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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 floatingbridge on May 27, 2010, at 2:24:25
People take cymbalta w/ tramadol and do well
I read of some happy and out of pain on pristiq and ultram.My new physiatrist would prefer me on ultram than Vicodin for pain. I'd love to try it, too, but because of the Psych meds, he didn't prescribe yet.
So what could the danger of seritonin syndrome be? (I take 50 pristiq and 20-25 mg Vicodin daily. At first it worked well, but increasing the dose makes me dumber than I am w/o
really addressing the pain.Then again, could one use ultram to taper pristiq? Hey science heads, is it possible?
I'm not looking validation, but power; hey, isn't knowledge power? ;)
Thanks anyone!
Posted by Phillipa on May 27, 2010, at 12:34:43
In reply to at it again: tramadol xr, posted by floatingbridge on May 27, 2010, at 2:24:25
I think so but I don't think tramadol can be used to wean off pristiq? What's the difference between vicodin and tramadol. Seriously I don't know? Love Phillipa
Posted by floatingbridge on May 27, 2010, at 17:07:03
In reply to at it again: tramadol xr, posted by floatingbridge on May 27, 2010, at 2:24:25
Ummm. Re-read my post. I actually take 15-20 mg per day. Doesn't really work for pain, and at above dose not great for mood.
(I was tired when I wrote the first post.)
Any info or experience on using tramadol w/ psych meds appreciated.
Posted by floatingbridge on May 27, 2010, at 17:10:46
In reply to Re: at it again: tramadol xr » floatingbridge, posted by Phillipa on May 27, 2010, at 12:34:43
Phillipa, not clear on the difference. Tramadol has some snri effect. It's also synthetic opoid--the implications of which are unclear to me. Pdoc said every opoid-like compound is different and would affect me differently....
Posted by Phillipa on May 27, 2010, at 20:22:32
In reply to Re: at it again: tramadol xr » Phillipa, posted by floatingbridge on May 27, 2010, at 17:10:46
FB think that's true as the lortab I just took was nothing like vicodin or percocet. I wonder why? Phillipa
Posted by jedi on May 27, 2010, at 23:58:51
In reply to at it again: tramadol xr, posted by floatingbridge on May 27, 2010, at 2:24:25
FB,
I would not risk taking tramadol with almost any of the ADs. Like meperidine it is one of the opioids that affects serotonin. When combining medications that affect serotonin in different ways your risk of serotonin syndrome is just too high. You do not want this affliction, it can lead to the long dirt nap.
Be careful,
JediReference:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714818/?tool=pubmed
Tramadol
Seizures, Serotonin Syndrome, and Coadministered Antidepressants
...
Serotonin syndrome (SS). SS is a potentially lethal event that is caused by excessive serotonergic agonism of serotonin receptors in the central and peripheral nervous system. SS may develop as a result of increased serotonin synthesis, decreased serotonin metabolism, increased serotonin release, inhibition of serotonin reuptake (e.g., SSRIs), and/or direct agonism of serotonin receptors. The syndrome is most often the result of a prescription drug, overdose of causative drugs, and/or complex interactions among several drugs. Three key clinical features of this syndrome are as follows: (1) neuromuscular hyperactivity (e.g., tremor, clonus, myoclonus, hyperreflexia, rigidity); (2) autonomic hyperactivity (e.g., diaphoresis, fever, tachycardia, tachypnea); and (3) altered mental status (e.g., agitation, confusion).23 There is no designated laboratory study for the diagnosis of SS.24 Management consists of discontinuing the offending agent and providing supportive care. Signs and symptoms typically resolve within 24 hours after the discontinuation of the causative medication, except in patients exposed to drugs with long elimination half-lives.25 Serotonin antagonists, such as cyproheptadine, may help alleviate symptoms, although the efficacy of this pharmacological intervention has not been rigorously studied.25
Tramadol as a factor. Like the risk of seizures, SS may occur with tramadol monotherapy but appears to be more common following either excessive use/overdose or with the coadministration of other medications, particularly antidepressants. With regard to the antidepressant interactions, SS has been reported with combinations of tramadol and the following: fluoxetine,2628 sertraline,2931 paroxetine,3235 citalopram,36 fluvoxamine,37 venlafaxine,38,39 and TCAs.40 In addition, Gnanadesigan et al41 reported four cases of SS among residents in a long-term care facility, all who were prescribed tramadol in combination with either SSRIs or mirtazapine. The majority of these preceding case reports describe elderly individuals who were oftentimes prescribed other medications as well.
Posted by floatingbridge on May 28, 2010, at 9:26:45
In reply to Re: at it again: tramadol xr » floatingbridge, posted by jedi on May 27, 2010, at 23:58:51
Jedi,
Thank you for the link. Excellent info. I read lots of patient reports of co-administration.... I don't think I 'll risk it (nor would my docs). O.K. rethink....
Curious: can't recall if there is a seizure risk for effexor. I know there is for Wellbutrin.
thanks for watching out Jedi!
fb
Posted by Phillipa on May 28, 2010, at 19:45:07
In reply to Re: at it again: tramadol xr » jedi, posted by floatingbridge on May 28, 2010, at 9:26:45
Jedi I also didn't know. You don't ever hear of this. I thought it was a safe med. Thanks. Love Phillipa
This is the end of the thread.
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