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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by pattisun on December 2, 2013, at 11:05:47
I had a severe reaction to Imitrex and Celexa, causing seritonin syndrome. Since I can no longer take this combintation my doctor is considering low dose Elavil and lowering my Celexa from 60 down to 20.
Anyone on this combination?
Anyone with successful migraine treatment who's on an SSRI?
Posted by ed_uk2010 on December 2, 2013, at 12:29:18
In reply to Amitriptyline and Celexa? Migraine relief, posted by pattisun on December 2, 2013, at 11:05:47
I do not personally suffer from migraine, but there are several preventive meds and symptom relief meds which can be combined with Celexa.
1. Amitrip and Celexa can be combined, but the dose of both should be kept low. Of course, doses should normally be adjusted gradually, not abruptly. Amitrip can help to prevent migraine, but tends to cause drowsiness, dry mouth and weight gain. It does not relieve the acute attack.
2. Unless you are asthmatic or have some other contraindication, the beta-blocker propranolol (Inderal) can be used in combination with SSRIs to prevent migraine.
3. Topiramate (Topamax) is now a well-established migraine preventive. The dose needs to be increased very slowly. Side effects may include slowness of thinking/word finding, tingling lips and extremities, strange taste (especially of soda water) and weight loss.
4. Another anticonvulsant, Depakote, can prevent migraine. Like Topamax, low doses are used and the side effects are therefore less than in epilepsy. Depakote can cause stomach upsets, weight gain and slight hair thinning.
To relieve acute migraine attacks, high dose ibuprofen (assuming you can tolerate it) + an anti-sickness drug can work very well (eg. metoclopramide, Reglan). You can also take a dose of Tylenol in combination with ibuprofen.
Posted by SLS on December 2, 2013, at 14:33:44
In reply to Amitriptyline and Celexa? Migraine relief, posted by pattisun on December 2, 2013, at 11:05:47
> I had a severe reaction to Imitrex and Celexa, causing seritonin syndrome. Since I can no longer take this combintation my doctor is considering low dose Elavil and lowering my Celexa from 60 down to 20.
> Anyone on this combination?
> Anyone with successful migraine treatment who's on an SSRI?What illnesses are you suffering from?
If the dosage of Celexa was titrated properly to the minimum effective dosage, it is my guess that the symptoms of the illness you are using Celexa to treat will recur by lowering the dosage so drastically. I hope I'm wrong.
Have you tried Topamax (topiramate) for treating migraine? Although known for producing cognititive and memory impairments, these can be mitigated by starting at 12.5 mg/day and titrating gradually to 100 mg/day (50 mg b.i.d.). Speaking for myself, I experienced no cognitive side effects at all at a dosage of 200 mg/day.
I don't know of any reason why you can't keep the Celexa at 60 mg/day if it works for you while adding amitriptyline. Nortriptyline, the daughter drug (metabolite), is reported to help with migraines, too, but has a milder set of side effects.
I hope you don't experience too many migraines as you go through your next series of drug trials. I can't imagine the pain you must suffer.
- Scott
Posted by pattisun on December 2, 2013, at 15:32:10
In reply to Re: Amitriptyline and Celexa? Migraine relief » pattisun, posted by SLS on December 2, 2013, at 14:33:44
Thanks for the replies.
Dear Scott:
>
> What illnesses are you suffering from?
(severe anxiety disorder, spinal stenosis w/nerve impingement, arthritis, pesky auto immune disorders)..I take Celexa, klonopin, hormone replacements, Fentanyl patches and Norco. I cant take any NSAIDs, thus deal with the narcotics. (yuck)
>
> If the dosage of Celexa was titrated properly to the minimum effective dosage, it is my guess that the symptoms of the illness you are using Celexa to treat will recur by lowering the dosage so drastically. I hope I'm wrong. I TEND TO AGREE
>
> Have you tried Topamax (topiramate) for treating migraine? Although known for producing cognititive and memory impairments, these can be mitigated by starting at 12.5 mg/day and titrating gradually to 100 mg/day (50 mg b.i.d.). Speaking for myself, I experienced no cognitive side effects at all at a dosage of 200 mg/day.
>
> I don't know of any reason why you can't keep the Celexa at 60 mg/day if it works for you while adding amitriptyline. Nortriptyline, the daughter drug (metabolite), is reported to help with migraines, too, but has a milder set of side effects.
>
> I hope you don't experience too many migraines as you go through your next series of drug trials. I can't imagine the pain you must suffer.
>
>
> - ScottHi Scott,
Thanks for the answers. First, I'm being treated by an Internist who hates to refer me to specialist so I appreciate the feedback.
I have a friend who's achieved NO migraines after amitriptyline. I am just concerned that I will be combining 2 antidepressants and may run into too much seratonin again.
Topamax side effects lists scares me!! I have a gazillion pesky medical problems and tend to always suffer side effects (like Congestive Heart failure from Vioxx--went away after discontinuing the med)
I've decreased my Celexa down to 40 mg without too many side effects, just a little moody so I can live with that dosage. Agree that I may not do well at 20 mg.
Thanks for your help!
Patti
Posted by Phillipa on December 2, 2013, at 16:34:05
In reply to to Scott-Amitriptyline and Celexa? Migraine relief, posted by pattisun on December 2, 2013, at 15:32:10
Are you in the USA? Vioxx gave you CHF? It went away? Assuming no permanent damage to heart was done. If it is not gone? Phillipa
Posted by pattisun on December 2, 2013, at 17:28:32
In reply to Re: to Scott-Amitriptyline and Celexa? Migraine relief » pattisun, posted by Phillipa on December 2, 2013, at 16:34:05
> Are you in the USA? Vioxx gave you CHF? It went away? Assuming no permanent damage to heart was done. If it is not gone? Phillipa
Yeah, I pursued legal remedy but I either had to have died or had a heart attack. CHF was not on their list of "damage they would pay for"==I've been checked out thoroughly since then, my heart is okay (thank God)!
Posted by Phillipa on December 2, 2013, at 20:52:28
In reply to Re: to Scott-Amitriptyline and Celexa? Migraine relief, posted by pattisun on December 2, 2013, at 17:28:32
That's the info was looking for. What was the vioxx for? Phillipa
Posted by pattisun on December 3, 2013, at 0:00:38
In reply to Re: to Scott-Amitriptyline and Celexa? Migraine relief » pattisun, posted by Phillipa on December 2, 2013, at 20:52:28
> That's the info was looking for. What was the vioxx for? Phillipa
Within 2 1/2 years I had a broken ankle (got pins, plates, screws); had rotator cuff surgery and eye surgery for my thyroid eye disease
Vioxx was a good anti inflammatory med (well, except for the CHF!)
Posted by ed_uk2010 on December 3, 2013, at 3:57:58
In reply to Re: Amitriptyline and Celexa? Migraine relief » pattisun, posted by SLS on December 2, 2013, at 14:33:44
>lowering my Celexa from 60 down to 20...
I agree with Scott that 20mg might be too low. I expect 40mg will be possible. 40mg is now the maximum recommended dose anyway (used to be 60mg), so reducing to 40mg seems very sensible.
The reason for the maximum dose being decreased to 40mg is because higher doses can affect the QT interval, which means it rarely causes abnormal heart rhythms. Since amitriptyline also affects the QT interval, reduced doses are recommended when combining the meds. The initial dose of amitriptyline should probably be 10mg at night. Your doctor may wish to do an EKG at some point, if s/he feels that it's necessary.
Posted by ed_uk2010 on December 3, 2013, at 4:01:15
In reply to to Scott-Amitriptyline and Celexa? Migraine relief, posted by pattisun on December 2, 2013, at 15:32:10
>I have a gazillion pesky medical problems
Topamax is very useful as a migraine preventive but I do think amitriptyline is much more likely to help your other forms of pain (as well as the migraine). As such, it could be a good choice, but will certainly need slow and cautious dosing with regular monitoring from your doctor.
Posted by Phillipa on December 3, 2013, at 18:13:13
In reply to Re: to Scott-Amitriptyline and Celexa? Migraine relief, posted by pattisun on December 3, 2013, at 0:00:38
That's a lot to deal with. And an vioxx was a good choice at the time. I didn't know one got eye surgery with what I'm guessing was hyperthyroidism? Phillipa
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