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Re: Cymbalta + SSRI a wise idea? Any experience?

Posted by Cairo on October 13, 2004, at 8:17:24

In reply to Cymbalta + SSRI a wise idea? Any experience?, posted by utopizen on October 12, 2004, at 17:33:44

I am currently going through a miserable time which I attribute to a combination of Desyrel and Cymbalta. I have been on only 20mg of Cymbalta for over a week and have had terrible agitation, headaches, neck stiffness, muscle tremors, dry mouth, elevated BP (at 30mg, so I decreased it to 20mg and now my BP is normal).

If you are a slow metabolizer of 2D6, this would only make things worse. I have cut my Desyrel dose in half, but now my sleep is disrupted and I can't really afford that. I'll continue this for another couple of days, but I'll probably ask my pdoc if I should decrease the Cymbalta instread or to change me to something else for sleep.

Here's some info from MedScape:

>Interaction between Serotonin Reuptake >Inhibitors/MAOI's
>1-Contraindicated Drug Combination: This drug >combination is clearly contraindicated in all >cases and should not be dispensed or administered >to the same patient.
>Symptoms of serotonin syndrome may include >irritability, altered consciousness, double >vision, nausea, confusion, anxiety, hyperthermia, >increased muscle tone, rigidity, myoclonus, rapid >fluctuations in vital signs, and coma. Serotonin >syndrome may result in death.
>Predisposing Factors
>None determined.
>Concurrent use of SSRI; SSNRI's, as well as >nefazodone or venlafaxine with MAOI's is >contraindicated. A minimum 5 week washout period >should separate the switch of fluoxetine to a >MAOI while a washout period of at least 2 weeks >is recommended for citalopram, escitalopram, >fluvoxamine, paroxetine, or sertraline. A washout >period of 7 days is recommended for the switch of >nefazodone and venlafaxine (non-selective >serotonin reuptake inhibitors) to a MAOI. A >washout period of 5 days is recommended for the >switch of duloxetine to a MAOI. Prior to starting >any SSRI, non-selective SRI treatment, or >duloxetine, allow a 2 week washout period after >stopping MAOI therapy.
>This serious interaction (serotonin syndrome) has >been reported with fluoxetine, sertraline, and >venlafaxine. Although this has been not been >reported with the fluvoxamine, nefazodone, or >paroxetine, current recommendations by their >manufacturers indicate that the potential for >this interaction should be assumed. >Manufacturer's product information for >fluoxetine, paroxetine, and venlafaxine state >that concurrent administration of these agents >with a MAOI is contraindicated. The other SSRI's >and non-selective SRI's have shorter half-lives >than fluoxetine. Therefore, the time frame during >which the interaction would be expected to occur >with these agents and MAOI's would not be >expected to be as prolonged as with fluoxetine. >Furazolidone is also known to be a monoamine >oxidase inhibitor. Serotonin syndrome has also >been reported in two patients receiving >concurrent citalopram and linezolid, in a patient >in whom linezolid was initiated three days after >the discontinuation of paroxetine, and in a >patient receiving concurrent linezolid and >sertraline.

Hope this helps.





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