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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 medamorphosis on October 8, 2010, at 1:28:03
Im currently taking Marplan 80mg, Trimipramine 75mg & Clonazepam 4mg. For the last 4 days ive brought myself off alcohol cold turkey. Im over that phase now.
Problem is, the trimipramine is still producing vivid bad dreams and disturbed sleep. I'm seeing my pdoc on Monday (3 days time) to get a switch from trimipramine to amitryptyline. BUT I am desperate for a decent nights sleep! I dont want to go back to alcohol for obvious reasons, but my dreams weren't this bad when i was drinking nor would i constantantly wake through the night.The easiest option for me would be to take diphenhydramine at night hoping it will get me through till the morning. But, some sources say not to take with MAOIs, some sources say not with TCAs and some dont mention a contra-indication at all with either!
So, am I ok to take diphenhydramine with my current meds or not?
And, not that im ungratefull for suggestions & recommendations, but I really only need factual based answers or no-nosense theories only please.Much gratitude for any responses,
med
Posted by medamorphosis on October 8, 2010, at 2:55:23
In reply to Diphenhydramine contra-indications?, posted by medamorphosis on October 8, 2010, at 1:28:03
This is interesting: http://ajp.psychiatryonline.org/cgi/content/full/157/9/1524-a
Perhapse Cyprohepdatine would allow me to stay on trimipramine and return to 100mg which is the most effective dose for me.
Posted by ed_uk2010 on October 8, 2010, at 14:28:56
In reply to Re: Diphenhydramine contra-indications?, posted by medamorphosis on October 8, 2010, at 2:55:23
Since you're already on a med with sedative antihistamine properties (trimipramine), I doubt that diphenhydramine would help you sleep.
Cyproheptadine (Periactin) is currently out of stock in the UK.
Posted by medamorphosis on October 8, 2010, at 14:58:19
In reply to Re: Diphenhydramine contra-indications?, posted by ed_uk2010 on October 8, 2010, at 14:28:56
> Since you're already on a med with sedative antihistamine properties (trimipramine), I doubt that diphenhydramine would help you sleep.
>
> Cyproheptadine (Periactin) is currently out of stock in the UK.Thanks mate.
Im aware lots of TCAs (and other meds) have a strong antihistamine effect (amitryptyline, mirtazepine, etc). But, theres something about trimipramine wich seems to enhance REM sleep- the dream stage of sleeping. Its very intense and i cant see how this can be put down simply to its antihistamine effect. I believe its something else. Hence why cyproheptadine, despite being a sedating antihistamine shows to reduce nightmares/dreams. Also, I can never recount having dreams or nightmares from taking diphenhydramine itself.
And although nightmares are a possible side effect of amitryptyline, its not renound for them, unlike trimipramine. And ive been on amitryptyline before on its own. No recount of dreams then either. Which is why I intend to switch to it, esp as you say cyproheptadine is out of stock in the UK so thats obviously not an option.I'll post tomorrow to say if the diphenydramine helped or not. I'll probably need 100mg but I'll start with 50mg.
BTW Ed, I should be getting Marplan again very soon- any minute now so-says my pharmacist. Apparently it went dry because if inpurities in the raw ingredients the drug-makers received prior to the drought. Just what my pharmacist said. Its a good job I stocked up well on it! Still have a bottle left :)
Posted by medamorphosis on October 9, 2010, at 9:13:56
In reply to Re: Diphenhydramine contra-indications? » ed_uk2010, posted by medamorphosis on October 8, 2010, at 14:58:19
OK. Last night was kinda odd. Went to bed by 10pm After taking 50mg diphenhydramine. Woke around 2am after having a vivid and slightly unpleasant dream which involved the usual paralysis 'inside' the dream.
So I sat up and watched a film seeing as I was too alert for sleep. Then after about an hour I took another 50mg. Woke up once or twice to use the toilet but went strait back to sleep. I awakened properly just after 8am, feeling pretty alert and in a normal mood. No particularly vivid dreams after the second dose.Perhapse the added antihistamine effect did make me sleep slightly deeper after the second dose, or maybe diphenhydramine's mild SRI effect helped the quality of my sleep, at least to a managable degree(?) Apart from the usual boredom my mood has been ok-ish today.
Tonight I plan to take a full 100mg at bedtime, hoping not to have such vivid dreams and that it will last a good 6+hrs. I could cope with that, at least till i see my pdoc on Monday.
BTW question for ed: You say UK is out of stock. Does that mean it is simply 'currently' out of stock, or is it actually no longer available in the UK?
med
Posted by medamorphosis on October 9, 2010, at 9:19:44
In reply to Re: Diphenhydramine contra-indications?, posted by medamorphosis on October 9, 2010, at 9:13:56
> BTW question for ed: You say UK is out of stock. Does that mean it is simply 'currently' out of stock, or is it actually no longer available in the UK?
The cyproheptadine I mean.
Posted by ed_uk2010 on October 9, 2010, at 9:40:02
In reply to Re: Diphenhydramine contra-indications? » ed_uk2010, posted by medamorphosis on October 8, 2010, at 14:58:19
>Also, I can never recount having dreams or nightmares from taking diphenhydramine itself.
Sorry, I thought you wanted to take trimipramine and diphenhydramine together.
>Apparently it went dry because if inpurities in the raw ingredients the drug-makers received prior to the drought.
I'm not sure of the reason for the shortage. Send me a babblemail if your medication doesn't arrive. I have information from the manufacturer.
Posted by medamorphosis on October 9, 2010, at 9:49:48
In reply to Re: Diphenhydramine contra-indications? » medamorphosis, posted by ed_uk2010 on October 9, 2010, at 9:40:02
> >Also, I can never recount having dreams or nightmares from taking diphenhydramine itself.
>
> Sorry, I thought you wanted to take trimipramine and diphenhydramine together.Oh I do and have mate. Think what I was trying to say was i doubted it would make the dreams worse taking them together. And that I hoped that the extra sedation might cloud my dreams somehow to make them more bareable. Difficult to word what I meant thats all lol
Posted by ed_uk2010 on October 9, 2010, at 9:59:00
In reply to Re: Diphenhydramine contra-indications?, posted by medamorphosis on October 9, 2010, at 9:13:56
>Perhapse the added antihistamine effect did make me sleep slightly deeper after the second dose, or maybe diphenhydramine's mild SRI effect helped the quality of my sleep, at least to a managable degree(?) Apart from the usual boredom my mood has been ok-ish today.
Perhaps the anticholinergic effect reduced the dreaming.
>BTW question for ed: You say UK is out of stock. Does that mean it is simply 'currently' out of stock, or is it actually no longer available in the UK?
As far as I know, MSD (the manufacturer) isn't releasing any Periactin into UK wholesalers at present. They either have no stock or very little stock. Periactin has not been officially discontinued in the UK, although I wouldn't be surprised if MSD does decide to discontinue it in the near future - it can't be very profitable, the price is low and it's very rarely prescribed. As an alternative to discontinuation, MSD might decide to divest Periactin to another pharma company. There are a handful of small pharma companies whose business model revolves around acquiring the rights to niche brands which are no longer of interest to big pharma.
There is no generic cyproheptadine in the UK. Generics manufacturers aren't usually interested in such rarely used products unless they can sell at a high price. They probably wouldn't be able to sell Periactin at a high price because doctors would stop using it altogether.
Posted by ed_uk2010 on October 9, 2010, at 10:30:02
In reply to Re: Diphenhydramine contra-indications? » ed_uk2010, posted by medamorphosis on October 9, 2010, at 9:49:48
So are you replacing both lofepramine and trimipramine with amitriptyline?
Posted by medamorphosis on October 9, 2010, at 11:45:24
In reply to Re: Diphenhydramine contra-indications?, posted by ed_uk2010 on October 9, 2010, at 10:30:02
> So are you replacing both lofepramine and trimipramine with amitriptyline?
Yes. Lofepramine, being an NRI seems ok with trimipramine as the latter has negligable NRI effects so can be safely prescribed together. But as the amitryptyline DOES have a somewhat more potent NRI effect there should be little need to add an NRI. NRIs are allways helpfull to me as they help keep me alert during the day.
I guess another choice would be mirtazepine but I wouldn't touch it unless I knew I could go over 30mg for a chance for its noradrenalin effects to kick in. Ive been on it before, solo, and even 30mg still wiped me out the rest of the following day. That was after 2 weeks at 30mg & I couldn't take the punishment any longer.
This is the end of the thread.
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