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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by ben on August 14, 2001, at 15:21:02
There is a theoretical interaction between Paxil and Efexor: Paroxetine (Paxil) inhibits the enzyme CYP2D6 which is responsible for the metabolism of Venlafaxine (Efexor). Could this drugs be combined "in praxis". I take 40 mg Paxil and have the idea of adding some Efexor. Any experiences or suggestions ?
P.S
I know someone who takes 450 mg Efexor along with 20 mg of Prozac instead there is the same theoretical interaction (Fluoxetine and Norfluoxetine are inhibitors of CYP 2D6 as well as Paroxetine). She didnt developed some strong or dangerous side effects.
Posted by JohnL on August 14, 2001, at 15:56:24
In reply to Is Paxil and Efexor together save ?, posted by ben on August 14, 2001, at 15:21:02
> There is a theoretical interaction between Paxil and Efexor: Paroxetine (Paxil) inhibits the enzyme CYP2D6 which is responsible for the metabolism of Venlafaxine (Efexor). Could this drugs be combined "in praxis". I take 40 mg Paxil and have the idea of adding some Efexor. Any experiences or suggestions ?
>
> P.S
> I know someone who takes 450 mg Efexor along with 20 mg of Prozac instead there is the same theoretical interaction (Fluoxetine and Norfluoxetine are inhibitors of CYP 2D6 as well as Paroxetine). She didnt developed some strong or dangerous side effects.Hi Ben,
I think what is safe and what is not safe varies considerably from one person to the next. However, over the years I've seen people combine all kinds of drugs that probably shouldn't have been combined, with no ill effects. That includes me. I've tried quite a few wild combinations. On the other hand, sometimes people have very bad reactions to just a single medication. So as with everything in psychiatry, I think trial and error is the only way to answer tough questions.Whatever you decide to do, the way to keep is safe is to start slow and low. It's wise, for example, to add a second drug at half or less of its minimum dose. Then as you see how you tolerate it, it can be increased slowly and in little steps.
In the example you provided of someone taking 450mg Effexor plus 20mg Prozac, that just indicates to me they are barking up the wrong tree. Such high doses are (just my opinion) indicative of a drug that is not targeting the real problem. Nobody's serotonin is so low that they need that much medicine. Their symptoms are more likely caused by a different chemistry which is only being partially affected by their current drugs, and thus it takes huge doses.
Over the years I have noticed a trend that people who do real well with whatever medicine usually only need small doses. That's because the med is hitting a bullseye. People who don't do so well require massive doses, where they would probably be a lot better off finding a better drug instead.
Posted by Cressida on August 14, 2001, at 17:11:47
In reply to Re: Is Paxil and Efexor together save ?, posted by JohnL on August 14, 2001, at 15:56:24
> Over the years I have noticed a trend that people who do real well with whatever medicine usually only need small doses. That's because the med is hitting a bullseye. People who don't do so well require massive doses, where they would probably be a lot better off finding a better drug instead.
I think someone has made an exceptionally valid statement. If an individual must take the maximum recommended drug dosage to realize any ameliorating affect, then it might be the wrong drug. I believe most psychological disorders, especially ADD/ADHD and depressive disorders, respond positively in 1-4 weeks to psychotropic medication. Something to consider: the risks are probably greater than the benefits when the maximum dosage is reached, or when a patient is treated with multiple drugs. Simplify, simplify, simplify!
Posted by ben on August 15, 2001, at 2:39:20
In reply to You know w/in 1-4 weeks if a med works for u, posted by Cressida on August 14, 2001, at 17:11:47
Hi thanks for your input
I think you can not generalize if someone needs a low or a high dose of the right drug ! It is often usual to rise the dosage too keep effectivness...that was the case with this girl.
Efexor works dual (serotonin and noradrenaline) only if you go over 150 mg/day. When you go over 300 mg then it works on dopamine too. Adding an SSRI to Efexor is not so usual because anyone thinks its enough serotonin lifting or too much. On the other hand it could be possible that adding an SSRI leads to shift the Efexor more to noradrenaline reuptake because the serotonine receptors are satured (competitive binding). I know this is sound very theoretical but its a try worth.> > Over the years I have noticed a trend that people who do real well with whatever medicine usually only need small doses. That's because the med is hitting a bullseye. People who don't do so well require massive doses, where they would probably be a lot better off finding a better drug instead.
>
> I think someone has made an exceptionally valid statement. If an individual must take the maximum recommended drug dosage to realize any ameliorating affect, then it might be the wrong drug. I believe most psychological disorders, especially ADD/ADHD and depressive disorders, respond positively in 1-4 weeks to psychotropic medication. Something to consider: the risks are probably greater than the benefits when the maximum dosage is reached, or when a patient is treated with multiple drugs. Simplify, simplify, simplify!
Posted by Cressida on August 15, 2001, at 11:15:33
In reply to Re:JohnL and Cressida, posted by ben on August 15, 2001, at 2:39:20
> Hi thanks for your input
> I think you can not generalize if someone >needs a low or a high dose of the right drug ! >It is often usual to rise the dosage too keep >effectivness...that was the case with this girl.
> Efexor works dual (serotonin and >noradrenaline) only if you go over 150 mg/day. >When you go over 300 mg then it works on >dopamine too. Adding an SSRI to Efexor is not so >usual because anyone thinks its enough serotonin >lifting or too much. On the other hand it could >be possible that adding an SSRI leads to shift >the Efexor more to noradrenaline reuptake >because the serotonine receptors are satured
>(competitive binding). I know this is sound very >theoretical but its a try worth.
>You raise a valid point, but I wouldn't speculate too much. There are a lot of impressionable individuals roaming in "Psycho-Babble".
Posted by ben on August 15, 2001, at 16:19:13
In reply to Re:JohnL and Cressida, posted by Cressida on August 15, 2001, at 11:15:33
Hi Cressida
What do you mean with... There are a lot of impressionable individuals roaming in "Psycho-Babble" ? I am not used to speak english, sorry. Can you explain your sentence ?
Benindividuals > > Hi thanks for your input
> > I think you can not generalize if someone >needs a low or a high dose of the right drug ! >It is often usual to rise the dosage too keep >effectivness...that was the case with this girl.
> > Efexor works dual (serotonin and >noradrenaline) only if you go over 150 mg/day. >When you go over 300 mg then it works on >dopamine too. Adding an SSRI to Efexor is not so >usual because anyone thinks its enough serotonin >lifting or too much. On the other hand it could >be possible that adding an SSRI leads to shift >the Efexor more to noradrenaline reuptake >because the serotonine receptors are satured
> >(competitive binding). I know this is sound very >theoretical but its a try worth.
> >
>
> You raise a valid point, but I wouldn't speculate too much. There are a lot of impressionable individuals roaming in "Psycho-Babble".
This is the end of the thread.
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