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Methadone Maintanence & SSRI
Methadone Maintanence & SSRI
Hello everyone im currently a methadone patient at a treatment center. ive been on and stable at 130mg of methadone daily for about 9 months now. I recently saw my doctor because i have just kinda been down lately and he suggested i try an anti-depressant. I said I would be willing to give it a try and he perscribed me Fluoxetine(Prozac) 20mg per day. my question is this, are there any interactions between anti-depressants and methadone or will this combination work fine together? will the methadone affect the prozac or will the prozac affect the methadone at all? thanks to anyone who answers and i appreciate and support all of you in your times of hardship.
Prozac (Fluoxetine) can increase methadone serum level
Selective Serotonin Reuptake Inhibitors(SSRIs), including Fluoxetine (Prozac) and tricyclic antidepressants can both increase methadone blood levels, because methadone and these antidepressants are both metabolized or broken down, by the same 3A4 liver detoxification pathway.
Originally Posted by CDFri
Sadly, some methadone patients have died, due to combining methadone and antidepressants.
This study demonstrates the ability of sertraline, generic name for Zoloft, to increase methadone plasma level. Sertraline and other Selective Serotonin Reuptake Inhibitor antidepressants are metabolized by the liver CYP 450 3A4 detoxification pathway and slow breakdown of methadone. While the average methadone serum level increase for 31 methadone patients was 26%, AT LEAST ONE PATIENT HAD A 118 % METHADONE LEVEL INCREASE. These increases were measured 6 weeks, after the antidepressant was started. If you start an antidepressant, while you are on methadone, you need to be very careful, since a methadone overdose could result.
Am J Addict. 2000 Winter;9(1):63-9.
The effect of sertraline on methadone plasma levels in methadone-maintenance patients.
Hamilton SP, Nunes EV, Janal M, Weber L.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, NY 10032, USA.
The authors examine methadone plasma levels in 31 depressed methadone-maintained opiate addicts enrolled in a 12-week placebo-controlled, double-blind study of sertraline. Between baseline and week 6, patients on sertraline showed a mean increase in methadone plasma level/dose (P/D) ratio of 26% (SD = 43%, range -32% to +118%), while patients on placebo showed a mean decrease of 16% (SD = 27%, range -62% to +50%). This difference was significant (p < 0.02). The sertraline and placebo groups did not differ in reported side effects or methadone dose adjustments. Between weeks 6 and 12, methadone P/D in the sertraline group decreased back towards baseline, and the treatment groups did not differ significantly at week 12. The results suggest sertraline may produce a modest increase in methadone serum levels over the first six weeks of treatment. Depression and anxiety disorders are common in methadone-maintained patients. Serotonin uptake inhibitors are attractive choices for treatment due to their low toxicity and low abuse potential, but these agents variously inhibit isoenzymes responsible for the metabolism of methadone. Clinicians treating depressed or anxious methadone patients with second-generation antidepressants should monitor for clinical signs of increased or decreased methadone levels and consider monitoring serum methadone levels.
Last edited by ddcmod; 12-17-2015 at 08:37 PM.
I am also on methadone maintenance!
I was at 155mgs. at the time and was put on the max dose of prozac as I had been on it before years back before methadone. After being put back on prozac I was given a peak and trough to justify a dose increase and found that my serum level was in the toxic range so they immediately started taking me down on my methadone. Unaware that it was the prozac causing it. I got down to 130mgs. still not much change and I read that it was the prozac in a article on the net and tapered myself down off the prozac and problem solved. but I stayed at 130 on the methadone because it helped my constipation but not my cravings now Im debating the issue of going back up. Just my experience.
Originally Posted by CDFri
Last edited by ddcmod; 12-17-2015 at 08:37 PM.
Lexapro & Methadone
I am on Lexapro and Methadone (90 mgs) daily as maintenence. Thank you for this informative post. My clinic is famous for not giving two $hits about anything but making money and having people die at their expense, so I will certainly bring this to the attention of my clinic Doctor and ask him why he never told me about any of this, or if he is even aware of it.
I myself do not feel any ill effects but that's not always a reliable method when answering questions like this.
Please don't take both
I was just researching some information on methodone and anti depressants because I am on methodone and it has changed my life. Like everyone one else we go through tough times and I thought to go see a doctor about it. So he prescribed me an anti depressant and he new I was on methodone. He said it was fine. Well I had a grand mal seizure and it was very serious because I was driving and thank God i am okay and no one got hurt. But I do beleive at the bottom of my heart that it was from the anti depressant mixed with the methodone. Please do not take any kind of antidepressant with methodone. I seriously beleive that it will cause death eventually. I am now only taking my methodone and I would rather be alive then be happier then die. People we love need us to stick around so please try to get through life without all the antidepressants and benzos. Methodone is enough. I dont think its good for me either and when I am ready I will tapper myself down but right now is not the time. Please Please Please get off of the other meds because there is so much doctors wont tell you because either they dont know or all they care about is the business. Thanks for listening i hoped this helps struggling addicts like myself.
everyone is different though??
I too have been attending a methadone treatment clinic as of 4/20/2011 I NEVER surpassed 40mgs and I began to SLOWLY taper in November. I am currently at 8 mg's. I had an appt with my doctor and he wanted to place me on 10mgs of Lexapro to begin as I am dropping 1 mg every 5 days and when I get to 5mg's I will stay on that dose for 5 days then I AM DONE or as they say "Jump at 5mgs" I began taking Lexapro when I awake at 5:30 each morning and i have felt fine. I BELEIVE people that are on 70, 80 even people over 180 mgs of methadone and taking a high dose of Antidepressants can have serious side effects.
Originally Posted by Damita33
I also decided I wanted to begin taking Lexapro due to the fact I have been on Xanax 4 mg's a day for 5 years. I want off ALL addicting meds and Lexapro has the BEST overall rating for treating GAD and Panic attacks. as doctors have decided to decieve the patients they place of this drug by telling them "you can take Xanax for the REST of your LIFE...they should loose their ability to practice medicine...!!!!!
My doctor adviced me that he would ONLY prescribe me the Lexapro due to me being at 8 mgs and I have maintained my taper and I plan to KEEP going till I never have to go back to those clinics EVER!!!
so for those who REALLY want off addictive meds I suggest you do your homework losts of research on methadone because if your SOLE intentions are to get on a MG so high to GET HIGH your just continuing to prolong your addiction.
I understand that
Originally Posted by rxqueen
Sounds like we go to the same clinic. They don't give a >>>> about us, just the money, at 15$ a day
I have noticed that also at my clinic. I've been on it 13 years now. I never thought I would be on it this long. I was up to 70 mgs but it made me sick. I'm down to 40 mgs. I don't get "high" from it. It just makes me feel normal. Anyways, Been on that for about a year. I'm just so tired of basically working to pay the clinic. I wish you the best. I would like to know how you are doing if you do get to read this. Would like to know how you did it and how the withdrawals were for you thank you and hope to hear from you .
Let me just start by saying i am not an English major so i apologize for the spelling, punctuation, sentence and paragraph structure.
Originally Posted by Tnm692
I am currently on 20mg of methadone, i started the methadone management program a little over 6 months ago on 20mg, moved to 40 mg as 20 was not enough to keep me happy. I'm not trying to be rude but i have a hard time understanding why people stay on such high doses for such a long period, if you taper even 1mg every 2 weeks you could be done in a year. I stayed at 40mg for 1 month and went down a few mg every few weeks and i am continuing to do so with zero withdrawal because its being done properly. I found that if you only go down 1-2mg at a time, every 2-3 weeks it should prevent any withdrawal, at least that has been my experience. I guess you just really have to be willing to put in the work to get better.
I see so many people at my clinic that have been on 100+mg and have been for many years, i was stunned until i spoke with one individual who opened my eyes to what was going on, it appears that a large percentage of the people that go to my clinic just use the methadone when they can't get any other drugs to feed their addiction, It's a sad cycle as even on very very high doses it's possible to be free of drugs and methadone in just a few short years and even just a few short month on the lower doses. I'm not sure where i was going with this but i just wanted to address your withdrawal question.
In summary. I was able to drop 20mg in 5 months with zero withdrawal because i did it the way i wanted to, on my own terms. I am driven by the feeling of accomplishment that i have every time i go down a dose, even if i do feel a little queezy due to the dose being lowered it goes away within the first day or two and it's nothing like full blown withdrawal, no restless limbs, no insomnia, no headaches, just a feeling of accomplishment. I am a firm believer that 70% of withdrawal is mental, and with all the damage done with drugs its hard to over come the mental aspect of it, some people just aren't strong enough to tell themselves it's going to be alright and to remain positive and think of the end goal, but if you are, it's a lot easier.
If you ever need anything, feel free to send me a message. I would be more than happy to share my experiences with any of you if they can in some small way help you through these hard times, it's always a little easier knowing you have someone in your corner.
Additionally; i am currently taking Zoloft so if anyone has any questions about the interaction between my methadone and the anti-depressant that i haven't already outlined don't hesitate to ask. In short, i am still on 20mg of methadone and it appears to still do its job at keeping me not sick. The Zoloft, although it makes me a little sleepy, makes me more optimistic and happy with my life, regardless of how awful i perceive it just hours before taking the Zoloft. I would recommend it to most anyone on a low methadone dose as it really has changed my life for the better, but i guess i am one of the lucky ones who got the "good" side-effects. Cheers!