Sleeping pills & Warfarin

[Barry]

I'm on Coumadin, and, like most Coumadin/Warfarin patients with any sort of co-existing disorder it's an ongoing saga looking for something I can take that won't affect my INR - especially if it's something that I'm just taking as needed, not every day: If it were something I was taking every day, they could just adjust my Coumadin levels over time to compensate.

I have episodic problems with insomnia. Mostly secondary (wake up in the middle of the night several times) or tertiary (wake up far too early in the morning), occasionally primary (can't get to sleep in the first place). My doc's prescribing Ambien for me, and it's good stuff but it's just way to expensive.

Some antidepressant meds (e.g. Elavil) make good sleeping pills, but Elavil interacts with Warfarin, so that wouldn't work for me as a drug that I only take once in a while.

Anyone know of a sleeping pill that doesn't interact with Warfarin/Coumadin that's affordable, preferably a generic.

I now take Diazepam, generic for Valium I think, anyway a benzodiazepine minor tranquilizor, for primary insomnia once in a while. But that stuff wears off after a few hours or so, so it doesn't do much for secondary insomnia and nothing for tertiary. And I don't want to take another one in the middle of the night or very early in the morning 'cause I don't want to be tranqed out when it's time to get up.

 

[djacq]

Barry,

Have you tried Trazodone for sleep. I think it has some effect on your INR and maybe Al can say if it is significant enough to be concerned about. It is inexpensive.

Also, a new long lasting, long term, non habit forming sleeping med will be out at the end of the month.

It is called Lunestra. I can't find info on how it affects the INR, if at all, but being a new drug, I am sure it will be as expensive as Ambien. I think it even has some of the same properties of Ambien.

Good luck,
Donna

 

[Barry]

Thanks, Donna. Alas...

Trazadone, like Elavil, is an antidepressant with sedating side-effects that accordingly makes for a good non-addicting sleeping pill when taken prn. I'd been trying to recall the name of that drug for my initial post, but couldn't pull it out of the memory banks:

Trazadone was the first drug my doc prescribed. After I picked it up, I remembered something from my days when I used to work as a mental health counselor: At the clinic I worked at, we had only one patient on Trazadone, and him only because nothing else had worked. Trazadone has a rare, but exceptionally serious side effect: Priapism. Fancy word for an erection that won't go away. On the face of it, that sounds swell (unintentional pun), except that it is very very painful, and that in some instances the only way to make it go away is surgically - which also means permanently, leaving you impotent. Very very rare, but not a risk I'm willing to take. That side-effect applies to women, too, BTW. As with most med side effects, your doc doesn't tell you about it [at mental health we were scrupulous about informed consent before prescribing meds, but I've found that regular docs and cardiologists just writ the 'script and say "Try this." - my doc mentioned nothing about priapism, but after I picked up the 'script I recalled a psychiatrist informing that one patient about it.]

Moral to that bit of yattering is that whenever you get a drug you're not already very familiar with, ask the pharmacist to give you a "med insert". You don't normally get one. Keep in mind that the insert will list all sorts of info, and if you were to read one for aspirin you'd probably think it was highly toxic - so keep what you read in a med insert in perspective.

Anyway, back on-topic...

Lunestra, being a new drug, is likely to have the same problem that Ambien has for me - it won't yet be available in generic, and thus will be very expensive.

BTW, I'm not particularly concerned about habit-forming sedative/hypnotics (e.g. barbiturates), anxiolytics (tranquilizers), or opiates (e.g. hydrocodone AKA Vicadin). I'm one of those aging hippie types, and have fooled around with drugs a lot. Those classes of drugs are ones I don't particularly care for, so I don't abuse them, and I know better than to take them all the time if for no reason than that they produce tolerance and will stop working if I take them too often.

Now, if cocaine were treatment of choice for heart problems, I'd be in very big trouble. I did enough cocaine to find out that I can't allow myself to do cocaine: A line of cocaine makes you feel like a new man. Problem is that the new man wants to do another line...


Again, addiction/abuse potential isn't really an issue because I really don't care for the sort of drugs that you use as sleeping pills, so the chances of my abusing them or getting addicted to them are nil.

Pot would work for some folks, but pot paradoxically energizes me. And even if it made me sleepy as it wears off after a couple of hours as it does for many folks but not me, it wouldn't be a good choice for me because I'm subject to drug testing at work if my employer has cause to believe that I've been abusing drugs.

Off-label use (e.g. using antidepressants as a sleeping pill when they're not designed to be a sleeping pill) is quite legit and I've got no problem with that, but, again, the only two available as generics that I know are worth considering are Elavil and Trazadone, the former messes with your INR and the latter carries a (admittedly small) risk of priapism. Maybe there's others???

So, back to the drawing board: Anyone know of a generic drug that folks on Coumadin/Warfarin can take as a sleeping pill and it won't mess with their INR.

 

[Guest]

I just checked the National Library of Medicine for reports of interactions between warfarin and amitriptyline - there are none. There was an animal study back in 1980 and some theoretical stuff written in 1975.

I have a hunch that something else caused the problem when you tried amitriptyline. You would likely be much better off trying it again than using Valium.

Valium quickly loses its effectiveness. Some experts feel that if you take Valium nightly for 10 nights, you will undergo withdrawal symptoms when you stop it. This is a particularly ugly drug to withdraw from. There is very little justification to use this as a sleep aid - the addiction liability is just too high.

 

[Barry]

I haven't tried Elavil AKA Amitriptyline. That was one of the first ones I looked into after I remembered the risk of priapism with Trazadone. Amitriptilene indeed does make for an excellent non-addicting sleeping pill even though it's on-label use is as an antidepressant.

Problem is that when I did an Internet search, I came up with info saying that it interacted with Warfarin. Here's another site, not the one I came up with at that time, that says basicly the same thing, although it mentions "blood thinners" and not Coumadin/Warfarin by name.

http://www.whatmeds.com/meds/elavil.html

Ah, here's another one which more specifically says that Elavil + Coumadin = an increased INR.

http://www.accessmednet.com/prescription-drug-information/coumadin-warfarin.html

Now, were I to take it every evening my Coumadin could be adjusted. But I just need something prn (and from my mental health days I also learned that the sedating side-effect of amitriptyline also begins to go away somewhat if you take it every day as your body habituates to it).

Anyway, looks to me like amitriptyline would not be a safe drug to take prn for insomnia for a person taking coumadin/warfarin. Are you sure about the info you've got???

FYI, I'm well aware of the dangers of benzodiazepine addiction - and the hazards of seizures upon withdrawal if you become seriously addicted. I've worked both in mental health and in substance abuse, and have worked with clients who have become addicted to benzodiazepines. It ain't pretty! Remarkably similar to severe addiction to alcohol, complete with risk of seizures upon withdrawal.

While I've got a 'script for Diazepam, if I were at risk of abuse of or dependence upon it I'd ditch it (a man's gotta know his limits!). I make it a point to only take it every once in a while both because if I take it all the time it's going to quit working - unless I then increase the dose (a classic road to addiction) - and, as noted in a previous post in this thread, I don't think Diazepam is a great sleeping aid in the first place - only helps with primary insomnia.

I am in full agreement with your caution about addiction potential with Diazepam (and all benzodiazepines, sedative/hypnotics, opiates). Thankfully, those are classes of drugs that I really don't care for that much and have absolutely no problem keeping my use down to minimal levels.

One of the ironies of drugs is that if you really really like a drug, you probably shouldn't take it!

I'm at exceptionally little risk of getting addicted to Diazepam. But you and I are in complete agreement that it's kind of a lousy sleep medication. Maybe that's good news in a way: If I found that it was a great sleep aid, I might take it more often, and then I perhaps would be putting myself at risk of addiction.

FYI, as a general rule, with an addictive drug I keep my use down to no more than three times a week, maybe four times a week occasionally. I don't think it would be safe for me to take Diazepam, Ambien, or Hydrocodone any more often than that (I have prescriptions for all three). Better a few sleepless nights or some pain than addiction. With daily use there is danger of tolerance and addiction, as you note in as few as 10 sequential days.

 

[Ross]

Trazadone=The stiffy

 

[Barry]

Trazadone=The stiffy

Alas, potentially a very painful one that won't go away unless you go under the knife, and then never comes back. Not gonna put Viagra out of business.

 

[Guest]

I'm sure about my information. NLM has millions of journals back to the 1960s abstracted. There were only 16 that mentioned warfarin and amitriptyline in the same article. That site you quote probably took its information from the 1975 and 1980 theoretical work that was done in rats. Many times these sites try to cover their ... by citing everything in site. I try to give relevant information. I can't think of when I wrote a page that mentioned an animal study.

 

[Robbyn]

Try Gravol

Try Gravol

I take Gravol. They also have extra strength. It not only takes away the nausea I have from all the meds I take - but helps me sleep. Whenever I am in the hospital they give it to me whenever I want it so I assume it does nothing to my INR. And it is absolutely not addictive. Maybe I will stand corrected??????

 

[Ross]

I take Gravol. They also have extra strength. It not only takes away the nausea I have from all the meds I take - but helps me sleep. Whenever I am in the hospital they give it to me whenever I want it so I assume it does nothing to my INR. And it is absolutely not addictive. Maybe I will stand corrected??????

Gravol has the same ingredient as Benedryl, Diphenhydramine. Works for some people, but not others.

 

[Marty]

? Percoset for sleep

? Percoset for sleep

Post op I was given Percoset. I really got to like it. Aches and pains went away and sleep followed. Also noted that when taking Percoset if I did not fall asleep right away- I didn't care. Just felt good like I had a lot of friends.
My sister in Indiana is a psychologist and involved in a lot of drug situations. She told me I could get addicted if I took as little as one oxycodone w/apap
5/325 tab every night. She was right. It was difficult to quit. Severe insomnia for two or three nights after going cold turkey. So now I use 5mgm Ambien maybe twice a week. TylenolPM ( for the benadryl) once or twice a week and occasionally my favorite Percoset. I never take Percoset more than once in three days.

 

[Granbonny]

Tylenol PM for me.....I was out for the last week or so...Then, the last few days..I have woke up at 4 a.m. (daughter in Russia adopting my Grandchildren)..I think, maybe I have an e-mail from her? They are 8 hours ahead of us. Jump up, check e-mails...Then, I have to stay up..No more going back to bed. ....so, today, finally remembered to buy some Tylenol PM..Maybe I can sleep past 4 a.m. I have often wondered how these News people on the Early morning shows in New York..can be so chipper at 7 a.m. and look so good Their minds are so sharp at that time of the a.m....I wonder what they take?.. Bonnie

 

[Guest]

The sleep-causing ingredient in these things is diphenhydramine. It has what is called an anticholinergic effect. This can lead to constipation in anyone - so not recommended if you have that problem. In addition it has one other effect in men with enlarged prostates - it can make it very difficult to urinate.

 

[Barry]

Post op I was given Percoset. I really got to like it. ...

Funny how idiosyncratic our reactions to drugs are. When I was post-op from valve replacement, at the beginning they had me on morphine. Which, as far as I was concerned, was about as useful as saline solution. Didn't do diddly-squat. As an aging 60-70's era drug fiend, the one thing I'd been looking forward to was morphine. Alas, another of life's bitter disappointments...

Anyway, they d/c'ed the Morphine and gave me a Percoset. Life is good!!! That stuff worked wonderfully.

Since that time I've been taking Hydrocodone (Vicodin) prn for pain, works OK, but not the miracle-worker that Percoset was. But, yeah, you've got to be careful with addicting drugs - if they work, you can't take them very often or they'll stop working unless you increase the dosage. And then that'll stop working unless you increase the dosage. And then...

Not really an issue for severe chronic pain. Who cares if you're addicted in that instance - in that instance it's a pharmacological side-effect, not a substance-abuse disorder so long as you're taking it the way the doc is prescribing it. Case in point is a friend of mine who takes a fairly whopping dose of Methadone each day for severe and chronic pain. She'd addicted to it now, will go into withdrawal if she misses doses. But that's better than the alternative of being completely incapacitated by pain.



Thankfully, opiates aren't my favorite drugs, don't really care for them, so I'm at very little risk of getting addicted.