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Re: Nardil, Trazodone and Amitriptyline

Posted by Robert_Burton_1621 on August 22, 2016, at 5:08:12

In reply to Re: Nardil, Trazodone and Amitriptyline, posted by David1973 on August 20, 2016, at 4:14:25

> Hi Scott, thats one of the reasons I turned it down but main reason were the side effects and an increase in the possibility of hypertension. I read somewhere that serotonin syndrome is extremely rare with both the main MAOI's, with the acute doses of seroternergic being the culprits. Certainly not willing to see if thats true.
> Thanks, Dave.

Hello Dave. I'd like to echo Scott's opinion about duloxetine co-administration with either Nardil or Parnate; indeed, you ought not go near an agent with substantial serotonergic potency for at least 10 days after stopping an MAOI. Such agents include all of the SSRIs, the new "SNRIs" venlafaxine and duloxetine, and the tricyclics imipramine and clomipramine. I'm not sure about the veracity of the proposition that serotonin syndrome is extremely rare with MAOIs. Does this proposition only apply to overdosing on MAOIs? Or does it apply to the co-administration of an MAOI with a serotonergic agent with a different mode of action? And if the later, is the proposition absolute or relative; i.e., in comparision to what other combination carrying the potential risk of serotonin toxicity is the MAOI + sert combination purportedly "extremely rare"?

The *rate* of serotonin toxicity induced by the combination of an MAOI with a sert drug may be, in relative terms, low owing to the lower rate of MAOI prescibing. But the absolute risk of serotonin syndrome occuring as a result of MAOI + sert combination is substantial.

Remember, though, that the clinical expression of serotonin toxicity falls on a spectrum of symptoms, is dose and timing dependent, and in minor cases may simply require close monitoring. But the combining (e.g.) clomipramine or duloxetine with an MAOI is absolutely contra-indicated.

There is excellent information at Dr Gillman's site on serotonin toxicity:

Amitriptyline is not significantly serotonergic, so should be safe to combine with an MAOI, with close monitoring. The active metabolite of amitriptyline - viz., nortriptyline - is an NRI and thus, from what I have read, safe to co-administer with an MAOI. The addition of NORT can also attenuate any pressor response from excessive tyramine consumption.

Sorry to hear of your continuing pain syndrome. If the pain is neuropathic, have you considered gabapentin?




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