Taking 2 SSRI's together

[Averroes]

Any papers, links, evidence of 2 SSRI's being used together....

[Rafael]

SSRI's and Tricyclics together!!

[Averroes]

any info.... on fluoxetine and paroxetine being used together. As well as zopiclone. Any opinions?

[Shwampa]

Let's start with the easy bit: Zopiclone is often co-prescribed with SSRIs to counteract sleep disturbances usually at the beginning of an SSRI treatment.

Now, why would you like to give 2 SSRIs? Never came accross it in any protocol and guideline. There's no rationale behind it.

Usually, you dose up the SSRI if still no adequate control (give it time >4 to 6 weeks), you switch or add an augmenting agent.

Fluoxetine is usually given to people who you want to wean off paroxetine, but not together. Those 2 ones are the most P450 interacting SSRis. Paroxetine and the SNRIs Venlafaxine are the nastiest ones for discontinuation symptoms.

[Averroes]

Yes, regarding this query.......

..resolved. It was a forged prescription.

Although through further investigation it became apparent that the patient was in fact on 2 SSRI's (in order to stop one and start other), initially on 40mg of paroxetine (greater incidence of suicidal behaviour), but now reducing and gradual discontinuation replaced by fluoxetine.

But the main point. The prescription was forged to include the second SSRI and zopiclone, rx originating from hospital.

Be careful with hand written scripts, also when are we going to get access to patient records!

[Fleegle]

You're trying to teach your granny to suck eggs here sunshine.

[Mrs. Robinson]

during 2004, selective serotonin reuptake inhibitors (SSRIs) caused significant toxic effects in 8187 persons, leading to 103 deaths.

patient taking two SSRI together will be more likely to develop serotonin syndrome.

and the above numbers will be higher.

[Pharmanaut]

You're trying to teach your granny to suck eggs here sunshine.

Take it easy Fleegle.
Its probably the young pharmacists first forgery and they haven't yet got the experience of the job that you have. Think of it as passing on experience to peers.

[Averroes]

I thought this was a forum to share such expirience, to be honest the site was recommended by a friend, but after using it I'm finding it more of a social networking site. Regardless of my expirience I would think such information would be useful to some. Also kindly don't mention my 'granny' again. If you kind such information a source of inexperience, then I alologise, but maybe it's worth passing on to the gentleman who was going to topple himself, and the pharmacist (expirienced may I add) who handed out the medication. It was only when counting the scripts at a shift change did I notice the odd looking script. The drugs were attainded by the police the following day, without any effect to the patient. So to all 'expirienced' pharmacists, please disregard this thread, and my sincere apologies.

[Rafael]

your post was useful, at least for myself, and i am sure the majority on this site as well( majority are students and pre-regs).

welcome to the forum