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Dr. Bob is Robert Hsiung, MD,
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Posted by shakingoscar on October 5, 2002, at 6:03:27
In reply to Re: Lexapro is much better than Celexa! *read!*, posted by shakingoscar on October 5, 2002, at 5:13:37
I want to ask a question about coffee.
I suffer with anxiety and depression and am now on lexapro 10mg which is brilliant. I was taking 60mg celexa before and have suffered for around 2 years.
My question is this.
If I drink one single cup of coffee I start to sweat HEAVILY and I get tremors which last maybe 2 hours, longer if I have 2 cups of coffee.
Is this really anxiety? I thought caffeine affected Nor-adrenaline and dopamine. Why am I now so sensitive to coffee and why does this happen when I am feeling perfectly ok?
I also take trazodone at night which I have noticed reduces this problem. Before taking trazodone, I could not drink ONE cup of coffee without nearling "losing it" because of the tremors and sweating (almost like Parkinsonian-type symptoms).
Is this anxiety or should I go back to my doctors?
Thanks
Posted by maririp on October 5, 2002, at 9:30:50
In reply to A SINGLE CUP OF COFFEE, posted by shakingoscar on October 5, 2002, at 6:03:27
shakingoscar ...coffee...hi..i can tell you when i first had panic attacks the thing i first noticed was when i drank coffee it sent me through the roof..same with chocolate..loaded with caffeine...those things triggerd my anxiety badly..try decaff..and give meds a time before you start with caffeine. It only took one cup of coffee to send me flying same with a candy bar.
Posted by ZeeZee on October 5, 2002, at 9:33:47
In reply to A SINGLE CUP OF COFFEE, posted by shakingoscar on October 5, 2002, at 6:03:27
Hi, I too am very sensitive to caffeine NOW! Used to have a cup or two before my relapse with no problem but now avoid all forms of caffeine. Even one cup of coffee has been shown to increase muscle tension and thus anxiety. I don't think it's worth it, but that's my opinion. I find that increased fluids such as OJ and water plus a protein breakfast works just as well to help me start the day - don't miss the caffeine at all.
Good Luck.
Posted by johnj on October 5, 2002, at 16:33:35
In reply to A SINGLE CUP OF COFFEE, posted by shakingoscar on October 5, 2002, at 6:03:27
Caffeine makes my anxiety much worse, and gives me a foggy feeling. If I were you I would quit or go to de-caff. See if that makes things better.
johnj
Posted by jflange on October 5, 2002, at 20:46:08
In reply to A SINGLE CUP OF COFFEE, posted by shakingoscar on October 5, 2002, at 6:03:27
The sweating and tremors sound like the effects of adrenaline to me. I am not sure why one cup of coffee could produce such a strong reaction. It could be that while Lexapro is taking care of your depression, it is not addressing your anxiety at the dose you are at now. Especially if you have just switched to Lexapro from Celexa, you might be experiencing some breakthrough anxiety from changing the meds.
When I had a similar caffeine reaction on Zoloft (for GAD), I came to the conclusion that an SSRI was not enough for my anxiety, and I began to supplement my regimen with BuSpar in order to temper that "keyed-up" SSRI sensation. You did not mention why you take Trazodone, which has a similar calming effect, especially for sleep. Or you could try to increase your dose of Lexapro and see if that helps (ironically, a dose increase alone sometimes nips the anxiety ).
In any case, it sounds like you should tell your doctor about your coffee jitters. Or you could just cut the coffee, as the others suggest. But who wants that? ;)
jflange
Posted by Phil on October 5, 2002, at 21:05:55
In reply to Re: A SINGLE CUP OF COFFEE, posted by jflange on October 5, 2002, at 20:46:08
Give up coffee? Shoot me first. : )
Posted by pharmrep on October 5, 2002, at 21:19:52
In reply to A SINGLE CUP OF COFFEE, posted by shakingoscar on October 5, 2002, at 6:03:27
> I want to ask a question about coffee.
>
> I suffer with anxiety and depression and am now on lexapro 10mg which is brilliant. I was taking 60mg celexa before and have suffered for around 2 years.
>
> My question is this.
>
> If I drink one single cup of coffee I start to sweat HEAVILY and I get tremors which last maybe 2 hours, longer if I have 2 cups of coffee.
>
> Is this really anxiety? I thought caffeine affected Nor-adrenaline and dopamine. Why am I now so sensitive to coffee and why does this happen when I am feeling perfectly ok?
>
> I also take trazodone at night which I have noticed reduces this problem. Before taking trazodone, I could not drink ONE cup of coffee without nearling "losing it" because of the tremors and sweating (almost like Parkinsonian-type symptoms).
>
> Is this anxiety or should I go back to my doctors?
>
>***** glad to hear the lexapro is working, it does treat anxiety too...usually in 1-2 weeks...the mix of meds could make it take longer, but how long have you been on lexapro now? maybe you just need a little more time.
Posted by Dinah on October 6, 2002, at 8:44:58
In reply to Re: A SINGLE CUP OF COFFEE, posted by jflange on October 5, 2002, at 20:46:08
I never use it when I'm in the more energetic phases of my mood cycles - avoid it like the plague. But when I'm on the sleep all the time phases I consume it like crazy.
Given its definite effects on my mood, I treat it like I would any psychotropic drug. I think sometimes we underestimate the effects of things that don't require a prescription.
Posted by Cindylou on October 6, 2002, at 13:22:38
In reply to A SINGLE CUP OF COFFEE, posted by shakingoscar on October 5, 2002, at 6:03:27
Hi all,
Thanks for those of you who responded to my question about Lexapro causing agitation. I wanted to add that the day after I took my 5 mg. dose, I was so exhausted I could barely function, and needed to sleep 2 hours in the afternoon. Also, my ears were ringing very loudly!The agitation I am talking about is extreme irritability, more than restlessness.
I did not take Lexapro again after that bout of fatigue, and I'm waiting until tomorrow to try again at 2.5 mg. Any thoughts on this?
Thanks again, pharmrep and others ...
cindy
Posted by pharmrep on October 6, 2002, at 13:58:26
In reply to Lexapro -- Agitation, then fatigue!?, posted by Cindylou on October 6, 2002, at 13:22:38
> Hi all,
> Thanks for those of you who responded to my question about Lexapro causing agitation. I wanted to add that the day after I took my 5 mg. dose, I was so exhausted I could barely function, and needed to sleep 2 hours in the afternoon. Also, my ears were ringing very loudly!
>
> The agitation I am talking about is extreme irritability, more than restlessness.
>
> I did not take Lexapro again after that bout of fatigue, and I'm waiting until tomorrow to try again at 2.5 mg. Any thoughts on this?
>
> Thanks again, pharmrep and others ...
> cindy***** I asked my dr's about the items I see here, and what they are hearing....it is common for any new drug in the body to create"reactions" like what has been mentioned in nearly all these posts. (especially antidepressants). They often last for a couple of weeks...even 1 month and longer....for lexapro, I have seen posts that say a few days or so...then mostly gone by one week, my doctors are seeing similar results....for those on multiple AD-type meds, maybe a little longer. I would suggest the 5mg again... so as to get some of the effect you are looking for, then see how you are doing in 1 wk...at 2.5mg, you probably wont see the effect, and might need to go higher which will start your timetable all over again. (did you take in morning?..if you didnt, try that) keep us posted...good luck
Posted by Ippopo on October 6, 2002, at 15:50:07
In reply to Re: Lexapro -- Agitation, then fatigue!?/bottom » Cindylou, posted by pharmrep on October 6, 2002, at 13:58:26
> > Hi all,
> > Thanks for those of you who responded to my question about Lexapro causing agitation. I wanted to add that the day after I took my 5 mg. dose, I was so exhausted I could barely function, and needed to sleep 2 hours in the afternoon. Also, my ears were ringing very loudly!
> >
> > The agitation I am talking about is extreme irritability, more than restlessness.> >
> > I did not take Lexapro again after that bout of fatigue, and I'm waiting until tomorrow to try again at 2.5 mg. Any thoughts on this?
> >
> > Thanks again, pharmrep and others ...
> > cindy
>
> ***** I asked my dr's about the items I see here, and what they are hearing....it is common for any new drug in the body to create"reactions" like what has been mentioned in nearly all these posts. (especially antidepressants). They often last for a couple of weeks...even 1 month and longer....for lexapro, I have seen posts that say a few days or so...then mostly gone by one week, my doctors are seeing similar results....for those on multiple AD-type meds, maybe a little longer. I would suggest the 5mg again... so as to get some of the effect you are looking for, then see how you are doing in 1 wk...at 2.5mg, you probably wont see the effect, and might need to go higher which will start your timetable all over again. (did you take in morning?..if you didnt, try that) keep us posted...good luckI'm Having a hard time adjusting to Lexapro(10mg) and Adderall(10mg). It's been about 3wks now. Wait... I think it might be about 2.5wks... Anyway, I'm really spacy and sleeping lots. I sleep like a log for 8 hrs. Before with a 3 wk run of effexor xr and adderall, and before that for 2yrs with Zoloft and Welbutrin. I was sleeping about 5hrs a night.
I've taken Lexapro at night(10.5pm) and Adderall twice a day(9am and noon). If I take the second adderall too late in the day(after 2.5pm) I won't fall asleep until 3am. Today I took Lexapro when I awoke. I have no idea if it's making me sleepy of keeping me awake at night
The first few days I was so tired. My moods are still swinging but not as bad as before.
Is this the med type you think may take a few more weeks to adjust?
My Dr just keeps saying give it time.
Posted by pharmrep on October 6, 2002, at 16:24:28
In reply to Re: Lexapro -- Agitation, then fatigue!?/bottom » pharmrep, posted by Ippopo on October 6, 2002, at 15:50:07
> > ***** I asked my dr's about the items I see here, and what they are hearing....it is common for any new drug in the body to create"reactions" like what has been mentioned in nearly all these posts. (especially antidepressants). They often last for a couple of weeks...even 1 month and longer....for lexapro, I have seen posts that say a few days or so...then mostly gone by one week, my doctors are seeing similar results....for those on multiple AD-type meds, maybe a little longer. I would suggest the 5mg again... so as to get some of the effect you are looking for, then see how you are doing in 1 wk...at 2.5mg, you probably wont see the effect, and might need to go higher which will start your timetable all over again. (did you take in morning?..if you didnt, try that) keep us posted...good luck
>
> I'm Having a hard time adjusting to Lexapro(10mg) and Adderall(10mg). It's been about 3wks now. Wait... I think it might be about 2.5wks... Anyway, I'm really spacy and sleeping lots. I sleep like a log for 8 hrs. Before with a 3 wk run of effexor xr and adderall, and before that for 2yrs with Zoloft and Welbutrin. I was sleeping about 5hrs a night.
> I've taken Lexapro at night(10.5pm) and Adderall twice a day(9am and noon). If I take the second adderall too late in the day(after 2.5pm) I won't fall asleep until 3am. Today I took Lexapro when I awoke. I have no idea if it's making me sleepy of keeping me awake at night
> The first few days I was so tired. My moods are still swinging but not as bad as before.
> Is this the med type you think may take a few more weeks to adjust?
> My Dr just keeps saying give it time.
>
** I agree w/ your Dr...it seems the more meds a person is on, the longer it can take to start working and stabilize in your body...lexapro isnt supposed to make you tired, but you could be in the minority. Im not sure how the adderal is affecting the picture, if I can find out I will post info...good luck, and keep us posted.
Posted by shakingoscar on October 7, 2002, at 1:26:22
In reply to Re: A SINGLE CUP OF COFFEE, posted by Phil on October 5, 2002, at 21:05:55
Thanks everyone for your posts. I know it is anxiety and no matter what meds Im on, the coffee always causes bad reactions in me.
I take the trazodone to help me sleep. 150mg at night. This is my regimen of pills (its mad!)
trazodone 150mg at night
buspar 40mg - 20mg in morning, 20mg at night (helps with sexual side effects of ssris)
lexapro 10mg dailyI love coffee though, and hate not being able to drink it as much as I would like.
Oh well.
Posted by shakingoscar on October 7, 2002, at 1:27:59
In reply to Re: CUP OF COFFEE/bottom » shakingoscar, posted by pharmrep on October 5, 2002, at 21:19:52
Ive been on meds for two years and lexapro for about 4/5 weeks now... I am just getting used to the lower doseage (down from 30mg to 10mg).
No matter what meds I take, coffee always makes me ill (never used to do that!).
Cheers
Posted by Alice Anne on October 7, 2002, at 11:40:52
In reply to Re: A SINGLE CUP OF COFFEE, posted by shakingoscar on October 7, 2002, at 1:26:22
I took a Trazadone (50mgs) the other night to help me sleep-- it was the following day that I had really severe muscle tension, jaw clenching and felt like I had to keep shaking my legs. Haven't taken it since and I haven't had those symptoms again. Regarding Lexapro--I'm still waiting to wake up in the morning without feelings of sadness and dread. Yesterday I just felt spacey and weird, but I'm having to deal with a lot of difficult situations right now. Don't know what's what.
Posted by maririp on October 7, 2002, at 11:47:47
In reply to Trazadone/Lexapro?, posted by Alice Anne on October 7, 2002, at 11:40:52
Alice Anne ..hi alice..how long have you been on lexapro? the first few days i woke up sad too and it upset me ..i felt worse...but after 4-5 days i woke up feeling happy..no feelings of saddness or dread..keep with it
Posted by hawkeye on October 7, 2002, at 12:04:28
In reply to Re: Lexapro is much better than Celexa! *read!*, posted by shakingoscar on October 5, 2002, at 5:13:37
I had reported earlier that while 10mgs/day of Lex was working very well for my depression, it was also causing for me total sexual dysfunction.
I cut back to 5mgs/day and nearly all the sexual side affects went away.
I then returned to taking 10mgs again. I split the pill and take 5mgs, once in the AM and once in the PM. Under this regimen I am experiencing practically no sexual side effects.
Posted by Alice Anne on October 7, 2002, at 13:23:36
In reply to Re: Trazadone/Lexapro?, posted by maririp on October 7, 2002, at 11:47:47
Hi maririp, thanks for responding. I appreciate any encouragement and I'm trying to stay hopeful. I've been on 10mgs. Lexapro for about 11 days now. I don't expect all the sadness, anxiety and dread to magically disappear, but it has interfered so greatly in my life that to have any of it alleviate would be such a blessing. I'm going to try to give it a month. How long have you been taking it? Had you tried other meds before? Thanks again.
Posted by maririp on October 7, 2002, at 14:25:23
In reply to Re: Trazadone/Lexapro?, posted by Alice Anne on October 7, 2002, at 13:23:36
Alice Anne hi...I have been on 10 mg of lexapro for a little over two weeks..the first few days were difficult...yes i have tried almost every meds you could think of..but havent been on may for the last 3 years until recently. I have tried paxil (no orgasms..night sweats) zoloft which made me very sick..tofrinal..remereron..gained too much weight..and prozac..helps allot but most antidepressants ruin orgasms..or mine anyway. Lexapro...too soon for me to really tell on the sexual side effects. Out of all the ones i have taken i like lexapro the best..so far the side effects have been minimal..but like you i did notice the first several days a feeling of waking up with great saddness. Everyone is different..my saddness went completely away in about a week...how long have you been on lex? I also dont take anything other than that on a daily basis.
Posted by CarolinaGirl on October 7, 2002, at 15:46:20
In reply to Re: Anyone switched to Lexapro? « ggrrl, posted by CarolinaGirl on September 25, 2002, at 15:21:26
I have now been on lexapro for three weeks. (5mgs)
This dosage makes me drowsy. Tomorrow I go to see my doc and she will increase it to 10 mgs.
I am still going to sleep without taking ambien, so it is really helping the insomnia. I feel a little less anxious.....there is still room for improvement though. No nausea. This is the first
antidepressant I have been able take. I don't hate it! I do wonder about lexapro interacting with my toprol (for blood pressure). The doc didn't mention there could be an interaction. Found a website that mentioned it. Anybody here know anything about it....also mentioned that lexapro could lower your heart rate.
Posted by pharmrep on October 7, 2002, at 19:37:09
In reply to Re: Anyone switched to Lexapro? « ggrrl, posted by CarolinaGirl on October 7, 2002, at 15:46:20
> I have now been on lexapro for three weeks. (5mgs)
> This dosage makes me drowsy. Tomorrow I go to see my doc and she will increase it to 10 mgs.
> I am still going to sleep without taking ambien, so it is really helping the insomnia. I feel a little less anxious.....there is still room for improvement though. No nausea. This is the first
> antidepressant I have been able take. I don't hate it! I do wonder about lexapro interacting with my toprol (for blood pressure). The doc didn't mention there could be an interaction. Found a website that mentioned it. Anybody here know anything about it....also mentioned that lexapro could lower your heart rate.** no...your heart rate/blood pressure shouldn't change...no lexapro will not interact with your medications. The drug to drug interaction profile for lexapro is awesome...the p450 system has 0 interactions. Celexa is very mild in only 2 of the 5 major pathways in the liver, zoloft is mild to moderate in all of the pathways, and both paxil and prozac are moderate to severe in the p450 system (very likely to interact with other meds).
Posted by jane d on October 7, 2002, at 23:14:02
In reply to Re: drug to drug interactions/bottom » CarolinaGirl, posted by pharmrep on October 7, 2002, at 19:37:09
> > I have now been on lexapro for three weeks. (5mgs)
> > This dosage makes me drowsy. Tomorrow I go to see my doc and she will increase it to 10 mgs.
> > I am still going to sleep without taking ambien, so it is really helping the insomnia. I feel a little less anxious.....there is still room for improvement though. No nausea. This is the first
> > antidepressant I have been able take. I don't hate it! I do wonder about lexapro interacting with my toprol (for blood pressure). The doc didn't mention there could be an interaction. Found a website that mentioned it. Anybody here know anything about it....also mentioned that lexapro could lower your heart rate.
>
> ** no...your heart rate/blood pressure shouldn't change...no lexapro will not interact with your medications. The drug to drug interaction profile for lexapro is awesome...the p450 system has 0 interactions. Celexa is very mild in only 2 of the 5 major pathways in the liver, zoloft is mild to moderate in all of the pathways, and both paxil and prozac are moderate to severe in the p450 system (very likely to interact with other meds).Pharmrep -
Are you aware that Lexapro's own prescribing information describes an interaction between Toprol and Lexapro? It may or may not be significant but I don't think it is appropriate for you to say or imply that it doesn't exist. I think you are misinterpreting the standard Lexapro advertising argument that it interacts with fewer other medications than do the other SSRI's to mean that it doesn't interact at all. That's a potentially dangerous misunderstanding.Jane
Posted by JLM on October 8, 2002, at 0:31:31
In reply to Re: Lexapro Toprol interaction - there may be one » pharmrep, posted by jane d on October 7, 2002, at 23:14:02
> > > I have now been on lexapro for three weeks. (5mgs)
> > > This dosage makes me drowsy. Tomorrow I go to see my doc and she will increase it to 10 mgs.
> > > I am still going to sleep without taking ambien, so it is really helping the insomnia. I feel a little less anxious.....there is still room for improvement though. No nausea. This is the first
> > > antidepressant I have been able take. I don't hate it! I do wonder about lexapro interacting with my toprol (for blood pressure). The doc didn't mention there could be an interaction. Found a website that mentioned it. Anybody here know anything about it....also mentioned that lexapro could lower your heart rate.
> >
> > ** no...your heart rate/blood pressure shouldn't change...no lexapro will not interact with your medications. The drug to drug interaction profile for lexapro is awesome...the p450 system has 0 interactions. Celexa is very mild in only 2 of the 5 major pathways in the liver, zoloft is mild to moderate in all of the pathways, and both paxil and prozac are moderate to severe in the p450 system (very likely to interact with other meds).
>
> Pharmrep -
> Are you aware that Lexapro's own prescribing information describes an interaction between Toprol and Lexapro? It may or may not be significant but I don't think it is appropriate for you to say or imply that it doesn't exist. I think you are misinterpreting the standard Lexapro advertising argument that it interacts with fewer other medications than do the other SSRI's to mean that it doesn't interact at all. That's a potentially dangerous misunderstanding.
>
> JaneIts my understanding that beta blockers may have an effect on 5HT, I think acting as an agonist. There has been some stuff published about beta blocker potientiation of SSRI's. I believe it was done by Ivan Goldberg.
Here's this too re: pindolol a common beta blocker:
"Thirty to forty per cent of patients will not respond to their initial antidepressant treatment. The augmentation of antidepressants is an important strategy for these treatment resistant patients (Thase & Rush, 1995). A new augmentation strategy, the use of pindolol, has been reported to potentiate the clinical effects of the selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors by enhancing serotonin function (Artigas et al, 1994, Blier & Bergeron, 1995). Pindolol, a known beta blocker, also blocks 5-HT1A receptors, thereby increasing the available amount of serotonin in the synaptic cleft (by preventing autoreceptor inhibitory regulation) (Hjorth & Auerbach, 1994).
There is also evidence of a role for serotonin in aggression (Mann, 1995). Perturbations in serotonergic system may exacerbate irritability and possibly trigger violent behavior. This could be a shortcoming of pindolol augmentation of SSRIs. We report a case of a patient who had an unexpected worsening of irritability after receiving pindolol to augment sertraline antidepressant action.
Case report
A 26-year-old male with a long history of dysthymic disorder presented for treatment after months of worsening of depressive symptoms (insomnia, anhedonia, irritability, poor concentration, low energy, and suicidal ideation), consistent with the diagnosis of major depression, -moderate. He also described episodes of physical aggression towards his spouse with increased irritability leading to violence. He was very regretful of his aggressive behavior, and reported a relation between irritability and proneness to violence. Despite the occurrence of violent behavior, the patient did not fill criteria for antisocial personality disorder. There was no evidence of alcohol or substance abuse during the treatment.
The patient was begun on sertraline 50mg/day and trazodone 50mg at bedtime with disappearance of irritability, partial improvement of insomnia and energy level, but persistence of sadness and anhedonia. A sertraline blood level was 17ng/ml (normal range 10-100ng/ml for our laboratory) after three weeks. His sertraline dose was increased to 150mg/day and trazodone was increased to 150mg/night in the following two weeks without improvement of sadness, anhedonia or residual insomnia. The patient developed anorgasmia. His sertraline dose was then decreased over one week to 50mg/day. There were no complaints of irritability, but patient still reported some anxiety and had transient withdrawal symptoms (mainly a flu-like syndrome for two days) during the one-week taper of sertraline from 150mg/day to 50mg/day.
At that point the patient was started on pindolol 5 mg twice a day (in addition to 50mg/day of sertraline). The patient reported an exacerbation of irritability and anxiety after two days, but no worsening of sadness, loss of concentration, decrease of energy, appetite or sleep. He missed work for the first time in two months and asked his spouse to leave him alone because he was afraid of becoming violent. Pindolol was discontinued at the end of the second day. Resolution of the irritability and anxiety occurred within 24 hours. On 50mg/day of sertraline there was no further irritability. The patient remained on 150mg/day of trazodone throughout these events.
Discussion
Our patient’s irritability was stable for two months on sertraline prior to the addition of pindolol. As a result of the augmentation, there was an unexpected exacerbation of irritability and anxiety. Despite the good results of Artigas et al. and Blier & Bergeron, increasing irritability was one of the reported shortcomings of this treatment. In our patient increased irritability occurred soon after adding pindolol (to sertraline and trazodone) and rapidly dissipated after pindolol was discontinued. He did not report worsening of sadness or other depressive symptoms. This strongly implies that in this patient augmentation with pindolol was associated with increased irritability without affecting antidepressive activity. We hypothesize that pindolol’s role in changing the serotonergic system caused this occurrence.
The complexity of the serotonergic system precludes an easy explanation of these phenomena. In a recent review of the neurobiology of violence, Mann (1995) pointed at the inverse relation between CSF 5-HIAA and irritability and aggression. This implies decreases in serotonergic function may relate to irritability. This contradicts the association between irritability/aggressiveness and pindolol augmentation in our patient (which implies increased serotonergic function). We currently know of a multitude of serotonergic receptor subtypes. These subtypes likely correspond to different systems. Our patient was also receiving trazodone, which blocks 5-HT2 receptors. Trazodone inhibits serotonin reuptake and may have a serotonomimetic action through its major metabolite, m-chlorophenylpiperazine (m-CPP) and we could not rule out a putative fluctuation on anxiety and irritability due to the interaction of pindolol and trazodone (Hyman et al, 1996). Therefore, augmentation with pindolol altered the function of the serotonergic system in a complicated way and it is unlikely that simple increases or decreases of the serotonergic neurotransmitter system adequately explain these phenomena. We agree with Coplan et al. (1995) that dysfunction of interdependent 5-HT pathways, possibly secondary to pathological receptor sensitivities, might account for disparate aggressiveness, anxiety and mood effects of 5-HT related compounds."
Pharmrep, with all due respect, to say that the drug to drug interaction profile is 'awesome' is grossly premature. The drug hasn't been in use in cliniical practice for long enough to say that with any degree of certainty, regardless of what the studies might have shown.
I'd like to ask you, how many TOTAL studies were done for Lex, and how many showed no improvement over placebo, out of that total amount?
Posted by pharmrep on October 8, 2002, at 0:43:06
In reply to Re: Lexapro Toprol interaction - there may be one » pharmrep, posted by jane d on October 7, 2002, at 23:14:02
> > > I have now been on lexapro for three weeks. (5mgs)
> > > This dosage makes me drowsy. Tomorrow I go to see my doc and she will increase it to 10 mgs.
> > > I am still going to sleep without taking ambien, so it is really helping the insomnia. I feel a little less anxious.....there is still room for improvement though. No nausea. This is the first
> > > antidepressant I have been able take. I don't hate it! I do wonder about lexapro interacting with my toprol (for blood pressure). The doc didn't mention there could be an interaction. Found a website that mentioned it. Anybody here know anything about it....also mentioned that lexapro could lower your heart rate.
> >
> > ** no...your heart rate/blood pressure shouldn't change...no lexapro will not interact with your medications. The drug to drug interaction profile for lexapro is awesome...the p450 system has 0 interactions. Celexa is very mild in only 2 of the 5 major pathways in the liver, zoloft is mild to moderate in all of the pathways, and both paxil and prozac are moderate to severe in the p450 system (very likely to interact with other meds).
>
> Pharmrep -
> Are you aware that Lexapro's own prescribing information describes an interaction between Toprol and Lexapro? It may or may not be significant but I don't think it is appropriate for you to say or imply that it doesn't exist. I think you are misinterpreting the standard Lexapro advertising argument that it interacts with fewer other medications than do the other SSRI's to mean that it doesn't interact at all. That's a potentially dangerous misunderstanding.
>
> Jane
**** I stand by my last note...I am not referring to ssri's, I am referring to the Greenblatt study presented at the Society of Biological Psychiatry Annual Meeting May 2001 (New Orleans, La) that shows how Lexapro metabolizes (with very very little inhibitory effects in the p450system.)
Did you read the Package Insert? it states "coadministration of lexapro and metoprol had no clinically significant effects on blood pressure or heart rate." Under the "drug interactions" section...10+ "common" meds are mentioned to show that they were specifically looked at...and none of them had "interactions." So what are you referring too?
Posted by pharmrep on October 8, 2002, at 0:51:44
In reply to Re: Lexapro Toprol interaction - there may be one » jane d, posted by JLM on October 8, 2002, at 0:31:31
> I'd like to ask you, how many TOTAL studies were done for Lex, and how many showed no improvement over placebo, out of that total amount?
>
**** I love your input as well as others, but dont make them so long...my eyes hurt. I have seen 9 full studies for Lexapro so far, and only posters/brief abstracts for 2 more...all of them have "positive" results, showing a statistically significant separation from placebo....I bet I know why you're asking....it's never been done before...there's usually at least 1 "negative" study, but so far lexapro has none.
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
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