SSRI's and Pheds

Nursing Students General Students

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Specializes in OR.

Hi:

I was hoping to get clarification on something. I had a test that asked what could not be mixed with SSRI's. The answer was any of the Pheds (sudafed, ephedra, etc.). However, in our notes and in the book, that answer (the pheds) belonged to MAOI's.

My teacher told me SSRI's and MAOI's work the same so they would have the same issues with the pheds.

Anyone out there that can clarify this for me?

Thanks,

Elizabeth

Hi:

I was hoping to get clarification on something. I had a test that asked what could not be mixed with SSRI's. The answer was any of the Pheds (sudafed, ephedra, etc.). However, in our notes and in the book, that answer (the pheds) belonged to MAOI's.

My teacher told me SSRI's and MAOI's work the same so they would have the same issues with the pheds.

Anyone out there that can clarify this for me?

Thanks,

Elizabeth

SSRIs and MAOIs do NOT work the same way. SSRIs inhibit the reuptake of serotonin. MAOIs prevent the breakdown of amines, like dopamine, norepi, and serotonin and cause higher levels of those substances. Two different things. I have not been able to find anything that says "Pheds" are contraindicated SSRIs. Which drug book are you using for the course?

Hi:

I was hoping to get clarification on something. I had a test that asked what could not be mixed with SSRI's. The answer was any of the Pheds (sudafed, ephedra, etc.). However, in our notes and in the book, that answer (the pheds) belonged to MAOI's.

My teacher told me SSRI's and MAOI's work the same so they would have the same issues with the pheds.

Anyone out there that can clarify this for me?

Thanks,

Elizabeth

Oh, and you can't mix MAOIs and SSRIs together.

Specializes in OR.
Oh, and you can't mix MAOIs and SSRIs together.

I couldn't find anything that says pheds are contraindicated for SSRI's either - I looked for about an hour and half on line before I posted here.

Pheds, accoring to my book "Pharmacology: A Nursing Process Approach" by Kee & Hayes, and my lecture notes, were contraindicated with MAOIs.

So I do not understand why the answer on the test for what you don't use with SSRI's would be pheds, unless the teacher made a mistake and isn't copping to it - could be likely in my school! When I pressed her on it, she said that I should know how MAOIs work and how SSRIs work and then I would come up with the Phed answer.

I am trying to figure this out before the next exam. Any help is appreciated.

I couldn't find anything that says pheds are contraindicated for SSRI's either - I looked for about an hour and half on line before I posted here.

Pheds, accoring to my book "Pharmacology: A Nursing Process Approach" by Kee & Hayes, and my lecture notes, were contraindicated with MAOIs.

So I do not understand why the answer on the test for what you don't use with SSRI's would be pheds, unless the teacher made a mistake and isn't copping to it - could be likely in my school! When I pressed her on it, she said that I should know how MAOIs work and how SSRIs work and then I would come up with the Phed answer.

I am trying to figure this out before the next exam. Any help is appreciated.

Ask what source she used so you can study up on it. If she is a good instructor, she followed an appropriate question development process, which means she validated her results.

Specializes in NICU.
Hi:

I was hoping to get clarification on something. I had a test that asked what could not be mixed with SSRI's. The answer was any of the Pheds (sudafed, ephedra, etc.). However, in our notes and in the book, that answer (the pheds) belonged to MAOI's.

My teacher told me SSRI's and MAOI's work the same so they would have the same issues with the pheds.

Anyone out there that can clarify this for me?

Thanks,

Elizabeth

Sounds like the question needs to be tossed out to me.

But definitely don't want to mix SSRI's with pheds! I didn't know this - yes I'm a nurse but I work in the NICU so most of my pharmacology (especially relating to adult psych meds) is rusty. So when I was briefly on Paxil and got a cold, I had no idea that I shouldn't have taken Sudafed. OH MY GOSH. I thought I was going crazy. I couldn't lay still that night, I felt this obsessive need to keep kicking my legs and moving my arms, like a billion bugs were tickling me. I was mentally freaking out as well, and that scared me enough to actually call the pharmacy where I got the Paxil to ask if there was something wrong with me. First thing they asked was if I took cold medicine. Needless to say, about twelve hours later I felt totally normal again. I just HAD to take the long-lasting formula!!!

Specializes in OR.
Ask what source she used so you can study up on it. If she is a good instructor, she followed an appropriate question development process, which means she validated her results.

Good idea - I'll do it. But I expect she will not have anything to show me. I'll keep you posted.

Specializes in OR.
Sounds like the question needs to be tossed out to me.

But definitely don't want to mix SSRI's with pheds! I didn't know this - yes I'm a nurse but I work in the NICU so most of my pharmacology (especially relating to adult psych meds) is rusty. So when I was briefly on Paxil and got a cold, I had no idea that I shouldn't have taken Sudafed. OH MY GOSH. I thought I was going crazy. I couldn't lay still that night, I felt this obsessive need to keep kicking my legs and moving my arms, like a billion bugs were tickling me. I was mentally freaking out as well, and that scared me enough to actually call the pharmacy where I got the Paxil to ask if there was something wrong with me. First thing they asked was if I took cold medicine. Needless to say, about twelve hours later I felt totally normal again. I just HAD to take the long-lasting formula!!!

Oh no! Thanks for the first hand account. I appreciate it!

Specializes in NICU Level III.

Weird, I'm on a SSRI and I take pheds and nothing out of the ordinary happens.

Specializes in ER, Peds, Charge RN.

This is the only thing I can think of, and it only happens sometimes.

People on SSRI's (some people) cannot take cold medicines that contain certain cough medicines or sudafed. The reasoning behind this is because these medicines can raise the levels of serotonin in one's body (through various pathways), leading to serotonin syndrome. This is not the same patho behind MAOI's and pheds though, so I'm not sure where your teacher got it.

"The symptoms of the serotonin syndrome are: euphoria, drowsiness, sustained rapid eye movement, overreaction of the reflexes, rapid muscle contraction and relaxation in the ankle causing abnormal movements of the foot, clumsiness, restlessness, feeling drunk and dizzy, muscle contraction and relaxation in the jaw, sweating, intoxication, muscle twitching, rigidity, high body temperature, mental status changes were frequent (including confusion and hypomania - a "happy drunk" state), shivering, diarrhea, loss of consciousness and death. (The Serotonin Syndrome, AM J PSYCHIATRY, June 1991) This sounds like what may have happened to another poster.

TABLE 2.

Drugs that Affect Serotonin Levels

Increase serotonin synthesis

L-tryptophan

Decrease serotonin metabolism

isocarboxazid

phenelzine

selegiline

tranylcypromine

Increase serotonin release

amphetamines

cocaine

reserpine

Inhibit serotonin uptake

amitriptyline

clomipramine

desipramine

doxepin

imipramine

nortriptyline

protriptyline

fluvoxamine

fluoxetine

paroxetine

nefazadone

sertraline

trazodone

amphetamines

cocaine

dextromethorphanmeperidine

venlafaxine

Direct serotonin

receptor agonists buspirone

lysergic acid

diethylamide(LSD)

sumatriptan

Nonspecific increase in serotonin activity:

lithium

Dopamine agonists amantadine

bromocriptine

bupropion

levodopa

pergolide

pramipexole

I only know this because it happened to me when I was on Zoloft, so I researched it. I have yet to see it in practice.

Val

Specializes in NICU.
"The symptoms of the serotonin syndrome are: euphoria, drowsiness, sustained rapid eye movement, overreaction of the reflexes, rapid muscle contraction and relaxation in the ankle causing abnormal movements of the foot, clumsiness, restlessness, feeling drunk and dizzy, muscle contraction and relaxation in the jaw, sweating, intoxication, muscle twitching, rigidity, high body temperature, mental status changes were frequent (including confusion and hypomania - a "happy drunk" state), shivering, diarrhea, loss of consciousness and death. (The Serotonin Syndrome, AM J PSYCHIATRY, June 1991)

This sounds like what may have happened to another poster.

WOW!!! The whole bit about overreaction of reflexes, contraction and relaxation of the ankle (I kept kicking hoping it would go away), dizziness, twitching, and mental status changes...right on. I mean, I didn't even feel like myself. It wasn't the same as being drunk, but it was like my body was doing things and I was aware of them, but I couldn't control them.

It wasn't the weirdest I ever felt in my life, though - that would go to the time I got IV Benadryl after a mild reaction to contrast during a CT scan. Now THAT was like an out of body experience!!!

Specializes in OR.
This is the only thing I can think of, and it only happens sometimes.

People on SSRI's (some people) cannot take cold medicines that contain certain cough medicines or sudafed. The reasoning behind this is because these medicines can raise the levels of serotonin in one's body (through various pathways), leading to serotonin syndrome. This is not the same patho behind MAOI's and pheds though, so I'm not sure where your teacher got it.

"The symptoms of the serotonin syndrome are: euphoria, drowsiness, sustained rapid eye movement, overreaction of the reflexes, rapid muscle contraction and relaxation in the ankle causing abnormal movements of the foot, clumsiness, restlessness, feeling drunk and dizzy, muscle contraction and relaxation in the jaw, sweating, intoxication, muscle twitching, rigidity, high body temperature, mental status changes were frequent (including confusion and hypomania - a "happy drunk" state), shivering, diarrhea, loss of consciousness and death. (The Serotonin Syndrome, AM J PSYCHIATRY, June 1991) This sounds like what may have happened to another poster.

TABLE 2.

Drugs that Affect Serotonin Levels

Increase serotonin synthesis

L-tryptophan

Decrease serotonin metabolism

isocarboxazid

phenelzine

selegiline

tranylcypromine

Increase serotonin release

amphetamines

cocaine

reserpine

Inhibit serotonin uptake

amitriptyline

clomipramine

desipramine

doxepin

imipramine

nortriptyline

protriptyline

fluvoxamine

fluoxetine

paroxetine

nefazadone

sertraline

trazodone

amphetamines

cocaine

dextromethorphanmeperidine

venlafaxine

Direct serotonin

receptor agonists buspirone

lysergic acid

diethylamide(LSD)

sumatriptan

Nonspecific increase in serotonin activity:

lithium

Dopamine agonists amantadine

bromocriptine

bupropion

levodopa

pergolide

pramipexole

I only know this because it happened to me when I was on Zoloft, so I researched it. I have yet to see it in practice.

Val

This is excellent information. Thank you. Basically, what my teacher is saying is that MAOIs increase seratonin in the synaptic cleft. SSRIs also increase seratonin in the synaptic cleft. Therfore, if pheds effect MAOI's they will also effect SSRIs.

I have dropped this particular issue with this teacher as I have her for clinical starting next week. I believe if I asked her to point me to her resources she would be unable to do so and it would adversely effect me to "call her out" on something.

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