![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Amigan on July 12, 2008, at 0:40:15
Hi.
Anafranil seems to have a unique pharmacological profile and it has been proven superior for the treatment of OCD and agoraphobia from the other ADs.
The problem for me is that i can't tolerate some of its side-effects.. Besides the full spectrum of the anticholinergic side effects that it gives me, it also causes me intense, disabling nausea. It's the nausea that i can't tolerate.
I read about people who take 30mg daily or even more and i can't believe it! 10-20mg are enough for me to make me stay lied on the bed, because if i stand up, i will vomit.
So, how do you fight the nausea? Do you take something else with it? I would really like to get some feedback from people who have some experience with Anafranil.
I would also like to know about which of its pharmacological action is responsible for this side effect.
Thank you.
Posted by SadDoggie on July 12, 2008, at 4:57:14
In reply to To Anafranil users, posted by Amigan on July 12, 2008, at 0:40:15
First take it with food. Always take meds that affect you like that with food. Second, if it's that bad I would ask my psychiatrist for some medication for the nausea. There may be something over-the-counter or a prescription med. They've got a lot of new prescription drugs for nausea nowadays. Lastly, ginger is a great home remedy for nausea. I've tried it and it works but I wouldn't settle for a home remedy if it's so bad.
Posted by yxibow on July 13, 2008, at 1:24:08
In reply to To Anafranil users, posted by Amigan on July 12, 2008, at 0:40:15
> Hi.
> Anafranil seems to have a unique pharmacological profile and it has been proven superior for the treatment of OCD and agoraphobia from the other ADs.
> The problem for me is that i can't tolerate some of its side-effects.. Besides the full spectrum of the anticholinergic side effects that it gives me, it also causes me intense, disabling nausea. It's the nausea that i can't tolerate.
> I read about people who take 30mg daily or even more and i can't believe it! 10-20mg are enough for me to make me stay lied on the bed, because if i stand up, i will vomit.You specifically used the words "stand up". Are you sure it is not causing orthostatic hypotension ? (low blood pressure). Swiftly standing up from that could make anyone tipsy and possibly prone to faint/vomit as well.
> So, how do you fight the nausea? Do you take something else with it? I would really like to get some feedback from people who have some experience with Anafranil.
> I would also like to know about which of its pharmacological action is responsible for this side effect.
> Thank you.
For you, since it seems you've been on it a while, if I am not correct and this is not going away, it is probably agonizing 5HT3 in a strong way like some SSRIs do (maybe).
One antiemetic in the AP related class that has fairly little by way of any dopamine issues is Tigan.It could still have some extrapyrimidal issues although it is far not as strong as some other ones such as Compazine (very strong) or the somewhat less weak Reglan, which is another choice if Tigan doesnt work (but it does carry risk that Tigan doesnt) . You could ask your doctor to try that. They work in the CMZ zone but its not necessarily 5HT3 specifically, I'm not sure of the chemistry
Otherwise, you would probably have to use one of the 5HT3 blockade drugs, and I don't know if your insurance would cover it outside of chemotherapy -- granisetron, ondansetron, etc. Some of the earlier released ones may be slighly "cheaper" but the retail still is around $25 a pill.
Ginger is a weak 5HT3 blockade agent in some trials and its pretty benign, so literally chewing on some raw ginger (which may not be your palate, I dont mind it) which is probably going to give you some of the most amounts of active ingredients might help. True ginger ale actually made from it might also help too, not the sugary stuff with flavor, but the natural store ginger ale. Candied hot ginger (australian typically) might also work to some extent.-- I hope that helps
Jay
Posted by Amigan on July 13, 2008, at 2:28:46
In reply to Re: To Anafranil users, posted by SadDoggie on July 12, 2008, at 4:57:14
> First take it with food. Always take meds that affect you like that with food.
Food doesn't help at all. It's not a matter of local irritation of the stomach. It seems that the nausea begins after the drug has been absorbed into the blood stream and passed through the BBB.
Food may slow down its absorption, but it still doesn't help.>Second, if it's that bad I would ask my psychiatrist for some medication for the nausea. There may be something over-the-counter or a prescription med. They've got a lot of new prescription drugs for nausea nowadays. Lastly, ginger is a great home remedy for nausea. I've tried it and it works but I wouldn't settle for a home remedy if it's so bad.
Ok. I see that yxibow also recommends ginger. It should worth a try. Thanks.
Posted by Amigan on July 13, 2008, at 2:42:01
In reply to Re: To Anafranil users » Amigan, posted by yxibow on July 13, 2008, at 1:24:08
> > Hi.
> > Anafranil seems to have a unique pharmacological profile and it has been proven superior for the treatment of OCD and agoraphobia from the other ADs.
> > The problem for me is that i can't tolerate some of its side-effects.. Besides the full spectrum of the anticholinergic side effects that it gives me, it also causes me intense, disabling nausea. It's the nausea that i can't tolerate.
> > I read about people who take 30mg daily or even more and i can't believe it! 10-20mg are enough for me to make me stay lied on the bed, because if i stand up, i will vomit.
>
> You specifically used the words "stand up". Are you sure it is not causing orthostatic hypotension ? (low blood pressure). Swiftly standing up from that could make anyone tipsy and possibly prone to faint/vomit as well.
Yes. I'm sure that is not related to orthostatic hypotension. It would be a slight dizziness and a feeling of light head, which last for some seconds in that case.> > So, how do you fight the nausea? Do you take something else with it? I would really like to get some feedback from people who have some experience with Anafranil.
> > I would also like to know about which of its pharmacological action is responsible for this side effect.
> > Thank you.
>
>
> For you, since it seems you've been on it a while, if I am not correct and this is not going away, it is probably agonizing 5HT3 in a strong way like some SSRIs do (maybe).Yes, i have been on it for a while.
5-HT3 agonism is what i believe is causing the nausea too. Clomipramine is not an 5HT3 agonist but it's the most potent SRI, to my knowledge.
So, i suppose i should try one of these 5-HT3 antagonists that are usually used in chemotherapy as antiemetics and see how i will react.Another possible cause, could be its anticholinergic action, which disturbs the "Acetylcholine-dopamine balance" of the brain, making the action of dopamine more pronounced. But this is less likely, imho.
Regarding the SSRIs, i can take as much as 60mg of Fluexetine and i experience only a mild dizziness. It's nowhere near the Clomipramine's nausea. I don't know why.. Perhaps Fluoxetine is a less potent SRI or because it doesn't have any notable anticholinergic action...
> One antiemetic in the AP related class that has fairly little by way of any dopamine issues is Tigan.
>
> It could still have some extrapyrimidal issues although it is far not as strong as some other ones such as Compazine (very strong) or the somewhat less weak Reglan, which is another choice if Tigan doesnt work (but it does carry risk that Tigan doesnt) . You could ask your doctor to try that. They work in the CMZ zone but its not necessarily 5HT3 specifically, I'm not sure of the chemistry
>
>
> Otherwise, you would probably have to use one of the 5HT3 blockade drugs, and I don't know if your insurance would cover it outside of chemotherapy -- granisetron, ondansetron, etc. Some of the earlier released ones may be slighly "cheaper" but the retail still is around $25 a pill.Right. If we are both right about what causes the nausea a 5HT3 antagonist should be a more proper choise than a dopamine antagonist.
I will ask if my insurance covers them or try to find a cheap source elsewhere.
> Ginger is a weak 5HT3 blockade agent in some trials and its pretty benign, so literally chewing on some raw ginger (which may not be your palate, I dont mind it) which is probably going to give you some of the most amounts of active ingredients might help. True ginger ale actually made from it might also help too, not the sugary stuff with flavor, but the natural store ginger ale. Candied hot ginger (australian typically) might also work to some extent.Ok.
> -- I hope that helpsIt does. Thanks a lot!
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.