I am a 79 years old male. In Sept. 2011 I had a severe shingles attack. It was a 4 to 6 inch band that extended from the center of my chest, under my right arm to the center of my back. My primary care physician said it was the worst case of shingles he has ever seen. Since then I have been suffering from chronic PHN pain. I have visited six different specialists including a dermatologist, two neurologists, two anesthesiologists, and an infectious disease pain management specialist. I have visited the Vanderbilt University Interventional Pain Center, Anesthesiology Pain Division; Duke University Medical Center, Pain and Palliative Care Clinic; and the Mayo Clinic Pikeville Medical Center. I have been prescribed fifteen different chronic neuropathic pain medications including antidepressants, anticonvulsants and opioid pain medications intended for the management of acute complex pain; all to no avail.
I also participated in a double blind pain management research study to determine if an investigational drug developed by Syntaxin Ltd, a UK company, in partnership with Allergan to relieve PHN pain is effective. I received 65 injections in the affected areas of pain. Although some experienced complete pain relief, I must have received a placebo because it didn’t work for me.
In a desperate attempt to find a cure for the relentless PHN pain I experience daily I decided to try the drug combo of anticonvulsant gabapentin and antidepressant nortriptyline. Dr. Ian Gilron, M.D., M.Sc., FRCP(C), a professor at Queen's School of Medicine and anesthesiologist at Kingston General Hospital in Ontario wrote “This trial shows that the combination of an antidepressant and an anticonvulsant drug seems to be superior to monotherapy for neuropathic pain,". (Published in The Lancet, medical journal September 2009.)
For the last 10 months I had been taking 800mg gabapentin three times a day with minimal side effects, i.e. drowsiness. To precisely replicate Dr. Gilron’s study, I weaned myself over a two week period to 400mg gabapentin three times a day. I maintained that level for two weeks before I started taking nortriptyline. My plan was to take 25mg nortriptyline once a day for two weeks before increasing it to 25mg twice a day.
After taking the first 25mg nortriptyline table with the gabapentin I started experiencing mild side effects including dizziness, light headedness, blurred vision, and dry mouth. I stuck it out for ten days when I had no choice but to stop taking the nortriptyline. The side effects became unbearable. The dizziness and light headedness became so severe I could hardly walk and fainted on two different occasions. I became extremely drowsy. I was sleeping 16 to 18 hours a day. The dry mouth resulted in an extremely bad sore throat. It got to a point where I had difficulty swallowing water. My blurred vision also got worse. I could hardly read a newspaper or my computer screen. It took about a week to get the nortriptyline out of my system and get rid of the horrible side effects I was experiencing from the combination of gabapentin and nortriptyline.
I am now back to where I started, i.e. 800mg gabapentin three times a day. I have good days and bad days. On a good day my pain level is typically in the 2 to 4 range. On bad days my pain level is in the 5 to 9 range. I think the gabapentin is helping me some; but it’s difficult to precisely saying how much.
I was wondering if anyone also experienced the extreme side effects from taking both gabapentin and nortriptyline as I did. Were you able to overcome it? If “yes” how