# Can You Combine SSRI's and Tricyclics?



## GailSusan (Dec 23, 2000)

I went on www.drugs.com to see if there were any major interactions between the Elavil and Effexor that the doctor has my 90 y.o. mom on. I was a bit alarmed to see:Aubs, Thank you. I did look it up and there is a major drug-drug interaction between Elavil and Effexor! Now what do I do? Adding the Elavil doesn't seem to be a good idea, but I don't want to start any trouble with the doctor. See below:amitriptyline and venlafaxine (major Drug-Drug) Description: MONITOR CLOSELY: The combining of agents that can inhibit serotonin reuptake and/or other agents with serotonergic activity (including some medications for migraine therapy and certain opioids) may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors. MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Close monitoring is recommended for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia. Particular caution is advised when increasing the dosages of these agents.Has anyone been on an SSRI (like Effexor, Prozac, Zoloft, Paxi) and a tricyclic (like Elavil) at the same time?I don't want to cause a problem, because the doctor is very touchy about questioning his judgment, but this scares me.Thanks.


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## trbell (Nov 1, 2000)

You might want to check with a pharmacist rather than rely on an internet source. There's a lot of loose talk about serotonin these days on the internet. But if you the information from this source you might want to ask this doctor what he is hoping to accomplish with this comvbination in an elderly patient. One of the problems is that we old fogeys sometimes need different dosages.Bada


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## GailSusan (Dec 23, 2000)

I know what the doctor is trying to accomplish. The Elavil/Neurontin combo is to get her neuralgia pain under control. She was already on the Effexor for depression. I do not have a pharmacist I can turn to for advice, unfortunately.


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## trbell (Nov 1, 2000)

i don't know what else to tell you. Sometimes when I'm working with a patient on several meds I find the docs sometimes are receptive to the wisdom of a wash out and starting over but patients don't usually like it.tom


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## honichou (Jun 30, 2002)

It all depends on the dosage, and in this case, your mother's age. I have been on Prozac since 1991, Tegretol since 1991, Lithium since 1994, and Pamelor (nortryptiline) since about 3 years ago. The Pamelor is for pain due to a spinal stenosis. I do just fine.Steven


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## GailSusan (Dec 23, 2000)

Steven, Thanks. I was able to locate a serotonin toxicity specialist (in Australia, believe it or not) who told me that the combo was not even close to being a problem. I guess there is a lot of misunderstanding about serotonin toxicity (which is called serotonin syndrome).


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