So upset... what would you do?
Moms View Message Board: General Discussion: Archive January 2008:
So upset... what would you do?
Ok, I have chronic back and joint pain, and was given percoset last month because no other pain killers work for me. Even with percoset, I have a naturally high tolerance for drugs, and have to take the max dose just to see any relief. I'm aware of the addiction possibilities so I only took it when needed, maybe 2 times a week. I'm also on Celexa, which is a SSRI. I went in on Monday, and my doctor (who I already planned on leaving because his staff had treated me HORRIBLY) and he prescribed me tramadol instead of the percoset, because it's less addictive. Well, I went into work today, and started shaking BADLY, my assistant said I was scaring her, and my face was bright red. I tried to calm myself, and finally had to be taken to the ER. Come to find out, tramadol should NEVER be prescribed with a SSRI, because it can cause seizures and seratonin syndrome, which can be deadly. My doctor almost killed me. The ER docs were on the phone with poison control to make sure I would be ok, and wanted to keep me for observation, unless I felt I would be ok going home. I opted to go back to work and promised to only do light work in my office, because going home would mean I would be alone. At least in my office there were people to keep an eye on me. So, most people I've talked to today feel I should contact a lawyer. I feel my doctor should pay the medical expenses from the situation, but don't know what the best way to go about it is. I had planned to just go in and demand they cover my expenses, but someone told me that could hurt me legally should I need to file a suit. Any advice? What would you do?
Wow, Crystal!!! I don't know what I'd do, but I guess you can contact an attorney and see what they say. How scary.  Were the meds from the same pharmacy? They should have caught that, too. I'm sure others will know more of what to do.
Yes, they were from the same pharmacy, but not filled at the same time. Of course, they could have checked, but when I filled the tramadol they were SUPER behind, and rushing to fill them because it was past closing. Not at all an excuse, but my doc DEFINITELY should have known better, even WebMD has a strong warning saying they have serious drug drug interactions.
What you describe sounds more like a drug allergy. I know of no contraindication between SSRI's and Tramadol. I take Zoloft and have for years. Last year, my rheumatologist prescribed Tramadol for arthritis pain when I have a really bad flare up. It helps me a lot and I have never had any problem. Tramadol is a very safe drug. My docotr is right on top of the latest information, and the pharmacists where I always get my prescriptions are, too. They would have told me.
I went on WebMD and saw nothing about a contraindication, and I could find nothing about "serotonin syndrome". Someone in your ER misinformed you.
There IS plain Tramadol and one with acetominophen (Tylenol). I take the plain one. My guess is that you are allergic to either the Tylenol or a filler ingredient in the med. Was it generic? I refuse to get generics because the quality control is not consistent because they are made by many different companies.
Also, in order to sue, you have to prove sustained harm.
No, I was not misinformed, here is the link. I am not allergic to any of the meds, I have taken tramadol before, just not with the SSRI. Actually, I've never had a bad reaction to ANY drug, my system is very tolerant of medications, such as those that should make me drowsy having no effect, etc. I have KNDA, and have taken acetemetphen many times, including in the percoset I was previously taken. The ER docs were also talking to poison control, who confirmed the information. Tramadol is not a very safe drug for all patients, you are lucky if you do not have any adverse reactions. I double checked with the pharmacist tonight (not where I got the tramadol) and she confirmed they can cause serious side effects including death when taken together. As for sustained harm, I looked up the requirements for a medical malpractice suit, and I only have to prove his negligence caused me to have adverse reactions, which led me to the ER.
Drug interactions
Tramadol
Serious Interactions WebMD
And honestly, Hol, I'm a little offended by your post. Just because you didn't have a reaction doesn't mean they are not contraindicated, and it's POSSIBLE your doc and pharmacist overlooked it. He!!, mine did. However, stating in your post that is a very safe drug is pretty rude, considering I could have died today. It can be an EXCELLENT medication for some people, but it is NOT supposed to be prescribed with SSRIs. Your post basically said me and my doctors are full of it, when a little more research would have shown you the information. Some people have used this combination to kill themselves, or attempt suicide, so it's not some unknown issue.
Yikes! I'm so glad you got help.
A few years ago, I had a sinus infection and my Dr gave me an antibiotic. Didn't recognize the name, took it and filled it. It was trick or treat night, so I popped a pill and went out on the porch to pass out candy. I always read the little info that comes with meds and it says people allergic to penicillin should not take this. OH CRAP, guess what I am allergic to!! Called the office, they paged the Dr and he called me within 5 minutes. Asked me all kinds of questions and told me what to watch for. Sent me to the pharmacy to get Benedryl and a new antibiotic. Luckily I had no bad reaction and all was well, but it was scary! To be honest, I was more angry that my pharmacy didn't catch it than I was at the doctor for some reason. I did learn my lesson and now read the patient info BEFORE taking new meds!
I think I would first call your doctor and tell them what happened and see what kind of response you get.
Wow, that's scary, Crystal. I'm glad you are okay!
Crys, I have a slightly different *take* on this. While I understand you are justifiably upset and angry and even afraid, I don't necessarily blame your doctor for this - BECAUSE in my experience, doctors are not aware of all the possible conflicts with specific drugs. I ALWAYS ask my pharmacist when I'm prescribed a new med. It's a pharmacist's job to know what drugs will interact negatively with others, and if you fill all your meds at the same pharmacy, they should red flag it. Mine has done that a few times for both me and DH. That said, I DO understand that things DO get overlooked. A pharmacist knows a LOT more about the meds, including the benefits, side effects, and what drugs would cause problems when taken together.
However, I want you to consider this. *If* you contact an attorney and begin legal action against your doc for prescribing this to you when you were taking another med where taking both was contraindicated, since you are having what appears to be a problem with your back that *may* require you to see another doctor for it, you don't want to put yourself in a position where doctors don't want to take you on as a patient. It happens, many docs turn down new patients who have legal action against another doctor, for the simple reason that they don't want to put themselves in the position where legal action *might* be instituted against them at some point. So, whoever told you that was right.
What kind of doc are you seeing (orthopedist, etc.)? What tests have you had - Xrays, CAT scans, MRI's, blood tests??? Have you seen a rheumatologist or neurologist? What's your diagnosis - have you been told you have a herniated or ruptured disk? There are many conditions that can cause what you are experiencing, and from what I see, you probably need more testing, and probably need to see some specialists.
I can totally relate, I've been dealing with a lot of stuff since 1996, and it's advanced now; I've seen numerous docs for it, have some firm diagnoses, and some *possible* ones. And with the joint pain, I *present* as classic RA, but all of my blood tests, etc. are negative. I guess what I'm trying to say is, when you have multiple symptoms/problems, it usually takes more than one doc and numerous tests or procedures to rule out or diagnose and pinpoint the causes, and docs don't always talk to each other about what you're taking, what their opinion is, and as I said above, they definitely don't know what they NEED to know about the drugs they prescribe. I trust a pharmacist MUCH more than a doc for that.
I'm glad to hear your reaction wasn't worse, and that you are OK!!!!
Crystal, e-mail me off the board - use the contact menu. I have some serious suggestions to make re any possible legal action. Mostly, I would recommend against it, for a number of reasons, but I don't want to go into this on the board.
Of course, do change doctors immediately. And, do your very best to stay very calm when you talk with anyone about this, and don't make any accusations that you cannot absolutely back up 100%.
I understand what you are saying about having high tolerance for pain meds. I do also. When I was in the first phases of having sustained a ruptured disk, I was taking 2 percoset 4 times a day, and the only side effects I experienced was loss of appetite (I lost about 10 pounds) and, of course, constipation. My middle son, on the other hand, took one percoset and said he was floating on the ceiling for the next couple of hours.
E-mail me, Crystal, and let's talk, before you do anything at all.
Wow, Crystal. I'm in the boat where I think that, if the ER and poison control can find that info in a blink of an eye, your doctor should NOT have prescribed it to you. That's why they have books and internet access at doctor's offices.
Is it in your chart that you take the other med? Was the other med part of your conversation at all?
Ugh...I'm just so happy you're ok!!!!!!!!!!!
No advice but I am so glad that you are OK!!!!!
I am a midlevel provider. I just referenced three databases available to me through my hospital. All indicate a possible reaction when SSRIs and Ultram are prescribe together. None of these databases indicate that the use of the drugs together is contraindicated.
There is only a caution against their use together but not a contraindication. This is what one database says: "Serotonin reuptake inhibitors (SSRI): Concomitant use with tramadol may increase risk for seizures and serotonin syndrome"
Someone should have warned you about the possiblity of this reaction. IMO the pharmacy should have mentioned this possiblity and possibly even called the doctor to ask if they still wanted to prescribe that medication to you. I'm a bit spoiled as I work in a hospital so pharmacy calls me often to question drug choices/doses/interactions. I reference my database often but I still get calls from pharmacy.
Every script that I write scares me because I know that no matter how careful I am, I cannot always predict the adverse reactions. NKDA patients can develop allergies at anytime. People don't take as prescribed. Sometimes your patients don't make you aware of all of their meds. Drug interactions aren't always absolute.
I think it was sloppy practice on the part of both the doc and pharmacy not to mention a possible reaction. However since the adverse outcome, although potentially serious, did not result in prolonged or serious harm...I doubt it would be worth your time to pursue it. (IMO, although probably not worth much because I know what it's like to be on the prescribing end). Definitely make your doctor aware of what happened and why before you switch. Good luck with whatever you decide.
Wow that sounds scary, I'm glad you are ok. It reminds me of an investigation I watched on 20/20 or dateline, one of those type of shows. It went into how pharmacists are so rushed nowadays, it's all about how many orders they can fill, not talking to people or double checking. Their big focus was on Walgreens. My sil used to work in a pharmacy and she said they were told to not answer medical questions since they were techs, not pharmacists but some did anyway. Many people think they know something since they wear a lab coat but most have very little if any college let alone medical school. Like so much else, it's all about the dollar, not people.
Ginny,
The email was returned, my email is in my profile, but it's cjaping at gmail dot com.
Karen,
The doc had not run any real test about my back and neck pain, until this recent visit. I had only gone in to have a script refilled to get me through, and had informed him I was switching docs after an incident with his receptionist. THEN he requested Xrays, since I mentioned I was also looking for a pain management specialist, and he thought I would need more tests done before going to one. I'd only had blood test before that, and also xrays back when I was seeing a chiro a couple years back. Prior to that appointment his excuse for my chronic pain and headaches was stress, this the Xanax.
Heidi,
The doc who prescribed the tramadol is the one who gave me all of the others. He knew exactly what I was on, and I carry my meds with me, and confirm my doses at every appointment.
Kelly,
I don't understand how many online references say the possibility of reaction is severe, but yours do not. Most references I found, including the one the pharmacist at Walgreens looked up when I went there to ask, indicated they should only be prescribed together when the benefits greatly outweigh the risks, because the seratonin syndrome is rare, but very serious. My ER doc told me there are things on the internet indicating people use the combination of these drugs for suicide, so I can't imagine they are not contraindicated. Did you read the links I posted? The docs in the ER immediately told me they shouldn't have been prescribed together, so that information must be out there somewhere. Considering I'm on other medications that also interact poorly with tramadol, the doctor should have at least WARNED me of these, and what to look for.
Anyway, thank you all for your concern, I really appreciate it!!! I'm doing 100% better today!
This from Drug Digest's site for checking drug interactions:
You searched for interactions between the following drugs:
Celexa
Tramadol
(Note: Not all drug interactions are known or reported in the literature, and new drug interactions are continually being reported. This information is provided only for your education and for you to discuss with your personal healthcare provider. )
TRAMADOL may interact with CITALOPRAM (in Celexa)
Both citalopram and tramadol have an effect on serotonin, a chemical that is found in the brain. Excess levels of serotonin in the brain may cause serious or potentially life-threatening side effects. Early signs of this problem include increased confusion and restlessness. Other possible symptoms may include weakness, fever, nausea, and anxiety. In rare cases, high levels of serotonin in the brain may cause severe complications like seizures, stroke, and even death. If citalopram and tramadol are used together, your doctor may want to closely monitor you for side effects. Ask your healthcare provider about these drugs and this potential interaction as soon as possible.
This interaction is poorly documented and is considered major in severity.
Last Updated: July 2007
The site, which I use when I am prescribed any new medication, is interactions
Crystal, I sent you a long email. Let me know on the board if you DO NOT receive it.
Crystal, I apologize if I offended you.
Karen is correct. You will have a hard time finding another doctor if you are involved in a lawsuit against your present provider.
In my opinion, it was very irresponsible of the ER doctor to tell you that people have been known to use that med combination to commit suicide.
Crystal, it really sucks that happened. I have had several unlikely reactions to meds, once neurontin landed me in the hospital (and it is supposed to very side effect free!) so I understand how scary it is.
Your doctor sounds as if he is very freely giving out drugs. That he would even be giving you percocet without trying to find out what is causing your pain alarms me. My father has had 5 back surgeries, and will be having another soon. He has been with the same neurosurgeon for 15 years. He gave my dad 15 percocet to help ease the pain once right before surgery, but he won't keep him on them because they are so highly addictive.
You really need to undergo some tests to try to get to the bottom of your chronic pain. You said the pills don't help much now, and your body will just become tolerant of these, too.
Good luck, and I hope that you can get some answers!
Adena,
It's not that he was freely handing out drugs, we have been attempting to get to the bottom of the pain, but in the meantime I needed pain management drugs. He didn't want me to continue on the percocet, thus trying the tramadol, but the pain was limiting my ability to do daily tasks. Percocet is the ONLY thing that works for me, and while I know the risks of addiction, I also know many people take daily narcotics without problem. Right now that is the only way I can tolerate the pain, so that is what I take.
For those that mentioned difficulty finding another doctor, I was switching before this incident, and had already set up an appointment with another doctor. I see him on Monday. Thank you all for your concern. 
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