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Dr. Ed Wilfong
Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience:  Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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Where are you located & are you accepting new patients?

Resolved Question:

Where are you located & are you accepting new patients?
Submitted: 8 months ago.
Category: Mental Health
Expert:  Elliott, LPCC, NCC replied 8 months ago.

Elliott, LPCC, NCC :

Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Elliott, LPCC, NCC :

Dear friend,

Elliott, LPCC, NCC :

I believe that I can help.

Elliott, LPCC, NCC :

ewilfong is no longer available at JustAnswer and I can give you no contact information.

Elliott, LPCC, NCC :

I am a top rated therapist with 6000 accepted answers in mental health, relationship, and other related areas and will be happy to help if you like.

Elliott, LPCC, NCC :

If not, please let me know and I shall be happy to refer you for a refund.

Elliott, LPCC, NCC :

Warm regards,

Elliott, LPCC, NCC :

Elliott, MAE, LPCC, NCC, CCMHC

Elliott, LPCC, NCC :

If you would like me to help, please explain your circumstances.

Customer:

Thank you. My question is a pharmaceutical, mental health question.

Elliott, LPCC, NCC :

I am listening.

Customer:

My daughter, age 21, has been having repeated seizures. She takes 100 mg Zoloft, 20 mg Suboxone, and xanex as needed. I control the xanex & administer. She usually takes it when she feels the seizure coming on since she believes it may prevent it. It usually does not. I have researched this combination and found little as far as seizures.

Elliott, LPCC, NCC :

What causes the seizures?

Customer:

Yes in relation to the medications.

Customer:

Do you see a direct correlation between the mixture of meds and the seizures?

Customer:

I understand this is a specialized area.

Elliott, LPCC, NCC :

Suboxone and Xanax together do not cause seizures, but they are nevertheless listed as high risk to take together.

Elliott, LPCC, NCC :

The reputable drugs.com says this about her meds:

Elliott, LPCC, NCC :

Interactions between your selected drugs



alprazolam ↔ buprenorphine


Applies to: Xanax (alprazolam), Suboxone (buprenorphine / naloxone)



Consumer information

Full Size Image
for this interaction is not currently available.


MONITOR CLOSELY: Concomitant use of buprenorphine with benzodiazepines or other central nervous system (CNS) depressants such as alcohol has been associated with increased risk of buprenorphine overdose, severe respiratory depression, coma, and death. Reported cases have primarily occurred in the setting of buprenorphine maintenance treatment for opiate addiction, and many, but not all, involved abuse or misuse of buprenorphine including intravenous self-injection. The exact mechanism of interaction is unknown, but preclinical studies

Full Size Image
suggest that benzodiazepines can alter the usual ceiling effect on buprenorphine-induced respiratory depression and render the respiratory effects of buprenorphine appear similar to those of full opioid agonists.

MANAGEMENT
Full Size Image
: Extreme caution is advised when prescribing buprenorphine in conjunction with benzodiazepines or other CNS depressants including alcohol, or when prescribing buprenorphine to patients who are addicted to opioids and also abusing benzodiazepines or alcohol. Due to potential risk of overdose and death, dependence on sedative-hypnotics such as benzodiazepines or alcohol is considered a relative contraindication for office-based buprenorphine treatment of opioid addiction. Dosage reduction of CNS depressants, buprenorphine, or both should be considered if concomitant use is necessary.



buprenorphine ↔ sertraline


Applies to: Suboxone (buprenorphine / naloxone), Zoloft (sertraline)



Using buprenorphine together with sertraline may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor

Full Size Image
about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.


Switch to professional interaction data



alprazolam ↔ sertraline


Applies to: Xanax (alprazolam), Zoloft (sertraline)



Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare

Full Size Image
provider can determine if adjustments to your medications are needed.

For a clinical details see professional interaction data.

Elliott, LPCC, NCC :

This is found at a site I "prepared" by listing the three meds together.

Elliott, LPCC, NCC :

Is your daughter in withdrawal from other drugs or alcohol (for which she is taking Suboxone)?

Elliott, LPCC, NCC :

This is the site, by the way

Elliott, LPCC, NCC :

http://www.drugs.com/interactions-check.php?drug_list=439-2040,133-54,2057-1348

Elliott, LPCC, NCC :

She could be getting the seizures because of her withdrawal from other drugs.

Customer:

She does take suboxone for opiate withdrawal (pain killers). I don't believe she is withdrawing from any drug. Since I administer the xanex & it doesn't have time to absorb her body, before the onset of the seizure, I didn't think it was the xanex.

Elliott, LPCC, NCC :

Xanax, or more likely another benzodiazepine, Klonopin (clonazepam) are sometimes used to control seizures, but are not recomended for the long term.

Elliott, LPCC, NCC :

It is very possible that the seizures are due to the opiate withdrawal, even with Suboxone.

Customer:

My daughter's neurologist and PCP did not warn her about the contraindications of these drugs & I need to know what, in particular may be causing the seizures.

Customer:

She has cut down on the suboxone gradually. She started at 8 mg and over a year, has reduced to 2mg.

Elliott, LPCC, NCC :

These contraindications are nevertheless well documented.

Customer:

which drug, in particular, do you think is the culprit?

Elliott, LPCC, NCC :

It could be the Suboxone.

Elliott, LPCC, NCC :

Once again I quote from drugs.com:

Elliott, LPCC, NCC :

 



Narcotic Analgesics (Includes Suboxone) ↔ Seizure Disorders


Moderate Potential Hazard, Low plausibility


Applies to: Seizures



Narcotic (opioid) analgesic agents may exacerbate seizures in patients with seizure disorders and, at higher dosages, have been reported to induce seizures in patients without previous history of seizures. The proconvulsant activity may be the greatest with meperidine, the active metabolite of which is thought to be responsible. Therapy with opioids should be administered cautiously in patients with or predisposed to seizures.

Elliott, LPCC, NCC :

from http://www.drugs.com/answers/can-suboxone-cause-seizures-if-youve-had-drug-162808.html

Elliott, LPCC, NCC :

People react differently to psychotropic medications and some adapt well and others are prone to side effects, some of them severe.

Customer:

I intend to print this chat out & give to my daughter. Do you have any further information or advice to give her, including alcohol use - whether or not it is occasional.

Elliott, LPCC, NCC :

She has an addictive personality and should not indulge in alcohol.

Elliott, LPCC, NCC :

Give me a moment please to add alcohol to her other drugs and give you the outcome:

Elliott, LPCC, NCC :

Here's what it looks like if you add ethanol (the alcohol and people drink):

Elliott, LPCC, NCC :

nteractions between your selected drugs



alprazolam ↔ buprenorphine


Applies to: Xanax (alprazolam), Suboxone (buprenorphine / naloxone)



Consumer information

Full Size Image
for this interaction is not currently available.


MONITOR CLOSELY: Concomitant use of buprenorphine with benzodiazepines or other central nervous system (CNS) depressants such as alcohol has been associated with increased risk of buprenorphine overdose, severe respiratory depression, coma, and death. Reported cases have primarily occurred in the setting of buprenorphine maintenance treatment for opiate addiction, and many, but not all, involved abuse or misuse of buprenorphine including intravenous self-injection. The exact mechanism of interaction is unknown, but preclinical studies

Full Size Image
suggest that benzodiazepines can alter the usual ceiling effect on buprenorphine-induced respiratory depression and render the respiratory effects of buprenorphine appear similar to those of full opioid agonists.

MANAGEMENT
Full Size Image
: Extreme caution is advised when prescribing buprenorphine in conjunction with benzodiazepines or other CNS depressants including alcohol, or when prescribing buprenorphine to patients who are addicted to opioids and also abusing benzodiazepines or alcohol. Due to potential risk of overdose and death, dependence on sedative-hypnotics such as benzodiazepines or alcohol is considered a relative contraindication for office-based buprenorphine treatment of opioid addiction. Dosage reduction of CNS depressants, buprenorphine, or both should be considered if concomitant use is necessary.



buprenorphine ↔ ethanol


Applies to: Suboxone (buprenorphine / naloxone), Alcohol (contained in alcoholic beverages) (ethanol)



Consumer information for this interaction is not currently available.


MONITOR CLOSELY: Concomitant use of buprenorphine with benzodiazepines or other central nervous system

Full Size Image
(CNS) depressants such as alcohol has been associated with increased risk of buprenorphine overdose, severe respiratory depression, coma, and death. Reported cases have primarily occurred in the setting of buprenorphine maintenance treatment for opiate addiction, and many, but not all, involved abuse or misuse of buprenorphine including intravenous self-injection. The exact mechanism of interaction is unknown, but preclinical studies suggest that benzodiazepines can alter the usual ceiling effect on buprenorphine-induced respiratory depression and render the respiratory effects of buprenorphine appear similar to those of full opioid agonists.

MANAGEMENT: Extreme caution is advised when prescribing buprenorphine in conjunction with benzodiazepines or other CNS depressants including alcohol, or when prescribing buprenorphine to patients who are addicted to opioids and also abusing benzodiazepines or alcohol. Due to potential risk of overdose and death, dependence on sedative-hypnotics such as benzodiazepines or alcohol is considered a relative contraindication for office-based buprenorphine treatment of opioid addiction. Dosage reduction of CNS depressants, buprenorphine, or both should be considered if concomitant use is necessary.



buprenorphine ↔ sertraline


Applies to: Suboxone (buprenorphine / naloxone), Zoloft (sertraline)



Using buprenorphine together with sertraline may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins

Full Size Image
and herbs. Do not stop using any medications without first talking to your doctor.


Switch to professional interaction data



alprazolam ↔ ethanol


Applies to: Xanax (alprazolam), Alcohol (contained in alcoholic beverages) (ethanol)



Using ALPRAZolam together with ethanol can increase nervous system side effects such as dizziness

Full Size Image
, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with ALPRAZolam. Do not use more than the recommended dose of ALPRAZolam, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.


Switch to professional interaction data



sertraline ↔ ethanol


Applies to: Zoloft (sertraline), Alcohol (contained in alcoholic beverages) (ethanol)



Using sertraline together with ethanol can increase nervous system

Full Size Image
side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with sertraline. Do not use more than the recommended dose of sertraline, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.


Switch to professional interaction data



alprazolam ↔ sertraline


Applies to: Xanax (alprazolam), Zoloft (sertraline)



Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

Elliott, LPCC, NCC :

It is contraindicated with Suboxone and she should refrain from drinking.

Elliott, LPCC, NCC :

Those are TWO important reasons not to drink.

Elliott, LPCC, NCC :

The third, is that alcohol could lower her resistance to temptation to take other drugs.

Customer:

can this chat be printed?

Elliott, LPCC, NCC :

Yes. Either print directly or copy the chat to WORD and then save and or print

Elliott, LPCC, NCC :

Or you can save this chat directlyo.

Elliott, LPCC, NCC :

It will also be available if you come back to it.

Elliott, LPCC, NCC :

I wish both of you great success and shall keep you in my prayers.

Elliott, LPCC, NCC :

Warm regards,

Elliott, LPCC, NCC :

Elliott

Customer:

thank you for your time & good advice. I will certainly give you positive feedback.

Elliott, LPCC, NCC :

Thank you so much. I wish you my heartfelt good wishes.

Customer:

Thank you for your kindness.

Elliott, LPCC, NCC :

You are so welcome. It is my pleasure.

Expert:  Elliott, LPCC, NCC replied 8 months ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Customer: replied 8 months ago.

Very pleased with Elliot. He is informative, patient & compassionate.


 

Expert:  Elliott, LPCC, NCC replied 8 months ago.
Thank you again. You are most kind.

Elliott
Expert:  Dr. Ed Wilfong replied 8 months ago.

As far as I know I am still available on JA. Unfortunately, I am on a medical leave of absence, so I am not sure when or if I will be available in near future. I am located on N.E. side of Sacramento, CA in a small suburb. Good luck in your search to find a good psychologist. Ed Wilfong, Ph.D.

 

PS. Suboxone can only be administered by by a licensed MD with specialized training (I took a peek at your ??), at least in CA. Theoretically it is to help with opiate withdrawal by blocking the euphoric effects of opiates, but it still has some opiate effects. It is a last resort treatment for opiate addiction and other drugs and vital signs must be monitored. Here (it is given in person daily in clinic) until patient is stable.

 

You really need to have consultation by MD with addiction speciality.

 

Regards,

 

Ed

Customer: replied 8 months ago.

Thank you for reviewing my question. My daughter is under the care of a neurologist. Before she commits to taking an anti-seizure medication for years, I need to eliminate the possibility or likelihood that it is a drug that is causing her seizures. Based on your response, it seems that you suspect that the suboxone may be the culprit?


 


 

Expert:  Dr. Ed Wilfong replied 8 months ago.
Given the complexity of her meds, it is tough to tell. Xanax and related medication Withdrawal can cause seizures. Alcohol withdrawal can also cause seizures.

Taking an anti-seizure drug is not a long term commitment. Some (e.g. Klonapin) are long acting benzodiazapines. Others, such as Neurontin are pretty benign.

I was more concerned about suboxone not be properly administered, not necessarily the cause of the seizures.

You are correct that the xanax could not be administered as need for seizure prevent. It would need to be a longer acting medication taken consistently to help.

I would be inclined to trust neurologist on this, make sure the opiate (and subsequent suboxone) are totally clear from system, then try to track down cause of seizures. The cleaner she is, the easier it will be. Once she is only on anti-seizure meds, it would make sense to repeat EEG and any brain scans and possibly try discontinuation of anti-seizure (depending on test results.) Always push your doctor for any info you don't understand.
Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience: Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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