I have suffered with back pain for 15 years now caused by a trapped nerve, the main problem is also that my feet are very numb, especially my right foot, which means that I am unable to drive great distances except just locally.
I had a minor op in 2019 to free the nerve, that did not work and I was told that I would need to live with it!
GP sent me to the pain clinic, they tried various injections, that did not work and I was told that I would need to live with it!
GP then tried Physio, they tried all sorts, non of them worked and I was told that I would need to live with it!
GP has tried various medication including Gabapentin and Pregabalin etc, non of those have helped.
My right foot numbness is getting worse, worried that I may need to consider packing up driving.
Visited GP yesterday and he has put me on Nortriptyline 10mg a day for week 1, 20mg a day for week 2, then 30mg a day. Problem being that I take Citalopram 20mg tablets 1 a day and I do not think that these two tablets should be mixed.
Anyone on Nortriptyline who could advise please?
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Spursboy
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I am on Nortriptyline, which is helpful for lowering my continuous headache. I have had quite a big range of side effects from it initially, a number of which remain, but are preferable to a worse headache.I looked up taking both these medicines together, and there are some significant warnings about that. But it does say you can take them if your gp has considered this, and thinks it is still may benefit you.
There is advice about which symptoms to be watching out for, closely. I would consider a conversation with your gp to clarify they have considered all of this. And get a list of what to watch for, or what checks might be required.
Or in my big gp practice you can have a phone appointment with the pharmacist, all about those kind of medication issues. They have been really helpful for me.
You could also ask to speak to the pharmacist in your own chemist if your gp doesn't have one. Hopefully you can then decide after that if you are happy to try them.
What is the issue with your back causing this numbness/pain? It maybe worth exploring that again/in further depth, possibly correct this and maybe solve your issue regarding adding medication, best wishes.
I too had this issue had the same tablets as you .and where they sent me to pain Clinic .they put me on duloxetine 60 mg a day .pain has gone in my feet .hope this helps you
I am very worried by the mix of Nortriptyline and Citalopram 20mg tablets 1 a day, a friend of mine has suggested that they should not be used together!!
Hmmm that’s strange, I’ve been on Citalopram and Noritriptyline for several years and had no issue. I take 40mg every night and it helps me sleep plus boosts my Gabapentin to ease my nerve pain.
I had lumbar/sacral surgery in 2018 which helped the severe pain down my leg, and in 2020 needed multiple cervical surgeries and it was post those cervical surgeries that I got passed to Pain Management. As I’ve already got several small spinal cord injuries it was felt injections or a SCS implant would just potentially make things worse and possibly make my paralysis more widespread. They suggested I try Noritriptyline just at bed time as it makes me tired added to my other medications.
I’ve had no problems on it and when I had a review with the Pain Management Head Consultant he looked at the meds I’m on and said he couldn’t see how it could be improved and while I still have some level of persistent chronic pain it is liveable. I’m able to do most things that I want to, but need to pace myself as I am very easily fatigued however that could be from my age or weight too.
Hello. You didn’t mention which nerve it is that is being pinched?
Also, what surgery did you have?
It sounds like your sciatic nerve may be the culprit. Quite possibly another nerve as well.
You should not have to live with this. Please persist in getting pain relief. Good luck.
PS I took 20 mg Nortriptyline three times a day and mixed it with prescribed Tylenol #3 along with Hydroxizine Hydrochloride. It caused fatigue and dry mouth. No other symptoms. ( a wee bit of weight gain )
I agree you must research whether the two meds your GP prescribed are safe when taken together. Good luck.
Here is my complete MRI Scan report, if you can understand it:
His lumbar MRI scan shows scattered aging changes throughout his lumbar spine. He does have evidence of a degenerative scoliosis with the apex in the mid lumbar area convex to the right and there is a fractional curve below with the concavity facing the right side. The degree of scoliosis is not marked but is sufficient to produce foraminal-narrowing at both the L4/5 and L5/S1 levels on the right side. However the foraminal narrowing at L4/5 produces L4 root entrapment and he does not seem to have any relevant L4 symptoms. He also has a Grade 1 degenerative spondylolisthesis at the L4/5 level and not surprisingly there is a bilateral lateral recess stenosis which clearly would produce the L5 nerve root symptom. At the L5/S1 level he also appears to have a small disc protrusion which encroaches to the traversing S1 nerve root and he has a mild degree of lateral recess stenosis at L5/S1 as well so that it would be difficult to tell whether the current leg pain is also contributed to from the L5/S1 level.
As he is primarily a claudicant I reassured him that he does not have any serious pathology responsible for the symptom and there is always an option for him to persevere with conservative care. In the long run injection treatment would have no value and I do not think that a facet injection would produce any positive effect for nerve root symptom as it is designed primarily to relieve facet joint pain which in his case does not seem to have had a positive effect. Assuming that his lower extremity symptom is primarily related to the lateral recess stenosis at the L4/5 and L5/S1 level, the main surgical option would be to decompress the lateral recess and being an anteroposterior decompression it would be relatively straight forward. However, doing so would not be able to address the foraminal narrowing and there is a possibility that he can develop subsequent L4 root symptom and if that becomes a problem surgical treatment would be rather more difficult as it would involve at least a total facetectomy and in situ fusion of the relevant level and the cranial caudal narrowing of the foramen may even be best addressed by an interbody fusion, which clearly is an even bigger undertaking.
I therefore-explained that if he can tolerate the current-level-of-symptom-by-punctuating the walking and standing- with some sitting he certainly would not come to any harm. Otherwise, he would have to contend with the potential risk of surgery and despite the best surgical solution there may still be incomplete relief of his symptom..
The spondylolisthesis creates instability within the spine thus creating numerous issues as you are experiencing. Any medication/injection or conservative therapy will only be a sticky plaster. Until your spine is stable these issues will remain or potentially worsen. Surgery is your only real option to gain that stability required to correct/make best of the other issues you’re experiencing. It’s a monster surgery that comes with its own risks/issues (spinal fusion) It’s a choice/decision you need to make, can you cope or get by with your current symptoms, if they worsen or run the risk of permanent nerve damage. I’m 5 months out from this procedure and I won’t lie it’s been a rollercoaster of a ride but my spine is now stable, nerves freed up, far less pain than pre surgery. There may be further issues in the future but I’ll take that over the debilitating pain I couldn’t function at all with. I wish you all the best.
This is what an online drug interaction site tells me:
2 Interactions Found
Don’t use together
Potential for serious interaction; regular monitoring by your doctor required or alternate medication may be needed.
Citalopram and nortriptyline both increase causing a dangerous abnormal heart rhythm.
Citalopram and nortriptyline both increase affecting serotonin levels in the blood. Too much serotonin is a potentially life-threatening situation. Severe signs and symptoms include high blood pressure and increased heart rate that lead to shock.
Additional Information: Risk of serious adverse effects may increase including serotonin syndrome or neuroleptic malignant syndrome (a neurological disorder). Potential risk for QT prolongation (abnormal heart beats). ECG (cardiac) monitoring by your doctor is recommended.
Some studies show benefit of taking both together for depression to be very effective.
Your doctor is wise to start you on low dose and if that helps your pain it will improve your quality of life. All medications have side effects, but they only effect some people. Weigh up the pros and cons. It depends how bad the pain is. I am very grateful for the pain relief it brings. We do need to be vigilant for complications. I have stopped taking co-codamol with it as I take it at night with a sleeping tablet and the co-codamol with the temazepam was depressing my breathing! I seem to be alright taking it during the day though.
I take them for neck/head pain and they are good for night time use. In the day, I take prescription 60 mg Ibuprofen, and two paracetamol every six hours.
I was referred to the Pain Clinic and have nerve block injections in the back of my head, every few months, which work for a while.
Re your foot numbness, have a blood test for high sugar.(Diabetes).
Hi I'm on nortyptaline 10 mgs for nerve pain (lumbar L2-L3 and Cervical osteophytes) and I find it does help. It makes me sleepy so I take it at night. I took a look on line at Citalopram 20mg and it said there were no incompatibilities. BNF - British National Formulary will often tell you about these.
Hope you find it helps. Main thing is of you are on nortyptaline not to stop it suddenly. It needs gradual tapering. I've had no problems with it.
My feet started to go numb 25 yrs ago prior too going numb they were giving me a lot of pain, I don’t know if that’s what happened to you before it went numb, now both feet are and my legs to just beyond my knees are also numb and it’s creeping up my legs, my back is inoperable as I have no disks left from L2 to L5 which was the cause of the numbness, and it’s now gone to my mid back and worst of all into my C2/C3 in my neck which has given me tremendous loss of muscle strength and bad spastic type cramps in both hands. I fully understand your concern but as far as I have been told it doesn’t get better, don’t mean to worry you but it seems to be the reality of the condition. I wish you all the best.John
Thanks for your reply John, so sorry to hear about the pain that you are in, seems to make my pain and problems very small.
I had no prior pain in my feet, just my lower back, but over time the numbness in my right foot appeared and has now got worse, so bad that I think that I will need to give up any distance driving, just OK to get us to the local shops etc.
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