Methadone & BP Meds
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Methadone, nausea and bipolar disorder medications (Sharon)

Hello Dr. Phelps, I have been taking 100mg of Topamax morning and 100mg at night for my BiPolar disorder. The first month my Doc gradually brought me up to this amount. I also take Methadone, celebrex, soma for my chronic pain. My question is, is there a possibility of toxic combination due to the Methadone. I seem to have bouts of nausea in the mornings since my pain doctor changed my pain meds from darvocet to methadone? Both doctors have said they checks and there is no problem with the combination of these drugs but the nausea only began with the beginning of Methadone. Thank You for this wonderful web site.

Dear Sharon --
I tell my patients "anything can cause anything".  The recognized Drug-A-causes-Reaction-B stuff can be found in the Physician's Desk Reference (PDR) and elsewhere, but if it's not there, it doesn't mean it can't happen!  It just means it doesn't happen often enough to be clearly recognized.  (Usually I have the other problem: people are wondering if their side effect is from the medication, and that side effect is listed all right -- but so many are, we are wondering if this side effect is really from their medication).

The topomax, or soma, or methadone are all potential causes -- or even something else.  The methadone sounds most suspicious on the basis of the timing. The only way to tell for sure is to do cautious trial of lowering one at a time, looking for nausea to decrease as the drug decreases.  Talk to your doc' about whether it's time for such trials.

Dr. Phelps

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