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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Whit_in_Texas on March 31, 2006, at 6:40:48
I took Parnate a couple of years ago, and it worked beautifully until it pooped out on my three months later. I wonder if my new pdoc would be more willing to augment than my other one was. I am now going through adderall withdrawal hell because I am tired of the rollercoaster--it is the only other thing that has worked for my depression. How long would I have to be free of adderall before trying parnate? I know most things they say 2 weeks, but adderall is completely out of your system in three days.
Is there anything else, besides wellbutrin, I would need to stop taking from this cocktail?:
Remeron 30 mg
Klonopin 4 mg
Clomiprimine 250mg (I am out of this so I haven't had it in days anyway)
Wellbutrin 450mg (obviously, I need to stop this)
Lamictal 125 mg and moving upAlso, how long after stopping adderall will it take before I even BEGIN to feel ok? I stopped cold turkey because tapering just seems to prolong the pain.
Thanks!
Posted by Whit_in_Texas on March 31, 2006, at 7:23:33
In reply to Maybe Parnate again?, posted by Whit_in_Texas on March 31, 2006, at 6:40:48
I forgot---I am also taking amantadine that was supposed to help with the adderall withdrawal, but I can't tell a difference!
Posted by SLS on March 31, 2006, at 7:25:18
In reply to Maybe Parnate again?, posted by Whit_in_Texas on March 31, 2006, at 6:40:48
Hi.
Actually, you can continue with the Wellbutrin if you want to. It's the clomipramine that must be discontinued so as to avoid serotonin syndrome. I was once on Parnate and Wellbutrin at the same time. It was my doctor's suggestion. You probably won't find too many doctors willing to try it. I doubt I could come up with any documentation that would be useful to you to present to your doctor. Mine based his decision on some of the work of John Feighner, MD.
I don't know how long you will feel the effects from the discontinuation of amphetamine. My guess would be 1-2 weeks. What are you experiencing?
- Scott
> I took Parnate a couple of years ago, and it worked beautifully until it pooped out on my three months later. I wonder if my new pdoc would be more willing to augment than my other one was. I am now going through adderall withdrawal hell because I am tired of the rollercoaster--it is the only other thing that has worked for my depression. How long would I have to be free of adderall before trying parnate? I know most things they say 2 weeks, but adderall is completely out of your system in three days.
>
> Is there anything else, besides wellbutrin, I would need to stop taking from this cocktail?:
>
> Remeron 30 mg
> Klonopin 4 mg
> Clomiprimine 250mg (I am out of this so I haven't had it in days anyway)
> Wellbutrin 450mg (obviously, I need to stop this)
> Lamictal 125 mg and moving up
>
> Also, how long after stopping adderall will it take before I even BEGIN to feel ok? I stopped cold turkey because tapering just seems to prolong the pain.
>
> Thanks!
Posted by Maxime on March 31, 2006, at 9:36:01
In reply to Maybe Parnate again?, posted by Whit_in_Texas on March 31, 2006, at 6:40:48
I took 30 mg of Adderall XR WITH Parnate 80 mg and never had a problem.
Maxime
> I took Parnate a couple of years ago, and it worked beautifully until it pooped out on my three months later. I wonder if my new pdoc would be more willing to augment than my other one was. I am now going through adderall withdrawal hell because I am tired of the rollercoaster--it is the only other thing that has worked for my depression. How long would I have to be free of adderall before trying parnate? I know most things they say 2 weeks, but adderall is completely out of your system in three days.
>
> Is there anything else, besides wellbutrin, I would need to stop taking from this cocktail?:
>
> Remeron 30 mg
> Klonopin 4 mg
> Clomiprimine 250mg (I am out of this so I haven't had it in days anyway)
> Wellbutrin 450mg (obviously, I need to stop this)
> Lamictal 125 mg and moving up
>
> Also, how long after stopping adderall will it take before I even BEGIN to feel ok? I stopped cold turkey because tapering just seems to prolong the pain.
>
> Thanks!
Posted by JaclinHyde on March 31, 2006, at 14:31:43
In reply to Re: Maybe Parnate again?, posted by Maxime on March 31, 2006, at 9:36:01
Whoa...it's the Remeron that you should be the most worried about. Here is what medscape has to say...
"Patient Regimen
REMERON ORAL
PARNATE ORALInteractions
Contraindicated Drug Combination
TRI;TETRACYCLIC COMPOUNDS/MAOIS
Remeron Oral and Parnate Oral may interact based on the potential interaction between TRI;TETRACYCLIC COMPOUNDS and MAOIS.Tri; Tetracyclic Compounds/MAOI'S
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
MONOGRAPH TITLE: Tri; Tetracyclic Compounds/MAOI'S
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Two possible mechanisms have been proposed for this interaction. MAO inhibitors may enhance the effects of the tricyclic antidepressants indirectly through inhibition of microsomal enzymes. Tricyclic antidepressants may sensitize adrenergic receptors to amines which then accumulate extraneuronally as a result of MAO inhibition.
CLINICAL EFFECTS: Increased effects of both drugs. Severe reactions including hyperpyrexia, convulsions, excitability, muscular rigidity, fluctuations in blood pressure, convulsions, grand mal seizures, coma, and death have been reported.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The concurrent use of tricyclic antidepressants and MAO inhibitors is contraindicated by the manufacturers of tricyclic antidepressants and tranylcypromine.
The manufacturers of tricyclic antidepressants and mirtazapine recommend at least 14 days between switching therapies. The manufacturer of tranylcypromine recommends a medication-free interval of at least a week when initiating tranylcypromine in patients who have previously received a tricyclic antidepressant, then initiating tranylcypromine at a reduced dosage of 50% for one week.
The manufacturer of phenelzine states that if phenelzine is used concurrently with or within 10 days of another antidepressant, the patient should be cautioned regarding the possibility of an adverse drug interaction.
DISCUSSION: It should be noted that if this interaction occurs, the consequences will be immediate and severe. Effects may continue to be seen for several days after discontinuing the MAOI. Similarity between cyclobenzaprine and TCA's warrants consideration of TCA interactions for cyclobenzaprine. Mirtazapine, a tetracyclic antidepressant, should also be considered for this interaction. Furazolidone and linezolid are known to inhibit MAO."
JH
Posted by JaclinHyde on March 31, 2006, at 14:39:02
In reply to Maybe Parnate again?, posted by Whit_in_Texas on March 31, 2006, at 6:40:48
Ok taking all of the meds in account plus parnate this is what Medscape says (it is loooong)
Patient Regimen
CLOMIPRAMINE ORAL
LAMICTAL ORAL
REMERON ORAL
PARNATE ORAL
WELLBUTRIN ORALInteractions
Contraindicated Drug Combination
TRI;TETRACYCLIC COMPOUNDS/MAOIS
Clomipramine Oral and Parnate Oral may interact based on the potential interaction between TRI;TETRACYCLIC COMPOUNDS and MAOIS.
TRI;TETRACYCLIC COMPOUNDS/MAOIS
Remeron Oral and Parnate Oral may interact based on the potential interaction between TRI;TETRACYCLIC COMPOUNDS and MAOIS.
BUPROPION/MAOI'S
Wellbutrin Oral and Parnate Oral may interact based on the potential interaction between BUPROPION and MAOI'S.Moderate Interaction
BUPROPION/ANTIDEPRESSANTS
Wellbutrin Oral and Clomipramine Oral may interact based on the potential interaction between BUPROPION and ANTIDEPRESSANTS.
BUPROPION/ANTIDEPRESSANTS
Wellbutrin Oral and Remeron Oral may interact based on the potential interaction between BUPROPION and ANTIDEPRESSANTS.Tri; Tetracyclic Compounds/MAOI'S
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
MONOGRAPH TITLE: Tri; Tetracyclic Compounds/MAOI'S
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Two possible mechanisms have been proposed for this interaction. MAO inhibitors may enhance the effects of the tricyclic antidepressants indirectly through inhibition of microsomal enzymes. Tricyclic antidepressants may sensitize adrenergic receptors to amines which then accumulate extraneuronally as a result of MAO inhibition.
CLINICAL EFFECTS: Increased effects of both drugs. Severe reactions including hyperpyrexia, convulsions, excitability, muscular rigidity, fluctuations in blood pressure, convulsions, grand mal seizures, coma, and death have been reported.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The concurrent use of tricyclic antidepressants and MAO inhibitors is contraindicated by the manufacturers of tricyclic antidepressants and tranylcypromine.
The manufacturers of tricyclic antidepressants and mirtazapine recommend at least 14 days between switching therapies. The manufacturer of tranylcypromine recommends a medication-free interval of at least a week when initiating tranylcypromine in patients who have previously received a tricyclic antidepressant, then initiating tranylcypromine at a reduced dosage of 50% for one week.
The manufacturer of phenelzine states that if phenelzine is used concurrently with or within 10 days of another antidepressant, the patient should be cautioned regarding the possibility of an adverse drug interaction.
DISCUSSION: It should be noted that if this interaction occurs, the consequences will be immediate and severe. Effects may continue to be seen for several days after discontinuing the MAOI. Similarity between cyclobenzaprine and TCA's warrants consideration of TCA interactions for cyclobenzaprine. Mirtazapine, a tetracyclic antidepressant, should also be considered for this interaction. Furazolidone and linezolid are known to inhibit MAO.
REFERENCES:
1.Brachfeld J, Wirtshafter A, Wolfe S. Imipramine-tranylcypromine incompatibility. Near-fatal toxic reaction. JAMA 1963 Dec 28; 186(13):1172-3.
2.Young JP, Lader MH, Hughes WC. Controlled trial of trimipramine, monoamine oxidase inhibitors, and combined treatment in depressed outpatients. Br Med J 1979 Nov 24;2(6201):1315-7.
3.Pentel P, Olson KR, Becker CE, Benowitz N. Late complications of tricyclic antidepressant overdose. West J Med 1983 Mar;138(3):423-4.
4.de la Fuente JR, Berlanga C, Leon-Andrade C. Mania induced by tricyclic-MAOI combination therapy in bipolar treatment-resistant disorder: case reports. J Clin Psychiatry 1986 Jan;47(1):40-1.
5.Pascual J, Combarros O, Berciano J. Partial status epilepticus following single low dose of chlorimipramine in a patient on MAO-inhibitor treatment Clin Neuropharmacol 1987 Dec;10(6):565-7.
6.Richards GA, Fritz VU, Pincus P, Reyneke J. Unusual drug interactions between monoamine oxidase inhibitors and tricyclic antidepressants. J Neurol Neurosurg Psychiatry 1987 Sep;50(9):1240-1.
7.Tackley RM, Tregaskis B. Fatal disseminated intravascular coagulation following a monoamine oxidase inhibitor/tricyclic interaction. Anaesthesia 1987 Jul;42(7):760-3.
8.O'Brien S, McKeon P, O'Regan M, O'Flaherty A, Patel R. Blood pressure effects of tranylcypromine when prescribed singly and in combination with amitriptyline. J Clin Psychopharmacol 1992 Apr;12(2):104-9.
9.Schuckit M, Robins E, Feighner J. Tricyclic antidepressants and monoamine oxidase inhibitors. Arch Gen Psychiatry 1971 Jun;24(6):509-14.
10.Graham PM, Potter JM, Paterson J. Combination monoamine oxidase inhibitor/tricyclic antidepressants interaction. Lancet 1982 Aug 21; 2(8295):440.
11.White K, Simpson G. The combined use of MAOIs and tricyclics. J Clin Psychiatry 1984 Jul;45(7 Pt 2):67-9.
12.Ponto LB, Perry PJ, Liskow BI, Seaba HH. Drug therapy reviews: tricyclic antidepressant and monoamine oxidase inhibitor combination therapy. Am J Hosp Pharm 1977 Sep;34(9):954-61.
13.Manshadi MS, Lippmann SB. Combined treatment of refractory depression with an MAO inhibitor and a tricyclic. Psychosomatics 1984 Dec; 25(12):929-31.
14.Spigset O, Mjorndal T, Lovheim O. Serotonin syndrome caused by a moclobemide-clomipramine interaction. BMJ 1993 Jan 23;306(6872):248.
15.Neuvonen PJ, Pohjola-Sintonen S, Tacke U, Vuori E. Five fatal cases of serotonin syndrome after moclobemide-citalopram or moclobemide-clomipramine overdoses. Lancet 1993 Dec 4;342(8884):1419.
16.Sjoqvist F. Psychotropic drugs (2). Interaction between monoamine oxidase (MAO) inhibitors and other substances. Proc R Soc Med 1965 Nov;58(11 Part 2):967-78.
17.Stern SL, Mendels J. Drug combinations in the treatment of refractory depression: a review. J Clin Psychiatry 1981 Oct;42(10):368-73.
18.White K, Simpson G. Combined MAOI-tricyclic antidepressant treatment: a reevaluation. J Clin Psychopharmacol 1981 Sep;1(5):264-82.
19.Nardil (phenelzine sulfate) US prescribing information. Parke-Davis January, 2005.
20.Elavil (amitriptyline hydrochloride) US prescribing information. AstraZeneca February, 2003.
21.Remeron (mirtazapine) US prescribing information. Organon Inc. January, 2005.
22.Pamelor (nortriptyline hydrochloride) US prescribing information. Mallinckrodt February 4, 2005.
23.Anafranil (clompiramine hydrochloride) US prescribing information. Mallinckrodt February 3, 2005.
24.Parnate (tranylcypromine sulfate) US prescribing information. GlaxoSmtihKline January, 2005.
Bupropion/MAOI'sThis information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
MONOGRAPH TITLE: Bupropion/MAOI's
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Unknown.
CLINICAL EFFECTS: The concurrent administration of bupropion and MAOI's may result in an increase in the acute toxicity of bupropion.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The manufacturer of bupropion states that concurrent administration of bupropion and a MAO inhibitor is contraindicated. The manufacturer recommends that 14 days should elapse between the discontinuation of a MAO inhibitor and the initiation of bupropion.(1)
DISCUSSION: There is no clinical documentation to support this interaction. The manufacturer of bupropion states that concurrent administration of bupropion and a MAO inhibitor is contraindicated. The manufacturer also states that 14 days should elapse between the discontinuation of a MAO inhibitor and the initiation of bupropion.(1)
REFERENCES:
1.Wellbutrin (bupropion hydrochloride) US prescribing information. GlaxoSmithKline January, 2005.
Bupropion/AntidepressantsThis information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
MONOGRAPH TITLE: Bupropion/Antidepressants
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Both bupropion and antidepressants are known to lower the seizure threshold.(1)
CLINICAL EFFECTS: Concurrent use of bupropion and an antidepressant may result in additive effects on the seizure threshold, increasing the risk of seizures.(1)
PREDISPOSING FACTORS: The risk of seizures may be increased in patients with a history of head trauma or prior seizure; CNS tumor; severe hepatic cirrhosis; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; use of over-the-counter stimulants an anorectics; a total daily dose of bupropion greater than 450 mg or single doses greater than 150 mg; rapid escalation of bupropion dosage; diabetics treated with oral hypoglycemics or insulin; or with concomitant medications known to lower seizure threshold (antipsychotics, theophylline, systemic steroids). (1)
PATIENT MANAGEMENT: The concurrent use of bupropion and antidepressants should be undertaken only with extreme caution and with low initial bupropion dosing and small gradual dosage increases.(1)
DISCUSSION: Because of the risk of seizure from concurrent bupropion and other agents that lower seizure threshold, the manufacturer of bupropion states that the concurrent use of bupropion and antidepressants should be undertaken only with extreme caution and with low initial bupropion dosing and small gradual dosage increases.(1)
REFERENCE:
1.Wellbutrin (bupropion hydrochloride) US prescribing information. GlaxoSmithKline January, 200"
JH
Posted by SLS on March 31, 2006, at 15:02:23
In reply to Re: Maybe Parnate again?, posted by JaclinHyde on March 31, 2006, at 14:39:02
Every drug manufacturer wants to distance themselves from MAOIs. It is easier to just say "don't do it" rather than research thoroughly adverse interactions.
Better safe than sorry, I guess.
For me, I have seen doctors who have been comfortable working with combinations using a MAOI with tricyclics, amphetamine, DA agonists, and Wellbutrin, to name a few. TRD people often need "exotic" combinations to find something that works.
Where would I find the Medscape drug checker?
Thanks.
- Scott
Posted by ed_uk on March 31, 2006, at 15:54:48
In reply to Re: Maybe Parnate again? » JaclinHyde, posted by SLS on March 31, 2006, at 15:02:23
The official drug monographs are frequently very poor.
Ed
Posted by TylerJ on March 31, 2006, at 16:49:20
In reply to Maybe Parnate again?, posted by Whit_in_Texas on March 31, 2006, at 6:40:48
> I took Parnate a couple of years ago, and it worked beautifully until it pooped out on my three months later. I wonder if my new pdoc would be more willing to augment than my other one was. I am now going through adderall withdrawal hell because I am tired of the rollercoaster--it is the only other thing that has worked for my depression. How long would I have to be free of adderall before trying parnate? I know most things they say 2 weeks, but adderall is completely out of your system in three days.
>
> Is there anything else, besides wellbutrin, I would need to stop taking from this cocktail?:
>
> Remeron 30 mg
> Klonopin 4 mg
> Clomiprimine 250mg (I am out of this so I haven't had it in days anyway)
> Wellbutrin 450mg (obviously, I need to stop this)
> Lamictal 125 mg and moving up
>
> Also, how long after stopping adderall will it take before I even BEGIN to feel ok? I stopped cold turkey because tapering just seems to prolong the pain.
>
> Thanks!
Just my personal opinion, I would discontinue everything except for the Klonopin, under your docs supervision of course. I know tech. you don't HAVE TO, but I think when starting an MAOI you want to see what the maoi does first, without all the other meds, heck maybe you won't need all those other drugs anymore. Or, just maybe Parnate won't work as well for you combined with the other meds. As always, your Pdoc will tell you what he thinks is best for you. Good Luck.Tyler
Posted by Phillipa on March 31, 2006, at 21:13:33
In reply to Re: Maybe Parnate again? » Whit_in_Texas, posted by TylerJ on March 31, 2006, at 16:49:20
Good luck I wish you well. Love Phillipa
Posted by JaclinHyde on April 1, 2006, at 0:57:20
In reply to Re: Maybe Parnate again? » JaclinHyde, posted by SLS on March 31, 2006, at 15:02:23
Here is the link to the medscape interactions board. You may have to register to use it but its free and you get to read alot of cool stuff :-)
JH
Posted by SLS on April 1, 2006, at 6:38:38
In reply to Re: Maybe Parnate again? Medscape link, posted by JaclinHyde on April 1, 2006, at 0:57:20
This is the end of the thread.
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