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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by MrBrice on December 29, 2006, at 18:51:33
hi,
is it safe to use rilatine together with the two i mentioned in the title?
thanks
Posted by Quintal on December 30, 2006, at 2:11:29
In reply to Rilatine together with seroxat and dosulpin?, posted by MrBrice on December 29, 2006, at 18:51:33
I would use that cocktail only with caution under the supervision of a pdoc. There are several potentially serious interactions that could occur between them. There's more info at this site (I used amitriptyline as an example of a generic sedating TCA as they do not list dosulepin - they are similar in their mode of action though).
Q
Posted by MrBrice on December 30, 2006, at 2:37:02
In reply to Re: Rilatine together with seroxat and dosulpin? » MrBrice, posted by Quintal on December 30, 2006, at 2:11:29
Yeah, i know it could be very dangerous.
i think i need the rilatine to study, as i have ADHD, but i can't just stop my tca either.
nasty situation...
Posted by MrBrice on December 30, 2006, at 2:39:42
In reply to Re: Rilatine together with seroxat and dosulpin? Q, posted by MrBrice on December 30, 2006, at 2:37:02
But i see you article is about the cocktail of seroxat and dosulpin?
I'm taking both for about 4 weeks now and experience no strange effects what so ever...so that's really not the problem.It's the rilatine i'm worried about, since it's actions have effect on the dopamine, and i have learnt that ssri or tca do not go together with dopamine medication (or is it just the maoi's that can't be taken with ssri/tca?)
thanks.
Posted by Quintal on December 30, 2006, at 6:06:32
In reply to Re: Rilatine together with seroxat and dosulpin? Q, posted by MrBrice on December 30, 2006, at 2:39:42
I'm just wondering why the prescribing doctor didn't check these drug interactions for you? Taking Seroxat with a TCA is very unusual and not often done because SSRIs can inhibit enzymes that break down the TCA. The result is very high - possibly dangerously high - levels of the TCA accumulating in your body so even if you feel well not that is no guarantee that you're safe. The amount of dosulepin in your blood plasma could be climbing every day until it reaches toxic levels. You should be having regular blood tests to determine that the level of dosulepin is still within safe parameters.
If you get superior benefit from the TCAs but need a more serotonergic med then clomipramine (Anafranil) is a good choice. This would eliminate the risks associated with the TCA+SSRI combo.
Ritalin can also inhibit the breakdown of the TCA and the SSRI so that is one hell of a dangerous cocktail unless you're under close supervision. You might want to have a closer look at that interaction sheet. Even if you feel well now that is no guarantee that you will still be safe in another 4 weeks. Adding Ritalin to the combo would complicate things even further. It seems just too dangerous to recommend unless you're having regular blood tests and even then there are safer combos that could be used.
Please be careful with those meds and if you do continue using them be alert to the onset of serotonin syndrome and TCA toxicity outlined below:
__________________________________________________
Pharmacodynamically, the combination of paroxetine (or any other selective serotonin reuptake inhibitor) and a TCA may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5HT1A receptors.MANAGEMENT:
In general, the use of paroxetine (or other SSRIs) with TCAs should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Pharmacologic response and plasma TCA levels should be monitored more closely whenever paroxetine is added to or withdrawn from therapy in patients stabilized on their existing antidepressant regimen, and the TCA dosage adjusted as necessary. Patients should be monitored closely for signs and symptoms of TCA toxicity (e.g., sedation, dry mouth, blurred vision, constipation, urinary retention) and/or excessive serotonergic activity (e.g., CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia).
__________________________________________________Q
Posted by MrBrice on December 30, 2006, at 6:33:19
In reply to Re: Rilatine together with seroxat and dosulpin? Q » MrBrice, posted by Quintal on December 30, 2006, at 6:06:32
Hey Quintal,
I really didn't know i was at risk by taking the two of the medications together, neither is my docter i think. I see him about every two weeks so maybe he would notice if something would go wrong...?
Another good reason for me not to worry to much is because i use both medications at low levels. I take 50mg's of dosulpin daily (normal dosage is 75), and 15mg's of paroxatine (20 is normal.).
i haven't asked him yet if i should use the rilatine, but judging by your reaction that's a stupid question right?
anyway thanks for the warning! i really wastn't aware...
Posted by Quintal on December 30, 2006, at 7:32:29
In reply to Re: Rilatine together with seroxat and dosulpin? Q, posted by MrBrice on December 30, 2006, at 6:33:19
>I really didn't know i was at risk by taking the two of the medications together, neither is my docter i think.
Dosulepin isn't mentioned in that interaction sheet and it could have different metabolites that are safe with Seroxat. Doctors aren't pharmacists though and not all are aware of the dangers of mixing meds. The dispensing pharmacist should have queried the unusual choice and double checked if there was an interaction. At least he's using low doses.
>I see him about every two weeks so maybe he would notice if something would go wrong...?
I would hope so, but I've found it's best to rely on yourself. Just keep an eye out for any of the symptoms on that list.
>i haven't asked him yet if i should use the rilatine, but judging by your reaction that's a stupid question right?
For that sort of technical information it may be better to ask the dispensing pharmacist - they know more about the pharmacology of interactions than most doctors. Maybe say you read that there could be an interaction between some of the meds you are taking or planning to take and you need more advice. They are almost always happy to help. Their phone number should be on the dispensing label they put on your meds if you need to contact them urgently.
Q
Posted by MrBrice on January 4, 2007, at 9:33:30
In reply to Re: Rilatine together with seroxat and dosulpin? Q » MrBrice, posted by Quintal on December 30, 2006, at 7:32:29
Hi,
i just wanna let you know i'm taking all three now and everything is more than fine. I feel fantastic, i feel myself...
grtz,
Brice
Posted by Quintal on January 4, 2007, at 10:01:41
In reply to Rilatine together with seroxat and dosulpin? Quint » Quintal, posted by MrBrice on January 4, 2007, at 9:33:30
That's great news MrBrice. Did you check with the pharmacy that all three were safe to take together? May I ask which country you are posting from?
Q
Posted by MrBrice on January 5, 2007, at 12:39:10
In reply to Re: Rilatine together with seroxat and dosulpin? Quint » MrBrice, posted by Quintal on January 4, 2007, at 10:01:41
> That's great news MrBrice. Did you check with the pharmacy that all three were safe to take together? May I ask which country you are posting from?
>
> Qi checked with my docter and i have faith in him...
I post from Belgium btw, the pride of Europe :-)
This is the end of the thread.
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