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Suggest Treatment For Dysmenorrhea

Posted on Wed, 8 Apr 2015

Question: Hi I am a surgeon from XXXXXXX XXXXXXX
Sir I started taking spasmoproxyvon due to dysmenorrhea and it has spiralled me out of control
Please can u help me in controlling this
I m currently taking 6-8 caps of sp per day
Also I am taking upto 40mg zolpidem.
I need to detox at home
I visited a specialist who suggested that in take nalotrexene for detox
Please let me know how best to do this
Can I stop sp suddenly
Wat about zolpidem
How do I stop

Answered by Dr. Rakesh Madhyastha (3 hours later)

Brief Answer:
Addiction

Detailed Answer:
Thanks for the query

Here is what I suggest

1. Lifestyle modification first

Please make sure that you have an early dinner
Do not watch tv till late in the night
Read a book in dim light before falling asleep
40 mg of zolpidem is very high, reduce it to 10 mg
Exercise daily and mediate in the morning for 30 min

2. You cannot stop spasmoproxyvon immediately

Reduce your dosage gradually. I recommend you to step down from 8 tablets daily to 7 for the next 10 days, then 6 and then 5 and then slowly stop just like how we stop steroids.
For pain an alternative pain killer like paracetamol can be used to substitute spasmoproxyvon. Local application of diclofenac can also help

3. Anxiety should be tackled with a betablocker like inderal, this will also reduce your dependence on spasmoproxyvon.

Do not stop both together, first bring down spasmoproxyvon and then reduce zolpidem.

Regards

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

Follow up: Dr. Rakesh Madhyastha (29 hours later)

Hi
Today I have tapered to 6 tablets
I'm having terrible hot flushes and leg pain and general discomfort
I have divided 6 tabs over the course of 24 hours is that right
Wat can I do regarding withdrawals

Answered by Dr. Rakesh Madhyastha (7 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back, I am sorry for the short delay in my reply. It was a busy day at the hospital

I suggest you to do the following

1. Check your blood pressure and pulse rate
2. Please do not take SP for the pain, I recommend a non opiod like aceclofenac or plain paracetamol instead
3. Tachycardia and high blood pressure can happen during withdrawals, a beta blocker is ideal for this.

I recommend that you seek professional one on one care. I understand that its difficult for you but still it is not advisable to go through this without supervision.

Regards

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

Follow up: Dr. Rakesh Madhyastha (7 minutes later)

I did not take anything for pain
It's not that severe
I just want to know if my tapering method is right
Till now I have taken only 3 from morning
I might have ti take 2 at night to
Making it a total of 5
I have reduced 3
Is that ok ? I feel so much happier and better

Zolpidem I have taken only 10mg today
I have cut that down too and I will stop

I cannot rake professional help
It's my fate that I need to get through this alone

Answered by Dr. Rakesh Madhyastha (2 minutes later)

Brief Answer:
Follow up

Detailed Answer:
Hello

I am happy you did not take anything for the pain

You continue to take a total of 5 in a divided manner. Continue to do this a week, then bring it down to 4. Please dont be in a hurry to reduce.

Continue to take 10 mg zolpidem, this is a good dosage to be on for a good night's sleep.

Regards

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

Follow up: Dr. Rakesh Madhyastha (6 minutes later)

Ok I will do that
Just a last query
As I reduce the total dose to one over a total of 1tab over a period of 4-5 weeks
Will I have problems weaning off the last one?
What about zolpidem can I stop in between now or should I try only after stopping sp

Answered by Dr. Rakesh Madhyastha (1 minute later)

Brief Answer:
Follow up

Detailed Answer:
Hello

As you reduce the dosage gradually, you will be able to wean of the last one with ease. There should not be too much difficulty in reducing the last one

You can reduce Zolpidem to 5 mg next week and then stop.

Regards

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

Follow up: Dr. Rakesh Madhyastha (3 hours later)

Sir I'm feeling much better
Please tell me the treatment for hot flushes and restless legs symdromw

Answered by Dr. Rakesh Madhyastha (14 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

Restless leg syndome is common in young females and it is most often associated with iron deficiency. Please check your hemoglobin and iron stores. If normal then the only treatment for you would be regular exercise, mediation and calcium channel blockers

Hot flushes could be due to withdrawal, please check your blood pressure during an episode and get back to me
I am so happy for you that you are feeling better. I wish you good luck and a speedy recovery

Regards

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

Follow up: Dr. Rakesh Madhyastha (11 minutes later)

My blood pressure is normal during the flushes
It's around 110/80
And my hb is 12.2gm%

Answered by Dr. Rakesh Madhyastha (4 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

Your hemoglobin is slightly on the lower side. I recommend that you take diet rich in iron. I dont think supplements is required for it at the moment.

Currently no medication is required for the hot flushes. If it becomes very severe please get a thyroid profile and vitamin D levels checked

I hope I was of help, please keep me informed.

Regards

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

Follow up: Dr. Rakesh Madhyastha (23 hours later)

Hi just wanted to say that iv cut down my tablet intake to 4 today
I'm very tired and irritable
Is this normal??
Zolpidem taking 20mg
Want to taper slowly due to headaches and st4ess
I'm also having difficulty in breathing which I feel is psychological
And I have severe headaches and Agitation
For how long do these withdrawal symptoms last? And when can I resume normal life

Answered by Dr. Rakesh Madhyastha (3 hours later)

Brief Answer:
reducing the drugs too fast

Detailed Answer:
Hello

Thanks for getting back

It does sound like you are having withdrawal symptoms, this is most likely because you are withdrawing from the drugs too soon. From 8 tablets a day to just 4 in a matter of 4 days.

While you are the hospital pleas check your heart rate, respiratory rate and also saturation. We should not miss a lower respiratory infection or wheeze thinking as withdrawal

Regards

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

Follow up: Dr. Rakesh Madhyastha (5 minutes later)

All vital parameters are within normal limits except bp which is slightly on lower side from before 90/60mm of hg
I'm just getting extremely worried about being on these pills as I feel very weak and tired and I look lifeless and drugged out
So trying to wean off
Is this too fast?
Should I slow down the tapering

Answered by Dr. Rakesh Madhyastha (7 hours later)

Brief Answer:
Slow down the tapering

Detailed Answer:
Hello

Thanks for getting back

Your blood pressure is too low, I suggest you to get admitted so that you can be put on IV fluids. It is hard to manage shock at home. In your previous post you have mentioned that your blood pressure was 110/80 which could be your baseline BP. Please lie down supine and raise the leg end.

Please slow down the tapering as you stand high risk of going into withdrawal.Also check your vital parameters every 2-3 hours.

Regards

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

Follow up: Dr. Rakesh Madhyastha (3 hours later)

Ok I will
Just please tell me how long does do withdrawal symptoms last

Answered by Dr. Rakesh Madhyastha (8 hours later)

Brief Answer:
4 weeks Or more

Detailed Answer:
Hello

Withdrawals are the toughest in the first two weeks but then you will start getting better.
You might feel completely drained and out of energy. The other common symptom is generalised body ache. It is important that you fight these symptoms , that is why tapering should be slow and steady

Regards

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

Follow up: Dr. Rakesh Madhyastha (2 days later)

I have now tapered to 3 tablets per day
Actually I don't feel any pain or anything like withdrawal symptoms at all
When I XXXXXXX taken the pill for more than 12 hours at night then I get I bit of shivering
Apart from which I feel fine
I have diarrhoea but I can manage that
Is this ok? Do u feel I'm going too fast??
Also my period is due
I don't want to take sp
Pls tell me what tabs for pain I can take as first 2 days I get pain
What about zolpidem sir?
My dosage is stil 20-30mg

Answered by Dr. Rakesh Madhyastha (14 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

I am sorry for the short delay in my reply
1. Please reduce Zolpidem to 10 mg like I have asked you to in my previous post
2. It is normal to get shivering probably it is withdrawal. Please fight the feeling with meditation or other activities to distract you
3. Tab Buscopan can be taken for the pain, if you want a more potent pain killer then you can take a non opiod like diclofenac for the first two days ( dont extent for more than 3 days as it is nephrotoxic)

I am sorry again for the delay in my reply

Regards

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

Follow up: Dr. Rakesh Madhyastha (4 hours later)

That's ok
I'm sure u must be busy
Ok I'm trying to do this
What about the tapering? Is this speed ok
I'm on 3 tabs now
I want to stop in one week at least

Answered by Dr. Rakesh Madhyastha (38 minutes later)

Brief Answer:
follow up

Detailed Answer:
Hello

A very happy shivarathri to you.

You are doing extremely well, although I prefer that you slow down the tapering to one tablet every 5 to 7 days.
Please make sure you check your blood pressure and heart rate daily in the hospital. Watch out for flushing and increased heart rate

Regards

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

Follow up: Dr. Rakesh Madhyastha (5 minutes later)

Wishing u the same
Ya I am doing this
Just want to get over it and start fresh

Answered by Dr. Rakesh Madhyastha (6 minutes later)

Brief Answer:
follow up

Detailed Answer:
Hello

You are on the right track and I am happy it's going well.

Regards

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

Follow up: Dr. Rakesh Madhyastha (6 days later)

Hi
Iv finally tapered down to 2 tablets
Now pls help me regarding zolpidem tapering
I'm on 30mg per day
I want to stop

Answered by Dr. Rakesh Madhyastha (9 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for the query

I am happy you are down to to only 2 tablets. You have been very successful in your deaddiction.

I would like you to take 25 mg of Zolpidem from tonight and reduce it by 5 mg every night until zero.

Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Rakesh Madhyastha (3 hours later)

I'm taking it in the day time too sir
As I feel very tired and unable to sleep
I will bring it down to 25mg today

Answered by Dr. Rakesh Madhyastha (10 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back.
1. Why are you taking it in the morning ? and how much mg in the morning?
2. How much are you taking at night?

Regards

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Rakesh Madhyastha (36 minutes later)

When I feel tired and unable to sleep i Take it in the afternoon
10mg during day
At night 20mg before sleeping
But I don feel anything if I don't take this
At times I take only 20mg at night
It varies

Answered by Dr. Rakesh Madhyastha (3 minutes later)

Brief Answer:
Dont take Zolpidem in the afternoon

Detailed Answer:
Hello

It is a bad idea to use zolpidem in the afternoon. As it leaves you drowsy for the rest half of the day.
How long have you been taking Zolpidem? It is usally not given for more than 6 weeks.
The withdrawal from Zolpidem should be very slow. I recommend that you only take the night dose from now on.

Regards

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

Follow up: Dr. Rakesh Madhyastha (8 minutes later)

I'm taking from around 5 weeks
Ok I will take only the night dose
20mg?
But I cannot sleep
What can I do?
I just want to stop this tablet taking

Answered by Dr. Rakesh Madhyastha (4 minutes later)

Brief Answer:
Follow up

Detailed Answer:
Hello

I am happy that it has only been 5 weeks so the withdrawal symptoms will be far lesser.

Here is what I suggest
1. Do not watch tv till late in the night
2. Have an early dinner
3. Empty the bladder before sleeping ( full bladder prevents deep sleep)
4. Read a book in a semi lit room ( dim room)
5. Yoga and mediation in the morning

Regards

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

Follow up: Dr. Rakesh Madhyastha (13 hours later)

What symptoms of withdrawal are generally expected with zolpidem ?
Yesterday I had terrible chills and body ache but I did not take any medication
I will start the tapering of zolpidem today
How should I stop spasmo since I'm on the last 2 tablets ?

Answered by Dr. Rakesh Madhyastha (20 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

I am extremely sorry for the delay in my reply. There was a family emergency.
The usual withdrawal symptoms insomnia, wight loss and anxiety. These withdrawal symptoms will be of a lesser degree as its not been too long since you are on these medications.

You can take Tab Avil for the chills, it is not related to tapering of zolpidem.

You can take one spasmo today, one tomorrow and then stop it altogeter.
Once again I am sorry for the delay
Regards

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

Follow up: Dr. Rakesh Madhyastha (4 hours later)

It's ok no problem at all
I am finding it a little diffucult to stop the last 2 tablets of spasmo
As for zolpidem I just cut it down to 25mg and I slept well last night
I will reduce over the course of this week

Answered by Dr. Rakesh Madhyastha (33 minutes later)

Brief Answer:
follow up

Detailed Answer:
Hello

Thanks for getting back

I understand it must be difficult for you, I recommend that you take two tablets of spasmo this week and 1 next week during height of withdrawal and then stop

Regards

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

Follow up: Dr. Rakesh Madhyastha (5 minutes later)

Thank you for ur understanding and help
I have come through this bcos of ur help
I will be very grateful if u can help me come off zolpidem as well and resume life normally
I am taking exams in May and this is the worst time this could have happened to me

Answered by Dr. Rakesh Madhyastha (1 minute later)

Brief Answer:
follow up

Detailed Answer:
Hello

Thanks for getting back

I will definitely help you in this regard, I am guessing your exams start from April 28, all the very best to you. You will do great in your exams and come out with flying colours

Regards

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

Follow up: Dr. Rakesh Madhyastha (10 hours later)

Thank u so much
I am grateful throughout my life to u
Pls tell me if I can taper zolpidem over daily basis
Today I never took it in the day time
I felt a little anxious but I was ok
Night dose how to taper

Answered by Dr. Rakesh Madhyastha (53 minutes later)

Brief Answer:
Follow up

Detailed Answer:
Hello

I was just helping and you have shown great strength and courage. I am proud to be your doctor.

Do not taper Zolpidem on daily basis, cut it down by 5 mg every 3 days. Little anxiousness is normal, take 25 mg today and 20 mg from tomorrow

Regards

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

Follow up: Dr. Rakesh Madhyastha (2 days later)

Doctor sp I have gone down to 1-2 caps some days just 1 also
But i need to stop
I'm worried about zolpidem
I'm not able to sleep with less than 25mg
And that too I get up In between and take more 10mg help me control this anxiety and mood swings I he'd to study seriously and I'm worried

Answered by Dr. Rakesh Madhyastha (6 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Please stop taking sp now. You will not need it anymore.

I recommend that you go this way

1. Meditation and yoga will help bring down anxiety.
2. I recommend a beta blocker at night to reduce anxiety instead of zolpidem.
3. Reduce zolpidem 5 mg a week, dont rush to reduce it.
4. Make sure you exercise daily, being tired is a very good trigger for good sleep.

Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Rakesh Madhyastha (1 hour later)

Ok I will do that
I'm tapering zolpidem have gone to 25mg
For chills can I take avil

Answered by Dr. Rakesh Madhyastha (3 hours later)

Brief Answer:
Avil can be taken for chills

Detailed Answer:
Hello

I recommend that you take 20 mg from tonight and continue the same dose for 1 week.
You can take 1 tab of avil for chills. It will bring down the chills

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Rakesh Madhyastha (3 minutes later)

For how long should I continue avil?

Answered by Dr. Rakesh Madhyastha (8 minutes later)

Brief Answer:
Follow up

Detailed Answer:
Hello

I suggest that you use it as sos basis, that is whenever you get chills. But not more than 2 to 3 a day

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Rakesh Madhyastha (3 days later)

Hi
I'm able to cut sp fully but I still take 1 pre day
How can I stop this
I heard taking avil is also addictive so I stopped it

Answered by Dr. Rakesh Madhyastha (7 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

Please stop the sp now. You will be fine. It is ok if you dont take avil.

1. How much zolpidem are you taking now?
2. Did you take beta blocker?
3. Are you sleeping well?

Regards

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

Follow up: Dr. Rakesh Madhyastha (1 hour later)

Zolpidem I have been taking 25mg at night and some times In the day
Around 35mg perdy
I did not take beta blocker
My sleep is terrible I need so,e Lomb term solution the this
Zolpidem even at high doses opi cannot sleep
So please. Suggest something to help me sleep comfortably at night
I do mot want to take day time tablets
Sp is almost stopped
I need a good sleep aid as zolpifem in high doses cannot make me sleep
Pls help
I stopped having chills and palpitations so I din take avil or inderal

Answered by Dr. Rakesh Madhyastha (7 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back, I am extremely sorry I did not check my mail before sleeping.

I was going through different articles, spoke to a few of my doctor friends here is what I suggest

1. Do not take more than 10 mg of Zolpidem at night
2. Do not take Zolpidem at day time, day time napping leads to less sleep at night time
3. Exercise for atleast 30 min a day. It will keep your mind fresh
4. Read for 30 min in dim light, this initiates of sleep
5. I dont want you to take any benzodiazapine like alprazolam as it is addictive as well
6. Avoid watching tv, eating food and caffeine before sleeping

Regards

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

Follow up: Dr. Rakesh Madhyastha (14 hours later)

Today I have not taken spasmoproxyvon
It's the second day I'm of it
Just mild muscle aches
My sleep is troubling me
I cannot sleep well with only zolpidem
Pls suggest some other medications for me to sleep

Answered by Dr. Rakesh Madhyastha (1 hour later)

Brief Answer:
Get evaluated

Detailed Answer:
Hello

I understand how debilitating it must be to just not get sleep. Since it is the imitation of sleep that's troubling you I think the best person for you to meet is a psychiatrist. however I don't think you have much option as far as getting medications which are not addictive
Did you try the lifestyle modifications I suggested ? please try them, it helps

Regards

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

Follow up: Dr. Rakesh Madhyastha (30 minutes later)

Ok I'll try these changes as u have suggested
I also want to stop zolpidem
I want to stop this
Shall I taper down I dowse of 5mg

Answered by Dr. Rakesh Madhyastha (7 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Please taper it down to 10 mg, you might not get sleep with 5mg. Please do not nap in the afternoon.

Regards

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

Follow up: Dr. Rakesh Madhyastha (16 hours later)

Ok sir. I will try to go to a psychiatrist tomorrow about other options
I'm very tired bcos of lack of sleep

Answered by Dr. Rakesh Madhyastha (6 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for taking my suggestion, it is wonderful to see you come out of SP addiction.
Please let me know what the psychiatrist suggested.

Regards

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

Follow up: Dr. Rakesh Madhyastha (12 days later)

Hi
I met the psychiatrist 2 days ago
He prescribed me mirtaz tablet 30mg
I stopped zolpidem completely 4 days back
I took mirtaz for 1 day but I did not like it
It makes me very drowsy the next day so I stopped it
Do u think I should take anything to aid in sleep or shall I just try on my own

Answered by Dr. Rakesh Madhyastha (5 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

I am happy you are off zolpidem and sp. I dont really think there is an indication now to start mirtaz however since you have met him personally and discussed it one on one basis maybe there is one.
Being drowsy during exam time is not a good thing.

Please do not take sleeping aid, go by the lifestyle modification I had advised earlier

Regards

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