New Prescription ~Drug Checker says Serious Interaction~ Um... What do I do???

So I went to see my psychiatrist today cuz we're trying to figure out a good medication balance, but um... this doesn't sound good. I've taken a plethora of different medications and typically check if there will be interactions; I'm a little hesitant to do this one though. I have BPD and ADD so I'v been on Lamictal and have recently tried Concerta for the ADD, but it doesn't work very well. I also have really bad anxiety so I have Valium and Ativan if it gets bad enough, but it's addictive and I don't want to take it; I just want something that doesn't make me anxious. So the Dr. decided to switch me to Adderall XR again, but to add a new SSRI called Viibryd, but when I looked for interactions, it says major interaction, use alternative... um, do I take it? I would imagine the Dr. would know if there's gonna be an interaction and all she said to me was to get my blood pressure checked often. Here's what it says... wth do I do?? I HATE trying new meds... I just want to feel normal!!!

amphetamine ↔ vilazodone
Applies to: Adderall XR (amphetamine/dextroamphetamine), Viibryd (vilazodone)
GENERALLY AVOID: Several case reports suggest that serotonin reuptake inhibitors may potentiate the pharmacologic response to sympathomimetic agents. The exact mechanism of interaction is unclear. In one case report, a patient experienced jitteriness, racing thoughts, stomach cramps, dry eyes, palpitations, tremors, and restlessness following a single dose of phentermine ingested approximately a week after she had discontinued fluoxetine. Because of the long half-life of fluoxetine and its metabolite, an interaction with fluoxetine is possible. Similar toxic reactions have been reported when fluoxetine was used concomitantly with amphetamine or phenylpropanolamine. Additionally, some sympathomimetic agents such as amphetamines may possess serotonergic activity and should generally not be administered with serotonin reuptake inhibitors because of the additive risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. The interaction was suspected in a patient treated with dexamphetamine who developed symptoms consistent with the serotonin syndrome approximately 2 weeks after the addition of venlafaxine. The medications were discontinued and the patient was given cyproheptadine for suspected serotonin syndrome, whereupon symptoms promptly resolved. A second episode occurred when dexamphetamine was subsequently resumed and citalopram added. The patient improved following cessation of citalopram on his own, and residual symptoms were successfully treated with cyproheptadine.

MANAGEMENT: In general, amphetamines and other sympathomimetic appetite suppressants should not be combined with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Close monitoring for enhanced sympathomimetic effects and possible serotonin syndrome is recommended if these agents must be used together. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

I would not take it until I called my dr to clarify things. I have taken drugs that may cause serotonin syndrome when taken together and was watched closely at first. I wasn't really comfortable with it tho.

Can you call your dr and wait to take it till you have more info? Even dr's make mistakes sometimes and they cannot remember all the interactions or side effects all the time from my experience.

I agree, ask your pdoc to get reassurance or discuss alternatives.

If it were me, I would have questions about why Vilazodone? It's a brand new SSRI without much of a track record. I would want to know what sort of compelling indication there is to take that drug instead of one of the more established and studied SSRIs, such as Lexapro or Zoloft.

Good luck.

Check with your pharmacist. They may actually know more about the med interactions than your doctor. I was put on viibryd a month ago and there is very little information out there about it. I am the first one my pdoc's office has ever prescribed it to.
I hope things get worked out for you

Thanks for the responses everyone! I actually did wait until I spoke to the doctor and told her what the site said the interactions were. It is a new drug so she looked into it and asked a few coworkers that have prescribed the same to patients and told me that it was a reasonable dosage I was given and I should be fine; but if I noticed any unusual side-effects to come in immediately. She chose the Viibryd because I have really bad anxiety sometimes and do not like taking benzodiazepines, so this medication effects the 5-HT1A and 2A receptors which should help with the anxiety so I don't need the Valium or Ativan. Day one and I feel ok, just a little wired.

Did you start on the 10mg ones?
I looked and I have a severe interaction potential with my trazodone.. am up to 40mg now and it hasn't happened.

You are the only one i have found that actually takes viibryd!

I did start out at the 10mg, I'm still on them actually. Is it that bad... I heard a few people get the Px, but I dunno if they took them

Sorry, guess i wasn't very clear. Viibryd has a serious potential to react with trazodone. Fortunately I have not had that reaction. Just the nausea for the first week or 3

Viibryd has a long list of interactions because of its mechanisms. Without getting into all the technical mumbo-jumbo, it affects a particular enzyme (CYP3A4), which is often used in the metabolism of many medications. Some of these medications do include valium.

Although it only has a few studies, one of which has a pretty small sample size, I think the reason for it being released is that it doesn't have significant sexual and weight side-effects, plus, it's a partial agonist of the 5-HT1A receptor. So overall, it uses a newer mechanism with fewer side-effects, so I think that is why it is getting used. Myself, I'm not too thrilled with that given there are very few studies of it.

As for why you're told to get your blood pressure checked, I imagine it's for two reasons. First, so little is known about Viibryd and its mechanism of action, so it could alter your blood pressure. Second, according to the Viibryd medication guide, it indicates there have been cases of "serotonin syndrome", where one of the symptoms is very high blood-pressure. Some of the interactions can also cause changes in blood pressure, high or low.

I can understand why you feel nervous taking it. Personally, if I were your doctor, I wouldn't give it at all because there's not much known of it and what is known isn't a huge up-lift.

NOTE: I am NOT a doctor in any way.

Thanks for the response Oxidopamine,

I read that the Adderall and SSRI's are not good to mix so I called the Dr and she said I should be fine if I use it as directed; I still wasn't excited to start it though. Today is day 4 of the medication and I'm definitely thinking this is not a good combo for me! I love the Adderall because it gives me a lot of energy, but I'm scared the Serotonin Syndrome is coming to play. I'm sure my heart is beating a little faster than normal, but my mood has been great; I'm pretty happy. The part that scares me the most though is this weird thing of me wanting to clench my jaw.

From 16 - 20 I did A LOT of ecstasy and the Dr knows this. I did it once the year before last and again one time last year... that last one almost caused me to OD; I'm very lucky I didn't. So this elated mood and jaw clenching really reminds me of the beginning feelings of ecstasy! The Dr better call me back soon cuz I'm not taking this anymore!!!

I'm very sorry about your experiences with ecstasy/MDMA.

Individuals with serotonin syndrome do NOT always display the same symptoms, as it can range from mild symptoms to fatal symptoms. If you feel you may be experience them, check your body temperature (if it gets to around 40C or 104F you may be experience it but at that temperature you should start seeking medical help). You may also have mydriasis, which is pupil dilation. There are also mental status changes, although it's best if someone else evaluates them.

More information is found in the scientific article called, "The Serotonin Syndrome" by Edward Boyer and Michael Shannon, published in 2005 in The New England Journal of Medicine. To read most articles you need granted access, however, this one can be easily read online. I would post the URL but unfortunately I do not have enough posts (apparently I need 10).

Thank you for the response. The Dr told me it wasn't Serotonin Syndrome, but since the SSRI combo is making me uncomfortable that I should stop taking the Viibryd... we'll see how I feel tomorrow!