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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by tampagirl70 on November 1, 2004, at 8:55:54
A couple weeks ago I got a cold. After 10 days it wasn't any better so I went to an ENT and he prescribed Augmentin and a cough suppressant pill called Entabs (dextromethorphan). I started taking the meds and slowly started to feel better physically. My mental status, however, was starting to get worse. I had been feeling a little down and also obsessing a little bit, but I thought it was because I'd been sick for a couple weeks and out of my usual routine. I checked online yesterday to see if there are any known interactions with the drugs I'm taking and it turns out the Entabs aren't supposed to be taken with SSRIs. Its been about 36 hours since I last took the Entab and I talked to my pdoc and he said to up my Celexa to 60mg from 40mg. Has anyone had this same thing happen to them and how long did it take you to get back on track? I can't stand feeling this way and I feel hopeless. Help!!
Posted by jboud24 on November 1, 2004, at 13:34:05
In reply to HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by tampagirl70 on November 1, 2004, at 8:55:54
I never found that taking DXM with an SSRI brought about any depressive change in my mood. Perhaps it has to do with the metabolism of augmenten or DXM affecting either your celexa or wellbutrin. If you are feeling really low though, you need to get yourself to a doctor or go to the emergency room and tell them you think you are having a drug reaction.
I hope you feel better,
Justin
Posted by tampagirl70 on November 1, 2004, at 13:38:40
In reply to Re: HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by jboud24 on November 1, 2004, at 13:34:05
Thanks for responding. The literature that came with the DXM said not to take it with SSRIs and when I spoke with my pdoc he said it could make you feel "weird". I've had a lot of things going on personally and a lot of emotions have come up, so I'm sure its a combination of a lot of things and the drug interactions probably didn't help.
Posted by Snowie on November 1, 2004, at 14:07:05
In reply to HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by tampagirl70 on November 1, 2004, at 8:55:54
Tampagirl,
Were you okay mentally until you started taking the Entabs? Do you believe you had a bad reaction after you took the Entabs with Celexa? If so, seems both the ENT and your pharmacist should have noted the drug interaction of the meds. I'm no pdoc or regular doc, so I have no idea how long it takes for Entabs (or Celexa for that matter) to leave your body. You may want to call your pharmacist about that. I don't know why your pdoc would want to up the Celexa when you may be having a drug interaction from another med.
I'm in Tampa as well. Good luck!
Snowie
> A couple weeks ago I got a cold. After 10 days it wasn't any better so I went to an ENT and he prescribed Augmentin and a cough suppressant pill called Entabs (dextromethorphan). I started taking the meds and slowly started to feel better physically. My mental status, however, was starting to get worse. I had been feeling a little down and also obsessing a little bit, but I thought it was because I'd been sick for a couple weeks and out of my usual routine. I checked online yesterday to see if there are any known interactions with the drugs I'm taking and it turns out the Entabs aren't supposed to be taken with SSRIs. Its been about 36 hours since I last took the Entab and I talked to my pdoc and he said to up my Celexa to 60mg from 40mg. Has anyone had this same thing happen to them and how long did it take you to get back on track? I can't stand feeling this way and I feel hopeless. Help!!
Posted by tampagirl70 on November 1, 2004, at 14:30:54
In reply to Re: HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan » tampagirl70, posted by Snowie on November 1, 2004, at 14:07:05
Hi Snowie - I was a little down and starting to obsess a little and that started right after I got my cold. I was home for 2 days (2 weeks ago) and I had too much time to think - never a good thing for me. I had recently dropped from 40mg celexa to 30mg and last week I decided I should go back up to the 40mg because I was starting to feel down and obsessing. Last Wednesday I started taking Augmentin and the Entabs. I only took 4 Entabs - Wednesday, Thursday and Saturday. Friday and Saturday mornings I had quite a bit of anxiety but no problem getting out of bed. Yesterday morning, I didn't want to get out of bed and then I broke down part way through the day crying about my family and my husband and everything else in my life. I feel like a complete mess and that my husband will get tired of dealing with this. Its been a good 3 years since I had any problems and in June this year I had a set back because I stopped my meds. Once they were back in my system, I was fine. Now I don't know what to do.
Posted by jboud24 on November 1, 2004, at 15:10:27
In reply to HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by tampagirl70 on November 1, 2004, at 8:55:54
There is always good ole Vicodin Tuss cough syrup. Its cough suppression is really much better than DXM, which has never stopped my coughing. I think you should call your doc, and ask him to call the V-Tuss in to your pharmacy instead of seeing him directly. Just be sure and tell him that you are having a reaction to the DXM cough syrup, and inform him about the warning against taking them with an SSRI. Who knows, by making your doc more informed, you could help prevent someone else from going through the same thing as you if nothing else. And besides, everyone likes V-Tuss cough syrup
:-).Good luck and best wishes,
Justin
Posted by tampagirl70 on November 1, 2004, at 15:32:33
In reply to Re: HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by jboud24 on November 1, 2004, at 15:10:27
At this point, I don't even need the cough syrup and I stopped taking the DXM. I just want to feel normal again and not depressed and like a walking disaster/nightmare. I'm sad about everything and want to cry all the time. I hate being like this.
Posted by gardenergirl on November 1, 2004, at 18:22:05
In reply to Celexa Dextromethorphan interactions?, posted by tampagirl70 on November 1, 2004, at 10:14:43
>> I posted this on the Babble board and haven't gotten any responses, so I thought I'd give it a shot here.
>
> A couple weeks ago I got a cold. After 10 days it wasn't any better so I went to an ENT and he prescribed Augmentin and a cough suppressant pill called Entabs (dextromethorphan). I started taking the meds and slowly started to feel better physically. My mental status, however, was starting to get worse. I had been feeling a little down and also obsessing a little bit, but I thought it was because I'd been sick for a couple weeks and out of my usual routine. I checked online yesterday to see if there are any known interactions with the drugs I'm taking and it turns out the Entabs aren't supposed to be taken with SSRIs. Its been about 36 hours since I last took the Entab and I talked to my pdoc and he said to up my Celexa to 60mg from 40mg. Has anyone had this same thing happen to them and how long did it take you to get back on track? I can't stand feeling this way and I feel hopeless. Help!!
>
>
Posted by gardenergirl on November 1, 2004, at 18:36:24
In reply to Celexa Dextromethorphan interactions?tampagirl70, posted by gardenergirl on November 1, 2004, at 18:22:05
Posted by OldPunk on November 1, 2004, at 18:48:19
In reply to Re: HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by tampagirl70 on November 1, 2004, at 15:32:33
> At this point, I don't even need the cough syrup and I stopped taking the DXM.
Probably a very good idea. According to the C450 substrates/inhibitions chart at http://medicine.iupui.edu/flockhart/table.htm
(Thanks to Chairman MAO's post on April 1, 2004), the DXM is metabolized using the 2D6 isoform, which is inhibited by Wellbutrin/bupropion. The Wellbutrin is itself a substrate for 2B6. Celexa also inhibits 2D6 and is a substrate for 2C19.The best I can guess is that it's just going to take a long time for the DXM to work its way out. For *ME* it extends the time to clear out the cough syrup's bleh-ness by a factor of 6, without really extending its beneficial effects. However, the DXM should eventually work its way out.
Posted by Larry Hoover on November 1, 2004, at 19:11:23
In reply to Celexa Dextromethorphan interactions?tampagirl70, posted by gardenergirl on November 1, 2004, at 18:22:05
> >> I posted this on the Babble board and haven't gotten any responses, so I thought I'd give it a shot here.
> >
> > A couple weeks ago I got a cold. After 10 days it wasn't any better so I went to an ENT and he prescribed Augmentin and a cough suppressant pill called Entabs (dextromethorphan). I started taking the meds and slowly started to feel better physically. My mental status, however, was starting to get worse. I had been feeling a little down and also obsessing a little bit, but I thought it was because I'd been sick for a couple weeks and out of my usual routine. I checked online yesterday to see if there are any known interactions with the drugs I'm taking and it turns out the Entabs aren't supposed to be taken with SSRIs. Its been about 36 hours since I last took the Entab and I talked to my pdoc and he said to up my Celexa to 60mg from 40mg. Has anyone had this same thing happen to them and how long did it take you to get back on track? I can't stand feeling this way and I feel hopeless. Help!!Augmentin is a combination antibiotic. It can make you feel sick, all by itself.
I can't find anything saying Entabs is dextromethorphan. The only Entabs I can find is sulfasalazine, used in e.g. rheumatoid arthritis.
However, if dextromethorphan is what you were taking, there is a mild interaction with citalopram. The effect would be the same as if you took a little extra dextromethorphan. No adverse effects from that interaction have been reported, anywhere I have looked (I have a number of book-marked interaction references).
As for lasting effects of dextromethorphan, that can happen, but it's not because of interactions. Some people just get a little dopey feeling on it. It will pass, and without any long-term effects.
Good luck,
Lar
Posted by Tyroneous1 on November 1, 2004, at 22:30:09
In reply to Re: Celexa Dextromethorphan interactions?tampagirl70 » gardenergirl, posted by Larry Hoover on November 1, 2004, at 19:11:23
I know first hand that dextrometorphan and any SSRI or SNRI can give you a good depressive and dissociative experience. It happened to me and anyone who reads this and disagrees...I'm just speaking from my personal experience. I'm sure it's not the rule and probably the exception to most. Anyway, I believe you experienced something along those lines. Anyhoo...I don't want you to feel alone.
Posted by tampagirl70 on November 2, 2004, at 9:22:51
In reply to Re: HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by OldPunk on November 1, 2004, at 18:48:19
What does all of that mean? My pdoc told me it would only take about 24-36 hours for it to leave my system, but not that its been over 48 hours and i don't feel much better, I'm thinking that was a bad time quote.
Posted by tampagirl70 on November 2, 2004, at 9:30:13
In reply to Re: Celexa Dextromethorphan interactions?tampagirl70, posted by Tyroneous1 on November 1, 2004, at 22:30:09
Thanks Tyroneous - I DO feel alone and am upset because I was doing so well before I got sick and then had this depression happen again. There were a lot of things building up inside me and I'm sure the mixing of the meds didn't help any. I'm just hoping that I get better soon because I love the holidays and don't want to be down during them.
Posted by OldPunk on November 2, 2004, at 11:14:37
In reply to Re: HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by tampagirl70 on November 2, 2004, at 9:22:51
> What does all of that mean? My pdoc told me it would only take about 24-36 hours for it to leave my system, but not that its been over 48 hours and i don't feel much better, I'm thinking that was a bad time quote.
Basically, that you have only so much of a certain type of an enzyme to remove the dextromethorphan in your system.
Wellbutrin and Celexa both can make the enzyme work some or much slower, so it takes longer to clear the dex. out than normal for you.
If you have less of the enzyme than other folks do (IIRC, 5% of the population have much less than normal) it will take longer still.From what I've read on dextromethorphan use/abuse sites, it's possible that some of the side effects associated with cough syrup *may* be increased by the Celexa. No guarantees either way, but if so it would make it feel like it's clearing out even slower.
In summary, you're going to have to be patient and maybe next time shoot for less DXM.
Posted by tampagirl70 on November 2, 2004, at 12:55:42
In reply to Re: HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by OldPunk on November 2, 2004, at 11:14:37
I'll never take it again, believe me. I didn't look at the literature that came with it from Walgreens, but it said not to take it if you're taking SSRIs. I basically assumed if there was a problem, the pharmacist or the prescribing doctor (both of whom knew I am taking the celexa and wellbutrin) would warn me about it.
Thanks for your info - I don't understand all of the technical stuff so getting it explained is very helpful.
Posted by gardenergirl on November 2, 2004, at 13:32:02
In reply to Celexa Dextromethorphan interactions?, posted by tampagirl70 on November 1, 2004, at 10:14:43
Hi,
I am by no means an expert. The issue with AD's and dextromethorphan is the possiblity of serotonin syndrome. This is a specific cluster of symptoms (I can't name them now, sorry). I do not recognize anything in what you describe as sounding dangerous. I think perhaps you might just be feeling worse due to having to deal with illness and depression at the same time.Hopefully you are already starting to feel better. I'm glad you called your doc. Keep trying on the med board. Sometimes it takes a couple times to get an answer.
Good luck,
gg
Posted by tampagirl70 on November 2, 2004, at 13:32:02
In reply to Re: Celexa Dextromethorphan interactions? » tampagirl70, posted by gardenergirl on November 1, 2004, at 14:23:46
What are the symptoms of serotonin syndrome?
Posted by gardenergirl on November 2, 2004, at 13:32:03
In reply to Re: Celexa Dextromethorphan interactions?, posted by tampagirl70 on November 1, 2004, at 14:47:18
The most common symptoms of serotonin syndrome include: restlessness, confusion, agitation, feeling overheated or excessive sweating, euphoria, racing heartbeat, headache (related to rise in blood pressure), confusion and concentration problems, shakiness, difficulty with reflexes, excessive salivation, rapid contraction and relaxation of the ankle muscle causing abnormal movements of the foot or jaw, clumsiness, feeling intoxicated or dizzy, sweating, muscle twitching, rigidity, loosening of bowels or diarrhea. (Serotonin syndrome is difficult to distinguish from a syndrome called neuroleptic malignant syndrome (NMS) due to a similarity in symptoms and signs.) If you experience any of these symptoms discontinue all non-essential medications, herbs, hormones, or supplements and contact your physician. Eat a high protein meal and allow yourself some physical activity (e.g. taking a walk) followed by rest as soon as you are able.
Cut and pasted from this site: http://www.mindbodyconsult.com/protocols/serotonin.html
gg
Posted by tampagirl70 on November 2, 2004, at 13:32:04
In reply to Serotonin Syndrome » tampagirl70, posted by gardenergirl on November 1, 2004, at 15:35:25
Nope, haven't had any of those symptoms. What about vitamin E or a multivitamin? I've been taking the multi for almost a year now and haven't had any problems. The vitamin E started in September and I figured it was probably pretty harmless. Was I wrong?
Posted by tampagirl70 on November 2, 2004, at 13:56:58
In reply to Re: Celexa Dextromethorphan interactions? » tampagirl70, posted by gardenergirl on November 1, 2004, at 14:23:46
Could there have been a reaction between the Augmentin and Celexa? I've never had a problem with antibiotics and my ADs, but maybe this time I wasn't so lucky.
Posted by Snowie on November 4, 2004, at 16:20:15
In reply to Re: HELP -Celexa/Wellbutrin/Augmentin/Dextromethorphan, posted by tampagirl70 on November 1, 2004, at 14:30:54
Hi Tampagirl,
Sorry, I just saw your post - I haven't been on this Board in a while. Just wondering if maybe the decrease in Celexa from 40 mg. to 30 mg., plus the Entab and your cold or flu, might have had anything to do with your feelings? It takes a while for the SSRI's to work, but you could have had a nasty reaction when you tried to taper too much too soon. How do you feel now?
Do you like your pdoc? Is he or she helping you? Maybe some cooler weather may improve your mood. I know I wouldn't mind a little cold snap, which we'll be getting soon. Plus, to be honest, all the negative political ads we've been subjected to here in Florida (which have seemingly lasted forever) prior to the election was enough to put anybody into a funk! Thank goodness the election is over.
Snowie
> Hi Snowie - I was a little down and starting to obsess a little and that started right after I got my cold. I was home for 2 days (2 weeks ago) and I had too much time to think - never a good thing for me. I had recently dropped from 40mg celexa to 30mg and last week I decided I should go back up to the 40mg because I was starting to feel down and obsessing. Last Wednesday I started taking Augmentin and the Entabs. I only took 4 Entabs - Wednesday, Thursday and Saturday. Friday and Saturday mornings I had quite a bit of anxiety but no problem getting out of bed. Yesterday morning, I didn't want to get out of bed and then I broke down part way through the day crying about my family and my husband and everything else in my life. I feel like a complete mess and that my husband will get tired of dealing with this. Its been a good 3 years since I had any problems and in June this year I had a set back because I stopped my meds. Once they were back in my system, I was fine. Now I don't know what to do.
This is the end of the thread.
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