![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Maxime on March 17, 2006, at 16:48:19
Hi
I saw my pdoc today and told him I stopped the Prozac. He wants me to start the Parnate NEXT WEEK. Prozac stays in your system for 5 weeks. When I mentioned this to him he said that the rules are often too strigent and that I should try just 10 mg next week. Even with other SSRIs you are suppose to wait 2 weeks.
What should I do?
Maxime
Posted by Racer on March 17, 2006, at 17:16:46
In reply to Scared to start the Parnate, posted by Maxime on March 17, 2006, at 16:48:19
It's funny, I just read something about exactly this subject -- that practitioners with more experience are more likely to make this sort of choice. It seems that, in many cases, the Official Guidelines are only that: guidelines. They're not engraved in stone, and there are situations in which it's perfectly acceptable to ignore them.
In fact, what I read was a comparison of how interns, residents, and experienced psychiatrists answered the question, "Can you ever combine MAOIs and SSRIs?" The interns said never, the residents said they'd heard of it being done, the experienced doctors said that they would or had done it.
In your case, you are what we call "OSC" One Smart Cookie. You know what the danger is -- serotonin syndrome. You know what the symptoms are, or where to look them up.
I think you're safe going ahead with it. You've had a good response to Parnate before, and you've been suffering a lot. I'd say it was probably a good idea to start sooner rather than later, especially because I know you were very concerned about being able to get through the washout period.
Good luck with it, Maxie.
Posted by naughtypuppy on March 17, 2006, at 18:07:04
In reply to Re: Scared to start the Parnate, posted by Racer on March 17, 2006, at 17:16:46
I don't know about one week, but I went from Prozac to Parnate after two and didn't have any problem whatsoever. I think the 5 weeks is a very conservative estimate where no trace of Prozac's active metabolite norfluoxetine, is left in your system
Posted by linkadge on March 17, 2006, at 18:41:12
In reply to Re: Scared to start the Parnate, posted by naughtypuppy on March 17, 2006, at 18:07:04
I would think it is ok if you were to just do 10mg and then go up slowly from that. If the 10mg is going to cause a problem it will probably do so on the first dose.
If you are scared to take that first dose, I am sure you could split it up into halfs or quarters. Adjust the meds slowly and I think you'd be ok.
Linkadge
Posted by Maxime on March 17, 2006, at 20:39:31
In reply to Re: Scared to start the Parnate, posted by linkadge on March 17, 2006, at 18:41:12
Thanks everyone. :-)
Actually Racer, my doctor said "well those are only guidelines. I've had some patients take both at the same time ... well only a small amount of Prozac, but still).
The man is in his 80's so I trust him.EXCEPT I really want to be off the Trileptal when I start and I don't think I can come off of it in one week. You see doctors told me that they thoughts that is why the Parnate stopped working ... because the trileptal was added on.
Thanks again everyone.
Maxime
Posted by Racer on March 17, 2006, at 20:48:24
In reply to Re: Thanks, posted by Maxime on March 17, 2006, at 20:39:31
I wonder...
So, Maxime, I get your thoughts on Trileptal, but don't you think you could cross taper it with the Parnate? It's going to take a little while for the Parnate to kick in, and by the time it does, you'd be off the Trileptal, wouldn't you? That way, you wouldn't have to worry about not being off Trileptal before starting the Parnate, and you wouldn't have a delay in starting the Parnate, which is supposed to help you feel better...
Just a thought, and my subject line should tell you how much I know about it...
Posted by Phillipa on March 17, 2006, at 20:49:15
In reply to Re: Thanks, posted by Maxime on March 17, 2006, at 20:39:31
Maxie how high a dose of trileptal are you on? Before I knew of side effects from stopping a med I used to just stop them and nothing happened to me I just felt better. I took l50 of trileptal and saw how high the cost was I just stopped it and this was in November. I have no history of seizure disorder . And had absolutely no side effects. Fondly, Jan
Posted by Maxime on March 17, 2006, at 21:22:53
In reply to Re: Thanks » Maxime, posted by Phillipa on March 17, 2006, at 20:49:15
I'm only on 450 mg. But in the hospital they brought me down to 300 mg for a couple of days and then stopped it. I went PSYCHOTIC. So they put me back on it. But I just think it was because they dropped the dosage so quickly. Either that or I really do need a mood stabiliser.
Maxie
> Maxie how high a dose of trileptal are you on? Before I knew of side effects from stopping a med I used to just stop them and nothing happened to me I just felt better. I took l50 of trileptal and saw how high the cost was I just stopped it and this was in November. I have no history of seizure disorder . And had absolutely no side effects. Fondly, Jan
Posted by Phillipa on March 17, 2006, at 21:37:46
In reply to Re: Thanks » Phillipa, posted by Maxime on March 17, 2006, at 21:22:53
Maxie seriously are you just afraid? Try dropping the dose by 150mg and see what happens. Love Jan
Posted by jedi on March 18, 2006, at 1:45:10
In reply to Scared to start the Parnate, posted by Maxime on March 17, 2006, at 16:48:19
> Hi
>
> I saw my pdoc today and told him I stopped the Prozac. He wants me to start the Parnate NEXT WEEK. Prozac stays in your system for 5 weeks. When I mentioned this to him he said that the rules are often too strigent and that I should try just 10 mg next week. Even with other SSRIs you are suppose to wait 2 weeks.
>
> What should I do?
>
> Maxime
Hi Maxime,
I would probably listen to my pdoc. 10mg is not a high dose, and I'm sure he has considered any potential risk. However the fluoxetine/tranylcypromine interaction is of course dangerous and potentially fatal.
Take care,
JediJ Clin Psychopharmacol. 1993 Oct;13(5):312-20.
Possible monoamine oxidase inhibitor-serotonin uptake inhibitor interaction: fluoxetine clinical data and preclinical findings.
Beasley CM Jr, Masica DN, Heiligenstein JH, Wheadon DE, Zerbe RL.
Psychopharmacology Division, Lilly Corporate Center, Indianapolis, Indiana 46285.
The primary objective of this article is to review information pertinent to and emphasize the seriousness of a potential adverse monoamine oxidase inhibitor (MAOI)-serotonin uptake inhibitor interaction by considering, within the context of preclinical data, clinical cases in which an MAOI and fluoxetine hydrochloride, a specific serotonin uptake inhibitor, were administered in close temporal proximity. Clinical cases were identified by a review of spontaneous adverse event reports submitted voluntarily to Eli Lilly and Company through its drug surveillance program and by a review of reports of MAOI interactions published in the scientific literature. A discussion of eight selected clinical cases of acute adverse reactions (seven with fatal outcomes; one with a favorable response after cyproheptadine therapy) reported to Eli Lilly and Company in which an MAOI was initiated concurrently or shortly after the discontinuation of fluoxetine and a review of preclinical data suggest a possible role of serotonin and/or serotonin-dopamine interactions in the hypermetabolic state that may occur when a serotonin uptake inhibitor and an MAOI are coadministered, although alternative etiologic processes are possible as well. Data reviewed reinforce the idea that the administration of an MAOI in close temporal proximity to fluoxetine is contraindicated.
PMID: 8227489 [PubMed - indexed for MEDLINE]
Posted by gibber on March 19, 2006, at 1:43:17
In reply to Re: Scared to start the Parnate » Maxime, posted by jedi on March 18, 2006, at 1:45:10
My doctor had me wait 5 weeks until starting Nardil after being on Prozac. He's a respected doctor in Boston.
Posted by SLS on March 19, 2006, at 7:09:07
In reply to Scared to start the Parnate, posted by Maxime on March 17, 2006, at 16:48:19
> In fact, what I read was a comparison of how interns, residents, and experienced psychiatrists answered the question, "Can you ever combine MAOIs and SSRIs?" The interns said never, the residents said they'd heard of it being done, the experienced doctors said that they would or had done it.
Despite what the experienced doctors in this survey had to say, I believe that combining Parnate + SSRI is absolutely contraindicated. If one of these doctors actually combined these drugs successfully, I doubt the dosage of the MAOI was high enough to block the percentage of enzyme necessary to obtain an antidepressant response. It would be like taking no MAOI at all.
With Prozac, I would wait two weeks before initiating a MAOI. You probably won't attain sufficient MAO inhibition to produce a reaction until you have been at 40mg for 5 days or so. Starting Parnate at 10mg and titrating gradually will probably allow enough time to pass for the Prozac to clear your system before a reaction is allowed to occur.
All of this concern is, of course, about the induction of serotonin syndrome. These are some of the things to look out for:
Mental status changes
Confusion (51%)
Agitation (34%)
Hypomania (21%)
Anxiety (15%)
Coma (29%)Cardiovascular
Sinus tachycardia (36%)
Hypertension (35%)
Hypotension (15%)Gastrointestinal
Nausea (23%)
Diarrhea (8%)
Abdominal pain (4%)
Salivation (2%)Motor Abnormalities
Myoclonus (58%)
Hyperreflexia (52%)
Muscle rigidity (51%)
Restlessness (48%)
Tremor (43%)
Ataxia/incoordination (40%)
Shivering (26%)
Nystagmus (15%)
Seizures (12%)Other
Diaphoresis (45%)
Unreactive pupils (20%)
Tachypnea (26%)
Hyperpyrexia- Scott
Posted by Maxime on March 19, 2006, at 19:08:50
In reply to Re: Scared to start the Parnate, posted by gibber on March 19, 2006, at 1:43:17
I think I will wait 2 weeks. I still need to come off the trileptal and I don't think I can do that in one week.
Meanwhile I am feeling so awful... suicidal and depressed.
Maxime
Posted by Phillipa on March 19, 2006, at 23:54:13
In reply to Re: Scared to start the Parnate, posted by Maxime on March 19, 2006, at 19:08:50
Maxie you can do it I know you can. I mean wait to start the parnate. Love Jan
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.