Ritalin and Tegretol - Could it be a toxic combo?

[C14H19NO2]

Ritalin with Tegretol-Agitation/Rigidity/Restless Leg Syndrome?

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Hi,

I occasionally use Ritalin recreationally; it has always been great, aside from the predictable tolerance. I usually use it for a couple days, with a day or two off, then a couple more days, etc, over about two weeks, then take a holiday for a couple of weeks. It gives me the smoothest high, with the least amount of anxiety or other adverse affects. (Adderall, in contrast, makes me *very* anxious). But I'm now experiencing an effect with Ritalin that I've never felt before, and it's really unpleasant.

A few days ago, after having taken 50mg Ritalin orally, I was feeling a bit anxious. I don't take benzos anymore, after going through the nightmare of severe withdrawal, and undergoing a year-long taper to get off of them. But, I remembered I had some Tegretol (XR, 100mg) left over from a time a pdoc tried using that on me for anxiety. I took 100mg of the Tegretol, and sure enough, a few hours later, I was feeling great. The next day, same situation, same great response, this time with 200mg of Tegretol.

I then took a day off Ritalin.

Today, I took 60mg Ritalin orally, and now I am having the strangest, most unpleasant symptoms. It feels like I have Restless Leg Syndrome...I just cannot sit still. It's awful! I also feel agitated in general, and my muscles feel somewhat leaden, like a rigidity.

I've *never* had sensations like this before, with any med or combo of meds that I've taken.

Other meds I take are: Lexapro 20mg qAM, Atenolol for mild hypertension (and I also use it to control any Ritalin-induced tachycardia and increased BP), and the *tiniest* amount of Mirtazapine (literally a crumb, I'd guess it's at most 100mcg) at night prn to help with sleep. I've taken all these agents with Ritalin for years, and have never had side effects like these while on them.

I know Tegretol has lots of drug interactions. I looked them up before I took it. But all I found was that Tegretol can increase the clearance of Mirtazapine, and to a lesser extent, Lexapro; I don't think either of these effects could be the cause of my problem.

Does anyone have any idea what could be going on? Do you think the Tegretol that's probably still on board, since it was the XR, and it has a long half-life, could be the culprit? Or is it something else entirely?

The symptoms almost seem sort of like drug-induced Parkinson's symptoms to me, that they could be attributed to a lack of Dopamine, but I don't get it, that they show up when I take Ritalin, which should give me more Dopamine.

I've read conflicting things about Tegretol; that it can act on Dopamine to block its effects, but I've also read that it can enhance its effects.

I'm stumped!

Anyone got any ideas as to what could possibly be going on here?

Thank you

 

[sekio]

Today, I took 60mg Ritalin orally, and now I am having the strangest, most unpleasant symptoms. It feels like I have Restless Leg Syndrome...I just cannot sit still. It's awful! I also feel agitated in general, and my muscles feel somewhat leaden, like a rigidity.

sounds like you took too much ritalin... if you wait a day to let it all clear out of your system (ritalin has a real short half life) then the next day you can expect the effects to be more intense rather than if you'd been on a 3 day binge accumulating tolerance every day.

it could also be that you're forgetting that if you were having a day that predisposes you to anxiety (not eating/sleeping well the night before, stressful events recently, et cetera) you are innately predisposed to have a bad time on stimulants. set and setting matter.

if you took 50mg a few days ago and it made you anxious then why you'd take 60mg and expect the anxiety to go away is a head scratching mystery. expecting stimulants to have nothing but positive effects day after day, esp. if you use them recreationally, is kind of foolish.

also, i had to remove all your carefully placed links to drugs-forum. we don't need to be linking to bizarro land to get our definitions of dopamine and half life.

also combination questions belong in bdd

 

[Kilfer]

I admire your courage, as Tegretol is one of the most unpredictable "mixer" out there. I see absolutely no benefit in using Tegretol alongside Ritalin or with any other recreational drug for that matter. Even at a therapeutic dose Tegretol on its own (prescribed for a weird facial pain but provided no relief) gave me such a headspin that I couldn't even enter my PIN for a purchase with a debit card, had to let the cashier do it for me. Couldn't drive either obviously, and this lasted for hours.

 

[dopamimetic]

Awww, prescribing traditional antiepileptics like Carbamazepine (Tegretol) to "try for anxiety" is crazy. (Like throwing antipsychotics around as sleep aids is, imo.) Like Kilfer wrote, this one has such a big bunch of side effects even when used correctly, titrated up etc. and are also more or less harsh on the body, I'd say that even for full bipolar disorder there are better things to try. When I was younger and naive, a psychiatrist also tried to put me on Oxcarbazepine as a mood stabilizer (a derivate that is said to have less side effects) and on day 3 or 4 with less than half of the targeted dose I felt like my head would explode and the world was all over gray and rainy, utterly hopeless feeling. Then I've read about that substance and would not touch them any more, really.

If one's desperately looking for a chemical of this "class" for something like anxiety etc. then I'd go for Pregabaline or Gabapentin. They have downsides too but it's a different level. If available in your country, Tiagabine is a somewhat promising chemical - an atypical anti epileptic that works by inhibiting GABA reuptake. For me it feels like a "different" benzodiazepine that is not sedating and causes less to no dependence (less than Pregabaline, which triggers bad RLS when withdrawn too fast).

Playing around with anti epileptics could even trigger seizures in the one or the other, without having had them before.

Also, using beta blockers with stimulants can be dangerous due to the epinephrine being still there and solely activating alpha receptors, causing the blood vessels to constrict (where beta receptors dilate them) and if levels raise too high one might get hypertensive crisis. This is actually a contraindication; nevertheless many people have no bad effects as long as dosages aren't too high. But in a overdose case, something like Clonidine is safer - this even counters the blood pressure issues with MAO inhibitors, at least in my body. Could be dangerous though.