Posted by King Vultan on November 16, 2004, at 9:08:47
In reply to prozac + nortripyline pharmacology questions, posted by yeltom on November 16, 2004, at 2:15:46
Prozac is one of the more notorious inhibitors of the 2D6 enzyme among the SSRIs, along with Paxil. As Panda indicates, the concentration of another 2D6 substrate, such as nortriptyline, can be increased many fold, and this is true even in a person with normal levels of the 2D6 enzyme (these people are referred to as extensive metabolizers, as compared to poor metabolizers, who are deficient in the enzyme). I would recommend getting your blood plasma level of the nortriptyline checked to see if it is in the therapeutic range. I suffered from constipation and dry mouth myself on as little as 50 mg of nortriptyline taken my itself, and I am an extensive metabolizer of the 2D6 enzyme.
The type of interaction you are seeing is the reason for the cautionary statements in such references as the PDR (Physician's Desk Reference) about mixing SSRIs and tricylics. People have unwittingly gone into overdose or near overdose states on a tricyclic when combining one with an SSRI and not taking this enzyme interaction into account. My opinion is that people should always have their blood plasma level of the tricyclic monitored when they are on one, regardless of whether they take one by itself or with something else.
Todd
poster:King Vultan
thread:416518
URL: http://www.dr-bob.org/babble/20041113/msgs/416631.html