Paxil, High BP, Muscular Spasm (a.k.a. Sex, Drugs and Rock-n-Roll)

[Max34]

Dear Doctor,

I’m a male, 34 years old, MBA, consultant, on Paxil 10 mg for last 5 years. Normal weight 5-9 144lb, physically active: climbing, mountain biking, hiking Sierra Nevada every weekend. Healthy diet: only fruits and vegetables.  Eight months ago I gradually stopped taking Paxil (5 mg for 2 weeks, 2,5 mg for 2 weeks) but I felt unhappy and suicidal after that. Therefore for last 6 months I’ve been drinking about a bottle of red wine tonight and went back to 10 mg of Paxil. In last six month my BP went from 110/60 to 145/100 (161/110 sometimes). At 2-3 am I usually have my pulse at 90-100 and I sweat like a dog. I also have a constant light chest pain (left side, echoes in left hand). I feel better when I walk then when I sit in my office.

I’d been diagnosed with some sort of “sore muscles / muscular spasm” two years ago. Massage therapy helps a lot.  Every night I also take 1 mg of Sirdalud aka Tizanidine aka Zanaflex (A muscle relaxant, is used to help relax certain muscles in your body. It relieves the spasms and increased muscle tone caused by medical problems such as multiple sclerosis or spinal injury). 1 mg of Sirdalud lowers my BP from 150/110 to 130/90 for 6 hours. 2 mg of Sirdalud lowers my BP from 150/110 to 110/70 for 6 hours. Sirdalud is not a hypertension drug.

My understanding is that Paxil had caused muscular spasms in my body (it feels like I’m always very tight, like constant static load, not relaxed physically). My heart has to work harder in order to pump blood over contracted vessels. Alcohol makes it harder for liver to remove Paxil from my body (higher than expected of 10 mg of Paxil plasma concentration? Equivalent to 15 0r 20 mg?).

I’m going to reduce Paxil to 5 mg and drink only 100-150 ml of wine daily. I’m also thinking about switching to minimal amount of Wellburtin (to go from Paxil). Does this plan sound right for you?

Thank you very much for your time!

[Roger Gould, M.D.]

Yes, but I would add some psychotherapy to the mix so you won't be so dependent on drugs or alcohol.  First of all, the waking at 3 a.m. is probably alcohol related..it is a stimulant 4-6 hours after its initial depressant effect. Cutting down will help. Switching to wellbutin will also help so it is a good idea. But the suicidal thoughts and muscle spasm ( internal tension,anxiety??) deserves more thoughtful analysis . IF you are in southern Californai, l.A., you can call me and I will see if I can help you with a referral...310 824 0622.

[Paule]

Your 10 mg is too low a dose.  You probably have muscle tension or High BP due to stress/anxiety. You should think about increasing your dose to 20 mgs before going down once again.  You should also consider CBT along with your treatment.

I'm 5' 8", 163, athletic, rock and ice climb and take 15 mg's currently (been on either 20, 10 or 15 mgs for 5 years) and my bp is normal but at times of stress or anxiety (white coat) it goes up--way up.  I determined that I had white coat by using a 24 hr bp monitor, usually available for free from a hospital.  You hook it up to your arm and leave it on for 24 hours.  You'll probably find--as my doctor did, and I told her so--that you don't have high bp.

good luck  

[papaiz]

I took paxil for two days several years ago and had an overwhelmingly bad reaction. But, for the next two to three months I had a resting heart rate of 100 to 110, while I had always had a resting pulse of about 64. My blood pressure stayed low. I also had a fever of about 100 to 101 during this time. Intetestingly I also had sleepiness, and lack of concern about anything, and the shivers. I know this was the drug and not some fear related rise in heart rate.I think when people use these drugs they are playing with fire as the ssri's seem to have the potential to dysregulate all of the feedback loops in the body. So, my layman's advice is to get off of the paxil, SLOWLY and let your doctor know if you get suicidal and don't do anything the drug tells you to do, believe your body (in other words you are not imagining these reactions), and be patient with yourself. The wine will keep you keyed up at night. I use choline/inositol caps (from the health food store) and eat some chicken or turkey with some carbs like apples when I feel pent up.