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Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS?

Posted by X-ray on July 14, 2009, at 4:14:23

In reply to Re: Parnate/Elavil or Nortriptyline? FATIGUE! SLS?, posted by ColoradoSnowflake on July 13, 2009, at 17:59:53

Hi,

TCAs and MAOIs should not be mixed.
I think that your doc is on the wrong track.

Best regards,
X-ray

P.S. I enclose this text from medscape.com.

MONOGRAPH TITLE: Tri; Tetracyclic Compounds/MAOI'S

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Some MAO inhibitors may enhance the effects of tricyclic and tetracyclic compounds indirectly through inhibition of microsomal enzymes. Tricyclic and tetracyclic compounds may sensitize adrenergic receptors to amines which then accumulate extraneuronally as a result of MAO inhibition.

CLINICAL EFFECTS: Concurrent use may result in a severe reaction including hyperpyrexia, convulsions, excitability, muscular rigidity, fluctuations in blood pressure, convulsions, grand mal seizures, coma, and death.

PATIENT MANAGEMENT: The concurrent use of tricyclic antidepressants and MAO inhibitors is contraindicated by the manufacturers of tricyclic antidepressants and tranylcypromine.

The manufacturers of tricyclic antidepressants and mirtazapine recommend at least 14 days between switching therapies. The manufacturer of tranylcypromine recommends a medication-free interval of at least a week when initiating tranylcypromine in patients who have previously received a tricyclic antidepressant, then initiating tranylcypromine at a reduced dosage of 50% for one week.

The US manufacturer of phenelzine states that at least 14 days should elapse between the discontinuation of phenelzine and the initiation of another antidepressant. If phenelzine is used concurrently with or within 10 days of another antidepressant, the patient should be cautioned regarding the possibility of an adverse drug interaction.

The US manufacturer of selegiline states that at least 14 days should elapse between the discontinuation of selegiline and the initiation of a tricyclic antidepressant.

DISCUSSION: It should be noted that if this interaction occurs, the consequences will be immediate and severe. Effects may continue to be seen for several days after discontinuing the MAOI. Similarity between cyclobenzaprine and TCAs warrants consideration of TCA interactions for cyclobenzaprine. Mirtazapine, a tetracyclic antidepressant, should also be considered for this interaction. Furazolidone and linezolid are known to inhibit MAO. The interaction has been reported with tricyclic antidepressants and selegiline.


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URL: http://www.dr-bob.org/babble/20090709/msgs/906682.html