Posted by Sunnely on March 6, 2001, at 19:57:12
In reply to Serzone Insomnia, posted by Mary Ann on March 6, 2001, at 17:53:40
Allow me to express my 2-cent opinion.
I'm not clear as to when you took Prozac and if you were directly switched from Prozac to Serzone. For the sake of discussion, I will suppose you were directly switched from Prozac to Serzone within the past 2 weeks.
Even though you are no longer taking Prozac, it remains in your system for several weeks (approximately 5-8 weeks). This is due to its very long half-life. Therefore, it continues to exert some pharmacological effects and interactions with Serzone.
Prozac is a potent inhibitor of a liver enzyme called CYP2D6. Serzone is metabolized into 3 different compounds (metabolites) via the liver enzyme called CYP3A4. In turn, these metabolites are further metabolized by different liver enzymes before they can be eliminated, usually via the kidneys. One of the metabolites of Serzone called mCPP (meta-chlorophenylpiperazine) has an activating effect, which can promote anxiety, even agitation and insomnia. Normally, this is not a problem. However, mCPP requires the action of the liver enzyme CYP2D6 for metabolism. Prozac, which can remain in your system for 5-8 weeks, is a potent inhibitor of this liver enzyme. Even though you are no longer taking Prozac, it continues to inhibit the metabolism of mCPP, leading to its accumulation and causing activating effect (anxiety and insomnia). This effect should wear off as Prozac's blood level continues to drop to insignificant level (5-8 weeks).
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> I have been on Serzone for about 2 weeks, gradually increasing my dose from 50 mg/bedtime to 200 mg/bedtime. My optimal dose will be 200 mg/bedtime and 100 mg/morning. When my dosage was at 100 mg/bedtime, I began having insomnia and bad dreams (I've woken up crying a few times) when I was finally able to sleep with the help of Benadryl. Has anyone else experienced this? What has worked with others? I have a call in to my P-doc to see what he recommends. I might switch back to Prozac and incorporate Wellbutrin (to combat the negative sexual side effects from Prozac). My P-doc said the Prozac/Wellbutrin was another option to the Serzone. Thanks for your help!
poster:Sunnely
thread:55758
URL: http://www.dr-bob.org/babble/20010302/msgs/55774.html