Update on cold sweats - Important

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Veteran Member

Date Joined Mar 2009
Total Posts : 599
   Posted 2/3/2010 4:08 AM (GMT -7)   
The ongoing saga of my fibro-associated cold sweats when I'm cold:

A few weeks ago I bought a silk quilt and polyester microfiber wicking bed sheets, and they work really well at keeping me warm and dry during the night. I bought them on EBay and they weren't expensive. Thank goodness, one solution!

HOWEVER - today I had a medication follow-up appointment but my doc was out sick. I was going to ask him about the cold sweats but could only see a PA and she wasn't comfortable providing information because she didn't have fibro experience. I said that was OK because I preferred working with my own doc, so I would come back in a few days.

I was sitting at the pharmacy counter while my refills were filled: tramadol, gabapentin, flexeril, and Cymbalta. The pharmacist noticed that, despite my big poofy down coat and sweater, I was still freezing cold in the building; other people were running around in t-shirts. Our weather today was 30-32F and drizzling, really mild for this time of year. He asked if I was going thru menopause despite my age (41) and I said no. Then he asked "Are you cold like that all the time?" I said no, it started a few months after starting the Cymbalta. "And do you sweat like that all the time?" I said no, only when I feel the cold. He became very concerned and printed me out some information on seratonin syndrome, a potentially deadly condition.

This syndrome is actually a drug reaction, similar to poisoning, from mixing triptan drugs like migraine medicines (I use Maxalt as needed) with antidepressants called selective seratonin/norepinephrine reuptake inhibitors, SSRIs and SNRIs. Seratonin is made in the nerve cells, and seratonin syndrome most often occurs when two or more drugs that increase the body's level of serotonin are taken together at the same time. Three of my medications cause seratonin levels to rise: tramadol, Cymbata, and gabapentin. The drugs cause too much serotonin to be released or to remain in the brain area, which is potentially fatal. Early symptoms include sweating and shivering, disorientation, dizziness (which I had at midday), progressing with diarrhea, vomiting, rigid muscles, uncontrollable fever, and seizures. If you Google seratonin syndrome there are several good websites such as the Mayo Clinic with full info on it. It is reversible by taking anti-seratonin agents.

The pharmacist called an ER doc to come look at me right there in the pharmacy before I left. But I was lucid, so they felt OK to let me go. The doc said the sweating and dizziness sound like early symptoms. Needless to say I made another appointment immediately with my doctor to discuss an alternate treatment. Boy, I learn something new every day with this darn fibro! This turned out to be a very good warning (for me especially, because I try to be so cavalier and not complain) to discuss even the smallest strange symptom with your doc to make sure all is well. I also thanked the pharmacist for being so observant; it was really above and beyond. The fact that he looks like Anderson Cooper as well was just an added bonus!

Veteran Member

Date Joined Nov 2008
Total Posts : 2858
   Posted 2/3/2010 6:15 AM (GMT -7)   

Littleneck...I am so glad your pharmacist was observant and asked you all the right questions.  Seratonin Syndrome is very dangerous.  Frankly, I am getting very frustrated with doctors that prescribe drugs without investigating interactions and side effects.  Not to beat a dead horse(I have mentioned this before on the forum) but my doctor put me on Lexapro obviously knowing very little about the drug.  I got free samples so I didn't have an insert with all the info in the blister packs.  When I wanted to go off due to constant blurred vision that didn't go away, I decided to go off.  No problem, he said.  You are on the smallest dosage (10mg) so you shouldn't have any withdrawals.  Wrong.  I have been suffering since October.  It was my pharamacist that told be that weaning from this particular drug should take a year, cutting the dosage by 10ths every month, as it is the most potent SSRI on the market.  Seratonin effects every organ in the body...and you are right.  An overload can be lethal.  Thank goodness for pharmacists!  Mine printed me a copy of the info that comes with Lexparo when you actually buy the drug.  My doctor who knows I take NSAID's for fibro didn't even know that one of the first alerts listed on the page is NO NSAID's while on this drug.  It can cause intestinal/stomach bleeding...which I was also treated to.  Oddly enough, I know how you feel as the lack of seratonin seems to pummel our bodies in the same manner as too much.  Hope you go to your doctor immediately and get this taken care of!



fibro, menieres disease, RLS, anxiety disorder, disc compression, scoliosis, spinal stenosis TMJ  Meds: valium Advil

Veteran Member

Date Joined Jan 2010
Total Posts : 1097
   Posted 2/3/2010 6:21 AM (GMT -7)   
I just recently started Tramacet (had to stop Percocet) along with my Cymbalta and Oxycontin...and while I'm never cold, I do suffer from massive hot flushes and sweating. Now, I went into surgical menopause a few years ago, but haven't really had a big problem with hot flashes before. Since being on this combo of meds, it's been at least 5 or 6 heavy sweats a day, and nighttime is more like constant sweating.

I was warned about the dangers of these drugs, so I'm keeping my eye on it, but this is good information. Thank you for sharing, and I hope you are able to work out something new in your meds that won't have these issues.

Conditions: Fibromyalgia, Chronic Pelvic Pain, FAI, Reynauds, IBS, Surgical Adhesions, Ophthalmic Migraines (plus physically unable to vomit due to Nissen, and I have extremely tiny veins...a joy for blood work or IV's)
Surgeries: Appendix, Uterus, Nissen Fundoplication for GERD, Left Ovary, Gallbladder, Right Ovary, TVT
Medications: Oxycontin, Tramacet, Cymbalta, Nortriptyline
Other: Vitamin D, Multi-Vitamin

getting by
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Date Joined Sep 2007
Total Posts : 41830
   Posted 2/3/2010 7:48 AM (GMT -7)   
Thank you from me too for sharing this information. As was posted above, good think the pharmacist noticed. You are lucky to have such a good pharmacist. He could have very well saved your life. And to call emt was a good thing. I hope that you get this all sorted out. I think you were lucky this time. I hope that your doc doesnt prescribe anything dangerous to you again.

Best wishes to you, keep posting.

Hugs, Karen
  Moderator-Depression and fibromyalgia
fibromyalgia, Chronic fatigue, depression,allergies

Veteran Member

Date Joined Aug 2007
Total Posts : 6067
   Posted 2/3/2010 8:14 AM (GMT -7)   
And people wonder why I have a medphobia!!!  Thank goodness for your pharmacist. I never go in to pick up meds, go through drive-thru. I'm glad you didn't do that.
I'm on 100 mg of amitriptyline and 40 of celexa and my rheumy brought up cymbalta again Mon when I had an app. A red flag went up in my head before when my docs have brought it up. I'm not adding another anti-depressant to the mix.
I think this is a good lesson for us all and we should get to know our pharmacist and rely on them when it comes to meds, they are the experts in that field.
Thanks for sharing this with us and I hope you are back to normal soon.
luv and hugs
Forum Moderator Fibromyalgia
Fibro,Sjogrens, Anxiety, Gastroparesis, IBS, Gastritis, Allergies, High Blood Pressure, Low Blood Sodium, Osteoarthritis and Celiac
Amitriptyline, Celexa, Xanax, Synthroid, Zyrtec, Micardis, Spironalactone, Tylenol, Reglan, Lidoderm Patches, Carafate and Prilosec
Vit D/calcium

Veteran Member

Date Joined Jun 2007
Total Posts : 906
   Posted 2/3/2010 1:44 PM (GMT -7)   
I'm glad to hear this too. I have taken nortriptylilne for a long time and it seems to help with my RLS. If I forget or run out, my RLS starts to act up. I also take Prozac, and have for at least 10 years. One time my dr. asked when I took them and he seemed ok with me taking Prozac in the am and the other at night. I haven't noticed any of the symptoms you stated, but thanks for this info. Diane
Fibromyalgia since 1984, Sjogren's, Hashimoto's Thyroiditis, Auto-immune eczema, GERD, osteoarthritis, IBS, RLS, sleep apnea

Veteran Member

Date Joined Jul 2009
Total Posts : 4796
   Posted 2/3/2010 4:09 PM (GMT -7)   
Littleneck, I am so glad that your pharmacist is so observant and took the time to ask
you questions. Serotonin syndrome is so dangerous. You must feel relieved to know that
you are no longer taking a potential deadly combo.

Thanks for sharing this info. I know I did a double check of my meds after I read your

Hugs, Robin
Fibromyalgia, MCTD (Lupus, Scleroderma & RA) Raynaud's, Osteoporosis,
Osteoarthritis, Degenerative Disc Disease, Migraines, and Hypertension
Prescription Meds: Savella, Cyclobenzaprine, Methotrexate, Diltiazem, Boniva,
Folic Acid.  OTC Meds: Multi-vitamin. Vit, D, Vitamin B12 & calciim supplements

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Date Joined Apr 2005
Total Posts : 17497
   Posted 2/3/2010 4:12 PM (GMT -7)   
Littleneck, what a story!  Thank you so much for posting this.  I have said many times on the forum that the pharmacists actually understand the medication better than the doctors.  That's their "specialty".  Even if I want to take a supplement, I talk to my pharmacist first.  He knows all about prescription meds and supplements.  The info on the meds are at their fingertips, too.
I'm soooo glad you went in today to pick up your prescriptions.  What a blessing!
Forum Moderator/ Fibromyalgia
Fibromyalgia, Crohn's Disease, Ostomy, Diabetes, Autoimmune Inner Ear Disease, Osteoporosis
God does not give us a spirit of fear, but of power and of love and of a sound mind.    2 Timothy 1:7

Nana Monster
Veteran Member

Date Joined Jul 2009
Total Posts : 957
   Posted 2/3/2010 5:42 PM (GMT -7)   
Sounds like you had a good pharmacist. Most of the ones in this area are morons. You ask them anything and they look at you
blankly. Ask about herbs and it's like you're from another planet; it's not FDA approved. Well, I tell them the stuff you prescribe
is FDA approved and they know how dangerous they are. Did I miss something here???

Good luck with your new adventures in modern medicine....hope the reactions are better. Godspeed.

Veteran Member

Date Joined Apr 2008
Total Posts : 1522
   Posted 2/3/2010 7:08 PM (GMT -7)   
Please write a letter to the pharmacy manager plus everyone else you can think of. Many pharmacies are cutting pharmacists to the minimum and adding pharmacy assistants to save money. In many of the chain pharmacies around here, you probably won't even see the pharmacist if you are just getting refills.

A few years ago, my pharmacist noticed that I was very aggressive while waiting to refill my prescription. He became very concerned and explained that the med I was taking could cause aggression. I knew it was a problem but I didn't realize how bad I was. I probably would have hurt someone had I gone back to work while still on the med.

There a a lot of people here that take tramadol and SSRIs. Many are not familiar with serotonin syndrome but they should be. It's supposed to be rare but one of our local fibro docs has been warning his patients about it because he thinks it's on the rise.

New Member

Date Joined Feb 2010
Total Posts : 1
   Posted 2/6/2010 7:29 AM (GMT -7)   
I am new on this forum, but I wanted to share an experience I had while on Cymbalta. I was experiencing extremely heavy sweating, and had complained about it to every doctor I saw, to which the standard response was "Oh, poor baby." Through some research, I found that Cymbalta can cause heavy sweating. I was experiencing dripping off my face sweat. I shared this with my family doctor, and I weaned off the Cymbalta (that's a whole other story!), but the sweating has disappeared. Thanks goodness. I would get chilled after the sweating episode as well, and then that would start a whole other sweating episode. I just wanted to share that bit of my experience.
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