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Re: EMSAM and seizures

Posted by Astounder on November 2, 2007, at 15:18:25

In reply to Re: EMSAM and seizures » trx resistant, posted by Larry Hoover on November 1, 2007, at 11:51:06

> > Wondering if anyone has information about 9mg EMSAM raising risk of seizures. Had 7 seizures in five hours at the age of 49 (no prior history) caused by Wellbutrin(450mg) in combo with 30 mg Dexidrine taken for MDD. Tried SSRIs but were of no help, especially at lowest dose. Seizure free for nearly 5 years but when my Cymbalta was raised to 120mg had 1 suspected nocturnal seizure. Bristol Meyers said 6mg risk was less than 1 in a thousand. So I am a very nervous starting a new drug. This is my first experience with a MAOI. It does seem to work fast. Tried 6mg for 4 weeks but needed more activation. Just started 9mg and notice big difference. EMSAM is my last hope because it works on dopamine like Wellbutrin and none of the SSRIs were helpful. I am hoping I can tolerate it but do notice it is more activating at 9mg which I desparately need to get me up and out of the house and able to rejoin the world.
> > trx resistant
>
> I've reviewed all the literature I can find, and I cannot find any correlation between Emsam exposure and seizure incidence. There is nothing whatsoever in the product monograph, so I'd presume that any seizure activity noted in the clinical trials was at the baseline level of the population at large. In other words, coincidental to Emsam exposure.
>
> In contrast, Wellbutrin is known to lower the seizure threshold. In fact, the upper dose recommendation was dropped from 600 mg/day to 450 mg/day, to reduce seizure risk to an acceptable level. It is quite possible that concurrent exposure to amphetamine might have increased the risk of seizure further. This risk does not transfer to Emsam, as far as I can tell.
>
> Lar

EMSAM reverses and prevents seizure in animal models of epilepsy, an effect synergistic with diazepam (Valium) and phenytoin (Dilantin). Amphetamines only very mildly decrease the seizure threshold, unlike cocaine & bupropion (Wellbutrin).

MAOIs in general are not epileptogenic. Chronic use of the full MAOI phenelzine (Nardil) is strongly antiepileptogenic in animal models by virtue of its active metabolite phenylethylidenehydrazine (PEH): PEH markedly increases CNS GABA levels by inhibiting its catabolizm by GABA-transaminase (GABA-T), an action shared by the valproates and vigabatrin (Sabril), which are used treat epilepsy. There is also some evidence the reversible inhibitor of MAO-A (RIMA) moclobemide increases the seizure threshold.


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poster:Astounder thread:792370
URL: http://www.dr-bob.org/babble/20071027/msgs/792992.html