Medicated Profile: Losec (Omeprazole)

Brand name(s): Prilosec, Losec, Antra, Gastroloc, Mopral, Omepral.

Generic name(s): Omeprazole.

Street name(s), if any: None.

Available form(s): Oral, IV (Europe only).

Available dose(s): 10mg, 20mg, 40mg, 80mg.

North American availability: Available by prescription only in Canada and the United States.

Class(es): Proton pump inhibitor.

Method(s) of action: Reduces gastric acid production.

Most commonly prescribed for: Dyspepsia, peptic ulcer disease, gastroesophageal reflux disease, laryngopharyngeal reflux, Zollinger-Ellison syndrome.

Also prescribed for: Elimination of Helicobacter pylori infections.

Possible side effect(s): Anaphylaxis, anaphylactic shock, angioedema, bronchospasm, interstitial nephritis, urticaria, fever, pain, fatigue, malaise, chest pain or angina, tachycardia, bradycardia, palpitations, elevated blood pressure, peripheral edema, gynecomastia, pancreatitis, anorexia, irritable colon, fecal discolouration, esophageal candidiasis, mucosal atrophy of the tongue, stomatitis, abdominal swelling, dry mouth, liver disease, liver necrosis, hepatic encephalopathy hepatocellular disease, cholestatic disease, mixed hepatitis, jaundice, elevations of liver function tests, hypoglycemia, hyponatremia, weight gain, muscle weakness, myalgia, muscle cramps, joint pain, leg pain, depression, agitation, aggression, hallucinations, confusion, insomnia, nervousness, apathy, somnolence, anxiety, abnormal dreams, tremors, paresthesia, vertigo, epistaxis, pharyngeal pain, toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, photosensitivity, rash, skin inflammation, pruritus, petechiae, purpura, alopecia, dry skin, hyperhidrosis, tinnitus, taste perversion, optic atrophy, anterior ischemic optic neuropathy, optic neuritis, dry eye syndrome, ocular irritation, blurred vision, double vision, hematuria, proteinuria, elevated serum creatinine, microscopic pyuria, urinary tract infection, glycosuria, urinary frequency, testicular pain, agranulocytosis, hemolytic anemia, pancytopenia, neutropenia, anemia, thrombocytopenia, leukopenia, leukocytosis.

Possibility of tolerance: None known.

Addictive potential: None.

Withdrawal potential: None (although underlying symptoms may return).

Withdrawal symptoms: None.

Potential for abuse/misuse: None.

Drug interaction(s): Omeprazole interferes with many antiretroviral drugs. It may interfere with the absorption of drugs that rely on certain gastric pH levels, such as Ketoconazole, Ampicillin esters, and iron salts. Dosage of drugs such as Cyclosporine, Disulfiram, and benzodiazepines may need to be adjusted. Simultaneous use of Omeprazole and Tacrolimus may increase serum levels of Tacrolimus.

Contraindication(s): Omeprazole is contraindicated in anyone who may have a hypersensitivity to any of its ingredients.

Overdose threshold: Unknown.

Symptoms of overdose: Confusion, drowsiness, blurred vision, tachycardia, nausea, vomiting, diaphoresis, flushing, headache, dry mouth.

Note: I am not a doctor, and the information I state on my blog is gathered from internet sources and physician’s handbooks. Therefore, it is important to speak to your doctor if you are unclear about something or if you have more questions that I am not qualified to answer.

Medication Profile: Chloral Hydrate

Brand name(s): Noctec, PMS-Chloral Hydrate, Somnote.

Generic name(s): Chloral Hydrate.

Street name(s), if any: Mickey Finn, Knockout Drops.

Available form(s): Oral, rectal suppository.

Available dose(s): Oral: 100mg/mL. Rectal: Unknown.

North American availability: Available in the U.S. and Canada by prescription only. Generic form in both U.S. and Canada; Noctec in the U.S. and PMS-Chloral Hydrate in Canada.

Class(es): Sedative, hypnotic.

Method(s) of action: Enhances the GABA receptor complex.

Most commonly prescribed for: Insomnia.

Also prescribed for: Minor medical/dental procedures.

Possible side effect(s): Disorientation, paranoia, incoherence, excitement, delirium, drowsiness, staggering gait, ataxia, lightheadedness, vertigo, dizziness, nightmares, malaise, mental confusion, hallucinations, leukopenia, eosinophilia, hives, erythema, eczematoid dermatitis, scarlatiniform exanthems, urticaria, gastric irritation, nausea, vomiting, flatulence, diarrhea, unpleasant taste, headache, hangover, idiosyncratic syndrome, ketonuria, uneven heartbeat, fainting, shallow breathing, weakness, lack of coordination, redness or drooping of the eyelids.

Possibility of tolerance: Moderate to strong.

Addictive potential: Moderate to strong (dependent on dose).

Withdrawal potential: Moderate to strong (dependent on dose).

Withdrawal symptoms: Similar to alcohol withdrawal, including agitation, anxiety, and tremor.

Potential for abuse/misuse: Strong.

Drug interaction(s): Warfarin: Chloral Hydrate can increase the rate at which Warfarin is metabolized, thus reducing its efficiency.
Furosemide: When administered intravenously, can cause sweating, hot flashes, and variable blood pressure.
Other sedatives: Chloral Hydrate has an additive effect on other sedatives, including alcohol.

Contraindication(s): Chloral Hydrate is contraindicated in patients with significant renal or hepatic impairment, severe cardiac disease, gastritis (oral form only), and in patients who have a hypersensitivity or allergy to it.

Overdose threshold: Estimates vary, but one source lists the average overdose rate as 10g (100mL). However, deaths have been reported after ingestions of just 4g, and there is at least one documented case of survival after ingestion of 30g.

Symptoms of overdose: Hypothermia, pinpoint pupils, drop in blood pressure, coma, slow or rapid and shallow breathing, vomiting, gastric necrosis, icterus, albuminuria.

Note: I am not a doctor, and the information I state on my blog is gathered from internet sources and physician’s handbooks. Therefore, it is important to speak to your doctor if you are unclear about something or if you have more questions that I am not qualified to answer.

Cymbalta Withdrawal Forums + Bruxism

While I was doing research for my latest medication profile, I stumbled upon cymbaltawithdrawal.com, a website started by someone who presumably went through the trials of Cymbalta withdrawal and the associated SSRI/SNRI discontinuation syndrome. It’s an open forum for other people who are going through the same experience, and people are free to discuss what’s going on for them during the withdrawal period. This website is a bit of a grim view into the future for me; if Cymbalta turns out to be just like all the other drugs I’ve tried (failures), then one day I’ll have to stop taking it and will probably suffer from the discontinuation syndrome. However, my pharmacist told me that Cymbalta withdrawal is apparently not as bad as Effexor (Venlafaxine) withdrawal, which I have also been through. If she’s right, then I think I should be able to manage.

Bruxism. Bruxism started becoming an issue for me about two months ago. I first started noticing jaw pain during the day, as though my mouth was constantly working throughout the night. Also when my mother came to check on me, she could hear my jaw creaking while I was asleep. Then I started to notice jaw clenching and tooth grinding during the day – first only a little bit, then more and more until I was constantly clenching unless I made a concerted effort not to. Even then, I would only last about three to five seconds before my jaw would clench again. As a result of all this clenching, I get a lot of pain in my jaw, and I assume I’m doing damage to my teeth, but I haven’t seen a dentist in years. That’s on my list of things to do. I already take the dietary supplements recommended for people with bruxism – Pantothenic Acid, Magnesium, and Calcium – but they don’t appear to be helping.

There are a number of things that could be contributing to my bruxism:

• Smoking
• Anorexia Nervosa
• Insomnia
• Consumption of caffeine
• High levels of stress and anxiety
• Cymbalta (Duloxetine)
• Dexedrine (Dextroamphetamine)
• Obsessive-Compulsive Disorder
• Generalized Anxiety Disorder

Any or all of those things could be impacting upon my bruxism, but it’s nigh impossible to tell exactly which one it is. On a hunch, my psychiatrist advised me to lower my dose of Dexedrine to see if that would affect the bruxism, but even after a week of being Dexedrine-free I was still bruxing heavily. To keep from grinding my teeth all day long, I try to bite my lip or tongue when I notice I’m bruxing, but I feel like it makes me look sort of funny. Some people, including my mother, a friend, and my psychiatrist, have mentioned that I visibly appear to be chewing or otherwise moving my jaw around constantly whenever I’m not speaking. It makes me very self-conscious about being out in public.

I’ve heard about people using benzodiazepines to relieve bruxism, but I’m not too keen on going back to those if I can help it. I don’t think my psychiatrist would be down for that either. Another totally extreme option is Botox – actually freezing the muscles that are doing the bruxing – but there’s no way I’m going to willingly allow someone to paralyze parts of my face.

Medication Profile: Cymbalta (Duloxetine)

Brand name(s): Cymbalta, Yentreve.

Generic name(s): Duloxetine.

Street name(s), if any: Unknown.

Available form(s): Oral.

Available dose(s): 30mg, 60mg.

North American availability: Available by prescription in the U.S. and Canada.

Class(es): SNRI (Serotonin-Norepinephrine Reuptake Inhibitor).

Method(s) of action: Inhibits the reuptake of serotonin and norepinephrine in the brain, making larger quantities of those chemicals available for use.

Most commonly prescribed for: Depression.

Also prescribed for: Stress Urinary Incontinence, Diabetic Peripheral Neuropathy, Generalized Anxiety Disorder, Fibromyalgia, Chronic Fatigue Syndrome.

Possible side effect(s): Palpitations, myocardial infarction, tachycardia, vertigo, ear pain, tinnitus, hypothyroidism, diplopia, visual disturbance, flatulence, eructation, gastritis, halitosis, stomatitis, gastric ulcer, hematochezia, melena, chills/rigors, feeling abnormal, feeling hot and/or cold, malaise, thirst, gait disturbance, gastroenteritis, laryngitis, weight gain, increased blood cholesterol, dehydration, hyperlipidemia, dyslipidemia, musculoskeletal pain, muscle tightness, muscle twitching, dysguesia, lethargy, parasthesia/hypoesthesia, disturbance in attention, dyskinesia, myoclonus, poor quality sleep, dysarthria, abnormal dreams, sleep disorder, apathy, bruxism, disorientation/confused state, irritability, mood swings, suicidality, dysuria, micturition urgency, nocturia, polyuria, abnormal urine odor, anorgasmia, abnormal orgasm, menopausal symptoms, sexual dysfunction, yawning, throat tightness, cold sweat, contact dermatitis, erythema, increased tendency to bruise, night sweats, photosensitivity, ecchymosis, hot flush, flushing, orthostatic hypotension, peripheral coldness.

Possibility of tolerance: Possible.

Addictive potential: Low.

Withdrawal potential: Moderate.

Withdrawal symptoms: Irregular heartbeat, “brain zaps”, speech impairment, emotional lability, dizziness, dysphoric mood, agitation, sensory disturbances, anxiety, confusion, headache, lethargy, insomnia, hypomania, tinnitus, seizures.

Potential for abuse/misuse: Low.

Drug interaction(s): Fluvoxamine, Cimetidine, Ciprofloxacin, Enoxacin: Increases the effect of Cymbalta.
Paroxetine, Fluoxetine, Quinidine: Increases the concentration of Cymbalta.
NSAIDs, Warfarin, and Aspirin: Altered anticoagulant effects, including increased bleeding.
Desipramine: Increases the concentration of Desipramine.
MAOIs (Monoamine Oxidase Inhibitors): May cause hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, agitation, delirium, and coma.
SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): May cause serotonin syndrome.
St. John’s Wort: May cause serotonin syndrome.
Triptans: May cause serotonin syndrome.
Linezolid: May cause serotonin syndrome.
Lithium: May cause serotonin syndrome.
Tramadol: May cause serotonin syndrome.
Tryptophan: May cause serotonin syndrome.

Contraindication(s): Hypersensitivity to Duloxetine or any of the ingredients in Cymbalta or Yentreve, concomitant use of MAOIs, uncontrolled narrow-angle glaucoma, simultaneous use of CNS-active (Central Nervous System) drugs, simultaneous use of Thioridizine.

Overdose threshold: Unknown.

Symptoms of overdose: Somnolence, coma, serotonin syndrome, seizures, syncope, tachycardia, hypotension, hypertension, vomiting.

Note: I am not a doctor, and the information I state on my blog is gathered from internet sources and physician’s handbooks. Therefore, it is important to speak to your doctor if you are unclear about something or if you have more questions that I am not qualified to answer.

And So Begins the Cymbalta Trial…

As I had discussed previously with my psychiatrist, we decided on Wednesday to put me on Cymbalta (Duloxetine). I took my first dose Wednesday night so that means I’m on my second full day of being on it. As with other SSRI/SNRI medications, it takes at least a week, but usually 2 – 4 weeks, to see any change. I think I’ve said this before but it bears repeating: I have little faith that Cymbalta is going to do anything for me. I think I just have a general tolerance to medications that work with serotonin, and perhaps norepinephrine. Maybe not norepinephrine, though; I did see a small (barely discernible, but apparent to the trained observer) change in my mood while I was on Effexor (Venlafaxine), which is an SNRI, so maybe I do respond a bit to norepinephrine inhibitors. Anyway the current plan is to take 30mg at night for two weeks, and then raise the dose to 60mg. My psychiatrist is prepared to go to 90mg if we don’t see any results after 3 weeks on 60mg.

Another thing we discussed on Wednesday was adjunct treatments; I’d been doing my usual research and had come across the name Abilify (Aripiprazole), an atypical antipsychotic that is also approved for treatment of Bipolar II and has recently been approved as an adjunct treatment for depression when used with another antidepressant. Abilify is specifically for people like me who haven’t seen any (or enough) effects from taking only one antidepressant. I’m not sure exactly how it works, but it sounds tempting. Another possible plus of Abilify would be that, as an antipsychotic, it may act like Risperidal (Risperidone) and control my verbal and motor tics, which would enable me to cut that medication out of my schedule. Cons of Abilify are:

- I would be taking yet another medication.
- It can cause insomnia, which would worsen an already horrible situation.
- It can cause shaking/tremors, which would make me even shakier.
- It can cause high blood sugar, and some people have developed diabetes while taking it (note that this was after long-time use – several years).
- It can cause speech disorders, which would complicate things because I already talk strangely because of my bruxism.
- It can cause permanent tardive dyskinesia. However, I’ve already been on Risperidone for about a year and a half and I haven’t developed this symptom. That said, though, I’m not sure what the risk factor is for Abilify in relation to Risperidone.

So there are, in fact, quite a few reasons why I shouldn’t go on Abilify. It seems, just from the readings I’ve done, to be more risky and potentially side effect-y than Risperidone. But it might be a valuable tool as an adjunct treatment – a lot of people are reporting great successes with it. I really wouldn’t want to miss out if there was a chance that this medication could help me.

The last thing I discussed with my psychiatrist was my anxiety. Due to certain environmental factors in my life at the moment and in the past few weeks, I’ve been a lot more anxious (in certain situations) than usual, but I also feel like my base level of anxiety has risen. I’m anxious about some things that are typical of people with anxiety disorders – social situations, public places, taking transit, the police/authority figures, etc., but I’m also anxious about other things, like getting out of bed. This anxiety is seriously keeping me from getting things done because it totally shuts me down and renders me unable to make effective decisions. Given all that, I decided it was time to ask my doctor about trying anxiolytic medication again. He’s really not a fan of benzodiazepines in the first place, and especially not in my situation, so he ignored them altogether and considered some other options. He ended up deciding that if the Cymbalta doesn’t have any anti-anxiety effect on me in 5 weeks, he’ll start me on a trial of Buspar (Buspirone). I’ve been on Buspar once before but the results were inconclusive. I don’t think we gave it enough time or a high enough dose to really see what it could do for me.

Anyway, here’s an idea of what my current meds look like. There’s some new additions in both the prescription and non-prescription categories.

Cymbalta (Duloxetine): 30mg nightly – for Depression
Imovane/Immovane (Rhovane) (Zopiclone): 22.5mg nightly – for Insomnia
Risperidal (Risperidone): 2.5mg nightly – for Tourrette Syndrome
L-Tryptophan: 1000mg nightly – for Insomnia
Dexedrine (Dextroamphetamine) Spansules: 40mg in the morning as needed – for Depression-related symptoms
Chloral Hydrate: 10mL nightly – for Insomnia

Clindoxyl (Clindamycin and Benzoyl Peroxide): apply topically at night – for acne
Delatestryl (Testosterone Enanthate): 60mg intramuscular once weekly (Friday) – for low testosterone
Erythromycin: 333mg in the morning and at dinnertime – for acne
Losec (Omeprazole): 20mg in the morning (before eating) – for acid reflux
Fucidin (Fusidic Acid): apply topically once daily – for Impetigo

Melatonin: 3mg nightly – for Insomnia
Multivitamin: 1 in the morning – for overall health
Salmon Oil: 1 in the morning, at dinnertime and at night – for high cholesterol
Vitamin C:  500mg in the morning – for overall health
Calcium + Vitamin D: 500mg Calcium and 125IU Vitamin D (1 tablet) in the morning and at night – for bone health
Valerian Root: 800mg (2 tablets) nightly – for Insomnia and Generalized Anxiety Disorder
“Stress Relief” B50 Complex with Sensoril: 1 capsule nightly – for anxiety
Siberian Ginseng: 250mg (1 tablet) in the morning, at dinnertime and at night – for stress and low energy
“Relaxing Night” herbal tea*: 1 bag steeped in hot water nightly – for Insomnia

* “Relaxing Night” tea contains Chinese jujube, subterranean fungus, white mulberry, lycium barbarum, and Chinese yam.