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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by mesonage on November 22, 2004, at 23:41:59
Hi all,
I was just wondering about the possibility of serotonin syndrome from combining an SSRI with narcotic painkillers (Lexapro and hydrocodone). I remember seeing something a while back of a case of either Serzone or Paxil with Vicodin - since Serzone, Paxil and Lexapro are all SSRI's, do you think it's a valid concern? My doc says no, but I think he downplays many of my concerns. Also, as Lexapro is fairly new, there may not be as much info, so I guess I'm just asking for guesses. What do you guys think?
Posted by Bill LL on November 23, 2004, at 8:47:15
In reply to serotonin syndrome question, posted by mesonage on November 22, 2004, at 23:41:59
I have taken the 2 together on 2 different occasions with no problems.
> Hi all,
>
> I was just wondering about the possibility of serotonin syndrome from combining an SSRI with narcotic painkillers (Lexapro and hydrocodone). I remember seeing something a while back of a case of either Serzone or Paxil with Vicodin - since Serzone, Paxil and Lexapro are all SSRI's, do you think it's a valid concern? My doc says no, but I think he downplays many of my concerns. Also, as Lexapro is fairly new, there may not be as much info, so I guess I'm just asking for guesses. What do you guys think?
Posted by Larry Hoover on November 23, 2004, at 12:30:09
In reply to serotonin syndrome question, posted by mesonage on November 22, 2004, at 23:41:59
> Hi all,
>
> I was just wondering about the possibility of serotonin syndrome from combining an SSRI with narcotic painkillers (Lexapro and hydrocodone). I remember seeing something a while back of a case of either Serzone or Paxil with Vicodin - since Serzone, Paxil and Lexapro are all SSRI's, do you think it's a valid concern? My doc says no, but I think he downplays many of my concerns. Also, as Lexapro is fairly new, there may not be as much info, so I guess I'm just asking for guesses. What do you guys think?I think you're confusing risk with probability. There is a risk that someone taking Lexapro, for example, all by itself, will develop serotonin syndrome. It happens, but it's very rare.
Taking hydrocodone with Lexapro might increase the risk of serotonin syndrome, but it will still be a very rare consequence. There is no warning in the drug monograph of Lexapro (or Celexa) about the combination. The two drugs are metabolized by different liver enzymes, as well.
Serotonin syndrome doesn't kill anyone quickly. It kills only when it is severe, and when it's not treated. Most cases are mild, and self-limiting (they go away on their own when the offending medication is discontinued). What would be best is for you to familiarize yourself with the symptoms, and go see a doctor right away, if they happen to you.
http://www.mindbodyconsult.com/protocols/serotonin.html
Lar
Posted by mesonage on November 23, 2004, at 17:10:19
In reply to Re: serotonin syndrome question » mesonage, posted by Larry Hoover on November 23, 2004, at 12:30:09
I'm thinking maybe it's just not a good combo for me. Yesterday I had taken 10mg Lexapro, and then 6 hours later took two Vicodin, then an hour later another one. About 45 minutes after I took the last one, very suddenly I became uncoordinated, I couldn't see straight, I couldn't hear out of one ear and started sweating. I ran back into my house and promptly puked in the nearest toilet. After that, I felt better, but still shaky. Feeling OK today. But I'll have to see my doc about a different painkiller I guess (for endometriosis). I have never had a reaction like that to Vicodin before - just started the Lexapro a few weeks ago. Think this was mild SS?
Posted by Larry Hoover on November 23, 2004, at 17:34:01
In reply to Re: serotonin syndrome question, posted by mesonage on November 23, 2004, at 17:10:19
> I'm thinking maybe it's just not a good combo for me. Yesterday I had taken 10mg Lexapro, and then 6 hours later took two Vicodin, then an hour later another one. About 45 minutes after I took the last one, very suddenly I became uncoordinated, I couldn't see straight, I couldn't hear out of one ear and started sweating. I ran back into my house and promptly puked in the nearest toilet. After that, I felt better, but still shaky. Feeling OK today. But I'll have to see my doc about a different painkiller I guess (for endometriosis). I have never had a reaction like that to Vicodin before - just started the Lexapro a few weeks ago. Think this was mild SS?
Nope. Sounds like a direct effect of hydrocodone. The side effects are more likely if you're up and about, compared to lying down.
Lar
Posted by mesonage on November 23, 2004, at 18:29:12
In reply to Re: serotonin syndrome question » mesonage, posted by Larry Hoover on November 23, 2004, at 17:34:01
Thanks for your responses Larry - it just seems weird to me because I have been taking Vicodin for cramps for almost 3 years now. Strange...I'm still going to ask my doc for a different PK.
Posted by Racer on November 24, 2004, at 12:31:47
In reply to Re: serotonin syndrome question, posted by mesonage on November 23, 2004, at 17:10:19
I'm with Larry, sounds like too much Vicodin. Even though you've been taking it for some time, that doesn't mean you'll be totally immune to some of its less pleasant effects. (That's exactly what it always does to me, although it'll do that at any dose no matter how low.)
Also, taking two, and then another an hour later sounds as if that would certainly cause additional problems. Vicodin takes a while to have an effect, so I'd consider taking fewer, or farther apart.
Just another voice piping up.
Posted by mesonage on November 24, 2004, at 20:16:39
In reply to Re: serotonin syndrome question » mesonage, posted by Racer on November 24, 2004, at 12:31:47
thanks for the piping up, Racer. i think i'm still going to ask for something else though - my scrip says 2-3 every 4-6 hours, so i didn't take too much, and no more than i've taken in the past, so it still seems weird to me. the only thing that's different from last month when i took it is the lexapro. or maybe i need a different anti-depressent. i don't know. something needs to be different though - that was awful.
This is the end of the thread.
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