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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by trx resistant on January 23, 2008, at 4:16:12
Hi everyone!
Have 2 questions.
Just finished 10 days on Levoquin, immediately following 5 day Z-Pack. sinus infection. Noticed marked increase in "high". Am I imagining or is it based on antibiotic interaction?
Also notice this fluttering heart, too. No heart problems, BP terrific, and I can't sleep. Only happened on antibiotic.
Kept reducing time I wore patch and skipped one day. Can't wait for the wash out. What do you think?
Posted by Phillipa on January 23, 2008, at 12:33:25
In reply to EMSAM and drug interactions, posted by trx resistant on January 23, 2008, at 4:16:12
I took levoquin once and it freaked me out and had to go off it years ago about five. I couldn't tolerate it yes I think it could have been the antibiotics seems everyone has some sinus thing this years. So you're off the antibiotics now? Hopefully things will be better now I can tolerate z-pack. Love Phillipa
Posted by trx resistant on January 23, 2008, at 13:31:43
In reply to Re: EMSAM and drug interactions » trx resistant, posted by Phillipa on January 23, 2008, at 12:33:25
I've taken levoquin before, twice, over the last couple of years without any problems. I think this is the combo with EMSAM. and I think the Z pack started it. Where's Larry and the rest of you biochemical researchers on this issue?
I'm sure Larry's too busy, but if he weren't, we could just give him a whole board for these questions!
Posted by Larry Hoover on January 23, 2008, at 16:48:37
In reply to EMSAM and drug interactions, posted by trx resistant on January 23, 2008, at 4:16:12
> Hi everyone!
> Have 2 questions.
> Just finished 10 days on Levoquin, immediately following 5 day Z-Pack. sinus infection. Noticed marked increase in "high". Am I imagining or is it based on antibiotic interaction?
> Also notice this fluttering heart, too. No heart problems, BP terrific, and I can't sleep. Only happened on antibiotic.
> Kept reducing time I wore patch and skipped one day. Can't wait for the wash out. What do you think?Neither Z-Pack (zithromycin), nor Levaquin (levofloxacin), have any kind of metabolic interaction with Emsam (selegiline), as far as I can tell.
Levaquin can have substantial psych effects, and can cause heart arrythmia, especially tachycardia and Q-T prolongation. I'd look to the Levaquin, on its own, although there may be an additive psych effect from the combination of Levaquin and Emsam.
I'd make sure your doctor was made aware of the heart rhythm effect. It may indicate a sensitivity to quinolone antibiotics.
Lar
Posted by Larry Hoover on January 23, 2008, at 16:52:10
In reply to Re: EMSAM and drug interactions, posted by trx resistant on January 23, 2008, at 13:31:43
> I've taken levoquin before, twice, over the last couple of years without any problems.
It could be an interaction, but it looks like sensitivity to the antibiotic is itself a sufficient explanation. Sometimes we just become sensitive to drugs that used to be okay.
> I'm sure Larry's too busy, but if he weren't, we could just give him a whole board for these questions!
I wish that was the explanation. I'm being very careful to limit my posting activity. I can only do a little bit.
Lar
Posted by Phillipa on January 23, 2008, at 19:42:06
In reply to Re: EMSAM and drug interactions » trx resistant, posted by Larry Hoover on January 23, 2008, at 16:48:37
Lar how well I know the unwanted psch effects it's listed on my charts at every docs. Shoulder? Phillipa
Posted by trx resistant on January 24, 2008, at 3:28:50
In reply to Re: EMSAM and drug interactions » Larry Hoover, posted by Phillipa on January 23, 2008, at 19:42:06
Lar:
I so very much appreciate the time you take and you have made my journey so positive. I am so grateful. Thank you from the bottom of my heart.
You give me more info and support than anyone in the second largest city and top 5 medical institutions!
Posted by trx resistant on January 29, 2008, at 0:49:45
In reply to Re: EMSAM and drug interactions, posted by trx resistant on January 24, 2008, at 3:28:50
Just trying to find out some possible cause for this heart fluttering thing. Thought it could be Emsam and 10 days of Levoquin but I've been off Levoquin for a week. Could it be the Topamax @ 12.5 mg which was started in late December combined with EMSAM. Neurologist says no, but he doesn't even know EMSAM and you are all so much better than the doctors for this very clinical drug interaction stuff! Larry, where art thou?
Thanks
Posted by trx resistant on January 29, 2008, at 1:13:36
In reply to Re: EMSAM and drug interactions, posted by trx resistant on January 29, 2008, at 0:49:45
Ok, Larry skip my last question as you answered it for queenie star before I submitted.
New question for friend without computer considering EMSAM for MDD: any drug interaction with Triamterene/hctz 75/50 tab which she could stop, if necessary to start EMSAM? If she starts EMSAM, does she need "washout" of this BP med? for how long? Dr. doesn't know about EMSAM.
Posted by Larry Hoover on January 29, 2008, at 17:45:02
In reply to Re: EMSAM and drug interactions, posted by trx resistant on January 29, 2008, at 1:13:36
> New question for friend without computer considering EMSAM for MDD: any drug interaction with Triamterene/hctz 75/50 tab which she could stop, if necessary to start EMSAM? If she starts EMSAM, does she need "washout" of this BP med? for how long? Dr. doesn't know about EMSAM.
I can't find any evidence for a possible interaction between either of the active ingredients in your friend's Dyazide and Emsam. That said, Emsam is known to put subjects at risk of orthostatic or postural hypotension (i.e. low blood pressure/dizziness on arising from reclining or sitting). There would therefore be a possibility for additive or even synergistic (greater than additive) effects of the group of meds on blood pressure. So, a little caution when standing up would be in order, along with perhaps a little greater than normal surveillance of blood pressure readings.
Lar
P.S. I'm only too happy to contribute the results of my own research, and interpretations therefrom, but I'm a bit distressed that doctors can't do much the same thing for themselves.
Posted by former trx resistant on January 30, 2008, at 0:11:58
In reply to Re: EMSAM and drug interactions » trx resistant, posted by Larry Hoover on January 29, 2008, at 17:45:02
> > New question for friend without computer considering EMSAM for MDD: any drug interaction with Triamterene/hctz 75/50 tab which she could stop, if necessary to start EMSAM? If she starts EMSAM, does she need "washout" of this BP med? for how long? Dr. doesn't know about EMSAM.
>
> I can't find any evidence for a possible interaction between either of the active ingredients in your friend's Dyazide and Emsam. That said, Emsam is known to put subjects at risk of orthostatic or postural hypotension (i.e. low blood pressure/dizziness on arising from reclining or sitting). There would therefore be a possibility for additive or even synergistic (greater than additive) effects of the group of meds on blood pressure. So, a little caution when standing up would be in order, along with perhaps a little greater than normal surveillance of blood pressure readings.
>
> Lar
>
> P.S. I'm only too happy to contribute the results of my own research, and interpretations therefrom, but I'm a bit distressed that doctors can't do much the same thing for themselves.A thousand blessings to you, Lar! My friend thanks you as do I. She willl begin her EMSAM journey tomorrow.
One last question for the moment for me: I stopped the Topamax tonight. New neuro can't see me until 2/15. Until them, suggesting pediatric dose of phenobarbital, just as a seizure precaution. What do think with EMSAM?
Sorry for taking your time but at the moment I only trust you, first!
Posted by Phillipa on January 30, 2008, at 19:02:31
In reply to Re: EMSAM and drug interactions, posted by former trx resistant on January 30, 2008, at 0:11:58
Lar is top notch. Love Phillipa
Posted by Larry Hoover on January 30, 2008, at 20:39:02
In reply to Re: EMSAM and drug interactions, posted by former trx resistant on January 30, 2008, at 0:11:58
> A thousand blessings to you, Lar! My friend thanks you as do I. She willl begin her EMSAM journey tomorrow.
A thousand! Kewl. You're both welcome.
> One last question for the moment for me: I stopped the Topamax tonight. New neuro can't see me until 2/15. Until them, suggesting pediatric dose of phenobarbital, just as a seizure precaution. What do think with EMSAM?
The phenobarbital monograph includes the following precaution: "MAOIs prolong the effects of phenobarbital probably because metabolism of the phenobarbital is inhibited." With older meds like phenobarbital, the pharmacokinetic information is usually quite limited. It's hard to say what kind of a difference taking it with Emsam might produce. With the pediatric dosing, it's probably going to be okay.
> Sorry for taking your time but at the moment I only trust you, first!
I take your faith in me seriously, rest assured.
Lar
Posted by former trx resistant on January 31, 2008, at 1:33:49
In reply to Re: EMSAM and drug interactions » former trx resistant, posted by Larry Hoover on January 30, 2008, at 20:39:02
Hear ye hear ye!!! I propose a thread to thank Lar!!!
This is turning into a serious love fest - I hope someday, somehow, in some world we can meet and I can thank you in person. It would take several pages to tell you all the "bad" things that have happened in just the last 48 hours. So take pride in your wondeful kind spirit and tell your loved ones that we, on this board, appreciate your contributions to our health since our own phsyicians won't take the time to do minimally adequate safe work. And I have nothing but love for my docs and I am widow of a doc who died very young and in his prime. So I have medical connections and know how the system works and I am treated better than most but really, Lar, you are so special.
Love and gratitude ( and yes, I bet you're blushing)
Posted by Larry Hoover on January 31, 2008, at 9:14:50
In reply to Re: EMSAM and drug interactions, posted by former trx resistant on January 31, 2008, at 1:33:49
That's very sweet of you to say all that. Blushing, no. Warm and fuzzy, yes. Thank you.
BTW, I forgot to mention one more thing about the phenobarbital. As it has a half-life of 2-5 days already, having its rate of metabolism reduced by an MAOI may be a moot issue, in any case.
Best,
Lar
Posted by former trx resistant on February 2, 2008, at 2:37:31
In reply to Re: EMSAM and drug interactions » former trx resistant, posted by Larry Hoover on January 31, 2008, at 9:14:50
your welcome!
Oh, Lar you would love this . . .the neuro who gave Topamax, then said maybe do the phenobarb, 4 weeks ago. I track him down after hearing from you and now 48 hours later and 2, 45 minutes waiting and "telling" pharmacist that the script is there . . .NO it's not, 4 calls, 4 VM, to dr. now 20+ hours later he finally says, "What was it that you wanted?!!!!!!!
Now I just decided to wait and introduce new drug into system because I think I'm not quite "down" from the Topamaz reaction with EMSAM! I'm learning better to be conservtive, stabalize, then add new drug into mix!!!
Thanks for leading me the way,
xoxox
Posted by trx resistant on February 6, 2008, at 2:30:04
In reply to Re: EMSAM and drug interactions » former trx resistant, posted by Larry Hoover on January 31, 2008, at 9:14:50
Hey Lar and everyone! One pediatric dose of phenobarbital and I can add to my list of drug allergies. Large hives and itching within a few hours. So I haven't a clue as to where to go next because I don't think anything is left. I keep telling them that seizure drigs and me don't mix.
Posted by trx resistant on February 10, 2008, at 13:14:44
In reply to Re: EMSAM and drug interactions, posted by trx resistant on February 6, 2008, at 2:30:04
Hi everyone!
Here's where I at: can't take phenobarbital due to allergic reaction this past Monday. Managing serious life isuues to the xtreme: [helping an niece (NOT BLOOD, RATHER APPOINTMENT BY HER FAMILY) navigate the ER/hospiital system due to undiagnosed paraylytic full body paralysis, periodic, for last 7 days] and a "dangegous criminal" may have targeted me at my apt and is leaving creepy stuff and police are trying to help.
Yeah, it's been tough and I was, until early this morning, coping well. I am EXHAUSTED physically and emotionaly.
So I continue to have heart palpatations, racy feelings, which a small dose of xanax 5mg boost to the 1mg xanax ER seems to help a bit. Cut EMSAM pacth first into 1/4, skip a day, then 1/2 patch for a few hours, then skip a day, over last 2 weeks. It's not changinf these symptoms)so I don't believe EMSAM is the culprit.But I have that other issue of a new brain lesion (12/31/07) which has not yet been evaluated by neurosurgeon.
My plan is to drop off 2005 brain and 2007 brain scan for his review tomorrow. Wait to see what he thinks.
Meanwhile police said not to go back to apt. and I don't any "friends" to stay with. So I guess I will find safe but inexpensive hotel which allows me and my dog.My new querie is: brain lesion = brain tumor (pituitary tumor?) or meningioma in an area (frontal lobe base, of the portion of the skull over sinus area)which coud be "irritating" the brain (electricaly) and causing misfires of electrical impluses????
I am feeling periodic dizzy, balance maybe slightly an issue, and as I said earlier frequent palpitations, racy speech pattern. I am severely deprived of sleep due to Topomax- 12.5 mg (started early December, 2007) given by neurologist (trusted him and I didn't read the black box warning on EMSAM box since XMAS.I am having exquisite moments of clarity (kinda weird), the language skill is like the best communicator on CNN, expression excellent and quite appropriate, and I can consciously slow everything speech-wise down to normal speed and my brain and thought process is the best it's ever been (NOT IN ANYWAY WAY RACY OR TOO FAST).
So I know this could be a bunch of coincidences or something like a brain lesion giving the extra good sysmptoms and the sleep deprivation could cause the exhaustion, relationship problems etc., causing the palpatations, dizziness, balance symptoms.BUT I KNOW TO START HERE TO ARM MYSELF WITH YOUR ADVICE BEFORE I GO TO DR. TO HEAR I'M JUST "IMAGINING" THIS STUFF.
THANKS SO MUCH
AN EXHAUSTED, SLIGHTLY ANXIOUS, NOW A LITTLE DEPRESSED "FORMER TRX REISTANT" GAL!
Posted by trx resistant on February 12, 2008, at 3:36:20
In reply to Re: EMSAM and drug interactions » trx resistant, posted by trx resistant on February 10, 2008, at 13:14:44
Just reporting in!
Had to go on and off the Emsam Patch last week. Last wore 1/2 patch (6 mg)on Saturday for 2-3 hours. Yesterday had same old almost asthma like breathing issues. It's almost gone today, especially since I took a Bendryl this evening. Trying to figure out if I should try 1/4 for a few hours to keep in my system tomorrow.
Posted by Phillipa on February 12, 2008, at 18:58:34
In reply to Re: EMSAM and drug interactions, posted by trx resistant on February 12, 2008, at 3:36:20
What did you decide and how are you doing tonight? Love Phillipa
Posted by trx resistant on February 12, 2008, at 19:46:17
In reply to Re: EMSAM and drug interactions » trx resistant, posted by Phillipa on February 12, 2008, at 18:58:34
I thought everyone was on vacation! I feel quite well, considering the freaky circumstances of life from every direction. Brain scan will get to neurosurgeon tomorrow. I decided 2 neurologists have failed me and I will now start at the top to see if it is something I need to look into and find a seizure med for protection.
I haven't worn patch since Sat. and Im still fine. Better, no palpatations or breathing issues. I'm trying to decide if I should put 1/4 on for a few hours tomorrow so I keep some Emsam in my system so I don't have future issues. And I really would love some feedback from you, all.
thanks
Posted by Phillipa on February 12, 2008, at 20:14:51
In reply to Re: EMSAM and drug interactions, posted by trx resistant on February 12, 2008, at 19:46:17
Are you saying you're getting a brain scan or seeing a neurologist or both? If it were me and only can speak for me I would wait and see what the doc says since the symptoms resoloved. Freaky allergy don't know. Phillipa
Posted by trx resistant on February 13, 2008, at 0:36:53
In reply to Re: EMSAM and drug interactions » trx resistant, posted by Phillipa on February 12, 2008, at 20:14:51
I'm seeing neuro surgeon instead of neurologist, since I'm told I have a brain lesion which could cause possible nocturnal seizures I'm not aware of. I have past seizure history caused by Wellbutrin in 2000. then one onCymbalta when dose was raised to 90mg. Hence the need for seizure protection but I'm allergic to most seizure meds or EMSAM interacts negatively with mixture. I know from dentist last week that I have several cracked teeth I was unaware of since last visit which was 9 mos. ago.
Emsam has been a life saver but maybe I don't it as much as before.
Trust me, I know this is a bit confusing, they refer to me at major med center for years as the "neurological nightmare" becasue I seem fine but have had multiple rare neurological issues. If you saw me and ask me, I am fine.
This is the end of the thread.
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