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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by fellowmike on October 3, 2009, at 0:20:11
okay i've been on amitriptyline 250mg for some time now....and its is only helping my agitated depression to a certain extent,,
so i asked my doctor about a amitriptyline+lexapro combo and he said he honestly doesn't know the exact enzyme and blood level effects when adding a SSRI to a TCA..so what is the maximum amount of amitriptline you can take with 10mg of lexapro w/o killing yourself...
im a very fast metabolizer and 300mg of amitriptyline wouldnt help much more than the 250mg i'm on now..so would 50mg of amitripyline + 10 lexapro be too much or what?
i dont really know and my doctor told me to do research....i know it shouldnt be my job, but my doctor knows i know a lot about psychoactive drugs....i just dont know this combo dosaging!!!long story short. im a young adult male 6'2 200 with a fast and strong and resistant to drugs liver and intestines..what should the amitripyline 'target' dose be with 10mg lexapro? and with 5mg lexapro?!!
thanks:]]]]]]]]
Posted by Phillipa on October 3, 2009, at 12:14:49
In reply to HELP! Amitriptyline and lexapro combo question!!, posted by fellowmike on October 3, 2009, at 0:20:11
Doesn't the doc do blood levels on the TCA? Might google drug checker and see if any info there. Phillipa
Posted by Brainbeard on October 3, 2009, at 13:13:16
In reply to HELP! Amitriptyline and lexapro combo question!!, posted by fellowmike on October 3, 2009, at 0:20:11
The only enzyme group that Lexapro moderately inhibits is 2D6. Amitriptyline, on the other hand, inhibits a bunch of enzymes, among which is 2C19, which it inhibits strongly.
And what do you know? 2C19 is one of the main group of enzymes metabolizing Lexapro. Further, 2D6 is one of the enzyme groups metabolizing amitriptyline, and it's essential to break down amitriptyline's active metabolite, nortriptyline.
So, combining Lexapro and amitriptyline will:
*) raise amitriptyline blood levels slightly
*) raise nortriptyline (active metabolite) blood levels more significantly (Prozac, which is a potent 2D6 inhibitor, raised nortriptyline levels about ninefold in this study: http://www.ncbi.nlm.nih.gov/pubmed/7751409)
*) raise Lexapro blood levels significantlyNortriptyline is an NRI (noradrenaline reuptake inhibitor), but a pretty mellow one. It's the least toxic TCA around, so blood levels would have to be very high to become dangerous.
All in all, you're getting more of everything. You could start with 5mg of Lexapro and cutting down your amitriptyline to, say, 75mg. I would ask for a blood level check after about a month. Obviously, they should check your nortriptyline blood levels too! If your blood levels don't run crazy and/or you're not experiencing troublesome side-effects (in which case you should immediately lower your amitriptyline intake), you could first try raising the Lexapro to 10mg, and wait another month, have another blood level check, and then slowly raise the amitriptyline again. Or you could keep the Lexapro at 5mg and slowly raise the amitriptyline.
I think this could be a very good combo, you just have to be careful because there are some significant interactions.
Posted by Helbel on August 16, 2016, at 0:25:37
In reply to Re: HELP! Amitriptyline and lexapro combo question!!, posted by Brainbeard on October 3, 2009, at 13:13:16
I found this reply incredibly helpful and I'm so glad I found this.
I have been on Lexapro 10mg for a year now (for anxiety) and last night took my first dose of Amitriptyline 5mg (for TMJ/D), woke up this morning with horribly anxiety, false skin sensations (burning) and I unfortunately threw up my breakfast during an anxiety/panic attack. These symptoms were present in the first week of taking Lexapro, and I couldn't get my head around why the Amitriptyline was bringing them back - but it all makes sense now. I will be halving the Amitriptyline dose to 2.5mg tonight and hopefully no more side effects, otherwise I'll try lowering the Lexapro to 5mg.
Thank you!
> The only enzyme group that Lexapro moderately inhibits is 2D6. Amitriptyline, on the other hand, inhibits a bunch of enzymes, among which is 2C19, which it inhibits strongly.
>
> And what do you know? 2C19 is one of the main group of enzymes metabolizing Lexapro. Further, 2D6 is one of the enzyme groups metabolizing amitriptyline, and it's essential to break down amitriptyline's active metabolite, nortriptyline.
>
> So, combining Lexapro and amitriptyline will:
>
> *) raise amitriptyline blood levels slightly
> *) raise nortriptyline (active metabolite) blood levels more significantly (Prozac, which is a potent 2D6 inhibitor, raised nortriptyline levels about ninefold in this study: http://www.ncbi.nlm.nih.gov/pubmed/7751409)
> *) raise Lexapro blood levels significantly
>
> Nortriptyline is an NRI (noradrenaline reuptake inhibitor), but a pretty mellow one. It's the least toxic TCA around, so blood levels would have to be very high to become dangerous.
>
> All in all, you're getting more of everything. You could start with 5mg of Lexapro and cutting down your amitriptyline to, say, 75mg. I would ask for a blood level check after about a month. Obviously, they should check your nortriptyline blood levels too! If your blood levels don't run crazy and/or you're not experiencing troublesome side-effects (in which case you should immediately lower your amitriptyline intake), you could first try raising the Lexapro to 10mg, and wait another month, have another blood level check, and then slowly raise the amitriptyline again. Or you could keep the Lexapro at 5mg and slowly raise the amitriptyline.
>
> I think this could be a very good combo, you just have to be careful because there are some significant interactions.
This is the end of the thread.
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