Psycho-Babble Medication Thread 77865

Shown: posts 1 to 9 of 9. This is the beginning of the thread.

 

PLEASE can you help - Cam, Sunnely, anyone

Posted by caroline on September 5, 2001, at 14:49:21

Hi, I use 75mg anafranil + 75mg remeron to help me live with Aspergers.

I was prescribed a course of pseudoephedrine by a GP to clear up a sinus infection. I took the prescription to a pharmacist, who said it could be dangerous in interaction with the anafranil. I asked the GP and they said they knew of no such danger, so I took it.

One night after I'd been on it for seven days, I was in bed when suddenly my heart started racing and then I passed out, when i came to I was gasping for breath and it was still racing and i passed out again. This cycle went on for about twenty minutes and then i passed out and didn't awake until my alarm went off in the morning.

I tried to get up to get ready for work but i had crushing pain in my chest and down my left arm, i also felt breathless and dizzy whenever i tried to stand up. In the end i went back to bed and slept through the day. I couldn't think what was wrong with me. The next day, my friend took me to see a GP and i explained all my symptoms and what the pharmacist had told me about possible tacchycardial ventricular arrhythmias, but my doctor said that as far as she knew there was no such dangerous interaction between the two drugs. She thought i'd maybe had an allergic reaction to the pseudoephidrine and that i'd feel better in a couple of days.

All that week, i couldn't stand up at all, i slept through every day; the second week i could stand up for short periods but not without a lot of chest pain. It is now 8 weeks on and i've been back at work five weeks but i still get a lot of chest pain, breathlessness and feel tired alot.

Is this a known interaction?
Have I experienced the tachycardial ventricular arrhythmia the pharmacist warned me about?
If so, what can i do to help myself?

I'm sorry this post is so long, I really am, but I'm really frightened and I would appreciate any information/advice anyone has on the subject.

Thanks so much in advance,

Caroline

 

Re: PLEASE can you help - Cam, Sunnely, anyone » caroline

Posted by SalArmy4me on September 5, 2001, at 15:01:34

In reply to PLEASE can you help - Cam, Sunnely, anyone, posted by caroline on September 5, 2001, at 14:49:21

The only thing I'm aware of is this: It suggests the use of beta-blockers as a treatment.

Pentel P. Toxicity of over-the-counter stimulants. JAMA. 1984;252:1898-1903:

"Over-the-counter stimulants (phenylpropanolamine hydrochloride, ephedrine, pseudoephedrine, caffeine) are used widely as decongestants, anorectic agents, amphetamine substitutes, and "legal stimulants." Toxic effects may result from overdose, drug interactions, or diseases that increase sensitivity to sympathomimetic agents. The most important toxic effect of the alpha-adrenergic agonist phenylpropanolamine is hypertension, which may result in hypertensive encephalopathy or intracerebral hemorrhage. The therapeutic index of phenylpropanolamine is low, and severe hypertension may occur after ingestion of less than three times the therapeutic dose. Ephedrine and pseudoephedrine may also cause hypertension, as well as tachyarrhythmias due to beta-adrenergic stimulation. Toxic reactions from caffeine are characterized by agitation, seizures, tachyarrhythmias, and hypotension. Management of toxic reactions to over-the-counter stimulants includes control of hypertension with a rapidly acting vasodilator, beta-blockers for tachyarrhythmias, and control of seizures."

Other source:

Grossman, Ehud MD. Messerli, H. Franz MD. High Blood Pressure: A Side Effect of Drugs, Poisons, and Food. Archives of Internal Medicine. 155(5):450-460, March 13, 1995:

"Most nonprescription anorexics contain combinations of an antihistamine and an adrenergic agonist (usually phenylpropanolamines, ephedrine, pseudoephedrine, or caffeine). All act by potentiating presynaptic norepinephrine release and directly activating adrenergic receptors. Known adverse effects of these substances include hypertension, tachycardia, ventricular ectopy, agitation, psychosis, and seizure [45]. The use of nasal decongestant and cough medications containing massive doses of oxymetazoline hydrochloride, phenylephrine hydrochloride, and ephedrine hydrochloride was reported to have resulted in severe hypertension, cardiomegaly, and congestive heart failure in a 34-year-old man [46]. Severe hypertensive crisis was reported in a young man after ingestion of seven azatadine maleatetopseudoephedrine sulfate (Trinalin) tablets (120 mg of pseudoephedrine and 1 mg of azatadine sulfate per tablet). Labetalol given intravenously was an effective treatment [47]. Phenylpropanolamine is the active ingredient in most diet aids and in many decongestant agents and is also used as a substitute for amphetamine. Excessive doses may result in severe hypertension and, in rare instances, hypertensive encephalopathy, intracerebral hemorrhage, and death [48-51]."

 

Re: PLEASE can you help - Cam, Sunnely, anyone » caroline

Posted by Cam W. on September 5, 2001, at 15:36:58

In reply to PLEASE can you help - Cam, Sunnely, anyone, posted by caroline on September 5, 2001, at 14:49:21

Caroline - Yes, there is an interaction between clomipramine and sympathomimetics (of which, pseudoephedrine is one). The clomipramine can increase the cardiovascular effects of pseudoephedrine. The GP may not have picked up on this, as most of the literature just mentions sympathomimetics, in general.

Most people do not have as pronounced response as you did to the combination. You usually see an interaction when high doses of both drugs are being taken.

Some people do react to very strongly to pseudoephedrine, by itself. This may have been the case, here. I would say, (although it is not necessary), don't take pseudoephedrine with clomipramine, again.

I doubt that you were experiencing ventricular tachycardia, as that is a worst case scenario (actually, I guess death via stroke or myocardial infarction - heart attack - would be a worse case scenario). It is very rare that any of these instances occur, but they have happened. You may have experienced tachycardia, which is basically a racing heart.

Or what you may have experienced could have been postural hypotension, where your blood vessels do not respond as quickly to a change in position; and you pass out. This is far more commonly seen with clomipramine, than any of the other conditions I mentioned. In theory, the pseudoephedrine should have counteracted the postural hypotension, although the dizziness from the interaction between the drugs could overshadow this.

I hope that the GP took your blood pressure, as this may have given an indication of what was going on. All in all, you are probably very sensitive to the effects of pseudoephedrine and the clomipramine just compounded the sensitivity.

I hope that this rambling is of some help (I was basically thinking out loud). - Cam

 

Re: PLEASE can you help - Cam, Sunnely, anyone » caroline

Posted by Sunnely on September 5, 2001, at 19:47:59

In reply to PLEASE can you help - Cam, Sunnely, anyone, posted by caroline on September 5, 2001, at 14:49:21

I believe Cam explained it very thoroughly.

If I may add a couple of cents, here. Anafranil and Remeron both have norepinephrine boosting effect (aside from serotonin effects). Anafranil is metabolized to desmethylclomipramine, an active metabolite which is a potent norepinephrine reuptake inhibitor (norepinephrine booster). Remeron, acts as an antidepressant by enhancing both the serotonin and norepinephrine effects.

IMHO, the addition of pseudoephedrine, a sympathomimetic, to Anafranil and Remeron could have led to an increased noradrenergic effect, which in turn could lead to increased stimulation of the myocardium (heart muscle) which could trigger the autonomic ventricular activity and facilitate the onset of re-entry arrhythmia (heart beat irregularity). The occurrence of a form of ventricular tachycardia (polymorphic type) called "torsades de pointes" could lead to episode of passing out or loss of consciousness. Most oftentimes, the heart reverses back to normal rhythm. However, occasionally it may progress to a more serious type of ventricular tachycardia (monomorphic) then to ventricular fibrillation and if not electrically corrected (defibrillator), to cardiac arrest.

How long have you been on Anafranil? Other than what you mentioned, are you taking other medications or herbs? Have you had any previous episodes of passing out? Do you have any heart condition? Have you had an electrocardiogram (ECG) prior to and during treatment of Anafranil? You are particularly prone to "torsades" if your ECG shows "prolongation of QTc" interval especially while on Anafranil. Being on Anafranil and your recent episode of passing out, I believe an ECG should be done.

> Hi, I use 75mg anafranil + 75mg remeron to help me live with Aspergers.
>
> I was prescribed a course of pseudoephedrine by a GP to clear up a sinus infection. I took the prescription to a pharmacist, who said it could be dangerous in interaction with the anafranil. I asked the GP and they said they knew of no such danger, so I took it.
>
> One night after I'd been on it for seven days, I was in bed when suddenly my heart started racing and then I passed out, when i came to I was gasping for breath and it was still racing and i passed out again. This cycle went on for about twenty minutes and then i passed out and didn't awake until my alarm went off in the morning.
>
> I tried to get up to get ready for work but i had crushing pain in my chest and down my left arm, i also felt breathless and dizzy whenever i tried to stand up. In the end i went back to bed and slept through the day. I couldn't think what was wrong with me. The next day, my friend took me to see a GP and i explained all my symptoms and what the pharmacist had told me about possible tacchycardial ventricular arrhythmias, but my doctor said that as far as she knew there was no such dangerous interaction between the two drugs. She thought i'd maybe had an allergic reaction to the pseudoephidrine and that i'd feel better in a couple of days.
>
> All that week, i couldn't stand up at all, i slept through every day; the second week i could stand up for short periods but not without a lot of chest pain. It is now 8 weeks on and i've been back at work five weeks but i still get a lot of chest pain, breathlessness and feel tired alot.
>
> Is this a known interaction?
> Have I experienced the tachycardial ventricular arrhythmia the pharmacist warned me about?
> If so, what can i do to help myself?
>
> I'm sorry this post is so long, I really am, but I'm really frightened and I would appreciate any information/advice anyone has on the subject.
>
> Thanks so much in advance,
>
> Caroline

 

Re: PLEASE can you help - Cam, Sunnely, anyone

Posted by stjames on September 6, 2001, at 1:31:09

In reply to Re: PLEASE can you help - Cam, Sunnely, anyone » caroline , posted by Sunnely on September 5, 2001, at 19:47:59

Anafranil

James here.....

If memory serves, this is a TCA, which are known for none to slight cardiac rythym changes. Slight changes are not uncommon. I had changes in EKG that were of no consern, but I did watch for other meds, like PE, PPA, ect that could have an additive effect.

Did your Rx express his/her consern to your GP ?

James

 

Re: please can you help - sunnely

Posted by caroline on September 6, 2001, at 12:33:19

In reply to Re: PLEASE can you help - Cam, Sunnely, anyone » caroline , posted by Sunnely on September 5, 2001, at 19:47:59

Sunnely, hi,

>How long have you been on Anafranil?<
-For about eighteen months this time.

>Other than what you mentioned, are you taking other medications or herbs?<
-Just zopiclone (Zimovane/Imovane 23mg per day)

>Have you had any previous episodes of passing out?<
-No, never

>Do you have any heart condition?<
-No

>Have you had an electrocardiogram (ECG) prior to and during treatment of Anafranil?<
-No, I'm in the UK and you don't get monitored.

>You are particularly prone to "torsades" if your ECG shows "prolongation of QTc" interval especially while on Anafranil. Being on Anafranil and your recent episode of passing out, I believe an ECG should be done<

- I did ask could I have one and the GP said no need.

As I'm still getting a lot of pain and breathlessness - when I am 30, totally fit, usually hyper-active, have never in my life been able to sleep without drugs knocking me out before now (due to my AS), and now I find I sleep late on weekend mornings, when I'd usually be up and hyper by six am - I have booked another appointment with a GP (earliest I could get was 3 weeks from now) when I will ask again can I have an ECG. I am told the waiting list, even if my GP agrees to a referral, will be between nine months and a year.

Can I help myself by putting extra energy in? Like glucose tabs, coke, extra high sugar foods?
And by lying down to rest when I'm feeling breathless and doing so is feasible?

I really don't want to do myself any long-term damage.

Thanks so much for replying to my post and for the advice.

Yours gratefully,

Caroline

>
> > Hi, I use 75mg anafranil + 75mg remeron to help me live with Aspergers.
> >
> > I was prescribed a course of pseudoephedrine by a GP to clear up a sinus infection. I took the prescription to a pharmacist, who said it could be dangerous in interaction with the anafranil. I asked the GP and they said they knew of no such danger, so I took it.
> >
> > One night after I'd been on it for seven days, I was in bed when suddenly my heart started racing and then I passed out, when i came to I was gasping for breath and it was still racing and i passed out again. This cycle went on for about twenty minutes and then i passed out and didn't awake until my alarm went off in the morning.
> >
> > I tried to get up to get ready for work but i had crushing pain in my chest and down my left arm, i also felt breathless and dizzy whenever i tried to stand up. In the end i went back to bed and slept through the day. I couldn't think what was wrong with me. The next day, my friend took me to see a GP and i explained all my symptoms and what the pharmacist had told me about possible tacchycardial ventricular arrhythmias, but my doctor said that as far as she knew there was no such dangerous interaction between the two drugs. She thought i'd maybe had an allergic reaction to the pseudoephidrine and that i'd feel better in a couple of days.
> >
> > All that week, i couldn't stand up at all, i slept through every day; the second week i could stand up for short periods but not without a lot of chest pain. It is now 8 weeks on and i've been back at work five weeks but i still get a lot of chest pain, breathlessness and feel tired alot.
> >
> > Is this a known interaction?
> > Have I experienced the tachycardial ventricular arrhythmia the pharmacist warned me about?
> > If so, what can i do to help myself?
> >
> > I'm sorry this post is so long, I really am, but I'm really frightened and I would appreciate any information/advice anyone has on the subject.
> >
> > Thanks so much in advance,
> >
> > Caroline

 

Re: please can you help - Cam, Sunnely, StJ, Sal

Posted by caroline on September 6, 2001, at 12:40:50

In reply to Re: PLEASE can you help - Cam, Sunnely, anyone » caroline , posted by Cam W. on September 5, 2001, at 15:36:58

To all of you,

Thankyou so much for responding!

And Cam, it's certainly reassuring to know it most likely couldn't have been the arrythmia the pharmacist warned me about.

I'm trying to help myself a bit by adding plenty of high energy, high sugar food to my diet, particularly at times when the chest pain is really bad or I am getting breathless when all I'm doing is sitting at my desk at work!

It really is incredible how much easier it is to get informed, educated and helpful responses from all of you at PB than it is from the British NHS!!!!

THANKYOU

Caroline

 

PBabble is superior to Britain's NHS ! Awright! (nm)

Posted by Zo on September 6, 2001, at 15:30:57

In reply to Re: please can you help - Cam, Sunnely, StJ, Sal, posted by caroline on September 6, 2001, at 12:40:50

 

Re: That's not saying much... (nm) » Zo

Posted by JahL on September 6, 2001, at 17:52:35

In reply to PBabble is superior to Britain's NHS ! Awright! (nm), posted by Zo on September 6, 2001, at 15:30:57


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