As you may have read my previous posts, I am on Gabapentin and Synthroid.

I had my follow-up consultation today with the neurologist who did the skin biopsy. I did not want to expect too much today but you must understand that in my heart, I was hoping that he would say something encouraging or worth pursuing.

Well, it was a let down, he just emphasized the negative result of my skin biopsy and he did not want to pursue any further tests. He said that whether my result was normal or abnormal, I will still hve to treat my symptoms.

He gave me another medicine - Nortriptyline. I know this is an anti-depressant medicine. This is supposed to be taken as complementary to the Gabapentin.

I am so hesitant to take this combination because of adverse side-effects. As it is, Gabapentine alone makes me so drowsy and sleepy. To add Nortriptyline will maybe makes me a zombie .

To add to all this, I have my unstable thyroid function. My last thyroid result was normal after 6 months of being low, but even then, the normal was still "below normal" level. And I read that Nortriptyline may result to exogenous thyroid.

I am stressed because I found out today that the Gabapentin and the Synthroid
I am taking all this time are with Gluten. I have been on gluten-free diet for a month now and yet all this time, I am ingesting gluten!!!

Does anyone have (had) a good experience with the combination of Gabapentin and Nortriptyline? Or is it better to be taken only either one of them. I was given with the lowest dosage for Nortriptyline. Doctor said that if the combination works, we will slowly taper down the Gabapentin.

Will appreciate your inputs.

Interaction with thyroid is considered a minor type:

http://www.drugs.com/interactions-ch...=1463-0,1734-0

I think it is worth considering, as it may be more useful than
the gabapentin. But that decision is yours and your doctor's.
Used in a low dose, may not be problematic.

Thank you Mrs.D.
You mean Nortriptyline may be more useful as a "stand-alone" treatment than being combined with Gabapentin?

It just makes me so concerned about the effect of all the medications that affect the central nervous system.

What could be the long term side effects of Nortriptyline in our body?

Thank you.

I am only saying that the nortriptyline may be more effective than the gabapentin. (new meta analysis of gabapentin found it only effective in about 30% of cases).

For that reason it is worth trying it. If it works well, you could consider tapering off gabapentin to see which is doing more for you. People all vary in responses to drugs, so one has to try them to see.

More on nortriptyline:
http://en.wikipedia.org/wiki/Nortriptyline

Usually low doses of this drug work for PN.

Thank you so much Mrs.D!

As you know, I am open to every medication available in the market, just to help me with the pain. I just have to get more information from experts like you - and for people who have actually used it.

Thanks for your time.

When you first start, there may be some sedation. That usually wears off in a week or so. The doctors give it at night for that reason.

The doctor actually said that it can cause insomia, so if I find it hard to sleep at night, I can take it in the morning. Perhaps when I take it in the morning together with the gabapentin, then I will be "floating" around the house instead of walking.

Mrs.D, in your experience, how long does a particular medicine reach its maximum effectiveness? I have read in some posts here that after reaching a maximum dosage for gabapentin, it stops working - and that applies to Nortriptyline too.

My word...... how will manage our pain????

I think insomnia is less likely than the reverse.

In antidepressant doses, the side effect profile is typically different than in the lower doses used for PN.

It can take up to a month to see effects.

When I tried amitriptyline (the parent compound) last winter I had pain relief within 3 days. But that wore off in the low dose I was taking after about 10 days. Because it made my blood sugar go up, I discontinued it. No sense in raising the dose etc, for me.

Nortriptyline is the active metabolite of amitriptyline (Elavil). So their actions are very similar.

Dear Mrs.D,
I was given 10mg 1x a day to be increased to 2x a day on the second week.
I understand that lower dosage of this medicine is intended for pain, but can it also improve the mood without increasing the dosage?

I am not sure Mrs. D but, I think my mood needs improvement. That is why I keep on taking SAM-e because aside from my arthritis which is really bothering me, I was hoping it can help my mood. but i notice that with the current dosage I am taking (200mg), I dont feel any change in my and instead I feel anxious. My plan was to increase the dosage so my arthritis can benefit more but with the nortriptyline coming in the picture, this will of course change.

By the way, thank you very much for advising me to stop SAM-e should I decide to take Nortriptyline. That was very thoughtful of you to advise me of the contraindication between the two. If I stop SAM-e, is there anything that you can recommend for my arthritis?

Mrs.D, as I mentioned in my earlier post, constipation is a problem to me now, Nilram warned me that constipation is one of hte side-effects of Nortriptyline, is taking virgin olive oil on daily basis safer than taking Metamucil, meaning that would it not affect the absorptions of all the drugs and supplements I am taking? As you know, with all my prescribed medicines and supplements, I have very little window for Metamucil.

Lastly (for now...), I understand that calcium affects the absorption of some prescribed medications, does it also affect the absorption of the supplements/vitamins?

Thank you so much.

Have you tried topical things for your finger swelling?

Salonpas patches OTC may help. The original ones can be cut to size to fit over fingers.

Have you soaked that hand in epsom salts?

If the SAMe is making you anxious, you may not need it.
Side effects are more common in people who already have enough SAM being made in their bodies.

I am also wondering about that finger...
Is this what you have?
http://www.orthogate.org/patient-edu...ntracture.html

Have you seen a hand specialist at all?