SHORT ANSWER: I think it can. Details and reasons are as follows, but this is from our case and only a little bit of study.
I’m thinking that some can get EM symptoms or even EM from Amytriptiline. My reasons for wondering this are based on just a few things, some reported to have had it happen to them. But these are my primary reasons.
- In my mom’s case, she had hot flares from Xanax, and discontinued it, but these were minor flares. She had other medical problems at the time and was being “treated” for “fear and anxiety” at least that is what we were told at the time. She ended up getting off that nerve pill. Well the nerve pills pass the blood brain barrier and our bodies seem to have a barrier that may cause drugs that don’t pass the blood brain barrier to not fully reach the peripheral nerves, so my “lay” theory is that drugs that can affect the brain, probably can cause side effects in nerves anywhere in your body. The Xanax in mom’s case caused minor burning and the side effect went away once she got off that drug. Now Xanax doesn’t seem to affect Serotonin much it affects other things, so it’s a clue that she reacted to nerve pills with EM, but it’s not liked to what caused mom’s full blown EM. Which was another nerve pill.
- Risperdone or Risperdal was later prescribed by a doctor to help her get off other nerve pills she had been taking. This when added to the mix caused her onset of EM around 2002 six weeks into taking the Risperdal the flares were at a constant 10 level. We have only gotten her flares down to zero with super cold chilling or freezing of the feet, or down to a level of 7 during her waking hours with heavy opiod drugs.
A rare side effect of Risperdol is it can cause the body to lose control of it’s temperature regulation. Mom seemed to display rare side effect of almost any medication at times, at least that seemed to be the case. So maybe she was more sensitive to medications, and maybe that’s something that is genetically rare for her, who knows? Just a guess. In any event the Serotonin receptors (there are 7 of them) that control blood flow and the contraction and expansion of blood vessels are receptor sites like the 5-HT 7 site. And these seven sites can in theory cause the body to get more or less blood flow and also control body temperature. Risperdone is an antagonist to these seven Neurotransmitter sites which can affect blood flow or temperature. Does it have the capacity to damage them in a permanent way? Most doctors and professionals would reply “no” and claim it was safe. But most people who gave to their young male children Risperdol didn’t expect them to grow breasts either. So my thought is the rare side effect of losing control of the bodies temperature is a result of permanent damage from Risperdol in my mom’s case. Now how does this relate to Amytriptiline?
3. Some who have tested the Ketamine/Amytriptiline cream have reported that their feet will “heat up” and after an application and then quickly go numb from the Ketamine. At first they may experience heat from the compounded cream that contains this mix. Typically a very low mix of .5% Ketamine and 1% Amitriptiline has been used for EM. Sometimes the Ketamine cream might be 1% or 2%, but usually EM patients in tests seem to use a very low dose. And we tried this after getting a prescription from a foot doctor. 1% Amytriptiline, 1/2 percent Ketamine.)
My mom had some heat with her first application of the cream that she tried. She also takes Ativan and many other pills so some of her “side effects” from the cream could be difficult to trace as different dosages or missing a dose of Ativan for example could change the balance of things acting on her nerves. Ativan will likely mitigate the results of restlessness of the Ketamine that one might experience when the cream starts to wear off. It seems and most of this is from very little research so you’ll need to vet my remarks with your doctors or those with more information. It seems that the Amytriptiline can help people deal with the side effects of the Ketamine. It may even work to relieve certain pain of certain diseases, but this is only from some notes or accounts I have read. In my mom’s case the Amytriptiline may have caused some of the side effects or some other things could have caused them as much as the ketamine. For example blurred vision can happen from something that is affecting your nerves and may cause your eyes muscles to start to not function as well. Relaxing the nerves, may effect your vision. In the case of my mom, some of the side effects we thought were from the Ketamine could have been from the Amytriptiline.
So how will we know for sure? We will know more when we do a test with Ketamine cream without the Amytriptilne in the mix, which will happen perhaps in the next week or two. We were able to get her Neurologist to prescribe the Ketamine cream and also ran that idea by her MD.
4. For mom’s case it seems Serotonin is “the smoking gun” clue. The smoking gun for me is a little bit of research I did reading about the Amytriptiline on Wikepedia. Notice the interactions it has with the Serotonin or 5-HT receptors. Six of the same seven receptors that control blood flow and body temperature which are affected as antagonists for Risperdol is also effected as antagonists with the Amytriptiline. This could mean that the mechanism that in our case caused mom’s EM from Risperdol could be present in Amytriptiline (Risperdol being the cause is our theory as we saw this happen, and although her MD at the time said the Risperdol caused it, he didn’t go into details as how the Risperdol caused it.)
Six of those same Serotonin/5-HT receptor sites which caused her problem could be affected in the same way with the Amytriptiline. Ironically the EM cream we were going to test, had something in the mix that was almost the same in it’s actions on the Serotonin receptors as the Risperdol that caused her EM damage.
This means Amytriptiline is going to be off our list of medications for mom’s condition for now. We will avoid it like the plague. If mom has nightmares or mood swings from the Ketamine, I believe the Ativan will be sufficient to help her deal with that side effect. We will cross that bridge when we come to it.
However, keep in mind my mom’s condition is really rare. It’s one of many versions of EM and could even be so very unique, perhaps hardly any EM suffering person has had onset with the same drugs. Those reporting EM from Amytriptiline however would seem to bolster the small amount of research I have done which seems to point to the 5-HT damage being done with Risperdol.
My suggestion to people who take a nerve pill and get minor burning foot symptoms from it, is to beware of taking other nerve pills. This is just a bit of friendly advice, but vet it with your doctor for your case.
I think if the medications do the same basic thing to your nerves, they may cause the same EM results or maybe do something worse. Of course this is just my opinion and I’m just a care giver so you can’t take this as medical advice. Please see trained doctors and specialists and run this by them if it seems like this would be applicable to your symptoms.
My mom suffers from large fiber neuropathy 50% reduction in nerve velocity, but not Small Fiber Neuropathy. She only gets burning, but some drug mixtures may bring a temporary onset of Raynauds like chilling of the feet. She may feel burning and heat up to her knees, but it’s usually confined to her feet. She may have cold or hot hands, she may have hot flares in her face as well, but the flares in her face and hands almost never have pain with the temperature changes.
Her constant pain level that she describes is a 7 on scale of one to ten and the flares are ten. She gets an average of 3 flares a day, that being a 10 level flare from a more or less constant flare of 7. If her feet are chilled enough the pain my subside, but it’s because the nerves are almost frozen. Her blood pressure will rise from pain, which is an easy thing to measure to confirm a bad flare, but at times her flare and pain can co-exist with low blood pressure.
In her case with the cream with two elements in them Amytriptiline and Ketamine she had the following side effects. (from 7 days of testing, a 3 day test, a 3 day test with lower dosage and a one day test.)
Racing heart, restless legs and tremors, mood changes which were very brief, a nightmare. She was upbeat much of the time and reported pain levels were down to 2 or 3, so low she could ignore the pain. So we want to try Ketamine cream again and hope removal of the Amytriptiline will give better results.
When her heart was racing she thought she might be on the verge of dying. She was missing a dose of Ativan however before that side effect/episode and it could have been a withdrawal. Ketamine may increase the effectiveness of other medications and mom was on a Fentynl 50mg pain patch and taking 10/325 norcos so the additive effects could cause more powerful side effects from the Opiod pain medication. We didn’t stop the opiod doses when using the cream as it seemed the cream would be a very low dose and not affect her system much away from the topical site.
One of the problems with our tests were things happened with a very short test and we often will quit a drug quickly if side effects are bad. We don’t wait and try to tough out the side effects, as we are quite afraid of bad side effects. . . wouldn’t you if you had EM flares for 15 years almost constantly after six weeks of Rispedone?
What is especially baffling is I don’t know if anyone has had the bad onset of EM symptoms from Risperdal that we have had. I have no idea. When I called the pharmacy company to see if they had any ideas, they sent me a “report form” to report the side effects, which is not really telling me anything or giving me a clue as to what we might do to negate the effects of that drug which likely can’t be fixed.
When I talked to her Neurologist and asked if an agonist for the Serotonin could exist, I had a feeling that nothing could be used to “reverse” permanent antagonist damage to the Serotonin receptor sites. This was just my own internal theory. I also know that agonists are drugs like Amphetamines. The doctor confirmed with his remarks that any agonist approach would affect her mind in a bad way. And I think that the damage in our case is permanent and not something that can be easily reversed.
PUSHING EM to cold symptoms via drug mixes.
Perhaps some mild forms of Serotonin Syndrome with mixtures of pills that affect that can cause cold symptoms Raynauds to happen. Cymbalta and flexerol for example with other drugs may cause Serotonin Syndrome. Serotonin Syndrome may cause a wide variety of symptoms and none of our doctors have said we need to worry about it with her pill mix, but a pharmacist said, be careful.
But we rarely push that level of medication with mixtures that could cause that side effect. Only twice in 15 years have we seen that possible “cold foot” side effect from drugs alone.
(The Ketamine and a few Tibial Nerve block tests caused her feet to be cold in areas and experience more Raynaud’s like symptoms with much less pain. But in both cases the block and ketamine cream didn’t cause her feet to get cold without environmental chilling. The feet would still get warm, they would not cause as much pain but be warm.)
We have had other issues and are trying to get mom back on her baseline of medication, which was another nightmare of the past couple of months. But that’s another story.
I really can’t give a medical conclusion as I’m not a doctor, but I think Amytriptiline can cause EM for a very small minority out there. I base that on the side effects I’ve seen and heard about, and what Risperdol seemed to do to my mom’s EM. I’m 95% certain that Risperdol caused her EM.