![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by James Parkman on June 18, 2011, at 22:12:58
I have been taking Prozac 40 mg. in the mornng and my doctor added Effexor HCL 75 mg. taken at night. Should I be worried about serotonin syndrome?
Posted by Christ_empowered on June 18, 2011, at 22:46:54
In reply to Effexor and Prozac, posted by James Parkman on June 18, 2011, at 22:12:58
I don't mean to scare you or whatever, but I'd be kind of worried, yeah.
Posted by Phillipa on June 19, 2011, at 0:47:25
In reply to Re: Effexor and Prozac, posted by Christ_empowered on June 18, 2011, at 22:46:54
Others here said even 50mg of luvox low dose and 5mg of lexapro could do that to me. So quit the lexapro. Phillipa
Posted by jms600 on June 19, 2011, at 4:56:26
In reply to Effexor and Prozac, posted by James Parkman on June 18, 2011, at 22:12:58
> I have been taking Prozac 40 mg. in the mornng and my doctor added Effexor HCL 75 mg. taken at night. Should I be worried about serotonin syndrome?
I know its a different drug, but my doctor is considering adding trazadone to my 225mg Effexor / 600mg lithium combo. He says he's tried it with patients before without any problems. I have also heard of mirtazapine being successfully prescribed along side Effexor.
Serotonin syndrome is always a risk I guess so always start with the lowest possible dose and work up from there.
Posted by SLS on June 19, 2011, at 5:30:27
In reply to Re: Effexor and Prozac, posted by jms600 on June 19, 2011, at 4:56:26
Table- Clinical features of serotonin syndrome
Central Nervous System Excess
Blood pressure changes
Body temperature changes
Confusion or agitation
Hallucinations
Rapid pulse
Shivering, sweats
Muscular/Movement Disorders
Tremors
Muscle Jerks or twitches
Restlessness
Loss of coordination
Increased reflexes
Gastrointestinal/Bowels
Diarrhea
Nausea
Vomiting
SymptomsSymptoms occur within minutes to hours, and may include:
Agitation or restlessness
Diarrhea
Fast heart beat
Hallucinations
Increased body temperature
Loss of coordination
Nausea
Overactive reflexes
Rapid changes in blood pressure
VomitingSymptoms
By Mayo Clinic staffSerotonin syndrome symptoms typically occur within several hours of taking a new drug or increasing the dose of a drug you're already taking. Signs and symptoms include:
Agitation or restlessness
Confusion
Rapid heart rate and high blood pressure
Dilated pupils
Loss of muscle coordination or twitching muscles
Heavy sweating
Diarrhea
Headache
Shivering
Goose bumpsSevere serotonin syndrome can be life-threatening. Signs and symptoms include:
High fever
Seizures
Irregular heartbeat
Unconsciousness
Table 2: Symptoms of Serotonin Syndrome
Stomach and other gastrointestinal and general somatic symptoms associated with anxiety or agitation
- Anorexia
- Anxiety
- Headache
- Lethargy
- Nausea
Sleep disturbance
- Drowsiness
- Excessive dreaming
- Fatigue
- Insomnia
Movement disorders
- Clumsiness
- Hyperreflexia
- Muscle contraction and relaxation in the jaw
- Parkinsonisms
- Rapid eye movement
- Rapid muscle contraction / relaxation in the ankle
- Restlessness / akathisia
- Rigidity
- Twitching of the muscles
Behavioral activation on a continuum to mania
- Confusion
- Dizziness
- Euphoria
- Intoxication / feeling of being intoxicated
- Irritability
Miscellaneous symptoms (cardiac arrhythmias)
- Fever
- Memory problems
- Mental status changes
- Paresthesia
- Sweating
Posted by orbital on June 20, 2011, at 15:06:04
In reply to Effexor and Prozac, posted by James Parkman on June 18, 2011, at 22:12:58
Basically, you can expect Prozac to increase the Effexor's amount/level in your blood.
To be on the safe side, you could definitely consider bringing up your concerns to your doc, and start low and carefully. The potential for serotonin syndrome is always present, even if you're taking just one serotoninergic drug alone.
For what it's worth, I'm on Effexor 150 and Paxil -which affects Effexor metabolism in a manner very similar to Prozac, inhibiting CYP2D6 enzymes in the liver among others- and have had no problems whatsoever. I'd never add a TCA, as the potential for toxicity is very narrow with these drugs, but Effexor is relatively safe in this regard.
> I have been taking Prozac 40 mg. in the mornng and my doctor added Effexor HCL 75 mg. taken at night. Should I be worried about serotonin syndrome?
Posted by bearfan on June 21, 2011, at 1:13:06
In reply to Re: Effexor and Prozac » James Parkman, posted by orbital on June 20, 2011, at 15:06:04
Probably makes sense to taper one off. Or increase Effexor to 150mg (when it becomes stronger SNRI) and decrease prozac to 10mg daily (or see if you can discontinue).
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.