I'm writing on behalf of my mother. She's 68 with Parkinson's and chronic pain from 5 slipped disks. She had horrible withdrawals last summer from stopping Lyrica, developed terrible anxiety, and was put on lorazepam. She has finally recovered from that and it has taken a year. She was on 60mg of Duloxetine and was increased to 120mg several months ago (at least 6), thinking it might help her pain and depression. It didn't seem to do that much.
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She has been improving markedly each week for the last 2-3 months. Her new neurologist added one new Parkinson's med, and told us to drop her lorazepam dosage 1/2 milligram per week until she was just taking one at bedtime. Once we got to 2 & 1/2 a day, we hit a brick wall where she would have crying fits for hours the day after the drop. I then tried reducing 1/8 of a pill per week, which led to 2 hours of crying the next day. So finally we are reducing 1/16 of a pill each week, which seems to be working.
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At our last appointment the new neurologist said he would like to switch her to nortriptyline from duloxetine, saying it is better tolerated for Parkinson's patience and may help more with her pain. Our schedule is:
The first week we degreased the duloxetine from 120 to 90, started nortriptyline 25mg.
Second week 60 duloxetine, 50mg nortriptyline.
Third week 30 duloxetine, 75mg nortriptyline.
Forth week stop duloxetine, continue 75 mg nortriptyline.
She has mostly done fine so far. She cried for 10 minutes the first day of 90 duloxetine/25 nortriptyline, but has improved steadily during her waking hours. The second week, she had some nights of nightmares, talking and screaming (which she has had before, and which is related to her Parkinson's, but she hasn't had it this bad in a long time). We started week three Sunday. Monday night she talked off and on in her sleep from 11:00 PM to 4:00, which ended in a blood curdling scream. She told me it was a pretty terrible nightmare.
So I looked up nortriptyline and nightmares may be a side effect. But I also looked up duloxetine withdrawal, and that also lists nightmares. And we are continuing to reduce the lorazepam 1/16 each week also (which I think is the main reason for her improvement the last 2-3 months).
I'm getting extremely anxious about this, probably irrationally so, but we spent the entire previous year dealing with the after effects of stopping the Lyrica. Does this weaning schedule off duloxetine and onto nortriptyline sound reasonable? Next week we are supposed to stop the duloxetine altogether.