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Re: prozac + nortripyline pharmacology questions » yeltom

Posted by Sad Panda on November 16, 2004, at 5:05:33

In reply to prozac + nortripyline pharmacology questions, posted by yeltom on November 16, 2004, at 2:15:46

> I've been on prozac or celexa for depression, anxiety, and OCD for quite a while. Have tried various ways of augmenting it with something to help with apathy, anhedonia, fatigue, etc. I also recently had some issues with IBS, and when my gastro doctor recommended a tricyclic, I spoke with my shrink and settled on nortriptyline. I figured I'd kill two birds with one stone. First I was on 40 mg celexa and 10 mg nortrip. Tried to up to 20 mg but couldn't handle it. 10 mg seemed to be remarkably effective. Then I switched back to 40 mg prozac for financial reasons, and I started suffering from dry mouth and bad constipation. So I hypothesized that prozac was inhibiting that enzyme that metabolizes nortrip and I dropped to 5 mg nortrip. (Have to open the stupid capsules because 10 mg is smallest amount) I'm just wondering if it would seem absurd that 5 mg of nortrip could be causing significant norepinephrine boost. It's definitely helping with the IBS, but it seems to be helping with mood too, but I'm wondering if that must be a placebo effect at such a low dose. When I tried strattera with prozac, I couldn't even handle 18 mg without bad constipation. Does this suggest that I'm very sensitive to that liver-enzyme suppression thing? I've heard that prozac causes serum levels of TCAs to at least double. But it would seem to be doing a lot more than doubling it, considering that you usually need at least 50 mg of nortrip for antidepressant effect. Is enzyme-inhibiting effect of prozac dose-dependent? Any reason to try lowering prozac and increasing nortrip? Thanks.
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Prozac & Paxil are potent inhibitors of CYP 2D6 & will increase the plasma level of Nortriptyline by alot.(up to 9x for some drugs) 2D6 is also subject to the most genetic variation & I would think that you are a poor metabolizer of drugs using 2D6, as are about 10% of the population because 10mg is a very small doseage. Blood testing is the best way to go with Nort because the most is known about it & it said that 50 to 150 ng/ml is the best level.

Cheers,
Paul.


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URL: http://www.dr-bob.org/babble/20041113/msgs/416539.html