antihistamines - yay or nay

[webslave]

Rated from most anticholinergic to least anticholinergic:

Amitriptyline +++
Doxepin +++
Imipramine ++
Nortriptyline ++
Protriptyline ++
Desipramine +

------------------------------

Tricyclic Antidepressants Antimuscarinic Effects

"¢Dry mouth
"¢Urinary retention
"¢Constipation
"¢Blurred vision

Tolerance develops to the antimuscarinic effects of these drugs

Tricyclic Antidepressants Miscellaneous Other Actions

"¢Hypomania or manic excitation
"¢Tremor
"¢Weight gain
"¢Acute glaucoma
"¢Impotence
"¢Jaundice
"¢Agranulocytosis
"¢Skin rashes

[Richard.N]

You will probably loose the benefit of the medication if you switch just to gain weight.

Sorry Ralph - don't get me wrong - weight gain would be a bonus but I have no intention of switching from Elavil unless there is something out there that works as well on my symptoms but doesn't cause urinary retention. Retention is my nemesis

My other option of course is to shop around for Alpha Blockers - I'm going to try Xatral as an alternative to my usual Flomax, but I may also try the titratable ones as well (Cardura/Hytrin).

[Richard.N]

Tolerance develops to the antimuscarinic effects of these drugs

That's interesting. I wonder then whether I should up the dose by a few mg's for a few weeks, get the tolerance I have now, and then drop back to 25mg

[Richard.N]

Just had a look at Doxepin and was surprised to find it has H1 + H2 antihistamine properties...

[Ralph]

Great summary of the side effects. The tricyclics are not very well tolerated by people being treated for depression because of many of the effects you listed. That's why they are not the drug of choice for depression treatment. I believe there is a Psychiatrist on this board. Perhaps he'll see this and respond with real expert information.

The urinary retention is a problem. In a way it is also why it works. The anticholenergic effect also reduces bladder spams. All antispasmotic drugs work this way, but can cause retention. I don't know what to tell you, but it sounds like you are approaching it in the right way. Perhaps one of the other alpha blockers would work better for you. It's worth a try. This condition requires a trail and error approach until you "stumble" upon the correct combination which works for you. I use Elmiron, Neurontin, Flomax, and occasionally Ultram. Antispasmotics, Librium, Prymidine Plus, Vioxx, Vicodin are kept close by. I keep a pill holder filled with my regular medication and my "emergency" meds in my pocket all the time. If a policeman ever searches me, I'll be arrested as a drug pusher.

[Ralph]

Here's a little summary. Hope it comes through.

http://www-personal.umich.edu/~mshlafer ... note03.pdf

[Richard.N]

If a policeman ever searches me, I'll be arrested as a drug pusher

Yeah - I know that feeling - I go on holiday to Turkey a fair bit and we've all seen Midnight Express.

I feel I'm getting closer to optimum amelioration anyway. I'm on Elavil, Flomax, and I've just started Elmiron and Milgamma N.

I know some of the properties of Neurontin Ralph, but how in particular does it help you?

[Richard.N]

Mark and Ralph - thank you both!

[latte]

I just started imipramine, 10mgs at bedtime, and my GP gave me some codeine with tylenol as needed. I was using the Ultram but it says not to take tricyclics with Ultram so I'll use the codeine once in a while. I tool Elavil last year with good results but my hands would go numb at nite(side effect). I'll let the board know how the imipramine works for me. So far I sleep really good but as soon as I pee or defacate my whole pelvis starts to ache and usually does for the rest of the day especially upon sitting even with a donut cushion.
Juggling these drugs takes a PhD in pharmo. My wife bought me the newest 2003 five inch thick drug guide to keep me sane.

[webslave]

Here's a little summary. Hope it comes through.

http://www-personal.umich.edu/~mshlafer ... note03.pdf

From that paper: "increased contractility/tone of sphincter muscles" - this is why antihistamines can hurt, and I suppose tricyclics too. The newer antihistamines like Allegra (which I am trying now -- seems OK) are far less of a problem in this regard, but there is still a little smooth muscle and sphincter effect (little twinge or two). I'm hoping this will subside in a few days, given all the assurances about the body adapting to these effects.

[Ralph]

Richard,

The Neurontin seems to help the generalized body aches I used to get. Mainly, I had pain radiating down my legs to the point that the bottom of my feet felt numb. Neuronton has taken most of this away. I hope I'll be able to ween myself of soon. Too many pills for such a young man as myself to take.

[Richard.N]

Mark - what's the active ingredient in Allegra?

[webslave]

Fexofenadine. It's derived from the old nasty one called Seldane (terfenadine), which was associated with rare, but serious heart problems when taken with certain other drugs, including certain antibiotics and antifungals.

In January 1997, FDA proposed removing all terfenadine products from the marketplace because of the approval of a safer alternative drug: Allegra (fexofenadine hydrochloride). Fexofenadine hydrochloride provides exactly the same benefits of terfenadine, but it does not cause a potentially fatal heart condition when taken with certain other commonly prescribed medications.

[Richard.N]

Cheers Mark. In the UK, Allegra is known as Telfast 120 and 180. Racey name eh? It's prescription only here. Is it OTC in the US?

Unlike Zantac and nearly every other antihistamine it doesn't appear to be contraindicated for use with Elavil.

Useful. Thanks.

[webslave]

Is it OTC in the US?

No, but it may be soon since Claritin has just become OTC and the insurance companies may drop support for all the other Rx antihistamines as a result.