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Does Propranolol Interact With Levothyroxine, Amitriptyline And Melatonin?

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Posted on Thu, 16 Feb 2017
Question: I have several conditions including RSD, Autonomic Neuropathy, hypothyroidism, pineal cyst, cervical disc replacement, chronic migraine, anxiety ...
My current medications include:
1. Propranolol 20mg 3x
2. Gabapentin 300 MG 2x
3. Topamax 100mg 3x
4. Clonazepam .5 MG 3-4x
5. Levothyroxine .088 MG 1x
6. Zolpidem 10 MG 1x
7. Amitriptyline 50 MG 1x
8. Oxycodone 10 MG 2x
9. Melatonin 5mg 1x
10. Phenergan 25 MG as needed
The propranolol is a beta blocker used to balance out my Autonomic Neuropathy ... blood pressure has never been an issue. The pineal cyst has really messed up my sleep cycle over the past several years, and I've had my melatonin levels checked several times ... I basically do not produce any ... thank you "Mr. Cyst"
Migraines are weekly and can put me to bed if a heavy storm front is passing through... I have a lot of bone spurs and scar tissue from my cervical surgery... C3-4, C4-5 and C6-7 were all replaced. C5-6 is herniated.

Anyhow, my pain management doctor prescribed two new med today that worry me, and I'm looking for an ear/voice. He prescribed Amrix 15 MG time release and Voltaren Gel. From what I am reading so far, the Amrix can react with the Amitriptyline causing Seretonin Syndrome ... but I think my dosage is low... Also, the Voltaren gel is an NSAID that has the potential of a reaction with my propranolol, beta blocker.

Can I please have your opinion on these two new meds? I'm a biologist, so I guess that means I know just enough to scare myself or at least sound important if the need arises! ;-) You were in school much longer than my 6 years, so I'll pass the baton over if you can provide some insight. I know you can't give a lot of medical advice, as we are not face to face, but I'm up at 3:30 AM stressing over this.

Thank you,
XXXXXXX
doctor
Answered by Dr. Mahaveer Patil (2 hours later)
Brief Answer:
Drug reaction less likely

Detailed Answer:
Hi,

Thank you for posting the question.

I have gone through your medical history and the medicines that you have been taking, in detail.

Amrix 15 mg,as a drug can react with amitryptiline and cause serotonin syndrome,yes.
But if you are planning to take amrix for short period of time,then it won't cause this syndrome for sure.
Only if these drugs are taken together for longer periods of time,then it can result in the serotonin syndrome.

Voltaren gel is a topical gel.Although some amount of the NSAID drug is absorbed into the systemic blood circulation,it is not enough to react adversely with propranolol.

So,in my opinion,it is absolutely safe to take these drugs along with the older ones that you have been taking.

However,personally,i would recommended you to take tramadol,instead of amrix,considering its safety profile.

I hope the answer was useful.

Feel free to ask me any doubts that you may have.

Thank you.
Kind regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mahaveer Patil (3 hours later)
I gave in and tried the Amrix 15mg and it has less of an effect than Tizanidine did. I'll get back with my doctor on what else we can try as a muscle relaxer ... The EMG that I had on December 27th showed not only the severe cubital tunnel syndrome in the left arm, but also increased insertional activity in both lower cervical paraspinals ... with reduced recruitment in the FDI on the left.
I'm going to go ahead with the Voltaren right away. What you said makes perfect sense as it's not oral or IV, so there is a far less amount of absorption.
As far as Tramadol goes, that's basically like a Tylenol to me. I had 11 laparoscopic surgeries within 1 1/2 years for ovarian cysts and endometriosis in my late twenties. Also had a 5 hour laparotomy, In Vitro, emergency C-section, and emergency hysterectomy within that time frame plus 2 years. My body has built up a tolerance to certain medications and strange side effects to others.
I might make an interesting book for someone to take on. :-)

Thank you again for your insight and time on this matter!
doctor
Answered by Dr. Mahaveer Patil (14 hours later)
Brief Answer:
Query answered

Detailed Answer:
Hi,

You are right.
After going through so many surgeries,you yourself is a better doctor of your body that anyone else.
You are well aware of which medicines are more beneficial and which ones cause side effects.

So,you can go ahead with the medicines and let me know if you need any help from my side.

Thank you.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Mahaveer Patil

Orthopaedic Surgeon

Practicing since :2002

Answered : 1209 Questions

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Does Propranolol Interact With Levothyroxine, Amitriptyline And Melatonin?

Brief Answer: Drug reaction less likely Detailed Answer: Hi, Thank you for posting the question. I have gone through your medical history and the medicines that you have been taking, in detail. Amrix 15 mg,as a drug can react with amitryptiline and cause serotonin syndrome,yes. But if you are planning to take amrix for short period of time,then it won't cause this syndrome for sure. Only if these drugs are taken together for longer periods of time,then it can result in the serotonin syndrome. Voltaren gel is a topical gel.Although some amount of the NSAID drug is absorbed into the systemic blood circulation,it is not enough to react adversely with propranolol. So,in my opinion,it is absolutely safe to take these drugs along with the older ones that you have been taking. However,personally,i would recommended you to take tramadol,instead of amrix,considering its safety profile. I hope the answer was useful. Feel free to ask me any doubts that you may have. Thank you. Kind regards.