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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by Kristopher on June 24, 2014, at 18:14:16
Hi everyone,
I am currently taking Brintellix (20mg) along with Nuedexta (20mg/10mg). Drug interaction checkers Ive referenced list this combination as a serious contraindication.
The two reasons stated are:
Serotonin syndrome: I assume because the dextromethorphan in Nuedexta also has SERT receptor binding affinity (Ki = 23 nM) although to a much lesser degree than vortioxetine (Ki = 1.6 nM).
and
The CYP2D6 inhibition caused by the quinidine in Nuedexta may increase levels of vortioxetine and dosage should be reduced by 50%. Does it make a difference that I only take Nuedexta once a day as opposed to the usual every 12 hours for PBA treatment?
Ive asked my doctor about this and he said the combination shouldn't be a problem because the quinidine amount in Nuedexta is so low, but still, seeing a serious contraindication warning on Medscape has me concerned.
I dont have Pseudobulbar Affect but was prescribed Nuedexta when I inquired about ketamine injections for treatment resistant depression. Ive was told they have similar effects as NMDA antagonists. It was also interesting to learn that dextromethorphan has Sigma1 agonist properties similar to fluvoxamine - the SSRI I responded to more robustly than the others.
Im doing well with these two medications so far and I dont want to change anything if I dont have to. Is serotonin syndrome something that comes on gradually? Is the Brintellix gradually building up to possible toxic levels in my system? I have a tendency to worry and Im probably overthinking this. Any thoughts or advice from babblers with psychopharmacology expertise?
Lastly, I was curious: with an approximate half life of 66 hours, Im wondering if Brintellix could be taken every other day instead of daily. It would certainly be more cost effective. Ive accidentally skipped a dose once or twice and didnt notice any withdrawal type symptoms.
Thank you,
Kristopher
Posted by jrbecker76 on June 25, 2014, at 14:14:38
In reply to Concerns about Brintellix / Nuedexta combination, posted by Kristopher on June 24, 2014, at 18:14:16
Hi Kristopher,
I'm sorry upfront that I can't offer any further insight on this. There are obviously precautions of taking certain antidepressants (e.g., SSRIs) with dextromethorphan. But I think you also have to temper that with your pdoc's knowledge of this. You are correct that due to the long half-life, it takes about 2 weeks to reach peak steady state. Brintellix has a weaker affinity for blocking 5-HT reuptake than the SSRIs though, and serotonin syndrome is usually rapid in its onset, not gradual.
How long have you been taking it as well as Nudexta?
On a more selfish topic, I'm curious how long you've been taking Nudexta for? Do you feel it's working for you?
As you may or may not know, Nudexta is currently in PH II clinical trials for a depression indication.
JB
This is the end of the thread.
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