Posted by Jedi on January 26, 2008, at 2:09:41
In reply to Food restrictions are not an absolute but a guide, posted by Tony P on January 25, 2008, at 20:54:53
> You're quite right, I do tend to play my own game and trust my knowledge a little too much. All my regular meds (including OTC) have been discussed with my MD, pdoc & pharmacist, but it's so easy to make a bad mistake on an OTC. I bought some dextromethorphan cough capsules recently, thinking nothing of it, then at the last minute checked the web and discovered they can interact seriously and even fatally with MAOI's including low-dose selegeline.
>
> My meds that have potential interactions are:
> - Selegeline 10 mg/day oral
> - Remeron 30 mg/day
> - Requip (DA agonist) 1.5 mg / day
> - Trimipramine 50-200 mg prn HS (usually 100 mg every few days)
>
> BTW, at least one source I checked said (I think) nortryptilline was one of the more dangerous TCA's to combine with a MAOI. I had been taking it occasionally instead of the trimipramine for sleep as its half-life is much shorter. I shall stop until I've seen a new pdoc & reviewed everything with him.
>
> Tony
____________________________________________________________________Hi Tony,
Check with your Doc but nortriptyline is one of the safer tricyclics to combine with a MAOI. The trick is to find tricyclics that do not increase serotonin in the brain. When you combine another med that increases serotonin by a different mechanism with a MAOI, Serotonin Syndrome is a possibly fatal result.Though officially contraindicated this MAOI/nortriptyline combination has been well studied. I have used phenelzine with nortriptyline (the active metabolite of amitriptyline) with no problem. The usual method is to add the MAOI to an established dosage of tricyclic or start the two simultaneously. Some people have been able to go the other way, but it is more risky. At the small dosage your describing, I dont know.
Be Well,
JediHere is an abstract of a long-term combination study:
J Affect Disord. 1995 Jun 8;34(3):187-92.
A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination.
Berlanga C, Ortega-Soto HA.
Division of Clinical Research, Mexican Institute of Psychiatry, Mexico, DF.Treatment-resistant depression is a clinical complication that not infrequently affects a certain number of patients. Within the treatment strategies proposed for this condition, the association of a MAO inhibitor (MAOI) with a tricyclic antidepressant has gained reputation both for its unusual efficacy, as for its potential toxicity. However, when cautions are taken, it may be safely administered. Most reports on this combination have been carried in nonresistant patients and, when resistant patients are included, only the acute phase of the treatment is reported. In this study, a group of well-defined resistant patients received an open trial with the association of isocarboxazide and amitryptiline (n = 25). Those who responded were followed during the next 3 years (n = 12) and every 6 months an attempt was made to discontinue the MAOI and continue only with amitryptiline. At the end of the study, 4 patients maintained response with single medication, 6 still required both drugs and 2 relapsed. No clinical differences were apparent between the outcome groups, except that those who maintained their response only with the 2 combined drugs had more previous depressive episodes than the others. The isocarboxazide/amitryptiline combination may be a good treatment option for at least some forms of resistant depression. The safety of this treatment modality is confirmed, even when given for long periods of time. The study also suggest that there are no clinical characteristics in resistant depression that may predict the treatment outcome but, perhaps in some patients, a combined treatment is required to obtain a broader biochemical effect that could convert them from nonresponders to responders.
PMID: 7560546 [PubMed - indexed for MEDLINE]
poster:Jedi
thread:808932
URL: http://www.dr-bob.org/babble/20080124/msgs/808956.html