Opioids Seratonin Syndrome from Tramadol UP AND DOWN

[hadini]

So last weekend I tried to do a little tramadol binge (first time with trams). Lets say Friday night I took 250ish... Sat maybe 250-300... Sun same thing. I made sure not to step too close to reccommended 400mg max. Anyway, on Sunday about an hour after dosing I had intense heart palpiations, was shaking like mad, felt like my brain would overload, weird sensory hallucinations, dilated pupils... pretty positive it was seratonin syndrome. Wound up going to the hospital late that night, and even though I told them about tram nobody guessed seratonin syndrome... it wasn't until day after doing research that I came upon that guess. At the time I called and said I thought I had a seizure (don't think I did)... but they did a brain scan and ruled that out and sent me back home the next day.

I wound up taking 100mg on mon, 50mg on tues, and maybe like 20mg on thurs morning. This was only because I feel I am very sensitive to withdrawal effects of any kind and wanted to step my body down from the opiates (was not guessing SS at this time). Thursday and Friday were good, though I think I was more anxious than usual friday, but I just figured it was normal very mild withdrawals. Friday night I came home from work, smoked a bowl around 7pm, watched some tv, all was good despite not feeling 'great'. Before bed around midnight I was feeling very restless and anxious (moreso than usual) and I smoked another bowl, and around 15 minutes later had intense palpitations, anixety, muscle aches, dilated pupils (eyes felt like they would pop out of my skull at times)... I popped a Halcion and the effects seemed to taper off as the weed did and I fell asleep. Woke up to mild shakiness, slight dilation in pupils, feeling warm like if I had a mild virus, eyes feel weird, headache, anxious, everything sucks.... The symptoms point to seratonin syndrome but I'm confused that it would present itself more than 24 hours after a tiny dose and be worse than the 24 hour mark after my 50mg dose on tuesday (though I'd say symptoms akin to sunday night but on a waay milder scale popped up a couple nights during the week).

Also worth mentioning that I smoked weed Tues-Fri nights and had no such reaction until Friday.

Is this SS despite not taking a fair sized dose since several days ago? Am I through the worst of it? When will this end? Advice is welcome.

If this is the trams... is there anything readily availible I could take to reduce duration or help this? I have Soma and Triazolam (the Triazolam I took Sunday as I thought it was a panic attack or seizure or something...) and I also took a Triazolam last night after I read around and guessed at SS; seemed to help but I don't want to take benzos if I'm nearly in the clear. Will the Soma help or hurt? Anything else?

Please help! This sucks and I am afraid it will climb back to an awful level again.

 

[pinpoint]

OP were you taking any other prescription or OTC drugs during your 'binge'? Also do you have an opiate habit? A weekend use would not cause a physical dependence so I'm trying to rule that out first.

 

[hadini]

Fri night I also took a bunch of lomotil (done this before with no problems) and 10-20mg of oxy IR. I also take daily Saw Palmetto, fish oil, magnesium, biotin, zinc, multivitamin in response to recent hairloss. I use Soma or ambien roughly once every 10 days for sleep (in small doses like quarter of a 350mg soma or half 5mg ambien). But TBH I was feeling fabulous until it all hit on sunday.

Worth mentioning that I tried St Johns wort a few weeks ago. Took one dose and about 24 hours later I felt very warm (moreso due to s johns wort effects on skin sensitivity) and uncomfortable. Nothing remotely like this, though. Might I just be very sensitive to RIs? But that wouldn't explain unpredictability of severity.


I have had 'habits' in the past... most lasting a week and longest lasting a month (not severe in context of this forum... but month habit (using 70mg hydro or 45mg oxy ever 2-3 days) led to a 2 week withdrawal of intense anxiety, depression, boredom, fast HR, sweating. After cleaning up I tried to take 15mg hydro and had noticeable cravings, anxiety, boredom, and hot temperature flushes over next few days (peaking around same time my withdrawals do). Kindling may be a big issue for me as early experiments with opiates had nowhere near this rebound. Prior to this tram bullshit I had been opiate free for a month or so.

In restrospect, the mornings where I woke up and took 50mg and 20mg of tram (because I felt anxious to point it would hurt my work persona) could have just been me misrreading mild SS anxiety, along with that gross warm bodied feeling that both seem to create for me. That said, taking the tram those mornings definitely helped my anxiety at the time.

 

[littlepenguin]

definitely not serotonin syndrome.
you're feeling like crap because you took a ridiculous amount of a drug.
stop piling various drugs on top of it to try & make yourself feel better.

 

[hadini]

definitely not serotonin syndrome.
you're feeling like crap because you took a ridiculous amount of a drug.
stop piling various drugs on top of it to try & make yourself feel better.

Good advice in part, and I would normally agree with you... the Halcion I am wary of using and don't think I am going to anymore because it makes me feel noticeably more shitty for a couple days even at tiny doses. I have only taken it because I read that benzos are used to treat SS and my heart rate/bp/head exploding made me feel like benzos would actually be easier on the body than just enduring it. The marijuana was not to make myself 'feel better' really but because I've relied on it for sleep for a long time... but I think I am going to cut that out until symptoms subside. However...

What makes you sure it's not seratonin syndrome (mild)? Is Tram known for INSANE withdrawal effects? Because I can't imagine what it would be like to cease an actual, sustained habit.

I stayed under (around 250mg for max dose) the daily guideline... I have had literally EVERY symptom of SS... and have been through opiate withdrawal or post binges many times and it has always felt distinctively different than this. Last night I almost went to the hospital because I thought my heart was going to explode or stop or something... my pupils were dialated to the extent that having eyes was painful and my ears keep popping I think from my BP being so high. I have experienced a variety of different withdrawals at times and this is unlike any narcotic withdrawal I have experienced. Even in worst parts of a withdrawal it wouldnt even cross my mind to go to the ER.

Symptoms seem a tad bit better than this morning, much more so than last night (but again THC was also in the mix last night).

 

[pinpoint]

definitely not serotonin syndrome.
you're feeling like crap because you took a ridiculous amount of a drug.
stop piling various drugs on top of it to try & make yourself feel better.

Agreed, not serotonin related. You'd need something to be inhibiting the reuptake of the serotonin for that to occur.

Sounds like you had a panic attack OP. Tramadol not only binds at the μ-opioid receptor - it also is a serotonin releaser, norepinephrine reuptake inhibitor, NMDA and acetylcholine antagonist among a few others I may forget. Keep this in mind next time you decide to play with 300MG doses of the stuff especially when combining it with other psychotropics.

 

[hadini]

I have experience with panic attacks and this was far unlike those. Not saying you are wrong (and I realize how stupid it was of me to mess with that crap... the more forgiving drugs really lure you into a false sense of security)... but is it possible my body is incredibly sensitive to some SSRI or SNRI effect caused by two day old metabolites? Am I maybe lacking an enzyme that helps clear it out? Sorry it may not be SS but panic attacks don't really linger, taper, and recur like this without prompt. They are very sudden.

I left work last night feeling slightly on edge and symptoms gradually progressed over time, and have since the seeming peak gradually, but slightly, tapered off.

I expected to feel like crap this week after the binge but this is... unique. And at times much more severe than 'feeling like crap'.

 

[pinpoint]

If you're not running a fever then you can rule out serotonin crises. I just wouldn't mess with the stuff at higher doses, you clearly don't tolerate the stuff well. Not a bad thing because tramadol habits are easy to pick up, dangerous to continue and hard to end.

 

[hadini]

Didn't check for fever but felt very hot all over last night and somewhat warm today... And I agree. Never again and it's a good thing, too.

 

[littlepenguin]

...I realize how stupid it was of me to mess with that crap... the more forgiving drugs really lure you into a false sense of security...

what exactly is a "forgiving drug"? you mean like, prescription drugs? or ibuprofen? any drug that's not a 'street drug?'
well, no matter what it is you categorize your drugs as, I have no idea how something like Tramadol would have lured you into a "false sense of security," especially after you clearly binged on this drug. Even though you said you were careful to not hit the "400 mg max dose," that doesn't mean in any sense of the definition that taking anywhere near that amount, especially without a tolerance to it or ever taking it before, would make it safe.

For example - I just looked up dosing for OxyContin and it says "a total daily dose of 80mg is only suitable for patients who show a tolerance to it or a similar opioid of equal potency." I've consumed oxies before, but not in a helluva long time. I wouldn't run out and take 70mg on my first go and NOT expect to feel like absolute shit after it wore off, much less repeating that dose 3 days in a row, taking myself to the hospital wondering what the hell is wrong, and then taking even more the day after I went to the hospital. (note - if my mg's/measurements are off in regards to speaking of oxycontin, please do excuse as I have a pretty decent sized lack of knowledge in this department, I am by no means a regular opiate user, I was only trying to show an example/comparison to a dosing 'binge' in a sort of, kind of, similar kind of drug to Tramadol.)

but is it possible my body is incredibly sensitive to some SSRI or SNRI effect caused by two day old metabolites? Am I maybe lacking an enzyme that helps clear it out? Sorry it may not be SS but panic attacks don't really linger, taper, and recur like this without prompt. They are very sudden.

it is fairly unlikely that you have an 'incredible sensitivity' or are lacking some type of 'clearing enzyme.'
I just looked through your list of drugs you'd taken [in the time or amount that would have had an effect on your symptoms] and there's a good chance I missed it, but I don't see any SSRI's or SNRI's listed? anyway, if I did miss it, or if I didn't, in reference to 'old SSRI/SNRI' metabolites - those drugs aren't 'instant reaction' kinds of drugs. Generally drugs in those two families, as well as many other antipsychotics/antidepressants etc. need time to build up in your system to reach functional levels - which in turn means that they leave your body slower. General medical advice says to wait at least 2 weeks after consuming SSRI's to take a drug with a possible negative interaction potential.

as for panic attacks, all the things you listed, are possible and likely happenings/symptoms. I have had panic attacks come out of NOWHERE, linger for wayyyy longer than I would have liked or expected, and mine usually do taper off, after I get a grip and do some relaxing breathing exercises and positive mental thinking...only for the PA to sneak back up within a few hours (and I know I'm not alone in experiencing these symptoms.)

serotonin syndrome isn't all that common. although studies show it to be slightly underdiagnosed (mistaken for something else, usually) from what I gather, serotonin syndrome is rather acute and even 'mild' cases are somewhat severe in nature.

Physical examination — Typical vital sign abnormalities include tachycardia and hypertension, but severe cases may develop hyperthermia and dramatic swings in pulse and blood pressure. Pertinent physical examination findings may include:

Hyperthermia
Agitation
Slow, continuous, horizontal eye movements (referred to as ocular clonus)
Dilated pupils
Tremor
Akathisia
Deep tendon hyperreflexia (common)
Inducible or spontaneous muscle clonus (common)
Muscle rigidity
Bilateral Babinski signs
Dry mucus membranes
Flushed skin and diaphoresis
Increased bowel sounds
Neuromuscular findings are typically more pronounced in the lower extremities.

Diagnosis and Diagnostic Criteria— Serotonin syndrome is diagnosed on the basis of clinical findings. We suggest diagnosing serotonin syndrome using the Hunter Toxicity Criteria Decision Rules. To fulfill the Hunter Criteria, a patient must have taken a serotonergic agent and meet ONE of the following conditions:

Spontaneous clonus
Inducible clonus PLUS agitation or diaphoresis
Ocular clonus PLUS agitation or diaphoresis
Tremor PLUS hyperreflexia
Hypertonia PLUS temperature above 38ºC PLUS ocular clonus or inducible clonus


source

 

[Morphling]

Err. I don't think there is any evidence to suggest that tramadol causes serotonin syndrome. Sounds like the normal sort of side-effects from too many SSRIs. Tramadol wears off after eight hours. I'm not an expert, but I think you're seriously just psyching yourself out.

Triazolam should calm you down, but the metabolite of soma is similar to a barbiturate, so they probably potentate each other, so be careful.

 

[Professer]

Yeah, I don't think trams could induce seretonin syndrome. I'm HIGHLY sensitive to SSRIs -- 20mg celexa (the 'standard starting dose' I was told) gave me a sort of accute SS attack of sorts. A reduced dose to 10mg didn't cause such an attack but made me a miserable zombie.

And I can take 300-400mg tram with no tolerance and have no problem. Not recommended though. Recently with tolerance I went through a rx of 30 50mg trams in... 3 days? Also I believe tram is a seretonin releasing agent, not reuptake inhibitor. Wikipedia told me so... tram has a interesting pharmacological profile.

I've also heard reports of pronounced WDs from tramadol due to the non-opioid mechanism of action too. I keep kilos of high quality kratom around as a baseline/maintenance kinda thing. Adjusting from my tram binge (while still taking normal kratom dose) back to kratom seemed more difficult than with other opioids.

Edit: The symptoms you describe sound more like tram OD then later WDs to me. Be happy you didn't take enough to get a tram-seizure.

 

[sekio]

This sounds like a regular ol' tramadol overdose, not serotonin syndrome.