Posted by ed_uk on June 6, 2005, at 17:47:46
In reply to Re: Neurontin to Topomax » ed_uk, posted by Larry Hoover on June 6, 2005, at 17:11:25
Hi Lar!
>The neurologist mentioned nortriptyline, but I was kind of put off by the potential anticholinergic effects. Does it have many?
Although it often causes dry mouth and constipation, it's quite a lot less anticholinergic than most TCAs. Low doses can be useful for pain, an initial dose of 10mg/day could be useful. Nortriptyline is essentially a norepinephrine reuptake inhibitor, 'pseudo-anticholinergic' side effects may occur as a result. Given your previous (bad!) responses to various antidepressants, I wondered whether you might be uncomfortable taking nortriptyline. Nevertheless, it does seem to be quite an effective antidepressant...........it's also sometimes useful for relieving the pain and diarrhea of IBS.
From Martindale............
Studies in vitro showed antidepressant affinities for human muscarinic acetylcholine receptors and therefore the likelihood of antimuscarinic effects to be, in *descending* order:
amitriptyline
protriptyline
clomipramine
trimipramine
doxepin
imipramine
nortriptyline
desipramineDesipramime, another norepinephrine reuptake inhibitor, is also sometimes effective for neuropathic pain. It is less likely to cause sedation than nortriptyline. Desipramine is sometimes quite 'activating' - it can cause insomnia. Nortriptyline is much less sedating than trimipramine- which I believe you've taken in the past.
Scott mentioned Cymbalta. I wondered whether you might be uncomfortable taking an SNRI given your previous bad reactions to SSRIs. I suppose you could start Cymbalta at a VERY low dose and see how it goes.
If you want to try another anticonvulsant, I think Trileptal is worth considering. What do you think??? Depakote is another option - you said your doc suggested it.
>Whoa.... I've got room, there, after all. I'm not even close.
Like morphine, oxycodone does *not* have a maximum dose. Provided that it is titrated *gradually*, tolerance develops to the respiratory depressant effect of the drug, allowing the dose to be increased as required.
RE morphine, doses in excess of 2500mg every four hours have been recorded!!! Obviously, such a high dose would be rapidly fatal to a person who was not tolerant to the respiratory depressant effect of morphine.
>Maybe I need a referral to a pain specialist.
That could be very useful :-)
>Or a copy of the manufacturer's recommendations.
Here is the UK data sheet........
http://emc.medicines.org.uk/emc/industry/default.asp?page=displaydoc.asp&documentid=2579
Kind regards,
Ed.
poster:ed_uk
thread:508502
URL: http://www.dr-bob.org/babble/20050606/msgs/508694.html