Promethazine

I've been taking promethazine for probably 10 weeks now to help me sleep. It did seem to work relatively well. I would still wake up bit I could drop back off to sleep quite easily. I was also prescribed it for during the day and sometimes take it in the morning if I'm feeling particularly anxious.

The last few nights it doesn't seem to have been working as well. Now it could be that because I have felt more anxious over the last few days, but I'm not sure. Could it have stopped working? In my prescription I can take 2 at night, wondering if I should try that?

I'm sure I did read somewhere that you can build up a tolerance to it. If so would upping the dose help?

Well I rang the doctor - he said to carry on at the dose I'm on now but he's also prescribed propanolol.

Feeling a bit uncertain about what to do for the best.

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Originally Posted by Catkins

.I'm sure I did read somewhere that you can build up a tolerance to it. If so would upping the dose help?

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Promethazine is an antihistamine with some antipsychotic properties. As with most antihistamines, tolerance can build though it is usually slow to do so. I can't say whether you're developing a tolerance to it, or are experiencing break-through anxiety. It might even be a combination of both. Increasing the dose may help for a while, especially if it is break-through anxiety.

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Well I rang the doctor - he said to carry on at the dose I'm on now but he's also prescribed propanolol.

Feeling a bit uncertain about what to do for the best.

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Propranolol can be sedating as it blocks adrenaline, aka epinephrine, so may help. It also diminishes the adrenaline fuelled symptoms of the 'flight-or-fight' response which can ease anxiety.

Personally, I would ask for immediate release trazodone to replace both promethazine and propranolol as it has a proven track record for easing SSRI/SNRI induced insomnia. It is mostly prescribed just for that these days despite being an effective AD.

I didn't realise it could be SSRI induced insomnia. I just thought it was my usual insomnia which had started to improv a bit.

I'll see how I get on with the propanolol and promethazine to go to bed with tonight. If after a few days there isn't an improvement will ring and ask for trazodone.

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Originally Posted by Catkins

I didn't realise it could be SSRI induced insomnia. I just thought it was my usual insomnia which had started to improv a bit.

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It may just be regular, garden variety insomnia, but if I remember right you began taking paroxetine not that long ago, hence my mentioning it. The treatment is the same either way.

It was a dose increase from 40mg - 50mg. Would that still have the same effect?

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Originally Posted by Catkins

It was a dose increase from 40mg - 50mg. Would that still have the same effect?

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Of the paroxetine? If so, then I wouldn't expect a 10mg increase to trigger significant insomnia, or other side-effects, nor for very long, but anything is possible with ADs, so... However, it does shorten the odds for it being just plain insomnia probably related to the heightened anxiety, imo. Is there a reason for the anxiety spike, or has it come out of the blue?

We went to London to see our son at the weekend. I think the stress of it all was probably a bit too early on in my recovery.

I was pretty much on an even keel before then. Things were still tough going at times but I'd started to feel a lot more normal. Saturday night/Sunday morning things went a bit tits up because I got an upset stomach, possibly what I ate, pos IBS. Things took a nose dive from there really. Not quite back to square one, but not doing great just now.

The stress of visiting London would likely have been enough to trigger a blip and the upset stomach wouldn't have helped. Anxiety and depression are arguably the manifestations of a type of auto-immune disorder and often worsen when the immune system is in overdrive as may have been the case with a stomach bug. All you can do is ride the storm until things right themselves again as they usually do. Even 'normies' have bad patches. All part of the rich tapestry of life. :sad:

Well I took the propanolol last night before bed. I don't know if it made any difference. I slept a bit more, but did wake up every couple of hours. Will see how I feel this morning before taking another one.

It may take a couple of days for propanolol to lower adrenaline activity enough for it to become tiring.

Does that mean I should take it during the day as well? I haven't. I was under the impression that it was fast acting so I would be able to take it as and when.

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Originally Posted by Catkins

Does that mean I should take it during the day as well?

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Not unless it was prescribed this way. I was prescribed it a few times in the past and noticed I tired more after a few days than at the beginning. Others have mentioned the same thing over the years, but your experience may differ.

I think I have the option to take it more, should I feel like I need to, he just suggested it for at night to help me with sleeping. He didn't say that I had to take it 3 times a day every day, he just told me to not take it and then go and do some aerobic exercise.

Right I think that's straight in my head. I'll take it again before I go to bed tonight and in future if I feel I need it during the day.

Thank you PDU.

Well after second night of propanolol - I was awake once in the night and was very drowsy, read, then fell asleep easily. Only problem is I am incredibly drowsy now. I thought that it would have warn off at some point during the night.

Might cut down to half tonight? See if that's a bit better. Mind you I could be just really tired because of having not much sleep for night on a week. Will think about it.

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Originally Posted by Catkins

.Only problem is I am incredibly drowsy now. I thought that it would have warn off at some point during the night.

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Propranolol is a little weird. It has a short half-life, around 4 hours, a little more if you factor in its active metabolite, and a little longer again if taken daily, but its effects tend to continue far longer than the half-life suggests, especially when taken daily.

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Might cut down to half tonight? See if that's a bit better. Mind you I could be just really tired because of having not much sleep for night on a week. Will think about it.

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Could be. If so, it should be a less a factor tonight so you should get a clearer indication of how it affects you. What is the full dose?

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Originally Posted by panic_down_under

Propranolol is a little weird. It has a short half-life, around 4 hours, a little more if you factor in its active metabolite, and a little longer again if taken daily, but its effects tend to continue far longer than the half-life suggests, especially when taken daily.



Could be. If so, it should be a less a factor tonight so you should get a clearer indication of how it affects you. What is the full dose?

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I'm prescribed 40mg 3 x per day. But so far have only taken 40mg at night for 2 nights.

I'll maybe give it a go again tonight at 40mg then. I took it about 9.30 last night and still felt completely wiped out this morning. Mmmm will decide later. I have a pill cutter so I could easily cut it in half. Not great at making decisions sometimes.

So I took the 20mg last night. Was awake once in the night, read for a bit, then went back to sleep. Not half as drowsy this morning as yesterday. So think I will carry on taking 20mg instead of 40mg.

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Originally Posted by Catkins

Not half as drowsy this morning as yesterday. So think I will carry on taking 20mg instead of 40mg.

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You might have had a second factor working for you besides the dose reduction per se. The liver loves the stuff and will remove it as quickly as blood flow can transport it there. However, at doses from around 30mg the liver removal system becomes saturated slowing down how quickly the med can be metabolised and taken out of circulation allowing more of the drug to accumulate in blood plasma. Secondly, the effects of the med on the cardiovascular system means blood flow can be less at 40mg slowing the rate at which propranolol is transported to the liver. Together these factors mean considerably more than twice as much of the med may still be in your system the next morning from a 40mg dose than at 20mg. As I wrote, propranolol is a weird med.

Bloody hell, that is weird.

Definitely will stick to the 20mg. I'm back at work on Monday and really wouldn't be able to function as I was on 40mg. I'm not a rocket scientist or anything but I need to be able to function.

Good to know that if I really need that effect it's there though (if a little scary).

Strangely my mother was on them for years - no wonder she was so bloody knackered all the time. (Although I assume that effect would lessen over time).

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Originally Posted by Catkins

Strangely my mother was on them for years - no wonder she was so bloody knackered all the time. (Although I assume that effect would lessen over time).

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It seems to persist much longer than the sedation from antihistamine based sedatives such as promethazine and mirtazapine does. The sad bit is that it turns out propranolol isn't that great a med for the main purposes it was mostly prescribed for in the past such as moderating high blood pressure.

It softens seems to be the case.