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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Severe Acid Indigestion...what from?
        
(Message started by: AVN on Sep 29^th, 2007, 4:58am)

Title: Severe Acid Indigestion...what from?
Post by AVN on Sep 29^th, 2007, 4:58am

Hi All,

I have just recently been diagnosed with CH and have started down the path of medications. I am a few days into a cycle and am now having great difficulty sleeping because of some rather severe acid reflux, nausea, modest stomach pain, and a low-grade fever (~100.5F).

I have taken Verapamil 120s for the first two nights (none tonight though) and took a Maxalt around noon today to arrest one that was coming on. The Maxalt worked, and I felt pretty good for several hours afterward, with the exception of a slight sore throat. However, around 6pm, the acid and nausea started up. I skipped dinner, avoided the verapamil tonight, and am still waking up restless and fevered.

Anyone else out there get a similar experience from either verapamil or Maxalt? If not, it may just be something different all together.

As an aside, my CH and shadows have not returned since my noon-time Maxalt.. and that was nearly 17 hours ago.

Any help would be greatly appreciated!
-Andy(AVN)

Title: Re: Severe Acid Indigestion...what from?
Post by JohnM on Sep 29^th, 2007, 5:23am

I suggest you stop eating wheat products for a while and drink plenty of water. See if the indigestion improves.

John

Title: Re: Severe Acid Indigestion...what from?
Post by Lotus on Sep 29^th, 2007, 6:25am

Verapamil doesnt cause low grade fever. Maxalt may if you have mixed it with other tryptans.

It sounds like something different altogether, maybe a gastric virus of some sort, but then serotonin syndrome can start out in a similar fashion as well.

If symptoms persists for more than 12 hours, please see your doctor.

Annette

Title: Re: Severe Acid Indigestion...what from?
Post by AVN on Sep 29^th, 2007, 9:09am

Hi All,

I mostly feel better this morning, but still have a mild fever. I have discontinued the use of all drugs and see if it goes away all together. If it is the beginning of Seratonin Syndrome, do you think 2-100 MG tabs of imitrex and 1-10MG tab in 3 days is enough to get it going?

Title: Re: Severe Acid Indigestion...what from?
Post by assaultme on Sep 29^th, 2007, 11:27am

AVN, I think I got some indigestion from Prednizone, but none from Imitrex pills or Verapimil.

Maybe some here who knows more than myself can comment...but it is my understanding that you are NOT supposed to just quit Verapimil after you have started taking it.

Better see your Doc. He/she should be able to help.
Regards, Dave

Title: Re: Severe Acid Indigestion...what from?
Post by nani on Sep 29^th, 2007, 12:06pm

on 09/29/07 at 06:25:01, Lotus wrote:

Maxalt may if you have mixed it with other tryptans.

Really? I know that mixing triptans can cause severe heart problems, but I hadn't heard that it could cause fevers.

AVN, I agree that you should see a doc should this continue. You can read about seratonin syndrome here:
http://www.uspharmacist.com/oldformat.asp?url=newlook/files/feat/acf2fa6.htm

Good luck.
pf wishes, nani

Title: Re: Severe Acid Indigestion...what from?
Post by Lotus on Sep 29^th, 2007, 5:32pm

All tryptans cause an increase in serotonin level. Mixing them can result in an increase big enough to cause symptoms of seretonin syndrome which is hyperpyrexia ( fever ), abdominal pain, nausea, vomiting , diarrhoea in the early stages. Other symptoms develop a bit later.

Two 100 mg Imitrex tablets and one 10 mg Maxalt tablet in 3 days is not above the recommended dose but it depends on how far apart you took them and different people tolerate medication differently so you should see your doctor if you get unexpected symptoms.

You shouldnt just stop taking meds like that, you should see your doctor. A proper physical examination would help distinguish the diagnosis for you. It may be just a simple virus or it maybe something else more significant.

By the way, Imitrex tablets are useless for CH because they take too long to kick in. Why dont you ask your doctor for Imitrex injection instead?

Hope things get better for you. Sending PF vibes.

Annette

Title: Re: Severe Acid Indigestion...what from?
Post by nani on Sep 29^th, 2007, 7:41pm

on 09/29/07 at 17:32:31, Lotus wrote:

OK, I'm having a hard time understanding this completely. I think it's important to clarify.
From what I've read, it's possible to induce serotonin syndrome (at least for us CHers) by:
A) using triptans and MAOIs, or SSRIs or other anti-depressant or psych meds ... or ...
B) Overdosing on any triptans (including using too much of one of them)

Also:
Using more than one type of triptan in 24 hours can cause serious heart complications.

I haven't seen a direct issue with mixing triptans (as long as one stays within dosing recommendations) and serotonin syndrome. Am I missing something?

Title: Re: Severe Acid Indigestion...what from?
Post by Lotus on Sep 29^th, 2007, 9:24pm

Serotonin syndrome occurs whenever there is too much serotonin in the body. This is most commonly caused by overdosing of tryptans or mixing tryptans with other meds that causes an increase in serotonin level.

Mixing tryptans within the recommended dosage may be safe but it is still not recommended, because potentially it can still cause the same problem.

All tryptans increase serotonin level and they have a synergistic effect on one another. One can not measure how these reactions would unfold in a particular person. A safe dosage for one person may be toxic to another. Furthermore different triptans have different half lives and when one effect gets prolonged by another triptan, one can never tell how long it will still be active in the body.

Other factors also play a role such as the renal ( kidney ) and hepatic ( liver ) functions of the person because they influence how fast the meds can be metabolised and eliminated.

I am not saying that everyone who mix tryptans will get serotonin syndrome. I am saying that the risk is there and it should be taken seriously.

How high the risk is depends on other factors, but to say that the risk is not present just because one hasnt heard about it would be the same as the doctor who would not prescribe oxygen to a CHer because he/she hasnt learnt about it.

One needs to apply knowledge to a clinical situation.

Annette

Edited to add: the recommended dosage is for each med on its own. No pharmaceutical company will say this is the recommended dosage for this med to be used with another. That decision is left up to the prescribing doctor, because there are so many other factors that can influence this.

Title: Re: Severe Acid Indigestion...what from?
Post by nani on Sep 29^th, 2007, 9:38pm

on 09/29/07 at 21:24:54, Lotus wrote:

I am not saying that everyone who mix tryptans will get serotonin syndrome. I am saying that the risk is there and it should be taken seriously.

My original question was based on your statement that mixing Maxalt with other triptans can cause fever. You said serotonin syndrome can start with a fever and took it from there. Would it be fair to say that, unless someone actually has serotonin syndrome, in which fever will be followed by other symptoms... that mixing triptans would not cause a fever?

Oh, and just to remind you...this is not a clinical situation. Your patients are the ones you see in clinic, not here.

Title: Re: Severe Acid Indigestion...what from?
Post by Lotus on Sep 29^th, 2007, 10:12pm

on 09/29/07 at 21:38:19, nani wrote:

Would it be fair to say that, unless someone actually has serotonin syndrome, in which fever will be followed by other symptoms... that mixing triptans would not cause a fever?

Oh, and just to remind you...this is not a clinical situation. Your patients are the ones you see in clinic, not here.

The most accurate statement would be mixing tryptans can lead to serotonin syndrome which can cause fever.

It would be the same as your statement saying that mixing tryptans causes severe heart problems. How does that happen? It happens because tryptans cause vasoconstriction amongst other things. Too much vasoconstriction causes heart problem. So if I want to be as picky as you are, I can say that Nani your statement is incorrect, because unless someone actually has enough vasoconstriction to severely affect the heart, mixing tryptan would not cause heart problems.

Many people here have mixed tryptans and have not developed heart problems but we all know that the risk is there and should be taken seriously.

Thanks for the remind, although I would need to explain to you that the word clinical doesnt mean " within a clinic ", but it means a situation involving a real person, and not an academic situation where arguments are based only on concrete statements.

Title: Re: Severe Acid Indigestion...what from?
Post by Kevin_M on Sep 29^th, 2007, 10:33pm

on 09/29/07 at 04:58:55, AVN wrote:

I am a few days into a cycle and am now having great difficulty sleeping because of some rather severe acid reflux, nausea, modest stomach pain, and a low-grade fever (~100.5F).

Hi Andy,

No doctor here of course but regularly take verapamil and haven't ever experienced these symptoms. Maxalt I don't know about.
As was mentioned earlier, it's possible it may be something different altogether and I can only term it a "bug", shows what I know. And it has been also mentioned about stopping verapamil. Adding though, my experience has been that if it has been helping, stopping it's use can take up to 48 hours to notice a difference. CH-wise, negatively if it has been effective for you.
There can be some nervousness about starting a cycle, all I can think of concerning stomach and not sleeping. Singularly about low-grade fever, all I know is that is a possibility with infections.

Only offering something since you asked

Quote:

Any help would be greatly appreciated!

but only verapamil is familiar to me, the rest is guessing. If you feel the need to see a doctor, do so.

:) Best for you.

Title: Re: Severe Acid Indigestion...what from?
Post by AVN on Sep 29^th, 2007, 11:26pm

Thanks all for the information. I am thinking that it is probably just a bug, but I had rarely felt stomach acid like that before. I thought that since I was using all of these new drugs, and that there is a pretty well informed community out here, that you were the ones to ask. The fever and acid are gone, but still have some stomach distress and nausea.

I am continuing to take the verapamil again.. I should note, I was at the initial dose when I stopped, so it shouldn't be any different then the last dose taken in a cycle. It was just that there was no way that was going to sit well in my stomach last night. Particularly, if there is too much stomach acid, I could have expedited the time-relief effects, just as grapefruit juice would.

Title: Re: Severe Acid Indigestion...what from?
Post by Kevin_M on Sep 29^th, 2007, 11:38pm

on 09/29/07 at 23:26:34, AVN wrote:

I am continuing to take the verapamil again.. I should note, I was at the initial dose when I stopped, so it shouldn't be any different then the last dose taken in a cycle. It was just that there was no way that was going to sit well in my stomach last night. Particularly, if there is too much stomach acid, I could have expedited the time-relief effects, just as grapefruit juice would.

Andy, please, no grapefruit juice with verapamil. I've not done it but have seen warnings with the two. If you read the precautions about verapamil it will list this. Mine says specifically it can increase the amount of certain medications in your system, and to consult your pharmacist or doctors for more details.
I don't know what you meant by "grapefruit juice" but am just tossing this in.

more best. :)

Title: Re: Severe Acid Indigestion...what from?
Post by Kevin_M on Sep 29^th, 2007, 11:44pm

Also keep note, increasing or decreasing verapamil should be done very, very gradually, with doctor notified first.

Title: Re: Severe Acid Indigestion...what from?
Post by AVN on Sep 30^th, 2007, 10:12am

Kevin_M,

I wish you would have read what I said rather than just posting an uniformed answer. I thought I clearly stated that I didn't take that 1 verapamil pill that night because of extreme acid indigestion. Doing so would have been like taking grapefruit juice with it. Which I was clearly not advocating.

Likewise, since I was taking only one verapamil, there is no way to go more slowly off the medication than to not take the one pill one night.

Title: Re: Severe Acid Indigestion...what from?
Post by Kevin_M on Sep 30^th, 2007, 10:29am

Yes Andy,

I did have a hard time putting it all together and clung to words like stopping, starting, and grapefruit juice. Just being cautious rather than uninformed as to verapamil, but in doing so did not capture your actions and reasons correctly.
Your post now clearly states matters more understandibly, I didn't read through the whole winding thread this time before replying. Let your doctor know how it goes, for some, verapamil helps at different levels of dosage.

Thank you.