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Re: strattera AND effexor AND wellbutrin? lisaj32

Posted by King Vultan on June 22, 2004, at 8:06:26

In reply to Re: strattera AND effexor AND wellbutrin?, posted by lisaj32 on June 21, 2004, at 19:56:02


> >
> >
>
> Thanks. The doses are
> Effexor SR = 300mg
> Wellbutrin SR = 100mg
> Strattera = 80mg
>
> The Effexor was just for depression, but the doc chose it knowing I was having trouble concentrating and focusing. They added the Wellbutrin while I was in rehab to help with cravings, which it did, and my mood seemed to be doing really well so we just left it there.
>
> This is a new doc, yah, a psychiatrist. When we talked about adding the Strattera she was a little worried about putting it with Effexor but she looked in a leeetle book and said it was ok.
>
> I don't like feeling this way but if the side effects are apt to pass I'm willing to ride it out. I have predominantly inattentive ADD, just diagnosed after I screwed up another job.
>
> Thanks for your reply.
>


Maybe because I've done so much reading at Dr. Preskorn's site (www.preskorn.com), my concern in combinations like this is always the CYP-450 enzyme interactions, particularly, the ones involving the 2D6 enzyme. Now, unfortunately, all of these drugs are metabolized by 2D6, and one of them (Wellbutrin) is a strong inhibitor of this enzyme, while another (Effexor) is a moderate inhibitor, if I remember correctly.

The concern in this case is that even though the dosage of Wellbutrin is thankfully rather low, there is likely still at least some increase in blood plasma level of the other drugs. I don't know how significant this might be, but the dosage of Strattera is already pretty high to begin with. Refer your doctor to the drug insert packet that comes with Wellbutrin and the example given involving 300 mg Wellbutrin SR and 50 mg desipramine, which is a classic 2D6 substrate. My own experience was that 150 mg Wellbutrin SR/day increased the blood plasma levels of desipramine by a factor of about 3 times more than they would have been taking the desipramine by itself. Applying this same reasoning to your situation, the 100 mg of Wellbutrin might possibly be doubling the effect of the Strattera, as well as increasing the effect of the Effexor, for that matter.

As mentioned, you do seem to be taking a lot of stuff. I question the wisdom of combining these three drugs and would perhaps consider some other combination. A fellow I work with takes 2 x 200 Wellbutrin SR and 2 x 15 mg Ritalin/day for ADD, and this seems to be a good combination for him, but he does not have your depression issues. Whatever you do, just keep in mind that there are med interactions that can alter the effectiveness of a particular dose of a drug, and the more drugs in a cocktail, the more of a concern this is.

Todd


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poster:King Vultan thread:358766
URL: http://www.dr-bob.org/babble/20040621/msgs/358941.html