Posted by medlib on January 22, 2001, at 13:32:17
In reply to Reboxetine, Paxil and Ultram, posted by Peri on January 22, 2001, at 10:11:15
> Is it alright to take Reboxetine, Paxil and Ultram at the same time? Are there any side effects from this combination?
Peri--
The short answer is NO!
Drug literature suggests that this combo is NOT a good idea. Both Ultram (tramadol) and Paxil (paroxetine HCl) are metabolized in the liver by the P450 family of enzymes, in fact, by the same enzyme (CYP2D6), which is saturable. This chemical bottleneck can lead to Serotonin Syndrome--an excess of this neurotransmitter produces a whole host of miserable symptoms, which can include death. There is also an increased risk of seizure. This drug-drug interaction potential is characterized as SEVERE.
US drug databases do not include reboxetine because it is not FDA-approved. Since rebox is an NRI and Paxil, an SSRI, their mechanisms of action do not overlap; but do check rebox drug lit to see how it is metabolized. If it mentions P450 liver enzymes, or especially, CYP2D6, you will have a similar conflict when combining it with Paxil or Ultram. (In that case one drug would potentiate the other; your body would react as if you had taken much more of that drug than you actually did.)
BTW, you were sensible to check before taking a combination of drugs for the first time, especially if they were prescribed by different docs and dispensed by different pharmacies. But, the best sources to check with are pharmacists or docs. It's also best if each one on your treatment team has your *complete* med record. Even that won't prevent the odd screwup, but it will certainly reduce their likelihood.
Well wishes---medlib
poster:medlib
thread:52217
URL: http://www.dr-bob.org/babble/20010122/msgs/52235.html