Posted by ed_uk2010 on December 22, 2013, at 0:34:07
In reply to so...tired...Abilify?, posted by Christ_empowered on December 21, 2013, at 20:56:45
>Here's the thing: Prozac does something to increase Abilify blood levels. Trileptal may do something to decrease them. I've been so tired, all the time, sleeping, having vivid dreams (usually nightmares), and I suspect my Abilify levels are way up, since my doc told me she adjusts dosage based on observable effects, not on drug-drug interactions.
As you say, there is a pharmacokinetic interacton. A reduction in Abilify to 15-20mg may be possible now you're on fluoxetine 40mg, but this is something of an unknown quantity because the precise increase in your Abilify blood level is not known, and fluoxetine also *decreases* the level of Abilify's active metabolite. I would suggest reducing to 20mg Abilify, if you wish to go down this route, but please discuss this with your pdoc. And avoid skipping more than a few doses! The excess sedation will not disappear suddenly (or at least it's unlikely, so you'll need to wait). Annoying, I know.
Alternatively, you could switch to an non-interacting SSRI (ie. not fluoxetine or paroxetine). Sertraline (Zoloft) would be a very sensible option, and would avoid the need to mess with your Abilify, which appears to be one of the most important contributors to you staying well.
Guidelines for switching from fluoxetine to sertraline are as follows:
1. Reduce fluoxetine down to 20mg for 2 weeks.
2. Stop fluoxetine.3. Wait 4-7 days (fluoxetine is very long-acting). Due to your current situation, I suggest waiting 7 days.
4. Start sertraline at 25mg per day (fluoxetine's active metabolite is still in your system at this point).
5. Increase sertraline to 50mg after 1-2 weeks according to tolerability.
6. Titrate sertraline according to tolerability and response. Avoid more than 100mg per day until you've been on it for several weeks. Rapid titration to higher doses can easily lead to you taking more than you actually need, because the low dose has not been given chance to work.
Hope this is helpful.
poster:ed_uk2010
thread:1056726
URL: http://www.dr-bob.org/babble/20131209/msgs/1056743.html