Opioids Anyone use an SSRI with fent ?

[Quinine121]

I’m on 25mg of setraline (ssri) aka zoloft

I have fent patches 100mcg but I heard that fent can precipitate serotonin syndrome when used alongside an ssri

Just wondering if anyone has used fent while also using an ssri

 

[Xorkoth]

I have never heard that fentanyl (or any opiate except tramadol which is itself an SRI) can produce or make serotonin syndrome more likely. Although to be safe, in the absence of someone with more concrete answers, I would refrain from using it.

 

[Quinine121]

I have never heard that fentanyl (or any opiate except tramadol which is itself an SRI) can produce or make serotonin syndrome more likely. Although to be safe, in the absence of someone with more concrete answers, I would refrain from using it.

Yes I was surprised myself but quite a few oppies produce serotonigic effects

Not all . Fent is quite well known for this various articles on the web and case studies of SS with fent + ssris

 

[Lucy20]

I was on an ssri and did alot of fentanyl and was fine. Just be careful with fentanyl

 

[Quinine121]

I was on an ssri and did alot of fentanyl and was fine. Just be careful with fentanyl

Thanks

I can take 1/2 a gram of H no problem 250mg ox gives me a mild buzz

I read 25mcg of fent patches is about 80mg oxy

I’m thinking 50-100mcg fent ? What type of ssri were you on ? And dosage ? I’m on
A low dose 25mg zoloft (setraline)

Would chewing a 100mcg be about right for a 250mg oxy tolerance

 

[Lucy20]

I was on mirtazipine 30mg. You are on a low dose so i wouldn't worry about that.

I looked at a conversion chart and it sais 100 of fentanyl was equivalent to 240mg of morphine and then oxycodone was 2.5 morphine.

Don't take that as true though, i looked at a couple and they gave different values.
Sorry i couldn't be more help but i will try to find a conversion chart that is more accurate.
Hopefully in the mean time some more knowledgeable people can chime in

 

[Quinine121]

I was on mirtazipine 30mg. You are on a low dose so i wouldn't worry about that.

I looked at a conversion chart and it sais 100 of fentanyl was equivalent to 240mg of morphine and then oxycodone was 2.5 morphine.

Don't take that as true though, i looked at a couple
and they gave different values.
Sorry i couldn't be more help but i will try to find a conversion chart that is more accurate.
Hopefully in the mean time some more knowledgeable people can chime in

That’s really helpful both counts thanks

 

[negrogesic]

I was on mirtazipine 30mg. You are on a low dose so i wouldn't worry about that.

Mirtazapine is not an SSRI but actually an antiserotonergic, and could even have utility in treating serotonin syndrome.

The risk of serotonin syndrome is low insofar as fentanyl and SSRI's are concerned, and would likely be encountered when fentanly is used at high doses (such as in a surgical setting). I would imagine that the few that it does occur to are also susceptible individuals on high doses of serotonergic antidepressants. Then again, if you are going to be chewing 100ug/hr patches in one shot, that is a pretty sizable dose of fentanyl. You'll probably be fine but of course there is a chance you wont.

 

[Quinine121]

Mirtazapine is not an SSRI but actually an antiserotonergic, and could even have utility in treating serotonin syndrome.

The risk of serotonin syndrome is low insofar as fentanyl and SSRI's are concerned, and would likely be encountered when fentanly is used at high doses (such as in a surgical setting). I would imagine that the few that it does occur to are also susceptible individuals on high doses of serotonergic antidepressants. Then again, if you are going to be chewing 100ug/hr patches in one shot, that is a pretty sizable dose of fentanyl. You'll probably be fine but of course there is a chance you wont.

Thanks ! You made some salient points that are noted and taken ?

I thought as setraline has a short half life 24 hours? I would skip the morning dose the evening I take the fent so

By the time I get to it I would have a mean blood level of 12.5mg or less of setraline.

Perhaps I should err on the side of caution and keep first time to 50mcg as well as a test to see my reaction ?

Funny enough but oxy (250mg a pop) is supposed to be seretonorgic with ssri and cases of ss have been reported as well .

Another is tramadol (upto 300mg) and I’ve taken both with no issues .

Hopefully it will be the same for the fent . I’ve taken bupe with as well as H with no issues but i don’t think those two contradict with ssri’s

Another one that has sertonergic properties is adderall which I take on occasion for ADD ( 90mg ED)

 

[negrogesic]

Years ago i was on fluvoxamine (an SSRI) along with 380mg of methadone a day, which is another serotonergic opioid (I actually did it to take advantage of the unique interaction between these two drugs, as fluvoxamine raises methadone blood levels). On top of this, on occasion, I used to take things like MDMA, methamphetamine, cocaine and other stimulants that involve the 5-HT system with out incident (at least none that I know of).

I think the risk is quite low, but I will concede that a risk exists.

 

[Quinine121]

Years ago i was on fluvoxamine (an SSRI) along with 380mg of methadone a day, which is another serotonergic opioid (I actually did it to take advantage of the unique interaction between these two drugs, as fluvoxamine raises methadone blood levels). On top of this, on occasion, I used to take things like MDMA, methamphetamine, cocaine and other stimulants that involve the 5-HT system with out incident (at least none that I know of).

I think the risk is quite low, but I will concede that a risk exists.

It does. I just wondered if fent is more sertonergic than ox or tramadol etc? hence why I created the thread . It’s a drug that is not as well used on forums by members and such, at least not as prevalent as the previous drugs we both mentioned at any rate, and one I have no experience with personally.

Plenty of people are using ssris and the other drugs but fent seems less so . Again because fent I suppose is not as readily proscribed as say Vicodin or morphine .

I would wager most fent users are either end of life , or chronic pain sufferers . Most of the guys slamming it are doing it via H then actually asking for or addicted to fent on its own per say as their DOC from what I gather.

Dude that was a LOT of methadone lol what was the experience like at such high doses along with the ssri? did you find it made the methadone stronger or was it more it created it’s own unique “feel”?

?

 

[negrogesic]

To be frank, I feel like the fluvoxamine didn't make much of a difference. The literature describes that those who are on both and discontinue the fluvoxamine can actually experience methadone withdrawal (while on the same dose of methadone, due to the additive effect), but I don't recall it being that profound.

Enough conjecture. Here are the numbers. According to this methadone is more potent (with the exception of 5ht1a, which ill admit is quite an exception) both directly AND at the transporter (unlike fentanyl which has no affinity for the transporter). You'll probably be fine (unless i am the victim of some undetected serotonin syndrome, though i feel like im mostly fine). Proceed at your own risk, caution is always good so i applaud you in that regard. (Your bigger concern should be in respect to ODing on fentanyl FYI.)

 

[negrogesic]

With that appreciable affinity for 5HT1a, just to ensure that i wasnt securing your untimely demise, through a cursory search this confirms my speculations well enough



Fentanyl is hardly used solely for hospice patients, and many pain patients are on SSRI's. Your larger concern should be in avoiding overdose.

 

[Quinine121]

Wet

With that appreciable affinity for 5HT1a, just to ensure that i wasnt securing your untimely demise, through a cursory search this confirms my speculations well enough



Fentanyl is hardly used solely for hospice patients, and many pain patients are on SSRI's. Your larger concern should be in avoiding overdose.

Thank you . While I don’t quite understand the chart or the biochemistry behind it . I can see via the graphs the figures and correlation with the more sertonergic drugs . I think looking at the chart tramadol is being an SNRI probably of more concern and I took that at 300mg with no issues .

I will go slow first test out 50mcg and see how I go ... unless I have some horrible allergy to fent I should be fine in terms of OD

 

[Lucy20]

Mirtazapine is not an SSRI but actually an antiserotonergic, and could even have utility in treating serotonin syndrome.

The risk of serotonin syndrome is low insofar as fentanyl and SSRI's are concerned, and would likely be encountered when fentanly is used at high doses (such as in a surgical setting). I would imagine that the few that it does occur to are also susceptible individuals on high doses of serotonergic antidepressants. Then again, if you are going to be chewing 100ug/hr patches in one shot, that is a pretty sizable dose of fentanyl. You'll probably be fine but of course there is a chance you wont.

Thanks, i didn't know that. I thought they were all SSRI's
Glad someone with more knowledge was able to chime in

 

[negrogesic]

Wet


Thank you . While I don’t quite understand the chart or the biochemistry behind it . I can see via the graphs the figures and correlation with the more sertonergic drugs . I think looking at the chart tramadol is being an SNRI probably of more concern and I took that at 300mg with no issues .

I will go slow first test out 50mcg and see how I go ... unless I have some horrible allergy to fent I should be fine in terms of OD

Sorry I should have mentioned that the lower the number the higher the affinity (or stronger action). SERT refers to the serotonin transporter, and 5-HTxx refers to the various serotonin receptor binding sites.

 

[Keif' Richards]

There is a pretty unlikely possibility of Serotonin Syndrome, but if the aforementioned is enough to scare you, you're going to be even more freaked out when you realize that Serotonin Syndrome can be precipitated by lot of different stuff. It is rare.

 

[Quinine121]

There is a pretty unlikely possibility of Serotonin Syndrome, but if the aforementioned is enough to scare you, you're going to be even more freaked out when you realize that Serotonin Syndrome can be precipitated by lot of different stuff. It is rare.

Yeah for an addict Keith I’m quite conscious of risk (an oxymoron I know) lol

Well I didn’t take my ssri this morning so I estimate blood levels at about 10-12mg so super low

Just chewing on a cpl of fent patches nothing
Much to report not even got pins yet 15 mins in lowered bp and resting heart rate maybe

Looking at those graphs it seems fent is no more serterongic than tram and I’ve taken those on a full dose of ssri no problem

I found a study online which I think the previous posted quoted from they took 4000+ patients who were co proscribed fent + an ssri less the 0.9% went on to develop SS ....

I think main risk is OD from too much rather than SS

I hate ssri’s I’d rather be free of needing those than my daily oppies .

So many sides and problems with that class of medicine .

 

[opiatekrzy]

I have not taken fentanyl with an SSRI. However I have taken standard opioids while on paxil 20mg. I FEEL that my opiate buzz was decreased in half, shorter duration...o would take hydrocodone and get a weak buzz for 20mins and then be completely sober, no itching no nausea no nothing.aame thing with codeine and oxycodone.
So yes for me I feel SSRIs decrease effectiveness

 

[Quinine121]

I have not taken fentanyl with an SSRI. However I have taken standard opioids while on paxil 20mg. I FEEL that my opiate buzz was decreased in half, shorter duration...o would take hydrocodone and get a weak buzz for 20mins and then be completely sober, no itching no nausea no nothing.aame thing with codeine and oxycodone.
So yes for me I feel SSRIs decrease effectiveness

Yep I echo this same experience same for me with oxy , h , morphine , ppt , codine and dhc as well as tram

It’s a pita as it means we “need” higher dosages so increased $ and tolerance

One good thing about taking ssri though if you ever want to w/d or take a tolerance break it mitigates a lot of symptoms I found . And helps with paws

1/2 a gram of H barely has an effect though I start to notice the histamine reaction as well as vomiting repeatedly .

Same with weaker oppies like dhc I can take 1000mg before I get the itch

Having said that when I first started to dabble with oppies years back 200mg of codine would produce hiccups and a nice buzz as well as the itchies so I think it’s a case of our tolerance growing as well as the ssri decreasing effectiveness imo.

MDMA is a total waste of time on a ssri as well risk for 0 reward ... years back I took I think a gram or so and got nothing while everyone else was off their face on much less .

I wonder if anyone knows how long it would take to clear the setraline for our systems ?

I’m guessing if the half life is 24 hours

By day 3 or 4 blood levels would be close to zero ... might be worth an experiment to see if my normal dose of ox at 250mg IR would increase duration and potency without the ssri blocking the effects .

Not sure it’s worth the shitty w/d effects of an ssri though just to increase my buzz by an hour or so .