Zofran elavil

So my sister in law who is a NP found me a good neurologist who prescribed Aimovig and Zofran…. United Healthcare said “nope you have to try a beta blocker, Elavil and Topamax first” I took those 3 years ago. They denied the prior authorization. So he switched to Nurtec, Emgality and Zofran. And lo and behold there is a delay on those too for the same reason. My temple is throbbing so badly that I imagine slicing it to relieve the pressure. Insurance companies have entirely too much power. When I “reminded” them I have already taken those meds, the chat disconnected. The hold on the phone was over an hour and still didn’t get help. Just so frustrated today. I hope everyone is feeling better than me lol.

31 year old male 6’6” / 315 lbs
I’ve been feeling symptoms of Low T for at least a few years now (dieting and exercising results became non existent over those years —went from 240 to 315).
I had my primary do some lab work which came back as follows:
Total Testosterone 116 ng/dL (09/03/22) 149 ng/dL (09/08/22)
Free Testosterone 7.06 ng/dL (09/08/22)
TSH 1.930 mlU/L (09/03/22) -EDIT-
Semen Analysis (10/10/22) Volume 1.8 mL Sperm Concentration 0.38 M/mL Total Motile Sperm 0.14 M
“Free testosterone ok Most important number No tx needed, just follow” - Primary Doctor -
I requested a referral to an urologist / endocrinologist.
I was referred to my Urologist, and she pulled the following labs
FSH 10.7 mlU/mL (10/23/22)
LH 9.7 mlU/mL (10/23/22)
Estradiol -17b 38 pg/mL (10/23/22)
TLDR The treatment plan she suggested is Anastrozole 1mg every other day. Repeat blood work in 4 weeks and sperm analysis in 3 months.
Has anyone had any experience with this? She said it’s an off label approach to treat male infertility and help testosterone.
Any advice? I’d prefer to go on TRT w/ HCG.
EDIT 2: Medications
Adderall XR 20 MGs - 2x/day Vitamin B1 - 100 MG 1x/day Lexapro 10 MG 1x/day Elavil 25 MG 2x/day Zofran 4mg -as needed-

Hello kava lovers!
I took quite a bit of time today to dig into this. It's been a long running issue that when you type in "Kava" in google you get some dubious results on the first page. I'm taking it upon myself to list those here, and refute them where they have issues.
Search Results for "Kava" on google in incognito window.
Result 1: Webmd

1. Overview

• Point 1: “Kava is a beverage or extract that is made from Piper methysticum, a plant native to the western Pacific islands. The name "kava" comes from the Polynesian word "awa," which means bitter. In the South Pacific, kava is a popular social drink. It is consumed as a beverage in ceremonies to promote relaxation.”

1. No issues with point one.

• Point 2: “There have been some safety concerns about kava. Cases of liver damage and even some deaths have been traced to kava use. Because of these reports, kava was withdrawn from the market in Europe and Canada in the early 2000s. However, most countries have allowed kava to return to the market since that time. Kava has never been taken off the market in the U.S.”

1. And my issues start here. “Cases of liver damage and even some deaths have been traced to kava use” is a hotly contested conclusion, and rather inflammatory when such paltry evidence exists to support it. The paragraph then goes on to state “However, most countries have allowed kava to return to the market since that time.” My issue here is; why are we not seeing these cases of liver failures and injury in countries where it’s freely available today, if it’s as liver toxic as it was said to be?

• Point 3: “Kava is most commonly used for anxiety. Some people take kava for stress, restlessness, sleeping problems (insomnia), and many other conditions. But there is no good scientific evidence to support these uses.”

1. “But there is no good scientific evidence to support these uses.” Hilariously they give quite good scientific evidence to support these uses directly in their references. Kava and kava extracts have been proven in double blind placebo controlled studies to reduce anxiety scores, and increase sleep duration/quality.
2. How does it work?

• Point 1: “Kava affects the brain and other parts of the central nervous system. The kavalactones in kava are believed to be responsible for its effects.”

1. No issues with this. This has been demonstrated repeatedly in research.
2. Possibly Effective for

• Point 1: “Anxiety. Most research shows that taking kava extracts that contain 70% kavalactones can lower anxiety and might work as well as some prescription anti-anxiety medications. Most studies have used a specific kava extract (WS 1490, Dr. Willmar Schwabe Pharmaceuticals). It seems that kava supplements containing at least 200 mg kavalactones daily should be taken for at least 5 weeks for symptoms to improve.”

1. Strangely, they just got finished saying there is no good scientific information on which to support these theories. Extra note: WS-1490 is an extract that has been embroiled in controversy. The extract is contested on the grounds that it was changed several times throughout the research periods from an ethanolic extract to an acetonic extract with no indication. You can see this by noting how the kavalactone percentage changes arbitrarily from 30% to 70%.
2. Possibly Ineffective for

• Point 1: “A type of persistent anxiety marked by exaggerated worry and tension (generalized anxiety disorder or GAD). Several early studies show that taking kava doesn't improve symptoms in people with GAD.”

1. They conveniently don’t mark their sources in the article, but this one comes from Dr. Sarris in Australia in 2020. This research concluded that kava was more suitable for the reduction in stress and tension related to ‘situational’ anxiety, than it was for direct treatment of G.A.D.
2. Insufficient Evidence for

• Point 1 “Withdrawal from drugs called benzodiazepines. Early research suggests that slowly increasing the dose of kava extract over the course of one week while decreasing the dose of benzodiazepines over the course of two weeks can prevent withdrawal symptoms and reduce anxiety in people who have been taking benzodiazepines for a long period of time.”

1. It can reduce anxiety, but the actual physical withdrawal is not treated by any action of the kavalactones themselves. It’s likely that the steady tapering of the BZP drug was what allowed these participants to cease their use with less acute withdrawal. Kava definitely helps, but it has different actions at the GABA-A receptor that are not similar to that of benzodiazepine drugs. Benzos target the BZP allosteric site on the GABA-A receptor where they exert their effect. Kava and flumazenil (a very potent anti-benzo or BZP antagonist) were administered at the same time in studies, and the effect of kava was not blocked.

• Point 2 “Cancer. There is some early evidence that taking kava might help to prevent cancer.”

1. I would say this “insufficient evidence” is actually an order of magnitude more studied and documented than the “liver damage” at the very beginning of this article. I’ve added additional citations below this papers citations, and I stopped citing at 12 research studies that show anti-cancer effects.

• Point 3 “Insomnia. Research on the effectiveness of kava in people with sleeping problems is inconsistent. Some research shows that taking kava extract daily for 4 weeks reduces sleeping problems in people with anxiety disorders. But other research suggests that taking kava three times daily for 4 weeks does not reduce insomnia in people with anxiety.”

1. The World Health organization monograph (2002) describes insomnia as a state supported by clinical data. This is generally accepted, however there were participants in studies on kava that dropped out due to insomnia complaints. While kava is overall a good fit for sleep issues, it likely won’t present that way to 100% of the people who drink it. We actually do see people complain about not being able to get to sleep after a strong kava. I say this to agree with the above paragraph where it states the research is inconsistent. It helps me with sleep, but that doesn’t mean it will be the same for everyone.

• Point 4 “Symptoms of menopause. Early research shows that taking kava daily for 3 months might reduce depression, anxiety, and hot flashes.”

1. While maybe insufficient, there is good evidence to support this. Two individual studies found improvement in mood, reduction in depression, and reduction in anxiety in perimenopausal individuals.

• Point 5 “Stress. Early research suggests that taking a single dose of kava by mouth might reduce symptoms associated with mentally stressful tasks.”

1. This is an odd one to say has insufficient evidence. A number of researchers including Münte, Sarris, Cropley, and Aporosa have found kava reduces symptoms associated with mentally stressful tasks.

• Point 6 “Seizure disorder (epilepsy).”

1. This is in line with reality. We only see glimpses into kava’s ability to modulate glutamate. Kavain was shown to inhibit veratridine-activated sodium channels. It’s possible that kava may help reduce seizures, but as said, there is insufficient evidence to say it precisely.

• Point 7 “Muscle pain.”

1. This I don’t agree with, and it’s a strange one to be saying there’s insufficient evidence for. Kava has marked antinociceptive (pain relieving) and muscle-relaxing properties. A good number of independent research studies have confirmed this.

• Point 8 “Other conditions”

1. I’m not really sure what to say here. I suppose it’s quite accurate to say that there is insufficient evidence for kava causing superhero-like powers to emerge.
2. Side Effects

• Paragraph 1 “When taken by mouth: Kava is POSSIBLY SAFE when taken for up to 6 months. Using kava can make you unable to drive or operate machinery safely. Do not take kava before you plan on driving. "Driving-under-the-influence" citations have been issued to people driving erratically after drinking large amounts of kava tea.”

1. This is good, and goes pretty far based on the double blind placebo controlled studies. The one issue I have is the 6 month limit. There really isn’t any indication that taking kava beyond this time frame causes issues, it’s just when they cut the time limit of the study. Empirical evidence suggests kava, when consumed as a beverage, is safe indefinitely as shown by the South Pacific people who drink kava on a daily basis and have for generations. In regards to driving, I fully agree. If you’re consuming anything that makes you question your abilities with driving, call an ubelyft.The risk is simply not worth it.

• Paragraph 2 “People may have heard that use of kava can cause liver damage. The use of kava for as little as 1-3 months has resulted in the need for liver transplants and even death in some people. Early symptoms of liver damage include yellowed eyes and skin (jaundice), fatigue, and dark urine. But these cases appear to be relatively rare. Most people who have used kava have not experienced liver toxicity. Also, some experts believe that the liver toxicity seen in these cases cannot be directly linked to kava. Other factors may have contributed to these toxic effects. To be on the safe side, people who choose to use kava can get liver function tests.”

1. That’s pretty honest, however the phrase “The use of kava for as little as 1-3 months has resulted in the need for liver transplants and even death in some people” really understates “some people”. The number of individuals allegedly harmed by kava is limited to less than 10. There has been no intrinsic (unable to be separated) toxicity seen in kava or any kava extracts, however idiosyncratic reactions of the immunologic type have occurred. This is extremely rare. I can’t say that enough. We’re talking on the scale of winning the lottery, being hit by lightning, and finding Jimmy Hoffa all at the same instant. If we turn our attention to things such as green tea extracts or acetaminophen we see intrinsic, predictable toxicity to the liver. This does not exist with kava.
2. Special Precautions and Warnings

• Point 1 “Pregnancy and breast-feeding: Don't use kava if you are pregnant or breast-feeding. Kava is POSSIBLY UNSAFE when taken by mouth. There is a concern that it might affect the uterus. Also, some of the dangerous chemicals in kava can pass into breast milk and might hurt a breast-fed infant.”

1. They’re speaking about kavalactones, and they’re not “dangerous chemicals” however we don't fully understand the function of GABAergic substances on the developing brain. Kavalactones are known as lipophilic, meaning they tend to combine or dissolve in fats. This means they could likely also pass on through breastfeeding. There is no data confirming this suspicion, however with no experience available, kava is not recommended for use by pregnant or breast-feeding women. It’s much better to err on the side of caution. In regards to kava affecting the uterus, I’m afraid there is absolutely nothing confirming this. It’s an old myth from Fiji that kava stimulates the uterus, this doesn’t happen, and shouldn’t be listed as a precaution. Histopathology was performed on rats at 2.0g/kg of kavalactones and found no-effect level on the uterus. (2012. “Toxicology and Carcinogenesis Studies of Kava Kava Extract (CAS No. 9000-38-8) in F344/N Rats and B6C3F1 Mice (gavage Studies).” National Toxicology Program 571 (1): 1–186. https://ntp.niehs.nih.gov/publications/reports/t500s/tr571/index.html)

• Point 2 “Liver disease: Kava might cause liver problems, even in healthy people. People who have a history of liver problems should avoid kava.”

1. Well this sounds familiar. This will be the 3rd time this website has decided it was pertinent to warn us of liver damage. What they’ll throw at you sometimes is the instance of GGT elevation in metabolism tests seen in kava users in the late 80s and early 90s in Australia's Northern Territory. This is NOT indicative of liver damage. It indicates liver adaptation and is seen in kava drinkers that consume about a pound of dried kava per week. AST and ALT increases are not seen. I would even go as far to say here that kava is not even detrimental to those with liver problems. Kava is not intrinsically toxic to the liver in any way.

• Point 3 “Parkinson disease: Kava might make Parkinson disease worse. Do not take kava if you have this condition.”

1. This one is interesting. You have research on one side saying kava has no or very little activity at dopamine, then you have other research indicating that some kavalactones drop dopamine levels considerably. The one kavalactone in question here is Yangonin. Yangonin has shown in research to lower dopamine to below detectable levels. I personally believe that this is happening evidenced by the extrapyramidal movements seen in kava drinkers that went way overboard. They end up looking like they have parkinsons. If you are on medication such as levodopa that is specifically meant to increase free dopamine levels in the brain, kava can counteract this effect and cause the resurgence of parkinson's symptoms. So yes, I agree with this statement. If you have parkinsons it’s best to skip the kava.

• Point 4 “Surgery: Kava affects the central nervous system. It might increase the effects of anesthesia and other medications used during and after surgery. Stop using kava at least 2 weeks before a scheduled surgery.”

1. This is not talked about very much but should be taken into close consideration when approaching a surgery. Kava has many properties that haven’t been studied all that intensively. Kava has shown to have some mild antithrombotic actions. This means it may be able to prevent, to a degree, blood clotting. Give yourself at least a week if not two before any surgery to let your system flush out. Kava has also been shown to increase the sedation of anesthetic drugs. You’ll want to observe this just to be on the safe side.
2. Major Interactions

• Point 1 Alprazolam “Kava can cause drowsiness. Alprazolam (Xanax) can also cause drowsiness. Taking kava along with alprazolam (Xanax) may cause too much drowsiness. Avoid taking kava and alprazolam (Xanax) together.”

1. Agreed

• Point 2 “Kava might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking kava along with sedative medications might cause too much sleepiness.Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.

1. Agreed as well. Sedation seems to be the pharmacodynamic interaction here.
2. Moderate Interactions

• Point 1 “Levodopa interacts with KAVA - Levodopa affects the brain by increasing a brain chemical called dopamine. Kava might decrease dopamine in the brain. Taking kava along with levodopa might decrease the effectiveness of levodopa.”

1. I believe this to be correct. Levodopa is a medication meant to increase the levels of dopamine in the brain. Yangonin can decrease dopamine levels in the brain and counteract this medication.

• Point 2 “Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interact with KAVA - Some medications are changed and broken down by the liver.- Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are changed by the liver might increase the effects and side effects of some medications. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver. Some of these medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.

1. This is also correct. CYP1A2 is the pathway of metabolization for caffeine. Kava causes inhibitory actions at this pathway and as such causes caffeine to appear in serum levels for much longer than without kava in the system. The individual effect of this combination may differ from person to person. CYP1A2 activity has a range of 40% between individuals. As such it’s quite difficult to make predictions of which drugs will do what when this pathway is inhibited.

• Point 3 “Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates) interact with KAVA - Some medications are changed and broken down by the liver Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are broken down by the liver can increase the effects and side effects of your medication. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver. Some of these medications changed by the liver include amitriptyline (Elavil), clomipramine (Anafranil), cyclophosphamide (Cytoxan), diazepam (Valium), lansoprazole (Prevacid), omeprazole (Prilosec), lansoprazole (Protonix), phenytoin (Dilantin), phenobarbital (Luminal), progesterone, and others.

1. Correct as well; however, issues at this cytochrome with drugs that use this pathway are not heavily researched in regards to kava. They generally encompass the sedative effects and their increase when in combination with the drugs above. Caution should still be taken when combining these drugs with kava as it will likely make them stay in your system for considerably longer periods of time. DMY seems to be the most potent inhibitory kavalactone in this regard.

• Point 4 “Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates) interacts with KAVA - Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver. Some medications that are changed by the liver include amitriptyline (Elavil), diazepam (Valium), zileuton (Zyflo), celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.

1. This inhibition was seen strongest with methysticin, the number 6 on chemotypes. The effect seen with methysticin was low, with only 1% of the strength of their positive control (Sulfaphenazole). I truly believe this would not have a strong impact on drugs that also use this pathway being kava/kavalactones have such a low affinity for it.

• Point 5 “Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates) interact with KAVA - Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are change by the liver can increase the effects and side effects of your medication. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver. Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.

1. This is incorrect. Kava has no inhibition property at this cytochrome even at absurdly high concentrations, and as such this is wrong.

• Point 6 “Medications changed by the liver (Cytochrome P450 2E1 (CYP2E1) substrates) interact with KAVA - Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are change by the liver can increase the effects and side effects of your medication. Before taking kava talk to your healthcare provider if you take any medications that are changed by the liver.Some medications that are changed by the liver include acetaminophen, chlorzoxazone (Parafon Forte), ethanol, theophylline, and drugs used for anesthesia during surgery such as enflurane (Ethrane), halothane (Fluothane), isoflurane (Forane), and methoxyflurane (Penthrane).

1. Again methysticin is the only kavalactone shown to interact with this cytochrome and it does it quite weakly. I wouldn’t suspect any immediate issues with drugs that use this pathway combined with kava.

• Point 7 “Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interact with KAVA - Some medications are changed and broken down by the liver. Kava might decrease how quickly the liver breaks down some medications. Taking kava along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking kava, talk to your healthcare provider if you are taking any medications that are changed by the liver. Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.

1. This effect, if present, will be very light. Kava has shown very slight inhibitory properties at CYP3A4 with methysticin being the most potent inhibitor. Methysticin has shown to be about 1% the inhibitory properties of their positive control, Ketoconazole. I would not expect major interactions with pharmaceuticals along this pathway with kava.

• Point 8 “Medications moved by pumps in cells (P-Glycoprotein Substrates) interacts with KAVA - Some medications are moved by pumps in cells. Kava might make these pumps less active and increase how much of some medications get absorbed by the body. This might increase the amount of some medications in the body, which could lead to more side effects. But there is not enough information to know if this is a big concern. Some medications that are moved by these pumps include etoposide, paclitaxel, vinblastine, vincristine, vindesine, ketoconazole, itraconazole, amprenavir, indinavir, nelfinavir, saquinavir, cimetidine, ranitidine, diltiazem, verapamil, corticosteroids, erythromycin, cisapride (Propulsid), fexofenadine (Allegra), cyclosporine, loperamide (Imodium), quinidine, and others.”

1. A single dose of 800mg kavain gave a serum concentration level of 40ng/ml or .1um. This plasma level is unlikely to cause any significant inhibition of P-gp in vivo. Also, 800mg of kavain is quite unlikely to be consumed at once in a typical kava consuming session. The likelihood of inhibition here is very low. Results obtained in vitro vs in vivo were contradictory.

• Point 9 “Medications that can harm the liver (Hepatotoxic drugs) interact with KAVA - Kava might harm the liver. Taking kava along with medication that might also harm the liver can increase the risk of liver damage. Do not take kava if you are taking a medication that can harm the liver. Some medications that can harm the liver include acetaminophen (Tylenol and others), amiodarone (Cordarone), carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa (Aldomet), fluconazole (Diflucan), itraconazole (Sporanox), erythromycin (Erythrocin, Ilosone, others), phenytoin (Dilantin), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and many others.”

1. It should be obvious to limit the intake of liver toxic compounds, however some of them are rather ubiquitous. Acetaminophen, also known as APAP, Panadol, Paracetamol, and Tylenol is a potent hepatotoxic drug due to its metabolites. Kava likely does not interact with these drugs other than APAP. There is research leaning to indicate that the combination of APAP and kava should be avoided on the issue of glutathione degradation. IF kava does indeed reduce glutathione levels, mixing it with APAP would increase its toxicity.
2. Dosing
3. Paragraph 1 “By Mouth: For anxiety: 50-100 mg of a specific kava extract (WS 1490, Dr. Willmar Schwabe Pharmaceuticals), taken three times daily for up to 25 weeks, has been used. Also, 400 mg of another specific kava extract (LI 150, Lichtwer Pharma) taken daily for 8 weeks has been used. Five kava tablets each containing 50 mg of kavalactones have been taken in three divided doses daily for one week. One to two kava extract tablets has been taken twice daily for 6 weeks. Calcium supplements plus 100-200 mg of kava taken daily for 3 months have also been used.”
4. This really doesn’t tell us anything to go by for our own personal dosing. In truth, there is no recommended dosage for powdered kava. These dosage recommendations come from several studies as well as the German Commission E. I take it that these numbers indicate the minimum amount of kavalactones it requires to see any effect without seeing intoxication. Seeing that many of us aim for intoxication these numbers are simply meaningless.

Citations Removed for length. See kavaforums post for full citations.
Kavaforums Discussion Thread: https://kavaforums.com/forum/threads/webmds-article-on-kava.19070/

I’m a 37F living in Los Angeles, CA, USA experiencing severely low vitamin C levels for many years. I am on Zofran, Dexilant, Hizentra, Humira, Elavil, Provigil, Birth Control, and Metroprolol Tartrate. I have GERD and gastroparesis in addition to multiple other comorbidities. Because of both of these medical issues I do not eat acidic foods, do not orally tolerate vitamin replacements, and have to cook all veggies and fruits to death. This has left me with a blood vitamin C level of <0.1 mg dL. (It has been as low as zero in the past.) I need my levels corrected through IV treatment as oral administration is not tolerated.
My primary does not know what type of specialist to send me to. My gastroenterologist, who works at a world renowned university medical center, also has no idea who to send me to.
So any idea what type of specialist I could see that could fix my deficiency and manage it long term?

Hi, I'm a 19 year old male (5'9 140lbs) that's been suffering from chronic, debilitating nausea and abdominal pain since the beginning of May 2019 that's massively impacted my quality of life. The pain started very suddenly, one week I was feeling fine, and the next week I was nauseous as hell. I just chalked it up to a stomach bug at the time, but the problems have persisted since then I've had every single test known to man (endoscopy, ultrasound, HIDA scan, gastric emptying study, CT scan, multiple blood tests, stool tests), all of which came back normal outside of a slightly elevated liver enzyme, slightly elevated calcium, and slow biliary transit time on the HIDA scan. Because of this scan (and my extensive family history of gallbladder problems), I decided to have my gallbladder out back in December. The surgery went well and seemed to fix all of my problems, for a short-ish period of tie but about 2 weeks afterwards the issues returned. The pain seems to follow a sort-of fixed schedule: I'll be nauseous when I wake up most mornings (maybe 5/7 days a week), but I will feel fine after I eat breakfast. Then, at around 4PM I'll start getting nauseous, and will end the night with maybe 2-3/10 nausea and a little twinge of stomach pain on the area under my ribs. However, some days I get massive attacks, and am left sitting in bed for 2-3 days straight, unable to get up because my nausea is so bad. These attacks happen maybe 3-4 times a month, with no symptoms during them other than the pain+nausea and maybe some bloating. The problems don't really seem to be triggered by food, some weeks I'll eat a very heavy meal and have no problems after, others I'll eat a light meal and be struck by an attack a few hours later. I also have alternating bowel issues, some days I have constipation for 2-3 days before going to the bathroom, others I'll have 2-3 soft bowel movements over the course of a few hours. The pain and nausea aren't always linked, sometimes I'll feel extreme stomach cramps in my upper left side with no nausea (those cramps only last 30 minutes or so), other times I'll feel like there's a mass stuck at the back of my throat all day long, and others again I'll feel strong pain all over my stomach in conjunction with nausea. I'll also have times when my stomach feels like a massively overinflated balloon, whenever I feel like this I'm always nauseous as well. I'll have other times when my stomach really feels upset but then makes a lot of noise, and any nausea that I had been feeling then is almost instantly replaced with a feeling of hunger. I don't have any blood in my stool, they're a normal medium brown color, no jaundice, and no strange tiredness. I've had a thyroid test and those levels were normal. None of my doctors have any clue at all what to make of this, and I'm really starting to lose hope that they'll be able to find anything at all. My gastro dr suggested a sphincter of oddi dysfunction, but he doesn't really believe this is my problem just because of how intermittent and random it is.
For a bit of context, I don't smoke, I still manage to exercise somewhat regularly, and never had any serious stomach issues growing up outside of the occasional stomach bug. I've tried eliminating gluten (didn't help), removing anything I may be allergic to (again, doesn't help), eating nothing but light foods for an extended period of time (and eating several small meals throughout the day rather than 3 big ones), and have had my gallbladder removed. The only medications I'm on for this is Elavil, Zofran, and Levsin; the levsin seems to help a little bit and the Elavil has seemed to lessen the frequency of attacks since I've started taking it. I actually went 2 weeks without any pain for the first time in over a year back in late August/early September, but right now I've relapsed massively and have felt terrible all this past week. This issue has impacted my life so much over the past year or so, I had to defer enrolling in college for a year until this semester, and even then I've only been able to do so because my classes are online. I'm really terrified that this problem is going to stay with me forever, and really could use some advice. I apologize for the wall of text, but please, if anyone can help me, let me know your thoughts.

(I apologise if and when the formatting looks terrible. Still figuring mobile out)
Hi guys.
I noticed this sub doesn't have an existing archive of products or supplements for treating IBS. Information can be difficult to obtain and new medicine and products often go unnoticed so let's gather it all in one place, shall we?
Comment with the trade name the product goes by in your country, the main active ingredient(s) and whether it's for treating diarrhea, constipation or general symptoms. You can also include a brief description of the latter if you'd like.
I'll update the post as the comments come in.

THE ARCHIVE

* = prescription-only

GENERAL

• Amitriptyline * (amitriptyline) for pain and anxiety
• Elavil * (amitriptyline) ⤴
• Bentyl (dicyclomine) for stomach and intestinal cramping and hypermobility
• Dramamine (dimenhydrinate) for nausea
• Draminate (dimenhydrinate) ⤴
• Gravol (dimenhydrinate) ⤴
• Cipralex * (escitalopram) for pain and anxiety
• Esipral * (escitalopram) ⤴
• Escitalopram * (escitalopram) ⤴
• Lexapro * (escitalopram) ⤴
• Levsin (hyoscyamine) for gut spasms, tremors and pain
• Vi-Siblin (ispaghula husk)
• Alflorex (lactic acid bacteria: bifidobacterium infantis)
• Mebeverine * (mebeverine) for spasms
• Mylan IBS Relief Tablets* (mebeverine) ⤴
• Multivitamin for IBS-related deficiencies
• Zofran * (ondansetron) for nausea
• IBgard (peppermint oil) for pain, discomfort and bloating
• Effexor (venlafaxine) for pain and anxiety
• Venlafaxin (venlafaxine) ⤴
• Vitamin D for IBS-related deficiency and osteopenia - calcium also recommended
• Vitex angus castus, herbal supplement for IBS symptoms worsened by PMS

DIARRHEA

• Librax * (chlordiazepoxide, clidinium)
• Lomotil * (diphenoxylate)
• Truberzi * (eluxadoline)
• Precosa (lactic acid bacteria: saccharomyces boulardii)
• Imodium (loperamide hydrochloride)
• Lopex * (loperamide hydrochloride)
• Mebeverine * (mebeverine)
• Mylan IBS Relief Tablets * (mebeverine)
• Litalgin (metamizole, pitofenone)
• Hidrasec (racecadotril)
• Targaxan * (rifaximin)
• Xifaxan (rifaximin)
• Gelsectan (xyloglucan)

CONSTIPATION

• Levolac (lactulose)
• Constella * (linaclotide)
• Linzess * (linaclotide)
• Amitiza * (lubiprostone)
• Misoprostol * (misoprostol)
• Cytotec * (misoprostol)
• Lax-A-Day (polyethylene glycol 3350)
• Miralax (polyethylene glycol 3350)
• Restoralax (polyethylene glycol 3350)
• Trulance * (plecanatide)
• Prudac (prucalopride)
• Resolor (prucalopride)
• Resotran (prucalopride)

Second post here to this group.
My GI doctor sucked so I went and saw my PCP recently.
He put me on Elavil. That in addition to Zofran with sickness and I take Gas-X anytime I feel bloated.
So far I feel “better” although my GP seems to change its symptoms every 3-5 weeks - so it’s kinda hard to tell.
Well long story short - the Elavil additional has helped. Now I may get a time or two a day with a icky-tummy feeling - but it’s much more manageable - almost feels like this afternoons lunch MIGHT give you food poisoning but turns out your fine.
Curious to anyone else’s experience?
Also - the Zofran isn’t a sure fire way to curb the nausea. What are your thoughts on some of the other nausea meds?
I feel like my GP is a work in progress - but it does seem like avoiding certain foods all the time, avoiding others only when I feel bad, and not eating past 9 (I am usually up until 11-12) seems to be helping a ton. If I need a snack and it’s past 9... it’s 10 Cheez-Its max.
My doctor thinks I have physical triggers - but also thinks some might me psychosomatic - hence trying The Elavil.
This group has really really helped me feel less alone - despite the normalization of symptoms with those around me.
Also - not giving medical advice. I’ve found it super helpful to ask lots of questions - and have been willing to get second opinions with doctors around me. You’re in your control of your health/body... and are paying enough in copays to ask whatever you want.
As gassy, bloated, nauseous, etc as we are - at least we can vent/ask question on a safe place.

(I am seeing a neurologist and getting tested. ) *Edit I am adding cognitive difficulties bc upon rereading, I see that this post is a mess. I have never posted something like this dumpster fire before in my life.
I started getting headaches/eye aches on the left side of my face and this triggered severe nausea. One day I realized I felt the tingling in my arm. Fast forward six weeks and I am in a prison, My legs and my back are stiff, my lips are totally numb and the face tingling is a constant fiery buzz, I have pronounced weakness on my left side, tingling and numbness in my right hand and foot, fiery pain with every step, I cannot open my child's sippy cups, I drop things constantly. I have shocks down my back, I can barely make it to the bathroom and I have been working on this post for two hours because I keep forgetting what I am doing. I am worse in heat but I have trouble with holdfing anything cold.
They have ordered an MRI of the brain and cervical spine with contrast and without. They suspect MS. But my question is this- can ms be this bad? I am worse every single day. I am watching the world like a bewildered observer because I just cannot believe I am this bad. I went from an active, vibrant mother to a a person who can barely walk watching their husband dump their bucket of pee because the bathroom was too far away.
I just feel like something this fast and devastating cannot be something that can be treated. My body is failing in so many ways, it makes me think I am dying.
Background & Demographics: Age 34 Approximate height & weight 5'7", 155 lbs Gender female Medications you take- baclofen 10mg,
albuterol inhaler (for squeezing pain in torso but they always say breath sounds are normal)
Elavil 25mg (sleep and antimigraine properties) Zofran 8mg 3x a day d's
ditropan but I won't take it yet. I am still making it, at least to the bucket.
Smoking status-former smoker, I quit 7 years ago
Previous and current medical issues, duration and location of complaint: I have (always had, dxed at 14) ehlers-danlos hypermobility type and slight mitral valve prolapse. In 2015 and 2016 I had sinus surgeries to relieve the pain and pressure in my face.
I have had a number of symptoms off and on throughout the years that I dismissed as being EDS or too insignificant to complain about - like the tingling between my shoulders.
In early 2017 I went back to the EN basilar migraines. No imaging studieT because my facial tingling had become constant. He diagnosed basilar migraines. His tx did not work and the constant tingling lasted for four months. It came back a few months later.

Demos: Age 34 Approximate height & weight 5'7", 155 lbs Gender female Medications you take- baclofen 10mg,
albuterol inhaler (for squeezing pain in torso but they always say breath sounds are normal)
Elavil 25mg (sleep and antimigraine properties) Zofran 8mg 3x a day
ditropan but I haven't started it yet.
Smoking status-former smoker, I quit 7 years ago
Previous and current medical issues, duration and location of complaint: I have (always had, dxed at 14) ehlers-danlos hypermobility type and slight mitral valve prolapse. In 2015 and 2016 I had sinus surgeries to relieve the pain and pressure in my face.
*edit- I am adding cognitive issues after looking at this disaster of a post.
I have had a number of symptoms off and on throughout the years that I dismissed as being EDS or too insignificant to complain about - like the tingling between my shoulders.
In early 2017 I went back to the EN basilar migraines. No imaging studieT because my facial tingling had become constant. He diagnosed basilar migraines. His tx did not work and the constant tingling lasted for four months. It came back a few months later.
I started getting headaches/eye aches on the left side of my face and this triggered severe nausea. One day I realized I felt the tingling in my arm. Fast forward six weeks and I am in a prison, My legs and my back are stiff, my lips are totally numb and the face tingling is a constant fiery buzz, I have pronounced weakness on my left side, tingling and numbness in my right hand and foot, fiery pain with every step, I cannot open my child's sippy cups, I drop things constantly. I have shocks down my back, I can barely make it to the bathroom and I have been working on this post for two hours because I keep forgetting what I am doing. I am worse in heat but I have trouble with holdfing anything cold.
They have ordered an MRI of the brain and cervical spine with contrast and without. They suspect MS. But my question is this- can ms be this bad? I am worse every single day. I am watching the world like a bewildered observer because I just cannot believe I am this bad. I went from an active, vibrant mother to a a person who can barely walk watching their husband dump their bucket of pee because the bathroom was too far away.
I just feel like something this fast and devastating cannot be something that can be treated. My body is failing in so many ways, it makes me think I am dying.

Cross post from chronic pain. Albeit a slow death that definitely can be avoided, it doesnt mean I don't have the pain still.
So story: I'm existing on <=90 calories a day due to gastroparesis. I have to choose if I want to continue this on a zofran patch for 1 to 2 weeks or a gj tube. The latter meaning I give up. Also meaning not giving up could be even more harmful. I actually would have to CHOOSE surgery and that alone is also terrifying.
Im also on elavil for stomach issues, which is an antidepressant. I missed one dose years ago at 30mg and the withdraw was horrific. Now im at 50mg. I have a lab quiz in the morning along with a 3 hour lab after and last time I went through withdraw I couldn't leave bed, now I have a double whammy.
I dont know what to do. I work part time in retail thats mildly physically demanding, and I'm a full time nursing student though I'm not yet in clinicals.
I can't tell if I want to die, or I just actually am dying. Help.

I'm existing on <=90 calories a day due to gastroparesis. I have to choose if I want to continue this on a zofran patch for 1 to 2 weeks or a gj tube. The latter meaning I give up. Also meaning not giving up could be even more harmful.
Im also on elavil for stomach issues, which is an antidepressant. I missed one dose years ago at 30mg and the withdraw was horrific. Now im at 50mg.
I dont know what to do. I work part time in retail thats mildly physically demanding, and I'm a full time nursing student though I'm not yet in clinicals.
I can't tell if I want to die, or I just actually am dying. Help.

My struggle with migraines.
For years I have dealt with the chronic and disabling pain that comes with migraines; I should take note here that I actually suffer from occipital neuralgia AND migraines both... Joy! Here is a long list of medicines I have tried from abortives, to rescue and pain management.
List of medicines in no particular order. Sumatriptan, Rizatriptan, Zolmitriptan, Naratriptan, Eletriptan, Indomethacin, Meloxicam, Diclofenac, Baclofen, Flexeril, Robaxin, Zanaflex, Reglan, (Causes horrible extra-pyramidial effects, think of the worst restless leg syndrome EVER.) Zofran, (Works wonders) Prochlorperazine, (Same as reglan but 100 times worse) Promethazine, Orphenadrine, Hydrocodone/APAP, Oxycodone/APAP, Dilaudid IR 2mg, Opana ER 20mg, Fioricet, Dipenhydramine, Topamax, (Boo caused Kidney stones) Elavil, Namenda, Toradol, Ativan, Pentazocine, Stadol, Depakote, Valproate sodium, Dexamethasone, (Steroid) Tylenol, Motrin, Excedrin migraine, Melatonin, Magnesium, COq10, Dihydroergotamine, Propanolol, Clonidine, Verapamil, Effexor, Lexapro, Keppra, Botox, Zoloft, Toradol, Skelaxin, Gabapentin, (Talk about becoming dissociated from yourself) Paxil, ButterbuFeverfew, sumavel, (Inject-able imitrex due to gastoperisis)
Procedures done: Occipital radiofrequency ablation. Intranasal Marcain/Lidocaine for a spheno-palatine ganglion block. This one has provided me with almost INSTANT relief; I cannot even begin to describe it. However... Once the numbing meds wear off I'm back to square one.
Whew, have I lost you yet?! My headaches just don't respond very well to meds. I swore off the opiates as that is NO way to live. I am very thankful I have two very knowledgeable and caring neurologists who have brought me back from the brink of insanity, I don't know what I would have done had I not found them. Until someone has felt a migraine first hand the pain is almost unreal and hard to describe. One of my biggest pet peeves is "I get headaches." my response to them. "... Headache... Really, a HEADache? Try having a neurological diease which cripples you, puts you out of commission and makes you wish you were under a rock, not to mention you'd be crying because the lights are like 1000 suns glaring into your corneas, that keyboard you are typing on would be like nails on a chalkboard magnified to the point if wanting to gouge your ear drums out. oh and that cologne you have on... You'd be retching your guts up because it's like well; I can't put words to this one. Oh! AND you'd be carrying a trash can because the nausea would be kicking your ass." I hate HATE HATE HATE, and I don't use that word lightly. People who suffer "Tension headaches." And think they are migraines. When I see you laughing and joking, I just can't take you serious, when I am half blinded, ghost white from the nausea I just want to kick you in the ass.
Now ends my little rant! TL:DR summary, meds not effective. only option is surgery. Also just for kicks, I'm basically a walking pharmacy O_O.

I am a healthy 16 year old male.
I have been to neurologists, head ache specialist, pain doctor, chiropractor, physical therapy, and therapeutic massage.
I have had CT scans and MRI's both showing no irregularities.
I have had 6 concussions.
I have suffered from occasional migraines for the past 6 years.
Since July of 2012 my migraines have progressively gotten worse. I went from a migraine once a month or every other month to almost a migraine every 3-4 days lasting 12-48 hours. What has worked for fellow migraine suffers?
EDIT Now that I plastered my medicine all over this. Sorry if it didn't apply to you. Thanks again for all the help.
This is my meds.
AM (6 pills)
Iron 65mg = 325 mg ferrous sulfate
B2 100 mg
Magnesium 400 mg
Butterbur 50MG
Feverfew 350 mg
Dinner Vitamin Supplements, taken at dinner time (12 pills)
Multi Vitamin
B Complex
D3 2000 iu
Feverfew 350 mg
Butterbur 50 mg x 2 (100 mg)
B2 (Riboflavin) 100 mg
CoQ10 300 mg
Iron 65mg = 325 mg ferrous sulfate
Fish oil 1400 mg (980 mg Omega3)
Calcium Citrate w/ 500 mg calcium
PM (12 PILLS)
Fexofenadine (Allegra) 180 mg
Melatonin 3mg x2 (6 mg total)
B2 (Riboflavin)100 mg
Iron 65mg = 325 mg ferrous sulfate
Butterbur 50MG
Feverfew 350 mg
Magnesium 400 mg
Cyclobenzaprine HCL 10 mg (Flexeril)
Amitriptyline (Elavil) 50 mg (5 tabs)
This is the medicine I take at onset of a migraine.
@ Onset
Zolmitriptan (Zomig) 5 mg
Ondansetron Hcl 4 mg (Zofran)
Cyclobenzaprine HCL 10 mg (Flexeril)
Ketorolac Tromethamine 10 mg (Toradol) 1 to 3 tabs as needed
@ 2 hours after onset
Zolmitriptan (Zomig) 5 mg
@ 6 hours after onset
Ketorolac Tromethamine 10 mg (Toradol) 1 to 3 tabs as needed
@ 6 hours after onset
Ketorolac Tromethamine 10 mg (Toradol) 1 to 3 tabs as needed
This is what I have tried and failed.
Zolmitriptan (Zomig)
Suatriptan (Imitrex) both pill and nasal spray
Rizatriptan (Maxalt)
Naratriptan (Amerge)
Almotriptan (Axert)
Frovatriptan (Frova)
Verapamil (CALAN-SR)
Seizure med, can’t remember the name or locate at this time
Guanfacine
Proranolol (Inderal)
Divalproex (Depakte)