Opioids Anafranil and opiates.... seretonin syndomre possible?

[bdomihizayka]

Anafranil and opiates.... serotonin syndrome possible?

Ok, so tricyclic antidepressants like Anafranil all potentiate downers like booze, opiates, benzos, etc.....but can you get serotonin syndrome from mixing roxycodone with the anafranil? I am a once in a while user and pop two of those beautiful blues for a nice high, but recently have been feeling out of it since yesterday which was the first time I used since on the antidepressant. I have been on the anafranil and it helps me tremendously for ocd and depression, for about one month, and I did my roxys for the first time since being on the antidepressant yesterday and have just been feeling WEIRD..... depersonalization, derealization, I feel like I cannot drive a car, my vision is messed up.... etc.

This really sucks if this is so... because the Anafranil is so thereputic and helps me out so much..... yet it seems like something in it doesn't agree with my roxycodone. So no more recreational drugs???

Any input is appreciated thanks!

 

[Downloader08]

TCAs are particularly known for their 'dirty' pharmacology (as in they bind to many different receptors causing all kinda of possible side effects unrelated to their seratonergic effects). If you were using pethidine or tramadol, the risk of seratonin syndrome would be very real. With oxycodone though... I don't know how much of an effect oxycodone has on seratonin, but I can't imagine it would do much (please correct me- mere speculation here).
It'd be much more reasonable imho to suggest that the strange feelings you are experiencing would simply be due to the normal psychological effects of TCAs combined with an opiate, resulting in a rather less pleasurable feeling for you.
I can't really see any potential for toxicity there, so perhaps that combo, unfortunately, just isn't for you

 

[Swimmingdancer]

Yes, while not common, I have definitely heard of cases of SS from mixing oxycodone and antidepressants.

Here's a quote from a paper about it:

Serotonin syndrome is a serious adverse reaction thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Coadministration of oxycodone with serotonin reuptake inhibitors has only recently been associated with the development of serotonin syndrome. A literature search revealed only four previous reports of serotonin syndrome involving oxycodone. 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. Oxycodone is a morphine analogue and so does not fall into this category of opioids. An alternative explanation is required.

Oxycodone differs from most other opioids in having a significant affinity for kappa opioid receptors. While most of the drug is N-demethylated by CYP 3A4 to noroxycodone, approximately 10% is O-demethylated by CYP 2D6 to the very potent active metabolite, oxymorphone. Compared to oxycodone, oxymorphone has a higher affinity for the mu opioid receptor and is 14 times as potent as oxycodone.

Other potential contributing factors for the drug interaction include the following:
(i) a pharmacokinetic interaction
(ii) an inhibition of CYP 2D6 affecting the metabolism of oxycodone
(iii) opioids do not directly stimulate serotonergic neuronal discharge but disinhibit neuronal activity by suppressing GABA-mediated inhibition. Thus, the short-term effect of morphine and perhaps other opioids is to increase serotonin release in widespread areas of the forebrain.
(iv) the patient may have been an extensive CYP 2D6 metaboliser. Whilst the metabolism of oxycodone to oxymorphone via CYP 2D6 is not responsible for all of the effects of oxycodone, experimental results indicate it does make a significant contribution in extensive CYP 2D6 metabolisers

Whilst serotonin syndrome is not currently listed as an adverse event within the product information for OxyContin tablets when given in combination with a selective serotonin reuptake inhibitor, the existing case studies to date suggests that it is prudent to closely monitor patients receiving this combination. The mechanism of interaction is unclear and warrants further investigation.

 

[bdomihizayka]

Thanks for the input guys... I really appreciate the info.

Just completely sucks that it looks like I'm going to have to stop messing with recreational pills for the time being.