Comment · Thu, October 15, 2020 · ND Owner
I took Tongkat Ali (2%) after taking Remeron (2mg) last night and instantly got muscle twitches?
Original post in this thread
Eihabu · 8 points
To clarify: Remeron last night... Tongkat within the last few hours.
Twitching started in my bicep, went to my legs, came back to my bicep... It's quite mild but it's definitely unusual for me, and it started almost instantly. Looks like twitching is a symptom of serotonin syndrome, but apparently twitching, spasms and tremor are all different? From what I can tell the only "real" risk of death with SS is hyperthermia, so unless I need to cool off all I need to do here is relax and wait for it to pass, maybe take a benzo?
I know Remeron is contraindicated with MAOIs and they say to put 2 whole weeks between taking the two but we're talking about potent prescriptions there. There's no evidence AFAIK that tongkat has MAOI properties, and even if it did the half life appears to be around 30 minutes (correct?)
And the mechanism of Remeron + MAOIs harming you is just SS (right?) so again all I need to do is wait for it to pass, relax, maybe benzo; if I go psycho or overheat, maybe then worry / have someone take me to a hospital.
If I'm probably safe, then I want to take it again in close proximity and see if this happens again. I really hope this is a fluke because being able…
What they were answering
Direct reply to the original post — see the thread post above.
u/MisterYouAreSoDumb · ND Owner
We have no idea how mirtazapine (Remeron) actually works. So it is going to be difficult to say for sure. We don't know all the receptor systems it is hitting. We don't know its primary mechanisms or all its interactions. It likely hits 5-HT receptors, adrenergic receptors, and histamine receptors. I would assume the adrenergic receptor affinities are the likely one affecting twitching, but it is really hard to say for sure.