ORachel - please read

Discussion in 'Fibromyalgia Main Forum' started by Rosiebud, Sep 21, 2005.

  1. Rosiebud

    Rosiebud New Member

    Rachel

    here's the article on Klonopin that Mikie posted in June.

    It may be worthwhile considering taking it to your doctor to see if he will prescribe it as it will help the ministrokes.

    I am so sorry you've come up against the psychiatric wall, I thought the medical profession were more enlightened now.

    Oh I've edited this in light of the following post - the dosage that Dr Cheyney recommends is a low dose. I'm not saying you should take it but you can read Mikie's posts on Klonopin and consider it. Klonopin didnt work for me as it kept me wide awake at night and I have enough probs with sleep.

    Also, Rachel, I wouldnt go near a psychiatrist!!!

    love Rosie


    Here's Dr. Cheney's Article 06/27/05 03:04 PM

    Dr. Paul Cheney Discusses the Benefits of Klonopin
    by Carol Sieverling
    ImmuneSupport.com

    10-12-2001


    Editor’s Note: The following is based on a recent interview conducted by Carol Sieverling with Dr. Paul R. Cheney, M.D., Ph.D., and the article "CFIDS Treatment: The Cheney Clinic’s Strategic Approach" (CFIDS Chronicle, Spring 1995). Dr. Cheney gave permission to share this information, but has not reviewed or edited it.

    Many CFIDS specialists prescribe the drug Klonopin. In the October 1999 issue of The Fibromyalgia Network, nine CFS/FM specialists summarized their most effective treatments, and six included Klonopin. Interestingly, the three who did not are primarily FM specialists.

    Dr. Cheney prescribes Klonopin to address a condition associated with CFIDS called "excitatory neurotoxicity." To explain this condition to patients, he draws a line with "seizure" on the far left and "coma" on the far right. A big dot in the middle represents where healthy people are when awake. A dot somewhat to the right of the middle indicates where healthy people are when asleep – slightly shifted toward coma. He highlights in red the left portion of the line, from seizure to the middle, and labels it "Neurotoxic State" (damaging to the brain). He highlights in blue the right portion of the line, from coma to the middle, and labels it "Healing State."

    In CFIDS, an ongoing injury to the brain shifts patients toward seizure. A dot to the left of the middle, marked "injury," represents the position of CFIDS patients. This puts us in the red "Neurotoxic" zone. When we shift toward seizure, we often experience "sensory overload." It’s as if our brain’s "radar" is too sensitive. Our neurons (nerve cells) are sensing stimuli and firing when they should not. This causes amplification of sensory input. Light, noise, motion and pain are all magnified. At the beginning of their illness, many patients report feeling exhausted, yet also strangely "wired." The "wired" feeling is the slight shift towards seizure that occurs as a result of the excitatory neurotoxicity.

    Cheney frequently uses the term "threshold potential" when discussing excitatory neurotoxicity. (Think of the threshold - bottom - of a doorway. The lower it is, the more accessible it is. When it is at floor level, everything can enter. When it is raised, access is restricted to taller people. If it is too high, no one can enter.) Threshold potential refers to how much stimulus it takes to make neurons fire. If the threshold potential is too low, even slight stimulation is "allowed to enter" and is detected by the neurons. This causes the neurons to fire, resulting in sensory overload. If the threshold is dropped to nothing, all stimuli get through and the neurons fire continuously, resulting in a seizure. If the threshold is raised, only stronger stimuli can make neurons fire. A healthy person’s threshold potential naturally rises at bedtime, promoting sleep. If the threshold potential is too high, you feel drugged or drowsy. If the threshold potential is raised extremely high, coma results.

    Two receptors in the brain, NMDA and GABA, determine the threshold potential. During the waking hours of a healthy person, NMDA and GABA should be equally active. This balances the person in the middle of the seizure/coma continuum. NMDA stimulates, and GABA inhibits. If NMDA increases, one moves toward seizure. If GABA increases, one moves toward coma.

    In CFIDS, NMDA is more activated than GABA, lowering the threshold potential. This causes neurons to fire with very little stimulation, resulting in sensory overload. This condition of excitatory neurotoxicity is dangerous. Dr. Cheney emphasizes that in an attempt to protect itself, the body will eventually kill neurons that fire excessively. He states that brain cell loss can result if this condition isn’t addressed.

    How can the brain be protected against excitatory neurotoxicity? Klonopin. This long acting benzodiazepine has been Dr. Cheney’s most effective drug for CFIDS over the years. He believes that Klonopin and the supplement magnesium may be two of the most important treatments for CFIDS patients because of their neuroprotective qualities. He recommends two or more 0.5 mg tablets of Klonopin at night. Paradoxically, very small doses (usually a quarter to a half a tablet) in the morning and mid-afternoon improve cognitive function and energy. If the daytime dose is low enough, you’ll experience greater clarity and think better. If the daytime dose is too high, you’ll become drowsy. Adjust your dose for maximum benefit, taking as much as possible without drowsiness. Adjust the morning dose first, then take the same amount mid-afternoon if needed, then take three to four times the morning dose at bedtime. Dr. Cheney recommends doubling the dose during severe relapses.

    Dr. Cheney most frequently prescribes the combination of Klonopin and Doxepin, along with the supplement "Magnesium Glycinate Forte." Magnesium Glycinate alone is a good choice for the more budget minded(www.ImmuneSupport.com sells it as "Magnesium Plus".) A common dosage of magnesium is 200 mgs at bedtime. Too much magnesium can cause diarrhea, though glycinate is usually the best tolerated form.

    Cheney prescribes Doxepin in the form of a commercial elixir (10mg/ml). At low doses, this tricyclic antidepressant acts as a very potent antihistamine and immune modulator. Doxepin acts synergistically with Klonopin to assist sleep, and may improve pain. Patients tend to be very sensitive to Doxepin, which can cause morning fog and fatigue if the dose is too high (5 to 10 mg or higher). He recommends starting at two drops a night and gradually increasing the dose until "morning fog" becomes a problem. Most patients can’t tolerate more than half a cc.

    On a handout entitled "Neuroprotection via Threshold Potentials," Cheney lists six substances that can protect the brain. Under the category "NMDA Blockers" Cheney lists:

    1. Parenteral magnesium and taurine (intramuscular injections of magnesium and taurine, usually given with procaine) 2. Histamine blockers (Doxepin Elixir) Under the category "GABA Agonists" (increases GABA) Cheney lists: 3. Klonopin 4. Neurontin 5. Kava Kava 6. Valerian Root

    Klonopin is taken "day and night"; Neurontin "night, or day and night"; kava kava “daytime only”; and valerian “nighttime only.” The first four are by prescription, the last two are herbs. In my limited experience, only certain patients are put on magnesium/taurine injections, and then only for a limited period before switching to oral supplements.

    Many myths abound concerning Klonopin. When asked about these myths, Dr. Cheney shared the following information.

    MYTH NUMBER ONE: THE GENERIC IS JUST AS GOOD.

    When the generic Clonazepam came on the market, many patients switched to it because it was less expensive than Klonopin. Cheney then began hearing that most patients had to take more Clonazepam to get the same effect. Generics aren’t exactly identical to the original products, and with most drugs the slight variations don’t matter. However, most CFIDS patients can tell the difference between Klonopin and its generic form, Clonazepam. Most find Klonopin to be more effective.

    MYTH NUMBER TWO: KLONOPIN IS ADDICTIVE.

    Dr. Cheney was adamant that Klonopin is not addictive. In treating thousands of patients, he has never seen a patient become addicted to Klonopin. He reviewed the definition of addiction, stating that it involves: (1) psychosocial disruption, (2) accelerated use, (3) inappropriate use, and (4) drug seeking behavior.

    Dr. Cheney said a case might be made that Klonopin is habituating. It’s true that it can’t be stopped suddenly. You must taper off of it gradually. However, he was cautious about even calling it habituating. The process of tapering off a drug is not the same thing as withdrawal, a term that implies addiction.

    Dr. Cheney said to keep in mind that Klonopin is given for a physiological problem – excitatory neurotoxicity. It’s prescribed to adjust the threshold potential: to keep neurons from firing inappropriately and being destroyed. He stressed that Klonopin should never be given unless you intend to raise the threshold potential. He stated, "Problems arise when you begin to use benzodiazapines for reasons other than threshold manipulation." However, CFIDS patients have a "threshold potential aberration" and need Klonopin (or something similar) to avoid brain injury. Dr. Cheney has never seen a recovered patient have difficulty coming off Klonopin. He stated, "When you no longer need the drug, coming off it is very easy."

    On the other hand, trouble arises when someone who still has an injured brain tries to come off Klonopin. It’s like a thyroid patient stopping their thyroid medication. Dr. Cheney warned, "All hell breaks loose". However, it’s not because the drug is addicting, and it’s not withdrawal. The condition still exists, and the body lets you know it has a legitimate physical need for the drug. Cheney stated, "When a CFIDS patient who is still experiencing the underlying mechanisms of brain injury goes off Klonopin, there is a burst of excess neural firing and cell death. That’s the havoc we hear about that is mistakenly called withdrawal."

    MYTH NUMBER THREE: KLONOPIN DISRUPTS STAGE 4 SLEEP.

    Dr. Cheney said that he honestly doesn’t understand this concern. He believes Klonopin might disrupt the sleep of people who take it for conditions other than the threshold potential aberration found in CFIDS. He also acknowledged that if you are looking just for drugs to facilitate sleep, Klonopin is certainly not the first one to come to mind, nor should it be used to induce sleep in "ordinary" patients. It’s not a sleep drug per se. However, a large part of the sleep disorder of CFIDS is excitatory neurotoxicity and the resulting shift toward seizure. If you treat this condition with Klonopin, then you have treated a large part of the sleep disorder in CFIDS. Most importantly, he said he simply does not see stage 4 sleep disruption in his patients on Klonopin.

    Towards the end of this discussion on Klonopin, Cheney smiled, and remarked, "But suppose I’m wrong about the brain injury and the threshold potential aberration and the shift toward seizure? What if I’m wrong about your need for Klonopin? I’m absolutely sure I’m right, but what’s the worst case scenario? Do you know what long-term studies on Klonopin have shown? Reduced incidence of Alzheimer’s Disease. Alzheimer’s Disease is a complicated and convoluted way of knocking out your neurons, and Klonopin protects your neurons. Now it’s believed that Klonopin didn’t actually stop Alzheimer’s. It just delayed its onset so long that everyone died of something else before they ever got it - which is to say you won’t get Alzheimer’s. You’ll die of something else first."

    The last question Cheney addressed concerned the dose: what happens if the dose is too high? He said the only down side was that if you took a little too much (we are not talking overdose here) it would shift you toward coma on the continuum. It would shut your brain down to some degree, and thus impact your ability to function. This is inconvenient, but it’s not harmful. In fact, it shifts you into the "healing state" on the continuum. You may feel like a zombie, but your brain is protected and your neurons are not getting fried. However, not being able to function isn’t an option for most of us, so we need to find the maximum dose that doesn’t make us drowsy.

    Dr. Cheney emphasized that Klonopin, Doxepin, and magnesium are very, very good at protecting the brain from cell death due to excess firing. However, they can’t stop the underlying mechanisms of CFIDS that are injuring the brain in the first place.

    Though it can’t stop the underlying mechanisms causing the injury, Klonopin can protect your brain and keep your neurons from being destroyed. Then, as Cheney put it, "When you come out on the other side of this, you’ll have more of your brain left."










    [This Message was Edited on 09/22/2005]
    [This Message was Edited on 09/22/2005]
    [This Message was Edited on 09/22/2005]
    [This Message was Edited on 09/22/2005]
  2. rileyearl

    rileyearl New Member

    I agree it's probably the drugs that are triggering the symptoms. Below are fact sheets for Klonopin, Ultram and Wellbutrin. All three have excitability and mania as possible side effects. I didn't quite understand whether you'd taken any of the elavil or other new drugs yet. I do know elavil is a powerful mood elevator. I can't stand it that you're going through this, Rachel. I think a psychiatrist is the place to go next. They know their drugs! Love, Francie


    The adverse experiences for Klonopin are provided separately for patients with seizure disorders and with panic disorder.Seizure Disorders: The most frequently occurring side effects of Klonopin are referable to CNS depression. Experience in treatment of seizures has shown that drowsiness has occurred in approximately 50% of patients and ataxia in approximately 30%. In some cases, these may diminish with time; behavior problems have been noted in approximately 25% of patients. Others, listed by system, are:Neurologic: Abnormal eye movements, aphonia, choreiform movements, coma, diplopia, dysarthria, dysdiadochokinesis, "glassy-eyed" appearance, headache, hemiparesis, hypotonia, nystagmus, respiratory depression, slurred speech, tremor, vertigo.Psychiatric: Confusion, depression, amnesia, hallucinations, hysteria, increased libido, insomnia, psychosis, suicidal attempt (the behavior effects are more likely to occur in patients with a history of psychiatric disturbances). The following paradoxical reactions have been observed: Excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares, and vivid dreams.Respiratory: Chest congestion, rhinorrhea, shortness of breath, hypersecretion in upper respiratory passages.Cardiovascular: Palpitations.Dermatologic: Hair loss, hirsutism, skin rash, ankle, and facial edema.Gastrointestinal: Anorexia, coated tongue, constipation, diarrhea, dry mouth, encopresis, gastritis, increased appetite, nausea, sore gums.Genitourinary: Dysuria, enuresis, nocturia, urinary retention.Musculoskeletal: Muscle weakness, pains.Miscellaneous: Dehydration, general deterioration, fever, lymphadenopathy, weight loss or gain.Hematopoietic: Anemia, leukopenia, thrombocytopenia, eosinophilia.Hepatic: Hepatomegaly, transient elevations of serum transaminases and alkaline phosphatase.Panic Disorder: Adverse events during exposure to Klonopin were obtained by spontaneous report and recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories. In the tables and tabulations that follow, CIGY dictionary terminology has been used to classify reported adverse events, except in certain cases in which redundant terms were collapsed into more meaningful terms, as noted below.The stated frequencies of adverse events represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation.Adverse Findings Observed in Short-Term, Placebo-Controlled Trials:Adverse Events Associated With Discontinuation of Treatment:Overall, the incidence of discontinuation due to adverse events was 17% in Klonopin compared to 9% for placebo in the combined data of two 6- to 9-week trials. The most common events (=1%) associated with discontinuation and a dropout rate twice or greater for Klonopin than that of placebo included the following: Adverse Events Occurring at an Incidence of 1% or More Among Klonopin-Treated Patients:Table 1 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse events that occurred during acute therapy of panic disorder from a pool of two 6- to 9-week trials. Events reported in 1% or more of patients treated with Klonopin (doses ranging from 0.5 to 4 mg/day) and for which the incidence was greater than that in placebo-treated patients are included.The prescriber should be aware that the figures in Table 1 cannot be used to predict the incidence of side effects in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses and investigators. The cited figures, however, do provide the prescribing physician with some basis for estimating the relative contribution of drug and nondrug factors to the side effect incidence in the population studied.Table 1. Treatment-Emergent Adverse Event Incidence in 6- to 9- Week Placebo-Controlled Clinical Trials* * Events reported by at least 1% of patients treated with Klonopin and for which the incidence was greater than that for placebo.† Indicates that the p-value for the dose-trend test (Cochran-Mantel-Haenszel) for adverse event incidence was =0.10.‡ Denominators for events in gender-specific systems are: n= 240 (clonazepam), 102 (placebo) for male, and 334 (clonazepam), 192 (placebo) for female. Commonly Observed Adverse Events:Table 2. Incidence of Most Commonly Observed Adverse Events* in Acute Therapy in Pool of 6- to 9-Week Trials * Treatment-emergent events for which the incidence in the clonazepam patients was =5% and at least twice that in the placebo patients.Treatment-Emergent Depressive Symptoms:In the pool of two short-term placebo-controlled trials, adverse events classified under the preferred term “depression” were reported in 7% of Klonopin-treated patients compared to 1% of placebo-treated patients, without any clear pattern of dose relatedness. In these same trials, adverse events classified under the preferred term “depression” were reported as leading to discontinuation in 4% of Klonopin-treated patients compared to 1% of placebo-treated patients. While these findings are noteworthy, Hamilton Depression Rating Scale (HAM-D) data collected in these trials revealed a larger decline in HAM-D scores in the clonazepam group than the placebo group suggesting that clonazepamtreated patients were not experiencing a worsening or emergence of clinical depression.Other Adverse Events Observed During the Premarketing Evaluation of Klonopin in Panic Disorder:Following is a list of modified CIGY terms that reflect treatment-emergent adverse events reported by patients treated with Klonopin at multiple doses during clinical trials. All reported events are included except those already listed in Table 1 or elsewhere in labeling, those events for which a drug cause was remote, those event terms which were so general as to be uninformative, and events reported only once and which did not have a substantial probability of being acutely life-threatening. It is important to emphasize that, although the events occurred during treatment with Klonopin, they were not necessarily caused by it.Events are further categorized by body system and listed in order of decreasing frequency. These adverse events were reported infrequently, which is defined as occurring in 1/100 to 1/1000 patients.Body as a Whole: weight increase, accident, weight decrease, wound, edema, fever, shivering, abrasions, ankle edema, edema foot, edema periorbital, injury, malaise, pain, cellulitis, inflammation localizedCardiovascular Disorders: chest pain, hypotension posturalCentral and Peripheral Nervous System Disorders: migraine, paresthesia, drunkenness, feeling of enuresis, paresis, tremor, burning skin, falling, head fullness, hoarseness, hyperactivity, hypoesthesia, tongue thick, twitchingGastrointestinal System Disorders: abdominal discomfort, gastrointestinal inflammation, stomach upset, toothache, flatulence, pyrosis, saliva increased, tooth disorder, bowel movements frequent, pain pelvic, dyspepsia, hemorrhoidsHearing and Vestibular Disorders: vertigo, otitis, earache, motion sicknessHeart Rate and Rhythm Disorders: palpitationMetabolic and Nutritional Disorders: thirst, goutMusculoskeletal System Disorders: back pain, fracture traumatic, sprains and strains, pain leg, pain nape, cramps muscle, cramps leg, pain ankle, pain shoulder, tendinitis, arthralgia, hypertonia, lumbago, pain feet, pain jaw, pain knee, swelling kneePlatelet, Bleeding and Clotting Disorders: bleeding dermalPsychiatric Disorders: insomnia, organic disinhibition, anxiety, depersonalization, dreaming excessive, libido loss, appetite increased, libido increased, reactions decreased, aggressive reaction, apathy, attention lack, excitement, feeling mad, hunger abnormal, illusion, nightmares, sleep disorder, suicide ideation, yawningReproductive Disorders, Female: breast pain, menstrual irregularityReproductive Disorders, Male: ejaculation decreasedResistance Mechanism Disorders: infection mycotic, infection viral, infection streptococcal, herpes simplex infection, infectious mononucleosis, moniliasisRespiratory System Disorders: sneezing excessive, asthmatic attack, dyspnea, nosebleed, pneumonia, pleurisySkin and Appendages Disorders: acne flare, alopecia, xeroderma, dermatitis contact, flushing, pruritus, pustular reaction, skin burns, skin disorderSpecial Senses Other, Disorders: taste lossUrinary System Disorders: dysuria, cystitis, polyuria, urinary incontinence, bladder dysfunction, urinary retention, urinary tract bleeding, urine discolorationVascular (Extracardiac) Disorders: thrombophlebitis legVision Disorders: eye irritation, visual disturbance, diplopia, eye twitching, styes, visual field defect, xerophthalmiaDRUG ABUSE AND DEPENDENCEControlled Substance Class: Clonazepam is a Schedule IV controlled substance.Physical and Psychological Dependance: Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (e.g., convulsions, psychosis, hallucinations, behavioral disorder, tremor, abdominal and muscle cramps) have occurred following abrupt discontinuance of clonazepam. The more severe withdrawal symptoms have usually been limited to those patients who received excessive doses over an extended period of time. Generally milder withdrawal symptoms (e.g., dysphoria and insomnia) have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation should generally be avoided and a gradual dosage tapering schedule followed (see DOSAGE AND ADMINISTRATION). Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving clonazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.Following the short-term treatment of patients with panic disorder in Studies 1 and 2 (see CLINICAL PHARMACOLOGY: Clinical Trials), patients were gradually withdrawn during a 7-week downward-titration (discontinuance) period. Overall, the discontinuance period was associated with good tolerability and a very modest clinical deterioration, without evidence of a significant rebound phenomenon. However, there are not sufficient data from adequate and well-controlled long-term clonazepam studies in patients with panic disorder to accurately estimate the risks of withdrawal symptoms and dependence that may be associated with such use.DRUG INTERACTIONSEffect of Clonazepam on the Pharmacokinetics of Other Drugs: Clonazepam does not appear to alter the pharmacokinetics of phenytoin, carbamazepine, or phenobarbital. The effect of clonazepam on the metabolism of other drugs has not been investigated.Effect of Other Drugs on the Pharmacokinetics of Clonazepam: Literature reports suggest that ranitidine, an agent that decreases stomach acidity, does not greatly alter clonazepam pharmacokinetics.In a study in which the 2 mg clonazepam orally disintegrating tablet was administered with and without propantheline (an anticholinergic agent with multiple effects on the GI tract) to healthy volunteers, the AUC of clonazepam was 10% lower and the Cmax of clonazepam was 20% lower when the orally disintegrating tablet was given with propantheline compared to when it was given alone.Fluoxetine does not affect the pharmacokinetics of clonazepam. Cytochrome P-450 inducers, such as phenytoin, carbamazepine and phenobarbital, induce clonazepam metabolism, causing an approximately 30% decrease in plasma clonazepam levels. Although clinical studies have not been performed, based on the involvement of the cytochrome P-450 3A family in clonazepam metabolism, inhibitors of this enzyme system, notably oral antifungal agents, should be used cautiously in patients receiving clonazepam.Pharmacodynamic Interactions: The CNS-depressant action of the benzodiazepine class of drugs may be potentiated by alcohol, narcotics, barbiturates, nonbarbiturate hypnotics, antianxiety agents, the phenothiazines, thioxanthene and butyrophenone classes of antipsychotic agents, monoamine oxidase inhibitors and the tricyclic antidepressants, and by other anticonvulsant drugs.

    UltramTramadol (TRAM a doll)


    What is the most important information I should know about Ultram?
    • Seizures have been reported as a rare side effect of treatment with Ultram. The risk of seizures may be increased in patients who take more than the prescribed dose, have a history of seizures or epilepsy, have head trauma, have a metabolic disorder, have a central nervous system infection, are experiencing alcohol or drug withdrawal, or are taking certain medications. Talk to your doctor about factors that may increase the risk of seizures during treatment.
    • Do not drink alcohol while taking Ultram. Alcohol may cause a dangerous decrease in breathing and/or liver problems when used during treatment with Ultram.
    • Use caution when driving, operating machinery, or performing other hazardous activities. Ultram may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
    • Do not take more of this medication than is prescribed for you. If the pain is not being controlled, talk to your doctor. Taking more than the prescribed amount of this medication could result in seizures or decreased breathing.
    What is Ultram?
    • Ultram is a pain reliever. Ultram affects chemicals and receptors in the body that are associated with pain.
    • Ultram is used to relieve moderate to moderately severe pain.
    • Ultram may also be used for purposes other than those listed in this medication guide.
    What should I discuss with my healthcare provider before taking Ultram?
    • Seizures have been reported as a rare side effect of treatment with Ultram. The risk of seizures may be increased in patients who have any of the conditions or are taking any of the medications listed below: Do not take Ultram without first talking to your doctor if you
    · have a history of seizures or epilepsy;
    · have a head injury;
    · have a metabolic disorder;
    · have a central nervous system infection;
    · are experiencing alcohol or drug withdrawal;
    · are taking a tricyclic antidepressant such as amitriptyline (Elavil), nortriptyline (Pamelor), doxepin (Sinequan), imipramine (Tofranil), clomipramine (Anafranil), and others;
    · are taking a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate);
    · are taking a psychiatric medication such as chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), loxapine (Loxitane), mesoridazine (Serentil), perphenazine (Trilafon), thioridazine (Mellaril), thiothixene (Navane), and others;
    · are taking a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or citalopram (Celexa);
    · are taking a narcotic pain reliever such as codeine, fentanyl (Duragesic), hydromorphone (Dilaudid), meperidine (Demerol), hydrocodone (Vicodin, Lorcet, Lortab, others), morphine (MS Contin, MSIR, RMS, Roxanol, others), oxycodone (Roxicodone, Percocet, Percodan, others), propoxyphene (Darvon, Darvocet, others), and others;
    · are taking promethazine (Phenergan) or prochlorperazine (Compazine);
    · are taking sibutramine (Meridia);
    · are taking bupropion (Wellbutrin, Zyban); or
    · are taking cyclobenzaprine (Flexeril).
    • Before taking Ultram, tell your doctor if you have
    · kidney disease;
    · liver disease; or
    · a history of alcohol or drug dependence.
    • You may not be able to take Ultram, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
    • Ultram is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant.
    • It is also not known whether Ultram passes into breast milk. Do not take Ultram without first talking to your doctor if you are breast-feeding a baby.
    • If you are over 75 years of age, you may be more likely to experience side effects from Ultram. The maximum daily dose of Ultram for people over 75 years of age is 300 mg.
    • Ultram is not approved by the FDA for use by children younger than 16 years of age.
    How should I take Ultram?
    • Take Ultram exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
    • Take each dose with a full glass of water.
    • Ultram can be taken with or without food.
    • Side effects from treatment with Ultram may be decreased by a slow increase in dose, as directed by your doctor. The tablets can easily be broken in half at the score if needed. The maximum dose of Ultram for an average healthy adult is 100 mg per dose, every 4 to 6 hours, up to 400 mg per day. People over 75 years of age should not take more than 300 mg per day. People with liver or kidney disease may need lower daily doses. Follow your doctor's directions.
    • Do not take more of this medication than is prescribed for you. If the pain is not being controlled, talk to your doctor. Taking more than the prescribed amount of this medication could result in seizures or decreased breathing.
    • Store Ultram at room temperature away from moisture and heat.
    What happens if I miss a dose?
    • Since Ultram is taken on an as-needed basis, missing a dose is usually not a problem. Take the dose as soon as you remember, and do not take another dose for the amount of time prescribed by your doctor. Do not take a double dose of this medication.
    What happens if I overdose?
    • Seek emergency medical attention.
    • Symptoms of a Ultram overdose include difficulty breathing; shallow, weak breathing; and seizures.
    What should I avoid while taking Ultram?
    • Do not drink alcohol while taking Ultram. Alcohol may cause a dangerous decrease in breathing and/or liver problems when used during treatment with Ultram.
    • Use caution when driving, operating machinery, or performing other hazardous activities. Ultram may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
    • Avoid sleeping pills, tranquilizers, sedatives, and antihistamines except under the supervision of your doctor. These drugs may increase drowsiness caused by Ultram.
    • Ultram may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, other antihistamines, pain relievers, anxiety medicines, seizure medicines, and muscle relaxants. Dangerous sedation, dizziness, drowsiness, or decreased breathing may occur if Ultram is taken with any of these medications. Tell your doctor about all medicines that you are taking, and do not take any other prescription or over-the-counter medicines, including herbal products, without first talking to your doctor during treatment with Ultram.
    What are the possible side effects of Ultram?
    • If you experience any of the following serious side effects, stop taking Ultram and seek emergency medical attention or contact your doctor immediately:
    · an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives); or
    · seizures.
    • Other, less serious side effects may be more likely to occur. Continue to take Ultram and talk to your doctor if you experience
    · dizziness, drowsiness, or headache;
    · nervousness, tremor, or anxiety;
    · nausea, vomiting, constipation, or diarrhea; or
    · itching, dry mouth, or sweating.
    • Ultram is habit forming. Physical and/or psychological dependence can occur, and withdrawal effects are possible if the medication is stopped suddenly after prolonged or high-dose treatment.
    • Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
    What other drugs will affect Ultram?
    • Ultram may increase the risk of seizures especially in patients who have epilepsy or another seizure disorder. Also, Ultram may increase the risk of seizures if you are taking any of the following drugs:
    · a tricyclic antidepressant such as amitriptyline (Elavil), nortriptyline (Pamelor), doxepin (Sinequan), imipramine (Tofranil), clomipramine (Anafranil), and others;
    · a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate);
    · an antipsychotic medication such as chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), loxapine (Loxitane), mesoridazine (Serentil), perphenazine (Trilafon), thioridazine (Mellaril), thiothixene (Navane), and others;
    · a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or citalopram (Celexa);
    · a narcotic pain reliever such as codeine, fentanyl (Duragesic), hydromorphone (Dilaudid), meperidine (Demerol), hydrocodone (Vicodin, Lorcet, Lortab, others), morphine (MS Contin, MSIR, RMS, Roxanol, others), oxycodone (Roxicodone, Percocet, Percodan, others), propoxyphene (Darvon, Darvocet, others), and others;
    · promethazine (Phenergan) or prochlorperazine (Compazine);
    · bupropion (Wellbutrin, Zyban); or
    · cyclobenzaprine (Flexeril).
    • Do not take Ultram without first talking to your doctor if you are taking any of the medicines listed above.
    • Before taking Ultram, tell your doctor if you are taking any of the following medicines:
    · carbamazepine (Tegretol);
    · quinidine (Quinaglute Dura-Tabs, Cardioquin, Quinora, others);
    · warfarin (Coumadin); or
    · digoxin (Lanoxin, Lanoxicaps).
    • You may not be able to take Ultram, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
    • Ultram may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), other pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any other prescription or over-the-counter medicines, including herbal products, without first talking to your doctor during treatment with Ultram.
    • Drugs other than those listed here may also interact with Ultram. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.



    Wellbutrin:

    Other Events Observed During the Clinical Development and Postmarketing
    Experience of Bupropion: In addition to the adverse events noted above, the following
    events have been reported in clinical trials and postmarketing experience with the
    sustained-release formulation of bupropion in depressed patients and in nondepressed smokers,
    as well as in clinical trials and postmarketing clinical experience with the immediate-release
    formulation of bupropion.
    Adverse events for which frequencies are provided below occurred in clinical trials with the
    sustained-release formulation of bupropion. The frequencies represent the proportion of patients
    who experienced a treatment-emergent adverse event on at least one occasion in
    placebo-controlled studies for depression (n = 987) or smoking cessation (n = 1,013), or patients
    who experienced an adverse event requiring discontinuation of treatment in an open-label
    surveillance study with the sustained-release formulation of bupropion (n = 3,100). All
    treatment-emergent adverse events are included except those listed in Tables 1 through 4, those
    events listed in other safety-related sections, those adverse events subsumed under COSTART
    terms that are either overly general or excessively specific so as to be uninformative, those
    events not reasonably associated with the use of the drug, and those events that were not serious
    and occurred in fewer than 2 patients. Events of major clinical importance are described in the
    WARNINGS and PRECAUTIONS sections of the labeling.
    Events are further categorized by body system and listed in order of decreasing frequency
    according to the following definitions of frequency: Frequent adverse events are defined as those
    occurring in at least 1/100 patients. Infrequent adverse events are those occurring in 1/100 to
    1/1,000 patients, while rare events are those occurring in less than 1/1,000 patients.
    Adverse events for which frequencies are not provided occurred in clinical trials or
    postmarketing experience with bupropion. Only those adverse events not previously listed for
    sustained-release bupropion are included. The extent to which these events may be associated
    with WELLBUTRIN XL is unknown.
    Body (General): Infrequent were chills, facial edema, musculoskeletal chest pain, and
    photosensitivity. Rare was malaise. Also observed were arthralgia, myalgia, and fever with rash
    and other symptoms suggestive of delayed hypersensitivity. These symptoms may resemble
    serum sickness (see PRECAUTIONS).
    Cardiovascular: Infrequent were postural hypotension, stroke, tachycardia, and
    vasodilation. Rare was syncope. Also observed were complete atrioventricular block,
    extrasystoles, hypotension, hypertension (in some cases severe, see PRECAUTIONS),
    myocardial infarction, phlebitis, and pulmonary embolism.
    Digestive: Infrequent were abnormal liver function, bruxism, gastric reflux, gingivitis,
    glossitis, increased salivation, jaundice, mouth ulcers, stomatitis, and thirst. Rare was edema of
    21
    tongue. Also observed were colitis, esophagitis, gastrointestinal hemorrhage, gum hemorrhage,
    hepatitis, intestinal perforation, liver damage, pancreatitis, and stomach ulcer.
    Endocrine: Also observed were hyperglycemia, hypoglycemia, and syndrome of
    inappropriate antidiuretic hormone.
    Hemic and Lymphatic: Infrequent was ecchymosis. Also observed were anemia,
    leukocytosis, leukopenia, lymphadenopathy, pancytopenia, and thrombocytopenia. Altered PT
    and/or INR, infrequently associated with hemorrhagic or thrombotic complications, were
    observed when bupropion was coadministered with warfarin.
    Metabolic and Nutritional: Infrequent were edema and peripheral edema. Also observed
    was glycosuria.
    Musculoskeletal: Infrequent were leg cramps. Also observed were muscle
    rigidity/fever/rhabdomyolysis and muscle weakness.
    Nervous System: Infrequent were abnormal coordination, decreased libido,
    depersonalization, dysphoria, emotional lability, hostility, hyperkinesia, hypertonia, hypesthesia,
    suicidal ideation, and vertigo. Rare were amnesia, ataxia, derealization, and hypomania. Also
    observed were abnormal electroencephalogram (EEG), akinesia, aphasia, coma, delirium,
    dysarthria, dyskinesia, dystonia, euphoria, extrapyramidal syndrome, hallucinations,
    hypokinesia, increased libido, manic reaction, neuralgia, neuropathy, paranoid reaction, and
    unmasking tardive dyskinesia.
    Respiratory: Rare was bronchospasm. Also observed was pneumonia.
    Skin: Rare was maculopapular rash. Also observed were alopecia, angioedema, exfoliative
    dermatitis, and hirsutism.
    Special Senses: Infrequent were accommodation abnormality and dry eye. Also observed
    were deafness, diplopia, and mydriasis.
  3. Rosiebud

    Rosiebud New Member

  4. orachel

    orachel New Member

    Thanks so much for all the articles! I can't wait to really be able to read and process the information! lol This nasty provigil (for me at least!) will be out of my system pretty soon and I'll be a lil more "with it" in the thinker.

    You guys can't imagine how good it makes me feel to have so many people taking time and energy to help me out! Really really kind of you!!!

    Looking forward to the read, as tried to slog thru a bit of it but just not able to focus quite yet. Sure I'll be back to my old self in no time, though!

    I'll talk at you guys soon, and thanks a million, really!!

    Huge Hugs,
    Rachel
  5. rileyearl

    rileyearl New Member

  6. orachel

    orachel New Member

    Back full force now (or at least as "full force" as I've been lately! LOL) Thanks again for the articles. Need to pick up some toner to print them and go over with hubby.

    Also planning to take ones that indicate "manic symptoms" possible with bad interaction to pompous doctor who tried to tell me my only medical needs were psychiatrist (my psychologist who deals with pain mgmt agrees...my mental health is A OK!) and not neurologist or any other docs. I'll drop them on his desk right as I hand over check for $50 to get the sum of all my medical records, and tell him to be a bit more educated and compassionate in the future in dealing with things he clearly isn't educated enough to understand! LOL

    Thanks a million, all....will be spending bit more time here next week. We have my beautiful stepkidlits coming this weekend, and am trying to work up my energy to go with my whole brood (including godmother whos' staying with us to help me out) to a barbeque hubby's coworker is having for charity. May take every bit of energy I have, but am determined to go and enjoy this with my family, even if I have to sit in a lawn chair to enjoy most of the festivities.

    Look forward to really catching up with both of you soon!
    Hugs (huge ones!)
    Rachel