Posted by jedi on November 22, 2008, at 12:01:02
In reply to Re: tranylcypromine + mirtazapine?, posted by CaptainAmerica1967 on November 22, 2008, at 10:49:38
> > I'd be rather worried about blood pressure on this combination, the alpha2 receptor is the feedback mechanism. I have looked and have not seen any documented combinations of MOAI & alpha2 antagonist being used, because i personally benefitted from yohimbe and wanted to try it with an MAOI, but decided it was too risky. Secondary TCAs don't have as bad as side effects as ones like amitriptilyine, if you have taken that before.
> >
> > -d/r
>
>
> You'd be worried about serotonin syndrome? Mirtazpaine is an adrenergic alpha-antagonist so it would theoretically block or lower BP like phentolamine which is used for hypertensive crisis for MAOI's.
>
>
>
There are documented, though rare, cases of serotonin syndrome in patients using mirtazapine as monotherapy. These patients probably had reduced, serotonin metabolism. Yes, I would be very careful mixing mirtazapine with a MAOI. JediAnn Pharmacother. 2002 Apr;36(4):641-3.
Severe serotonin syndrome induced by mirtazapine monotherapy.
Hernández JL, Ramos FJ, Infante J, Rebollo M, González-Macías J.
Department of Internal Medicine, Hospital Marqués de Valdecilla, Santander, Spain. joselhh@teleline.es
OBJECTIVE: To document a case of serotonin syndrome (SS) associated with mirtazapine monotherapy, review the previously reported cases of SS associated with this tetracyclic antidepressant, and discuss the possible pathogenic mechanisms leading to this serious adverse drug reaction. CASE SUMMARY: A 75-year-old man developed agitation, confusion, incoordination, and gait disturbance because of progressive rigidity. Mirtazapine had been started 8 days earlier to control major depression. Physical examination revealed diaphoresis, low-grade fever, hypertension, tachycardia, bilateral cogwheel rigidity, hyperreflexia, tremor, and myoclonus, symptoms and signs that are consistent with severe SS. DISCUSSION: A review of the cases of SS with implication of mirtazapine as the cause was performed. The possible pathogenic mechanisms leading to this adverse reaction in this patient are also discussed, and pathophysiologic hypotheses are formulated. CONCLUSIONS: Although mirtazapine offers clinicians a combination of strong efficacy and good safety, we suggest bearing SS in mind when prescribing this drug, especially in frail, elderly patients with underlying chronic conditions. In these patients, it might be more adequate to start mirtazapine therapy at a lower dose (<15 mg/d).
Publication Types:
* Case Reports
PMID: 11918514 [PubMed - indexed for MEDLINE]Clin Neuropharmacol. 2003 Mar-Apr;26(2):54-7.Click here to read Links
Comment in:
Clin Neuropharmacol. 2003 Nov-Dec;26(6):287-8; author reply 289-90.
Clin Neuropharmacol. 2003 Nov-Dec;26(6):288-9; author reply 289-90.
Mirtazapine-induced serotonin syndrome.
Ubogu EE, Katirji B.Division of Neuromuscular Diseases, Department of Neurology, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Hanna House 5th Floor, 11000 Euclid Avenue, Cleveland, OH 44106-5040, USA. eeubogu@excite.com
An 85-year-old woman developed sudden confusion and dysarthria progressing to mutism, orobuccal dyskinesias, generalized tremors worse with activity, ataxia, and rigidity with cog wheeling without high-grade fevers or dysautonomia. These findings were related temporally to the institution of mirtazapine as monotherapy for a major depressive illness with superimposed anxiety disorder. Withdrawal of the agent resulted in early notable clinical resolution with only residual hypertonia after 2 weeks. This is a rare report of serotonin syndrome induced by mirtazapine monotherapy. The hypothesized pathophysiologic mechanism in this case is overstimulation of serotonin (5-hydroxytryptamine or 5-HT) type 1A receptors (5-HT(1A)) in the brainstem and spinal cord in an individual with risk factors for hyperserotoninemia resulting from reduced, acquired endogenous serotonin metabolism.
PMID: 12671522 [PubMed - indexed for MEDLINE
poster:jedi
thread:864556
URL: http://www.dr-bob.org/babble/20081114/msgs/864631.html