I have two questions. First I have truble eating much in the morning with my morning meds which include. Tegretol, Cymbalta, Glucophage, Amaryl, and a Soy/Black Cohosh supplement. My stomach hurts and I get indigestion almost every day after taking my meds. I am afraid to take an over the counter stomach medicine because I don't want to affect the breakdown and/or absorbtion of my medications, What should I do? Secondly, since I have been taking the Cymbalta I have found it to be very helpful but it causes alot of vivid dreaming. The dreams consist of a mix of everything that is on my mind currently and some stuff from my past. The memories of the dreams stay with me all day and I find myself thinking I have done some of the things that I dreamed such as paying a bill or having a conversation with someone. Is this normal or should I see my pdoc for this? thank you for your time.


Dear Ms A' -- 
Let's see, two medications for mood (Tegretol and Cymbalta), two for diabetes (Glucophage and Amaryl), and soy/Black Cohosh. As I'm sure you've tried to figure out, the obvious and usual approach is to work backward, looking at when the stomach problem showed up and any medication that might have been added just prior to that. If that approach doesn't suggest the most likely culprit, perhaps because several things were added at once or other variables confuse matters, then there's the "usual suspects" approach:  we look at which medications are most commonly associated with stomach pain.  "Indigestion" could mean nausea or other sensations, so your doc' might have to ask you for specifics on just what happens, which could narrow the search.  For example, Tegretol, particularly the immediate release versions (generic carbamazepine; as opposed to Tegretol XR or Carbatrol or Equetro, the non-generic sustained release versions), is commonly associated with nausea. But it sounds like you were on that for a while before the Cymbalta was added, so I'd presume you weren't having this stomach problem back then.  

If not, then you'd have to use the last routine approach, namely cautiously lowering the most likely culprit, and you should definitely do that only with your doctor's full involvement (in other words, DO NOT try figuring this out on your own. Your doctor deserves to know what the problem is and have a chance to figure it out with you, and know just what you're going to do with the medications, before you do it). 

As for the dreams on Cymbalta, that is not an uncommon experience on antidepressants (I haven't used Cymbalta yet, so I don't know from experience if there's anything unusual about it in this respect)..  I'm not sure that it necessarily means anything one way or another (that is, whether it's a warning sign or just an interesting shift). If that progresses to the point where the dreams are so vivid, you're not really sure if you're awake or asleep while having them, or if it's moving to become more dramatic in any other way, you should definitely let your doc' know about that.   

Dr. Phelps
 

May, 2005