Posted by tom2228 on March 18, 2014, at 10:33:43
In reply to Re: TCAs calming vs. sedating/ nortrip vs. Saphris SLS » tom2228, posted by SLS on March 18, 2014, at 1:34:36
> Hi.
>
> I prefer nortriptyline to desipramine. I find that nortriptyline is less apt to cause "anticholinergic" side effects. Desipramine increases sympathetic tone more potently than nortriptyline due to its being a more potent NRI. This causes desipramine to produce side effects that appear much like anticholinergic effects. These include dry mouth, constipation, blurred vision, tachycardia, delayed micturition, urinary retention, nasal stuffiness, etc. For me, NOR is milder than DMI. However, NOR made me very sleepy for the first two days. I began treatment at 25 mg/day. I probably should have started at 10 mg/day. Thereafter, I found NOR to be free of somnolence and sedation. It is actually a pretty clean drug. Some people will respond to NOR and not to DMI. The reverse is also true.
>
> DMI and NOR are good choices to add to Marplan. They are safe, and even have a protective effect against a tyramine pressor reaction. Hypotension with dizziness can be a problem, as the TCA will block NE alpha-1a receptors peripherally. This usually is limited to orthostatic challenge, though. Although trimipramine should be safe to add to MAOI, I have never heard of it being done. Clomipramine is prohibited, and I would avoid imipramine as well. Both of these drugs are too serotonergic and can produce serotonin syndrome. I would also add that Wellbutrin is safe to take with MAOI.
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> - ScottThanks for your reply.
Can alpha-1 antagonism also be a source of sedation? and If so, the NET action would likely override that, is that right?
Here's a link referring to a trial of trimipramine + MAOIs.
http://www.ncbi.nlm.nih.gov/pubmed/6355073
Supposedly that combo is one of the only if not the only controlled trial of the TCA + MAOI combo, as of 1983. Trimipramine monotherapy was found to be superior to the combination and MAOI monotherapy.If I have to ditch the MAOI -- is imipramine less sedating that nortrip, as per the binding table? (24 nm vs. 8.2 for H1, respectively)?
I was thinking, if she doesn't go for the combo, I do have 3 refills of Marplan left (as long as it's not imipramine or clomi).. and I'd tell her in a few months or so. Although that's probably enough for a new doctor to drop you. Ugh it's enough trying to hide the meth history until she trusts me w/ Desoxyn.
poster:tom2228
thread:1062693
URL: http://www.dr-bob.org/babble/20140307/msgs/1062723.html