Codeine & Zoloft

The Codeine FAQ says:

"The body converts codeine into morphine (~10%) by using the so called P450 cytochrome pathway, especially cytochrome 2d6 (cyp2d6).... Some drugs interfere with cyp2d6. Prime among these are the SSRIs, with the exception of Zoloft (if I remember correctly)"

According to this information I chose Zoloft over Lovan, having just been prescribed it because I am often "uptight" and "neurotic" (hehe).

However, I read somewhere else that Zoloft does actually fuck with Codeine (by interfering with cyp2d6). I think Codeine is mad shit and I may not want to continue taking Zoloft, on this basis.

Can anyone clear this up for me? Also I would be interested to hear people's opinions of and experience with Zoloft, since I have just begun taking it and am curious of its effects.

- Xherrus

As I understand it, cyp2d6 is involved in the metabolisation of Zoloft. But, it is considered to be the SSRI which has the lowest potential for interactions with other drugs in the cyp2d6 arena. From what I've gathered, the general consensus is that you shouldn't do it as it can lead to a dangerously sedated state (I'd imagine you'd need a fair dose of codeine for that), and they do have the potential to interact. Perhaps the codeine could reduce the effectiveness of the Zoloft?

The bottom line - if you don't want to risk it, you'll have to make a decision between Zoloft & Codeine. I know of someone who was on a course of Paxil (paroxetine - another SSRI) and took codeine a few times with no side effects, but everyone is different, so take that with a grain of salt.

Perhaps you could ring your doctor and ask?

LOL... my doctor thinks I'm a dodgy bastard already.

Thanks for clearing that up, it's what I assumed... if Zoloft does interfere with cyp2d6, it is on a relatively small scale.
I've only been on 25mg Zoloft (half the standard dose) for 4 days so far, with very little noticeable effects. I took a hit of codeine last night and the familiar euphoria was for the most part absent, although this was probably because it was a minuscule amount (144mg). Is this small amount of Zoloft likely to interfere with the codeine already, despite the fact it can take up to 2 weeks to really take effect?

Tell him you're taking Panadeine Forte and you need to know the details of any interactions between the two

There could be a lot of factors at play here. I think that the two weeks is likely to be an inflated figure - the longest duration (within reason) that sertraline takes to reach it's full potential. They'd use the longest period instead of the average to make sure they cover all patients I reakon.

Keep in mind that two weeks probably refers to the length of time it takes to effect your neurological processes (by selectively inhibiting serotonin reuptake) and its effects on your metabolic processes (cyp2d6 and whatever else) may be establised after only one or two doses.

It's hard to tell whether it's sertraline's effects on your metabolic processes or neurological procesess which effected the codeine, but either way it's entirely possible that one, the other or a combination of both has made a difference already.

I have also found conflicting reports re: Zoloft and CYP2D6 inhibition. You mentioned not feeling 25mg of Zoloft affected the codeine, but keep in mind that enzyme inhibition can be dependent on the amount of the drug you are taking. Once you go up to a higher dose you may notice a difference.