methadone and prozac

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Helen518
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methadone and prozac

Postby Helen518 » Fri Nov 20, 2009 2:47 pm

Hi All, Long time since I've logged in. I'm really falling apart and missing my antidpressant (14 months since I've been off it). I take 15 mg of methadone a day. My Psych is suggesting 20 mg prozac per day.

however, I read that methadone and prozac may not be a good combination. I have a call in to my neuro but know that you all are a great source of experiential info.

Has anyone heard about this combo or taken this combo of meds?

I also take a tiny dose (.25 mg) of klonopin at bed time.

I've had 3 car accidents in 6 months . . . I lose my keys, my atm card, and i've messed up some things at work. Thank god I never screw up with regards to my son. My marriage almost hit the skids this fall but is much better thanks to counseling. It's been a really hard year. Hooray- just found out yesterday that my LYme disease test was a false positive.

Thanks!
Last edited by Helen518 on Fri Nov 20, 2009 7:09 pm, edited 1 time in total.

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Neco
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Postby Neco » Fri Nov 20, 2009 6:09 pm

Sorry that you are still having problems Helen.. Are those accidents being attributed to Methadone or just some bad luck you're having?

That's a big concern.

I will try to find some information if I have some free time. I have heard conflicting information about Methadone and anti depressants that involves seizures.. I'm not quite sure what to believe

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Helen518
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Postby Helen518 » Fri Nov 20, 2009 7:07 pm

Thanks for your concern, Zach. Scatterbrained-ness and carelessness has been a lifelong problem for me, back as far as age 8. It gets much worse when I am under stress. ANxiety/depression started to be aproblem around age 11, I think. Since age 22, I've been on and off antidpressants. When I am on them, I can concentrate and I am organized and rarely get overwhelmed. WHen I am off them, after a few months, my health starts to deteriorate and my anxiety level goes thru the roof. I went off after 8 years in 2005 to try to conceieve a child. My health has been problematic since then. My marriage counselor says she can see the physical manifestation of my stress just by looking at me, and she believed I need to quiet my mind by comitting to regular practcie of mind-body techniques.
I tried mirtazapine in May on top of the methadone with disastrous consequences. The highly sedative nature of mirtazapine, mixed with the methadone is what caused the first car accident (I fell asleep and rear ended someone stopped at a light at a slow speed). The second one was just poor judgement on my part - i took my eyes off the perso nin front o fme after they started to move forward and did not see them stop sharply and so I hit them. This third one is not my fault but one coudl argue that if I had been more aware I might have avoided this idiot. I was going straight and he made a left turn into my car.
My Psych says its possible that the meds are affecting my attention but I'm inclined to believe it is the lack of antidepressant. The problem is that methadone works btter on my RLS than any other meds I've tried. I don't want to give it up!! Every med that works on RLS has sleepiness side effects. That's fine if you only have RLS at night but I have it during the day too - and it affects my concentration if it is not controlled. So I'm damned if I do take methadone and damned if I don't take it I guess.

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Neco
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Postby Neco » Fri Nov 20, 2009 7:31 pm

I can sympathize with you..

Have you tried adjusting your sleep schedule? Maybe going to bed an hour earlier when possible?

I have found since being on Methadone, now that I actually sleep at night I usually need at least 7 - 8 hours to not get real tired during the day. I was up until 9:30 last night and pretty tired on the way home from work this morning (I get up at 4 and get home around 8 or 9 depending). I actually had a nap this morning for the first time in a while.

Have you asked about getting something to help keep you awake?

Mirtazipine can be real sedating at first, and it helped me fall asleep real fast (I had sub lingual tablets at the beginning) but that fades over time. Only problem was my appetite skyrocketted and so did my weight.. Like you wouldn't believe..

If not prozac, than another medication to look into would be Luvox. It is an anti-anxiety/obsessive compulsive disorder medication and it seemed to really helped me.. I can't take most common anti-depressants because they irritate my prostate too much, but Luvox didn't seem to have that affect and I noticed a big drop in behavior I interpretted as mildly compulsive (I used to be a fiend about cleaning my keyboard and mouse w/ 91% Isopropryl Alcohol every day and it -had- to be 91%). Although I haven't taken it since my original problems when I mixed it with Tramadol.

I've been kind of worried about another problem again, since I can't tolerate Tramadol even by itself anymore. Its a good medication though, I think.

It is on a list of medications that will potentiate Methadones effects (it affects the amount of the drug that remains in your blood stream, so it can be more efficient at keeping your dose down, but you have to watch out at the same time for a dangerous buildup if you are taking a lot of Methadone).

Also, have you discussed the possibility of Adult Attention Deficit Disorder?

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SquirmingSusan
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Postby SquirmingSusan » Fri Nov 20, 2009 7:53 pm

I looked for interactions here: http://www.drugs.com/drug_interactions.php# and there were none reported. I would ask a pharmacist; they are best qualified to tell you about drug interactions. But you're probably OK taking them both.

The only interaction it reported was with grapefruit juice and methadone. Apparently taking methadone with grapefruit juice raises the peak plasma level by an average of 17%.

Sorry you're feeling badly. I hope you get feeling better.
Susan

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Helen518
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ADD meds for depression/anxiety?

Postby Helen518 » Fri Nov 20, 2009 8:47 pm

My neuro got back to me and said that there should be no bad effect of prozac, though it will likely aggravate my legs.

What about ritalin or something like that? I've been told over the years multiple times that my attention problems are due to preoccupation and anxiety not ADHD, but can ritalin help me and not aggravate my legs?

My Psych already called the prozac prescription in to my pharmacy but I'm not ready to try it yet until I talk with my husband about it with the marriage counselor on Monday. ALso I want to talk to the neuro at greater length at my appointment on Tuesday. Maybe I'll bring up the topic of ADD meds.

I do need to go to bed earlier. It's hard with a todler though. We get home at 5:45 and he goes to bed at 8:30 (Read stories until 8:45 or 9) but sometimes he is not so cooperative or i have things I have to get done before bed. The werid thing is that I had the best and longest night sleep I have had in six months the night before this most recent accident.

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Neco
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Postby Neco » Fri Nov 20, 2009 10:29 pm

Adullt ADD was more of me just postulating than anything. If people believe its due to your anxiety and other stuff then that is likely the place to look first. Although some people have claimed Ritalin has helped their RLS (some say it doesn't make a difference).

Regarding grapefuit juice. That's a general warning for all opiates and other medications that are metabolized via the Cytochrome P450 pathway.

When you take food or drugs that compete for the use of this pathway, one of them generally wins out and the other suffers. The result is one or more drugs do not get metabolised properly and it results in higher peak levels of the drug/compound in your bloodstream (as if you had taken a larger dose). In the case of fatal interactions, they happen because the drug in the form that you take it is actually toxic, but the method of action it uses requires it to be processed inside your body, to converted to the less toxic metabolites that provide that actual desired effect: For example in Tylenol #3 w/Codeine, the Codeine isn't actually providing you with much pain/RLS relief, what happens in that your body starts processing the codeine and converting it into Morphine that you body then uses via your opiod receptors.

This is why Codeine overdoses can be much more easily fatal than something like Hydrocodone, if I am not mistaken. As your body can only process about 450mg of Codeine per day, so when you start going beyond that your system is already saturated and has nowhere to dump it. The Codeine builds up in your bloodstream until it hits a toxic (LD50) level and you suffer respiratory failure and (painful) seizures as an effect of what the codeine does inside your body, since it is not being converted to Morphine any longer.

This is why there are Alcohol warnings painkillers and other products that contain acetaminophen and other compounds that are metabolized via the same pathway. For instance, if you drink grapefuit or alcohol, your body becomes busy shifting all its attention to those substances and it ties up your system until it is eliminated. In Alcohols case, its good that it gets priority because your body sees it as toxic and tries to get rid of it ASAP.. This is why you sometimes see "Alcohol poisoning" as a cause of death for Alcoholics or binge drinkers; they took in more than their body could cope with in a given period of time.

Methadone has a long list of drugs that interact with it because of the PY450 pathway, with drugs that either

causes no effect (neutral),

increasing its effects (potentiation: you should take less with those drugs),

decreasing its effects (a larger dose is required to maintain the same effect as a normal dose without the interacting medication.

For example. I routinely take OTC cough syrup because Dextromethorphan is an opiate potentiator. Meaning my 15 - 20mgs of Methadone every day is actually giving more of an effect than it normally would without the DXM present. I get the benefit of stronger peak effects, and a longer duration of relief at a more comfortable level.

However this is very risky business all the same. Some combinations are listed as precautionary for a reason. While others are less harmful depending on the dose/invidual. The main reason I even try to justify my OTC regiment is because DXM was once studied as an additive to make painkillers more effective.


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