Posted by Brainbeard on October 11, 2010, at 15:49:33
In reply to Re: Advice please re. clomipramine/anafranil, posted by hopefullynow on October 11, 2010, at 13:38:51
Adding nortriptyline to clomipramine for noradrenergic reuptake inhibition (NRI) is like adding sugar to candy, since clomipramine's metabolite, desmethylclomipramine, is a much stronger NRI than nortriptyline; it's at least ten times as strong. (See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/pdf/0707253a.pdf for receptor affinities in Ki; the lower the number, the stronger the affinity.)
In fact, as you go higher on clomipramine, the SRI/NRI ratio (2:1 according to Gillman (see mentioned article)) will become smaller and smaller, perhaps approaching 1:1 eventually, since the NRI metabolite has a much longer half-life than the mother drug and will therefore accumulate more in the blood over time.
Desipramine could be a little stronger than desmethylclomipramine.
I haven't seen numbers for maprotiline.
Current meds: clomipramine 225mg, fluvoxamine (Luvox) 50mg
As needed: bethanechol 25-50mg, oxazepam 5-10mg