Posted by Quintal on December 30, 2006, at 6:06:32
In reply to Re: Rilatine together with seroxat and dosulpin? Q, posted by MrBrice on December 30, 2006, at 2:39:42
I'm just wondering why the prescribing doctor didn't check these drug interactions for you? Taking Seroxat with a TCA is very unusual and not often done because SSRIs can inhibit enzymes that break down the TCA. The result is very high - possibly dangerously high - levels of the TCA accumulating in your body so even if you feel well not that is no guarantee that you're safe. The amount of dosulepin in your blood plasma could be climbing every day until it reaches toxic levels. You should be having regular blood tests to determine that the level of dosulepin is still within safe parameters.
If you get superior benefit from the TCAs but need a more serotonergic med then clomipramine (Anafranil) is a good choice. This would eliminate the risks associated with the TCA+SSRI combo.
Ritalin can also inhibit the breakdown of the TCA and the SSRI so that is one hell of a dangerous cocktail unless you're under close supervision. You might want to have a closer look at that interaction sheet. Even if you feel well now that is no guarantee that you will still be safe in another 4 weeks. Adding Ritalin to the combo would complicate things even further. It seems just too dangerous to recommend unless you're having regular blood tests and even then there are safer combos that could be used.
Please be careful with those meds and if you do continue using them be alert to the onset of serotonin syndrome and TCA toxicity outlined below:
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Pharmacodynamically, the combination of paroxetine (or any other selective serotonin reuptake inhibitor) and a TCA may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5HT1A receptors.MANAGEMENT:
In general, the use of paroxetine (or other SSRIs) with TCAs should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Pharmacologic response and plasma TCA levels should be monitored more closely whenever paroxetine is added to or withdrawn from therapy in patients stabilized on their existing antidepressant regimen, and the TCA dosage adjusted as necessary. Patients should be monitored closely for signs and symptoms of TCA toxicity (e.g., sedation, dry mouth, blurred vision, constipation, urinary retention) and/or excessive serotonergic activity (e.g., CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia).
__________________________________________________Q
poster:Quintal
thread:717378
URL: http://www.dr-bob.org/babble/20061224/msgs/717525.html