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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Areila on June 26, 2001, at 22:38:05
Hi there.
I started taking Zoloft about a week ago, and although the first few days were terrible, I'm feeling better now. I felt sick, I couldn't eat, sleep, I was very anxious etc.
The anxiety still continues (especially in my body, not as much my brain now) I feel like I've drank some coffee, and my body is restless.
My doctor said he may prescribe anti-anxiety medication. I've heard about Kava, and I would rather try that. My question is, has anybody heard of any drug interaction with Zoloft and Kava? I've read all I can about it, and I haven't seen any concrete information about this exact drug interaction. As long as there is no negative effect, I would like to try Kava to see if it alleviates my anxiety.
Any help, comments etc would be greatly appreciated.
Areila
Posted by Sunnely on June 26, 2001, at 23:58:09
In reply to Zoloft and Kava interactions?, posted by Areila on June 26, 2001, at 22:38:05
Hi Areila,
There is a case report of reduced effectiveness of levodopa when an individual used kava and levodopa concomitantly, possibly due to dopamine antagonism. What's the connection?
Well, theoretically, the combination of kava and Zoloft may cause you to experience extrapyramidal symptoms (EPS) such as muscle stiffness, tremor and motor restlessness. How?
Zoloft is a serotonin-booster. Serotonin is a neuromodulator of dopamine, that is, it inhibits the action of dopamine. This may lead to extrapyramidal symptoms as described above. (Actually, EPS has been reported with the use of SSRIs.) Coupled with kava's possible dopamine antagonism, the risk of EPS may be enhanced.
Another theoretical effect of this combination is increased risk of bleeding. One of kava's component, kavapyrone(+)-kawain can have antithrombic action on platelet, probably due to inhibition of cyclo-oxygenase and decreased thromboxane 2 (TXA2) production. Zoloft, being a serotonin-enhancer may also cause increased risk of bleeding. How?
Well, the exact mechanism as to how Zoloft (and the other SSRIs) increases risk of bleeding is unknown. It appears it may have something to do with its serotonin effect. Under normal circumstances, platelets (blood particles responsible for clotting) release serotonin at the site of vascular tears, leading to further platelet aggregation and vasodilation (blood vessels enlarge). This permits sealing of the tear stopping the bleeding. It appears that the SSRIs block the reuptake of serotonin into the platelets which leads to decreased serotonin to be released by the platelets into the site of bleeding. So, theoretically, kava + Zoloft could lead to increased risk of bleeding.
Just my own 2 cents.
***********************************
> Hi there.
>
> I started taking Zoloft about a week ago, and although the first few days were terrible, I'm feeling better now. I felt sick, I couldn't eat, sleep, I was very anxious etc.
>
> The anxiety still continues (especially in my body, not as much my brain now) I feel like I've drank some coffee, and my body is restless.
>
> My doctor said he may prescribe anti-anxiety medication. I've heard about Kava, and I would rather try that. My question is, has anybody heard of any drug interaction with Zoloft and Kava? I've read all I can about it, and I haven't seen any concrete information about this exact drug interaction. As long as there is no negative effect, I would like to try Kava to see if it alleviates my anxiety.
>
> Any help, comments etc would be greatly appreciated.
>
> Areila
Posted by Areila on June 27, 2001, at 7:44:41
In reply to Re: Zoloft and Kava interactions? » Areila, posted by Sunnely on June 26, 2001, at 23:58:09
Hi Sunnely,
Thanks for your comments!
I've heard that benzodiazepines such as Xanax, Valium and Librium combined with Zoloft also have negative combinational effects. Specifically the famous case of the man who was "in a semi-comatose state" after taking Kava and Xanax, which is actually a misconstruction of the facts, as he was on two other medications as well, with a possible four-way drug interaction, and apparently the three initial prescribed drugs alone could even have similar effects even without the Kava. I simply don't know which combination is LESS harmful Kava and Zoloft or benzodiazepines with Zoloft.
I am not very knowledgeable about other types of anxiolytic drugs, so I am assuming my doctor would prescribe a benzodiazepine. Perhaps he has something else in mind, that would not have such problematic interactions.
However, I have not heard about Kava's dopamine antagonism. Could somebody reading the thread confirm this? This would be a problem certainly. I've read that Kava has muscle relaxant properties, that it "directly relaxes muscles by fast and specific inhibition of voltage dependent Na+ channels" without affecting the central nervous system, etc. and so it shouldn't aggravate or lead to EPS. In fact I started feeling EPS when I started taking Zoloft, and although it's improved significantly, it's also to relieve this even more that I want to try Kava, or something to help.
The bleeding issue is a good point, I'll have to consider that as a side-effect. Plus of course I'll stay away from alcohol, sedatives, MAO inhibitors etc, all the contraindicated substances, which can cause many disastrous effects.
Well, anyway it certainly has opened up an interesting discussion, and I thank you again for that. I hope more people join in this particular thread, it helps to have different perspectives on the issue. It's so difficult still even in this day and age to be able to know with any degree of certainty how to help yourself with regards to mental health.
Hope to see more follow-ups about this.
Areila
Posted by Bill L on June 27, 2001, at 8:33:25
In reply to Zoloft and Kava interactions?, posted by Areila on June 26, 2001, at 22:38:05
I have had no problems with kava along with Celexa. Kava works very well. It only takes 30 minutes to kick in. It has a full effect in a couple of weeks.
> Hi there.
>
> I started taking Zoloft about a week ago, and although the first few days were terrible, I'm feeling better now. I felt sick, I couldn't eat, sleep, I was very anxious etc.
>
> The anxiety still continues (especially in my body, not as much my brain now) I feel like I've drank some coffee, and my body is restless.
>
> My doctor said he may prescribe anti-anxiety medication. I've heard about Kava, and I would rather try that. My question is, has anybody heard of any drug interaction with Zoloft and Kava? I've read all I can about it, and I haven't seen any concrete information about this exact drug interaction. As long as there is no negative effect, I would like to try Kava to see if it alleviates my anxiety.
>
> Any help, comments etc would be greatly appreciated.
>
> Areila
Posted by Salby on June 27, 2001, at 15:49:08
In reply to Zoloft and Kava interactions?, posted by Areila on June 26, 2001, at 22:38:05
Areila,
Give the Zoloft more time. I am now taking it again (third time in 2 years) and I am noticing it too is making me jittery, this time, but that is going away. It works wonders with anxiety as well as depression for me. Also, make sure you take it with food so it doesn't make you sick. Your body will get used to it very soon. Except for the sexual side effects I have had very good luck with it.
Stay well!
Salby> Hi there.
>
> I started taking Zoloft about a week ago, and although the first few days were terrible, I'm feeling better now. I felt sick, I couldn't eat, sleep, I was very anxious etc.
>
> The anxiety still continues (especially in my body, not as much my brain now) I feel like I've drank some coffee, and my body is restless.
>
> My doctor said he may prescribe anti-anxiety medication. I've heard about Kava, and I would rather try that. My question is, has anybody heard of any drug interaction with Zoloft and Kava? I've read all I can about it, and I haven't seen any concrete information about this exact drug interaction. As long as there is no negative effect, I would like to try Kava to see if it alleviates my anxiety.
>
> Any help, comments etc would be greatly appreciated.
>
> Areila
Posted by Sunnely on June 28, 2001, at 1:01:58
In reply to Kava VS. Benzodiazepines » Sunnely, posted by Areila on June 27, 2001, at 7:44:41
> I've heard that benzodiazepines such as Xanax, Valium and Librium combined with Zoloft also have negative combinational effects. Specifically the famous case of the man who was "in a semi-comatose state" after taking Kava and Xanax, which is actually a misconstruction of the facts, as he was on two other medications as well, with a possible four-way drug interaction, and apparently the three initial prescribed drugs alone could even have similar effects even without the Kava.
Pharmacokinetic-wise, there should be no clinically significant drug-drug interaction between sertraline (Zoloft) and alprazolam (Xanax). Xanax is mainly metabolized by the cytochrome enzyme CYP3A4. Zoloft does not interfere with the action of this enzyme. Same is true with diazepam or Valium (via CYP2C19) and chlordiazepoxide or Librium (via CYP2C19 and 3A4). In general, however, the combination of Zoloft and any of the benzodiazepines you mentioned is considered safe and well-tolerated.
With regard to the case of "semicomatose" patient, this is actually a 54-year-old man whose medications included cimetidine (Tagamet), terazosin (Hytrin), and Xanax. Reportedly, 3 days prior to his admission to a hospital in a "semicomatose" state, he started taking the "natural tranquilizer" kava. After several hours, he returned to an alert state. Indeed, this may not be just a case of drug interaction between Xanax and Kava. Cimetidine, itself is notorious for inhibiting a number of cytochrome enzymes that could lead to clinically significant interactions. Nonetheless, caution should be observed when taking Xanax or any centrally-acting depressant drugs with Kava.
>
>
> However, I have not heard about Kava's dopamine antagonism. Could somebody reading the thread confirm this?This is just one case report of kava interfering with levodopa treatment in a Parkinson's patient, leading to reduced effectiveness and worsening of Parkinson's.
This is the end of the thread.
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