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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by RunawayAmericanDream on October 8, 2004, at 14:32:48
I am passing the 2-week mark on Cymbalta. 10 mg daily. I tried 20 mg 2 days, but dropped back quickly. (I open a 20 mg capsule and remove half the white pingpong ball-like things.)
I'm very sensitive to side effects in general. Cymbalta has the requisite dry mouth & constipation.
Somnolence and foggy thinking are the worst s/e. I'm normally insomniac, but Cymbalta hasn't allowed me to sleep more at night. But it sure makes me * want * to sleep every waking hour. Zero motivation, except for naps, even tho I rarely fall asleep.
It's hard to summon even a sexual thought. My soldier stopped saluting. We added some Viagra, which restores the salute. But there are some unusual weirdnesses when the flag reaches the top of the pole. This s/e doesn't stop me at this point, because there are several strategies for this s/e if Cymbalta proves worth staying on.
But, so far, no antidepressance. And raising the dose intensifies the s/e to the point where I couldn't safely drive, much less do anything useful.
I was already taking Wellbutrin 300 mg daily. (There was no a/d effect, but it stimulates me some and my doctor thinks that helps me get my butt moving.) But 10 mg Cymbalta is beating 300 mg WB in the somnolence/insomnia battle.
Some of you report Cymbalta s/e lessening after several weeks. I'm wondering if it's worth spending weeks or months finding if my body can adapt to the Cymbalta, and if so, can I move up to a useful dose? It would be nice to find something that helps.
But it's really screwing up my motivation and I feel awful. What are the odds that a guy who can't tolerate Effexor 37.5 is going to reach meaningful levels with Cymbalta?
That's my soap opera.
RAD
Posted by Rhapsody on October 8, 2004, at 19:49:54
In reply to Cymbalta @ 2 Weeks, posted by RunawayAmericanDream on October 8, 2004, at 14:32:48
Hi RAD,
You are not at a therapeutic dose of Cymbalta so it is hard to tell if it will work for you or not. Talk to your doctor about finding a way to increase your dose to the therapeutic level. Some people have said they experienced less side effects at 60 mg than at 30mg!
Good luck!
> I am passing the 2-week mark on Cymbalta. 10 mg daily. I tried 20 mg 2 days, but dropped back quickly. (I open a 20 mg capsule and remove half the white pingpong ball-like things.)
>
> I'm very sensitive to side effects in general. Cymbalta has the requisite dry mouth & constipation.
>
> Somnolence and foggy thinking are the worst s/e. I'm normally insomniac, but Cymbalta hasn't allowed me to sleep more at night. But it sure makes me * want * to sleep every waking hour. Zero motivation, except for naps, even tho I rarely fall asleep.
>
> It's hard to summon even a sexual thought. My soldier stopped saluting. We added some Viagra, which restores the salute. But there are some unusual weirdnesses when the flag reaches the top of the pole. This s/e doesn't stop me at this point, because there are several strategies for this s/e if Cymbalta proves worth staying on.
>
> But, so far, no antidepressance. And raising the dose intensifies the s/e to the point where I couldn't safely drive, much less do anything useful.
>
> I was already taking Wellbutrin 300 mg daily. (There was no a/d effect, but it stimulates me some and my doctor thinks that helps me get my butt moving.) But 10 mg Cymbalta is beating 300 mg WB in the somnolence/insomnia battle.
>
> Some of you report Cymbalta s/e lessening after several weeks. I'm wondering if it's worth spending weeks or months finding if my body can adapt to the Cymbalta, and if so, can I move up to a useful dose? It would be nice to find something that helps.
>
> But it's really screwing up my motivation and I feel awful. What are the odds that a guy who can't tolerate Effexor 37.5 is going to reach meaningful levels with Cymbalta?
>
> That's my soap opera.
>
> RAD
>
Posted by hawkeye on October 8, 2004, at 23:11:28
In reply to Cymbalta @ 2 Weeks, posted by RunawayAmericanDream on October 8, 2004, at 14:32:48
You are probably getting a much larger dose of Cymbalta than you realize.
Wellbutrin is a potent inhibitor of the CYP2D6 enzyme.
According to the PDR for Cymbalta: "Because CYP2D6 is involved in duloxetine [Cymbalta] metabolism, concomitant use of duloxetine with potent inhibitors of CYP2D6 may result in higher concentrations of duloxetine."
In short, if you take Wellbutrin and Cymbalta together you could be getting a MUCH HIGHER dose of Cymbalta than indicated from the specifications for the Cymbalta capsule.
I took the two together for a short period of time but got severe sexual side-effects. I then stopped taking the Wellbutrin and continued with the Cymbalta (40mgs/day) and the side-effects almost went away completely.
Posted by boomarang on October 9, 2004, at 14:09:28
In reply to Re: Cymbalta @ 2 Weeks, posted by hawkeye on October 8, 2004, at 23:11:28
it the same thing true of lamictal with cymbalta? i thought i had heard that the lamictal did something to the cymbalta to make it seem like a higher dose. i'm at 200mg lamictal with 40 mg cymbalta.
Posted by Cecilia on October 11, 2004, at 2:46:47
In reply to Re: Cymbalta @ 2 Weeks, posted by hawkeye on October 8, 2004, at 23:11:28
What other drugs are affected by the CYP2D6 enzyme? I`m also having very bad side effects at only 10 mg/day of Cymbalta (sweating, hot flashes, nausea, fatigue, dilated pupils, heart palpitations). I also take clonazepam, atenolol, levothyroxine regularly, ambien, benadryl, xanax prn. Is there a link somewhere saying what drugs are metabolized by what enzyme? I`m definitely getting discouraged, I was so hoping the Cymbalta would work as there`s really nothing else left for me to try. Cecilia
Posted by cache-monkey on October 11, 2004, at 4:45:22
In reply to Re: Cymbalta @ 2 Weeks-question for hawkeye, posted by Cecilia on October 11, 2004, at 2:46:47
I figured I might as well butt in, since this is something I've been thinking about lately...
Do you think you're CYP2D6 deficient, or is one of the drugs you're on an inhibitor of that enzyme? I had the same reaction to Cymbalta and ended up having to discontinue. As it happens, I got a CYP2D6 genotype test based on a couple of drug reactions in the past and it turns out that I'm naturally an intermediate CYP2D6 metabolizer. Add that on to Cymbalta's natural inhibition of the enzyme and, well, it sucked.
If you think you're CYP2D6 deficient you should look into whether your insurance covers a genotyping test. I had to do all the legwork with mine, including informing my GP as to what the test even was. But I think it's worth it so that I know now to be careful with 2D6-metabolized drugs. Anyway, since I've been aware of this, I've started looking more carefully at the various drugs I've been on or have contemplated going on in relation to 2D6.
If you have CYP2D6 issues, you might want to stay away from Serzone. I had a horrible reaction to it, which I think could be based on my 2D6 status. One of its metabolites (mCPP) is known to cause anxiety and is metabolized by 2D6. For most people (extensive metabolizers) this doesn't cause a problem, but for people slow in 2D6 mCPP can accumulate to the point of washing out any of the "normally" calming effects of Serzone.
I currently take BuSpar, whose primary metabolite (1-PP) is metabolized on the second pass by 2D6. But 1-PP is anxiolytic and pro-sexual, which could explain my pretty good relationship with BuSpar so far. (It's not leaving me anxiety-free, but it's helping a lot.)
I've been looking at going on selegiline, which is an MAO-B inhibitor at low concentrations and only at higher concentrations is an MAO-A inhibitor (necessitating the special diet). It's metabolized by 2D6, so I'm going to start out at half of the normal starting dose so that it doesn't over accumulate and go MAO-A on me.
Other drugs that I know to be metabolized at least in part by 2D6: Lexapro, Prozac, as well as primary metabolites of Celexa and Wellbutrin. So, if you have reason to suspect that you have 2D6 issues, you would want to start low and go slow with these.
The following links have useful, but not complete, information on the enzymes that metabolize, and are inhibited by, various drugs:
http://www.preskorn.com/books/ssri_s7.html
http://medicine.iupui.edu/flockhart/table.htm
Neither of those links seems to be a complete listing, so I usually round out the information with a web search.Sorry if this is information overload, but I hope it helps.
peace,
cache-monkey<< What other drugs are affected by the CYP2D6 enzyme? I`m also having very bad side effects at only 10 mg/day of Cymbalta (sweating, hot flashes, nausea, fatigue, dilated pupils, heart palpitations). I also take clonazepam, atenolol, levothyroxine regularly, ambien, benadryl, xanax prn. Is there a link somewhere saying what drugs are metabolized by what enzyme? I`m definitely getting discouraged, I was so hoping the Cymbalta would work as there`s really nothing else left for me to try. Cecilia
>>
Posted by hawkeye on October 11, 2004, at 13:52:49
In reply to Re: Cymbalta @ 2 Weeks-question for hawkeye, posted by Cecilia on October 11, 2004, at 2:46:47
Cecilia, I don't know if any of the drugs you are taking inhibit the CYP2D6 enzyme. Usually, the PDR for each drug includes such metabolism information. You can usually find the PDR info for drugs using the Google search engine.
This is the end of the thread.
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