Posted by SLS on June 1, 2001, at 8:34:32
In reply to Re: Tricyclics » Shirley 2, posted by Elizabeth on May 31, 2001, at 23:10:33
Hi folks.
> A caveat about the combination approach: because Luvox is an inhibitor of several hepatic enzymes involved in TCA metabolism (cytochromes P450 1A2, 3A4, and 2D6 in particular), it can alter serum levels of tricyclics and their metabolites. (Most of the SSRIs do this.) Therefore, if you're going to use such a combination, you should be monitored for elevated TCA levels. This is particularly important if you're going to be on nortriptyline, which has an inverted U-shaped dose-response curve: it becomes less effective when serum levels exceed 150 ng/mL or so (disclaimer: I may be misremembering the numbers here).
(you are not)
The accepted therapeutic window for nortriptyline is 50 - 150 ng/ml. For me, 75mg is too little and 125mg is too much. Guess what? 100mg is just right. At 100mg/day, my blood level of nortriptyline is 123ng/ml.
> You're entering relatively uncharted territory, and I can't help but admire your courage. Godspeed.
I once combined Paxil and desipramine. I may be misremembering the numbers here ;-), but I believe I had to cut my dosage of desipramine in half. Both drugs compete for CYP450 D26. I think Luvox is metabolized mainly via 3A4, so I don't know how it would affect nortriptyline blood levels. I can't guess what dosage to make as the first target, but I wouldn't take more than 50mg before getting the first blood test. I found the combination of Paxil and desipramine to be quite safe and without any adverse side effects other than those that are carried by both drugs. I don't remember that anticholinergic side effects were exaggerated, at least after a few weeks of treatment. I doubt this would be a concern with Luvox, anyway. It is much less anticholinergic than Paxil.
I am also curious about the choice of Luvox (fluvoxamine). It seems to be superior to other SSRIs for treating OCD, but I don't know how it compares as an antidepressant. Of course, depression is the condition that this drug was screened and developed for. I wonder if the drug company opted to seek FDA approval for the treatment of OCD because it felt that it had a better chance of getting it approved for an indication that has fewer drugs available.
How do you think Luvox compares to the other SSRIs in terms of efficacy as an antidepressant?
- Scott
poster:SLS
thread:64764
URL: http://www.dr-bob.org/babble/20010530/msgs/64992.html