I am in the process of discontinuing Cymbalta for osteoarthritis, I am also on Wellbutrin xl 300 mg daily. I have been reading about Sam-E for Osteoarthritis, can I take it now with the other 2 meds since there is also an antidepressant component to Sam-E?
22 Feb 2012
Anaru, this is the information I found for you. Sam-E must be new because they didn't have any info but I would be careful about the Cymbalta and welbutrin combo. Discuss any and all interactions with your doctor and don't let him off the hook for not giving you complete and accurate info. I have been through this before. Lots of luck to you! I hope this helps. Lisa Z
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Drug interactions for the following 3 drug(s):
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Interactions between your selected drugs
bupropion ↔ duloxetine
Applies to: Wellbutrin (bupropion), Cymbalta (duloxetine)
MONITOR CLOSELY: The use of bupropion is associated with a dose-related risk of seizures. The estimated incidence of seizures is approximately 0.1% at dosages up to 300 mg/day and 0.4% at dosages between 300 to 450 mg/day, but increases almost tenfold between 450 mg and 600 mg/day. The risk may also be increased during coadministration with selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, and/or any substance that can reduce the seizure threshold (e.g., carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, theophylline). These agents are often individually epileptogenic and may have additive effects when combined.
MANAGEMENT: Extreme caution is advised if bupropion is administered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with a history of seizures or other risk factors for seizures (e.g., head trauma; brain tumor; severe hepatic cirrhosis; metabolic disorders; CNS infections; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin). Bupropion as well as concomitant medications should be initiated at the lower end of the dose range and titrated gradually if feasible. The total dose of bupropion should generally not exceed 450 mg/day (or 150 mg every other day in patients with severe hepatic cirrhosis). Bupropion should be discontinued and not restarted in patients who experience a seizure during treatment.
No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.
Other drugs that your selected drugs interact with
•Cymbalta (duloxetine) interacts with more than 500 other drugs.
•Wellbutrin (bupropion) interacts with more than 300 other drugs.
Interactions between your selected drugs and food
duloxetine ↔ food
Applies to: Cymbalta (duloxetine)
GENERALLY AVOID: Use of duloxetine in conjunction with chronic alcohol consumption may potentiate the risk of liver injury. Duloxetine alone can increase serum transaminase levels. In clinical trials, 0.3% of patients discontinued duloxetine due to liver transaminase elevations. The median time to detection was about two months. Three duloxetine-treated patients had liver injury as manifested by transaminase and bilirubin elevations, with evidence of obstruction. Substantial intercurrent ethanol use was present in each of these cases, which may have contributed to the abnormalities observed. Duloxetine does not appear to enhance the central nervous system effects of alcohol. When duloxetine and ethanol were administered several hours apart so that peak concentrations of each would coincide, duloxetine did not increase the impairment of mental and motor skills caused by alcohol.
MANAGEMENT: Due to the risk of liver injury, patients prescribed duloxetine should be counseled to avoid excessive use of alcohol. Duloxetine should generally not be prescribed to patients with substantial alcohol use.
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