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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Phillipa on April 9, 2009, at 20:25:22
More warnings now it's luvox and other meds triptans etc. Phillipa
April 8, 2009 The US Food and Drug Administration (FDA) has approved safety labeling revisions to provide updated information regarding drug interactions that raise the risk for serotonin syndrome in patients receiving treatment with fluvoxamine maleate, drug interactions between angiotensin-converting enzyme inhibitors and injectable gold therapy, and the risk for hepatotoxicity in patients receiving nitrofurantoin therapy.
Additional Agents Implicated in SSRI-Related Risk for Serotonin Syndrome
On February 24, the FDA approved class labeling changes for fluvoxamine maleate tablets and extended-release capsules (Luvox and Luvox CR, Jazz Pharmaceuticals) to provide updated information regarding drug interactions that increase the risk for serotonin-related adverse events in patients receiving treatment with selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine. This information also applies to selective serotonin-norepinephrine reuptake inhibitors.
The agency previously warned of the risk for potentially life-threatening serotonin syndrome in patients receiving 5-hydroxytryptamine receptor agonists (triptans) in conjunction with SSRIs.
An expanded section of the monograph now warns that serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions can occur with use of SSRIs alone but are more likely with concomitant use of serotonergic drugs (including triptans), agents that impair serotonin metabolism (including monoamine oxidase inhibitors [MAOIs]), or antipsychotics and other dopamine antagonists.
Symptoms of serotonin syndrome may include mental status changes (eg, agitation, hallucinations, and coma); autonomic instability (eg, tachycardia, labile blood pressure, and hyperthermia); neuromuscular aberrations (eg, hyperreflexia and incoordination); and/or gastrointestinal symptoms (eg, nausea, vomiting, and diarrhea). Severe cases can resemble NMS, which includes hyperthermia, muscle rigidity, autonomic instability with possible rapid fluctuation of vital signs, and mental status changes. Patients should be monitored for the emergence of serotonin syndrome or NMS-like signs and symptoms.
Clinicians are reminded that concomitant treatment of depression with MAOIs and SSRIs is contraindicated. SSRI-treated patients receiving triptans should be followed up closely, particularly during initiation of therapy, dose increases, or the addition of another serotonergic drug.
Concomitant use of SSRIs with serotonin precursors (eg, tryptophan) is not recommended. Treatment with SSRIs and any concomitant serotonergic or antidopaminergic agents, including antipsychotics, should be discontinued immediately in patients who develop symptoms of serotonin syndrome.
Fluvoxamine tablets and controlled-release capsules are indicated for the treatment of obsessive-compulsive disorder; the capsules can also be used to treat social anxiety disorder.
Posted by yxibow on April 10, 2009, at 2:45:56
In reply to Now It's luvox and Others., posted by Phillipa on April 9, 2009, at 20:25:22
> More warnings now it's luvox and other meds triptans etc. Phillipa
>
> April 8, 2009 The US Food and Drug Administration (FDA) has approved safety labeling revisions to provide updated information regarding drug interactions that raise the risk for serotonin syndrome in patients receiving treatment with fluvoxamine maleate, drug interactions between angiotensin-converting enzyme inhibitors and injectable gold therapy, and the risk for hepatotoxicity in patients receiving nitrofurantoin therapy.
>
> Additional Agents Implicated in SSRI-Related Risk for Serotonin Syndrome
>
> On February 24, the FDA approved class labeling changes for fluvoxamine maleate tablets and extended-release capsules (Luvox and Luvox CR, Jazz Pharmaceuticals) to provide updated information regarding drug interactions that increase the risk for serotonin-related adverse events in patients receiving treatment with selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine. This information also applies to selective serotonin-norepinephrine reuptake inhibitors.
>
> The agency previously warned of the risk for potentially life-threatening serotonin syndrome in patients receiving 5-hydroxytryptamine receptor agonists (triptans) in conjunction with SSRIs.
>
> An expanded section of the monograph now warns that serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions can occur with use of SSRIs alone but are more likely with concomitant use of serotonergic drugs (including triptans), agents that impair serotonin metabolism (including monoamine oxidase inhibitors [MAOIs]), or antipsychotics and other dopamine antagonists.
>
> Symptoms of serotonin syndrome may include mental status changes (eg, agitation, hallucinations, and coma); autonomic instability (eg, tachycardia, labile blood pressure, and hyperthermia); neuromuscular aberrations (eg, hyperreflexia and incoordination); and/or gastrointestinal symptoms (eg, nausea, vomiting, and diarrhea). Severe cases can resemble NMS, which includes hyperthermia, muscle rigidity, autonomic instability with possible rapid fluctuation of vital signs, and mental status changes. Patients should be monitored for the emergence of serotonin syndrome or NMS-like signs and symptoms.
>
> Clinicians are reminded that concomitant treatment of depression with MAOIs and SSRIs is contraindicated. SSRI-treated patients receiving triptans should be followed up closely, particularly during initiation of therapy, dose increases, or the addition of another serotonergic drug.
>
> Concomitant use of SSRIs with serotonin precursors (eg, tryptophan) is not recommended. Treatment with SSRIs and any concomitant serotonergic or antidopaminergic agents, including antipsychotics, should be discontinued immediately in patients who develop symptoms of serotonin syndrome.
>
> Fluvoxamine tablets and controlled-release capsules are indicated for the treatment of obsessive-compulsive disorder; the capsules can also be used to treat social anxiety disorder.
>
This is more aas protection between the new patented re-release of Luvox and the FDA.There was a warning recently about EVERY antidepressant made since the 1960s that suicide could happen and all sorts of things which may be true but were released in light of a lot of litigation and other factors.
The same went for EVERY sleep agent still marketed since about the same time also that people could sleepwalk and all sorts of things that are theoretically possible but do NOT happen regularly to people.
And also because of some cases of liver damage ALL COX-2 inhibitors were withdrawn except for Celebrex. Litigation also ensued. Yes, we need to be cautious with drugs, but personally at least my physician thought that was a complete travesty. Of course people are free to disagree.
Yes, serotonin syndrome can occur with any SSRI and other agents, and its something actually that wouldn't be clear to the patient at the time, so it is something to be concerned about, but careful monitoring and proper prescribing rarely brings on SS.NMS is very rare with APs, especially modern ones, and I would imagine the same with SSRIs. Probably as rare as torsades de pointes.
Of course other drugs being taken, such as sumatriptan for migraine, should be discussed with your psychiatrist -- all agents, including OTC supplements should be mentioned.
As far as myself, I do take 5-HTP and l-tryptophan with a modest dose of Anafranil plus Seroquel and other agents not directly related to serotonin.
But, anyone should mention such supplements to their doctor. I'm not suggesting that anyone should add what I take as supplements -- but l-tryptophan is at least known somewhat in the psychiatric community as a possible agent to help sleep.
We have enough fear and sorrow in our lives -- I think sometimes this goes overboard to the point that NO medication will ever reach anyone because of some possible rarity.
And I'm speaking of someone who has iatrogenic neurological things probably never seen before by psychiatry. But I am one of those rare exceptions with neuroleptics.
So do we wistfully talk about new pipelines and approvals for medications to palliate our ills, or do we argue and call for their removal from the market 6 months after they come out ?
I guess its a touchy balance between the sky is falling, side effects that come with all medications, and real disasters.
Yes, the first SSRI, not released here, but in Europe caused travesties. Thalidomide caused countless problems yet it is allowed now in special situations.
Lariam, related to quinine, for malaria prevention can and has caused psychiatric disorders and other problems. Doxycycline is recommended now, at least by the army.
tidings
-- Jay
Posted by manic666 on April 10, 2009, at 4:11:23
In reply to Re: Luvox, others, FDA has been there before » Phillipa, posted by yxibow on April 10, 2009, at 2:45:56
phillipa. why do you keep reading all the sh*t things , start reading pationt reviwes on who the drugs helped no all the doom, an gloom you just make yourself worse,same as just said above you wouldnt take a headace tab if you believed every thing on the leaflet, that just like my old dad 97 year old if he get anxierty witch hes had all his life ,an look how old he is .he says its something he ate, he has a giant list of what he thinks he carnt eat,he has had tests all his life for stomarch troubles an there is nothing wrong with him, only anxierty makes gas ,an the docs never think of this just give him more tests.i tell him an he thinks im takeing the piss . o an 1 om my sisters an her husband never watch a medical programe or read any thing with illness as it scares them to death is like a phobia so be carful what you read
Posted by bleauberry on April 10, 2009, at 5:34:54
In reply to Re: Luvox, others, FDA has been there before, posted by manic666 on April 10, 2009, at 4:11:23
Well, Phillipa, manic666 said it more bluntly than I would have, but really, would it maybe be healthier to read positive things instead of negative things? Would it maybe be tons better to read about inexpensive herbs you can treat yourself with that are deadly to Lyme bacteria? Natural adrenal support treatments that take the monkey of an endo out of the equation? Deciding on another med to switch to instead of Luvox?
Stuff like that? Ya know? The negatives and doom-n-gloom will only make disease worse, in my opinion. It does not represent an effort to move forward, but rather to stay stuck or move backward.
You are an email friend of mine and I have a lot of compassion for you. My words are meant to be caring and helpful, so I hope they are not mistakenly taken any other way.
As for serotonin syndrome, I thought it was fairly basic knowledge that any med having any effect on serotonin carries the risk, most especially when two different ones are combined. Or put it this way. Anyone who didn't know that luvox could be a player in a serotonin syndrome risk must have been living on Mars or Jupiter for the last 50 years.
Posted by Zana on April 10, 2009, at 14:09:06
In reply to Now It's luvox and Others., posted by Phillipa on April 9, 2009, at 20:25:22
What are triptans?
Zana
Posted by Zana on April 10, 2009, at 14:16:24
In reply to Re: Now It's luvox and Others., posted by Zana on April 10, 2009, at 14:09:06
Jeez, I didn't hear Phillipa's post as doom and gloom, just good information to have. I think the more information we have, good news and bad news, the better patients we can be and the better treatment we will receive. Maybe I have missed a pattern of doom and gloom posting. If so I hope Phillipa is not stuck in a dark place.
Zanz
Posted by Phillipa on April 10, 2009, at 19:17:37
In reply to Re: Now It's luvox and Others., posted by Zana on April 10, 2009, at 14:16:24
Zana triptans are used for headaches but never have recommended with SSRI's per my pdoc. The article came from my Nursing online newsletter receive daily. Get Ceu's for reading taking an after test which I didn't include. Thought since this is what's being taught to pharmacists, doctors and nurses it was interesting. And the Ceu's are also given to docs and pharmacists. Love Phillipa
Posted by 49er on April 12, 2009, at 13:52:40
In reply to Now It's luvox and Others., posted by Phillipa on April 9, 2009, at 20:25:22
I find negative reactions to Philipa's post very interesting.
When I thought that psych meds were great, I reacted the same way. My attitude was, "How dare you say anything bad about something that is helping me function?"
But my perspective changed once I was diagnosed with a hearing loss that I definitely linked to being on Remeron.
The side effect is listed as rare but then again, can we really trust the reporting of side effects when it is estimated that only 2% to 10% of all adverse side effects are ever reported to the FDA. Also, the side effects reported are based on a very short trial period. So that is why I think so called rare side effects might not be as rare as you think.
Anyway, I had a very positive attitude. It didn't prevent my hearing loss. I wish to god I had paid more attention to the articles warning about ADS that I would rant against as a hearing loss isn't the only adverse affect I suffered.
Sorry if I am rambling a bit. A noisy neighbor has caused insomnia for two days in a row.
Happy Easter and Passover to everyone.
Palm
Posted by Vincent_QC on April 12, 2009, at 19:51:34
In reply to Now It's luvox and Others., posted by Phillipa on April 9, 2009, at 20:25:22
> Fluvoxamine tablets and controlled-release capsules are indicated for the treatment of obsessive-compulsive disorder; the capsules can also be used to treat social anxiety disorder.
>Thanks Jan ;-)
Hummm...I also think it's a new patented thing for the Luvox-CR...but that's important information...I still prefer to get advise before I take a new meds of any serious interractions...By the way...it's write that the capsule can be use for social phobia... I always wonder if Luvox was helpfull more than the others SSRI'S for the social phobia???
I write above a list of all the newer AD's I try in the past and the results...
Someone on the babblesite can told me if the Luvox is more good than all the other SSRI, or I should go with the newer Pristiq???
- Prozac (get very unstable on it, was ok at 20mg, but no improve so increase at 30mg... 1 week after, I get a lot anxious, 3 times more than usual and had to increase my benzos intake, it was my 32yo birthday and we go all the familly to the restaurant, I had to leave I was thinking I was becoming crazy!!! I was not able to tolerate it at all), worse my social phobia in general and my anxiety... no weight gain on it... I had also a small dose of Remeron at the same time for sleep...
- Remeron: 60mg...the one who disolve in the mouth... OMG... waste of time...sedation, weight gain...nightmares all night long... 3 months or more on that dose... nothing for the anxiety, general or social... just make me think about food...
-Zoloft: Do nothing...major weight gain..but no side-effect at the maximum dose for 3 months or more...try it 2 times in the past...and by nothing I really mean nothing... I feel like I was on a placebo... I ask for the real Zoloft, not the generic because I had read somewhere that the Generic was not good at all...
-Paxil: The one I take the longest time...4 years...I was just turning at the time...I was on 60mg/day... felt no improve, the therapy and the psychologist I had at the time was more helping me than the Paxil...I gain more than 150 pounds on it, had to do severals proteine diets to loose weight... stop it around 23yo...was put on Celexa and Zoloft after...
- Celexa: Same as Zoloft...with the weight gain and no side-effects at 60mg day for 3 months...it was new when I try it back in 1999 (Canada)...
- Lexapro: 30mg day, Worse of all the SSRI's...major weight gain, worse my anxiety, dizness, daytime sedation, lack of motivation and energy, no interrest in life...totally kill me (last september,october and november 2008...had to take Ritalin with it to have some energy...don't help also...nothing for the anxiety, worse my state... Take it with wellbutrin also...nothing to improve my dizness and tired feeling...
- Effexor-XR: Try it 2 times...the last time was in the summer of 2008...more than 400mg/day...gastric by-pass restriction so had to take severals pills of 75mg at different hours of the day...worse my anxiety, make me taking too much xanax, 8 mg day...end at the hospital...2 months on it at this dosage...nothing for my social phobia or general anxiety... Was less bad for the sedation...in fact, make me more agitated...no wonder why I increase the benzos intake...
- Cymbalta: Never try it...another XR formulation...seem to be more acvite in the NE than field than the Effexor-XR...but I know some people on it personnaly and they feel quite anxious on it (my sister especially)...and make the heart rate more fast... More good for fybromialgia and pain...in general...
- Nardil: 75mg/day for 3 months...nothing for social phobia or anxiety...a lot of sedation...no weight gain... tired all the time, had to drink a lot of coffee... just help me reduce the benzo intakes at the time...go from 8mg of Rivotril day to 4mg...so after 3 months, increase the dosage to 90mg day...was not able to stay at this dosage...orthostatic hypotension was intoloreble...
- Parnate: High blood pressure, hypotension...make my heart f*ck up...help just to reduce my benzos intakes...cut the Valium 20mg to 10mg day...
-Manerix: Headache...migraine...call it like you want...hate it the week I was on it...
-Clomipramine: Get anxious...had eyes burning sentation, strange sensation in my head, repetitive thoughts...3 weeks at 50mg was enought for me...look like a BAD SSRI'S, not a clean drug at all...
-Nortriptiline: Heart problem...fast pulse rate...
- Pristiq: My next option if the Marplan is not approved... is it worthing the try? Nobody answer to that question the last time I post a thread on the babble site...
-Luvox: Never try it... is it worse than the others SSRI'S for the weight gain??? Is it a clean drug? Did 300mg/day can help me for the social phobia and my general anxiety, without getting me always tired at daytime and increase again my benzos intake?
Thanks for any inputs...
Posted by Phillipa on April 12, 2009, at 21:21:45
In reply to Re: Now It's luvox and Others. » Phillipa, posted by Vincent_QC on April 12, 2009, at 19:51:34
Vincent for me only staying at a low starting dose of luvox and lower doses of benzos is no better or no worse than higher doses of either med. Would like off all of them Hence counting on this bioidentical hormone doc. Now thyroid is stabalized. No weight gain. Years ago was on 250 of luvox and got energy despite the benzos but it didn't last. And never could handle high doses of any meds again. Love Phillipa
This is the end of the thread.
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