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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Dragon Black on August 29, 2007, at 9:35:24
So I emailed Servier, the french company that makes Stablon (tianeptine) yesterday, asking for clarification as to why it was contraindicated with MAOIs. I got a response today. If someone can tell me what it says that would be great. I'm deplorably monolingual, as I'm American (I lied in my email to Servier and said I was french; figured they wouldn't respond otherwise. Didn't realize that they would feel free to respond in French as a result : ) ).
Madame, Monsieur,
Comme le précise la monographie de STABLON , son association aux IMAO est contre-indiquée et il est nécessaire de laisser un intervalle libre de 2 semaines entre une cure d'IMAO et un traitement par STABLON.
Recevez, Madame, Monsieur mes salutations distinguées.
Dr XXXXXXXXXXX
Information Scientifique
Servier International
Posted by Squiggles on August 29, 2007, at 9:46:59
In reply to Anyone speak French? Please interpret Dr.'s email, posted by Dragon Black on August 29, 2007, at 9:35:24
> So I emailed Servier, the french company that makes Stablon (tianeptine) yesterday, asking for clarification as to why it was contraindicated with MAOIs. I got a response today. If someone can tell me what it says that would be great. I'm deplorably monolingual, as I'm American (I lied in my email to Servier and said I was french; figured they wouldn't respond otherwise. Didn't realize that they would feel free to respond in French as a result : ) ).
>
> Madame, Monsieur,---
Madam, Sir,
>
> Comme le précise la monographie de STABLON ,As indicated in the STABLON monograph,
son association aux IMAO est contre-indiquée
its interaction with IMAO is contra-indicated
et il est nécessaire de laisser un intervalle
and it is necessary to allow an interval
libre de 2 semaines entre une cure d'IMAO et un
of approximately 2 weeks between the course of IMAO treatment and STABLON treatment.
traitement par STABLON.
>
> Recevez, Madame, Monsieur mes salutations distinguées.Please accept my best regards, Madam, Sir.
[that's what i understand anyway]
>
> Dr XXXXXXXXXXX
> Information Scientifique
> Servier International
>
>
>Squiggles
Posted by sam123 on August 29, 2007, at 9:51:30
In reply to Anyone speak French? Please interpret Dr.'s email, posted by Dragon Black on August 29, 2007, at 9:35:24
> Madame, Monsieur,
>
> Comme le précise la monographie de STABLON , son association aux IMAO est contre-indiquée et il est nécessaire de laisser un intervalle libre de 2 semaines entre une cure d'IMAO et un traitement par STABLON.
>
> Recevez, Madame, Monsieur mes salutations distinguées.
>
>Madam, Sir,
Like the monograph of STABLON specifies it, its association with the IMAO is contra-indicated and it is necessary to leave 2 weeks a free interval between a cure of IMAO and a treatment by STABLON.
Receive, Madam, Mister my greetings best.
Posted by gardenergirl on August 29, 2007, at 10:40:55
In reply to Anyone speak French? Please interpret Dr.'s email, posted by Dragon Black on August 29, 2007, at 9:35:24
It doesn't sound like they answered your question, but rather just reiterated the contraindication. Bummer.
gg
Posted by Dragon Black on August 29, 2007, at 11:41:39
In reply to Re: Anyone speak French? Please interpret Dr.'s e » Dragon Black, posted by Squiggles on August 29, 2007, at 9:46:59
Thanks!
Posted by Dragon Black on August 29, 2007, at 11:44:50
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by gardenergirl on August 29, 2007, at 10:40:55
yeah, no help whatsoever. maybe I'll start a new thread and see if anyone here knows.
Posted by Squiggles on August 29, 2007, at 11:46:40
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by Dragon Black on August 29, 2007, at 11:44:50
> yeah, no help whatsoever. maybe I'll start a new thread and see if anyone here knows.
Try Rx.com
S
Posted by Phillipa on August 29, 2007, at 11:47:13
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by Dragon Black on August 29, 2007, at 11:44:50
Check the archieves too. Might be something there. Phillipa
Posted by Dragon Black on August 29, 2007, at 12:29:37
In reply to Re: Anyone speak French? Please interpret Dr.'s e » Dragon Black, posted by Squiggles on August 29, 2007, at 11:46:40
Since tianeptine isn't approved in U.S. it isn't on their list. Thanks for the suggestion, though.
Posted by Bonnie_CA on September 1, 2007, at 13:31:36
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by Dragon Black on August 29, 2007, at 12:29:37
That French answer was irritating to me. It's like, "thanks for pointing out the information I ALREADY KNOW!" lol
I'm sure you were looking for a better answer. Sorry they sent you a standardized email of obvious answers. :-\
-Bonnie
Posted by sam123 on September 2, 2007, at 12:19:02
In reply to Anyone speak French? Please interpret Dr.'s email, posted by Dragon Black on August 29, 2007, at 9:35:24
It is related to the TCA's, for which MAOI's are contraindicated:
Complications
In most reports, serotonin syndrome has been mild to moderate in severity without medical complications. However, a distinct minority of cases, particularly those associated with MAOI-tricyclic and MAOI-SRI combinations and MDMA, were severe and some fatal. Overall, medical complications appear to be less common than in NMS. Rhabdomyolysis was the most common serious medical complication of serotonin syndrome, occurring in 45 (26.8%) cases. Myoglobinuria and renal failure were reported in 8 (4.8%) patients. Generalized seizures were reported in 18 (10.7%) cases, including 7 fatalities. Similarly, DIC occurred in 8 patients, 5 of whom died. Thus, although medical complications were not common in patients with serotonin syndrome, they were associated with a substantial mortality risk.
ONSET AND PREDISPOSING FACTORS
Serotoninergic Medications
Nearly all medications that enhance CNS serotoninergic neurotransmission have been reported in association with cases of the serotonin syndrome (Table 3-1). Since the cases reviewed by Sternbach (1991), the most commonly implicated agents reported in subsequent case reports and case series have been combinations of MAOIs (reversible and irreversible) and tricyclics (N=18) and MAOIs and SRIs (N=34). These combinations also have been involved in 11 (61.1%) of the 18 fatal cases of serotonin syndrome. Serotonin syndrome has been reported when an MAOI was used in combination with L-tryptophan, dextromethorphan, or clonazepam. Tricyclics combined with alprazolam, amoxapine, SRIs, lithium, SRIs and lithium, trazodone and lithium, nefazodone and thioridazine, and m-chlorophenylpiperazine (m-CPP) also have been associated with the syndrome. SSRIs in combination with lithium, venlafaxine, buspirone, dextromethorphan, carbamazepine, clonazepam, mirtazapine, m-CPP, nefazodone, trazodone, risperidone, sumatriptan, dihydroergotamine and tramadol have been reported to produce serotonin syndrome. Combinations of nefazodone with trazodone, fluoxetine, valproate, and dothiepin have been reported.
Posted by Dragon Black on September 4, 2007, at 18:17:54
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by Bonnie_CA on September 1, 2007, at 13:31:36
Yeah, not only wholly unresponsive, but their answer was recited in my question to them in the first place. Like entering the bizarro world for a minute. I'm guessing the actual answer could be used to justify ignoring the contraindication, so no way they are going to offer that up just for the asking. "Lie-ability," methinks.
> That French answer was irritating to me. It's like, "thanks for pointing out the information I ALREADY KNOW!" lol
>
> I'm sure you were looking for a better answer. Sorry they sent you a standardized email of obvious answers. :-\
>
> -Bonnie
Posted by Squiggles on September 4, 2007, at 18:27:41
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by Dragon Black on September 4, 2007, at 18:17:54
When i became addicted to Xanax, i called
Upjohn to ask what to do and to report it,
and i got a very "rep" sounding man, saying
"aahh, it looks like this drug is not for you
m'am".I can't say the same for a smaller company here
in Montreal when i got the botched lithium supply.
He actually became quite involved in e-mails; so
it varies.Squiggles
Posted by Dragon Black on September 4, 2007, at 20:17:34
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by sam123 on September 2, 2007, at 12:19:02
Hmm, maybe, but I don’t think so. Yes, tianeptine is structurally similar to the TCAs, in that the molecule has 3 rings, but that’s where the similarities end. I think what it does is bound to be more important, and the mechanism of action of tianeptine is opposite the TCAs – it enhances the reuptake of serotonin while the TCAs inhibit the reuptake of one or more monoamines. So I’ve surmised that one of the following must be the reason that Servier, the make of tianeptine, has contraindicated MAOIs:
1. Serotonin Syndrome – that even though it’s the anti-SSRI, its still serotonergic in nature and therefore they don’t want people messing with multiple serotonergic agents. Whether this is a legitimate fear is a question out of my league, but I suspect it is not. It is worth noting, however, that like fluoxetine, tianeptine increases serotonin innervation in the forebrain. http://www.tianeptine.com/forebrain.html More interesting is the fact that on their website, they list MAOIs under “Contraindications,” but under “Drug Interactions” they get more specific and say “with nonselective MAOIs.” http://www.servier.com/pro/Neurosciences/stablon/stablon_spc.asp So maybe if we mess with type A we could have a problem, but to me it looks like low dose selegiline is in like slim.
2. Tianeptine increases extracellular dopamine in the nucleus accumbens. http://www.tianeptine.com/dopamine-nacc.html Since MAOIs inhibit dopamine deamination, and tend to be off limits with anything that touches dopamine, maybe this presents a problem. Again, I don’t really know but I doubt it.
3. They just didn’t study it enough and they don’t want to hassle with the possibility of liability. I can’t for the life of me find it now, but someone on here posted a while back that this is what his Dr. thought, that the Pharms just weren’t willing to countenance having an MAOI related lawsuit on their hands.
But who really knows, right? My guess is no one, even in the research community. In the end it’s, “Buy the ticket, ride the ride.”
> It is related to the TCA's, for which MAOI's are contraindicated:
>
> Complications
>
> In most reports, serotonin syndrome has been mild to moderate in severity without medical complications. However, a distinct minority of cases, particularly those associated with MAOI-tricyclic and MAOI-SRI combinations and MDMA, were severe and some fatal. Overall, medical complications appear to be less common than in NMS. Rhabdomyolysis was the most common serious medical complication of serotonin syndrome, occurring in 45 (26.8%) cases. Myoglobinuria and renal failure were reported in 8 (4.8%) patients. Generalized seizures were reported in 18 (10.7%) cases, including 7 fatalities. Similarly, DIC occurred in 8 patients, 5 of whom died. Thus, although medical complications were not common in patients with serotonin syndrome, they were associated with a substantial mortality risk.
>
> ONSET AND PREDISPOSING FACTORS
>
> Serotoninergic Medications
>
> Nearly all medications that enhance CNS serotoninergic neurotransmission have been reported in association with cases of the serotonin syndrome (Table 3-1). Since the cases reviewed by Sternbach (1991), the most commonly implicated agents reported in subsequent case reports and case series have been combinations of MAOIs (reversible and irreversible) and tricyclics (N=18) and MAOIs and SRIs (N=34). These combinations also have been involved in 11 (61.1%) of the 18 fatal cases of serotonin syndrome. Serotonin syndrome has been reported when an MAOI was used in combination with L-tryptophan, dextromethorphan, or clonazepam. Tricyclics combined with alprazolam, amoxapine, SRIs, lithium, SRIs and lithium, trazodone and lithium, nefazodone and thioridazine, and m-chlorophenylpiperazine (m-CPP) also have been associated with the syndrome. SSRIs in combination with lithium, venlafaxine, buspirone, dextromethorphan, carbamazepine, clonazepam, mirtazapine, m-CPP, nefazodone, trazodone, risperidone, sumatriptan, dihydroergotamine and tramadol have been reported to produce serotonin syndrome. Combinations of nefazodone with trazodone, fluoxetine, valproate, and dothiepin have been reported.
>
> http://www.nmsis.org/Related_Syndromes.shtml
Posted by sam123 on September 4, 2007, at 22:57:29
In reply to Why you 'can't' combine tianeptine w/ MAOIs, posted by Dragon Black on September 4, 2007, at 20:17:34
> 3. They just didn’t study it enough and they don’t want to hassle with the possibility of liability.
Yep, that plus every other antidepressant excludes
MAOI's,generally. At least in the monograph.
Posted by blueboy on September 7, 2007, at 14:12:27
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by sam123 on September 2, 2007, at 12:19:02
>Serotonin syndrome has been reported when an MAOI was used in combination with L-tryptophan, dextromethorphan, or clonazepam.
LOL! More junk science -- "Post hoc ergo prompter hoc". I'm sure that if they asked the right questions, they could "report" serotonin syndrome when an MAOI was used "in combination with" a full moon.
AFAIK the prescription of MAOIs and benzo's is widely accepted and has never been contraindicated.
Posted by sam123 on September 8, 2007, at 9:58:21
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by blueboy on September 7, 2007, at 14:12:27
> LOL! More junk science -- "Post hoc ergo prompter hoc". I'm sure that if they asked the right questions, they could "report" serotonin syndrome when an MAOI was used "in combination with" a full moon.
>
> AFAIK the prescription of MAOIs and benzo's is widely accepted and has never been contraindicated.
A report of SS with MAOI's:http://ajp.psychiatryonline.org/cgi/content/full/164/2/346-b
From the UK:
http://www.mc.uky.edu/Pharmacy/DIC/DDI/DextromethorphanMAOIDDI.htm
Ohio Health:
http://www.ohiohealth.com/bodymayo.cfm?id=6&action=detail&ref=3733
Case studies in the Canada Medical Association:
Posted by Phillipa on September 8, 2007, at 20:24:48
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by sam123 on September 8, 2007, at 9:58:21
The last study shows most taking mephrobamate didn't think it was used anymore. Took it myself in the 70's. Phillipa
Posted by sam123 on September 9, 2007, at 0:51:46
In reply to Re: Anyone speak French? Please interpret Dr.'s e » sam123, posted by Phillipa on September 8, 2007, at 20:24:48
> The last study shows most taking mephrobamate didn't think it was used anymore. Took it myself in the 70's. Phillipa
Soma is a prodrug of meprobamate.
Posted by Phillipa on September 9, 2007, at 20:30:40
In reply to Re: Anyone speak French? Please interpret Dr.'s e, posted by sam123 on September 9, 2007, at 0:51:46
Thanks thought it was a pain med? will google it. Thanks again. Phillipa
This is the end of the thread.
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