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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Sandy Garner on August 28, 2000, at 10:56:06
I was in a car accident and was seriously hurt. Also my 4 year old daughter was killed by being thrown from her car seat and the vehicle. I have been dealing with severe pain, depression and anxiety. Needless to say I haven't slept well in so long I can't remember. The Dr. prescriped Paxil 20 mg and Ambien 10 mg. I was exhausted all day and nearly passed out when taking the Ambien at bedtime. Of a daytime I have amnesia symptons, severe, SEVERE, head aches, nausea and confusion. I feel my world is spinning and disoriented. Is this fromt he two combinations or what. I need help! Has anyone else experienced this? I am afraid to go off the Paxil because of the news on withdrawel and I am afraid to go off the Ambien for fear I won't sleep. It's bad enough to feel this way all day, I don't also want to be awake all night feeling this way to! Anyone- please give me info!
Thanks,
Sandy
Posted by Greg on August 29, 2000, at 14:26:26
In reply to Paxil and Ambien, posted by Sandy Garner on August 28, 2000, at 10:56:06
Sandy,
I've been on Paxil for about 4 weeks now and quite honestly I can't say that it's done anything for me. I haven't had any noticible side-effects from it, it just doesn't do anything for me. I started Depakote yesterday so I am playing the wait-and-see game right now.
I have been on Ambien for over a year and am very happy with it. I am an insomniac and it is the only thing that allows me any sleep. I've never noticed any negative effect resulting from the two meds together, but that doesn't mean that they aren't having that effect on you. I would suggest talking to your doctor about this at your earliest convenience.
You've been thru a nightmare in your life and I'm sure that is contributing greatly to what you are feeling. I have three children and the thought of losing any of them is terrifying. Please know that my thoughts and prayers are with you in this most difficult of times.
Please stay in touch with us and let us know how you are doing. And call your doc and let him/her know what's happening with you.
My deepest sympathies,
Greg> I was in a car accident and was seriously hurt. Also my 4 year old daughter was killed by being thrown from her car seat and the vehicle. I have been dealing with severe pain, depression and anxiety. Needless to say I haven't slept well in so long I can't remember. The Dr. prescriped Paxil 20 mg and Ambien 10 mg. I was exhausted all day and nearly passed out when taking the Ambien at bedtime. Of a daytime I have amnesia symptons, severe, SEVERE, head aches, nausea and confusion. I feel my world is spinning and disoriented. Is this fromt he two combinations or what. I need help! Has anyone else experienced this? I am afraid to go off the Paxil because of the news on withdrawel and I am afraid to go off the Ambien for fear I won't sleep. It's bad enough to feel this way all day, I don't also want to be awake all night feeling this way to! Anyone- please give me info!
> Thanks,
> Sandy
Posted by jane on August 29, 2000, at 18:27:27
In reply to Re: Paxil and Ambien » Sandy Garner, posted by Greg on August 29, 2000, at 14:26:26
> > I was in a car accident and was seriously hurt. Also my 4 year old daughter was killed by being thrown from her car seat and the vehicle. I have been dealing with severe pain, depression and anxiety. Needless to say I haven't slept well in so long I can't remember. The Dr. prescriped Paxil 20 mg and Ambien 10 mg. I was exhausted all day and nearly passed out when taking the Ambien at bedtime. Of a daytime I have amnesia symptons, severe, SEVERE, head aches, nausea and confusion. I feel my world is spinning and disoriented. Is this fromt he two combinations or what. I need help! Has anyone else experienced this? I am afraid to go off the Paxil because of the news on withdrawel and I am afraid to go off the Ambien for fear I won't sleep. It's bad enough to feel this way all day, I don't also want to be awake all night feeling this way to! Anyone- please give me info!
> > Thanks,
> > Sandy
Sandy - I have taken Ambein and Paxil together.
Paxil did give me severe headaches, esp coming off of it, but maybe I did that too quickly.
I'm still on Ambein and have been for several years. I do have memory loss with Ambien, and it is different than the short term memory loss that is discussed in other threads. It is more like a blackout. After I take Ambien in the evening, I don't remember much until the next morning. I can email, do household chores, have conversations, before I go to sleep and not necessarily remember. The blackout is worse if I happen to wake up in the middle of the night. But it is still worth it to take the ambien because I won't sleep at all without it; I have just become very careful about the time I take it and what I do afterwards. Hope this helps.
Let us know how you are doing. jane
Posted by bee on August 29, 2000, at 19:40:23
In reply to Re: Paxil and Ambien, posted by jane on August 29, 2000, at 18:27:27
Maybe it's time to talk to your doctor about the side effects you are experiencing. I haven't taken these two combos but I would contact my doctor if I was experiencing these side effects. There are a lot more medications out there. The older tricyclics helped me with depression and insomnia but every one is different on medications. Talk to your doctor.
If you withdraw slowly off the Paxil and keep up with your sleep, it should be okay. A slow process but better than going along the way you are now. Your doctor has way more knowledge than me about this. Also, this board is wonderful for help on meds.
I'm very sorry about the death of your daughter. Losing a child at any age is awful. I have been going through something along this line when a friend's child who died at 10 and can only imagine what you are feeling. Please know you are in my thoughts. Try to look after yourself.
Take care.
bee
Posted by Sunnely on August 30, 2000, at 19:52:13
In reply to Paxil and Ambien, posted by Sandy Garner on August 28, 2000, at 10:56:06
> The Dr. prescriped Paxil 20 mg and Ambien 10 mg. I was exhausted all day and nearly passed out when taking the Ambien at bedtime. Of a daytime I have amnesia symptons, severe, SEVERE, head aches, nausea and confusion. I feel my world is spinning and disoriented. Is this fromt he two combinations or what.
> SandySandy,
Although these adverse effects can occur with the use of either paroxetine (Paxil) or zolpidem (Ambien) alone, they are probably magnified more by the combined use of these drugs; a form of drug-drug interaction.
I would venture to say that your blood level of Ambien is at toxic level causing these problems. Allow me to explain how this can happen in your case. Based on "pharmacokinetic" drug-drug interaction, Paxil can intensify the pharmacological effects (therapeutic and adverse effects) of Ambien. Paxil is a potent inhibitor of the liver enzyme called CYP2D6. Ambien is primarily metabolized (broken down) by the liver enzyme CYP3A4. Therefore, this practically rules out the role of liver enzymes in these adverse effects caused by the Paxil-Ambien interaction. The "pharmacokinetic" drug interaction involved is most likely the "protein-binding" displacement. Paxil is highly protein-bound (approximately 95%) while Ambien is approximately 92%. The portion of the drug that is not bound to proteins is called "free fraction." Only the "free fraction" of the drug is considered pharmacologically active, exerting both the therapeutic and adverse effects. The protein-bound portion of the drug is considered pharmacologically inactive, therefore does not have any role in its pharmacologic effects.
Since Paxil is highly protein bound, it will displace Ambien from its protein-binding, therefore more unbound or "free fraction" of Ambien is formed, leading to increased side effects and even toxicity. It's like playing "musical chairs." There is not enough proteins available to accomodate both Paxil and Ambien, together. Therefore, the more "powerful" (Paxil) attaches itself to the available proteins much stronger than Ambien, leading to more Ambien portion being displaced ("free fraction").
Aside from the one I described above (protein-binding effect), other risk factors to increased Ambien side effects/toxicity include gender, dose, and the cytochrome enzymes.
Gender seems to play an important role in risk of Ambien toxicity. (I am assuming you are a woman.) Eighty-two percent (82.4%) of Ambien-induced hallucinations (psychosis) reported were among female patients. Women have been found to have a significantly higher blood level of Ambien (40%) than men at equivalent dosages. Therefore, women may experience Ambien toxicity at the same doses that male patients are able to tolerate well.
The dose of Ambien used is also another risk factor. In case reports of Ambien-induced hallucinations (psychosis), they tend to occur more in doses greater than 5 mg per day. There were no reports of hallucinations or psychosis when patients took doses of 5 mg or less.
Finally, the extent of liver enzyme (CYP3A4) inhibition by the concmitantly used drugs with Ambien, is also a risk factor for Ambien toxicity. Any drug that significantly inhibits the action of this liver enzyme could reduce Ambien metabolism, leading to toxic levels. Examples of these drugs are Serzone (nefazodone), Prozac (fluoxetine, norfluoxetine), antibiotics such as erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), antifungal drugs (Nizoral, Sporanox), cimetidine (Tagamet), and grapefruit juice.
Based on the above analysis, you meet at least 3 (out of 4) risk factors for Ambien toxicity: 1) the use of a highly protein-bound drug (Paxil) along with Ambien; 2) female gender (I assume you are); and 3) the dose is greater than 5 mg per day.
FYI, numerous side effects have been associated with Ambien use. In a review of the clinical trials, central nervous system (CNS) related adverse effects included lightheadedness or dizziness (5.2%), daytime drowsiness (5.2%), headache (3.0%), fatigue (2.4%), memory deficits (1.8%), nightmares (1.6%), confusion (1.6%), and depression (1.2%). The most commonly seen non-CNS related adverse effects included nausea or vomiting (2.5%), falls (2.3%), malaise (1.4%), stomach or abdominal pain (1.1%), and dry or coated mouth (1.1%).
In a later postmarketing study of 1,972 patients treated with Ambien, 8.9% reported adverse effects and 5.2% of patients discontinued treatment. In this study, the most common CNS-related adverse effects were "residual daytime sedation-like symptoms" (3.7%). Delirium, nightmares, and hallucinations were reported in less than 1% of patients.
The daytime amnesia you described seems to occur more commonly with the short half-life hypnotics (sleeper) drug such as triazolam (Halcion) and zolpidem (Ambien). This is called the "morning-after amnesia," wherein you don't remember what you did the night before. This adverse reaction can be frightening sometimes.
I suggest you discuss this problem with your doctor, and the possibility that you are experiencing a drug-drug interaction (Paxil + Ambien), ASAP. I believe you need some dosage adjustments, at least a dose reduction of Ambien.
JMHO (Just my humber opinion).
References:
1. Toner LC, Tsambiras BM, Catalano G, Catalano MC, Cooper MS: Central nervous system side effects associated with zolpidem treatment. Clinical Neuropsychopharmacology 1999;23(1):54-58.
2. Zolpidem-induced delirum. In: Primary Psychiatry, August 2000.
Posted by LucindaLinda on September 2, 2000, at 1:08:38
In reply to Re: Paxil and Ambien, posted by Sunnely on August 30, 2000, at 19:52:13
Hi Sandy,
My heart goes out to you.I took Ambien for about 8 months, and boy I had to be next to the bed when I took it because it worked so quickly. In the first couple days I also had headaches but started breaking the pills in 1/2 (5mg.) and no more headaches and I still got to sleep rather quickly. I began noticing after about 4 months that I could not feel my husbands touch and was unable to experience any kind of satisfactory sex after that and when I told my doctor of this side affect, she said that response was not listed in the side affects for that drug. I quit taking it about a month ago and went back to Elavil 25 mg. at night and Celexa 1/4 tab in the morning. So far so good. I was on Paxil several years back and felt so flat, blah, no up but no downs either sorta zombie like and of course no sex :o( Hope this helps some, of course everyone is so different, just have to keep after the doctors till you find something that helps you and listen to what your body is telling you is going on even if your doctor doesn't. I thought that if I could get a good nights sleep I would not be so depressed but it didn't work that way for me. I have Fibromyalgia and the depression is just part of that syndrome, along with full body ache, loss of memory and insominia. Good luck to you...
> > The Dr. prescriped Paxil 20 mg and Ambien 10 mg. I was exhausted all day and nearly passed out when taking the Ambien at bedtime. Of a daytime I have amnesia symptons, severe, SEVERE, head aches, nausea and confusion. I feel my world is spinning and disoriented. Is this fromt he two combinations or what.
> > Sandy
>
> Sandy,
>
> Although these adverse effects can occur with the use of either paroxetine (Paxil) or zolpidem (Ambien) alone, they are probably magnified more by the combined use of these drugs; a form of drug-drug interaction.
>
> I would venture to say that your blood level of Ambien is at toxic level causing these problems. Allow me to explain how this can happen in your case. Based on "pharmacokinetic" drug-drug interaction, Paxil can intensify the pharmacological effects (therapeutic and adverse effects) of Ambien. Paxil is a potent inhibitor of the liver enzyme called CYP2D6. Ambien is primarily metabolized (broken down) by the liver enzyme CYP3A4. Therefore, this practically rules out the role of liver enzymes in these adverse effects caused by the Paxil-Ambien interaction. The "pharmacokinetic" drug interaction involved is most likely the "protein-binding" displacement. Paxil is highly protein-bound (approximately 95%) while Ambien is approximately 92%. The portion of the drug that is not bound to proteins is called "free fraction." Only the "free fraction" of the drug is considered pharmacologically active, exerting both the therapeutic and adverse effects. The protein-bound portion of the drug is considered pharmacologically inactive, therefore does not have any role in its pharmacologic effects.
>
> Since Paxil is highly protein bound, it will displace Ambien from its protein-binding, therefore more unbound or "free fraction" of Ambien is formed, leading to increased side effects and even toxicity. It's like playing "musical chairs." There is not enough proteins available to accomodate both Paxil and Ambien, together. Therefore, the more "powerful" (Paxil) attaches itself to the available proteins much stronger than Ambien, leading to more Ambien portion being displaced ("free fraction").
>
> Aside from the one I described above (protein-binding effect), other risk factors to increased Ambien side effects/toxicity include gender, dose, and the cytochrome enzymes.
>
> Gender seems to play an important role in risk of Ambien toxicity. (I am assuming you are a woman.) Eighty-two percent (82.4%) of Ambien-induced hallucinations (psychosis) reported were among female patients. Women have been found to have a significantly higher blood level of Ambien (40%) than men at equivalent dosages. Therefore, women may experience Ambien toxicity at the same doses that male patients are able to tolerate well.
>
> The dose of Ambien used is also another risk factor. In case reports of Ambien-induced hallucinations (psychosis), they tend to occur more in doses greater than 5 mg per day. There were no reports of hallucinations or psychosis when patients took doses of 5 mg or less.
>
> Finally, the extent of liver enzyme (CYP3A4) inhibition by the concmitantly used drugs with Ambien, is also a risk factor for Ambien toxicity. Any drug that significantly inhibits the action of this liver enzyme could reduce Ambien metabolism, leading to toxic levels. Examples of these drugs are Serzone (nefazodone), Prozac (fluoxetine, norfluoxetine), antibiotics such as erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), antifungal drugs (Nizoral, Sporanox), cimetidine (Tagamet), and grapefruit juice.
>
> Based on the above analysis, you meet at least 3 (out of 4) risk factors for Ambien toxicity: 1) the use of a highly protein-bound drug (Paxil) along with Ambien; 2) female gender (I assume you are); and 3) the dose is greater than 5 mg per day.
>
> FYI, numerous side effects have been associated with Ambien use. In a review of the clinical trials, central nervous system (CNS) related adverse effects included lightheadedness or dizziness (5.2%), daytime drowsiness (5.2%), headache (3.0%), fatigue (2.4%), memory deficits (1.8%), nightmares (1.6%), confusion (1.6%), and depression (1.2%). The most commonly seen non-CNS related adverse effects included nausea or vomiting (2.5%), falls (2.3%), malaise (1.4%), stomach or abdominal pain (1.1%), and dry or coated mouth (1.1%).
>
> In a later postmarketing study of 1,972 patients treated with Ambien, 8.9% reported adverse effects and 5.2% of patients discontinued treatment. In this study, the most common CNS-related adverse effects were "residual daytime sedation-like symptoms" (3.7%). Delirium, nightmares, and hallucinations were reported in less than 1% of patients.
>
> The daytime amnesia you described seems to occur more commonly with the short half-life hypnotics (sleeper) drug such as triazolam (Halcion) and zolpidem (Ambien). This is called the "morning-after amnesia," wherein you don't remember what you did the night before. This adverse reaction can be frightening sometimes.
>
> I suggest you discuss this problem with your doctor, and the possibility that you are experiencing a drug-drug interaction (Paxil + Ambien), ASAP. I believe you need some dosage adjustments, at least a dose reduction of Ambien.
>
> JMHO (Just my humber opinion).
>
> References:
>
> 1. Toner LC, Tsambiras BM, Catalano G, Catalano MC, Cooper MS: Central nervous system side effects associated with zolpidem treatment. Clinical Neuropsychopharmacology 1999;23(1):54-58.
>
> 2. Zolpidem-induced delirum. In: Primary Psychiatry, August 2000.
This is the end of the thread.
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