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Is a Zoloft/Adderall XR combo dangerous?


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#1 HaloGirl66

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Posted 22 April 2006 - 11:34 AM

from the aids meds interaction checker - is this something to worry about? I've been taking 50 mg of Zoloft and 30 mg of Adderall XR for 2 months now

Major Drug-Drug Interaction:  Zoloft (sertraline) and Adderall XR (amphetamine-dextroamphetamine)
* The interaction is due to amphetamine which is a component of amphetamine-dex troamphetamine

GENERALLY AVOID: Several case reports suggest that patients treated with serotonin reuptake inhibitors (SRIs) may exhibit an increased sensitivity to sympathomimetic agents. The mechanism of interaction is unclear. The reaction has been reported when fluoxetine was used concomitantly with phentermine, amphetamine, or phenylpropanolamine. Additionally, some sympathomimetic agents (e.g., amphetamines) may possess serotonergic activity and should generally not be administered with SRIs because of the additive risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors. The interaction occurred in a patient treated with dexamphetamine approximately 2 weeks after the addition of venlafaxine. The medications were discontinued and the patient was given cyproheptadine for suspected serotonin syndrome, whereupon symptoms promptly resolved. A second episode occurred when dexamphetamine was subsequently resumed and citalopram added. The patient improved following cessation of citalopram on his own, and residual symptoms were successfully treated with cyproheptadine. MANAGEMENT: In general, amphetamines should not be combined with serotonin reuptake inhibitors. Close monitoring for enhanced sympathomimetic effects is recommended if these agents must be used together. Patients should also be monitored 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.


I am *not* any kind of medical professional. I can't spell either. I do the best I can.

My brain cooties: ADD, Wicked Insomnia, SI, Nonverbal Learning Disorder, Generalized Anxiety Disorder, Periodic Depression and various neurological issues.

Current Meds: 10mg Ambien & 2 mg Xanax at bedtime, 1mg Xanax XR in the morning, 10mg Flexril as needed, 40mg Adderal
Not gonna list previous meds because this signature ain't long enough!


And when I squinted the world seemed rose-tinted
And angels appeared to descend
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Things looked even better than when they were opened...

M. Gore


#2 AirMarshall

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Posted 22 April 2006 - 01:59 PM

Whether those two drugs are commonly used together, despite the warnings, I don't know.†† The two major concerns are Sympathomimetic effects and Serotonin syndrome.† Both can kill you.

The sympathomimetic effects would be related to heart arrythmias and breathing difficulties and tremor.†† I would think that this would appear sooner, and can be treated in the er.

The serotononin syndrome could appear slowly and causes mental confusion, muscular effects and other symptoms like fever, nausea and sweating etc.†† No treatment is available other than to withdraw offending meds and wait clearance, usually 24 -48 hours, and provide support to symptoms.

The real answer is: Discuss your concerns with your doctor.

a.m.

Edited by AirMarshall, 22 April 2006 - 02:01 PM.

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#3 Velvet Elvis

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Posted 22 April 2006 - 03:14 PM

You're fine.  SSRIs almost always reduce the side effects from amphetamines.  In this particular case the interaction checker is just being silly.  Wellbutrin has more serotonic action that amphetamine for christssakes.  I don't think I've ever been on a stimulant without being on an SSRI, actually.

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#4 Ocracoker16

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Posted 22 April 2006 - 09:04 PM

You're fine.† SSRIs almost always reduce the side effects from amphetamines.† In this particular case the interaction checker is just being silly.† Wellbutrin has more serotonic action that amphetamine for christssakes.† I don't think I've ever been on a stimulant without being on an SSRI, actually.

<{POST_SNAPBACK}>



I agree.  It seems like there is always someone on this board having used an interaction checker and found a warning on SSRI's and stimulants.  It can be disconcerting to find a supposed contraindication.  Personally, I have been taking Celexa 40 mgs with Adderall XR 40 mgs for awhile without a problem.

Katie ;)

#5 HaloGirl66

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Posted 23 April 2006 - 10:54 AM

merci
I am *not* any kind of medical professional. I can't spell either. I do the best I can.

My brain cooties: ADD, Wicked Insomnia, SI, Nonverbal Learning Disorder, Generalized Anxiety Disorder, Periodic Depression and various neurological issues.

Current Meds: 10mg Ambien & 2 mg Xanax at bedtime, 1mg Xanax XR in the morning, 10mg Flexril as needed, 40mg Adderal
Not gonna list previous meds because this signature ain't long enough!


And when I squinted the world seemed rose-tinted
And angels appeared to descend
To my surprise with half-closed eyes
Things looked even better than when they were opened...

M. Gore

#6 null0trooper

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Posted 23 April 2006 - 09:05 PM

merci

<{POST_SNAPBACK}>


Ecstacy is an amphetamine derivative with a strong serotonin release and to my knowledge
is probably the main "amphetamine" connected with serotonin syndrome. The PI sheet cites
ONE case of Celexa/dextroamphetamine interaction (Effexor's a whole different critter),
along with reported Prozac/adrenergic interactions (  fluoxetine has some additional
sympathomimetic effects (abstract) that sertraline and other SSRIs may not... )

Is there a risk? If there wasn't there'd be NO reported interactions.  Is it large or common? If it
was, they wouldn't be throwing Effexor and Celexa reports in, but would have Zoloft/Adderall
reports to cite.  As A.M. pointed out, serotonin overload can resolve quickly with cessation
of one of the meds, and cyproheptadine will knock it down rapidly if it requires an ER visit.

It rarely hurts to discuss with your doctor or a competent pharmacist anyway.

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#7 Bianca

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Posted 26 April 2006 - 09:46 AM

This was what I found.  3 potential interactions were found for the drugs you selected.

You searched for interactions between the following drugs:

    * Adderall XR
    * Zoloft

Add or Delete Drugs

Start Over with a New List of Drugs

(Note: Not all drug interactions are known or reported in the literature, and new drug interactions are continually being reported. This information is provided only for your education and for you to discuss with your personal healthcare provider. )

AMPHETAMINE (in Adderall XR) may interact with SERTRALINE HYDROCHLORIDE (in Zoloft)

Although the cause of this potential interaction is not clearly understood, sertraline may increase the effects of amphetamine. This could cause an increase in side effects including irritability and depression, restlessness, and anxiety. Other more serious side effects include an increase in blood pressure, a rapid heart beat, and an abnormal heart rhythm. If sertraline and amphetamine are used together, your doctor may want to monitor you closely for side effects and adjust the dose of either drug if needed. Ask your healthcare provider about these drugs and this potential interaction as soon as possible.

This interaction is poorly documented and is considered major in severity.

Last Updated: December 2003

DEXTROAMPHETAMINE (in Adderall XR) may interact with SERTRALINE HYDROCHLORIDE (in Zoloft)

Although the cause of this potential interaction is not clearly understood, sertraline may increase the effects of dextroamphetamine. This could cause an increase in side effects including irritability and depression, restlessness, and anxiety. Other more serious side effects include an increase in blood pressure, a rapid heart beat, and an abnormal heart rhythm. If sertraline and dextroamphetamine are used together, your doctor may want to monitor you closely for side effects and adjust the dose of either drug if needed. Ask your healthcare provider about these drugs and this potential interaction as soon as possible.

This interaction is poorly documented and is considered major in severity.

Last Updated: December 2003

SERTRALINE HYDROCHLORIDE (in Zoloft) may interact with GRAPEFRUIT JUICE

Sertraline is broken down in the body by the liver. Grapefruit may interfere with the liverís ability to break down the sertraline, causing sertraline to remain in the body for a longer period of time. This could cause an increase in both the intended effect and the side effects of sertraline including nausea, dizziness, headaches, and sleep disturbances. Patients taking sertraline may want to avoid any type of grapefruit including its juice, the fruit itself, and any supplements that may contain grapefruit. You may drink other types of juices with sertraline. You may want to ask your healthcare provider about this potential interaction if you think you are having problems.

This interaction is poorly documented and is considered minor in severity.

Last Updated: April 2006


I'd say if your doc rx it then he/she knows what they're doing.

;)

#8 HaloGirl66

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Posted 30 April 2006 - 05:38 PM

merci

<{POST_SNAPBACK}>


It rarely hurts to discuss with your doctor or a competent pharmacist anyway.


Lord knows I am drowning in pharmacists, but weather they are competent ot not, we'll see.

Thanks for the reassurance folks, I figured it wasn't a big deal.
I am *not* any kind of medical professional. I can't spell either. I do the best I can.

My brain cooties: ADD, Wicked Insomnia, SI, Nonverbal Learning Disorder, Generalized Anxiety Disorder, Periodic Depression and various neurological issues.

Current Meds: 10mg Ambien & 2 mg Xanax at bedtime, 1mg Xanax XR in the morning, 10mg Flexril as needed, 40mg Adderal
Not gonna list previous meds because this signature ain't long enough!


And when I squinted the world seemed rose-tinted
And angels appeared to descend
To my surprise with half-closed eyes
Things looked even better than when they were opened...

M. Gore





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