Dr. Chan referred my complaint of a long siege of migraines to my neurologist, who sent the following email in response to Dr. Chan’s order to TRIPLE my current dose of nortriptyline.
From: BRET DAVID ANDREWS DO
Sent: 8/18/2016 7:40 PM PDT
To: Jacqueline Hegarty V
Subject: Neurology
Hello–
Got a message form Dr Chan that you are having a run of migraines and she stated I should email you first so here goes:
Note I am leaving out of town for two weeks so may need to discuss further with Dr Chan or another neurologist
Recommendations:
1. Take a short course of steroids to break the cycle: 60mg for 2 days, then 40mg for 2 days, then 20 mg for 2 days.
I have placed a prescription as a file order so that you can activate it at your preferred pharmacy.
2. It looks like you may need an update of your prevention medication. Normally, I would suggest increasing the nortriptyline if you would tolerate a higher dose. However, Nortriptyline is generally not recommended for those over 65 because it has anticholinergic activity which can be detrimental to the brain.**
My suggestion would be to consider topiramate as an alternative going forward.
Sincerely,
Bret Andrews
**It has been found that older adults using medications that have anticholinergic features for just two months are at an increased risk for mild cognitive impairment. For most, this is potentially reversible.
The cumulative dose is important: Malaz Boustani, MD, associate director, Indiana University Center for Aging Research, studying the issue of anticholinergic agents found that the risk for cognitive impairment increased by 50 percent in adults receiving at least 3 mild anticholinergic agents for more than 90 days and by 100 percent for those receiving one or more stronger anticholinergic agents for 60 or more days.
A more recent study JAMA Intern Med. 2015;175(3):401-407 showed a dose-related increase risk of developing dementia with anticholinergics as well.
From my own research:
Topamax and High blood sugar – from FDA reports
High blood sugar is found among people who take Topamax, especially for people who are female, 40-49 old , have been taking the drug for 1 – 6 months, also take medication Seroquel, and have Bipolar disorder . We study 31,957 people who have side effects while taking Topamax from FDA. Among them, 141 have High blood sugar. Find out below who they are, when they have High blood sugar and more.
http://www.ehealthme.com/ds/topamax/high%20blood%20sugar/
Topamax and Weight Loss
Topamax is an anti-seizure medication that helps reduce the number of seizure attacks and reduce or prevent migraines. It also has been shown to work for weight loss. However, it also has many negative effects that can impact on your health.
http://www.md-health.com/Topamax-For-Weight-Loss.html
Back Pedaling on Beta Blockers (Atenolol, Metoprolol, Propranolol) for Hypertension
New guidelines published in the Journal of the American Medical Association (JAMA, Dec. 18, 2013) for the treatment of hypertension have relegated beta blockers to the back of the line. That’s because the evidence for their effectiveness in treating high blood pressure has been disappointing and there is even some suggestion of harm.
https://www.peoplespharmacy.com/2013/12/23/post-14/
