Posted by ed_uk on November 7, 2004, at 7:21:45
In reply to Re: Wellbutrin + Paxil? » jujube, posted by King Vultan on November 6, 2004, at 22:58:18
> > Would the same concern apply to a combination of Anafranil and Celexa? My pdoc just prescribed Anafranil and has told me to reduce my dose of Celexa to 20 mg (from 40 mg) and continue to use it at the same time as the Anafranil. I have never taken 2 ADs at the same time, so I have been a bit worried about this.
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> > Thanks.
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> > Tamara
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> Not exactly, because the enzyme interactions between these two drugs are pretty limited. Celexa is only a weak 2D6 inhibitor and is not going to increase the blood plasma levels of the Anafranil appreciably. The only thing I would question is why your pdoc is having you take two SSRIs at once (Anafranil/clomipramine is a tricylic AD, but it is also an SSRI, as it is selective for blocking serotonin reuptake). Was any reasoning given for this?
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> Todd
Hello it's Ed! I was thinking exactly the same thing as Todd... I expect the reason for continuing the Celexa at 20mg/day is probably to help prevent withdrawal symptoms from the celexa while the Anafranil dose is still low. Since Anafranil also inhibits the reuptake of serotonin, you shouldn't get any major withdrawal symptoms from the Celexa. Once the Anafranil dose has been increased to a decent level it would make sense to stop the Celexa completely.
Although the clomipramine molecule itself is a potent (selective) serotonin reuptake inhibitor, its major active metabolite is a norepinephrine reuptake inhibitor. Clomipramine also blocks certain serotonin receptors, all these properties give the Anafranil a good chance of helping your depression when Celexa hasn't. If Anafranil doesn't suit you, nortriptyline or desipramine could be next on your list.
As Todd said, the pharmacokinetic interaction between citalopram and TCAs is much less significant than it is with Paxil.From Stockleys drug interactions...
.....'5 patients on amitriptyline, clomipramine or maprotiline showed no changes in their plasma tricyclic antidepressant levels when 20 to 60mg citalopram daily was added'.....
.......'In another general study, in which 18 patients were given citalopram and tricyclic antidepressants, serum levels of citalopram were doubled in those receiving the tricyclic clomipramine'.... A good reason to halve your Celexa dose, what do you think??!!All the best..
Ed.
poster:ed_uk
thread:411372
URL: http://www.dr-bob.org/babble/20041103/msgs/412794.html