Somnolence symptoms and conditions

I have type 2 diabetes for a few years and am 59 yrs old-and do not have fibromyalgia or kidney,liver problems or depression or a history of any painful muscles ever. I work up to 90 hrs a week as a doctor for the past 12 years and am a DIY renovator of my home in mt free time. I exercise regularly and am fairly fit, I do have a congenital mitochondrial myopathy characterized by non painful arm and leg muscle weakness- but have not been symptomatic significantly for 20 years. I take vitamins and one aspirin a day and have no medication allergies. weeks ago I started Januvia- my only diabetes medication. I worked well to normalize my mild to moserate elevation of BS.Over the past 2 weeks or so, I have had an increased somnolence without feeling rested upon awakening. I felt like I had been beaten with telephone poles and hammers, More distressing is the insidious onset of neuromuscular pains episodic sharp ones, more persistent aching and burning and tingling tingling, with a dense heaviness in legs more than arms worse with exertion and relieved by rest. 3 days ago it was to the point where I had to stop walking after 8 steps and could not climb a ladder beyond one step . I should not curl 2 lb weights even twice, Typing on a keyboard fatigued my arms after 5 minutes. I stopped Januvia three days ago, slept 30 hours,, felt better yesterday,restarted januvia last pm, Today, after 12 hours of sleep I feel exhausted like I did hard manual labor for a few days without ant sleep. The telephone pole beaten feeling returned, My weakness and pain are back with a vengeance and I cannot walk very well and have to stop typing this every 2 or 3 minutes to rest my arms, and have weakness also in my back muscles with curious sparing of abdominal muscles. Heat and massage do not help and are uncomfortable. I feel tired like I do when my myopathy acts up and my Krebs cycle is disrupted and thus my mitochondria do not make ATP to power my muscles- with the additional new symptom of significant pain. Aside from a mild tachycardia of about 100 at rest, my vital signs are normal, my cpk, Mg, thyroid function tests, comprehensive metabolic panel and sed rate are all normal . Heavy metal screen is negative. I will stop Januvia and probably never take it again, If my glucose goes back up I will go back to metformin which I took a few months about a year ago,
I suspect in my case that Januvia disrupted my mitochondrial function as well as being additionally toxic to my muscles and nerves by some additional pathogenesis, I question whether those individuals who have weakness, somnolence and neuromuscular symptoms might have some underlying mitochondrial dysfunction - a very under diagnosed condition - patients being told that their symptoms are of psychiatric origin.

I have been on 50 mg topiramate for a while now. It is part of a 5 drug mix used to address bipolar, anxiety and adult residual add. I take the topamax in one dose at night. When I first started it, I DID try to titrate up to at least 200 mg, but never made it past 75 mg. I took it in the morning, and, after about a week and a half on 75 mg, somnolence kicked in big-time and I was a zombie.
My Dr. and I kicked it back to 50, and moved it from a daytime drug to a night-time drug, and I have not really have problems since. It certainly still seems to have some mood stabilizing benefits for me, even at the relatively low dose I am taking. It also has helped with the awful headaches that I used to get far more frequently than I do now. I do not think that I ever received a weight benefit from it, but it seems that most people generally do not at this dose. Late last year, I had to switch to a different physician. Sadly, the new practicioner is no replacement for the former.
I have gained weight over the past few years for a variety of reasons. A somewhat sedentary lifestyle, social and emotional eating, too frequent consumption of caloric alcohol, (once a week or so,) as well as weight-gain contributory atypical anti-psychotic or mood stabilizing drugs have all helped put me in an unpleasant location on the BMI chart.
I have been enrolled in a hospital-associated, medically-monitered weight-loss program for several months and have een successfully losing weight. My new psychiatrist felt that an increase in topamax dose might be beneficial. I am going to attempt moving up to 100 mg, provided that I feel the change is warranted, and that the side effects do not kick in as before. The aforementioned practitioner has a tendency to be pixelated with respect to the approach towards a patient. This person does not seem to put much effort into reading, absorbing, integrating and using patient file information very well. For instance, this physician would miss the importance of the fact that topamax can cause an acidosis condition, and that the hospital diet typically intentionally puts patients on a diet that causes ketosis. These two conditions together would be unpleasant, to say the least. The doctor never even asked what type of diet I was on....
This is not the first time such an oversight has been made on the doctor's part, and it is my own educational background and awareness that has kept me from being the victim of the doctor's inattention and carelessness, not to mention probable nasty outcomes had I followed the instruction without question.
I am fortunate to be educated about this stuff, and so I do not have to rely on the practitioner's judgment alone. I am shopping for a new one, actually.
As it is, I am not on the hospital's most common diet, the ketosis-inducing one, and so I am not worried much about the potential acidosis due to topamax.
( I am not on the ketosis diet because I am aware of the problem such a diet can cause for bipolar disorder management, independent of any drug interactions. I read about this, consulted with the dieticians and weight-loss center physician, and chose a non-ketosis diet. I have been losing weight at a regular pace. the speed of loss is slower than with a ketosis diet, but safer for me. All it demands is better behavior on my part, but that is life.)
But I want to communicate a few things here.
First, I see that many people suffer not only from adverse effects, but also from arguably adverse treatment by physicians who either are not aware of a drug's information, are marginally aware of it, are not aware of their patient, or some combination of the above, or perhaps they just don't care.
There is also a clear tendency for many docs to balk when the patient's experience doesn't fit the prescriber's leaflet, resulting in dismissal of the patient's concerns and experiences, and may lead to arguably unnecessary tests and diagnostics rather than discontinuation of an offending drug.
Be aware that such treatment is indicative of a problem with your doctor, and the relationship between the two of you. Don't allow yourself to be tossed off that way, especially with no resolution to your problem; get a second opinion. Second, topamax is a specialty drug, and should be prescribed by, and treatment should be monitored by, a specialist. namely, this specialist should be a psychiatrist or neurologist, depending on what you ar taking the topamax for. Even if topamax had been prescribed for you for migraines or weight loss, the doctors most likely to be most educated about its main and adverse effects are psychiatrists and neurologists. There are a very few internal medicine or family practice docs who might be "with it" enough to be following the literature on this type of medication. A sub-point to this is a suggestion that education and information can only help you, and you should seek it out. Don't just read about a diagnosis, or about adverse effects, though. You'll run the risk of getting "medical students' disease", finding that your symptoms seem to match the disease descriptions for all manner of ailments. A general education is actually more useful. Text books can be a great help. Where you find something in a text is a bit advanced for you, try a more elementary text. Texts are available at libraries, so you don't have to buy them all. But reading up on psychology, understanding a little about metabolism, having some familiarity with medical terms, such things can save you from the results of a doctor's distraction, disinterest or disdain. It can also be immensely comforting just to understand how one's body works, and how drugs work within it, when one must face a disease such as Bipolar, Depression, Anxiety, Diabetes, etc. College intro level classes are thorough enough to demonstrate how a 25 mg pill can cause such disruption or such relief in a person's life. Eating certain things, and at certain times, sleeping well or poorly, ambient temperature, hygiene, reading habits, ALL of these things can have a profound effect on a person's day-to-day life. All of those factors, and more, can effect the physiology of an individual. It is good to know a little about how the system works, the better to maintain it. Some pop-sci books are pretty good, too. "You: The Owner's Manual" for instance. But some may read such books and find themselves wanting more information, and this is where any number of college texts about anatomy and psysiology, neuro-physiology, psychology and physiology, metabolism, diet and nutrition, genetics, etc. will come in handy. For those with insatiable curiosity and a deep desire to understand and manage a given disease or condition, there are usually medical texts available specifically covering THAT condition. For instance, those with Bipolar might wish to read at least parts of the text Manic Depressive Illness:Biolar Disorders and Recurrent Depression by F. Goodwin and K. Jamison. This text covers most of the meds those with bipolar would be interested in, it surveys the research done to date, what is known about combo therapies, adverse effects, including hair loss and weight gain, it covers patient experiences, as well as physician descriptions. One of the co-authors, for those who do not recognize the name, is not only a top researcher of affective disorders, but also suffers from manic-depression. The text is almost a good a friend as a patient could have, especially if your own physician is lacking in knowledge about your condition.
Third, several posts express a desire to report adverse effects, as well as doubt that a given personal physician would do so. If you have suffered from adverse effects, and want to report it, you do not require your doc, family practice, psychiatrist, or whatever type, to do so. There is a government website available for the reporting of adverse effects, and it is available to consumers, too. The report data goes to the FDA, which sorely needs such reports, as the drug companies are less than honest with THEIR submissions of information, and the dissemination of research data leaves much to be desired when it comes to the publication of information that is less than glowing about any given drug. I believe that you can find the reporting website on the FDA's site, or some link there. I wish I could recall it here for you.
Fourth, topamax, like most complex drugs for complex diseases and conditions, will affect each person very differently. Some will have little or no problems with adverse effects, while others will find the drug to be anywhere from uncomfortable, intolerable to damn near, or actually fatal. fatalities have occurred with topamax, as they have occurred with almost all, if not all, drugs. There is always a risk for adverse effect, sudden sensitivities, allergic reactions and other wonders and horrors of medicine. This is the nature of it. You have a bad reaction to anything that your body comes in contact with at any time for reasons we do not undrstand and can not even yet identify. Your typical cough syrup could, without warning, suddenly produce in you a rash that could kill you. But the conditions and diseases that drugs treat can be just as awful, and leave us with no option but to take the drugs to survive. Most experiences are not so extreme. For those that are, the greatest sympathy. But just because one had a bad experience with a drug doesn't mean the drug is wholly bad, evil, toxic, or should be banned, or that the drug company should have a class action lawsuit lobbed at it. Drug companies are NOT, in general, being fully honest with their disclosures. But banning a drug because some people react badly doesn't address this, nor does it do any good for the segment of the population that benefits from the same drug with little trouble. I have had very bad experiences with some drugs, but do not feel that these medications should be banned. i know other people who depend on them, and I would not deny them just because I lots hair, gained weight, experienced akasthesia, etc. The individual reaction to a drug requires, sadly, at this time in history with our very limited unerstanding of pharmacokinetics and pharmacodynamics, individual trials. And those trials will often have their share of troubles, too. That is how we find out what works for us and what does not, and that is where we re right now. Maybe in two or three decades, with better understanding of genetics, genomics, epigenetics and related fields, we will be able to customize our cocktails with less trial and much less error. I would love a day when a blood test will tell us who will benefit the most from which drug while having the least adverse effects. I hate going through trials. right now, what I am taking is working without giving me problems. For that reason alone I may decide to NOT try and increase the topamax as my current psychiatrist would like. After all, she wants to increase it so that it might help me lose more weight. I am already losing weight without the increase, and the increase might bring adverse effects, or the additional topamax could simply destabilize my currently very stable mood. The last would then require me to go through another dreaded drug trial to find a new cocktail, a mess I have not had to endure for nearly two years now. I do not think that, for me, the additional POSSIBLE weight loss benefit is really worth the possible adverse effects. The doctor is rather casually experimenting with my life, probably curious to gather more data about topamax's efficacy as a weight-loss drug. I am not so sure that I want to rock my boat. I get the benefits from topamax that i am interested in, mood-stability and headache prevention, from the 50 mg that I already take. I'd rather not exp-erience what most of the posts here have described for adverse reactions, and I most especially do not want a rather casual, needless sort of medication modification to set off a chain of events that results in mood destabilization. That said, I am glad to have topamax available for me to take, as I am fairly sure that it contributes to my cocktail, turning down the amplitude of my highs and lows at a mere 50 mg per night. I would be sore to lose it, and do not want it banned. But I do not think I would want to take more than I am taking now. The somnolence I experienced in the past at 75 mg was not comfortable, and was the type that prevents any meaningful work from being done, anything from reading to laundry to following a conversation. I would not like "pins and needles." I hate it enough when I hit my elbow or when my foot falls asleep! And I really hated akasthesia that I experienced when I tried ability, a drug that made me right sick, but that I know absolutely saves others from oblivion, like my grandmother. I hate the adverse effects, or the experience of them, but I do not hate the drugs. and while I may dislike the drug companies, it is not just because drug have adverse effects, it is for the more perverse behavior of the companies themselves. One still has to try and be, if not positive, rational about one;s experiences. It is healthier to see experiences with drugs as learning experiences. Not everything in life is fun, but try to make everything have some value in experience.
I wish you all better days, and calmer, too. May you all find good and caring doctors, and develop excellent therapeutic relationships with them. May you know your diseases and conditions, own them, control them and thus conquer them.

I find that this medication (Cheratussin AC) is less effective than Tussionex. I believe that the hydrocodone component in Tussionex is more influential and efficacious on the respiratory system than the otolaryngological effects produced by codeine. Codeine, surprisingly, is less potent, in my experience, than hydrocodone. One would expect that codeine would yield more beneficial effects concerning pain relief and cough suppression, as opposed to a more distant relative of morphine, such as hydrocodone. It's interesting how medication affects physiological functioning. This medication, though, generally creates sides effects that are fatigue-oriented, including drowsiness, decreased energy or enervation, and related somnolence symptoms.

Gerald-Mark B., MA

Below is the latest ADR report on Singulair from the United Kingdom. I deleted side effects reports by very small numbers of patients in order to keep the post briefer. This shows the total number of reports since Singulair was approved in the UK.

I don't know the total number of prescriptions for Singulair in the UK. It is considered expensive.

Drug Analysis Print
Drug name: MONTELUKAST
Drug name: MONTELUKAST Report type: Spontaneous
Report run date: 13-May-2008 Report origin: UNITED KINGDOM
Data lock date: 09-May-2008 08:00:02 PM Route of admin: ALL
Period covered: 01-Jul-1963 to 09-May-2008 Reporter type: ALL
Earliest reaction date: 01-Jan-1997 Reaction: ALL

Cardiac disorders-TOTAL 64
Palpitations 29
Myocardial infarction 6
Tachycardia 6
Diarrhoea 84
Dyspepsia 24
Abdominal pain 98
Abdominal pain upper 22
Nausea 84
Vomiting 52
Dry mouth 15
Asthenia 13
Fatigue 45
Malaise 32
Sudden death 1
Pyrexia 10
Chest discomfort 12
Feeling abnormal 16
Influenza like illness 17
Irritability 18
Drug interaction 13
Chest pain 13
Arthralgia 59
Myalgia 38
Muscle spasms 24
Pain in extremity 14
Balance disorder 10
Lethargy 16
Somnolence 23
Psychomotor hyperactivity 25
Headache 221
Dizziness 68
Neuropathy peripheral 7
Convulsion 6
Epilepsy 7
Dysgeusia 7
Hypoaesthesia 6
Tremor 18
Nervous system disorders TOTAL 526
Abnormal behaviour 13
Agitation 12
Anxiety 18
Aggression 30
Depression 23
Insomnia 58
Abnormal dreams 12
Nightmare 49
Hallucination 21
Sleep disorder 15
Psychiatric disorders TOTAL 364
Asthma 36
Allergic granulomatous angiitis 43
Angioedema 12
Swelling face 12
Erythema 13
Pruritus 32
Rash pruritic 17
Rash 55
Urticaria 33

TOTAL NUMBER OF REACTIONS 2841
TOTAL NUMBER OF FATAL ADR REPORTS* 19
TOTAL NUMBER OF ADR REPORTS* 1489

Some of you have even mentioned some things you can just buy off the pharmacy shelf. Remember, even those Flintstone's vitamins are drugs too. I picked just a couple of common medications that people may get for themselves or their kids. I know Amoxicillin is a prescription but I am sure it is very commonly used.

Tylenol- Bloody or black, tarry stools; bloody or cloudy urine; fever with or without chills (not present before treatment and not caused by the condition being treated); pain in lower back and/or side (severe and/or sharp); pinpoint red spots on skin; skin rash, hives, or itching; sores, ulcers, or white spots on lips or in mouth; sore throat (not present before treatment and not caused by the condition being treated); sudden decrease in amount of urine; unusual bleeding or bruising; unusual tiredness or weakness. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); dark urine or pale stools; unusual fatigue; yellowing of the skin or eyes.

Ibuprofen/Motrin/Advil - Nausea, epigastric pain, heartburn, diarrhea, abdominal distress, nausea and vomiting, indigestion, constipation, abdominal cramps or pain, Dizziness, headache, nervousness, Depression, insomnia, confusion, emotional liability, somnolence, aseptic meningitis with fever and coma, Paresthesias, hallucinations, Syndrome of abdominal pain, fever, chills, nausea and vomiting

Amoxicillin - Reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions, behavioral changes, and/or dizziness have been reported rarely. Dizziness, fatigue; insomnia; reversible hyperactivity, Urticaria; maculopapular to exfoliative dermatitis; vesicular eruptions; erythema multiforme; skin rashes, itchy eyes, glossitis; stomatitis; sore or dry mouth or tongue; black “hairy” tongue; abnormal taste sensation; laryngospasm; laryngeal edema. anorexia; nausea; vomiting; abdominal pain or cramps; epigastric distress; diarrhea or bloody diarrhea; rectal bleeding; flatulence; enterocolitis

I read that many of you blame Singulair for your side effects when you are also taking multiple drugs. As a public service, I put together a list of side effects from some of the other drugs mentioned on this site. These are by no means all the side effects listed for each drug. The first group is from allergy medications people have mentioned.
Zyrtec & Zyzol -
suicidal ideation, suicide, aggressive reaction, anaphylaxis, cholestasis, convulsions, glomerulonephritis, hallucinations, hemolytic anemia, hepatitis, orofacial dyskinesia, severe hypotension, stillbirth, thrombocytopenia.
abnormal thinking, agitation, amnesia, anxiety, decreased libido, depersonalization, depression, emotional liability, euphoria, impaired concentration, insomnia, nervousness, paroniria, sleep disorder.
accidental injury, asthenia, back pain, chest pain, enlarged abdomen, face edema, fever, generalized edema, hot flashes, increased weight, leg edema, malaise, nasal polyp, pain, pallor, periorbital edema, peripheral edema, rigors.

Benadryl-
Sedation, sleepiness, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, irritability, insomnia, euphoria, paresthesia, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, neuritis, convulsions. Epigastric distress, anorexia, nausea, vomiting, diarrhea, constipation, Urinary frequency, difficult urination, urinary retention, early menses

Allegra -
insomnia, nervousness, sleep disorders or paroniria, and hypersensitivity reactions (including anaphylaxis, urticaria, angioedema, chest tightness, dyspnea, flushing, pruritus, and rash). Back Pain, Stomach discomfort, Pan in extremity, Headache, Vomiting, Somnolence/Fatigue, diarrhea,

Claritin -
Hypotension; hypertension; palpitations; tachycardia; syncope, Headache; somnolence; fatigue, nervousness; hyperkinesia; paresthesia; dizziness; migraine; tremor; vertigo; impaired concentration; depression; agitation; anxiety;

Interestingly, the side effects reported by other people here are mentioned in the Singulair package insert in France, which I found online in a 2005 edition on the manufacturer's French website. I don't think the same list is included in the American package inserts. The French distributor is "Laboratoires Merck Sharp & Dohme-Chibret" which appears to be a Merck-related entity. So if Merck has known about these side effects at least since 2005 and includes a warning in the French packaging, I think people should be asking Merck and the FDA why the French warnings are not given to U.S. patients and physicians. It may be that our laws need to be improved. Here's the info in French, then in English:

4. QUELS SONT LES EFFETS INDESIRABLES EVENTUELS ?
Comme tous les médicaments, SINGULAIR, est susceptible d’avoir des effets indésirables. Il a été décrit la survenue de douleurs abdominales et de maux de tête lors du traitement par ce médicament. Deplus, les effets suivants ont été rapportés : réactions allergiques incluant éruption cutanée, gonflement du visage, des lèvres, de la langue, et/ou de la gorge pouvant entraîner des difficultés à respirer ou à avaler, démangeaisons et urticaire, fatigue, fébrilité, agitation y compris comportement agressif, irritabilité, étourdissements, hallucinations, somnolence, rêves anormaux ou cauchemars, insomnie, fourmillements/engourdissements, convulsions, malaises, douleurs articulaires, douleurs musculaires, crampes musculaires, sécheresse de la bouche, nausées, vomissements, troubles digestifs, diarrhée, hépatite, augmentation de la tendance au saignement, ecchymoses et oedème, palpitations.

Si vous remarquez des effets indésirables non mentionnés dans cette notice, veuillez en informer votre médecin ou votre pharmacien.

4. WHAT ARE THE POSSIBLE ADVERSE EFFECTS? Like all the drugs, SINGULAIR may have adverse effects. There have been reported incidents of abdominal pains and headaches during treatment by this drug. In addition, the following side effects have reported: allergic reactions including rash, swelling of the face, lips, tongue, and/or the throat, possibly including difficulties with breathing or swallowing, itching and hives, tiredness, fever, agitation including aggressive behavior, irritability, dizzy spells, hallucinations, somnolence, abnormal dreams or nightmares, insomnia, tingling/numbness, convulsions, faintnesses, arthralgia, muscular pains, muscular cramps, dryness of the mouth, nausea, vomiting, turbid digestive, diarrhea, hepatitis, increase in the tendency to bleed, bruises and edema, palpitations.

If you notice adverse effects not mentioned in this note, please inform your doctor or your pharmacist.

ARE YOU EXPERIENCING ANY OF THESE
LIPITOR SIDE EFFECTS??

The following adverse events were reported, regardless of causality assessment in patients treated with atorvastatin in clinical trials. The events in italics occurred in >2% of patients and the events in plain type occurred in <2% of patients.

Body as a Whole: Chest pain, face edema, fever, neck rigidity, malaise, photosensitivity reaction, generalized edema.

Digestive System: Nausea, gastroenteritis, liver function tests abnormal, colitis, vomiting, gastritis, dry mouth, rectal hemorrhage, esophagitis. eructation, glossitis, mouth ulceration, anorexia, increased appetite, stomatitis, biliary pain, cheilitis, duodenal ulcer, dysphagia, enteritis, melena, gum hemorrhage, stomach ulcer, tenesmus, ulcerative stomatitis, hepatitis, pancreatitis, cholestatic jaundice.

Respiratory System: Bronchitis, rhinitis, pneumonia, dyspnea, asthma, epistaxis.

Nervous System: Insomnia, dizziness, paresthesia, somnolence, amnesia, abnormal dreams, libido decreased, emotional lability, incoordination, peripheral neuropathy, torticollis, facial paralysis, hyperkinesia, depression, hypesthesis, hypertonia.

Musculoskeletal System: Arthritis, leg cramps, bursitis, tenosynovitis, myasthenia, tendinous contracture, myositis.

Skin and Appendages: Pruritus, contact dermatitis, alopecia, dry skin, sweating, acne, urticaria, eczema, seborrhea, skin ulcer.

Urogenital System: Urinary tract infection, urinary frequency, cystitis, hematuria, impotence, dysuria, kidney calculus, nocturia, epididymitis, fibrocystic breast, vaginal hemorrhage, albuminuria, breast enlargement, metrorrhagia, nephritis, urinary incontinence, urinary retention, urinary urgency, abnormal ejaculation, uterine hemorrhage.

Special Senses: Amblyopia, tinnitus, dry eyes, refraction disorder, eye hemorrhage, deafness, glaucoma, parosmia, taste loss, taste perversion.

Cardiovascular System: Palpitation, vasodilatation, syncope, migraine, postural hypotension, phlebitis, arrhythmia, angina pectoris, hypertension.

Metabolic and Nutrtional Disorders: Peripheral edema, hyperglycemia, creatine phosphokinase increased, gout, weight gain, hypoglycemia.

Hemic and Lymphatic System: Ecchymosis, anemia, lymphadenopathy, thrombocytopenia, petechia.

Post Introduction Reports

Adverse events assocaited with atorvastatin that have been received since market introduction, that are not listed above, and that may have causal relationship to drug include the following: angioneurotic edema and rhabdomyolysis.