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#31 fishinghat

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Posted 26 July 2016 - 04:15 PM

Welcome greyeyed
 
That weaning schedule (referred to as a cross-over taper) is a little fast. It usually takes 6 weeks for the nortriptyline to fully kick in. Especially dealing with other withdrawal symptoms at the same time.

 

I don't understand drs attitude about withdrawing from a benzo like lorazepam/ It is relatively easy and symptom free if you use a technique called water titration. The daily dose is dissolved in around 200 ml of water and 50 mls is taken 4 times per day. This can then be lowered by as little as 1 ml at a time (Take 1 ml out of the 200 ml lorazepam solution and replace it with 1 ml of water). This is a STANDARD technique for benzo withdrawal and can be done with little or no symptoms. The normal drop rate for lorazepam is 1 to 5% every 2 weeks. The patient is to start at 1/2% drops (which is a 1 ml drop). After two weeks at that dose and no withdrawal then the patient can start dropping 2 mls every 2 weeks. Usually a patient can workup to dropping about 6 mls every 2 weeks. If you start to show symptoms then drop back to the previous dose and stay at that level til done. A one year or more  withdrawal is normal. Remember, with benzos NEVER go back up in dosage as it will make the withdrawal much worse and last longer.

 

Please keep us posted and let us know how she is doing and if you have any questions. I believe that the change over of meds could have been done more seamlessly if the dr hadn't rushed things.


#32 greyeyed123

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Posted 26 July 2016 - 05:18 PM

Thanks Fishinghat

 

Today hasn't been so great for mom. She's clearly having some kind of problem and her pain has increased. (Almost every day for the last 3 weeks have been "good days", after a year of mostly bad days, so I am concerned we're doing something wrong.)  Yesterday was the first day she got only 30 mg of the duloxetine, so I'm thinking that is the culprit. I looked at the 30 mg prescription bottle for weaning, and there are several more than the 14 I would need for the schedule he gave us, plus 2 refills, so I'm thinking he may have foreseen we would need more time. She took her second 30 mg capsule at around 10:00 today, and since she has had increased pain, has slowed down a bit, and just has a bit of a "sad" aspect she hasn't had for this long in a while, I gave her another 30mg capsule around 2:00 and will see how she fairs. I may call the neurologist tomorrow or continue to play it by ear. We have plenty of the 60mg capsules also, with refills, so I can take the beads out as mentioned earlier in the thread if needed.

...

Would you happen to know the difference between taking the Nortriptyline all at once at bedtime (three 25 mg capsules) or spreading them out, say, one every 8 hours?  The neurologist said they may make you sleepy right after taking them so he recommended taking them all at bedtime. I was thinking if the Nortriptyline was causing the nightmares it may be from taking them all at once, as her talking in her sleep and nightmares seem to stop completely about 3 or 4 in the morning (leaving me pretty tired; and I'm a teacher so I'd like to get this stabilized before I have to go back to work).  All the websites I have seen said you can take them either way but don't give any benefits or drawbacks to either method.  She seems to be sleeping very hard in that it is difficult to wake her out of her talking/nightmares. But previously when she had this problem she would often (although not always) stop after being awakened. Now she seems to go immediately back to sleep and continue talking. 


#33 fishinghat

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Posted 26 July 2016 - 05:49 PM

Your neurologist has the standard approach. The sleepiness after taking it will last about one month and then subside some. He kust doesn't want her to take it during the day and maybe accidentally her self because she is groggy. Once she has been on it a while you should be able to take it in the morning if you want to but check with the dr first. The half life of Nortriptyline is 25 hours. That means that when you take it the second day you still have 1/2 of the first days dose in you and ext. That's why it takes so long for it to build up in the body and have full effect. This also means that taking one pill every 8 hours or 3 pills at bedtime makes little difference in the blood concentration and side effects.

 

Only 0.65% of people develop nightmares from this medicine (per FDA). Most of the nightmares subside within 2 years (a long time).


#34 greyeyed123

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Posted 26 July 2016 - 06:25 PM

She was better today by 3:30pm after taking a second 30mg duloxetine at 2:00pm.  I'm now thinking the nightmares are probably just her underlying REM behavior disorder related to the Parkinson's--it's probably just worse from the med changes, hopefully mostly from reducing the duloxetine, although maybe from reducing the lorazepam also.  She had been on 1mg of clonazepam at bedtime for her sleep disorder, but once they put her on the lorazepam last summer they told her not to take both so we stopped. We haven't been back to the sleep doctor in over a year because the sleep problem seemed to resolve itself, maybe from the lorazepam, and she had so many problems that were much worse it wasn't a priority. I suppose we need to go back now, although I hate to add one more doctor to the list--going to so many doctors, they sometimes seem to work at odds with each other and then you have to figure things out for yourself anyway.


#35 fishinghat

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Posted 26 July 2016 - 06:57 PM

Your probably right, her sleep problems probably did get better because of the lorazepam. It has even been used in emergencies as an anaethsia (sp). By the way, it is the third most addictive benzo with one of the worse withdrawals.


#36 greyeyed123

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Posted 26 July 2016 - 07:11 PM

Thanks. I added up her daily lorazepam dose and it's now 2mg a day, maybe a tiny bit less. So far my method of cutting the pills seems to be working, but I will keep in mind the water method also.  I really wish someone would have explained lorazepam and its rebound effect to me last summer. She was only on it for a couple of weeks at first after leaving the ER, but I think that was enough for withdrawal effects and the rebound effect so whenever we tried to stop her symptoms returned worse than they were to begin with...so we thought she still had severe underlying anxiety...so the doctors prescribe more since she was having such difficulties in the wake of her Lyrica withdrawal.  We probably could have weaned her off the lorazepam a long time ago if I had known better and avoided most of a year that was pretty bad.  ...or maybe not. I don't know.


#37 greyeyed123

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Posted 27 July 2016 - 11:44 AM

Briefly, mom had an uneventful night. No nightmares, talked in her sleep for 3-4 minutes at 2:00am, and that's it. Only change yesterday was back to 60 mg duloxetine. No change in lorazepam.  She did have a burst of anger and crying that lasted 30 min before bed last night, but I'm attributing that to the 1/16 reduction in lorazepam that started Friday?  In any case, she even laughed a little this morning, so her mood seems much better.


#38 fishinghat

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Posted 27 July 2016 - 12:00 PM

At this point are you planning on weaning her off the Cymbalta?  If so I would give her a few days to stabilize first.


#39 greyeyed123

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Posted 27 July 2016 - 12:50 PM

That's my plan, using the bead method. My hope is the nortriptyline will build up a bit more in her system before we start.  I may hold off on reducing the lorazepam any more for a couple of weeks also.


#40 fishinghat

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Posted 27 July 2016 - 01:33 PM

I think that is a great idea.


#41 greyeyed123

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Posted 31 July 2016 - 08:55 PM

Thanks for reading this an any help you can offer.

 

I started the duloxetine taper Saturday (yesterday) for mom. The capsules have well over 500 beads in them, so I took out 6 beads for Saturday's pill, and 12 for Sunday's pill (she takes them in morning).  Today (Sunday) at 5pm she had 30+ minutes of anger and "weepiness", but not really crying (she kicked her walker and stormed around the house in frustration at just about everything...without any need of her walker, so I guess that's good, but it's got me on edge).  I haven't changed her lorazepam, but Thursday she dropped part of her dose in the bathtub (her caregiver was bathing her at the time) so I had no idea if she dropped the 1/8 of a pill or the 1/4 of a pill (to make the 3/8 dose for 1pm).  So I just gave her 1/4 a pill when I arrived home at 2:00pm. So she may have gotten 1/8 extra Thursday, or the normal amount. Perhaps that could cause a problem 3 days later (**IF** it was the 1/8 extra, which I don't know)?

...

I'm thinking the outburst today was just interdose withdrawal from lorazepam, her previous dose being at 4:00pm (she occasionally has this, but not usually with the outburst of anger). It usually takes an hour to kick in, but she didn't seem to start calming down until 5:35 or so (and her outburst began at the time when the lorazepam usually kicks in, although the dose is lower now than it used to be and it's not always predictable).  Or could such a small reduction in the duloxetine cause this? I'm finding that hard to imagine.

...

Prior to 5pm today she had a really good day. She even went to the store and had only very minor problems. She used the cart at the store to steady herself and you wouldn't have known she had Parkinson's (or any problem except being old) from looking at her.

Also I didn't mention previously that she takes Oxycodone 5/325 for her back pain (4 a day), and buspar (10mg 3 times a day) to help with the anxiety.  (She's also on a whole bunch of other medicines for various other things, but I don't know how helpful it would be to list them all. Her Parkinson's meds can cause similar problems also.)

...

I was going to try to reduce her lorazepam 1/16 of a pill tomorrow, but now I'm holding off on that. I was thinking of moving part of her daytime dose to her bedtime dose tonight.  She usually takes 5/8 at bedtime, and 1/4 at 10AM.  I was thinking of giving her 6/8 at bedtime, and 1/8 at 10am tomorrow.  (Her new neurologist originally wanted me to keep her bedtime dose at 1mg, but it was so hard to reduce her daily dose without major problems that cutting her bedtime dose had the least negative impact.)  I may have to move the rest of her daytime doses up an hour just in case tomorrow and then slowly spread them back to her normal times throughout the week.

...

Thanks for reading this.  I'm feeling a bit frazzled and have no one to talk to but a few family members who don't understand what I'm dealing with.  (I'm an only child taking care of both parents; dad has heart failure, PTDS, diabetes, manic depression, and stopped taking his lithium and sertraline two years ago and refuses to go to a psychiatrist.) Should I take 18 beads out for tomorrow or wait or what?


#42 gail

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Posted 01 August 2016 - 07:55 AM

I would say hold off on reducing lorazepam and cymbalta. No hurry!

That is a lot of weight on your shoulders, take care of yourself.

#43 fishinghat

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Posted 01 August 2016 - 08:28 AM

Gail's right. Let her stabilize. I really would advise dropping both meds at the same time. Way to much for her especially at her age. Patience.


#44 greyeyed123

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Posted 01 August 2016 - 10:40 AM

Thanks for the advice and support. I didn't mean to sound like the sky was falling--she did have a very good day yesterday until 5.  Once she calmed down I think I was more anxious than she was.  I think the nortriptyline is starting to do something. Her mood seemed stable and even a little upbeat at times (before 5 yesterday), although her memory seems a little disrupted...in a way different than the lorazepam disrupts it.  Now she will forget something and almost immediately remember part of it, and get herself back to remembering whatever it is. With the lorazepam, she forgets and it's gone...at least for a few minutes.  And it was much worse when she was on more of it. Four or five months ago, she couldn't follow a tv program, didn't really react to anything to show she was understanding it. Now she's laughing at commercials (at the right spots) and asking questions about this or that on the screen, and I attribute all of that to reducing the lorazepam. (She's also noticeably walking and talking much, MUCH better.) It's just damn hard getting through the "reducing" part.


#45 Carleeta

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Posted 01 August 2016 - 11:09 AM

All I can say is God Bless you.  You are an amazing child to your parents.  It's very difficult these days to see such an amazing child help out their parents.  You are simply and angel.

 

I do agree with Fishinghat and Gail, as to leave things in place right now and to not change anything.  Let mom stabilize right now because there truly is no hurry. 


#46 greyeyed123

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Posted 01 August 2016 - 11:38 AM

The only change I made was to take 1/8 of her lorazepam for her 10AM dose today (which is usually 1/4) and moved it to her bedtime dose last night (so now her bedtime dose is 3/4).  She's been doing very well in the morning and early afternoon for at least a month, maybe two, so I don't think this will have a major impact. But if she starts having difficulty, I'll just move all her other doses up an hour or two for a while. I've done that before with no problem.

...

She's gotten so much better these last 3-4 months that I get really scared of backsliding, especially if it's for something preventable that I just don't see or know about.  I am very grateful we have a new neurologist. The last one only had 5 years experience and...was not as competent as I would have liked. I won't go into it or I'll end up writing another 10 paragraphs.


#47 greyeyed123

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Posted 02 August 2016 - 11:06 AM

Got through yesterday with very little problem.  After 1pm she seemed to be having a little bit of interdose lorazepam withdrawal, so I moved our 4pm, 7pm, and bedtime doses up one hour (to 3, 6, and 8pm). She started to show some anger/frustration at 4:30, but it only lasted a minute or 2.  She even sat on her shower chair and gave herself a bath last night before bed. She is complaining a bit more of pain in her feet and legs, and her stomach seems upset more often, especially in the morning. She takes omeprazole since complaining of a burning stomach a couple of months ago, but they did the "blow in a bag" test and said she didn't have any ulcers. She still complains of the burning, though. I suspect her Parkinson's meds are causing that. We see her family doctor tomorrow, so we'll see what they say this time. Hope today is a good day also.


#48 fishinghat

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Posted 02 August 2016 - 06:50 PM

Yes the Cymbalta withdrawal will mess with the old digestive tract. By the way Omeprazole is NOT to be used with Cymbalta as it interfers with uptake of the Cymbalta. Zantac is the medicine my drs have recommended for that.


#49 greyeyed123

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Posted 02 August 2016 - 07:42 PM

She had terrible constipation for months and months (sitting on the toilet for hours a day, often crying), but they told us it was a combination of the Parkinson's itself and opiod constipation from the oxycodone.  I started buying Movantik (because the insurance wouldn't cover it) in April or May, and it helped enough for me to keep buying it but she still needed to take lactulose and occasionally phillips (in addition to 4-5 capfulls of miralax, 4-5 stool softeners, and whatever else would seem to work).

...

But around the end of June her constipation improved markedly. She stopped asking me for lactulose and phillips altogether, and she says she is still taking one or two stool softeners each day but I've never seen her take one. I mix a bottle of 2 caps of miralax, and six small scoops of benefiber, and that seems to work.  I asked her general doctor at our last appointment if he thought it might have been from the lorazepam, and he said it was possible. Otherwise I am at a loss as to how or why it resolved.  (It seemed to resolve in the middle of reducing the lorazepam.)

...

We have a family doctor appointment tomorrow, so I'll ask him about the omeprazole.

...

We've had several appointments at the local pain clinic due to her slipped disks which cause back and leg pain, and they inserted a Nevro spinal stimulator for a week's trial in May. But they wrapped her in a very tight Velcro girdle to hold everything in place for the trial, and she just couldn't wear it. She was still having terrible constipation at that point, and belly bloat, plus she's fairly sensitive to any new discomfort. They said we could take the girdle off, just be careful with the wires, etc, but she was going to the bathroom dozens of times a day (her bladder problems are better now with a new medication also, but she also had the constipation problems at the time). One of the two wires came loose from her back at some point, she got no pain relief, and the insurance company considers it a "failure" so won't authorize another trial. The doctor said we could try something similar through a different company, which is what we're doing next week, and the insurance company would have to cover it. I am disappointed, however, because we were told the Nevro implant was the gold standard, and she tried a Medtronic implant years ago that did nothing. (The new one she's getting is through Boston Scientific.)

...

My sense is that her pain is bad (she always says 7-8 on scale to 10), but her brain changes from the Parkinson's has caused depression and anxiety, which has caused any pain she has to feel much worse. 


#50 fishinghat

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Posted 03 August 2016 - 08:24 AM

Just FYI...

omeprazole ↔ duloxetine

Applies to:omeprazole and Cymbalta (duloxetine)

Coadministration of enteric-coated duloxetine with substances that raise gastrointestinal pH may result in earlier release of duloxetine from the formulation. The enteric coating is intended to resist drug dissolution until reaching a segment of the gastrointestinal tract where the pH exceeds 5.5. However, coadministration with aluminum- and magnesium-containing antacids (51 mEq) or famotidine has been shown to have no significant effect on the rate or extent of duloxetine absorption following administration of a 40 mg oral dose. It is unknown whether concomitant administration of proton pump inhibitors would affect duloxetine absorption.


#51 fishinghat

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Posted 03 August 2016 - 08:40 AM

https://www.ncbi.nlm...tacids Cymbalta

Clin Pharmacokinet. 2011 May;50(5):281-94. doi: 10.2165/11539240-000000000-00000.

Duloxetine: clinical pharmacokinetics and drug interactions.

Knadler MP1, Lobo E, Chappell J, Bergstrom R.
Author information
⦁ Abstract
Duloxetine, a potent reuptake inhibitor of serotonin (5-HT) and norepinephrine, is effective for the treatment of major depressive disorder, diabetic neuropathic pain, stress urinary incontinence, generalized anxiety disorder and fibromyalgia. Duloxetine achieves a maximum plasma concentration (C(max)) of approximately 47 ng/mL (40 mg twice-daily dosing) to 110 ng/mL (80 mg twice-daily dosing) approximately 6 hours after dosing. The elimination half-life of duloxetine is approximately 10-12 hours and the volume of distribution is approximately 1640 L. The goal of this paper is to provide a review of the literature on intrinsic and extrinsic factors that may impact the pharmacokinetics of duloxetine with a focus on concomitant medications and their clinical implications. Patient demographic characteristics found to influence the pharmacokinetics of duloxetine include sex, smoking status, age, ethnicity, cytochrome P450 (CYP) 2D6 genotype, hepatic function and renal function. Of these, only impaired hepatic function or severely impaired renal function warrant specific warnings or dose recommendations. Pharmacokinetic results from drug interaction studies show that activated charcoal decreases duloxetine exposure, and that CYP1A2 inhibition increases duloxetine exposure to a clinically significant degree. Specifically, following oral administration in the presence of fluvoxamine, the area under the plasma concentration-time curve and C(max) of duloxetine significantly increased by 460% (90% CI 359, 584) and 141% (90% CI 93, 200), respectively. In addition, smoking is associated with a 30% decrease in duloxetine concentration. The exposure of duloxetine with CYP2D6 inhibitors or in CYP2D6 poor metabolizers is increased to a lesser extent than that observed with CYP1A2 inhibition and does not require a dose adjustment. In addition, duloxetine increases the exposure of drugs that are metabolized by CYP2D6, but not CYP1A2. Pharmacodynamic study results indicate that duloxetine may enhance the effects of benzodiazepines, but not alcohol or warfarin. An increase in gastric pH produced by histamine H(2)-receptor antagonists or antacids did not impact the absorption of duloxetine. While duloxetine is generally well tolerated, it is important to be knowledgeable about the potential for pharmacokinetic interactions between duloxetine and drugs that inhibit CYP1A2 or drugs that are metabolized by CYP2D6 enzymes.

http://www.ncbi.nlm..../pubmed/9224780

Drug Metab Dispos. 1997 Jul;25(7):853-62.

Evaluation of omeprazole and lansoprazole as inhibitors of cytochrome P450 isoforms.

Ko JW1, Sukhova N, Thacker D, Chen P, Flockhart DA.
⦁ Abstract
The human clearance of omeprazole and lansoprazole is conducted primarily by the hepatic cytochrome P450 (CYP) system.


#52 greyeyed123

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Posted 03 August 2016 - 09:50 AM

I'm not sure what to make of yesterday/last night.  She didn't have any outbursts, but her pain seems worse, her memory seems worse, and she was having some confusion that was lasting longer than usual. She talked in her sleep much of the night. Usually it stops at 4 (when it's a worse night), but she went until 5 this time. Her constipation seems to be back. She starting some of the strange behavior she had last summer during the Lyrica withdrawal--complaining about wrinkles in her bed, making sure her feet are covered up (they always are), needing help in and out of bed, turning the heater on in the bathroom, wanting me to follow her from bed to the bathroom "just in case", complaining of foot and leg pain more often.  I'm beginning to think this nortriptyline isn't going to work.  Her hearing has been getting worse over the last 6 or 8 months, but the last few days it seems even worse. She's also complaining of headaches on the top of her head (never had that before at all).  She may have gained some weight also, but she was gaining a little before the switch so I'm not sure. (She lost 20+ during her Lyrica withdrawal last summer and just recently started gaining a little back.)

...

Not that many days ago I was astonished that she said she could go to the bathroom with just her socks (she always wants both socks and slippers because of foot pain).  Now she wants both again, and needs help getting in and out of bed again.  Maybe this med change was a mistake.  We have a doctor's appointment today, so I'll talk to him about it.


#53 fishinghat

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Posted 03 August 2016 - 10:07 AM

Med changes are difficult for anyone but especially the elderly. I have read so many articles on that. This is one situation where I have sympathy for the drs. There is no set pattern for us age-challenged people.


#54 greyeyed123

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Posted 03 August 2016 - 11:42 AM

Well, she got up on her own about 30 minutes ago and seems completely fine--walking without her walker, not shaking or breathing strangely, not complaining about her pain (yet), seems clear headed.  But she's usually better in the morning anyway.  Maybe the lorazepam is interacting differently with the nortriptyline in the afternoon/evening (she takes almost no lorazepam in the morning now), or maybe it's just a med adjustment as you said.  I wish I knew.


#55 fishinghat

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Posted 03 August 2016 - 01:55 PM

From drugs.com...


Applies to:

nortriptyline, lorazepam

Using nortriptyline together with LORazepam may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns.


#56 greyeyed123

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Posted 03 August 2016 - 02:43 PM

I have the drug interactions tab always open on my computer. The thing is, she has many interactions that say the very same thing, ie "dizziness, drowsiness, confusion," etc.  They generally involve oxycodone, lorazepam, buspar, duloxetine, nortriptyline...and her Parkinson's meds, sinemet, entacapone, and amantadine.  So they are either medications she has to have to function (that's how we ended up on them to begin with), or can't easily stop without worse consequences.

...

I talked with her this morning about her confusion yesterday, but she doesn't remember, at least not specific instances.  I know her memory and thinking improved greatly when we were reducing the lorazepam, but now that we added the nortriptyline it seems something has changed, at least in the afternoon and evening (when she takes her doses of lorazepam).  She also takes her duloxetine around 10AM, so maybe there could be an interaction there by afternoon/evening; the interaction list gives that as a "Major" possible interaction with "serotonin syndrome"--she has two or three of those symptoms, but overall it doesn't seem to fit...and she's had some of those symptoms for more years than she's taken the medications. She did have many fainting episodes a few months ago, which is apparently common with Parkinson's and Parkinson's meds, but that resolved by dropping metoprolol entirely and adding more salt to her diet to raise her blood pressure. She hasn't fainted in two or three months now.

...

I've made a list of questions for her family doctor today, so maybe he'll have some insight. It will also be interesting to see how she is in the afternoon and evening today and the next few days. If the nortriptyline is building up in her system now, maybe a possible interaction with lorazepam will continue.  If not, maybe it was something else...or maybe her system needs to adjust.

...

It's 12:30 now and she still seems to be doing ok. She's complained about her side hurting, but I think that's either the ongoing constipation or irritation from one of her meds--probably one she can't stop taking, so we're kind of stuck (I've read that the Parkinson's meds can cause irritation in the GI tract, especially after taking them for as long as she has been). She doesn't like either of those two answers, but I do know that whenever she had the constipation problems before, once we started to get her insides moving the pain got better, even if it didn't go away, and when she says a specific pain is "better" I *know* it is because she so rarely says anything is better (even when it's an outward symptom like walking or talking or whatever, she will rarely say it's "better" when everyone can see that it is).


#57 fishinghat

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Posted 03 August 2016 - 05:48 PM

Hi Greyeyed

 

I think your first paragraph summed it up well. With that many of those type medications the adverse effects she is having may have no other alternative unless you can find some way to get her of or down on some of the doses. It is a tough call to decide which ones and how much to reduce. Especially when all of us are different and considering her age. I sympathize with your situation. With so many variables it will be a tough task.


#58 greyeyed123

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Posted 03 August 2016 - 07:33 PM

I think we'll be tapering back onto the duloxetine.  Her family doctor said to just leave her at 60mg duloxetine and 75 nortrip, and if she isn't better in a couple weeks to start tapering back to duloxetine from the nortriptyline.  But she started to have another outburst in the car on the way home, so I don't see any reason to wait. She's complaining about pain in her legs and feet and butt, all the things she complained about when we reduced the duloxetine previously. I just gave her a 30mg capsule in hopes it will help for the evening.  She's been crying steadily for 30 minutes.

...

I'm thinking of giving her 50 nortriptyline tonight instead of the 75 (she has already gotten almost 90 of the duloxetine for today now).

For the next week I was thinking of 50 notrip and 90 duloxetine.

Then the next week 25 and 120.

Then the next week 120 again.

...

Does that sound too fast?  She was doing so much better before starting the nortrip. I don't know what to do about her spinal stimulator. The timing of the pain clinic always seems to be the absolute worst possible time for her.  Maybe they can postpone it.


#59 fishinghat

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Posted 04 August 2016 - 08:34 AM

Maybe a little fast but not bad. I am afraid she will have some more bad days before things get better. Don't let the emotional swings get to you. It is very common. It should pass.


#60 greyeyed123

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Posted 04 August 2016 - 09:30 AM

She stopped crying 45 minutes after I gave her the 30mg duloxetine last night, then she was fine for the rest of the evening. She did talk on and off all night, but not as loudly or as often.  I'm hoping switching back eventually helps with that also. I'm thinking there is some kind of interaction between the lorazepam and the nortrip in the afternoons, but we can't cut the lorazepam fast enough to find out anyway. Plus she's having other side effects she didn't have before, an the lower body pain is worse.

...

I'm thinking that since she's only been on the nortrip a short time, the withdrawal shouldn't be too bad. Is that right?





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