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.

[Typicallygaslit]

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

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