24 replies to this topic

[neogenic]

I consider myself a supplement expert, but I know only some basics about pharmacology of drugs. I have occipital neuralgia and cerivcal compression that gives me a great deal of headaches, inflammation, fatigue, etc. The only things that have helped through the years are frequent deep tissue massages to my neck/traps (once every two weeks) and recently I've tried cymbalta and lyrica per a MD. And it does make a notable difference. I wouldn't say I am depressed, but the toll of the pain/inflammation is legitimate. The weird thing is I am feeling somewhat depressed/apathetic NOW. And cymbalta has decreased my sex drive. And I get some tachycardia from cymbalta...like ephedrine "lite" (maybe the norepinephrine pathway). I am usually happy/funny, etc. and people are constantly asking me, "What's wrong?" and I say, "I am not sure." But it's more significant lately. I am on 60mg QD.

While cymbalta is not exactly a SSRI (given the norepinephrine effect) in classification, I came across this in a Google search:
http://depression.ab...out-of-love.htm
That raising serotonin lowers dopamine and there's hundreds of comments on these loss of feelings for love, tenderness and a general apathy. I could use help. I don't want to feel apathetic and I don't like having significant pain either. Is this common? Is there a better path I should take?

Thank you so much for your help.

[jadamgo]

I'm not sure what your other options for pain relief are (except potentially increasing the dose of lyrica), but to combat the emotional numbing and sexual side effects of cymbalta you can add a dopaminergic. Something like Wellbutrin should work. Other options include amantadine, sulbutiamine, tyrosine, DLPA, iron, or cabergoline. I'm sure there are other options out there.

[tham]

How about acupuncture ?

http://www.ncbi.nlm....t_uids=19004197


Carbamazepine (Tegretol) has been used to treat
trigeminal neuralgia, the closest to occipital neuralgia,
for decades. It has also been used for tinnitus.

http://www.ncbi.nlm....t_uids=10030430


Carbamazepine's structure looks very much like
the tricyclic antidepressants.

However, carbamazepine has a risk of causing
blood disorders, as well as liver toxicity.

So I took oxcarbazepine (Trileptal) on my own accord,
after checking out its pharmacokinetics, for tinnitus
years ago. It didn't really help though, but perhaps that
was because I took too low a dose and for too short a time.

http://en.wikipedia....i/Oxcarbazepine

You may try it out for your neuralgia.


Nevramin, which has TTFD or fursultiamine in place
of standard thiamine.

http://www.reviewstr...eviews/?p=52045


If you can't get Nevramin over there, just take Ecological
Formula's Allithiamine plus 500 mg of methylcobalamin
and 250 mg B6.


I wonder why you would want to take Cymbalta, a SNRI
similar to Effexor, with a heavy incidence of withdrawal
symptoms.

[tham]

There is an increased risk of suicide with Trileptal, though.

http://www.reuters.c...E63C4R020100413

[neogenic]

How about acupuncture ?

http://www.ncbi.nlm....t_uids=19004197


Carbamazepine (Tegretol) has been used to treat
trigeminal neuralgia, the closest to occipital neuralgia,
for decades. It has also been used for tinnitus.

http://www.ncbi.nlm....t_uids=10030430


Carbamazepine's structure looks very much like
the tricyclic antidepressants.

However, carbamazepine has a risk of causing
blood disorders, as well as liver toxicity.

So I took oxcarbazepine (Trileptal) on my own accord,
after checking out its pharmacokinetics, for tinnitus
years ago. It didn't really help though, but perhaps that
was because I took too low a dose and for too short a time.

http://en.wikipedia....i/Oxcarbazepine

You may try it out for your neuralgia.


Nevramin, which has TTFD or fursultiamine in place
of standard thiamine.

http://www.reviewstr...eviews/?p=52045


If you can't get Nevramin over there, just take Ecological
Formula's Allithiamine plus 500 mg of methylcobalamin
and 250 mg B6.


I wonder why you would want to take Cymbalta, a SNRI
similar to Effexor, with a heavy incidence of withdrawal
symptoms.

I will check some of this out. Cymbalta, as an SNRI, is quite effective with neuropathic pain and can be prescribed for it, with no case of depression.
Any other thoughts on combination therapy with the cymbalta, a better pharmacologic choice, supplemental choice or other treatment? Thanks!

[nowayout]

Tramadol works pretty well for neuropathic pain, and in my case it definitely acts as an antidepressant. It can make you feel euphoric.

Edited by viveutvivas, 07 November 2010 - 09:35 PM.

[pycnogenol]

Tramadol works pretty well for neuropathic pain, and in my case it definitely acts as an antidepressant. It can make you feel euphoric.

Can't stand that useless Tramadol garbage - it never worked for me anyway. Pain lowering? My posterior.

Cymbalta is even worse. That utter crap made me damn near suicidal back in '04 and I was only on that evil junk for 2 weeks.

Turns out that my doctor at the time was getting big kickback $$$ from the company that makes it and I called him out on it. Heh, heh.

Psst...wanna know if YOUR doctor is on the take with the pill-happy, profit-mongering Rx pushers? Plug his/her name into this very useful website and find out:

http://projects.prop...org/docdollars/

Edited by pycnogenol, 07 November 2010 - 11:39 PM.

[neogenic]

Tramadol works pretty well for neuropathic pain, and in my case it definitely acts as an antidepressant. It can make you feel euphoric.

Can't stand that useless Tramadol garbage - it never worked for me anyway. Pain lowering? My posterior.

Cymbalta is even worse. That utter crap made me damn near suicidal back in '04 and I was only on that evil junk for 2 weeks.

Turns out that my doctor at the time was getting big kickback $$$ from the company that makes it and I called him out on it. Heh, heh.

Psst...wanna know if YOUR doctor is on the take with the pill-happy, profit-mongering Rx pushers? Plug his/her name into this very useful website and find out:

http://projects.prop...org/docdollars/

Well neither doctor I go to at my clinic is on there. FYI.

[neogenic]

What does the TTFD/fursultiamine/sulbutiamine do in this regard BTW? I've used them in the past along with other nootropics.

I took DOPA Macuna product from NOW Foods tonight to see if lower dopamine is at play here.

I do get this apathetic/detached from reality/immobilized feeling sometimes like I am watching a movie instead of living life that, quite frankly scares me. It's fairly transient, but bothers me nonetheless.

[pycnogenol]

Well neither doctor I go to at my clinic is on there. FYI.

My doctor took $1,676 from Pfizer. Could of been worse I suppose.

Edited by pycnogenol, 08 November 2010 - 04:05 PM.

[jadamgo]

What does the TTFD/fursultiamine/sulbutiamine do in this regard BTW? I've used them in the past along with other nootropics.

I took DOPA Macuna product from NOW Foods tonight to see if lower dopamine is at play here.

I do get this apathetic/detached from reality/immobilized feeling sometimes like I am watching a movie instead of living life that, quite frankly scares me. It's fairly transient, but bothers me nonetheless.

This is a form of dissociation, often called depersonalization or derealization. In and of itself, it's harmless. It's a normal experience that happens occasionally to many (perhaps most) people, and only represents a problem if it happens often enough to cause problems for you, or if you let yourself feel distinctly bothered by it, or if it's associated with symptoms of a psychiatric problem.

Please don't take DOPA for this. It has too many side effects, especially if you aren't taking a peripheral DOPA decarboxylase inhibitor like carbidopa. Other dopaminergics are much safer.

[neogenic]

What does the TTFD/fursultiamine/sulbutiamine do in this regard BTW? I've used them in the past along with other nootropics.

I took DOPA Macuna product from NOW Foods tonight to see if lower dopamine is at play here.

I do get this apathetic/detached from reality/immobilized feeling sometimes like I am watching a movie instead of living life that, quite frankly scares me. It's fairly transient, but bothers me nonetheless.

This is a form of dissociation, often called depersonalization or derealization. In and of itself, it's harmless. It's a normal experience that happens occasionally to many (perhaps most) people, and only represents a problem if it happens often enough to cause problems for you, or if you let yourself feel distinctly bothered by it, or if it's associated with symptoms of a psychiatric problem.

Please don't take DOPA for this. It has too many side effects, especially if you aren't taking a peripheral DOPA decarboxylase inhibitor like carbidopa. Other dopaminergics are much safer.

So you think the Macuna supplement could be dangerous? Why do you feel that way?

[nowayout]

So you think the Macuna supplement could be dangerous? Why do you feel that way?

Tolerance to l-dopa develops very rapidly.

Edited by viveutvivas, 08 November 2010 - 10:37 PM.

[pycnogenol]

So you think the Macuna supplement could be dangerous? Why do you feel that way?

Tolerance to l-dopa develops very rapidly.

I'm certainly not doubting you but I've not found that to be the case as I take mucuna pruriens (usually 5 days on / 2 days off).

This is the product I take:

http://www.tattvashe...ruriens,/Detail

Edited by pycnogenol, 08 November 2010 - 11:21 PM.

[neogenic]

TTFD, sulbutiamine, etc brought up here...how exactly would that help in my scenario?

[tham]

Anticonvulsants and antidepressants, including
the tricyclics, are the first choice for neuropathic
pain, superior to the opoids and NSAIDS.


Guidelines for the management of neuropathic pain.

http://www.ncbi.nlm....t_uids=20426709

http://www.ncbi.nlm....t_uids=19801049

http://www.mayoclini...3_suppl/S3.long

http://www.ncbi.nlm..../issues/185965/

http://www.ncbi.nlm....t_uids=19238782

http://www.ncbi.nlm...._uids=19471799


Looks like your doctor is on the right track with pregabalin.

http://www.ncbi.nlm....t_uids=20087480


Otherwise, you can always fall back on gabapentin, its predecessor.

http://www.ncbi.nlm....t_uids=18705259


Lacosamide, new generation anticonvulsant.

http://en.wikipedia....wiki/Lacosamide

http://www.ncbi.nlm....t_uids=17092498

http://www.ncbi.nlm....t_uids=18986235


" Lacosamide is effective as an analgesic in a
bone cancer pain model as well as chemotherapy-
induced neuropathic pain model in animals and
even reduced hyperalgesia where morphine
did not. "

http://www.ncbi.nlm....t_uids=17395176



Lamotrigine.

http://www.ncbi.nlm....t_uids=20492571

http://www.ncbi.nlm....t_uids=19040151

http://www.ncbi.nlm....t_uids=19928414


The snail drug, ziconotide, which I suggested to Bill
for his cancer pain last year.

http://www.ncbi.nlm....t_uids=20142352

http://www.ncbi.nlm....t_uids=18050098

http://www.ncbi.nlm....t_uids=20097124


" The evidence suggests that carbamazepine is still the
first line drug for medical management, but this should
be changed to oxcarbazepine if there is poor efficacy
and an unacceptable side effect profile. Combination
of carbamazepine with lamotrigine or baclofen is the
second line treatment when monotherapy fails, but
the evidence is weak. "

http://www.ncbi.nlm....t_uids=17612914


" Carbamazepine (or oxcarbazepine) and lamotrigine
appear to be the most effective, followed by baclofen. "

http://www.ncbi.nlm....ez/queryd.fcgi?
db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=16533146


The old antiarrhythmic, mexiletine. I considered trying this
drug over two decades ago for tinnitus, along with the other
two lidocaine-type analogs in its class, tocainide and
flecanide. Risk of blood disorders, but rare with mexiletine.

Antiarrhythmic drugs also typically have a paradoxical
proarrhythmic effect.

If your pain responds to IV lidocaine, you will likely
respond to this class of drugs.

http://en.wikipedia....wiki/Mexiletine

http://www.ncbi.nlm....t_uids=15661106

http://www.ncbi.nlm....st_uids=1312797

http://www.ncbi.nlm....t_uids=20097124

http://www.ncbi.nlm....t_uids=19504185

http://www.ncbi.nlm....t_uids=18222627

http://www.ncbi.nlm....t_uids=18484790



" Local anaesthetics are used less often, because
of the high incidence of side effects (especially
with tocainide, flecainide). An analgesic effect
has been described in neuropathic pain, however,
probably due to membrane stabilization and
reduction of aberrant signal conduction.
Mexiletine is considered to be the safest local
anaesthetic, and should be used initially in small
doses (100-150 mg/d). If side effects do not occur,
doses can be increased step-wise up to 900 mg/d.
Local anaesthetics are indicated for the treatment of
severe neuropathic pain; this treatment is
contraindicated in patients with cardiac arrhythmias. "

http://www.ncbi.nlm....t_uids=18415535



Mexiletine in erythromelalgia, a rare condition.

http://en.wikipedia....Erythromelalgia

http://pediatrics.aa...full/115/4/e504

http://www.ncbi.nlm....t_uids=20392536


Mexiletine in refractory headache.

http://www.ncbi.nlm....t_uids=18793209



Tocainide.

http://www.ncbi.nlm....st_uids=3103044

http://www.ncbi.nlm....t_uids=12504783

http://www.ncbi.nlm....st_uids=9131907

Edited by tham, 09 November 2010 - 04:58 PM.

[nowayout]

Anticonvulsants and antidepressants, including
the tricyclics, are the first choice for neuropathic
pain, superior to the opoids and NSAIDS.

The OP is taking them already, but was looking for alternatives due to side effects.

Also, it depends on the type of pain.

For back pain, I had no success with amitriptylene, and only limited success with hydrocodone, but Tramadol turned out to help a lot.

http://painmuse.org/?p=52

Conventional Treatments DO NOT work for leg pain radiculopathy.
After all this hype that Tricyclic Antidepressants should be tried first for Neuropathic pain, it was amazing that it worked so poorly for lumbar radiculopathy, the commonest of all neuropathic pains.

Initially, although a very small study, (6 patients on Nortriptyline) there was a suggestion of modest improvement of Nortriptyline,
Pain 76 (1998) 287–296
A placebo-controlled randomized clinical trial of nortriptyline for chronic low back pain
J. Hampton Atkinson et al
However, in 2007,a larger trial found Nortriptyline faired poorly with an average dose was 84 mg.; Morphine, tested separately, did poorly as well with an average does of 62 mg.
Pain 130 (2007) 66–75
Morphine, nortriptyline and their combination vs. placebo in patients with chronic lumbar root pain
Suzan Khoromi et al.

"In the 28 out of 61 patients who completed the study, none of the treatments produced significant reductions in average leg pain or other leg or back pain scores. Pain reduction, relative to placebo treatment was, 14% for nortriptyline (95% CI = [-2%, 30%]), 7% for morphine (95% CI = [-8%, 22%]), and 7% for the combination treatment (95% CI = [-4%, 18%]). Mean doses were: nortriptyline alone, 84 ± 24.44 (SD) mg/day; morphine alone, 62 ± 29 mg/day; and combination, morphine, 49 ± 27 mg/day plus nortriptyline, 55 mg ± 33.18 mg/day. Over half of the study completers reported some adverse effect with morphine, nortriptyline or their combination. Within the limitations of the modest sample size and high dropout rate, these results suggest that nortriptyline, morphine and their combination may have limited effectiveness in the treatment of chronic sciatica."

Pregabalin apparently failed in radiculopathy as well:
A.E.S.U. Remmers, L. LaMoreaux, J.P. Young, J. Moore and M. Poole,
Pregabalin treatment of patients with chronic low back pain (2000) Presented at the American Pain Society Annual Meeting, Atlanta, Georgia, November 2-5.

Given that Gabapentin is structurally very similar to Pregabalin, it is unlikely it would fare any better.

Another more recent larger study of pregabalin failed to find benefit in radiculopathy:

The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Ralf Baron^{a, ,} , Rainer Freynhagen^b, Thomas R. Tölle^c, Christian Cloutier^d, Teresa Leon^e, T. Kevin Murphy^e, Kem Phillips^e and on behalf of the A0081007 Investigators

^a Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts University, Kiel, Germany

^b Department of Anaesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Benedictus Krankenhaus Tutzing, Germany

^c Department of Neurology, Technische Universität München, Germany

^d Clinique Multidisciplinaire de la douleur Centre Hospitalier, Université de Sherbrooke, Sherbrooke, Québec, Canada

^e Pfizer Global Research and Development, New York, NY, USA

Received 17 September 2009; revised 28 February 2010; accepted 12 April 2010. Available online 20 May 2010.

Abstract
We evaluated the efficacy of pregabalin in patients with chronic lumbosacral radiculopathy. This randomized, controlled, withdrawal trial included five phases: screening (4–18 days); run-in (4–10 days) to screen out placebo responders; single-blind (28 days) to identify pregabalin responders; double-blind to randomize responders to pregabalin or placebo (35 days); and final study medication taper (7 days). The primary endpoint was time to loss of response (LOR) during the double-blind phase (1-point increase in pain, discontinuation, or rescue-medication use). In the single-blind phase, 58% of patients had 30% pain reduction. In the double-blind phase, pregabalin (n = 110) and placebo (n = 107) groups did not differ significantly in time to LOR. Adverse events caused the discontinuation of 9.9% and 5.6% of pregabalin-treated and placebo-treated patients, respectively. Most patients with chronic lumbosacral radiculopathy responded to pregabalin therapy; however, time to LOR did not significantly differ between pregabalin and placebo. Considering the results of all phases of the study, it is difficult to draw definitive conclusions from it, suggesting a need for further work to understand the clinical potential of pregabalin treatment for lumbosacral radiculopathy.

<a title="Pain.">Pain. 2007 Dec 5;132(3):237-51. Epub 2007 Oct 24.


Pharmacologic management of neuropathic pain: evidence-based recommendations.
Dworkin RH, O'Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, Kalso EA, Loeser JD, Miaskowski C, Nurmikko TJ, Portenoy RK, Rice AS, Stacey BR, Treede RD, Turk DC, Wallace MS.

University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. robert_dworkin@urmc.rochester.edu

Comment in:

• Pain. 2007 Dec 5;132(3):225-6.

Abstract
Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered for recommendation if their efficacy was supported by at least one methodologically-sound, randomized clinical trial (RCT) demonstrating superiority to placebo or a relevant comparison treatment. Recommendations were based on the amount and consistency of evidence, degree of efficacy, safety, and clinical experience of the authors. Available RCTs typically evaluated chronic NP of moderate to severe intensity. Recommended first-line treatments include certain antidepressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine), calcium channel alpha2-delta ligands (i.e., gabapentin and pregabalin), and topical lidocaine. Opioid analgesics and tramadol are recommended as generally second-line treatments that can be considered for first-line use in select clinical circumstances. Other medications that would generally be used as third-line treatments but that could also be used as second-line treatments in some circumstances include certain antiepileptic and antidepressant medications, mexiletine, N-methyl-D-aspartate receptor antagonists, and topical capsaicin. Medication selection should be individualized, considering side effects, potential beneficial or deleterious effects on comorbidities, and whether prompt onset of pain relief is necessary. To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP. Long-term studies, head-to-head comparisons between medications, studies involving combinations of medications, and RCTs examining treatment of central NP are lacking and should be a priority for future research.

Edited by viveutvivas, 09 November 2010 - 05:22 PM.

[neogenic]

I am going to click through all the links. I wish doctors were more progressive and allowed off-use, or less used drugs to try as alternatives, but they seem stuck on them. My doctor told me its in my head that cymbalta lowered my sex drive (amidst us trying to have a baby)...and yet, online it seems fairly common. He says, "Its like a 1 in a 100 chance".

I do have to say adding the Macuna/DOPA does seem to help. I feel a little more "bouncy" and less disconnected. BTW that disconnected feeling that was addressed above, yes, may happen to all people, but let's say prior to cymbalta was once a month...now its once a day. Since adding the DOPA I have not felt that though (on my second day).

But things to counteract other things can be a slippery slope. I continue to appreciate all the feedback. It's taking me time to read through all the information and research it that's been offered up. Thanks.

[pycnogenol]

Anticonvulsants and antidepressants, including
the tricyclics, are the first choice for neuropathic
pain, superior to the opoids and NSAIDS.

First choice? Superior? That is a bunch of bull crap.
I don't care how many links you post. Thank goodness
you're not a chronic pain doctor.

Edited by pycnogenol, 10 November 2010 - 12:15 AM.

[tham]

First choice? Superior? That is a bunch of bull crap.
I don't care how many links you post. Thank goodness
you're not a chronic pain doctor.

The people in my office took one look at your
post and advised me not to waste my time,
bringing myself down to your extremely low
level, by replying to you.

One of them commented that "this is obviously
one of those stupid young Neo-Nazi racists
who go around writing crap himself all over
forums on the net, belittling other people.
Don't waste your time talking to such low-life !"

However, I still felt compelled to write this.
Obviously I will be listening to my office
colleagues' advice after this single reply,
and won't be wasting further time conversing
with primates of such a low level of intelligence.


I spent a lot of time looking up the research on
drugs to help Neogenic, not for first-class
troublemakers like YOU (whom I
couldn't care less about and ought to
be banned immediately by the administrators
here), who have nothing better to do on
forums than make cynical remarks at other
people's legitimate efforts, tantamount to
young kids on Yahoo chatrooms blubbering
nonsense, while relishing the anonymity and
security of the internet - i.e. hiding behind
their computers from thousands of miles
away, confident that no one will ever find
out about their inferiority complexes,
childishness and other serious psychological
shortcomings.


Seriously, I believe you should be the one
on heavy psychotropic drugs, not Neogenic.
May I recommend Luvox (fluvoxamine) -
typically reserved for exhititionists and other
forms of compulsive-obsessive paraphilia ?
You are also urged to throw in haloperidol,
phenytoin and cyproterone for good measure.

http://www.ncbi.nlm....st_uids=8071253

http://www.ncbi.nlm....st_uids=7964261

http://www.ncbi.nlm....st_uids=2238716

http://www.ncbi.nlm....t_uids=10751915

http://www.ncbi.nlm....t_uids=18557968

http://www.ncbi.nlm....t_uids=10736576



Incidentally, your avatar looks very
much idiotic and mentally compromised
- a perfect fit for your personality.

Take care.

Edited by tham, 10 November 2010 - 11:01 AM.

[nowayout]

I spent a lot of time looking up the research on
drugs to help Neogenic, ...

But you missed the fact that Neogenic is already on the type of drugs you recommend, but wanted an alternative to anticonvulsants/antidepressants because of side effects.

[pycnogenol]

First choice? Superior? That is a bunch of bull crap.
I don't care how many links you post. Thank goodness
you're not a chronic pain doctor.

The people in my office took one look at your
post and advised me not to waste my time,
bringing myself down to your extremely low
level, by replying to you.


Incidentally, your avatar looks very
much idiotic and mentally compromised
- a perfect fit for your personality.

Wow, what a comeback!

Seriously, you have NO medical credentials to help anybody here.

We should all be very grateful that you are not a chronic pain doctor.

You're just another copy & paste blowhard on the Imminst Forums. Big whoop.

Get over yourself Tham and please seek professional help instead of trying
to give bad medical advice over the internet.

By the way, my avatar is an SNL character named Debbie Downer.

http://en.wikipedia....i/Debbie_Downer

For goodness sakes THAM you take things here so personally.

Perhaps the people in your "office" are residing in your small cranium.

Lighten up and please back away from the keyboard.

Edited by pycnogenol, 10 November 2010 - 04:23 PM.

[neogenic]

I did want to report I've been taking NOW's Macuna this whole week. I've never felt better. Its funny I feel like I am "back". I must've been deficient in dopamine, much the article I referenced in my original post discussed. That link showed hundreds of replies from people all reporting the same thing, so I guess it's fairly common. Anyway. I will report back, but things are much improved for the moment.

[nowayout]

I did want to report I've been taking NOW's Macuna this whole week. I've never felt better. Its funny I feel like I am "back". I must've been deficient in dopamine, much the article I referenced in my original post discussed. That link showed hundreds of replies from people all reporting the same thing, so I guess it's fairly common. Anyway. I will report back, but things are much improved for the moment.

Good to hear.

Just be aware that Mucuna should normally be cycled to remain effective. Some people recommend 1 day on and 1 day off, others do 5 on 2 off.

[jadamgo]

While you're taking Mucuna, I would suggest a good tea supplement that contains EGCG. When doctors prescribe levodopa, they prescribe it in combination with something (a DDCI drug) to prevent dopamine from being formed outside of the central nervous system and messing up things like blood pressure. Since you aren't getting your levodopa from a doctor, you'll need to find your own DDCI. Green tea supplements or other tea supplements with EGCG should do the job, because EGCG is thought to be a good peripheral DDCI. But there is a chance that EGCG could prevent the Mucuna from working; you could try increasing the dose of Mucuna and see if that helps. But if not, then of course stop taking the EGCG.