My pain doc is in the process of changing my meds....He is taking me off of Topamax at the urging of a RA doc and putting me on Lyrica....and then I asked for Cymbalta so he is putting me on both...The insurance company said no to both...well definitely no to the Cymbalta, but I am thinking of picking it up on my own...I want it because it has the anti-depressant element to it too....so they might be able to talk the insurance company into the Lyrica and I will just pay for the Cymbalta..

The insurance company replaced the Cymbalta with Effexor...I said no thanks to that one...

Any opinions...I thought too if they do not approve the Lyrica...I could just stay on the Topamax and add the Cymbalta to the Topamax...Anyone try that?
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Gloria, I wrote you a long reply about 2:20 am and it is floating around in cyber space.
I have been on both meds, I started cymbalta for nerve pain that nothing had touched and have to say it has helped but for it to really help I have to take more then the required doseage and my ins. won't pay for that and cymbalta is expensive, I have however been on it a for a couple of yrs and am in the process of going off for several reasons and have to say that if you research you will see that WD can be really hard.
I was also on lyrica and it helped the pain but I had to tirate up to get good coverage and the more I triated up the worse the side effects, mine was sleeping all the time, and being in lala land and swelling and the swelling was so bad I had to stop it.
I do have to say that I have heard from a lot that both these meds have really.
I have followed your story for sometime and know how well you research, I recommend you do a lot with both these meds as they both work on the brain and can have serious side effetcs.
I wish you the best of luck with what you choose.
Linda

Linda,

Thanks for helping with these drugs...I was prescribed four new drugs this week and have not started any...I am so darn pill phobic. My docs think I am non-compliant, but in truth I am scared to death of drugs. I react terribly to them and I hate the having to wait for them to be out of the body....I have read good and bad things about both drugs. All of my docs with the exception of two have pushed and pushed for me to be on the Neurontin...I mean my pcp handed me a script and said trust me....I just cannot bring myself to put one in my mouth...I do not know why, yet I have taken the Topamax....The Topamax was difficult to get used to though too..It took weeks...but now I have to try two new drugs for pain and two for the stomach...It is too much too soon...so I will take it one step at a time. I had to pay out of pocket for the Cymbalta since the insurance would not approve it...I did not want the Effexor...I heard terrible things about that as well...I hate having to use any drug...

I don't know if this helps or not. My Cymbalta was approved by the insurance company, but I'm already in high doses of so many other generic drugs, like Amitryptiline, Gabapentin, Amantadine, and I'm also already on Depakote. I don't know if they'll approve me when I have to get to the higher dosage for Cymbalta to work for the pain. I think the best way is for you to talk to your MD and/or his NP, and discuss about the reason they think you should be on either drug or both drugs, if necessary. The approval really based on the "letter" from your MD and your records that the insurance has. there has to be a strong reason why the insurance company has to pay for really expensive drugs like Cymbalta.

Since it is very expensive, unless it's really necessary I wouldn't pay for it - but that is me. I pay Zyrtec from my own pocket because the insurance wouldn't cover and I really allergic to many things and I have not found a satisfying alternative. If I found that it works, and insurance company only approved for the small dosage, I probably will pay for the remaining dosage - only IF it works very well for my pain.

The other thing about Cymbalta is it is relatively new. It is only approved for depression and diabetic neuropathic pain. So you kind of gambling the long term effect more than the scenario that use the alternative to Cymbalta.

What was the reason that your MD wants to discontinue the Topamax?
Have you ever been on Neurontin (Gabapentin)? Now the generic is available, and it also contains anti-depressant effect though not much. Have you been on Amitriptyline? It works a MIRACLE for the pain. And I'm sure your insurance company will approve, even on very high doses (I'm taking 150mh HS) And, it has strong anti-depressant property.

hope you'll feel better soon..

p.s. I just noticed your second message. Every night I look at the mouthful of drugs I have to take. Well.. different persons react differently to the drugs. Some just have allergic reaction to almost anything, but some like me, could tolerate drugs very well. Each of us is made differently, and sometimes we forgot that. But even I have to take a month or two to be "free" of unpleasant side effects and get the maximum effects of the drugs. I think you have to ask yourself why you go to the doctor in the first place. I hate doctors who just order me things.. I love doctors that always include me in decision making. But it makes no sense for you to go all that hasle, making appointment, getting to the hospital etc., if you would just contemplate the prescriptions in front ot you. If you really2 have problem (phobia) with it, probably u should see a psychologists. They could help you to overcome your phobia.

You are right it is a phobia...My mother did it to us...She was so afraid that we would use street drugs she made us afraid of drugs that might help us...

I am about to come off topamax. Not because I dont like it but I dont think its working very well any more, and I'm on top dose for pain relief. I'm withdrawing, starting tomorrow. If I get a lot worse, then I'll go back on them. I hate drugs. I tried cymbalta much against my doctors wishes. It made me quite ill. Then I did quite a lot of reading up about it. The clinical trials were short, as far as I could see. As well as treating depression it seemed in some cases to cause it, and there were some cases of suicide. One was a girl who killed herself while taking part in the clinical trials, and had never suffered from depression before. It made me feel very sick, and really upset my insides. It also treats urinary incontinence, but as I was suffereing from retention of urine at the time, and had to self catheterise for six months following an operation, I didnt need to exacerbate that situation!! I take dosulepine, which seems to help me to sleep, and is very similar to Amytryptalline. Neurontin was dreadful. I put on about 28 pounds, very quickly indeed, and I wouldnt consider even trying Lyrica, although my pain management doc wanted me to, as I understand its chemical composition is very similar. The other reason I'm trying to come off Topa. is to see if any of my symptons are actually caused by the drug itself, as my GP has often hinted darkly that they might be. My neuropathy kicks in every day a couple of hours after I get up. Some days are worse than others. When I start I'm going to keep a diary. I believe that you couldnt take both Cymbalta and Topamax because your body could go into a kind of shock which could be fatal. There is a name for it, but I cant remember what it is!
PS. One of the other side effects I got was Thrombocytopenia, which was little pin pricky bruises underneath the skin, but I didnt even mention it to my doc because I got so so sick of going to her, and I began to feel like I was a malingerer. I dont really feel like that any more. But I still feel like there is nothing she can do. except listen to me, and also that my problem is going to go on and on and on, and I am going to live a very long time with it!!

Just wondering how long you've been on Topamax (or others) before you disconitnue use. I was sicker when I was first starting on Neurontin too, but only for the first month or two. The same thing with amitryptiline - i got pretty nauseas at first. But then it just helps more and more with the pain. Don't give up too quickly - that's my "motto."

Except, of course, if you faint or suddenly blind (which happen sometimes with Topamax) - BUT, only in the initial week. If you have glaucoma you shouldn't be on it. If you're one of those people who react violently to some drugs, just be on the viscninity of Emergency Room in the first week.

Also you should start in small dose (or very small dose if you get too much side effects), then increase every one or two weeks, depending on how your body reacts. If you still nauseous, for example, wait until the side effects gone before you go up the dose. And when you go up the dose and you got too sick that you can't manage, go back to the previous dose. Then try again after a week or two. These kind of thing only you could decide - with approval of your doctor.

hope you feel better soon.

agnuscrucis,

This is my problem ....The docs prescribed these medications in the highest dosage possible....Why don't they start at the smallest dose and then work up from there?...If they start low and then work up I might not be as afraid to take them...I do not like to take a capsule either...I like to take a pill that I can break into pieces...Then I can start a low dose and see if I react badly ...if I do not then I can take more of it...I know that sounds crazy, but I have had some really bad reactions to some of these medications....I am getting better though...I feel so badly now I usually just pop them into my mouth and hope for the best...I have stopped reading all of the side effects until after I take it and feel badly......

I do hope your doctor will go to bat for you. My insurance didn't want to pay for the exact same meds either, but my doctor contacted them to make it very clear that it wasn't being used for "depression". It's a proven scientific fact that one of the benefits of Cymbalta is that is does help with neuropathy. There are countless articles available online and in medical journals to support this. Buying it on your own is an option, but you may find as I did, that these meds are VERY expensive and over time could rob you of substantial amounts of money. If I could suggest, talk to your doctor and explain what's going on. See if they're willing to take up your cause. I've been on both meds for some time now. My insurance company pays for both, and both seem to help with symptoms of the neuropathy. I wish you great luck with this. Don't give up or let them bowl you over. These meds help.