mixing upper and downers

[pharmacisttotherescue]

Hey everybody,

so I'm a new practicing pharmacist working for a chain and I had a question regarding mixing upper and downers. yesterday I received a script for Vyvanse and Paxil and upon looking at the patients profile, she had been getting it for a while. Can anyone please give me any insight on this, or mixing benzos with stimulants, or stimulants with hypnotics such as Ambien, its stuff Im starting to see as a practicing pharmacist and it seems like all the pharmacist I work with just seem to verify all these combinations, but before I have my name on the verification, would any of you verify these combos? I would like to have some insight on this subject. Any input is greatly appreciated. Thank You!

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[KennethCool]

The issue with paxil + vyvanse is that paxil is a CYP2D6 inhibitor. Look at the vyvanse dose. It would be okay if it is dosed on the low end.

The big side effect of stimulants is that people can't sleep. That's why they are being prescribed z-drugs or benzos. It's fairly common to see this combo.

 

[animalsasleaders]

Hey everybody,

so I'm a new practicing pharmacist working for a chain and I had a question regarding mixing upper and downers. yesterday I received a script for Vyvanse and Paxil and upon looking at the patients profile, she had been getting it for a while. Can anyone please give me any insight on this, or mixing benzos with stimulants, or stimulants with hypnotics such as Ambien, its stuff Im starting to see as a practicing pharmacist and it seems like all the pharmacist I work with just seem to verify all these combinations, but before I have my name on the verification, would any of you verify these combos? I would like to have some insight on this subject. Any input is greatly appreciated. Thank You!

Current pharmacy student. Which is the upper and downer? One increases NE and Dopamine, and the other Sertraline, right?

 

[RxPreceptor]

Paroxetine does not really fall into the upper/downer category...although it is an SSRI, it also has anticholinergic properties (sedating..."downer") and NRI (attention..."upper"). Like most of the other SSRI's ADR %s will be fairly close between sedation & insomnia; very patient variable/trial and error. Not as clear cut as lisdexamfetamine or even bupropion ("uppers"....I officially hate this nomenclature of "uppers/downers" now)

 

[Dr. Pill]

Current pharmacy student. Which is the upper and downer? One increases NE and Dopamine, and the other Sertraline, right?

Are you under the impression that sertraline is a NT?

 

[animalsasleaders]

Are you under the impression that sertraline is a NT?

Lol yes?

 

[gwarm01]

Lol yes?

Sertraline = drug
Serotonin = neurotransmitter

 

[animalsasleaders]

Sertraline = drug
Serotonin = neurotransmitter

Hahaha, wow. That's definitely not the first time I've accidentally said sertraline instead of serotonin. But I feel like more of a ******* everytime it happens. I'll walk myself out now.

 

[lane one]

Current pharmacy student. Which is the upper and downer? One increases NE and Dopamine, and the other Sertraline, right?

Hopefully you just started...

 

[pharmacisttotherescue]

Okay so I received a script a couple days ago from a store I floated to from a usual patient for the same prescriptions :modafinil, xanax, and ambien, I don't understand what these doctors are doing and the pharmacists that are filling these scripts. Do I continue the regimen or reject it its such a bad predicament to be in, in that the patient has been getting it and don't know what the right move is, fill or not?

 

[Charcoales]

Okay so I received a script a couple days ago from a store I floated to from a usual patient for the same prescriptions :modafinil, xanax, and ambien, I don't understand what these doctors are doing and the pharmacists that are filling these scripts. Do I continue the regimen or reject it its such a bad predicament to be in, in that the patient has been getting it and don't know what the right move is, fill or not?

All new? Shady MD? Hopefully not paying cash or using discount card on the controls. Also make sure not more than 1 day early on controls. Are doses being started at highest dose right away? Doctor shopping on pdmp? Most of the time I wouldn't bat an eye because usually there is no red flags.

 

[Modest_anteater]

Hey everybody,

so I'm a new practicing pharmacist working for a chain and I had a question regarding mixing upper and downers. yesterday I received a script for Vyvanse and Paxil and upon looking at the patients profile, she had been getting it for a while. Can anyone please give me any insight on this, or mixing benzos with stimulants, or stimulants with hypnotics such as Ambien, its stuff Im starting to see as a practicing pharmacist and it seems like all the pharmacist I work with just seem to verify all these combinations, but before I have my name on the verification, would any of you verify these combos? I would like to have some insight on this subject. Any input is greatly appreciated. Thank You!

apparently there are no interactions between hydrocodone and amphetamine salts which blows my mind

 

[Charcoales]

apparently there are no interactions between hydrocodone and amphetamine salts which blows my mind

Yeah but theoretically, an upper could mask symptoms of a downer and so on (ethanol + adderall for example)

 

[Modest_anteater]

Yeah but theoretically, an upper could mask symptoms of a downer and so on (ethanol + adderall for example)

I don't see how uppers and downers should be mixed at all. Cocaine and heroin can kill you the same way oxycodone and amphetamine can kill you. These drugs are sending the cardiac system opposite, conflicting commands that I think would be very dangerous.

 

[CetiAlphaFive]

I don't see how uppers and downers should be mixed at all. Cocaine and heroin can kill you the same way oxycodone and amphetamine can kill you. These drugs are sending the cardiac system opposite, conflicting commands that I think would be very dangerous.

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