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Re: bethanechol for TCA-induced cognitive impairment? » LouisianaSportsman

Posted by tom2228 on April 17, 2014, at 15:09:23

In reply to Re: bethanechol for TCA-induced cognitive impairment?, posted by LouisianaSportsman on April 17, 2014, at 3:31:50

> I wouldn't suggest nortriptyline tirtration above 100mg. then with your side effects. Forward, blood plasma testing is advised.
>
> I would titrate to 100mg. notriptyline max until you've tried it along with up to a maxed out modafinil dose, e.g. Nuvigil trialed at a least 250mg. or Provigil at 600mg. It's a nootropic that directly relieves the histaminergic effect of nortriptyline by countering it pharmacological. I think it should be first-line treatment for anyone taking TCAs experiencing your cognitive problem or sedation.

I have thought about this and think it is a fantastic idea on paper. I'm afraid of modafinil though because it being an inhibitor of the DAT would inhibit methamphetamine-mediated dopamine release and thereby block my Desoxyn. nortriptyline, being an NET, already does this with the norepinephrine side of things -- my focus IS off, but that may not be due to this and may be due to the side-effects instead.

although I am still spacey, I think I am going to ask for an increase to 100mg today because the AD effects of my combo have seemed to diminish to an extent.

if 100mg is intolerable then I guess a switch to desipramine would be better for less antihistamine and antimuscarinic effects.

being on less Marplan now may explain my spaciness too, as it increases my baseline attention and potentiates Desoxyn. maybe going up to 40mg or back to 50mg would help.

as well, thinking of taking you suggestion and asking for Namenda XR in place of Mirapex ER


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