Posted by adiaphora on January 16, 2019, at 19:57:26
In reply to Nardil 75mg + Amitripyline 10mg Combination, posted by David Hanifin on December 2, 2018, at 1:36:31
Hi David,
I don't think there's too much published on this topic, but here is the relevant section from a 2015 article in the journal Pharmacology reviewing some of the literature on combination treatment with MAOIs:
MAOI plus TCA
The literature on TCA-and-MAOI combination therapy is mixed. Small studies and case reports have demonstrated its safety, but the combination has generally been found to be less well tolerated than either agent alone.
In addition, there are studies that suggest that the combination is no more efficacious than either agent alone and should be reserved for individuals with high depression scores, TRD, or atypical depression. Our patients who received TCA and MAOI combination therapy show sustained tolerability and efficacy (Table 3, cases 1315;Table 4, cases 1013). Three of the seven patients remained on this regimen for at least 2 years, two of whom also received trazodone in combination with the TCA and MAOI. The combination was discontinued in four patients due to one case of hypotension (patient was also receiving trazodone), one case with suspicion of serotonin syndrome, one patient who experienced fatigue with the combination, and one patient who could not tolerate pruritis associated with the selegiline patch. These results support existing data that this combination is relatively safe, with variable efficacies. If this combination is used, the TCA should be initiated first or at the same time as the MAOI.
It should be noted here that clomipramine, a TCA, exhibits potent inhibition of serotonin and should not be used incombination with an MAOI.
https://deepblue.lib.umich.edu/bitstream/handle/2027.42/111275/phar1576.pdf?sequence=1&isAllowed=y
Hope that is of some help.
p.s. FWIW, I second the suggestion of Trazodone over Amitriptyline if you are just looking for help with sleep. The combination seems to be safer and Trazodone is better on the nasty anticholinergic side effects.
poster:adiaphora
thread:1102238
URL: http://www.dr-bob.org/babble/20181024/msgs/1102821.html