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Re: TCA and MAOI Combo

Posted by Elizabeth on December 13, 1998, at 20:13:21

In reply to Re: TCA and MAOI Combo?? Help anyone?, posted by Toby on November 12, 1998, at 14:55:57

> If your doctor is good, you trust him, and get to see him pretty often, then that combo can be a worthwhile effort, especially if you have tried other combinations without benefit. You have to stick with the MAO diet very carefully. It is dangerous to add a tricyclic to an MAOI but can be OK (sometimes) to add an MAOI to a tricyclic. The reason is that the tricyclic can increase the blood level of the MAOI but not the other way around, so adding a small dose of MAOI to the tricyclic won't tend to cause a toxic level of MAOI and won't do anything to the tricyclic level.

Where can I read about this? I've found hardly any info on MAOI pharmacokinetics.

> According to the 2nd edition of Psychotropic Drugs by Ward and Maxmen, it is safer to add an MAOI to doxepin, amitriptyline or trimipramine but should avoid adding an MAOI to imipramine, desipramine, venlafaxine, bupropion or SSRI's. Nevertheless, talk to your doctor and see what the exact plan is to monitor your blood levels of both medications and what his thinking is about the above cautions on adding an MAOI to other medicaitons. Good luck.

What about amoxapine or mirtazapine? Does it say why imipramine would be more of a problem than amitriptyline or doxepin?

Lots of doctors are using MAOI+bupropion without problems, by the way. This combination appears to be safe. Clomipramine is contraindicated.

What I have read about mixing MAOIs with TCAs is that it is rarely more effective than using an MAOI alone but might be considered if both agents have been tried by themselves with partial response. There are other, less troublesome augmentation strategies, though.




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