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Serotonin Syndrome - Fluoxetine & Tramadol (prescribed)

Posted , 6 users are following.

IanG
IanG

The article is illustrative of the general lack of understanding of the use of SSRIs (in particular Fluoxetine - Prozac) in general hospitals. In my case I had been on 60mg daily Prozac for some 6 months with increasing neurological symptoms when I required the prescribed use of Tramadol. This is potentially disaterous. During December 2008 I was admitted to hosiptal after suffering a period of blindness in one eye, visions, hallucinations, anxiety and irrational behaviour. The attending physicians were minded to suggest miss-use of 'opoid-like' pain killers and I was kept under observation for 2 or 3 days.

Subsequent to this I was luckily referred to a Psychiatrist who immediately put me on a Prozac reduction protocol. After about 10 days, I began to feel better. I am now on Citalopram (30mg) with much better stability of my depression and 10mg amitryptyline for diabetic neuropathy. I suffer my arthritic pain in silence and have not taken Tramadol again, although I have had Morphine perscribed on several occassions without problems (the latest being CABGx3).

When looking at the problems with Prozac, is it not time that this drug was de-listed? There appears to be more induced problems than 'cures'.

Ian

2 likes, 6 replies

6 Replies

  • Tanzi
    Tanzi IanG

    Posted

    Hi Ian

    Glad to hear you are more stable. Personally I would blame the Tramadol.  I was using it to control pain for trochanteric bursitis whilst taking antidepressants and my mood became so bad I had to go to A&E to keep myself safe. They said I shouldn't have been prescribed Tramadol and should stick to Cocodamol. It clearly interacts with other medications.  Cocodamol 15/500 only dulls my pain but I would rather have it that way and stay relatively sane.  All the best.

  • RafaUK
    RafaUK IanG

    Posted

    I have a chronic neuropathy. Some years ago when a full diagnosis was not yet been made. The doctors thought my symptoms were all in my mind. I had burning patches all over the place and pains in my muscles.  All neurological tests to date were normal. (Only those that had been done.)  So I was labled a hypochondriac and it was all in my mind; maybe I was "depressed."  I was put onto paroxitine (Aropax) and I was also on tramadol (Tramal) as an analgesic.  Within 48 hours I started to become agitated, shivering, sweating and so restless and so much pain that my wife thought I was going to kill myself and was too scared to go out.  The doctor was unable to come (he was in ameeting!) and she could not go to the pharmacy to get what he wanted to give me, a strong benzodiazpine. Eventualy with friends help this was got and I was sedated and knocked out.  strangely I was reading a medical update series at the time, and the next day when I was better, I read all about Serotonin Syndrome. At that stage I had not heard of it. (I am now a retired doctor)  I fitted the bill, but relatively mildly so it would seem.  Fortunately not so severe that it could have killed me.  A few years on a clever neurologist took a skin biopsy and found T-cell infiltration into my nerve endings with a vasculitis.  The diagnosis of an autoimmune sensory neuropathy was made.  It was followed up with a full sural nerve biopsy (I still have problems with that.) and a muscle biopsy.  It had taken 15 years to make the diagnosis! 15 years later I still have the problem and am now contolled by a Pain Clinic.

    Every pharmacy or prescribing doctor should have software to warn about the cross reactions between drugs,  Serotonin syndrome is a very serious complication!

    All the SSRIs have been now shown to react with analgesics, in particular tramadol.

  • PharmaSara
    PharmaSara IanG

    Posted

    Hi

    tramadol is the problem, not fluoxetine. Serotonin syndrome is grossly under-reported and as another poster said, pharmacists and prescribers should be aware of the risks of this combination (SSRI and tramadol), the software does warn you. I'm not keen on tramadol- I speak to so many patients who cannot get off it. Wasn't it marketed in the beginning as a non-addictive painkiller, ha!

  • norahs
    norahs IanG

    Posted

    I have just read this review and can't believe that I have been taking both these meds for about 3 months (tramadol introduced 3 months ago). There has been no improvements to my pain at all. I have very vivid dreams that are quite messed up and scarey. Wonder if this has anything to do with the mix of meds.
    • RafaUK
      RafaUK norahs

      Posted

      It is very possible that one of the drugs is causing your dream problems.  The only way ito solve the mystery s that one is stopped and replaced with an alternative drug and see what happens.  It is just a process of elimination. Your GP should know this. Either drug or the combination could be the cause.

      Good luck and sweet dreams.

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