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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Roslynn on July 28, 2010, at 17:23:25
Hi,
I'm just wondering if anyone else has taken this combo successfully. I seemed to have a good response to it when I was tapering off Prozac and adding clomipramine 50mg. I'm not sure what my doctor thinks of this combo...I would just like to know if there are any other babblers who have taken it.
Thank you,
Roslynn
Posted by ed_uk2010 on July 28, 2010, at 18:00:50
In reply to Anyone had success with prozac+clomipramine???, posted by Roslynn on July 28, 2010, at 17:23:25
Be careful. Fluoxetine (Prozac) interferes with the metabolism of tricyclic antidepressants. This could potentially lead to toxicity eg. seizures.
Posted by Roslynn on July 28, 2010, at 18:37:16
In reply to Re: Anyone had success with prozac+clomipramine???, posted by ed_uk2010 on July 28, 2010, at 18:00:50
Hi,
I have taken Prozac+desipramine, Prozac+protriptyline, and also Prozac+nortriptyline, all over long periods of time, and these did not cause me any problems.
Is there a difference since it's clomipramine?
Thank you,
Roslynn> Be careful. Fluoxetine (Prozac) interferes with the metabolism of tricyclic antidepressants. This could potentially lead to toxicity eg. seizures.
>
>
>
Posted by Phillipa on July 28, 2010, at 19:03:58
In reply to Re: Anyone had success with prozac+clomipramine??? » ed_uk2010, posted by Roslynn on July 28, 2010, at 18:37:16
I thought the TCA's only were dangerous with MAOI's not SSRI's? Phillipa
Posted by Phillipa on July 28, 2010, at 19:10:14
In reply to Re: Anyone had success with prozac+clomipramine???, posted by Phillipa on July 28, 2010, at 19:03:58
Just googled this boy it's long but supports Ed. Phillipa
Posted by europerep on July 29, 2010, at 14:42:15
In reply to Re: Anyone had success with prozac+clomipramine???, posted by Phillipa on July 28, 2010, at 19:10:14
well, combining serotonergic agents is in itself a danger, if there are further complications through metabolism through the same cytochromes it just adds up to that, since plasma levels of the drugs might be higher than usually..
of course one must be careful, but the combination of TCAs and SSRIs in general in TRD is a possible, though unconventional strategy.. I just read an article the other day that valided that, I just happen to have read a lot of articles this week so I don't remember where exactly it was..I believe there is no serious risk in trying to reproduce the effect that the two drugs had together, by starting at a steady-state of the two drugs, only increasing one drug at time by a small amount, and then see what happens.. it's what I would do at least..
Posted by Roslynn on July 29, 2010, at 16:36:00
In reply to Re: Anyone had success with prozac+clomipramine???, posted by europerep on July 29, 2010, at 14:42:15
Europrep,
Thank you for the information.
Is the danger that you could possibly develop serotonin syndrome?
> well, combining serotonergic agents is in itself a danger, if there are further complications through metabolism through the same cytochromes it just adds up to that, since plasma levels of the drugs might be higher than usually..
> of course one must be careful, but the combination of TCAs and SSRIs in general in TRD is a possible, though unconventional strategy.. I just read an article the other day that valided that, I just happen to have read a lot of articles this week so I don't remember where exactly it was..
>
> I believe there is no serious risk in trying to reproduce the effect that the two drugs had together, by starting at a steady-state of the two drugs, only increasing one drug at time by a small amount, and then see what happens.. it's what I would do at least..
Posted by europerep on July 31, 2010, at 8:19:41
In reply to Re: Anyone had success with prozac+clomipramine??? » europerep, posted by Roslynn on July 29, 2010, at 16:36:00
yes, serotonin syndrome would be the first thing that comes to mind. obviously you should also check for other possible "systemic" side effects, but personally I wouldn't be aware of anything particularly dangerous.. but as for SS, by going slowly, only increasing a dose when being on steady-state before, etc., the risk can be minimized.
I do not want to pretend knowing stuff better than ed, because that sure is not the case, and he has a very correct point of course with the metabolism issue. if your doc is willing to try out this combination with you, then have him/her take your blood at regular intervals in the beginning to check the respective doses of both ADs.. also, are you taking any other drugs, prescribed or not? that might be important because they too might be metabolized through the same cytochrome..
MAOIs bring risks with them too, like any med, so I would give this combination a try first.
Posted by ed_uk2010 on July 31, 2010, at 12:57:54
In reply to Re: Anyone had success with prozac+clomipramine??? » ed_uk2010, posted by Roslynn on July 28, 2010, at 18:37:16
> Hi,
>
> I have taken Prozac+desipramine, Prozac+protriptyline, and also Prozac+nortriptyline, all over long periods of time, and these did not cause me any problems.
>
> Is there a difference since it's clomipramine?
>
> Thank you,
> RoslynnYes, clomipramine is different because it is a very potent serotonergic antidepressant. If you wanted to take clomipramine in combination of fluoxetine, the clomipramine dose would need to be kept very low. Careful monitoring would be essential.
Posted by Roslynn on July 31, 2010, at 16:15:56
In reply to Anyone had success with prozac+clomipramine???, posted by Roslynn on July 28, 2010, at 17:23:25
This is the end of the thread.
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