Concurrent Use of Topamax/Drugs with anticholinergic activity (In this case Latuda/other antipsychotics)

[Narcissism]

I have an extremely complicated array of physical medical issues. I suffer from Pseudotumor Cerebri (as a male), which is always due to secondary precipitating factors. Mayo Clinic denied me as a patient, as they did not think they could help, considering the treatments I had tried. I have been a patient at Johns Hopkins, without much success. I suffer from severe- constant head pain from the increased intracranial pressure and chronic nausea and vomiting 30-40x daily.

When I was 18, I was prescribed opiates, beginning from Vicodin, to injectable Stadol (for its interaction with mu-receptors- injecting 6mg as much as 6-8x daily) then to Fentanyl 200mcg to in the unavailability of Stadol in its injectable form. I then switched to Subutex 32mg daily, I was vomiting so much, that I couldn't last long enough for the sublingual tabs to disolve. Probably 40-60x a day, dry-heaving etc. After my use of fentanyl, I realized, this was not a way to live. Unfortunately, Stadol is one of the few drugs that really allows me to sleep.

Due to the intracranial pressure, I also have a partially empty sella, and hypopituitarism/adrenal dysfunction. The neuroendocrine/pain control picture is complicated enough, until you throw in a genetic background of obsessive compulsive disorder that has not responded to any typical therapies.

I've been in therapy/diagnosed with OCD since age 5 (I'm 21 now). I was a New Orleans resident until Katrina, following Katrina, I was forced to move 5 times during high school- and things with my OCD really became overwhelming and began to take over (5-6 hour showers, counting, extreme cleaning, unable to perform daily tasks, extreme anxiety...mental exhaustion) It only got worse when at age 18 I was diagnosed with PTC and gained 80 lbs, since a lot of my OCD is tied into my physical appearence.

Needless to say, I take 200mg of Topamax (partially for the head pain) even though it has never helped, but physicians really need to Topamax for that sort of thing, so I like to please when I can, even though the cognitive side effects are worse then that of most opioid based medications (except Fentanyl, which is the equivalent of death). I really enjoy Topamax usage, because now that my neuroendocrine situation is under control for the most part that the intracranial pressure is normalized, I ceased gaining weight, but losing weight was challenging for me, (I had always been skinny, and I used to be athletic, running 10 miles daily, but not since becoming ill). My diet isn't conducive to LOSING weight though. Topamax has really given me an edge with curving appetite without exercising, in a few months, I have lost about 25lbs.

I am seeing a really good Psychiatrist who originally wanted me to start Latuda, then went to Abilify (which I was totally against due to the weight gain), so I told him I'd try Latuda, which we will later augment with an SSRI. I am currently prescribed 40mg, which my insurance covers without prior auth thankfully. I am concerned about the interaction between

carbonic anhydrase inhibitors and drugs with anticholinergic activity. Can anybody chime in and let me know if others use Topamax while on similar antipsychotic drugs? I have read that some do without any issues, and have continued to take my 200mg of Topamax w/ 40mg of Latuda without issue for a few days, but I have seen the effects of polypharmacy first hand, receiving two DVTs in my antecubital fossa, when physicians played with three contraindicated medications in the same IV. I do not want any bad experiences again. I believe my Psych will also be increasing my dosage of Latuda to 80mg in about three weeks at the time of my next visit.

Also has anybody used Latuda augmented with an SSRI/SNRI for the treatment of OCD? I see many of you whom are on Latuda report weight loss as well, which is awesome. I haven't really noticed the nausea, but again, I take a CII drug for chemo induced nausea & vomiting, Cesamet (Nabilone), as well as IM Zofran 8-12MG q4-6hrs/Phenergan 50mg IM prn. So I wasn't really worried about being nauseated from the drug. Thanks so much.

[LunaRufina]

Why aren't you in the hospital for long term care? The amount of vomiting that you describe would debilitate you with dehydration?

[WinterRosie]

Hey Narcissism, do you mind if I ask some clarifying questions?

- why do you like the Topomax if you only take it to humour others, and that you're not finding it effective? Does its weight-loss properties attract you?

- are you still throwing up every half-hour or so? It can cause an electrolyte imbalance which can lead to heart attacks. The stress of frequent vomiting is intense, too. It can lead to a ruptured oesophagus, or you could lose all of your teeth. I don't want for any of that to happen to you!

- How many doctors do you have right now? Sometimes when there are lots they lose track of what's going on with the rest of you and things can go downhill rapidly.

[Narcissism]

Hey Narcissism, do you mind if I ask some clarifying questions?

- why do you like the Topomax if you only take it to humour others, and that you're not finding it effective? Does its weight-loss properties attract you?

- are you still throwing up every half-hour or so? It can cause an electrolyte imbalance which can lead to heart attacks. The stress of frequent vomiting is intense, too. It can lead to a ruptured oesophagus, or you could lose all of your teeth. I don't want for any of that to happen to you!

- How many doctors do you have right now? Sometimes when there are lots they lose track of what's going on with the rest of you and things can go downhill rapidly.

I have several physicians, actually, my case is so..."complex" that doctors tend to take their hands off immediately and refer me around, it's kind of hopeless. I've had electrolyte testing before, sometimes I have slight potassium imbalance, but nothing too out of range, I drink A LOT of fluids, and I tend to keep one meal down a day without vomiting. But yes, other then that I do vomit an abundance of times a day. It can be limited using Cesamet at its maximum dosages if I can tolerate the extreme dry mouth/blood shot eyes augmented with Zofran, but I can't always do that on a daily basis.

You hit the nail on the head, I want my old weight back, the Topamax has been simply assume in keeping me away from the carbohydrates. I find it weird I have issue losing weight with the amount of N/V I experience.

My GI scopes were clean, aside from having an "extremely redundant colon" for which I've been referred to a university motility clinic (Mayo won't accept me as a patient as they do not feel they can help me) and I don't have the funds to go back to Hopkins as I was just there in November, and they didn't do much. I also have a Hiatal Hernia, I will be seeing a specialist at Northwestern University locally in Chicago next month to try and ween out some of the GI issues. Most GI physicians feel as though the high ICP caused some neuro transmitter damage/constant neuro pain is causing me to throw up consistently. The only thing that really helps is THC, but like I said, unfortunately Cesamet seems to dry my mouth/throat out, and as far as smoking, it's not legal in IL (though extremely affective for pain/nausea in my limited experience in CO- when I lived there) and I am not one to do illegal things.

Also, I tend to stay away from hospitals for two reasons:

1) Extreme debilitating OCD, hospitals gross me out.

2) Everytime I go to a hospital for inpatient care, I wind up with more issues, last time, three contraindicated clotting medications where used resulting in the DVTs I mentioned.

I appreciate the responses.

[WinterRosie]

Generally speaking, the more that people throw up the more that their bodies want to hold on to whatever nutrients they can - this can result in weight gain. At the very least it doesn't encourage weight loss. Throwing up a lot can also cause the lack of motility as body figures that it isn't really necessary any more.

I learned all this from having an eating disorder. They tend to be specialists in digestive troubles like this as well.

[Narcissism]

Generally speaking, the more that people throw up the more that their bodies want to hold on to whatever nutrients they can - this can result in weight gain. At the very least it doesn't encourage weight loss. Throwing up a lot can also cause the lack of motility as body figures that it isn't really necessary any more.

I learned all this from having an eating disorder. They tend to be specialists in digestive troubles like this as well.

I used to weigh 145 lbs, for 8 years, and then I had elevated Prolactin, Estradiol, and Cortisol levels going along with the increased intracranial pressure, but never any masses visible on MRI. I had rapid, 40-60 lbs in less then a month of weight gain. I'm almost (finally back down to my normal weight). Unfortunately the weight gain has played hell on my self image, and increased my OCD symptoms exponentially. I'd really like to continue with the Topamax for another month or so, but at this point am not sure if it safe to do so.

[Wooster]

Sounds like you need to be talking with your health care providers about all that, and maybe requesting some case management/care coordination services due to the complexities.

I wish you the best with all that.

[WinterRosie]

Do you have a patient advocate? Because that is exactly their department.