Patient's Query
Hello doctor,
I have had severe anxiety, fast heartbeat, palpitation, depression, and IBS diarrhea for the last 20 years. I tried various medicines, Ayurvedic, Allopathic, and Homeopathic but no results. Most psychiatric medicines do not suit me. Presently I have consulted a psychiatrist and he suggested some medicines (Nexito Forte, Pronol H, and Nortimer 25 mg).
The above medicine suits me well and controls my IBS diarrhea problem. But my anxiety issue is not controlling. I consulted again with my psychiatrist and he suggested increasing Escitalopram by 5 to 10 mg as per the given below combination to control my anxiety with IBS diarrhea problem.
Nexito Forte 10 mg twice daily.
Nexito plane 5 to 10 mg twice daily.
Pronol H twice daily.
Nortimer 25 mg twice daily.
I am confused about which combination is best suited for IBS diarrhea with severe anxiety, depression, and heart palpitation. I have heard that Escitalopram should not be used more than 20 mg. If I increase Nortriptyline then it creates a heart palpitation issue.
All laboratory tests found normal except for tachycardia in ECG.
Please suggest it to me as I have been suffering for the last 20 years and not getting a proper solution to my problem.
Kindly help.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
As with current medications, your IBS (irritable bowel syndrome) is under control but you still have anxiety. In such cases, the Escitalopram (selective serotonin reuptake inhibitor) dose can be increased.
Escitalopram has been used in higher doses clinically, for example, it has been used up to 40 mg (milligrams) or even more in OCD (Obsessive-compulsive disorder). So higher doses can be used but under regular supervision.
Nortriptyline (tricyclic antidepressants) dose can be used up to 100 to 150 mg per day.
So you should keep regular and frequent follow-ups with your doctor during the process of increasing the drug dose.
I suggest you consult your specialist doctor, discuss with him or her, and take the medicines with their consent.
I hope this helps.
Do get back in case of any further queries.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I can not increase the dose of Nortriptyline as it creates palpitation and sweating issues. However, I do have not not much issue with Escitalopram. Presently I am taking 20 mg Nexito Forte 10 mg in the morning and 10 mg in the evening. Should I increase Nexito to 10 mg thrice?
Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
It is fine if you continue the same dose of Nortriptyline (tricyclic antidepressants) at which you are comfortable.
The dose of Escitalopram (selective serotonin reuptake inhibitors) is to be increased as suggested by your treating doctor. if you are too anxious to increase it to 35 mg (milligrams) a day, then increase it slowly, from 20 to 30 mg per day for a week, and then decide according to response or side effects.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
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Answered byDr. Ramchandra Lamba
Medically reviewed byiCliniq medical review team
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