CYMBALTA, SAVELLA AND LYRICA. THE TERRIBLE TRIO

I've always said....

it's not what they tell you....

it's what they don't tell you.

I'm as guilty as the next person. When a doctor prescribes a medicine I usually take it, however, there are a few of them that I haven't. Cymbalta and Savella were two of them. I know myself and I know that if the side effects are icky.....well, I'll quit. The problem is that we've become anesthetized to prescription medication. Again, I'm as guilty as the next person. We need to remember some of these medications are POWERFUL.

So I started looking.

I've included the sources at the bottom of this post. I was pretty amazed at what I'd found. What amazed me the most is that the FDA seemed to chide Eli Lilly (the maker of Cymbalta) about the fact that they had not designed a safe protocol for the discontinuation of the medication. They also don't tell the doctors how severe the symptoms of that discontinuation can be. 

Now, the class action lawsuits are coming out.

What? You mean you didn’t read the fine print?

Ok…we’ll settle. My bad.

You can't quit either drug cold turkey, hence my reason for not taking them. The problem as far as Cymbalta goes is that it only comes in three dosages; 20mg, 30mg and 60 mg. Plus, it is a capsule so you can't cut it in half. You are advised against opening the capsule so how do you know that you supposed to wean off slowly? Who would think to do that?

I am not coming against anyone who chooses to take Cymbalta or Savella. These medications are approved for Fibromyalgia and for anyone who has a depressive disorder. All I am saying is that people should be aware of side effects and what happens if you stop taking it. Stopping doesn't necessarily mean after weeks or months either. It can be after one dose but the longer you take it the worse the symptoms could be. 

What are the symptoms of withdrawal?

Actually it's called Cymbalta Discontinuation Syndrome.

Brain zaps that feel like an electric shock, suicidal thoughts, nausea and vomiting, headache, nightmares, diarrhea, excessive sweating, involuntary laughing or crying, tinnitus (ringing in the ears), extreme mood swings, paranoia, confusion, limb pain, fatigue, insomnia, anxiety, agitation, hypomania and seizures.

Discontinuation can be severe and extend for weeks and even months.

With Savella, there were adverse reactions during the clinical trials.

Again, I'm not coming against anyone who chooses to use these medications. Your doctor thought their use would be in your best interest. I just think all the information should be on the table. Some people may have no trouble with discontinuing these medications....others may be blindsided.

In the sources below, I also added all the information on Lyrica. Commercials make everyone think that you can take a pill and everything will work out and you'll be happy. Just for the record: I hate that commercial. I'm not one of those people that are suspicious of doctors and conventional medicine. Medications are necessary but just have all the information so you can make an informed choice.

After all....

If Eli Lilly won't tell you.......

The FDA will.......

In some archived obscure document......

Somewhere........

But I found it.

The sad part is?

The only one who will win will be the attorneys.

Sources: 

http://www.fda.gov/downloads/Advisor.../UCM172866.pdf


http://medlibrary.org/lib/rx/meds/savella-7/

                        http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021446s013s014lbl.pdf
           

THE DAMAGE DONE BY 60 MINUTES

I watched 60 minutes.

And my heart sank.

Pain patients don't matter.

I know those people are hurting. They lost someone they loved to addiction and the problem all started with opioids. I basically heard them tell me that I don't know what it's like to lose someone and that it could have been different if they hadn't gotten hooked on opioids.

They wrong.

I know very well what it's like and it makes me angry. 

Very angry.

I'm not angry at the system and I'm not angry at the drugs. I'm angry because the typical reaction is, when any tragedy happens, is to blame the object and outlaw it. It doesn't matter that there are many law abiding people that depend on these medications to live a functional life. The only thing that matters is that some people have died and that they are somehow not to blame; the pills are to blame.

Funny, it doesn't work that way with alcohol related deaths.

We don't blame the car.

Let's put this under a microscope and have people spend more than 30 seconds in pain management. Instead of throwing hydrocodone or oxycodone at patients who have a tooth pulled let's try using some common sense. Instead of spending less than ten minutes with a patient in pain management and leaving with narcotics wouldn't it make sense to have some counseling go along with it? Let's also do some genetic testing so we know what the dosage should be and how it will be metabolized by the individuals system. Instead of throwing prescriptions at people could they just talk to you first and find out what is going on? Would that be too difficult?

And while I'm on the subject.......

All this so-called "shaming." There's fat shaming, body shaming, skinny shaming, illness shaming and now pill shaming..... all this garbage. When is just being mean "shaming." Puts a sweet spin on someone who just wants to be cruel. Everyone has an opinion behind a keyboard. Social Media is wonderful in some respects but, I'll tell you, I'm REAL glad it wasn't around when I was in school. 

If you don't agree with someone it is now ok to be cruel.
No. It isn't.

So we are now going to pill shame. It's not like I've got a boo-boo on my finger and prescribed pain medication. Voodoo pain is the pain that I live with. I know that at any point in time someone is going to stab that little voodoo doll with a pin and I will feel a stabbing pain somewhere. If they hug and squeeze that little voodoo doll I'm going to have a dull ache all over my body. Again, this pain I've learned to handle. It's when the pain increases to whole other level; my whole body feels likes it's being compressed like a junk car that is being compressed to the size of a box of cornflakes. That voodoo doll? It's being stabbed all over....over and over again with a ferocious intensity. 

It is that pain that makes have to take pain medication to make it tolerable.

There are a lot of people like me. Maybe I don't have an addictive personality. I heard that one from my doctor. Maybe it's because I metabolize opioids slowly. I can't take very much because it stays with me. People that metabolize it quickly may have to have a different dosage or maybe that's where the trouble comes in. I don't know. I just think we have to do things differently.

The knee jerk reaction of taking it all away will not work.

It didn't work with Prohibition.

It didn't work with the war on drugs.

All it serves is to push it underground.

Which is precisely what is happening.

WHICH HIGHWAY AM I ON?

Ok.

I've heard it before.

I may be a tad opinionated.

A tad.

Where is the fine line that is forever blurred between feeling absolutely lazy and the laziness that depression absolutely brings? What is the difference between tenacity and stupidity and why can't I recognize the difference? Why do I long to control the wrong things and let the right things go? Where is the recognition of "this is very doable" and "I shouldn't touch this with a ten foot pole?" This is all very good except that I continually want to touch the things that I shouldn't touch with a ten foot pole.

Let's try a 6" ruler.
That's the story of my life.

As I got older I started trying to see if I could be still and not constantly butt my head against the brick wall titled "things I cannot change." I've come to the conclusion that it does no good. There was a story, I think in Pulp Fiction, about the scorpion and the frog. I heard it from my best friend and we always refer to it and say, "you can't change someones nature." The scorpion wants to hitch a ride on the back of the frog across the stream. Frog says, "no, you'll sting me." The scorpion eventually reassures the frog that it won't happen so the frog relents. What happens? The scorpion stings the frog. When the frog asks why? The scorpion replies, "it's my nature."

There it is.

I think it's in my very DNA to fight city hall. 

It comes down to medical issues as well. I'm not one of those people that thinks the right diet cures everything. I do believe in modern medicine. While I like to use oils and supplements, I don't think they are the end-all, be-all of medicine. I have gotten advice to end thyroid medication and go on holistic supplements. While I think that's great for some, I also think that it's dangerous. Not every medication is a conspiracy of "big pharma." I think you have to weigh the risks and benefits but it's a conversation between you and a physician who's been trained; not between you and people on social media. Having said that, I've been prescribed all sorts of things that I'm not going to take. Steroids, antidepressants and statin drugs.....well, I'm just too afraid to take them. I know that if I have any adverse reaction whatsoever, well, I'm done. 

Do I think I know better than the doctor? 

No, I don't.

What I know is my personality.

So where is the middle ground?

Do I have any?

If history tells me anything.

No, I don't.

I'VE WALKED MILES IN MY SHOES

It's been awhile.

I need more shoes.

So.

More walking in my shoes.

Mornings? Coffee with a diet coke chaser.

Doctors just throw more pills at you that don't work.

I want to get moving again.

I never know from one day to the next what lovely symptom is going to pop up. 

 Of course then there are the words we all love to hear, "I get tired too."

I don't even remember what it was like to wear these all the time. 

Sometimes it just gets depressing.

It costs a lot to have Fibromyalgia.

It feels like you've been hung out to dry.

So when all those symptoms seem to never go away.

I always try to remember that tomorrow will be a better day.

or....

sometimes.....

I just can't help it......

I just have to say.........

CHRONIC CASUALTIES

Why?

Societal pressure?

Weakness?

Sometimes we are our own worst enemy. Every day we have to fight a war. War against pain, war against fatigue, war against an invisible illness that most don't understand, war against indifferent doctors and war against pharmacies just trying to fill our prescriptions.

Why then do we turn the war on ourselves?

I've been to support meetings and read blogs and hear people talk about medication. Some even seem proud that they don't and haven't given in to prescription medication. That's good if it works for them but to make anyone else feel less than human for taking them is wrong. Using medication that you might become physically dependent upon isn't a sign of weakness. That is an unfortunate side effect of maybe feeling normal and productive. I know I am intensely aware of the fact that I am dependent upon them. 

Dependent not addicted.

We, however, err on the side of the addict.

Maybe we're trained to believe that it's greedy and selfish to want something for ourselves. All I know is every time I swallow a pill I feel weak. 

And that, my friends, is stupid.

If we are responsible and knowledgeable about the power of the pills, if we "follow the rules" then there shouldn't be any self-loathing about using narcotics or pills that help us get the restorative sleep we need or take away intense pain. When did it become the norm that suffering is noble? 

It isn't.

We can do so much more when pain isn't creating havoc in our bodies. If we can sleep then maybe, just maybe, we won't be as stiff and sore in the morning. If that happens maybe, just maybe, we can get the exercise that we need. Don't people get it? It's a vicious cycle. We need exercise but it just hurts too much to start. There are days that I'm at the gym with tears running down my face. 

I think we need to like ourselves a little bit more and not look at medication as weakness. There are a lot of therapies out there and every one of us need to tweak them for our own use.  I don't think we should feel bad if we use medication to feel better. Having said that, there is a fine line between believing the pill will keep us out of pain and knowing that it will never eradicate the pain. The difference between a tool and a crutch is huge.

We fight a war every single day.

And sometimes it feels like we should give up.

We can't.

And we shouldn't be one of the civilian casualties.

LYRICA: ONE AND DONE

It doesn't matter.

Every time I watch it.

Every single time.

I get really ticked off.

What am I talking about? I am talking about the truly amazing Lyrica commercial that's on TV. I can be in another room and hear, "I used to be active," in the pseudo-pain-filled voice designed to elicit a poor-pitiful-me response and I can feel my blood pressure start to rise.

Lyrica is Pfizer's number one selling drug and generates approximately 5.2 billion dollars in revenue for the company. I really don't understand how it got approved for Fibromyalgia. The side effects are frightening. I don't want to tell people not to take Lyrica. Some people have been helped and experience very mild side effects. I don't want to tick people off so maybe I should stick to the commercial. I would, however, like to see the women accurately portray the pain. Maybe one of the actors should look like something the cat dragged in. 

One of my favorites is the female architect. She's in full makeup and smiling. She puts on her hard hat, gathers her plans and sails out the door. Now, I used to work in new homes and would have to go on-site in homes that were anywhere from framed to complete. Sorry, but Lyrica just wouldn't cut it.

And I wouldn't be smiling.
Snarling is more like it.

Anyway, I noticed that the women, with the exception of the architect, on the commercial aren't thin. Does that mean that they've already experienced the weight gain from Lyrica or are they just starting out? Then, the commercial seems to tell the public that these poor people who are experiencing horrible pain can just take one of their pills and all will be right with the world. Does that mean if we don't take Lyrica we cannot be well? Or, if we choose not to, then maybe we want to be sick? 

Imagine that. 

You can flick that pesky fly of pain off your shoulder with just a little pill.

All the pain will go away and your life will resume.

Oh joy.

Everyone will get better.

But I still hate that fricking commercial.

By the way, here's the link to the FDA flyer on Lyrica. 

Click here.    http://www.fda.gov/downloads/Drugs/DrugSafety/UCM152825.pdf

COLLATERAL DAMAGE

Why?

Societal pressure?

Weakness?

We are our own worst enemy. Every day we have to fight a war. War against pain, war against fatigue, war against an invisible illness that most don't understand, war against indifferent doctors and war against pharmacies just trying to fill our prescriptions.

Why then do we turn the war on ourselves?

I've been to support meetings and read blogs and hear people talk about medication. Some even seem proud that they don't and haven't given in to prescription medication. That's good if it works for them but to make anyone else feel less than human for taking them is wrong. Using medication that you might become physically dependent upon isn't a sign of weakness. That is an unfortunate side effect of maybe feeling normal and productive. 

We err on the side of the addict.

Maybe we're trained that it's greedy and selfish to want something for ourselves. All I know is every time I swallow a pill I feel weak. 

And that, my friends, is stupid.

If we are responsible and knowledgeable about the power of the pills, if we "follow the rules" then there shouldn't be any self-loathing about using narcotics or pills that help us get the restorative sleep we need. When did it become the norm that suffering is noble? 

It isn't.

We can do so much more when pain isn't creating havoc in our bodies. If we can sleep then maybe, just maybe, we won't be as stiff and sore in the morning. If that happens maybe, just maybe, we can get the exercise that we need. Don't people get it? It's a vicious cycle. We need exercise but it just hurts too much to start. 

I think we need to like ourselves a little bit more and not look at medication as weakness. There are a lot of therapies out there and every one of us need to tweak them for our own use.  I don't think we should feel bad for wanting to feel better.

We fight a war every single day.

And sometimes it feels like we should give up.

We can't.

And we shouldn't be one of the civilian casualties.

THE MEDICATION CONUNDRUM

I was looking through papers. 

One in particular stood out. 

It was the flyer about medication. 

I've been looking at the medications that are currently used for the treatment of Fibromyalgia. Pain relievers, muscle relaxants, antidepressants and even anti-epileptic drugs. The approved drugs like Lyrica have side effects that can be serious.

So what are some of those medications?

I tried Lyrica and I still haven't lost all the weight I gained when I took that stuff. Not only do I hate the commercials but Lyrica made me squirrely. I gained weight (a lot), wondered if life was worth it and I couldn't trust my own mind. Even if it promised to take the pain away forever, I still wouldn't take it ever again. 

See, I will aways believe that Fibromyalgia has sub-groups. I have pain but not depression. I still feel that if depression accompanies the pain then Cymbalta or Savella may help and work for people in this group. It doesn't help me AT ALL. 

I have pain and terrible muscle spasms. I always say I'd take a baseball bat to my legs and beat the crap out of them because it would feel better than those stupid spasms. I take Zanaflex (tizanidine) and it does help. It helps normalize the amount of Substance P in the spinal fluid. Substance P is a neurotransmitter and it has been found that people with Fibromyalgia have an excess of Substance P in the spinal fluid. For me, it helps.

Back to the flyer.

It states that Zanaflex is ranked in the "poor" category.

I'll get back to that.

In the "excellent" category is Cymbalta, Lyrica, Savella and, funnily enough, Hydrocodone. Again, if you have pain and depression it's quite possible that these medications will help. The thing about hydrocodone, in my humble opinion, is that it isn't good for the long term. It is  usually combined with acetaminophen and there is a possibility of liver damage with long term use. The drugs in the excellent category in the flyer have weight gain as a side effect. I don't know about anyone else but pain is difficult enough to deal with.....

Weight gain?

Let's just add a tiara.

While I think the flyer gives good information about the approved medications that are used for Fibromyalgia, I think it's a mistake to rank them. The problem with Fibromyalgia is that this is a crap shoot. No one really knows what is going to work for whom. While a low dose opioid and tizanidine work for me to manage the symptoms, it may not work for someone else. 

Medications are tricky. They are to be used with caution. We have been made to believe that popping a pill will be magic. The pharmaceutical companies are big business and the side effects of the medications that we take are wide and varied. When I hear the disclaimers I think that the illness is almost better than what we have to take to manage it. Plus, they always talk REAL fast when they hit the real icky side effects. 

I think that sometimes we're being sold an illusion. They really don't know what these drugs can do. Is it possible, years from now, we will be told that these drugs are really not safe? I think there is a place for everything and we need a strategy that encompasses a pharma-exercise-alternative-behavioral-nutritional strategy. 

Let's face it, until they figure out what causes our pain perception and reception to go haywire......well then.......

We are where we are.

It the middle of the stream.

Reaching for any paddle that can get us to shore.

KEEP THE MOTOR RUNNING

The African Griffonia plant.

The seed pods are a natural source of 5-HTP.

Wasn't there a motor oil like that?

5-HTP is an amino acid that is made by the body from the essential amino acid L-tryptophan.  The body uses it to increase the production of serotonin. People with Fibromyalgia are usually deficient in serotonin. That's why for some people with Fibromyalgia, Cymbalta works wonders.

There is also a natural supplement of 5-HTP that can be taken. 

The dosage can be anywhere from 50 to 500 milligrams. That seems like a pretty wide variation in the dosage. Eating foods that contain tryptophan, such as poultry, seafood, nuts and dairy is a pretty healthy way to increase the amount of L-tryptophan in your body. The supplement sounds like a harmless way to increase the levels in your system.

Just remember one thing.

Even though it's natural that doesn't mean it isn't a drug.

Always let your doctor know what you're taking. Even if its a simple vitamin or a supplement. They can interact with the medications you take.....even the over-the-counter ones. These supplements can have strong biologic effects. We need to be careful....we have enough pain. 

Natural doesn't always mean safe.

I'm just as guilty of this as anyone else. Sometimes you get so tired of the pain that you'll try anything. I went to a support group meeting and a woman told me she took a supplement called lithium orotate and it took away the pain. Well, I went online and ordered it. I can tell you that I didn't have a real good reaction. There can be some real serious side effects and I didn't research it until I started taking it. 

Now, I'm very, very careful about medication.

Again, I understand the desperation to feel better. If there was something that worked the journals would be filled with studies and trials. The point is that we must be very transparent with our physicians. It may seem silly to list vitamins and supplements but they need to know. If you don't think your doctor will know, ask the pharmacist. Some supplements can interact not only with your current medication but even with certain foods.

This could happen to any of us.

Plus, we shouldn't mess around with our serotonin levels. That is only for trained medical professionals. There can be serotonin poisoning and that can be fatal. It can be as simple as combining medications that increase the levels. There's even cough syrup containing dextromethorphan that can do this. It just depends on how much of a serotonin increasing medication that we're already taking. Part of the problem is that we're prescribed so many things for so many different symptoms. 

There is also a great website where you can check the interaction of your medications and supplements. It's called MEDSCAPE DRUG INTERACTION CHECKER. I've included the link so just click on the the word. 

So just be careful taking medication.

We have enough issues to deal with.

HTP...STP..........

Still sounds like motor oil to me.

I guess it is.........kinda...........