PieceByPiece
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How dangerous is mixing morphine and fluoxetine together? I heard it can cause serotonin syndrome? It the risk as high as mixing fluoxetine and DXM?
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BDD Moderators: Keif’ Richards | negrogesic
Morphine + Fluoxetine - SS?
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Ignio
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I saw a case study where a person was suffering from serotonin syndrome due to the combination of oxycodone and citalopram. However, as the oxycodone was changed to morphine, the person stopped suffering from serotonin syndrome.
In the discussion of the study it is written: "The opioids of the phenylpiperidine series: pethidine, tramadol, methadone, fentanyl, dextromethorphan, and propoxyphene are weak serotonin reuptake inhibitors and are thus known to have an association with serotonin symptoms". A literature review was furthermore conducted in the study where they concluded that oxycodone causing serotonin syndrome is very rare and they only found "four previous reports of serotonin syndrome involving oxycodone". The case of Morphine causing serotonin syndrome is also very rare to find in empirical studies and the fact that the change from oxycodone to morphine resulted in the disappearance of serotonin related symptoms, it might be even more rare that morphine is part of a combination of two chemicals that results in serotonin syndrome.
This leads me to believe that morphine rarely causes serotonin syndrome. However, as is evident from the study, in rare cases opiats and opioids that are not normally related to serotonin syndrome can cause it, due to several variables. Therefore, I don't think it is possible with certainty to say that morphine can't cause serotonin syndrome when combined with other chemicals that influence serotonin. Therefore, my conclusion is that though it is rare, one should always be careful when mixing morphine and other opiats or opioids with chemicals that influence serotonin, even when the opiats and opioids are normally said to influence serotonin.
You can see an abstract of the study I am quoting from here http://www.hindawi.com/journals/crionm/2012/261787/
In the discussion of the study it is written: "The opioids of the phenylpiperidine series: pethidine, tramadol, methadone, fentanyl, dextromethorphan, and propoxyphene are weak serotonin reuptake inhibitors and are thus known to have an association with serotonin symptoms". A literature review was furthermore conducted in the study where they concluded that oxycodone causing serotonin syndrome is very rare and they only found "four previous reports of serotonin syndrome involving oxycodone". The case of Morphine causing serotonin syndrome is also very rare to find in empirical studies and the fact that the change from oxycodone to morphine resulted in the disappearance of serotonin related symptoms, it might be even more rare that morphine is part of a combination of two chemicals that results in serotonin syndrome.
This leads me to believe that morphine rarely causes serotonin syndrome. However, as is evident from the study, in rare cases opiats and opioids that are not normally related to serotonin syndrome can cause it, due to several variables. Therefore, I don't think it is possible with certainty to say that morphine can't cause serotonin syndrome when combined with other chemicals that influence serotonin. Therefore, my conclusion is that though it is rare, one should always be careful when mixing morphine and other opiats or opioids with chemicals that influence serotonin, even when the opiats and opioids are normally said to influence serotonin.
You can see an abstract of the study I am quoting from here http://www.hindawi.com/journals/crionm/2012/261787/
PieceByPiece
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Thank you for your reply. It was extremely helpful.
Pilll_head
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I take an SSRI and Mirtazapine for depression daily and I have not noticed any serotonin syndrome symptoms with morphine, although my usual dosage was only about 60 mg. My main hangup with morphine is that the typical opioid side effects like itching, flushing, stomach cramps / nausea were worse compared to oxycodone or hydrocodone.
DXM and Demerol are the main recreational drugs that come to mind which definitely cause SS symptoms when taken with SSRIs or MAOIs.
DXM and Demerol are the main recreational drugs that come to mind which definitely cause SS symptoms when taken with SSRIs or MAOIs.
Ignio
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Add tramadol (and Tapentadol, the new tramadol look-a-like which however influence serotonin much less that tramadol) and MDMA, methylphenidate, (meth)amphetamine, and cocaine to your list of main recreational drugs causing serotonin syndrome and I will be satisfied All are notoriously dangerous to take the with other serotonin reuptake inhibitors. A few but relatively rare psychedelics can cause serotonin syndrome as well.
In relation to anti-depressants monoamine oxidase inhibitors (MAOIs) and atypical antidepressants like nefazodone and mirtazapine (although newer research indicate that atypical antipsychotics, like mirtazapine, do NOT cause serotonin syndrome) should be listed as well. MAOIs should ESPECIALLY be on the list, as this is one of the most dangerous drugs to combine with other drugs that influence serotonin.
The most severe cases of serotonin syndrome have been caused by tramadol, MDMA and amphetamines in combination with MAOIs or for instance SSRIs. Therefore, DO NOT combine tramadol MDMA and (meth)amphetamines with SSRIs, or other serotonin reuptake inhibitors, taking this combination will put you at serious risk.
Medicines influencing GABA neuroreceptors in the brain has lately been connected to serotonin syndrome as well. This is a rather new discovery however, thus the hypothesis lacks an empirical foundation. However, as I have experienced paradoxical effects from Lyrica I can support this. Lyrica is used as an anti-epileptic, but in my case in makes my epilepsy and related symptoms worse. I have had a full blown grand mal seizure one hour after taking Lyrica, and just recently I started on Lyrica again, the first days I took 50 mg a day totaling 150 mg, this resulted in muscle jerks and twitching, spasms, worse motor control skills and brain zaps which led me to fear that a seizure might be on its way, as these symptoms can be warning signs. However, after taking 2 mg clonazepam and 5 diazepam the side effects stopped.
All are notoriously dangerous to take the with other serotonin reuptake inhibitors. A few but relatively rare psychedelics can cause serotonin syndrome as well.In relation to anti-depressants monoamine oxidase inhibitors (MAOIs) and atypical antidepressants like nefazodone and mirtazapine (although newer research indicate that atypical antipsychotics, like mirtazapine, do NOT cause serotonin syndrome) should be listed as well. MAOIs should ESPECIALLY be on the list, as this is one of the most dangerous drugs to combine with other drugs that influence serotonin.
The most severe cases of serotonin syndrome have been caused by tramadol, MDMA and amphetamines in combination with MAOIs or for instance SSRIs. Therefore, DO NOT combine tramadol MDMA and (meth)amphetamines with SSRIs, or other serotonin reuptake inhibitors, taking this combination will put you at serious risk.
Medicines influencing GABA neuroreceptors in the brain has lately been connected to serotonin syndrome as well. This is a rather new discovery however, thus the hypothesis lacks an empirical foundation. However, as I have experienced paradoxical effects from Lyrica I can support this. Lyrica is used as an anti-epileptic, but in my case in makes my epilepsy and related symptoms worse. I have had a full blown grand mal seizure one hour after taking Lyrica, and just recently I started on Lyrica again, the first days I took 50 mg a day totaling 150 mg, this resulted in muscle jerks and twitching, spasms, worse motor control skills and brain zaps which led me to fear that a seizure might be on its way, as these symptoms can be warning signs. However, after taking 2 mg clonazepam and 5 diazepam the side effects stopped.