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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
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?
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
Posted by Peri on January 23, 2001, at 8:42:08
In reply to Re: Reboxetine, Paxil and Ultram, posted by medlib on January 22, 2001, at 13:32:17
I asked my doctor about the interaction with Ultram and Paxil and she said not to worry. If I have not had any symtoms then all should be fine. Is this not so.
Peri
Posted by Leonardo on January 23, 2001, at 12:03:16
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?
I have taken reboxetine and Paxil (paroxetine) together successfully in the UK, though I know nothing of Ultram. In the UK Pdocs are very reluctant to prescribe any combinations of ADs because of theoretical unsafe side effects, and because its harder to work out whats going on.
I found the rebox plus Paxil combo myself accidentally when tapering from one to the other. Neither worked much by itself, tho' the combo was quite effective. In particular I found that they largely cancelled out each others side effects. I stuck to low doses (max 10mg Paxil and 4 mg reboxetine per day). My Pdoc wasn't overjoyed by this, but let me continue.
I think the risk of adverse reactions like serotonin syndrome is small if you don't take the full doses of all the meds, eg try half dose of each. Reboxetine plus Paxil is unlikely to give problems since their actions are very different (reboxetine acts largley on noradrenaline, where Paxil acts largley on serotonin).
In the end I gave up this combo as it seemed to lose its effectiveness after about 6 months. Trying Zoloft next...
Shout if you want any more info.
Regards
Leonardo
Posted by Gracie2 on January 23, 2001, at 16:12:07
In reply to Re: Reboxetine, Paxil and Ultram » Peri, posted by Leonardo on January 23, 2001, at 12:03:16
Ultram is a non-narcotic, prescription painkiller
and not an AD.
-Gracie
Posted by Leonardo on January 24, 2001, at 5:15:04
In reply to Re: Reboxetine, Paxil and Ultram-Leonardo, posted by Gracie2 on January 23, 2001, at 16:12:07
>
> Ultram is a non-narcotic, prescription painkiller
> and not an AD.
> -Gracie
Thanks Gracie. Looks to me like this is not a particularly risky combination then. Peri, I'd just be careful if increasing doses - do it slowly and proceed only if you get no bad reactions. What dosed are youi taking now?I'd be interested to hear how you get on, reboxetine plus Paxil has been the most successful drug treatment for me so far ( I took it for about 9 months), but it still has something missing to get me back to normal.
Leonardo
Posted by Dr. Bob on January 25, 2001, at 0:13:26
In reply to Re: Reboxetine, Paxil and Ultram-Leonardo, posted by Gracie2 on January 23, 2001, at 16:12:07
> Ultram is a non-narcotic...
Yes, but:
http://www.dr-bob.org/tips/split/Potential-tram-addiction.html
And regarding the combination with antidepressants:
http://www.dr-bob.org/tips/split/Warning-concerning-tramado.html
Bob
Posted by Leonardo on January 25, 2001, at 4:18:27
In reply to Re: Paxil and Ultram, posted by Dr. Bob on January 25, 2001, at 0:13:26
> > Ultram is a non-narcotic...
>
> Yes, but:
>
> http://www.dr-bob.org/tips/split/Potential-tram-addiction.html
>
> And regarding the combination with antidepressants:
>
> http://www.dr-bob.org/tips/split/Warning-concerning-tramado.html
>
> BobThanks Bob. I'm relieved that this doesn't suggest any problems with Paxit + reboxetine which I have taken, just combinations with Ultram.
Did the Paharmacology tips stop at aroung 1997, I haven't seen any newer ones...
Leonardo
Posted by Dr. Bob on January 26, 2001, at 23:40:54
In reply to Re: Paxil and Ultram » Dr. Bob, posted by Leonardo on January 25, 2001, at 4:18:27
> Did the Paharmacology tips stop at aroung 1997, I haven't seen any newer ones...
That's supposed to be my next project, reviving it...
Bob
Posted by michael on January 27, 2001, at 15:41:06
In reply to Re: Psychopharmacology Tips, posted by Dr. Bob on January 26, 2001, at 23:40:54
Dr. Bob,
This isn't a terribly substantive post...
But I must say, that's great news. I'm glad to hear that it's on the horizon! I know it must be a lot of work, but what a GREAT resource the first "Tips" has been!
I can't tell you how much I look forward to combing through the new one when it's up and running. Thanks for everything you put together for us here, and here's to "Tips II". michael
> > Did the Paharmacology tips stop at aroung 1997, I haven't seen any newer ones...
>
> That's supposed to be my next project, reviving it...
>
> Bob
Posted by quilter on January 28, 2001, at 0:30:37
In reply to Re: Psychopharmacology Tips, posted by Dr. Bob on January 26, 2001, at 23:40:54
> > Did the Paharmacology tips stop at aroung 1997, I haven't seen any newer ones...
>
> That's supposed to be my next project, reviving it...
>
> BobGood news! :-) Quilter
Posted by Leonardo on January 29, 2001, at 5:43:56
In reply to Re: Psychopharmacology Tips, posted by Dr. Bob on January 26, 2001, at 23:40:54
> > Did the Paharmacology tips stop at aroung 1997, I haven't seen any newer ones...
>
> That's supposed to be my next project, reviving it...
>
> BobI too would be very pleased to see some new tips! I am a little wary of advice which is already 5 years old in many cases, but I am consoled by this observation - the UK the medical establishment isn't even up to speed on the 1995 period US prsecribing approaches yet! (Or decided to not to follow it).
Hope you can find the time... Valuable though Babble is, it hard to pick out the wheat from the chaff..
Thanks
Leonaro
This is the end of the thread.
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