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My mom is on lexapro, remeron and a very low dose of klonopin. Psych APRN wants to discontinue the Klonopin and add Tramadol. Does anyone have any thoughts?

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Tramadol is a weird drug. It works well for some, does nothing for others. Like most pain medicines it can cause constipation. Too much can cause seizures, although the threshold is pretty high and beyond the usual therapeutic dose. It can be addictive and from what I've heard it's every bit as hard to stop as the regular opiate drugs are. I used it when I fractured my tailbone (not recommended, BTW) and it worked OK for a few days, then it became useless. I don't care for the goofy "chemically" feeling it gave me.
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Thanks ALL for helping to clarify the confusion!!!

Babalou~ I truly hope this medication regemin works for your Mom. I must express a concern about you Mom's medication; however. Why is she being prescribed 2 types of antidepressants (Lexapro and Remeron)? Thinks I would ask the prescribing MD to be sure this combination is safe. By no means do I profess to be a MD and I certainly do not intend to frighten you, but there is a possible issue regarding Serotonin Syndrome. In other words...When a person takes more than one drug known to increase serotonin levels. Please, see the article from the link for Drugs.com regarding...
http://www.drugs.com/mcd/serotonin-syndrome
The best to your Mom and you.
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Thanks Bablou...I was thinking that I answered one question pretty well---when you are following several posts...gets confusing (maybe helps us to understand what our "patients" feel.

Glad you are finding a good combo for your mom. Glad that melatonin works for her, mt mother takes 4 things to help her sleep--and she does, very well, and that's important. (Wish I could find something that consistently works for me!)
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Dear all, so sorry for the confusion. The psych nurse practitioner agreed to stick with mom's current antidepressant regimen and a small dose of klonopin each day. Melatonin is being given for her sleep issues and is working well.
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The confusion between Tramadol and Trazadone is because Babalou originally asked about experiences with TRAMADOL, an analgesic (pain killer). Two days later (on June 26) Babalou changed her posting, correcting herself. She intended to ask about experiences with TRAZADONE an anti-depressant of the "old school", not usually prescribed any more for depression --there are more modern and more effective antidepressants on the market but, very low doses, say 1.25 mg or 2.5 mg, of Trazadone can be prescribed for a person with dementia to help with sleep.
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My 90-year-old mother who has severe arthritis and macular degeneration with Charles Bonnet Syndrome (seeing things that aren't there because of vision loss), was prescribed Tramadol after falling and hurting her back. Since she sometimes sees things that aren't there anyway, piling hallucinations on top of that made for one heck of a mess. She was paranoid, scared to be alone in her room at the ALF, seeing my dead uncles, etc. I'm still questioning the doc who, knowing she sometimes sees things, would prescribe something that has hallucinations as a side effect. Since discontinuing the Tramadol, she's been using a lidocaine patch that has worked wonders. No pain, no hallucinations, no dead uncles. The only problem with that is Medicare won't pay for it. I'm happily paying $200 per month out of my pocket in order to keep the pain and hallucinations at bay.
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OOps--the sidebar on my computer said "Trazadone"..so I barely skimmed the OP. Tramadol is just what sheridui said. I was thinking that it did make sense to take out a benzo and add a drug that causes sleepiness. Tramadol, for me, is just meh. My mother had it after her hip surgery and LOVED it, for pain. HOWEVER, it can cause hallucinations, esp in oler people. Mom suffered from those and she has to stop taking it. Too bad, b/c it really worked for her. Again--sorry!
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This is a very confusing conversation. The topic is a question about the use of Tramadol (brand name, ULTRAM). Some of you are discussing Trazodone, an antidepressant medicine (also used for other reasons), that is an entirely different class of medication and another subject altogether.
With respect to this discussion...I have taken Tramadol for nearly 20 years, well before it became generic.
Tramadol is a "synthetic" (man-made) narcotic and it affects the same area of the brain as a narcotic medication. Tramadol was designed to use as a long-term treatment for moderate to moderately severe pain. Tramadol is NOT effective if taken PRN (as needed). It takes around a couple of weeks of continuous, daily use (as prescribed), for the medication to reach a level in the bloodstream to truly become an effective pain reliever.
Tramadol is an analgesic medication, but is NOT helpful for the pain from inflammation. In general, analgesics ease surgical pain, muscle pain, body aches from fever and headaches. Tylenol (Acetaminophen), is another analgesic and used for mild to moderate pain.
To boost the effectiveness of Tramadol, for more severe pain, you can take Tramadol with a dose of Acetaminophen (Tylenol or generic). For inflammatory pain, you can also take Tramadol along with a dose of an anti inflammatory medication (Mobic, Celebrex, Aleve, etc. or their generic versions).
Years ago, I took the prescription medication, Ultracet, a combination of Acetaminophen and Tramadol. However, I prefer to not take Acetaminophen on a regular basis unless it is absolutely needed.
Sometimes I wonder if Tramadol is truly relieving my pain, but realize how much pain relief IS present if I accidentally miss a dose. Since I suffer with Arthritis along with Fibromyalgia pain, I must also take anti inflammatory medication along with the Tramadol for more complete relief.
Nonetheless, the strength of any pain medication that Doctors prescribe for us to use at home, will never relieve the pain entirely.

HERE IS A QUOTE FROM MedicinNet..
GENERIC NAME: tramadol
BRAND NAME: Ultram
DRUG CLASS AND MECHANISM: Tramadol is a man-made (synthetic) analgesic (pain reliever). Its exact mechanism of action is unknown but similar morphine. Like morphine, tramadol binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain from throughout the body to. Tramadol, like other narcotics used for the treatment of pain, may be abused. Tramadol is not a nonsteroidal antiinflammatory drug (NSAID) and does not have the increased risk of stomach ulceration and internal bleeding that can occur with NSAIDs.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets (immediate release): 50 mg. Tablets (extended release): 100, 200, and 300 mg.
STORAGE: Store at room temperature, 15-30°C (59-86°F). Store in a sealed container.
PRESCRIBED FOR: Tramadol is used in the management of moderate to moderately severe pain. Extended release tablets are used for moderate to moderately severe chronic pain in adults who require continuous treatment for an extended period.
DOSING: The recommended dose of tramadol is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain. The maximum dose is 400 mg/day. To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25 mg every 3 days to reach 100 mg/day (25 mg 4 times daily). Thereafter, doses can be increased by 50 mg every 3 days to reach 200 mg day (50 mg 4 times daily). Tramadol may be taken with or without food.
Recommended dose for extended release tablets is 100 mg daily which may be increased by 100 mg every 5 days but not to exceed 300 mg /day. Extended release tablets should be swallowed whole and not crushed or chewed.
DRUG INTERACTIONS: Carbamazepine reduces the effect of tramadol by increasing its inactivation in the body. Quinidine (Quinaglute, Quinidex) reduces the inactivation of tramadol, thereby increasing the concentration of tramadol by 50%-60%. Combining tramadol with monoamine oxidase inhibitors (for example, Parnate) or selective serotonin inhibitors [(SSRIs, for example, fluoxetine (Prozac)] may result in severe side effects such as seizures or a condition called serotonin syndrome.
Tramadol may increase central nervous system and respiratory depression when combined with alcohol, anesthetics, narcotics, tranquilizers or sedative hypnotics.
PREGNANCY: The safety of tramadol during pregnancy has not been established.
NURSING MOTHERS: The safety of tramadol in nursing mothers has not been established.
SIDE EFFECTS: Tramadol is generally well tolerated, and side effects are usually transient. Commonly reported side effects include nausea, constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Some patients who received tramadol have reported seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations.
Last Editorial Review: 7/16/2007
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My MIL was prescribed tramadol and it made her immediately sick to her stomach. There is also an article about it on AARP website as being a drug that is sending many to the emergency room. I would advise reading it if you would like further information. She could not keep it down because she does not eat enough to offset the medication.
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I, occasionally take tramadol for pain, its a great alternative to those whom are sensitive to narcotics, its non addictive but can be habit forming. I find it works for up to 4 hours and in persons who have hyperactivity like myself it will keep me awake vs. make me sleepy, most persons, however it will have a sedative effect.
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I was given this as I have severe chronic back problems and fibromylagia. I had terrible side affects from this medicine and my doctor took me off of it. But I am sensitive to a lot of medicines. All I can say, is have her try it, but read the specs on the drug fact sheet, especially side affects, and keep a close eye on her for a few weeks!

Is she not doing well on the medicines he has her on now? If she is doing OK, why does he want to try something new? Besides, Tramadol is for pain and what she is on now is for anxiety. I am taking care of my 88 year old godmother who has early dementia, and she gets worse when our doctor tries different medicines on her. We found meds that are helping her right now and are keeping her on an even keel, so we are not trying anything new. My doctor is big into vitamin therapy, and he has her on two different vitamins for cognitive therapy which is helping her a lot.
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Tramadol is good for mild to moderate pain. As my father's nurse, I gave it to him for cervical pain. He also had dementia. I take 50 mg for migraines. The only caution I have is that it lowers the seizure threshold. So, as long as there's no propensity for seizures, you're good.
Jen
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Llama, yes, my husband could not take Morphine as he would hallucinate terribly. Whereas, I have RA and I am on morphine every 12 hours. It has not affected me at all and I don't even feel like I am on a drug at all. However, my RA does not bother me and if I miss a dose, my RA will act up. When I tell people what I am on, they are shocked. But, the other drugs they use for RA caused me horrible vomiting and loss of appetite. Every drug must react different ways for people
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Really, I was told it was not a Narcotic, but had some ingredients that act as a narcotic would. It does absolutely nothing for my partner. He never used any drugs in his lifetime so if it was a narcotic, and it was affecting him that way, I would believe we would know. If it is truly a narcotic, then I am surprised.
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I took Trazodone for a while for insomnia. Like many things it was helpful for a few days and then no longer helpful. But it made my nose and throat so dry I ended up with a sinus infection! A humidifier in the room can help with that.
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Babalou: Tramadol is a "narcotic like" pain med. For elders, any narcotic meds are very bad because they can't handle them due to their age. E.g., my mother was given morphine at the hospital. Then when she was sent to the NH, the drug manifested into EXTREMELY bad hallucinations...thoughts and actions.
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My Partner's doctor put him on Tramadol for nerve pain. He has a lower back pain that goes down his leg. But, I have been told it was used for seizures and for anti-depression also. It does not seem to cut his pain much. His new Pain Mgt Dr., is going to replace the Tramadol, but we are presently going through a rash for last 6 months, which the dermatologist thinks one of his meds caused. So, my partner has to stay on the tramadol until we narrow down what drug caused the rash. It seems to do the job, but it just dulls the pain, does not remove it.
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Sorry about my post I now see you made an error and was asking about Trazadone. No experience with that pill.
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I have to chime in here--Trazadone is an old tri-cyclic antidepressant and I believe is almost NEVER used for depression. The dosages required to TX the patient for depression would leave them catatonic.
I have taken Trazadone (also known as Deseryl) and it worked for about 2 hrs to help me sleep. I also gained about 40 lbs on it---so stopped taking it. Klonipin is a good benzodiazepine, calms and relaxes the body. It's also considered "clean" meaning, acc to my psych doc, you do not feel the sudden absence of it when it wears off. I think Xanax has a really sharp "drop off" period. Sadly, due to an unmanageable type of anxiety in my life, Klonipin is a daily med. It would help an anxious ALZ patient, I think. I would ask about combining the two--but at low dosages...probably OK. (This post brings up the issue of MANY drugs having similar names Tramadol/ Trazadone)..Just an FYI, Tramadol can be very effective for a lot of people. BUT in geriatrics, it can cause confusion, hallucinations and blackouts. We learned that the hard way.
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I do not have personal experience with Tramadol. However, my husband was placed on it in years past and I absolutely hated the side effects.

He became hard to wake up and would often foam at the mouth (had me thinking he was on his way out/dying half the time because the breathing would be so faint). The last time he tried to take one we got into the biggest fight. I called his pain management doctor and begged them to see him sooner.

Of course this was the 100mg tablets. He was giving this for chronic/severe nerve pain at the hospital one weekend.
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My Mom started Trazadone about two months ago and is doing great on it. She's at an AL and has moderate to severe ALZ. Her doctor started her on it as she started wandering at night wanting to "go home"... the first week she had a few accidents (incontinent) but fortunately that went away quickly. She's had an increased appetite; great because she's so thin.
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I found thus medication made my gtandfatger in kaw very loopy and increased his alzheimer's symptoms. I guess it depends on the person.
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My mom was on Remeron & Trazadone - they are both old-school meds, generic with very very small bad side effects. Both seemed to work well with each other on anxiety & depression. Remeron up'd appetite & Trazadone made her sleep better (without the totally scary that ambien does) as on off-label effect.

Why the Lexapro?
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Trazadone is a wonderful medication. It is one of the older anti depressants. When I took it, I slept good and I also gained weight which at the time was not what I wanted.
It would be good for a person with a poor appetite. It is used for several things besides depression.
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My Mom was given Trazadone for sleep, but it was originally made for depression I think the psychiatrist said. She also had Klonopin.
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A nice medication for nerve pain is Neurontin. It typically does not cause drowsiness and is specifically given for nerve pain.
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Sorry, I meant trazadone.
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My husband has nerve pain in his leg from a stroke. He can take it up to 4 times a day if he wants. It's another med that makes him tired.
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Klonopin (0.25mg -0.5mg are the general doses) is not generally used for pain. It is a medication for anxiety and wonderful for people with dementia. Tramadol is a mild pain medication but stronger than "over the counter" medications. Does your Dr think that her anxiety is due to pain?
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I have taken Tramadol for years PRN for pain, it works very well for me
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