Jack asked
I am currently on Plaquenil and Cymbalta. I was considering asking my doctor to put me on Vyvanse. Is this safe?
Answer
There is not a known interaction between Plaquenil (hydroxychloroquine) and Vyvanse (lisdexamfetamine), but there is an interaction between Cymbalta (duloxetine) with Vyvanse. Caution is advised when using both of those medications together.
Vyvanse
Vyvanse is a CNS stimulant drug used to treat Attention Deficit Hyperactivity Disorder (ADHD) and binge eating disorder. Vyvanse is a prodrug of amphetamine considered a schedule II medication due to a risk of drug abuse and dependence. Vyvanse causes an increases levels of dopamine and norepinephrine in the brain. This will lead to a release of serotonin in the brain.
Cymbalta
Cymbalta is commonly used to treat generalized anxiety disorder, major depressive disorder, fibromyalgia, and musculoskeletal pain. This drug is classified as a serotonin and norepinephrine re-uptake inhibitor (SNRI).
Taking Cymbalta With Vyvanse
As you can see, both of these medications will increase the amount of serotonin, which can potentially increase the risk of serotonin syndrome.
Symptoms of serotonin syndrome include:
- Mental status changes (Including hallucinations, agitation, delirium, and coma)
- Tachycardia
- Labile blood pressure
- Dizziness
- Sweating
- Flushing
- Hyperthermia
- Neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination)
- Seizures
- Gastrointestinal upset
In addition, as both Vyvanse and Cymbalta increase norepinephrine, there is the potential that blood pressure can be increased.
There may be situations where both medications are the best therapy options for you, but be sure to talk to your doctor about your concerns.
Summary
- It is recommended to avoid taking Cymbalta with Vyvanse because of the additive serotonin effects.
- In addition, both Cymbalta and Vyvanse can increase blood pressure.
Talk to your doctor to determine what is best for you and the conditions that you are trying to treat.
