Shown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by ColoradoSnowflake on July 12, 2009, at 19:56:10
Hi- I'm still on 50mg Parnate, 200mg Provigil and 12 1/2mg Elavil. The Provigil helps with the fatigue but not nearly enough. I am just too tired to show up for life. My pdoc isn't back until Sept 1st. I wont make any major changes until I talk to him, but I want to be READY! Do you know if one can change from Elavil to Nortriptyline easily, or is it a big deal tapering down and drug cleanse and tapering up? Also, what side effects does Pamelor have? do you think it would help me sleep ? or I'd have insomnia and have to add some kind of sleep augmentation? 12mg of Elavil seems like a small amount to give me such fatigue! The Parnate itself must be giving me a lot of fatigue. I suppose I could take more Provigil, but it's so expensive I may not be able to take it at all unless I can find a cheaper way to get it.(Any ideas on that score?) That aside, what do you think? I was SO hoping the Parnate would work. Fatigue has always been my most awful symptom. Any ideas, Scott? or anyone else with this experience? I would VERY MUCH appreciate information!!
Thanks!!! Gayle
Posted by Phillipa on July 12, 2009, at 20:59:55
In reply to Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by ColoradoSnowflake on July 12, 2009, at 19:56:10
From a true insomniac l0mg of pamelor knocked me out felt like glued to the bed. Never had a med affect me this way. Phillipa
Posted by ColoradoSnowflake on July 12, 2009, at 22:28:50
In reply to Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS? » ColoradoSnowflake, posted by Phillipa on July 12, 2009, at 20:59:55
Hey, that sounds kind of good Phillipa!! But how did you feel the next day????? g
Posted by X-ray on July 13, 2009, at 5:00:22
In reply to Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by ColoradoSnowflake on July 12, 2009, at 19:56:10
Hi,
I've been on Elavil for 37 years.
This drug is a very good sleep aid.But I would never mix Elavil with another antidepressant.
I'm not surprised to hear that you are very tired.Parnate and Elavil would not be a good combo by my experience.
Best regards,
X-ray
Posted by SLS on July 13, 2009, at 5:06:59
In reply to Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by ColoradoSnowflake on July 12, 2009, at 19:56:10
> Hi- I'm still on 50mg Parnate, 200mg Provigil and 12 1/2mg Elavil. The Provigil helps with the fatigue but not nearly enough. I am just too tired to show up for life. My pdoc isn't back until Sept 1st. I wont make any major changes until I talk to him, but I want to be READY! Do you know if one can change from Elavil to Nortriptyline easily, or is it a big deal tapering down and drug cleanse and tapering up? Also, what side effects does Pamelor have? do you think it would help me sleep ? or I'd have insomnia and have to add some kind of sleep augmentation? 12mg of Elavil seems like a small amount to give me such fatigue! The Parnate itself must be giving me a lot of fatigue. I suppose I could take more Provigil, but it's so expensive I may not be able to take it at all unless I can find a cheaper way to get it.(Any ideas on that score?) That aside, what do you think? I was SO hoping the Parnate would work. Fatigue has always been my most awful symptom. Any ideas, Scott? or anyone else with this experience? I would VERY MUCH appreciate information!!
> Thanks!!! Gayle
What role was amitriptyline chosen to play?You might feel much less sedated on the nortriptyline. I hate the way amitriptyline makes me feel - sedation and malaise. Nortriptyline is much better in this regard. I don't know if there is an established protocol for switching TCAs while taking Parnate. However, I have done it several times in different ways. If I were taking such a small dose of amitriptyine, I would probably simply skip one day by not taking any amitriptyline and begin nortriptyline the next day. If you want, you can go several days without adding a TCA to see if the Parnate is to blame for daytime sedation or fatigue.
It might very well be that the Parnate is producing the fatigue. Nortriptyline will not make as effective a sleep medication as the amitriptyline. Nortriptyline can produce the same kind of side effects as amitriptyline, but not to the same degree. After you have been on it for awhile, you will probably not notice them anymore.
I need 80mg of Parnate for it to be worth taking. I also need 150mg of nortriptyline. Most people do well with 75mg. It depends how rapidly you metabolize the drug.
Currently:Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
lithium 150-300mg
- Scott
Posted by ColoradoSnowflake on July 13, 2009, at 17:59:53
In reply to Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by SLS on July 13, 2009, at 5:06:59
Thanks XRay and Scott for the information!
My pdoc likes to prescribe one of three or 4 TCAs with Parnate. He feels it makes the Parnate more effective and mellows out the whole thing and actually makes it safer from bad reactions. I chose the amytriptyline because I didn't want to deal with any insomnia. And I thought the Parnate would be very stimulating, which it certainly hasn't been for me. The Provigil is very helpful but I don't know how long I can afford it. I will have to say, I haven't had any insomnia so that's great! But I am still somewhat tired even on the Provigil. I hope my pdoc will let me change the elavil. I know he definitely wants me on a tricyclic, that's not a problem, but I have gotten the feeling he thinks its a real big deal to change. I can e-mail him next week and see. Sounds like I should suggest nortriptyline. He likes that one I just don't know if he'll let me switch.
Could taking MORE Parnate make me less tired? or is the tiredness just inherent and dose related with Parnate for some people?
Thanks again for the help! gayle
Posted by Phillipa on July 13, 2009, at 19:40:37
In reply to Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by ColoradoSnowflake on July 12, 2009, at 22:28:50
Seriously? I hated it as was in bed til 2pm. So didn't take it again. I do think was taking cymbalta 60mg at the time. How come your doc likes the Tca's . Just curious? Love Phillipa
Posted by X-ray on July 14, 2009, at 4:14:23
In reply to Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by ColoradoSnowflake on July 13, 2009, at 17:59:53
Hi,
TCAs and MAOIs should not be mixed.
I think that your doc is on the wrong track.Best regards,
X-rayP.S. I enclose this text from medscape.com.
MONOGRAPH TITLE: Tri; Tetracyclic Compounds/MAOI'S
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Some MAO inhibitors may enhance the effects of tricyclic and tetracyclic compounds indirectly through inhibition of microsomal enzymes. Tricyclic and tetracyclic compounds may sensitize adrenergic receptors to amines which then accumulate extraneuronally as a result of MAO inhibition.
CLINICAL EFFECTS: Concurrent use may result in a severe reaction including hyperpyrexia, convulsions, excitability, muscular rigidity, fluctuations in blood pressure, convulsions, grand mal seizures, coma, and death.
PATIENT MANAGEMENT: The concurrent use of tricyclic antidepressants and MAO inhibitors is contraindicated by the manufacturers of tricyclic antidepressants and tranylcypromine.
The manufacturers of tricyclic antidepressants and mirtazapine recommend at least 14 days between switching therapies. The manufacturer of tranylcypromine recommends a medication-free interval of at least a week when initiating tranylcypromine in patients who have previously received a tricyclic antidepressant, then initiating tranylcypromine at a reduced dosage of 50% for one week.
The US manufacturer of phenelzine states that at least 14 days should elapse between the discontinuation of phenelzine and the initiation of another antidepressant. If phenelzine is used concurrently with or within 10 days of another antidepressant, the patient should be cautioned regarding the possibility of an adverse drug interaction.
The US manufacturer of selegiline states that at least 14 days should elapse between the discontinuation of selegiline and the initiation of a tricyclic antidepressant.
DISCUSSION: It should be noted that if this interaction occurs, the consequences will be immediate and severe. Effects may continue to be seen for several days after discontinuing the MAOI. Similarity between cyclobenzaprine and TCAs warrants consideration of TCA interactions for cyclobenzaprine. Mirtazapine, a tetracyclic antidepressant, should also be considered for this interaction. Furazolidone and linezolid are known to inhibit MAO. The interaction has been reported with tricyclic antidepressants and selegiline.
Posted by ColoradoSnowflake on July 15, 2009, at 10:47:35
In reply to Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by SLS on July 13, 2009, at 5:06:59
Scott:
Thanks for answering my questions! I really appreciate it. Especially since you take parnate and an maoi I feel so much better about doing it myself. It seems you have extensive experience with top notch pdocs and researchers! Why do you think some pdocs think its so bad when others like my pdoc and yours(?) think it makes it smoother and safer?I have now been on Parnate 2 1/2 months and I am starting to feel better!! Yippee!
Thanks again, Scott,
Gayle
Posted by ColoradoSnowflake on July 15, 2009, at 11:08:38
In reply to Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by X-ray on July 14, 2009, at 4:14:23
Hi XRay:
EEEKs!!
Thanks for responding to my questions.
Your information is sobering and very scary! But
I totally appreciate your concern for me and taking your time to get good information for me!I am trusting my pdoc on this one, but when I see him again I'm going to ask him to explain it again to me! He's 70 and been doing this combo for a long time and never had a patient have a problem. (I surely don't want to be the one to break his record!)
Thanks again,Gayle
Posted by floatingbridge on July 16, 2009, at 4:05:27
In reply to Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS? » SLS, posted by ColoradoSnowflake on July 15, 2009, at 10:47:35
CSF, so glad to hear it!
fb
Posted by ColoradoSnowflake on July 22, 2009, at 12:05:06
In reply to Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by SLS on July 13, 2009, at 5:06:59
Hi I've been in e-mail contact with my pdoc this week and he agreed to let me try Nortriptyline instead of Amytriptyline. He said to substitute one for the other mg. for mg. I'm on 12 1//2mg amytriptyline at night, so I'll just start 12 1/2 mg Nortriptyline tonight.
I am hoping so much that this will reduce the awful fatigue I have much of the time.
Thanks for the help I've received about this!
Gayle50mg.Parnate
200mg Provigil
12 1/2 mg. Nortriptyline
Posted by floatingbridge on July 22, 2009, at 12:16:11
In reply to Parnate-Nortriptyline OK'd » SLS, posted by ColoradoSnowflake on July 22, 2009, at 12:05:06
Yeah! Right on Gayle!
Hope this does the trick!
fb
Posted by SLS on July 22, 2009, at 14:23:47
In reply to Parnate-Nortriptyline OK'd » SLS, posted by ColoradoSnowflake on July 22, 2009, at 12:05:06
> Hi I've been in e-mail contact with my pdoc this week and he agreed to let me try Nortriptyline instead of Amytriptyline. He said to substitute one for the other mg. for mg. I'm on 12 1//2mg amytriptyline at night, so I'll just start 12 1/2 mg Nortriptyline tonight.
> I am hoping so much that this will reduce the awful fatigue I have much of the time.
> Thanks for the help I've received about this!
> Gayle
>
> 50mg.Parnate
> 200mg Provigil
> 12 1/2 mg. Nortriptyline
Although I think 12.5mg is a very safe dosage to start at, be advised that amitriptyline and nortriptyline are not milligram for milligram equivalent. Nortriptyline is twice as potent.100mg of amitriptyline = 50mg of nortriptyline.
Most people respond to 75mg of nortriptyline. A rapid metabolizer like me can need 150mg or more. Forturnately, there is a blood test you can take to help determine how much nortriptyline to use.
Good luck!
- Scott
Posted by ColoradoSnowflake on July 22, 2009, at 16:18:18
In reply to Re: Parnate-Nortriptyline OK'd » ColoradoSnowflake, posted by SLS on July 22, 2009, at 14:23:47
Thanks for the info and encouragement.
I'm glad to know the 2x1 ratio.
I just remembered (when I dug up an old rx bottle) that I had taken Nortriptyline in '07 and early '08. Last refill 12/07 Danbury generic 25mg capsules 3/day (to take along with Wellbutrin). I'm going to use those old capsules. I'm sure they are still ok. He was ordering me tablets so I could cut them up. These capsules have powder in them but very easy to open and pour out..should work.
Anyway, I remember I dropped it because the Nortriptyline made me REALLY TIRED and extremely HUNGRY, ALL THE TIME.
I'm hoping that with the Parnate it will be good! I remember getting a blood level on the Nortrip and I imagine he'll do that again.
Thanks so much for the helpful input!!
I'm glad you're in a good place right now!!
Gayle
Posted by ColoradoSnowflake on July 23, 2009, at 18:35:02
In reply to Re: Parnate-Nortriptyline OK'd SLS, posted by ColoradoSnowflake on July 22, 2009, at 16:18:18
I ditched the Amytriiptyline last night and took 12 1/2mg Nortrip. I already feel much better today, not so fatigued and sleepy. BUT, I only slept a couple of hours last night. My gosh that insomnia happened fast. I guess I'll have to get into the "sleep aids" but haven't been able to find one that doesn't give me a hangover, altho all I've tried are Ambien (Yuk), klonipin (double yuk) and Ativan (hangover).
Anyone have any ideas about an effective mild sleep aid?
Scott, do you think the Nortrip will cause me more insomnia as I take it longer? Pdoc didn't say anything about raising the dose or not.
Thanks so much for the encouragement to get off the Elavil. I don't know that I would ever have figured that out myself! I really appreciate your interest and help!!
Gayle
Posted by floatingbridge on July 23, 2009, at 22:27:25
In reply to Feel Better!!! but OhNo, Insomnia already, posted by ColoradoSnowflake on July 23, 2009, at 18:35:02
Hi Gayle,
Glad to hear that you're feeling better--less fatigue! For insomnia I use lunesta (don't know if there's a generic) or sonata (the generic). Ambien didn't work for me. I can augment them when necessary with xanax. Don't know how those are with parnate....
Hope you get some good sleep tonight,
fb
Posted by SLS on July 24, 2009, at 5:33:50
In reply to Feel Better!!! but OhNo, Insomnia already, posted by ColoradoSnowflake on July 23, 2009, at 18:35:02
> I ditched the Amytriiptyline last night and took 12 1/2mg Nortrip. I already feel much better today, not so fatigued and sleepy. BUT, I only slept a couple of hours last night. My gosh that insomnia happened fast. I guess I'll have to get into the "sleep aids" but haven't been able to find one that doesn't give me a hangover, altho all I've tried are Ambien (Yuk), klonipin (double yuk) and Ativan (hangover).
>
> Anyone have any ideas about an effective mild sleep aid?
>
> Scott, do you think the Nortrip will cause me more insomnia as I take it longer? Pdoc didn't say anything about raising the dose or not.
>
> Thanks so much for the encouragement to get off the Elavil. I don't know that I would ever have figured that out myself! I really appreciate your interest and help!!
>
> Gayle
>My guess is that the insomnia is not so much attributable to the addition of nortriptyline as it is to the withdrawal of the amitriptyline. The insomnia might even be worse than it was initially, as some drugs cause a rebound effect when they are withdrawn. In other words, until the brain gets used to not seeing the amitriptyline you will have this rebound insomnia.
What other sleep aids have you tried in the past? Personally, I have tried Ambien (zolpidem) and had no positive effect from it. For me, Ativan (lorazepam) helps. Others have recommended Lunesta (eszopiclone). I don't see too many people taking Sonata (zaleplon). When I experienced 2 weeks of nearly total insomnia while taking an antidepressant cocktail, I needed two sleeping aids. I combined Halcion (triazolam) with Ativan. I don't recommend Halcion, though. It is very powerful and can produce amnesia along with rebound awakenings at night. Dentists like using it because it is potent, has a very short half-life, and the patient wakes up remembering nothing of the procedure.
Just work closely with your doctor and attack the insomnia aggressively if it continues.
How was your sleep before you began taking amitriptyline?
For how long had you tried the Ativan before discontinuing it? Another benzodiazepine often used for sleep is Restoril (temazepam).
There are people here who are more expert than am I on treating insomnia, so you might want to wait until you receive more feedback before committing to something.
- Scott
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