Medication worries

[ElizabethJane]

I am currently taking dothiepin and lithium. My psychiatrist Dr J wants me to introduce duloxetine/cymbalta. I started the duloxetine nearly three weeks ago. I see Dr J on Tuesday and I expect that he will want me to reduce the dothiepin. My GP thinks I am over medicated and I do feel a bit drugged up. So I'm awaiting my appointment on Tuesday. My local pharmacist has told me that I shouldn't be taking lithium and dothiepin together but she couldn't tell me why. So now I'm feeling really afraid as I have been on this combination for about eleven years. What is going to happen to me? I have already been told that I shouldn't be taking zopiclone with dothiepin which I had done on a very occasional basis. Can somebody help please? I am aware of serotonin syndrome plus being more sedated if I use zopiclone as well. I am also aware of NICE guidelines to get people off dothiepin as it is very toxic in overdose. It is hard enough transferring onto a new drug without all these worries as well. I'm told that the withdrawal of dothiepin has to be really slow or the old symptoms could come back again. Help please.

[ElizabethJane]

Please can anybody help me?

[Kells81]

Hi Elizabeth

Sorry I dont know the answer to your question but surely your Doctor wouldnt have prescribed it if it was unsafe to take with your other meds?

Try not to worry xxx

[reallyfedup]

You could phone a supermarket pharmacy... Probably open till 10 pm? Try nhs direct? Phone dr and ask over the phone for some advice? It might put your mind to rest if you get advice sooner rather than later x

[emma30982]

sorry im no help either but if your that worried can't you ring the nhs helpline maybe they know something, sorry im new to this i have only been on meds for 10 weeks so really not experianced anyway hope you sort it out soon
emma

[ElizabethJane]

I have had a bad night. I had a really bad headache all day. I went to bed feeling really nauseated and was sick about 12am. I felt better after that and managed to take something for my headache. I was really worried that I was going to die or be poisoned. My tablets would have been vomited out. I had not consumed any alcohol. It could have been a migraine I'm not sure. I was a bit dehydrated and thought my husband would have to call the edmergency docs. I am much better today. Will tell Dr J on Tuesday.

[alias_kev]

Hey, elizabethjane - your other post clearly showed how worried this had all made you. The stress could quite easily have produced a migraine especially if you are normally a sufferer. Many migraines produce a vomiting. Indeed some people get only the stomach effect and very little of the spear-though-the-eye pain that most peope associate with migraine.

I've done a quick web search and for some reason the dothiepin (under any name and there are a few) is not documented on my favourite and most trusted sites. Looking elsewhere there was little mention of a lithium interaction that I can find.

Documentation for lithium basically says doctors should be wary of interaction with almost anything and even brand differences should be avoided. Powerful stuff.

AHHA: A very recent SPC (~ pharmacy leaflet) for a lithium product CAMCOLIT mentions that "Tetracycline antibiotics" can mess up lithium levels. So at first I wondered if your pharmacist had confused antibiotics with antidepressants. Then I found http://emc.medicines.org.uk/medicine/1239/SPC/CAMCOLIT+250/#CLINICAL_PRECAUTIONS
Symptoms of nephrogenic diabetes insipidus are particularly prevalent in patients receiving concurrent treatment with tricyclic or tetracyclic antidepressantsAnd dosulepin (http://en.wikipedia.org/wiki/Dosulepin) (dothiepin (http://en.wikipedia.org/wiki/Dothiepin)) is one of the many tricyclic. The rarity of this warning suggests to me (just an untrained sufferer like you) that the interaction warning is a new one. Ofcourse this does not necessarily mean the risk is new, just the warning. Given you've been on it so long its a difficult judgement of whether you are more or less at risk - it hasn't visibly hurt you (good) but it might be doing subtle harm. Also coming off or changing meds is rarely something to do in a hurry.

Good Luck with this.
(http://en.wikipedia.org/wiki/Tetracycline_antibiotics)

[ElizabethJane]

Thanks Kev for that. The lithium has been a real life saver for me but the side effects are horrendous. When I can begin coming off the dothiepin I think that I shall start to feel a bit better. It is just having all this plus the duloxetine makes me worried. My psychiatrist wanted to see me after two to three weeks. As I see him privately and medical insurance has run out I couldn't afford to do this. I used to suffer from migraines and after being sick I felt better and my husband gave me some paracetamol. I was worried as I knew I was dehydrated but taking some water would make me vomit. Fortunately I have got Tuesday off. It has been stressful the last few days as I am involved in a lot of Easter music. I had to step in and sing a small aria at the last minute. I couldn't stop shaking. I was shaking during commnunion but i'm not sure if it is the drugs or me. I have told my husband to call for an ambulance if he thinks I'm unconscious. He must have thought it was a risk as he starts talking about life insurance!!!

[alias_kev]

Most migraines that involve the stomach often get better pretty quickly after the sickness - its a brain, digestion interaction thing. For reference with similar migraines I found ibuprofen (ie. nurofen) better than paracetamol and they seem to annoy the stomach less. That makes them more effective when you sense the pre-migraine build up. Dehydration is also often a factor in triggering a migraine even with no other issues or medications involved.

Sounds like you've had quite a tough "life week" as well as your medication worries. Its impressive if someone with any anxieties can go to something public like communion let alone sing. If its any reassurance a relative suffered from Syncope (extreme fainting) for 18 months and suffered no real harm to fainting or collapsing is not too much of a risk. The two areas of concern are "why it occures" and "what you hit on the way down"; only those can have major risks involved. Provided your colour and breathing are ok its not too much of an issue in many cases. The problem is knowing the few occasions when its an emergency, eg: heart, stroke, etc.

[ElizabethJane]

Thanks again Kev. I am unable to take ibuprofen as it interferes with the lithium. I just hope that the migraines are not going to be a regular occurence. I used to get them. I had a hyst two years ago and I thought that it had put paid to them.