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Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Serotonin Syndrome
(Message started by: lililola on Jan 16th, 2007, 6:51am)

Title: Serotonin Syndrome
Post by lililola on Jan 16th, 2007, 6:51am
Triptan-Antidepressant Interaction Causing Serotonin Syndrome
FDA Public Health Advisory
On July 19, 2006, the FDA issued a Public Health Advisory warning of the potential danger associated with the use of 5-hydroxytryptamine agonists (triptans) in patients who are also taking selective serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SNRIs).

http://www.pswi.org/irx/triptan.htm

Title: Re: Serotonin Syndrome
Post by chewy on Jan 16th, 2007, 7:27am
ALI!

Title: Re: Serotonin Syndrome
Post by Redd715 on Jan 16th, 2007, 7:39am
My first reaction as well....

Title: Re: Serotonin Syndrome
Post by nani on Jan 16th, 2007, 8:19am
Ali? Maybe.
The warning is real, though.

Title: Re: Serotonin Syndrome
Post by georgej on Jan 16th, 2007, 9:15am
A search at fda.gov shows the following:

http://www.fda.gov/cder/drug/advisory/SSRI_SS200607.htm

Best,

George


Title: Re: Serotonin Syndrome
Post by Barry_T_Coles on Jan 16th, 2007, 5:09pm
pswi = Pharmacy Society of Wisconsin

Title: Re: Serotonin Syndrome
Post by Ob1kanobee on Jan 16th, 2007, 9:49pm
What does this mean in Laymans terms?

Title: Re: Serotonin Syndrome
Post by floridian on Jan 16th, 2007, 10:16pm
Be careful about triptans if you take prescription antidepressants.  The anti-depressants could amplify the triptans to the point that serotonin syndrome occurs - higher body temperature, grinding jaw, other problems that could be life threatening.

Title: Re: Serotonin Syndrome
Post by Ob1kanobee on Jan 16th, 2007, 11:27pm
So if I'm taking say Paxil, I can't take an Imitrex injection?

Or rather if i am taking Paxil, I have a higher chance of having a body malfunction if i were to take a shot of Imitrex?

If this is the case, are they not alowing people on anti-depressents to take Imitrex, or do they have to be monitored or something?

Title: Re: Serotonin Syndrome
Post by nani on Jan 16th, 2007, 11:56pm
From the FDA link:

Serotonin syndrome occurs when the body has too much serotonin, a chemical found in the nervous system. Serotonin syndrome 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. Serotonin syndrome may be more likely to occur when starting or increasing the dose of a triptan, SSRI or SNRI.

The FDA has determined that serotonin syndrome occurs with combined use of triptans and a SSRI or SNRI through reports describing serotonin syndrome in people taking these medications together. Each of these types of medicine increases serotonin levels on its own, as well.

Patients who are taking a triptan along with an SSRI or SNRI should talk to their doctor before stopping their medications.

Physicians prescribing a triptan, SSRI or SNRI should:

keep in mind that triptans are often used intermittently and that either the triptan, SSRI or SNRI may be prescribed by a different physician
weigh the potential risk of serotonin syndrome with the expected benefit of using a triptan with an SSRI or SNRI
discuss the possibility of serotonin syndrome with patients if a triptan and an SSRI or SNRI will be used together
follow patients closely if a triptan and an SSRI or SNRI are used together, particularly during treatment initiation, with dose increases, or with the addition of another serotonergic medication
instruct patients who take a triptan and an SSRI or SNRI together to seek medical attention immediately if they experience the symptoms of serotonin syndrome (described above).
Patients should know which medicines they take and tell all of their healthcare providers (physicians, nurses, and pharmacists) what these medicines are.

Triptans are drugs used to treat migraine headaches, and SSRIs and SNRIs are drugs used to treat depression and other mood disorders.

The FDA has requested that all manufacturers of triptans, SSRIs and SNRIs update their prescribing information to warn of the possibility of serotonin syndrome when triptans and SSRIs or SNRIs are taken together.


Title: Re: Serotonin Syndrome
Post by Karla on Jan 18th, 2007, 5:00pm
My dr said antiphycotics and imitrix can cause this problem as well.  I am taking 2 antiphycotics and 2 antidepressants.  I use imitrix nasal spray 20mg sparingly.  Like 4-6x/month or less.  So my dr is ok with this.

Now I was for 2 years using 6x/day everyday and had no problem.  That was before the warning was issued.  So my dr said he wasn't comfortable with that much imitrex use and for me to cut down.  Well since I now have a preventative that works for me I don't need imitrex except for my migraines that occurr a few times a month.

Bottom line.  Talk to your dr and be aware of potential side effects and risks.    

Title: Re: Serotonin Syndrome
Post by mcf69 on Jan 20th, 2007, 11:25am
Serotonin syndrome is very real and all taking perscription SSRI's and other anti depressant/anti psychotics should be monitored for symptoms of serotonin syndrome.....

Title: Re: Serotonin Syndrome
Post by gonz2112 on Jan 21st, 2007, 2:05pm
My non-Kaiser neuro is not real easy to get a hold of so I emailed my P.A. at Kaiser about this...


Quote:
Subject: Serotonin Syndrone

Since I am on Citalopram and averaging about 1 Imitrex injections per day is this something I should be concerned about?

Triptan-Antidepressant Interaction Causing Serotonin Syndrome - FDA Public Health Advisory
On July 19, 2006, the FDA issued a Public Health Advisory warning of the potential danger associated with the use of
5-hydroxytryptamine agonists (triptans) in patients who are also taking selective serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SNRIs).
http://www.fda.gov/cder/drug/advisory/SSRI_SS200607.htm

----- Message -----
Subject: RE: Serotonin Syndrone

Requiring Imitre daily is way too much.  You need some daily preventative medication.  I have not seen you since March of last year so scheadule an appointment to decide what we should do.

----- Message -----
Subject: Serotonin Syndrone

Over the past 20 years I have tried most all the preventatives: inderal, lithium, sansert, prednisone, depakote, topamax, and verapamil. All had very little or no noticeable effect on the frequency/intensity of the headaches or the length of the cycles and in most cases the side effects outweighed any benefits.

Given my past experience, the possibility that meds can extend a cycle, and the fact that I am about 7 weeks into what is usually an 8-12 week cycle I am not really interested in trying a preventative. That being said, I am open to suggestion and would certainly like your professional opinion.

As far as my Imitrex usage, I use half an injection per headache and can often abort with oxygen alone. I get about 2-4 headaches per day so some days I use up to 2 injections and there are some days I don't use any. I also have usually one pain free day a week.

Thanks and let me know what you suggest.

----- Message -----
Subject: Serotonin Syndrone

Sounds like you have already been the Gamut of treatments. I guess all we can do is what you are doing now.


So basically if they can't get my $30 copay they just don't care. Nice!

Mark

Title: Re: Serotonin Syndrome
Post by thomas on Jan 23rd, 2007, 10:29am

on 01/16/07 at 08:19:25, nani wrote:
Ali? Maybe.
The warning is real, though.

The warning is very real.  As one who uses Prozac as part of my preventive regimin, I strongly urge people to use extreme caution when combining these drugs.



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