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Dr. Bob is Robert Hsiung, MD,
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Posted by Maisey on February 10, 2012, at 16:49:43
In reply to Re: SSRIs etc. » Maisey, posted by ed_uk2010 on February 9, 2012, at 18:42:42
Are there cough and cold medicines that CAN be taken safely with anti-d's? I always thought the biggest concern is that they up each other's chance of side effects. Generally, I haven't had problems. Even with Benadryl - it't just an anti-histamine. I don't take it with elavil b/c you're not supposed to go overboard on HCLs. Though, I take such a small dose of elavil. That's why I didn't worry last night until I read the Allergy&Sinus label, and discovered it was more than just an HCL like I had thought...
Posted by ed_uk2010 on February 11, 2012, at 7:50:28
In reply to Re: SSRIs etc., posted by Maisey on February 10, 2012, at 13:35:33
>I didn't read anything about Delsym/elavil interactions.
There might not be an interaction. Some dextromethorphan medicines in the UK come with a vague warning to avoid when taking antidepressants. This is probably because of the interaction with MAOI antidepressants. Amitriptyline is not an MAOI so I wouldn't expect any serious interaction with dextromethorphan. The warning to avoid it 'with antidepressants' is probably overcautious.
>I know Benadryl I'm not supposed to do.
This is because many of the side effects of Benadryl overlap with amitriptyline eg. dry mouth. There are other antihistamines which are more suitable, although amitriptyline already has an antihistamine effect on its own.
>But, I took Robitussin DM with elavil last night.
Robitussin contains dextromethorphan, the same drug used in Delsym.
>I guess next time I have a bad cold like this, I'll just not take elavil.
You don't need to do that. Next time, ask a pharmacist for advice on what to take.
>I think SSRIs are like tricyclics in their interactions.
Not really, but the interactions vary from drug to drug. For example, Paxil and Prozac have more interactions than Zoloft and Lexapro.
Posted by ed_uk2010 on February 11, 2012, at 8:08:26
In reply to Also, wanted to ask, please..., posted by Maisey on February 10, 2012, at 16:49:43
>Are there cough and cold medicines that CAN be taken safely with anti-d's?
Yes. For a blocked nose you can use a decongestant nasal spray for a few days. For a fever or aches and pains you can take acetaminophen. Cough medicines are not very effective, there is not much point in taking them.
>I always thought the biggest concern is that they up each other's chance of side effects. Generally, I haven't had problems. Even with Benadryl - it's just an anti-histamine.
You could take a small dose of Benadryl at night if you need to, just don't take a lot. If you need an antihistamine for allergies, you could take cetirizine (Zyrtec) or fexofenadine (Allegra).
>I don't take it with elavil b/c you're not supposed to go overboard on HCLs. Though, I take such a small dose of elavil. That's why I didn't worry last night until I read the Allergy&Sinus label, and discovered it was more than just an HCL like I had thought...
I'm not sure what you mean. A large number of drugs are given as the hydrochloride/HCl eg. amitriptyline hydrochloride. The hydrochloride/HCl refers to the atoms which are bonded to the drug to make it into a form which can be used in medicines. There is *no* problem taking different medicines containing HCl at the same time. When looking at the ingredients in a product, just look at the drug names, don't worry whether they are HCl or not, it's not relevant.
As an example, Benadryl + amitriptyline might cause a dry mouth. This is because diphenhydramine (the drug in Benadryl) and amitriptyline can both cause a dry mouth, and the effect is increased if they are taken together. It is nothing to do with HCl.
Hope this helps.
Posted by Maisey on February 11, 2012, at 16:38:56
In reply to Re: Also, wanted to ask, please... » Maisey, posted by ed_uk2010 on February 11, 2012, at 8:08:26
Thank you - that cleared up several things for me. I wish my head would clear up now, lol. Ever since I took those cold medicines the night before last, I've been in a fog. I don't think it's the cold. I hope this effect is not long-lasting or permanent. :-(
Posted by ed_uk2010 on February 12, 2012, at 12:54:25
In reply to Re: Also, wanted to ask, please..., posted by Maisey on February 11, 2012, at 16:38:56
>Thank you - that cleared up several things for me. I wish my head would clear up now, lol. Ever since I took those cold medicines the night before last, I've been in a fog. I don't think it's the cold. I hope this effect is not long-lasting or permanent. :-(
It's the combined effects of lack of sleep and the cold. You will get better for sure, but it could take a few more days. If you get ill again, ask a pharmacist for advise on what to take for your symptoms. They can also check for interactions with your medication. You will feel much better knowing that what you're taking is safe, and you will get the most effective treatment for whatever is wrong with you.
Posted by Maisey on February 13, 2012, at 16:58:19
In reply to Re: Also, wanted to ask, please... » Maisey, posted by ed_uk2010 on February 12, 2012, at 12:54:25
Can you also tell me, in your opinion (Nobody has responded to my new thread about Lexapro yet.), would it be better to take Lexapro with a multivitamin in the morning, or at night with elavil? Those are the only times I would be able to work it in. I went ahead and purchased generic Lexapro online, but I am waiting until I get a T3 test done (tomorrow) to make sure I don't need more thyroid hormone supplementation. I plan to start Lexapro as soon as I know the results of that test (assuming it comes out ok). Thanks.
Posted by ed_uk2010 on February 14, 2012, at 17:07:24
In reply to Re: Also, wanted to ask, please..., posted by Maisey on February 13, 2012, at 16:58:19
>Can you also tell me, in your opinion (Nobody has responded to my new thread about Lexapro yet.), would it be better to take Lexapro with a multivitamin in the morning, or at night with elavil? Those are the only times I would be able to work it in.
The standard time to take Lexapro is in the morning. If you feel tired after your dose, you can try taking it at night instead, so long as it doesn't interfere with your sleep. Most people continue to take it in the morning.
>I went ahead and purchased generic Lexapro online
I hope it's from a reputable pharmacy. Some online medicines are counterfeit. There is no generic version of Lexapro in Europe because it is still patent protected. I believe that a generic version will be launched in the US relatively soon.
Posted by Phillipa on February 14, 2012, at 21:30:21
In reply to Re: Also, wanted to ask, please... » Maisey, posted by ed_uk2010 on February 14, 2012, at 17:07:24
I take it at night. Phillipa
Posted by Maisey on February 15, 2012, at 23:11:30
In reply to Re: Also, wanted to ask, please..., posted by Phillipa on February 14, 2012, at 21:30:21
Thanks, you two. I haven't heard back from my thyroid test so I assume it's normal. That means I'll go on Lexapro.
I have yet another question. My doctor added a liver function test when I started taking mefformin (I don't take it any more.) and when I was taking Lexapro. I don't think he does one regularly any more but he stated when I was on those medicines he was doing it because... I was on those medicines. Does Lex have any long-term effect on the liver or does it up the risk of liver probs?
I know taking cinnamon does, and I still take that. Should I not take it if I go on Lex, or should I just take them at different times? There is an enzyme in cinnamon that can affect the liver at large doses but I don't take much which is why I didn't care before.
What is Lexapro's effect on the liver and if I add it on, should I subtract something? I take a multivitamin daily, though I alternate b/w a women's multivitamin and gummy vitamins. I take a calcium supplement (chewable) at dinner along with either flaxseed oil capsules or cinnamon (about 1000 mg). I take synthroid in the morning, 12.5 mg. I take elavil at night (25mg), and occasionally asprin at night if I have trouble sleeping. I can cut out flaxseed/cinnamon - those are just for lowering cholesterol and helping with PCOS symptoms - but, I have a ton of each and want to use them up.
Posted by ed_uk2010 on February 16, 2012, at 15:31:39
In reply to Re: Also, wanted to ask, please..., posted by Maisey on February 15, 2012, at 23:11:30
Hi,
>Does Lex have any long-term effect on the liver or does it up the risk of liver probs?
No, Lexapro is not a high-risk medication for the liver.
>I know taking cinnamon does, and I still take that. Should I not take it if I go on Lex, or should I just take them at different times?
Cinnamon may be good for you in small amounts. Like most foods, it may be bad in very large quantities.
>aspirin at night if I have trouble sleeping.
Aspirin is not a sedative. It is not likely to be effective for insomnia.
Take care!
Posted by Phillipa on February 16, 2012, at 19:30:19
In reply to Re: Also, wanted to ask, please..., posted by Maisey on February 15, 2012, at 23:11:30
Maisey the synthroid is in mcg. So it could be l.25 or .125both mcg. 12.5mg would be an overdose. Just thought I'd add. Phillipa
Posted by Maisey on February 16, 2012, at 20:10:28
In reply to Re: Also, wanted to ask, please... » Maisey, posted by ed_uk2010 on February 16, 2012, at 15:31:39
Yeah, I have very dry, itchy skin that I notice more at night so aspirin helps me sleep, as an anti-inflammatory.
Phillipa, strange I never noticed that. I think it's b/c my other meds are in mg and my 25 mcg Levothyroxine tablet (I half them.) doesn't look much smaller than my 50mg Elavil tablet. I changed it on my meds list, though - thanks.
Posted by Phillipa on February 16, 2012, at 21:18:28
In reply to Aspirin, posted by Maisey on February 16, 2012, at 20:10:28
Maisey just trying to help. Important though for someone reading your list of meds. Phillipa
Posted by Maisey on February 25, 2012, at 18:49:54
In reply to Thyroid levels and Serotonin, posted by bulldog2 on September 27, 2008, at 19:11:43
Anyone else can join in - I had a lot of discussion on this thread with ed_uk2010, so I'm hoping he'll respond.
I opted to buy generic Lexapro from an online pharmacy site - Cipralex 20 (made in India). I'd heard good things about buying meds this way, esp from India. I've been on this for 4 days at 5mg, and I feel BAD. I recently read about someone else who'd taken another generic Lexapro from India (called something different), and he felt similarly. I just wonder if it's possible that, even though I've been on Lexapro before, I can get a different reaction when re-starting. I don't want to believe that I got ahold of something bad tho that is prolly the most logical answer. I feel hazy, very like when I took Citralopram. I'm also going through bad moodswings, though IDK if that has to do with the med. I feel like I should be feeling better, though, as I did when I originally started Lexapro (in 2006). I guess I'm looking for advice - any advice - it's the weekend, or I'd call my doctor. He is aware that I'm taking this.
Posted by ed_uk2010 on February 26, 2012, at 6:35:52
In reply to Ed_uk2010 - are you there?, posted by Maisey on February 25, 2012, at 18:49:54
Hi,
>I opted to buy generic Lexapro from an online pharmacy site - Cipralex 20 (made in India).
Cipralex isn't a generic, it's the brand name for escitalopram in many countries. The problem with buying online from that type of site is that it's very difficult to know whether the medicine is genuine or counterfeit. Some websites sell very sophisticated counterfeits which can make it difficult to tell. I'm not saying that your medicine is a counterfeit, just that it's a possibility. I really can't say.
>I'm just wonder if it's possible that, even though I've been on Lexapro before, I can get a different reaction when re-starting.
Yes, it's possible. We often hear people report that.
>I feel hazy, very like when I took citalopram.
This can happen when starting citalopram or escitalopram, to be fair.
Hope you're OK until you see your doc.
Posted by Maisey on February 26, 2012, at 11:37:31
In reply to Re: Ed_uk2010 - are you there? » Maisey, posted by ed_uk2010 on February 26, 2012, at 6:35:52
>
> Cipralex isn't a generic, it's the brand name for escitalopram in many countries. The problem with buying online from that type of site is that it's very difficult to know whether the medicine is genuine or counterfeit. Some websites sell very sophisticated counterfeits which can make it difficult to tell. I'm not saying that your medicine is a counterfeit, just that it's a possibility. I really can't say.
>I also read that in generics in the U.S., the generic formulation can have up to 20% variance to the original's formulation. And, in tests of some drugs, 30% variance was found! So, that worries me a little bit - not knowing India's standards.
>
> This can happen when starting citalopram or escitalopram, to be fair.
>
I didn't feel this way, I don't think, when I began Lexapro before - maybe a little bit. I started out on 10mg at that time, too, which is 2x what I've been taking.> Hope you're OK until you see your doc.
>
>
I think I'll be ok going off this cold turkey since it's only a 5mg dose. I def don't feel like taking it again! Yesterday evening, I was very weepy and upset over things in the past. I *can* get that way, but usually not that bad. I got strange brain twitches toward evening, and felt almost jerky. I've heard of people getting that way going off an AD, but never experienced it myself.Thanks for your response - I do feel better today.
Posted by ed_uk2010 on February 27, 2012, at 1:25:15
In reply to Re: Ed_uk2010 - are you there? » ed_uk2010, posted by Maisey on February 26, 2012, at 11:37:31
>I also read that in generics in the U.S., the generic formulation can have up to 20% variance to the original's formulation. And, in tests of some drugs, 30% variance was found! So, that worries me a little bit - not knowing India's standards.
India has a substantial pharmaceutical industry. A lot of generics and branded medicines are made (for the rest of the world) in India. The problem isn't where your medication was made, it's the issue of whether it's actually a genuine product. Some medicines sold over the internet are fakes.
Assuming your medicine is genuine, Cipralex is not a generic. Cipralex is the brand name used by the manufacturer, Lundbeck, in many countries, including the UK.
US generics do not differ from the brand by 20% in terms of formulation. The quantity of drug contained in the tablets is exactly the same as the brand. The 20% figure is part of a statistical bio-availability calculation, and is often misquoted.
>I think I'll be OK going off this cold turkey since it's only a 5mg dose.
I think you'll be OK to just stop. To be honest, I think you would feel much safer taking something from your doctor. You could try generic sertraline (Zoloft), starting at a low dose initially. Sometimes people get worse before they get better, but it's generally a useful medicine. Alternatively, you could ask your doctor about taking a higher dose of amitriptyline, since you are already used to this medication.
Posted by Maisey on February 28, 2012, at 17:04:43
In reply to Re: Ed_uk2010 - are you there? » Maisey, posted by ed_uk2010 on February 27, 2012, at 1:25:15
But, could the variance from generic to original matter in terms of side effects? With metformin, for example, I had terrible emotional side effects. I was told to try the brand name, Glucophage, because some people had better luck with it. They even said try met from a different manufacturer because a lot of people who took metformin from Teva had problems with it when they'd never had probs from metformin before. I never tried the brand name metformin b/c I reacted so badly to met, I doubted it would make a difference. But, I wonder if it WOULD make a difference in a medication like an anti-depressant?
When I took Zoloft before, I didn't have any issues, but I don't want to take something that will make me feel worse before I feel better -something that has a reputation of doing that. I'm hesitant to get back on an anti-d now because I really felt unstable on Cipralex, and if I'd felt any more unstable, I probably would have put myself and other people in danger. It is common for me to have passing suicidal feelings and visions, on a normal day, and if I'm going through a bad spell, the feelings are much more frequent and much more real. The difference is, normally when something goes wrong and I have the vision, I'm able to logically think thorugh it and get it out of my mind. If I'm going through a "bad spell," or less commonly, when I take a medication that doesn't agree with me (metformin and birth control pills were ones), I get an inclination to commit this act. I obviously haven't done it or I'd be dead, but the feelings are quite strong. I feel if the right provocation came along when I already felt badly, I would do it. It used to be drowning that I'd think about. Now, it is ramming my car into a semi. I logically thought it through and at some point decided this would be an easier, quicker way, but there is more alarm b/c it possibly puts other people at risk. That is why it's important to me to have the "right" medication - it's why I was so intent on getting Lexapro. It did so well for me before. Now, the problem is I don't know if Cipralex was an exact Lexapro equivalent and I no longer agree with the medicine OR did I get some phony drug and Lexapro prescribed by my doctor is still the best solution? OR, it could be I was going through a bad spell anyway, and the drug had no effect. Lexapro, in the past, though, did seem to help me work out of the bad spells faster. I tend to have the bad spells at the end of my cycle, though I mentally note when they arrive, and I don't see a definite trend.
Anyway, I've been having a pretty stable last couple of days, so I'm taking this time to think about what I want to do.
Posted by Maisey on February 28, 2012, at 19:18:11
In reply to Re: Ed_uk2010 - are you there? » Maisey, posted by ed_uk2010 on February 27, 2012, at 1:25:15
Have you heard anything about elavil working for OCD? I know it's not approved for it. From what I've read, it doesn't sound like it would help (my skin and hair picking issues) - it hasn't at this dose. I like the idea of using elavil for an AD rather than sleep aid, but I actually cut its dose down even more just before adding the Cipralex on. I've still kept it at that dose - I may go back to 25mg. I'm not sure I could function at a higher dose than that, even if I split up the dose b/w day and night.
Posted by ed_uk2010 on February 29, 2012, at 13:36:01
In reply to Re: Ed_uk2010 - are you there? » ed_uk2010, posted by Maisey on February 28, 2012, at 17:04:43
>But, could the variance from generic to original matter in terms of side effects?
It's not likely, but Cipralex is not a generic anyway. Cipralex is the original brand from Lundbeck. The product is sold directly by Lundbeck in most countries. In the US, Lexapro is sold by Forest laboratories under license from Lundbeck.
>When I took Zoloft before, I didn't have any issues, but I don't want to take something that will make me feel worse before I feel better -something that has a reputation of doing that.
All anti-depressants can do that, it is not specific to Zoloft. It can happen with Lexapro/Cipralex and others.
There's no easy way of knowing whether the medication you bought online was real or counterfeit. It's best to get something from your doctor.
Posted by ed_uk2010 on February 29, 2012, at 13:38:59
In reply to Also..... » ed_uk2010, posted by Maisey on February 28, 2012, at 19:18:11
>Have you heard anything about elavil working for OCD?
Amitriptyline is not very effective for OCD.... but you don't have OCD. Trichotillomania is possibly related to OCD but no medication is established as being effective. It's mainly treated psychologically.
Posted by Maisey on February 29, 2012, at 14:43:22
In reply to Re: Also....., posted by ed_uk2010 on February 29, 2012, at 13:38:59
Dermotillmania and trichotillmania are related to OCD and SSRI's (as well as Anafranil) offer at least some support for the disorders. Habit reversal training and Cognitive behavioral therapy do, too, but I doubt that standard CBT would help, and that is the only therapy I have access to. I would not go to it for something like this alone, and probably will never try it again for my depression as it's not something I'm comfortable with at all.
Posted by Maisey on February 29, 2012, at 14:54:06
In reply to Re: Ed_uk2010 - are you there? » Maisey, posted by ed_uk2010 on February 29, 2012, at 13:36:01
I feel that the medicine I got could be a generic posed as Cipralex. I don't know how likely that is, but it seems to me something that could happen, since, at least in the U.S., generics are soooo much cheaper than the original. I would think generics would be easy for the company to obtain, and very cheap to re-sell.
I'm still not sure what to do. I dread calling my doctor's office. I hesitate to fully leave it up to them (which is my only choice if I call them) and end up with something else. I'm thinking of going w/a higher dose of elavil or else trying citralopram (I still have it in the cupboard) at a 5mg dose during the day (since it interfered with my sleep). I even may not give up on Cipralex - it does seem pretty unlikely it's an illegitimate medicine (not Cipralex in general, but what I received)...
Posted by ed_uk2010 on February 29, 2012, at 16:45:14
In reply to Re: Ed_uk2010 - are you there? » ed_uk2010, posted by Maisey on February 29, 2012, at 14:54:06
> I feel that the medicine I got could be a generic posed as Cipralex. I don't know how likely that is, but it seems to me something that could happen, since, at least in the U.S., generics are soooo much cheaper than the original. I would think generics would be easy for the company to obtain, and very cheap to re-sell.
The problem is, because you can't guarantee exactly what it is, it's going to be a cause of anxiety if you continue to take it.
Posted by ed_uk2010 on February 29, 2012, at 16:53:45
In reply to Re: Also..... » ed_uk2010, posted by Maisey on February 29, 2012, at 14:43:22
> Dermotillmania and trichotillmania are related to OCD and SSRI's (as well as Anafranil) offer at least some support for the disorders.
Possibly yes, but the relationship between trichotillomania and obsessive-compulsive disorder is not entirely clear. SSRIs have been tried in trichotillomania but results are mixed. OCD seems to lead to greater disability but response to SSRIs is more reliable and sustained.
Amitriptyline is a well established antidepressant so it could still help you. Do you think you would be able to take a higher dose without unpleasant side effects?
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