Posted by Sad Panda on April 16, 2004, at 12:35:24
In reply to Re: Any Benefit to SSRI+TCA?, posted by King Vultan on April 15, 2004, at 21:44:16
> > I was wondering if it is okay and/or beneficial to be on both and SSRI (paxil cr) and a TCA Amitriptyline for anxiety.
> > I've started on paxil cr, and a neurologist just prescribed me amitriptyline for migraines. Will this combo work?
> > I'm taking this means to quit klonopin?
>
>
> Unfortunately, Paxil and amitriptyline is a potentially dangerous combo because Paxil is a powerful CYP-450 2D6 inhibitor, and amitriptyline is a 2D6 substrate. What this means is that Paxil will tend to tie up such large amounts of the 2D6 enzyme that very little will be left over to metabolize the amitriptyline, which may result in the blood plasma level of the amitriptyline rising to dangerous levels. The danger comes about because amitriptyline, like all tricyclic antidepressants, is cardiotoxic and lethal in overdose.
>
> However, all is not lost. Because amitriptyline has been around for decades, it has known therapeutic blood plasma levels. If you are cautious, you can embark on this combination by starting out at a very low level of the amitriptyline and checking the blood plasma level to assure that you are not outside of the safe range. I had my blood plasma level checked when I was on a combination of Wellbutrin, another fairly strong 2D6 inhibitor, and the tricyclic desipramine. My opinion is that if someone is looking to take a therapeutic amount of any tricyclic antidepressant, the blood plasma level of the tricyclic should really be tested, regardless of whether or not it's being taken in combination with something else.
>
> FWIW, nortriptyline, which is a natural metabolite of amitriptyline, was the first tricyclic I tried, and I did find it very effective at reducing my chronic headaches, though, I do not actually suffer from migraines. I believe that amitriptyline has a similar efficacy.
>
> Todd
>I would say use Amitriptyline alone at AD strength, or, if SSRI's are good for you try Zoloft with Nortriptyline as it would have a lot less interactions.
Cheers,
Panda.
poster:Sad Panda
thread:336654
URL: http://www.dr-bob.org/babble/20040412/msgs/336911.html