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Thread: Xanax, wellbutrin, tegretol, and trazodone.

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    Xanax, wellbutrin, tegretol, and trazodone. 
    #1
    Hi I'm on 75 mg wellbutrin 100 mg tegretol and 100 mg trazodone. My psychiatrist wants me to try xanax to help calm my anxiety. I feel like that's a lot of mood stabilizing in one day, does anyone know anything about these drug interactions?
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    #2
    The carbamazepine (Tegretol) doesn't really make sense in that combination. It can interfere with the alprazolam (Xanax) and bupropion (wellbutrin), decreasing their effectiveness.

    What is your full diagnosis (in other words, what is the list of conditions these drugs are meant to treat?)
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    #3
    Bluelighter deaf eye's Avatar
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    Quote Originally Posted by lingerfeltkk View Post
    Hi I'm on 75 mg wellbutrin 100 mg tegretol and 100 mg trazodone. My psychiatrist wants me to try xanax to help calm my anxiety. I feel like that's a lot of mood stabilizing in one day, does anyone know anything about these drug interactions?
    go to drugs.com they have an interaction checker

    i checked it and theres several moderate to one major interactions , but i think the major interaction is at higher doses, plus are you taking extended release pills ?

    bupropion ↔ trazodone

    Applies to: Wellbutrin (bupropion), trazodone

    MONITOR CLOSELY: The use of bupropion is associated with a dose-related risk of seizures. The estimated incidence of seizures is approximately 0.1% at dosages up to 300 mg/day and 0.4% at dosages between 300 to 450 mg/day, but increases almost tenfold between 450 mg and 600 mg/day. The risk may also be increased during coadministration with selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, and/or any substance that can reduce the seizure threshold (e.g., carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, theophylline). These agents are often individually epileptogenic and may have additive effects when combined.

    MANAGEMENT: Extreme caution is advised if bupropion is administered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with a history of seizures or other risk factors for seizures (e.g., head trauma; brain tumor; severe hepatic cirrhosis; metabolic disorders; CNS infections; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin). Bupropion as well as concomitant medications should be initiated at the lower end of the dose range and titrated gradually if feasible. The total dose of bupropion should generally not exceed 450 mg/day (or 150 mg every other day in patients with severe hepatic cirrhosis). Bupropion should be discontinued and not restarted in patients who experience a seizure during treatment.
    carbamazepine ↔ alprazolam

    Applies to: Tegretol (carbamazepine), Xanax (alprazolam)

    MONITOR: Some antiepileptic agents such as carbamazepine and phenytoin significantly reduce the effect of oral midazolam. The mechanism may be due to enhanced gut and liver metabolism of midazolam (via CYP450 3A4 enzyme induction by carbamazepine). Parenteral midazolam is not likely to be affected. Other oral benzodiazepines metabolized by the 3A4 isoenzyme may interact similarly.

    MANAGEMENT: Patients receiving this combination should be monitored for clinical response. Alternative oral sedative hypnotics may be preferable in patients receiving carbamazepine.
    carbamazepine ↔ bupropion

    Applies to: Tegretol (carbamazepine), Wellbutrin (bupropion)

    MONITOR: Bupropion is extensively metabolized by hepatic microsomal enzymes, primarily CYP450 2B6. Theoretically, plasma concentrations and pharmacologic effects of bupropion may be diminished when given concurrently with some CYP450 enzyme inducers.

    MANAGEMENT: Pharmacologic response to bupropion should be monitored more closely whenever a CYP450 inducer is added to or withdrawn from therapy, and the bupropion dosage adjusted as necessary.
    alprazolam ↔ bupropion

    Applies to: Xanax (alprazolam), Wellbutrin (bupropion)

    MONITOR: Excessive use or abrupt discontinuation of benzodiazepines and other sedatives after chronic ingestion may precipitate seizures in patients receiving bupropion. Conversely, bupropion may antagonize the central pharmacologic effects of sedatives. Bupropion can cause agitation, anxiety, and insomnia and has been shown to decrease the sedative effect of diazepam in healthy volunteers given single doses of the drugs.

    MANAGEMENT: Although sedatives may be prescribed to treat agitation, anxiety, and insomnia associated with bupropion use, patients should be alerted to the possibility of an increased risk of seizures during excessive exposure to these drugs. Patients should not attempt to alter the dosages or discontinue the medications on their own without consulting with their physician. The use of bupropion is contraindicated in patients undergoing abrupt discontinuation of sedatives.
    carbamazepine ↔ trazodone

    Applies to: Tegretol (carbamazepine), trazodone

    MONITOR: Coadministration with carbamazepine may decrease the plasma concentrations of trazodone and its active metabolite, meta-chlorophenylpiperazine. The proposed mechanism is carbamazepine induction of trazodone metabolism via CYP450 3A4. In six depressed patients treated with trazodone 150 mg to 300 mg daily, plasma concentrations of trazodone and meta-chlorophenylpiperazine were reduced by 76% and 60%, respectively, following administration of carbamazepine 400 mg/day for four weeks compared to pre-carbamazepine values. An isolated case report also suggests that trazodone may inhibit the metabolism of carbamazepine, possibly by competitive inhibition of CYP450 3A4 metabolism. The case patient was a 53-year-old white man who had an increased carbamazepine concentration-dose ratio from 0.89 to 1.12 two months after beginning trazodone treatment. The patient did not exhibit any signs or symptoms of carbamazepine toxicity.

    MANAGEMENT: Pharmacologic response to trazodone should be monitored more closely whenever carbamazepine is added to or withdrawn from stabilized therapy, and the trazodone dosage adjusted as necessary. Similarly, it may be appropriate to monitor carbamazepine levels and pharmacologic effects following initiation, change of dosage, or discontinuation of trazodone therapy. Patients should be advised to contact their physician if they experience potential signs and symptoms of carbamazepine toxicity such as nausea, visual disturbance, dizziness, or ataxia.
    alprazolam ↔ trazodone

    Applies to: Xanax (alprazolam), trazodone

    MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

    MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

    No other interactions were found between your selected drugs.
    Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.


    hope this helps
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    #4
    Bluelighter TheTwighlight's Avatar
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    You need a new Dr., bro.
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    #5
    I'm on wellbutrin for depression, tegretol for anger, xanax for anxiety, trazodone at night just because I have an extremely difficult time sleeping, and then she also prescribed me lamotrigine yesterday for anxiety the xanax being more for panic attacls. I would find a new doctor but the process is terrible. She also offered me ambien instead of trazodone would I be better off with that? Also none of these are extended release, I take two tegretol, wellbutrin, and lamotrigine a day and btw the lamotrigine is 25 mg xanax is only .25 mg.
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    #6
    Bluelight Crew paranoid android's Avatar
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    Jesus christ your doc certainly loves those pills. That fucking overkill by anyones standards really and unless you have epilepsy or bipolar there is no real reason to be on the carbamazepine.
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    #7
    Bluelighter TheTwighlight's Avatar
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    .25mg alpazolam wouldn't help one of my goldfish with anxiety. And they need it to cuz they murdered the fiddler crab and even ate his bones.
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    #8
    Quote Originally Posted by paranoid android View Post
    Jesus christ your doc certainly loves those pills. That fucking overkill by anyones standards really and unless you have epilepsy or bipolar there is no real reason to be on the carbamazepine.
    I guess I should have mentioned I'm not stable yet this is pretty much the beginning of it. And she said I am bipolar or isn't that what a mood disorder is? I just get really angry a lot and she said it'll help me not want to punch people in the face, which it does.

    - have a lot that I'm finally coming to terms with and I feel like she's doing the best she can going off of what I say but I know absolutely nothing about all these pills I just don't want to die or become crazy. Crazier than I am that is.

    As for the xanax being so low I feel like they never give out high doses right away because of the abuse being sooo ridiculous with this drug. Mind you I'm only 20 and she doesn't want me getting addicted blah blah.

    Also, does smoking pot really make of these pills not work? That's what she told me and I can't speak for the other pills but it definitely intensifies xanax.

    I appreciate everyones help!
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