Posted by ed_uk on May 6, 2005, at 6:28:01
In reply to Clomipramine + prozac = HELP:!!, posted by temoigneur on May 5, 2005, at 20:55:24
Hi Ben!
Prozac can produce very large increases in clomipramine serum levels. It will be necessary for you to reduce your clomipramine dose. If you continue to take 115mg clomipramine in combination with Prozac, your serum clomipramine level may continue to rise. If I were you, I'd reduce the clomipramine dose immediately, as little as 25mg a day might be sufficient- although you will definitely need to experiment. You could try taking 25mg or 50mg clomipramine for the next day or two. If you start to suffer from withdrawal symptoms you will know to increase the dose. If you still feel sedated or if other (clomipramine) side effects are present, you could reduce the dose even further.
Fluoxetine-induced tricyclic toxicity: extent and duration.
Westermeyer J.
Department of Psychiatry and Behavioral Sciences, University of Oklahoma, Oklahoma City 73190.
Combined fluoxetine-tricyclic medication has been recommended for patients who are partial responders or nonresponders to tricyclic medication alone. Three cases were encountered in which the addition of fluoxetine to tricyclic medication resulted in toxic, potentially dangerous elevations in tricyclic blood level, amounting to approximately 100-300% increases over recent tricyclic levels. In reducing the tricyclic dosage after fluoxetine, blood level decreases were behind dosage decreases; and blood level and dosage decreases were not well correlated with each other. Symptoms associated with toxic levels are described. Due to the long half-life of fluoxetine, such increases in tricyclic medication must be anticipated well in advance of initiating treatment with these two compounds. Based on these few cases, a procedure is tentatively recommended for patients on combined fluoxetine-tricyclic regimens, until such time as a definitive regimen can be developed.
'The interactions of fluoxetine with amitriptyline, clomipramine, desipramine, imipramine and nortriptyline are established and clinically important. Monitor concurrent use (measure plasma levels), be alert for any evidence of antidepressant toxicity and reduce the dosage appropriately. Initial dosage reductions to a quarter have been advised if 20 mg fluoxetine daily is added, and regular monitoring for several weeks or even months.'
Kind regards,
Ed.
poster:ed_uk
thread:494252
URL: http://www.dr-bob.org/babble/20050504/msgs/494411.html