HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

question-icon

Can Paxil, Remeron And Trazodone Be Taken Together?

default
Posted on Mon, 18 Apr 2016
Question: We thought my Mom might a UTi and that is why she has been acting strange but the results from the lab came back negative. I am now thinking she has SSRi overload.
doctor
Answered by Dr. Ivo Ditah (34 minutes later)
Brief Answer:
Paxil, Remeron and Trazadone are not advised to be used together!

Detailed Answer:
Hi and thank you so much for this query.

I am so sorry to hear about what your mom is experiencing. Paxil at 30mg is okay but the combination with trazadone is not advised because this can case what is called serotonin syndrome. This manifests through syndromes such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. If these are similar to her symptoms, please report to her doctor to consider changing the drugs immediately.

I hope this helps. I wish you well. Feel free to ask for more information and clarifications if need be. Above all, thanks for using our services.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Ivo Ditah (55 minutes later)
Thank you for your response. I would like to follow up with this additional comment or question to see if I am on the right track.....

My Mother was exhibiting the symptoms as described above.
Her Doctor wanted to stop the Trazadone and reduce the Paxil to 20MG FROM 30 MG the same Doctor wanted to introduce an atypical antipsychotic Zyprexa generic Olanzapine at 2.5 every night. I told the Doctor that I would like to check to make sure that she did not have a UTI.

I got the results back on the UTI this morning and the culture is negative.

It was me who started to think that my Mother actually might have SSRI overload or syndrome even though she was experiencing the same symptoms as someone who might need an antipsychotic. Over the weekend I stopped the Trazadone and reduced the Paxil to 20 mg and she has been doing so much better the past couple of days.

I think the Doctor misdiagnosed and should have considered SSRI Syndrome first, rule out the UTI, reduce the SSRI's in her system and wait and see how she does before introducing an antipsychotic. Am I right in thinking that my Mother might not need an antipsychotic?
doctor
Answered by Dr. Ivo Ditah (3 hours later)
Brief Answer:
What is her psychatric diagnosis?

Detailed Answer:
Hi,

I will really love to know what her current diagnosis is which warrants all these drugs. If she's doing better without these drugs, then she clearly doesn't need them. Change in mental state for all elderly must have an UTI ruled out. Your reasoning is correct and makes so much sense. Are you of the medical corps?

Keep me posted about this.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Ivo Ditah (2 hours later)
My Mother (94 year old) has been diagnosed with Frontal Temporal Dementia with Aphasia that resulted from a minor stroke in 2012. She has not had a formal diagnosis because she would not get and MRI and CT scan. She might have even experienced other TIA's since 2012. Her dementia has progressively gotten worse. She specifically did not want to go into any kind of memory care facility or nursing home so I am managing her care at home with the help of experienced care givers.

Thank you for your help I will keep you appraised but at this moment I plan to take it day by day I will keep her on the 7.5 Remeron/Mirtazapine at night and 20 mg Paxil/Par in the am until her Dr. Appt this Thursday. She is doing good with the reductio in SSRI's and not experiencing withdrawl. On Thursday I will talk with the DR. about all that has transpired and why I decided to not follow her directions and administer the antipsychotic Zeprexa/Olanzapine. If she has trouble between now and Thursday adjusting I have Ativan/Lorazepam .5 MG Tab for an emergency and can use 1/2 to 1 tab.

Gosh I really appreciate this opportunity to have a second opinion from an M.D and to answer your question no I am not in the medical corps but I do think I might have missed my calling. Thank you for your help.
doctor
Answered by Dr. Ivo Ditah (16 hours later)
Brief Answer:
Am sure you are doing the right things!

Detailed Answer:
Hi,

Your thought process makes a lot of sense and supported by the fact that your mom is feeling better. No matter how good a treatment plan is, it is best judged by the response to treatment. That's why I support you going with the reduced doses and chatting with her doctor when you next meet.

I wish you well. We often have more than a single calling, I am confident you are working miracles in whatever field you are.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Ivo Ditah (6 days later)
In follow up to our previous consultation. My Mother did NOT have a UTI. The Doctor agreed that Serotonin Symptom might be what my Mother was exhibiting and she agreed to stop the Zyprexa/Olanzapine and see how she does with the following reductions/increases in her Paxil and Remeron-

Paxil from 30mg to 20 mg (in the morning)
Remeron/Mirtzipine from 7.5mg to 15mg (evening)
She has been on an EXelon Patch 4.6mg/24 hr patch in the morning for the past two years I realize the efface is questionable after two years but we decided not to stop it yet. Might be the placebo effect that I notice.

Ativan/Lorazepam PRN as need half to full Tab of 0.5mg Tab am & pm (sun downing) if needed.
She is now almost seven days into this regime. All of us have tried not to administer the Ativan so we can see how the increase in Remeron is working. The getting to bed at night and staying asleep seems to be the biggest problem. Some nights she goes to sleep for just an hour or hour and half and then is up then back to bed. Other nights she is up a few times and back to bed. Some nights she has slept through the night. Supposedly the Remeron is supposed to fix this problem (put her to sleep and keep her asleep). Her normal sleeping pattern is 7 to 8 hours of sleep. I wonder how long the Remeron takes to work? I would like to know (in your opinion) if there is any other kind of sleeping aid that might work with her current medications? She has a night nurse that is with her at night so she never gets up alone. The Dr. did not want her to take Zolpidem.
doctor
Answered by Dr. Ivo Ditah (3 days later)
Brief Answer:
How is she now?

Detailed Answer:
Hi and thanks for this follow up.

I will like to know what her current state is before commenting more as it has been three days and I would expect that there are changes and the Remeron certainly working better at this time. If it is not the case and her sleeping pattern is not getting better, then I will recommend more options. However, we must be careful not to overload her with more drugs because I hate putting my clients on several drugs especially when not fully justified.

Let me hear from you, please!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Ivo Ditah (1 hour later)
You are absolutely right about letting the Remeron get into her system. She is doing better according to her night nurses. I plan to be with her for the next three days so I will have first hand experience with her sleeping pattern and will advise. Thank you.
doctor
Answered by Dr. Ivo Ditah (29 minutes later)
Brief Answer:
Waiting for the updates!

Detailed Answer:
Hi,

I will patiently wait for the updates. Very happy to hear we are getting some positive feedback. Until next, I wish you and your mom well.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3984 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
Can Paxil, Remeron And Trazodone Be Taken Together?

Brief Answer: Paxil, Remeron and Trazadone are not advised to be used together! Detailed Answer: Hi and thank you so much for this query. I am so sorry to hear about what your mom is experiencing. Paxil at 30mg is okay but the combination with trazadone is not advised because this can case what is called serotonin syndrome. This manifests through syndromes such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. If these are similar to her symptoms, please report to her doctor to consider changing the drugs immediately. I hope this helps. I wish you well. Feel free to ask for more information and clarifications if need be. Above all, thanks for using our services.