Lexapro and Cymbalta

[GroovyGwen]

So I am going to be going on Cymbalta and off lexapro.  My first doc told me that I should go to 10mg of lex for a week, then add 10mg Cymbalta for a week, then go off lex and up the cymbalta to 20.  Second doc (who I have to see because first doc is MOVING to NC damn her.) just said to add cymbalta 20 to lex for a week, then stop lex.  WTF?  When I did the drug interaction thing this is what it said:

escitalopram and duloxetine (major Drug-Drug)

Description:

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and 5-hydroxytryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors.

MANAGEMENT:

In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Close monitoring is recommended for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia. Particular caution is advised when increasing the dosages of these agents.

So I guess I should talk to doc, but what do you guys think?  Any experiences with combining AD's?

[zsandoz]

Yup I've heard about the serotonin syndrome, but these are really low doses of cymbalta and lexapro, so i think whichever doctor's advice you are more comfortable with should be fine

So I am going to be going on Cymbalta and off lexapro.  My first doc told me that I should go to 10mg of lex for a week, then add 10mg Cymbalta for a week, then go off lex and up the cymbalta to 20.  Second doc (who I have to see because first doc is MOVING to NC damn her.) just said to add cymbalta 20 to lex for a week, then stop lex.  WTF?  When I did the drug interaction thing this is what it said:

escitalopram and duloxetine (major Drug-Drug)

Description:

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and 5-hydroxytryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors.

MANAGEMENT:

In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Close monitoring is recommended for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia. Particular caution is advised when increasing the dosages of these agents.

So I guess I should talk to doc, but what do you guys think?  Any experiences with combining AD's?

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[brandymac29]

I have just switched from lexapro 20mg to effexor XL.  I'm on my 2nd day of effexor 37.5 mg, and I reduced my dose of lex to 5mg since I started the effexor 2 days ago and I feel fine.  No problems at all.  Tonight, I'm not even gonna take the lex.  I think as long as you take some form of drug that helps w/ seratonin, you can discontinue the lex fairly easily.  Plus, the doses tht your taking are pretty low, so even if you slowly wanted to discontinue the lex slowly you should be ok.  My doc told me b/c effexor acts like an ssri at lower doses, I could ultimately discontinue the lex cold turkey if I wanted to. 

Brandy

[jmb252]

It's all a crap shoot as to whether you develop serotonin syndrome problems. I'm taking 120 mg Cymbalta and 40 mg Lexapro as a regular part of my cocktail and haven't had any problems at all.

jen

[GroovyGwen]

Crapshoot - it's all a crapshoot isn't it??

Doc has me on 20 lex and 20 cymbalta for a week, then 10 lex and 40 cymbalta probably, then off lex altogether.  He also upped my lamictal to 250 because I had some problems a few days ago.  So we'll see.  Hopefully I won't freak out too bad.