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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Storm on August 29, 2001, at 18:35:28
I have some remeron my dr had given me a while back. I am finding prozac not to work well anymore and would like to switch. will it interact with the lithium & neurontin I take, or prozac that might still be in my system? do I have to wait a certain amount of time before switching from the prozac, or can I immediately. thanks.
Posted by SalArmy4me on August 29, 2001, at 18:46:35
In reply to Taking combination of drugs ok?, posted by Storm on August 29, 2001, at 18:35:28
There are 4 interactions for Prozac , Remeron and lithium :
1 severe, 1 medium, and 2 mild (3 are drug/drug interactions , 1 is a food/drug interaction).
1. Severe Interaction between lithium (generic: lithium) and Prozac (generic: fluoxetine)Several case reports suggest that fluoxetine may elevate serum lithium levels through an unknown mechanism. Patients who must take both drugs should be monitored for evidence of lithium toxicity. One case report has also suggested that the combination of fluoxetine and lithium may produce the "serotonin syndrome," which manifests akathisia, myoclonus, increased reflexes, shivering, tremor, diarrhea, and ataxia.
References:
1. Hadley A, Cason MP. Mania resulting from lithium-fluoxetine combination. Am J Psychiatry. 1989;146:1637-8. more info
2. Muly EC, McDonald W, Steffens D, Book S. Serotonin syndrome produced by a combination of fluoxetine and lithium. Am J Psychiatry. 1993;150:1565. more info
3. Noveske FG, Hahn KR, Flynn RJ. Possible toxicity of combined fluoxetine and lithium. Am J Psychiatry. 1989;146:1515. more info
4. Salama AA, Shafey M. A case of severe lithium toxicity induced by combined fluoxetine and lithium carbonate. Am J Psychiatry. 1989;146:278. more info
2. Medium Food Interaction for Remeron (generic: mirtazapine)
Grapefruit juice, by inhibiting cytochrome P-450 3A4 enzymes could theoretically reduce mirtazapine clearance. The clinical significance, if any, of this potential interaction is unknown. It is recommended that the clinician be aware of a potential increased response to mirtazapine in patients regularly consuming grapefruit juice.
References:
1. Anonymous. Product Information. Remeron (mirtazapine). Organon, West Orange, NJ. PROD; : .3. Mild Interaction between lithium (generic: lithium) and Remeron (generic: mirtazapine)
CNS-depressant and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects.
Posted by Storm on August 29, 2001, at 19:04:05
In reply to Re: Taking combination of drugs ok? » Storm, posted by SalArmy4me on August 29, 2001, at 18:46:35
in your opinion do you see any problem with me switching from the prozac to remeron in less than a day? is that too soon, or do you advise me not to switch them myself at all? (I'm still on the neurontin & lithium). I've never had a problem with lith/prozac combination & I'll stay away from grapejuice. the reason it's so important is I've started feeling awful, and I'm away at college. haven't been able to get in touch with dr yet, but I have samples of remeron from a year ago or something. sorry to bother you. thanks soooo much.
> There are 4 interactions for Prozac , Remeron and lithium :
>
> 1 severe, 1 medium, and 2 mild (3 are drug/drug interactions , 1 is a food/drug interaction).
>
> 1. Severe Interaction between lithium (generic: lithium) and Prozac (generic: fluoxetine)
>
> Several case reports suggest that fluoxetine may elevate serum lithium levels through an unknown mechanism. Patients who must take both drugs should be monitored for evidence of lithium toxicity. One case report has also suggested that the combination of fluoxetine and lithium may produce the "serotonin syndrome," which manifests akathisia, myoclonus, increased reflexes, shivering, tremor, diarrhea, and ataxia.
>
> References:
> 1. Hadley A, Cason MP. Mania resulting from lithium-fluoxetine combination. Am J Psychiatry. 1989;146:1637-8. more info
> 2. Muly EC, McDonald W, Steffens D, Book S. Serotonin syndrome produced by a combination of fluoxetine and lithium. Am J Psychiatry. 1993;150:1565. more info
> 3. Noveske FG, Hahn KR, Flynn RJ. Possible toxicity of combined fluoxetine and lithium. Am J Psychiatry. 1989;146:1515. more info
> 4. Salama AA, Shafey M. A case of severe lithium toxicity induced by combined fluoxetine and lithium carbonate. Am J Psychiatry. 1989;146:278. more info
>
>
> 2. Medium Food Interaction for Remeron (generic: mirtazapine)
>
> Grapefruit juice, by inhibiting cytochrome P-450 3A4 enzymes could theoretically reduce mirtazapine clearance. The clinical significance, if any, of this potential interaction is unknown. It is recommended that the clinician be aware of a potential increased response to mirtazapine in patients regularly consuming grapefruit juice.
>
> References:
> 1. Anonymous. Product Information. Remeron (mirtazapine). Organon, West Orange, NJ. PROD; : .
>
> 3. Mild Interaction between lithium (generic: lithium) and Remeron (generic: mirtazapine)
>
> CNS-depressant and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects.
>
>
>
Posted by SalArmy4me on August 29, 2001, at 19:16:26
In reply to Re: (SalArmy4me)Taking combination of drugs ok?, posted by Storm on August 29, 2001, at 19:04:05
A reaction between Prozac and Remeron is possible and has been noted once in the literature:
Benazzi F. Serotonin syndrome with mirtazapine-fluoxetine combination. International Journal of Geriatric Psychiatry. 13(7):495-6, 1998 Jul.
But I myself have not seen a bad drug-drug interaction between the two in clinical practice... Generally there is a low incidence of interactions between an SSRI and mirtazapine:
Holm KJ. Markham A. Mirtazapine: a review of its use in major depression. Drugs. 57(4):607-31, 1999 Apr:
"The low potential for interaction with drugs that are metabolised by CYP2D6, including antipsychotics, tricyclic antidepressants and some SSRIs, may also make mirtazapine an important option for the treatment of major depression in patients who require polytherapy..."
Bottom-line in this case: Do what your physician tells you to do.
Posted by Jane D on August 29, 2001, at 19:28:33
In reply to Re: (SalArmy4me)Taking combination of drugs ok? » Storm, posted by SalArmy4me on August 29, 2001, at 19:16:26
Sal,
The wording of your post implies that YOU haven't seen anything in clinical practice. It is only on very close reading that it becomes clear this is another quote. Since you are another 'consumer' like the rest of us I'm sure that this was an accident and that you didn't mean to suggest that.
Jane
> A reaction between Prozac and Remeron is possible and has been noted once in the literature:
>
> Benazzi F. Serotonin syndrome with mirtazapine-fluoxetine combination. International Journal of Geriatric Psychiatry. 13(7):495-6, 1998 Jul.
>
> But I myself have not seen a bad drug-drug interaction between the two in clinical practice... Generally there is a low incidence of interactions between an SSRI and mirtazapine:
>
> Holm KJ. Markham A. Mirtazapine: a review of its use in major depression. Drugs. 57(4):607-31, 1999 Apr:
>
> "The low potential for interaction with drugs that are metabolised by CYP2D6, including antipsychotics, tricyclic antidepressants and some SSRIs, may also make mirtazapine an important option for the treatment of major depression in patients who require polytherapy..."
>
> Bottom-line in this case: Do what your physician tells you to do.
Posted by Jane D on August 29, 2001, at 19:47:03
In reply to Re: (SalArmy4me)Taking combination of drugs ok?, posted by Storm on August 29, 2001, at 19:04:19
> in your opinion do you see any problem with me switching from the prozac to remeron in less than a day? is that too soon, or do you advise me not to switch them myself at all? (I'm still on the neurontin & lithium). I've never had a problem with lith/prozac combination & I'll stay away from grapejuice. the reason it's so important is I've started feeling awful, and I'm away at college. haven't been able to get in touch with dr yet, but I have samples of remeron from a year ago or something. sorry to bother you. thanks soooo much.
Storm,
You mention that you are a student. Does your school have any kind of student health service? Most do.I don't know much about interactions of the particular drugs you are proposing other than that Prozac stays in your system a LONG time (many weeks). In other words it will be interacting for a long time to come. I'm hoping that the change of header will concern other posters enought to make them jump in here.
My own concern is that you are on an awfully long list of drugs to be considering self medication and probably shouldn't do it.
Using old drugs can also mean that they are weaker than they should be. Read Cam W's explanation of this above this thread at
http://www.dr-bob.org/babble/20010828/msgs/76849.html
and decide if this applies to you.I'm also curious about why you discontinued Remeron in the first place and why you think it will work for you now.
Please push hard to find a doctor who will see you right away.
Jane
Posted by Pennie Lane on August 29, 2001, at 20:47:36
In reply to Re: (SalArmy4me)Taking combination of drugs ok? » Storm, posted by SalArmy4me on August 29, 2001, at 19:16:26
> A reaction between Prozac and Remeron is possible and has been noted once in the literature:
Does that represent the result of an exhaustive literature review? Are you saying there is only one reference, or are you saying you found only one? Are you trained and funded to conduct thorough literature reviews?
> But I myself have not seen a bad drug-drug interaction between the two in clinical practice... Generally there is a low incidence of interactions between an SSRI and mirtazapine:How much clinical practice have you observed? Are you a clinical practitioner with access to confidential patient records?
Posted by Storm on August 29, 2001, at 21:34:43
In reply to Re: Self med w/ Remeron Prozac Neronton Lithium » Storm, posted by Jane D on August 29, 2001, at 19:47:03
nope, there is no student health service here; Im in the great state of mississippi lol. and no drs here are covered by insurance. so now I have to relay info through mom to dr at home (since it seems impossible for him to get ahold of me here; roommates tying up the phone line, etc.)
and I have never tried remeron, probably a year ago my dr gave me a choice between remeron & celexa, I tried celexa & so I still have the two weeks of remeron left. and the date is still good too. I left a message for the dr to call mom & let her know. thanks for the suggestions.> > in your opinion do you see any problem with me switching from the prozac to remeron in less than a day? is that too soon, or do you advise me not to switch them myself at all? (I'm still on the neurontin & lithium). I've never had a problem with lith/prozac combination & I'll stay away from grapejuice. the reason it's so important is I've started feeling awful, and I'm away at college. haven't been able to get in touch with dr yet, but I have samples of remeron from a year ago or something. sorry to bother you. thanks soooo much.
>
> Storm,
> You mention that you are a student. Does your school have any kind of student health service? Most do.
>
> I don't know much about interactions of the particular drugs you are proposing other than that Prozac stays in your system a LONG time (many weeks). In other words it will be interacting for a long time to come. I'm hoping that the change of header will concern other posters enought to make them jump in here.
>
> My own concern is that you are on an awfully long list of drugs to be considering self medication and probably shouldn't do it.
>
> Using old drugs can also mean that they are weaker than they should be. Read Cam W's explanation of this above this thread at
> http://www.dr-bob.org/babble/20010828/msgs/76849.html
> and decide if this applies to you.
>
> I'm also curious about why you discontinued Remeron in the first place and why you think it will work for you now.
>
> Please push hard to find a doctor who will see you right away.
>
> Jane
Posted by Tony P on August 29, 2001, at 23:50:42
In reply to Re: Self med w/ Remeron Prozac Neronton Lithium, posted by Storm on August 29, 2001, at 21:34:43
I tried Remeron fairly recently. Most people, to judge from the posts here, have had good experience with it, and there may be no bad interactions with the meds you're BUT it's a very powerful and fast-acting drug. I found it completely intolerable and was in a very bad state for several days.
I would not want you to risk going through what I went through unless you have some good support available - both emotional and medical. It's tempting, I know, when you're feeling awful - you think anything would feel better than how you're feeling now. Not necessarily true.
Is there any sort of Need/Crisis line in your area? Not just to talk things out, but they are often also a primary source of info on where you can get low- or no-cost assistance.
Tony P
> nope, there is no student health service here; Im in the great state of mississippi lol. and no drs here are covered by insurance. so now I have to relay info through mom to dr at home (since it seems impossible for him to get ahold of me here; roommates tying up the phone line, etc.)
> and I have never tried remeron, probably a year ago my dr gave me a choice between remeron & celexa, I tried celexa & so I still have the two weeks of remeron left. and the date is still good too. I left a message for the dr to call mom & let her know. thanks for the suggestions.
>
[snipped]
... Jane > >
> > My own concern is that you are on an awfully long list of drugs to be considering self medication and probably shouldn't do it.
> >
> > Using old drugs can also mean that they are weaker than they should be. Read Cam W's explanation of this above this thread at
> > http://www.dr-bob.org/babble/20010828/msgs/76849.html
> > and decide if this applies to you.
> >
> > I'm also curious about why you discontinued Remeron in the first place and why you think it will work for you now.
> >
> > Please push hard to find a doctor who will see you right away.
> >
> > Jane
Posted by Tony P on August 29, 2001, at 23:52:03
In reply to Re: Self med w/ Remeron Prozac Neronton Lithium, posted by Storm on August 29, 2001, at 21:34:43
I tried Remeron fairly recently. Most people, to judge from the posts here, have had good experience with it, and there may be no bad interactions with the meds you're BUT it's a very powerful and fast-acting drug. I found it completely intolerable and was in a very bad state for several days.
I would not want you to risk going through what I went through unless you have some good support available - both emotional and medical. It's tempting, I know, when you're feeling awful - you think anything would feel better than how you're feeling now. Not necessarily true.
Is there any sort of Need/Crisis line in your area? Not just to talk things out, but they are often also a primary source of info on where you can get low- or no-cost assistance.
Tony P
> nope, there is no student health service here; Im in the great state of mississippi lol. and no drs here are covered by insurance. so now I have to relay info through mom to dr at home (since it seems impossible for him to get ahold of me here; roommates tying up the phone line, etc.)
> and I have never tried remeron, probably a year ago my dr gave me a choice between remeron & celexa, I tried celexa & so I still have the two weeks of remeron left. and the date is still good too. I left a message for the dr to call mom & let her know. thanks for the suggestions.
>
[snipped]
... Jane > >
> > My own concern is that you are on an awfully long list of drugs to be considering self medication and probably shouldn't do it.
> >
> > Using old drugs can also mean that they are weaker than they should be. Read Cam W's explanation of this above this thread at
> > http://www.dr-bob.org/babble/20010828/msgs/76849.html
> > and decide if this applies to you.
> >
> > I'm also curious about why you discontinued Remeron in the first place and why you think it will work for you now.
> >
> > Please push hard to find a doctor who will see you right away.
> >
> > Jane
Posted by Jane D on August 30, 2001, at 1:10:36
In reply to Re: Self med w/ Remeron Prozac Neronton Lithium, posted by Storm on August 29, 2001, at 21:34:43
> nope, there is no student health service here; Im in the great state of mississippi lol. and no drs here are covered by insurance.
Sorry to hear that. It really stinks.
> so now I have to relay info through mom to dr at home (since it seems impossible for him to get ahold of me here; roommates tying up the phone line, etc.)
For the sake of your own sanity invest in call waiting. It may not be in time to help you connect with your doctor but there will be many other times when it may keep you from killing your roommate. And vice versa.
>
good too. I left a message for the dr to call mom & let her know. thanks for the suggestions.I'm glad you're getting in touch with the dr by whatever means it takes. Hang in there and keep posting.
Jane
Posted by Andre Allard on September 1, 2001, at 0:13:09
In reply to Re: Taking combination of drugs ok? » Storm, posted by SalArmy4me on August 29, 2001, at 18:46:35
One peice of advice from experience. Pdocs do not like treating patients that change meds and dosages around at their own discretion. One pdoc, who in my opinion was absolutely awful at treating my condition, told me that he no longer wanted to see me because I liked to do things my own way. The funny thing is if I had waited around for him to wake up and become a pdoc I might lay in a casket right now.
Augmenting the prozac with remeron is an effective augmentation strategy. The only problem is that when you run out of remeron you will have to tell your pdoc or doc that you decided to do things on your own.
If it was me though, I would begin augmenting with 15mg remeron at night.
One more thing, I always took it in my own hands to make a change when I thought necessary. And you know what? I never made a change that was detrimental to my health because I made sure that I did the research first. Like I mentioned above, if I would have flown straight and only done what my pdocs prescribed I can guarantee you that I would have killed myself.
Pdocs to me are the one's that have the prescription pads and the one's that stand in the way of my recieving adequate dosages to treat my chronic condition.
Ayways, good luck!
This is the end of the thread.
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