1636 replies to this topic

[ForLyla]

I have to say the elemental diet is tough for someone in withdrawal with the high intake of sugar throughout the day. Withdrawal makes treatment so much worse. Not sure how to get around this as I need enough easily digestible calories.

[fishinghat]

Definitely a catch 22 situation you are in. With Cymbalta Withdrawal and its serotonin issues and fighting sibo at the same time. A bad combination.

 

Prayers and best wishes my friend.

[ForLyla]

Day 3 of almost a full elemental liquid diet with a bit of chicken and white rice for dinner. Feeling very lightheaded, heart pounding and really faint sometimes. Any ideas why this would be? I think I'm getting enough sodium but definitely not potassium. Wonder if that could be it.

[fishinghat]

Possibly the potassium. Do you have a way of checking your bp during these events?

[ForLyla]

Hey guys my doctor prescribed me prucalopride and I definitely want to try it. I cant find any interactions with cymbalta but wanted to run it by you FH and anyone else that might know.

Still doing the elemental diet but full liquid now. Symptoms have improved but way too early to tell.

[fishinghat]

https://www.drugs.co...-succinate.html
Substrate of CYP3A4,1 P-glycoprotein (P-gp),7 and breast cancer resistance protein (BCRP) in vitro.7
Low potential to inhibit CYP isoenzymes 1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, 2E1, and 3A4 or to induce CYP isoenzymes 1A2, 2B6, and 3A4 at clinically relevant concentrations.


Oh well, maybe. as they say, the effect will be light

[ForLyla]

But FH it works on 5HT receptors so doesnt it have to effect it?

[fishinghat]

Cymbalta works on 5ht2 and 6 receptors and prucalopride works on 5ht 4 receptors so there shouldn't ba any competition.

[ForLyla]

Thanks FH.

[ForLyla]

So precalupride... took a pill last night and woke up with crazy anxiety and heart pounding. Sigh . Might move on to the natural route of ginger and artichoke. Also increasing magnesium intake which doesnt seem to affect me too badly.

[fishinghat]

A shame but hang in there.

[ForLyla]

So I'm back to square one... again! The all liquid diet doesnt seem to have done anything for me but make me worse actually. I really need to get off of cymbalta. I met up with a psychiatrist that said I can do a crossover. FH do you remember how you did a cross taper? I'd love if you can share your experience doing it.

[fishinghat]

There are two approaches to cross overs.

 

1) Stop the Cymbalta cold turkey and then start on a low dose of the new AD with an increase in dose each week for 4 to 6 weeks. This reduces the chance of serotonin syndrome but there can be some serious issues with the withdrawal until the new AD kicks in.  

 

2) Slowly taper off the Cymbalta and slowly increase the new AD over a 4 to 6 week period. This provides for less withdrawal but an increase in the risk of serotonin system. I have always chosen method number 2 and have had no issues except for temporary withdrawal (albeit significant).

[fishinghat]

Remember that if you go from an snri like Cymbalta to an ssri like say Zoloft then it will not control the norepinephrine like Cymbalta did and you will be left with some anxiety to deal with until things settle down.

[invalidusername]

Remember that if you go from an snri like Cymbalta to an ssri like say Zoloft then it will not control the norepinephrine like Cymbalta did and you will be left with some anxiety to deal with until things settle down.

 

I can vouch for that having gone from Cymbalta back to Citalopram - took quite some time before the anxiety stopped, and then I was left with the physical residual effects.

[ForLyla]

This or just taper the cymbalta and stay off. However, I tried tapering at a rate of 10% a month 2 years ago and it sent me into severe withdrawal so I'd need to go even slower than that. I dont know if I have that much time. It's also not a given then the ssri will be easier to taper, is it?

[fishinghat]

Normally it is easier, especially Zoloft, Lexapro or Prozac. The problem is there is no guarantee that it will even be effective. I tried 3 before I found one that would work.

[ForLyla]

So perhaps the way to go is just to taper the cymbalta and deal with it. Perhaps I can figure out a 10 month taper. Taper slower in the beginning and quicker at lower doses. Another option is to stay where I am and take a fast action ppi despite the devastating consequences. Isnt the half life of pantoprazole like 1 hour? I dont understand why it would affect it so badly. I'm going to create a taper plan and I'll run it by you guys.

[fishinghat]

Pantoprazole half life is 1 to 3 hours depending on what research article you read.

I would say a 10 month taper and focus on then finding something that will help the symptoms.

[ForLyla]

Thanks FH. The prucalopride really did a number on me. Maybe even worse than ppi's. That drug has a 24 hour half life. Got no sleep last night. I can feel my heart thumping away.

[fishinghat]

Poor Lyla, my sympathy and prayers for you.

[ForLyla]

Sorry if this is TMI but ironically enough my bowels are working very well right now, maybe too well. I only took 3 doses of prucalopride and my last dose was 5 days ago. Shouldn't it be out of my system by now? It didn't work while I was on it but I'm curious as to it perhaps having a lagging effect or if my motility is working on its own right now. I really hope its the latter because then I wouldnt need to worry about taking anything. My sibo symptoms have been better the last couple days. Now if only I can make a quick recovery from the prucalopride then I'd be in pretty decent shape compared to where I was.

[fishinghat]

Prucalopride reaches max levels in the blood after 2.77 hours. Maximum blood levels would be achieved around 3 hours after the third dose. Once you stop taking it then it is 97% out of your system in 5 days.

[ForLyla]

I'm going back into war tomorrow. I'm going to take pantoloc sodium. No other choice at this point. I need to try everything. Wondering why pantoloc affects me so bad with such a short half life. I cant make sense of how these drugs work. They dont even work on the same liver enzymes.

This is all I can find and have no idea what it means...

"This irreversible binding means the effects ofpantoprazole last much longer than its short half-life, which is about one hour, would suggest because it takes roughly 24 hours for new proton pumps to be synthesized. Pantoprazole is, therefore, taken only once or twice per day.Jul 11, 2019"

[fishinghat]

Half life is based on the blood levels of the drug. How long for half your drug to leave your blood stream. They are saying that this does not really apply to pantoprazole because once it attached to its binding site it stays in place for a long period of time before being discarded. Most meds attach, cause a reaction, are discarded and excreted by not pantoprazole. It stays in place a lot longer.

[ForLyla]

FH oh so that's why it causes such terrible cymbalta withdrawals. So it doesnt leave your system for like 24 hours?

[fishinghat]

right!

[ForLyla]

Well I've taken 2 doses of pantoprazole again. Not feeling terrible yet but can feel the heart pounding coming on. Just gonna keep taking it until I cant stand it anymore. I really think my symptoms are from chronic gastritis and not from sibo. Though my sibo is a really bad case. Problem is that I start to go nuts from ppi's after just a few days and it takes about 4 weeks for it to cure the gastritis.

[fishinghat]

Hang in there Lyla. We are praying for you to make it.

[ForLyla]

Any anecdotal evidence that suggests melatonin is bad news with cymbalta? I've been taking it to help me sleep. I've been feeling kind of groggy the next day but no bad side effects so far after a few days. I'm back down on my cymbalta dose. Down 2% from where I was at a month ago and I'm staying here! It's not much but I'm not going to sneeze at 2% less poison I have to take every day. If I do ok, it will be 3% next month. Slowly but surely I'm getting off of this.