Can you see any problem when taking these sleep meds?

Posted by laughlin1947 @laughlin1947, Aug 21 7:58pm

I take several meds for differing reasons at night before bedtime. Lately I've seen that adding gabapentin 100 mg along with my other meds has given me better sleep. I wake up after 6-1/2 hours feeling refreshed and not hung over, same as before. I get up twice a night to use the bathroom, but other than some temporary balance issues, that is the same as before. I think my doctor would not approve of the gabapentin I've just added because she is too worried about respiratory depression when it is combined with the other nighttime meds, in particular the clonazepam. So, my nighttime meds are these: gabapentin 100 mg; Lyrica 50 mg for back and leg nerve pain relief; clonazepam 2 mg for general anxiety relief; melatonin 5 mg sleep aid; meloxicam 15 mg NSAID for back pain; doxylamine succinate (OTC sleep aid, an antihistamine) 25 mg. I also take thyroid medication - levothyroxine 150 mcg for hypothyroidism. It has no effect on sleep quality. I am 77 years old, male, 185 lbs., 5'10" in height.

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Profile picture for laughlin1947 @laughlin1947

From HealthCentral.com: "Levothyroxine is the second-most-prescribed drug in the US, with more than 102 million prescriptions in 2019. Historically, people were advised to take their pill first thing in the morning, on an empty stomach, and wait at least an hour before having breakfast. This is because a number of foods and beverages can interfere with its absorption, including milk, soy, coffee, papaya, and grapefruit.

More recently, the American Thyroid Association has endorsed two options for levothyroxine timing: either first thing in the morning, at least an hour before eating, or at bedtime, several hours after eating dinner.
Many studies have looked at whether one of these options is better than the other in terms of ensuring maximum absorption of oral levothyroxine, which is a synthetic form of the thyroid hormone T4 and most often prescribed to treat hypothyroidism (underactive thyroid). Newer research, including a meta-analysis published in 2020 in Clinical Endocrinology, suggests that taking levothyroxine at night may actually hold a slight edge over taking it in the a.m. But experts we spoke with voted for whichever time is more convenient for you, and more importantly, when you are most likely to remember the medication.

Taking at Night - Is Bedtime Better?
In the systematic review and meta-analysis published in 2020, researchers from North Sichuan Medical College in China analyzed data from 10 prospective or randomized controlled trials conducted in seven countries comparing levothyroxine schedules at morning to bedtime. Studies were conducted between 2001 and 2018, with duration ranging between two and six months. All formulations of levothyroxine were in oral tablet form.

Findings showed that across studies, taking levothyroxine before breakfast compared with before bedtime had no significant difference on the level of thyroid-stimulating hormone (TSH), an indicator of whether a person has adequate thyroid hormone in their system. However, in an additional analysis performed on nine studies, researchers found that levothyroxine administered at bedtime was associated with a higher free thyroxine (T4) level when compared with breakfast administration.

Although the finding did not reach statistical significance, these results appeared to “favor” a bedtime dose, the researchers wrote. One possible explanation they offered was that about 60% to 82% of levothyroxine is absorbed over three hours, so the one-hour interval before eating breakfast may not be sufficient. They also noted that a high-fat, large American-style breakfast may impact absorption of the drug.

Preference - A Matter of Choice: Experts we interviewed framed the choice of a morning or bedtime dose as mainly a matter of patient convenience.

“In general, it really doesn’t matter what time a patient takes their levothyroxine,” says David S. Cooper, M.D., MACP, director of the Thyroid Clinic and professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism at Johns Hopkins University School of Medicine, in an email.

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I’ve been taking my levothyroxine first thing in the morning and delaying breakfast since 2005. Things became more difficult when I was prescribed alendronate which also needs to be taken alone on an empty stomach 1 hour before eating.

Thank you for your response. Medicine marches on, and I haven’t kept up! Now that I only have to to take alendonate, life will be considerably less complex!

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Search on iodine supplements Mayo Clinic - Apparently iodine deficiency is rare, and added iodine supplements can make Thyroid problems worse.
So probably not, except the unlikely case of a primary MD or endocrinologist recommending extra iodine.

Best wishes

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Profile picture for sharshy @sharshy

Why not take more idodine we dont have enough of it in our diets.

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Do you have any scientific data to support adding iodine to our diets? What is your reference information?

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Profile picture for laughlin1947 @laughlin1947

From HealthCentral.com: "Levothyroxine is the second-most-prescribed drug in the US, with more than 102 million prescriptions in 2019. Historically, people were advised to take their pill first thing in the morning, on an empty stomach, and wait at least an hour before having breakfast. This is because a number of foods and beverages can interfere with its absorption, including milk, soy, coffee, papaya, and grapefruit.

More recently, the American Thyroid Association has endorsed two options for levothyroxine timing: either first thing in the morning, at least an hour before eating, or at bedtime, several hours after eating dinner.
Many studies have looked at whether one of these options is better than the other in terms of ensuring maximum absorption of oral levothyroxine, which is a synthetic form of the thyroid hormone T4 and most often prescribed to treat hypothyroidism (underactive thyroid). Newer research, including a meta-analysis published in 2020 in Clinical Endocrinology, suggests that taking levothyroxine at night may actually hold a slight edge over taking it in the a.m. But experts we spoke with voted for whichever time is more convenient for you, and more importantly, when you are most likely to remember the medication.

Taking at Night - Is Bedtime Better?
In the systematic review and meta-analysis published in 2020, researchers from North Sichuan Medical College in China analyzed data from 10 prospective or randomized controlled trials conducted in seven countries comparing levothyroxine schedules at morning to bedtime. Studies were conducted between 2001 and 2018, with duration ranging between two and six months. All formulations of levothyroxine were in oral tablet form.

Findings showed that across studies, taking levothyroxine before breakfast compared with before bedtime had no significant difference on the level of thyroid-stimulating hormone (TSH), an indicator of whether a person has adequate thyroid hormone in their system. However, in an additional analysis performed on nine studies, researchers found that levothyroxine administered at bedtime was associated with a higher free thyroxine (T4) level when compared with breakfast administration.

Although the finding did not reach statistical significance, these results appeared to “favor” a bedtime dose, the researchers wrote. One possible explanation they offered was that about 60% to 82% of levothyroxine is absorbed over three hours, so the one-hour interval before eating breakfast may not be sufficient. They also noted that a high-fat, large American-style breakfast may impact absorption of the drug.

Preference - A Matter of Choice: Experts we interviewed framed the choice of a morning or bedtime dose as mainly a matter of patient convenience.

“In general, it really doesn’t matter what time a patient takes their levothyroxine,” says David S. Cooper, M.D., MACP, director of the Thyroid Clinic and professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism at Johns Hopkins University School of Medicine, in an email.

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Thank you for your thorough, intelligent presentation of information. Taking thyroid medication in the morning --waiting an hour before eating--can be an inconvenience. Taking in at bedtime, instead, is an appealing option--something I will consider.

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Profile picture for kdalda75 @kndaustin71

Do you have any scientific data to support adding iodine to our diets? What is your reference information?

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It seems we are starved of iodine. Doctors on YouTube recommend taking iodine.

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Here is some information from the NIH. Main source of iodine in the United States is iodinizes salt which 88% of Americans use. At risk for dificiency in the US includes pregnant women, vegans , others listed on websites. Most of the iodine deficiency is not in the US. Link also shows high iodine foods
https://ods.od.nih.gov/factsheets/Iodine-Consumer/#h2

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Get off the clonazepam, but do it slowly. It will likely cause you all kinds of problems. It will stop working, and you will have to keep taking more to get the same effects. In the meantime, it is destroying your GABA receptors and leaving your system flooded with glutamate, the fight or flight neurotransmitter. These drugs should be illegal. They should never be taken for more than two weeks. But doctors are ignorant and keep prescribing them. Lyrica is similarly dangerous. You are polydrugged, and it’s very dangerous.

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Thank you for your insights. I wouldn't mind getting off clonazepam, but I need a proven alternative first. I was on 10 mg zolpidem tartrate for a while, and I thought that worked well until my doctor got all jacked up about those obscure side effects where people were reportedly sleepwalking and doing zombie like behaviors. I looked up the federal agency study that debunked the side effects and showed how minimal they are. He refused to read the report and that led to prescribing the benzo. I
I've tried to wean off the clonazepam several times and each time, I needed to go back on it due the general anxiety effects that prevented me from having normal daily basis activities. I think my dose is pretty small, but like I say, I'd get off of it if something else worked as well. Maybe hydroxyzine. I've been on clonazepam for several years now. I'm not certain that Lyrica is doing me a lot of good, but I have such broad-based back injury/damage with resultant back pain all the way from my lower back thru my legs and feet, that I thought it would help me hold off on more epidural injections if I took it at bedtime. My doctor seems like she is more concerned about suppressed pulmonary function when taking it at night rather than any other side effect.
Do you have a clinical report detailing those side effects with clonazepam? Thank you , again!

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