Dex + Pristiq (SNRI) and Klonopin

[Yellow]

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

[fxfake]

Originally Posted by Yellow

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 (unlikely). Don't drink booze. Don't drink/eat too much grapefruit. You might want to avoid Tagamet (cimetidine).

[Yellow]

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

[Scarletta]

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.

[Yellow]

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.

[Yellow]

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.

[Scarletta]

http://www.pubmedcentral.nih.gov/art...id=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.

[Yellow]

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?

[Scarletta]

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_st...th_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.

[bobC]

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

[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

[Scarletta]

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.

[Yellow]

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

[Scarletta]

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

[Yellow]

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