Should I risk starting new meds before tilt table?

Question

After a recent appointment, my neurologist wants to begin treating me for migraine.  Because of lightheartedness associated with my symptoms, though, she ordered a tilt table test.  The hospital could not schedule my test until about two from today.  So I'm wondering - can I start taking these new medications or can they potentially "mask" whatever might be found on the tilt table test?

The medications and supplements prescribed include:

Topamax
Imitrex
Magnesium supplementation
Riboflavin supplementation
CoQ-10 supplementation 

Thank you

Heiferly · Accepted Answer

You need to call the lab where the tilts are done and ask what drugs interfere with the tilt table test protocol and they will have you go over your med list and tell you which meds you need to go off and also how far in advance you would need to be off of them; if you do need to go off meds, you'll then need to talk to your doc or pharmacist to find out if you need to taper off or can go cold turkey on/off the meds for the test.  But as I said, generally speaking, the technicians in the lab are more knowledgeable about what meds interfere with the testing than the doctors who order the test.  You may want to double-check with your doc who ordered the test, but I would make certain you talk to the lab tech.  

Off the top of my head, Imitrex is a triptan and has potential effects on vasoconstriction, blood pressure, and heart rate.  I'm guessing you're prescribed the Imitrex as-needed for migraine attacks?  I would imagine they'll ask that you not take Imitrex within 24 hours of the test, and certainly not during the test as they will want to know if symptoms such as migraine are triggered by the test (unfortunately).  I don't know about your supplements at all; make sure you tell them dosages as well as what you're taking.  I'm not sure if it makes a difference if you're taking megadoses vs. "normal" supplementation.  As for topamax, that one I really *should* know because I take it myself, but it's been several years since I had a tilt table test without doing multiple other tests the same day, so I don't remember if that med is okay in the context of a tilt alone.  If you want to be *absolutely* sure, contact one of the testing labs at the major autonomic testing clinics at either Mayo, Vanderbilt, or Cleveland Clinic and ask if they require patients to go off topamax for tilt table testing.  I know Cleveland was able to tell me exactly which of my meds were problematic for which tests.

I hope your tilt goes well.
(If you do anticipate migraines triggered by the tilt, ask if they can have rapid IV medications ready for you to quell the pain and/or nausea as soon as the testing is over in case that does occur.  Better to be prepared in advance if they anticipate that may be an issue, especially since they probably will have an IV in place for the test anyway.  If this is your first tilt and no one has mentioned it to you yet, one other note:  you'll want to have someone else drive you for the test in case you're feeling unwell after it's over.)

Keep us updated,
heiferly.

bookworm8 · Answer

Thank you very much for the information.

You are correct about the Imitrex and migraines.  I have not nor plan to take it before the test next week though.  In fact, I've read it is not good for the type of migraine I am tentatively diagnosed with, so I may never take it at all.

I did call the lab yesterday (Cleveland Clinic) but they did not return my call.  Thus, I haven't started Topamax or Cyproheptadine (forgot that on the list.  I almost never take pills and suddenly staring at six to eight of them!).  Believe you me, I'd love to start trying something to get some relief, but it's getting so close to the test date that I doubt it would be worth starting.

I'll give them another call today.  Thanks again.

bookworm8 · Answer

I'm sorry for the important word omission; the tilt table test has to wait almost two weeks.  So by then I'd not only be on those new meds for awhile but I would also have titrated up one step with the Topamax.

Thanks again.

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