Mixing multiple meds question

[April62]

I am on Cymbalta 60 mg's a day for severe nerve pain ( just now on a new Neuro hoping he won't mess with this one). Clonzapam 1 mg a day ( Dr just stopped scripting it OH WOW) Elavil 25 mg's for sleep. I have migraines and take imitrex. I also take preventative seizure meds. Tramadol for pain.
All of these are supposedly not to be taken together... but what do you do.. and they are Dr prescribed. although by 2 different Dr's..
Am I the only one who is prescribed these together?

[Thinkimjob]

Does Dr A know what Dr B is prescribing?
They need to know. These are pretty heavy duty drugs.

[rdmc]

I am on Cymbalta 60 mg's a day for severe nerve pain ( just now on a new Neuro hoping he won't mess with this one). Clonzapam 1 mg a day ( Dr just stopped scripting it OH WOW) Elavil 25 mg's for sleep. I have migraines and take imitrex. I also take preventative seizure meds. Tramadol for pain.
All of these are supposedly not to be taken together... but what do you do.. and they are Dr prescribed. although by 2 different Dr's..
Am I the only one who is prescribed these together?

I've found my pharmacist is the "gatekeeper" to protect against medicinal interactions.

If they think the doctor or doctors have prescribed meds that are not compatible with each other, they withhold the script and make a call to the doctor. Example, I was Rx'd a med by my urologist and the side effect was lowered BP. They called me, and called the doctor to make sure they understood the implication of adding another bp lowering med to the one I was already taking.

As far as just stopping Clonazepam...is your doctor tapering you off the med? I don't think that
Clonazepam can be stopped "cold turkey." But I'm neither a doctor or pharmacist, so I'm not
quite sure if there are circumstances where you can just stop taking it.

[Waydwnsouth1]

Such a dilemma and I feel for you. Hopefully you have all of your prescriptions filled at the same pharmacy. Since you are concerned I would suggest you talk to your pharmacist about your concerns.

I have made a habit of printing a list of the side effects of all the meds I take and keep them in a binder so my family can have access to them should they need them.

Any concerns I have, such as you have, I talk with my pharmacist. They all know me by my first name, which is not a good thing really, but I have established a working relationship with them. The pharmacist will be better prepared to answer your questions about drug combinations than your doctor. I think you will find there is not as much danger as one might think.

Best of luck to you and I hope my suggestion will help you out.

[jessiesmom]

Multiple Medications


You are certainly taking a lot of medications. As others have suggested it is VERY important that each of your prescribing doctors is aware of what the other is prescribing. I agree that your pharmacist is a good source of information.

Both Elavil and Cymbalta are anti-depressants. The recommended maximum number of medicines in this category is usually ONE. This would seem to be therapeutic duplication. You need to find out if this is an over-medication.

If you run the list of drugs through a drug interaction checker it shows that there are "major" interactions between Elavil/Tramadol, Imitrex/Tramadol, Elavil/Cymbalta, Imitrex/Cymbalta and Tramadol/Cymbalta.

The drug interaction checker shows "moderate" interaction between Elavil/clonazepam, Tramadol/clonazepam and Cymbalta/clonazepam.

I hope this information was helpful. If nothing else it provides a starting point for a much needed conversation with your doctors.

[J-Bo]

It's true that making sure that your doctors and pharmacist are paying attention, but combinations of meds like that aren't all that unusual for treating nerve pain. I've been on some pretty flaggable cocktails over the years, and still am. None of them help the nerve pain for me, though. But I've never had any problem with taking them together either. Just get serious brain fog from Gabapentin, with or without other meds.

[April62]

It's true that making sure that your doctors and pharmacist are paying attention, but combinations of meds like that aren't all that unusual for treating nerve pain. I've been on some pretty flaggable cocktails over the years, and still am. None of them help the nerve pain for me, though. But I've never had any problem with taking them together either. Just get serious brain fog from Gabapentin, with or without other meds.

The Cymbalta is for severe nerve pain. The elavil and Clonapam is because of insomnia brought on by Tysabri and Cymbalta. The Cymbalta and Imitrex are not something I feel I can do without. Yes, the dr said it was heat from the DEA.. not sure if he was in trouble or trying to avoid it.

[J-Bo]

The Cymbalta is for severe nerve pain. The elavil and Clonapam is because of insomnia brought on by Tysabri and Cymbalta. The Cymbalta and Imitrex are not something I feel I can do without. Yes, the dr said it was heat from the DEA.. not sure if he was in trouble or trying to avoid it.

Oh, by "flaggable", I didn't necessarily mean opiods, although I am currently on methadone. I just meant I've been on multiple antidepressants and anticonvulsants in addition to Ambien, for example. I don't think those would get the attention of the DEA, but they would ping a drug interaction checker.

[JerryD]

Wow... Who are your doctors ? Dr. Feelgood and Dr. Feelgood junior? Or is it possible doctor 1 doesn't know that doctor 2 is prescribing meds ? That's not good ! You should make a list of the meds that you are taking and take it with you to any doctor's visit. Good luck

[April62]

Oh, by "flaggable", I didn't necessarily mean opiods, although I am currently on methadone. I just meant I've been on multiple antidepressants and anticonvulsants in addition to Ambien, for example. I don't think those would get the attention of the DEA, but they would ping a drug interaction checker.

I didn't believe his story on this either. I just have to go with, he isn't scripting it anymore. So I will take it up with the neuro.
My GP has been writing my script for Cymbalta and said he would continue..Neuro writes script for imitrex and preventatives.. Hope nobody makes big changes. This is a new neuro is my reason for concern.

[April62]

Wow... Who are your doctors ? Dr. Feelgood and Dr. Feelgood junior? Or is it possible doctor 1 doesn't know that doctor 2 is prescribing meds ? That's not good ! You should make a list of the meds that you are taking and take it with you to any doctor's visit. Good luck

If only it's not that they don't know. It's seeing a new neuro and concerned about changes being made. The GP just stopped the Clonozpam. ( should not have been JUST STOPPED) When I said severe nerve pain. The GP had been treating it, the GP was scripting the Cymbalta because the previous neuro had refused to treat the nerve pain? Doesn't sound like DR.Feelgood HUH.. I am now with a new neuro. I really don't need a lot of medication changes. Not if the answer is going to be Pain. I still have ton's of breakthrough pain.

[J-Bo]

Sorry you're having such a hard time with the pain, April. I too have pretty bad nerve pain that is not under control, and never has been, so I truly sympathize. Since your original question was about the multiple meds, I was trying to explain that it's very common for neuro/pain management docs to Rx combinations of antidepressants and anti-convulsants because for some unknown reason, they sometimes have a synergistic effect when taken together. And often, there's also an opioid in the mix.

As for dr. feelgoods, um, no, they are pain management professionals who are trying everything they can think of just to make my life worth living. It's only the hope that we'll find something that helps and their willingness to keep trying that stops me from just checking out for good.

Incidentally, Pennsylvania finally passed their MMJ law, so I'm hoping that maybe that could do some good. Unfortunately, it's going to take 18 months to 2 years for the dispensaries to get up and running. Is MMJ legal where you live, April, and if so, would you consider trying that?

[jreagan70]

When I said severe nerve pain. The GP had been treating it, the GP was scripting the Cymbalta because the previous neuro had refused to treat the nerve pain?... I still have ton's of breakthrough pain.

It's admirable that your GP stepped in when your previous neuro chose not to treat your pain. But if you're in that much pain, neither your GP nor your neuro should be dabbling with trying to treat it, especially at the cost of poisoning you or putting you in other danger from misuse. That much pain should be handled by pain specialists, who are well-trained in the use of pain meds. (Is your GP even aware of the use of, and success with, anti-seizure drugs for neuropathic pain? Or was Cymbalta chosen because that's what GPs prescribe routinely for their general patient base and general meds are all he has training in?)

From what you've described, none of your doctors is skilled enough to be fooling around with your pain treatment, using medications they don't actually understand all the implications of.

Are you concerned that your new neuro might want to stop you from doing something risky?

[Lyndagail]

Mixing multiple meds question

I 100% agree with jreagan70. A pain specialist is the best doctor to see to treat pain.

Not only are they up on the best methods, they understand pain and your need to get control of your pain.

I had to travel 6 hours to see a pain specialist but it was the best trip I ever made.

[April62]

It's admirable that your GP stepped in when your previous neuro chose not to treat your pain. But if you're in that much pain, neither your GP nor your neuro should be dabbling with trying to treat it, especially at the cost of poisoning you or putting you in other danger from misuse. That much pain should be handled by pain specialists, who are well-trained in the use of pain meds. (Is your GP even aware of the use of, and success with, anti-seizure drugs for neuropathic pain? Or was Cymbalta chosen because that's what GPs prescribe routinely for their general patient base and general meds are all he has training in?)

From what you've described, none of your doctors is skilled enough to be fooling around with your pain treatment, using medications they don't actually understand all the implications of.

Are you concerned that your new neuro might want to stop you from doing something risky?

I think the Cymbalta was scripted because it was my safest med and it has done the job. I haven't had to raise it in 3 yrs. No mmj here, so that is not an option. When things are working, I don't like changes.