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Pharmacology of Prozac + Nortriptyline, Bruxism

Posted by yeltom on April 6, 2006, at 22:05:42

A while back, I added 10 mg of nortriptyline to 40 mg Celexa. It was as much for gastro reasons(IBS) as for mental reasons, but it was amazingly helpful for my mood even at that tiny dosage. I figured I'd need more than 10 mg, but was never able (and never needed) to increase without ridiculous sedation and constipation. I learned that celexa is a mild inhibitor of the P-450 2D6 liver enzyme, which means that if you take a drug that is metabolized by that enzyme (called a substrate), blood concentrations will be higher than expected. Later I switched to 40 mgs Prozac and suddenly felt sick. Eventually I realized that it was because of constipation and other side effects of the nortriptyline. I learned that prozac is a POTENT inhibitor of 2D6. So I had to start taking 5 mg of nortrip per day (which meant ordering the tablet form of the nortrip from New Zealand cuz 10 mg capsules are the smallest domestic dose.) At some point I learned that I was grinding my teeth. Learned that SSRIs can do that. Went off the nortip at some point. Eventually came back to it. And believe it or not, 2.5 mg. is having a really strong effect on me. The usual intitial dose is 10 TIMES that amount. Plus I noticed that my teeth grinding is getting worse again. I feel that I'm even more sensitive to the nortrip than I was. Does anyone have any explanation? I also recently learned that nortip is sometimes used to CONTROL teeth grinding. So I'm wondering if it is possible for a 2D6 SUBSTRATE (nortrip) to increase the blood concentratrion of an INHIBITOR (prozac), since prozac is the drug that's supposed to cause bruxism. Thanks for the help, professional and amateur p-docs alike.




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