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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by brynb on July 21, 2012, at 17:07:13
Hi All,
I'm on 20mg of Lexapro, 300mg of Lithium and 50mg of Tramadol, and though I had some side effects from Lithium, they seem to have disappeared and I'm feeling pretty good now.
The thing is, my pdoc wants me to go off Tramadol and take Nortriptyline. I haven't stopped Tramadol yet, but I started Nortriptyline two nights ago, and it's making me feel sick (shaky, nauseas, faint, etc.). I almost passed out this morning. I had a similar reaction from Cymbalta a few years ago. I'm also becoming more irritable and having racing thoughts. Is it even possible these side effects are from just a couple of days on it (at 10mg)??
Thanks.
Posted by papillon2 on July 23, 2012, at 1:50:28
In reply to Sick from Nortriptyline?, posted by brynb on July 21, 2012, at 17:07:13
> Hi All,
>
> I'm on 20mg of Lexapro, 300mg of Lithium and 50mg of Tramadol, and though I had some side effects from Lithium, they seem to have disappeared and I'm feeling pretty good now.
>
> The thing is, my pdoc wants me to go off Tramadol and take Nortriptyline. I haven't stopped Tramadol yet, but I started Nortriptyline two nights ago, and it's making me feel sick (shaky, nauseas, faint, etc.). I almost passed out this morning. I had a similar reaction from Cymbalta a few years ago. I'm also becoming more irritable and having racing thoughts. Is it even possible these side effects are from just a couple of days on it (at 10mg)??
>
> Thanks.Hmmm, I can't remember my starting dose of Nortriptyline, but I definitely had shakiness, nausea and light-headedness with every dose change. I think these went away after two weeks on the new dose, if not they were definitely gone by week four. Be sure to sit and stand up slowly.
It may not be common, but it is possible to have severe side effects from only small doses of a psychoactive medication.
You may not get these, but in case you do, the cardiac side effects (palpitations, chest pain, tachycardia) would decrease at four weeks post dose increase. Taking mini aspirin and high-dose fish oil has helped with these side effects.
Is it particularly hot or humid where you live? Increased blood levels of Lithium can also cause shakiness, nausea and dizziness. For me, a tell-tale sign this was happening was an increase in the metallic taste in my mouth which often comes with Lithium use. Just throwing this out there.
Hope this helps.
Posted by bleauberry on July 23, 2012, at 18:02:39
In reply to Sick from Nortriptyline?, posted by brynb on July 21, 2012, at 17:07:13
In my opinion they do not make a dose of Nortriptyline low enough. For me, I sort of liked it for alwhile, but the most I could take was 5mg. I had to open capsues and make my own custom doses. No big deal, it's just that it would be nice to be able to buy 5mg or 2.5mg. Just because the general elite establishment decides 10mg is the right dose does not at all mean it is the right dose for you or me.
You've got other meds in there so it is hard to predict interactions. I do not agree with replacing tramadol with nortriptyline. Makes no sense to me.....take a patient off of something that works, and put them on something we don't know anything about. Huh??? Ok, I understand, tramadol has addiction and tolerance issues, pretty darn strong ones actually, but if you view what patients have to say at drug rating forums, the ones that found tramadol helpful to them were all willing to accept the dependence as a fair trade off. And they willingly accept that if the day ever comes where they have to get off it, it will be really nasty. But as long as someone is doing well, I dunno, I guess it is an individual decision, I would say don't fix it if it aint broke.
Just going by patients at med rating forums, those who found tramadol helpful did so by accident....post op pain or something....but once they discovered it they realized it was much better than the 10 or 20 years of dozens of meds they had already tried.
Since I am skinny I was looking forward to weight gain on nortriptyline, since that's what usually happens with that drug. Instead, I got constant nausea and lost weight I didn't have to lose. It was horrible. Just sayin...we are all different. Go with what works. In terms of nortriptyline, that was no more than 5mg for me. For someone else, maybe 150mg. I don't really care about that, I do care about my own dose being right for me, because I'm the one swallowing it and dealing with it.
I just disagree with the whole nortriptyline thing. I can see the rationale though. I recommend that drug all the time, almost always in combination with an ssri, but in your case you've already got a good SNRI thing happening, a good effect, and I just do not see nortriptyline being able to do for you what tramadol does. I just can't see that.
Posted by brynb on July 24, 2012, at 11:29:48
In reply to Re: Sick from Nortriptyline?, posted by bleauberry on July 23, 2012, at 18:02:39
> You've got other meds in there so it is hard to predict interactions. I do not agree with replacing tramadol with nortriptyline. Makes no sense to me.....take a patient off of something that works, and put them on something we don't know anything about. Huh??? Ok, I understand, tramadol has addiction and tolerance issues, pretty darn strong ones actually, but if you view what patients have to say at drug rating forums, the ones that found tramadol helpful to them were all willing to accept the dependence as a fair trade off. And they willingly accept that if the day ever comes where they have to get off it, it will be really nasty. But as long as someone is doing well, I dunno, I guess it is an individual decision, I would say don't fix it if it aint broke.
>That's EXACTLY how I feel, bleauberry. And, I'm on such a low dose of Tramadol and haven't had to increase it. Coming of off ANY psych drug is no picnic, including Lexapro, so yeah, I'm not worried about the tradeoff.
Thanks.
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