Posted by Cairo on October 23, 2004, at 7:00:29
In reply to Re: Cymbalta 60 mg-side-effects » sedona, posted by utopizen on October 22, 2004, at 17:36:14
Desyrel could potentially increase the levels of Cymbalta, so you need to be careful if you are having SE with Cymbalta. I am extremely sensitive to meds and I believe Desyrel, which I have taken for a long time for sleep, has increased my levels of Cymbalta causing terrible agitation and increased BP even at 20mg. Some have reported no problems, but you never know. Here's something I found on MedScape:
DULOXETINE HCL ORAL
Interaction between SSRI's; Duloxetine/Tricyclic Compounds; Trazodone
Severity
3-Moderate Interaction: Assess the risk to the patient and take action as needed.Action
SSRI's and duloxetine impair oxidative hepatic metabolism. These agents may lead to a more rapid down regulation of postsynaptic beta-adrenergic receptors, thus possibly contributing to a faster onset of the antidepressant effect of other agents.Effect
Concurrent administration of an SSRI or duloxetine with a TCA or trazodone may result in an increase in serum levels, toxicities, and/or clinical effects of the TCA or trazodone.Predisposing Factors
None determined.Management
Patients should be observed for increased adverse effects and clinical effects of TCAs at the initiation of concurrent therapy with SSRI's or duloxetine. Plasma concentrations of the TCA should should be monitored and the dosage adjusted accordingly. If SSRI or duloxetine treatment is discontinued in a patient receiving TCA therapy, the dosage of the TCA may need to be adjusted. The effects of fluoxetine on hepatic metabolism may last for 5 weeks after fluoxetine discontinuation. A TCA started after the discontinuation of fluoxetine should be started a lower initial dosage.Discussion
In a study, pretreatment with duloxetine (60mg twice daily) increased the area-under-curve (AUC) of a single dose of desipramine (50mg) by 3-fold. Case reports have shown that the addition of fluoxetine to TCA therapy can result in an increase of 100-300% in the TCA plasma concentration as well as an increase in adverse effects, including seizures and delirium. Fluvoxamine has been shown in an in vitro study to inhibit the metabolism of imipramine. Three case reports have shown increased serum levels of imipramine (32%, 198%, and 470% increases) and an increase in adverse effects (anticholinergic effects, confusion, and sedation) during concurrent administration with fluvoxamine. Two case reports of adverse effects (tonic-clonic seizure, tremors, dizziness, and confusion) and increased plasma desipramine levels (79% and 54% increases) with concurrent administration of fluvoxamine exist. Increased plasma levels of clomipramine (586%) and amitriptyline (100-150%) without signs of clinical toxicity were seen following the addition of fluvoxamine to TCA therapy. Sertraline has been shown to increase the maximum concentration (Cmax) and AUC of desipramine by 31% and 23%, respectively. There is one case report of serotonin syndrome during concurrent therapy with paroxetine and trazodone. The affinity of the different SSRI's for CYP P-450 may vary.Good luck!
Cairo
poster:Cairo
thread:406044
URL: http://www.dr-bob.org/babble/20041018/msgs/406308.html