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Re: TCA Augmentation

Posted by zeugma on December 8, 2004, at 15:45:57

In reply to Re: TCA Augmentation, posted by dove on December 8, 2004, at 13:01:49

I think Wellbutrin is not a good combination with TCA's because it can block the enzymes that metabolize the TCA. 75 mg Anafranil is not a high dose, but I would be concerned, nontheless, about the combination.

Another reason for concern is that both meds lower the seizure threshold considerably. Anafranil is the most epileptigenic of the tricyclics, and Wellbutrin and maprotiline are considered to be the most epileptigenic meds overall.Again, I think in low doses this would not be a major cause for concern, but if you have any history of seizure disorder this is a strict contraindication.

Provigil also blocks another enzyme that breaks down Anafranil (it's in the PI sheet for Provigil). Again, something to consider: I would definitely pay close attention to possible increased s/e on this combo.

I took Provigil with nortriptyline for a while, and Provigil treated my ADD and narcolepsy symptoms beautifully: I just had too many upsetting side effects to stay on it. So I'm taking nortriptyline with Ritalin instead. Ritalin is no bargain in the side effect department for me, either, and is only modestly effective, but one of the s/e I find aggravating (weight loss) might be desirable for you.

I asked my pdoc about Anafranil months ago. He said the reason he didn't favor it for me was because of the difficulties it can cause for polypharmacy, because it is metabolized by various enzymes (hence more possibility for reactions because many drugs block an enzyme or two). Provigil, from what I read, is not contraindicated with Anafranil: it just needs to be monitored closely.


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poster:zeugma thread:426110
URL: http://www.dr-bob.org/babble/20041206/msgs/426269.html