Effexor: decrease of chronic pain.
Works via the norephinephrine reuptake mechanism.
Cymbalta & Elavil, which are approved for pain (neuropathic pain in the case of cymbalta) work off of the same mechanism. However effexor never got the approval.
There are studies which back up Effexor's use to relieve pain.
Fibromyalgia patients will also benefit from the above meds.
"Seroquel in low doses as prn for anxiety in pts w/hx sub abuse..."
No offense fiatslug, I bring up a professional counter opinion- I would not give Seroquel for this reason. (Forgive any frustration you may detect in the following rant)
Why does Seroquel work as an antianxiety med? Its antihistaminic property.
So then, why give Seroquel (cost: $113.31-$353.85: 25 mg-60 tab supply-$113.31, 100mg 60 tab supply 188.35, 200 mg 60 tab supply 353.85)
---WHEN BENADRYL 50MG 60 TABS COSTS $8.99?
Hmm--2 meds, work off the same mechanism--one is over $100 (in some cases over $350.00) per month, the other, $8.99.
Benadryl is considered a safer med & has an FDA approval for sedation.
Another problem with seroquel---several drug abusers want it for abuse purposes. That's why so many drug abusers "love it". They do not want it for legitimate reasons.
There are some that want it for valid reasons, who happen to be drug abusers. It seems to work well with opioid addicts.
Think about why--how do you treat opioid withdrawal? Well 2 of the well established meds are an antihistamine and an alpha agonist. Seroquel has both an antihistaminic and alpha agonist property. Why then give Seroquel when benadryl & clonidine are available?
If you give seroquel to a drug abuser on an outpatient basis, you are seriously running the risk of providing this person with a med they will use for abuse purposes or will be used to be sold on the street. Seroquel does have a high street value.
Seroquel is not addictive, but when mixed with other meds does potentiate the the level of the "high" and length of duration of the "high". I'd advise you consider giving out seroquel to drug abusers in a highly scrutinized manner if at all.
Forgive this rant--It seems to be the popular thing now for doctors to give out Seroquel as a sleep aid. It does work for that, for the same reason benadryl works. Again--we have the problem of giving a med with a cost that's over 1000% higher than a OTC that does the same thing (benadryl), and is not approved for that purpose, while the OTC is approved.
Several docs are giving seroquel to help their patients sleep. I then see the patient for whatever reason--and tell them they're on an antipsychotic, and they flip out. "WHAT, HE PUT ME ON A DRUG FOR SCHIZOPHRENICS?!?!?!?!?"?.
The patient gets ticked off, and understandably so. The doctor didn't explain to them what the drug is for. Then the patient, who has no DSM dx is now worrying that perhaps they have mental illness when in fact they do not.
Another problem is as with several sleep meds, a sleep tolerance develops. So when this happens, the doctor simply ups the dosage of Seroquel. Fine, (and we won't get into the perils of simply upping the med when its only going to be a short term solution).
The antihistaminic benefit of seroquel tops off at 200mg. BUt the doctor goes above 200mg. So now you got a patient on 600mg of Seroquel just to go to sleep. Its ridiculous. So then I see the patient for whatever reason (e.g. consult), and I'm suspecting that the patient has mental illness (when the patient doesn't) because their idiot outpatient doctor put them on a dose of Seroquel effective for schizophrenia, and for sleep--well it tops off at 200mg, and I'm actually giving the outpatient doctor the benefit of the doubt, hoping this doc actually knows what he's doing (which he doesn't).
So I bring up mental illness to the patient, and the patient blows up at me. I end up calling the doctor, and the doctor doesn't know what the heck he's doing with the seroquel, but since I'm a resident, he won't listen to me.
Part of my post is pure rant...but you get the point?"
