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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by tonyz on April 10, 2010, at 11:26:14
I'm currently taking, 900mg lithium, 125mg seroquel, 125mg Notriptyline, 0.25mg of clonazepam, and 30-60mg of restoril.
I noticed that recently I have gotten a lot shakier especially when I put any strain on my muscles. Also have some tremor (loss of fine motor control) when bringing a cup to my mouth etc.
I had been on seroquel as high as 400mg and have been tapering, the Notriptyline has been at 125mg for a while now, the clonazepam was at a higher dosage and the restoril was just introduced yesterday. Lithium was increased from 600 to 900/ day on 4/1.
Is this shakiness normal and will it go away? What drug is the likely culprit?
Posted by Frustratedmama on April 10, 2010, at 11:32:41
In reply to Shaking and trouble with fine motor control, posted by tonyz on April 10, 2010, at 11:26:14
Most likely the lithium....there are ways to combat it if it is working better at 900 mg- is it?
Posted by tonyz on April 10, 2010, at 12:12:35
In reply to Re: Shaking and trouble with fine motor control, posted by Frustratedmama on April 10, 2010, at 11:32:41
Thanks for your reply.I know at 600mg it was just outside the therapeutic range.
But basically feel awful and getting very little sleep. So I' not noticing any improvement.
I'm not sure how much time I have to give these meds?
Posted by Lou Pilder on April 10, 2010, at 12:24:48
In reply to Shaking and trouble with fine motor control, posted by tonyz on April 10, 2010, at 11:26:14
> I'm currently taking, 900mg lithium, 125mg seroquel, 125mg Notriptyline, 0.25mg of clonazepam, and 30-60mg of restoril.
>
> I noticed that recently I have gotten a lot shakier especially when I put any strain on my muscles. Also have some tremor (loss of fine motor control) when bringing a cup to my mouth etc.
>
> I had been on seroquel as high as 400mg and have been tapering, the Notriptyline has been at 125mg for a while now, the clonazepam was at a higher dosage and the restoril was just introduced yesterday. Lithium was increased from 600 to 900/ day on 4/1.
>
> Is this shakiness normal and will it go away? What drug is the likely culprit?tonyz,
You wrote,[...is this..normal and will it go away?...]
The chemical combining of two chemicals that are in Seroquel and Nortriptyline can have additive effects on the nervouss system in relation in particular the anticholinergic properties of such.
This could cause twitching.
But the overiding aspect of thosse drugs that you are taking together is that they could have mind-altering consequences such as disorientation, hallucinations, psychosis,and there is the increase of the risk for Tardive Dyskinesia, which could be not reversible and have the potential to be life-ruining.
I am unsure as to the following and if you could post answers to such, I could have the opprotunity to respond accordingly.
A. Are these drugs being prescribed to you to take together?
B. If so, what kind of doctor wants you to take them together? (general practicioner or psychiatrist or some other type of doctor)
C. Has the addictive potential of taking clonazepam been explained to you by whoever prescribed the drugs, if they are prescribed?
D. Can you determine if Li tremor is what you have verses twitching from the combinming of the two drugs in question?
E. other questions if these are answerd
Lou
Posted by Justherself54 on April 10, 2010, at 12:40:17
In reply to Shaking and trouble with fine motor control, posted by tonyz on April 10, 2010, at 11:26:14
Both lithium and nortriptyline can cause tremors. My hands shook so badly on lithium that I couldn't type or handle the computer mouse..it would shoot right out of my hand and I had terrible edema.
I've never been on a high dosage of seroquel, but 25 mg. would do the trick for sleep.
Your pdoc should know how your meds are affecting you and perhaps some tweaking may help.
I hope you feel better soon.
Posted by Phillipa on April 10, 2010, at 12:45:11
In reply to Re: Shaking and trouble with fine motor control, posted by Justherself54 on April 10, 2010, at 12:40:17
Have you had your lithium levels checked? I know from seeing other I know relatives that they always had a tremor and shaking of extremities and gained weight. Phillipa
Posted by tonyz on April 10, 2010, at 12:53:35
In reply to Lou's response-wutchiend » tonyz, posted by Lou Pilder on April 10, 2010, at 12:24:48
Thank you for your response, I will try to answer your questions.
a)Drugs were prescribed to be taken together. was in hospital as an outpatient doctor there lowered nortriptyline 50 and raised seroquel to 400 over time, kept jerking around with the nortriptyline in changing the dosage. I decided I wasn't getting proper help so I left. Saw another psychiatrist and pa. Blood level done on nortriptyline so that at 125 right in the middle of the therapeutic range for me. I think at that time the seroquel was at 300 and the pdoc told me to just lower it to 200 I have been reducing by 25mg/ night, and now holding at 125mg.
b)originally prescribed by PA who reviewed with pdoc and I also have had follow on sessions w/ pdoc.
c)additive effect of clonazepam - I would have to say no with the exception that these drugs cause cns suppression. Clonazepam was at 1 mg and tried 0.25mg and restoril to see if that might work better for sleep.
d) It is relative but I would say this is pretty bad shaking. In the past when I have just taken Nortriptyline I would become a little unstable when bike riding for example. Last night after some light exercise I came home and while waiting for a traffic light, the right side of my body started shaking maybe oscillations of 2-3 inches. Do you think this could be the beginning of td - I am doubtful with the dosages where they are, but I don't know. So I don't think this is lithium tremor and at 900mg it is still not a major dose of lithium.Please tell me what you think, and thanks if you have read this far
Posted by tonyz on April 10, 2010, at 12:56:22
In reply to Re: Shaking and trouble with fine motor control, posted by Phillipa on April 10, 2010, at 12:45:11
Thanks for your question, at 600mg it was at 0.4 so just outside the therapeutic range. So at 900 should be ok, but level has not been checked at 900.
Posted by Frustratedmama on April 10, 2010, at 12:58:48
In reply to Re: Shaking and trouble with fine motor control, posted by tonyz on April 10, 2010, at 12:12:35
Lithium made me shake at 900 mg but I am a small female.....I was at therapeutic range at 600 mg....but the experience you explained at the most recent post worries me- call doc as soon as you can- sounded more seizure like as the whole side of body was shaking.....I had hand tremors not entire side of body....
Posted by tonyz on April 10, 2010, at 13:00:54
In reply to Re: Shaking and trouble with fine motor control, posted by Justherself54 on April 10, 2010, at 12:40:17
Sounds like you had some serious reactions from lithium, it has not been that bad for me. Typing is no problem. My main issue besides depression is sleep. The shakiness if primarily when I exercise where there is some weight bearing on the muscle; it is annoying but hopefully temporary.
Posted by Lou Pilder on April 10, 2010, at 13:35:37
In reply to Re: Lou's response-wutchiend, posted by tonyz on April 10, 2010, at 12:53:35
> Thank you for your response, I will try to answer your questions.
>
> a)Drugs were prescribed to be taken together. was in hospital as an outpatient doctor there lowered nortriptyline 50 and raised seroquel to 400 over time, kept jerking around with the nortriptyline in changing the dosage. I decided I wasn't getting proper help so I left. Saw another psychiatrist and pa. Blood level done on nortriptyline so that at 125 right in the middle of the therapeutic range for me. I think at that time the seroquel was at 300 and the pdoc told me to just lower it to 200 I have been reducing by 25mg/ night, and now holding at 125mg.
> b)originally prescribed by PA who reviewed with pdoc and I also have had follow on sessions w/ pdoc.
> c)additive effect of clonazepam - I would have to say no with the exception that these drugs cause cns suppression. Clonazepam was at 1 mg and tried 0.25mg and restoril to see if that might work better for sleep.
> d) It is relative but I would say this is pretty bad shaking. In the past when I have just taken Nortriptyline I would become a little unstable when bike riding for example. Last night after some light exercise I came home and while waiting for a traffic light, the right side of my body started shaking maybe oscillations of 2-3 inches. Do you think this could be the beginning of td - I am doubtful with the dosages where they are, but I don't know. So I don't think this is lithium tremor and at 900mg it is still not a major dose of lithium.
>
> Please tell me what you think, and thanks if you have read this faryonyz,
You wrote,[...please tell me what you think...]
From what you have posted, I think that you are in a situation that you acknowlege as the presence of chemicals in your nervouus system.
Are you aware of the risk that the taking of the combination of a TCA with Lithium can cause to you? I'm talking about psychosis, confusion, tremors, mania and neurotoxicity and mind-alterd states. And how could you ever prevent nauroleptic-like syndrome which could cause death?
Here is a link to articles that could help you make a more informed decision IMO as to if you want to combine these drugs that you are prescribed and you could share this with those that want you to take them. In this link, you could find Lithium and other psychotropic drugs down the page.
Lou
http://www.changehealthcare.com/rx_brands/drug_interactions/10338
Posted by tonyz on April 12, 2010, at 20:48:02
In reply to Lou's reply-lluhghoptrbbhl » tonyz, posted by Lou Pilder on April 10, 2010, at 13:35:37
Lou,
Thanks for your posting I will follow up with my pdoc.
Posted by alchemy on April 15, 2010, at 19:16:02
In reply to Lou's reply-lluhghoptrbbhl » tonyz, posted by Lou Pilder on April 10, 2010, at 13:35:37
I have it especially with my left hand. Very embarassing. I'm sure it's drug related, but for me it's a minor side effect.
Cocktail: lamictal, xanax, wellbutrin, celexa, sythroid.
This is the end of the thread.
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