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Ask Dr. Kaushik Your Own Question
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4616
Experience:  MD Psychiatry
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I have severe insomnia, from radiation and chemo from stage

Customer Question

I have severe insomnia, from radiation and chemo from stage IV cancer. Also, Willis Ecbom's disease (sever RLS affecting whole body) which is under control from Mirapex and Gabapentin. Virtually all sleeping aids exacerbate RLS beyond control. I've tried Paxil, Zoloft, Pamelor, Prozac Wellbutrin, Transene,Diphenylhydramine, which increase RLS. Clonazepam does the same at 1mg, but seems to help some at 2mg. Seratonin, Lexapro, Myocalm, Melatonin,Tryptophan,Cymbalta, Effexor, Doxepin HCL, Celexa, Remeron Tofranil, are all ineffective. Belsombra seems minimally effective, is expensive, and insurance won't cover it. Chamomile, Valeran root,
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 1 year ago.


Welcome to the site.

I am sorry to learn about your condition and your struggle with chronic insomnia.

I would like you to consider and discuss use of ELavil ( Amitriptyline ) starting at 25 mg dose at night +/- Promethazine hcl at dose of 25 mg to be used PRN that is as and when required, which will be when the single 25 mg dose of elavil is ineffective in bringing you sleep. So in other words you need to take elavil 25 mg at bedtime and wait for half to 1 hour to take promethazine hcl if you are still awake. So, elavil is going to be regular while promethazine ( i.e phenergan) 25 mg is going to be as and when required.

After, 1 week up the dose of elavil to 50 mg at night while taking promethazine PRN.

Then AFTER 1 WEEK, if the need arises you may further up the dose of elavil to 75 mg at bedtime provided you have not still reaped a content and refreshing sleep from the 50 mg dose.

I have used this sort of regime in my own patients with chronic insomnia and they have given very good feedback on the same, so you consider this strategy and discuss this with your own doctor and hopefully he will be willing to try the same on you. Plus you must know that promethazine hcl which i have recommended as an add on medication, this drug is very safe drug.

I hope this helps.

Wish you all the best and i shall pray for your recovery.

Please kindly leave a POSITIVE RATING if you are satisfied with the answer.


Expert:  Dr. Kaushik replied 1 year ago.

If you have any further query please feel free to ask.

If you have no further query and if you are satisfied with the answer then kindly please leave a POSITIVE RATING.