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What Causes Aggression, Paranoia, Suicidal Thoughts And Anxiety After Taking Cymbalta And Nucynta?
Question: Hello. i have been taking valsartan 160, ,m -eslon 10 mg, dialaudid 1mg ,trazadone 1oomg for roughly 10 years. my doctor also perscribed me cymbalta ,first 30 mg and then 60 mg for the last 3 years. I had no serious side effects. After 2 years on the cymbalta, i then moved across the country and had to find a new doctor. when i did 4 months ago,he changed my meds, and took me off the dialaudid and m-eslon and instead put me on nucynta er 50 mg twice daily. Within days, i started to have side effects,aggression,paranoia,mania,anxiety,heavy sweating ,suicidal thoughts and higher blood pressure. the paranoia and hostile aggression ended up costing me my job! Is it possible that these severe side effects were caused by the nucynta and the cymbalta being taken together? I have heard that this is called serotonin syndrome. It was extremely scary. Can you help me?
Brief Answer:
A differential diagnosis between different causes should be performed
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern and would like to explain that your symptoms are not typical of serotonin syndrome.
You should know that concomitant take of cymbalta and nucynta has no potential pharmacological interactions. This means that these two drugs do not effect each others use and don't cause adverse side effects on your body.
This syndrome is common in patients taking many medicines that increase serotonin plasma levels (only cymbalta has this effect) and is associated with other symptoms like (confusion, headaches, nausea, diarrhea, fevers, high blood pressure, muscle stiffness, tremor, muscle twitching, tachycardia, etc.).
This syndrome can be related to trazodone and doluxetine intake, but the fact that you have been using them for a long time, without any side effects, excluded this possibility.
BUT, your symptoms are more suggestive to be related to withdrawal syndrome from m-eslon and dilaudid stopping. The fact that your symptomatology began after stopping these drugs and starting nucynta is another argument in favor of this diagnosis.
You should know that these drugs are opioids, which can cause tolerance and dependence when used for a long term therapy (like in your case) and stopping these drugs can lead to withdrawal syndrome, with a similar clinical scenario like yours.
I recommend consulting with your GP for a careful physical examination, which is essential in ruling in/out possible serotonin syndrome ( there are no specific lab tests for this diagnosis).
Further lab tests may need to be performed:
- complete blood count
- inflammation tests ( PCR, fibrinogen, sedimentation rate)
- kidney and liver function tests
- thyroid hormone levels
- blood electrolytes
- fasting glucose
- muscular enzymes, etc.
to exclude other possible metabolic causes related to this symtomatology.
Both withdrawal syndrome and serotonin syndrome need to be treated by specialists of these fields.
I recommend discussing with your attending physician on the above issues.
Hope to have been helpful!
Feel free to ask any other questions, whenever you need.
Best regards,
Dr. Iliri
A differential diagnosis between different causes should be performed
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern and would like to explain that your symptoms are not typical of serotonin syndrome.
You should know that concomitant take of cymbalta and nucynta has no potential pharmacological interactions. This means that these two drugs do not effect each others use and don't cause adverse side effects on your body.
This syndrome is common in patients taking many medicines that increase serotonin plasma levels (only cymbalta has this effect) and is associated with other symptoms like (confusion, headaches, nausea, diarrhea, fevers, high blood pressure, muscle stiffness, tremor, muscle twitching, tachycardia, etc.).
This syndrome can be related to trazodone and doluxetine intake, but the fact that you have been using them for a long time, without any side effects, excluded this possibility.
BUT, your symptoms are more suggestive to be related to withdrawal syndrome from m-eslon and dilaudid stopping. The fact that your symptomatology began after stopping these drugs and starting nucynta is another argument in favor of this diagnosis.
You should know that these drugs are opioids, which can cause tolerance and dependence when used for a long term therapy (like in your case) and stopping these drugs can lead to withdrawal syndrome, with a similar clinical scenario like yours.
I recommend consulting with your GP for a careful physical examination, which is essential in ruling in/out possible serotonin syndrome ( there are no specific lab tests for this diagnosis).
Further lab tests may need to be performed:
- complete blood count
- inflammation tests ( PCR, fibrinogen, sedimentation rate)
- kidney and liver function tests
- thyroid hormone levels
- blood electrolytes
- fasting glucose
- muscular enzymes, etc.
to exclude other possible metabolic causes related to this symtomatology.
Both withdrawal syndrome and serotonin syndrome need to be treated by specialists of these fields.
I recommend discussing with your attending physician on the above issues.
Hope to have been helpful!
Feel free to ask any other questions, whenever you need.
Best regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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