Patient's Query
Hello doctor,
I have been struggling with depression, severe anxiety, palpitations, and IBS (irritable bowel syndrome) diarrhea for the past many years. Despite consulting multiple doctors and psychiatrists, I have not found an effective combination of medications that suits both my IBS and anxiety issues. Currently, I am under the care of a psychiatrist who has prescribed the following:
1. Nexito Forte: 1-1.
2. Pronol H: 1-1.
3. Nortimer 25 mg: 1-1.
While I have experienced some relief from my IBS symptoms, my severe anxiety remains largely unresolved. My doctor has suggested adding one of the following medications: Prothiaden 50 mg, Paroxetine 12.5 CR, Stablon 12.5, or Desvenlafaxine 50 mg. However, I am confused about which option would be best to control both my anxiety and IBS without causing side effects.
This ongoing struggle has severely impacted my personal, social, and professional life, leading to frequent absences from work due to my symptoms. I desperately need guidance on which medication to add to my current regimen to improve my condition.
Please help.
Hi,
I am glad you chose icliniq for your medical-related queries.
I understand your concern and will try to help you with it.
Based on your symptoms, it is clear that you are experiencing both anxiety and IBS (irritable bowel syndrome). Starting Paroxetine (selective serotonin-reuptake inhibitor) could be a good option, as it is effective in managing both anxiety and IBS, with minimal gastric side effects. You can gradually increase the dosage of Paroxetine while tapering down the dosage of Nexito (Escitalopram). In addition to medication, daily exercise is crucial. Diet plays a significant role in managing IBS, so it is important to avoid fast and oily foods. Instead, focus on eating small, frequent meals and avoid smoking and drinking, if applicable. If you experience heaviness in the abdomen, acidity, or a burning sensation, consider taking a combination of Rabeprazole (antacid)with Levosulpiride (benzamide class) on an empty stomach. Remember that IBS is often secondary to anxiety, so managing your anxiety will likely help control your IBS. Alongside physical exercise, incorporate relaxation exercises into your routine. If Paroxetine does not suit you, Desvenlafaxine (selective serotonin and norepinephrine reuptake inhibitor) can be a good alternative, with Stablon (atypical tricyclic antidepressant) as a last resort.
Kindly consult a specialist, talk with them, and take medications with their consent.
Thank you for consulting me.
You can always reach me at icliniq.com.
Patient's Query
Hi doctor,
Thank you for the reply.
I attempted to add Paroxetine 12.5 CR alongside Nexito Forte and Nortimer 25 mg in the past. However, when I tried to reduce the dose of Nexito Forte, I experienced a significant increase in anxiety and stomach discomfort, making it difficult to lower the Nexito Forte dose. Desvenlafaxine suits me well, but I am unsure how effective it will be in managing both my IBS diarrhea and anxiety when taken with Nexito Forte and Nortimer. Could you please advise on what I should do in this situation and the appropriate dosage of the medications? Additionally, I would appreciate guidance on how I can continue treatment under your care.
Please suggest.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
I suggest you follow the instructions mentioned below.
1. Do not reduce the dosage of Nexito immediately. First, increase the dosage of Paroxetine to 25 mg and allow your body to adjust before attempting to taper off Nexito.
2. Consider starting Etizolam (Thienodiazepine) with Propranolol (beta blocker) instead of using Propranolol alone.
3. Desvenlafaxine can also be beneficial for IBS with diarrhea. Since any medication that effectively controls anxiety will help manage IBS, you can start Desvenlafaxine as well.
4. Begin with 50 mg of Desvenlafaxine for the first ten days, and then gradually increase the dosage up to 150 mg if necessary.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
I have depression, severe anxiety, palpitation and IBS diarrhea problem from last 20 years. I have shown to various doctors and psychiatrist but not getting good combination of medicine for both IBS Diarrhea and anxiety related issue. Lots of medicine do not suits me. Presently I am taking treatment from one of psychiatrist and he has prescribed me given below medicine. Nexito Forte- 1-1 Pronol H - 1-1 Nortimer 25mg - 1-1 Sir, I am not feeling much improvement in IBS diarrhea and anxiety Problem. My doctor suggested me to add Clonil 25 mg in night to help me in IBS diarrhea problem. Sir, once you suggested to add Paroxetine HCL along with above medicine to control my IBS diarrhea with anxiety. As I reduce doses of nexito forte it causes brain zap, severe anxiety and fast heartbeat and too much sweating issue. Please suggest what should I do. Please help me and guide me as it's affecting my personal life and i am unable to concentrate on my office work and avoid to go in social gathering. Sometime I think of suicide due to my IBS diarrhea and severe anxiety problem. Please help me.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
According to me you need to gradually stop Nexito once you get the good effect of paroxetine. Do not immediately stop Nexito as it creates more anxiety. So, in your case first add paroxetine 12.5 with ongoing medicine for at least 15 days and then gradually stop Nexito and increase the dosage of paroxetine to 25 mg. Avoid fast food and oily food. Do start exercise. Take small but frequent meals.
Looking forward to your response in order to help you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
So I may start this combination. Please confirm.
Sir, if above combination does not suits me well than how good is Clonil 25 along with Nexito forte and Pronol H for IBS diarrhea and anxiety issue. Please suggest.
Hi,
Welcome back to icliniq.com.
I read and understand your concern.
Start with Pari CR lite 12.5 (paroxetine with clonazepam 0.25) two times a day. Then gradually discontinue it. If this combination does not suit you then go for Clonil. But other than medicine go for non-pharmacological management.
Looking forward to your response in order to help you.
Thank you.
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Answered byDr. Vipul Chelabhai Prajapati
Medically reviewed byiCliniq medical review team
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