Anyone taking Carbidopa with Mirtazapine? How's it working for you?

[roamer1]

Saw Dr. Vernino today and we discussed one of my issues since all this autonomic stuff started: Severe insomnia. My sleep doctor had prescribed mirtazapine 7.5mg before bed to help with super bad insomnia. It took a few days to start working and by 1wk was doing ok but not perfect. Still better than anything else I've tried since this all started a few months ago. I could deal with the weight gain and constipation from the medicine but it turns out it was pushing my BP up to 150+ systolic despite being on 2 BP meds to treat whatever is going on (always had normal BP until this began end of July). 

 

Apparently, mirtazapine also happens to effect dopamine and raises norepinephrine levels. Since I'm suffering autonomic issues with my BP, my body cannot seem to compensate and my BP starts rising; its a rare side effect of mirtazapine. So Dr. Vernino recommended giving carbidopa a try as it suppresses norepinephrine and may allow me to get the sleep benefits of mirtazapine without the rise in BP.

 

Anyone take carbidopa for this purpose? Or anyone take it for other issues and if so what was your experience? Were there a lot of side effects? I'm always nervous adding meds and having rough side effects.

[p8d]

Oh @roamer1 I feel for you. Insomnia has been really, really bad for me from day 1 of this and after trying every med and supplement available the only thing that gets me to sleep is mitrazipine. I take a quarter tablet. It raises my BP as does diphenhydramine and especially gabapentin. I take guanfacine to counteract my constantly high norepi and a beta blocker (coreg) in the evening and then the tiny dose of mitrazipine at bedtime to keep supine hypertension at bay. I also take guanfacine in the morning. My cardiologist prescribed carbidopa but someone here recorded bad results so I never tried it. This was before I realized that the bedtime gabapentin was causing hypertension >150 systolic. I also take Prosom 1mg at bedtime which also keeps the supine hypertension down. I will send you a pm too. I will be interested in seeing if this combination helps you.

[roamer1]

5 hours ago, p8d said:

Oh @roamer1 I feel for you. Insomnia has been really, really bad for me from day 1 of this and after trying every med and supplement available the only thing that gets me to sleep is mitrazipine. I take a quarter tablet. It raises my BP as does diphenhydramine and especially gabapentin. I take guanfacine to counteract my constantly high norepi and a beta blocker (coreg) in the evening and then the tiny dose of mitrazipine at bedtime to keep supine hypertension at bay. I also take guanfacine in the morning. My cardiologist prescribed carbidopa but someone here recorded bad results so I never tried it. This was before I realized that the bedtime gabapentin was causing hypertension >150 systolic. I also take Prosom 1mg at bedtime which also keeps the supine hypertension down. I will send you a pm too. I will be interested in seeing if this combination helps you.

Gabapentin was raised as a possibility in first few weeks, particularly when I was having severe burning skin sensations in face, lips, arms, and upper chest. But sleep psychiatrist was concerned that I would quickly tolerate and get stuck on another medicine that has history of physical withdrawal issue. He figured the mirtazapine low dose could help with sleep, anxiety, and maybe reduce the skin sensations. From what you are saying about the BP, I'm even more glad I didn't try it. The mirtazapine is dramatic enough. Just one 7.5mg tablet raises my systolic/dystolic +10/+5 and 15mg +20/+10, and as well my resting pulse goes up and I get more heart palpitations. Which was sad, because it working decently for sleep. Would still wake up several times a night but would drift back to sleep each time. Didn't really like the increased constipation and weight gain but would tolerate that if something like the carbidopa would counter the norepinephrine impact. No one mentioned that happening and it was only when I showed doctor my history of BP readings did he then say it can rarely happen, and probably more likely in my situation where my autonomic system is easily overwhelmed/hyperstimulated by things. It took awhile to document this, because when I take the mirtazapine the BP goes up right afterwards but takes 3 days off it to start coming down and back to more normal about 5 days after last taking; due to lingering drug in system (half life). 

 

I'm Leary adding more meds so trying to see if I can replicate with supplements instead. I've finally come up with a routine that is has been working for 5 days now and crossing fingers it will keep working. It's not as good as mirtazapine though: with supplement routine below, I will fall asleep quickly but wake back up after 3hrs,  then up for a couple hours and then at some point drift back to sleep and sleep another 3 to 4hrs. And only marginal 5pt impact on BP (most likely due to the 5-HTP):

* 7pm: Chamomile & Lavender tea, 530mg valerian root, 200mg magnesium

* 8pm: 100mg 5-HTP, 5mg time released melatonin, 125mg GABA, 1 sublingual dropper (26mg) of CBD oil

* 9:30pm: 530mg valerian root, 3mg fast dissolve melatonin, 200mg magnesium

Quite a laundry list, but seems to be working without really any of the side effects of mirtazapine, so if it keeps working then it's worth the tradeoff of slightly worse sleep vs. Mirtazapine. Once I can replicate it working for a few weeks, will try slowly removing different supplements to get to the narrowest list possible. probably start with 5-HTP since it's probably the one giving me a slight BP increase. Adding the valerian root was what finally seemed to help me.

 

If this doesn't work, unless anyone has any other suggestions ?, I'll probably go back to 7.5mg mirtazapine and try the carbidopa.