Humanity and Science Behind Depression, Bipolar Disorder, and Mental Health - by Jane Chin PhD
20 Jul
U.S. Food and Drug Administration (FDA) published a warning that mixing certain sSRI/SNRI-type of antidepressant medications and triptan-based migraine drugs may cause a potentially lethal condition called Serotonin Syndrome.
According to the FDA website, when the body has too much serotonin, symptoms of Serotonin Syndrome will occur. These symptoms may include restlessness, hallucinations, loss of coordination, fast heart beat, rapid changes in blood pressure, increased body temperature, overactive reflexes, nausea, vomiting, and diarrhea. Usually symptoms happen when the drug dose is increased or when the patient is started on the drug.
The FDA website listed some commonly prescribed drugs within the classes at risk:
SSRIs and a Combination Drug Containing an SSRI
* Celexa (citalopram)
* Fluvoxamine
* Lexapro (escitalopram)
* Paxil (paroxetine)
* Prozac (fluoxetine)
* Symbyax (olanzapine/fluoxetine)
* Zoloft (sertraline)
SNRIs
* Cymbalta (duloxetine)
* Effexor (venlafaxine)
Triptans
* Amerge (naratriptan)
* Axert (almotriptan)
* Frova (frovatriptan)
* Imitrex (sumatriptan)
* Maxalt and Maxalt-MLT (rizatriptan)
* Relpax (eletriptan
* Zomig and Zomig ZMT(zolmitriptan)
15 Responses for "Mixing Some Antidepressants and Migraine Drugs May Cause Lethal Serotonin Syndrome"
Good Afternoon,
My name is C. and I have been ’somewhat’ diagnosed with Bipolar disorder, however my Doctor does not want to say yes or no due to potential error (miss-diagnosis). She has given me a prescription of Seroquel, which I had taken before, but this time she suggests I take it at my high points, but what about my low points. The reckless euphoria can be beat, but the hopelessness I feel like I can’t go on. Do you have any suggestions? Should I be on another Med. for my down time? I was on Celexa and Seroquel at the same time before but I had many suicide attempts. I just want to feel normal. Thanks for your time. Hope to hear from you soon. Take Care! C.
Dear C,
I can understand your concern for your “low points.”
You may want to seek a second opinion with a psychiatrist who specializes in treating bipolar disorder. I’m not sure if the doctor you are visiting is your family doctor or a specialist.
I encourage you to call your insurance carrier’s mental health division and ask for a referral to a specialist in the BP area.
Best wishes,
Jane
Thank you very much much Dr.Chin. I appreciate the feed back and have talked to my psychiatrist and counsellors and they have put on Celexa once again, and am feeling much better. Take Care
C.
is it ok to mix citalopram with effexor?the dr is slowly taken my husband off effexor to start him on citalopram he went from 300 mgs to 150 to 75 now hes on 35mgs then after that iam to start him on the citalopram 20mgs, but hes depression is there i was wondering if it would be ok if i started the citalopram she also has him on 4mgs f risperidone,maybe iam losing my mind but afetr all these years iam looking for a wonder drug!
Jackie,
I’d follow your husband’s doctor’s instructions EXACTLY as given and not change anything. If you are noticing side effects or concerns with your husband, you would want to notify his doctor immediately and ask what, if anything, may be done.
Best wishes,
Jane Chin
Is it okay to mix citalopram and and acetaminophen? I take 40mg of Celexa every day, and was never told if taking 1000mg of acetaminophen would alright, or if that would cause some kind of reaction.
Leda,
I’d ask your psychiatrist that question. Here’s some additional information that may be useful:
My understanding is that both drugs are metabolized in the liver through the cytochrome P450 enzyme system, although acetaminophen is only metabolized 5% in the liver, and when acetaminophen is mixed with alcohol, this becomes a potentially harmful 5%. If the same enzymes process both drugs, then the drug levels of one or both drugs may be different in the blood when compared to taking either citalopram alone or acetaminophen alone.
P450 CYP3A4 and CYP2C19 enzymes metabolize citalopram. Based on this link, acetaminophen is metabolized by P450 CYP2E1, so it appears that the drugs go through different enzymes in the liver.
Most of the caution I’ve found re: acetaminophen and citalopram involve formulations of narcotic drugs that include acetaminophen, but not acetaminophen alone. For example:
Citalopram Interactions (scroll down)
Best wishes,
Jane
has mixing wellbutrin sr and seroquel ever worked for anyone ?
What are the risks of mixing Paxil and Sandoz with weed. My husband is on both medication and I think he has started smoking pot.
Rachel,
As a general rule, mixing any medications without the doctor’s oversight is a very bad idea, and mixing any medications with weed is both a very bad idea and a potentially dangerous idea. It may be time to have an honest talk with your husband about this because he may be putting himself at medical risk without realizing it.
Jane
Can you take Axert if you are currently taking 10mg of Lexapro a day? What can you take if you have a headache? Is Tylenol okay?
I take very low dose of celexa is it okay to take maxalt for an occasional miagraine
hi i was just wondering if mixing celexa and relpax is okay?
Hi Jessica, Carole, and Sheila -
For these types of questions you definitely need to ask your doctor. You want to be careful mixing any medications (prescription or otherwise) whether one or both is/are “low dose” or regular dose.
Sheila, since Celexa and Relpax are both listed above in the post relating to the serotonin syndrome risk, you will need to check with your psychiatrist regarding the pharmacology of the drugs and whether the dosages you’re taking (I assume you are taking both) are within what your doctor believes to be acceptable.
Jane
hi can i mix celexa and cymbalta together… i liked celexa, however, hated the hunger and cymbalta makes me less patience…
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