Posted by cache-monkey on September 15, 2004, at 23:07:58
In reply to Re: GAD/Dysthymia/Smoking: Pamelor/Nortriptyline » cache-monkey, posted by zeugma on September 15, 2004, at 19:04:47
<< I have considerable experience with nortriptyline, as I've been on it for longer than all other meds combined. It has a long half life (average half life 18-32 hrs. depending on which source you read) so you don't have to worry about multiple dosing during the day. Generally it's taken at night as most find it sedating. The side effects? yes, they can be annoying: dry mouth, constipation, and drowsiness are among the most common. The drowsiness tends to pass but the dry mouth and constipation may require increased dental hygiene and regular intake of fiber pills.
the CYP-2D6 issues are also important. Essentially if you are a rapid metabolizer you will require a higher dosage but ironically, fewer side effects. This is because nortriptyline's metabolites have fewer s/e than the parent drug but equal efficacy. If you are a slow metabolizer you will need a lower dosage and be at risk for increased s/e. Doctors generally quiz you on what s/e you are experiencing as a rough guage of your status, and it's also important to have your bp monitored as it can cause tachycardia or hypotension. These things are a matter of course for treatment with any TCA. >>
Hey,
It's good to know about the relative side effects between nortriptyline and its metabolites. The dry mouth is a particular concern for me, since my gums might be receding in a couple of places.
I have reason to think that I'm a poor CYP-2D6 metabolizer. I had a really bad experience on Serzone, hugely increased anxiety to the point of consistently being near panic, and a complete lack of appetite. This is consistent with the effects of the nefazodone metabolyte MCPP, which can build up to significant levels for those who are 2D6 deficient. (MCPP accumulation also helps explain the one positive of Serzone: increased libido and sexual function.)
I'm actually getting a blood test done to determine my genetic 2D6 capacity. These seem to have recently come available and are covered by my insurance. I'll see how that goes, but in the mean time Pamelor might not be the way to go for me.
Thanks for the info! It's been really helpful.
peace,
cache-monkey
poster:cache-monkey
thread:390925
URL: http://www.dr-bob.org/babble/20040915/msgs/391346.html