[ Interaction & Mélange ]

DPH + tramadol : syndrome seroto...

Hello les psychos. J'utilise surtout le DPH avec les opiacés, je trouve que c'est largement un des meilleurs AH1.
Le problème : je veux faire une homebrew tramadol/DPH.
Et je viens de tomber sur une étude qui disait que le DPH avait une action sérotoninergique, bien que légère, mais présente. Qui a d'ailleurs résulté en un syndrome séroto chez une personne agée. J'ai chercher parceque l'apo m'avait déjà dit que le DPH à un léger effet seroto.

National Library of Medecine a écrit

The patient is a 66-year-old man with hypertension, non-insulin-dependent diabetes mellitus type 2, seasonal allergies, and a recent traumatic injury to the head that occurred 20 days prior to admission, resulting in magnetic resonance imaging (MRI)-confirmed C5 superior facet fracture deemed non-surgical. The patient was subsequently prescribed tramadol, 50 mg tablets, as needed for symptomatic pain relief. On day one of his prescription, he took 100 mg tramadol. On day 2 of his prescription, he took 50 mg of tramadol. In addition, on day 2, he experienced a flare of seasonal allergies and took two tablets of 25 mg of diphenhydramine. Approximately 30 minutes after administration of the diphenhydramine, he experienced a sudden onset of spontaneous tongue fasciculations and tongue protrusion in a random, abnormal, semi-rhythmic manner that he recorded using his cell phone. He also had perioral twitching of the muscles and developed dystonic movements.
[...]
Tramadol is a synthetic analog of codeine that exerts analgesic effects by acting primarily on the opioid mu receptor [1]. Tramadol, with its lower risk of addiction and overall safety profile, is generally considered safe medication and efficacious in providing pain relief as compared to other opioids. Interestingly, it is thought that tramadol’s analgesic effect is due to the inhibition of serotonin and norepinephrine reuptake in the CNS [2] and the risk of causing serotonin syndrome is currently well-recognized. Diphenhydramine, a first-generation antihistamine that acts as an inverse agonist on the H1 receptor [3] may also inhibit the reuptake of serotonin. It is known that SSRIs like Fluoxetine are analogs of diphenhydramine [4]. Although weaker, diphenhydramine does retain some activity at the serotonin receptor. In pre-clinical models, it was shown that by acting as a completive antagonist at the muscarinic acetylcholine receptor, diphenhydramine inhibits post-synaptic reuptake of serotonin, which is estimated a sixty-four percent in the presence of narcotics [5]. Taken together, in conjunction with another serotonergic drug, the otherwise weak activity of diphenhydramine at the receptor could result in serotonin syndrome, as in the present cas

[...]
The present case is consistent with a diagnosis of mild to moderate serotonin syndrome.

(je voulais mettre le lien de l'étude mais il me semble que les liens externe à PA sont interdits, si vous la voulez en entière le nom c'est : Serotonin Syndrome Presenting with Concomitant Tramadol and Diphenhydramine Use: A Case Report of an Unlikely Side-Effect)

ça a l'air d'être le seul cas signalé donc bon je sais pas si je dois absolument changer d'AH ou si étant jeune (et vigoureux lol), tout devrais bien se passer...

Vous avez déjà fait le mélange ?
Des effets secondaire notable ?
Quel AH1 vous utilisez avec votre tramadol si vous le faite ?

parceque bon j'en ai utilisé aucun autre à part le DPH (avec de la codéine).
Quelle est votre AH "préféré", avec vos opiacés ?
Aux US la prometh reviens beaucoup mais bon, c'est une galère a avoir, et puis c'est pas le plus plaisant selon moi (DPH>prometh).

Sur drugs.com ils disent que la combinaison des deux a une interaction "moderate". Et ne parlent même pas de syndrome seroto, seulement :

drugs.com a écrit

may increase the risk and/or severity of some side effects such as dizziness, drowsiness, confusion, difficulty concentrating, difficulty urinating, dry mouth, abdominal cramping, and constipation. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination.

Merci, Eroth

PS : je sais pas si il a plus sa place dans la section opiacés ou AH... les mods déplaceront si jamais.
Fin bon ça parle d'interaction donc à voir.

Dernière modification par Erothisback (11 octobre 2024 à  18:49)