Photo by Irene Kredenets on Unsplash

Let’s say your doctor has prescribed a medication for you, based on your health issues and symptoms. It is a drug that you have never taken before. Your doctor believes it will help you.

Many people will simply fill the prescription and take the medicine. I, however, cannot do that because I have a whole lot of allergies. I learned the hard way that some medicines contain things I am allergic to.

My decision on whether or not to take a medication starts with research.

Disclaimer: I am not a doctor. I am certainly not your doctor. I am also not a pharmacist, and have absolutely no medical education or background. The method I use to determine whether or not a specific medication is safe for me to take has absolutely no bearing on whether or not you should take that same medication.

What I am providing here is the framework I use to do research on medication I am considering taking. You can substitute out the drug I’m focusing on and replace that with whatever you need to do research on.

Step One: Find the name of the drug.

I had an appointment with my rheumatologist a few days ago. Based on examinations, and the results of blood tests, he has determined that I do not actually have rheumatoid arthritis (as he first thought). I do not have any form of arthritis.

That said, he is absolutely certain that I have fibromyalgia. I agree with his assessment, as I’ve been getting symptoms of fibromyalgia since high school, long before anyone knew what it was.

The name of the drug he prescribed for me is Cymbalta. The “generic” name is Duloxetine Hcl. My rheumatologist told me he would prescribe a low dose of it for me. We ended the appointment with the understanding that I would do research on this medication and have the results of what I discover determine whether or not I decide to take this drug.

Step Two: What does this drug treat?

The Mayo Clinic is a very good source of medical information. It says that Cymbalta is also called Irenka. According to the Mayo Clinic:

  • Duloxetine is used to treat depression and anxiety. I don’t have either one of those. My rheumatologist kept asking me if I felt depressed or anxious, over and over again. Nope.
  • It is also used to treat nerve damage associated with diabetes (diabetic peripheral neuropathy). I am not diabetic, and do not have diabetic peripheral neuropathy.
  • Duloxetine is also used to treat fibromyalgia (muscle pain and stiffness) and chronic (long-lasting) pain that is related to muscles and bones. I have been diagnosed with fibromyalgia and I do experience muscle pain.
  • This medicine is only available with a doctor’s prescription. This could be a problem. What if I lose my health insurance and can no longer afford this medication? I’ll have to check and see what happens if a person has to suddenly stop using this drug.
  • Duloxetine is in a group of medicines known as “selective serotonin and norepinephrine reuptake inhibitors (SSNRIs)” My rheumatologist explained this by saying the drug takes away pain by doing something with the nerve impulses when they get to the brain.

Question: What happens if I suddenly stop taking Cymbalta?

The National Alliance on Mental Illness provides detailed information that answers my question:

…Do not stop taking duloxetine, even when you feel better. Only your healthcare provider can determine the length of treatment that is right for you.

Missing doses of duloxetine may increase your risk for relapse in your symptoms.

Stopping duloxetine abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin)…

…Medical attention should be sought if serotonin syndrome is suspected. Please refer to serious side effects for signs and symptoms…

Question: What is serotonin syndrome and what are its symptoms?

The Mayo Clinic has the answer to this question:

Serotonin syndrome occurs when you take medication that cause high levels of the chemical serotonin to accumulate in your body.

Serotonin syndrome can occur when you increase the dose of such a drug or add a new drug to your regimen. Certain illegal drugs and dietary supplements also are associated with serotonin syndrome.

Serotonin is a chemical your body produces that’s needed for your nerve cells and brain to function. But too much serotonin causes symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can be fatal if not treated…

According to the Mayo Clinic, symptoms of serotonin syndrome include:

  • Agitation or restlessness
  • Confusion
  • Rapid heart rate and high blood pressure
  • Dilated pupils
  • Loss of muscle coordination or twitching muscles
  • Muscle rigidity
  • Heavy sweating
  • Diarrhea
  • Headache
  • Shivering
  • Goose bumps

Severe serotonin syndrome can be life-threatening. Signs and symptoms include:

  • High fever
  • Seizures
  • Irregular heartbeat
  • Unconsciousness

Ok, that sounds really scary! At the time I am writing this blog post, there is a lawsuit going through the courts about the Affordable Care Act (also known as “Obamacare”).

In short, the Republicans voted to remove the individual mandate from Obamacare. (That’s the part that required everyone to purchase health insurance coverage, or pay a fine). A judge has ruled that the removal of the individual mandate means the entire Affordable Care Act is unconstitutional, and should end.

It appears the lawsuit will end up at the Supreme Court, potentially sometime in 2020. If the majority of Justices of the Supreme Court decide to kill “Obamacare” – I would be among the millions of Americans who would no longer have health insurance coverage.

Lack of health insurance coverage would mean the cost of Cymbalta would be higher than the price I would pay for it with my health insurance coverage. If I start taking Cymbalta, I could be stuck in a situation where I suddenly cannot afford it. The symptoms that come with sudden withdrawal sound horrific.

Step Three: What are the inactive ingredients?

I look at the inactive ingredients of a medication because I want to avoid being exposed to an allergen that is hidden in it. My rheumatologist doesn’t know all my allergens. (That’s not his speciality).

I have learned that pharmacists have absolutely no idea whether or not a drug has gluten in it. They are not taught about this when going through medical school (or whatever the training pharmacists get is called).

Here is what the Mayo Clinic says in it’s “Before Using” section about Duloxetine:

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals…

Oh, boy. This does not bode well. I have tons of allergies, including ones to foods, dyes, preservatives, and animals.

The U.S. National Library of Medicine has information on the ingredients in Cymbalta.

I will consult Celiac.com’s Unsafe Gluten-Free Food List (Unsafe Ingredients) to determine whether or not an inactive ingredient is gluten-free. I am very allergic to gluten (and was diagnosed with a severe allergy to wheat, rye, and barley back in the 1990’s, long before anyone had heard of celiac disease).

In addition, I will check to see if any other inactive ingredient is something that I am allergic to.

Ingredient name: Duloxetine Hydrochloride

Inactive ingredients:

Gelatin: According to Bon Appétit, gelatin is “derived from tissue and is a form of collagen.” I have eaten JELL-O before, and have not reacted to the gelatin itself, but sometimes have reacted to things that were added to the gelatin for flavor. This ingredient is safe for me.

Hypromellose: According to Drugs.com, hypromellose is used in eye drops. Science Direct says it also used as a gel layer on some medications. Hypromellose includes:

  • Glycerin: According to Healthline, glycerin “is typically made from soybean, coconut, or palm oils”. There does not appear to be any way to know, for certain, which one of those things is in the glycerin that is in a medication. I am allergic to coconut, so this ingredient is unsafe for me.
  • Hypromellose: According to WebMD, hypromellose may contain one or more of the following ingredients: carboxymethylcellulose, dextran, glycerin, hypromellose, polyethylene glycol 400, polysorbate, polyvinyl, alcohol, povidone, or propylene glycol, among others. I don’t need to look up all these things because it contains glycerin, which I learned can contain coconut. This ingredient is unsafe for me.
  • Polyethylene Glycol 400: According to Drugs.com, this ingredient is also called PEG. It is used for many things, including: “ointment and suppository base, and tablet and capsule lubricant”. It is also used as “bowel prep for colonoscopy procedures and as a laxative”. I cannot identify any allergens in it from the information I found, but that doesn’t mean there aren’t any. Also, I don’t see a need for me to consume something that is used for colonoscopy procedures – every day – since I’m not about to have a colonoscopy.

Hypromellose Acetate Succinate: According to Ashland.com, (which makes something called AquaSolve), this ingredient is used to coat medications. It is a cellulosic polymer with four substituents: methoxyl, hydroxpropoxy, acetyl, and succinoyl. I don’t entirely understand what any of these things are. This ingredient may be unsafe for me.

Sodium Lauryl Sulfate: According to LiveStrong, this ingredient is used in personal care products because it allows cleansing products to foam. It is often found in shampoo. LiveStrong says it is derived from coconuts. This is one of the ingredients that prevent me from safely using most shampoos and soaps. I am allergic to coconut, so this ingredient is unsafe for me.

Sucrose: According to Dictionary.com, sucrose is: a crystalline disaccharide, C12, H22, O11, the sugar obtained from sugarcane, the sugar beet, and sorghum, forming the greater part of maple sugar; sugar. Personally, I have no issues with table sugar, so this ingredient is safe for me. That said, I do not understand why this medication, which contains sugar, is prescribed to people who are diabetic. That seems like a really bad idea.

Talc: The U.S. Food and Drug Administration (FDA) says that talc is: a naturally occurring mineral, mined from the earth, composed of magnesium, silicon, oxygen, and hydrogen. Chemically, talc is a hydrous magnesium silicate with a chemical formula of Mg3, Si4, O10 (OH)2. The FDA has ongoing research into whether or not there is an association of talc powder with the incidence of ovarian cancer.

Titanium Dioxide: According to the Titanium Dioxide Manufacturers Association, titanium dioxide (TiO2) is used in a wide variety of things, including food. In food, TiO2 is called E171. It acts as a whitener, but also as a color and texture enhancer. It can give smoothness when used in some chocolates. It can be used in food and pharmaceuticals without affecting other ingredients and is non-toxic.

Triethyl Citrate: According to Drugs.com, tritehyl citrate is “a trimester of ethyl alcohol and citric acid. It is used in the pharmaceutical industry for coating and in plastics. According to the FDA Select Committee on Generally Recognized as Safe (GRAS) food substances, citrate salts, include tritehyl citrate, are generally regarded as safe when used in normal quantities.” I break out in spots that look like hives when exposed to too much citric acid, and my tolerance level varies depending on what other allergens I’ve been exposed to. This ingredient is likely unsafe for me.

FD&C Blue No. 2: According to Celiac.com’s Safe Ingredients List, this ingredient is safe. However, there is a disclaimer (of sorts). Celiac.com’s Unsafe Ingredients List points out that “coloring” may or may not contain gluten, depending on where and how they are made, and it is sometimes necessary to check with the manufacturer to find out. This means that this ingredient is likely unsafe for me.

Ferric Oxide Yellow: According to Drugs.com, ferric oxide yellow is an inorganic yellow pigment used in the pharmaceutical industry as a coating pigment. It is also known and yellow iron oxide (FeOH3) It exists as an amorphous yellow powder, and is primarily used in the cosmetics industry. According to Drugs.com, one of the drugs that is coated with ferric oxide yellow is Naproxen, which I have taken. I think this ingredient is safe for me.

This brings up new questions that I have no answers for. This drug contains sugar, so why is it being prescribed to people who are diabetic? Why does this drug have, let’s see… at least three ingredients that are coatings?

Step Four: Conclusion

I haven’t even started looking at the potential side effects that Cymbalta may have, but I don’t need to in order to conclude that it is not the drug for me. Three ingredients are coconut, which I am allergic to. Another ingredient may or may not contain gluten, which my body cannot properly process. One ingredient contains citric acid, which can make me break out in hives.

I will not be taking Cymbalta.

#Blaugust2019

How to Research a Medication for Allergens is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites.

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