Flexeril prozac

38, Caucasian female. Non smoker, occasional marijuana use, might have a couple drinks monthly. I take nexium, Prozac, lamictal and buspirone, and Flexeril sometimes. I also take melatonin and a multivitamin.
I have to have an upper GI endoscopy Friday and I’ve had them before and always with sedation. I had one provider who gave only the white liquid that looks milky and hurts when it goes in and when I had that I woke up mid procedure. The other times I’ve had this procedure done with Versed and I didn’t wake up or remember anything.
I’m seeing a new provider Friday and I’m afraid to wake up. Can I request to not have the milky IV stuff?

42, 5'6", 151 lb, white lady nurse work the last 2 months due to intense pain in my shoulder and neck. Symptoms of shoulder and upper arm pain started 5 months ago. History of C5-7 DDD dx in 2022. Taking bcp, semiglutide, atarax PRN for sleep, prozac, and vyvanse. I don't smoke or drink and no rec drug use. I was finally able to get an MRI last week and my ortho doc says it's bursitis in a very odd spot by the coracoid process, tricky to reach a needle for a cortisone injection. He cleared me to go back to work but said to come back if I'm still having pain after trying voltaren and a c-spine traction collar to use about 20 minutes daily. I'm still having a lot of pain. I've tried NSAIDs (although I hate taking them daily), Voltaren, Flexeril, capsacin, traction, rest, ice, heat, cupping, PTx8 weeks, dry needling, lido patches, acupressure with no luck, ultimately it comes back soon after if I'm doing anything physical or even computer work. I'm looking for a less physical job. Not sure if I should get arthroscopic surgery to remove the bursitis? Does DDD cause this? I would hate to have a spinal fusion. I'm not an ortho nurse so this is a bit out of my wheelhouse and would love insight/advice! I am so frustrated.

Before I get into my situation here are my demographics/medical info 21 y.o. Female 5’6” 114lbs (I was 130lbs at the beginning of November but I’ll get into that below) Caucasian Healthcare worker Occasional alcohol use but little to none in the last 3 months Non- smoker but active vaping Medical/psychological diagnoses • depression • ADD • Generalized anxiety disorder • hemiplegic (aka complex) migraines with aura • POTS • Endometriosis • Small vertebral fracture • COVID-19 (tested positive via home test 01/09 and via pcr test 01/10) • Bunions/ hammer toe and equinus contracture in the calf (I will get into why this and the COVID diagnosis is important below as well)
UNOFFICIAL DIAGNOSES • PTSD • Seasonal depression • OCD Current Medications Concerta 54 mg ER daily Ubrelvy 100mg as needed Aimovig injection 1x/30 days Myfembree daily Flexeril as needed Zofran as needed Mirena IUD I have been on Zoloft, Prozac and Lexapro at different times within the last 7-8 years on and off.
Recent life changes- October to now • Was in a car accident • My boyfriend’s car was scrapped because the engine went out the day before we moved • Moved in with my boyfriend Oct 10 23 • Got a dog late Oct • Had to drive a rental car for the first time • Had foot and calf surgery Nov 10 23 this meant heavy restrictions to my daily life because it’s my right foot • Was on heavy narcotics for a week or so • My boyfriend needed a car so we spent 2 months searching • The company I work for has to be out of the office I work in by Jan 26 and I found out 2 weeks ago • I applied for a position with the company that’s taking our place (I don’t want to give out much detail because I can get in trouble for it) • My boyfriend and I both have COVID • I lost 20lbs between November and now which I worked very hard to gain as I have struggled with weight for over a decade
Now that I got the specifics out of the way… I am lost. I have had depressive episodes for the last 2.5 months. I have had issues with sleeping since surgery. I have lost 20lbs which is what has upset me most. I am not cleared to go to the gym and weightlift yet but I am to the point where if I don’t start trying I’m going to have a mental break or something. I want to cry most of the time. I feel disconnected from my life. I don’t enjoy things anymore. I don’t know what to do. I need help and guidance on what to do. I am currently transitioning to an adult PCP because things got complicated for me so I hadn’t switched yet.

The appointments leading up to it were CONFUSING. I had it in my head to just take them both and stay flat. This doctor told Me i was the perfect candidate for nipple sparing direct to implant. My head was spinning and i decided i wanted. WELL I go to see the plastic surgeon who was wonderful BUT it seems like she actually did a little digging on my file. I haven't had my radiation and she's worried what that will do to my already very thin skin. Also my SMOKING HISTORY. I don't hide it from anyone, cigs for 17 years and I moved on to vaping. So she told me that day if I couldn't promise I would stop for 2 months she wouldn't do it. I told her right there that I just wanted to be flat anyway. She said I didn't have to make that decision right now and ok the day of surgery she would have everything with her in case i changed my mind.
I was in the pre-op room and I guess they told her I was talking about staying flat, so she came to talk to me about the expanders, and if they don't work out I'll just go flat anyway. So I ended up doing the one thing I didn't want to lol.
All of this occurred a week before my surgery. I finished chemo June 21 and they dropped the ball on getting the referrals in. (Tri-care is just special like that, they want referrals straight from the doc.)
Any way they're gone and they look WEIRD. Drain tubes suck, and they gave me a ton of meds like Lyrica, pregablin, celebrex, flexeril, and 20 whole hydro FIVES (lol) and my usual prozac and klonopin.
I'm stumbling and running into corners all day, I know it's the meds. I think it would he cool to wipe out all the crap and just give me the appropriate narcotic dose to dull down the pain. I know very well about addiction, I wish they'd stop putting that crap on surgery patients. I understand pill seekers and that's not what I'm doing. But I feel like if I even ask they will look at me funny. We shall see.

Hello all, I am a 37 year old female who is almost 5ft 3 and I weigh about 125. I lost 15 lbs recently after a hiatal hernia repair, which has been a real doozy to recover from. In 2020 I had a roux en y gastric bypass and went from 210 to about 135-140, and maintained my weight pretty easily since then. I do not smoke and have never. I do drink a couple drinks...maybe monthly? Sometimes less frequently than that.
In 2021 I had a tummy tuck. In 2022, I had a gallbladder removal and at that time the surgeon found a mesenteric defect but nothing more sinister. Recently I had severe nausea with no clear origin, and they did an endoscopy but didn't find any issues. However, since I had symptoms my surgeon continued to investigate, and they did a barium swallow - that's how they found the hiatal hernia. Earlier this year, I had iron deficiency anemia and had an iron infusion. I had this issue several times before surgery and some trouble taking supplements that had required infusions. Prior to my roux en y, I also had type 2 diabetes and gastroparesis, which is why I had the roux en y in the first place.
I take Prozac, Buspar, 20 mg of Nexium everyday (was 40 but I am tapering). Right now I am taking Valium after surgery but of course that's temporary. I take Flexeril PRN for TMJ headaches, and also sometimes a Pepcid A/C if I was having really bad GERD.
My question is just about some recent bloodwork. My RBC was 3.63. Hemoglobin 12.1, Hematocrit 35.3 which is just barely back into the normal range. Just wondering if I should be worried about this. I have an appointment with an internal med doc in mid September but it is taking awhile to get in, so I am just sort of worrying in the meantime.

40F, Caucasian, overweight
Existing medical issues: PCOS, chronic low back pain of 10+ years, hx of Mohs surgery for dermatofibrosarcoma protuberans at age 31, major depressive disorder, one live birth (c-section).
Family hx: Long family history of a variety of cancer, including mother (breast cancer at age 42 - deceased from), brother (acidic cell carcinoma at age 25 - alive), several aunts (breast, colon, skin, etc. cancer - all deceased), uncles (lung, unknown cancer - all deceased).
Current medications: Prozac 80mg, Flexeril as needed.
No smoking or drugs. Drink 3-4 glasses a month of red wine.
Current complaint: For six months, I have been consistently having my period every two weeks. Period lasts the normal 4-5 days, repeat exactly on schedule every two weeks. Other complaints are fatigue for the last 3 months. Primary provider referred for labs and pelvic and transvaginal ultrasound and to gynecology, but there is a long wait time to get in to that department.
Lab results: Ferritin - 4 ng/ml, Iron 28 ug/dl, TIBC 437 ug/dL, % saturation 6, WBC K/uL 6.2, RBC 4.09, Hemoglobin GM/DL 9.9, Hematocrit 30%, MCV 73, MCH 24, MCHC 33, RDW 14.8, Platlet count 311, Neutrophils, 3.8 K/uL, Lymphocytes 1.6 K/uL.
My provider responded to the lab work and said I'm clearly anemic and to start taking iron.
Ultrasound: I just had the ultrasound. It lasted over 30 minutes which is the longest I've had an ultrasound last. At the end, the tech asked me if I was on any immunocompromised drugs. I said no and she left. I can't get her question out of my head and Google is driving me up a wall. I know I should just patiently wait for the ultrasound results, but I'm looking for some advice about why that would be asked. Did the tech see something that made her ask that question? Is it a routine question now? She only asked about the number of pregnancies and started the exam. I've never been asked this before in all the years I've had ultrasounds.

Hi, I'm 24(NB, they/them, AFAB), US, and a longtime lurker of this subreddit. I was diagnosed with fibromyalgia back in March of this year by a rheumatologist, after dealing with widespread chronic pain for most of my life. Alongside this, I have also been diagnosed with chronic migraine headaches, tics of organic origin, sacroiliitis, TMJ disorder, bipolar 2, and ADHD. I suspect I may also have CFS/ME, and I'm planning on asking my PCP about it at my yearly appointment next month. I have a vitamin B12 and D deficiency as well, and I've been taking supplements for those for the last year with little change in pain and energy.
In the last year, I have been on Cymbalta, Prozac, Abilify, Guanfacine, Olanzapine, Straterra, Risperidone, Propranolol, Flexeril, Rizatriptan, Meloxicam, Gabapentin, Lamictal, and Effexor. Flexeril helped my tics to go away after a few months of taking it daily (and now as needed when I feel them wanting to come back), but other than that, aside from making me gain weight or become hypomanic/extremely depressed, none of these medications have done anything for my mental and physical health. Aside from the Cymbalta, which I had to stop immediately due to it making me uncontrollably ill, I was on each of these medications for a minimum of four weeks, usually 2-3 medications at a time (ex. Lamictal and Effexor, Prozac and Abilify.) I've just started Ajovy for my migraines this month, so obviously I have nothing to say about that for the next couple of months.
I'm not asking for advice, I guess I'm just looking for some empathy. I'm about ready to call it quits on the whole medication shtick and just tough it out like I always have, but I'm worried that now that I've started medication, my problems will become much worse after stopping (which comes from experience- I'm also on pantoprazole for heartburn and a hiatal hernia, and any time that I've stopped it in the past my problems have gotten worse than they were before I started the med.) I've considered medical marijuana, which is legal in my state, but any time I've tried weed it's made my heartburn worse.
Unfortunately, I'm pretty much out of options now. I know there are other medications out there, but with my combination of diagnoses it's kind of a balancing act of trying to figure out what I can take that's not going to exasperate everything else to the point of redundancy. I feel so hopeless now, having tried to many medications with no positive results.
Anyways, what a way to join this sub (along with reddit itself), amiright?

As title shows, I have been to the hospital three times in the pass two weeks because I can hardly walk more than .1 mile without feeling like I’m about to tip over along with the panic attacks this fatigue has gave me.I took a 1000 mg NOW NAC tablets daily at the last week of August (for a total intake of 5 talbets over the course of the week and stopped). Many suggested taking these tablets for my OCD as SNRI (Cymbalta/Prozac) gave me horrible side effects and similar side effects. NAC actually helped my OCD but left me house ridded with fatigue/anxiety.
It’s also worth mentioning I took one 200 mg kava pill around the end of august.
Outside of that I take nothing and have a great diet. I do have grass and mold allergies. I have very slight itching during this time of year.
Thanks for reading and let me know what you guys think because ER says they can’t do anything about it cause blood work comes back fine.
Edit: need to also mentioned that flexeril two years ago gave me fatigue but no anxiety
NAC: https://www.amazon.com/gp/aw/d/B00KT3H13C?psc=1&ref=ppx_pop_mob_b_asin_title

I am 17F. I first noticed sexual dysfunction while taking Prozac 20-40mg. So I no longer take it, the last time i took it was roughly 1.5 weeks ago, by then my dose had been lowered to 10mg. Here is my newest med list:

• Cymbalta 40mg
• Gabapentin 300mg 3x a day
• Seroquel 50mg
• Flexeril 5mg as needed
• Tri-Linyah birth control

I still cannot orgasm easily anymore, I’ve had two orgasms while being on this list and I no longer enjoy masturbation, and even sex to a lesser extent. Mentally I want it but my body won’t work. Is it still the Prozac left in me, or are these meds indicative of sexual dysfunction as well? :( Thank you.

I recently got prescribed baclofen as a muscle relaxer to help with a chronic pain condition I have. Am I able to tale 5mg of baclofen on an as needed basis or do I need to take it consistently? I used to take flexeril about once a week but recently started prozac so wanted an option that does not impact seratonin. I don't want to take it every day, just once a week or so when the pain gets bad

Hello all, I was wondering if anyone has taken a muscle relaxer known as flexeril while taking prozac. I've been prescribed 5mg of flexeril long before I started prozac due to a chronic pain condition. Since I've started taking prozac I've been hesitant to mix the two because of the rare case of seratonin syndrome. Both the doctor and the pharmacist said it was a very rare side effect and it would he fine if I took them both. However, I have bad health anxiety and worry a lot about the possibility of getting seratonine syndrome so I wanted to see if anyone here had experience with them both or can offer some insight on taking both? Btw I've been taking prozac for about 6 weeks and I'm currently on 20mg. Thanks in advance!

My teeth are in so much pain, but I can't stop. I'm 2 weeks in and I don't recall having this issue before. I'm about to just pull the plug on all anti-depressants because they're always causing some kind of issue for me even if they're beneficial in some way. I was doing REALLY well on wellbutrin recently but the motor tics were so bad it was bordering on tourettes like. I was popping my shoulder out of place so bad my back was in agony. In fact, I'm still not 100% over that. I'm prone to mild motor tics, but this ramped them up to 11.
Prozac appears to be doing something similar. I know the clenching will hurt, particularly my top teeth over my bottom teeth (got some overbite). I know it will hurt, but my OCD says DO IT ANYWAY, or "hmm, it doesn't hurt now, try it again and see if it does" it's so frustrating. I've been on prozac several times before and I do not recall this being an issue.
It seems this does not get better for many people :/ can anyone chime in? I take 20mg in the morning, having come from cymbalta 20mg (had upped it to 40mg for a bit with zero success). I'd been meaning to quit that one entirely for awhile, but the withdrawals were unbearable. It was hard even bridging into prozac, but I suppose if I did want to jump off now, it would be easier.
My last resort is a TCA. These are the only ones that don't seem to be associated with increased motor tics. Unfortunately I cannot afford to see a psychiatrist so I can only play spin the drug on the wheel (what?) with my GP until I figure something out... I hate my brain. I really do. I have so much untapped potential, TOO much untapped potential, and I am 2 years shy of 30. Things need to change.
I'm at least working to see a therapist the best I can right now. They may not be able to prescribe meds, but I know there is more to helping myself than meds. I've tried so many.
​
And yes I've heard buspirone can prevent this from SSRI/SNRIs. I didn't really have this issue with the cymbalta, but I used to take buspirone. Perhaps I will try it again one day, maybe not. It certainly helped with sexual side effects, libido was back 100%. My doc put me on flexeril at night to see if that makes a difference but I literally don't see how it will? I don't think I grind in my sleep at all due to it's tie to OCD, and I don't wake up with sore teeth.
I have been supplementing magnesium glycinate 400mg at bed and attempting to gain more control with this. I took prilosec for a few months recently and I'm sure my magnesium was badly depleted. Didn't even have acid reflux either lol.. just anxiety and googling symptoms. Worst year of my life, I'm tellin ya... at least I get major sinus surgery in 2 weeks that I've needed all year. The headaches have been no f*cking joke.

I have been prescribed cyclobenzaprine (a muscle relaxant also known as flexeril) for about 5 years for tension headaches. I just started Prozac 20mg about a month ago for anxiety. I’m definitely noticing an improvement in my anxiety symptoms already. But I have had a headache almost every day. I have taken Tylenol almost every time and Ibuprofen twice when it was really bad. I had to work up the courage to even take the ibuprofen because I know it’s not great to take with the Prozac.
I know that if I just take a muscle relaxer my headache will go away for good instead of coming back every day. My doctor did check my other medications before prescribing me the Prozac and she said that I could take the cyclobenzaprine but if the Prozac makes me sleepy, to not take them at the same time because it will increase those symptoms. Google says taking them together can cause serotonin syndrome so I have been too scared to do it. I take Prozac in the morning and would normally take the cyclobenzaprine at night since it’s knocks me out. Has anyone ever taken them together? Or should I discuss other options for my headaches with my doctor? Thank you!

Hello kava lovers!
I took quite a bit of time today to dig into this. It's been a long running issue that when you type in "Kava" in google you get some dubious results on the first page. I'm taking it upon myself to list those here, and refute them where they have issues.
Search Results for "Kava" on google in incognito window.
Result 1: Webmd

1. Overview

• Point 1: “Kava is a beverage or extract that is made from Piper methysticum, a plant native to the western Pacific islands. The name "kava" comes from the Polynesian word "awa," which means bitter. In the South Pacific, kava is a popular social drink. It is consumed as a beverage in ceremonies to promote relaxation.”

1. No issues with point one.

• Point 2: “There have been some safety concerns about kava. Cases of liver damage and even some deaths have been traced to kava use. Because of these reports, kava was withdrawn from the market in Europe and Canada in the early 2000s. However, most countries have allowed kava to return to the market since that time. Kava has never been taken off the market in the U.S.”

1. And my issues start here. “Cases of liver damage and even some deaths have been traced to kava use” is a hotly contested conclusion, and rather inflammatory when such paltry evidence exists to support it. The paragraph then goes on to state “However, most countries have allowed kava to return to the market since that time.” My issue here is; why are we not seeing these cases of liver failures and injury in countries where it’s freely available today, if it’s as liver toxic as it was said to be?

• Point 3: “Kava is most commonly used for anxiety. Some people take kava for stress, restlessness, sleeping problems (insomnia), and many other conditions. But there is no good scientific evidence to support these uses.”

1. “But there is no good scientific evidence to support these uses.” Hilariously they give quite good scientific evidence to support these uses directly in their references. Kava and kava extracts have been proven in double blind placebo controlled studies to reduce anxiety scores, and increase sleep duration/quality.
2. How does it work?

• Point 1: “Kava affects the brain and other parts of the central nervous system. The kavalactones in kava are believed to be responsible for its effects.”

1. No issues with this. This has been demonstrated repeatedly in research.
2. Possibly Effective for

• Point 1: “Anxiety. Most research shows that taking kava extracts that contain 70% kavalactones can lower anxiety and might work as well as some prescription anti-anxiety medications. Most studies have used a specific kava extract (WS 1490, Dr. Willmar Schwabe Pharmaceuticals). It seems that kava supplements containing at least 200 mg kavalactones daily should be taken for at least 5 weeks for symptoms to improve.”

1. Strangely, they just got finished saying there is no good scientific information on which to support these theories. Extra note: WS-1490 is an extract that has been embroiled in controversy. The extract is contested on the grounds that it was changed several times throughout the research periods from an ethanolic extract to an acetonic extract with no indication. You can see this by noting how the kavalactone percentage changes arbitrarily from 30% to 70%.
2. Possibly Ineffective for

• Point 1: “A type of persistent anxiety marked by exaggerated worry and tension (generalized anxiety disorder or GAD). Several early studies show that taking kava doesn't improve symptoms in people with GAD.”

1. They conveniently don’t mark their sources in the article, but this one comes from Dr. Sarris in Australia in 2020. This research concluded that kava was more suitable for the reduction in stress and tension related to ‘situational’ anxiety, than it was for direct treatment of G.A.D.
2. Insufficient Evidence for

• Point 1 “Withdrawal from drugs called benzodiazepines. Early research suggests that slowly increasing the dose of kava extract over the course of one week while decreasing the dose of benzodiazepines over the course of two weeks can prevent withdrawal symptoms and reduce anxiety in people who have been taking benzodiazepines for a long period of time.”

1. It can reduce anxiety, but the actual physical withdrawal is not treated by any action of the kavalactones themselves. It’s likely that the steady tapering of the BZP drug was what allowed these participants to cease their use with less acute withdrawal. Kava definitely helps, but it has different actions at the GABA-A receptor that are not similar to that of benzodiazepine drugs. Benzos target the BZP allosteric site on the GABA-A receptor where they exert their effect. Kava and flumazenil (a very potent anti-benzo or BZP antagonist) were administered at the same time in studies, and the effect of kava was not blocked.

• Point 2 “Cancer. There is some early evidence that taking kava might help to prevent cancer.”

1. I would say this “insufficient evidence” is actually an order of magnitude more studied and documented than the “liver damage” at the very beginning of this article. I’ve added additional citations below this papers citations, and I stopped citing at 12 research studies that show anti-cancer effects.

• Point 3 “Insomnia. Research on the effectiveness of kava in people with sleeping problems is inconsistent. Some research shows that taking kava extract daily for 4 weeks reduces sleeping problems in people with anxiety disorders. But other research suggests that taking kava three times daily for 4 weeks does not reduce insomnia in people with anxiety.”

1. The World Health organization monograph (2002) describes insomnia as a state supported by clinical data. This is generally accepted, however there were participants in studies on kava that dropped out due to insomnia complaints. While kava is overall a good fit for sleep issues, it likely won’t present that way to 100% of the people who drink it. We actually do see people complain about not being able to get to sleep after a strong kava. I say this to agree with the above paragraph where it states the research is inconsistent. It helps me with sleep, but that doesn’t mean it will be the same for everyone.

• Point 4 “Symptoms of menopause. Early research shows that taking kava daily for 3 months might reduce depression, anxiety, and hot flashes.”

1. While maybe insufficient, there is good evidence to support this. Two individual studies found improvement in mood, reduction in depression, and reduction in anxiety in perimenopausal individuals.

• Point 5 “Stress. Early research suggests that taking a single dose of kava by mouth might reduce symptoms associated with mentally stressful tasks.”

1. This is an odd one to say has insufficient evidence. A number of researchers including Münte, Sarris, Cropley, and Aporosa have found kava reduces symptoms associated with mentally stressful tasks.

• Point 6 “Seizure disorder (epilepsy).”

1. This is in line with reality. We only see glimpses into kava’s ability to modulate glutamate. Kavain was shown to inhibit veratridine-activated sodium channels. It’s possible that kava may help reduce seizures, but as said, there is insufficient evidence to say it precisely.

• Point 7 “Muscle pain.”

1. This I don’t agree with, and it’s a strange one to be saying there’s insufficient evidence for. Kava has marked antinociceptive (pain relieving) and muscle-relaxing properties. A good number of independent research studies have confirmed this.

• Point 8 “Other conditions”

1. I’m not really sure what to say here. I suppose it’s quite accurate to say that there is insufficient evidence for kava causing superhero-like powers to emerge.
2. Side Effects

• Paragraph 1 “When taken by mouth: Kava is POSSIBLY SAFE when taken for up to 6 months. Using kava can make you unable to drive or operate machinery safely. Do not take kava before you plan on driving. "Driving-under-the-influence" citations have been issued to people driving erratically after drinking large amounts of kava tea.”

1. This is good, and goes pretty far based on the double blind placebo controlled studies. The one issue I have is the 6 month limit. There really isn’t any indication that taking kava beyond this time frame causes issues, it’s just when they cut the time limit of the study. Empirical evidence suggests kava, when consumed as a beverage, is safe indefinitely as shown by the South Pacific people who drink kava on a daily basis and have for generations. In regards to driving, I fully agree. If you’re consuming anything that makes you question your abilities with driving, call an ubelyft.The risk is simply not worth it.

• Paragraph 2 “People may have heard that use of kava can cause liver damage. The use of kava for as little as 1-3 months has resulted in the need for liver transplants and even death in some people. Early symptoms of liver damage include yellowed eyes and skin (jaundice), fatigue, and dark urine. But these cases appear to be relatively rare. Most people who have used kava have not experienced liver toxicity. Also, some experts believe that the liver toxicity seen in these cases cannot be directly linked to kava. Other factors may have contributed to these toxic effects. To be on the safe side, people who choose to use kava can get liver function tests.”

1. That’s pretty honest, however the phrase “The use of kava for as little as 1-3 months has resulted in the need for liver transplants and even death in some people” really understates “some people”. The number of individuals allegedly harmed by kava is limited to less than 10. There has been no intrinsic (unable to be separated) toxicity seen in kava or any kava extracts, however idiosyncratic reactions of the immunologic type have occurred. This is extremely rare. I can’t say that enough. We’re talking on the scale of winning the lottery, being hit by lightning, and finding Jimmy Hoffa all at the same instant. If we turn our attention to things such as green tea extracts or acetaminophen we see intrinsic, predictable toxicity to the liver. This does not exist with kava.
2. Special Precautions and Warnings

• Point 1 “Pregnancy and breast-feeding: Don't use kava if you are pregnant or breast-feeding. Kava is POSSIBLY UNSAFE when taken by mouth. There is a concern that it might affect the uterus. Also, some of the dangerous chemicals in kava can pass into breast milk and might hurt a breast-fed infant.”

1. They’re speaking about kavalactones, and they’re not “dangerous chemicals” however we don't fully understand the function of GABAergic substances on the developing brain. Kavalactones are known as lipophilic, meaning they tend to combine or dissolve in fats. This means they could likely also pass on through breastfeeding. There is no data confirming this suspicion, however with no experience available, kava is not recommended for use by pregnant or breast-feeding women. It’s much better to err on the side of caution. In regards to kava affecting the uterus, I’m afraid there is absolutely nothing confirming this. It’s an old myth from Fiji that kava stimulates the uterus, this doesn’t happen, and shouldn’t be listed as a precaution. Histopathology was performed on rats at 2.0g/kg of kavalactones and found no-effect level on the uterus. (2012. “Toxicology and Carcinogenesis Studies of Kava Kava Extract (CAS No. 9000-38-8) in F344/N Rats and B6C3F1 Mice (gavage Studies).” National Toxicology Program 571 (1): 1–186. https://ntp.niehs.nih.gov/publications/reports/t500s/tr571/index.html)

• Point 2 “Liver disease: Kava might cause liver problems, even in healthy people. People who have a history of liver problems should avoid kava.”

1. Well this sounds familiar. This will be the 3rd time this website has decided it was pertinent to warn us of liver damage. What they’ll throw at you sometimes is the instance of GGT elevation in metabolism tests seen in kava users in the late 80s and early 90s in Australia's Northern Territory. This is NOT indicative of liver damage. It indicates liver adaptation and is seen in kava drinkers that consume about a pound of dried kava per week. AST and ALT increases are not seen. I would even go as far to say here that kava is not even detrimental to those with liver problems. Kava is not intrinsically toxic to the liver in any way.

• Point 3 “Parkinson disease: Kava might make Parkinson disease worse. Do not take kava if you have this condition.”

1. This one is interesting. You have research on one side saying kava has no or very little activity at dopamine, then you have other research indicating that some kavalactones drop dopamine levels considerably. The one kavalactone in question here is Yangonin. Yangonin has shown in research to lower dopamine to below detectable levels. I personally believe that this is happening evidenced by the extrapyramidal movements seen in kava drinkers that went way overboard. They end up looking like they have parkinsons. If you are on medication such as levodopa that is specifically meant to increase free dopamine levels in the brain, kava can counteract this effect and cause the resurgence of parkinson's symptoms. So yes, I agree with this statement. If you have parkinsons it’s best to skip the kava.

• Point 4 “Surgery: Kava affects the central nervous system. It might increase the effects of anesthesia and other medications used during and after surgery. Stop using kava at least 2 weeks before a scheduled surgery.”

1. This is not talked about very much but should be taken into close consideration when approaching a surgery. Kava has many properties that haven’t been studied all that intensively. Kava has shown to have some mild antithrombotic actions. This means it may be able to prevent, to a degree, blood clotting. Give yourself at least a week if not two before any surgery to let your system flush out. Kava has also been shown to increase the sedation of anesthetic drugs. You’ll want to observe this just to be on the safe side.
2. Major Interactions

• Point 1 Alprazolam “Kava can cause drowsiness. Alprazolam (Xanax) can also cause drowsiness. Taking kava along with alprazolam (Xanax) may cause too much drowsiness. Avoid taking kava and alprazolam (Xanax) together.”

1. Agreed

• Point 2 “Kava might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking kava along with sedative medications might cause too much sleepiness.Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.

1. Agreed as well. Sedation seems to be the pharmacodynamic interaction here.
2. Moderate Interactions

• Point 1 “Levodopa interacts with KAVA - Levodopa affects the brain by increasing a brain chemical called dopamine. Kava might decrease dopamine in the brain. Taking kava along with levodopa might decrease the effectiveness of levodopa.”

1. I believe this to be correct. Levodopa is a medication meant to increase the levels of dopamine in the brain. Yangonin can decrease dopamine levels in the brain and counteract this medication.

• Point 2 “Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interact with KAVA - Some medications are changed and broken down by the liver.- Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are changed by the liver might increase the effects and side effects of some medications. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver. Some of these medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.

1. This is also correct. CYP1A2 is the pathway of metabolization for caffeine. Kava causes inhibitory actions at this pathway and as such causes caffeine to appear in serum levels for much longer than without kava in the system. The individual effect of this combination may differ from person to person. CYP1A2 activity has a range of 40% between individuals. As such it’s quite difficult to make predictions of which drugs will do what when this pathway is inhibited.

• Point 3 “Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates) interact with KAVA - Some medications are changed and broken down by the liver Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are broken down by the liver can increase the effects and side effects of your medication. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver. Some of these medications changed by the liver include amitriptyline (Elavil), clomipramine (Anafranil), cyclophosphamide (Cytoxan), diazepam (Valium), lansoprazole (Prevacid), omeprazole (Prilosec), lansoprazole (Protonix), phenytoin (Dilantin), phenobarbital (Luminal), progesterone, and others.

1. Correct as well; however, issues at this cytochrome with drugs that use this pathway are not heavily researched in regards to kava. They generally encompass the sedative effects and their increase when in combination with the drugs above. Caution should still be taken when combining these drugs with kava as it will likely make them stay in your system for considerably longer periods of time. DMY seems to be the most potent inhibitory kavalactone in this regard.

• Point 4 “Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates) interacts with KAVA - Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver. Some medications that are changed by the liver include amitriptyline (Elavil), diazepam (Valium), zileuton (Zyflo), celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.

1. This inhibition was seen strongest with methysticin, the number 6 on chemotypes. The effect seen with methysticin was low, with only 1% of the strength of their positive control (Sulfaphenazole). I truly believe this would not have a strong impact on drugs that also use this pathway being kava/kavalactones have such a low affinity for it.

• Point 5 “Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates) interact with KAVA - Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are change by the liver can increase the effects and side effects of your medication. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver. Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.

1. This is incorrect. Kava has no inhibition property at this cytochrome even at absurdly high concentrations, and as such this is wrong.

• Point 6 “Medications changed by the liver (Cytochrome P450 2E1 (CYP2E1) substrates) interact with KAVA - Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are change by the liver can increase the effects and side effects of your medication. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver.Some medications that are changed by the liver include acetaminophen, chlorzoxazone (Parafon Forte), ethanol, theophylline, and drugs used for anesthesia during surgery such as enflurane (Ethrane), halothane (Fluothane), isoflurane (Forane), and methoxyflurane (Penthrane).

1. Again methysticin is the only kavalactone shown to interact with this cytochrome and it does it quite weakly. I wouldn’t suspect any immediate issues with drugs that use this pathway combined with kava.

• Point 7 “Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interact with KAVA - Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking kava, talk to your healthcare provider if you are taking any medications that are changed by the liver. Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.

1. This effect, if present, will be very light. Kava has shown very slight inhibitory properties at CYP3A4 with methysticin being the most potent inhibitor. Methysticin has shown to be about 1% the inhibitory properties of their positive control, Ketoconazole. I would not expect major interactions with pharmaceuticals along this pathway with kava.

• Point 8 “Medications moved by pumps in cells (P-Glycoprotein Substrates) interacts with KAVA - Some medications are moved by pumps in cells. Kava might make these pumps less active and increase how much of some medications get absorbed by the body. This might increase the amount of some medications in the body, which could lead to more side effects. But there is not enough information to know if this is a big concern. Some medications that are moved by these pumps include etoposide, paclitaxel, vinblastine, vincristine, vindesine, ketoconazole, itraconazole, amprenavir, indinavir, nelfinavir, saquinavir, cimetidine, ranitidine, diltiazem, verapamil, corticosteroids, erythromycin, cisapride (Propulsid), fexofenadine (Allegra), cyclosporine, loperamide (Imodium), quinidine, and others.”

1. A single dose of 800mg kavain gave a serum concentration level of 40ng/ml or .1um. This plasma level is unlikely to cause any significant inhibition of P-gp in vivo. Also, 800mg of kavain is quite unlikely to be consumed at once in a typical kava consuming session. The likelihood of inhibition here is very low. Results obtained in vitro vs in vivo were contradictory.

• Point 9 “Medications that can harm the liver (Hepatotoxic drugs) interact with KAVA - Kava might harm the liver. Taking kava along with medication that might also harm the liver can increase the risk of liver damage. Do not take kava if you are taking a medication that can harm the liver. Some medications that can harm the liver include acetaminophen (Tylenol and others), amiodarone (Cordarone), carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa (Aldomet), fluconazole (Diflucan), itraconazole (Sporanox), erythromycin (Erythrocin, Ilosone, others), phenytoin (Dilantin), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and many others.”

1. It should be obvious to limit the intake of liver toxic compounds, however some of them are rather ubiquitous. Acetaminophen, also known as APAP, Panadol, Paracetamol, and Tylenol is a potent hepatotoxic drug due to its metabolites. Kava likely does not interact with these drugs other than APAP. There is research leaning to indicate that the combination of APAP and kava should be avoided on the issue of glutathione degradation. IF kava does indeed reduce glutathione levels, mixing it with APAP would increase its toxicity.
2. Dosing
3. Paragraph 1 “By Mouth: For anxiety: 50-100 mg of a specific kava extract (WS 1490, Dr. Willmar Schwabe Pharmaceuticals), taken three times daily for up to 25 weeks, has been used. Also, 400 mg of another specific kava extract (LI 150, Lichtwer Pharma) taken daily for 8 weeks has been used. Five kava tablets each containing 50 mg of kavalactones have been taken in three divided doses daily for one week. One to two kava extract tablets has been taken twice daily for 6 weeks. Calcium supplements plus 100-200 mg of kava taken daily for 3 months have also been used.”
4. This really doesn’t tell us anything to go by for our own personal dosing. In truth, there is no recommended dosage for powdered kava. These dosage recommendations come from several studies as well as the German Commission E. I take it that these numbers indicate the minimum amount of kavalactones it requires to see any effect without seeing intoxication. Seeing that many of us aim for intoxication these numbers are simply meaningless.

Citations Removed for length. See kavaforums post for full citations.
Kavaforums Discussion Thread: https://kavaforums.com/forum/threads/webmds-article-on-kava.19070/

Hi there, I'm a 200 lb 24m, I take prescription 10mg prozac nightly, I was recently prescribed 5mg flexeril for some severe shoulder pain. Google says I'll die if I take them together. I'm pretty sure I'll be fine, but I'm just curious what the likelihood of a reaction is. TIA

I’ve been tracking my blood pressure at my doctors request due to having symptoms of Dysautonomia. My blood pressure and heart rate take a notable upswing upon standing and are within a normal range while supine. My symptoms include near syncope, extreme nausea and vomiting, speech and neurological difficulties and cranial pressure. My general practitioner was able to get me in last Wednesday and I was able to get an appointment with a cardiologist for today (Monday). What are some questions/tests I should be addressing? I’m scheduled for Septorhinoplasty in early January, should this be rescheduled until this issue is understood? Can this cardio anomaly be caused by medications or would it be present while supine also? I’ll list my confirmed diagnosis and medications so you have a full picture of potential causation. Thanks for your time!
Please note that these are the dates in my official record of my diagnosis not the day it first presented itself which was often months or years earlier.
Diagnoses

• General anxiety disorder diagnosed by Peter Luea MD in June 2005
• Dysthymia, Left Shoulder Injury diagnosed by Terry Whiteman MD On January 24, 2013
• Insomnia, Depression diagnosed by Terry Whiteman MD on February 7, 2013
• Muscle weakness syndrome diagnosed by terry Whiteman MD on August 12, 2013
• Chronic fatigue syndrome diagnosed by Dr. Peter Cody on March 27, 2014
• Left shoulder tendinitis diagnosed by Ryan O’Connor D.O. On May 28, 2015
• Psoriatic arthritis diagnosed by Monica Mohan MD on January 18, 2016
• Moderate episode of recurrent major depression disorder diagnosed on By Lovonna L Evans NP on May 12 2016
• Fibromyalgia diagnosed on By Lovonna L Evans NP on August 9, 2016
• Environmental allergies and Multiple Food Allergies diagnosed by V. Cuneyt Kalfa MD on September 6, 2016
• Hypertriglycerdemia diagnosed By Lovonna L Evans NP On October 6, 2016
• Psoriasis diagnosed By Lovonna L Evans NP on February 6, 2017
• Left shoulder tendinitis diagnosed by Dr. Ryan O’Connor D.O. On December 20, 2017
• Arthralgia diagnosed by Iris Zink NP on February 23, 2018
• Ehlers Danlos syndrome diagnosed by Iris Zink NP on July 9, 2018
• PTSD diagnosed by professional psychological and psychiatric services on August 7, 2018
• Migraine diagnosed by Carl Ross MD on October 13, 2018
• Altered mental status diagnosed by Carl Ross MD on October 13, 2018
• Bi-Polar type one Diagnosed by Dr. Zulfiqar Ahmed MD on November 19, 2018
• Hemiplegic/ Complex migraine diagnosed by Dr. Ahmed Ali Jouan on November 28, 2018
• Sciatica of the right side diagnosed by Jennifer Joseph D.O. on March 11, 2020

Medication and Supplement List
Current Prescribed Medications 1. Tramadol HCL-50 mg as needed, up to eight tablets per day 2. Mobic-15 mg tablet once a day (temporarily suspended) 3. Klonopin-1 mg as needed, up to three tablets per day 4. Imitrex- 100 mg one tablet as needed for complex migraine headache 5. Methotrexate-2.5 mg five tablets every Friday 6. Folic Acid-1 mg two tablets per day 7. Vitamin D-6,000 units once capsule daily 8. Taltz-80 mg injectable once every two weeks for twelve weeks then once monthly 9. For acute Migraine relief-400 mg Magnesium Citrate, 600 mg Motrin, 4 oz of Coke 10. Lamictal-100mg nightly 11. Venlafaxine ER-75mg one capsule every morning 12. Aimovig-140mg injectable once every month 13. Triamcinolone 0.1% Cream as needed 14. Fluocinonide 0.05% Topical Solution as needed 15. Zofran ODT 4mg as needed 16. Lidocaine Patches 5% Apply two areas with sciatica every 12 hours. 17. Flexeril 10mg 3 times a day (temporarily suspended) 18. Singulair 10 mg once a day 19. Claritin 10 mg once a day 20. Verapamil 40mg tablets titrate up to 1 in the morning and 1 at bedtime 21. Promethazine 25 mg 1/2 to 1 tablet as needed maximum of 3 times a day 22. Ubrelvy 100 mg as needed 23. Nurtec 75 mg as needed
Past Medications (intolerant or allergic) Celexa Robaxin Prozac Trazadone Zolpidem Duloxetine Rexulti Gabapentin Lyrica Hydroxyzine Amitriptylin Rayos Low dose Naltrexone (compounded to 3 mg) Inderal no positive effects
Vitamins and Supplements (taken daily in the morning) 1. Adult Multi-Vitamin 2. Vitamin C-1000 mg 3. DHEA-50mg 4. Vitamin B6-100 mg 5. Co-Q10-200 mg 6. Vitamin D3-3200 IU 7. EPA-DHA Balance- Omega 3 600 mg, EPA 400 mg, DHA 200 mg, Fish Oil Concentrate 1,000 mg. 8. Turmeric Curcumin Complex-500 mg 9. Magnesium Optimizer- Magnesium Malate 100 mg, Potassium Citrate 50 mg, Taurine 350 mg 10. Acetyl-L Carnitine Arginate-500mg 11. Acetyl-L Carnitine-200mg 12. Arginine-170mg 13. Alpha Lipoic Acid-100mg 14. D-Ribose Powder-2 grams 15. L-Arginine Complete-L-Arginine 5000mg, L-Citrulline 1000mg, Chromium 200mcg, Magnesium20mg, Vitamin B12 15mcg, Folate DFE 667mcg, Vitamin B6 2mg, Vitamin K2 20 mcg, Vitamin D 62.5mcg, Vitamin Cmg 16. Ultima Electrolyte Supplement-Vitamin C 100mg, Calcium 65mg, Phosphorus 70mg, Magnesium 100mg, Zinc 1mg, Selenium 1.25mcg, Copper 0.2mg, Manganese 0.2mg, Chromium 5mcg, Molybdenum 3.5mcg, Chloride 79mg, Sodium 55mg, Potassium 250mg

More info @:http://www.ayahuasca.com/science/foods-and-meds-to-avoid-with-maois/
The following foods are recommended to be avoided with MAOIs:
– Meat that is not fresh, especially unfresh liver (fresh meat and fresh liver are safe) – Bologna, pepperoni, salami, corned beef, sausage, hot dogs, any cured meats – Smoked, fermented, pickled (herring) and otherwise aged or dried fish, lox; any fish that is not fresh – Fermented tofu, fermented bean curd, fermented soybean paste, miso soup (contains fermented bean curd) – Soy sauce (soy sauce even in very small quantities has been implicated in a number of anecdotal reports on this forum) – Teriyaki sauce – Cheeses, especially aged cheeses (ricotta cheese, mozzarella cheese, cottage cheese and cream cheese are safe) – Protein extracts – Liquid or powdered protein dietary supplements – Canned soups, or soups made with protein extracts or bouillon – Gravies and foods made with meat extracts – Dried egg whites – Defatted peanut flour – Brewer’s yeast, yeast vitamin supplements, yeast extracts, foods with yeast in ingredients – Sourdough bread – Shrimp paste – Sauerkraut – Pickled foods – Olives (unless you can get fresh ones) – Fruits that are bruised or overripe – Avocados that are very soft, mushy, overripe or starting to turn grey (slightly underripe avocados are fine in moderation). Guacamole should be avoided. – Banana peels (as though you’d eat them anyway) and bananas that are overripe (turning brown or black). Bananas that are not overripe or bruised are totally fine, and are often eaten around Ayahuasca ceremonies in the Amazon. – Dried fruits, such as raisins and prunes – Fruit cake and candied fruits – Cranberries, canned – Red wine, especially Chianti; sherry, vermouth, champagne, brandy; beers and ales, including nonalcoholic; whiskey and liqueurs such as Drambuie and Chartreuse – Dairy products that are close to the expiration date or that have been unrefrigerated (fresh yogurt is safe) – Any food that has the word “hydrolyzed” or “autolyzed” in the ingredient list
In addition to the preceding foods (which are aged, fermented, preserved, overripe, etc) avoid the following in large quantities:
– Broad beans (fava and lima beans) – in large quantities – Navy beans – in large quantities – Peanuts – in large quantities – Brazil nuts – in large quantities – Coconut and coconut oil – in large quantities (coconut juice or coconut milk is safe) – Raspberries – in large quantities – New Zealand or Hot Weather Spinach (Tetragonia tetragonioides, a different plant from regular spinach, Spinacia oleracea, which is safe) – in large quantities – Parsley – in large quantities – Dill weed – in large quantities – Dried seaweed – in large quantities – Nutmeg – in large quantities – Kombucha – in large quantities – Dark chocolate – in large quantities (the theobromine in it may be potentiated, causing fast heartbeat) – Caffeine in large quantities (in a few rare individuals, there may be a severe interaction with even small amounts of caffeine)
Also avoid: – Aspartame (Nutrasweet) – Monosodium Glutamate (MSG) (or anything with the word “hydrolyzed,” code for MSG)
These drugs and meds can be dangerous with MAOIs:
– other MAOIs – SSRI’s (any selective serotonin reuptake inhibitor) – antihypertensives (high blood pressure medicine) – appetite suppressants (diet pills) – medicine for asthma, bronchitis, or other breathing problems; antihistamines, medicines for colds, sinus problems, hay fever, or allergies (Actifed DM, Benadryl, Benylin, Chlor-Trimeton, Compoz, Bromarest DM or DX, Dimetane DX cough syrup, Dristan Cold & Flu, Phenergan with Dextromethorphan, Robitussin-DM, Vicks Formula 44-D, several Tylenol cold, cough, and flu preparations, and many others) — anything containing dextromethorphan/ DXM or with DM, DX or Tuss in its name, or anything containing pseudoephedrine. – CNS (central nervous system) depressants – vasodilators – antipsychotics – barbiturates – alcohol
Illegal or recreational drugs that are VERY dangerous to combine with MAOIs:
– cocaine – amphetamines (meth-, dex-, amphetamine), ephedrine, MDMA (Ecstasy), MDA, MDEA, PMA – opiates (heroin, morphine, codeine, and especially opium) – dextromethorphan (DXM) – nutmeg – 5-Meo-DMT
There are recorded fatalities from the combination of cocaine with MAOIs and 5-Meo-DMT with MAOIs.
Illegal or recreational drugs that can potentially be dangerous to combine with MAOIs:
– mescaline (any phenethylamine) – barbiturates – alcohol – kratom – kava
Some specific pharmaceutical drugs that should not be combined with MAOIs (some are mild risks, others serious): – Adderall – Alaproclate – Albuterol (Proventil, Ventolin) – Amantadine hydrochloride (Symmetrel) – Amiflamine – Amineptine – Amitriptaline – Amoxapine (Asendin) – Atomoxedine – Bazinaprine – Befloxetone’ – Befol – Benadryl – Benmoxinb (Nerusil, Neuralex) – Benylin – Benzedrine – Benzphetamine (Didrex) – Bicifadine – Brasofensine – Brofaromine (Consonar) – Buprenorphine – Bupropion (Wellbutrin) – Buspirone (BuSpar) – Butriptyline – Carbamazepine (Tegretol, Epitol) – Chlorpheniramine – Chlor-Trimeton – Cimoxetone – Citalopram (Celexa) – Clomipramine (Anafranil) – Clorgyline – Codeine – Cyclobenzaprine (Flexeril) – Cyclizine (Marezine) – D-deprenyl – Dapoxotine – Desipramine (Pertofrane, Norpramin) – Desvenlafaxine – Dextroamphetamine (Dexedrine) – Dextromethorphan (DXM) – Dibenzepin – Dienolide kavapyrone desmethoxyyangonin – Diethylpropion – Disopyramide (Norpace) – Disulfiram (Antabuse) – Dobutamine – Dopamine (Intropin) – Dosulepin – Doxepin (Sinequan) – Duloxetine (Cymbalta) – Emsam – Entacapone – Ephedrine – Epinephrine (Adrenalin) – Escitalopram (Lexapro) – Esuprone – Etorphine – Femoxitine – Fenfluramine (Pondimin) – Flavoxate Hydrochloride (Urispas) – Fluoxetine (Prozac) – Fluvoxamine – Furazolidone (Furoxone) – Gabapentin – Guanethedine – Guanadrel (Hylorel) – Guanethidine (Ismelin) – Hydralazine (Apresoline) – Hydrazine – 5-Hydroxytryptophan – Imipramine (Tofranil) – Iprindole – Iproniazid (Marsilid, Iprozid, Ipronid, Rivivol, Propilniazida) – Iproclozide (Sursum) – Isocarboxazid (Marplan) – Isoniazid (Laniazid, Nydrazid) – Isoniazid rifampin (Rifamate, Rimactane) – Isoproterenol (Isuprel) – L-dopa (Sinemet) – Ladostigil – Lazabemide (Pakio, Tempium) – Levodopa (Dopar, Larodopa) – Linezolid (Zyvox, Zyvoxid) – Lithium (Eskalith) – Lofepramine – Loratadine (Claritin) – Maprotiline (Ludiomil) – Mebanazine (Actomol) – Medifoxamine – Melitracen – Meperidine (Demerol) – Metaproterenol (Alupent, Metaprel) – Metaraminol (Aramine) – Metfendrazine (Inkazan) – Methamphetamine (Desoxyn) – Methyldopa (Aidomet) – Methylphenidate (Ritalin) – Metralindole – Mianserin – Milacimide – Milnacipran – Minaprine (Cantor) – Mirtazapine (Remeron) – Mofegeline – Moclobemide (Aurorix, Manerix) – Monomethylhydrazine – Montelukast (Singulair) – Nalbufrine – Naloxone – Naltrexone – Nefazodone – Nialamide (Niamid) – Nisoxetine – Nomifensine – Norepinephrine (Levophed) – Nortriptyline (Aventyl) – Octamoxin (Ximaol, Nimaol) – Oxybutynin chloride (Ditropan) – Oxycodone – Oxymetazoline (Afrin, Dimetapp) – Oxymorphone – Orphenadrine (Norflex) – Pargyline (Eutonyl) – Parnate – Paroxetine (Paxil) – Pemoline (Cylert) – Percocet – Pethedine (Demerol) – Phendimetrazine (Plegiline) – Phenelzine (Nardil) – Phenergen – Phenelzine (Nardil, Nardelzine) – Pheniprazine (Catron) – Phenmetrazine – Phenoxypropazine (Drazine) – Phentermine – Phenylephrine (Dimetane, Dristan decongestant, Neo-Synephrine) – Phenylhydrazine – Phenylpropanolamine (found in many cold medicines) – Phenelzine (Nardil) – Pirlindole (Pirazidol) – Procarbazine (Matulane) – Procainamide (Pronestyl) – Protriptyline (Vivactil) – Pseudoephedrine – Oxymetazoline (Afrin) – Quinidine (Quinidex) – Rasagiline (Azilect) – Reboxetine – Reserpine (Serpasil) – Risperidone – Salbutemol – Salmeterol – Selegiline (Eldepryl, Emsam, Zelapar) – Sercloramine – Sertraline (Zoloft) – Sibutramine – Sumatriptan (Imitrex) – Terfenadine (Seldane-D) – Tegretol – Temaril – Tesofensine – Tetrindole – Theophylline (Theo-Dur) – Thesbutiaint – Thioridazine (Mellaril) – Tianeptine – Tolcapone – Toloxatone (Humoryl) – Tramadol – Tranylcypromine (Parnate) – Trazodone – Tricyclic antidepressants (Amitriptyline, Elavil) – Trimipramine (Surmontil) – Triptans – Tyrima – Vanoxerine – Venlafaxine (Effexor) – Viloxezine – Yohimbine – Zimelidine – Ziprasidone (Geodon)
Also avoid the following herbs for at least 48 hours before and after:
St. Johns Wort (if it has been taken regularly, needs two weeks to clear the system) Betel Boswellia Carrot seed Chamomile Cowhage Curcumin Dill seed Ephedra Fennel seed Fo-Ti Ginseng Horny Goat Weed Kanna Kava Kratom Licorice Root Nutmeg Parsley seed Rhodiola Rosea Scotch Broom Siberian Ginseng Sinicuichi Turmeric Yerba Mate Yohimbe
<3

36F 6’1” 255lbs Mexican-American, I am, first of all, not a good historian, as I have DID and am missing pieces here and there memory-wise. I want to know if it is normal or if something is wrong with me that a have a bowel movement every single time I urinate. And I urinate quite often as I drink at least a gallon of water a day. I’ve been experiencing this specific situation since at least last January, because I had to go to the hospital for an anal fissure that would not stop bleeding January 10th. I really don’t know if this is normal and I’m just tripping out because I’ve been so constipated my entire life, or if there’s something I need to worry about. I have Lupus, fibromyalgia, Hashimoto’s thyroiditis, epilepsy, migraines, major depressive disorder, and general anxiety disorder. Because of my lupus and the current flare, I am taking a bunch of meds: (forgive the formatting, I’m on mobile and I copied and pasted)
Benlysta 200 MG/ML solution auto-injector Generic drug: Belimumab busPIRone 7.5 MG tablet Commonly known as: Buspar cholecalciferol 25 MCG (1000 UT) tablet Commonly known as: Vitamin D3 cyclobenzaprine 10 MG tablet Commonly known as: Flexeril FLUoxetine 20 MG capsule Commonly known as: PROzac gabapentin 600 MG tablet Commonly known as: Neurontin hydroxychloroquine 200 MG tablet Commonly known as: Plaquenil hydrOXYzine Pamoate 50 MG capsule Commonly known as: Vistaril levothyroxine 200 MCG tablet Commonly known as: Synthroid, Levothroid Meloxicam 15 MG tablet Commonly known as: Mobic ProAir HFA 108 (90 Base) MCG/ACT inhaler Generic drug: albuterol Topiramate ER 200 MG capsule sustained-release 24 hr Commonly known as: Trokendi XR
Allergies Augmentin [amoxicillin-pot Clavulanate], Gluten Meal, Chili peppers
No drinking or smoking; only drink water, period; eat a gluten-free, pork-free, mostly chicken free diet.

hi, all. a few weeks ago I went to my doctor about the shouldeupper back pain I've had for a last few years that's just been getting worse. since high school (I'm 29 now), I've had grinding/snapping/popping in my shoulder blade. it used to not hurt, now it does. a lot. I got a referral to PT (with a specific rec to have dry needling done) and an orthopedic doctor. I see them in a month. my primary doc asked if I was comfortable taking muscle relaxers, but I panicked and said I'd be fine with just 800mg ibuprofen. I don't have a problem with substance abuse, I just have known a lot of folks addicted to pain killers/etc. and they make me nervous. I regretted this, as the ibuprofen hasn't been working. I'm in a lot of pain (like even just laying still hurts/I can never get comfortable) and have some leftover 10mg flexeril that I didn't take when I sprained my foot. I've got to pack today for a move on sunday, so I don't want to knock myself out, but I also am having a hard time getting anything done with the pain. is flexeril gonna knock me out cold or just help with the pain? I am prescribed prozac and adder all for depression/ADHD. would it interact with that?

Age: 25
Sex: Female
Height: 5’8
Weight: 140
Race: Caucasian / Eastern European
Duration of Complaint: 8/9 years
Location: Currently in the southeast US, but have lived in all parts of US over past four years.
Location of complaint: Muscles (back of calves is the absolute worst), Eyes, Neurological, Legs, hands, hair falling out,severe fatigue, severe tremor
Existing medical issues: Rheumatoid Arthritis, Pernicious Anemia, Epilepsy, Lupus, Sjögrens, PTSD, MDD —--Past Medical Problems: Acute liver failure, Hepatitis C, Meningitis, Sepsis (2), Endocarditis, Hyperthyroidism
Current Medications: Celebrex, Keppra, Gabapentin, Seroquel, Prozac, Klonopin, Flexeril, valacyclovir,
Okay so I have not yet seen my rheumy, but blood work confirmed the Lupus and RA. I have been diagnosed with MS but then another MRI showed no lesions so they said that was not it. Another MRI showed lesions, but the doctor said they were from migraines (which I only get one every two years or so) and I’m not sure how she could tell the difference. Anyway, I think the RA and Lupus don’t cover all of my symptoms. I have a severe, permanent tremor in my hands. I have blurry vision, no night vision, faded vision, and eye pain in one eye - the same eye and have had this since I was 16 and it’s gotten worse. No eye doctor seems to know what’s going on. I have a horrible heat intolerance but also a horrible cold intolerance, although heat makes me flare up so much worse. Most days I cannot get out of bed. The days I can, I can hardly stand or walk and must use assistance. The back of my calves give me the absolute worst pain out of anywhere on my body. To the point I start hitting them with heavy objects because that feels better than the actual pain. It’s a tight pain and no matter how much I massage it or sit in hot water they never get better. I’m just not convinced it’s just RA and Lupus.
Can you have MS with no lesions? can lesions come and go? Is there really a way to tell what lesions are from? (Like from a migraine or MS?) MS and all of these autoimmune disorders are in both sides of my family as far back as you can go. I’m only 25, I shouldn’t feel like this or hurt like this. The Neurological effects are horrible and embarrassing. I’ve been trying for so long for a doctor to take me seriously. This one reluctantly do extra bloodwork and was surprised when the RA factor and everything was positive. My muscles seem to be atrophying. I can’t wear bras or bathing suits because of the pressure the put on my neck and/or shoulders.
I really don’t know what to do anymore. This is no life for anyone, especially a 25 year old. I’m in so much pain I think about just ending it all.
Can a doctor answer my questions or give me advice? Because I’m just at a loss here.

Posted in the loperamide sub but it's a slow sub. Trying here for increased visibility.
Former cancer patient here. Prescribed Hydrocodone 9 years ago. Every year we increased dosage until I beat cancer. By that time, I was dependant. Not so much addiction. Never abused to get high. Currently at 90mg a day. 3 in the morning, lunch, bedtime.
Long story short, I was sent out of the country for work. I brought my meds with me. I had enough to cover my stay. Work has extended my stay by 3 weeks. I'm going to run out of Hydrocodone tomorrow night with 12 days left until I return to the states. I can get my refill then. I've had zero luck getting it sent here and refilled. What is abundant is loperamide. I can get 400 tabs for 16.00. Wondering if I can use loperamide as a bridge until I return home for a proper refill.
Remember, I only need to take enough to stave off withdrawal and to survive a very long flight home. Goal is not to try and get a high. Do I start at 20mg? 40mg?
Other meds I have with me are Xanax, Prozac, and Flexeril. All enough on hand to last me until I return home.
Thanks in advance.