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Suggest Remedy For Severe Fatigue After Implantation Of A Defibrillator
Question: Hello. My husband has had two heart attacks, the last resulting in the implantation of a defibrillator.
He is taking a number of medications which seem to be contraindicated according to drug interactions on the site. 1) First of all, what is the use of colchicine for heart patients (he has never been diagnosed with gout)?
2) Then, what is the likelihood of serotonin toxicity by his taking a combination of that, Cardizem, Plavix, Metoprolol succinate, Viibryd and Lexapro (for depression), Clonazepam (anxiety), Prevastatin, Tramadol and Savella? Is it possible to space certain medications to minimize the risk (only Tramadol, Clonazepam and Neurontin are taken more than 2x/day)?
3) He is troubled by constant fatigue - would the combination of his meds (and his recovery from surgery on July 2) explain this, or should he be concerned about serious medication side effects?
He is taking a number of medications which seem to be contraindicated according to drug interactions on the site. 1) First of all, what is the use of colchicine for heart patients (he has never been diagnosed with gout)?
2) Then, what is the likelihood of serotonin toxicity by his taking a combination of that, Cardizem, Plavix, Metoprolol succinate, Viibryd and Lexapro (for depression), Clonazepam (anxiety), Prevastatin, Tramadol and Savella? Is it possible to space certain medications to minimize the risk (only Tramadol, Clonazepam and Neurontin are taken more than 2x/day)?
3) He is troubled by constant fatigue - would the combination of his meds (and his recovery from surgery on July 2) explain this, or should he be concerned about serious medication side effects?
Brief Answer:
Drug Modifications are the need of the choice.
Detailed Answer:
Hi Madam,
I understand your concern.
The use of Colchicine in heart diseases has been in approval since 2012.
1.This drug is known to reduce the risk of the primary end point--defined as ACS(acute coronary syndromes-ex MI), out-of-hospital cardiac arrest, or noncardioembolic ischemic stroke--by 67%, driven largely by a reduction in non–stent-related ACS.
2.The risk of Serotonin toxicity is high in your case-because of combination of all the following drugs--Viibryd,Savella,Lexapro/VLS.
Clonazepam will contribute minor additional risk.
Neurontin will not cause serotonin toxicity.
Savella has high risk of causing serotonin toxicity when given along with the rest.
Hence minimizing use of other drugs like VLX is important.
Also the risk high with regards to dosage of these drugs that is >2x/day.
Yes it is possible to minimize the risk.
Both Lexapro and Viibryd has same action.One of the drugs can be withdrawn.
Preferably Viibryd.
Likewise too much use of tramadol is not safe.Even this can be withdrawn.
And for the remaining drugs,Once a day dosing is advisable.
Remember all drug withdrawals have to preceeded by drug tapering.
Likewise drug holiday has to be issued once a week say,sunday.
All the above measures will minimize serotonin toxicity.
Remaining drugs -Cardizem,Plavix,Metoprolol,Prevastatin can be used as usual.
3.Fatigue can be a part of the surgical recovery as well as Fibromyalgia.This should be a worry as of now.
Once this drug modifications are done,we can expect improvement in his fatigue.
Post your further queries if any.
Thank you.
Drug Modifications are the need of the choice.
Detailed Answer:
Hi Madam,
I understand your concern.
The use of Colchicine in heart diseases has been in approval since 2012.
1.This drug is known to reduce the risk of the primary end point--defined as ACS(acute coronary syndromes-ex MI), out-of-hospital cardiac arrest, or noncardioembolic ischemic stroke--by 67%, driven largely by a reduction in non–stent-related ACS.
2.The risk of Serotonin toxicity is high in your case-because of combination of all the following drugs--Viibryd,Savella,Lexapro/VLS.
Clonazepam will contribute minor additional risk.
Neurontin will not cause serotonin toxicity.
Savella has high risk of causing serotonin toxicity when given along with the rest.
Hence minimizing use of other drugs like VLX is important.
Also the risk high with regards to dosage of these drugs that is >2x/day.
Yes it is possible to minimize the risk.
Both Lexapro and Viibryd has same action.One of the drugs can be withdrawn.
Preferably Viibryd.
Likewise too much use of tramadol is not safe.Even this can be withdrawn.
And for the remaining drugs,Once a day dosing is advisable.
Remember all drug withdrawals have to preceeded by drug tapering.
Likewise drug holiday has to be issued once a week say,sunday.
All the above measures will minimize serotonin toxicity.
Remaining drugs -Cardizem,Plavix,Metoprolol,Prevastatin can be used as usual.
3.Fatigue can be a part of the surgical recovery as well as Fibromyalgia.This should be a worry as of now.
Once this drug modifications are done,we can expect improvement in his fatigue.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
In light of the above, would the risks associated with Seroquel oral be outweighed by its possible use as a substitute for Ambien (zolpidem)? My husband has been complaining of terrible nightmares and occasional feelings of disorientation on waking. Thank you.
Brief Answer:
Seroquel is strongly contraindicated
Detailed Answer:
Hi Mam,
I understand your concern.
Seroquel is strongly contraindicated in patients with known heart disease.
This drug can run risk of arrhythmias.
Hence Zolpidem or Clonazepam is enough.
These are the actual drugs of choice to treat or prevent nightmares.
Use either Zolpidem or Clonazepam,but not both.
Concerning the disorientation on waking,this is strongly related to the usage of all the above psychotropic medications.
To overcome this drug modifications as suggested in my earlier answer will be the solution.
Post your further queries if any.
Thank you.
Seroquel is strongly contraindicated
Detailed Answer:
Hi Mam,
I understand your concern.
Seroquel is strongly contraindicated in patients with known heart disease.
This drug can run risk of arrhythmias.
Hence Zolpidem or Clonazepam is enough.
These are the actual drugs of choice to treat or prevent nightmares.
Use either Zolpidem or Clonazepam,but not both.
Concerning the disorientation on waking,this is strongly related to the usage of all the above psychotropic medications.
To overcome this drug modifications as suggested in my earlier answer will be the solution.
Post your further queries if any.
Thank you.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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