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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 72. This is the beginning of the thread.
Posted by inanimate peanut on July 16, 2010, at 19:59:34
OK, I'm on Parnate which is the culprit in keeping me awake (plus a little help from the Mirapex)
Last night (over 6 hours trying to fall asleep):
approx. 30mg seroquel
8mg perphenazine
3mg lunesta
4-25mg benadryl
8mg ativan
50mg nortriptyline
12.5mg ambien CR
I finally fell asleep and slept 3 hoursSome notes...
I won't normally be able to take the lunesta and ambien together because my insurance won't cover both at once and the pharmacy won't fill both at once.
I don't think the seroquel is working at all. Drugs stop working when I go off them and then try to go back on them-- I did this with the seroquel I've tried the seroquel at high doses (300mg) and low doses (approx 30mg)
Perphenazine makes me depressed, so I can't take more than 8mg. I don't want to take any at all
I take the ativan 2mg at a time every hour
I took the benadryl 4 hours apart
THIS IS RIDICULOUS!
Does anyone have ANY suggestions of what can be taken with Parnate and nortriptyline for sleep other than what I'm already taking? I would like to get off the seroquel and especially the perphenazine!
Posted by emmanuel98 on July 16, 2010, at 21:34:45
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
Ativan alone works for me. I just take 1-2mg.
Posted by Guy on July 16, 2010, at 21:47:21
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
It sound like you are chasing sleep and that is a surefire way to stay awake all night. You have to try to still your thoughts and then sleep will sneak in the back door. If you can tolerate anti-depressants, Remeron is the med for anxious insomniacs. Failing that, you could substitute the Seroquel for a low dose (2.5 mg) Zyprexa, but get set for weight gain and possibly Type 2 diabetes. You might also consider substituting the Ativan for a longer acting benzo like clonazepam. Good luck to you. I know how awful it is to go without sleep...but you mustn't focus on that. Relaxation is the key.
Posted by Zyprexa on July 16, 2010, at 22:18:51
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
30mg seroquel is not much. 2.5mg zyprexa is not much. 8mg perphenazine is not much. If you need something to counter the parnate, which I know nothing about. You should try a large dose of seroquel. Or you could take zyprexa. 300mg seroquel at night would probably put you to sleep. Or 10mg zyprexa.
Posted by inanimate peanut on July 16, 2010, at 22:32:59
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY!, posted by Zyprexa on July 16, 2010, at 22:18:51
Seroquel and Zyprexa are great ideas. My problem is that once I go off a drug, it doesn't work when I go back on it. I've been on up to 300mg seroquel, up to 400 mg seroquel xr, and up to 10 zyprexa, but since I quit all of them at one time or another, none of them work any longer. Does anyone have any non-seroquel, non-zyprexa suggestions?
Posted by inanimate peanut on July 16, 2010, at 22:34:21
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY!, posted by Guy on July 16, 2010, at 21:47:21
I was thinking about Remeron, but I'll probably have to wait until I'm done with this trial of nortriptyline. I will keep it in mind though. My doc may or may not allow it in combo with Parnate. Thanks!
Posted by emilyp on July 16, 2010, at 23:47:46
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 22:34:21
Try sonata Even though it is short term, it will help you fall asleep. You can take a second one if you wake up. (It is now generic so it should not cost too much.)
Posted by Phillipa on July 16, 2010, at 23:59:57
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY!, posted by emilyp on July 16, 2010, at 23:47:46
Peanut just had a thought I bet it's the nortriptalline keeping you awake. As you're afraid something will happen on this combo and your doc doesn't support it. I feel you should discontinue it. At least you were sleeping without it before weren't you? Phillipa
Posted by europerep on July 17, 2010, at 9:30:52
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY!, posted by Phillipa on July 16, 2010, at 23:59:57
hmm, there may be something to what philippa says.. do you do psychotherapy in general? because, even before, sleeping only with so many different meds might have some more deep-rooted problems, and all these meds surely compromise your sleep quality... which in turn is bad for treating depression.
in general, I would suggest psychotherapy unless you haven't done so already, but in the short term, can't you either talk to your pdoc (what is she supposed to do when you tell her? she can't call the cops on you or something...) or consult a different psychiatrist?
also I noticed you're upping the nortriptyline quite rapidly, right? maybe going a little slower would be better, in order to have the brain adapt to a certain dose before raising it..
but, personally, and I have really no knowledge to back this up, but I have a hard time believing that so many different meds are going to work together.. do you notice any effect of the nortriptyline so far?
Posted by jade k on July 17, 2010, at 9:33:32
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
Hey,
I recently (last night) posted at your thread above. Its the same post I would have put here.
Good luck,
~Jade
Posted by nadezda on July 17, 2010, at 10:08:31
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
You are seriously playing with fire upping your nortriptyline dose so quickly. Do you understand the ramifications of doing so? If you are one of the people who can't mix parnate and nortriptyline, you can set of serotonin syndrome by repeating a dose even if it's okay on the first, second, and third days== much less going up 10 mg a day each day.
Willful
Posted by jade k on July 17, 2010, at 10:21:43
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY! » inanimate peanut, posted by nadezda on July 17, 2010, at 10:08:31
> You are seriously playing with fire upping your nortriptyline dose so quickly. Do you understand the ramifications of doing so? If you are one of the people who can't mix parnate and nortriptyline, you can set of serotonin syndrome by repeating a dose even if it's okay on the first, second, and third days== much less going up 10 mg a day each day.
>
>
Not sure, but I think you just got told. Maybe Nadezda is right. You're taking a lot of stuff. Has anyone on the board raised nortrip that quickly while on the dose of Parnate you're on?? I know you wanna sleep, but be careful. You are overtired too. Thats when med mistakes happen, so be careful, okay!~Jade
>
>
>
Posted by chujoe on July 17, 2010, at 11:22:07
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
I am no expert & my experience in these matters is limited, but it strikes me that you may be taking too many drugs in too quick succession & playing too quickly with the doses. I am concerned for you. I have recently seen remarkable improvement in my self & a good friend by reducing the amount & number of medications. And I am by no means anti-med, as any number of folks around here will attest! Please be careful with what you are doing.
Posted by inanimate peanut on July 17, 2010, at 16:00:37
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY!, posted by chujoe on July 17, 2010, at 11:22:07
Yes, I am on too many meds-- there's a thread about that about a week ago. I happen to be on this many meds to sleep because more have been added over time as less have proven ineffective. I was trying to get to a sleepable dose of nortriptyline hoping that would solve the problem. Plus, I figured if the titration was the most dangerous part, I would just get that part over with (yes- questionable logic there). My BP and temp have not gone above normal in a single test. Not one. I take it every 15-30 minutes for at least 3 hours after dosing but it's been more like 6 hours since I can't sleep anyway and then hourly while I'm awake during the rest of the day. My arm is so marked up from pressure marks from my BP cuff that it looks like I've been fighting with my cat. Had I had even one reading, one single indication of a problem, I would have stopped at that dose. I've had no other symptoms of serotonin syndrome either. I'm at 70 now, which is as close as I can get to the therapeutic dose of 75 (pills too small to split) both for mood and for sleep, so it is where I will stay for 3 weeks to see what happens. I knew that people would think I was increasing too fast and I could have lied about it, but why am I going to lie to a group of people who are just trying to help me. Omission is one thing; lying is another.
As for whether the nortriptyline itself is keeping me awake, I was having sleep problems before this, but I was just taking 1.5-2 ambien but I had to stop that because I will run out of pills before my prescription runs out. I've had sleep problems ever since I went off Zyprexa a few weeks ago.
As for the guilt of the whole thing... I have plenty of things to feel guilty about in my life that could keep me awake, but this isn't one of them. I don't think I'm doing anything wrong. The literature says it's safe if you do it right (once again, have your debate about whether I'm doing it right or not) and my doc doesn't want the liability of doing it. That's fine. I take the liability of it away from her. If she knew and continued to prescribe Parnate, she could be help liable if something happens to me-- as long as she knows nothing, there's no way she can be held liable for something I'm doing on my own. As for psychotherapy, yes, I'm in it; no, I won't tell them as they are then liable to tell my doc who then becomes liable. In the end, I don't get my Parnate and end up in the hospital for a very long time. It's all very ugly. If I feel bad about anyone, it's SLS and ed_uk2010 and the others who answered my questions and trusted me to be responsible with the information who I'm sure would feel that I haven't used it responsibly (even though, as I said above, I feel that I took all precautions, even though the dose increase was probably too fast). That's why I stopped posting my dose increases, because I didn't want to worry people unnecessarily. I honestly do value people's opinions but was trying to do it my way at the same time. I don't want people to stop helping me or think I'm not listening because I honestly am-- I just went a little fast this time. I would definitely prefer lectures over no help at all. I really do value your opinions.
Posted by jade k on July 17, 2010, at 16:47:36
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 17, 2010, at 16:00:37
Peanut,
You okay there? You sound a little manic. You know your health is the most important thing here. I know mental health is an important goal as well. Please read the posts you have gotten recently, both here, and your other thread.
Sit down and make a reasonable plan. Then run it by us. But slow down. Please. If you're in trouble, you need to be seen. Okay?~Jade
Posted by inanimate peanut on July 17, 2010, at 17:07:16
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY!, posted by jade k on July 17, 2010, at 16:47:36
Thanks Jade. I'm not manic- still pretty depressed unfortunately. I just hate having people disappointed in/upset at/worried about me. The plan is just to stay on the 70mg Nortriptyline and keep monitoring it closely. As for sleep, I really don't have a plan except to try some of the things people have mentioned here and hope something takes.
Posted by jade k on July 17, 2010, at 17:28:01
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY! » jade k, posted by inanimate peanut on July 17, 2010, at 17:07:16
> Thanks Jade. I'm not manic- still pretty depressed unfortunately. I just hate having people disappointed in/upset at/worried about me. The plan is just to stay on the 70mg Nortriptyline and keep monitoring it closely. As for sleep, I really don't have a plan except to try some of the things people have mentioned here and hope something takes.
Hey,
Its just we worry when you are near the danger zone and their is nothing we can do. I think it would be wise to take any future advice you get from the people you mentioned, they are knowledgeable about these things. And again, this is not worth your health. Get help if you need it. The cocktail you are on may not be working because of how rapidly it was increased. Give it time.
~Jade
Posted by inanimate peanut on July 17, 2010, at 17:51:33
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY! » inanimate peanut, posted by jade k on July 17, 2010, at 17:28:01
Hey Jade,
Thanks for your concern. I will try to listen better. As for it not working, I wouldn't expect anything yet. I'm an early responder, so maybe sometime next week but not yet.
Posted by Lou Pilder on July 17, 2010, at 18:29:20
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
> OK, I'm on Parnate which is the culprit in keeping me awake (plus a little help from the Mirapex)
>
> Last night (over 6 hours trying to fall asleep):
> approx. 30mg seroquel
> 8mg perphenazine
> 3mg lunesta
> 4-25mg benadryl
> 8mg ativan
> 50mg nortriptyline
> 12.5mg ambien CR
> I finally fell asleep and slept 3 hours
>
> Some notes...
>
> I won't normally be able to take the lunesta and ambien together because my insurance won't cover both at once and the pharmacy won't fill both at once.
>
> I don't think the seroquel is working at all. Drugs stop working when I go off them and then try to go back on them-- I did this with the seroquel I've tried the seroquel at high doses (300mg) and low doses (approx 30mg)
>
> Perphenazine makes me depressed, so I can't take more than 8mg. I don't want to take any at all
>
> I take the ativan 2mg at a time every hour
>
> I took the benadryl 4 hours apart
>
> THIS IS RIDICULOUS!
>
> Does anyone have ANY suggestions of what can be taken with Parnate and nortriptyline for sleep other than what I'm already taking? I would like to get off the seroquel and especially the perphenazine!
>
> Inanimate peanut,
You wrote,[...Does anyone have ANY suggestions...].
I have to wonder why you are taking Lorazapam 2mg every hour. Is this a mistake? Now every hour could be 16 times a day. At that dosage, my understanding would be to find out if you are being prescribed that amount in error. But now this could bring up more issues.
You see, Ativan, AKA Lorazapam, is a potent benzodiazepine. And at the dosage you list here, if it is correct, could cause death. When the drug is combined with other drugs, the aspect of death is increased. If alcohol is taken with the drug, this could cause death.
But there is much more to this than just finding out if the dosage is in error. For by the nature that you are taking an addictive drug, to discontinue the drug will bring up additional considerations, fo withdrawal from this drug has its own set of issues to know how to deal with.
My suggestion is:
A.Call your doctor and ask if the dosage is correct.
B. If he/she says it is correct, forward this post to him/her.
Lou
C.redacted by respondent
Posted by Lou Pilder on July 17, 2010, at 18:49:47
In reply to Lou's response-, posted by Lou Pilder on July 17, 2010, at 18:29:20
> > OK, I'm on Parnate which is the culprit in keeping me awake (plus a little help from the Mirapex)
> >
> > Last night (over 6 hours trying to fall asleep):
> > approx. 30mg seroquel
> > 8mg perphenazine
> > 3mg lunesta
> > 4-25mg benadryl
> > 8mg ativan
> > 50mg nortriptyline
> > 12.5mg ambien CR
> > I finally fell asleep and slept 3 hours
> >
> > Some notes...
> >
> > I won't normally be able to take the lunesta and ambien together because my insurance won't cover both at once and the pharmacy won't fill both at once.
> >
> > I don't think the seroquel is working at all. Drugs stop working when I go off them and then try to go back on them-- I did this with the seroquel I've tried the seroquel at high doses (300mg) and low doses (approx 30mg)
> >
> > Perphenazine makes me depressed, so I can't take more than 8mg. I don't want to take any at all
> >
> > I take the ativan 2mg at a time every hour
> >
> > I took the benadryl 4 hours apart
> >
> > THIS IS RIDICULOUS!
> >
> > Does anyone have ANY suggestions of what can be taken with Parnate and nortriptyline for sleep other than what I'm already taking? I would like to get off the seroquel and especially the perphenazine!
> >
> > Inanimate peanut,
> You wrote,[...Does anyone have ANY suggestions...].
> I have to wonder why you are taking Lorazapam 2mg every hour. Is this a mistake? Now every hour could be 16 times a day. At that dosage, my understanding would be to find out if you are being prescribed that amount in error. But now this could bring up more issues.
> You see, Ativan, AKA Lorazapam, is a potent benzodiazepine. And at the dosage you list here, if it is correct, could cause death. When the drug is combined with other drugs, the aspect of death is increased. If alcohol is taken with the drug, this could cause death.
> But there is much more to this than just finding out if the dosage is in error. For by the nature that you are taking an addictive drug, to discontinue the drug will bring up additional considerations, fo withdrawal from this drug has its own set of issues to know how to deal with.
> My suggestion is:
> A.Call your doctor and ask if the dosage is correct.
> B. If he/she says it is correct, forward this post to him/her.
> Lou
> C.redacted by respondent
>
> Inanimate peanut and friends,
I am requesting that you watch the following video if you are going to respond in this thread o parallel threads.
If you could, I think that the educatioanl as pects in the video could be helpful if you are going to post here.
The video is about sleeping pills. You can view thiss video by:
A. bring up google
B. type in:
[youtube, dangers of sleeping pills]
The video is produced out of the U of California at San Diego and you will see
SIRA
The presentation is by Dr. Danial Kripke, MD
Lou
>
Posted by inanimate peanut on July 17, 2010, at 18:50:56
In reply to Lou's response-, posted by Lou Pilder on July 17, 2010, at 18:29:20
I'm not taking 2mg every hour for 8 hours. I take 2mg every hour for maybe 2-3 hours. It's just to help get me to sleep. i don't actually use it at any other time of day.
Posted by Lou Pilder on July 17, 2010, at 19:33:43
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
> OK, I'm on Parnate which is the culprit in keeping me awake (plus a little help from the Mirapex)
>
> Last night (over 6 hours trying to fall asleep):
> approx. 30mg seroquel
> 8mg perphenazine
> 3mg lunesta
> 4-25mg benadryl
> 8mg ativan
> 50mg nortriptyline
> 12.5mg ambien CR
> I finally fell asleep and slept 3 hours
>
> Some notes...
>
> I won't normally be able to take the lunesta and ambien together because my insurance won't cover both at once and the pharmacy won't fill both at once.
>
> I don't think the seroquel is working at all. Drugs stop working when I go off them and then try to go back on them-- I did this with the seroquel I've tried the seroquel at high doses (300mg) and low doses (approx 30mg)
>
> Perphenazine makes me depressed, so I can't take more than 8mg. I don't want to take any at all
>
> I take the ativan 2mg at a time every hour
>
> I took the benadryl 4 hours apart
>
> THIS IS RIDICULOUS!
>
> Does anyone have ANY suggestions of what can be taken with Parnate and nortriptyline for sleep other than what I'm already taking? I would like to get off the seroquel and especially the perphenazine!
>
> inanimate peanut,
You wrote for suggestions.
In the list of drugs that you take above, I find it very hard to understand why a doctor precribed all of those to you, if that is the case.
You see, in my study of the chemical actions of these drugs, when taken together they could increase what they do. This means that if one drug causes central nervous system depression, then taking another drug with it could cause even more central nervous system depression. In the list of drugs at you give here, many of them taken together could be life -threatening due to CNS depression, heart problems, respiratory depression and the increase of the potential to cause movment disorders and tardive dyskinesia and other syndromes that could be life-ruining or cause death.
I am unsure as to what you posted as to if all of these drugs have been prescribed to you to take together or not. My suggestion is if all the drugs are prescribed to you to take together to forward this post to the doctor that did the prescribing and have a discussion to see why they were prescribed to take together.
Lou
Posted by jade k on July 17, 2010, at 19:34:07
In reply to Lou's response-kripke » Lou Pilder, posted by Lou Pilder on July 17, 2010, at 18:49:47
Posted by jade k on July 17, 2010, at 19:39:07
In reply to Re: You hangin in there peanut? (nm), posted by jade k on July 17, 2010, at 19:34:07
What's the plan for tonight? Have you gotten ANY sleep yet? I remember a few nights on Parnate where I just never went to sleep and carried on the next day and then sleep finally came the next night.
Posted by inanimate peanut on July 17, 2010, at 20:06:30
In reply to Re: You hangin in there peanut?, posted by jade k on July 17, 2010, at 19:39:07
I got sleep last night because I took lunesta and ambien (and nothing else). I checked the drug interaction checker and it was only a moderate risk so I decided it couldn't be worse that what I usually take. I can't get in the habit of that though because my insurance will only cover one or the other, not both. Tonight the plan is lunesta, perphenazine, seroquel, benadryl, ativan again and I bet I still won't sleep. This is just insane. Surely lunesta and ambien alone have to be safer than that cocktail, but the insurance says no. And yes, my doctor knows about/prescribes all of it except the benadryl, which is OTC. So yeah, I'm hangin in there and just shaking my head at how crazy this all is...
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