Advice for an antidepressant needed

[David Baxter PhD]

Going back to the very beginning of this discusssion, I pointed out that clonazepam utilizes cytochrome P-450 for its metabolism as well. This competition for the enzyme may result in higher than expected blood levels of trazodone, causing unexpected adverse effects.

50 mg of trazodone is a very low dose, so even if the result is higher blood levels it's still unlikely to be a concern.

Your doctor is probably aware of this intereaction potential and has likely modified the dosage accordingly, but this is a subject worthy of discussion with the doctor as well as the pharmacist.

Almost certainly, since trazodone and clonazepam are not new medications and the potential for interaction is well known.

 

[Gene53]

50 mg of trazodone is a very low dose, so even if the result is higher blood levels it's still unlikely to be a concern.

You're quite right David, I had a good talk with my pharmacist and he said that side effects are to be expected and carefully monitored until my system gets used to them and when I talked about the CYP-450, he assured me that there are over 30 human P-450 isoenzyme and that there was nothing to worry about and stop fretting over everything I read on the Net.

Almost certainly, since trazodone and clonazepam are not new medications and the potential for interaction is well known.

He also confirmed the same.

Cheers,
Gene

You can safely take Tylenol (acetomenophen) as it does not compete for cytochrome P-450.

That's good to know, even though I rarely use them.

You could always ask your pharmacist for a second opinion,for your personal satisfaction, but in an earlier post, Dr. Baxter shared his reasurance based on his clinical experience as well.

As you'll see in one of my replies to David, I had a long talk with the pharmacist and he assured me that there was nothing to worry about.

In time you should be feeling better. However monitor your body responses, and be prepared to report any changes, good or bad with your doctor on your next visit.

You can be sure I'll be monitoring the effects and if I feel that something is really out of whack, I'll call him.

Thanks,
Gene

 

[Gene53]

Update

Hi,

As I mentioned in one of my above posts, my PDoc has changed my clonazepam dosage from 1mg twice/daily to .5mg every 4 hours, prescribed Celexa 20mg and Trazodone 50mg both at bedtime.

I'm aware that my brain chemistry will take a bit of time to adjust to the new meds but I've been having unpleasant side effects and was wondering if they were normal and not to be really concerned with or should I call up my pharmacist being that my PDoc is away till Monday.

Wednesday (day 1):
Tremors (which I already had due to CNS problems but twice as intense)
Dizziness and drowsiness (hangover type of feeling)
Slight nausea
Slightly blurred vision

The above feelings lasted till 4PM then gradually decreased.

Thursday (day 2)
Same as above but very light, no nausea and was quite functional.

Today (day 3)
Same as Wednesday (day 1) but a bit more intense plus muscle aches (cramps in my left leg). It's now 5:40 and the side effects haven't significantly decreased yet.

When I saw my therapist on Wednesday, I told him how I was feeling (really out of it) and he mentioned that the probable cause for these side effects would be the Trazodone.

Feedback would be appreciated.

Thanks,
Gene

 

[David Baxter PhD]

Side-effects for a new SSRI within the first 5-7 days aren't uncommon - they're really more like adaptation effects in that time frame and usually start to decline within 5 days or so. My general advice is to get back to your doctor if they don't show signs of diminishing within 5-7 days.

I'm not sure the leg cramps are related to any of your medications, and the tremors you said were preexisting. If you're worried and things don't improve within the next day or so, you could discontinue the trazodone until you can see the doctor again, but I'd try to stay on the Celexa.

Alternatively, you could try reducing the clonazepam slightly but don't try to do anything big there or you'll find yourself spiking with anxiety and insomnia.

 

[Gene53]

Hi David and thanks for answering.

Side-effects for a new SSRI within the first 5-7 days aren't uncommon - they're really more like adaptation effects in that time frame and usually start to decline within 5 days or so. My general advice is to get back to your doctor if they don't show signs of diminishing within 5-7 days.

Thanks, I wasn't aware that such symptoms would start tapering off after 5 to 7 days. I assume I should keep on going till Monday (it'll be 5 days by then) and call my PDoc if there's no significant decrease in side effects.

I'm not sure the leg cramps are related to any of your medications, and the tremors you said were preexisting. If you're worried and things don't improve within the next day or so, you could discontinue the trazodone until you can see the doctor again, but I'd try to stay on the Celexa.

I read on E-Drugs that either or both Trazodone and Clonazepam may cause muscle cramps, aches or pains. As far as the tremors go, they were preexisting but are twice as bad. As I said, I'll stick with the program and if tomorrow's worse, I'll take your advice and discontinue the trazodone but will stick with the Celexa.

Alternatively, you could try reducing the clonazepam slightly but don't try to do anything big there or you'll find yourself spiking with anxiety and insomnia.

That could be a good idea but I find that the symptoms diminish slightly about an hour after I've taken the clonazepam.

Forgot to mention, I've been having occasional elocutionary problems since yesterday, I start a sentence and it turns into gibberish (somewhat like mispronunciation that leads to nonsense) about half-way through. LOL! Makes me laugh cause I can't even understand myself.

Thanks again,
Gene
:woohoo:

The bad feelings are starting to diminish, about time, it's 7:10...

 

[David Baxter PhD]

I read on E-Drugs that either or both Trazodone and Clonazepam may cause muscle cramps, aches or pains.

Hmmm... I've never heard of that.

 

[Gene53]

Opps, sorry, that was on Drug Digest but the database seems to be down at the moment.

 

[David Baxter PhD]

No I meant I've never heard ofthat side effect - I'd guess it's pretty rare.

 

[Gene53]

No I meant I've never heard of that side effect - I'd guess it's pretty rare.

OK, they're site's back up:
Trazodone side effects:
http://www.drugdigest.org/DD/DVH/Uses/1,3915,678|Trazodone%2BTablets|872,00.html#sideEffects
Clonazepam:
http://www.drugdigest.org/DD/DVH/Uses/1,3915,163|Clonazepam%2BTablets|486,00.html#sideEffects

I'm feeling much better today, similar as I did on Thursday but I find it funny that the Trazodone doesn't knock me out at night.

Cheers,
Gene

 

[David Baxter PhD]

I find it funny that the Trazodone doesn't knock me out at night

It shouldn't knock you out, especially not at that low a dose. It's not a hypnotic like Imovane. It should just make you a little drowsy and help you get to sleep.

 

[Gene53]

It shouldn't knock you out, especially not at that low a dose. It's not a hypnotic like Imovane. It should just make you a little drowsy and help you get to sleep.

Thanks David, I wasn't aware of that on account that my GF is also on Trazodone and 1/2 hour after taking it, it makes her quite sleepy and as soon as she hits the pillow, she's out like a light. I thought it would do the same to me LOL!

Cheers,
Gene

 

[David Baxter PhD]

No doubt some people are more sensitive than others. For many people, 0.5 mg or even 0.25 mg of lorazepam or clonazepam will have that effect. For my wife, most cold tablets will do it.

 

[Gene53]

No doubt some people are more sensitive than others. For many people, 0.5 mg or even 0.25 mg of lorazepam or clonazepam will have that effect. For my wife, most cold tablets will do it.

Thanks, makes sense to me.

Gene

 

[Halo]

Gene,

I remember being on Trazadone a few years back and it didn't knock me out at all. What it did though was help me to relax enough that I was able to fall asleep and stay asleep and feel rested in the morning.

 

[Gene53]

Gene,

I remember being on Trazadone a few years back and it didn't knock me out at all. What it did though was help me to relax enough that I was able to fall asleep and stay asleep and feel rested in the morning.

Thanks, that's exactly what it does to me. Did you also experience weird side effects for the first few days?

Cheers,
Gene

 

[Halo]

I normally always experienced side effects from medications for about a week. I have come to realize that it happens with most if not all of them, for me at least. If after a week some side-effect doesn't subside then that is when I go back to my doctor and talk about it.

 

[Gene53]

I normally always experienced side effects from medications for about a week. I have come to realize that it happens with most if not all of them, for me at least. If after a week some side-effect doesn't subside then that is when I go back to my doctor and talk about it.

Thanks for the swift answer, I'm fine today (Saturday), only a bit groggy. Let's see what tomorrow will bring...

Cheers,
Gene

Thanks for the reassurance everyone, it seems that the new meds side effects are fading, today (Sunday), I'm only feeling a bit tired and my tremors have diminished a lot.

Cheers,
Gene

 

[Halo]

Glad that the side-effects are fading and that you are feeling better

 

[Gene53]

Glad that the side-effects are fading and that you are feeling better

Thanks and I forgot to mention that I haven't had any bouts with anxiety since taking the new meds.

Cheers,
Gene

 

[ladylore]

That's so cool Gene! Glad your feeling better. :jiggy: