Orangeblossom77

December 17, 2018

What about the Tricyclic antidepressants? Brake or accelerator?

December 18, 2018

Hi Orangeblossom and welcome to SA,

I've moved your post and created your own Introduction topic which is the place that you can ask questions and journal your progress.

So that we are better able to offer suggestions please create a drug signature using the following format. Keep it simple by following these instructions (NO diagnoses or symptoms please - thank you):

details for last 2 years - dates, ALL drugs, doses
summary for older than 2 years - just years and drug/s

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December 18, 2018

Hi, thanks. I was looking at the topic on brakes and accelerators and which drug to reduce first. Wondering about the amitryptilline. Have been reducing the prozac first and feel it is too stimulating recently, not sure about the amitryptilline though.

December 18, 2018

Please put all drugs you are currently taking into the Drug Interactions Checker then copy and paste the either the link or the results in a post in your Intro topic.

December 18, 2018

Interactions between your drugs

Major

amitriptyline FLUoxetine Professional

Applies to: amitriptyline, fluoxetine

GENERALLY AVOID: Coadministration with fluoxetine may significantly increase the plasma concentrations of some tricyclic antidepressants (TCAs). The proposed mechanism is fluoxetine inhibition of CYP450 2D6, the isoenzyme responsible for the metabolic clearance of many antidepressant and psychotropic drugs. Seizures and delirium have been reported, as well as a fatality attributed to fluoxetine-induced chronic amitriptyline toxicity. Pharmacodynamically, the combination of fluoxetine (or any other selective serotonin reuptake inhibitor) and a TCA may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5HT1A receptors.

MANAGEMENT: In general, the use of fluoxetine (or other SSRIs) with TCAs should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Pharmacologic response and plasma TCA levels should be monitored more closely whenever fluoxetine is added to or withdrawn from therapy in patients stabilized on their existing antidepressant regimen, and the TCA dosage adjusted as necessary. Patients should be monitored closely for signs and symptoms of TCA toxicity (e.g., sedation, dry mouth, blurred vision, constipation, urinary retention) and/or excessive serotonergic activity (e.g., CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia). Due to the long half-life of fluoxetine and its active metabolite, norfluoxetine, the risk of interaction may persist for several weeks after discontinuation of fluoxetine.

References

Vaughan DA "Interaction of fluoxetine with tricyclic antidepressants." Am J Psychiatry 145 (1988): 1478
Preskorn SH, Beber JH, Faul JC, Hirschfeld RM "Serious adverse effects of combining fluoxetine and tricyclic antidepressants." Am J Psychiatry 147 (1990): 532
Bergstrom RF, Peyton AL, Lemberger L "Quantification and mechanism of the fluoxetine and tricyclic antidepressant interaction." Clin Pharmacol Ther 51 (1992): 239-48

Interactions between your drugs

Major

amitriptyline FLUoxetine Consumer

Applies to: amitriptyline, fluoxetine

Talk to your doctor before using amitriptyline and FLUoxetine. This combination may cause sedation, dry mouth, blurred vision, constipation, and urinary retention. You could also have high levels of FLUoxetine which include altered consciousness, confusion, poor muscle coordination, abdominal cramping, shivering, dilation of the pupils, sweating, high blood pressure, and increased heart beat. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using your medications without talking to your doctor first.

Yes, this is being prescribed with knowledge of the doctors, the amitryptilline is very low does for pain not depression which is why they are willing to prescribe but I need regular blood tests to monitor. and warned about serotonin syndrome. They only let me take the two together as on low doses. I have regular blood tests and blood pressure measurements which are generally OK.

I am feeling in general that Amitryptilline is helping with pain and sleep even at a low dose of 10mg, maybe keep taking that and continue with the fluoxetine taper. and then possibly wean off the amitryptilline. The docs have told me to just see how it goes with the anitryptilline for pain and 'play around with the dose up to 50mg'. It seems to be causing less problems than the prozac. Even when I just take the prozac alone it causes bad side effects more recently. So I'm thinking of doing this swap perhaps http://wiki.psychiatrienet.nl/index.php/Fluoxetine-amitriptyline

Stop fluoxetine

Before day 1: Gradually reduce dosage of fluoxetine to a maximum of 20 mg/ day, when this dosage is > 20 mg/day.
Day 1: When a dosage of 20 mg/day is reached, stop administration.

Start amitriptyline

Caution is necessary for at least four weeks.

Day 1: start administration of amitriptyline in a low dosage of 25 mg/day.
Day 14: increase dosage of amitriptyline to 50 mg/day.
Day 28: gradually increase dosage of amitriptyline.

But using lower doses as already lower than that and just keep the lower dose of amitryptilline. Any thoughts welcome.

December 18, 2018

23 hours ago, Orangeblossom77 said:

What about the Tricyclic antidepressants? Brake or accelerator?

Tricyclics are brakes and should be tapered after more activating drugs like SSRI's. I tapered my tricyclic, Imipramine, before discovering SA and after getting down fairly low experienced extreme anxiety. I put my Imipramine taper on hold and started tapering my Lexapro. You are right to taper the Prozac first.

Taking multiple psych drugs? Which drug to taper first?

December 18, 2018

Welcome, orangeblossom.

Your doctor was remiss in prescribing those drugs together, it's a dangerous combination. If I were you, I'd taper Prozac, see Tips for tapering off Prozac (fluoxetine)

I'd also ask for liver and kidney function blood tests to make sure you don't have any drug damage.

Please let us know how you're doing.

December 18, 2018

Hi, thanks for the replies.

Yes, the doctors agree, in fact the psychiatrist was concerned the GP had prescribed the low dose amitryptilline for pain on advice of another consultant (for pain) and only agreed if they closely monitored me and it was low dose. So they do the blood tests as mentioned for liver and kidney function, along with others as well, and did an ECG as well. All Ok. We did have a slightly off liver function tests and did it again to check and was OK. It's a bit complicated as under different consultants for different things. They are pretty good really and have advised I take care with this. and monitor things.

Anyway, yes am reducing the fluoxetine which seems to be going Ok so far. Will keep updated here.

December 19, 2018

Hi orange blossom,

Just wanted to welcome you to SA as well. I’m so sorry the doctors gave you two meds that they shouldn’t have put together, but I’m glad you found this site. I’m sorry you’re in pain too. My journey of meds started with pain too.

Going through withdrawals is certainly quite a struggle as well, but we will all get there in the end. All we need to do is just take a day at a time, an hour at a time, or a minute at a time sometimes.

Please find yourself some good coping strategies when things get tough. I find distractions have always worked best for me. I just keep distracting myself with different hobbies, music, Netflix n DVDs, nature, animals etc when withdrawals are bad.

I’m glad everything is going well for you so far, wishing you all the best with your tapering and please keep us updated.

Sending hugs🤗

December 19, 2018

Thanks. Yes so what has happened is for the pain these two can help together in low doses, e.g.

https://www.aafp.org/afp/2000/1001/p1575.html

"Antidepressant Agents. Although antidepressants have a lengthy history in the treatment of chronic pain syndromes, they have received only limited study in the treatment of fibromyalgia. The tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), or combinations of both, produce mild to moderate improvement in symptoms. In controlled studies,1 approximately one third to one half of patients responded to pharmacologic treatment. One study13 found that while 25 mg of amitriptyline (Elavil) or 20 mg of fluoxetine (Prozac) reduced the symptoms of fibromyalgia, the combination of the two was twice as effective as either agent taken alone. The dosages used are somewhat lower than those needed to treat depression. The older agents (such as amitriptyline) can be started at a dosage of 10 mg taken daily two to three hours before bedtime. This allows the peak sedative effect to be realized while avoiding unwanted carry-over sedation on awakening. The time of administration can be adjusted depending on individual patient response.

The dosage of antidepressant must be individualized. This is particularly true of the tricyclic agents, given their variable absorption, metabolism and excretion. Dosages should be gradually increased, not to exceed the recommended maximum for the drug. Even patients who are able to tolerate very small amounts of these medications may derive benefit from them."

So despite the psych not being keen I asked the GP to try this, and they agreed but going to keep the dose as low as possible and possibly come off the fluoxetine altogether. It feels like the combination is making the fluoxetine more potent. Now, the last few days have been managing with 5mg fluoxetine (am) and 10-20mg amitryptilline for pain and sleep in the evening. My next med review and blood tests are due in the new year so will be able to see how things are going with that as well.

December 19, 2018

18 minutes ago, Orangeblossom77 said:

It feels like the combination is making the fluoxetine more potent.

From https://reference.medscape.com/drug-interactionchecker

Serious - Use Alternative

fluoxetine + amitriptyline

fluoxetine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
fluoxetine + amitriptyline

fluoxetine will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.

Monitor Closely

amitriptyline + fluoxetine

amitriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

December 19, 2018

Hi Orangeblossom,

Yes, I definitely think it’s a good idea to get off the fluoxetine. Make sure you go really slowly though, no more than 10% a month. I can only taper by 4% to 5% myself but many are fine with 10%. It’s all trial and error, just never exceed 10%.

I think you can see that the amytriptilline is affecting the Prozac. It’s really not a good combination, but it’s up to you what you do. I personally wouldn’t be taking both together and think your plan to slowly taper the Prozac is great.

I’m so sorry you have fibromyalgia, I’ve actually had CFS for about 24 years but I never got fibromyalgia. That must be awful. Did you know that CFS n fibromyalgia are CNS illnesses, you probably did. I only found that out in the last couple of years. Check out Dan Neuffer. A lot of people have recovered.

I have no chance of recovering from this illness though until I’m off the meds as they affect the CNS as well. We have to calm our CNS and these meds and withdrawals play havoc with the CNS.

Take care, sending hugs🤗

December 19, 2018

Ah, that makes sense it is increasing the lethargy as well which is maybe due to the combinations with the amitryptilline. Thanks again for the replies. Going to maintain this small dosage of both over the festive break just due to keeping things simple for now and then reduce the fluoxetine even more, in the new year. Have a good Christmas

December 19, 2018

The 5mg fluoxetine and 10mg amitryptilline seems to be slightly easier to tolerate than higher dose with the fluoxetine so going to keep this going for now and reduce from this amount. I suppose due to the combination and it increasing the serotonin etc. maybe easier reducing more. for now anyway. I don't think this combination has helped with pain a lot for me to be honest- things like swimming heat and relaxation, better. So have some other stuff to help too.

December 20, 2018

Had a call from my GP who has been discussing my case with the psych. Advising to come off the amitryptilline (due to above adverse interaction) They mentioned I was Ok previosuly on just the fluoxetine and only since adding the other med it has been really problematic.

They want me off it ASAP. So going to have to do that i think, and continue with the fluoxetine for now. I am not great at taking the amitryptilline anyway due to it's side effects so don't think this should be too much of a problem. Going to try and keep the fluoxetine stable for now then till I get through this.

December 20, 2018

I've asked the other mods for their thoughts about how quickly you could get off the Amitriptyline. Your doctors might try and get you off too fast. It will be important for you to keep daily symptom notes and to listen to your body.

December 20, 2018

That is kind of you Chessie. Yes they told me to just stop it. as low dose etc. To be honest I don't feel I have built up amitryptilline as have been a bit wary of it and on/off particularly with this 'play around with the dose' advice from the docs. It is very sedating which I don't like. Haven't taken my wee dose this evening and feeling quite buzzy, but hoping that this combined effect of the two might be the cause and this might settle down a bit. Bit worried about sleep but trying to stay calm as stressing won't help.

It just feels like it's not a pleasant drug. Not sure how to explain, but like I trust / know prozac a bit more due to the years spent on it, also. I think I can with this one just stop, unlike with the fluoxetine. It's just different. I'll keep updating here.

December 20, 2018

Rather than stopping the amitryptiline CT it would be better to do a fast taper. It might be better to take 3/4 of your 10mg dose so take 7.5mg. You might find that making a couple of larger reductions quickly and then slowing down might be the way to go.

From this topic tips-for-tapering-off-amitriptyline

"Theoretically, you should be able to make a solution of amitriptyline in water, and use an oral syringe for precise dosing. See How to make a liquid from tablets or capsules"

Please also see:

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's Withdrawal Symptoms

December 20, 2018

1 hour ago, Orangeblossom77 said:

To be honest I don't feel I have built up amitryptilline

What you may not realise is the the drugs add chemicals to our brain and it adapts to getting the drug. When we take it away the brain has to adapt. If we take it away too quickly we get withdrawal symptoms. If we sneak it away more slowly then the brain doesn't have to adapt as much in one big go.

This might help you to understand this:

On 8/31/2011 at 5:28 AM, Rhiannon said:

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

Please also check out this topic, especially the post about Cold Turkey and Fast Tapers. The link is in Post #1:

are-we-there-yet-how-long-is-withdrawal-going-to-take

December 21, 2018

On 12/19/2018 at 1:15 AM, Orangeblossom77 said:

So despite the psych not being keen I asked the GP to try this, and they agreed but going to keep the dose as low as possible and possibly come off the fluoxetine altogether. It feels like the combination is making the fluoxetine more potent. Now, the last few days have been managing with 5mg fluoxetine (am) and 10-20mg amitryptilline for pain and sleep in the evening. My next med review and blood tests are due in the new year so will be able to see how things are going with that as well.

You reduced your fluoxetine dosage from 10mg to 5mg? When did you do this?

On 12/19/2018 at 11:40 AM, Orangeblossom77 said:

The 5mg fluoxetine and 10mg amitryptilline seems to be slightly easier to tolerate than higher dose with the fluoxetine so going to keep this going for now and reduce from this amount. I suppose due to the combination and it increasing the serotonin etc. maybe easier reducing more. for now anyway. I don't think this combination has helped with pain a lot for me to be honest- things like swimming heat and relaxation, better. So have some other stuff to help too.

Your doctor has you taking these two drugs together for 2 years although they didn't help your fibromyalgia?

18 hours ago, Orangeblossom77 said:

Had a call from my GP who has been discussing my case with the psych. Advising to come off the amitryptilline (due to above adverse interaction) They mentioned I was Ok previosuly on just the fluoxetine and only since adding the other med it has been really problematic.

They want me off it ASAP. So going to have to do that i think, and continue with the fluoxetine for now. I am not great at taking the amitryptilline anyway due to it's side effects so don't think this should be too much of a problem. Going to try and keep the fluoxetine stable for now then till I get through this.

They weren't concerned for 2 years, but now they have second thoughts, since you've been asking questions.

I would not suddenly quit the amitriptyline. "Buzzy," which is a withdrawal syndrome, may or may not go away. Plus, you've just made a 50% cut in fluoxetine.

Prior to this, exactly how inconsistent have you been in taking your amitriptyline dose every day? What times of day do you take your drugs?

December 21, 2018

Quote

Quote

You reduced your fluoxetine dosage from 10mg to 5mg? When did you do this?

Quote

Your doctor has you taking these two drugs together for 2 years although they didn't help your fibromyalgia?

They weren't concerned for 2 years, but now they have second thoughts, since you've been asking questions.

I would not suddenly quit the amitriptyline. "Buzzy," which is a withdrawal syndrome, may or may not go away. Plus, you've just made a 50% cut in fluoxetine.

Prior to this, exactly how inconsistent have you been in taking your amitriptyline dose every day? What times of day do you take your drugs?

Hi, I think I have got a bit mixed up with the docs advice on the amitryptilline. They advised me to take "up to 1-5 tablets a day as directed by the doctor" (which it says on the label) and it is for pain, told me to "play around with the dose and see how it helps." I should be OK up to 50mg with the fluoxetine. So I have been kind of taking it for pain, like on bad pain days. Not very often as it makes me quite groggy. Maybe twice a week, at most.

They prescribed them around two years ago on recovery from surgery for post surgical pain, then got shingles and fibro as well. In fact I remember this as first they gave me a few pills and told them to take for pain over a weekend. It works as well, one tablet and the pain goes (but it zombifies you as well). So, it was kind of introduced to me like that, to be taken for pain. I think, maybe if you take it properly / regularly the sedating side effects might improve as you get used to it a bit.

I reduced the fluoxetine while trying to take the amitryptilline daily as thought was the idea to increase that as it might help as a 'break'.

I take the prozac in the mornings and amitryptilline in the evenings.

I took 10mg fluoxetine this morning and feeling OK today and slept Ok without the amitryptilline last night.

I am wary of taking the amitryptilline on a daily basis again since bad side effects. I'll try the taper then and report back when off that.

Oh dear think I have got a bit muddled, probably not helped by my surgical consultant then mentioning I had found the amitryptilline useful for pain leading to it being put on my prescription list but by this time had been discharged from the psych...more of a communication problem than anything I think. He did mention he wasn't a medic as well. It's been a bot of a complicated situation with the different consultants and GP as well. Then, we all got changed to a new GP practice as the one one closed so don;t think that helped matters. I should have asked more about it really. 😕

Quote

January 1, 2019

Just an update. Am off the amitryptilline now and feeling quite a but better especially in terms of fatigue. Interested to find the fibro symptoms have improved also despite the stressful time of year.

Going to continue with the low dose prozac for now and see how things go, as to whether it was mainly the interaction and dose the problem, rather than needing to completely go off all tablets. Maybe just allow things to settle for a month or two. I'm on roughly a quarter of a 20mg capsule so 5mg a day. Finding if I take any more it isn't good, now, this seems about right.

Sleep is OK, which is a good sign, and taking some magnesium and also omega 3 oils which I have anyway. Also vitamin D as that was low in a blood tests so

to keep that OK during the winter, just in case. My main symptom I'm having I think is akathisia, (but also had this on the higher doses meds in recent times) - this seems to be worse as the day goes on, better in the mornings after a sleep. I'm dealing Ok with it though, went for a swim in the afternoon yesterday which seemed to help quite a bit. It will be easier once the festive season is over. Been drinking a bit through that which also helps, but alcohol I know is not a good thing and going to stop that now for the new year I think. the lower dose. Seems to help me relax a bit, help with mood and pain. It's quite expensive though. I have tried in the past a kind of magnesium also, magnesium threonate (Magmind) which seemed to help also in the evenings but it is expensive and just got usual magnesium at the moment. I might get some more. I just took a third of the dose (mainly due to cost) but seemed to be restful.

the other thing I'm taking as well as a general multivitamin is Longvida curcumin, this seems to help me a bit although not sure how much, I have been taking this for quite a while now and maybe helping a bit with things.

It is noticeable the difference already in terms if feeling more emotions and trying to be mindful of this, even when getting some quite angry feelings and thoughts, I like mindfulness and trying not to be too thought identified, letting them come and go etc, not easy is it though at times. Noticed more sexual feelings and able to orgasm more easily, (sorry if tmi). Forgot to mention have also come off the Progesterone only pill in last year, which seemed to make me more depressed, as well.

Hoping for a good new year for us all

January 1, 2019

Thanks for the update, Orangeblossom. It sounds like you're doing better on less drugs.

You might try magnesium citrate, which is less expensive, or magnesium glycinate.

7 hours ago, Orangeblossom77 said:

My main symptom I'm having I think is akathisia

What is this symptom like? Does it occur at any particular time of day?

Prozac comes in 5mg capsules or tablets, you might want to get a prescription for that dosage rather than guessing when you cut your tablets.

January 1, 2019

Hi thanks for the reply.

Yes i have some of the citrate also. I think this akathisia is like a kind of tense feeling in the muscles, some aches (different to fibro which tends to be one sided and in nerve lines so down the arm for example) these aches are more generally in the muscles, the buzzy / wound up / restless and anxious feeling. also a bit like skin crawling feeling. It's pretty unpleasant, but i think it is improving slightly. It's still early days from this change. Hopefully the sleep will stay Ok as that seems to help it. My goal now is to reduce alcohol consumption to deal with it as it's been available lots in the evenings due to the festive season. Maybe I can replace this with an epsom salts bath in the evenings some days. I've got kids also so evenings can be a bit stressful too adding to it.

this feeling gets worse as the day goes on and it is worse in the evenings, it is usually Ok morning after a rest.It was there too on the meds kind of like a 'caffeine running through the veins' feeling and was i think worse then, it came with a headache too and tension, it is better on less meds than more, definitely which is a good sign. It was a good sign the swimming helped it as it never used to as much when on more meds.

And also with the fibro hard to know where that ends and the other begins, I'm feeling overall relieved that seems to be Ok for now as usually would get much worse under stress. I guess as prozac might take a long time (months even) for the higher dose to reduce over time will need to see how things go and will be going slow from now on.

January 2, 2019

That symptom sounds like paresthesia and muscle tension. Does it occur mostly in the hand or side you use for mousing on the computer?

Generally, alcohol with drug-induced hypersensitivity is not a good idea.

January 6, 2019

More writing for a record than anything to see how things are going.

So continuing the 5mg prozac, no amitryptilline now. (need to update sig but not sure how)

To help support this am continuing with my 500mg Longvida Curcumin, and Omega 3 oil, with a multivitamin.

and Magnesium Citrate with a single magmind capsule in the evening.

Things I've noticed:

Better: more motivated, can do more stuff like cooked a bit more.

Less lethargic

Worse: Headache. Whooshing feeling in head, (just once) feeling a bit spacey. Stronger emotions, quite tearful feeling.

(but have period due so could be that as well)-

Trying to go with the flow with these things and remembering 'it's the meds'.

Have been able to relax enough to have a bath in the evenings which is good, helps the buzzy / achy feeling (think that is improving a bit).

Been reading some experiences on here and thinking might try staying at this 5mg dose for a good few months to hopefully have things settle down a bit, before deciding whether to reduce further, especially as been on this prozac a few years.

Other thing I'm working on is only having small glass wine and no more, co-codomol is something else I have to take as and when for pain, and it helps with the 'akathisia' type feeling, but don't want to take much of that as can be addictive.

January 6, 2019

Account Settings – Create or Edit a signature

co-codamol please add this information to your drug signature. Thank you.

ALCHOHOL/DRUG:

Moderate

codeine ethanol

Applies to: codeine, Alcohol (contained in alcoholic beverages) (ethanol)

Do not use alcohol or medications that contain alcohol while you are receiving treatment with codeine. This may increase nervous system side effects such as drowsiness, dizziness, lightheadedness, difficulty concentrating, and impairment in thinking and judgment. In severe cases, low blood pressure, respiratory distress, fainting, coma, or even death may occur. With certain long-acting formulations of narcotic pain medication, consumption of alcohol may also cause rapid release of the drug, resulting in high blood levels that may be potentially lethal.

Moderate

amitriptyline ethanol

Applies to: amitriptyline, Alcohol (contained in alcoholic beverages) (ethanol)

Ask your doctor before using amitriptyline together with ethanol, this can alter the effects of amitriptyline and cause increased side effects. Call the doctor if you experience uneven heartbeats, extreme drowsiness, confusion, agitation, vomiting, blurred vision, sweating, muscle stiffness, feeling light-headed, and seizures. You should be warned not to exceed recommended dosages, to avoid alcohol, and to avoid activities requiring mental alertness.

Moderate

FLUoxetine ethanol

Applies to: Prozac (fluoxetine), Alcohol (contained in alcoholic beverages) (ethanol)

Using FLUoxetine together with ethanol may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with FLUoxetine.

DRUG/DRUG:

Moderate

codeine amitriptyline

Applies to: codeine, amitriptyline

Consumer information for this interaction is not currently available.

MONITOR: Opioids may potentiate the effects of serotonergic agents and increase the risk of serotonin syndrome. The interaction has primarily been reported with the phenylpiperidine opioids (e.g., meperidine, fentanyl) and tramadol, which are known to possess some serotonergic activity, although a few cases have involved other opioids such as oxycodone, methadone, morphine, hydromorphone, codeine, and buprenorphine. Serotonin syndrome is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Since many serotonergic agents can also cause central nervous system depression, concomitant use with opioids may result in increased sedation and impairment of judgment, thinking, and psychomotor skills.

January 7, 2019

"Opioids may potentiate the effects of serotonergic agents and increase the risk of serotonin syndrome. The interaction has primarily been reported with the phenylpiperidine opioids (e.g., meperidine, fentanyl) and tramadol, which are known to possess some serotonergic activity,"

Ok, maybe explains a but why it helps with the symptoms perhaps. I'll need to use sparingly, not easy as get big packs of 100 in my prescriptions. Even just the one makes quite a difference. I'll keep for emergencies, and reserve a small glass of red for maybe once a week.

January 13, 2019

I'm kind of coping OK but getting the followong:

Prickling / tingling under the skin

Headaches

Vertigo at times

Tearfulness for no apparent reason

Lots of anger / irritation at small things

Hot and cold feelings

Period over so isn't that.

Trying to be balanced so on the plus side

It is a relief to not have the really wound up tense feeling - think was possibly having some symptoms of serotonin syndrome before

Fibro is not flaring up too much! This is a different kind of feeling. It actually seems improved, less fatigue and more motivated despite the

above.

Sleeping a lot- fitbit says 9 hrs last night for example with 3.5-4 hrs deep sleep in a night. Maybe as recovering? Who knows but with me

bad sleep is closely linked with depression and mental health, so hoping this is a positive sign.

Very few palpitations.

What I'm doing so far: swimming and walking, bath helping with prickling feeling

Relaxation and occasional co-codomol for headaches

Staying away from people and things which irritate me. Music helping a bit.

Kind thoughts to all going through this.

January 13, 2019

Hi orange blossom, I also get a prickling feeling as you call it. Kind of how your limbs feel when they’re about to fall asleep + an inner itchiness? Quite a bizarre sensation. I’m glad you’re finding things that help. I’ve found that warm baths and showers help suppress it for a short time too.

January 16, 2019

Yes, baths helps and the sauna. Swimming seems to help me a bit too. Need to go today. It helps with anxiety too.

Not getting any more whooshing feelings in head, which is good but quite a lot of vertigo, quite disorientating.

and still tearfulness, not very, down though, just grumpy / irritated. Headaches, more tired, sleeping OK though.

It can be a concern that maybe depression will return.

But kind of planned this for a quiet time and luckily things not too stressful just now. Family life etc, kids a bit older so not as

demanding / at school etc helps.

I keep feeling tempted just to stop the meds totally but keeping going with the 5mg dose at present until things settle down a

bit. Keep reminding myself it is better than having the horrible wound up feeling on the meds. and the goals for the future

January 16, 2019

9 hours ago, Orangeblossom77 said:

I keep feeling tempted just to stop the meds totally but keeping going with the 5mg dose at present

I know this feeling and I completely understand. Just before Christmas I was thinking the exact same thing off the exact same dose of 5mg. And that was just after I had spent $75 on my new batch of compounded capsules. I've also been a member here since October 2015 and have seen members having issues trying to get off too quickly and/or too soon.

I think the impatience to get it over and done with is part and parcel of the tapering journey. However, we have to remember that our brain still needs the drug.

When to end the taper and jump to zero?

January 18, 2019

Yes, I agree. It doesn;t make sense either as already having quite significant withdrawal affects. and did quite a big reduction to start

with.

I guess a way to get over that impatient feeling is reminding myself it is just being kind to your brain and giving it time to adjust, rather than 'shocking' it with stopping totally. In my case I dropped a bit quick to start with as i just really couldn't tolerate the drug side effects (possibly a bit too quick) and that is a relief to get rid of them.

There's a drama on the radio today about how we might run out of antidepressants due to the brexit, so might need to stockpile anyway!

Feeling quite grotty the last couple of days, especially the prickling and mental stuff. So have booked some sessions for a month, every week, for aromatherapy all body massage at the local college (students are training and do it cheap) I had this yesterday and it really helped. It does help to know there are things to help with (some) of these symptoms, whereas with the side effects, especially the horrible would up feeling, nothing seemed to helps that at all. It takes an effort to do this self care stuff especially when the house is messy and have children etc.

January 19, 2019

Well I think more effects are kicking in now, which sort of makes sense as it's about a month since I lowered the dose. Perhaps.

Woke in the night all shaking and bad headache, took a painkiller, managed a bit more sleep then bad again this morning. It seems the

prickling feeling has been joined by these 'shakes' and also bad anxiety. I took my 5mg and things calmed down a bit after that. So it seems that

is helping me for now. and best to keep on with that. as even that lower dose seems to make a significant effect. Still a but jittery but less so, and calmer.

January 24, 2019

Finding swimming is helping a bit with the symptoms- it's really hard to make yourself go in the January cold though!

Just updating to see a record of how things are going really. Sleep a bit messed up but when swim those days seem to

get a bit better sleep. Think I'm finding that magnesium citrate helpful too. When I wake sometimes previously used to

take a co-codomol, now taking the magnesium instead. So basically just need to keep going really.

Was feeling very angry / cross in general over small things, so have done a few things like come off social media and

the computer in general. stop reading news, etc. and having a bit of space from people in general (except close family)

and having a few early night with a bath. listing to the radio etc. bit of headspace really. Hoping things might be easier in

general when the days get a bit lighter.

January 27, 2019

Last couple of days the prickly pain feeling all over is starting to go thankfully, still getting bad headaches though.

Think things are starting to stabilise on the 5mg and planning to keep it there for now.

Been good to have a break from being online and quite liking being off social media - thinking of staying off now.

maybe these things can force us to make changes for the better. perhaps. Been trying to stay off the wine and

co-codomol also, bit easier now than at Christmas time.

Orangeblossom77

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