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NJPharmacist, Pharmacist
Category: Pharmacy
Satisfied Customers: 116
Experience:  Hospital Pharmacist, with solid clinical knowledge.
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Customer Question

I have been diagnosed with PTSD along with my long-time chronic depression. The psychiatrist increased my Effexor from 300 mg. to 375 mg. and added 75 mg. of trazodone to aid in sleeping. For the first three weeks I felt good, but now I feel dizzy, irritable, nervous and nausous. Could this be a negative reaction to the combination of Effexor and the Trazodone?
Submitted: 4 years ago.
Category: Pharmacy
Expert:  DrThomasMd replied 4 years ago.
Yes it could
You need to talk to the doc about the dosing, and possibly switching one of the meds.
This can also be temporary but the doc needs to evaluate the dosing

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Customer: replied 4 years ago.
I clicked on "Ask a Pharmacist". A doctor is the one that prescribed the two medications together. Since pharmacists know drug interactions by nature of their business, that was the expert I asked to be connected to. I know that I should contact the doctor, but I wanted a drug expert's advice to discuss with him. Thank you anyway.
Expert:  NJPharmacist replied 4 years ago.

Hello. I would love to answer your question.


I do agree with the expert regarding speaking to the combination of the medications.


I can tell you, though, that both of these medications do work similiar pathways, via serotonin, and both can certain cause a side effect of nervousness, tremors, increased anxiety when increasing doses.


In rare cases, when combining too many of these medications, one can experience serotonin syndrome, which requires immediate medical assistance.


Are you taking Effexor XR?


The maximum of Effexor XR is 300 mg for PTSD. Some MDs may choose to go above this under close watch, however, this is not generally recommended. Also, Effexor XR is used Off-label for PTSD. This generally means that has been accepted by members of the medical community to treat the condition, just has not received the indication yet from the FDA

Expert:  NJPharmacist replied 4 years ago.

Sorry typo. I mean to say I do agree with the previous expert . You always have to speak to an MD regarding this combination, and can be temporary. However, it seems like your doses are a little high, especially with the combination with trazodone. This can generally be a little troublesome in terms of the side effects for a patient. However, some MDs may believe a patient will have a benefit from increasing a dose. I would certainly seek medical care if this becomes a problem.


Do you currently take any other medications? Herbals? Over the counter medications?

Expert:  NJPharmacist replied 4 years ago.
And also, are you seeing a general physician, or a psychiatrist?
Expert:  NJPharmacist replied 4 years ago.

I see you have said you are seeing a psychiatrist. Let me sum up some advice for you:


1) The combination of medications can certainly cause what you are feeling. This is especially true when adding/increasing dosages. The combination of the two medications, is sometimes avoided due to the interaction. Some psychiatrists, however, like to give this combination of medication if they believe there is a benefit for the patient.


2)The Effexor dose is above the maximum for PTSD. I would speak to your MD regarding so. Using Effexor above the maxmium along with trazodone , can have bad consequences. Your MD should be very very careful with your drug regimen. I am not an MD, but from a pharmacists stand point, I cringe when I see these combos at high doses.


3) Avoid herbals, such as St John's Wart, as these can increase these symptoms, and toxicities.


4)Never take more/less than what is prescribed unless you speak to an MD first.


Let me know if you have changed any drug doses, or added anything too. The more info you give me, the better equipped I am to help you.

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