20mg Yohimbine, 20mg hydrocodone, 16mg chloropheniramine taken. Danger? URGENT ADVICE

[Alfa]

Someone FUBAR knows has taken 20mg Yohimbine, 20mg hydrocodone, 16mg chloropheniramine. What danger could arise from the interaction of this MAOI with 20mg hydrocodone and 6mg chloropheniramine?

Please advise ASAP.

[PandorymDMT]

First off yohimbe is a very weak MAOI, So SWIY shouldn't be in any real danger but here is a list of possible side-effects, that could indicate a serious problem and should lead to a trip to the nearest medicine-practicing location.

MAOI + Opiate = Hypotension, Respiratory depression, or Coma.
MAOI + Chloropheniramine = A potentiation of the Chloropheniramine, which could lead to overdose symptoms such as... Dry mouth, Tachycardia, Nausea, Agitation, Rapid Breathing, Drowsiness, Dilated Pupils, Flushing, Fever, Low Blood Pressure, Confusion, Hallucinations, Delirium, Psychosis, Seizures, Coma, and possibly Loss of life.

However from SWIM's personal experience, Yohimbe (at least the tincture sold at health-stores) does not have any adverse effects by being combined with Chloropheniramine alone, or with Hydrocodone alone. The effects of all three should be negligible, although spontaneous reactions may occur from combining these substances, and any noticable negative effects should be treated as more serious than usual.

SWIY should be fine, but if he experiences any of the above effects, he should seek medical attention.

EDIT: It should also be noted that Chloropheniramine could possibly potentiate the hydrocodone and increase the effects of it, but it should still have no noticeable effects from the addition of the Yohimbine.

EDIT2: I found the article Herbal Healer 019 was probably referencing
Article
Potentiation of yohimbine-induced lethality in mice: Predictor of antidepressant potential

Jeffrey B. Malick *Biomedical Research Department, Stuart Pharmaceuticals, Division of ICI Americas, Inc., Wilmington, Delaware

*Correspondence to Jeffrey B. Malick, Biomedical Research Department, Stuart Pharmaceuticals, Division of ICI Americas, Inc., Wilmington, DE 19897

Keywordsyohimbine • antidepressants • potentiation

Abstract

The ability of antidepressant agents to potentiate the lethal or toxic effects of yohimbine in mice was evaluated. With very few exceptions, the antidepressants were the only agents that significantly enhanced yohimbine-induced lethality. All of the clinically effective antidepressants, both typical (e.g., amine reuptake inhibitors, monoamine oxidase inhibitors) and atypical (e.g., mianserin, iprindole, bupropion, quipazine) drugs, produced a dose-related potentiation of yohimbine in mice. Representative anxiolytics and antipsychotics failed to potentiate yohimbine over a wide range of doses. Although several possible false positives (e.g., atropine, chlorpheniramine, and d-amphetamine) would be detected in this procedure, these same agents would be detected in other models (e.g., tetrabenazine antagonism, behavioral despair) considered predictive of antidepressant potential. Thus, the potentiation of yohimbine-induced lethality test in mice appears to represent a useful screening procedure for discovering potential antidepressant drugs.

Reputation Comments on this post:

Good information and response time, many thanks.

[Herbal Healer 019]

Originally Posted by PandorymDMT

EDIT2: I found the article Herbal Healer 019 was probably referencing

Article
Potentiation of yohimbine-induced lethality in mice: Predictor of antidepressant potential
 
Jeffrey B. Malick *Biomedical Research Department, Stuart Pharmaceuticals, Division of ICI Americas, Inc., Wilmington, Delaware
 
*Correspondence to Jeffrey B. Malick, Biomedical Research Department, Stuart Pharmaceuticals, Division of ICI Americas, Inc., Wilmington, DE 19897
 
Keywordsyohimbine • antidepressants • potentiationAbstractThe ability of antidepressant agents to potentiate the lethal or toxic effects of yohimbine in mice was evaluated. With very few exceptions, the antidepressants were the only agents that significantly enhanced yohimbine-induced lethality. All of the clinically effective antidepressants, both typical (e.g., amine reuptake inhibitors, monoamine oxidase inhibitors) and atypical (e.g., mianserin, iprindole, bupropion, quipazine) drugs, produced a dose-related potentiation of yohimbine in mice. Representative anxiolytics and antipsychotics failed to potentiate yohimbine over a wide range of doses. Although several possible false positives (e.g., atropine, chlorpheniramine, and d-amphetamine) would be detected in this procedure, these same agents would be detected in other models (e.g., tetrabenazine antagonism, behavioral despair) considered predictive of antidepressant potential. Thus, the potentiation of yohimbine-induced lethality test in mice appears to represent a useful screening procedure for discovering potential antidepressant drugs.

Yep, that's the study I was refering to.

[Herbal Healer 019]

The antihistimine chlorpheniramine is a potentiator of yohimbine toxicity.

However, SWIM does not think 20mg yohimbine is a toxic dose.

"The combined use of MAOIs and certain narcotic analgesics may result in hypotension, hyperpyrexia, sedation, somnolence, and death. Although documentation with hydrocodone is lacking, concurrent therapy with MAOIs should be avoided if possible or monitored closely as the consequences are potentially severe if an interaction does occur."

http://www.hhsc.state.tx.us/HCF/vdp/.../hydrocod.html

Keep an eye out for adverse effects & seek medical assistance if necessary.

[MisterV]

There are mainly two forms of interaction:

1. stimulating

- uncontrolled behavior
- headache
- hypertonia
- muscle stiffness
- convulsion
- coma

counter measure to take:

- phentolamine
- sodium nitropusside
- Phenothiazine

2. sedative

- hypoventilation
- hypotension
- coma

counter measure to take:

- ventilation
- Norepinephrine

SWIM doesnt know how strong the yohimbines MAOI effects are. The hydrocodone itself is not risky if zero tolerance and about 60kg. If the stimulating interaction occours the chloropheniramine could help a little bit, too. If not sure what to do see a doctor immediatelly.

[runitsthepolice]

Well... is there some reason to be worried about it? What happened to the person are they having problems?

Is this combo for sure dangerous? I'm not a doctor or anything but that doesnt sound too crazy. I'm pretty sure chloropheniramine is combined with hydrocodone or dxm in different medicines.

[fnord]

Can you describe any symptoms/effect/side effects your friend is having?

[Alfa]

Originally Posted by fnord

Can you describe any symptoms/effect/side effects your friend is having?

increased pulse, anxiety, shortness of breath. 1 hour. 20 minutes after intake.

[salviablue]

I don't really know other than the obvious when taking maois i.e. avoiding tyramine. From a quick look around it seems here has been taken two maois in combination with an opiate.
No probs with the opiate and chloropheniramine as they are often combined in cough medicine.

Ignore everything after the food avoidance list. I think eveyone else will have already covered it.

so I would


 

• 1AVOID:
• 2Meat, fish, poultry and eggs
• 3Dairy
• 4Vegetables
• 5Nuts and seeds
• 6Beverages
• 7Desserts/sweets:
• 8Other

[top]AVOID:

[top]Meat, fish, poultry and eggs

Anything aged, dried, fermented, salted, smoked or pickled. Watch out especially for pepperoni, salami and liverwurst.

[top]Dairy

Aged cheese. If you get migraines, the best cheese for you is farmers cheese, cottage cheese and cream cheese.

[top]Vegetables

Fava or broad beans, sauerkraut, pickles, olives. Any fermented soy products (ie miso, soy sauce, teriyaki sauce).

[top]Nuts and seeds

All nuts.

[top]Beverages

All alcoholic and fermented beverages

[top]Desserts/sweets:

mincemeat pie

[top]Other

MSG and related chemicals (see our page about MSG for details) Marmite and products containing marmite.

For the next 48 hours

WATCH BREATHING

Check breathing rate. be aware it may slow down to a dangerous level.

Look for signs of seratonin syndrome:
Signs and symptoms

Symptom onset is usually rapid, often occurring within minutes. Serotonin syndrome encompasses a wide range of clinical findings. Mild symptoms may only consist of increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent tremor or twitching), as well as overresponsive reflexes.[1] Moderate intoxication includes additional abnormalities such as hyperactive bowel sounds, high blood pressure and hyperthermia; a temperature as high as 40 °C (104 °F) is common in moderate intoxication. The overactive reflexes and clonus in moderate cases may be greater in the lower limbs than in the upper limbs. Mental status changes include hypervigilance and agitation.[1] Severe symptoms include severe increases in heart rate and blood pressure that may lead to shock. Temperature may rise to above 41.1 °C (106.0 °F) in life-threatening cases. Other abnormalities include metabolic acidosis, rhabdomyolysis, seizures, renal failure, and disseminated intravascular coagulation; these effects usually arise as a consequence of hyperthermia.[1][3]

Although from the doses mentioned, in my limited knowledge, there doesn't seem to be too much cause for concern, however, I am no doctor and have forgotten alot of what I knew about maois and their actions and contraindications etc.


There is this I found just which as far as i understand, is saying that chlonopheniramine may not contribute to seratonin syndrome as previously thought. So there may not be any real reason to worry.

Lost the source now but I also read chlonopheniramine potentiates the toxic effects of yohimbine in mice or rats.

basically, if fubar is so worried they feel all the symptoms, barely breathing, drfiting near unconsciousness call 911/999.
If fubar is capable of comprehending this post then s/he may be fine.

Someone PLEASE correct me if i am painting a dangerously incomplete picture.

Fubar is obviously worried and needs reassurance either way.

Keep us informed.

[PandorymDMT]

Originally Posted by Alfa

increased pulse, anxiety, shortness of breath. 1 hour. 20 minutes after intake.

That basically sounds like the effect of a opiate and a minor stimulant, not a health problem.

[The baine]

Unless Fubar has no tolerance to opiates, he should be OK unless an allergic reaction has taken place. A shot of narcan if he/she is not an addict. The quantity of paracetamol might be a problem which is probably not too much at 20 mg. If in doubt, always go to hospital. IMHO

[MisterV]

Originally Posted by The baine

The quantity of paracetamol might be a problem which is probably not too much at 20 mg.

Who tells SWIY that there even is one. Hydrocodone is hydrocodone.
Theres no mix mentioned.

[kasbeq]

Drug Interaction Results
Back
Drug interaction results for the following 3 drug(s):
chlorpheniramine
hydrocodone
yohimbine
Interactions between your selected drugs
chlorpheniramine and hydrocodone (Moderate Drug-Drug)
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.


Other drugs that your selected drugs interact with
• There are more than 1000 other drugs known to interact with chlorpheniramine
• There are more than 900 other drugs known to interact with hydrocodone
• There are more than 90 other drugs known to interact with yohimbine
Interactions between your selected drugs and food
No results found - however, this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

[I_8_my yellow crayon]

Okay, the yohimbine is a mild maoi inhibitor, it does not have as much activity as an maoi as the other commonly prescribed ones. When given a normal dose of an maoi, patients can still be treated by narcotics, however their dosage must be reduced 25% of the normal for the narcotic. Also, any food containing tyramine, ie: red wine, liver, cheese, chocolate and such must be avoided. Also any anti-histamines or diet aids must be avoided especially diet aids containing phenylpropaanolamine. So the reaction of what swiy is talking about depends on many, many things. If there is any way, this persons blood pressure must be checked immediatly, as this can potentially cause a crash in blood pressure. Also the chloropheniramine is a horrible drug to throw into this mad mix. This mix is just asking for blood prssure drop. Whoever has taken this should go to hospital, or even a drug store with a blood pressure check, and they should be accompanied with someone. As it can take a couple hours before this reaction will occur. This was a bad ideas to take this, not trying to scare anyone. On a posative note, these are relativly small doses of these drugs. Please do not blast swims reputation for this post, he is only trying to help. Swim asked his girlfriend for this information, she is in her third year of registered nursing. I know myself though that yohimbine is a very very mild maoi. Again swim is just saying his opinion and his girlfriends. All in all swim thinks the user will be okay, but should go get checked. Please post back if any questions

[kasbeq]

Hydrocodone with yohimbine no known interactions

Drug interaction between hydrocodone and yohimbine
Drug interaction results for the following 2 drugs:

hydrocodone
yohimbine

There are no known interactions between hydrocodone and yohimbine
However, this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.
Hydrocodone is in the following drug classes: antitussives, narcotic analgesics.
Yohimbine is a member of the drug class impotence agents.
Yohimbine is used to treat the following conditions: Erectile Dysfunction, Sexual Dysfunction, SSRI Induced.
See also...


kasbeq added 1 Minutes and 7 Seconds later...

Drug interaction between chlorpheniramine and hydrocodone
Drug interaction results for the following 2 drugs:

chlorpheniramine
hydrocodone

chlorpheniramine ⇔ hydrocodone
Moderate Drug Interaction
Applies to: chlorpheniramine and hydrocodone
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

[fnord]

Is there pulse rate elevated to a dangerous point? As im sure you already know the best idea is to play it safe and seek medical advice. Is this FUBAR or one of FUBARs friends?

[I_8_my yellow crayon]

Swim also wants to note that all of the above information is correct, and that his girlfriend also said panicking will not help matters any, and to keep a cool head, and just relax, there are minimal reactions between these drugs, its just when these drugs are combined together, the normal narcotics dosage is decreased by atleast 50%. If someone doesn't believe swim, ask a doctor.

[Alfa]

This concerns a friend of FUBAR. Not FUBAR himself.

[Bajeda]

The 20mg hydrocodone and 16mg chloropheniramine have a synergestic CNS depressant effect on each other. I think the yohimbine potentiated this synergy, or perhaps otherwise affected it.

The subject has a low tolerance to opiates from recent use (which was spaced out), but has taken up to 50mg of hydrocodone with little to no tolerance in the past and not had any problems.

Likewise, the subject has mixed stronger stimulants and opiates and/or other depressants in the past and not experienced this set of effects, so it seems likely that either MAOI activity or some other idiosyncratic feature of one substance has engendered this atypical reaction.


Currently, approximately 2hr 30min after ingestion, the shortness of breath is less pronounced but diastolic blood pressure is 55 (borderline hypotension) and systolic is under 110, though not as low relative to diastolic.

Heard that with the extended release mechanism in Tussionex the effects should plateau at around 3 hours.

Subject will continue to monitor blood pressure to make sure it doesn't drop too low, and keep swim informed of situation. It looks like there is no serious danger at this point though.

[PandorymDMT]

Originally Posted by Bajeda

Subject will continue to monitor blood pressure to make sure it doesn't drop too low, and keep swim informed of situation. It looks like there is no serious danger at this point though.

Good to hear! Thanks for keeping SWIM informed of SWIY's status, SWIM is interested in the effects of this tri-combo.

[fnord]

How did you friend turn out?

[Bajeda]

After 3.5-4 hours after ingestion his breathing was less laboured and after a full meal with red meat he took his blood pressure and it was back up to a more normal range.

Everything was fine in the end. Its just an experience the subject doesn't want to repeat.

He suggests caution using Tussionex, and recommends not mixing Yohimbe or Yohimbine with CNS depressants.