Posted by JANNBEAU on December 12, 2001, at 11:53:16
In reply to Effexor an opiate?, posted by dhldn on December 8, 2001, at 11:40:37
>My God! So that's why I felt I was going to DIE when my so-called "pain management specialist" put me on Effexor XR (37.5 mg qday) AND tramadol (50 mg every six hours up to a maximum of 6 tabs per day) without warning me of interactions! I stayed on this regimen for one week, then got what I can only figure was "serotonin syndrome" (completely unable to function-- memory loss; cognitive dysfunction; dizziness; possible seizure activity; somnolence; nervousness; sweating; tremors; nausea; anorexia; somnolence). DC'd tramadol--within hours, I was back to "normal"--at least I could function again and remember my name!
By the way, in the U.S., Ultram is NOT yet a controlled substance (although there are rumors that the FDA is moving that way--I figured out the narcotic properties of tramadol by reading the literature on the drug).
Is it possible that tramadol has some sort of "mixed" profile in that the parent drug may act primarily on serotonin, norepinephrine, and, perhaps, dopamine, while the principal metabolite has a higher affinity for the mu opioid receptors? Certainly, pain relief from tramadol seems to be delayed for several hours (6 hrs--the time it takes to get significant AUC for principal metabolite?).
If anything is deceiving, it is that the manufacturer of tramadol has claimed for five years that tramadol (Ultram in the U.S.) is not addictive! We've heard that one before, haven't we? You might not remember the hype when DARVON was first approved, but I do (I'm old!). Same story with Ultram! Again, as you stated above, 'history repeats itself' and 'history is repeatedly ignored!' I resent it that I received NONE of this information for Effexor (venlafaxine) OR tramadol prescribed concomitantly. Although I may (probably) would have chosen to go through with treatment, I would have been better able to make an INFORMED decision had I been given the facts! I wonder if the physician who prescribed these meds for me even KNOWS the facts?
I WOULD like to state that I noticed an immediated and dramatic reduction in my pain level when I started EFFEXOR XR (37.5 mg qd; I have chronic "intractable" pain from extensive degenerative changes in my cervical and thoracic spine, costochondral joints, knees, etc). Although I THINK the doc was prescribing Effexor as an AD, the pain relief makes sense in light of the structural similarity of Effexor and Ultram, as does the interaction between the two that I suffered. Thus, beware of drug interactions between Effexor and Ultram!
The structure and opiod properties of Effexor may, also, account for the stories of difficulty discontinuing Effexor. The signs and symptoms are strangely similar to those of any narcotic withdrawal syndrome, are they not?
Interestingly, the antidepressant effects of Effexor (if there WERE any) seem to have diminished dramatically after about two months, but the pain-relieving effects are still potent.
Forgive the disorganization. My apologies; there is a lot to say and I don't have much time to organize.
poster:JANNBEAU
thread:13781
URL: http://www.dr-bob.org/babble/20011202/msgs/86670.html