![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 38. Go back in thread:
Posted by Zzzz on August 30, 2010, at 23:36:28
In reply to Re: Pseudoephedrine (sudafed) » Zzzz, posted by highhatsize on August 30, 2010, at 20:47:08
I am glad you read the post. Your pharmacy needs to know of the combination of drugs. Please check with them before you even add one more over-the-counter or prescription drug. They will tell you about the cytochrome P450 for the drug and if it will cross react.
Let me make up a story to explain better. If you were the only customer in a store and somebody yelled fire you could run right out the open exit with no trouble. If you were a customer and there was only standing room because the store was filled with people....Then someone yelled fire. That one exit is going to take a long time to run through.
The reason you get the same effect with a reduced dose is because the drugs that you are using must exit through the same pathway. They can not get out of your body as fast and stay at a higher dose longer.
The danger is if you are given another drug on top of those drugs that requires that same exit pathway. Then a toxic overdose may happen. Please, please check the drugs before adding anything else.
Doctors do sometimes select drugs on purpose that enhance the dosage of each other.However, extreme care needs to be taken before adding any drug, vit., herbs or even grapefruit juice. Some drugs cause more problems than others. Some antihistamines had to be taken off the market.
Hope this helps explain it better?
Posted by Zzzz on August 31, 2010, at 16:16:27
In reply to Re: Pseudoephedrine (sudafed) » highhatsize, posted by Zzzz on August 30, 2010, at 23:36:28
Dear Highhatsize,
Goggle the name of your medication along with CYP450 Websites will pop up that tell you what drugs will interact. Such a website may be Drugs.com.
Also, pseudoephedrine is a NET substrate not a antihistamine. It does not use the CYP450 isoenzyme system. It has minor interaction with MAO.
The reason I would never use Providgil which is Modafinil is that there are 1506 brand and generic drugs known to interact with it according to Drugs.com. Then providgil is combined with an antidepressant. Those drugs have multiple drug-drug interactions also. The older the person the more likely additional medication will be used such as blood pressure, diabetic meds and so forth. It can become a nightmare of trouble.
Posted by Gup on April 22, 2011, at 16:49:50
In reply to Pseudoephedrine (sudafed), posted by blueboy on April 9, 2010, at 9:52:55
> I got hay fever and took some Sudafed (2x30mg pseudoephedrine). The results were miraculous. My only side effects are insomnia, which is actually not as bad as it was on Mirapex at higher dosage; mild hypomania; and weight loss!
I discovered a similar effect, and found this thread while trying to research just exactly what was going on. I have unipolar major depression, and discovered that 1x 120mg time-release Pseudoephedrine gave me a substantial boost in mood and focus, as well as reduction in anxiety (which I did not expect from a sympathomimetic such as pseudoephedrine).
I've tried skipping a few days at a time, and there is definitely a difference when I take it. While it is possible a placebo effect is in play, I have failed trials on many other anti-depressants, and the effect of the pseudoephedrine is pretty dramatic.
After playing around with dosage time a bit, I now take it at night just before bedtime (doesn't seem to disrupt my sleep, and it's possible I may be sleeping better, actually).
Thus far, I only have a few weeks of experience with PE. I'm not sure if the best tactic will be to occasionally skip doses (if it builds tolerance), or to take it daily (if it works best with consistent use, like many anti-depressants).
Blueboy, if you happen to see this post -- any chance you'd be willing to point me in the direction of the Emory researchers? I would be interested to know if they have any information on what may be going on (or to offer any information that could further their research).
Posted by creepy on April 26, 2011, at 13:49:42
In reply to Re: Pseudoephedrine (sudafed), posted by Gup on April 22, 2011, at 16:49:50
Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
Not usually a strong antidepressant, but a good pain reliever with some added bonuses if you have allergies.
Posted by mtdewcmu on April 30, 2011, at 12:43:28
In reply to Re: Pseudoephedrine (sudafed), posted by creepy on April 26, 2011, at 13:49:42
> Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
> Not usually a strong antidepressant, but a good pain reliever with some added bonuses if you have allergies.That's an interesting way to use desipramine. Maybe it should be the new gold standard for chronic allergies.
Posted by mtdewcmu on April 30, 2011, at 13:21:36
In reply to Pseudoephedrine (sudafed), posted by blueboy on April 9, 2010, at 9:52:55
> But anyway, I am taking 4x30mg pseudoephedrine daily (I weigh 255 pounds) with the blessing of a good psychiatric team, and so far it has been startlingly effective to treat on a wide range of mental problems, including Axis I diagnosis of bipolar II.
This is an old zombie-thread, but I would be curious to know if the benefits were sustained. It's not hard to believe that PSE would have an up-front benefit, but I would be surprised if it lasted. In college I noticed that it was somewhat easier to get my homework done if I took some pseudoephedrine. The benefit was not very robust.
Pseudoephedrine (PE) has an identical structure to methamphetamine with the addition of a hydroxyl group. The effect of the hydroxyl group is to make the molecule more hydrophilic, and therefore less of it can cross the blood-brain barrier. If you eliminate the hydroxyl by reduction, you get methamphetamine (MA). If you eliminate the hydroxyl by oxidation, you get methcathinone (MC), which is a potent CNS stimulant similar to MA. Again, the reason MC is a more potent CNS stimulant than PE is that MC is less hydrophilic due to less opportunity to form hydrogen bonds. To the extent that some small amount of PE crosses the blood-brain barrier and gets into the CNS, it probably has effects very similar to MA. The only thing preventing PE from being as potent a stimulant as MA is its relative inability to get into the CNS. So, when looking at psychoactive effects, it makes sense to think of pseudoephedrine as being a very weak methamphetamine, with dosages being limited by its tendency to cause peripheral stimulant effects that become dangerous well before the CNS effects become intense.
So, I don't think pseudoephedrine is something new to psychiatry. I think a propensity to respond to PE is probably an indicator that you would do well if given amphetamines. (Meth)amphetamine has a long-established place in psychiatry, and it is an all-around cleaner stimulant than pseudoephedrine, with a greater degree of headroom to play with dose.
Posted by desolationrower on April 30, 2011, at 18:28:08
In reply to Sudafed: A weak amphetamine, posted by mtdewcmu on April 30, 2011, at 13:21:36
yeah, thats about right.
The reason we use pseudoephedrine is because the thing we used ot use for congestion, amphetamine, has strong effects on the CNS so it got restricted. (and interestingly, ephedrine/cathionine was the orignial allergy medication, since they are in ephedra/khat. and people could eat plants a long time before they could synth drugs.) so back the the future, i guess.
-d/r
Posted by mtdewcmu on April 30, 2011, at 19:39:12
In reply to Re: Sudafed: A weak amphetamine, posted by desolationrower on April 30, 2011, at 18:28:08
It would be strange if you got a cold and were given Dexedrine or Adderall for it. I think switching to pseudoephedrine was progress, since most people don't want to feel that high just to unclog their noses.
One thing I have not figured out is why pseudoephedrine became the standard for congestion and not ephedrine. Is there a pharmacological reason?
Posted by Gup on May 2, 2011, at 15:32:11
In reply to Re: Pseudoephedrine (sudafed), posted by creepy on April 26, 2011, at 13:49:42
>Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
Will do. Also, any opinion on the related tricyclic Imipramine?
Posted by desolationrower on May 2, 2011, at 18:15:57
In reply to Re: Pseudoephedrine (sudafed), posted by Gup on May 2, 2011, at 15:32:11
> >Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
>
> Will do. Also, any opinion on the related tricyclic Imipramine?its a dirtier drug
-d/r
Posted by Gup on May 3, 2011, at 18:24:47
In reply to Re: Pseudoephedrine (sudafed), posted by desolationrower on May 2, 2011, at 18:15:57
Ok, thanks for the update. Any opinion on Protriptyline as well? I see it's listed as causing more psychomotor stimulation than other TCAs.
Posted by desolationrower on May 3, 2011, at 21:09:51
In reply to Re: Pseudoephedrine (sudafed), posted by Gup on May 3, 2011, at 18:24:47
> Ok, thanks for the update. Any opinion on Protriptyline as well? I see it's listed as causing more psychomotor stimulation than other TCAs.
>
>Its hard to get information on it (nothing on the kidb, but TCA page on wiki does have values), but if i recall correctly it works similarly as other secondary amine tcas (i would geuess more stimulation is a combination of less sedation from the mach, antihist, sri, etc effects that tcas like imipramine or amytryptaline have, plus you can/need to push the nri harder to get full depression relief.) It is not one of the genotoxic TCAs (http://www.ncbi.nlm.nih.gov/pubmed/1902910), so i guess that might be a reason to choose it vs desipramine.
-d/r
Posted by deepreason on May 7, 2011, at 9:31:41
In reply to Re: Pseudoephedrine (sudafed) » creepy, posted by mtdewcmu on April 30, 2011, at 12:43:28
> > Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
> > Not usually a strong antidepressant, but a good pain reliever with some added bonuses if you have allergies.
>
> That's an interesting way to use desipramine. Maybe it should be the new gold standard for chronic allergies.My mother suffers from chronic sinus pain, back pain and allergies. Her doctor previously tried her on Amitryptaline but no luck.
As far as I can see Desipramine / Norpramin / Pertofane don't exist in the UK. I can't find them in the BNF (British national formulary) prescribing guide. Can anyone recommend what would be the next closest relation drug wise that might work on sinus pain, back pain and allergies?
Posted by mtdewcmu on May 7, 2011, at 10:02:42
In reply to Re: Pseudoephedrine (sudafed) » mtdewcmu, posted by deepreason on May 7, 2011, at 9:31:41
> > > Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
> > > Not usually a strong antidepressant, but a good pain reliever with some added bonuses if you have allergies.
> >
> > That's an interesting way to use desipramine. Maybe it should be the new gold standard for chronic allergies.
>
> My mother suffers from chronic sinus pain, back pain and allergies. Her doctor previously tried her on Amitryptaline but no luck.
>
> As far as I can see Desipramine / Norpramin / Pertofane don't exist in the UK. I can't find them in the BNF (British national formulary) prescribing guide. Can anyone recommend what would be the next closest relation drug wise that might work on sinus pain, back pain and allergies?
>I haven't heard of doctors deliberately prescribing antidepressants for their side benefits on allergies and sinus problems. I have heard of doxepin seeing some use as an antihistamine, but that's it. For sinus problems, topical drugs are typically the most potent. Nasal steroids like Flonase (or equivalent generics) are worth a try, and oxymetazoline nose spray (Afrin) is a very strong decongestant. There is also NasalCrom, which is ok if she can't tolerate steroids, and Astelin and Patanase, which are antihistamines. If she has itchy eyes, I use Opticrom, which I actually have to order from the UK, or there are other effective eye drops by prescription.
As far as systemic drugs, as far as I know, there is nothing stronger than pseudoephedrine as a decongestant. For antihistamines, there are the non-drowsy ones, Zyrtec, Allegra, and Claritin, and if those fail, I think most doctors would recommend diphenhydramine (Benadryl) next if she can tolerate it. There are a bunch of prescription antihistamines, but I don't know that they work any better. I guess doxepin may make the list, as I think it's one of the most potent antihistamines known.
Has your mother seen an allergy specialist?
Posted by mtdewcmu on May 7, 2011, at 10:38:59
In reply to Re: Pseudoephedrine (sudafed) » mtdewcmu, posted by deepreason on May 7, 2011, at 9:31:41
Another drug that may have benefit in allergy treatment is montelukast (Singulair). It's not one that I've ever come across, but apparently it can be added to an antihistamine for extra help.
Posted by deepreason on May 7, 2011, at 14:29:54
In reply to Re: Pseudoephedrine (sudafed) » creepy, posted by mtdewcmu on April 30, 2011, at 12:43:28
The doctor should be fine with prescribing a TCA as he has tried amitryptaline with her last year in an attempt to try and allow her to get some sleep. Her Sinus pain is bad enough that she's spent the last 5 years or so having to take 60 mg of di-hydrocodeine every night but she still sleeps very few (less than 4) hours a night.
The antihistamine she uses is Benadryl as well as steroid nose sprays. She also has a course of Prednisilone as many times a year as she is able without thinning her skin too badly. As well as 30 day courses of antibiotics every other month or so when the sinuses get infected.
Sadly she's had no luck with allergy specialists either, even being seen at a specialist centre in Southampton for a while.
I've come across Montlukast with regard to my son's asthma. It's used as a 2nd line treatment here if the usual Ventolin / Becotide combinations don't work. I'm not sure if my mother has tried it though.
I guess it's why I got my hopes up a little when I saw the post mentioning Desipramine having really helped someone with chronic sinus problems. It's a real shame it doesn't seem to be available over here in the UK.
Posted by mtdewcmu on May 7, 2011, at 17:32:37
In reply to Re: Pseudoephedrine (sudafed), posted by deepreason on May 7, 2011, at 14:29:54
> The doctor should be fine with prescribing a TCA as he has tried amitryptaline with her last year in an attempt to try and allow her to get some sleep. Her Sinus pain is bad enough that she's spent the last 5 years or so having to take 60 mg of di-hydrocodeine every night but she still sleeps very few (less than 4) hours a night.
>
> The antihistamine she uses is Benadryl as well as steroid nose sprays. She also has a course of Prednisilone as many times a year as she is able without thinning her skin too badly. As well as 30 day courses of antibiotics every other month or so when the sinuses get infected.
>
> Sadly she's had no luck with allergy specialists either, even being seen at a specialist centre in Southampton for a while.
>
> I've come across Montlukast with regard to my son's asthma. It's used as a 2nd line treatment here if the usual Ventolin / Becotide combinations don't work. I'm not sure if my mother has tried it though.
>
> I guess it's why I got my hopes up a little when I saw the post mentioning Desipramine having really helped someone with chronic sinus problems. It's a real shame it doesn't seem to be available over here in the UK.I've never heard of such a nasty sinus problem. Is it associated with other really bad allergy symptoms? If so, maybe she should try the allergy shots. If it's just the sinus pain, has she had X-rays or any imaging done of her sinuses? There could be something wrong that has to be fixed surgically.
Has she had the skin test for allergies? If so, what is she allergic to?
Posted by mtdewcmu on May 7, 2011, at 17:44:11
In reply to Re: Pseudoephedrine (sudafed), posted by deepreason on May 7, 2011, at 14:29:54
Some people have written good things about Astelin on another board. It can be combined with steroid sprays for added effect, I read. Patanase is another topical antihistamine like Astelin and it's new. I don't know if NHS generally pays for the new meds or prefers generics. Astelin is available as a generic.
Posted by desolationrower on May 7, 2011, at 21:22:00
In reply to Re: Pseudoephedrine (sudafed) » mtdewcmu, posted by deepreason on May 7, 2011, at 9:31:41
based on this leaflet http://www.nhs.uk/Conditions/Depression/Pages/Treatment.aspx you can get notriptyline on the nhs
and protriptyline and desipramine aren't sold in the UK any longer
oh, i think you can get reboxetine there too.
-d/r
Posted by desolationrower on May 7, 2011, at 21:28:07
In reply to Re: Pseudoephedrine (sudafed), posted by desolationrower on May 7, 2011, at 21:22:00
Oh, i forgot about lofepramine. actually is metabolised to desipramine
-d/r
Posted by mtdewcmu on May 7, 2011, at 21:37:51
In reply to Re: Pseudoephedrine (sudafed), posted by desolationrower on May 7, 2011, at 21:22:00
> based on this leaflet http://www.nhs.uk/Conditions/Depression/Pages/Treatment.aspx you can get notriptyline on the nhs
>
> and protriptyline and desipramine aren't sold in the UK any longer
>
> oh, i think you can get reboxetine there too.
>
> -d/rNortriptyline is the one with the least side effects, and I think it's partly the side effects that are doing the good here. The H1-blocking and the antimuscarinic effects probably play a part. I'm not sure why an NRI that gets into the brain would be better than pseudoephedrine otherwise.
Posted by deepreason on May 8, 2011, at 4:01:02
In reply to Re: Pseudoephedrine (sudafed), posted by desolationrower on May 7, 2011, at 21:28:07
I'm not sure about whether she's had any x-rays done but they did all the skin tests at the allergy centre. She's always been very allergic to all animals, pollens, dust etc (usually wears a mask if she has to do any gardening or visit anyone with pets). She spent time in hospital with eczema as a child which is all related I hink.
She also had a few discs removed from her back in her 30's and the pain from that at night contributes to the not sleeping I think. I understand TCA's are sometimes used for neuropathic pain.
I'll look into th topical antihistamines suggested but Lofepramine sounds like a route really worth trying if it metabolises to Desipramine.
Thankyou all for your help :)
Posted by creepy on May 12, 2011, at 8:55:29
In reply to Re: Pseudoephedrine (sudafed) » deepreason, posted by mtdewcmu on May 7, 2011, at 10:02:42
you probably wont see it prescribed for allergies and congestion, its not indicated for it at all. I think it is indicated for pain. I was prescribed it for depression to augment lexapro and it worked ok for that. The effects on pain and sinus congestion were a bonus.
My point is that if you have a few unrelated (actually immune response might be more related to mental illness than we think) conditions sometimes the unwanted properties of some of these old TCAs can become very useful.
Posted by mtdewcmu on May 12, 2011, at 17:30:34
In reply to Re: Pseudoephedrine (sudafed), posted by creepy on May 12, 2011, at 8:55:29
> you probably wont see it prescribed for allergies and congestion, its not indicated for it at all. I think it is indicated for pain. I was prescribed it for depression to augment lexapro and it worked ok for that. The effects on pain and sinus congestion were a bonus.
> My point is that if you have a few unrelated (actually immune response might be more related to mental illness than we think) conditions sometimes the unwanted properties of some of these old TCAs can become very useful.
>The antimuscarinic effect of the TCA could be the missing ingredient for some people's sinus problems that makes TCAs seem superior to other drugs. Those people could probably get the same or better effect from Atrovent, an antimuscarinic nose spray. For other people, the effect could make their sinus problems worse, by drying secretions and impairing the nose's ability to clean itself.
Posted by mtdewcmu on May 13, 2011, at 0:52:47
In reply to Re: Pseudoephedrine (sudafed), posted by deepreason on May 8, 2011, at 4:01:02
Take a look:
http://www.nytimes.com/ref/health/healthguide/esn-sinusitis-ess.html
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.