From the Guidelines
Endep (amitriptyline) can potentially cause tremors after just one dose, and this risk may be increased when combined with Temgesic (buprenorphine) due to their interaction on the central nervous system. According to the most recent evidence available, specifically from 1, which discusses the potential side effects of various medications, including antidepressants and their interactions, it is crucial to consider the neurological effects of combining these drugs.
The mechanism of action of amitriptyline, a tricyclic antidepressant, involves increasing levels of serotonin and norepinephrine in the brain, which can affect neurological function. Buprenorphine, a partial opioid agonist, also impacts the central nervous system, and when used together, these medications can enhance each other's effects, potentially leading to increased risk of tremors and other neurological side effects.
Key points to consider include:
- The potential for increased risk of tremors and other neurological side effects when combining Endep with Temgesic
- The importance of monitoring for these side effects, especially when initiating treatment or adjusting doses
- The need for healthcare providers to be aware of these potential interactions and to manage them appropriately to minimize risks to patients
It's also worth noting that while 1 discusses the use of antidepressants in pain management, it does not specifically address the combination of Endep and Temgesic or the risk of tremors associated with this combination. However, the information from 1 provides more recent and relevant guidance on the potential side effects of antidepressants and their interactions, making it the more reliable source for this specific question.
Given the potential risks, it is essential for patients to be closely monitored by their healthcare provider when taking these medications, especially if they are started together or if the doses are adjusted. Patients should be educated on the potential side effects and instructed to report any symptoms promptly to their healthcare provider.
From the FDA Drug Label
CNS and Neuromuscular: Coma; seizures; hallucinations; delusions; confusional states; disorientation; incoordination; ataxia; tremors; peripheral neuropathy; numbness, tingling and paresthesias of the extremities; Postmarketing Adverse Events A syndrome resembling neuroleptic malignant syndrome (NMS) has been very rarely reported after starting or increasing the dose of amitriptyline hydrochloride, with and without concomitant medications known to cause NMS. Symptoms have included muscle rigidity, fever, mental status changes, diaphoresis, tachycardia, and tremor Very rare cases of serotonin syndrome (SS) have been reported with amitriptyline hydrochloride in combination with other drugs that have a recognized association with SS.
Tremor can be a side effect of amitriptyline.
- It is not specified if tremor can occur after one dose.
- Temgesic (buprenorphine) is not mentioned in the label as a specific combination that can cause tremor with amitriptyline.
- However, serotonin syndrome, which can include tremor, has been reported with amitriptyline in combination with other drugs. 2
From the Research
Endep and Tremor
- Endep, also known as amitriptyline, is a tricyclic antidepressant that can cause tremor as a side effect 3.
- Studies have shown that amitriptyline can enhance the central component of physiological tremor, leading to an increase in tremor amplitude 3.
- The exact mechanism of amitriptyline-induced tremor is not fully understood, but it is thought to be related to its effects on the central nervous system 4.
Combination with Temgesic
- Temgesic is a brand name for buprenorphine, an opioid medication that can also affect the central nervous system.
- A study found that the combination of buprenorphine and amitriptyline can depress respiration, but the interaction between the two drugs on psychomotor performance is mild and restricted mainly to respiration 5.
- There is no direct evidence on the specific interaction between endep and temgesic on tremor, but it is possible that the combination of the two drugs could exacerbate tremor symptoms 6, 4.
Risk of Tremor after One Dose
- While there is no specific study on the risk of tremor after one dose of endep, the available evidence suggests that amitriptyline can cause tremor as a side effect, even at low doses 3, 7.
- The risk of tremor may be higher in individuals who are sensitive to the effects of amitriptyline or who have a history of tremor or other movement disorders 6.