View Full Version : Celexa and Vistaril dangerous?
My GP prescribed 10mg celexa and 25mg Vistaril q.i.d for anxiety. I've been taking this for several weeks along with gabapentin 700mg/day. Tonight I google drug interactions and apparently celexa and vistaril should not be taken together as they both increase the risk for torsades de pointes. Every site I went to warned against it, saying there was a major interaction. How did my doctor not know this? How can I trust her? I am tempted to just bin all the drugs and focus on diet and exercise
Double check with your pharmacist. My doc has also prescribed meds that Google has told me should not go together, but I’ve taken them and it was fine. The dosages were not enough of either one to cause issues.
panic_down_under
08-09-19, 09:12
How did my doctor not know this?
I'm sure she is well aware of the potential interaction, as would have been your pharmacist who is supposed to be the gatekeeper guarding against potentially dangerous drug combinations. But as with all medications, the dose is the thing, as is your state of cardiovascular health. Long QT syndrome and torsades de pointe may be an issue at high doses of each med especially if there is a potential risk of some heart diseases, but are only a remote possibility at the sub therapeutic dose of citalopram and low dose of hydroxyzine you're on. It is by no means an unusual combination, and arguably a better one than citalopram plus a benzodiazepine.
Also be aware that while they were right in this case, online drug interaction sites are far from foolproof. For example many will list the citalopram + mirtazapine combination as likely to trigger serotonin syndrome/toxicity (SS, ST). They are all wrong. Not my assertion, but that of Dr Ken Gillman (http://scholar.google.com.au/citations?user=ea6KeD0AAAAJ&hl=en), one of the two leading experts on the syndrome:
As I have pointed out before, drugs like bupropion and mirtazapine, that have no significant serotonergic activity, are no more likely to cause ST than is vitamin C. This scenario has already been enacted, over a decade, with the antidepressant mirtazapine, which was claimed, erroneously, to have serotonergic activity. Many poor quality case reports of ST with mirtazapine were published. This probably led to misdirected treatment of overdoses, some of which may have caused morbidity. It took several reviews to correct this error and establish that mirtazapine cannot cause ST
PK Gillman, 2010 PDF (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550296/pdf/13181_2010_Article_84.pdf)
Apparently, his reviews have not yet reached the compilers of the interaction websites. Maybe they are on a very slow boat to China.
And lest there be any doubt, the other leading expert, Ian Whyte and his team at the Hunter Toxicology Group, who wrote the book on diagnosing ST, agrees (5-HT=serotonin):
In some cases this has led to reports of serotonin toxicity for drugs that, from well-defined receptor binding studies, are unlikely to cause increased levels of CNS 5-HT. Important examples include the 5-HT2A receptor antagonist olanzapine and the 5-HT receptor antagonist mirtazapine.
The Hunter Serotonin Toxicity Criteria (https://academic.oup.com/qjmed/article/96/9/635/1522590)
Drug interaction sites claims should only be considered as a general indicator to follow up with a physician or pharmacist, but holy writ.
Thank you, panic. I was hoping you would chime in. I wore a 48-hour holter last year and no long QT was detected on that. The plan is to titrate me up on the citalopram, but I think I will stop the vistaril in any case. It makes me sleepy as heck, but also sort of wired, and I'm not crazy that it's an anticholinergic that is messing with my short-term memory already. It is good for sleep though. My main issue is anxiety, not depression, and insomnia is a problem. Does citalopram even help with anxiety? (I'd still rather a benzo, but get why doctors are reluctant to prescribe)
Anyway, thanks so much for your explanation.
PS I woke in the middle of the night this week to go to the loo, and the top part of my vision was black in both eyes. Is this a side effect you are aware of for either of those meds?
:P Mel... not even a hi for me :lac:
Sorry! How are you, Antsy?! Been a while
I can't let Ian think he's more popular than me, it'll go to his head ;)
I'm doing pretty well. Yeah, last school year I was super busy... It's quieted down more this year, so I'm trying to spend more time on here. You still living up North?
Yep, and quietly despairing over the state of this country between anxiety meltdowns. So nothing's changed :yesyes:
LOL yes, Terry and I have been discussing international politics with Mezzi here (https://www.nomorepanic.co.uk/showthread.php?229085-Today%92s-headlines&highlight=today%27s+headlines)
panic_down_under
09-09-19, 00:51
Does citalopram even help with anxiety?
It sure does, but as with everything about ADs, YMMV. As a generalization, SSRIs are more effective for anxiety than depression.
(I'd still rather a benzo, but get why doctors are reluctant to prescribe)
If you only have anxiety occasionally, i.e. once a week or less most of the time, plus the odd bad week, then BZDs would be the better option, but they are counterproductive in daily use as they block hippocampal neurogenesis which is the underlying cause of anxiety and depression.
PS I woke in the middle of the night this week to go to the loo, and the top part of my vision was black in both eyes. Is this a side effect you are aware of for either of those meds?
No. Don't recall it ever having been mentioned before. Both citalopram and hydroxyzine may cause blurry vision, and, as with many ADs, citalopram may dilate the pupils. There are several other listed visual side-effects, all rare, but nothing like what you describe.
I wouldn't read to much into this if it's only occurred once. Most of what we see doesn't come directly from our eyes. The optic nerves don't have enough 'bandwidth' for that. Mostly, the eyes just transmit shapes and lines and the brain's visual cortex 'colours' in the rest. It doesn't always get it right and can be extra fallible soon after wakening. Definitely raise it with your doctor if it continues to happen, but, to quote the Bard, it's probably much ado about nothing.
panic_down_under
09-09-19, 01:00
I can't let Ian think he's more popular than me, it'll go to his head ;)
Ah, heckling from the cheap seats right up the back. :ohmy: There's always one! :weep:
Some of my, soon to be ex, friends would claim that train left the station a very long time ago, Vee. :roflmao: All I can say is just imagine how insufferable I could be if incredible self-effacing modesty wasn't my most endearing trait. :scared15:
Thanks again, Ian. I will stick with the citalopram in that case. I didn't realised SSRIs were more effective for anxiety than depression. Mine is constant and debilitating. Do you think the citalopram is a good SSRI for anxiety? My doctor is stuck on it, even after I asked for lexapro. Also, apparently I have some polymorphism that makes SSRIs less likely to cross the blood-brain barrier or something and therefore less effective. Is this a concern? I was taking mirtazapine at 7.5mg to stimulate my appetite and help me sleep. My GP got me to stop that, so now I can't sleep (without the vistaril) or eat. But I guess I just need to suck it up for a couple of months while my brain adjusts to the new meds. Thanks so much for your replies. Last time I called my pharmacist with a question about a med, he literally pulled out the insert and started reading it to me :/
Ah, heckling from the cheap seats right up the back. :ohmy: There's always one! :weep:
Some of my, soon to be ex, friends would claim that train left the station a very long time ago, Vee. :roflmao: All I can say is just imagine how insufferable I could be if incredible self-effacing modesty wasn't my most endearing trait. :scared15:
LOL It's okay, Ian. No one is more insufferable than me ;) Obnoxiousness is my number one trait! :yahoo:
LOL yes, Terry and I have been discussing international politics with Mezzi here (https://www.nomorepanic.co.uk/showthread.php?229085-Today%92s-headlines&highlight=today%27s+headlines)
What a freaking mess the world. Glad I am paying someone to listen to all my grievances (yes, I am finally seeing a therapist). I called you Antsy instead of Vee because my brain is soup at the moment while I get used to these meds. Gabapentin makes me forget my words - an insight into dementia
Well, as I told Ian, the one good thing about world politics going to $hit is that at least it makes some students interested in learning government in my class...although, I do think it depresses a few :(
panic_down_under
09-09-19, 04:40
Do you think the citalopram is a good SSRI for anxiety?
With the possible exception of fluvoxamine for OCD, no SSRI is necessarily better than the others for a particular disorders, however, one may be for you. The difficult bit is finding it. :weep:
My doctor is stuck on it, even after I asked for lexapro.
Six of one, half a dozen of the other. They both have the same active chemical, the 'S' enantiomer (isomer) of citalopram. The difference is citalopram also contains the less biologically active 'R' form. Escitalopram lacks the 'R' enantiomer which is why dose equivalence is half that of citalopram. There can be subtle differences in side-effects because of the small difference in chemistry, but there's not much difference in efficacy. If one doesn't work the other is unlikely to. Escitalopram was mostly about extending the patent, not producing a more effective med.
Also, apparently I have some polymorphism that makes SSRIs less likely to cross the blood-brain barrier or something and therefore less effective. Is this a concern?
So your doctor got your insurance company to pay for a gene sequence test to get a nice little kick-back from the lab, huh? :emot-rolleyes:
At this stage of the art these tests don't tell us anything worthwhile. They may prove useful in the future as understanding grows about how to interpret the results, but at this stage in their development genetic tests are mostly snake oil. This editorial in the journal Psychotherapy and Psychosomatics provides a good overview of the various tests currently available: The Limitations of Genetic Testing in Psychiatry (https://www.karger.com/Article/FullText/443512)
You also have to wonder why if your GP prescribed a SSRI if s/he actually believed the test result?!
I was taking mirtazapine at 7.5mg to stimulate my appetite and help me sleep. My GP got me to stop that, so now I can't sleep (without the vistaril) or eat.
Was there an explanation for dropping the mirtazapine? I wouldn't be too concerned about the loss of appetite. One of the most frequent ongoing SSRI side-effects is carbohydrate craving. Citalopram tends to less intense than some of the others, but most people put on at least a couple of pounds while on it.
panic_down_under
09-09-19, 04:49
No one is more insufferable than me
You might say that, Vee, I couldn't possibly comment. :whistles:
Everyone duck! INCOMING!! :scared11:
MyNameIsTerry
09-09-19, 05:01
You might say that, Vee, I couldn't possibly comment. :whistles:
Everyone duck! INCOMING!! :scared11:
https://media1.giphy.com/media/NTSMCNXQQ1xiE/giphy.gif?cid=19f5b51a57f82ef98f1b63ea66f8b8758a0e 81d838fc19ce&rid=giphy.gif
:roflmao:
You might say that, Vee, I couldn't possibly comment. :whistles:
Everyone duck! INCOMING!! :scared11:
its okay. I’ll just put some spiders in your bed ;)
One of the most frequent ongoing SSRI side-effects is carbohydrate craving. Citalopram tends to less intense than some of the others, but most people put on at least a couple of pounds while on it.
^^^that is very true. The first few months on Lexapro I ate a bag of salt and vinegar potato chips a week! And I don’t even like those!
Thank you for adding duckies to my thread. Cheering :yesyes: Also, hello Terry
Hey Ian, my doctor didn't do the gene test, it's info I got from running my raw 23andMe data through a third-party app. And now that I have revealed the true depth of my ignorance about SSRIs ... :doh: Seriously, though, this has been a tremendous help and I don't feel so in the dark. I was on the verge of just stopping the lot and sticking with expensive vitamins and despair
panic_down_under
10-09-19, 00:32
I’ll just put some spiders in your bed ;)
I'm an Aussie so spiders hold no fears...well except for redbacks under the toilet seat. There are two huge tarantula types looking at me right now from the cornice across the room. We have an arrangement, they stay up near the ceiling eating any bugs seeking to take up residence and I leave them alone. Works well except for the time one lost its footing and fell into a freshly made cup of tea and quietly drowned without me noticing. Interesting!!!! :emot-yuk:
I ate a bag of salt and vinegar potato chips a week! And I don’t even like those!
Sacrilege!!!! :ohmy: Salt and vinegar chips are the true staff of life. :emot-yum: I'm reliably informed :emot-pinochio: the manna from heaven which fed the Hebrews cooling their heels in the Sinai back in the day was really S&V crinkle cut chips. It's probably why they hung around there for so long. :D
panic_down_under
10-09-19, 01:30
my doctor didn't do the gene test, it's info I got from running my raw 23andMe data through a third-party app.
Ah. I've been meaning to have a genealogy tests myself. I can trace my dad's ancestors back to the early 1700s, but my mother's side is a mystery. The late 1800s must have been a bad time in central Europe because orphans are prevalent on both sides of her family tree.
However, while they may accurately determine where your ancestors came from, the medical findings should be taken with a very large dollop of salt because we are more than just our DNA. In particular they don't/can't take into account how other factors, particular epigenetics, influences gene expression.
I was on the verge of just stopping the lot and sticking with expensive vitamins and despair
Around 2/3rds of those prescribed ADs stop taking them within the first month, mostly because they've been given little to no information on what to expect. A large part of the problem is their doctors are often no better informed than they are. Psych disorders get little attention in their training, literally just a couple of weeks here and there, possibly less than the time spent on exotic diseases most of them will never see in their entire career. Which is odd given how many of the problems their patients present with daily have a psych component. Psychiatric disorders are the leading cause of premature death because they often promote the cardiovascular and metabolic diseases and cancers which hasten the grim reapers appearance through alcohol and drug abuse, smoking, sedentary lifestyles , eating disorders, chronic high stress hormone levels, etc, etc.
Well, Ian, I know I said I wouldn't do anything to stroke your ego...but if you can keep Mel on her meds, you're my hero ;)
As for the spiders...that's probably the least thing you have to worry about in Australia. Apparently, Australia has more ways to die than Florida LOL :roflmao:
Well, maybe that's why I craved the salt and vinegar chips...I am Jewish, after all :yesyes:
Ha, well I promise to stay on my meds for at least three months. How's that Vee? Ian, I'm Australian too. Battling the US healthcare system is what's going to send me to an early grave. I was in hospital for five nights recently: bill is $67,000 and counting. No surgery involved. Just a drip and vitals monitoring. Oh, and so far my insurance company is declining the claim :roflmao:
Damn, Mel. That’s with or without insurance?
That's with insurance denying the claim, so the total amount. I'm waiting for the hospital to get its shit together and provide them with the necessary paperwork. Pretty sure it doesn't default to me unless I signed a waiver (I signed a LOT of things, hopefully not a waiver)
Yeah, that happened to a family member of mine because they took him gave him doctors not in our "network". We sued and won.
panic_down_under
11-09-19, 11:04
I'm Australian too. Battling the US healthcare system is what's going to send me to an early grave. I was in hospital for five nights recently: bill is $67,000 and counting
Yikes!! :ohmy: I would have been straight back into the ER with a heart attack after receiving the bill. :weep:
Had a few U.S. job offers of the years and knocked them back mainly because of the U.S. health 'system.' I think I've cost ours about $300k over the years and counting, but from memory the most it has ever cost me is $70 for a taxi fare home from hospital and now that I'm in Tassie I don't even have to worry about that. Apparently, if you arrived in an ambulance you go home the same way, all compliments of the taxpayer. I wonder if the flashing lights and siren are extra? :shades:
There's so much pushback here against socialised medicine, it's nuts. Obamacare was a lousy, half-arsed compromise. The system needs to be rebuilt from the ground up, and I just can't see that happening
There's so much pushback here against socialised medicine, it's nuts. Obamacare was a lousy, half-arsed compromise. The system needs to be rebuilt from the ground up, and I just can't see that happening
Amen.
It might happen here in California. But it would have to be something our state would have to do alone, like Covered California. Soon it will be mandatory that all Cali citizens have some form of health care here. It's a beginning.
panic_down_under
12-09-19, 08:42
There's so much pushback here against socialised medicine, it's nuts.
Unfortunately, the insular nature of their society makes Americans easy prey to the FUD spread by vested interests. Sad. :weep:
I, for one was delighted with our version of socialised medicine, Comrade, when watching fireworks lighting up Adelaide Oval from my ring side seat on the 8th floor of the most expensive building in the Southern Hemisphere, the new Royal Adelaide Hospital, following an appendectomy in January last year. I might start giving a stirring rendition of the Internationale on the anniversary of the occasion from now on in solidarity to the cause. :yahoo:
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