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  • BDD Moderators: Keif’ Richards | negrogesic

Duloxetine (Cymbalta) + DXM, risk of possible serotonin syndrome

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Renald

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Jul 8, 2015
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At this moment I am taking very low doses of duloxetine (about 5-10 mg daily) trying to withdraw the drug totally. Sometimes I am not using the drug for 2 or more days, what mean I am at 4+ half-lifes of drug from the last dose, and simple math tells me there is almost no drug in my system at this time. Despite this I am paraoid about possible serotonin syndrome and am afraid to take even 1 small 15 mg tab. of DXM. I want to try 1st plateau dose of DXM, but do not want to risk, if the risk is present. Is the possibility of serotonin syndrome dependant only on the concentration of serotonergic drugs in system, or there are possibilities it may happen with increased chances due to disregulation of receptors after long term SSRI usage? Are the recommendations not to use any MAOI or serotonergic agent 2 weeks after SSRI based on Prozac long half life (2-3 days vs 12 hours of duloxetine; 3 days stopping duloxetine will mean you are in 6+ T1/2 "zone"), or it is something what is common to all the SSRIs?
 
You should at least wait two weeks after your last duloxetine dose.
Longer would be safer.

If not you are indeed risking serotonine syndrome.

Some people might say a low dose of dxm should be fine but it is not.

Also I dont advice on quitting your ad for a dxm trip.
 
Why 2 weeks, not 1 week or 2 months? What is the statement based on?
 
There's been studies done on DXM + SSRI's and at "normal" DXM doses to treat cough (10-30 mg) there's no serotonin syndrome seen . I personally have taken 150 mg DXM (typical first plateau dose) while on Cymbalta and did not notice any SS. If I remember correctly I would usually skip my Cymbalta that day. However I ended up having SSRI withdrawal symptoms like brain zaps the next day from skipping. The only time I've noticed SS like symptoms is when I used DXM to potentiate hydrocodone while on Cymbalta and that was only like 80 mg.

Cymbalta is one of those damn medications that really throws a monkey wrench into recreational drug use because it inhibits liver enzyme CYP2D6 which is required for some drugs to be activated including DXM (and also codeine)
 
I have also not found any papers regarding SS when DXM was used therapeutically with SSRI/SNRI.
What were your SS-like symptoms? I want to be able do differentiate possible mild SS and panic attack (I am suffering from PA). Now I am trying to increase the DXM dosage every day by very small amount to titrate the dosage.
 
Renald, why not wait it out for a week or two and have no chance of any interaction? DXM is cool for the right people, but out of my top 20, it wouldn't make the list. Just wait it out. Personally, DXM makes me mad that I do not have K. Is this some sort of " I'll take a break off my ssri so I can trip(subjectively)on DXM"?
 
I know I'm normally an idiot, so take what I say with a grain of salt... I take 20 mg celexa a day, and 2 nights ago I took 888 mg of dxm polistirix, with no problems (very unintelligent, but was fun). To everyone else, don't worry, I'm getting some weed tomorrow. I have a trip report in the trip reports section if you want to read it.
 
Speed King, the problem is I cannot fully stop Cymbalta, as either I have panic attacks, or discontinuation syndrome, which lasts quite a long time. Ketamine was perfect for my depression, but I cant get it anymore, so I tried DXM when I was SSRI/SNRI free, and noticed little similarity with ketamine, I had an afterglow a day after.
I am interested what symptoms should I be aware of to know that I am experiencing mild SS. I know all the typical symptoms, but maybe you have something interesting to add.
 
I never came close. Body overheating, blood pressure rising, fever, talking gibberish. I think you know if something's wrong going on. You might not like this but 30mg DXM and your ssri should be okay, but you might be the one guy it goes wrong on. Check Drugs. Com for example.
 
I take cymbalta just recently this past year.. And I use it off and on cause I'm addicted to dxm and it fucks with the high.. Dxm just takes away my anxiety and makes me feel at ease and I was hoping maybe cymbalta would do that and therefore I wouldn't need dxm to get that edge off.. I've been in numerous rehabs the past 3 years, I'm 18 years old and I started my addiction at 15. I guess the reason I'm typing this is cause I'd like if you could share any information that you know of the long term effects of dxm on serotonin and how cymbalta will interact with that.
 
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