Can Taking Oxycodone And Fluoxetine Together Cause Any Side-effects?

Posted on Fri, 10 Nov 2017

Question: This was my initial question in quotes but I have a follow up question: "I had a horrible reaction to my 2 medications. I had been taking 90 mgs of oxycodone a day (for about a year) and started taking a new Rx - approximately 20 mgs of fluoxetine. After the 3rd day (approximately) of taking the new medication, fluoxetine, I could no sleep at all....and started having horrific symptoms (intense severe anxiety, couldn't breath (but more like hyperventilating) cold sweats, extremely shaky all over especially arms and legs, and muscle aches and extremely lethargic. I felt like I was dying because the symptoms were tortuous! It seemed like the fluoxetine completely blocked the oxycodone and seemed like I was going through intense opiate withdrawals but how could this be because I was still taking the oxycodone. I stopped the fluoxetine and after a few days of t he intense symptoms, I stopped the oxycodone since it wasn't doing anything. These symptoms lasted 3 weeks! Do you know what happened to me? I've been researching and personally believe this to be serotonin syndrome toxicity and then opiate withdrawals but not too sure how you go through opiate withdrawals while still taking the oxycodone.. I had to go to the ER. They gave me an IV and Ativan. It helped some. But the symptoms continued for a total of 3 weeks and then I was still left with no energy. I was so weak. I finally resumed taking 15 mgs to now 25 mgs (a day) of my prescription oxycodone after 3 weeks of the tortuous symptoms and started so much better. Can you help me understand what happened to me please?"

My question now is how can I explain this to my FMLA coordinator to get the FMLA approval for the 3 to 4 weeks that it took me to get better and well enough to return to work? My FMLA Coordinator is asking why it was medically necessary to be out of work for this amount of time. I would greatly appreciate your advise on this. I am worried that I could lose my job.

Answered by Dr. Lekshmi Rita Venugopal (2 hours later)

Brief Answer:
Diagnosis: Serotonin syndrome

Detailed Answer:
Hello,
Thank you for trusting HCM for your health concern.

The combination of oxycodone and fluoxetine will increase the serotonin levels in the body, called serotonin syndrome. The increased serotonin levels will lead to anxiety, agitation, hyperventilation, muscle spasms, hypertension, headache, irritability and even seizures, death in very severe cases. The symptoms you experienced is consistent with serotonin syndrome.
Stopping the Fluoxetine was the right choice for managing serotonin syndrome.

Serotonin syndrome is a life-threatening and serious condition. The symptoms will subside only when serotonin levels return back to normal. This can take several weeks especially since you have been taking a long-acting SSRI (Fluoxetine). Fluoxetine will persist in your body for several days even after stopping. This is why it took about 3-4 weeks for your symptoms to completely subside.

Since you stopped oxycodone along with fluoxetine, there must also have been symptoms of opiate withdrawal that contributed to the long recovery time.

You can continue oxycodone as prescribed. Avoid medications which raise the serotonin levels like SSRIs, dextromethorphan, MAO inhibitors, recreational drugs like LSD, cocaine etc while on oxycodone to prevent future occurrence of serotonin syndrome.
If you plan on stopping oxycodone in future, make sure to slowly taper down the dose before stopping it to prevent development of withdrawal symptoms.

Hope this answers your question
Please address further questions here
Regards
Dr.Lekshmi

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Above answer was peer-reviewed by : Dr. Raju A.T