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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by floatingbridge on June 5, 2010, at 19:38:33
Because of seizure risk, pdoc has withdrawn the o.k. for replacing vicodin with tramadol.
Using an interaction checker, both dexedrine and lithium are contraindicated (seizures).
Any advice or real world experience? I could lose the 300 lithium. Dexedrine is the only thing to date that made a real difference... That would be tough to contemplate replacing.
Still working on this.
Any thoughts?
Thanks again.
Posted by Phillipa on June 5, 2010, at 22:16:38
In reply to seizure threshold, tramadol, dexedrine, posted by floatingbridge on June 5, 2010, at 19:38:33
FB no tramadol now? Thought was replacing pritiq with it???? Love Phillipa
Posted by bulldog2 on June 6, 2010, at 10:07:52
In reply to seizure threshold, tramadol, dexedrine, posted by floatingbridge on June 5, 2010, at 19:38:33
> Because of seizure risk, pdoc has withdrawn the o.k. for replacing vicodin with tramadol.
>
> Using an interaction checker, both dexedrine and lithium are contraindicated (seizures).
>
> Any advice or real world experience? I could lose the 300 lithium. Dexedrine is the only thing to date that made a real difference... That would be tough to contemplate replacing.
>
> Still working on this.
>
> Any thoughts?
>
> Thanks again.Could your p-doc consult other p-docs about this? You've been on the this combo without any problems to date. Or consult a pharmacist about this combo? I'd like to see him do a little more work on this than an interaction checker. Do some legwork to find out if there is really a danger.
If he takes you off lithium how about lamictal or trileptal?
Posted by floatingbridge on June 7, 2010, at 14:59:03
In reply to Re: seizure threshold, tramadol, dexedrine, posted by bulldog2 on June 6, 2010, at 10:07:52
Hey Bulldog,
We are talking lamictal. I've got to read up. Instead of pristiq--as my antidepressant.
I ran the interaction checker, not him. He's very good, I think, just conservative. Not that that stopped him from suggesting dex, which I realize now is a little extraordinary. What will I do when he retires?!
So it is the dex that nixes it for him. Unless the is something to increase the seizure threshold. Maybe lamictal would benefit. I have mood instability but stabilizers have failed to help. We'll see.
Thanks for your post. I wish you well with any upcoming med change.
fb
Posted by jade k on June 7, 2010, at 18:02:00
In reply to seizure threshold, tramadol, dexedrine, posted by floatingbridge on June 5, 2010, at 19:38:33
> Because of seizure risk, pdoc has withdrawn the o.k. for replacing vicodin with tramadol.
>
> Using an interaction checker, both dexedrine and lithium are contraindicated (seizures).
>
> Any advice or real world experience? I could lose the 300 lithium. Dexedrine is the only thing to date that made a real difference... That would be tough to contemplate replacing.
>
> Still working on this.
>
> Any thoughts?
>
> Thanks again.Hi floatingbridge,
I don't know you so I hope I get some of this right. You are currently on vicodin, dexedrine, and...pristiq as per phillipa's post?
Dex plus tramadol sounds great to me. I've experience with both, not together.
Here's what I have: I'm on 50mg Pristiq, tried to discontinue with scary sides. I recently read that pdocs "may" be using tramadol as an augment for trd. It worked on mood and pain for me (long time ago). It was only prescribed for pain, otherwise I'd still be taking it.
Let me know if dex and tramadol become an option, I'll be 2nd in line. Good luck!
~Jade
PS-sorry, know nothing about the siezure threshold...which was your question.
Posted by Phillipa on June 7, 2010, at 21:51:50
In reply to Re: seizure threshold, tramadol, dexedrine » floatingbridge, posted by jade k on June 7, 2010, at 18:02:00
you back? Phillipa
Posted by floatingbridge on June 8, 2010, at 2:11:05
In reply to Re: seizure threshold, tramadol, dexedrine » floatingbridge, posted by jade k on June 7, 2010, at 18:02:00
Hi Jade,
Today pdoc said tramadol and dex a no-go unless I add something to reduce the overall risk of seizure--an anti-convulsant. I appreciate the guy doing his part to keep me alive :)
He said the way we would withdraw pristiq (if ever) would be with prozac. Thought I'd pass that on to you. How did you go about it, and why off the pristiq?
Thanks for your post. I do read and hear that tramadol/ultram has a place in TRD.
Best to you.
Posted by SLS on June 8, 2010, at 5:52:47
In reply to seizure threshold, tramadol, dexedrine, posted by floatingbridge on June 5, 2010, at 19:38:33
> Because of seizure risk, pdoc has withdrawn the o.k. for replacing vicodin with tramadol.
>
> Using an interaction checker, both dexedrine and lithium are contraindicated (seizures).
>
> Any advice or real world experience? I could lose the 300 lithium. Dexedrine is the only thing to date that made a real difference... That would be tough to contemplate replacing.
>
> Still working on this.
>
> Any thoughts?
>
> Thanks again.
I don't know what the "real world" risks are of combining tramadol with amphetamine. It takes a lot of tramadol to produce seizures. It has been suggested that the mechanism by which tramadol produces seizures involves the inhibition of GABA neurotransmission. I am wondering if gabapentin would be more effective than lamotrigine to prevent tramadol-induced seizures. Of course, it might not be as effective as an antidepressant adjunct.
- Scott
Posted by floatingbridge on June 8, 2010, at 10:33:31
In reply to Re: seizure threshold, tramadol, dexedrine » floatingbridge, posted by SLS on June 8, 2010, at 5:52:47
Thanks Scott, for the info. Has it ever been in your regime? That was mentioned, too. He seems to favor lamictal, not that he's insisting upon it, but definitely 'brightens up' at the mention of it.
Seems many classes of meds lower seizure threshold. Benzo and opiates, too. I didn't know. And lithium, though my 300 doesn't do much of that.
Posted by SLS on June 8, 2010, at 10:55:33
In reply to Re: seizure threshold, tramadol, dexedrine » SLS, posted by floatingbridge on June 8, 2010, at 10:33:31
Hi FB.
I found the following abstract. The authors demonstrate that gabapentin reduces the seizure promoting effects of tramadol. If your doctor likes the idea of using lamotrigine, I would probably try that first because of its antidepressant properties. Tramadol looks interesting. I hope it works for you.
- Scott
-------------------------------------------------
Basic Clin Pharmacol Toxicol. 2008 Sep;103(3):262-6. Epub 2008 Jul 18.
Tramadol-induced seizurogenic effect: a possible role of opioid-dependent gamma-aminobutyric acid inhibitory pathway.Rehni AK, Singh I, Kumar M.
Chitkara College of Pharmacy, Chandigarh-Patiala National Highway, Rajpura-140401, Patiala, Punjab, India. ashishkrehni@gmail.com
AbstractThe present study has been designed to pharmacologically investigate the role of opioid and gamma-aminobutyric acid receptors on the seizurogenic effect of tramadol. A single injection of pentylenetetrazole (80 mg/kg) was used to elicit seizure activity in mice. Seizures were assessed in terms of the time latency of the onset of Straub's tail phenomenon, onset of jerky movements of whole body, convulsions and death. Tramadol administration (50 mg/kg) caused a marked increase in seizurogenic activity of pentylenetetrazole as measured in terms of a significant decrease in the time latency of the onset of Straub's tail phenomenon, jerky movements of whole body, convulsions and death. Moreover, prior administration of naloxone (2 mg/kg) and gabapentin (25 mg/kg), respectively, attenuated the seizurogenic activity that tramadol exerted on pentylenetetrazole-treated mice. Furthermore, prior administration of naloxone (2 mg/kg) and gabapentin (25 mg/kg), respectively, also attenuated the seizurogenic activity exerted by tramadol per se. Therefore, it is suggested that tramadol exerts a seizurogenic effect on mice possibly via an opioid-dependent gamma-aminobutyric acid inhibitory pathway.
PMID: 18684224 [PubMed - indexed for MEDLINE]
Posted by floatingbridge on June 8, 2010, at 11:03:29
In reply to Re: seizure threshold, tramadol, dexedrine, posted by SLS on June 8, 2010, at 10:55:33
Thanks Scott. I appreciate this.
Posted by jade k on June 9, 2010, at 14:47:47
In reply to Re: seizure threshold, tramadol, dexedrine » jade k, posted by floatingbridge on June 8, 2010, at 2:11:05
> Hi Jade,
>
> Today pdoc said tramadol and dex a no-go unless I add something to reduce the overall risk of seizure--an anti-convulsant. I appreciate the guy doing his part to keep me alive :)
>
> He said the way we would withdraw pristiq (if ever) would be with prozac. Thought I'd pass that on to you. How did you go about it, and why off the pristiq?
>
> Thanks for your post. I do read and hear that tramadol/ultram has a place in TRD.
>
> Best to you.Hi again,
Pristiq just doesn't agree with me, headaches etc. I just stopped it cold, first 2 days were fine, 3rd I was a wreck. I started taking it again day 4 and have been fine. Like you, I'm gonna find a way to ease off.
Are you adding tramadol for pain or as augment to dexedrine? Just wondering what pdocs are willing to prescribe it for. I'm curious to see what you decide to do!
jade :)
Posted by Dan_MI on June 9, 2010, at 23:26:50
In reply to seizure threshold, tramadol, dexedrine, posted by floatingbridge on June 5, 2010, at 19:38:33
I was prescribed tramadol for a bad back, and I'm full of lithium.
I bring this up because I think lithium is just a miracle, and if you can tolerate it....
Posted by floatingbridge on June 10, 2010, at 0:39:59
In reply to Re: seizure threshold, tramadol, dexedrine, posted by Dan_MI on June 9, 2010, at 23:26:50
Thanks Dan. Seems that lithium lowers the threshold. Go figure, huh? I think this would not be an issue except my pdoc went to a lecture a few days ago and the seizure risk was emphasized while seretonin syndrome chances diminished. My luck.
After reading a bit, having cold feet about lamictal. My cognitive functions are already compromised. I can't see how, given what I've been reading, that that s/e wouldn't hit me hard.
I do like my 300 lithium. (Gained weight, though.) Glad it's working for you!
Your back is better? :)
Posted by Dan_MI on June 10, 2010, at 10:43:29
In reply to Re: seizure threshold, tramadol, dexedrine » Dan_MI, posted by floatingbridge on June 10, 2010, at 0:39:59
Back is better! Ironically, it got injured while I was working out and trying to alleviate depression.
This is the end of the thread.
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