vetdoc going off valium and Wellbutrin

[Altostrata]

I guess holding for now might be a good idea. See how you do on your trip.

[vetdoc]

Hey guys

 

Checking in after a pretty long hiatus of 3 months away from the board.  I did go on my trip for a month in mid July and it went pretty well.  I was fairly stable traveling and sleeping in strange surroundings went pretty well.    The trip was fun and i enjoyed seeing family and friends I had not seen for awhile.

 

The past several months things have been quite stressful unfortunately, dealing with some family issues with my 20 yr old son.  My wife and I have been stressed to the max.  The stress has taken it's toll on me, increasing some of my symptoms some poor  sleep,( still getting 6 hrs restless sleep), an  increase in my anxiety and  my tinnitus is louder.  I'm also feeling a bit depressed upon awakening in the morning, which subsides by noon.

 

I am now down to 187. 5 mg on my Wellbutrin taper.  I am taking 150 mg SR in AM and 37.5 mg IR around 1:00PM.  I will probably go down to 168 mg (150mg SR and 18.75 mg IR) in about 2 weeks.  I started my taper from 300mg Wellbutrin last January so it's taken me a little longer then I wanted, but so be it.  I might hold my Wellbutrin taper when I get to 150 mg SR , and start my Lamictal taper.  I would like to reduce my lamictal down to reduce the side affects of this med.

 

I am definitely having some additional side effects from the meds lately.   The lamictal has always given me some headaches and marked fatigue  which seems to be getting worse.  Also it appears I have become tolerant to the Doxepin, it is hardly  working anymore as a sleep aid.,  It does keep my head  foggy all day and affects my cognition as well.  It's really hard to say which medication is making me feel worse.  I really wish I could just stop a medication for a week to see if some of my symptoms  are a result of the side effect of the med.   I know of course I cannot. 

 

I'm just a bit disillusioned right now with all that is going on and feeling like these meds are ruling my life . I have lost some confidence and self esteem lately and I find it difficult to make many decisions.   It feels like it will always be like this, especially when I'm feeling poorly and can't keep a positive attitude.  I know it can and will get better at some point, but it seems so far away right now.  Like my wife tells me what else can I do but just plug along and bear with it and stay positive.

 

Meds  and times taking them:

 

Wellbutrin 150mg SR AM    37.5 mg IR 1:00 PM

Lamictal 200mg AM

valium 2mg 10PM

melatonin 2mg 10 PM

Doxepin 7 mgs 12:30AM

 

Thanks

[Altostrata]

Hi, vetdoc.

 

Sorry to hear it's been rough lately. What is your daily symptom pattern -- the headaches, etc.?

[vetdoc]

Hi, vetdoc.

 

Sorry to hear it's been rough lately. What is your daily symptom pattern -- the headaches, etc.?

Hi Alto Hope all is well with you.

 

The start of my day upon awakening  my tinnitus is a few octaves louder.   It seems to quiet down after taking my morning Wellbutrin and lamictal.  It makes me think that either the valium or doxepin may be the culprit since I take them late in the evening.  I also am very foggy upon awakening which takes a few hours for my head to clear.  I definitely think the Doxepin is causing this.

 

I seem to get headaches about  two hours after taking the lamictal, sometimes nausea, also  fatigue like symptoms which hinders me on most days. 

I definitely still feel the activation, and  head buzz  after taking the wellbutrin which lasts until the afternoon, although much less at these lower doses. 

 

I still try to go to the gym 3 times a week and I am still working about 3 days a week. It's important for me to stay physically fit and keep my mind from stagnating.  My work definitely helps me to stay focused and is good for me.

 

Alto the frustrating thing is just a few years ago before all these meds I was a very vibrant and healthy 65 year old man feeling much younger then my years.  Now I dont feel very well on most days and I am no longer a very vibrant person, it's kinda sad.  I still have to try and stay positive since I have a family with a young son to still care for and a wife who has been very understanding during this process.  I am really hoping that when I get off these drugs I will feel so much better, more like my old self, though I will be an elderely individual. 

[Altostrata]

I'm sorry it's the way it is, vetdoc. No way out except to go through.

 

Have you tried dividing the lamotrigine dose? Move a portion, maybe 50mg, an hour or so later each day, to the evening. That might help both the adverse reaction and tinnitus.

 

Perhaps after that, reduce the doxepin?

[Meimeiquest]

Maybe some therapy to process the issues with your son? It's hard to know where the boundaries are with "adult" children of that age. It might not help with the sad part, but maybe with the stress part?

[vetdoc]

I'm sorry it's the way it is, vetdoc. No way out except to go through.

 

Have you tried dividing the lamotrigine dose? Move a portion, maybe 50mg, an hour or so later each day, to the evening. That might help both the adverse reaction and tinnitus.

 

Perhaps after that, reduce the doxepin?

Alto

I have throughout the several years taking the lamictal tried dividing the dose 100mg AM and !00mg PM and I felt it was contributing to my insomnia aking a dose at night.  I know Lamictal calms the glutaminergic system but I have read it can cause marked insomnia in some people?  I always wonder if I'm one of the ones who Lamictal is causing my difficult sleep, along with the wellbutrin.  Of course its also possible lamictal is helping counteracting the Wellbutrin activation.

It's very confusing as you know trying to figure out which drug is doing what to cause symptoms.

 

I guess I could try moving just 50mg to the evening and see what happens.  I assume you are suggesting this to try and lessen my tinnitus at night and early morning?

 

Yes the doxipen may be causing me problems at this point.  It had definitely been my friend for several years as a sleep aid during the valium withdrawl, but I may be tolerant to it now.  My P doc said to increase it but I won't do that.  I may start a very slow 0.5 mg reduction a month and see what happens for  several months.

 

Also possibly getting down lower on my Wellbutrin may also help with my restless sleep and tinnitus.

 

One last question how "normal' is it to feel pretty good for 3-4 days and then feel poorly for a few days. I know there are windows and waves but,  I ask this because I had mostly good days during my slow valium taper.  It seems since I started my Wellbutrin taper no matter how slow I go my taper is been very rocky compared to my almost 2 year valium taper. 

 

Thanks

[vetdoc]

Maybe some therapy to process the issues with your son? It's hard to know where the boundaries are with "adult" children of that age. It might not help with the sad part, but maybe with the stress part?

Hi Meim

 

 I guess you are talking about my own individual therapy?   I do go with my son  to his addiction counseling sessions most times every week and to his college NA meetings.

Yes it would probably help some with my stress issues, but it won't change what is going on with him.  Maybe it would help how I deal with the situation and help me let go some.  I'm really very enmeshed in the whole situation.  It's really hard when you see your young kid struggling with an addiction problem and you can't do anything except support him, get him help and pray that he can get in recovery.

 

This situation has become  a nightmare for my wife and I and I'm sure it adds to my symptoms and why I've been doing poorly the past several months.  I will look into getting some counseling for myself and thanks for the suggestion Meim.

[Altostrata]

vetdoc, those do sound like they could be windows and waves, thus "normal" for withdrawal.

 

It sounds to me like 200mg Lamictal at once is too much for you, you're getting an adverse reaction (headache, nausea) characteristic of too high a dose.

 

Too high a dose of lamotrigine in the evening can cause insomnia through a paradoxical reaction. A low dose can complement the normal winding-down that should occur in the evening. It's a balancing game.

 

Since you're not ready to taper Lamictal, my guess is you might reduce the adverse effects by dividing the dose. Perhaps you might want to experiment moving 10mg to the evening first, to see if that helps.

[vetdoc]

Alto

 

I'll try moving 25mg lamictal up to the evening and see what happens.  I think when I get down to 150mg Wellbutrin I might hold and start a slow Lamictal taper., at least down to 100mg, then hold the lamictal and continue the Wellbutrin taper.  What do you think?

 

Also I was thinking that as I reduce my wellbutrin it may be affecting my valium and doxepin dose.    It appears there is an interaction by which wellbutrin slows the metabolism of valium and doxepin.  So as I reduce the Wellbutrin I am in turn also reducing the valium and doxepin as they are metabolized faster.  This might explain why my symptoms rev up about 5 days after each Wellbutrin cut and the wave lasts about 3-4 days?

 

Thanks

[Altostrata]

Yes, it could be reducing one drug affect the metabolism of the others.

 

Let's see what happens when you split the lamotrigine dose. Don't change anything else while you do this.

[vetdoc]

Yes, it could be reducing one drug affect the metabolism of the others.

 

Let's see what happens when you split the lamotrigine dose. Don't change anything else while you do this.

Ok Thanks Alto

I'll check in around 7 days or so

[vetdoc]

Hi

Just checking in.  Alto It's been about 12 days since I moved a small dose 25mg lamictal to the evening to see if it could help with sleep and reduce the morning symptoms nausea , headache, cognitive dysfuction when taking the full 200mg all in the morning

It does seem that taking the 25 mg of lamictal has helped some with sleep.  I am able to fall asleep quicker and sleep for 4-5 hrs without waking, then getting back to sleep. I have been averaging about 6-7 hrs of total sleep nightly.

 

I'm not sure exactly when to take the evening dose, tried one hour before bed, but wonder if it would be better to take it a few hours before bed?

 

Im down to 187mg of wellbutrin, thinking of reducing down to 168mg in another week as long as my sleep continues to stabilize.

[Altostrata]

Wow, that's good news. I'd time it for the maximum sleep benefit.

 

I'd give your nervous system a little longer to stabilize with the lamotrigine change -- perhaps 2 more weeks? Enjoy!

[vetdoc]

Wow, that's good news. I'd time it for the maximum sleep benefit.

 

I'd give your nervous system a little longer to stabilize with the lamotrigine change -- perhaps 2 more weeks? Enjoy!

Thanks Alto  I will wait till the end of the month before making another Wellbutrin cut.

[vetdoc]

Hi checking in again.  I was doing pretty well until about 4 days ago when  some bothersome symptoms  started coming up.    I started having very disturbed sleep again, but this time with depression and fear symptoms.   The depression has been pretty bad and the fear emotions scare me a bit.  I have definitely been under extreme stress for the past month which I am certain may be triggering some of these symptoms and disturbing my sleep once again.  The insomnia symptom is always the first to emerge when I am in some type of wave. 

 

The doxepin that I was prescribed and have taken for a few years for sleep seems to have finally pooped out.  I no longer get groggy after I take it and sometimes wonder if it actually is starting to prevent me from sleeping?   I know I feel very heavy headed and unclear when I awake in the morning with some depression.  I also have pretty bad night terrors when I awake in the middle of the night.   I have read that doxepin can cause depression and fear like emotions, but I don't know why after two years it would do that to me.

 

I am concerned that maybe I tapered my Wellbutrin to quickly from the 205 mg down to 187 mg in a months time which may be causing withdrawl symptoms.  I know when I was on 225mg I tried to taper down to 205mg in a month and needed to updose back to 225 for an additional 8 weeks due to withdrawl symptoms.   I'm thinking I may need to updose back to 205mg and see if some of my symptoms improve?  Please let me know what you think about this . I may be very sensitized to wellbutrin after being put on it for quite some time and taken off and then reinstated several times over the years. So I may need a slower taper.

 

I did see my P Doc yesterday for a med check and told him what was going on right now.  He did think that I probably have become tolerant to doxepin for my sleep and advised me to taper off it as well as taper off lamictal. He finally is on board with me getting off the meds even though he is not experienced in doing a proper 10% or slower taper.  He did say that I may be very sensitized to the meds due to my history.

 

Thanks

[Altostrata]

vetdoc, it could be the lamotrigine has calmed your system down enough at night so that the doxepin is, indeed, too much of a "brake" at this point.

 

You might hold on everything else, start reducing the doxepin, and see what happens.

 

I would not change two drugs at once!!

 

Good to hear your pdoc is showing some common sense.

[vetdoc]

Hi Alto

I'm going to start a slow taper of doxipen and hold my wellbutrin taper.  I read about the interaction with doxepin and lamictal causing cognitive dysfunction as well as confusion.  I defintely feel really druggy and confused upon awakening until mid day.  I heard doxepin an be tough to taper but I am on a low dose so hopefully it won't be to bad.  I'll probably use liquid doxepin and titrate a dose to remove a certain number of drops each day, to equal a 10% total reduction a month.

One other question.  I have been taking omega fish oil for several years , but recently with my insomnia issues it feels like the fish oil may be activating and adding to my sleep issues.  Have you ever heard of fish oil being activating?

thanks

[JanCarol]

Hey VetDoc - 

 

How are you going?  Did you get the doxepin down any?  Did it help?

 

My only comment is about your other drugs - blood pressure and PPI.  I suggest you read Armon P. Neel, Jr's excellent book "Are your Prescriptions Killing You?"  His focus is geriatrics.  Despite the dramatic name, he discusses many cases which sound similar to yours - where a vital person is reduced to illness by too many drugs.  He mentions psych drugs, but also talks about hypertension drugs, statins, and PPI's.  He talks about how the geriatric body no longer metabolizes many of these drugs, and that the prescription levels are frequently too high for seniors and cause problems, and further "prescription cascades" (as you have experienced)

 

I'm suggesting that your hypertension drug may be contributing to your side effects, as Alto hinted at early on.  I know nothing about these drugs, other than what I've read in Neel's book, and the knowledge that some people take them for anxiety or racing heart.

 

Since you are a science man, you might be able to read his book and references and be able to figure out for yourself what you need to optimize your dosages.  Otherwise, you can contact a "geriatric consulting pharmacist" (google that phrase) in your area.  I'm trying to get my Mother on this service (she is 86) but she thinks I'm "the crazy one" and is too trusting of what her doctors have been taught about pharmaceuticals, so - it doesn't seem a priority to her, even though she is falling down a lot and I'd like to keep her independent as long as possible.

 

The good part of Neel's book is this:  in case study after case study, upon reduction of the drugs, the patients - often in their 80's - achieve well being, vitality, improvement - and - they get to keep money in their pocketbook, as well.  I'm not saying you're elderly - but - your metabolism may have changed since you were put on the hypertension and PPI drugs.

 

You may wish to look at our topics on:

http://survivingantidepressants.org/index.php?/topic/1976-high-blood-pressure/

http://survivingantidepressants.org/index.php?/topic/6216-non-psych-drugs-causing-psych-symptoms/

http://survivingantidepressants.org/index.php?/topic/999-beta-blockers/

 

http://survivingantidepressants.org/index.php?/topic/2533-that-acid-reflux-pill-may-be-causing-your-health-problems/

http://survivingantidepressants.org/index.php?/topic/4361-tips-for-tapering-off-stomach-acid-blockers-or-ppis-esomeprazole-lansoprazole-omeprazole

http://survivingantidepressants.org/index.php?/topic/9026-acid-reflux/

 

There are others in here - some with hiatal hernia - who have either gone off their PPI totally, using sodium bicarb or TUMS, ginger and/or mint teas, or there are some who still take the PPI but only as needed, not every day. I haven't followed the hypertension drugs as much - but I have seen people come off of them.  Again, as your Wellbutrin comes down (one of its side effects is hypertension), you may need less quantity, potency, etc. in that category, too.

 

I don't mean to confuse you by throwing more variables into the mix - but you know the procedure, please taper one drug at a time, and carefully.  The drugs I've mentioned here - even the PPI - need to be tapered in order to reduce or get off them safely.  I mention it to you, because all of the drugs are variables in your mix, not just the psych ones.  It's something to research while you are holding, waiting for your next taper.

 

I hope you see the sun today.

 

 

[Altostrata]

Thanks, JC.

 

Yes, vetdoc, some people find fish oil to be activating. They can often go back to it later.

[vetdoc]

Hey VetDoc - 

 

How are you going?  Did you get the doxepin down any?  Did it help?

 

My only comment is about your other drugs - blood pressure and PPI.  I suggest you read Armon P. Neel, Jr's excellent book "Are your Prescriptions Killing You?"  His focus is geriatrics.  Despite the dramatic name, he discusses many cases which sound similar to yours - where a vital person is reduced to illness by too many drugs.  He mentions psych drugs, but also talks about hypertension drugs, statins, and PPI's.  He talks about how the geriatric body no longer metabolizes many of these drugs, and that the prescription levels are frequently too high for seniors and cause problems, and further "prescription cascades" (as you have experienced)

 

I'm suggesting that your hypertension drug may be contributing to your side effects, as Alto hinted at early on.  I know nothing about these drugs, other than what I've read in Neel's book, and the knowledge that some people take them for anxiety or racing heart.

 

Since you are a science man, you might be able to read his book and references and be able to figure out for yourself what you need to optimize your dosages.  Otherwise, you can contact a "geriatric consulting pharmacist" (google that phrase) in your area.  I'm trying to get my Mother on this service (she is 86) but she thinks I'm "the crazy one" and is too trusting of what her doctors have been taught about pharmaceuticals, so - it doesn't seem a priority to her, even though she is falling down a lot and I'd like to keep her independent as long as possible.

 

The good part of Neel's book is this:  in case study after case study, upon reduction of the drugs, the patients - often in their 80's - achieve well being, vitality, improvement - and - they get to keep money in their pocketbook, as well.  I'm not saying you're elderly - but - your metabolism may have changed since you were put on the hypertension and PPI drugs.

 

You may wish to look at our topics on:

http://survivingantidepressants.org/index.php?/topic/1976-high-blood-pressure/

http://survivingantidepressants.org/index.php?/topic/6216-non-psych-drugs-causing-psych-symptoms/

http://survivingantidepressants.org/index.php?/topic/999-beta-blockers/

 

http://survivingantidepressants.org/index.php?/topic/2533-that-acid-reflux-pill-may-be-causing-your-health-problems/

http://survivingantidepressants.org/index.php?/topic/4361-tips-for-tapering-off-stomach-acid-blockers-or-ppis-esomeprazole-lansoprazole-omeprazole

http://survivingantidepressants.org/index.php?/topic/9026-acid-reflux/

 

There are others in here - some with hiatal hernia - who have either gone off their PPI totally, using sodium bicarb or TUMS, ginger and/or mint teas, or there are some who still take the PPI but only as needed, not every day. I haven't followed the hypertension drugs as much - but I have seen people come off of them.  Again, as your Wellbutrin comes down (one of its side effects is hypertension), you may need less quantity, potency, etc. in that category, too.

 

I don't mean to confuse you by throwing more variables into the mix - but you know the procedure, please taper one drug at a time, and carefully.  The drugs I've mentioned here - even the PPI - need to be tapered in order to reduce or get off them safely.  I mention it to you, because all of the drugs are variables in your mix, not just the psych ones.  It's something to research while you are holding, waiting for your next taper.

 

I hope you see the sun today.

 

Hi JC

 

I'm sorry I didn't respond to your older post back in December.  I missed it since my last post was right before yours and I haven't been on the board since December.  Everything you say in your post  absolutely has  truth in it.   I  to recognize that most of my meds are definitely adding to my symptoms, besides  the psych drugs during my taper. 

 

I actually made a list of the side affects and interactions between all my meds and I was shocked at all the things I found out.

 

1.  Lanzprezole  PPI

Nervous System - abnormal dreams, agitation, amnesia, anxiety, apathy, confusion, convulsion,  dementia, depersonalization, depression, diplopia, dizziness, emotional lability, hallucinations, hemiplegia, hostility aggravated, hyperkinesia, hypertonia, hypesthesia, insomnia, libido decreased/increased, nervousness, neurosis, paresthesia, sleep disorder, somnolence, Alzheimersality, tremor, vertigo

Musculoskeletal System - arthralgia, arthritis, bone disorder, joint disorder, leg cramps, musculoskeletal pain, myalgia, myasthenia

Urogenital System - abnormal menses, breast enlargement, breast pain, breast tenderness, dysmenorrhea, dysuria, gynecomastia, impotence, kidney calculus, kidney pain, leukorrhea, menorrhagia, menstrual disorder, penis disorder, polyuria, testis disorder, urethral pain, urinary frequency, urinary retention, urinary tract infection, urinary urgency, urination impaired, renal failure

 

2. Famotidine (pepcid) H2 blocker

Musculoskeletal: rhabdomyolysis, musculoskeletal pain including muscle cramps, arthralgia

 

Nervous System/Psychiatric: grand mal seizure; psychic disturbances, paresthesia; insomnia  including hallucinations, confusion, agitation, depression, anxiety, decreased libio; somnolence. Convulsions, in patients with impaired renal function, have been reported very rarely.

 

 

3. Benicar blood pressure

 

Common side effects of Benicar include dizziness, bronchitis, back pain, joint or muscle pain, tinnitus

 

Lamictal

·  dizziness

·  tremor

·  headache

·  rash

·  blurred or double vision

·  fever

·  lack of coordination

·  abdominal pain

·  sleepiness

·  back pain

·  nausea, vomiting, diarrhea

·  tiredness fatique

·  insomnia

 

4. Tamulosin

 

1. headache
2. congestion
3. lack or loss of muscle strength,weakness
4. sneezing
5. stuffy or runny nose
6. tender, swollen glands in the neck
7. trouble swallowing
8. insomnia

5. Doxipen

Nervous System Effects

Drowsiness is the most commonly noticed side effect. .  confusion, brain fog, disorientation, hallucinations, numbness, paresthesias, ataxia, extrapyramidal symptoms, seizures, tardive dyskinesia, and tremor.

 raising or lowering of blood sugar levels, and syndrome of inappropriate antidiuretic hormone secretion have been reported with tricyclic administration.

 

6. Wellbutrin

Nervous system

  Insomnia

  Dizziness

Tinnitus

  Agitation

  Anxiety

 Tremor

memory decreased

paresthsia

 

Bupropian strong inhibiter 450 enzyme cyp2d6, since doxipen metabolized by cyp2d6 Bupropian  increases doxipen blood levels as much as  3-5 fold  So I may be taking much higher doses of the doxipen then I was prescribed

 

7.Valium

 

drowsiness, dizziness, spinning sensation, fatigue, constipation, ataxia (loss of balance), memory problems, restlessness or irritability, muscle weakness

 

Sorry for the long list, maybe it can help others on the same meds. All those in red are symptoms I have, which includes insomnia which 5 of the drugs can cause.  Unfortunately for me I can't drop these meds during my taper off the psychotropics.

So I never really know what is causing my symptoms all the time, is it the side effects of the meds or just another wave or both!  Since I am a senior citizen 69 yrs old, these meds can be wreaking havoc on my system.

 

 

Thanks

[vetdoc]

I

Hi all

 

I haven't been on the board for quite awhile and during the past 3-4 months I have developed some pretty serious problems.  I am having to go to surgery on June 1st to have a prostate operation.  I have had symptoms of an enlarged prostate,( inability to empty my bladder completely, urinary retention, urge incontinence, and urinary tract infections) for a few years.  The problem has  finally become so bad ( I'm now 69 yr old),  that I need to have part of my prostate removed to relieve my blocked urethra .  I'm very anxious about this surgery.  The operation will take about 2 hours and require general anesthesia.  I know I can't take any benzos, and I will try and see if I can be anesthetized initially with an injection of  propofol, and then put on gas anesthesia.  Post op Im not sure if I should take any pain meds ie: morphine, tramadol.  I may need something however immediately following surgery

 

To add to the mix I have also just developed some kind of peripheral nueropathy about a month ago in my lower legs and feet.  I have some tingling-numbness feeling in my feet along with muscle spasms and muscle cramps of my lower legs.  I just had blood tests to see if it is something due to mineral or vitamin deficiency or some other metabolic abnormality.  I didn't get the results yet.  If the tests don't show anything the next step will be a referral to the neurologist, for nerve function tests. 

 

I really feel like I'm physically rapidly deteriorating.  This of course has my anxiety level thru the roof which doesn't help my withdrawal symptoms from my psych meds.  I have gotten into such a negative spiral thinking that I may not have to much more longevity to my life.  The prostate surgery has me anxious, but not knowing why my legs have some type of nerve dysfunction is really scaring me big time.  I keep thinking it has to be something bad and incurable, which of course causes me to have little hope, which just adds to my anxiety.  I'm normally a hopeful person but I'm feeling so poorly its really taking a toll on my physical and mental health.  I am of course not sleeping well, which makes me feel poorly.   I really  wanted to go into this surgery in good shape and feeling strong.

 

My wife keeps telling me to stay positive and she is right, but it is so damn hard the way I'm feeling.  It;s been a huge burden  as you all know just tapering my psych meds for the past 3 years.  Now adding to the mix these other physical maladies is so overwhelming for now.

 

I would appreciate hearing from all of you that either had similar circumstances and how you were able to cope thru it. I'd love to hear from anyone with any suggestions or moral support at this vulnerable time.

 

Thanks guys

 

 

[Altostrata]

Hello, vetdoc.

 

Please let the anesthesiologist know you have autonomic instability and potential difficulty with benzos. The propofol is relatively low-risk.

 

I did okay with general anesthesia (with the above caveats) for a cardio procedure that lasted 4 hours. I had pain pills after. It took me a good while to recover, but I'm fine now.

 

Do you do a lot of sitting? That could contribute to the neuropathy symptoms. Stretching exercises each day can help, also walking.

[vetdoc]

Hello, vetdoc.

 

Please let the anesthesiologist know you have autonomic instability and potential difficulty with benzos. The propofol is relatively low-risk.

 

I did okay with general anesthesia (with the above caveats) for a cardio procedure that lasted 4 hours. I had pain pills after. It took me a good while to recover, but I'm fine now.

 

Do you do a lot of sitting? That could contribute to the neuropathy symptoms. Stretching exercises each day can help, also walking.

Hi Alto

 

Hope all is well with you.  It's good to hear that you had major surgery and it went well, with complete recovery.  It gives me hope for a similar outcome.

Thanks for the advice about reminding the anesthesiologist about autonomic instability.  I'm hoping I don't need to take pain meds for more then a day.

 

I do a fair amount of sitting.  I have started walking about a mile and half each day and I stretch in the AM and PM.  I will get some tests done to determine what is going on with my neuropathy after my surgery.  I am going to try and take each step one at a time and try to stay in the moment.  If I start thinking about all the things that I may have and will they be curable I get terribly anxious.  The surgery is my first step and I need to plan that for now.

 

I'm going  get back into my meditation to try and relax myself and stay just in the moment.  I hope it will help.

 

I'm also not tapering at all during this time until my surgery is over and I recover some.

 

Thanks

[mammaP]

Hi Vetdoc, sorry to hear that you are unwell and needing surgery. I had 2 ops last year and was very nervous before them because of the drugs and anaesthesia. 

I had nerve blocks and did quite well but the pain relief after was tricky because I am so sensitive to drugs. Tramadol is an SNRI with synthetic opiate and one that I am struggling to taper so couldn't use that and to be honest wouldn't recommend it. Talk to the anaesthetist and tell him/her your concerns about pain relief and they should try and take into consideration your experiences with drugs and sensitivities.  Post surgery remember that the pain will get better as your body heals. 

 

I hope your surgery goes well and you recover quickly. 

[vetdoc]

Hi Vetdoc, sorry to hear that you are unwell and needing surgery. I had 2 ops last year and was very nervous before them because of the drugs and anaesthesia. 

I had nerve blocks and did quite well but the pain relief after was tricky because I am so sensitive to drugs. Tramadol is an SNRI with synthetic opiate and one that I am struggling to taper so couldn't use that and to be honest wouldn't recommend it. Talk to the anaesthetist and tell him/her your concerns about pain relief and they should try and take into consideration your experiences with drugs and sensitivities.  Post surgery remember that the pain will get better as your body heals. 

 

I hope your surgery goes well and you recover quickly. 

Hi Mamma

Thanks for your support and encouragement.  If I need pain meds upon waking from the surgery immediately post op  I was thinking about tramadol one time injection.  Do you not recommend it even  for a single dose.  Also they are using IV tylenol for moderate pain which is the safest for people tapering from psych meds.

[mammaP]

Personally I wouldn't, I checked for interactions and this came up. When I was in hospital I checked everything with the interactions checker at drugs.com before I agreed to anything because I am so sensitive.  It is your call, but look carefully at all their suggestions before you decide what to allow . Morphine would be my drug of choice post surgery but it makes me very sleepy and they wouldn't give injections here, it is a patient controlled pump where you have to press the button to get a dose. It makes me very very sick so I need cyclizine injections which also make me sleepy and can't press the button!  

 

Interactions between your selected drugs

Major bupropion  tramadol

Applies to: Wellbutrin (bupropion), tramadol

TraMADol may rarely cause seizures, and combining it with other medications that can also cause seizures such as buPROPion may increase that risk. The interaction may be more likely if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid 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.

Switch to professional interaction data

[vetdoc]

 

Personally I wouldn't, I checked for interactions and this came up. When I was in hospital I checked everything with the interactions checker at drugs.com before I agreed to anything because I am so sensitive.  It is your call, but look carefully at all their suggestions before you decide what to allow . Morphine would be my drug of choice post surgery but it makes me very sleepy and they wouldn't give injections here, it is a patient controlled pump where you have to press the button to get a dose. It makes me very very sick so I need cyclizine injections which also make me sleepy and can't press the button!  

 

Interactions between your selected drugs

Major bupropion  tramadol

Applies to: Wellbutrin (bupropion), tramadol

TraMADol may rarely cause seizures, and combining it with other medications that can also cause seizures such as buPROPion may increase that risk. The interaction may be more likely if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid 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.

Switch to professional interaction data

 

Mamma

 

Yes I looked at the interactions of all my meds and it looks like tramadol and even morphine can increase the risk of seizures when taking bupropian.  I wonder if since I am lamictal which is an anticonvulsant  it would protect my nervous system from seizure.  If I need pain meds I may have to use intravenous Tylenol, it works for moderate pain according to literature.  I hope the anesthesiologist and staff at the hospital will understand the issues I have and be tolerant with me.

[vetdoc]

Hello, vetdoc.

 

Please let the anesthesiologist know you have autonomic instability and potential difficulty with benzos. The propofol is relatively low-risk.

 

I did okay with general anesthesia (with the above caveats) for a cardio procedure that lasted 4 hours. I had pain pills after. It took me a good while to recover, but I'm fine now.

 

Do you do a lot of sitting? That could contribute to the neuropathy symptoms. Stretching exercises each day can help, also walking.

Alto

What pain meds did you take post op for your surgery?   The interaction of bupropian and morphine is increase risk of seizure.  Im wondering if the lamictal I'm on would protect this.

 

Also since lamictal is a central nervous system depressant I think the surgery nurse said I may not be able to take it the day of surgery.  I need to talk to the anesthesiologist and tell him I cant miss a day of taking my Psych meds.  Maybe I can move the lamictal to the evening the day of my surgery.

 

What do you think?

Thanks

[vetdoc]

If the anesthetist doesn't want me to take the lamictal the morning of surgery like I normally do,  I could move my lamictal dose to the PM the day of  surgery.  I don't know if that would cause some withdrawls messing with lamictal that acutely? 

[cymbaltawithdrawal5600]

The apparent plasma half-life in healthy subjects is estimated to be approximately 33 hours (range 14 to 103 hours).

 

The above quote leads me to believe taking your dose as you were thinking would be very good. What does doc say? I am sure Alto will weigh in later.

 

Lamo is of a class 'sodium channel blockers', not sure how its neural protection works for seizures. Alto may know that one too. Not all side effects occur when combining drugs, people do that for years and only find out after they come here and we tell them there's interactions to be considered that they may have sx of drug interaction cautions.

[vetdoc]

The apparent plasma half-life in healthy subjects is estimated to be approximately 33 hours (range 14 to 103 hours).

 

The above quote leads me to believe taking your dose as you were thinking would be very good. What does doc say? I am sure Alto will weigh in later.

 

Lamo is of a class 'sodium channel blockers', not sure how its neural protection works for seizures. Alto may know that one too. Not all side effects occur when combining drugs, people do that for years and only find out after they come here and we tell them there's interactions to be considered that they may have sx of drug interaction cautions.

Hi cymbalta

 

Thanks for your input here.  I haven't talked to the anesthetist yet so I'm not sure, but my DR said he thought I would have to stop the lamictal and wellbutrin the day of surgery.  I would be very concerned if I had to stop the Wellbutrin or lamictal for a day. I'm hoping the anesthetist allows me to take them.  I will tell him  I could have some withdrawals just stopping them even for a day and hopefully he is aware of this.

[cymbaltawithdrawal5600]

Yes it can but I don't think it will cause so much of an uproar as you might think. Halflife - I think that means half the drug is still circulating (active) in your system. 33 hrs is good, I think. When I was on the cymbalta, it had a half life of 4 or something. I'd feel it soon after a missed dose. But if you must delay them, I guess you must. At least you are aware that there may be consequences. Most patients have no clue and of course the docs say there is no such thing as wd.

 

You live within 50 miles of me if you are in Ft Myers. I think I mentioned that to you once before but you never commented back. Funny to see someone so close after all these years......

 

Good luck with the surgery!

[vetdoc]

Yes it can but I don't think it will cause so much of an uproar as you might think. Halflife - I think that means half the drug is still circulating (active) in your system. 33 hrs is good, I think. When I was on the cymbalta, it had a half life of 4 or something. I'd feel it soon after a missed dose. But if you must delay them, I guess you must. At least you are aware that there may be consequences. Most patients have no clue and of course the docs say there is no such thing as wd.

 

You live within 50 miles of me if you are in Ft Myers. I think I mentioned that to you once before but you never commented back. Funny to see someone so close after all these years......

 

Good luck with the surgery!

Yes you are right, lamictal has long half life.  I am thinking of moving at least 100mg of my 200 mg morning dose to the evening , so I will only miss a 100mg  AM dose the day of my surgery.  I'm not going to anx over it , just need to stay in the moment everyday leading up to my surgery.  I'm doing some positive visualizations of how things will be the day of surgery and how the surgery and my recovery will go.  I trust my surgeon and I know I am in good hands.

 

I do apologize if I didn't comment back to you if you posted to me in the past.  Yes I live in Fort Myers, are you north or south of Fort Myers? 

 

Thanks for your well wishes on my surgery

[cymbaltawithdrawal5600]

"A barrier island about 30 miles southwest of Ft Myers" is, I think, how where I live is described.

 

I thnk you'll do fine with your meds. The body is a remarkably tolerant machine and we worry about it unnecessarily sometimes. But worry we must because it is prudent to be well prepared for eventualities.

 

So what's the saying? Trust God but tie your camel and then forget about it and go into the mall and shop like crazy.

 

I don't think that is quite right but I think you'll get my drift.

[vetdoc]

I had my surgery June 1st and all went well. The anesthesia and pain meds did knock me for a loop for a few days. I'm still pretty tired.  I am now taking a sulfa antibiotic which has ramped up my tinnitus pretty bad.  I have 3 more days of the antibiotic so hoping my tinnitus goes back down to low levels when I finish.

 

 

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