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Mixing meds with serotonin tendencies

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Posted 8/27/2008 2:59 PM (GMT 0)
Hello all,
Happy Wednesday. I am wondering if any of the cymbalta users are currently mixing tramadol and immitrex with their med. I have been on a low dose of Tramadol (37.5 1x at night) and immitrex (about twice a week) for awhile. My psych just put me on cymbalta for pain and depression and to deal with my "hypervigilant" tendencies. I was on 10 mg for 3 weeks and now started 20. Struggling actually with more pain in the am's on wakeup. Very heavy headed and neck/upper back pain and referred head pain seems worse. Have noticed this change since I started cymbalta. Actually feel like my symptoms have been exacerbated even tho I do seem to be getting slightly better sleep (as compared to chronic insomnia for last 3 years). Can't figure this out. I know I need to get to a therapeutic dose but I am struggling. Dr. told me ok to mix these meds up as long as I space them out. My fear was serotonin sydrome. I have read so much about it. Any input on mixing these meds up with success? I must give this med a chance I know as I have been on the hamster wheel for over 3 years now.

DX: Fibro/MPS complicated with horrible sleep and perimenopausal symptoms
RX: currently 37.5 tramadol at night, immitrex 100mg as needed about twice a week on average and 20 mg of cymbalta once a day.

I am new to the forum and am still trying to figure out how to utilize it correctly so forgive me if I mess up!!!

Dally
Posted 8/27/2008 3:10 PM (GMT 0)
Hi Dally and welcome.
I was on the two of those simultaneously but have since stopped the tramadol due to adverse side effects. It comes up as a major drug interaction warning on the site I use to check for interactions because of the risk of serotonin syndrome but that is supposedly very rare. They are prescribed together often. as for Cymbalta, it doesn't work for everyone and if your symptoms are increasing, it may not be the med for you.
Holly
Posted 8/27/2008 3:38 PM (GMT 0)
Hi Dally and welcome. I'm on two anti-depressants and have had two docs trying to get me to take cymbalta but to me that is just too much and I won't take it for that reason. I do take tramadol sometimes but not that often. The best thing is to check with your pharmacist which is a problem for me since we get most of our meds through the military.

 

Make sure you read the fibro 101 thread, the second on first page, it contains lots of info.

 

luv and hugs

Marlee

Posted 8/27/2008 3:48 PM (GMT 0)
it's so weird that you asked this question....i was thinking of asking the same thing.....

i had a very rough week and my symptoms flared....i was already in a flare, so now i'm in a double flare! mad

anyways, i went to the doc yesterday and told her the tramadol wasn't working as well so she added the cymbalta.....i asked about interactions and she said they will be less likely with cymbalta than with another antidepressant.....

i am still worried tho....i lowered my tramdol dose from 100mgs. to 50mgs and i am now on 30 mgs of cymbalta. moving up to 60mgs next week....

i suppose the doc knows what she's talking about.....

i read that if you start having a lot of shaking, nervousness, sweating, muscle jerking then call the doc right away!
Posted 8/27/2008 6:39 PM (GMT 0)
Thank you ladies for the input.

I guess what I do have going for me is that I do not take much of the Tramadol. I am not ready to totally quit it because I know that it does kick down my pain a notch a night to help with sleep and does not hurt my stomach. I only take one 37.5 at bedtime and then maybe 1/4 of a cap if I need a bump. I am more concerned about the Immitrex I guess. I do know that when I take my tramadol at night and then at say 5 or 6 am I wake up with a tension headache, I take the Immitrex then. My dose of cymbalta is still very low and I take that one in the mid afternoon. That is my way to "space them out". I have noted that on a bad day when I must take the imitrex with other meds, I feel VERY groggy and out of it. Prior to taking the cymbalta, I seemed to rebound better from immitrex. I do believe that I am having a slight reaction, but it is very tough to figure out the full effects since I am just on my first week of 20 mgs of cymbalta. Prior I was only taking 10 mg a day for 3 weeks just to "babydose" it into my system. I desperately want something to take me to the next level to give me back more of my life. I am willing to give the cymbalta a shot as my MD has assured me that it has done very well for many of her patients. But man, I sure do hate this. My aim is to hope that the cymbalta works and that I can get off the tramadol. And if sleep and pain get better than I should only need an Imitrex now and then. Nice dream, huh?!!! I have a 3 1/2 year old who is a joy and a terror. I must find some relief after 3 years of running to drs and trying to get some relief.

To alicat, remember that even a little downdosing on Tramadol if you have been taking it a long time might give you the sweats and make you feel icky for a little while and it may be hard to tell the difference between side affects of that and cymbalta updose. I hope that tomorrow is a more gentle day for you and that your pain lightens up. I will keep in touch as best as I am able with my 3 year old rampaging around the house and look forward to more input from members!!!

Thanks all!!! God bless.
Posted 8/28/2008 10:09 AM (GMT 0)
I have been taking the combo of cymbalta and ultram for several years. I take 60mg daily of cymbalta and 200 mg daily of ultram. I am considering increasing the cymbalta to 120mg for pain management. I have not had any problems and I am aware of drug interactions. I would like to be on something specifically for pain, but my new doc is not open to it. I will find a new doc of course, but for now the combo is all I have to handle the increasing pain. I have begun some low impact exercise classes, including water fitness. We'll see over time if that helps the way everyone insists it will.
Posted 8/28/2008 2:08 PM (GMT 0)
hey dally-

oh my....did i ever feel funky from lowering the tramadol dose! i kept thinking i must feel weird from the cymbalta until i took my second dose of tram......i felt better then and realized what was going on....

the cymbalta is also making me feel a bit hyper...and i did not sleep at all the first night...so my doc called in a script for restoril....that worked ok....but i woke up at 4am...geez...i suppose it will take a little time for me to get used to the cymbalta....

anyways...not trying to derail your thread blush
Posted 8/28/2008 3:47 PM (GMT 0)
Alicat,
I've been on Cymbalta for a month and the sleeplessness is still a huge issue. Tramadol kept me awake too when I took that. I'm hanging all my hopes for decent sleep on the results of my sleep study and a script for Xyrem. We'll see. Tramadol is a little funky. My favorite all time adverse effect to watch out for:
Call your doctor immediately if you experience coma LOL, okay, I'll definitely keep that in mind. I think that is so hilarious. Who should I call if it kills me?
Posted 8/28/2008 4:31 PM (GMT 0)
 

Hi Dally,

 

I have been on Tramadol 200mg in the morning and 200mg in the afternoon, Lyrica 300mg in the am and 300mg in the pm and Cymbalta 60mg in the morning for over a year. Until this spring I felt better than I had since I had to go on disability in 2002. I was on Oxycontin 80mg 3x a day for about 9 years. All that did was give me no relief from the pain and a terrible drug addiction which I had to kick.

 

This spring I had a stressful family event which knocked me down so hard, I was afraid that I would never get back up. Gradually I have been feeling better except for an increase in pain in my lower back and the whole way down my legs. I went to my rheumatologist last week and instead of a stronger pain med he doubled my Cymbalta dosage to 120mg every morning. I think it is helping but I am still evaluating it...you all know how this disease can change from one minute to the next.

 

Hope this helps you Dally.

Posted 8/28/2008 7:25 PM (GMT 0)

A few replies in one message from Dally:

Sara Smiles:Thx for input as I am not ready to give up my Tramadol yet! and I must maintain my Imitrex as well so I will try to use caution.  A few months back I spent some time in a "warm Water Pool" at a local pool, which was really nice and warm.  I actually found that spending some time in that warm water and just floating and moving around was good for my body and my head.  I will be joining a water walking program this fall just to use their 96 degree warm water pool a few times a week.  I am not looking to swim ( I don't have the stamina!) but the movement and warmth are so good for your muscles and pain points.  I do get regular PT for last 6 months which involves deep muscle/myofascial work on neck and back and it has had varying results. My Rheumy swears that this will be the fix.   Sometimes great, others not so great.  Depends so much on sleep! Just can't seem to get the right sleep for so long.  Sleeping pills just don't do it for me.  Maybe a month in Tahiti will do it!  Anyway, good luck and do stick to some movement and try the water.  We really don't have many choices except to keep on keeping on and trying the next hopeful option.  Take Care!

Alicat:No apology needed!  I just love the input.  Makes me feel like I am not totally losing my mind.  Glad you were able to figure out the Tram issue.  Just downdose slowly, like maybe break your cap (get a pill slicer at drugstore) in half for a week and then quarters for a week.  Take your system down slowly.  I have always had to go that route as I am very sensitive to meds.  And yes, time is the biggest issue as we sure do run out of patience with this stuff and it can make you so tired.  I am learning the meaning of "patience" and humility.  Talk about being brought to your knees.....not once, but many times.  They say that is the time to say that prayer that you have been meaning to say.   God bless.

HHH:I had a sleep study done in May and while I did not have sleep apnea or RLS, my Dr. told me that I wake or my brain wakes up 30 times an hour.  HMMMM.  Maybe that would explain always feeling like a truck hit me every morning and why I have turned into Linda Blair from the Exorcist the last few years.  So, Cymbalta may be a blessing and may be a curse.  I love having to wait at least 6-8 weeks to find out.  I tried Ambien CR, pointless.  Have now given Sonata a shot.  Also seems pointless.  Can't be too drugged our I can't function at 7:30 am when my 3 year old barges into my room with a demand for chocolate milk and Curious George.  Perhaps a lobotomy would be the answer!  Good luck.  I hope your sleep study gives you some great input.

Bev: I hope that your updose helps you.  It is so true how this condition can change constantly and disguise itself as other problems.  Most of the battle is figuring out the most problematic issue you are dealing with at the time and try to go after it. Throw in my perimenopause/menopause and we really have a party!!! I am still not totally sure that I am actually a fibro sufferer or a chronic Myofascial Pain sufferer as the symptoms overlap so much.  One Dr. tells me that they are the same and my PT therapist tells me she beleives they are different.  Very frustrating.  I only hope that in the next 10 years they can come up with alot more help for people suffering these conditions.   Take Care of yourself and that wonderfaul family and husband!!

Happy Labor Day Holiday to all if I don't get back on...... cool   

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