Posted by ed_uk on April 17, 2005, at 18:23:56
In reply to Tianeptine withdrawal?, posted by sukarno on April 16, 2005, at 8:28:49
Hi Paul!
How are you doing???
>I wonder though, is it safe for Dave to take amineptine, a TCA, with selegiline, an MAO-b inhibitor?
I think he's been taking the combination for quite some time, I expect that if there was going to be an interaction he would have had symptoms shortly after combining :-)
>I've read that TCAs are contraindicated with MAO inhibitors. I know that my Stablon package insert says it is.
Some TCAs are contra-indicated with MAOIs, most notably clomipramine. Clomipramine + MAOI = serotonin syndrome because clomipramine is a potent serotonin reuptake inhibitor. Imipramine is rarely combined with MAOIs due to the risk of serotonin syndrome. Some TCAs such as desipramine do not usually appear to interact with MAOIs, desipramine is a norepinephrine reuptake inhibitor. There is no information on Stablon + MAOI, the manufacturer has therefore contra-indicated the combination.
>Have you heard of Parlodel? We have that here. What's your opinion of that drug?
Bromocriptine and other ergot alkaloids have (rarely) resulted in various fibrotic reactions after long-term use. As a result, many neurologists prefer the newer non-ergot dopamine agonists such as ropinirole.
>Do you have panic disorder?
No, I have multiple difficult-to-classify mental health problems!
>I suppose the stimulants such as amineptine and amphetamine could enable you to do multiple tasks?
Some people find that. Other people find that stimulants tend to make them 'hyper-focus' on one task for a long period of time.
>About the nortriptyline, since it is can inhibit the reuptake of serotonin, would that conflict with tianpetine, since it does the opposite? (accelerates/enhances the reuptake of serotonin)
Nortriptyline is predominantly a norepinephrine reuptake inhibitor, it has little effect on serotonin reuptake. I find it difficult to say what would happen if you combined it with Stablon.... AFAIK, no info is available on the interaction.
If you were to take nortriptyline again, do you think you would consult a cardiologist? I don't know whether the arrhythmias that you experienced on TCAs were serious- you didn't have an ECG done during the episode. If you were to take nort in future, I think you would need to be very closely monitored- possibly by a cardiologist. You could have your serum nort level monitored at each dose eg. 5mg, 10mg etc. Regular ECGs could be performed to monitor the QTc interval. You could have an ECG before treatment, several days after initiation of treatment, and a few days after each dose increase. I do think that you might find a low dose of nort very effective but there are risks involved..... considering your previous experience. I am concerned that you might experience serious ventricular arrhythmias on nort. Certain TCA-induced arrhythmias may be relatively benign but ventricular arrhythymias can be life-threatening.
I wonder how you would respond to a different NRI such as reboxetine. I know several people who have responded badly to reboxetine so I am cautious to recommend it. Nevertheless, you might find it effective. Although, reboxetine commonly causes sinus tachycardia, serious arrhythmias are unlikely.
>What do you think of the risks of amineptine with regards to hepatotoxicity?
I think you'd need to have regular monitoring of liver function- before treatment and at regular intervals during treatment. Make sure that your doc is knowledgeable about liver tests!
>If I am indeed a slow metaboliser (CYP2D6) does that put me at increased or decreased risk for hepatotoxicity from amineptine?
It probably doesn't make any difference. The only relevent study suggested that amineptine liver toxicity was *not* related to CYP2D6 status.
'These results show that hepatotoxicity of several drugs, including amineptine.........is related neither to an impairment in dextromethorphan oxidation capacity nor to an unusually high capacity to oxidize this drug.'
>Now, that bromocriptine (Parlodel) sounds good to me! lol. Is it good as an antidepressant too?
I think it's been found effective in a few case reports- it's not been well studied in depression.
>I forgot to mention that I remember taking dextromethrophan in the past for coughing years ago and it was quite strong. It made me feel drowsy, foggy-headed and a bit "spaced-out" like mild marijuana intoxication.
Dextromethorphan has been reported to be more sedating in poor metabolisers. It produces greater psychomotor impairment in PMs.
>I took Stablon and then 30-45 minutes later felt a relaxation along with a restoration of my mental function.
>I am guessing this is due to its short half-life.Do you take one tablet once daily? Can you cut the tablets and take it in divided doses? I'm not even sure
Kind regards,
Ed.
poster:ed_uk
thread:474445
URL: http://www.dr-bob.org/babble/20050413/msgs/485591.html