I am prescribed the SNRI Pristiq and klonopin.

I used to take Dextrostat and I would like to go back on it, especially now that my anxiety, depression, and mostly all other symptoms aside from ADHD are now under adequate control.

Pristiq is very new, and I do not know of many people taking it with any Dextroamphetamine. Actually, I have read two posts of people using Dexedrine with Effexor, which is a similar SNRI, and that is working well for them.

I dont see any serious interaction problems. If I take a dose of 20mg of Dex (1-2 times a day 4-6 hours apart) + 50 mg of Pristiq (+and small amount of klonopin maybe .5 - 1mg), does anyone see anything wrong with this?

Does anyone have any input in general? Thanks

I dont see any serious interaction problems. If I take a dose of 20mg of Dex (1-2 times a day 4-6 hours apart) + 50 mg of Pristiq (+and small amount of klonopin maybe .5 - 1mg), does anyone see anything wrong with this?

The important question is, does your doctor (same for all 3 drugs, right?) see anything wrong with this? How about your pharmacist (you can always ask)?

Otherwise, seems fine (but don't trust me, though I'm on both dex and klon).

Don't stop klonopin or Pristiq cold turkey. Watch out for signs of Serotonin Syndrome (http://en.wikipedia.org/wiki/Serotonin_syndrome) (unlikely). Don't drink booze. Don't drink/eat too much grapefruit. You might want to avoid Tagamet (cimetidine).

my doctor whos giving me the pristiq and klonopin said she would consider letting me go back on dex.

my question was basically if SNRI's would be a reason for her to say no to dex?

i dont want adderrall, or anything else really

In my mind, yes. I was on both Effexor (SNRI) and Adderall for awhile and a toxicity built up in my system. It was only later in a medical journal that I read something like "it is well known the Effexor and Amphetamine are contraindicated." Something like the Effexor blocks the clearance of noradrenaline out of your system, it's an inhibitor of CYP 2D6, I believe, which is the enzyme that breaks down amphetamine.

I also had a bad experience on Adderall plus Wellbutrin. Again, basically the same thing. Wellbutrin is primarily dopaminergic but also blocks reuptake of noradrenaline. It was just too much flooding of these chemicals into my brain.

Of course my doctor did not mention anything about how either of these two antidepressants might work with Adderall.

Check with your doctor but do some research yourself. Is there any reason you can't go on an SSRI instead? I'm on Lexapro now, with Adderall and Klonopin, and there's no problems.

SSRI's dont really work for me, nor really my father. He's on Wellbutrin. I don't like its effects and it wasn't for me. I did not recently try any SSRI's, but I have tried celex, prozac (or paxil, the p's get me confused), and zoloft, for about a month+ each time, and didn't feel any changes at all.

Pristiq was almost instantaneous, effects took place by the third day, and I am nearly totally adjusted with it at 50mg (and luckily no titration needed which means this is my therapeutic dose) so since this is really working out, and im hardly using my klonopin, i dont want to risk losing this.

ive read a scientific journal articles that really support that SNRI's, and ive also read different reports that say SNRI's actually prevent toxicity from d-amphetamine. so what your saying i have seen as well.

but ill keep what you said in mind.

actually the SNRI prevents neurotoxicity from the amphetamine. the toxicity you are referring to may be from just amphetamine toxicity, maybe in the liver or kidneys, but as far as the brain goes, it would seem the SNRI would block negative effects of amphetamines on the brain. if you have any links to reports or journals, please let me read them because i would really like to know about any damage.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1448696#b43

The theory is that Effexor is a weak inhibitor of the enzyme CYP 2D6. That is the enzyme used to break down Amphetamine and clear it out of the brain. Combining the two could lead to toxic buildup of amphetamine, b/c it is not being broken down.

That's what they think happened to me.

But everybody's different as to what they can tolerate.

http://www.ncbi.nlm.nih.gov/pubmed/8846618

That is the link from your source. It says effexor is the least interactive, and i think pristiq being the active metabolite is supposed to have very little activity in the liver anyway. the brain, i dont know. it seems that there is little interaction, but your case is different....... in any case, i will see what she says.

thanks

btw did effexor help with dex comedowns/anxiety/crashes?

Here's an article, in the middle of it, it states:

"In summary, amphetamine definitely has been involved in deaths with MAOIs, and exhibits significant toxicity with venlafaxine (probably serotonin toxicity, as opposed to noradrenergic toxicity). "

Significant toxicity. That's something. MAy not affect everyone, but it did me.

http://www.psychotropical.com/CNS_stimulants_with_MAOIs.shtml

And no I"ve never really had an Adderall crash, Effexor did not help with any comedown.

I've also switched between Klonopin and Ativan over the years and if there is a "come down" needed those would be much better than Effexor.

Only a tiny fraction of amphetamine is metabolized. That drugs like ssri's prevent it may be a good thing to prevent the liver from breaking it down. Since amphetamine is a man made chemical + not in nature. Amphetamine is cleared out of the body via the kidneys and most of it is chemically unchanged in urine.

MAOI's are very different and are not usually combined with anything + a strict diet must be followed to avoid enzymes in food like cheese.

BobC

Some care should be taken when combining stimulants with SNRI's as increasing NE too much can cause fatigue/dry mouth/dry eyes and slowed digestion. However increasing Serotonin actually counters the slowing of digestion.

BobC

If you read the article, they were talking primarily about MAOIs but they also stated specifically that there was a known interaction between amphetamine and venlafaxine.

Scarletta is right. I have seen exactly that issue with Effexor and amphetamine, the possibility of serotonin syndrome. But that same risk exists with SSRi's too, so i think each person has to find out, if thats the route you choose to take i guess. Thank you though again.

And specifically, the desvenlafaxine is already metabolized, and the side effects are supposed to be greatly reduced.

as for what bob says, i think i read that pristiq is actually a more potent NRI than effexor is, so i dont know if that poses any problem. like i said scarletta had bad experience with it, b ut others on other boards have said they not only had good experience, but the effexor eased anxiety and definitely dulled the crash. i dont know, about scarletta, she doesnt seem to have that problem, but dex can leave me (and others) feelin a little less than great when it wears off. ( and klonopin is known to help)

i saw my doc today and she said she wanted to give it some more time, she doesnt really know if she agrees with my previous doctors diagnosis. so she wants to see if my inability to focus, concentrate, sit still for too long, fidgeting or fatigue from trying to sit still (like it takes more energy to focus to do a task than it does to do the task), have to do with anxiety and not adhd, although ive exhibited add symptoms as a child as well, but never really stuck with any therapy. the dex helped with all of this, but also kinda of stabilized my mood and stopped my impulsivity.

so in the end, she doesnt have a problem with the combination, though i should look more into the serotonin syndrome risk. she just thinks i have anxiety issues that affect focus and concentration and wnats to see if that subsides in a month of bein on pristiq.

thing is though, ive been on it long enough where everything anxiety and depression related is almost in the background, but my concentration isnt helped.

i guess well see what happens first week of april, ill keep u updated.

in the meantime, if anyone has anymore info or experiences, please post. thanks

When did Pristiq come out and do you know its actual chemical name? I've never even heard of it.

desvenlafaxine - effexor after its been metabolized through the liver, may 2008. it is effexor's improved patent successor/extender

and in addition to extra NRI its supposed to be slightly DRI, not like wellbutrin, but it is supposed to be slight.

Did you ever take Effexor before? What is the difference?
I read that Pristiq is a form of a metabolite of Effexor.

its an improved and more effective "active metabolite" of effexor, it is made after effexor passes through your liver, but for some reason, it seems that it has less side effects, a lower therpeutic dosage range, and a higher receptor affinity rate.

i was thinking about wellbutrin+effexor, but thats almost the same as the dex.

if i take a high dosage of pristiq, perhaps it will be an SNDRI so it will be the same combo, and it might take care of everything.

when i go back to my psych, im gonna discuss if there are any high dose studies of pristiq, cuz effexor is used up to like 600mg or so but since pristiq is twice as potent, maybe i could reach SNDRI levels at 250mg or so.

so far everything is working allright tho

UPDATE:

I am still on 50mg pristiq, .5 mg klonopin as needed (which is usually only half a pill if any at all, so .25 mg every other day or so), and now I am on the generic dextroamphetamine.

The dr didnt have a problem with the combo, and SS was not even mentioned. I guess other people take effexor and dex as well...

The combination is actually quite perfect right now. I am not depressed as I used to be, I am calmer and less impulsive, I have focus and ability to concentrate, and I generally feel better about things, which is making me start to feel motivated. I am pleased so far and I thought I'd share this just in case anyone else is thinking about/taking this combo?

I started on Effexor 37.5 Went from dexedrine 10, to 20, and am now on 30. I'm happy with the dosage of dexedrine, I believe. I just went to 75 mg Effexor, because I still have motivation issues.

The current plan, I believe, is to see what the 75 mg Effexor does. Last time, it made me tired. I'm tired today, but I had a really stressful day. The 5% or less days are that stressful and depression, type day. I'm not making any judgments about my medications when I have reason to be upset. I took Effexor 75 yesterday and was alright.

On 37.5 and 30mg dexedrine, I was able to wake up, focus, and do thinks I enjoyed. My problem was I couldn't do things I "need to do" but "don't want to do." Currently adjusting Effexor to see what happens, there.

I am feeling pretty weird today, but I believe that's because I'm incredibly tired, physically, and the dexedrine is counteracting that. It's similar, but 1/10th as bad, as when I took rittalin. Then, I was tired as hell and completely unable to sleep. I imagine if you take dexedrine at the expense of sleeping it really screws you up. Although arguably, since I sleep so much, I am doing that - there is a balance.

Anyway, doctor didn't even mention anything special about the interaction of effexor and dexedrine, when he gave the prescription. I wouldn't worry too much about it. Just look for "any symptoms of poor health." You should always be on the lookout for symptoms regardless of whether you take medications or not. Things can happen.

I do have a habit of posting on message boards, or writing things, for long periods of time on dexedrine. Just gotta start applying that to reading books, I think.

Yeah, doing the "things i need but dont wanna" still isnt easy. No medicine will ever make a person want to do something they don't. However, it's easier...

My only problem really is dosing.

My doctor told me, since I was getting generic (barr) 10mg instead of brand names, that dosing may be an issue. as we know, generics often contain 20% less active ingredient and are also sometimes cheaply made.

for this reason, he initally recommended adderall, which i declined because of levoamphetamine anxiety. and then vyvanse, which i also thought wasn't in my best interest because of possible insomnia. sometimes, i dont need full day stimulation i dont think, but now im reconsidering the choice. he says vyvance is smoother and much easier to predict with dosing.

i hope its not because they are barr pills that the dosing isn't easy. im allowed 30mg a day, but sometimes its less and sometimes its more. i start with either 5mg or 10mg, and either stay or move up.

the worst side effect is sexual impotence at higher dosages, but this goes away when the amphetamine is out of my system.

Any suggestions on the dosing issue? Should I try vyvanse, because I obviously cannot get Shire Dextrostat since its not in production.

actually another side effect would be loose stool/borderline diareah, which Ive read Barr's are notrious for...

ive read the 5mg are better, maybe instead of 90 10mg pills, ill get 180 5mg pills?

Head felt funny, heart was racing, focus was off. Effexor was increased to 75 mg and dexedrine remained at 30. Going to the doctor, hopefully, tomorrow. Not talking any more Effexor at the moment. I've accidentally skipped pills before. Luckily, I'm usually alright.

As far as effexor reducing amphetmine metabolism. Amphetamine is not metabolized in any meaningful way. While the liver does convert a small amount of amphetamine into hydroxyamphetamine. Hydroxyamphetamine has the same effects as amphetamine on the body. Decreasing amphetamine metabolism has no effect on levels since amphetamine is removed via the kidney's.

However SNRI's and amphetamine both increase NE levels which are directly related to heart rate. Higher NE levels are associated with fatigue, drymouth, reduced circulation, anti-inflamation, and slowed digestion. NE also opens up the lungs and breathing is slowed. At normal levels I tend to notice perception/memory is improved. At above normal levels time seems to fly by. I tend to notice rapid heart rate, pupil constriction, and decreased productivity when my NE levels are too high.

BobC

thanks for the response

The pristiq actually is totally blocking SET/NET overstimulation that would naturally occur without them present, of course much slightly considering the dex is only 15mg.

There would be so many adrenal effects(NE Sfx: jittery, anxious) without the SNRI. I hardly touch my klonopin now. i have like a whole months supply left and im seeing my psych this week. of course, they are always great to have around just in case of emergencies.

anyway, the combination is perfect. there is neurotoxicty from the Dex because of the SNRI blocking any DA or NE from going to into the wrong MAO pumps (most likely), there are so many less NE side effects than without the SNRI (and virtually none whenever i take .25 to .5 mg of klonopin, forget about 1mg), and its working well.

only issue is dosing.....

i meant SNRI prevents NEUROTOXICITY FROM AMP

5mg barrs have eliminated most side effects btw

ok now that i am on 5mg pills, 15mg/2-3x a day....

everything is fine. no problems of any kind. if anyone needs any info or updates, ask, but i give this combo my seal of approval for this with

AD/HD+Depression+Anxiety+mood issues....its works for me when nothin else does

Yeah, doing the "things i need but dont wanna" still isnt easy. No medicine will ever make a person want to do something they don't.

There are plenty of meds that will make you do things that you previously did not want to do. The problem is that those things are not under the user's control :). For example, Mirapex can turn people who don't like to gamble into gambling addicts.

yeah man, but i dont wanna go there...mirapex's pharmacology sounds serious..more so than meth! id rather take desoxyn than mirapex.

but in regaurds to the quote, i meant, if i take my meds, id still rather NOT do my homework than something that interests me (hobbies, going out, etc...), however, I will not procrastinate and avoid doing them in lieu of having fun....you know what i mean? in other words, the meds help by getting me past the "no work zone" and getting into a total "Work zone" even if id rather be fishing as the saying goes. thats all.

I found out that the official govt prescribtion service for Australia had a newsletter in April saying Desvenlafaxine does not have any benefits above Effexor and has show that it causes more side effects! Also other research shows that it does indeed cause problems with Dexamphetamine - Serotonin Syndrome.

I was diagnosed ADHD (Inattentive) and immediately was to swap to Pristiq (strangley the Psych just happened to have a couple of sample boxes on the desk!!) at a lower dose for 1 week while I also started dexamphetamine The first two weeks I felt better than ever. Once the Pristiq full dose kicked in I started to go backwards and could have lost everything!

I'm trusting my instincts and the people who love me. I never benefitted from Effexor in the past so how could it help me now? I had ADHD, not depression!

Also, why do things just because others want you to? We are better able to succeed and be profitable when doing things that we enjoy, why not try to make things that you like, and are good at, profitable? That is what all good leaders like us do. Why be a sheep like everyone else on the way to the slaughterhouse.

didn't you just say that pristiq was helping you? How are you a sheep bro, you don't have to take it?

pristiq can be a good medication. it has its s/e's too, but especially with dexedrine it can be fatally dangerous.

Hi Emmanemm, are you finding things work better without the Pristiq?

I've also been put on the dexamphetamine (3 x 5mg/day) and Pristiq (150mg) combo for ADD Inattentive - it's been two weeks now and my mood is better, but attention/motivation is still bad.