Posted by Bob on July 1, 2010, at 22:37:37
In reply to Re: Agomelatine add-on to Nardil » ed_uk2010, posted by Ron Hill on July 1, 2010, at 21:48:15
> >>So far, we cannot find any evidence for there being a contraindication against doing this. Do you know of any?
>
> > I am not aware of any contra-indication. I suppose it's just a case of there not being any evidence to support the safety of combined use.
> ---------------------------
>
> Ed,
>
> Sorry for the length of this post.
>
> Scott and I are both interested in adding 25 mg/day of agomelatine (Valdoxan) to 90 mg/day of Nardil.
>
> My previous p-doc would have trusted me to CARFULLY try the addition of agomelatine to my current combo (see below). But, he changed jobs and went to work as a p-doc in the U.S. Veterans Administration. I am not a Veteran, so I no longer have access to him.
>
> My new p-doc is a good doc, but is totally into CYA (cover his butt) and refused my request to add agomelatine. But, Im not going to give up. Please respond to the following:
>
> Can Valdoxan be combined with Nardil (phenelzine), if done carefully under the direct supervision and care of a qualified psychiatrist? In the Valdoxan - Summary of Product Characteristics document, MAOIs are not contraindicated. Also, it is not contraindicated in this document: http://www.ema.europa.eu/humandocs/PDFs/EPAR/valdoxan/H-915-PI-en.pdf
>
> Clearly, there is not any risk of serotonin syndrome, since Valdoxan does not release serotonin.
>
> So, my question comes down to this: Since Valdoxan is an antagonist of post-synaptic 5-HT2c receptors; does the disinhibition (NDDI), resulting in the release of dopamine and norepinephrine in the frontal cortex, cause an unacceptable risk of a hypertensive crisis when 25 mg/day of Valdoxan is added to 90 mg/day of Nardil?
>
> My p-doc is afraid of the risk a of hypertensive crisis. But, I am super safe when adding a med with some risk. I would start by trying ¼ of a 25 mg tablet. I would monitor my blood pressure continually for the first couple of hours, and I would have one of my nifedipine capsules close at hand.
>
> Anecdotally, there are reports of this being done:
>
> http://www.dr-bob.org/babble/20100305/msgs/939363.html
>
> Ed, do you agree with the following paragraph? Beware of the source (see link below).
>
> Notably, although phenelzine inhibits the breakdown of norepinephrine and epinephrine (which in concept should lead to increased levels of these two respective neurotransmitters), it actually typically significantly decreases their overall activity with time via a complex interaction with octopamine. This is the cause of the side effect of orthostatic hypotension commonly seen with phenelzine and the other MAOIs. Importantly, it has been demonstrated that the antidepressant effects of serotonin are actually mediated through norepinephrine. [9] As a result, this depletion of norepinephrine and epinephrine may significantly inhibit the full therapeutic potential of phenelzine and the other MAOIs. For this reason, augmenting with an adrenergic agent such as a norepinephrine reuptake inhibitor (NRI) or releasing agent (NRA) in conjunction may be desirable, though strict professional supervision is advised to minimize the risk of a potentially dangerous drug interaction such as hypertensive crisis.
>
> http://wapedia.mobi/en/Phenelzine
>
> If the above is true, agomelatine would improve the effectiveness of Nardil.
>
> Ed, here is the home page for Valdoxan. Please click around.
>
> http://www.valdoxan.com/
>
> Also, enter the following as a medical professional (which you are). The first four options, counting from left to right, all get you to the same place with good information. The fifth one leads you to the laymans watered down version.
>
> http://www.valdoxan.co.uk/landing.aspx?redirect=/frequently-asked-questions-about-Valdoxan.aspx
>
> FWIW, I sent in a Medical Enquiry to Servier, but they did not reply.
>
> Ed, thank you for reviewing this information and providing your accessment. I am particularly interested in agomelatine because, as a BP II ultra rapid cycler, I want to take advantage of the tx of circadian rhythms.
>
> However, I cannot merely replace Nardil with agomelatine, because the latter does not have enough antidepressant horsepower in and of itself. I need my Nardil.
>
> Further, I am fully convinced, based on my reaction to other meds, that Valdoxan without Nardil will cause me to become irritable. This is due to the lack of a serotoninergic component.
>
> My bottom line is that the addition of agomelatine to Nardil is simillar in risk to the careful addition of a p-stim to Nardil. This is done often.
>
> Aside from the potential liver issue, is 25 mg/day of Valdoxan safe to add-on to Nardil?
>
> -- Ron
>
> dx: Bipolar II with ultra rapid cycling, and mild OCPD
> 600 mg/day Trileptal
> 200 mg/day Lamictal
> 500 mg/day Keppra
> 90 mg/day Nardil
>
> 3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)
> 35 ml of Calsons Bottled Fish Oil
> 100 mg/day phosphatidylserene
> Centrum Chewable Multi-vitamins; Only 100% of all the usual vitamins
> 2000 IU Vitamin E
> 850 mg/day of Mg 212% of RDA (as 5 grams of MgMalate).
> Dark therapy via LowBlueLight glasses (When I remember)
>
>
> Whats next to add:
>
> 25 mg/day agomelatine (if my p-doc wakes up and smells the roses due to my submitted research) {Valdoxan}
> 300 mg/day of lithum carbonate
> CoQ10
> NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid, + Vitamin C
> GTF Chromium
> Cromium Picolinate
> Cinnamon
>
>
>
Agomelatine is not available in the US, right?
poster:Bob
thread:952388
URL: http://www.dr-bob.org/babble/20100628/msgs/952904.html