Can anyone with medical/pharmacological knowledge answer my question?

[Plato'sCaveDweller]

I've got my SN and I'm just waiting on my Metoclopramide to arrive. But ever since I made the Meto order, I've started to become concerned about the potential adverse effects of it, and whether they'd fuck up my SN plan. Especially since I'll be actively mixing the SN drinks while the Meto takes effect, and I'm worried some sort of nasty condition will hit me like Tardive Dyskinesia or another extrapyramidal symptom that prevents me from executing my protocol.

So I've been reading through some medical info online, posts here on the forum, and threads on other sites, and it appears that Diphenhydramine is used to effectively treat and possibly prevent these symptoms/effects (it's apparently used in hospitals for such conditions). So I'm wondering if anyone here that has any medical or pharmacological experience can confirm this.

Would taking 50mg of DPH about an hour prior to Meto ingestion prevent any potential extrapyramidal effects?

@schrei_nach_liebe would you happen to know anything regarding this? You seem to have a good bit of medical knowledge.

 

[schrei_nach_liebe]

I'm not too familiar with combatting TD, if I have I've usually administered something like benztropine (I don't think anyone would be able to get their hands on that without a really good reason). I'm having a little trouble figuring out why DPH would be effective with that, but I don't really see any issue with taking a tiny amount like that if it makes you more comfortable. Also, I've given truckloads of AE drugs and I've taken truckloads myself, I've never ever seen TD occur. I have seen TD with certain antipsychotics. The most profound thing I've seen is specifically with ondansetron and a prolonged QT interval while on a monitor. All my patients at my last job were on a monitor of some type at all times as I was in critical care. Usually with the QT interval, it never resulted in anything other than what we saw on the monitor and it was usually short-lived and usually only when someone didn't follow the protocol for how slowly we are supposed to push the drug (IV). I've heard a lot that many times when someone says they are having TD they are someone who knows exactly what TD is and that it may occur with one of their drugs, and rather magically the people who have no idea what it is never seem to notice anything or display any signs of it. A lot of things are in peoples' heads sometimes, whether intentional or not. I can't even count the number of people who thought they'd had strokes and not a single thing was wrong with them yet their face was drooping, yet when they fell asleep it wasn't drooping anymore. Their pupils were always equal. EPS can be really bad, but it's pretty damn rare. Almost everything you read about drugs is curated and twisted by lawyers.

 

[Plato'sCaveDweller]

I'm having a little trouble figuring out why DPH would be effective with that, but I don't really see any issue with taking a tiny amount like that if it makes you more comfortable.

Apparently it has something to do with the anticholinergic effect of DPH. It can help with "parkinsonian effects" and tremors, which would be classed as extrapyramidal afaik.

I don't have the link anymore (can't find it now), but I read in a medical report that a person checked into the emergency room with extrapyramidal symptoms, and they administered an 50mg IV dose of DPH and then 25mg orally after 4 hours, and then they left the hospital shortly after with no more symptoms. And I read anecdotal reports of individuals taking DPH at home for TD caused by schizophrenia meds, and they apparently had success with that.

Also, I've given truckloads of AE drugs and I've taken truckloads myself, I've never ever seen TD occur. I have seen TD with certain antipsychotics. The most profound thing I've seen is specifically with ondansetron and a prolonged QT interval while on a monitor. All my patients at my last job were on a monitor of some type at all times as I was in critical care. Usually with the QT interval, it never resulted in anything other than what we saw on the monitor and it was usually short-lived and usually only when someone didn't follow the protocol for how slowly we are supposed to push the drug (IV). I've heard a lot that many times when someone says they are having TD they are someone who knows exactly what TD is and that it may occur with one of their drugs, and rather magically the people who have no idea what it is never seem to notice anything or display any signs of it. A lot of things are in peoples' heads sometimes, whether intentional or not. I can't even count the number of people who thought they'd had strokes and not a single thing was wrong with them yet their face was drooping, yet when they fell asleep it wasn't drooping anymore. Their pupils were always equal. EPS can be really bad, but it's pretty damn rare. Almost everything you read about drugs is curated and twisted by lawyers.

Oh I am aware that these potential adverse effects are pretty rare. but still, I've never taken Meto before (I've only ever had Ondansetron at the hospital, which didn't help with vomiting at all LOL) and it is a bit of a risk given its rather infamous reputation. Though as you say, it could be hyped up by lawyers and companies as a sort of CYA, but there's a lot of people who swear off this drug entirely due to how strongly it affected them. But there's also people who've taken it for 10 years straight with no issues, so there's also that.

I would do a test dose of maybe 20mg, just to see how it affects me. But if it were to adversely affect me, I'm not sure if it'd be so bad that I need to get checked out by a doctor, and I don't know how I'd explain it away to them considering I don't have a prescription for the medication.

Hopefully I get some other answers here, as it'd be nice to confirm that this for sure would help. Anything for a bit of peace of mind.

Thanks for responding! I appreciate it.

 

[schrei_nach_liebe]

Yeah I guess the anticholinergic effects would make sense. No one can say meto wouldn't cause an issue, but I don't think it's likely to. Even if it did cause an issue I think it's super less likely to cause something that actually requires intervention. But that's just based on what I've come across personally.

 

[Plato'sCaveDweller]

Yeah I guess the anticholinergic effects would make sense. No one can say meto wouldn't cause an issue, but I don't think it's likely to. Even if it did cause an issue I think it's super less likely to cause something that actually requires intervention. But that's just based on what I've come across personally.

Well that is very reassuring, on both points.

Again, I appreciate you making your medical experience available to me and anyone who comes across your posts. It's highly valued!

 

[schrei_nach_liebe]

You're welcome. Yeah, AEs don't tend to be terribly effective and I think they're ordered more than they should be. Yes, vomiting too often isn't great, but in the setting of the ICU if we're concerned about that we're giving you potassium and managing your hydration and pH, or other methods based on what the root cause is thought to be. Vomiting exists for a reason and in many scenarios we actively avoid preventing it. Meto and domperidone are most useful in my experience with gastroparesis or other decreased gut motility, however domperidone is not available or certified for use in the US because it's excreted in breast milk and probably other reasons.

 

[Plato'sCaveDweller]

You're welcome. Yeah, AEs don't tend to be terribly effective and I think they're ordered more than they should be. Yes, vomiting too often isn't great, but in the setting of the ICU if we're concerned about that we're giving you potassium and managing your hydration and pH, or other methods based on what the root cause is thought to be. Vomiting exists for a reason and in many scenarios we actively avoid preventing it. Meto and domperidone are most useful in my experience with gastroparesis or other decreased gut motility

Yeah that lines up with my experience. When I was given Fentanyl for my chest tube insertion after a lung collapse, I was vomiting for hours and hours. Even with the Zofran they ended up giving me, I was still throwing up constantly. I could not keep a meal down and I was just dry heaving and puking out bile.

And this also lines up with the intended role for AEs with SN, as we aren't really trying to stop the nausea and vomiting (though that would be nice), but rather we're trying to speed up gastric emptying so the SN can be absorbed quicker. It's good to hear that it's effective for this purpose in your experience, though we already knew that it was pretty good for that. Still, it's nice to have an additional supporting anecdote.

however domperidone is not available or certified for use in the US because it's excreted in breast milk and probably other reasons.

This is why I went with Meto instead of Dom. I'd've preferred Dom, since it doesn't penetrate the blood-brain barrier and cause extrapyramidal symptoms (while still being equally as effective for gastric emptying as Meto). But it's not an approved drug here in the US, so if I wanted to sneak an AE through customs it'd have to be Meto.

I didn't know that's why Dom isn't used here though, thanks for the fun-fact.

 

[DOHARDTHINGS24]

Well that is very reassuring, on both points.

Again, I appreciate you making your medical experience available to me and anyone who comes across your posts. It's highly valued!

Hey
Full disclaimer- I have zero medical knowledge, only personal experience & a little bit from here.
So this may or may not be of use but at a minimum, might act as a bump…
If you're on any other meds, at all, put all of that into a good drug interaction checker - it's why I can't get / won't use meto as my AE, even though it's the first or best choice for most people. The interaction checker explicitly mentions TD as a major response / high probability for meto & my meds but not a mention of it at all with prochlorperazine which is how I had it legitimately prescribed in the past. Apologies if the interaction checker was already covered, my vision problems are a lot worse than usual today & I'm having a struggle reading. I also did a trial of just 1 tablet of my AE, to help overcome the fear - I think leaning towards stat dose might be better in that case. And zero side effects, even though I was both actively looking for them but also aware that my brain might imagine some as per above. I really thought SOMETHING would hapoen, real or imagined, but for me, nothing. And I can get ridiculous side effects even from OTC painkiller etc. But if you're only trialling it out & get sick & have to see a doctor, they may not need evidence of prescription if it's not your regular doctor. And there's always the fib - "I usually have such bad side effects from meds but can take exactly what my brother / sister / mother does, & I know I really shouldn't have but I took one of theirs because I couldn't stop vomiting & was scared…." I'm a bad liar but I can read a script so if that's the route you take, have your script ready. I hope something in this ramble was useful, & if not, apologies &
BUMP, BUMP, BUMP

 

[schrei_nach_liebe]

Yeah, being excreted through breast milk is totally not unique to domperidone but in true arbitrary US behavior they just decided to not understand if that actually was a problem. I used to bring in domperidone from my home country whenever I could in large quantities for my own use because I find it actually really good for my nausea compared to the others.

Hey
Full disclaimer- I have zero medical knowledge, only personal experience & a little bit from here.
So this may or may not be of use but at a minimum, might act as a bump…
If you're on any other meds, at all, put all of that into a good drug interaction checker - it's why I can't get / won't use meto as my AE, even though it's the first or best choice for most people. The interaction checker explicitly mentions TD as a major response / high probability for meto & my meds but not a mention of it at all with prochlorperazine which is how I had it legitimately prescribed in the past. Apologies if the interaction checker was already covered, my vision problems are a lot worse than usual today & I'm having a struggle reading. I also did a trial of just 1 tablet of my AE, to help overcome the fear - I think leaning towards stat dose might be better in that case. And zero side effects, even though I was both actively looking for them but also aware that my brain might imagine some as per above. I really thought SOMETHING would hapoen, real or imagined, but for me, nothing. And I can get ridiculous side effects even from OTC painkiller etc. But if you're only trialling it out & get sick & have to see a doctor, they may not need evidence of prescription if it's not your regular doctor. And there's always the fib - "I usually have such bad side effects from meds but can take exactly what my brother / sister / mother does, & I know I really shouldn't have but I took one of theirs because I couldn't stop vomiting & was scared…." I'm a bad liar but I can read a script so if that's the route you take, have your script ready. I hope something in this ramble was useful, & if not, apologies &
BUMP, BUMP, BUMP

Yeah, whatever else is in your system can mess with things, but those interaction checkers are double layers of twisted lawyer info lol. As for my personal experience, I'm usually pretty tolerant of lots of meds and almost never get the common side effects, but sometimes I get significant side effects with newer forms of a drug that are supposed to have eliminated or decreased said side effects,and yet I never got those side effects with a first gen drug that was supposed to have them be pretty common. Everybody is different

 

[Plato'sCaveDweller]

Hey
Full disclaimer- I have zero medical knowledge, only personal experience & a little bit from here.
So this may or may not be of use but at a minimum, might act as a bump…
If you're on any other meds, at all, put all of that into a good drug interaction checker - it's why I can't get / won't use meto as my AE, even though it's the first or best choice for most people. The interaction checker explicitly mentions TD as a major response / high probability for meto & my meds but not a mention of it at all with prochlorperazine which is how I had it legitimately prescribed in the past. Apologies if the interaction checker was already covered, my vision problems are a lot worse than usual today & I'm having a struggle reading.

I actually have been doing this as I've cooked up my protocol. None of the meds I'm using interact except acetaminophen and meto, but it's a very minor interaction that isn't noteworthy. and the prescription med i do take regularly, mirtazapine, doesn't interact with anything except the DPH, and it only increases drowsiness like with alcohol.

The med checker was not covered here, so don't worry!

I also did a trial of just 1 tablet of my AE, to help overcome the fear - I think leaning towards stat dose might be better in that case. And zero side effects, even though I was both actively looking for them but also aware that my brain might imagine some as per above. I really thought SOMETHING would hapoen, real or imagined, but for me, nothing. And I can get ridiculous side effects even from OTC painkiller etc. But if you're only trialling it out & get sick & have to see a doctor, they may not need evidence of prescription if it's not your regular doctor. And there's always the fib - "I usually have such bad side effects from meds but can take exactly what my brother / sister / mother does, & I know I really shouldn't have but I took one of theirs because I couldn't stop vomiting & was scared…." I'm a bad liar but I can read a script so if that's the route you take, have your script ready. I hope something in this ramble was useful, & if not, apologies &

This is also reassuring! I'm glad nothing happened and it went well.

And yeah I suppose I could cook up a good lie. I thought about saying "oh well I've been having migraines with really bad nausea, and my doc wouldn't prescribe be anything strong for it so I took my family member's Meto" but I'm awful at being convincing with my lies. It's the tone of my voice and my face, it's so obvious. I used to be a prolific and effective liar when I was a kid, so I must've lost that skill somewhere along the way. And I'm totally awful reading off of a script, it doesn't sound genuine at all lol.

BUMP, BUMP, BUMP

Thank you! I really could use some answers here.

 

[schrei_nach_liebe]

lol, disclosing to a doctor you took someone else's prescribed meds is almost never a good idea, I will advise against that haha

 

[Plato'sCaveDweller]

lol, disclosing to a doctor you took someone else's prescribed meds is almost never a good idea, I will advise against that haha

ah, gotcha. LOL.

Yeah, as I said, I'm not sure how to explain it away if things go awry. I'll have to work on that one.

 

[maniac116]

I'm sorry that life has brought you to this point.
I was a nurse & yes diphenhydramine was used for TD symptoms some time but today I think there are better TD meds.
So it may work but how well, I'm not sure.
I hope you find all you're looking for in the end

 

[Plato'sCaveDweller]

I'm sorry that life has brought you to this point. I hope you find all you're looking for in the end

I appreciate that, a lot. Though honestly, I'm glad life has brought me here since I'm effectively going to be taking a shortcut to where we're all headed anyways. Not many people bring themselves to do such a thing, so I'm fortunate in that regard (but I've unfortunately been unsuccessful in all of my attempts so far). I also philosophically disagree with the way life works on the whole, so I'd never want to be in the position where I'd want to endure and witness more of it. But I genuinely do appreciate your kind sentiment :)

I was a nurse & yes diphenhydramine was used for TD symptoms some time but today I think there are better TD meds.
So it may work but how well, I'm not sure.

That is good to hear. I suppose I could give it a try, and it couldn't hurt as it will also act as a mild anxiolytic which'll help with SI slightly.

I appreciate you providing your input here. It's helping me and potentially others who may have the same question/concern.

 

[DOHARDTHINGS24]

Yeah, whatever else is in your system can mess with things, but those interaction checkers are double layers of twisted lawyer info lol.

I agree. I definitely ignored all the other flagged interactions - they may or may not be a problem with long term use etc but might not matter for a day. And also, wouldn't matter in the slightest if buying online. But for me to get a prescription, which I did, I used the interaction checker first - if I'd asked for meto, they would have refused immediately & it would be suspicious if I pushed for it. So I needed to know what was both likely to be legitimately prescribed & also be one endorsed by the PPH. If I hadn't done my research & was refused meto, the doctor could've prescribed any old AE & then if I found out not helpful with SN, I would've had to have waited, gone back to doc & paid again (big issue for me, money), said I had side effects from what they prescribed & go through the whole thing again. I understand a lot of people have money or access to free health care or purchase their AE online or don't take any or many medications, reducing the possibility of interactions. Just outlining my boring & complicated circumstances in case it applies to anyone else.
The only interaction I paid attention to was the red major that flagged TD - the others sounded tolerable

Everybody is different

Absolutely. I can get major side effects from the "little or no side effects" category & no side effects from the "everybody gets this one" category.

 

[DOHARDTHINGS24]

Going to bed but doing a goodnight semi-subtle bump for OP. As helpful as everyone's been, if anyone else has any relevant info to add, please do.

 

[ceilng_tile]

You're not going to get tardive dyskinesia after one use. Usually this happens after people have been on medication for a long time.

 

[willitpass]

Extrapyramidal effects aren't typically after one time use. They usually are seen in chronic patients. I suppose a higher dose of meto would increase the chances of them after one dose, but I doubt it. The extrapyramidal side effects are also relatively rare, they are just common enough and severe enough to require a warning.

 

[Plato'sCaveDweller]

You're not going to get tardive dyskinesia after one use. Usually this happens after people have been on medication for a long time.

really? so the stories about people getting TD after just a single use aren't true? or perhaps just so incredibly rare that it's not worth worrying about? I hope that's the case.

Extrapyramidal effects aren't typically after one time use. They usually are seen in chronic patients. I suppose a higher dose of meto would increase the chances of them after one dose, but I doubt it. The extrapyramidal side effects are also relatively rare, they are just common enough and severe enough to require a warning.

this is what I remember reading - that the higher the dose the higher the risk. and with the SN protocol, it's a decent sized dose but nothing too high or anything.

I suppose my worries are unfounded. But the stories of a person getting TD from just a single dose were concerning. and of course the general reputation the drug has among patients and doctors certainly doesn't help.

 

[willitpass]

really? so the stories about people getting TD after just a single use aren't true? or perhaps just so incredibly rare that it's not worth worrying about? I hope that's the case.

this is what I remember reading - that the higher the dose the higher the risk. and with the SN protocol, it's a decent sized dose but nothing too high or anything.

I suppose my worries are unfounded. But the stories of a person getting TD from just a single dose were concerning. and of course the general reputation the drug has among patients and doctors certainly doesn't help.

I wouldn't say it's a non chance. Every body reacts to medications differently. I think it can become an unfortunate case of placebo though. Worrying about it so much that you take it and suddenly become hyper aware of everything your body feels and starting to think you may be developing it. I actually stopped looking at side effects before taking meds because I know I get myself wrapped up in that and all of a sudden I'm developing Steven's Johnsons syndrome from a little red spot on my skin. It can happen after one dose, don't get me wrong, but it isn't super common. It definitely isn't the drug of choice for many, and the risk of that is a big part of what played into the downfall of its use. I think if you're worried about it then taking benadryl can help with the psychological aspect.

 

[Plato'sCaveDweller]

I wouldn't say it's a non chance. Every body reacts to medications differently.

true. i won't know for sure until i give it a shot. i'm still deliberating over whether i wanna do a 20mg test run or not before the real event. it's probably a good idea, but i wonder if merely taking it once is better than two times, as that's an additional window of opportunity for these adverse effects to arise - it may not happen the first time, but it could the second time. idk, i tend to overthink things lol.

I wouldn't say it's a non chance. Every body reacts to medications differently. I think it can become an unfortunate case of placebo though. Worrying about it so much that you take it and suddenly become hyper aware of everything your body feels and starting to think you may be developing it. I actually stopped looking at side effects before taking meds because I know I get myself wrapped up in that and all of a sudden I'm developing Steven's Johnsons syndrome from a little red spot on my skin. It can happen after one dose, don't get me wrong, but it isn't super common. It definitely isn't the drug of choice for many, and the risk of that is a big part of what played into the downfall of its use.

lmao, i apologize for laughing but this is so relatable. i'm a worrier, if that wasn't already obvious, and i do the same shit when i research side effects for meds or illness symptoms i'm having. with the web search results i get, i suddenly begin to think i'm proper fucked, but it's literally a nothingburger. the placebo effect and the power of an anxious mind is crazy.

I think if you're worried about it then taking benadryl can help with the psychological aspect.

I'm definitely going to take the DPH, regardless of whether it really prevents anything, as I could use the peace of mind here. that alone is worth a lot, and hopefully it actually helps prevent some of those symptoms.