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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by krzeekat on September 24, 2005, at 12:06:32
My doc just prescribed Meridia to help with appetite control so I can get back on track with eating healthy (I just learned via this site that the Celexa I've been taking may be triggering the binge eating). I'm wondering if it is Ok to take 10mg Meridia along with my 200mg of Wellbutrin. My doc knows I take Wellbutrin but the Pharmacist was really concerned today when she filled the Rx and saw that I take Wellbutrin. She was also concerned about the Celexa but I told her I'm stopping it. Also, I understand that Meridia was originally being developed as an anti-depressant. So, could it perhaps take the place of the Wellbutrin?
Any comments? Thanks is advance
Posted by TexasChic on September 24, 2005, at 12:06:32
In reply to Meridia Wellbutrin, posted by krzeekat on September 20, 2005, at 3:15:48
If your doctor knows you're on Wellbutrin, it should be okay. Pharmacists are supposed to question things like that, I guess because of the chance of liabilty. If I were you I would call my doc and tell her what the pharmacist said and see what she has to say on the subject. In the past, I've had my doc prescribe things that have raised a red flag with the pharmacy too. I trust my doctor, but appreciate that someone else is looking out for me too!
Posted by ButterflyHigh on September 24, 2005, at 12:06:32
In reply to Meridia Wellbutrin, posted by krzeekat on September 20, 2005, at 3:15:48
I gotta tell you, I just posted in frustration about this weight thing, and I was taking WellbutrinSR for oh about 3 months, I discontinued it about 3 weeks ago and have been eating A LOT and have gained 10 pounds, but I also am in recovery and not getting high any longer.
May I ask why your pharmacist was really concerned today when she filled the Rx and saw that you take Wellbutrin and also concerned about the Celexa? After about 3 months on the WB, I started getting headaches, and did not want to increase my dose, my goal is to wean of all psychiatric meds (after 10 years on most of them) but that's my stuff. I don't know anything about Meridian, except that it's used for weight control, I lost weight on Celexa and gained on Lexapro, it's all the dang deck of cards our bodies are dealt I guess.
Hang in there - hope you get some more help:)
Posted by krzeekat on September 24, 2005, at 12:06:32
In reply to Re: Meridia Wellbutrin » krzeekat, posted by ButterflyHigh on September 24, 2005, at 1:39:28
Apparently, taking Meridia along with SSRI's can sometimes cause a condition called "Sertonin Syndrome". Here's a link for anyone interested:
http://www.uspharmacist.com/oldformat.asp?url=newlook/files/feat/acf2fa6.htm
I guess Wellbutrin in not an SSRI (My psych doc told me the other day)so it SHOULDN'T be an issue. Anyway, I am going to try upping my Wellbutin to 400mg a day and see if that helps before trying the Meridia. My Primary care doc prescribed Ambien for me and it does not agree with me. I have had a couple of rough days. So, I'm reluctant to try another new med.
My goal is also to one day be totally off all Rx meds. It may not happen because my depression is so pervasive but it is still a good goal to try for.
Thanks for writing.
Posted by Racer on September 24, 2005, at 12:42:42
In reply to Re: Meridia Wellbutrin » ButterflyHigh, posted by krzeekat on September 24, 2005, at 3:59:33
>
> I guess Wellbutrin in not an SSRI (My psych doc told me the other day)so it SHOULDN'T be an issue.
SSRI = Selective Serotonin Reuptake Inhibitor. Thus, they increase the amount of serotonin in the synaptic gaps.Wellbutrin, on the other hand, works through the norepinephrine and dopamine systems -- no action on serotonin that anyone knows about.
So, the Celexa might be a problem, but the Wellbutrin wouldn't be. Serotonin Syndrome is a serious thing, but if you're not taking anything that works through serotonin manipulation, it shouldn't be an issue.
As for the pharmacist, while he or she might know something we don't, it's also possible that he or she isn't aware of the actions of Wellbutrin. (Wellbutrin hasn't been well understood. It's only recently that I've come across articles showing how it works, so it wouldn't be surprising that someone else hasn't read those yet.) It's possible that your pharmacist just assumes that all anti-depressants have some action on the serotonin system.
Just a few thoughts...
Posted by SLS on September 24, 2005, at 14:38:20
In reply to Re: Meridia Wellbutrin » krzeekat, posted by Racer on September 24, 2005, at 12:42:42
> Wellbutrin hasn't been well understood. It's only recently that I've come across articles showing how it works
Don't leave me in suspense!
How does it work?
Are the articles online?
Thanks.
- Scott
Posted by Phillipa on September 24, 2005, at 15:43:44
In reply to Re: Meridia Wellbutrin » Racer, posted by SLS on September 24, 2005, at 14:38:20
Scott, you don't know? I want to know too. Please reply Racer. Fondly, Phillipa
Posted by Nickengland on September 24, 2005, at 18:20:40
In reply to Re: Meridia Wellbutrin » SLS, posted by Phillipa on September 24, 2005, at 15:43:44
Here some really interesting information about the drug in general and briefly about its mode of action..
Bupropion (amfebutamone) is an antidepressant of the aminoketone class, chemically unrelated to tricyclics or SSRIs. It is similar in structure to the stimulant cathinone, and to phenethylamines in general. It is a chemical derivative of diethylpropion, an amphetamine-like substance used as anorectic.
History
Bupropion was first synthesized by Burroughs Research in 1966, and patented by Burroughs-Wellcome (later Glaxo-Wellcome) in 1974. It was approved by the FDA in 1985 and marketed under the name Wellbutrin as an antidepressant, but clinical trials indicated that incidence of seizure was two to four times greater than other antidepressants and the drug was quickly pulled from the market. Glaxo, realizing that seizure risk was a function of dosage, then developed and marketed a sustained-release (SR) version of Wellbutrin which, when ingested, releases bupropion hydrochloride at a constant, gradual rate into the body. Because of this altered mechanism of delivery, incidence of seizure with Wellbutrin-SR is comparable to, and in some cases, lower than that of other antidepressants.
In 1997, bupropion HCl was approved by the FDA for use as a smoking cessation aid. Because the name Wellbutrin was still associated with high seizure risk, the drug was subsequently marketed by Glaxo under the name Zyban to help people stop smoking tobacco by reducing the severity of withdrawal symptoms. It can be used in combination with nicotine replacement therapies. Bupropion treatment course lasts for seven to twelve weeks, the patient halting the use of tobacco around ten days into the course.
It is contraindicated in people taking medication for seizure disorders (phenytoin, phenobarbital), with bulimia or anorexia, with kidney or liver dysfunctions, or people already taking any monoamine oxidase inhibitor. It can also cause problems with cold remedies, certain herbal supplements, creatine, cimetidine, ephedrine, and benzodiazepines.
Mode of action
Bupropion is a selective catecholamine (norepinephrine and dopamine) reuptake inhibitor. It has only a small effect on serotonin reuptake. It does not inhibit MAO. The actual mechanism behind bupropion's action is not known, but it is thought to be due to the effects on dopaminergic and noradrenergic mechanisms.
Pharmacokinetics
Bupropion is metabolised in the liver. It has at least three active metabolites; hydroxybupropion, threohydrobupropion and erythrohydrobupropion. These active metabolites are further metabolised to inactive metabolites and eliminated through excretion into the urine. The half-life of bupropion is 20 hours as is hydroxybupropion's. Threohydrobupropion's half-life is 37 hours and erythrohydrobupropion's 33 hours.
From Wikipedia, the free encyclopedia. :-)
Kind regards
Nick
Posted by med_empowered on September 24, 2005, at 18:21:33
In reply to Re: Meridia Wellbutrin » SLS, posted by Phillipa on September 24, 2005, at 15:43:44
hey! I've never heard of wellbutrin being a major player in serotonin syndrome--that seems to happen alot with combos involving SSRIs and stimulants, or multiple antidepressants...anyway, that particular complication shouldn't be an issue. A possible problem, though, would be cardiovascular stuff; Wellbutrin, probably b/c its kind of stimulating, can raise blood pressure/heart rate all by itself. Meridia is pretty safe, but its been linked to a couple strokes and heart attacks (pretty much what you'd expect from any diet pill). Keep in mind that Wellbutrin itself is related to an older diet pill, Tenuate--a non-amphetamine stimulant type appetite suppressant that was popular in the 70s, I think. Good luck!
Posted by Phillipa on September 24, 2005, at 18:30:14
In reply to Re: Meridia Wellbutrin » SLS, posted by Phillipa on September 24, 2005, at 15:43:44
Thanks, Nick, your knowledge is awesome! Fondly,Phillipa
Posted by SLS on September 24, 2005, at 19:50:03
In reply to Re: Meridia Wellbutrin, posted by Nickengland on September 24, 2005, at 18:20:40
Believe it or not, bupropion is also an antagonist at the nicotinic ACh receptor. This might act to diminish the mood-modulating and reward properties of smoking by blocking the effects of nicotine on that receptor and thus reduce the release of dopamine in response to smoking.
- Scott
Posted by ButterflyHigh on September 24, 2005, at 20:33:28
In reply to Re: Meridia Wellbutrin » ButterflyHigh, posted by krzeekat on September 24, 2005, at 3:59:33
You're right, Wb isn't an SSRI, it's one of those atypical dopamine/norepinephrine ad's. I think you have a good idea increasing it to 400mg a day. I went back on it today, I only take 150mg, it just seems to do the trick for now, I was starting to feel very irritable lately after not taking for about a week.
Anyway, best to you with the increase.
I'd be reluctant to try another med as well, I understand.
All the best in reaching your goals
:)
Posted by ButterflyHigh on September 24, 2005, at 20:36:32
In reply to Re: Meridia Wellbutrin, posted by med_empowered on September 24, 2005, at 18:21:33
Got a question for you: it's a coincidence you posted this above.
Is Wellbutrin considered an methamphetamine (sp?) - type drug? I heard that it was, and I tested poistive on a drug screen for amphetamines.*confuzzled*
Posted by Racer on September 24, 2005, at 21:06:05
In reply to Re: Meridia Wellbutrin » Racer, posted by SLS on September 24, 2005, at 14:38:20
> > Wellbutrin hasn't been well understood. It's only recently that I've come across articles showing how it works
>
> Don't leave me in suspense!
>
> How does it work?
>
> Are the articles online?
>
> Thanks.
>
>
> - ScottUh, so I guess you're not the one who sent them to me? I know that they were online, but can't for the life of me remember where. Let me check my files, which it's too dark to do now, and I'll see where that one was published and let you know.
I think, if I remember correctly, it does inhibit reuptake, but has another, more novel, mode of action as well. I'll let you know when I find it.
Posted by med_empowered on September 25, 2005, at 0:23:33
In reply to Re: Meridia Wellbutrin » SLS, posted by Racer on September 24, 2005, at 21:06:05
hey butterfly...I honestly don't know the answer to that. My guess would be that since non-amphetamine, stimulant-type diet drugs (ex: tenuate, bontril, phentermine, didrex) will often give "false positives" for amphetamines, it would theoretically be possible for Wellbutrin (which is related to Tenuate) to do the same. Plus..the drug tests given out in a lot of places have a tendency to give lots of false positives; its a big problem.
Posted by krzeekat on September 25, 2005, at 3:08:19
In reply to Re: Meridia Wellbutrin, posted by Nickengland on September 24, 2005, at 18:20:40
>>>>The actual mechanism behind bupropion's action is not known, but it is thought to be due to the effects on DOPAMINERGIC and noradrenergic mechanisms.<<<<
This is what my psych doc said - I just couldn't remember the terms.
Posted by krzeekat on September 25, 2005, at 3:13:38
In reply to Meridia Wellbutrin, posted by krzeekat on September 20, 2005, at 3:15:48
Thanks for all the information, everyone! I appreciate it! I'm going to talk to my doc a bit more about the Meridia. Plus, I'll wait and see what happens as I increase my WB to 400mg.
I didn't realize that WB was related to amphetamine like diet meds. I do know that when my son was presribed it (he has mutiple neuro disorders) he became anorexic so we had to take him off it.
Posted by maddy4 on September 25, 2005, at 11:21:30
In reply to Re: Meridia Wellbutrin, posted by Nickengland on September 24, 2005, at 18:20:40
"It can also cause problems with cold remedies, certain herbal supplements, creatine, cimetidine, ephedrine, and benzodiazepines."
how does it cause prob.s w/ benzos??
Posted by Phillipa on September 25, 2005, at 17:42:39
In reply to Re: Meridia Wellbutrin question / nick, posted by maddy4 on September 25, 2005, at 11:21:30
Maddy that's a good question. All I know is when I took wellbutrin at l50mg I fell in the road while walking my small dog. Can't even remember how or why. So if wellbutrin is like an amphetimine then maybe a benzo with it they just cancel themselves out? Someone please answer. Fondly, Phillipa
Posted by Nickengland on September 25, 2005, at 17:52:46
In reply to Re: Meridia Wellbutrin question / nick, posted by maddy4 on September 25, 2005, at 11:21:30
Hi Maddy,
>how does it cause prob.s w/ benzos??
I think it can cause problems because in a sense the drugs are completely the oppisite of one another, i.e a benzodiazepine is a sedative (downer) type drug used to treat seizures, whereas Wellbutrin is more like an upper stimulant substance in a sense and can in effect induce seizures...Although I think the 2 drugs can actually be taken together, but with care. Also I guess it would depend on the specific benzodiazepine you would be taking along side Wellbutrin. (theres a mention of diazepam - Valium below, although the actual interaction is about clonazepam and benzodiazepines in general)
Bupropion and Clonazepam (moderate Drug-Drug)
Description:MONITOR:
Excessive use or abrupt discontinuation of benzodiazepines and other sedatives after chronic ingestion may precipitate seizures in patients receiving bupropion. Conversely, bupropion may antagonize the central pharmacologic effects of sedatives. Bupropion can cause agitation, anxiety, and insomnia and has been shown to decrease the sedative effect of diazepam in healthy volunteers given single doses of the drugs.MANAGEMENT:
Although sedatives may be prescribed to treat agitation, anxiety, and insomnia associated with bupropion use, patients should be alerted to the possibility of an increased risk of seizures during excessive exposure to these drugs. Patients should not attempt to alter the dosages or discontinue the medications on their own without consulting with their physician. The use of bupropion is contraindicated in patients undergoing abrupt discontinuation of sedatives.That information is from an online drugs interactions checker at drugs.com
Hope that helps :-)
Kind regards
Nick
Posted by Nickengland on September 25, 2005, at 18:05:32
In reply to Re: Meridia Wellbutrin » Nickengland, posted by SLS on September 24, 2005, at 19:50:03
Hi Scott
>Believe it or not, bupropion is also an antagonist at the nicotinic ACh receptor. This might act to diminish the mood-modulating and reward properties of smoking by blocking the effects of nicotine on that receptor and thus reduce the release of dopamine in response to smoking.
I'm very tempted to ask my GP for this drug in sense - as I could really do with some extra help to quit smoking. If it wasn't for the antidepressant properties I think I'd try it...guess i'll have to rely on will power and patches (just can't bring myself to quit though yet lol)
Thanks for that information :-)
Kind regards
Nick
Posted by ButterflyHigh on September 25, 2005, at 20:48:45
In reply to Re: Meridia Wellbutrin, posted by med_empowered on September 25, 2005, at 0:23:33
This is the end of the thread.
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