1636 replies to this topic

[invalidusername]

Hat is right on the money there.

 

My last withdrawal was Lexapro... stomach issues. Pregabalin before that.. stomach issues. Cymbalta before that... wait for it...

 

...stomach issues.

[ForLyla]

Is this something I should be worried about? Will gastritis go away? I don't think I've ever had a case where it's been this bad before. My stomach is in a great deal of pain. 

[invalidusername]

Very mild may do, but it should be treated if it is a diagnosed gastrsitis. Have you been tested? H Pylori is not something you want to leave untreated...

[fishinghat]

Most gastritis during withdrawal is from serotonin imbalance and will clear in a month or so. My drs said to take a ppi as often as allowed by the package description for one month or until symptoms are totally gone which ever comes first. They also recommended routine doses of Gas-x (simethicone). In addition I took a lot of Kao Pectate to help coat the stomach walls and decrease the irritation to the lining of the stomach. Things slowly got better with time.

[invalidusername]

Quite - but if not tested and she has H Pylori which can frequently accompany gastritis, this needs an antibiotic to clear. Untreated and you are looking at ulcers and so forth which will then call for invasive GI surgery!! No-one wants that - the risk of a surgeon catching the soft tissue is too great for my liking...

 

... especially with a UK doctor - right Hat??

[fishinghat]

Right, when in doubt have it checked.

[ForLyla]

I'm going to the doc next week. I was diagnosed with gastritis with a scope a couple years ago. So GasX is safe in WD?

[invalidusername]

I assume that you have had bloods to rule out any infection alongside the gastritis? Assumption is not enough under these circumstances.

 

I cannot say on the GasX, but Hat would not have recommended it if there were any significant interaction I am sure - but he will confirm in the morning.

[fishinghat]

I have found no drug interaction of Gas-x with any of the typical psych drugs.

[ForLyla]

Thanks IUN and FH. As always, you guys are my saviours! FH, which ppi did you take beyond Zantac? 

[fishinghat]

I only took Zantac because of my drs recommendation.

[ForLyla]

Thanks! Today I've been having crazy right leg pain and cramping. I do have restless leg but this isn't it. Anyone else get this?

[ForLyla]

So my calf pain is severe to the point where I'll need to go to emergency. It came out of nowhere and is extremely painful. I cant even walk with it. I had something like this last year towards the end of my benzo withdrawal but not nearly this bad. I'm thinking it could be a blood clot but I've never had one before so dont know.

[invalidusername]

Blood clots generally aren't painful - they are are a dull ache, with bruising marks around the affected area, but if in doubt, get it looked at for sure...

[fishinghat]

I agree with IUN. get it checked out. Leg pain and muscle cramps are fairly common with withdrawal but what you describe concerns me.

[ForLyla]

I went to the doctor. She just said to wait it out - that it's likely muscular instead of it being a blood clot. 

 

Question - do you guys think using hand sanitizer is ok? I'm assuming the alcohol content evaporates pretty quickly. I ask because sometimes I use it before I eat lunch and wondering if some of it would get on my food. I'm extremely scared and cautious about any alcohol - still have PTSD from my last bouts of setbacks. 

[fishinghat]

That is a good question Lyla. I had never thought of that. I don't know how much is absorbed through the skin but like you say, most would evaporate off quickly. I will see what I can find.

[fishinghat]

This research was looking at the absorption of alcohol would be toxic. While not toxic the levels indicated in the blood might present a problem during wuthdrawal. It is interesting to note that most was due to inhalation of fumes and that being absorbed into the blood from the longs. If you could hold you breath during use that would decrease the amount in the blood by around 80%.

https://www.ncbi.nlm...pubmed/21741120
Am J Infect Control. 2012 Apr;40(3):250-7. doi: 10.1016/j.ajic.2011.03.009. Epub 2011 Jul 8.
Dermal and pulmonary absorption of propan-1-ol and propan-2-ol from hand rubs.
Institute of Hygiene and Environmental Medicine, Ernst Moritz Arndt University, Greifswald, Germany. below@uni-greifswald.de

Abstract

BACKGROUND:
It has been shown that nontoxic concentrations of ethanol are absorbed after hand hygiene using ethanol-based hand rubs. This study investigated whether absorption of propan-1-ol and propan-2-ol from commercially available hand rubs results in measurable concentrations after use.

METHODS:
The pulmonary and dermal absorption of propanol during hand rubs was investigated. Rubs contained 70% (w/w) propan-1-ol, 63.14% (w/w) propan-2-ol, or 45% (w/w) propan-2-ol in combination with 30% (w/w) propan-1-ol.

RESULTS:
Peak median blood levels were 9.15 mg/L for propan-1-ol and 5.3 mg/L for propan-2-ol after hygienic hand rubs and 18.0 mg/L and 10.0 mg/L, respectively, after surgical hand rubs. Under actual surgical conditions, the highest median blood levels were 4.08 mg/L for propan-1-ol and 2.56 mg/L for propan-2-ol. The same procedure performed with prevention of pulmonary exposure through the use of a gas-tight mask resulted in peak median blood levels of 1.16 mg/L of propan-1-ol and 1.74 mg/L of propan-2-ol.

CONCLUSION:
Only minimal amounts of propanols are absorbed through the use of hand rubs. Based on our experimental data, the risk of chronic systemic toxic effects caused by hand rubs is likely negligible. However, our study did not evaluate the consequences of long-term daily and frequent use of hygienic hand rubs.

[invalidusername]

Well done Hat - that is some interesting info dug up.

 

Really cannot underestimate the potential these things can do. People go on plenty about secondhand smoke, but just because you can't see the vapour of alcohol doesn't mean it cannot operate the same way and cause symptoms where potential lies...

[ForLyla]

I feel like I have setbacks when I go to bars or use hairspray. The vapors make sense, although the setbacks are usually pretty minimal compared to drinking. Thanks for the good research!

[fishinghat]

Any time Lyla. Hang in there.

[ForLyla]

I started taking Pantoloc (sodium version) last night and I had the craziest vivid nightmares ever. I woke up this morning feeling pretty shaky and out of it. I did a bit of research and found the following. What do you think? Is it all in my head? I thought I was being safe by taking the ppi about 8 hours after my duloxetine. 

 

 

acid-related disorders. As such, they are frequently prescribed for patients who are concurrently using other medications. PPIs may interact with other drugs through numerous mechanisms. The most important include competitive inhibition of hepatic cytochrome P (CYP) 450 enzymes involved in drug metabolism, and alteration of the absorption of other drugs via changes in gastric pH levels. Poor metabolizers, who lack CYP2C19, may be particularly predisposed to drug interactions. Although the potential for drug interactions is high, few clinically significant interactions have been reported for the PPIs. Nevertheless, caution is indicated when certain drugs are co-prescribed with these agents. The incidence of clinically significant drug interactions increases proportionately with the number of drugs taken and with the age of the patient. The drug interaction with the greatest clinical importance is the reduction in benzodiazepine clearance by omeprazole.

[fishinghat]

I posted this on your thread some time ago but in  looking at it deeper after your post today I see that is necessary to take Pantoloc with a prokinetic drug because of inactivity in the acidic environment of the stomach. Did they give you a second medicine to take with the Pantoloc. I am going to look at this deeper and will be back soon.

"Pantoprazole (Pantoloc) is metabolized in the liver by the cytochrome P450 system.[17] Metabolism mainly consists of demethylation by CYP2C19 followed by sulfation. Another metabolic pathway is oxidation by CYP3A4. Pantoprazole metabolites are not thought to have any pharmacological significance. It is usually given with a prokinetic drug because of inactivity in the acidic environment of the stomach

Duloxetine undergoes predominately hepatic metabolism via two cytochrome P450 isozymes, CYP2D6 and CYP1A2.

As you can see the processing by the liver is for separate CYP pathways so they will not effect each other. The good news is they are compatible and may be used together. Zantac is compatible as well but if the Pantaloc works there is no reason to change."

[fishinghat]

Further information

https://dailymed.nlm...4a-75f9f9215ff0
Drug insert for Pantoprazole

"Effect of Other Drugs on Pantoprazole

 

Pantoprazole is metabolized mainly by CYP2C19 and to minor extents by CYPs 3A4, 2D6, and 2C9. In in vivo drug-drug interaction studies with CYP2C19 substrates (diazepam [also a CYP3A4 substrate] and phenytoin [also a CYP3A4 inducer] and clopidogrel), nifedipine, midazolam, and clarithromycin (CYP3A4 substrates), metoprolol (a CYP2D6 substrate), diclofenac, naproxen and piroxicam (CYP2C9 substrates), and theophylline (a CYP1A2 substrate) in healthy subjects, the pharmacokinetics of pantoprazole were not significantly altered."

 

Duloxetine undergoes predominately hepatic metabolism via two cytochrome P450 isozymes, CYP2D6 and CYP1A2.
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Note - If it in the form of a delayed release tablet/capsule then it does not have to be taken with a prokinetic drug.

 

I found no specific medical research on this drug combination.
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Side effects of Pantoprazole

 

https://www.ehealthm...zole/nightmare/
0.14% reported nightmares as a side effect.
No reports of shakiness found.
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Your symptoms are most likely from the withdrawal but can not promise. One thing you can do is what if these symptoms are worse an hour or two after taking the pantoprazole and better the hour before having to take another one.  If so the symptoms may be linked to the pantozole.

[ForLyla]

Ok I'll try that out. I'll see how I feel within an hour of taking it. I took it right before bed last night so couldn't tell. Just to be safe, I did space it pretty far from taking my duloxetine. Thanks again for the excellent research. 

[ForLyla]

I stupidly forgot to mention that I tapered 1 bead a couple weeks ago for the first time since last October. It equals out to about 1.5% of my total dose. I wanted to taper 2 beads or about 3% over the course of about 3 months to make my dose an even 25mg and just stay there for a good long while. It would make it easier for me to measure. Can such a small drop make a big difference? Will it send me back into the throes of hell for a long time?

[fishinghat]

"Can such a small drop make a big difference? Will it send me back into the throes of hell for a long time?"

Normally I would say you would be Ok but you are so sensitive to these changes. How much worse do you feel now after the drop a week ago?

[ForLyla]

I was feeling alright up until today. The shakiness is worse than it's been in a good while. Heart pounding is back. I'm thinking it could also be because I got an unusual amount of sleep as well but could also be the pantoloc. We'll see how I feel over the next few days. Just so tired of suffering.

[ForLyla]

If tapering 1.5% throws me into terrible acute like withdrawal again then I'll have a big problem on my hands. Should I just go back up? I'm assuming that will make things even harder though.

[fishinghat]

Most members who are very sensitive taper at a rate around 0.3% a week which is around 1.5% every 5 weeks.