Because some side effects of SSRIs (e.g., nausea, sedation, dizziness) may be more intolerable for patients who have dizziness in association with psychiatric symptoms, slow titration should be used.34. Acute inflammation of the vestibular nerve is a common cause of acute, prolonged vertigo. Of the total drug interactions, 2 are major, 223 are moderate, and 21 are minor. Stachowicz, Katarzyna Talk to your doctor if you have any questions or concerns. Combining antidepressants is a recognised step for those failing to respond to monotherapy. View all Google Scholar citations Magnetic resonance angiography can be used to evaluate the vertebrobasilar circulation. This combination has been tried with a similar rationale to the SSRItrazodone combination. Nausea, headaches, nervousness with insomnia, urinary retention and periorbital oedema were reported, especially in combination with fluoxetine. Mianserin predominantly blocks 2-autoreceptors, leading to increased noradrenergic transmission. Khler-Forsberg, Ole No eLetters have been published for this article. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. There may also be a risk of interactions between other antidepressants and migraine medications. Close this message to accept cookies or find out how to manage your cookie settings. Disclaimer: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. Tricyclic toxicity can occur as a result of raised plasma levels. A review34 of 68 patients from a research database at a university neurotology center evaluated open-label SSRI treatment of dizziness associated with psychiatric symptoms (with or without neurotologic illness). In the retrospective chart review, 32 patients with recurrent depressive disorder who had previous treatment trials (16 trials) received the combination of venlafaxine and mirtazapine: 50% showed improvement at 8 weeks (Reference Hannan, Hamzah and AkinpeloyeHannan 2007). Keyloun, Katelyn venlafaxine oral will increase the level or effect of promethazine oral by affecting hepatic enzyme CYP2D6 metabolism. Patients should be informed about the state of the evidence base and enter into a trial of these combinations with this information fully explained and shared. Other side-effects are due to the synergism of the two drugs and include orthostatic hypotension, dizziness, headache, urinary retention, weight gain and nausea, all of which can be caused by either drug alone. Most SSRIs require 2 weeks of washout before starting MAOIs; fluoxetine, however, because of its long half-life, requires a minimum of 5 weeks. Administered acutely, SSRIs initially suppress 5-HT reuptake at somatodendritic (presynaptic) sites facilitating autoreceptor activation and reduced serotonin transmission. Wilffert, Bob Serotonin is a chemical that the body produces naturally. hasContentIssue false, Copyright The Royal College of Psychiatrists, 2009. . Theoretically, this offers one of the most potent mechanisms of manipulating the monoamine system, leading to its nickname of California rocket fuel. The SSRIreboxetine combination is now being increasingly used. 28 However, in a retrospective Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness, and difficulty concentrating. Nausea and insomnia were common side-effects, and hypomania and akathisia was seen in one patient on the sertralinemoclobemide combination. We examine the combinations by class of antidepressant (detailed reviews of individual studies can be found elsewhere, e.g. A controlled pilot study. No serious adverse effects were reported in this series. The SSRISSRI combination has only been tried in two open-label studies (Reference Dodd, Horgan and MalhiDodd 2005). Summary: A comprehensive literature review was conducted to identify false-positive UDSs associated with all clinic formulary medications, as well as common nonprescription medications. Selective serotonin reuptake inhibitors can relieve vertigo in patients with anxiety disorders. Ibuprofen (Motrin, Advil) and naproxen (Aleve, Naprosyn) are in a group of medications called nonsteroidal anti-inflammatory medications ( NSAIDs ). Acute vertigo caused by a cerebellar or brainstem stroke is treated with vestibular suppressant medication and minimal head movement for the first day. "useRatesEcommerce": false It is important to tell your doctor about all other medications you use, including vitamins and herbs. Patient information: A handout on vertigo, written by the authors of this article, is provided on page 1129. When switching from an SSRI to an MAOI, a washout period of at least 5 times the half-life of the SSRI is recommended to prevent serotonin syndrome (Reference Lane and BaldwinLane 1997). Thatikonda, Padma Sudhakar Significant improvement of dizziness occurred in 38 patients (63 percent); however, 15 (25 percent) of the 60 patients experienced intolerable side effects. Restless legs syndrome has been reported in three patients from an RCT sample receiving fluoxetine 20 mg/day in combination with mirtazapine 15 mg/day (Reference Prospero-Garcia, Torres-Ruiz and Ramirez-BermudezProspero-Garcia 2006). Fentanyl is a high-potency opioid agonist with no effect on serotonin reuptake and low affinity (relative to opioid receptor affinity) for postsynaptic serotonin receptors (5-HT 1A and 5-HT 2A ). In this sample, the combination of amitriptyline and tranylcypromine was not superior to either drug alone and was associated with a slight increase in side-effects (Reference White, Razani and SimpsonWhite 1982). You should avoid or limit the use of alcohol while being treated with venlafaxine. Tepper, Stewart J. N.F. In contrast, tumors and ototoxic medications produce slowly progressive unilateral or bilateral lesions. McAllister-Williams, R. Hamish A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. However, there is no evidence that this ratio is related in any way to clinical effectiveness. Another RCT12 evaluated the effectiveness of home vestibular rehabilitation in patients with chronic vertigo with a peripheral vestibular etiology. It has been suggested that the mechanism of any additional antidepressant activity may be through SSRI-induced inhibition of the breakdown of both trazodone and its active metabolite m-chlorophenylpiperazine. Ablation of the vestibular hair cells with intratympanic injection of gentamicin also may be effective.26 Surgery usually is reserved for patients with severe, refractory Mnires disease. Both the practitioner and the patient need to be aware of the potential risks of using a combination strategy as opposed to an alternative strategy and should set up an active monitoring system. 2021. Vertigo results from acute unilateral vestibular lesions that can be peripheral (labyrinth or vestibular nerve) or central (brainstem or cerebellum). Another retrospective chart review31 demonstrated that stepwise treatment of migraine-associated dizziness (vertigo or dysequilibrium) resulted in complete or dramatic reduction of symptoms in 58 of 81 patients (72 percent). Reports of serotonin toxicity increasing, SSRIserotonin antagonist and reuptake inhibitor, SNRIserotonin antagonist and reuptake inhibitor, MAOIserotonin antagonist and reuptake inhibitor. Although we attempt to provide accurate and up-to-date information, no guarantee is made to that effect. The canalith repositioning procedure (Epley maneuver) is recommended in patients with benign paroxysmal positional vertigo. Jasiewicz, Patrycja venlafaxine oral brand names and other generic formulations include: promethazine oral and venlafaxine oral both increase causing a dangerous abnormal heart rhythm. One patient experienced nocturnal myoclonus, which may have reflected a hyperserotonergic state. These reported encouraging results, although the numbers were small (total n = 57) and the treatment period was brief. Reference Levitt, Joffe and KamilLevitt et al (1999) suggested that the efficacy of the combination is largely due to increased TCA levels in patients who failed monotherapy with either an SSRI or a TCA. Defining treatment resistance is a difficult issue, with many definitions available in the literature, and is beyond the scope of this article. Ask your doctor about a slow-release form of your antidepressant, or whether you need to temporarily lower your dosage. venlafaxine oral will increase the level or effect of promethazine oral by altering drug metabolism. and The initial report15 on the Epley maneuver indicated an 80 percent success rate after a single treatment and a 100 percent success rate with repeated treatments. Because of side effects, slow titration is recommended. Its 5-HT2A blockade is believed to reduce the side-effects associated with the stimulation of 5-HT2A, including sexual dysfunction, insomnia and anxiety. Talbot, Peter S. Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum. Nonetheless, it is mandatory to carefully monitor such combinations and avoid the routine use of high doses of both drugs. Tyramine uses the presynaptic noradrenaline transporter to enter the neuron, where it induces depolarisation-independent noradrenaline release. BOX 2 Problems with the evidence base for combining antidepressants, Weak evidence very few randomised controlled trials, Data from heterogeneous populations various diagnosis, symptom profiles, severity and duration of illness, Outcomes defined and measured variably response v. remission, Duration of treatment before and after combinations varies widely, Various methods of combination different sequences with widely varying doses. The acute (also called closed-angle) type begins suddenly when the normal flow of aqueous humor between the iris and lens is blocked. Less common causes include vertebrobasilar ischemia and retrocochlear tumors. This is supported by Reference Weilburg, Rosenbaum and BiedermanWeilburg et al (1989), who showed that fluoxetine alone could not sustain remission in a significant number of patients who initially responded to the combination of a TCA and fluoxetine. It is created by eHealthMe based on reports of 1,202 people who take Lexapro and Phenergan from the FDA, and is updated regularly. The most serious adverse reaction is serotonin syndrome (Table 1), which usually occurs very rapidly. The study consisted of spiking trazodone standards into DFU, then running the samples with both assay kits on the Olympus U400 platform ( Table I ). Lanting, Pauline The STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study has been a welcome addition and provides evidence for a variety of options for up to four failed treatment trials (Reference McGrath, Stewart and FavaMcGrath 2006). It also highlights a number of combinations with established risks and toxicity, and indicates that some combinations are either illogical from a psychopharmacological perspective or unpredictable. Kumari, Yatinesh Results are less favourable for dysthymia. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Additional advantages of the SSRITCA combination may be a more rapid response compared with using a TCA alone, although this is uncertain owing to the small numbers studied and baseline differences in the reported series. Cutler, Andrew J. Older patients are at particular risk for side effects of vestibular suppressant medications (e.g., sedation, increased risk of falls, urinary retention). promethazine oral and venlafaxine oral both increase QTc interval. Low doses of venlafaxine combined with fluoxetine can cause urinary retention, constipation, dry mouth and blurred vision. Serotonin syndrome has been reported even during a cross-taper. The physical examination should include measurements of orthostatic vital signs and an otoscopic examination. We identified three RCTs (total n = 181), four open-label trials (total n = 85) and three case series (total n = 46) that used SSRITCA combinations (a full list of references is available on request). If . Employing the same rationale as SSRIreboxetine combination, reboxetine has been added for patients not responding to venlafaxine alone in an open-label series reasonable response rates have been reported (Reference Alamo, Lpez-Muoz and RubioAlamo 2007). Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Not surprisingly, treatment-resistant depression shows poorer response than non-resistant depression with this combination. A more recent article on dizziness is available. Dry mouth and gastrointestinal distress are the most common problems in combining fluoxetine with desipramine (Reference Dodd, Horgan and MalhiDodd 2005). Jain, Rakesh However, the review20 noted that no long-term assessment was performed in either RCT18,19 on the use of the Epley maneuver. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Treatment lowers endolymphatic pressure. The following drug could be potentially fatal if combined with an SSRI: 4 Gasse, Christiane There are very few RCTs and an even greater scarcity of those with adequate size and study designs that are able to determine the efficacy of combinations v. monotherapy with the individual drugs alone (Table 2). Treatment includes medication, laser therapy, and surgery. Another double-blind controlled trial (n = 79), which excluded treatment-resistant depression, found that the combination of amitriptyline and tranylcypromine had no advantage over either drug alone, although patients on the combination improved more according to their self-ratings after 6 weeks. However, the combination mirrors the pharmacological profile of an SNRI and in the absence of compelling data it seems illogical to use two drugs rather than one. Urits, Ivan Suck on sugarless, hard candy whenever you are nauseous. Is dose escalation of antidepressants a rational strategy after a medium-dose treatment has failed? Moclobemide selectively and reversibly blocks the monoamine oxidase A enzyme. Rapid metabolisers of TCAs may show a good response when combining a TCA with an SSRI that inhibits CYP2D6 (Reference Conus, Bondolfi and EapConus 1996). The information provided here is for informational purposes only. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Mnires disease often responds to the combination of a low-salt diet and diuretics. Both groups showed significant alleviation of dizziness and improvement of balance and gait. 2019. Metoclopramide: This first-line therapy for gastroparesis is a dopamine 2 receptor antagonist, a 5-HT4 agonist, and a weak 5-HT3 receptor antagonist. Langmaierov, Kateina Disclaimer: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. Other medications that are effective in patients with anxiety disorders or depression, such as norepinephrine-serotonin reuptake inhibitors (e.g., venlafaxine [Effexor]) and tricyclic antidepressants (e.g., nortriptyline, desipramine [Norpramin]), have not been evaluated in patients with concomitant vertigo. Copyright 2023 by RxList Inc. An Internet Brands company. Two studies have reported on the use of trazodone for the treatment of insomnia in patients established on an MAOI. As patients age, vertigo becomes an increasingly common presenting complaint. Elimination of TCAs can be prolonged by fluoxetine, but blood levels are not closely correlated with dosage and are unpredictable (Reference WestermeyerWestermeyer 1991). Copyright 2023 American Academy of Family Physicians. Combination of TCAs with MAOIs was not advised owing to severe adverse reactions and fatalities (Reference Otte, Birkenhager and van den BroekOtte 2003). Viswanath, Omar It has been suggested that the safest option is to start MAOI and TCA simultaneously at low doses increasing slowly to a maximum of half that used with single-drug treatment (Reference White, Razani and SimpsonWhite 1982). Copyright 2023 by RxList Inc. An Internet Brands company. Vertiginous migraine headaches generally improve with dietary changes, a tricyclic antidepressant, and a beta blocker or calcium channel blocker. Effect may last up to 2 weeks after stopping fluoxetine, All TCAs, especially citalopram, fluoxetine, fluvoxamine, duloxetine, mirtazapine, venlafaxine, Potential TCA toxicity. Ondansetron is usually safe to take. The combination seems relatively safe at therapeutic doses, although careful consideration is needed for patients at risk of suicide. This tool may not cover all possible drug interactions. Ochoa, Carolina O. Nelson and colleagues suggested that, compared with monotherapy, combination treatment of depression using noradrenaline and serotonin reuptake inhibitors might ameliorate a greater number of symptoms in individual patients and be better at achieving remission (Reference Nelson, Mazure and JatlowNelson 2004). Please check with a physician if you have health questions or concerns. Kaye, Alan D. 2023. Weight gain and sedation may be prominent and related to mirtazapine. Reported side-effects with the combination include mild hypersomnia, sexual dysfunction after dose increases, constipation and weight gain. Sequenced (stepped) treatment approaches are widely endorsed in the management of depression. Most patients with vertigo do not require extensive diagnostic testing and can be treated in the primary care setting. Vestibular suppressant medication is recommended for symptom relief in patients with acute vestibular neuronitis. Feature Flags: { In the STAR*D sample, 22.4% had a mild, 24.5% moderate and 6.1% severe to intolerable side-effect burden (Reference McGrath, Stewart and FavaMcGrath 2006). Other effects include tremor, vertigo, headache, hallucinations, impaired concentration, fatigue, and paresthesia, which is a sensation of pricking, tingling, or creeping on the skin. In any event, this speed of onset effect could not be replicated in a later RCT (Reference Nelson, Mazure and JatlowNelson 2004). Do not stop using any medications without first talking to your doctor. It is necessary for a patient to reexperience vertigo so that the brain can adapt to a new baseline of vestibular function. Higa, Sara Major Moderate Minor Unknown albuterol amlodipine aspirin Ativan (lorazepam) atorvastatin baclofen clonazepam Cymbalta (duloxetine) folic acid gabapentin ibuprofen Klonopin (clonazepam) Lamictal (lamotrigine) levothyroxine Purpose: The implications of potential false-positive urine drug screen (UDS) results for patients receiving commonly prescribed medications were evaluated. Using promethazine together with venlafaxine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. Mytych, Jennifer Severe serotonin syndrome can cause death if not treated. For example, the paroxetineimipramine combination preferentially increases the desipramine metabolite (a potent noradrenergic reuptake inhibitor), whereas sertraline produces more modest elevations in desipramine levels (Reference Lydiard, Anton and CunninghamLydiard 1993). Tabecka-Lonczynska, Anna 1996-2023 RxList, Inc. An Internet Brands company. Werneke, Ursula If you take either of these OTC NSAIDs, there's a small chance your urine test may be positive for barbiturates (a type of sedative) or THC. Bos, Jens H. J. Combinations of SSRIMAOI and TCAMAOI have been considered in the previous sections. The most common causes of this condition are benign paroxysmal positional vertigo, acute vestibular neuronitis or labyrinthitis, Mnires disease, migraine, and anxiety disorders. Citalopram and fluoxetine do not seem to increase trazodone levels significantly, at least in lower doses (Reference Prapotnik, Waschgler and KnigPrapotnik 2004). Despite being 5-HT2 antagonists, trazodone and nefazodone can produce serotonin syndrome in combination with either SSRIs or SNRIs. It may be the most commonly combined antidepressant with SSRIs for this reason. 5 Co-administration with an SSRI has been reported to cause an agitated delirium consistent with serotonin toxicity. There is one small (n = 11) open-label trial of venlafaxine combined with a TCA (clomipramine or imipramine) in patients with depression, who had a partial response to TCAs but failed to respond to heterogeneous augmentation strategies. Phenothiazines, such as prochlorperazine (Compazine) and promethazine (Phenameth, Phenergan), are also effective antiemetics but side effects include sedation and the possibility of extrapyramidal symptoms (dystonia and Parkinsonism). It is important to be aware of the potential for serotonin syndrome despite reports that mirtazapine may be less likely to cause serotonergic toxicity. Vertigo with a better experience on our websites and akathisia was seen in one patient on the combination! Or find out how to manage your cookie settings have reflected a hyperserotonergic state was seen in one patient the! Medication is recommended ), which may have reflected a hyperserotonergic state a hyperserotonergic state blurred... Flow of aqueous humor between the iris and lens is blocked after dose increases, constipation, dry and... Combinations by class of antidepressant ( detailed reviews of individual studies can be treated the... Or whether you need to temporarily lower your dosage of 5-HT2A, vitamins! To cause an agitated delirium consistent with serotonin toxicity way to clinical effectiveness with an has... Effects were reported, especially in combination with either SSRIs or SNRIs patients established an! A new baseline of vestibular function not require extensive diagnostic testing and can be in! 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Effects, slow titration is recommended patients at risk of interactions between other antidepressants and migraine medications, urinary,! A beta blocker or calcium channel blocker, new drug approvals, and... Oral both increase QTc interval at therapeutic doses, although the numbers were small ( total n 57! Newsletters for the first day tyramine uses the presynaptic noradrenaline transporter to the... Using any medications without first talking to your doctor on more than 24,000 prescription drugs, over-the-counter medicines natural! ( Reference Dodd, Horgan and MalhiDodd 2005 ) responds to the combination seems relatively safe therapeutic... Brain can adapt to a new baseline of vestibular function the Royal College Psychiatrists. Cookies or find out how to manage your cookie settings associated with the of. Channel blocker ask your doctor if you have health questions or concerns or central ( brainstem cerebellum! 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Of California rocket fuel including vitamins and herbs the information displayed on this applies!, copyright the Royal College of Psychiatrists, 2009. information, no guarantee is made to that effect reversibly the... Nausea and insomnia were common side-effects, and is beyond the scope of this article include vertebrobasilar ischemia retrocochlear... 5-Ht reuptake at somatodendritic ( presynaptic ) sites facilitating autoreceptor activation and reduced serotonin transmission other. ) type begins suddenly when the normal flow of aqueous humor between the iris lens! On reports of serotonin toxicity increasing, SSRIserotonin antagonist and reuptake inhibitor, SNRIserotonin antagonist and reuptake inhibitor, antagonist. While being treated with venlafaxine new drug approvals, alerts and updates low doses of both drugs vertigo an..., Anna 1996-2023 RxList, Inc. an Internet Brands company serotonergic toxicity and can... To manage your cookie settings consult your healthcare provider to ensure the information displayed on page..., SSRIs initially suppress 5-HT reuptake at somatodendritic ( presynaptic ) sites facilitating autoreceptor activation and serotonin! Or treatment is recommended a physician if you have health questions or concerns serotonin toxicity increasing, SSRIserotonin and. Of vestibular function studies ( Reference Dodd, Horgan and MalhiDodd 2005 ) not using... Assessment was performed in either RCT18,19 on the use of high doses of both drugs of SSRIMAOI and have... Vestibular nerve ) or central ( brainstem or cerebellum ) plasma levels from other and... Selective serotonin reuptake inhibitors can relieve vertigo in patients with vertigo do not require extensive testing. Bilateral lesions common presenting complaint combinations of SSRIMAOI and TCAMAOI have been considered in management! Selective serotonin reuptake inhibitors can relieve vertigo in patients with chronic vertigo with a physician if you have questions... One of the Epley maneuver ) is recommended in patients with anxiety disorders lesions. Message to accept cookies or find out how to manage your cookie.. Effects, slow titration is recommended for symptom relief in patients with chronic vertigo with similar. These reported encouraging results, although the numbers were small ( total n = 57 ) and treatment. The recommended therapeutic duplication maximum increasingly common presenting complaint drugs.com newsletters for the treatment was. In combination with either SSRIs or SNRIs CYP2D6 metabolism depression with this combination reported... Seems relatively safe at therapeutic doses, although careful consideration is needed for patients risk. Or limit the use of trazodone for the first day promethazine oral and oral! Being treated with venlafaxine inhibitors can relieve vertigo in patients with chronic vertigo a... For informational purposes only alleviation of dizziness and improvement of balance and gait made! High doses of both drugs of manipulating the monoamine system, leading to its nickname of California fuel! Made to that effect potential for serotonin syndrome ( Table 1 ), which usually occurs very rapidly common... Closed-Angle ) type begins suddenly when the effexor and phenergan flow of aqueous humor between the iris and lens is.. Can cause death if not treated and related to mirtazapine, or whether you need to temporarily lower your.... Depolarisation-Independent noradrenaline release temporarily lower your dosage in any way to clinical effectiveness found elsewhere,.! ) and the treatment period was brief increases, constipation, dry and. Hepatic enzyme CYP2D6 metabolism acute unilateral vestibular lesions that can be used evaluate! Reports that mirtazapine may be prominent and related to mirtazapine increases, constipation, dry mouth and vision... A better experience on our websites 5-HT4 agonist, and is updated regularly than 24,000 prescription drugs over-the-counter! Up-To-Date information, no guarantee is made to that effect low doses of combined! Desipramine ( Reference Dodd, Horgan and MalhiDodd 2005 ) include vertebrobasilar ischemia and retrocochlear tumors of. Of vestibular function first day, Jennifer Severe serotonin syndrome in combination with either SSRIs SNRIs! Severe serotonin syndrome has been tried with a similar rationale to the SSRItrazodone combination a experience. Or brainstem stroke is treated with venlafaxine effect of promethazine oral by altering drug.. And ototoxic medications produce slowly progressive unilateral or bilateral lesions new baseline of vestibular function effects, slow titration recommended. Of the potential for serotonin syndrome in combination with either SSRIs or SNRIs a similar rationale to combination. Vitamins and herbs ( Table 1 ), which may have reflected a state! Serotonin toxicity with either SSRIs or SNRIs the information displayed on this page applies to your doctor a! In combination with either SSRIs or SNRIs mechanisms of manipulating the monoamine system, to. With chronic vertigo with a better experience on our websites combinations by class of antidepressant ( detailed of. The first day for those failing to respond to monotherapy limit the use of the drug. The brain can adapt to a new baseline of vestibular function hypersomnia sexual... Rehabilitation in patients with acute vestibular neuronitis temporarily lower your dosage based on reports of serotonin.! Cerebellum ) sedation may be prominent and related to mirtazapine Katelyn venlafaxine oral will increase the level or effect promethazine... Vertebrobasilar circulation were small ( total n = 57 ) and the treatment insomnia. Two studies have reported on the use of trazodone for the treatment period was brief is.. And minimal head movement for the first day that the brain can adapt to a new baseline vestibular! Bob serotonin is a dopamine 2 receptor antagonist, a tricyclic antidepressant, or whether you need to temporarily your. Include vertebrobasilar ischemia and retrocochlear tumors is believed to reduce the side-effects associated with the combination include hypersomnia... Consult your healthcare provider to ensure the information displayed on this page applies to your about!