Posted by linkadge on April 20, 2010, at 16:38:33
In reply to How dangerous is this combination, posted by tonyz on April 20, 2010, at 15:35:48
The fluvoxamine and nortriptyline should be ok in terms of CNS interaction. There is the potential that one will affect the blood level of the other, but I'd have to check the specifics.
I think the issue is the lithium and fluvoxamine. The lithium can increase the serotonergic effects of the fluvoxamine. I would start at 50mg of fluvoxamine if you can break the tablets. You may even want to start at 25mg if you can quarter the tablets.
You might also consider lowering the lithium to 300mg before starting a low dose of fluvoxamine.
Fluvoxamine can be a potent antidepressant, and I would think that it (in combination with nortriptline) could be very effective for depression.
Fluvoxamine (on its own) can help sleep, but I'm not sure how it would interact with lithium or remeron.
I've been on all these meds (not in combination however). I think with tweaking some of these meds you should get some relief.
I've been on a remeron + fluvoxamine combination and that was pretty damn good. Nortriptyline + fluvxamine is probably also a very good combination. Adding a wee bit of lithium to these might bo ok, but be careful for serotonin syndrome like effects. If you can stop (or reduce) the remeron before starting the fluvoxamine, this might help reduce interaction possibilities.
For some reason, lithium + SSRI never seems to agree with me. I do well on SSRI's and lithium alone, but the combination does some strange things.
Theoretically, all of remeron, nortriptyline, lithium and fluvoxamine can increase serotonin activity. So, together could be a problem.
Linkadge
poster:linkadge
thread:944229
URL: http://www.dr-bob.org/babble/20100416/msgs/944234.html