Patient/caregiver was educated on precautions to be exercised while taking Pamelor as follows:
- Serotonin is one chemical in the brain, which in permissible amounts, is believed to reduce anxiety and promote happiness and well-being. Very excessive concentrations of serotonin in the brain can lead to serotonin syndrome. Individuals with serotonin syndrome can present with mania, excitement, hallucinations, agitation, insomnia, pounding heartbeat, very rapid heart rate, overactive reflexes, and diarrhea. Pamelor use, especially along with a few other antidepressants, such as, citalopram, fluoxetine, and sertraline, can significantly increase the serotonin levels in the body, lead to development of serotonin syndrome, and so, is contraindicated. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on Pamelor, by observing a window period of atleast 2 weeks, before the transition to Pamelor is made. Using Pamelor with these medications closely can result in dangerously elevated serotonin in the blood, leading to development of serotonin syndrome.
- Pamelor use can sometimes increase the risk for deterioration and worsening of clinical symptoms of mood disorders. Continue taking Pamelor, as recommended, even if your mood feels better and discontinuing the medication abruptly, without your physician’s recommendation, can result in disruption of chemical balance in the brain, resulting in worsening of mood disorder and severe withdrawal symptoms. Individuals can present with complaints such as, feeling low, anxiety, panic attacks, trouble sleeping, gross appetite changes, impulsiveness, agitation, aggression, hallucinations, mania, and suicidal thoughts. Report any continuing/deteriorating symptoms of mood disorder immediately to your physician, so that, a dose change or change in plan of care could be considered.
- Pamelor takes some time to fairly balance the chemicals in the brain, before any improvement in mood and behavior are noted. It could take about 3 – 6 weeks to see this change in mood. So, do not discontinue taking the medication without consulting your physician, as you failed to see the improvement with depression and anxiety symptoms immediately after taking the medication.
