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I am currently taking Wellbutrin SR (150mg twice a day) and recently found out that I need to have reconstructive knee surgery.  Does anyone know if there is a danger for interaction with anesthesia and morphine/other pain killers and Wellbutrin?  I called the manufacturer and they "could not make a recommendation one way or the other".  i.e. they probably have no clue and dont want to be liable for anything.  Any help would be appreciated!  Thanks..

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I am currently taking Wellbutrin SR (150mg twice a day) and recently found out that I need to have reconstructive knee surgery.  Does anyone know if there is a danger for interaction with anesthesia and morphine/other pain killers and Wellbutrin?  I called the manufacturer and they "could not make a recommendation one way or the other".  i.e. they probably have no clue and dont want to be liable for anything.  Any help would be appreciated!  Thanks..

<{POST_SNAPBACK}>

The AIDSmeds Check My Meds page said:

Moderate Drug-Drug Interaction:  morphine (morphine) and Wellbutrin SR (bupropion)

ADJUST DOSE: Coadministration with bupropion may increase the plasma concentrations of drugs that are substrates of the CYP450 2D6 isoenzyme. The mechanism is decreased clearance due to inhibition of CYP450 2D6 activity by bupropion, which is expected to occur in patients who are CYP450 2D6 extensive metabolizers (93% or more of the general population). MANAGEMENT: Caution is advised if bupropion must be used concomitantly with medications that undergo metabolism by CYP450 2D6, particularly those with a narrow therapeutic range. Concomitant medications should be initiated at a lower dosage. Clinical and laboratory monitoring may be appropriate for some drugs whenever bupropion is added to or withdrawn from therapy.

Moderate Drug-Drug Interaction:  ketamine (ketamine) and Wellbutrin SR (bupropion)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them. Patients should also be advised to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Moderate Drug-Drug Interaction:  lidocaine-dexamethasone (dexamethasone-lidocaine) and Wellbutrin SR (bupropion)

* The interaction is due to dexamethasone which is a component of dexamethasone-lidocaine

ADJUST DOSE: The manufacturer reports that concurrent administration of bupropion and systemic steroids may lower seizure threshold. The mechanism has not been described but may be related to additive adverse effects. MANAGEMENT: Concurrent administration of bupropion and systemic steroids should be undertaken with extreme caution, initially using low doses and titrating up gradually. Patients should be monitored for tremors, involuntary muscle movements, and seizures.

Moderate Drug-Drug Interaction:  sufentanil (sufentanil) and Wellbutrin SR (bupropion)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them. Patients should also be advised to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Moderate Drug-Drug Interaction:  propofol (propofol) and Wellbutrin SR (bupropion)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them. Patients should also be advised to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Moderate Drug-Drug Interaction:  meperidine-promethazine (meperidine-promethazine) and Wellbutrin SR (bupropion)

* The interaction is due to meperidine which is a component of meperidine-promethazine

ADJUST DOSE: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking meperidine with other drugs that cause these effects, especially in elderly or debilitated patients. Profound sedation, delirium, hypotension, respiratory depression, or coma may occur. MANAGEMENT: Extreme caution and dosage adjustments are recommended for patients receiving meperidine with other narcotic analgesics, anesthetics, phenothiazines, tranquilizers, sedative-hypnotics, tricyclic antidepressants, and/or other CNS depressants. Meperidine dosage reductions of 25% to 50% are recommended for patients receiving phenothiazines and other tranquilizers. Patients should be closely monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them. Patients should also be advised to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Moderate Drug-Drug Interaction:  meperidine-promethazine (meperidine-promethazine) and Wellbutrin SR (bupropion)

* The interaction is due to promethazine which is a component of meperidine-promethazine

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them. Patients should also be advised to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Moderate Drug-Drug Interaction:  remifentanil (remifentanil) and Wellbutrin SR (bupropion)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them. Patients should also be advised to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

I got the anesthetic names off of the Wikipedia History of Anesthetics: the twentieth century page.

And yes, the meperidine-promethazine combination is used in surgery.

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thanks for the answer, Strung.  (String, Strang Strung? ....never mind)  I am not quite sure what to make of all that.  Maybe the anesthesiologist would know more, but at that point it will be too late to do anything.  Supposedly this is a very painful surgery, so I dont want to not be able to take the pain meds. But, at the same time, I am sure the surgery and aftermath of recovery will be very depressing and I may have a harder time not being on anything for that.  I am not sure what to do.  Is a "moderate" interaction not enough to worry about?

Thanks for answering!

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I am not a doc so this is just from my experience... I have had 2 major surgeries while being on welbutrin as well as several other psych meds. I was sure to disclose everything to my doc, and the anesthesiologist. They are the ones who should know and ask them, express your concerns and I am sure they will be able to help you.

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Shoomers,

The best thing to do is to talk to your surgeon ASAP. Let him/her know the problem, i.e. your concerns. A doc should know all the medictations you are taking and this information should be passed along to the anesthesiologist as well. Ask if it is possible to speak with him/her as well. In many cases there are some medications you may have to stop taking a few days before surgery, but generally after surgery you should be able to start taking the medications again. The anesthesiologist  is trained to know about drug interactions and would be your best choice is to discuss this with him. So, because none of us here are medical doctors, I would get ahold of your surgeon, let him know your concerns, and ask to speak with his anesthesiologist. This way you can get the answers you need well before the surgery date.

Erika

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thanks for the answer, Strung.  (String, Strang Strung? ....never mind)

You're welcome.

Is a "moderate" interaction not enough to worry about?

<{POST_SNAPBACK}>

The site said that basically, it can be done, it won't kill you, and be careful, but the thing is, I don't think you'll be in any condition to tell a doctor if something's not right. Or ambulatory (walking). They talk about Wellbutrin having "central nervous system- and/or respiratory depressive effects" but Wellbutrin is supposed to be stimulating, sometimes enough to treat AD/HD, with any unusual sleepiness indicating too high a dose. Ususally.

And it is assumed that you will still be conscious, which makes sense for lidocaine--

I am...wondering what's going on.

Shoomers,

The best thing to do is to talk to your surgeon ASAP. Let him/her know the problem, i.e. your concerns. A doc should know all the medictations you are taking and this information should be passed along to the anesthesiologist as well. Ask if it is possible to speak with him/her as well. In many cases there are some medications you may have to stop taking a few days before surgery, but generally after surgery you should be able to start taking the medications again. The anesthesiologist  is trained to know about drug interactions and would be your best choice is to discuss this with him. So, because none of us here are medical doctors, I would get ahold of your surgeon, let him know your concerns, and ask to speak with his anesthesiologist. This way you can get the answers you need well before the surgery date.

Erika

<{POST_SNAPBACK}>

Why the flying fuck didn't I think of this?

Gah.

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jag,

it sounds like it worked out okay for you.  Were you taking pain meds afterwards also?

Erika,

that is probably the best idea, but the problem is I dont think my orthopedic surgeon knows much about anti-depressants. When I told him the meds I was taking he didn't say anything about them, sent me on my way and said "see you in six weeks for the surgery".  I guess I will try and find out who the anesthesiologist is and call them.  Just wanted to know if anyone on here had expreience with this.  I know it's best to taper off the welbutrin, so I better find out soon!

Strung,

I am sure you DID think of that, you were giving me very valuable information.  I really appreicate it, because I was able to link to some other info about anesthesia and surgery, that helps me.  I am actually scared to death about it, being "put under" kind of makes me freak out about not waking up.  I guess that's one of the reasons I'm not sure about going off the welbutrin right now-dont want to fuck myself up even MORE before hand!  But, seizures dont sound like much fun either!  I am taking it for major depression, and I know I'll be depressed after the surgery. And, you are right-I wont be able to tell anyone much of anything for a while, will be out of it and in a leg brace/on crutches for 8 weeks. I am wondering what's going on, too... ;)

So, thanks to everyone for the info-if anyone else has been on welbutrin and had surgery or also on morphine/other pain meds, I'd appreciate your comments!

Shoomers

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Strung,

I am sure you DID think of that, you were giving me very valuable information.

The "that" I was referring to was talking to your doctor.

I really appreicate it, because I was able to link to some other info about anesthesia and surgery, that helps me.
Thanks.

I am actually scared to death about it, being "put under" kind of makes me freak out about not waking up.  I guess that's one of the reasons I'm not sure about going off the welbutrin right now-dont want to fuck myself up even MORE before hand!

You might not have to. If it is morphine, you might be able to get away with taking less of both to compensate for the mutual metabolic interference.

I don't know. Ask your doctor.

But, seizures dont sound like much fun either!
When I entered lidocaine into the aidsmeds search engine, I decided to pick the lidocaine-dexamethasone for some reason. Probably because some doctors think it could be used to detect depression (I know Aetna has a policy of paying claims for dexamethasone-suppression tests to tell psychotic depression from schizophrenia on a case by case basis. The other depression-type claims for that were basically listed "uh-uh." I don't know if lidocaine-dexamethasone combinations are used in surgery! I know it's used in joint soft tissue inflammation based on this.

I am wondering what's going on, too... ;)

<{POST_SNAPBACK}>

The more I think about it, the more I wonder if something wasn't entered wrong into the AIDSmeds database. I have never heard of Wellbutrin having respiratory depressant effects.

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