Posted by SLS on March 21, 2014, at 5:03:43
In reply to Adding low dose Nortrityline to Prozac, posted by BusuB on March 20, 2014, at 18:02:20
> I've been on 10mg Prozac for PD for the last 9.5 weeks and was still having difficulty sleeping and breakthrough anxiety.
What about increasing the dosage of Prozac? 20 mg/day is normally the minimum maintenance dose.
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From the Prozac package label:
"Panic Disorder
Initial Treatment In the controlled clinical trials of fluoxetine supporting its effectiveness in the treatment of panic disorder, patients were administered fluoxetine doses in the range of 10 to 60 mg/day [see Clinical Studies].
Treatment should be initiated with a dose of 10 mg/day. After one week, the dose should be increased to 20 mg/day. The most frequently administered dose in the 2 flexible-dose clinical trials was 20 mg/day."
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> I'd been taking 50mg Trazodone for the sleep part which was nice but left me incredibly groggy. When I called my pdoc for a refill, he suggested 10mg Nortriptyline, which I've done for the last 3 nights. While I have been sleeping through the night (as predicted by pdoc), I notice that I've been feeling extra edgy lately as if I'd consumed too much caffeine.
>
> Can this be an effect of the Nortriptyline, even at such a low dose? Also, I understand that Prozac slows the metabolism of Nortriptyline to a certain extent, making lower doses more potent. Does anyone know how much more potent Nortriptyline becomes in this instance?I am under the impression that Prozac doubles the blood concentration of nortriptyline and the other TCAs (P450 2D6). If the ability of nortriptyline to act as a sleep aid disappears, there are other drugs that can be tried. As far as the caffeine effect is concerned, nortriptyline is a powerful drug, even at low dosages. If this is uncomfortable and continues unabated, you will have to look for another drug. Low dosages of doxepin and amitriptyline are often chosen if one would like to stay with TCAs. Remeron is a popular choice, but you will need to remain at a dosage no higher than 30 mg/day. 7.5 - 15.0 mg/day usually works pretty well.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1062878
URL: http://www.dr-bob.org/babble/20140307/msgs/1062919.html