Posted by Sunnely on September 5, 2001, at 19:47:59
In reply to PLEASE can you help - Cam, Sunnely, anyone, posted by caroline on September 5, 2001, at 14:49:21
I believe Cam explained it very thoroughly.
If I may add a couple of cents, here. Anafranil and Remeron both have norepinephrine boosting effect (aside from serotonin effects). Anafranil is metabolized to desmethylclomipramine, an active metabolite which is a potent norepinephrine reuptake inhibitor (norepinephrine booster). Remeron, acts as an antidepressant by enhancing both the serotonin and norepinephrine effects.
IMHO, the addition of pseudoephedrine, a sympathomimetic, to Anafranil and Remeron could have led to an increased noradrenergic effect, which in turn could lead to increased stimulation of the myocardium (heart muscle) which could trigger the autonomic ventricular activity and facilitate the onset of re-entry arrhythmia (heart beat irregularity). The occurrence of a form of ventricular tachycardia (polymorphic type) called "torsades de pointes" could lead to episode of passing out or loss of consciousness. Most oftentimes, the heart reverses back to normal rhythm. However, occasionally it may progress to a more serious type of ventricular tachycardia (monomorphic) then to ventricular fibrillation and if not electrically corrected (defibrillator), to cardiac arrest.
How long have you been on Anafranil? Other than what you mentioned, are you taking other medications or herbs? Have you had any previous episodes of passing out? Do you have any heart condition? Have you had an electrocardiogram (ECG) prior to and during treatment of Anafranil? You are particularly prone to "torsades" if your ECG shows "prolongation of QTc" interval especially while on Anafranil. Being on Anafranil and your recent episode of passing out, I believe an ECG should be done.
> Hi, I use 75mg anafranil + 75mg remeron to help me live with Aspergers.
>
> I was prescribed a course of pseudoephedrine by a GP to clear up a sinus infection. I took the prescription to a pharmacist, who said it could be dangerous in interaction with the anafranil. I asked the GP and they said they knew of no such danger, so I took it.
>
> One night after I'd been on it for seven days, I was in bed when suddenly my heart started racing and then I passed out, when i came to I was gasping for breath and it was still racing and i passed out again. This cycle went on for about twenty minutes and then i passed out and didn't awake until my alarm went off in the morning.
>
> I tried to get up to get ready for work but i had crushing pain in my chest and down my left arm, i also felt breathless and dizzy whenever i tried to stand up. In the end i went back to bed and slept through the day. I couldn't think what was wrong with me. The next day, my friend took me to see a GP and i explained all my symptoms and what the pharmacist had told me about possible tacchycardial ventricular arrhythmias, but my doctor said that as far as she knew there was no such dangerous interaction between the two drugs. She thought i'd maybe had an allergic reaction to the pseudoephidrine and that i'd feel better in a couple of days.
>
> All that week, i couldn't stand up at all, i slept through every day; the second week i could stand up for short periods but not without a lot of chest pain. It is now 8 weeks on and i've been back at work five weeks but i still get a lot of chest pain, breathlessness and feel tired alot.
>
> Is this a known interaction?
> Have I experienced the tachycardial ventricular arrhythmia the pharmacist warned me about?
> If so, what can i do to help myself?
>
> I'm sorry this post is so long, I really am, but I'm really frightened and I would appreciate any information/advice anyone has on the subject.
>
> Thanks so much in advance,
>
> Caroline
poster:Sunnely
thread:77865
URL: http://www.dr-bob.org/babble/20010902/msgs/77897.html