Patient/caregiver was educated on contraindications for using 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 reportedly reduces the release of acetylcholine, thus reducing the action of acetylcholine on various body tissues. Pamelor must be avoided or used with extreme caution along with any other medications that can have similar spectrum of activity of reducing the action of acetylcholine. Many inhaler medications used in treating breathing disorders and medications used to manage Parkinson’s disease can reduce action of acetylcholine and thus, can potentiate the side-effects of Pamelor intake. So, Pamelor must be avoided/used with extreme caution in individuals with history of asthma, COPD, and Parkinson’s disease. Discuss with your physician regarding safety with Pamelor intake, if you have history of breathing disorders and Parkinson’s disease.
- Pamelor can interact with many antibacterial and antifungal antibiotics, antiarrhythmic medications, antidepressants, and antipsychotic medications, resulting in development or aggravation of underlying cardiac arrhythmias, leading to debility and sudden cardiac death. Avoid taking Pamelor along with medications belonging to the above-mentioned groups, to prevent any dangerous arrhythmias from developing.
