Oxycodone/Oxycontin and SSRI's, leads to sratonin syndrome?

[ttocs]

Diacetylus or whatever your name is. You calling me bullshit? Whatever buddy. Opioids and opiates do not INTERACT at all with the Serotonegetic system. I've talked to different pharmasists across the city, if anything it would lead to increase drowsiness, not serotonin syndrome. I don't know where you getting this info from. Take a look at rxlist.com as well, it says the only precausion with Oxycodone and Oxycontin is to be precausious while on an MAOI, not SSRI. Maybe a very rare reaction if someone was prone to opiate reactions already.

And no shit sherlock, I knew this was a harm reduction site. But instead of asking people on here and not getting the right opinion you want. Give your pharmacist a call and I can guarantee you that she will say there is no problem with the combination. So stop with the flaming.

 

[ttocs]

Ok then D.r. bullshit! care to explain these studies then:


http://www.ncbi.nlm.nih.gov/entrez/..._uids=16051647&query_hl=2&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/..._uids=16368927&query_hl=2&itool=pubmed_docsum
???

Just because you seem to have no adverse reactions with the combo of SSRI's and Opiates, does NOT mean it won't happen to another individual.

I would think bilz0r and the studies he linked to Pubmed would know slightly more about the possibilities, consdering how well bilz0r is versed with pharmacology and all.

...and just because something is a rare case, does not mean it should be completely dismissed and deemed not completely possible to happen.

In case you didn't know... this is actually a harm reduction board.

Those links you posted were referring to serotonin syndrome with an MAOI, not an SSRI. MAOI and SSRI's are not the same thing. They are completely different. Get your facts straight before you start with the flames there buddy.

 

[Diacetylus]

ttocs: First of all, when someone posts a link, I highly suggest you read further than the title, ok? If you did, care to explain this:

OBJECTIVE: To report a case of severe serotonergic symptoms following the addition of oxycodone to fluvoxamine. CASE SUMMARY: A 70-year-old woman developed severe serotonergic features, including confusion, nausea, fever, clonus, hyperreflexia, hypertonia, shivering, and tachycardia, following the addition of oxycodone 40 mg twice daily to fluvoxamine 200 mg/day, easily fulfilling diagnostic criteria for serotonin syndrome. Discontinuation of the offending drugs resulted in resolution of her symptoms over 48 hours, and no other cause of the syndrome was identified. Use of the Naranjo probability scale indicated a probable relationship between the serotonergic symptoms and the addition of oxycodone to fluvoxamine therapy.

Opioids and opiates do not INTERACT at all with the Serotonegetic system.

Why? Because you say so? Lol. Right-on then champ.
Again, I would think that pubmed and Bilz0r is a much more credible source of info than you. But, whatever.

I've talked to different pharmasists across the city, if anything it would lead to increase drowsiness, not serotonin syndrome.

Well, these Pharmacists are obviously not very aware of the dangers and aren't up to date with their studies regarding the SSRI-Opioid combination. Just because they haven't heard of any cases doesn't necessarily mean that it has never occured.

I don't know where you getting this info from. Take a look at rxlist.com as well, it says the only precausion with Oxycodone and Oxycontin is to be precausious while on an MAOI, not SSRI. Maybe a very rare reaction if someone was prone to opiate reactions already.

I got my info from the links that Bilz0r posted above. Both being very, very credible sources might I add.

And no shit sherlock, I knew this was a harm reduction site.

Then how about we treat it as such then, eh?
Saying that Seratonin Syndrome won't[i/] happen at all. Not ever!! Is serious. You possibly killed off a few people with your stupid un-researched statement. However, investigating and researching further won't kill anybody, will just make you more knowledgable. It never hurts to spare a few minutes of your time to read a medical journal article accurately , say as opposed to just reading the titles and expecting to get the info you're looking for from that.

Get your facts straight before you start with the flames there buddy.

Uhm... how about you get yours straight? Before coming to such conclusions.

 

[ttocs]

ttocs: First of all, when someone posts a link, I highly suggest you read further than the title, ok? If you did, care to explain this:




Why? Because you say so? Lol. Right-on then champ.
Again, I would think that pubmed and Bilz0r is a much more credible source of info than you. But, whatever.


Well, these Pharmacists are obviously not very aware of the dangers and aren't up to date with their studies regarding the SSRI-Opioid combination. Just because they haven't heard of any cases doesn't necessarily mean that it has never occured.



I got my info from the links that Bilz0r posted above. Both being very, very credible sources might I add.


Then how about we treat it as such then, eh?
Saying that Seratonin Syndrome won't[i/] happen at all. Not ever!! Is serious. You possibly killed off a few people with your stupid un-researched statement. However, investigating and researching further won't kill anybody, will just make you more knowledgable. It never hurts to spare a few minutes of your time to read a medical journal article accurately , say as opposed to just reading the titles and expecting to get the info you're looking for from that.


Uhm... how about you get yours straight? Before coming to such conclusions.

What the hell makes you love Bliz0r and suck him off and think he is so knowledgeable? Just because he is a mod here doesn't mean he knows everything. Just like the bluelight.nu mods on here seem to think GBL and GHB are the exact same thing. GBL is far worse for your body, and studies don't even know the long term effects of GBL use. So the mods on here aren't too bright, but I won't get into that on here, because nobody seems to do any actual research but run their mouth. I would trust the pharmacists I called over some stupid bullshit website where people just have assumptions. So as far as I'm concerned Difuckus or whatever your name is, go fuck yourself. Treat people the way you want to be treated dicksmack.

 

[BilZ0r]

If this dude wants to think SSRIs and opioids are completely safe in combination, that is his business. If he wants to abuse people who disagree with him, that is also his business. Some people may believe him, but I'm sure the majority of people will see that you have cited peer-reviewed case reports from scientific journals to support your case, while he has cited nothing but chats with pharmacists.

 

[ttocs]

If this dude wants to think SSRIs and opioids are completely safe in combination, that is his business. If he wants to abuse people who disagree with him, that is also his business. Some people may believe him, but I'm sure the majority of people will see that you have cited peer-reviewed case reports from scientific journals to support your case, while he has cited nothing but chats with pharmacists.

And you don't even know what an SSRI is, do you bliz0r. The links you posted had to do with MAOI's. Also, please care to show me a link where any opioid or opiate effects the Serotonegetic system? And, no, Tramadol is not an opiate.

 

[Diacetylus]

^Either you're trolling or you are incredibly fucking stupid. If it is the former, then I won't give you any shit about that, as it's not fair to mock others who are intelectually challenged.
But, I will once more tell you to read the text I quoted from one of the links provided. It saysquite clearly that fluvoxamine had an interaction with another opioid. Here, let me re-post it:

A 70-year-old woman developed severe serotonergic features, including confusion, nausea, fever, clonus, hyperreflexia, hypertonia, shivering, and tachycardia, following the addition of oxycodone 40 mg twice daily to fluvoxamine 200 mg/day, easily fulfilling diagnostic criteria for serotonin syndrome.

There ya go, I even put the keywords in bold for you to make it more clear.

 

[ttocs]

^Either you're trolling or you are incredibly fucking stupid. If it is the former, then I won't give you any shit about that, as it's not fair to mock others who are intelectually challenged.
But, I will once more tell you to read the text I quoted from one of the links provided. It saysquite clearly that fluvoxamine had an interaction with another opioid. Here, let me re-post it:



There ya go, I even put the keywords in bold for you to make it more clear.

fluvoxamine is not an SSRI you fucking retard. There is your first problem. You call this a harm reduction site? bluelight.nu is full of complete bullshit.

 

[ttocs]

Take a look at her age as well, 70 years old you shouldn't be taking antidepressants at the age, thats the first problem for fuck sakes.

 

[ttocs]

You quacks and mods on here claim the site to be a harm reduction site, then start fucking acting like it. This is going off topic here, but for the mods or whoever the fuck was saying "GBL is the same as GHB" is completely nuts, both have different highs. GBL is a toxic solvent, GHB metabolizes into carbon dioxide + water, and is also much easier to dose. Its idiots like youguys that are the ones that got GHB banned, because you thought you were getting GHB when infact you were getting GBL. If I hear one more fucking post about GBL and GHB being the same thing, i'll report this board. Go take a look at a fucking link for fuck sakes. http://www.ceri.com/feature.htm

 

[ttocs]

None of you on here are actual doctors anyway, i'm just wasting my time. Diacylyfucknut, if you are so concerned, find out for yourself or call your doctor. Thats what they are there for. Not some drug internet message board.

 

[BilZ0r]

Just incase someone else (i.e. not ttocs) was interested in further sources of information for the interactions between opioids and SSRIs:

http://www.ncbi.nlm.nih.gov/entrez/..._uids=9747665&query_hl=22&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/...uids=16005413&query_hl=26&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/...uids=12243617&query_hl=34&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/...uids=11210406&query_hl=34&itool=pubmed_DocSum

 

[Diacetylus]

fluvoxamine is not an SSRI you fucking retard.

Ohh really?

DESCRIPTION
Fluvoxamine maleate is a selective serotonin (5-HT) reuptake inhibitor (SSRI) belonging to a new chemical series, the 2-aminoethyl oxime ethers of aralkylketones

http://www.rxlist.com/cgi/generic/fluvox.htm

Strange, maybe rxlist have no idea what they're talking about either.
Face it ttocs... you have been proven to be wrong multiple times and even after credible sources have provided us with information to suggest you have no clue what you're talking about, you still come in here babb;ing about how we don't know what we're talking about.

Take a look at her age as well, 70 years old...

Yea... but just because she is 70 years old doesn't mean that we should ignore the possibility of Seratonin Syndrome.

You quacks and mods on here claim the site to be a harm reduction site, then start fucking acting like it. This is going off topic here, but for the mods or whoever the fuck was saying "GBL is the same as GHB"

Erm... what the fuck does GHB and GBL have to do with this thread? But anyways... I thought I'd just let you know that once GBL is metabolised by the liver it is converted into GHB anyways.

None of you on here are actual doctors anyway, i'm just wasting my time. Diacylyfucknut, if you are so concerned, find out for yourself or call your doctor. Thats what they are there for. Not some drug internet message board.

Actually, in all honesty, I'd be surprised if my doctor knew what seratonin syndrome was anyways. Alot of doctors are clueless about pharmacology and only know basic shit when it comes to brain chemistry. Besides, if I mentioned illicit drug use to my doctor, he would just say "don't do it". Not quite the answer I'm looking for.

 

[anafagodma]

I believe bilzOr quoted this study

ttocs, Diacetylus doesn't need to call you bullshit. I'll do it.

Serotonin Syndrome Induced by Fluvoxamine and Oxycodone
Harindra Karunatilake, MRCP MD

Registrar, The Canberra Hospital, Canberra, New South Wales, Australia

Nicholas A Buckley, FRACP MD

Associate Professor, Department of Clinical Pharmacology & Toxicology, Canberra Clinical School, The Canberra Hospital

Reprints: Dr. Buckley, Department of Clinical Pharmacology & Toxicology, Canberra Clinical School, The Canberra Hospital, PO Box 11 Woden, ACT 2606, Canberra, New South Wales, Australia, fax 61 2 6244 2594, [email protected]

OBJECTIVE: To report a case of severe serotonergic symptoms following the addition of oxycodone to fluvoxamine.

CASE SUMMARY: A 70-year-old woman developed severe serotonergic features, including confusion, nausea, fever, clonus, hyperreflexia, hypertonia, shivering, and tachycardia, following the addition of oxycodone 40 mg twice daily to fluvoxamine 200 mg/day, easily fulfilling diagnostic criteria for serotonin syndrome. Discontinuation of the offending drugs resulted in resolution of her symptoms over 48 hours, and no other cause of the syndrome was identified. Use of the Naranjo probability scale indicated a probable relationship between the serotonergic symptoms and the addition of oxycodone to fluvoxamine therapy.

DISCUSSION: Serotonin syndrome is a serious adverse reaction usually due to interactions with serotonergic drugs. There have been only 3 previous reports involving oxycodone. Most previous reports of serotonin syndrome involving analgesics have been associated with meperidine, dextromethorphan, and tramadol. Unlike these synthetic opioids, however, oxycodone does not inhibit the reuptake of serotonin. In addition, there are a number of other possible pharmacologic mechanisms for the interaction we observed.

CONCLUSIONS: Monitoring for serotonergic adverse events should be done when oxycodone is given to patients receiving serotonin-reuptake inhibitors.

Key Words: oxycodone, serotonin syndrome

You can get links to read more about it here. Registration to access some articles (including this one) is free, just a PITA.
But it's your civic duty, ttocs- to share your wisdom, enlighten the world.
And there seem to be people all *over* the place under the impression that Luvox is an SSRI. Why, some crazy folks even say it was the first SSRI on the market. These guys must really have their heads up their asses. You'd better go straighten them out.

While you're at it, be sure and remind them that a THC pill for people with AIDS and Cancer is just a clever marketing scheme directed at scum who just want to get high. So go set them straight. Then why doncha go ahead and wash down your daily dose of phenelzine with a nice bottle of red wine?

Sibutramine is an SSRI, too.

 

[pin]

I do not know what I am talking about and Im just trolling around.

Thats better.

 

[TheTripDoctor]

SSRI endorphin action

I skipped past all the posts, sorry.

SSRIs cause endorphins to be released, but opiates dont cause serotonin to be released (or inhibit theyre destruction or reuptake).

Opiates themselves are metabolized by CYP2D6, so the real harm here is that any time you take 2 drugs together (opiates and SSRIs) that are metabolized by the same liver enzyme, one or the other will be stronger. Thats true of 1/4 of all CNS active drugs on the market. In this specific case, your just getting more of the SSRI because its not being properly metabolized. Thats your serotonin increase.

And any drug that is metabolized by a liver enzyme can be considered to be an inhibitor of that enzyme, since it would take up a large amount of it which is then no longer available to metabolize other drugs.

As an aside, be careful if your taking SSRIs and then try to potentiate an opiate with something like cimetidine or any other drug that is metabolzed by CYP2D6. Most enzyme inhibitors will prevent the SSRI from being converted by liver enzymes, which then means your getting a far higher dose of SSRI than you realized. Its happened to me, and im fully aware of what serotonin syndrome feels like, and it was borderline dangerous.

 

[ttocs]

I'm sorry, but I'll take a pharmacist's opinion with a 7 year degree in pharmacology than some bluelight website with mainly 16 yearold kids on it, or some government propaganda bullshit. Anything with .gov in it is usually spreading mispropaganda. You all should know that by now.

 

[BilZ0r]

^ Pharmacists don't have degrees in Pharmacology, they have bachelors of Pharmacy.

but opiates dont cause serotonin to be released (or inhibit theyre destruction or reuptake).

Some do, that is the whole point. Tramadol is the classical SSRI/Opioid.. Pethidine and Methadone definately have affinity for the serotonin transporter [1]. While all opioids, via their actions on the mu-opioid receptor cause serotonin release [2, 3].

 

[TheTripDoctor]

Bilzor is right

I have never seen any clinical paper saying that before, but your right. I should have looked up non-phenathrenes as well. I knew about tramadol, However....

The paper you cited (No. 1) says this "The phenylpiperidine series opioids, pethidine (meperidine), tramadol, methadone and dextromethorphan and propoxyphene, appear to be weak serotonin re-uptake inhibitors and have all been involved in serotonin toxicity reactions with MAOIs (including some fatalities). Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs."

That says they're SSRIs as well, not serotonin releasing drugs. In addition, if an MAOI cant cause serotonin syndrome in combination with oxycodone or the other phenathrenes, SSRIs definitely wont be any worse through that pathway. However it is still possible that oxycodone (and others) can inhibit liver enzymes and prevent them from metabolising another SSRI, this was vaguely stated somewhat in a post above by someone. Quote here "however, oxycodone does not inhibit the reuptake of serotonin. In addition, there are a number of other possible pharmacologic mechanisms for the interaction we observed." I cant be sure thats what was meant because i didnt see that study, and i dont know what they were thinking

That same paper bilzor posted (No. 1) says this:
"It is only combinations of serotonergic drugs acting by different mechanisms that are capable of raising intra-synaptic serotonin to a level that is life threatening. The combination that most commonly does this is a monoamine oxidase inhibitor (MAOI) drug combined with any SRI."

However I still stand corrected, opiates do interact with serotonin

 

[soda]

Wow, I came back to this thread and have seen all the flaming. All I can say is, please refer back to my original post which is based on my experience as it happened. It would back up what Diacetylus and B1lZ0r have said 100%. OK, I haven't had a white paper written about me and published in a medical journal but guess what, I don't give a shit because I know what happened. And for the record, I'm in my mid 30s, not 16.