Posted by Crotale on June 20, 2008, at 19:27:33
In reply to Re: To Scott - Nortriptyline Not Good For Atypical, posted by SLS on June 20, 2008, at 14:00:35
> > Err, what's Ixel?
>
> Minalcipran. SNRI. I believe it is being investigated as a treatment for fibromyalgia and other pain disorders.What a weird brand name.
Point of clarification: what does "SNRI" mean on this board? (selective NE reuptake inhibitor (e.g. Strattera), or serotonin-NE reuptake inhibitor (e.g. Effexor)?)
> I have had a number of experiences with MAOI + TCA combinations. The two safest in my estimation are desipramine and nortriptyline. I can only guess that *perhaps* trimipramine would be safe, too, given its apparant lack of monoamine reuptake inhibition. Imipramine definitely produced serotonin syndrome when I added it to Nardil. I had no such trouble with desipramine.
Desipramine is the most selective for NE-reuptake. It's also the "cleanest" in terms of not antagonizing other receptors (alpha-adrenergic, muscarinic-ACh, type-1 histaminic, etc.).
I'm not sure about trimipramine, although according to my pharmacology textbook it has hardly any effect at the serotonin transporter, same as desipramine (but is "dirtier" in other respects). I've used amoxapine with Parnate, as well as desipramine and nortriptyline, and it didn't cause serotonin syndrome either. According to my textbook it also has little effect at most other receptors except alpha1-NE and D2, although that isn't consistent with my experience of its side effects.
Other TCAs that should be safe with MAOIs (or at any rate, shouldn't cause 5-HT syndrome) are maprotiline (although this one is supposed to be more likely to cause seizures than other TCAs) and protriptyline (but this one is supposedly more cardiotoxic than the rest). Their possible greater toxicity is the reason I don't recommend these two.
poster:Crotale
thread:829828
URL: http://www.dr-bob.org/babble/neuro/20080418/msgs/835718.html