Q: I have suffered from depression almost my whole life. I’ve also been diagnosed with fibromyalgia and arthritis. I was prescribed Cymbalta, as it is supposed to help depression and fibromyalgia.
I lost my state health insurance when I got a new job, and there have been delays before I can get health insurance again. As a result, I had no choice but to go off this drug cold turkey.
I had seizures the first four days. In addition, I had hot flashes, “brain zaps,” sensitive nerves, emotional swings, diarrhea, constant nausea and severe aches and pains. This has been the worst time of my life.
A: When health professionals prescribe duloxetine (Cymbalta) for fibromyalgia, arthritis, depression, nerve or muscle pain, they may not mention that stopping the drug can be challenging. The official prescribing information warns that discontinuation can lead to dizziness, headache, nausea, diarrhea, electric-shock sensations, insomnia, anxiety and fatigue. Seizures also have been reported.
If stopping becomes necessary, very slow withdrawal is preferable. We are sending you our Guide to Dealing With Depression, which discusses a number of antidepressants and the difficulties of withdrawal. It also offers some ways to manage depression without drugs. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. E-7, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.
Q: I have suffered with rosacea for a long time. People always stare at my blemishes and red face, which makes me extremely self-conscious. My doctor prescribed Metrogel, which had no noticeable impact on the pimples or on the redness. Is there a more effective medication?
Please do not recommend a home remedy. I have tried several, to no avail.
A: We understand your reservations about home remedies. Such approaches are rarely, if ever, tested scientifically.
You may want to ask your dermatologist about a prescription cream called ivermectin (Soolantra). This medication was originally developed as an oral drug to treat a terrible parasitic disease called river blindness (onchocerciasis). It also works against many other parasites and has been used widely in veterinary medicine for worm infestations.
When used topically as a cream or lotion, it has been found to be effective against scabies, lice and the mites (Demodex) that may trigger inflammatory rosacea skin reactions. A new study suggests that Soolantra performed a bit better than metronidazole (Metrogel) in reducing rosacea symptoms (American Academy of Dermatology Annual Meeting, March 20-24, 2015).
Sadly, the drug is pricey. Without insurance, a tube of Soolantra could cost more than $200, though the company (Galderma) does offer an online coupon.
Q: You wrote about saline spray for dry nose. My ENT (ear-nose-throat specialist) told me about Ayr Saline Gel OTC for dry nose. It really works.
I used to suffer from bad bloody noses. As long as I use the gel, they no longer trouble me. It keeps the mucous membranes moist much longer than just plain saline.
A: We suggested using saline spray in the nostrils rather than petroleum jelly because of the danger of lung inflammation (lipid pneumonitis) if petrolatum is inhaled. A gel formulation sounds handy.
Joe and Teresa Graedon answer letters from readers. Write to them in care of this newspaper or email them via their Web site: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”
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