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Re: Effexor/Cymbalta combo

Posted by sam123 on August 28, 2007, at 22:45:20

In reply to Re: Effexor/Cymbalta combo » Racer, posted by grumpii on August 28, 2007, at 13:55:46

> Wow, I just read about Serotonin Syndrome and I've been on Effexor 300mg and taking every triptan known w/o relief and my neuro doc. knows about the effexor and said nothing???
>


It depends on what you mean by triptan. In the class of drugs that includes imitrex, there are some that can be taken with AD's. Serotonin Syndrome (SS) is pretty rare, so much so as it is not well understood. This also means it is not always recognized when it happens. Often it is an additional med that causes SS, true synthetic opioids like Demerol, Ultram and DMX + an AD are often common in the reports I have seen. Non and semisynthetic opioids seem OK. A MAOI + AD seems to be a cause of some reports of SS. MAOI + demerol or DMX is another suspected cause of some cases of SS. Abuse of DMX is common and I have seen quite a few reports of SS when the person is also taking an AD.

I have taken Effexor with other AD's; it must be done with care. Effexor is a powerful RI of Serotonin, adding another AD can change metabolism such that you get large (several times to exponential) increases of levels of one, the other, or both AD's in the body. A good way to cause SS. A good doc and low and slow were key for me to avoid a drug-drug problem. Some have reported SS from use of a single AD; it seems
this happens on starting an AD and not after you have been taking an AD for a while, unless you add another med that can cause SS.

Effexor/Cymbalta combo...yuck. Just my personal opinion. Effexor is a powerful RI of Serotonin and a moderate RI of norephinepherine. Cymbalta more potently blocks serotonin and norephinepherine transporters in vitro and in vivo than venlafaxine. (see note 1). So one or the other, but not both. better to just take more of one, if tolerated, to get the same effect of taking two.

I love norephinepherine RI's but many do not. Increased heart rate and blood pressure, sweating,
anxiety, and urinary hesitation (Note 2) are common side effects. I would argue they are not side effects but primary effects as all use norephinepherine in some way.

Note 1:
Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, Shaw JL, Thompson L, Nelson DL, Hemrick-Luecke SK, Wong DT. "Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors". Neuropsychopharmacology. 2001 Dec;25(6):871-80

Note 2:

Urinary Side Effects of Duloxetine in the Treatment of Depression and Stress Urinary Incontinence

http://www.psychiatrist.com/pcc/pccpdf/v06n02/v06n0204.pdf


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poster:sam123 thread:779301
URL: http://www.dr-bob.org/babble/20070824/msgs/779438.html