Posted by Rick on October 30, 2001, at 0:37:44
In reply to Re: modafinil and Serzone » krista, posted by Sunnely on June 15, 2001, at 0:23:51
Don't know if I should respond to a post that's four months old, but as a very satisfied Serzone+Provigil (modafinil) user I thought this one demanded a correction. (Not to slight Sunnely's generally expert knowledge about psychotropics -- far broader-reaching than my own!)
Anyway, Serzone is NOT an inducer of enzyme CYP3A4. Quite to the contrary, it is a potent *inhibitor* of CYP3A4.
Since Provigil (modafinil) depends partly on CYP3A4 for its metabolism, the actual interaction effect is that Serzone's inhibition of this enzyme can increase the amount of Provigil (modafinil) in the bloodstream and slow down Provigil elimination.
More to the point, Provigil will NOT decrease Serzone's potency in any way. In fact, it's a great combo for many including myself. Provigil offset my Serzone+Klonopin induced fatigue completely, and (unexpectedly) added other welcome dimensions to my treatment at the same time.
Rick
> Hi Krista,
>
> Modafinil (Provigil), a central nervous system stimulant which is FDA-approved for narcolepsy, induces the cytochrome P450 enzyme 3A4 (CYP3A4). Nefazodone (Serzone) is mainly dependent on this enzyme for its metabolism. The combination of Provigil and Serzone could lead to increased metabolism of Serzone (rapid formation of daughter compounds) ---- > decreased in Serzone blood level ---- > loss of Serzone effectiveness. Incidentally, one of Serzone's daughter compounds called mCPP (meta-chlorophenylpiperazine) is known to induce anxiety (anxiogenic). Theoretically, the rapid formation of mCPP could lead to anxiety and, this could become even more problematic if you belong to the 7-10% of Caucasian population who are genetically deficient of the cytochrome P450 enzyme that mainly metabolizes mCPP, CYP2D6. Provigil, being a psychostimulant itself, could further complicate this problem (i.e., anxiety, activation, insomnia).
>
> *******************************
>
> > I have been on Serzone for 6 months now and am not sedated but not exactly
> > awake. My doctor was thinking about adding modafinil. But I read a post on here that disturbed me about those two meds as a combo.
> > It was posted that Modafnil lowers a enzyme from the body that is needed to metabolize Serzone. I was just wondering if anyone knows this to be true. Or is there
> > a website where I can actually ask a doctor this question directly? I'd like to get a second opinion before I jump into taking the Modafinil.
> >
> > thanks
> > Krista
poster:Rick
thread:66507
URL: http://www.dr-bob.org/babble/20011025/msgs/82637.html