Fibromyalgia Action UK
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No confirmation but concerned over medications given

Hello and hope you are all dealing with the pain.

A quick question really. My doctor has given me Duloxetine on top of me already taking Citalopram, co codamol and Gabapentin. Does anyone else have this combination and how do you feel? I haven't taken the Duloxetine yet as I am concerned

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I'm on duloxetine and gabapentin myself. I could take the codamol if I wanted to but I don't need it. The citalopram/Celexa I don't need either, but I do take quetiapine/Seroquel. I'm preparing to ask to up my gabapentin as my neuropathy in my feet is too obviously signaling me with phantom feelings. I already know that my neurologist will say yes.

Regarding your drugs as prescribed, there's a potentially major negative interaction plus several moderate reactions with too many drug type duplications warned of here:

Interactions between your selected drugs

ONE: Major

citalopram and duloxetine

Applies to: citalopram, duloxetine

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, cyclobenzaprine, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and tryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life. For example, some experts suggest a 5-week washout period following use of fluoxetine and 3 weeks following the use of vortioxetine before administering another serotonergic agent. Individual product labeling for washout periods should be consulted for current recommendations. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

TWO: MODERATE

gabapentin citalopram

Applies to: gabapentin, citalopram

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. 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.

References

"Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.

Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3

Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35

View all 36 references

Switch to consumer interaction data

THREE: Moderate

gabapentin duloxetine

Applies to: gabapentin, duloxetine

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. 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.

FOUR: MODERATE

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:

caffeine (active ingredient in acetaminophen/aspirin/caffeine/salicylamide)

citalopram

duloxetine

gabapentin

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.

FIVE: MODERATE

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:

SIX: MODERATE

citalopram

duloxetine

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.

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You are the pill master Sue x

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Thank you so much for this. I am always wary of taking multiples of medications, especially the ones that kind of do the same thing! The side effects are a huge concern for me as we all need to function at some kind of level without adding to the illness. Another conundrum for me. Leaning towards not taking Duloxetine on top at the moment. Kindest regards x

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Please feel free to go to the website to print out the interactions with cautions if you need them. Ditto with the plants I have in color.

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Yes I take all of those plus Loranzipam for sleep The codrydamol are good for pain

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Hi silverandglass , I font take the combination of those meds I only take Citalopram along with others. I hope they work for you it can sometimes take a while to get meds sorted.Good luck. Peck.🐤

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PS I know from inserts with meds you must be careful with Citalopram.Insert states to read each time you get a refill for changes with side effects.

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Hi , I take gabapentin, co codamol, matrazapine diazapam, zomorph and oxycodon as we as many others for my breathing but those are the main ones I have for fibro as well as antidepressant ,

If you are concerned about the medication the doctors prescribed for you then go back and see what else they can do to help.

Take care ; have a nice weekend

Loraine x

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Hi silverandglass

I do not take these particular medications myself so I cannot really comment? However, I want to sincerely wish you all the best of luck with whatever you decide to do? And please take care of yourself my friend.

All my hopes and dreams for you

Ken

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OT but I have been away from the group for a while- how are your aquaria? We got new fish at the museum tank but I was sad that within a week, the female of the new hawkfish pair died(or was killed).

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Hi Hurtingmom It is absolutely wonderful to hear from you my friend. My aquariums are doing very well thank you. I have got another one up and running at the moment for small fish (babies that I have bred myself). They are absolutely amazing to watch.

I really am so genuinely sorry to read about the lady hawkfish. They are predators but are hunted down themselves as they are not good swimmers, because they do not have a swim bladder, and seem to push themselves through the water instead of swimming. So they become prey to larger fish? The male most likely killed her? Such a shame, and they are so beautiful.

I want to sincerely wish you all the best of luck and please take care of yourself my friend.

All my hopes and dreams for you

Ken x x

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We have a session with the chief aquarist tomorrow. I am going to ask if he has an idea of who or what killed her.

I love to see baby fish- we had some baby clownfish added to our tank. It is great that you can breed your fish. The aquarist company breeds fish but not in our tank- they bring them to us but not that often. The new fish were the first we had in 2 years or so and before that it was 6 years(before my time at the museum)

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Hi Hurtingmom I genuinely hope that you can find some answers to this issue? I know how upset I feel when one of my fish dies! I will have to make another YouTube short of these particular babies and post it on to the forum. My son has some clown fish and I think they are one of the most beautiful fish there is. Take care my friend.

All my hopes and dreams for you

Ken x

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The aquarist said it just happens sometimes when new fish are added to a tank. I don't know if it just couldn't deal with the change or if it got attacked. We don't have any predators but I saw the older Yellow tangs attack a new young tang and kill it. Our clown fish fought over territory to the point where one had a bite(with the sandpapery teeth they have) that blistered(a bubble looking thing that turned into a dark patch) but healed.

He told us that 8 years ago the museum set up for the tank cost over $600,000 but a lot of that is all the equipment and sensors in the room behind he tank. The tank is 1700 gallons but the room behind is pretty large

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Sadly that happens form time to time. I lost several shrimps a couple of years ago despite the aquarium standing for two months. I did everything that we recommended as well?

WOW! That is a lot of money of a tank? But it is a massive size and with the sensors etc it all mounts up. I owuld simply love to work in such a place. Take care my friend.

I have some equipment for a new aquarium but I am waiting on some help to get it sorted. I have a mini air / light volcano and rock scenery for some crustaceans. It has to be kept slightly warmer than my other tanks. I am so excited and can't wait to get it up and running!

All my hopes and dreams for you

Ken x

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HI! I now we are all different and reasct to drugs differenty but PLEASE think long and hard abou taking Duluxotine. I have just had two horrendous months weaning myself off this evil drug. Harder than stopping morphine tablets, oramorph, tramadol, co codymol, Diazipam and Ambien together. It really was that bad, it destroyed my digestive system, gave me horrendous headaches my eyeballls hurt, vision blurred, sick, anxious and periods of extreme rage, tears, bleeding gums, no appetite or libido. I could go on and on. They. Gave me no benefits on them at all.

If you look at my previous post and you will see others sharing they had similar experiences. Do a google search and see page after page of people sharing their awful experiences around the world Also once on they do not intend you to ever come off it as only 30 and 60 mgs capsules. No 25, 20, 15, 10 or 5mgs. No way to wean off without splitting open ad dividing tiny whie balls in.

It's your choice and I'm no DR but I would never touch this again ever a friend told me today that it is banned in the states now. I guess you can tell I don't like it! But please question it before taking it see what others say here and other sites

Good luck

Patrick

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Thank you Patrick. This is the reason I am questioning this drug! But also as I am taking Citalopram at the same time. The last time I had an SSNRI after weaning off an ssri, I like you, had such a bad reaction after only taking for one day! To have both (when I feel at an even level with Citalopram) I couldn't comprehend. My doctor keeps bunging more pills on me without listening to me really. Over the last couple of months we have tried Amitripteline and tramadol on top - now this. I hadn't taken the others and don't intend to take these. Thanks for your reply 😊

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I am a diabetic also and nearly all the drugs say to check with Dr first, but as he's prescribed them one hopes he's aware! However, in reality and the ten minutes you get with them I doubt it!

My partner takes Citalopram but nothing else apart from some HRT drug to help with menopause. Both seem to help.

What shocked me was the amount of time fussing and warning about opioids, Duluxotine was far, far worse and no warning. Never again will I trust a dr to be infallible , tbh their put in such a position of trust it must be an ego trip or a heavy burden.

Best wishes

Patrick

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Silverandglass- I would ask the pharmacist you go to for advise on mixing drugs.

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I can only say Duloxetine did not work for me. Read reports on it before I took it but gave it a try. It made my twitches and little jerks far worse unable to piick a cup up without spilling it. Needless to say stopped taking it. I am also on gabapentin, Zapain,fluoxetine,amatryptaline,omeprasole,ramipril, (Uncle Tom cobbler and all. I'm sure there's a song in there somewhere! lol.) Hope this is of some help.

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