SSRIs and Codeine

[elsie1920]

So, this may already have been mentioned here, but thought I'd post it for those taking codeine for their rls.

I take escitalopram and codeine. I'm doing a slow taper off the escitalopram because of my rls. (I've since changed to 300mg Wellbutrin, and it's working well for me).

The codeine just hasn't worked well enough at the dose allowed (because of the parmcetamol). I just found out, on rlshelp.org on the treatment page, that if you take an SSRI, it inhibits the breakdown of codeine to its therapeutic form of morphine. I looked into it further and sure enough. med.stanford.edu/news/all-n...

Here is the blurb from rlshelp.org: (sorry, there is no direct link to it)

Warning: Some of the SSRI antidepressants (Paxil, Prozac, and Luvox) can cause a decrease in the effectiveness of codeine. These drugs inhibit the O-demethylation of codeine to its active form of morphine. The pain-killing effect of codeine can be significantly decreased if you are taking one of the above antidepressants. This problem does not occur with other painkillers on this list.

Last night I started gabapentin 200mg and 50mg Tramadol. No rls!!! This is like a miracle. I know I have to be very careful of the Tramadol as I've read it can cause augmentation, and I've been avoiding it until now. But it's the only other opiate my neuro doc is willing to prescribe, so....I will not take it daily. I think my rls will lessen as I get lower on my Lexapro, though right now, I think the taper is making it worse! And hoping the gabapentin works for me at a low dose, though I'm sure I'll have to increase a bit. But I finally got some sleep last night. Sigh.

[SueJohnson]

That's very interesting and another reason to get off SSRIs. Thank you for finding this! I will add it to my notes.

[Islay9]

Side note, re the codeine, you could take dihydrocodeine instead as it has no paracetamol.

[SueJohnson in reply to Islay9]

Actually codeine and paracetamol are more effective taken together.

[Islay9 in reply to SueJohnson]

Sure, I was replying to this comment: “The codeine just hasn't worked well enough at the dose allowed (because of the parmcetamol)”

[elsie1920 in reply to Islay9]

Thank you, but they don't do a 'pure' codeine here in Belgium. At least that is what my neuro doc told me when I asked her for it the other day. She said there isn't enough call for it. 🙄That's why she offered me Tramadol.

[Islay9 in reply to elsie1920]

That’s a shame. I hope that the Tramadol works well for you, sounds good so far 😊

[SueJohnson in reply to elsie1920]

I would check with a pharmacy because I believe it is available.

[elsie1920 in reply to SueJohnson]

Do you think? Ok, I'll find out, thanks! I have taken Tramadol the last three nights as I increase my Gabapentin. 50mg worked great the first two nights, but last night I had to take a second one.

[elsie1920 in reply to elsie1920]

So, when I went to pick up my Tramadol, there was none at the pharmacy. I went home and called her. The receptionist said doc (a neurologist and rls/sleep specialist) would not order me that as it's too addictive. When the doctor had offered it to me at my appt. last week, she said it was because it was not an opiate. Stupid me said 'of course it is'. She said, 'no it's not'. She must have done some research after I left and discovered that I was correct. When I spoke with the receptionist, she told me I must have misunderstood because the doctor would never prescribe that; it's way too addictive. Now I'm being gaslighted. Lovely.

I told her codeine (which they prescribe me) is more addictive than Tramadol and has the lowest addiction profile of all the opiates. At that point, the receptionist started treating me like a 'dope fiend'. That conversation was over.

These doctors make me so angry. Not so much for me, but for all the other sufferers, especially the elderly, who just trust their doctors and can't speak up for themselves. I am disgusted. Codeine doesn't work for me as stated in the opening post. I'm not taking enough Gabapentin to last me through the night, so I had RLS from 3am to 6am.

My husband had an 'old' tramadol prescription that he never used. I've been using it for the past few days, and it works so well for me, just 50mg. I had some decent sleep for the first time in weeks, maybe months. Now that's over. (at least once I finish his prescription, which I will use sparingly now).

Sue Johnson, I have a question: is it true that Gabapentin takes 3 weeks to reach full effect and shouldn't increase until then? Also, they don't have Gabapentin Encarbil (horizant) here in Belgium. I've asked at two pharmacies, and they never heard of it. I think that has a longer half-life.

Anyway, I am going to find another doctor. Someone recommended Dr Pierre Maquet, a neurologist and sleep specialist. He is apparently very sympathetic and helpful, though I don't know if he is 'pro' opiate. I'm hoping all this will be moot once I get lower/off my escitalopram. 😕

Sorry for the lengthy post.

[elsie1920 in reply to elsie1920]

I tried to make an appt. with Dr. Maquet, and he only sees memory issues and brain injury. He was recommended to me from someone in chat. Maybe he didn't realize that was all he did. I've called around and have booked something, but I suspect I'm on my own with this lovely disorder. Oh, except thank goodness I have you guys and all of your expertise. 😊

[Typicallygaslit]

Just be careful of serotonin syndrome, all those together could cause it and one symptom is agitation.

cambridge.org/core/journals...

[elsie1920 in reply to Typicallygaslit]

You are correct, thanks for pointing that out. I'm familiar with it. The types and amounts of the meds I'm on are generally not concerning, though, but I do keep it in mind.

[Typicallygaslit in reply to elsie1920]

Good to hear, not even doctors are aware of it for the most part!