GetMeOuttaThisMess Posted November 8, 2016 Share Posted November 8, 2016 Do you make a conscious effort to avoid venlafaxine and dextromethorphan due to serotonin syndrome risk? The reason I ask is that a recent pt. was upset when I substituted separate ant./decong. and cough preparations in lieu of the three in one combos available. Surprisingly, I have not had a single pt. on venlafaxine that I've asked whose prescriber had made them aware of the interaction risk since DM is so readily available OTC. While the risk may be low it would be difficult to defend ones position if it should occur. This makes me wonder if folks are even aware of the inherent risk of the two combined? Link to comment Share on other sites More sharing options...
DizzyJ Posted November 8, 2016 Share Posted November 8, 2016 Is this just specific to venlafaxine or all serotonin antidepressants? My opinion.....I am not prescribing the DM. So, if the patient gets an OTC med it is their responsibility to talk to the pharmacist about any drug interactions. Now, this does not apply to all meds. For instance, patient's taking coumadin need specific instructions about drug interactions. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted November 8, 2016 Administrator Share Posted November 8, 2016 Since the EBM says that Dextromethorphan is not statistically beneficial, why even risk it? Tell 'em to stop it, even if serotonin syndrome seems to be a rather remote risk. Link to comment Share on other sites More sharing options...
RuralER/Ortho Posted November 8, 2016 Share Posted November 8, 2016 Since the EBM says that Dextromethorphan is not statistically beneficial, why even risk it? Tell 'em to stop it, even if serotonin syndrome seems to be a rather remote risk. Do you have further info on this? I know that in peds, there is no benefit compared to placebo.... but in adults, the recent literature that I have reviewed demonstrated that it was effective for adults. As effective as codeine. I admittedly Ex a decent amount of DM-promethazine (95% sure this was an EMEDPA recommendation...) with good results, so I'm curious. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted November 9, 2016 Administrator Share Posted November 9, 2016 Do you have further info on this? I know that in peds, there is no benefit compared to placebo.... but in adults, the recent literature that I have reviewed demonstrated that it was effective for adults. As effective as codeine. I admittedly Ex a decent amount of DM-promethazine (95% sure this was an EMEDPA recommendation...) with good results, so I'm curious. I don't; I'm not aware of that recent literature stating adult efficacy. Funny how it doesn't get promoted on Medscape like studies on non-generic drug benefits... Tell me more? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted November 9, 2016 Author Share Posted November 9, 2016 OMG! Now they're going to come to your ED with a dystonic reaction! "Nurse! Have the Benadryl ready!" [emoji6] Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 10, 2016 Moderator Share Posted November 10, 2016 thanks for the info. did not know this. I generally write tessalon for cough. Link to comment Share on other sites More sharing options...
chichamorada Posted November 10, 2016 Share Posted November 10, 2016 Thank you for pointing this out. I'm in school, and just finished two semesters of pharm and never heard about this combo as potentially causing serotonin syndrome. This is a great reminder for me to be careful once I'm out in 'the world' and address all the OTC meds that a person could be taking prn. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted November 10, 2016 Author Share Posted November 10, 2016 Is this just specific to venlafaxine or all serotonin antidepressants? My opinion.....I am not prescribing the DM. So, if the patient gets an OTC med it is their responsibility to talk to the pharmacist about any drug interactions. Now, this does not apply to all meds. For instance, patient's taking coumadin need specific instructions about drug interactions. Should be a risk for any medication that impacts serotonin. For review, here are more common preparations which could be hazardous to your health. See "Causative Agents tab. http://www.medscape.com/viewarticle/733706_2 There are some pretty COMMON medications on that list! Link to comment Share on other sites More sharing options...
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