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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by lizbeth on April 30, 2002, at 14:29:24
Hello,
I've been diagnosed BPII since March 2001. Was maintained on 625 of Depakote Sprinkle (regular Depakote had too many GI side effects). with 20-30 mg. of Prozac since then (concomitant depression). Am seeing a psychopharmacologist who I trust and who's been a good partner in making adjustments.
I decided to explore other anticonvulsants as I believe the Depakote was blunting me too much cognitively at work. I started Trileptal, the newer version of Tegretol, 7 days ago (no washout on Depakote). My prescription is 450, 300 at night, 150 in morning.
I had fairly significant side effects at the 450 mg. dose. I've done some research and it seems that Prozac raises the blood level of carbemapezine (tegretol) and I would intuit, Trileptal. I've been best when I skipped a day on the Prozac. I've gone down as low as 150 on the Trileptal last night but as soon as I took 30 mg. of Prozac this morning, the dizziness and yuckiness took over.
I want to give the Trileptal a chance, already feeling clearer cognitively, even with all the side effects. My fiance thinks I should try taking the Prozac at night. I'm going to try stopping the Prozac for a few days and see if I'm better. I'm open to staying with Trileptal and looking for a new AD if necessary (or maybe just Trileptal at 450 will be enough?). Effexor XR has worked o.k. for me in the past.
Compounding things, I think I may be one of those "poor metabolizers" with a funky P450 system because it always seems like need lower doses with meds that hit that site. Also on Claritin, Protonix (for heartburn), Singulair and Advair 250/50 (Asthma).
Thanks in advance for any insight.
Lizbeth
Posted by Elizabeth on May 3, 2002, at 2:41:02
In reply to Trileptal-Prozac Interaction? Cam--any insight?, posted by lizbeth on April 30, 2002, at 14:29:24
Hi. I take Trileptal (600 mg in the morning and at bedtime). It's a different drug than Tegretol, not just a new version of the same drug. It lacks many of the side effects and interactions that are common with Tegretol. Although it does still interact with some things (notably, birth control pills), I don't know of any reason why it should interact with Prozac. The manufacturers' monographs for Prozac and Trileptal don't mention any interaction, either.
> Compounding things, I think I may be one of those "poor metabolizers" with a funky P450 system because it always seems like need lower doses with meds that hit that site.
That shouldn't matter if you're taking Prozac. (The metabolic quirk you're referring to is a deficiency -- genetically inherited -- in the cytochrome enzyme P450 2D6, which is inhibited by Prozac anyway.)
-elizabeth
Posted by lizbeth on May 5, 2002, at 9:45:08
In reply to Re: Trileptal-Prozac Interaction? » lizbeth, posted by Elizabeth on May 3, 2002, at 2:41:02
Thanks Elizabeth for your reply--that was very nice of you to take the time to read the Product Insert.
I'm an Elizabeth too, had to find a different board name because you beat me to it :)
For whatever reason, the Prozac seems to interact with the Trileptal for me!!! I did some experiments last week, and even adding 10 mg of the Prozac would induce some pretty bad headaches, naseua, etc.
Of course, without the Prozac in my system I got depressed, so going in to see doc this week. It'll either be Zoloft or Effexor XR.
If you don't mind me asking, are you BiPolar? If so, I or II? Do you taking any other psychotropic drugs? There's been some controversy (namely, at psycheducation.org) about whether BPII's who have depression as well should be taking AD's. I go back and forth--I understand their logic, but I'm rapid cycling mixed episode and have never hit true "mania", so not concerned with switching per se. I'm always switching!!!
Anyway, thanks again!!
Elizabeth
Posted by Elizabeth on May 6, 2002, at 23:31:48
In reply to Thanks Elizabeth!, posted by lizbeth on May 5, 2002, at 9:45:08
> Thanks Elizabeth for your reply--that was very nice of you to take the time to read the Product Insert.
Not at all -- I read up on the stuff before I started taking it. It was kind of new at the time, and I wanted to know how it differs from Tegretol.
> I'm an Elizabeth too, had to find a different board name because you beat me to it :)
Yes, it's a good thing for me that I got here early on; there have been a few other Elizabeths on PB since I've been around who could have laid claim to the name if I hadn't already got it. (I seem to recall that one of them chose a confusing handle -- maybe it was "elizabeth," in all-lowercase?)
> For whatever reason, the Prozac seems to interact with the Trileptal for me!!! I did some experiments last week, and even adding 10 mg of the Prozac would induce some pretty bad headaches, naseua, etc.
Had you ever tried taking the same amount of Prozac (10 mg more than what you're taking now, that is) *without* the Trileptal?
> Of course, without the Prozac in my system I got depressed, so going in to see doc this week. It'll either be Zoloft or Effexor XR.
Good luck with whichever you choose.
> If you don't mind me asking, are you BiPolar?
No, I'm not. I take the Trileptal for seizure prophylaxis.
It's true that some bipolar people can't take antidepressants, but others need them and can use them safely as long as they have adequate mood stabilization too.
> Do you taking any other psychotropic drugs?
Effexor XR 375 mg/day; Buprenex 0.3 mg (1 mL) thrice a day; and Ambien and Xanax as-needed.
> There's been some controversy (namely, at psycheducation.org) about whether BPII's who have depression as well should be taking AD's.
By definition, bipolar II disorder includes major depression. But anyway, like I said, this is an individual thing. You just have to find out what works for you. In general, if the bipolar diagnosis is pretty well established, you want to get the mania/cycling under control with mood stabilizers before you start adding antidepressants. Some bipolar people find that mood stabilizers alone are enough to control both the [hypo]manic and depressed phases, but others really need an antidepressant too.
> I go back and forth--I understand their logic, but I'm rapid cycling mixed episode and have never hit true "mania", so not concerned with switching per se. I'm always switching!!!
Mixed states and rapid-cycling can be more dangerous than straight mania or hypomania; I seem to recall reading somewhere that mixed episodes are supposed to be predictive of suicide attempts, for example. It's important to get that stuff under control.
best,
-elizabeth
Posted by KarenRB53 on November 24, 2008, at 21:25:05
In reply to Trileptal-Prozac Interaction? Cam--any insight?, posted by lizbeth on April 30, 2002, at 14:29:24
> Hello,
>
> I've been diagnosed BPII since March 2001. Was maintained on 625 of Depakote Sprinkle (regular Depakote had too many GI side effects). with 20-30 mg. of Prozac since then (concomitant depression). Am seeing a psychopharmacologist who I trust and who's been a good partner in making adjustments.
>
> I decided to explore other anticonvulsants as I believe the Depakote was blunting me too much cognitively at work. I started Trileptal, the newer version of Tegretol, 7 days ago (no washout on Depakote). My prescription is 450, 300 at night, 150 in morning.
>
> I had fairly significant side effects at the 450 mg. dose. I've done some research and it seems that Prozac raises the blood level of carbemapezine (tegretol) and I would intuit, Trileptal. I've been best when I skipped a day on the Prozac. I've gone down as low as 150 on the Trileptal last night but as soon as I took 30 mg. of Prozac this morning, the dizziness and yuckiness took over.
>
> I want to give the Trileptal a chance, already feeling clearer cognitively, even with all the side effects. My fiance thinks I should try taking the Prozac at night. I'm going to try stopping the Prozac for a few days and see if I'm better. I'm open to staying with Trileptal and looking for a new AD if necessary (or maybe just Trileptal at 450 will be enough?). Effexor XR has worked o.k. for me in the past.
>
> Compounding things, I think I may be one of those "poor metabolizers" with a funky P450 system because it always seems like need lower doses with meds that hit that site. Also on Claritin, Protonix (for heartburn), Singulair and Advair 250/50 (Asthma).
>
> Thanks in advance for any insight.
> Lizbeth
>
>
Hi: Just found this posting and hope you read this. I'm thinking of using the Trileptal with Prozac and wondering if you were able to stay on the combination or did you have to switch to another antidepressant?Thanks, Karen
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