Hi, I was reading the posts on Amitriptyline yesterday and tried to look up the information on Barts Blog that was mentioned . This isnt available at the moment. Is anybody able to fill me in on this please. Ive just started taking Amitriptyline again so any info would be useful. Thanks xx
Ok, I’m going to attempt to briefly paraphrase, since for once in my life I actually printed out the relevant blog post!
So, the posting is about anticholinergics and their possibly of their adding to cognitive disfunction in MSers, in particular it talks about oxybutynin and Amitriptyline adding to people’s risk of dementia.
With regard to the older type of older generation anticholinergics for bladder disfunction, the #clinicspeak writer is recommending that they not be used because they cross the blood-brain barrier, instead, the recommendation is to use newer anticholinergics such as tolterodine or solifenacin.
With regard to amitriptyline, it’s more difficult because their central effects for pain relief and to aid sleep are very good for MSers. The question is whether there is an adequate alternative. The writer of this blog piece has started prescribing duloxetine which apparently works well for pain relief but is less sedating than the tricyclics such as amitriptyline. Which of course would help a lot of people who’ve experienced Amitriptyline ‘hangovers’.
So the recommendation is for people to consider what anticholinergic drug load they have and to consider reducing it in order to protect against any potential cognitive impairment, including dementia and Alzheimer’s.
The article is dated 5/4/15. I’m not sure who write individual blog entries, whether they can be attributed to any specific person (eg Prof Giovannoni).
My feeling about it is that we need to weigh up risk against benefit. I am at present taking both Oxybutynin and Amitriptyline. Personally I’m unlikely to stay on oxybutynin, (I don’t think it’s doing what I want it to, plus I am half expecting that it’s affecting my liver enzymes) and added to this blog post, it’s not really worth it. However, I’ll probably be staying on Amitriptyline rather than try to swap onto duloxetine because I know that my liver will tolerate Amitriptyline and I’m reluctant to swap onto something which is metabolised by the liver (I have a history of problematic LFTs).
I hope I’ve got all of this right, it’s a quick non-scientific basic run through as far as I understand it.
Sue
Thanks sue, its so tricky getting the balance right and weighing up the pros and cons thank you for taking the time to reply, that was a lot of info…much appreciated jackie x