Need some opinions

Discussion in 'Fibromyalgia Main Forum' started by wld285, Oct 11, 2006.

  1. wld285

    wld285 New Member


    I had to call Dr. (nurse) at FCC yesterday to let them know how I was doing on the hydrocortisone. Before I even started with them I was taking 2mg. ativan and 50 mg. zoloft at HS. He had put me on Flexeral 10 mg. on my first visit. When I went back, told him did not do anything for my sleep so he put it to 20 mg. Told nurse yesterday that really did not do anything for my sleep either.

    She called me last night nad said he wanted me to take 10 mg. of Flexeral and he was adding doxepin, starting at a very low dose and increasing every 3 days if it does not help. I questioned the doxepin and zoloft together.

    I called her again this morning to make sure they were looking at the right chart (more than one with same name). She assured me again he said it was o.k.

    So it would be 2mg. ativan, 50 mg. zoloft, 10 mg. flexeral. and doxepin at bedtime. Anyone see a BIG problem with that.
    Thanks everyone
  2. 1faith

    1faith New Member

    I looked it up-Is classified as an antidepressant too. Lowest form capsule is 10mg. Do not take with Clonidine, evening primrose oil, St. John's wort, SAM-e, yohimbe. If you don't feel okay about it I wouldn't do it.
  3. Kimba4318

    Kimba4318 New Member

    I WOULD call you pharmacist about it to make sure. I have had docs make mistakes too & it is your health that will be affected.

    Please call to make sure.
    Take Care!
    Kim
  4. kjfms

    kjfms Member

    Flexeril is a TRICYCLIC COMPOUND. I entered you meds in Medscape's Interaction Checker and below you will find the interactions.

    You might want to call your physician and pharmacist to discuss this.

    I had this same problem with Lexapro and Flexeril and can not take the two together. Combined they put me out of my mind and I do not remember 2 days when I took them together without looking it up first.

    SSRIs and Flexeril cause an intensified effect of the Flexeril -- for me not a good thing so if I were you I would give it some thought.

    You might want to email this to your physician.

    I hope this helps a little,

    Karen :)




    www.medscape.com

    Multi-Drug Interaction Checker

    Patient Regimen

    ATIVAN ORAL
    FLEXERIL ORAL
    ZOLOFT ORAL
    DOXEPIN ORAL


    Interactions

    Moderate Interaction

    SSRI'S; DULOXETINE/TRICYCLIC COMPOUNDS; TRAZODONE
    Zoloft Oral and Doxepin Oral may interact based on the potential interaction between SSRI'S; DULOXETINE and TRICYCLIC COMPOUNDS; TRAZODONE.


    SSRI'S; DULOXETINE/TRICYCLIC COMPOUNDS; TRAZODONE
    Zoloft Oral and Flexeril Oral may interact based on the potential interaction between SSRI'S; DULOXETINE and TRICYCLIC COMPOUNDS; TRAZODONE.



    Selective Serotonin Reuptake Inhibitors; Duloxetine/ Tricyclic Compounds; Trazodone


    This information is generalized and not intended as specific medical advice.

    Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.


    MONOGRAPH TITLE: Selective Serotonin Reuptake Inhibitors; Duloxetine/

    Tricyclic Compounds; Trazodone


    SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.


    MECHANISM OF ACTION: Selective serotonin reuptake inhibitors and duloxetine impair oxidative hepatic metabolism.

    These agents may lead to a more rapid down regulation of postsynaptic beta-adrenergic receptors, thus possibly contributing to a faster onset of the antidepressant effect of other agents.


    CLINICAL EFFECTS: Concurrent administration of a selective serotonin reuptake inhibitor or duloxetine with a TCA or trazodone may result in an increase in serum levels, toxicities, and/or clinical effects of the TCA or trazodone.


    PREDISPOSING FACTORS: None determined.


    PATIENT MANAGEMENT: Patients should be observed for increased adverse effects and clinical effects of TCAs at the initiation of concurrent therapy with selective serotonin reuptake inhibitors or duloxetine.

    Plasma concentrations of the TCA should be monitored and the dosage adjusted accordingly.

    If selective serotonin reuptake inhibitor or duloxetine treatment is discontinued in a patient receiving TCA therapy, the dosage of the TCA may need to be adjusted.

    The effects of fluoxetine on hepatic metabolism may last for 5 weeks after fluoxetine discontinuation. A TCA started after the discontinuation of fluoxetine should be started a lower initial dosage.


    DISCUSSION: In a study, pretreatment with duloxetine (60 mg twice daily) increased the area-under-curve (AUC) of a single dose of desipramine (50 mg) by 3-fold.

    Case reports have shown that the addition of fluoxetine to TCA therapy can result in an increase of 100-300% in the TCA plasma concentration as well as an increase in adverse effects, including seizures and delirium.

    Fluvoxamine has been shown in an in vitro study to inhibit the metabolism of imipramine.

    Three case reports have shown increased serum levels of imipramine (32%, 198%, and 470% increases) and an increase in adverse effects (anticholinergic effects, confusion, and sedation) during concurrent administration with fluvoxamine.

    Two case reports of adverse effects (tonic-clonic seizure, tremors, dizziness, and confusion) and increased plasma desipramine levels (79% and 54% increases) with concurrent administration of fluvoxamine exist.

    Increased plasma levels of clomipramine (586%) and amitriptyline (100-150%) without signs of clinical toxicity were seen following the addition of fluvoxamine to TCA therapy.

    Sertraline has been shown to increase the maximum concentration (Cmax) and AUC of desipramine by 31% and 23%, respectively.

    There is one case report of serotonin syndrome during concurrent therapy with paroxetine and trazodone.

    The affinity of the different selective serotonin reuptake inhibitors for CYP P-450 may vary.


    REFERENCES:

    1.Preskorn SH, Beber JH, Faul JC, Hirschfeld RM. Serious adverse effects of combining fluoxetine and tricyclic antidepressants. Am J Psychiatry 1990 Apr;147(4):532.

    2.Kahn DG. Increased plasma nortriptyline concentration in a patient cotreated with fluoxetine. J Clin Psychiatry 1990 Jan;51(1):36.

    3.Ciraulo DA, Shader RI. Fluoxetine drug-drug interactions: I. Antidepressants and antipsychotics. J Clin Psychopharmacol 1990 Feb; 10(1):48-50.

    4.Vaughan DA. Interaction of fluoxetine with tricyclic antidepressants. Am J Psychiatry 1988 Nov;145(11):1478.

    5.Bell IR, Cole JO. Fluoxetine induces elevation of desipramine level and exacerbation of geriatric nonpsychotic depression. J Clin Psychopharmacol 1988 Dec;8(6):447-8.

    6.Aranow AB, Hudson JI, Pope HG, Jr, Grady TA, Laage TA, Bell IR, Cole JO. Elevated antidepressant plasma levels after addition of fluoxetine. Am J Psychiatry 1989 Jul;146(7):911-3.

    7.Goodnick PJ. Influence of fluoxetine on plasma levels of desipramine. Am J Psychiatry 1989 Apr;146(4):552.

    8.Schraml F, Benedetti G, Hoyle K, Clayton A. Fluoxetine and nortriptyline combination therapy. Am J Psychiatry 1989 Dec;146(12):1636-7.

    9.Downs JM, Downs AD, Rosenthal TL, Deal N, Akiskal HS. Increased plasma tricyclic antidepressant concentrations in two patients concurrently treated with fluoxetine. J Clin Psychiatry 1989 Jun;50(6):226-7.

    10.Downs JM, Dahmer SK. Fluoxetine and elevated plasma levels of tricyclic antidepressants. Am J Psychiatry 1990 Sep;147(9):1251.

    11.Westermeyer J. Fluoxetine-induced tricyclic toxicity: extent and duration J Clin Pharmacol 1991 Apr;31(4):388-92.

    12.Rosenstein DL, Takeshita J, Nelson JC. Fluoxetine-induced elevation and prolongation of tricyclic levels in overdose. Am J Psychiatry 1991 Jun; 148(6):807.

    13.Nierenberg AA, Cole JO, Glass L. Possible trazodone potentiation of fluoxetine: a case series. J Clin Psychiatry 1992 Mar;53(3):83-5.

    14.Bergstrom RF, Peyton AL, Lemberger L. Quantification and mechanism of the fluoxetine and tricyclic antidepressant interaction. Clin Pharmacol Ther 1992 Mar;51(3):239-48.

    15.Maskall DD, Lam RW. Increased plasma concentration of imipramine following augmentation with fluvoxamine. Am J Psychiatry 1993 Oct; 150(10):1566.

    16.Spino E, Campo GM, Avenoso A, Pollicino MA, Caputi AP. Interaction between fluvoxamine and imipramine/desipramine in four patients. Ther Drug Monit 1992 Jun;14(3):194-6.

    17.Bertschy G, Vandel S, Vandel B, Allers G, Volmat R. Fluvoxamine-tricyclic antidepressant interaction. An accidental finding. Eur J Clin Pharmacol 1991;40(1):119-20.

    18.Seifritz E, Holsboer-Trachsler E, Hemmeter U, Eap CB, Baumann P. Increased trimipramine plasma levels during fluvoxamine comedication. Eur Neuropsychopharmacol 1994 Mar;4(1):15-20.

    19.Skjelbo E, Brosen K. Inhibitors of imipramine metabolism by human liver microsomes. Br J Clin Pharmacol 1992 Sep;34(3):256-61.

    20.Preskorn SH, Alderman J, Chung M, Harrison W, Messig M, Harris S. Pharmacokinetics of desipramine coadministered with sertraline or fluoxetine. J Clin Psychopharmacol 1994 Apr;14(2):90-8.

    21.Reeves RR, Bullen JA. Serotonin syndrome produced by paroxetine and low-dose trazodone. Psychosomatics 1995 Mar-Apr;36(2):159-60.

    22.Cymbalta (duloxetine hydrochloride) US prescribing information. Eli Lilly and Company June, 2006.







    [This Message was Edited on 10/12/2006]
  5. kjfms

    kjfms Member