[AnishinaaBabe]

Hello my name is Maia. I have been taking methadone for my pain, which includes, migraines, arthritis & fibromyalgia, plus for muscle & bone accident from when I was 3 years old. I am 36 years old, but my pain makes me feel 136 at times.

Anyway, my question is this, I was just given amitriptyline at 75 mg at bedtime, but I have been on methadone for nearly 3 years at 115 mg. It just doesn't seen safe to me. I have had problems with other medications with making me depressed, when I am not a depressed person, my Pharmacist didn't think it was a problem. I have heard that amitriptyline & methadone made some people suicidal & extremely depressed. A friend of mine that I go to pain therapy with took the methadone & amitriptyline combination, she became very suicidal, was put in the hospital for over dosing on her methadone. She & I are both not the depressed type of women, I am just very afraid that this would happen to me. My husband wanted me to find a group to ask, he & I are open about everything, so outside support is helpful to us both!
Thank you!

[mrsD]

Welcome to NeuroTalk:

The combination of amitriptyline + methadone carries a risk of sudden cardiac death. This is because both drugs affect the heart and its electrical conduction system.

Methadone is the only opiate for pain that does this:

This older post of mine explains it in detail:
http://neurotalk.psychcentral.com/post15298-4.html

This special website goes into more detail:
http://www.azcert.org/

Even people only using methadone can be at risk. When you add other drugs which also do the same thing, you get a much higher risk. Add to that a case of stomach flu...with a loss of potassium and magnesium and you have a triple risk.
Add to that a genetic flaw in heart conduction and you have a far greater risk again!

Amitriptyline is an antidepressant in higher doses. At the 10-25mg a day dose it is less so. As you increase daily dosing it starts to work as an antidepressant.

All people using methadone should be screened by the doctor for prolonged QT risk. And then if methadone is increased, periodic EKGs should be done. The patient should also guard against losing electrolytes while on therapy because this can tip one into a conduction emergency if they get low.

As far as amitriptyline making people depressed? All antidepressants carry that potential. Mostly in the beginning of use they are sedating. The SSRIs have a history of increasing serotonin in some people genetically prone to suicidal thoughts. This is less likely with TCAs like amitriptyline. But mixed with an antiseizure drug like gabapentin, or Lyrica or other similar drug and then TCAs may tip into suicidal ideation--since the antiseizure drugs cause this too.
This does not happen in everyone however.

Your biggest problem with this combination is the cardiac risk.

I really cannot imagine a pharmacist telling you there was no problem. This combination is well known and should be on the pharmacy's database and should FLAG this interaction and stop the pharmacist from filling the two drugs together.
example from drugs.com :
http://www.drugs.com/interactions-ch...t=168-0,1578-0

Please read the link above carefully.

[Dr. Smith]

Welcome AnishinaaBabe,

Forewarned is forearmed. I would take any concerns along with any supporting documentation to your doctor; s/he is most familiar with all of your medical conditions & history, and has the knowledge and experience to make the best evaluations of benefit vs. risk. There are risks attached to everything, and there are always options; if your doctor feels that either the combination or your fear don't justify the therapy, s/he will take that into account.

You and your husband know about the potential for depression, and how you feel. Therefore you have two people who are going to watch you like a hawk for any signs of trouble or changes in your mood and behavior. If you experience any symptoms that concern you - physical or mental - you know what to do.

Doc

[razzle51]

have you been checked for Chiari Malformation ?

[AnishinaaBabe]

Originally Posted by razzle51

have you been checked for Chiari Malformation ?

I have been checked, believe me, I have weighed every option before taking Methadone, it's just the Amitriptyline I have my apprehensions about! Thank you for asking!

[AnishinaaBabe]

Seems you have apprehensions about Methadone, I have been well educated on Methadone. I know more than my Medical doctor, she didn't prescribe Methadone, my Pain Management Doctor did. Also my Mother & Sister are both Registered Nurses, I just stayed out of the medical field. They both work for a very well known clinic that deals with Opiate addiction, Methadone done works very well for that addiction. I just have seen in people that taking Amitriptyline can cause suicidal tendencies. Thank you for your response. Sometimes, I have seen my pharmacist doesn't catch everything, he fills my prescription for Methadone every month, but never says anything about my allergy for codeine & morphine, so he doesn't catch everything! My pain management doctor knows about the allergy & taking Methadone hasn't caused an allergy reactions, my pharmacist didn't even ask!