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Dr. Bob is Robert Hsiung, MD,
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Posted by inanimate peanut on December 15, 2009, at 10:12:08
Everything I'm reading says you can't combine Nortriptyline (or any TCA) and Parnate (or any MAOI). Who here is doing it and are there any problems with it?
Posted by Phillipa on December 15, 2009, at 10:39:13
In reply to Combining Nortriptyline and Parnate, posted by inanimate peanut on December 15, 2009, at 10:12:08
I've seen the same on the internet. But it seems a lot of docs allow the combo have you asked your doc? Is that your plan to combine the two meds? Phillipa
Posted by SLS on December 15, 2009, at 11:39:33
In reply to Combining Nortriptyline and Parnate, posted by inanimate peanut on December 15, 2009, at 10:12:08
> Everything I'm reading says you can't combine Nortriptyline (or any TCA) and Parnate (or any MAOI). Who here is doing it and are there any problems with it?
I came across a great review article last week describing the safe use of a combination of a MAOI and a TCA. I can't find it now.
I have mixed and matched either Parnate or Nardil with desipramine and nortriptyline. I have also come upon people who have used doxepin and amitriptyline with a MAOI. However, imipramine and clomipramine should not be used with MAOIs because they are too potent as serotonin reuptake inhibitors. Serotonin syndrome is the concern here.
Problems that arise during combination treatment include hypotension and urinary hesitancy. These are usually manageable, though, and can mitigate over time to some extent.
- Scott
Posted by SLS on December 15, 2009, at 11:45:16
In reply to Re: Combining Nortriptyline and Parnate » inanimate peanut, posted by SLS on December 15, 2009, at 11:39:33
REVIEW
Tricyclic antidepressant pharmacology
and therapeutic drug interactions updatedPK Gillman
PsychoTropical Research, Bucasia, Queensland, Australia
New data on the pharmacology of tricyclic antidepressants (TCAs), their affinities for human cloned CNS receptors and their
cytochrome P450 enzyme inhibition profiles, allow improved deductions concerning their effects and interactions and indicate
which of the TCAs are the most useful. The relative toxicity of TCAs continues to be more precisely defined, as do TCA
interactions with selective serotonin reuptake inhibitors (SSRIs). TCA interactions with monoamine oxidase inhibitors (MAOIs)
have been, historically, an uncertain and difficult question, but are now well understood, although this is not reflected in the
literature. The data indicate that nortriptyline and desipramine have the most pharmacologically desirable characteristics as
noradrenaline reuptake inhibitors (NRIs), and as drugs with few interactions that are also safe when coadministered with either
MAOIs or SSRIs. Clomipramine is the only available antidepressant drug that has good evidence of clinically relevant serotonin
and noradrenaline reuptake inhibition (SNRI). These data assist drug selection for monotherapy and combination therapy and
predict reliably how and why pharmacodynamic and pharmacokinetic interactions occur. In comparison, two newer drugs
proposed to have SNRI properties, duloxetine and venlafaxine, may have insufficient NRI potency to be effective SNRIs.
Combinations such as sertraline and nortriptyline may therefore offer advantages over drugs like venlafaxine that have fixed
ratios of SRI/NRI effects that are not ideal. However, no TCA/SSRI combination is sufficiently safe to be universally applicable
without expert knowledge. Standard texts (e.g. the British National Formulary) and treatment guidelines would benefit by
taking account of these new data and understandings.
British Journal of Pharmacology (2007) 151, 737748; doi:10.1038/sj.bjp.0707253; published online 30 April 2007
Posted by Maxime on December 16, 2009, at 16:13:44
In reply to Combining Nortriptyline and Parnate, posted by inanimate peanut on December 15, 2009, at 10:12:08
Hi
I am taking 80 mg of Parnate with 75 mg of Nortrip and it's working great!
Maxime
This is the end of the thread.
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