GAD DISORDER

[dlcottage]

I was diagnosed 14 years ago with  GAD/pannik attacks .I was put on zoloft 50 mg and ativan .5 prn and inderal ..That was years ago . Went down on zoloft to 25 mg every the day i was still fine at this dose for like maybe 5 years or so now  The GAD is back since  Most recenty developed trigiminal neuralgia and was put on Tegretol 600 mg per day ..in november of 2007 to the present , I was started back on zoloft 50mg per day 18 days ago and i am so shakey and it has seemed to make me nauseas and no appetite and more anxiety attacks . one pharmecist told me that the zoloft is being metobolized faster by the tegretol than i am taking it is this true? I am confussed and why is zoloft acting this way never had a problem befor with zoloft is because of the combination with tegretol ? Any input wouldbe great .
Thanks

[RCA7591]

"one pharmecist told me that the zoloft is being metobolized faster by the tegretol than i am taking it is this true?"

^quote

Tegretol (Carbamazepine) is a CYP3A4 inducer (not an inhibitor). CYP3A4 is the liver enzyme pathway responsible for the metabolization of Tegretol.

Other drugs that are metabolized by CYP3A4 will either lead to an increased or decreased plasma level of Tegretol or vice-versa (ie: the plasma level of the drug in question may be increased or decreased).

In the case of SSRI's such as Paxil, Prozac, Lexapro, Zoloft, etc, the plasma level is decreased, as CYP3A4 metabolization of these drugs is accelerated in the presence of Tegretol. Likewise, the Tegretol plasma level is increased (which isn't good).

The concomitant use of the folowing drug classes with Tegretol is absolutely contraindicated:

(1) SSRI's
(2) Tricyclic Antidepressants
(3) Benzodiazepines (except Lorazepam)
(4) Macrolide Antibiotics
(5) Atypical Antipsychotics
(6) Calcium Channel Blockers
(7) Thiazide Diuretics

Would suggest speaking with the doctor about replacing the Zoloft with Ativan (Lorazepam) - 0.5 mg - 1 mg, t.i.d. Ativan has no bearing on the CYP3A4 or P-450 enzyme systems. Ativan is more specific for addressing your needs. Likewise, it complements Inderal nicely.

Would also recommend periodic blood counts and liver function testing while under Tegretol therapy. Bone marrow supression, while moderately rare, is a possible adverse effect of long-term treatment.

Cordially,

Ryan

[dlcottage]

Thank you for that info ..  I think im folloowing u  so it could be or is that the zoloft really isnt getting into my system ?  Also i  had gone to m reg gp she put me on lopressor as the beta blocker i had asked her why i could not go back on the inderal like many years ago which helped ,her reply was that lopressor does the same thing and is  a newer med ?   truly had very good luck with the inderal in the past i will keep pushing for this med.. So far 15 days on lopresser 25 mg once a day  is not helping with the anxiety at all .I do have apt next week with  physc.. Also it was advised by my gp to ask neuro about neurotin less side effects and goes with most meds would u concur with the neurotin vs tegretol?
Thanks so much rose

[RCA7591]

Rose,

My thought would be that the Zoloft is being rapidly metabolized, and as such, is predisposing you to adverse side effects. The Zoloft would peak rapidly in the blood with the concomitant use of Tegretol. This rapid spike (then trough) in the Zoloft plasma level could explain your symptoms (partially).

Metoprolol (Lopressor) is a cardio-selective beta-blocker, and affects only the beta receptor sites on the myocardium (heart). Propranolol (Inderal) affects all beta receptor sites, including those in the central nervous system. As such, Inderal is more effective for addressing the autonomic manifestations precipitated by anxiety (ie: tachycardia, numbness/tingling sensations, shortness of breath, dilated pupils, etc). Metoprolol is a poor choice for you in my opinion, since it only blocks the effects of Adrenaline on the heart. This is an advantage for folks with heart issues, but is a disadvantage for folks with anxiety. Demand Inderal. Short of having Asthma, there is no logical reason why your GP should not prescribe Inderal.

Neurontin has no useful benefit in the treatment of Trigeminal Neuralgia - Tegretol is the best choice for this condition. If you are experiencing anxiety with the Tegretol, you could ask about Baclofen or Ativan. Baclofen increases the efficacy of Tegretol in the treatment of Trigeminal Neuralgia, and also possesses some anti-anxiety qualities. If the Tegretol is working well for the Trigeminal Neuralgia, Ativan may be added for the anxiety component.

I'd inquire about the following:

(1) Replace the Lopressor with Inderal
(2) Discontinue the Zoloft due to interaction with Tegretol
(3) Substitute Ativan or Baclofen in place of the Zoloft
(4) Do not accept Neurontin, as it will not help your Trigeminal Neuralgia

Ryan

[dlcottage]

Hi ryan thanls for the input . Neuro Dr taking me off tegretol putting me on lyrica 75mg at bedtime . He is tappering me off tegretol as i have been on 600 mg since november . My diagnosis is PHN i never recvd the rash but i had burning stabbing pains in face after having a tooth pulled then 2 surgerys for neurcrotic bone take out .But had  herpes blood test recently  was positive that i have that virus in my system although not active at this time but might have been as i broke out in big canker sores in my mouth after dental work but was put on valtrex 1 gr 2x day but was given it to late virus already in my trigimnal nerve i think thats what they said . I also went to reg gp on weds i was put on diovan as i have high blood pressure and lisinprill was not doing it and also vytorin for choles. as Dr did not like my very high numbers .Since all this happened and then getting my  Gad Back again i have lost 46 lbs because of the nausea .Went to gastro this week as well he feels it might be the tegretol that could be causing the nausea with the zoloft does not mix . But i will still be going to phsyc on monday .Thank you for your input u helped me so much ..

[dlcottage]

hi Ryan can i have your input again please? Went to neuro he took me off tegretol put me on lyrica 50mg 1x a day. he now said that he thinks i have PHN affecting the trigiminal nerves not typical trigiminal neuralgia  as  blood test confirmd herpes zozter but not active  he ordered this test because i broke out in canker sores after each dental surgery i had  in oct 2007 . He said it would be better with lyrica as tegretol did not goe with zoloft as u had mentioned im off tegretol now  4 days today  I m still on the zoloft they upped it to 75mg once a day  ,Went for complete phhys by gp she ordered a echo found out the lisinipril for bp not working she changed it to diovan 160 1 x day , Also she finnally gave me inderal like you had mentioned. Taking attivan 0.5 as needed for panick attacks that remains the same  but they really dont want me taking too much ativan , I  have been` taking at least one a day sometimes 2 , then sometime there might be a day or so i dont have to take any. And the physc said thats too much ! Ativan rather see an upped dose of zoloft . I have been feeling so shakey and dizzy now legs feel wobley during the day.  they put 2 new meds on me the diovan and the lyrica and upped zoloft and the inderal 10 mg 1x day  i dont know whats causing that feelin . I know its not my bp being low as its still 140 to 150 over 90 i dont think diovan is working i have been on it now 10 days. Im still getting  tons of panik attacks a day the physc  just keeps upping zoloft my question being that i have taken zoloft for so many years is it possible the zoloft is not helping me this go around , and actually making the panik attacks worse? Im still losing weight still have nausea dont know how long it takes to clear my body of the tegretol to see if that was it .Any in put would gladly be accepted . meds are  now  diovan 160 1x a day ,inderal 10 mg 1x a day,zoloft 75 mg a day ,ativan 0.5 prn ,lyricia  50 mg at bed time ..
Thanks rose                        ps if you want u can email me ***@**** thanks!!