Plaquenil, Amitriptyline and now Cymbalta

[patmackfin]

Hi Again,

(this is a followup to a previous post)

So I went to see my regular doctor as a couple of you had suggested. I explained about waking up hot and cold while taking the Plaquenil and Amitriptyline and feeling worse than ever lately. The doctor printed out the letter sent to her from the Rheumatologist stating that because of the positive ANA he had put me on a trial of Plaquenil to see if it works, and if it didn't work on the pain he was basically going to "park" the mixed connective tissue idea/diagnosis and go with chronic fibromyalgia instead, also commenting on the physical exam findings.

So my doctor took me off the Plaquenil today and said to stay on the Amitriptyline for now and gave me a prescription for Cymbalta (30 mg a day for two weeks and then 60). She put my hot and cold nights as being (peri)menopausal symptoms starting to kick up a gear,(I turn 50 in March).

I am confused now.... she looked up interactions on the computer while I was there and said it was fine, but me being me, I looked it up myself just now and this is what it states :

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Interactions between your drugs

Major **

amitriptyline DULoxetine

Applies to: amitriptyline, Cymbalta (duloxetine)

Using amitriptyline together with DULoxetine 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. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. 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.

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I am totally confused and fed up. I feel like just going back to managing the pain myself with extra vitamin B 12 shots and Motrin as needed, now that I (think they finally) know what's causing all these pains.

She did say to eventually get myself off the Amitriptyline and just take the Cymbalta, that it helps better than Amitriptyline for pain and may even help the upcoming peri-menopausal symptoms.

Any thoughts or experiences would be very helpful.

THANKS SO MUCH x

[whisperit]

Hello patmackfin

As you say, your GP did check the interactions herself. It may be worth bearing in mind that drug info on amitriptyline interactions and side effects will be based on all uses, and historically, it was used mainly as an antidepressant, at doses of up to 200mg a day.

I'm guessing that your prescribed dose is less than 50mg?

Similarly, as far as I know, serotonin syndrome is rare, and usually seen in cases of SSRI overdosing.

So I would not want to play down your concerns, but my assumption is that your GP assessed the risk of your developing this rare side effect as being outweighed by the potential benefits. It should be easy to give your GP a ring to put your mind at ease anyway? x

[Hidden]

Hi, I am on Prozac and Amitriptyline, and asked the Gp about this as read the same. She said that my dose of Amitriptyline was small, I am only on 25mg, and 20mg of Prozac. The risk is therefore very small with these doses. I think it’s that people who are treated for depression with Amitriptyline are on much higher doses.

Hope this helps.

[patmackfin in reply to Hidden]

Thanks so much for putting my mind at rest. I am only on 10mg of Amitriptyline. I didn’t take it last night and never slept a wink.

THANKS AGAIN

[Polly2Cats in reply to patmackfin]

I get hot flushes and menopausal type symptoms but I’ve had a hysterectomy and gone through menopause years ago. The hot flushes and sweating is different for me to what most menopausal ladies describe.

I’ve previously had low dose amitrip to help with restless legs. I couldn’t get on with it at all. It seemed to make my fatigue worse.

Your GP clinical system won’t allow them to prescribe a drug if there are contra indications without fully checking them out and weighing up the risks. Most GPs I would hope would discuss possible risks and side effects to help you make an informed choice about your treatment.

I really value the advice of my local independent pharmacist they are usually hot on stuff like risks and interactions. Usually more approachable too! I was worried about sumatriptan and they helped reassure me loads. I talked to him twice before I would take it.

Hope you get a good sleep tonight

[Hidden]

I had terrible hot flashes when I was peri menopausal, it started when I was about 46, ( I am 51 now and now post menopausal) and around the same time started with the aches and pains. A little stiff in the morning etc.

I also got a positive ANA, but my Rheumatologist diagnosed fibromyalgia straight away because my anti Ds DNA was negative.

I was offered Gabapentin, which really did not agree with me. My Gp then offered me Cymbalta too, but having read many posts, it seems that a lot of people are trying desperately to come off it. I think you need to be very careful with this drug, if you decide to come off it. though I am sure it’s very helpful for some.

I’ve tried to limit my drug intake now, as it seems to me some are taking huge amounts of all sorts but still get pain. I personally just don’t want to end up on high doses and then go through the long hard struggle of coming off them.

I do get terrible pain, but now trying mindfulness, which is helpful. I get profoundly fatigued too, but the Gabapentin etc just made it worse for me,

Everyone is different though and what suits some doesn’t suit others, it’s just personal preference and trial and error I guess, finding what’s right for you. I hope you do well on it, and it helps ease your pain. Your circumstances seem very similar to mine. Good luck. X

[patmackfin]

Thanks guys,

This is just my third day taking it, and I took the 10mg of Amitriptyline last night too, I had a terrible migraine last night (Ocular) which I haven't had in a while. My appetite seems to have decreased ( actually I just looked it up to see if this is a common thing with Cymbalta , and it is) . I will check back in soon. Trial and error as we all know.

Thanks again