Posted by Donna Louise on June 21, 2006, at 8:44:00
In reply to Re: Emsam + Nortriptyline: Day T - 2, posted by SFY on June 17, 2006, at 9:32:01
> I'm still leaning towards doing it despite the waiver. My pdoc has experience with MAOI/TCA combos and there is literature supporting using selegiline and TCAs without incident.
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> Ann Clin Psychiatry. 1997 Mar;9(1):7-13. Related Articles, Links
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> Retrospective study of selegiline-antidepressant drug interactions and a review of the literature.
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> Ritter JL, Alexander B.
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> University of Washington Medical Center, Seattle 98105, USA.
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> Selegiline is a selective monoamine oxidase inhibitor used in the treatment of Parkinson's disease. It is estimated that approximately one-half of Parkinsonian patients will develop depression requiring antidepressant drug treatment. Recently, selegiline's package insert was revised to reflect the potential risk of adverse effects when it is used in combination with selective serotonin reuptake inhibitors and tricyclic antidepressants. The objective of our study is to assess the safety of combining selegiline with antidepressants. A retrospective chart review was performed on all 28 patients with Parkinson's disease receiving selegiline and antidepressants concurrently to identify possible drug interactions. Compliance was assessed according to prescription refill records. Suspected adverse reactions with combination therapy were documented. There was a total of 40 selegiline-antidepressant drug combinations involving tricyclic antidepressants (n = 25), selective serotonin reuptake inhibitors (n = 7), trazodone (n = 5), and bupropion (n = 3). One patient receiving fluoxetine developed a reaction consistent with the serotonin syndrome; however, it was never documented as such. No other selegiline drug interactions were found. Adverse effects noted were typical of antidepressant monotherapy. Although no selegiline drug interactions were documented in our study, the concurrent administration of selegiline and selective serotonin reuptake inhibitors should be avoided because of literature-reported interactions. We believe that bupropion, tricyclic antidepressants, and trazodone are reasonable choices in combination with selegiline, although tricyclic antidepressants and trazodone may be reserved as second-line treatments.
>I am so glad that you are not having any conflict with this combination. I just wanted to point out that the study referenced here refers to selegiline used in a dosage that is selective. Which is the usual oral dose given to parkinsonian patients. EMSAM however, is non selective and does effect levels of serotonin. So maybe it has to do with with TCA which is used in combination as to whether there is a problem or not. I believe nortriptyline does not effect serotonin.
donna
poster:Donna Louise
thread:657616
URL: http://www.dr-bob.org/babble/20060617/msgs/659654.html