Prozac + Promethazine = Insane nods?

[jackadrug]

Alright guys so the other night I was just chilling doin my normal thing and my doc recently put me on Prozac 20mg and 1mg Klonopin 2x a day from 3 a day..... Ive been taking the promethazine 25mg tab and klonopin for awhile now.

I've been feeling awfully drowsy day in and day out; almost like I cant get enough sleep...
Anyway I figured this was just a side effect of the Prozac as it is a new drug for me.. Woke up this morning after the second night of nodding myself to sleep awfully early.

The first night I just felt extremely relaxed and absolutely nothing on my mind (PTSD, Anxiety ect) And as time went by I found myself listening to music and just falling forward/sideways out of my chair every few seconds or it felt like, and I could NOT keep my eyes open for longer than about 15 seconds at a time. I think I recall not being able to see too straight either, "One eyeing it" to beable to read things.. Got great sleep needless to say; Woke up so confused as was my mother who was concerned. So again last night continued meds as usual and I started getting really bad sweating and a little "pale" feeling again... It was bad if I was sitting or standing but if i was laying I was okay no sweating and would just nod....

I researched and there was actually a "Major/Moderate" reaction in Promethazine + Prozac... Can anyone explain this to me or why this happened? Was i ODing?.... I have never nodded that hard in my life, Even on opiates, oxy, vics, morphine, and mixtures....

Also can this cause any long term damage? (Worried about serationin syndrome) but as I read the Prozac potentates the Promathazine??? not the other way around?

Thanks guys

 

[PotatoMan]

SS is not an issue.

promethazine is a first gen antihistamine that has little to no effect on serotonin.

you're feeling very drowsy because promethazine is very sedating, along with klonopin.

you're experiencing a compounding drowsy effect from all the meds.

i've never taken prozac but it also is used for anxiety so i'm assuming it is likely also adding onto the strong relaxation.

you're fine and not ODing, don't worry about that.

you'd be at risk for SS if you were taking a serotonin releaser along with your prozac.

you'd be at risk for ODing if you were taking multiple CNS downers with your klonopin and both prozac and promethazine do not depress the CNS afaik.

and if they do, the effect is minimal and your risk for OD is very low.

don't worry and you'd be fine..

perhaps you can talk with your doctor about decreasing your klonopin dose or just leave the promethazine out entirely...

 

[d1nach]

"fluoxetine oral will increase the level or effect of promethazine oral by affecting hepatic enzyme CYP2D6 metabolism."

"Strong inhibitor being one that causes at least a 5-fold increase in the plasma AUC values, or more than 80% decrease in clearance." [1]

Prozac is a strong p450 cyp inhibitor [1]

[1] Flockhart DA (2007). "Drug Interactions: Cytochrome P450 Drug Interaction Table". Indiana University School of Medicine. Retrieved in July 2011

Basically, prozac may be drastically increasing the potency of promethazine not by causing sedation but by interacting with the metabolism of promethazine

Promethazine is a sedative with anticholinergic antihistamine effects

You may of been unable to read because anticholinergics cause blurred vision

Anyway got to go

 

[jackadrug]

SS is not an issue.

promethazine is a first gen antihistamine that has little to no effect on serotonin.

you're feeling very drowsy because promethazine is very sedating, along with klonopin.

you're experiencing a compounding drowsy effect from all the meds.

i've never taken prozac but it also is used for anxiety so i'm assuming it is likely also adding onto the strong relaxation.

you're fine and not ODing, don't worry about that.

you'd be at risk for SS if you were taking a serotonin releaser along with your prozac.

you'd be at risk for ODing if you were taking multiple CNS downers with your klonopin and both prozac and promethazine do not depress the CNS afaik.

and if they do, the effect is minimal and your risk for OD is very low.

don't worry and you'd be fine..

perhaps you can talk with your doctor about decreasing your klonopin dose or just leave the promethazine out entirely...

Thanks for the input! Do you think this would be safe to continue or potentially dangerous?

"fluoxetine oral will increase the level or effect of promethazine oral by affecting hepatic enzyme CYP2D6 metabolism."

"Strong inhibitor being one that causes at least a 5-fold increase in the plasma AUC values, or more than 80% decrease in clearance." [1]

Prozac is a strong p450 cyp inhibitor [1]

[1] Flockhart DA (2007). "Drug Interactions: Cytochrome P450 Drug Interaction Table". Indiana University School of Medicine. Retrieved in July 2011

Basically, prozac may be drastically increasing the potency of promethazine not by causing sedation but by interacting with the metabolism of promethazine

Promethazine is a sedative with anticholinergic antihistamine effects

You may of been unable to read because anticholinergics cause blurred vision

Anyway got to go

So pretty much im getting about 5x potency or so out of my promethazine?
Also would you say this is safe to do every other day or so at night?

 

[d1nach]

Kind of im not smart enough to do the math to calculate auc.

You could try cutting it in half or even quarters maybe.

Maybe you could try vistaril if the anticholinergic side effects are interfering.

Idk if its safe buy am guessing tolerance might grow pretty quickly same as if you tried benadyrl to sleep.