Posted by 4WD on May 11, 2005, at 22:28:58
In reply to Re: Clomipramine + prozac = HELP:!! » temoigneur, posted by ed_uk on May 6, 2005, at 6:28:01
> Hi Ben!
> Prozac can produce very large increases in clomipramine serum levels. It will be necessary for you to reduce your clomipramine dose. If you continue to take 115mg clomipramine in combination with Prozac, your serum clomipramine level may continue to rise. If I were you, I'd reduce the clomipramine dose immediately, as little as 25mg a day might be sufficient- although you will definitely need to experiment. You could try taking 25mg or 50mg clomipramine for the next day or two. If you start to suffer from withdrawal symptoms you will know to increase the dose. If you still feel sedated or if other (clomipramine) side effects are present, you could reduce the dose even further.
> Fluoxetine-induced tricyclic toxicity: extent and duration.
> Westermeyer J.
> Department of Psychiatry and Behavioral Sciences, University of Oklahoma, Oklahoma City 73190.
> Combined fluoxetine-tricyclic medication has been recommended for patients who are partial responders or nonresponders to tricyclic medication alone. Three cases were encountered in which the addition of fluoxetine to tricyclic medication resulted in toxic, potentially dangerous elevations in tricyclic blood level, amounting to approximately 100-300% increases over recent tricyclic levels. In reducing the tricyclic dosage after fluoxetine, blood level decreases were behind dosage decreases; and blood level and dosage decreases were not well correlated with each other. Symptoms associated with toxic levels are described. Due to the long half-life of fluoxetine, such increases in tricyclic medication must be anticipated well in advance of initiating treatment with these two compounds. Based on these few cases, a procedure is tentatively recommended for patients on combined fluoxetine-tricyclic regimens, until such time as a definitive regimen can be developed.
> 'The interactions of fluoxetine with amitriptyline, clomipramine, desipramine, imipramine and nortriptyline are established and clinically important. Monitor concurrent use (measure plasma levels), be alert for any evidence of antidepressant toxicity and reduce the dosage appropriately. Initial dosage reductions to a quarter have been advised if 20 mg fluoxetine daily is added, and regular monitoring for several weeks or even months.'
> Kind regards,
Would this be true for Celexa plus nortriptyline as well? I.e. would Celexa increase blood levels of nortriptyline? I am on 25mg nort and 10mg Celexa. I desperately need the anxiolytic effect of the nortr., asked my pdoc if I should go up on the dose, he said no but then my 15 minutes were up and I couldn't ask why not. I am also taking Inderal for anxiety and I fear that it will cancel out the effects of the nort. since inderal blocks norepinephrine in the brain, doesn't it?
I couldn't ask him about that either. I did ask if it would contribute to my depression and he said we'd just have to wait and see.
This board is where I get my questions answered = not from the guy I pay money to.