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Posted 8/29/2012 3:00 AM (GMT 0)
I had a Dr. appointment yesterday. He has changed my meds. from, 50mg. Amitriptylin a day and 500mg. Etodolac 2X a day to 100 mg. Tramadol 2x a day and 30 mg. Cymbalta a day. I am supposed to increase the Cymbalta to 60 mgs. after 2 weeks. Last night was the first time taking the new meds. (I have my alarm set for 7:30 am to get up to eat and take my meds). I fell asleep approx. 2 am last night and woke up for my alarm this morning, but don't remember eating or taking my meds. I went back to bed and didn't wake up until 6:00 pm. tonight. I am feeling really out of it since I woke up. It was too late to call the doctor. Has this sort of thing ever happen to anyone else, please let me know.

Margaret
Posted 8/29/2012 2:26 PM (GMT 0)
It is a bit concerning when I see a Dr. just take someone off of two medications abruptly and start two new ones.

Elavil should always be tirated down to prevent any terrible withdrawal symptoms. So PLEASE be careful...

With the Cymbalta...it is the same thing....do NOT just go cold turkey from this medication if for some reason it does not work later on for you.

When I was on Cymbalta...I had very good relief from my nerve pain. I used it for quite a few years.

Another thing to be careful of is Serotonin Syndrome. This has been known to happen with "some" people when on a SSRI or SNRI (which Cymbalta is) and Tramadol.

I would think that jumping to 200mg of Tramadol a day should put a very large dent in any pain that you have. Again, it is concerning that he started you so high on this medication when most people will start at 50mg a day and then tirate up to make sure how they tolerate the medication and side effects. As well as to keep tolerance low.

I was on 50mg for about 6 months before I moved to 100mg a day and then stayed on that for years.

Obviously we are all different and I am NOT a Dr. I am just reacting to what your Dr. is doing by just pulling you off certain meds and going on others with a large dosage. My Dr. has always changed one medication at a time and started slow so then we can see what is working and what isn't.

Please be very careful with any driving as in many states now, Tramadol is a controlled substance as well as it can cause drowsiness so don't want you getting into an accident.

I certainly hope things go well for you...keep us posted..
Posted 8/29/2012 5:44 PM (GMT 0)
Snowbunny 21, I am still taking the Amitriptyln, I am supposed to take 25mgs for 2 weeks, then stop. He said to take 1-2(1 is 50mgs Tramadol) in the morning and the evening, or I can take 1 in the morning, afternoon and evening. So that is between 100-200mgs of the Tramadol a day. I feel like I am hung over, I get sweaty, my fingers are tingly, I just feel BLAH. Does this sound like it is too much? Should I call the office and see if he made a mistake? I'm worried now!! And I would never even think about driving when I'm like this!!
Posted 8/29/2012 6:17 PM (GMT 0)
I'm glad to hear that he is tirating down the Elavil...

Again, because he is starting you on two different medications at once...The Cymbalta and Tramadol...it will be hard to tell which is giving you the side effects. This is why I was saying it was strange for him to be doing this instead of one medication at a time so you can specifically know what the side effects are and have them be more manageable.

Many medications will have side effects that will go away within a few weeks to a month. This is different than any severe actual allergic reaction.

So, it could be either the Cymbalta or the Tramadol causing you the sweaty, fingers and tingly sensation. When I first started the Cymbalta I was taking it in the morning...but because it made me jittery and caused sleeplessness....I moved to taking it in the evening before bed so I got a good night's sleep and helped with energy in the morning.

You can read the inserts that came with each medication about the side effects...

If it were me...I would certainly be using the least amount of Tramadol I could each day to start. Calling your Dr. to let them know of your side effects and your concerns is certainly fine and something I would do.

Again, for me, I started on only 50mg a day for the Tramadol and used this for 6 months until moving up to the 100mg a day and never went above that in a few years. Just because I was doing many other things to help my pain levels like exercise (walking 7 days a week 30-45 min), aqua therapy, yoga/stretching, physical therapy at home with stretchy bands and light weights, acupuncture, massage, ice, heat, TENS unit, no smoking (never have thankfully), eating well and maintaining a healthy weight, counseling to help deal with chronic pain...

And then the other medication of the muscle relaxer. This is something that I personally feel anyone who has Fibro should have on hand as an opiate does not work on muscle or nerve pain. So to take as needed to help those spasms very well.

Just to name some modalities. Because I know that the chronic pain is likely going to last a lifetime for me, I always want to use the least possible amount of any pain medication to avoid tolerance and tirating up quickly. So whenever I have Fibro pain...I use all the other "tricks" in the bag...LOL...or take a muscle relaxer and rest for a bit. This way I am not reaching for a pain med to do all the work.

Obviously these are just my own thoughts/suggestions living with Fibro for 17 years now.

Each person has to work out their own path of treatment with their Dr. I hope that you can figure out the best amount of meds to take and that the side effects will go away after a few weeks for you:)
Posted 8/30/2012 11:52 AM (GMT 0)
Thank you all for your input.
Posted 8/30/2012 2:14 PM (GMT 0)
My rheumatologist will only change one medication at a time. That way we know if there are bad side effects, know what caused them. Also in my experience in a pharmacy and a patient who also takes cymbalta 90mg a day....you should not take nsaid's for pain. Only tylenol. When I went on cymbalta he switched me to talwin nx . He said that ultram/tramadol and cymbalta could be fatal.
Posted 8/30/2012 2:33 PM (GMT 0)
Lucky...I have never heard of someone taking Cymbalta not being able to take NSAIDs like ibuprofen for pain at the same time? What is your Dr. saying is the issue with this?

With Cymbalta and Tramadol....there is a possibility of serotonin syndrome but it is rare. But it's always good to monitor symptoms...I was on that combo for over 3 years without a single issue. I also took Advil/ibuprophen as well as used Flector patches during that time and didn't have any problems as these are NSAIDs.

It is more dangerous and common with mixing a SSRI/SNRI and a MAOI....

So if you could please quickly elaborate (don't want to hijack thread) on ibuprophen and Cymbalta being an issue. If you have a link to any reputable websites for these studies that would be helpful...thanks:)
Posted 8/30/2012 4:35 PM (GMT 0)
Thanks Donna...I never had my Pharmacist or any Dr. have this as an issue but I guess if people have certain bleeding disorders, ulcers, or other issues it is of course best to speak with the Dr...

There are so many "potential" side effects with every single medication including over the counter that they have to list it even if one person has had an issue while taking them..

Thankfully I never had problems with serotonin syndrome or with the ibuprophen..
Posted 8/30/2012 4:44 PM (GMT 0)
Snowbunny...I got intestinal bleeding from mixing Advil with an SNRI...I never considered the mixture to be unsafe until I had this happen to me.   The possibilty of this happening was not listed in the insert...maybe it's too rare....but this was several years ago and I think drug companies are more careful in listing side effects now.

Donna

Posted 8/30/2012 6:12 PM (GMT 0)
Snowbunny,

I take oxycodone and it helps my pain. just for your fyi...

Hugs, Karen...

I do have muscle relaxers too if I need them. Flexeril and soma...

Have a great day!!!
Posted 8/30/2012 7:18 PM (GMT 0)
Ok Karen..thanks for sharing...LOL:)

I'm not sure if my post was misunderstood in some way and that is why you are referencing the Oxycodone?

I was only stating that opiates don't work for nerve or muscle pain...but they are good for overall pain as I am on them myself. I was just stating that those who have nerve pain....there are nerve pain meds that work for this...And with Fibro...the addition of having a muscle pain med around to take just in case is always good as muscle spasms are a big part of the symptoms many get.

An opiate is a medicine that hits our receptors in the brain that just makes us not care as much about the pain...but it doesn't relax muscles like a muscle relaxer actually does:)

So...I wasn't trying to say that opiates are bad in any way shape or form or they shouldn't be a part of anyone's treatment. I was only stating that with Fibro and other illnesses....a multi-faceted approach is always best...

Everyone needs to find what works best for them. Medicine is just one piece of the puzzle...

So I apologize if my post wasn't clear on all of that...
Posted 8/30/2012 8:21 PM (GMT 0)
I thought that oxycodone was an opiate. Or am I wrong? Just wondering...

Hugs, Karen...
Posted 8/30/2012 8:54 PM (GMT 0)
It is:)

I guess I'm still lost in that you were replying directly to me and I was trying to make sure that my other posts weren't misunderstood in saying that opiates are bad in any way shape or form..

So I'm a bit confused...LOL....Sorry if I am missing something...

I was only trying to help the member with saying that if she has nerve pain or muscle pain...that the opiate (in her case it's actually Tramadol which is opiate like) doesn't work for that type of pain and maybe she could speak with her Dr. about adding a muscle relaxer if she needs down the line...

Again...it's all about everyone finding the best treatments that work for them and if I somehow didn't make that clear in my posts....I apologize...

 

Post Edited (Snowbunny21) : 8/30/2012 2:57:48 PM (GMT-6)

Posted 8/30/2012 10:22 PM (GMT 0)
You didn't do anything wrong. I thought I was mixed up. Thanks for clarifying. Have a wonderful day!!!

Hugs, Karen
Posted 8/31/2012 2:28 AM (GMT 0)
I am learning so much on this forum. I am still new to fibro, I have taken so many different anti-inflammatories, muscle relaxers, and pain meds in the past not ever knowing what was really going on. When something didn't work the Dr. just tried something else, but it seems that nothing ever worked. Now I know I have to find the right combination. Thank you all so much for all your input, it is greatly appreciated. I am still wondering if I have the best Dr. for me, I guess only time will tell. It still worries me that he would change both my meds at one time, when you all say that your Dr.'s only change one at a time.

Margaret
Posted 8/31/2012 4:23 AM (GMT 0)
So are the Dr.'s on this website good or bad?
Posted 8/31/2012 12:03 PM (GMT 0)
I remember doing something like that. I don't remember where I looked now, but the Dr I was trying to see was not accepting new patients. The one that I am seeing was recommended by my PCP. I did find a site of top 19 dr.'s in the area, the one I was trying to get to see was rated #3 and the one I am seeing now is rated #6.

Margaret
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