Wednesday, May 13, 2009 bobbffxx asks

Q: NARCOTICS ALSO!!! Are there any side affects taking 3 anti-depressants and an anti-psychotic?

Original question posted;

"My 69 yr old mother has been prescribed Celexa, Lexapro, Cymbalta, & Resperdal all at the same time. She has a history of addiction to Valium, Vicodin, Morphine, & God knows what else (starting about 40 yrs ago). She also has a history of depression. She has diminished mental capacity, cannot walk without assistance, & has memory problems.

She acts as though she is still drugged out "

MORE DRUGS TAKEN Besides all of these I found out she is also taking Ultram ER, some type of nerve pain medication that is also used for diabetes(she was prescribed this for sciatica), & Klonopin. She had back surgery a few months ago for the sciatica, but was still taking the drugs that were prescribed from before. She also had been taking Vicodin & Morphine patch for a long time up until Jan of this year. She is also taking Lipitor & has medication for her heart, but her BP has been so low that they haven't given her that. They meaning the hospitals & the skilled nursing facillity she is transferred to because she is so weak & is almost non-ambulatory. She is also incontinent now. I had no idea she was taking all these drugs. I thought her husband was helping her with taking her meds, but they where all thrown in a drawer in the kitchen- ALL 23 BOTTLES. He's not in great shape either. Heart, diabetes, & bronchitis a lot. She is like a baby. She can hardly say more than 2 words at a time. Slops food all over. Is in a wheel chair. Falls. Wets herself. My sisters & brother don't know where to turn. I was going to make her an app Mon. for a Neurologist, but her husband took her back to the quack that prescribed all the narcotic & anti depressants. We are hoping she's like this because of all the drugs & after they get out of her system she'll 'come back'. Should we have her see a Neurologist? Should we put her in a specialized drug rehab? (Because she needs round the clock care right now. She can't be left alone) PLEASE HELP I need some answers. Thank you in advance!

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Answers (4)

Teri Robert, Health Guide

5/14/09 12:00pm

Bobbi,

If she's taking all of these medications at the same time, there are some potentially serious issues with the medications you've listed. Here are some potential interactions I found:

Avoid/Use Alternative

1. Celexa <-> Lexapro
avoid combo: combo may incr. risk of serotonin syndrome, neuroleptic malignant syndrome (additive toxicity; duplicate tx)

Caution Advised

2. Celexa <-> Cymbalta
caution advised: combo may incr. risk of serotonin syndrome, neuroleptic malignant syndrome, other adverse effects (additive effects)
3. Celexa <-> Risperdal
caution advised: combo may incr. risperidone levels, risk of adverse effects; may incr. risk of serotonin syndrome, neuroleptic malignant syndrome (hepatic metab. inhibited; additive effects)
4. Celexa <-> Ultram ER
caution advised: combo may incr. risk of serotonin syndrome, neuroleptic malignant syndrome, seizures; may incr. tramadol or decr. metabolite levels, incr. toxicity or alter efficacy (additive effects; hepatic metab. inhibited, decr. conversion to active metabolite)
5. Celexa <-> Vicodin
caution advised: combo may decr. hydrocodone efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)
6. Cymbalta <-> Lexapro
caution advised: combo may incr. risk of serotonin syndrome, neuroleptic malignant syndrome, other adverse effects (additive effects)
7. Cymbalta <-> Risperdal
caution advised: combo may incr. risk of serotonin syndrome, neuroleptic malignant syndrome (additive effects)
8. Cymbalta <-> Ultram ER
caution advised: combo may incr. risk of serotonin syndrome, neuroleptic malignant syndrome, seizures; may incr. tramadol or decr. metabolite levels, incr. toxicity or alter efficacy (additive effects; hepatic metab. inhibited, decr. conversion to active metabolite)
9. Klonopin <-> morphine sulfate
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)
10. Klonopin <-> Risperdal
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)
11. Klonopin <-> Ultram ER
caution advised, consider lower tramadol dose: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
12. Klonopin <-> Vicodin
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)
13. Lexapro <-> Risperdal
caution advised: combo may incr. risperidone levels, risk of adverse effects; may incr. risk of serotonin syndrome, neuroleptic malignant syndrome (hepatic metab. inhibited; additive effects)
14. Lexapro <-> Ultram ER
caution advised: combo may incr. risk of serotonin syndrome, neuroleptic malignant syndrome, seizures; may incr. tramadol or decr. metabolite levels, incr. toxicity or alter efficacy (additive effects; hepatic metab. inhibited, decr. conversion to active metabolite)
15. Lexapro <-> Vicodin
caution advised: combo may decr. hydrocodone efficacy (hepatic metab. inhibited, decr. conversion to active metabolite)
16. morphine sulfate <-> Risperdal
caution advised, consider opioid dose reduction: combo may incr. risk of CNS depression, hypotension, other adverse effects (additive effects)
17. morphine sulfate <-> Ultram ER
caution advised, consider lower doses: combo may incr. risk of CNS and resp. depression, psychomotor impairment, seizures (additive effects)
18. morphine sulfate <-> Vicodin
caution advised, consider dose reduction: combo may incr. risk of CNS and resp. depression, profound sedation, hypotension, other adverse effects (additive effects)
19. Risperdal <-> Ultram ER
caution advised: combo may incr. risk of CNS depression, psychomotor impairment, seizures; combo w/ haloperidol may incr. tramadol or decr. metabolite levels, incr. toxicity or alter efficacy (additive effects; hepatic metab. inhibited, decr. conversion to active metabolite)
20. Risperdal <-> Vicodin
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)
21. Ultram ER <-> Vicodin
caution advised, consider lower doses: combo w/ other opioids may incr. risk of CNS and respiratory depression, psychomotor impairment, seizures (additive effects)

One big question is does anyone know when she's taking which of these medications.

Obviously, you know this is a problem. In part, the answers will depend on what types of care are available for her.

Does she have a primary care physician? If so, that doctor should be coordinating all of her care.

There's the added issue that she is married and, legally, her doctors may not even be able to talk with you. Have you talked with her husband to see if he'll work with you on her care? You really don't have the authority to take her to a neurologist, rehab center, etc.

A couple of things to try:

1) Is there a social worker or patient advocate at the facility where she is now? If so, they might be able to make some suggestions for you, if they're allowed to talk with you about her case.

2) The only other thing I can think of goes along with Paul's answer -- consult an attorney.

Bobbi, I really feel for you and wish I could give you more definite advice. I was in a somewhat similar situation with my mother at one point. She was in the hospital for surgery, and the anesthesia and the strain of the surgery caused a real mess with her mental health meds and status. She was making no sense, and wouldn't stay in her bed. My father passed away years ago. What Mom needed was to be transferred to our other local hospital where they have a mental health ward, but she wasn't able to make that decision. I'm not quite sure why I couldn't do that as her next of kin, but I couldn't. Anyway, we had to get a judge's order to move her. When she was coherent again, she had a medical power of attorney drawn up so my brother and I could speak for her if she can't speak for herself. This may be something else to look into.

Please let us know how things go? And, please take care of yourself along the way.

Good luck,

Teri

Paul

5/13/09 5:27pm

The way it seems is that, her husband is making all her healthcare decisions?

It may help to have a doctor become her healthcare coordinator, someone willing to supervise her care and medications among all her physicians. Someone needs to coordinate all of those drugs.

Perhaps you can keep the appointment with the neurologist and discuss everything you've written here.He may be able to advise you on what steps can be taken to get her medications and care under control. To give you some answers.

If you feel her husband is not capable, you could even approach an attorney about who should make her health decisions. This is all just my opinion, trying to help, I'm not implying that is the case.

Fawn

5/18/09 11:38pm

I will do my best to try to answer your question. My name is Fawn and I am new here. If she were my mother, I certainly would get her in the care of a competent doctor, which the one you described does not sound like he is. He sounds more to me like just a pill pusher and there are plenty of those around. It will take time for all of that medication to be detoxed from her systom though, so please be patient but it sounds to me like the poor woman is on an overload and, yes, it certainly can have all of the effects that you described. She needs to certainly be weened off of at least half of what she's now taking.

I know because my own mother had a doctor like that also and I went to her house one day and threw away half of what he had perscribed which one was five different kinds of blood pressure medication and she wondered why she couldn't even hardly get out of her chair.

Perhaps you could consider a rehab center for a few weeks while she is detoxing so that she could be under nursing care because it maybe difficult for her to cope with.

I hope that I have helped you.

Donna-1

4/26/11 5:40pm

I am on 3 antidepressants: Wellbutrin, Zoloft and Trazodone, plus Klonopin and the antipsychotic Saphris. Plus bp med, GERD med and hypothyroidism med. But I am only 52. Many antipsychotics are not supposed to be given to the elderly who have dementia, so I would question that. But it is possible for someone who is otherwise healthy and not addicted to pain and other meds to be placed on 3 antidepressants plus an antipsychotic and do well.

Q: NARCOTICS ALSO!!! Are there any side affects taking 3 anti-depressants and an anti-psychotic?

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