1636 replies to this topic

[fishinghat]

No issues with the melatonin and Cymbalta but be aware that your body builds tolerance to it so most members have had to use it for a week and then off for a week. Hang in there Lyla, we are pulling for you.

[ForLyla]

Thanks FH. Day 6 of taking the ppi (pantoprazole 40mg sodium) and feeling insanely tired, brain fog and a little heart pounding but I'm hanging in there. I figure I have about another 3 or 4 weeks on this crap so it's going to be a long haul. Ppi's make sibo worse but I figure I'll try to treat the gastritis first and sibo later. If this doesn't work then I'm really screwed because I will have made my sibo much worse and potentially have made my withdrawal worse for no reason. When I took Lansoprazole it took about 8 days before the insanity kicked in so I'm kind of waiting for it to hit me.

Check out this study I found. Maybe I should drop my cymbalta dose by 20%.

https://www.ncbi.nlm...les/PMC4297217/

[fishinghat]

WOW!!  That is a great find Lyla. This will make a great addition to the ebook and may help a lot of future people.
 
I wouldn't be in a hurry to change that dose as the article addresses the inpact of PPIs on CYP2C19 which is not part of the process of Cymbalta metabolism. The percent change could be totally different.

[ForLyla]

FH do you think ppi's have a major impact on duloxetine? I guess theres two things to consider - the change of PH of your stomach and direct interaction with liver enzymes. Wondering how much both of these factors would influence it. Would I be right to assume that seeing as it doesnt work directly on the same enzymes that it would be less than the 20% demonstrated on the ssri's in that study?

I'm feeling worse with each dose to be honest. I wonder why I'm so tired. Insane fatigue and brain fog creeping back in which I havent had in a while. In all likelihood, I have at least 3 weeks left on the ppi. I hope to god I can come out of it alive. I just need time for my gastric mucosa to heal enough so that I no longer have the intense throat symptoms. That's all I want.

[fishinghat]

The change in pH and its effects on Cymbalta absorption depends if the pH effects the small intestines or not. As long as the snall intestines stay at a fairly normal pH then absorption would be consistant. Of course how much the pH would be effected depends on the food you eat, age and physical function of your gastric valves, liver, bile, etc.

 

Because it doesn't work on the same CYP enzymes the effect should be significantly less.

[ForLyla]

Ppis have a huge impact on the ph of your small intestine from my understanding. Hence why ppi's cause sibo to begin with. I just wonder how much that effects absorption and does it enhance it or degrade it. If it increases serotonin levels then now might be a better time to taper. I'm supposed to taper another bead tomorrow. I wait about 7 hours to take my ppi after taking duloxetine, although I have no idea if that changes anything.

If I can stay at my current level of feeling crappy then I could probably last 4 weeks but much worse and I may need to stop. It's so hard taking care of a 1 year old while dealing with this. I feel so guilty for not being able to care for her as well as I should.

[ForLyla]

Found this on RX List. I read that ppi's raise ph to 6 which is 0.5 over when cymbalta gets broken down. Seeing as cymbalta has a half life of about 12 hours, should I perhaps take it earlier so that there's a 12 hour difference? I do have slow gastric emptying due to sibo.

CYMBALTA has an enteric coating that resists dissolution until reaching a segment of the gastrointestinal tract where the pH exceeds 5.5. In extremely acidic conditions, CYMBALTA, unprotected by the enteric coating, may undergo hydrolysis to form naphthol. Caution is advised in using CYMBALTA in patients with conditions that may slow gastric emptying (e.g., some diabetics). Drugs that raise the gastrointestinal pH may lead to an earlier release of duloxetine. However, co-administration of CYMBALTA with aluminum-and magnesium-containing antacids (51 mEq) or CYMBALTA with famotidine, had no significant effect on the rate or extent of duloxetine absorption after administration of a 40 mg oral dose. It is unknown whether the concomitant administration of proton pump inhibitors affects duloxetine absorption.

[fishinghat]

That is also a good catch Lyla and I do agree with a 12 hour seperation between Cymbalta and the PPI. It may not get rid of all symotoms but it should help. 

[ForLyla]

FH the only problem with that is that now I have to switch the time of my duolextine. I used to take it at 130pm and I'm supposed to take the ppi before dinner each night, hence the current 7 hour gap between the two.

So now I'm thinking duloxetine at 7am and ppi at 7pm. Couldn't that have a major impact on me switching the time from 130pm to 7am? I'm worried the damage I'm doing by taking the ppi might not be reversible.

[fishinghat]

The impact in changing times should be minimal as you are moving it up earlier in the day. If you were delaying it until later in the day I would be more concerned because on the day of change there would be an extended time between doses. 

 

I don't think there is enough data to know what type of ;longterm effects there could be from the PPI usage. Once you factor in the digestive effects of Cymbalya, sibo, PPIs, etc it would be hard to even guess.

[ForLyla]

I cant take the ppi's anymore. As the day progressed, I felt worse and worse and I'm not functional. I feel so tired and mentally ill. I feel like I'm having a seizure almost and my vision is so bad. I'm so done with this all. I just need to focus on getting off the cymbalta once and for all. I just dont know how to do it in a timely manner. How the heck do I get off this stuff? What would happen if I just jumped off after a few months of tapering? No doubt I'd go into crazy withdrawal but would I recover from it?

I keep trying with the ppi's hoping I can just tough them out and heal myself but it's just not possible while I'm on this crazy poison. Im just going to keep tapering the duloxetine, keep taking useless supplements that dont do anything and hope I dont get throat cancer or something until I'm able to get off this poison and take the ppi's.

[fishinghat]

Go for it girl!! 

[ForLyla]

You ever heard of lactoferrin FH? I'm taking it to destroy the bacteria as they feed off of iron. However, it increases iron absorption but not in the intestines. Wonder if this would effect cymbalta if I take it a good 7 hours apart.

[fishinghat]

A very beneficial compound that helps greatly with the immune system and gut health. Considered very safe. One thing to note, you need to take an enteric coated form  as stomach acid can destroy lactoferrin.

[ForLyla]

Is it safe with cymbalta though? I know it's not iron but worried about extra iron absorption.

[invalidusername]

Iron is absorbed at different rates by different people in my experience. Best bet is to start 12 hours apart and work back if possible.

 

As Hat will remember, I had a REALLY nasty experience after just one dose of this super iron supplement. It can stay in the system longer as well as interrupt something you have previous taken.

[ForLyla]

IUN ya I remember you telling me about that. Iron is the worst but this isnt iron, it just affects the absorption of it in a way.

[fishinghat]

Very true Lyla. Ferritin is a compound in all humans that is primarily responsible for iron transport. This really shouldn't effect Cymbalta as it does not effect the CYP system in any way that I know off. It has been shown to bring the GI system bacteria back into balance within 12 to 16 weeks depending on which article you read. It should be noted that iron is involved in the synthesis of serotonin and dopamine so it may impact your emotions through that route. Glutamate and GABA homeostasis is modified by changes in brain iron status. Such changes not only produce deficits in memory/learning capacity and motor skills, but also emotional and psychological problems. Iron also competes with copper, calcium and zinc in human body.

So the bottom line is lactoferritin will absorb iron out of the blood and the reduced serum iron will effect the many items listed above.

[ForLyla]

So Lactoferrin removes iron from being absorbed by bacteria in my intestines? I'd assume this would be a good thing for overgrowth but still not sure if it would affect cymbalta absorption.

[fishinghat]

I would think that it would only effect Cymbalta by its increasing blood calcium and zinc which should be a minimal effect but by reducing brain iron levels could worsen emotional swinfs however if you have enough iron in your blood to compensate there should be no issue. Did I mention if, maybe, possibly...lol.

[ForLyla]

I got a blood test done and apparently I'm anemic, they think from iron and b12 deficiency causes by sibo. Also, zinc causes absorption issues with cymbalta?? I've been supplementing with high doses zinc but take it about 5 hours apart.

[invalidusername]

I got a blood test done and apparently I'm anemic, they think from iron and b12 deficiency causes by sibo. Also, zinc causes absorption issues with cymbalta?? I've been supplementing with high doses zinc but take it about 5 hours apart.

 

Magnesium, Iron... sure, but Zinc is a new one on me. Its not a good idea to take with antibiotics, but other than that I have not heard about interactions between the two.

 

Maybe Hat can shed light?

[ForLyla]

Ok so my b12 came in at 362 and iron at 94. This has me very worried. Why do I have anemia??

[fishinghat]

I would say an inbalance from the sibo. 

 

Did you get your zinc levels checked/ High zinc can cause excessive anxiety. This is a common occurance with some varieties of denture creams and some psoriasis meds. 

 

"If you take high doses of zinc long-term (50 mg or more per day for 10 weeks or longer ), be aware that it can cause copper deficiency, so you may need to supplement with copper as well."

 

"Iron, copper and zinc are competitive for absorption."  Your zinc supplement may be causing your iron to drop and therefore increasing the risk of anemia.

 

https://pubmed.ncbi....h.gov/23602205/

Zinc supplementation in conjunction with antidepressant drugs might be beneficial for reducing depressive symptoms.

[ForLyla]

That officially marks the last time I'm ever taking a ppi. I've fainted twice now and I'm in the ER. I havent felt right at all since I took it. Way worse than ever. My heart feels like it's going to give out. I hope I'll be ok . All this from taking ppi's for a week. I'm so sad.

[fishinghat]

I don't blame you Lyla. You are surely in a tough spot. 

 

God Bless

[invalidusername]

Great find Hat...

 

"No significant differences were observed in plasma levels... between zinc-supplemented and placebo-supplemented group.

 

Zinc supplementation in conjunction with antidepressant drugs might be beneficial for reducing depressive symptoms."

 

Sounds like your medical advisory panel need to have a read up before coming out with such claims Lyla.

 

I am so sorry for your experience with the PPI. So much going on with you at any given moment Lyla. My sympathies and prayers are with you.

 

EDIT - Replay from Hat at 2.29am GMT?! Think that is the latest I have ever seen you online!!

[fishinghat]

Yea, IUN. Looonngg day yesterday but wanted to give a quick visit to my freind here before crashing for the night.

[invalidusername]

Commitment to the cause. I'd expect nothing less from you dear brother.

[ForLyla]

I love you guys. Thanks so much. I took a cbd pill and antihistamine yesterday and I feel out of it but better. This is the best day I've had for my stomach and reflux issues in forever. I have no idea why. I'm at my friends cottage and I decided to live a little - I had ice cream, fruit, hot dogs, hamburgers, chips and no acid reflux symptoms at all. Dont know what changed but whatever it is, I pray to God this stays, even for a little while.