Opioids Think I almost had a seizure tonight from Tramadol

[colpeterson]

Some of you may have seen my posts from a few days ago, but short story is I have been on 50mg Tram x 2 per day for about 6 months from a back injury with chronic pain. Doc put me on Cymbalta about 2 months ago, and recently added Wellbutrin to prepare for coming off Tram for a month or two to let my tolerance reset. I've been on the 60mg Cymbalta for 7 weeks now with no issues other than delayed climax during sex, and some appetite loss. Once I was leveled out on the Cymbalta they added 150mg Wellbutrin, which I was on for about two weeks. After about day 9 or 10, I noticed I was no longer getting anything at all from my normal Tramadol dose. Called my doc and they weren't certain but said it was likely related to the Wellbutrin. All fine and good, but I now had zero pain relief, so they told me to discontinue the Wellbutrin for now and give it a week to clear my system. Being stupid and impatient, I waited 5 days and dosed 100mg of Tram this past Saturday and felt nothing still. So I didn't take any Saturday night, Sunday, or Monday. Tonight, I decided I'd go big or go home, so I dosed 300mg at once. Within about 45 minutes I started to feel the normal "come up" of how Tram works for me, a generally feeling of well being and LOTS of productive energy. I was like "Cool, the Wellbutrin must finally be clearing out of my system!". Fast forward another hour, and I'm starting to feel very dizzy and sweating profusely, which has never happened to me from Tram. Walking around the house felt like I was drunk, bumping in to walls and overalll just dizzy as hell and nauseated. I had to go drop off a couple packages at UPS which is about a mile from my house, so I decided to walk there and get some fresh air and maybe that would help. Well, about halfway there I started getting really weird eye jerking movements, and twitches in my arms and hands. I couldn't focus my eyes on any one thing for more than a second or two before they'd dart to something else, out of my control. To compound that, my heart rate on my FitBit HR was at 55. I'm normally around 68-72 while walking at a regular pace. I might be wrong, but I'm pretty damn sure I was on the borderline of a seizure. I've never had one before, so it's hard for me to say, but it sure seems to fit the symptoms. Not knowing what else to do, I called my wife and told her I was having a panic attack (didn't want to tell her I was an idiot and dosed 300mg Tram). She came and picked me up and drove me back home. I laid down at home for about 20 minutes, and then everything cleared right up, and I had that normal awesome feeling Tram gives me of being content, energetic and just in an overall positive and social mood. I got a bunch of housework done, finished building a new PC I'm working on, and helped my kids with their homework...

So, moral of the story, even though the consensus is 400mg Tram is usually considered the max to avoid getting into seizure danger, it can happen with less. I'm not sure, but I'm thinking the combination of Tram and Cymbalta may drop that floor even lower. So I'm going to take 2 or 3 days off the Tram for good measure and then try my old 50mg x 2 per day and see how it goes. Be safe people!

 

[Speed King]

IMO, your combination of pills is simply bad in general. I agree with all you said and feel that you were very close to a seizure. If you have the resources, I would fire that doctor of yours and get one that understands drug combinations.

Welcome to Bluelight. The quicker you learn how to use the search function, you will be able to look up the drugs like these and learn about interactions.

You made some decent observations, so good post. For future reference, you didn't ask any questions. This post should be in the trip reports forum.

 

[Hodor]

Shit, I remember I replied to your post from a few days ago and a while later thought "hmmm, maybe I should also warn the guy about the increased risk of seizures", but then forgot about it

Basically, since both Cymbalta and Tramadol are SNRIs, there's a much a greater risk of seizures than with Tramadol alone. Wellbutrin is also said to lower your seizure threshold. And lastly, as I mentioned in the other thread, Cymbalta and Wellbutrin both inhibit your liver enzymes. That means they inhibit the formation of O-Desmethyl-Tramadol (which is a more potent opioid than Tramadol proper) and result in higher levels of unmetabolized Tramadol (which is a more potent serotonin reuptake inhibitor than its metabolites), diminishing the opioid effect while compounding the risk of seizures.

 

[colpeterson]

IMO, your combination of pills is simply bad in general. I agree with all you said and feel that you were very close to a seizure. If you have the resources, I would fire that doctor of yours and get one that understands drug combinations.

Welcome to Bluelight. The quicker you learn how to use the search function, you will be able to look up the drugs like these and learn about interactions.

You made some decent observations, so good post. For future reference, you didn't ask any questions. This post should be in the trip reports forum.

Thanks, Speed. I am going to call a therapist today that specializes these types of things. Too scary to play around with these risks even though my primary doc assured me they are safe to mix.

 

[colpeterson]

Could a mod move this thread to trip reports?

 

[StaffWriter]

Funny, tramadol always made me sweaty and nauseated to the point of vomiting. Never once got me high. Even thinking about them hurts my stomach. But yeah, the Cymbalta tramadol AND Wellbutrin is a dangerous combo. Ask your doc about changing your meds.

 

[Speed King]

colpeterson, glad you are looking for a new doctor/therapist.
Primary care doctors, in my experience, are bad at treating pain issues like yours, or afraid to use stronger, opiate pain killers to treat your type of pain. The combination of medications you are/were on sound like first line treatment drugs and also get prescribed to people who are not allowed to take narcotics. I see a pain management doctor who takes care of my issue nicely.
I let you know about the trip reports section, because, at first, that is how the post sounded.
Your post is detailed and has information that can help others out.
Tramadol comes up a lot on this site. Great post.

 

[colpeterson]

Hey Speed King, can you give me an idea of what a pain management Doctor is as compared to a family doctor? I see lots of "pain clinics" in my area but I can't say I really understand how they work.

 

[Speed King]

Simply put, Pain Management doctors, listen to what your problem(s) is/are. They may just interview you. Some may do a exam of some sort.
You usually need a primary care physician to give you a referral to the Pain doctor.
Having a medical record to back up your claim helps a lot.
As referenced in my other post, a normal protocol is first line treatment with non opiate pain killers such as NSAIDs, Tylenol, and the stuff you took. If that first line medication doesn't work, makes you sick, you have a bad reaction, etc, then depending on your condition, you may be placed on an opiate like Vicodin or Percocet, with a non opiate on the side to help with pain.
Doctors do not like giving opiates out unless you have a serious(subjective) condition. That's it in a nutshell.

 

[HartfordReport]

Yea so tramadol releases serotonin and without looking I think your cymbalta does too. The seizure you had would be associated with serotonin Syndrome. Seizures usually leave you daZed and confused. Very confused depending on depth of seizure with acute local memory loss. Serotonin syndrome can also and usually cause diarrhea and feverish chills etc.