Hey Michele, I have all the drug interactions done. I put it on my desktop to
send to you cuz it is so big. Please let me know how I can get it to you. I
didn't list side effects because it would be easier to list what side effects
there are not. Just the interactions are extensive enough. I didn't list the
pred cuz i put all that in another post. I think we'd all be interested to hear your findings Lorster. Do you think some of her medications are causing her extensive problems? Thanks so much!!! Would email be the easiest? Its michelebrake@sbcglobal.net
I saw the actual pain doctor yesterday for the trigger point injections and she is going to call the rheumy and talk to her. Apparently there is a web site that only drs use and they can post about difficult patients and she asked my permission. They don't give patients name or personal info, just white female, 36 < size="19" ="text">, blah sort of thing so I said SURE!
She admitted she really didn't know for sure what was going on either but promised to do some more research before my next appt with her June 13. In the meantime, she increase the water pill to 50mg.
I am not sure the tpi's really helped much. When she pressed the trigger points I only had minimal referred pain. I got 6 of them in my lower back. I guess we will see.
The massage therapist was concerned though because my neck was so swollen and HOT. She said she would tell the doctor.
The pt guy worked on some muscle con strictures in my knees and arms and man, am I bruised and hurting today!
Overall though, I am seeing a general improvement.
prednisone
bc pill
spirolactone
nystatin
cymbalta
miralax
Oxycontin
xanax
zanaflex
previcid
ambien
Rare but serious side effects of Birth Control Pills
Blood clots_BCPs can make women slightly more prone to form blood
clots. A blood clot can occur in a vein or artery and can have different
symptoms depending on where it forms. Clots can occur in the legs,
abdomen, heart, lungs, eye, or brain. In the brain, a clot could manifest
as a stroke. The risk of these events occurring is very low, but increases
in women over 35, in smokers, and in those with high blood pressure,
heart disease, diabetes, clotting tendency, or a family history of clotting
abnormalities. The warning signs of a blood clot spell out the word
ACHES:
0. Abdominal pain
0. Chest pain (also shortness of breath)
0. Headaches (especially those that are new, severe, or associated with
persistent dizziness, difficulty speaking, fainting,numbness or weakness
in extremities
0. Eye problems (blurred vision or loss of vision)
0. Severe leg pain (and/or redness and swelling in the calf or thigh)
0. If you develop any of the ACHES side effects or jaundice (a yellowing of
the eyes or skin) while on BCPs, call Health Services right away at
863-1330. If you need emergency medical attention, call EMS at
863-4111. If you are out of town, contact a local health provider or go to
a hospital emergency room.
0. High blood pressure_BCPs can raise your blood pressure.
Aldactone Interactions:
DRUG INTERACTIONS: Tell your doctor of all medications you may use
(both prescription and nonprescription) especially of: other diuretics
("water pills" such as amiloride or triamterene), lithium, digoxin,
potassium supplements, cyclosporine, mitotane, ACE inhibitors (e.g.,
lisinopril, captopril, enalapril), NSAIDs (e.g., ibuprofen, naproxen). Aspirin
may decrease the effects of spironolactone. Many nonprescription
products contain aspirin. Consult your pharmacist if you are uncertain
your nonprescription medicines contain aspirin. This medication may
increase your potassium levels. Consult your doctor or pharmacist before
using potassium-containing products (salt substitutes or potassium
supplements) or large amounts of potassium-containing foods (e.g.,
bananas, potatoes). Do not start or stop any medicine without doctor or
pharmacist approval.
use, there was no indication of drug-seeking behavior in the clinical
trials. However, it is not possible to predict on the basis of premarketing
experience the extent to which a CNS active drug will be misused,
diverted, and/or abused once marketed. Consequently, physicians should
carefully evaluate patients for a history of drug abuse and follow such
patients closely, observing them for signs of misuse or abuse of Cymbalta
(e.g., development of tolerance, incrementation of dose, drug-seeking
behavior).
Cymbalta May Have a Clinically Important Interaction with the Following
Other Drugs:
Alcohol
When Cymbalta and ethanol were administered several hours apart so
that peak concentrations of each would coincide, Cymbalta did not
increase the impairment of mental and motor skills caused by alcohol. In
the Cymbalta clinical trials database, three Cymbalta-treated patients had
liver injury as manifested by ALT and total bilirubin elevations, with
evidence of obstruction. Substantial intercurrent ethanol use was present
in each of these cases, and this may have contributed to the
abnormalities seen (see PRECAUTIONS, Hepatotoxicity).
CNS Acting Drugs
Given the primary CNS effects of Cymbalta, it should be used with caution
when it is taken in combination with or substituted for other centrally
acting drugs, including those with a similar mechanism of action.
Serotonergic Drugs
Based on the mechanism of action of SNRIs and SSRIs, including Cymbalta
and the potential for serotonin syndrome, caution is advised when
Cymbalta is coadministered with other drugs that may affect the
serotonergic neurotransmitter systems, such as triptans, linezolid (an
antibiotic which is a reversible non-selective MAOI), lithium, tramadol, or
St. John's Wort (see WARNINGS, Serotonin Syndrome). The concomitant
use of Cymbalta with other SSRIs, SNRIs or tryptophan is not
recommended (seePRECAUTIONS, DRUG INTERACTIONS).
Triptans
There have been rare postmarketing reports of serotonin syndrome with
use of an SSRI and a triptan. If concomitant treatment of Cymbalta with a
triptan is clinically warranted, careful observation of the patient is
advised, particularly during treatment initiation and dose increases (see
WARNINGS, Serotonin Syndrome).
Potential for Interaction with Drugs that Affect Gastric Acidity
Cymbalta has an enteric coating that resists dissolution until reaching a
segment of the gastrointestinal tract where the pH exceeds 5.5. In
extremely acidic conditions, Cymbalta, unprotected by the enteric
coating, may undergo hydrolysis to form naphthol. Caution is advised in
using Cymbalta in patients with conditions that may slow gastric
emptying (e.g., some diabetics). Drugs that raise the gastrointestinal pH
may lead to an earlier release of duloxetine. However, co-administration
of Cymbalta with aluminum- and magnesium-containing antacids (51
mEq) or Cymbalta with famotidine, had no significant effect on the rate or
extent of duloxetine absorption after administration of a 40-mg oral
dose. It is unknown whether the concomitant administration of proton
pump inhibitors affects duloxetine absorption.
Monoamine Oxidase Inhibitor
Interactions with oxycodones
All prescription and nonprescription/herbal products you may use,
especially of: other medications for pain (e.g., butorphanol, codeine,
pentazocine, tramadol), anti-seizure drugs (e.g., carbamazepine),
anticholinergic medications (e.g., atropine, scopolamine), drugs affecting
removal of oxycodone from your body (e.g., cimetidine, SSRI
antidepressants such as fluoxetine), drugs that lower blood pressure
(e.g., diuretics such as hydrochlorothiazide, furosemide), MAO inhibitors
(e.g., furazolidone, isocarboxazid, linezolid, phenelzine, procarbazine,
selegiline, tranylcypromine), muscle relaxants (e.g., carisoprodol,
methocarbamol), pyridostigmine, sodium oxybate. Tell your doctor or
pharmacist if you also take drugs that cause drowsiness such as:
antihistamines that cause drowsiness (e.g., diphenhydramine), anti-
anxiety drugs (e.g., diazepam), medicine for sleep (e.g., sedatives),
psychiatric medicines (e.g., phenothiazines such as chlorpromazine, or
tricyclic antidepressants such as amitriptyline), tranquilizers. Check the
labels on all your medicines (e.g., cough-and-cold products) because
they may contain drowsiness-causing ingredients. Ask your pharmacist
about the safe use of those products. This product can affect the results
of certain lab tests. Make sure laboratory personnel and your doctors
know you use this drug.
What drugs will affect Xanax?
Before taking Xanax, tell your doctor if you are using any of the following
drugs:
0. birth control pills;
0. cimetidine (Tagamet);
0. diltiazem (Tiazac, Cartia, Cardizem);
0. isoniazid (Nydrazid, Rifamate);
0. propoxyphene (Darvon, Darvocet);
0. seizure medication;
0. antibiotics such as fluconazole (Diflucan), itraconazole (Sporanox) or
ketoconazole (Nizoral); or
antidepressants such as fluvoxamine (Luvox), desipramine (Norpramin),
or imipramine (Janimine, Tofranil).
DRUG INTERACTIONS of Zanaflex
in vitro studies of cytochrome P450 isoenzymes using human liver
microsomes indicate that neither tizanidine nor the major metabolites are
likely to affect the metabolism of other drugs metabolized by cytochrome
P450 isoenzymes.
Fluvoxamine
The effect of fluvoxamine on the pharmacokinetics of a single 4 mg dose
of tizanidine was studied in 10 healthy subjects. The Cmax, AUC, and
half-life of tizanidine increased by 12-fold, 33-fold, and 3-fold,
respectively. These changes resulted in significantly decreased blood
pressure, increased drowsiness, and increased psychomotor impairment.
(See CONTRAINDICATIONS and WARNINGS).
Ciprofloxacin
The effect of ciprofloxacin on the pharmacokinetics of a single 4 mg dose
of tizanidine was studied in 10 healthy subjects. The Cmax and AUC of
tizanidine increased by 7-fold and 10-fold, respectively. These changes
resulted in significantly decreased blood pressure, increased drowsiness,
and increased psychomotor impairment. (See CONTRAINDICATIONS and
WARNINGS).
CYP1A2 inhibitors
The interaction between tizanidine and either fluvoxamine or
ciprofloxacin is most likely due to inhibition of CYP1A2 by fluvoxamine or
ciprofloxacin. Although there have been no clinical studies evaluating the
effects of other CYP1A2 inhibitors on tizanidine, other CYP1A2 inhibitors,
including zileuton, other fluroquinolones, antiarrythmics (amiodarone,
mexiletine, propafenone, and verapamil), cimetidine and famotidine, oral
contraceptives, acyclovir, and ticlopidine may also lead to substantial
increases in tizanidine blood concentrations. Concomitant use of
tizanidine with CYP1A2 inhibitors should ordinarily be avoided. If their
use is clinically necessary, they should be used with caution (see
WARNINGS).
Acetaminophen
Tizanidine delayed the Tmax of acetaminophen by 16 minutes.
Acetaminophen did not affect the pharmacokinetics of tizanidine.
Alcohol
Alcohol increased the AUC of tizanidine by approximately 20%, while also
increasing its Cmax by approximately 15%. This was associated with an
increase in side effects of tizanidine. The CNS depressant effects of
tizanidine and alcohol are additive.
Oral Contraceptives
No specific pharmacokinetic study was conducted to investigate
interaction between oral contraceptives and tizanidine, but retrospective
analysis of population pharmacokinetic data following single and multiple
dose administration of 4 mg tizanidine showed that women concurrently
taking oral contraceptives had 50% lower clearance of tizanidine that
women not on oral contraceptives.
What drugs will affect Prevacid?
Before taking Prevacid, tell your doctor if you are using any of the
following drugs:
0. theophylline (such as Elixophyllin, Respbid, Slo-Bid, Theobid,
Theoclear, Theo-Dur, Uniphyl);
0. digoxin (Lanoxin, Lanoxicaps);
0. ampicillin (Omnipen, Principen);
0. ketoconazole (Nizoral);
0. iron (Feosol, Mol-Iron, Fergon, Femiron, others); or
a blood thinner such as warfarin (Coumadin).
What drugs will affect Ambien?
Before taking Ambien, tell your doctor if you are using any of the
following drugs:
0. itraconazole (Sporanox);
0. rifampin (Rifadin, Rimactane, Rifater);
0. antidepressants such as imipramine (Janimine, Tofranil), fluoxetine
(Prozac, Sarafem), or sertraline (Zoloft); or
narcotic pain medications, muscle relaxers, seizure medications, or anti-
anxiety medications.
Michele, the side effects were so numerous, it would have taken days to
print it all. Lets just say that every single side effect that there could be, was
listed. Most of these meds can really affect sex drive. I wanted to go to the
PDR but the last two shifts I worked were the shifts from hell so I didn't get
a chance and they didn't have an extra copy for me to bring home. I"m sure
the PDR will list more interactions than this. I hope this helps.Ack, no wonder I feel so toxic!!
Ack!! I found the same things Lorster did. i don't know what you can give up either Michele, but something has to go. You don't just feel toxic..you are toxic!!!
Please let us know what your doc says.
Well, you certainly cannot do it quickly or abruptly. You will have to go slowIsn't it a big no no to stop anti depressants and anti anxeity meds cold turkey? I have heard different things about that but always thought you have to wean off of them.
How would the doc approach this? One med at a time? Which one first? Go by what is causing the most side effects and interactions??
Personally, I think I will probably always need some sort of ad. The cymbalta seems to have finally started working after we increased the dose to 60mg. I would like to cut back the xanax and zanaflex but I tense so much in my sleep, I have splints and an expensive bit guard so I don't dislocate my jaw. I am just at a loss. I am hopeful though the new rheumy I see on Monday has some useful advice.