or after taking my daily medications (and supplements.) None of them work that fast. As far as I can tell, they all take time to build up in my system enough to have any effect and so the effects are gradual - except for when I take the hydrochlorothiazide (for leg and foot edema caused by the MAOI) or the potassium (for leg cramps, also caused by the MAOI)

 

I have apologized to my housemate and we seem to be on better terms again. 

 

Thank you thank you thank you for letting me know that what I am going through is not abnormal or not understood by you or the rest of this community. I can't express how much it meant to me to read that.

Edited September 4, 2019 by nunya
forgot something

[Sassenach]

Hi Nunya

 

I hope this is what you are looking for.

https://www.survivingantidepressants.org/index.php?app=core&module=attach&section=attach&attach_id=440

[nunya]

Hi WiggleIt,

 

Thank you for your insights about friendships and other relationships and how they are or can be affected by going through WD. I have had so many really close friends over my lifetime and we are mostly all still fond of one another but I cannot claim that we are still close. If what I am learning about AWD is correct (and I am convinced that it is) I have spent a large portion of my adult life in and out of severe WD. No wonder my close friendships have waxed and waned so much. I see these people on FB who I just barely knew years ago and they have these close knit groups of friends for years, sometimes since childhood. I have never understood how they do it or what's wrong with me that I don't have friends like that. At least now I am beginning to have answers to why I have not had long-lasting close friendships. 

 

My formerly closest friends all still seem fond of me but it is obvious that we are not close like we once were. And, of course, having less and less in common with them has not helped matters. 

 

Mostly my family is pretty great about at least trying to understand and accept whatever it is I am going through or trying to accomplish. There are just some that don't understand, either they wrote me off long ago (and I returned that favor) or they just don't have the time or energy to put into our relationship. Or they are my mom and her mom who are narcissists so I have had to learn to be very careful having them in my life. 

 

This thing with my brother is particularly painful because we used to be so close. It was at times quite literally us against the world. But now he is married with children and a small business and since I went into this most recent bout of WD, our connection feels broken in a way I can't explain and never expected. I feel like I'm mourning so many things right now and one of them is my connection with my brother. 

[nunya]

Hi Sassenach, yes, that is one of the documents I was trying to find. Thank you so much!

[ChessieCat]

5 hours ago, nunya said:

got the Glenmullen symptom checklist as a pdf from this website. I have looked for it on SA again today but I can't find it. Somewhere on here there is a post with links to download a pdf copy of an Appendix page from a book by Dr. Glenmullen which is a long checklist of withdrawal symptoms and there are also links to a spreadsheet based on that list which can be checked off. The titles of the documents I got from here are glenmullen_symptoms_AS Appendix 1.pdf and Dr Glenmullens Symptom List for Month to Print.pdf. I just can't find where they are located on this website right now. 

 

Dr Joseph Glenmullen's Withdrawal Symptoms

[nunya]

Thank you, ChessieCat. That's the other one I couldn't find earlier.

[nunya]

Spoke with my Dr yesterday. He agrees that I'm dealing with WS and is in agreement with me about doing the 10% (or possibly slower) taper. But first, he wants to get me stabilized and toward that goal he had me go from 15mg up to 30mg per day. (We discussed the option of pill-splitting in order to make a smaller increase but then we both forgot about it by the end of the conversation and so I went ahead and increased by a full tablet.) 

 

Everything still sucks - inside and outside of my physical body. I keep trying to write about any aspect of it at all but it all just makes me cry more and I delete it. That's all I can do about giving an update right at the moment. Maybe I'll be better or more coherent later. 

[ChessieCat]

Please create your drug signature using the following format.   Keep it simple.  NO diagnoses or symptoms please - thank you.

• details for last 2 years - dates, ALL drugs, doses
• summary for older than 2 years - just years and drug/s

Account Settings – Create or Edit a signature

[nunya]

Hi ChessieCat,

 

I have planned to do the "Drug Signature" thing ever since I first found this site and decided to join but the only information I can include in it right now is the medications I am currently taking and I cannot even give sort of close to exact dates on most of those. Right at the moment I am unable to remember most of that information; neither am I able to locate it.

It is my understanding that cognitive problems are one of the symptoms of WS. I am in (what I glean is) relatively severe withdrawal right now. I hope that you and the SA community can wait a bit longer before requiring me to create the detailed drug signature that you are requesting.

 

If it is acceptable to you I will put a list of my current medications and dosages into the signature area but that is as close as I can get right now to creating a drug signature. 

 

As an aside: there does not seem to be a specific format for the drug signature. I've seen so many different versions of it on various people's posts. I have no idea which of those I am supposed to use as a model format for my own information. Is there a standardized and agreed upon format other than what you have included in your post above?

[ChessieCat]

Just type it up this way:

 

drug name:  dose, date; dose, date; dose, date

 

for each drug.

[composter]

Hi nunya, are you wondering what dosage you should reinstate to in order to stabilize? 

 

Feel free to read my personal intro post because I went through a sequence of events quite similar to yours. In my case, the best thing that I did was reinstate back to my original dosage, even though I took a few months on my first taper go-round. I was so far gone physically and emotionally (I could barely even walk). Taking the original dosage helped me stabilize, but stability took 6-8 months. Know that this process will take time! Have patience with it. 

 

I also have benefitted greatly from making my own customized Glenmullen symptom chart. You're doing a great job advocating for your needs.

[ChessieCat]

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

 

NOTE:  This interaction check does not include potassium (because I don't know what type nunya is taking), beano or gas-x.

Nardil,  Metformin, Clonazepam , Gabapentin ,  L-Tryptophan,  Melatonin,  hydrochlorothiazide, potassium, ibuprofen,  Benadryl,  tums, beano, gas-x

Serious - Use Alternative

• phenelzine (Nardil) + L-tryptophan

  phenelzine and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug.

Monitor Closely

• calcium carbonate (Tums) + gabapentin

  calcium carbonate decreases levels of gabapentin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• melatonin + ibuprofen

  melatonin increases effects of ibuprofen by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

• phenelzine (Nardil) + metformin

  phenelzine will increase the level or effect of metformin by unspecified interaction mechanism. Use Caution/Monitor.

• phenelzine (Nardil) + diphenhydramine (Benadryl)

  phenelzine increases effects of diphenhydramine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration of phenelzine and antihistamines may result in additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

• ibuprofen + hydrochlorothiazide

  ibuprofen increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diphenhydramine (Benadryl) + clonazepam

  diphenhydramine and clonazepam both increase sedation. Use Caution/Monitor.

• diphenhydramine (Benadryl) + melatonin

  diphenhydramine and melatonin both increase sedation. Use Caution/Monitor.

• clonazepam + melatonin

  clonazepam and melatonin both increase sedation. Use Caution/Monitor.

Minor

• hydrochlorothiazide + ibuprofen

  hydrochlorothiazide will increase the level or effect of ibuprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• hydrochlorothiazide + metformin

  hydrochlorothiazide will increase the level or effect of metformin by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• hydrochlorothiazide + metformin

  hydrochlorothiazide decreases effects of metformin by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

• hydrochlorothiazide + calcium carbonate

  hydrochlorothiazide increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

[ChessieCat]

Drug Interaction Report

NOTE:  This report does not include potassium

This report displays the potential drug interactions for the following 12 drugs:

• Nardil (phenelzine)
• metformin
• clonazepam
• gabapentin
• tryptophan
  The interactions information for this drug may not be up-to-date. More...
• melatonin
• hydrochlorothiazide
• ibuprofen
• Benadryl (diphenhydramine)
• Tums Regular Strength (calcium carbonate)
• Beano (alpha-d-galactosidase)
• Gas-X (simethicone)

Major (1)

Moderate (11)

Minor (2)

Food (3)

Therapeutic Duplication (1)

Interactions between your drugs

Major

phenelzine tryptophan

Applies to: Nardil (phenelzine), tryptophan

Using phenelzine together with tryptophan 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 tryptophan. Conversely, if you have recently been on tryptophan 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

hydroCHLOROthiazide metFORMIN

Applies to: hydrochlorothiazide, metformin

Talk to your doctor before using hydroCHLOROthiazide together with metFORMIN. HydroCHLOROthiazide can increase blood sugar levels and interfere with diabetic control. You may need a dose adjustment or more frequent monitoring of your blood sugar to safely use both medications. Due to its effects on the kidneys, hydroCHLOROthiazide can also increase the risk of a rare but serious and potentially life-threatening condition known as lactic acidosis that may occasionally occur during treatment with metformin-containing products. Lactic acidosis is caused by a buildup of lactic acid in the blood, and is more likely to occur if you have kidney or liver disease, acute or unstable congestive heart failure, dehydration, or an excess intake of alcohol. You should seek immediate medical attention if you develop potential signs and symptoms of lactic acidosis such as fatigue, weakness, muscle pain, increasing drowsiness, abdominal pain or discomfort, fast or irregular heartbeat, difficult or rapid breathing, chills, and other unusual symptoms. 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

ibuprofen metFORMIN

Applies to: ibuprofen, metformin

Consumer information for this interaction is not currently available.

MONITOR: Coadministration with nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of lactic acidosis associated with the use of metformin. The precise mechanism for this interaction has not been clearly delineated. Since NSAIDs have been shown to cause a deterioration in renal function, the likelihood of lactic acidosis occurring may be increased in patients with pre-existing renal impairment.

MANAGEMENT: Caution and monitoring of renal function is advised if metformin is used concomitantly with NSAIDs. Dose adjustments may be considered, particularly in patients with renal impairment. Close monitoring for the development of lactic acidosis is also recommended, particularly in patients with renal impairment. Patients should contact their physician immediately if they experience potential signs and symptoms of lactic acidosis such as malaise, myalgia, respiratory distress, increasing somnolence, and nonspecific abdominal distress (especially after stabilization of metformin therapy, when gastrointestinal symptoms are uncommon). With more marked acidosis, there may also be associated hypothermia, hypotension, and resistant bradyarrhythmias. Metformin should be withdrawn promptly if lactic acidosis is suspected. Serum electrolytes, ketones, blood glucose, blood pH, lactate levels, and blood metformin levels may be useful in establishing a diagnosis. Lactic acidosis should be suspected in any diabetic patient with metabolic acidosis lacking evidence of ketoacidosis (ketonuria and ketonemia).

 

Moderate

phenelzine gabapentin

Applies to: Nardil (phenelzine), gabapentin

Using phenelzine together with gabapentin 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

diphenhydrAMINE gabapentin

Applies to: Benadryl (diphenhydramine), gabapentin

Using diphenhydrAMINE together with gabapentin 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

hydroCHLOROthiazide phenelzine

Applies to: hydrochlorothiazide, Nardil (phenelzine)

Phenelzine and hydroCHLOROthiazide 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

diphenhydrAMINE phenelzine

Applies to: Benadryl (diphenhydramine), Nardil (phenelzine)

Using phenelzine together with diphenhydrAMINE may increase side effects such as dizziness, drowsiness, blurred vision, dry mouth, constipation, heat intolerance, flushing, decreased sweating, difficulty urinating, palpitation, rapid heart beat, confusion, disorientation, and memory problems. Side effects may be more likely to occur if you are elderly. 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. 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

clonazePAM phenelzine

Applies to: clonazepam, Nardil (phenelzine)

Using clonazePAM together with phenelzine may occasionally cause high blood pressure and flushing. Contact your doctor if you experience severe headache, blurred vision, confusion, seizures, chest pain, nausea or vomiting, sudden numbness or weakness (especially on one side of the body), speech difficulties, fever, sweating, lightheadedness, and/or fainting during treatment with these medications, as these may be signs and symptoms of excessively high blood pressure. 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

hydroCHLOROthiazide calcium carbonate

Applies to: hydrochlorothiazide, Tums Regular Strength (calcium carbonate)

Using hydroCHLOROthiazide together with calcium carbonate can cause your blood calcium levels to become too high. Contact your doctor if you experience symptoms such as dizziness, drowsiness, weakness, lethargy, headache, nausea, vomiting, or seizures. You may need a dose adjustment or special test if you 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

clonazePAM hydroCHLOROthiazide

Applies to: clonazepam, hydrochlorothiazide

HydroCHLOROthiazide and clonazePAM 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

ibuprofen hydroCHLOROthiazide

Applies to: ibuprofen, hydrochlorothiazide

Before taking hydroCHLOROthiazide, tell your doctor if you also use ibuprofen. You may need dose adjustments or special tests in order to safely take both medications together. If you are receiving this combination drink plenty of water. Blood pressure and kidney function should be monitored as well. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor first.

 

Moderate

clonazePAM diphenhydrAMINE

Applies to: clonazepam, Benadryl (diphenhydramine)

Using clonazePAM together with diphenhydrAMINE 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

clonazePAM calcium carbonate

Applies to: clonazepam, Tums Regular Strength (calcium carbonate)

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

clonazePAM melatonin

Applies to: clonazepam, 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

gabapentin food

Applies to: gabapentin

Alcohol can increase the nervous system side effects of gabapentin 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 gabapentin. Do not use more than the recommended dose of gabapentin, 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 four medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

• Nardil (phenelzine)
• clonazepam
• gabapentin
• Benadryl (diphenhydramine)

[Altostrata]

On 9/4/2019 at 9:52 AM, nunya said:

....

 

AM

• Nardil 15mg
• Metformin 500mg
• Clonazepam 1mg
• Gabapentin 300mg
• Omega3-6-9 2000mg
• A mostly Cranberry extract but with low doses of Vitamin C, Calcium, & Magnesium included
• methyl-folate 1000mcg
• CoQ10 200mg
• methyl-B12 1000mcg
• D3 5000IU/5 days per week

Midday

• 1 scoop of a powder mix that has a bunch of vegetables, fruits, fiber, and probiotics in it. (It was recommended to me because my diet is so bad. I'm ok on protein and fiber but there are far too many carbs and almost no fresh veggies in my daily intake of food. Not leaving the house and not knowing how to cook will do that to you.)

PM

• Metformin 500mg
• Clonazepam 1mg
• Gabapentin 300mg
• Omega3-6-9 2000mg
• L-Tryptophan 500mg
• Melatonin 10mg
• AREDS2 (includes Vitamins C and E, Zinc, Copper, Lutein, & Zeaxanthin)

PRN

• hydrochlorothiazide 12.5mg 
• potassium 595mg
• magnesium oxide 500mg (planning to get a different form of magnesium soon and add it to AM regimen)
• ibuprofen (dosage depends on if it's for normal pain or a migraine)
• benadryl 
• tums
• beano
• gas-x
• clonazepam (I am allowed 1mg more per day to take as needed but that is only since I started having the WD symptoms and most days I forget that I have this option available)

....

 

Why are you taking the items in bold above?

 

Since you reinstated 15mg Nardil on August 30, how do you feel?

 

Do your symptoms follow any daily pattern?  Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. You can post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

We need to know the TIMES OF DAY throughout. If you're taking your drugs haphazardly, that itself could be causing symptoms. Please figure out a schedule, stick to it, and post notes here.

[ChessieCat]

2 hours ago, Altostrata said:

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day.

 

Example:

DATE:

 

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