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Old 04-15-2008, 08:52 AM   #1
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Medications which could interact with opiates:

Hi to all! I got great magazine at my PM DR office (at HSS). Due to the rules, unfortunatelly i can't give you the name , but it's related to us, CP patients: treatments, medications, pain stimulators, etc.

I read interesting article about meds interaction with Opiates and want to share this with you. A lot of us take meds which CAN interact with narco meds, but for some reason DRs still prescribe them to us.

1. Central nervous system (CNS) depressants, antihistamins, tranquilizers, other prescription pain relievers, seizure med., muscle relaxants, sleeping pills, some anesthetics.

2.Monoamine oxidase (MAO) inhibitors, such as Nardil or Parnate (either one combined with Demerol is especially dangerous).

3. Tricylic antidepressants.

4. Anti-seizure medicines, such as Tegretol, Neurontin, which may lead to serious side effects when combined with Darvocet or Darvon especially.

5. Muscle relaxants, such as Flexeril and others.

6. Sleeping pills, like Ambien, Lunesta and others.

7. Blood thinning drugs like Coumadin.

8. Naltrexone (Trexan, Revia) which cancels the effect of opioids.

9. Rifadin

10. Azastam (AZT) or Retrovir which can cause serious side effects when combined with Morphine.

Now I wonder if some reaction to some meds we have (like Fentanyl patch for example) in reality is a reaction to combination of meds we are taking?
Who knows?

I am pretty sure if some of us discuss this apticle with their DRs, the answer will be not to worry.... But than what is this article written by a very reputable DRs is about??

Have a great day today!

 
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Old 04-15-2008, 10:43 AM   #2
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Re: Medications which could interact with opiates:

Moldova, Thank you so much for taking the time and going through the discomfort that I know typing on the computer causes you. You are always so kind and caring. God Bless you for that.

I know when I was first prescribed the blood pressure meds, I first went to a couple of the internet interaction sites and put in all of my meds. Nothing showed up on the 2 sites I tried, but I am never sure how accurate they are, or if they keep them updated properly.

I have taken muscle relaxers and opiates together for several years, and have been prescribed and taken several of the anti-siezure meds as well.

I do find that the pharmacists, in most cases, are more up to date with these facts and findings, so I do try to ask them when I am prescribed a new medication.

What a great thread. Thank you again for sharing this. God Bless, cmpgirl

 
Old 04-15-2008, 11:53 AM   #3
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Re: Medications which could interact with opiates:

Good job Moldova.

What I understand to be the major issues are:

• never take opioid partial agonists or antagonists with full agonists like morphine, fentanyl, oxycodone, etc. The offending meds would be buprenorphine (Suboxone), Stadol, pentazocine (Talwin), Naltrexone, Naloxone, etc. These meds will usually send us into immediate withdrawal.

• some meds like the antidepressant SSRIs (Prozac, Celexa, Serzone, etc) can affect the performance of opioids. Usually they will reduce the potency of the opioids. Other antidepressants like the tricyclics (Elavil, Nortriptlyne, amitryptline, etc) can increase the potency of opioids.

•anti-seizure meds can make opioids either more or less potent depending on which one.

• Demerol and Darvon produce nasty metabolites when used chronically and should be avoided. When taken with Nardil or Parnate the results can be terrible.

Looks like we read similar stuff, although you've got a few I hadn't heard of.

Thanks again Moldova,

steve

 
Old 04-15-2008, 02:36 PM   #4
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Re: Medications which could interact with opiates:

I think this article probably came out after the famous celebrities that have died, including Heath Ledger. The most important thing to remember is TELL ALL DOCTORS THE MEDICATIONS YOU ARE TAKING. The other thing is to USE ONE PHARMACY AND MAKE SURE THEY CHECK FOR DRUG INTERACTIONS.

The one big interaction to look for and remember is ULTRAM(tramadol), Ultracet, Ultram ER along with ANY SSRI, SNRI antidepressant medication which can cause a VERY SEVERE REACTION CALLED SEROTONIN SYNDROME, which I experinced(tramadol & Prozac). This reaction can actually KILL YOU.

brian

p.s. Adding ALOCOHOL, in any amount or form can be extremely deadly especially with things like OPANA which will release all of it and can potentially kill someone. It's usually best to NOT DRINK AT ALL which is the rule that I take.

Last edited by brianpain33; 04-15-2008 at 02:38 PM.

 
Old 04-15-2008, 02:59 PM   #5
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Re: Medications which could interact with opiates:

Thanks Brian.

Alcohol is the one I forgot. I don't drink so I always forget it.

steve

 
Old 04-15-2008, 05:07 PM   #6
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Re: Medications which could interact with opiates:

Quick question:

Didn't Topamax used to be an old anti-seizure med used long ago. One of the current meds used for nerve pain was used "way back in the day" as an anti-seziure med. I was thinking it was Topamax, and I take that along with the opiates, and paxil, for migraines. SO, should I be concerned?

Guess I should be dead, because I've been on this combo (add Lunesta in there for a while too) for about 4+ years. Hmmmmmm!!!!

Now I'm worried.

My pharmacist has never said anything, nor has my doc!
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Old 04-15-2008, 05:38 PM   #7
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Re: Medications which could interact with opiates:

Quote:
Originally Posted by SpinalMalady View Post
I was thinking it was Topamax, and I take that along with the opiates, and paxil, for migraines. SO, should I be concerned?
Now I'm worried.
Now don't go "catastrophising" like I do No, I would not be too worried if your doctor knows all the meds, your pharmacy does, and they run an interaction checker. If you aren't having and bad or severe effects then you should be fine.

brina

 
Old 04-15-2008, 05:48 PM   #8
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Re: Medications which could interact with opiates:

LOL!! OK Brina! I won't!
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Old 04-15-2008, 07:44 PM   #9
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Re: Medications which could interact with opiates:

As many have pointed out, there are lots of individual specific drug interactions one should be aware of....Most of which are dependent upon your particular drug(s). But, there are also, three "general" rules or med categories I think all PM patients should consider:

(1) Be careful with aspirin containing products (shotgun cold meds for example)....Especially those who take aspirin for heart issues....Aspirin thins your blood, thereby making pain meds more potent.

(2) Antihistamines- Many potentiate narcotics....Some can significantly...As much as 15-20%. Shot gun cold meds, and allergy meds are loaded with antihistamines.

(2) Sleeping aides and / or anxiety meds.- Any med that assists one in sleeping, or relaxing can cause an over sedation. Many PM patients have died peacefully in their sleep from over sedation....The combination of narcotics and anxiety meds (like valium or ativan) and / or sleep meds, simply put the patient to sleep....Forever.

This is a very important topic as everyone should be keenly aware of what their taking. Many drugs by themselves are perfectly safe, but the combination of those same drugs can be lethal.

Ex

 
Old 04-15-2008, 08:00 PM   #10
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Re: Medications which could interact with opiates:

Quote:
Originally Posted by Executor View Post
This is a very important topic as everyone should be keenly aware of what their taking. Many drugs by themselves are perfectly safe, but the combination of those same drugs can be lethal.
Ex
Let's not forget that it is not only the combination but the doses of each of those medications. If you notice on your med bottle "may cause drowsiness" or "do not take alcohol or taking alcohol will increase drowsiness" this also means adding more drugs that have this effect will have a combination effect and if you add enough drugs that cause drowsiness then either you will sleep for a long time or forever as Ex stated. Just like with Heath Ledger, all of his medications were presribed and could be taken together, it's just the doses and combination effect were TOO much and he died in his sleep. The time to be aware is BEFORE this happens and NOT AFTER because you don't wake up after you die

brian

 
Old 04-15-2008, 09:37 PM   #11
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Re: Medications which could interact with opiates:

I thought I'd read that Heath Ledger was taking Xanax and Valium, Ambien, hydrocodone, klonopin.... a pretty deadly cocktail, obviously. Why would you need both Xanax and Valium? I take Xanax occasionally with my regular Ambien CR and promethazine, and my doctor (and presumably the pharmacist) know about it. I have such horrific chronic insomnia that once we found a combo that worked fairly well (after more than 10 years of suffering), we stuck with it. Should I be worried? What if I add an opiate pain medication? What about Lyrica added into the mix?

I use a CPAP machine; without it, I would be much more worried about dying in my sleep. But perhaps I should be more concerned?? As if I didn't already have enough to worry about.

TexMom

 
Old 04-16-2008, 07:07 AM   #12
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Re: Medications which could interact with opiates:

According to the news reports I have seen, more than one Doc was involved (at least one in CA and the other TX). Just me speculating, but the Docs probably didn't know about the other(s). Additionally, any type of state abuse computer program probably doesn't coordinate well with other states. I also read where there is supposedly a video documenting / showing him doing recreational drugs....So, one doesn't know if they were in play also.

Besides the list you gave, I read where Oxycontin was one of the drugs. It doesn't matter what kind of Doc I see or what I'm being seen for....One of the first questions just about any Doc asks, is "what medications are you on"? This is just one example why.

Just speculating here, but I think famous people...Hollywood people, sports starts, politicians, & etc., get more leeway with Docs in a lot of cases. At the end of the day, however, each patient is responsible for what they put in their bodies.

Very sad, and certainly preventable.........

Ex

Last edited by Executor; 04-16-2008 at 07:09 AM.

 
Old 04-16-2008, 08:00 AM   #13
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Re: Medications which could interact with opiates:

Ex,

I think you are right about HL and the Oxycontin. He was obviously making a conscious effort to get multiple medications from multiple sources and thereby creating his own potion for disaster. He had some issues not related to the normal usage of the medications as well, so that obviously contributed to his death.

Like you, I have doctors who ask what I am taking, but sometimes I do wonder if they pay attention. I am proactive in that regard, and my internist is VERY good at balancing the medications and ensuring that I am safe. I know I have to be careful, especially since I take sleep medications as well as pain meds. So far, I've been okay, but like the point you made, we are ultimately responsible for researching and being our own watchdog. You can never be too careful!

Blessings,
Tex

 
Old 04-16-2008, 08:10 AM   #14
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Re: Medications which could interact with opiates:

I take Topomax for Migraines, a Seizure Disorder and it also helps with my BiPolar, I've taken it for 2 yrs. now and it seems to do okay with the other 8 meds I take each day, including Fentanyl, Tramadol, Norco, Percocet, Ambien Cr, Sonata, Singulair, Premarin, Zoloft and a few Vitamin compounds.

 
Old 04-16-2008, 10:35 AM   #15
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Re: Medications which could interact with opiates:

Thank you for your responds!

Ex, you just said something what concerns me too. I use one PM Dr and Neurologists (they both work on me) and only one Pharmacy to fill my medications.

Meanwhile I am on Oxy (LA and BT), Ambien as sleep aids (I don't take every night though), Neurontin for neuropathy pain, Flexeril (muscle relaxer).... and all this "coctail" is no-no accorging to the "Interact with opiates" list...
not to mention heart meds...

Go figure...

 
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