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Re: prozac + nortripyline pharmacology questions

Posted by darkhorse on November 16, 2004, at 6:52:06

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.

Hello,
I also tried prozac 20 + nort 25 and had very very bad reaction....but I also tried amitriptyline 25-50,and later imipramine 25mg with prozac which was OK....so I guess some people are poor metabolizer,and nort in particular along with desipramine are metabolized only by 2d6...so for poor metabolizer, one must be very cautious adding nort to either prozac or seroxat/paxil.

Adam


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URL: http://www.dr-bob.org/babble/20041113/msgs/416567.html