Posted by zefdie on March 17, 2004, at 14:16:13
In reply to Re: Off to doctor in a few--help w/ Effexor questions? » zefdie, posted by King Vultan on March 17, 2004, at 12:51:03
Thanks so much for the quick reply. I got to my doctor and they had accidentally cancelled my appointment, so now I've got a few more hours of waiting around before I can go back to see another doctor.
I'm on a lot of other drugs for various other things and think I should avoid MAOIs. I'm definitely going to ask about Effexor 75 mg--is this XR? Is it once or twice a day?
Thanks again for your help. I want to be prepared, as I'm seeing a GP and not a psychiatrist.
> Keep in mind that Wellbutrin is a CYP-450 2D6 inhibitor, and Effexor is a 2D6 substrate. What this means is that Wellbutrin can increase blood plasma levels of Effexor to higher levels than they would be with just the Effexor taken by itself. Even 150 mg of Wellbutrin can do this, based on my own experience combining this dosage of Wellbutrin with desipramine, which is a classic 2D6 substrate. Fortunately, my doctor and I were aware of this and were monitoring my desipramine blood plasma levels (they were increased by about a factor of about 3.5 times from what they would have been otherwise).
>
> Effexor lacks the well known therapeutic blood plasma levels established over decades of use of tricyclics like desipramine, so you need to use your best judgement and make an educated guess. I guess what I am trying to say is that I would caution against trying to swing for the fences with a high initial dosage of Effexor. Start out at lower level and then go higher if you find you are able to tolerate any adverse effects. I guess if it were me, I would perhaps ask to start at 75 mg of Effexor with an eye towards maybe increasing this to 150 mg/day at some point.
>
> One other thing, I don't know how your drug copays work, but these are two relatively expensive drugs. If the cost is burdensome, you may wish to consider the MAOIs Nardil or Parnate, which do essentially the same thing as Effexor + Wellbutrin, with lower cost and greater effectiveness. Most people seem to be scared off by the dietary restrictions, which are overblown, and the drug interactions, which are real, but these dangers can be minimized by doing a little research and exercising some prudence and caution.
>
> Todd
poster:zefdie
thread:325263
URL: http://www.dr-bob.org/babble/20040313/msgs/325319.html