Posted by yxibow on January 13, 2007, at 3:02:06
In reply to Re: can Remeron + Luvox be combined safely?, posted by blueberry1 on January 12, 2007, at 19:34:21
> Geez. Another lame apathetic pdoc story. Where are the good pdocs hiding?
>
> Ok, so remeron is the best antidepressant you've tried. And he wants to take you OFF it? I'm sorry, but that is mental insanity on display. What are the risks of ongoing OCD compared to the risks of depression? Depression is far more dangerous and life threatening in many ways.
I definately agree and was probably the reason I was switched from Luvox to Cymbalta, but drug interactions are unpredictable and few are challenged between medications except obvious ones such as warfarin, cimetidine, etc...
> Not being a doctor, I would humbly think a better approach would be leave the remeron in place and add something to it for OCD. A benzo, a ssri, something. It took long enough to find the improvement of depression with remeron, don't say goodbye to that! Does the pdoc somehow think luvox will replace what remeron is doing? Like I said, lame.
>
> Yes, the two drugs can be combined. I used to combine 20mg prozac+30mg remeron.
>
> If you are going to wean off remeron, you might find it easier to cut the 7.5mg chunks in half.I weaned off remeron after several years on it. The last 7.5mg was the hardest. I was cutting it down in tiny chunks. I still do not see any sense in saying goodbye to a drug that has helped your depression.One has to look at the P450 potential interactions. Remeron has never been tested other than in the lab as a substrate for 2D6, 1A2, and 3A4. Substrate, meaning that an inducer will increase the level of that medication. It has been noted in the PI that Remeron does have some effect on diazepam, which is at 3A4.
So what does this mean -- due diligence, because Luvox is an inhibitor at 1A2 and definately at 3A4 meaning that it will increase the time Remeron takes to leave your body, if, Remeron is metabolized there, which is unclear.
Drugs.com does give the warning of serotonin syndrome between the two, so a balance as noted by the above successful user of two (in her case 2D6, Prozac) may have to be carefully struck by the doctor. I developed mild serotonin syndrome when Robaxin, a completely nonpsychiatric medication for back/neck spasms was added and increased to a higher level. Mild flushing and other uncomfortable but not life threatening things developed and we backed off about 25% of the dose. But when you're dealing with two serotonergic agents, more caution has to be applied. Being in the hospital with cyproheptadine and IVs isn't really a good plan.-- Jay
poster:yxibow
thread:721753
URL: http://www.dr-bob.org/babble/20070107/msgs/721899.html