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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by tonyz on April 20, 2010, at 21:18:50
I've been prescribed Nortrityline and fluvoxamine. I've read that fluvoxamine can raise tricyclics to dangerous levels. I was taking 125mg Nortriptyline and told to start 100mg of fluvoxamine and lower the Nortriptyline to 75mg. I've previously posted about this along with the other meds I'm taking in a separate thread.
I found the following and I'm wondering if someone can interpret this for me. Primarily concerned with the interaction between Nortriptyline and fluvoxamine
* fluvoxamine + imipramine: raised levels of imipramine, quite probably to a degree that will be dangerous. A similar interaction with clomipramine can raise levels to over 1200 mg/l (8).
* fluvoxamine + nortriptyline: safe, but not recommended, because the only CYP450 isoform fluvoxamine does not inhibit is 2D6.
* fluvoxamine + caffeine: definite increase in risk of adverse and possibly toxic effects from caffeine, because of fluvoxamines extraordinarily potent inhibition of CYP450 1A2. This may include cardiac problems, and even possibly increased rates of spontaneous abortion (9-11).
Posted by Phillipa on April 21, 2010, at 0:50:12
In reply to Can someone explain this, posted by tonyz on April 20, 2010, at 21:18:50
I also take fluvoxamine luvox for many years. I know it also raises the effects of xanax, valium but not ativan and also some antibiotics and soma and yes coffee. Why the TCa's maybe that's why this hasn't been a popular med. Phillipa
Posted by tonyz on April 21, 2010, at 15:46:07
In reply to Re: Can someone explain this » tonyz, posted by Phillipa on April 21, 2010, at 0:50:12
Thanks Phillipa - my doc seems to think this is a rarity but to address my concerns he lowered the nortriptyline to 50mg.
So now I will be taking
50mg fluvoxamine
50mg nortriptyline
600 LI
50mg seroquel
30 restoril
1-2 mg clonazepamLast night I skipped the lithoium but it was still in my system - I didn't have any problems other than sleeping for only 3 hours
Did you experience insomnia on luvox?
Posted by linkadge on April 21, 2010, at 17:51:23
In reply to Can someone explain this, posted by tonyz on April 20, 2010, at 21:18:50
>fluvoxamine + nortriptyline: safe, but not >recommended, because the only CYP450 isoform >fluvoxamine does not inhibit is 2D6.
Just checking google: Nortriptyline is metabolized by cyp2d6. Because fluvoxamine does not inhibit this enzyme, it should not influence the metabolism of nortriptyline. Not sure why they said not recomended.
Even if the fluvoxamine does increase the nortriptyline to some extent, a simple nortriptyline blood test would tell you if you have too much in your system.
Linkadge
Posted by Phillipa on April 21, 2010, at 21:28:58
In reply to Re: Can someone explain this, posted by tonyz on April 21, 2010, at 15:46:07
Tony that's a starting dose of luvox. I was also at the time taking ativan which it doesn't potentiate and add chloral hydrate then no more yes slept most definitely and did get up to 250mg of luvox was working well the dumb doc took me off to trial celexa was new then and it never worked the same again. Still take the 50mg but with xanax low low dose valium. But you know what Link says is definitely correct. Phillipa
This is the end of the thread.
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