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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by fachad on June 14, 2005, at 0:53:14
Are there any specific medications that are NOT to be used with Remeron or is it safe to combine Remeron with anything/everything?
Posted by SLS on June 14, 2005, at 7:26:38
In reply to Any Meds that CANNOT be combined with Remeron?, posted by fachad on June 14, 2005, at 0:53:14
> Are there any specific medications that are NOT to be used with Remeron or is it safe to combine Remeron with anything/everything?
That's a great question. MAOIs are usually the first thing to check for. Someone here successfully added Remeron to Nardil. That's the only class of drugs that I can think of as possibly being problematic right off the top of my head - and I would probably try the combination myself if Remeron didn't actually make my depression worse. Otherwise I think you can add it to everything else.
Remeron is a substrate for CYP450 1A2, 3A, and 2D6, but not an inhibitor. When mixing it with drugs that are potent inhibitors of one of these three enzymes, you might want to titrate the Remeron more slowly.
Please wait for others to chime in on this one I'm sure there are a few things I have not taken into consideration.
- Scott
Posted by Tom Twilight on June 14, 2005, at 7:53:51
In reply to Re: Any Meds that CANNOT be combined with Remeron?, posted by SLS on June 14, 2005, at 7:26:38
As far as I know Remeron can safely be combined with MAOIs.
A doctor writes
"Mirtazapine can be used safely in combination with MAOIs, and the agent has been reported to acutely treat serotonin syndrome"from ttp://www.currentpsychiatry.com/article_pages.asp?AID=515&UID=10450
Posted by SLS on June 14, 2005, at 8:08:24
In reply to Remeron and MAOIs, posted by Tom Twilight on June 14, 2005, at 7:53:51
Posted by Shawn. T. on June 14, 2005, at 8:14:52
In reply to Remeron and MAOIs, posted by Tom Twilight on June 14, 2005, at 7:53:51
Fluvoxamine can increase Remeron concentrations 3 to 4 fold (Anttila et al., 2001), so care should be taken when combining these two drugs.
Shawn
Posted by linkadge on June 14, 2005, at 15:33:23
In reply to Re: Remeron and MAOIs, posted by Shawn. T. on June 14, 2005, at 8:14:52
Remeron, like yohimbine, can lead to hypertention when combined with TCA's, Effexor, or other NE reputake inhibiting drugs.
Linkadge
Posted by SLS on June 14, 2005, at 16:45:38
In reply to Re: Remeron and MAOIs, posted by linkadge on June 14, 2005, at 15:33:23
> Remeron, like yohimbine, can lead to hypertention when combined with TCA's, Effexor, or other NE reputake inhibiting drugs.
I've never heard of such a reaction actually occurring.
Stephen Stahl, MD feels quite strongly that combining Effexor with Remeron is safe and extremely effective. Of course, that's just one doctor. I really like him, though.
Before Effexor was approved, Andrew Nierenberg, MD at Harvard recommended to me that I combine yohimbine with a TCA. I really like him too.
- Scott
Posted by Phillipa on June 14, 2005, at 18:59:25
In reply to Re: Remeron and MAOIs, posted by SLS on June 14, 2005, at 16:45:38
Luvox increases the effects of xanax too. Fondly, Phillipa
Posted by Phillipa on June 14, 2005, at 19:04:02
In reply to Re: Remeron and MAOIs, posted by Shawn. T. on June 14, 2005, at 8:14:52
You know in thinking about it, luvox increases a lot of meds. Maybe that's why it's not popular anymore. Fondly, Phillipa
Posted by linkadge on June 14, 2005, at 19:43:55
In reply to Re: Remeron and MAOIs, posted by SLS on June 14, 2005, at 16:45:38
"I've never heard of such a reaction actually occurring"
I know that SLS is very anti-linkadge right now, but yes it can occur. My psychiatrist would not consider giving me effexor in combination with remeron because he had too many cases of high blood pressure on the combination. The combination is not dubbed "California Rocket Fuel" for nothing.
Again, I am not saying it "WILL" occur, I am just saying it is indeed a possabaility.
Linkadge
Posted by linkadge on June 14, 2005, at 20:18:27
In reply to Re: Remeron and MAOIs, posted by linkadge on June 14, 2005, at 19:43:55
These people didn't have a happy remeron + effexor experience.
http://www.dr-bob.org/babble/20020617/msgs/110938.html
http://www.dr-bob.org/babble/20020617/msgs/110942.html
http://www.dr-bob.org/babble/20020628/msgs/111149.html
Linkadge
Posted by SLS on June 14, 2005, at 20:58:51
In reply to Re: Remeron and MAOIs, posted by linkadge on June 14, 2005, at 20:18:27
> These people didn't have a happy remeron + effexor experience.
>
> http://www.dr-bob.org/babble/20020617/msgs/110938.html
>
> http://www.dr-bob.org/babble/20020617/msgs/110942.html
>
> http://www.dr-bob.org/babble/20020628/msgs/111149.html
>
>
> Linkadge
None of your citations mention hypertension. That is what we are talking about here, right?
- Scott
Posted by Tom Twilight on June 15, 2005, at 4:56:36
In reply to Re: Remeron and MAOIs, posted by linkadge on June 14, 2005, at 19:43:55
> I know that SLS is very anti-linkadge right now
Linkadge, I am sorry if your having a bad day (I know I am), but you have no right to accuse SLS of being 'out to get you' just because he dissagrees with you!
I also don't understand why your so dead against combining Remeron with other drugs.
You correctly point out that some people have bad experiences combining Effexor with Remeron; however with every drugs, or combination of drugs some people will react badly, and others will react well.
Personaly I had a very positve experience combining Effexor with Remeron, it lifted me out of a deep depression, and I hardly had any side effects.
I really think the combination of Effexor and Remeron is fairly safe, even in the UK were doctors are very wary of combining drugs this combination is used.
There probably is some risk with this combination, but as long a people are careful I don't think there will be much of one.
Posted by linkadge on June 15, 2005, at 6:31:59
In reply to Re: Remeron and MAOIs, posted by SLS on June 14, 2005, at 20:58:51
Would you like the name and number of my psychiatrist? He refused my request of the combination based on his experience with a number of patients who had clinically significant hypertention.
------------------------------------------------
http://home.caregroup.org/clinical/altmed/interactions/Herbs/Pausinystalia_y.htm
mechanism: TCA's can interfere with uptake of norepinephrine, and yohimbine has been shown to interact with tricyclic antidepressants in human subjects. These studies were performed to examine whether yohimbine could ameliorate TCA adverse effects such as dry mouth; however the general finding is that a mutual increase in occurrence and intensity of adverse effects takes place when TCA's are combined with Yohimbine.------------------------------------------------
While hypertention is not specifically mentioned, it is well known that alpha-2 antaonists will enhance the noradrenic effects of the medication.Since clinically meaningful hypertention can occur on effexor alone, I fully believe my psychiatrist when he says he has observed hypertention on the combination.
Linkadge
Posted by linkadge on June 15, 2005, at 6:42:50
In reply to Remeron is (relativly) Safe with Effexor!, posted by Tom Twilight on June 15, 2005, at 4:56:36
I am certainly not dead against the combination of remeron with other drugs, it worked quite nicely with celexa for me for a while.
I just think caution should be given about the combination. It was asked if interaction exists. Simply put, this is a potential mechanism of interaction.For some it will be a posative interaction, creating an overall net increase in norepinephrine, but for others, this dramatic noredrenic increase might be cause for for concern.
It is best to note all potential interactions. If the patient had hypertention, then this would be a possability he might be interested in.
I just thought it was worth mentioning since I have heard of a number of people who have had very bad experiences on the combination.
Thats not to say your experience is not also important.
Linkadge
Posted by SLS on June 15, 2005, at 7:15:13
In reply to Re: Remeron is (relativly) Safe with Effexor!, posted by linkadge on June 15, 2005, at 6:42:50
Although I am still dubious that there should be a danger of an acute hypertensive reaction when combining TCA + remeron at therapeutic dosages, it should be noted that the potency of a TCA to inhibit the reuptake of norepinephrine (NE) has been measured in the past using a yohimbine lethality test - LD50. For most TCAs, yohimbine potentiates lethality so that it takes a smaller dose to kill 50% of the rats tested.
- Scott
Posted by iforgotmypassword on June 15, 2005, at 9:00:35
In reply to Re: Remeron is (relativly) Safe with Effexor!, posted by SLS on June 15, 2005, at 7:15:13
death still seems to be one of our most effective treatments for depression. har har.
Posted by gromit on June 15, 2005, at 13:54:34
In reply to Re: Remeron and MAOIs, posted by linkadge on June 15, 2005, at 6:31:59
> Would you like the name and number of my psychiatrist? He refused my request of the combination based on his experience with a number of patients who had clinically significant hypertention.
I thought your pdoc was so conservative he was bordering on useless. I've never taken Remeron but I once combined yohimbe with desipramine. I didn't actually get my pressure checked but it felt like my heart was going to explode out of my chest for an hour or so.
Peace,
Rick
Posted by linkadge on June 15, 2005, at 20:25:14
In reply to Re: Remeron and MAOIs, posted by gromit on June 15, 2005, at 13:54:34
"I thought your pdoc was so conservative he was bordering on useless. I've never taken Remeron but I once combined yohimbe with desipramine. I didn't actually get my pressure checked but it felt like my heart was going to explode out of my chest for an hour or so."
Yes, he is very conservative. I am not sure if he initiated the combination or if he was just the one to take people off of it, but he did say that a number of his patients developed significant hypertention on the combination.
But, what is poison to one is a cure for another. Just go slow if contemplating the combination thats all.
Linkadge
This is the end of the thread.
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