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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by IslandAngel on October 28, 2011, at 0:12:19
I feel like I am trying to keep my head above water, feel confused, weird, like I'm standing/sitting sideways, foggy, hot face. My head feels like a bobble head. It sounds funny but it is not. This is not a good feeling. I just got off the phone with my psychiatrist. I recently switched from Cymbalta to Effexor. Cymbalta made me cry all the time.
I have Spondylitis and I am having a major flare that affects my tendons (aka enthesopathy). Right leg, achilles tendon got so bad I have to wear an air cast/boot. My PCP prescribed Tramadol. Took 150 mg Tramadol last night and it seemed to work fine and put me right to sleep. Took Effexor this morning, I took 50mg Tramadol. The Tramadol didn't do much so took another this afternoon. OMG! Big mistake!!! I'm at work and the serotonin overload symptoms hit. I work at a hospital so I looked at the drug interaction checker. Big warning label! Husband got me to call my Psych doc. Psych doc confirmed I am experiencing Serotonin Syndrome. UGH! What an awful feeling. I want to share this story so anyone taking SSRI should be aware of this and do not take Tramadol!
Tramadol inhibits reuptake of serotonin and noradrenalin. It's a bummer because when I first took it at night I thought it worked so well without the feeling of a narcotic. Then, morning taking Effexor and Tramadol... big no no.By the way, Effexor does not work for me. Disappointment. Will wean off of it and try something else. Effexor made OCD thoughts incredibly worse (intrusive thoughts, excessive rumination, picking face).
Appreciate your comments and input.About me:
40 yr old female, Ankylosing Spondylitis, Fibromyalgia and inattentive ADD. Enbrel 25mg shots every 72 hours, Effexor, Adderall as needed, Gabapentin 2,300mg per day (divided doses).
Posted by Phillipa on October 28, 2011, at 10:56:32
In reply to Seratonin Syndrome Effexor and Tramadol, posted by IslandAngel on October 28, 2011, at 0:12:19
I'm sorry this happened to you. So there must be levels of serotonin syndrome if you were able to function and work. With the physical problems also how do you manage to work? Sitting or walking job. Hospitals are tough work as was an RN. Do you also have anxiety? Phillipa
Posted by Phidippus on October 28, 2011, at 17:06:01
In reply to Seratonin Syndrome Effexor and Tramadol, posted by IslandAngel on October 28, 2011, at 0:12:19
Tramadol is a tricky drug to work with. There is a extended release version that's less likely to cause an interaction. Just keep the dose on the lower side.
Are you aware that tramadol has a lot of evidence backing it up as treatment for OCD? The APA guidelines recommend it as monotherapy.
Eric
Posted by jono_in_adelaide on October 28, 2011, at 18:48:13
In reply to Seratonin Syndrome Effexor and Tramadol, posted by IslandAngel on October 28, 2011, at 0:12:19
Swap the Tramadol for Vicodin ES, 1 every 4 hours
Taking tramadol with any SSRI, SNRI or Clomipramine is a bad idea.
Posted by Phillipa on October 28, 2011, at 21:00:19
In reply to Re: Seratonin Syndrome Effexor and Tramadol, posted by jono_in_adelaide on October 28, 2011, at 18:48:13
Jono over in the USA getting a med like vicodin is next to impossible as "they are addictive". So are any other med I can think of Phillipa
Posted by jono_in_adelaide on October 30, 2011, at 18:34:22
In reply to Seratonin Syndrome Effexor and Tramadol, posted by IslandAngel on October 28, 2011, at 0:12:19
I would def stop the tramadol right away - tramadol plus effexor can be a recipie for disaster.
For the pain, ry high dose ibuprofen (600mg 4 times a day, thats 3 of the 200mg otc tablets) or ask your doc for tylenol with codeine #3, 2 tabs every 4 hours as needed.
Ibuprofen is an excelent analgesic at the 600mg dose, people tent to poo poo it because itsavaliable otc, but for many types of pain, it beats narcotics in controlled trials, especialy inflamatory pan.
Posted by Phillipa on October 30, 2011, at 21:00:14
In reply to Re: Seratonin Syndrome Effexor and Tramadol, posted by jono_in_adelaide on October 30, 2011, at 18:34:22
Jono did you know they now say ibuphrophen causes heart disease and it's great for imflammation and pain. Phillipa
Posted by islandangel on October 30, 2011, at 22:18:10
In reply to Re: Seratonin Syndrome Effexor and Tramadol, posted by jono_in_adelaide on October 30, 2011, at 18:34:22
Hi All, Oh Philipa! I haven't heard from you in years (last post). I appreciate everyone's input. I'm actually already on Vimovo. This is a new RX of Naproxen with pre release Esomeprizole (stomach protectant) plus the Enbrel also acts as anti inflammatory so yu can imagine I must have hypersensitivity to pain. I have 800mg RX ibuprofen as needed.
It also does not help that I take Adderall for my unattentive ADD. I think the Effexor plus Adderall plus Tramadol equaled disaster. Yes, Philipa I do believe there are different levels of Seratonin Syndrome. Per your question, I have a leadership position so I was able to stay at my desk. I just sat at my desk and texted & talked with husband & best friend until it passed. They both stuck with me worrying i would faint or fall. It was the most awful feeling ever. The Neurontin is probably what saved me from seizure. Yes, tramadol has a risk of seizures. My head was wobbly & it most certainly affected my CNS, concentration, focus, caused numb emotions, raised temperature (without sweating) etc. The following day, I had diarrhea & upset stomach. I was told to expect this.I'm already weaning off of Effexor. I started taking the beads out little by little yesterday. I don't think Effexor has done anything but increase my OCD thoughts & disorganization.
Yes, I've heard about Tramadol's positive effect on the brain, anxiety & OCD. Its very interesting and someday I believe it will be marketed as a sleep & psych RX. For now though I cannot take it. Its too bad! I do have Peroset but don't want to take it because of the chance of opioid rebound pain & getting hooked. I know... so complicated. I am now looking to find a different RX to replace Effexor. Not just because of this incident but because it doesn't work for me.
I will keep you posted.
Posted by Phillipa on October 30, 2011, at 23:04:00
In reply to Re: Seratonin Syndrome Effexor and Tramadol, posted by islandangel on October 30, 2011, at 22:18:10
Isn't Embrel used for rheumatoid arthritis? Will google. Sounds like a horrible situation. Phillipa
Posted by jono_in_adelaide on October 31, 2011, at 6:54:59
In reply to Re: Seratonin Syndrome Effexor and Tramadol » jono_in_adelaide, posted by Phillipa on October 30, 2011, at 21:00:14
I think most of the NSAID's (except for aspirin) have been implicated in causing heart attacks, though some were worse than others (thats why vioxx was pulled from the market)
Diclofenac seems to be about twice as bad as ibuprofen, naproxen seems to have very little effect.
I guess if you're in accute pain, the risk of you having a heart attack there and then is so small that taking ibuprofen for a week or two is worth it - if you had a chronic condition like osteoarthritis and were going to need it for years, then it might be a different story.
Its about risk vs benifit - there is a risk driving your car, you might be killed in an accident, but the benifits of driving a car are such that we all take the risk.
I find ibuprofen a lot better for pain than paracetamol/acetaminophen, so I use it. Aspirin upsets my stomach badly, but ibuprofen doesnt, even in high doses.
re your comment about Vicodin, most doctors seem loathe to give out pain releivers, just before my mother died, she had a hip replacement..... she got the strong stuff in hospital, but when she was discharged, they told her to just take the Australian equivalent of Tyelnol 4 times a day...... which naturaly didnt cut it. Lucky for her she was a pharmacist, and was able to take matters into her own hands to some extent.
Posted by Phillipa on October 31, 2011, at 18:33:20
In reply to Re: Seratonin Syndrome Effexor and Tramadol, posted by jono_in_adelaide on October 31, 2011, at 6:54:59
Jono I take ibuphrophen as the only med that works for back and headache pain. Dentist once said at 800mg it's great for imflammation also and took it for 24 hours and felt mentally better also. Phillipa
Posted by Phidippus on November 1, 2011, at 10:26:53
In reply to Seratonin Syndrome Effexor and Tramadol, posted by IslandAngel on October 28, 2011, at 0:12:19
Have you tried Clomipramine yet?
Eric
This is the end of the thread.
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