question about a pharmaceutical any had any experience

[Reenee]

I have a shoulder problem. Calcified tendonopathy of the rotator cuff. I explained via e mail about my disturbed sleep because of the pain and cpap. My Dr. prescribed a medicine for pain that I googled and it is actually an anti depressant. I read all the side effects, and what it is used for and and mostly it is for major depression, but it is also used to treat some nerve problems. (I am assuming this is why she prescribed it) I can't reach my dr. because she is out till the 26th, I wanted to discuss it w/ her but I can't. I just hate taking these things and wondered if anyone else had some experience with Nortriptyline for pain and if it affect their sleep apnea in a negative or positive way. I am very wary of all pharmaceuticals, especially ones that disrupt your digestive system, as this aggravates other things. Thanks so much.

[oneguest]

Have you tried talking to your pharmacist, if your doc is not available and has no one covering?

[Pugsy]

I have taken low dose amitriptyline (10 to 20 mg only at bedtime) for 2 years now.
Given it for pain relief (bad arthritis in spine and pelvis) to help relieve the pain somewhat and sleep better without wake ups with every little movement in bed.
Only negative side effect that I have seen is a bit of morning fogginess when I forget to take the pill until late in the evening. If I remember to take it around 8 PM for bedtime of 11 PM then I have minimal morning hangover.
No digestive issues that I have seen.
No apparent different in sleep apnea events and certainly not a worsening of their occurrence when compared to nights where I don't take it.
For me its a win-win situation.
I don't know how different it is with Nortriptyline though. Shouldn't be much difference though.
The depression dosage is much, much larger dose and I imagine I would be a walking zombie at that dose.

[Reenee]

Thank you so much Pugsy. Great info. Is this medicine the same thing?

Also, I did talk to the pharmacist and he did not mention that it was an anti depressant, I didn't find that out till I got home.

[Pugsy]

I don't know if you med is the same thing or not. From what I could gather with a quick read was that they were similar as the Nortriptyline has amitriptyline as the active ingredient.
http://en.wikipedia.org/wiki/Nortriptyline
"Nortriptyline is an active metabolite of amitriptyline that is demethylated in the liver."
I don't understand all the deep chemical jargon.

If you were prescribed a small low dose at bedtime then there not likely much chance of adverse effects.
When my doctor first suggested amitriptyline I balked because I knew it was commonly used for depression. Once I did some further research on its use for pain then I was good with the trial.
My normal daytime pain meds make me a bit hyper so not good for sleep and that is why I wanted something to help me sleep through the pain. Without it I wake up 20 to 30 times a night and no matter how well my OSA is treated I am going to feel like crap with that many awakenings.
So the amitriptyline was a good compromise. It doesn't cause worsening of the obstructive sleep apnea that muscle relaxors or opiates for pain might do and it sort of helps me get to sleep and stay asleep. In low doses it really has minimal negative side effects for most people.
Worse thing I have found is that if I forget and take it late at night I have a little bit of trouble getting the cobwebs cleared out of my head the next morning.

[Reenee]

Pugsy, you are a lifesaver. God Bless you for your time. Peace and Love.

[jencat824]

I've been on amitriptyline (brand name elavil) 25mg for about 18 yrs, I also experience fogginess in the morning if I don't take it early enough in the evening. At first I kind of 'ramped up' to my current dosage. The initial my dr wanted me on was 25, but I had to go with 5, then 10, then 20, finally to 25mg. I started taking this while I was still working & could not handle the full dose until after I stopped working. It was given to me for fibromyalgia pain, and is quite effective. Has few side effects except morning 'hang over' fogginess.

Out of all my meds, my primary care dr said it is one of the prescriptions I take with the least side effects. My pain dr wants me to ramp up to more, but the 25mg is the highest I've been able to get to with having such a hard time waking up the next morning. Same as Pugsy said, if you take early in the evening, it has fewer morning fogginess/hang over effect.

Since your dr prescribed nortriptyline, and it is a close cousin of amitriptyline, I would try to get the pharmacist to translate the exact meaning of the 'active metabolite' but sounds like me to be a derritive of, which means to me it is a part of amitriptyline, so to me that means it acts like amitriptyline. If I were in your shoes I would feel safe taking it. The part about it being an antidepressant is probably confusing to you, but I've been a pain management patient for a number of years and can tell you that many antidepressants are also used as drugs to combat pain. I'm also on cymbalta, which is an antidepressant used for pain. Confusing, but true, and these drugs work for me. I am not depressed at all, so have argued thru the years that I don't need an antidepressant every time I'm put on one, but most of them have worked wonders for pain.

Hope your shoulder feels better,
Jen

[reenee]

Jen,
Thank you for your thoughtful reply. Peace and love to you! Great info!

[SleepyToo2]

"Nortriptyline is an active metabolite of amitriptyline that is demethylated in the liver."
I don't understand all the deep chemical jargon.

All this means is that amitriptyline is broken down by the liver to nortriptyline. If you really want to know, the liver removes a methyl group from the amitriptyline as part of the process that leads to elimination of the amitriptyline from the body. With the products that the doc prescribes, the pharmaceutical company has already removed that methyl group. The two products may not be exactly the same, but they probably are for most people. Just follow the instructions for how many tablets/capsules to take, and you won't see any difference.

The reason some docs prescribe antidepressants for pain is that there is a signal that goes to the brain when you feel a pain, and the antidepressants may alter that signal. It does not mean that the doc thinks you have depression.

Many drugs do have multiple effects (they are like using a sledge hammer at full stretch to crush a walnut), so it may be possible that the product you were given will have an effect on the illness you have, even if it is not the "usual" reason for taking it. If the pharma industry promoted it, it would be called "off-label" promotion. If a doc prescribes it, it is very different because he is taking advantage of known pharmacological effects of the product. As a young pharmacist many years ago I was told to always ask the patient what the doc told them when they asked "what's it for."

Let me know if you have any more questions.

[LSAT]

I also use amitriptyline for sleep...all I need is 1/2 of a 10 mg tablet to keep me sleeping for 7-8 hours.

[avi123]

I have a shoulder problem. Calcified tendonopathy of the rotator cuff. I explained via e mail about my disturbed sleep because of the pain and cpap. My Dr. prescribed a medicine for pain that I googled and it is actually an anti depressant. I read all the side effects, and what it is used for and and mostly it is for major depression, but it is also used to treat some nerve problems. (I am assuming this is why she prescribed it) I can't reach my dr. because she is out till the 26th, I wanted to discuss it w/ her but I can't. I just hate taking these things and wondered if anyone else had some experience with Nortriptyline for pain and if it affect their sleep apnea in a negative or positive way. I am very wary of all pharmaceuticals, especially ones that disrupt your digestive system, as this aggravates other things. Thanks so much.

Comment,

Check this article on how to treat it:

http://www.ncbi.nlm.nih.gov/pubmed/10797220

I would take plain Aspirin (or its generics) until you can consult with your physician.

[Nate]

I have a shoulder problem. Calcified tendonopathy of the rotator cuff. I explained via e mail about my disturbed sleep because of the pain and cpap. My Dr. prescribed a medicine for pain that I googled and it is actually an anti depressant. I read all the side effects, and what it is used for and and mostly it is for major depression, but it is also used to treat some nerve problems. (I am assuming this is why she prescribed it) I can't reach my dr. because she is out till the 26th, I wanted to discuss it w/ her but I can't. I just hate taking these things and wondered if anyone else had some experience with Nortriptyline for pain and if it affect their sleep apnea in a negative or positive way. I am very wary of all pharmaceuticals, especially ones that disrupt your digestive system, as this aggravates other things. Thanks so much.

Reenee,

I'd urge you not to take it if you aren't comfortable based on what you know. Doctors are not there to mandate that we take a certain drug. It certainly doesn't sound like your condition is life threatening, just painful. The 26th isn't that far away, so why not wait?

As far as side effects you have to balance the good with the potential bad. Your doctor can't guarantee you that you won't have any, but the statistics are on your side. As a comparison take a look at these side effects for Ibuprofen, pretty scary list and many of the same things listed for Nortriptyline. I'm certainly not comparing the two drugs, however you should put the data you find via the internet in to perspective. Talking with your doctor about your concerns would be the best next step (in my opinion).

chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance;
black, bloody, or tarry stools, coughing up blood or vomit that looks like coffee grounds;
swelling or rapid weight gain;
urinating less than usual or not at all;
nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
bruising, severe tingling, numbness, pain, muscle weakness; or
severe headache, neck stiffness, chills, increased sensitivity to light, and/or seizure (convulsions).

Less serious side effects of ibuprofen may include:

upset stomach, mild heartburn, diarrhea, constipation;
bloating, gas;
dizziness, headache, nervousness;
skin itching or rash;
blurred vision; or
ringing in your ears.

[DoriC]

The only reservation I'd have is starting a new med during a holiday in the event you have any adverse reaction and can't reach your Dr. On the other hand, it's been my experience that amitryptiline is pretty well tolerated and nortriptiline is in the same class. If you can get by until the holiday is over when your Dr is available, that might not be a bad idea.

[zoocrewphoto]

The only reservation I'd have is starting a new med during a holiday in the event you have any adverse reaction and can't reach your Dr. On the other hand, it's been my experience that amitryptiline is pretty well tolerated and nortriptiline is in the same class. If you can get by until the holiday is over when your Dr is available, that might not be a bad idea.

That would be my concern as well. Earlier this year, my primary doctor prescribed ambien to help me sleep when I am traveling since I struggle to sleep in hotel rooms. But I was concerned about a bad reaction and being out of town at the same time. I have already been to an emergency room while traveling. Not fun. I had no other choice since I was 3 hours from home, plus it was a Sunday morning.

So, I decided to stick with the mild muscle relaxers. They aren't a miracle, but they do help me sleep better than without. When it came time for my sleep study, I decided it was time to try the ambien. I knew I would be monitored, and the building was in the same complex as the hospital, so if anything did happen, somebody would be there to help me. As it turned out, the ambien cr was not covered by my insurance, so I bought one pill for the sleep study. Seemed to work okay. I slept well, never felt drugged, and the titration was spot on.

I have also discovered that I do not react to at least some narcotics in the normal way. Years ago, I was prescribed a cough syrpup with codeine for severe back pain. I have trouble with pills, so I asked for small pills or liquid. It didn't do a thing for me. No pain relief. Not sleepy either. The nurse at the ER told me I would spend the day asleep. I waited 6 hours to fall asleep, and had to use an ice pack until I could switch to regular tylenol which did better than the codeine. About 5 years ago, I went to the ER again for back pain, and this time, they gave me darvocet. I had to cut it into pieces to get it down. Not sleepy, no pain relief. She dizzy (almost fainted).

This past summer, I had a chronic cough. Two weeks and then the next month, it started up again and went 6 weeks. It was keeping me awake. I was getting some reduction with cough drops, but no help at all from the regular cough syrpup, and I am limited in which kinds I can use because of high blood pressure. My doctor prescribed the cough syrpup with codeine. The pharmacist warned me not to use it at work because it will make me sleepy. I waited 5 hours to fall asleep that night. After two nights with improved cough, but not being sleepy with it, I started using it at work. Together with the cough drops, I was not coughing as long as I kept both going.

When I had my wisdom teeth out, they did a liquid medication since the vicadin was a larger pill. I'm not sure what it is. The bottle says Hydro/Acet. It did not help with pain, and I was nauseous and dizzy all day. I finally read the info with it and learned that it should have been taken with food. Not something I considered when I came home with gauze in my mouth. I took the medicine and went to bed. Then every time I got up to heat some mashed potatoes, I felt sick and went back to bed without eating. Once I realized it was the medicine that was bothering me, I waiting until I was past the 6 hours and switched to regular tylenol. Pain improved, and no more nausea.

[Reenee]

Wow...
Every response is so appreciated. I love that others question, as sometimes I feel like a whacko when I question my dr. about everything. I have been through a great deal with dr's, not just for me but with my other family members. I also have had some not so good reactions to drugs that are supposed to be helping me. Sounds like most of us do. All of your answers are so thoughtful and caring.

Any how, the good news is, I tried it. Based on Jencat's advice to take it before 8, I did. I wore the mask for 7 hrs 36 minutes, got up 2 x to use loo, woke up in a little pain after 8 hrs, but main thing is it really took the edge off. I am a little groggy, and my ahi went up to 2.8, I average about 1, that is not too bad.

Nate, your post about ibuprofen was interesting because that is what is prescribed during the day. I guess I have to die of something.... The calcified tendonopathy post was so interesting, the pharmacist's comments, as were all the others.

For now, if it lets me get a bigger amount of sleep, I'm going to keep trying, especially since I need to have about 17 people over for Christmas Eve! Don't worry, Pot luck. Then, on Christmas day, I am going to the movies with my daughter!! Poor husband has to work...but we will make him dinner.. I'm doing the Christmas Eve thing because no one else would...and no one else ever wanted to come to my house because it is small and what they perceived as far away. Also...I keep trying to make new traditions because this time of year is so hard for anyone, especially if you have had a loss. To all of you: Your generosity is the greatest gift. To all those in the news who have suffered loss, and those not in the news: PEACE.