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caz72me 10-14-2015 08:14 AM

Amitriptyline vs Nortriptyline
I have suspected Piriformis Syndrome & SI Joint Dysfunction also causing sciatica, have also had some nerve pain in the back of my thigh, occasional calf cramps, toe cramps, and foot pain. Since my last Cortisol injection into my SI joint it has made everything horribly worse, I cannot sit now for very long without severe left foot pain that makes me feel nauseous its so horrible. I have informed the consultant of this and am on a waiting list to go back and see him, this is the 2nd time the injections have caused me extra pain so have now lost faith in these and want to try alternatives.

My consultant previously wanted to put me on Amitriptyline but I have been on this before and was taken off it due to serious sedative side effects (even fell asleep eating in a restaurant) was on a small dose and still didn't improve with time. So I've read that Nortiptyline is an alternative with less side effects, can anyone advise if they have had less sedative side effects with this than Amitriptyline please?

Other meds I've tried without success are Lyrica and Tramadol

tortoisegirl 10-14-2015 07:03 PM

Re: Amitriptyline vs Nortriptyline
I found Nortriptyline to be less sedating than Amitriptyline. I tried both only once a day though, as far before bedtime as I could tolerate, to minimize grogginess the following morning. However, Nortriptyline appears to have a lower chance of success, which is why doctors usually start with Amitriptyline.

Did you get up to the max dose of Lyrica and stay there for awhile before giving up on it? These sorts of meds should usually be tried for a period of months.

Seems like a nerve pain med would be ideal for nerve pain. There is also Gabapentin, Cymbalta, etc. Gabapentin is pretty similar to Lyrica. Cymbalta is another anti depressant, but has a tougher side effect profile for some folks.

Besides giving a medication as much time as you can tolerate to see if side effects subside, it may be possible to start at even a lower dose than your doctor would typically start you at. Discuss with your doctor & pharmacist if there is a smaller dosage pill/capsule, you can cut the pill in half, empty some beads out of the capsule, etc.

If you have to be on a waiting list just to schedule a follow up with your doctor to discuss other options, it may be time for a new doctor. Best wishes.

caz72me 10-21-2015 08:20 AM

Re: Amitriptyline vs Nortriptyline
Thanks for your help

If I remember correctly I was taken off Lyrica as am on Losartan for another issue and started to swell up, I'm on quite a few other meds for other things so suppose sometimes they don't interact very well together.

I am in the UK hence the long waits on the NHS, no choice but to just wait for the appointment as any other Doctor would have the same waiting time :-( but I have wrote to my Doctor this week telling him I am not too keen on any future injections and would like to discuss medications and working with a Physio (after 18 months of seeing my Doctor for this issue, he still has not discussed my case with a Physio so I can start some Physio sessions)

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