AboutBarbara Judge Expertise Outpatient pharmacy and general health. I have recently completed a Pharmceutical Care Certificate Program offered by Purdue University (Spring 1999 completion). I have personal experience dealing with terminally ill persons and their needs, as well as their families` needs. I graduated in 1984 from Pharmacy School and have been a Licensed Pharmacist since then. I have 18 years retail pharmacy experience. Prior to my pharmacy training I have 3 years hospital experience as a Nurse`s Aide.
Expert: Barbara Judge Date: 5/7/2008 Subject: Medication change
Question I stopped taking 50 mg.of amitriptyline at bedtime for sleep purposes and have started taking 20 mg. of fluoxetine instead,in the hopes of staying off of the amitriptyline. I started this 20 days ago, but I have been feeling quite a lot of anxiety during the day and have had a lot of trouble sleeping. My Dr. prescribed 10 mg. of zolpidem tartrate for short term use to help me sleep, until my body adjusts to the new medication routine. She said it takes about a month to see the full effect. I am planning a vacation to Hawaii in mid -June and am concerned that I will be feeling too stressed- out to enjoy myself. I guess I didn't anticipate this much trouble. If I don't feel better soon, I plan to start taking the amitriptyline again. My Dr. did not have me reduce my dose of amitriptyline gradually before starting the prozac; do you think this could be one of the problems?
Thanks for your help with this!
Kim
Answer It does take 4 to 6 weeks to see the full effect from fluoxetine as an antidepressant. For a few people, less than 10%, difficulty sleeping can be a side effect. This can be minimized by taking it in the morning rather than taking it at bedtime. It is possible that not slowly withdrawing you from amitriptyline did add to your difficulty sleeping, but since you have been off the amitriptyline for 20 days so far that should no longer be the problem. The zolpidem should be safe for occasional use for insomnia while your body is adjusting but I would not recommend taking it on a daily basis. If you have not adjusted to your new medication by the middle of this month I would recommend that you see your doctor and explain to her the side effects that you are having. Until then, make sure you take the fluoxetine in the morning.
