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Dr. Bob is Robert Hsiung, MD,
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Posted by Jocor on June 29, 2001, at 11:29:16
Taking 300mg Effexor XR and 10mg Prozac. Idea is to switch to Prozac.
Possibility of serotonin syndrome at this dosage??
What do I look for?Thanks
Jocor
Posted by SalArmy4me on June 29, 2001, at 12:14:26
In reply to Serotonin Syndrome, posted by Jocor on June 29, 2001, at 11:29:16
I ran that through a drug checker and they said that serotonin syndrome from that combination is possible, but highly rare:
Effexor XR has a "major" interaction with Prozac:
"The combining of agents that can inhibit serotonin reuptake and/or other agents with serotonergic activity (including some medications for migraine therapy and certain opioids) 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. In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Close monitoring is recommended for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia..."
Posted by DebbieLynn on June 29, 2001, at 17:58:34
In reply to Re: Serotonin Syndrome, posted by SalArmy4me on June 29, 2001, at 12:14:26
> I ran that through a drug checker and they said that serotonin syndrome from that combination is possible, but highly rare:
>
> Effexor XR has a "major" interaction with Prozac:
> "The combining of agents that can inhibit serotonin reuptake and/or other agents with serotonergic activity (including some medications for migraine therapy and certain opioids) 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. In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Close monitoring is recommended for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia..."
>
What about 225mg of Effexor XR and 20mg of Celexa?? Any risk of serotonin syndrom? I have been at these doses for 4 days. Actually, I feel pretty good.
Debbie
Posted by Elizabeth on June 29, 2001, at 19:42:59
In reply to Serotonin Syndrome, posted by Jocor on June 29, 2001, at 11:29:16
> Taking 300mg Effexor XR and 10mg Prozac. Idea is to switch to Prozac.
> Possibility of serotonin syndrome at this dosage??
> What do I look for?I posted about this in response to someone else's question a short time ago. Take a look at:
http://www.dr-bob.org/babble/20010612/msgs/66624.html
I went into a bit of detail about the usual symptoms.
There can be pharmacokinetic interactions between Effexor and Prozac as well. This would mean cutting the dose of Effexor. At the same time, many people take very high doses of Effexor, or Effexor with an SSRI (including Prozac), without complications.
-elizabeth
Posted by Elizabeth on June 29, 2001, at 21:48:21
In reply to Re: Serotonin Syndrome, posted by DebbieLynn on June 29, 2001, at 17:58:34
> What about 225mg of Effexor XR and 20mg of Celexa?? Any risk of serotonin syndrom? I have been at these doses for 4 days. Actually, I feel pretty good.
My pdoc says he's actually had some great successes from combining Effexor and SSRIs. Celexa and Zoloft have less potential for drug-drug interactions than Prozac, Paxil, and Luvox do. You should watch for symptoms of serotonin syndrome and/or hypomania, though.
I have survived fairly clear-cut serotonin syndrome three times (although it's not generally common, I seem to be unusually prone to this type of reaction), one of which included mixed mania. The symptoms common to all three episodes were lightheadedness, dilated pupils, tremor, chattering teeth, agitation, exaggerated reflexes, confusion (in two of the three incidents, this progressed to delirium), fever, elevated or abnormally fluctuating blood pressure, and memory loss (to various degrees). Other symptoms that I experienced during one or more of the three episodes included nausea and vomiting, sweating, ataxia (loss of coordination), shifting in and out of consciousness, visual illusions, nystagmus (some weird involuntary eyeball movements), clenched jaws, and (in one case) a seizure (complex partial, I think).
-elizabeth
Posted by medlib on June 29, 2001, at 22:52:27
In reply to Serotonin Syndrome, posted by Jocor on June 29, 2001, at 11:29:16
Jocor--
I take 375mg. Effexor and 20mg. Prozac daily with beneficial effects and no problems. YMMV.
Well wishes---medlib
Posted by Jocor on July 5, 2001, at 14:14:14
In reply to Re: Serotonin Syndrome, posted by medlib on June 29, 2001, at 22:52:27
Thank you everyone for you input.
It has been a week now and I feel OK. I feel a bit more tired and my head may feel a bit "lighter" but other than that I have no symptoms as yet. I will remain on this for 1 month.
Jocor
This is the end of the thread.
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