Posted by AndrewB on March 16, 2001, at 9:45:17
In reply to Re: Any potent Alpha-1 adrenergic agonist, posted by JohnX on March 16, 2001, at 0:05:29
John,
I have a lot of unresolved questions about NE drugs in general, specifically when and how they provide efficacy.
I do not know of anyone using an alpha agonist to counteract the properties of another drug’s alpha 1 antagonism.
Direct acting agents of alpha 1 agonism include: phenylethamines, phenylephrine, methoxamine, metraminol, imidazolines, oxymetazoline, tetrahydrozoline and naphazoline.
I don't know anything about the actual effects of the drugs on the above list except naphazoline. As I mentioned in an above post, naphazoline, though not necessarily a permanent solution, will give you a quick idea of whether alpha 1 agonism will help you counter the effects of alpha 1 antagonism.
Adrafinil and Provigil both gave me headaches and made 'tense'. Comparing the effects of these meds to reboxetine and naphazoline, I felt that Provigil and adrafinil, if they do have alpha 1 agonist action, the action is centrally acting and thus will not counteract the peripheral effects of alpha 1 antagonism. Both these meds also reportedly have glutaminegic action (i.e. increasing glutaminergic activity in the hippocampus.) This may the actual mode of action for these drugs.
First hand reports on reboxetine seems to indicate that it rarely provides mood benefit as a stand alone, while, interestingly, inducing depression in a select number of people. It is not what I would consider a clean drug. It seems to have a broad action which induces a variety of side effects in various people.
There is the idea that people with treatment resistant depression will benefit from a combo of reboxetine + an SSRI inhibitor. Caution is warranted though. Serzone is marked inhibitor of the liver enzyme CYP3A4. Reboxetine is primarily metabolized by this enzyme. The combo may lead to increased reboxetine blood levels and side effects.
Sunnely in a post suggested that among the SSRIs, citalopram (Celexa), is probably the top choice to combine with reboxetine for people with treatment resistant depression. Celexa has little or no effect on the CYP3A4 enzyme, therefore it isn’t likely to have a pharmokinetic interaction with reboxetine. Also celexa is, according to Sunnely, the most selective SSRI., while rebox. is selective for NE. So apparently there is not an overlap in their actions. There is a published report of 4 treatment resistant patients benefiting from this combo.
AndrewB
poster:AndrewB
thread:56463
URL: http://www.dr-bob.org/babble/20010310/msgs/56646.html