Posted by ed_uk on January 28, 2005, at 14:29:45
In reply to Re: Treating side effects » ed_uk, posted by zeugma on January 27, 2005, at 18:59:13
Hi Z!
>Thanks for your kind and detailed replies. i really appreciate them.
You're welcome :-)
>The tachycardia, chest pain, etc. is very upsetting and troubling, obviously, and I did have my BP measured regularly during treatment. As you pointed out, NOR tends to reduce BP, and at no point was I hypertensive. But my heart rate fluctuated depending on time of day, and this was causing the chest pain etc. and making it impossible to exercise.
Methylphenidate is an indirect-acting sympathomimetic. Pain on exertion is believed to result from the stimulation of beta-1 receptors in the heart. Atenolol is a selective beta-1 antagonist and is an effective treatment for tachycardia and angina ie. pain on exertion. I still think you should try it, how are you going to stay awake and alert without a stimulant? Start at 25mg/day atenolol and increase in steps of 25mg up to a maximum of 100mg/day if necessary. I expect you'd probably need 50-100mg. As I said, your pdoc is unlikely to be particularly familiar with atenolol, you may need to see a different doctor. As I said before, I would stay away from non-selective beta-blockers like propranolol.
>I increased the clonazepam this week, but that is not a real solution, since it doesn't mitigate the 'edginess' I feel on Ritalin...
Are you taking any MPH at all at the moment?
>I'm also adding back strattera at 25 mg tomorrow.
Why did you decide to try Strattera?
>I wonder what you think of this.
I must admit that I'm not the world's greatest fan of Strattera, it seems to make people fatigued and depressed.
>My pdoc's theory is that strattera is selective for different regions of the brain (TCA's=brainstem, Strattera=cortex).
Do you know whether there is any evidence to support this theory?
I have wondered whether Strattera may be more effective for some people because it lacks nort's antihistamine effect. Also, nort is a weak antimuscarinic. Antimuscarinic drugs impair cognitive functioning, memory and attention. Desipamine is less antimuscarinic than nort.
>He told me, basically, that I am going to have to deal with the fatigue myself (exercise, and coffee).
I don't really understand why your pdoc thought that it was ok to prescribe methylphenidate but won't let you try dextroamphetamine, I'm really not convinced that there is good logic behind this. Since it is theoretically possible that nortriptyline may potentiate the effects of dex, I would suggest that you start dex at a very low dose to see how it effects you eg. 1.25mg every four hours, three times a day. You could then increase the dose gradually as necessary. It might be necessary to combine it with atenolol.
Do the cardiovascular side effects of MPH cause you a lot of anxiety? If they do, perhaps atenolol would reduce your anxiety.
Ed.
poster:ed_uk
thread:446337
URL: http://www.dr-bob.org/babble/20050128/msgs/449235.html