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Dr. Bob is Robert Hsiung, MD,
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Posted by Mark25 on July 24, 2016, at 18:57:52
Do you think this combo is safe?
Drug interaction checkers state MAOIs shall not be combined with trazodone, but quite a few people take those two meds without problems.
Also the German manufacturer of tranylcypromine (Aristo Pharma) says the combination is safe, as long as the MAOI is added to existing trazodone therapy. This study confirms it: http://www.ncbi.nlm.nih.gov/pubmed/2365668
Aristo Pharma states that combining tranylcypromine with atypical antipsychotics is OK. And in fact, olanzapine has been used to treat serotonin syndrome.
But there a rare reports of serotonin syndrome following treatment with olanzapine (and other serotonergics).
Quite confusing.
Posted by rjlockhart37 on July 24, 2016, at 23:33:19
In reply to MAOI + Trazodone + Olanzapine combination, posted by Mark25 on July 24, 2016, at 18:57:52
olanzapine seems very safe with a MAOI because it lowers nuerotransmitter levels, trazadone ... may be safe because it's a serotonin antagonist and reuptake inhibitor (SARI) so it does block the reptake like an SSRI but it also blocks it from being released.....
this is a study about trazadone and MAOI's combinations
Posted by rjlockhart37 on July 24, 2016, at 23:37:08
In reply to Re: MAOI + Trazodone + Olanzapine combination, posted by rjlockhart37 on July 24, 2016, at 23:33:19
sorry lol wrong article
http://www.ncbi.nlm.nih.gov/pubmed/2708555
it looks safe, because it doesnt act the same way a SSRI does by blocking and filling the synapse with serotonin, it prevents the release of it
Posted by Mark25 on July 25, 2016, at 2:43:03
In reply to Re: MAOI + Trazodone + Olanzapine combination, posted by rjlockhart37 on July 24, 2016, at 23:37:08
Thanks for your answer and the link to the study!
"A case report by Haslett and Kumar noted the development of serotonin syndrome after olanzapine was added to a drug regimen of lithium and citalopram. The mechanism is thought to be 5HT-2A and 5HT-3A receptor antagonism by these atypical antipsychotics, resulting in serotonin accumulation and cumulative activation of 5HT-1A receptors."
Even with this knowledge I still believe MAOI + Olanzapine is safe, especially when you have been on the Olanzapine for quite some time and then slowly add the MAOI:
This is the end of the thread.
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