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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I have been suffering from severe diarrhea since 11/24/2018. I

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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 3003 Questions

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Posted on Thu, 27 Dec 2018 in Mental Health
Question: I have been suffering from severe diarrhea since 11/24/2018. I have visited Olive Branch Family Medical Center twice to get help. I am NOW suffering constipation alternating with the diarrhea AND swollen feet.AND a very dry mouth. I tried taking the medication (Ondansetron 4 mg) that the clinic prescribed for me three days ago; however I have not taken it since because I believe that the drug may have irritated my problems.
IN ADDITION, my inability to sleep has INCREASED. My psychiatrist told me that I could temporarily increase the dosage of Doxepin 25 mg capsules from 3 pills per night to as many as 6. I tried 4 pills once and 5 pills twice. The increased dosage has made my insomnia much worse. IS IT POSSIBLE THAT I HAVE POISONED MYSELF? HAS THE INCREASED DOSAGE JUST PROLONGED MY DIGESTIVE PROBLEMS?
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Answered by Dr. Ashok Kumar 4 hours later
Brief Answer:
Consultation

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

First of all I like to inform you that use of five or six tablets of Doxepin on a single day is well within limits and there is no risk of toxicity with this dose. Upto 300 mg of doxepin is therapeutic dose and anything below this is considered normal dose.

Secondly I feel that diarrhoea and sleep problem are related. It appears to me that due to altered bowel movements you are having sleep issues and without dealing with one there is little possibility to improve other. I mean to say that diarrhoea and constipation need to be dealt by specialist as current treatment is neither sufficient nor appropriate as evidenced by complications such as swollen feet.

Thirdly I feel that you need to see your psychiatrist again as doxepin in the current situation is not an ideal medication. First it causes constipation and secondly it causes activation at higher dose. Which means that there is need for alternative medication to cause sleep.

Although it is upon your psychiatrist to decide appropriate medication for sleep but I feel low dose seroquel should be tried for sleep issues.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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