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Suggest Remedy For Drug Interaction Of Duloxetine, Escitalopram And Lamotrigine

Posted on Sat, 31 Oct 2015

Question: information on drug interaction of duloxetine, escitalopram and lamotrigine. particularly want information on side effect of akathisia, or restless leg syndrome

Answered by Dr. Seikhoo Bishnoi (38 minutes later)

Brief Answer:
Concurrent use of SSRIs and SNRIs might increase Akathisia

Detailed Answer:
Hello thanks for asking from HCM for your health related queries

I can understand your concern. Duloxetine is a SNRI drug and the drug helps to increase serotonin and noradrenalin neurotransmission in brain. Escitalopram is a SSRI drug and it also increases serotonin neurotransmission. So it is not advisable to take these two drugs together because of risk of serotonin syndrome and this also increases restlessness. Akathisia can also aggravate due to concurrent use of both these drugs. Lamotrigine is relatively safer drug and is not associated with very much increased risk of serotonin syndrome and restless legs.

If we consider RLS then SSRIs and SNRIs both can increase the risk to mild degree but are not the cause of RLS. In my opinion you should consider decreasing the dose of Escitalopram gradually and stabilise yourself to Duloxetine. This will reduce your symptoms especially akathisia and will surely help you.

Thanks, I hope this helps you. Please don't hesitate to ask again for more doubts.

Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (1 hour later)

Thank you. I am seeing my GP today and will discuss stopping Lexapro and continuing with Cymbalta, in an effort to reduce the RLS.

However, I have long standing RLS; it runs in my family.

I think I have experienced augmentation of RLS recently from being on Requip (ropinirole) as the RLS is getting worse.

I have read about the use of Gabapentin or Lyrica for RLS.

Please advise if you think switching to an anticonvulsant is a good idea.
I have been experiencing a syndrome of excessive spending (SE of dopamine?)
recently and I think I need to get off the dopamine agonist.

Thank you for your input. If you can, please reply within the next few minutes, since my GP appt is this morning at 1140AM, EDT

Answered by Dr. Seikhoo Bishnoi (8 minutes later)

Brief Answer:
Yes Lyrica or Gabapentin are good options.

Detailed Answer:
Hello again and thanks for asking a follow up

Gabapentin and Pregabalin both though are classified under anti seizure drugs but have a large therapeutic profile. Both these drugs have good efficacy in RLS and I am using these drugs in my patients with anxiety and restless leg syndrome. Gabapentin is relatively more sedating than Pregabalin but both have good efficacy. You can discuss with your doctor for these drugs also. These will help in controlling persisting RLS symptoms. I'd also advise you to take vitamin B12 (Methylcobalamine preferably) and Vitamin E supplements, as this will help to control RLS symptoms also.

Yes Ropinirole might result in some compulsive behaviours like over spending. But these side effects are not very common. Still if you are feeling that the drug is the cause of these symptoms then switching to Lyrica or Gabapentin will be a good idea.

Thanks, Still have more doubts please ask again.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (5 hours later)

Hello, Dr. Bishnoi,

Thanks for the info on gabapentin and pregabalin. I saw my GP today; he discontinued Requip and Lexapro.

I remain on Cymbalta 30mg daily. Dr. added Gabapentin 300mg TID.
Hopefully this streamlining will improve RLS. I already take B-12 and Vit E.
I'm looking into an iron supplement as I've read this is helpful for RLS.

My question about Gabapentin - does it take time to build up a therapeutic
blood level to stop RLS?

I took 600mg after lunch today, laid down within an hour of taking the
medicine, but the RLS was alive and kicking.

When I took Requip, it would take effect within the hour and totally stop
the RLS.

Is Gabapentin different in this regard? Does there have to be a therapeutic
blood level over a period of time, or will it have a similar action as Requip?
If so, how long does it take to take effect?

thank you for your help. This RLS is driving me crazy. I can't get rest and am irritable.

XXXX

Answered by Dr. Seikhoo Bishnoi (5 hours later)

Brief Answer:
The drug will take some time to show its effects

Detailed Answer:
Hello again and thanks for asking a follow up

The drug start showing effects from first week only. Though with time response improves and tolerance to its side effects develop. Try to distract yourself and don't think about RLS again and again. This is also one of important cause of poor response. Wait for some times and the drug will start controlling the symptoms. RLS persisted because Requip has been stopped.

The drug has different action thant Requip and continue to take drug for at least a week to start seeing its effects.

Thanks, Hope this helps you. Please don't hesitate to ask again for more doubts.

Takecare

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (11 hours later)

Thank you for the info on Gabapentin. Good to know it will take a while to kick in.

Last night was a terrible night without Requip. I was up and down all night long. Not only have RLS but PLM as well. I finally took 1mg Requip to stop the movement and got to sleep around 4AM.

Is it ok to take this combination:
Cymbalta 30mg Q AM
Gabapentin 300mg TID
Requip 1mg HS

Wanting to know if ok to continue taking Requip until Gabapentin takes effect.

Thank you so much,
XXXX

Answered by Dr. Seikhoo Bishnoi (3 hours later)

Brief Answer:
Yes the combination is safe and ok to take

Detailed Answer:
Hello again and thanks for asking a follow up

Yes the combination is ok but try to reduce the doses of Ropinirol in about 1-2 weeks. This will help you to remain stabilised on Gabapentin and Cymbalta. Over all the combination is safe.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (8 minutes later)

Thank you very, very much. I really appreciate your expertise and taking the time to answer my questions. Here in the USA, doctors do not have time to explain all this in detail.

I am a psychiatric nurse and I know some things about these medications,
but when I am the patient, it is a different scenario.

I will take your advice and taper down and off the Requip over the next 1-2 weeks.

I have one more question. Does Gabapentin provide mood stabilization, similar to
Tegretol, Depakote and Lamictal?

I am not bipolar, have been treated in the past with anti-depressants only for depression. However, lately I've had mood swings, irritability and spending more money than usual. I don't think it is a bipolar type behavior, but rather too much dopamine from the Requip. I am hoping my mood will stabilize with the discontinuance of Requip.

However, I have a lot of stress at work, which triggers the irritability and mood swings. Will Gabapentin help to mellow me a bit?

Thank you,
XXXX

Answered by Dr. Seikhoo Bishnoi (8 minutes later)

Brief Answer:
Gabapentin is not a mood stabiliser drug.

Detailed Answer:
Hello again and thanks for asking a follow up question

Gabapentin is not a mood stabiliser drug but the drug helps to reduce the anxiety and sometimes help to control the stressful situations. But the drug doesn't act as mood stabiliser drug. Irritability, stress, anxiety will decrease with this drug, no need to worry. You might suffer increased sedation with this drug but tolerance to this will develop in some days.

Thanks. Still have doubts please ask again.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (3 minutes later)

Thanks for your prompt reply. I think that Cymbalta and Gabapentin will be a
good combination.

Again, I really appreciate your expertise and advice.

XXXX

Answered by Dr. Seikhoo Bishnoi (30 minutes later)

Brief Answer:
Thanks for your appreciation.

Detailed Answer:
Thanks for your appreciation and take care.

If you have more doubts you can ask again.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (16 minutes later)

I don't have any questions at this time. I understand there are 2-3 more days to keep this discussion open before it automatically closes.
I'll leave this open and follow up with you in a few days if I have more questions about this new med. regimen.

Thank you,
XXXX

Answered by Dr. Seikhoo Bishnoi (7 hours later)

Brief Answer:
Thanks, you can ask at any time.

Detailed Answer:
Hello again,

Yes you can ask at any time. No need to worry.

Thanks.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar