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Suggest Antidepressant That Can Be Taken Along With Azithromycin
Question: I have been taking Remeron for 1.5 yrs and it's done wonders for me. It cured my IBS and I gained weight from 88lbs to 99lbs, and it helps me sleep.
Three weeks ago I started treatment for a lung disease called MAC. It means taking 3 antibiotics together, 3x/wk. I have taken 3 EKGs since then and the QTc has been rising and is now close to the range where women are at risk for sudden cardiac arrest. My pulmonologist wants me to stop Remeron since there's a drug interaction with Azithromycin (one of the antibiotics) that increases the risk of QT prolongation.
I looked online to find another antidepressant also in the NaSSA class, but didn't find any.
Question: What antidepressant is close in action to Remeron?
Thank you --XXXX
Three weeks ago I started treatment for a lung disease called MAC. It means taking 3 antibiotics together, 3x/wk. I have taken 3 EKGs since then and the QTc has been rising and is now close to the range where women are at risk for sudden cardiac arrest. My pulmonologist wants me to stop Remeron since there's a drug interaction with Azithromycin (one of the antibiotics) that increases the risk of QT prolongation.
I looked online to find another antidepressant also in the NaSSA class, but didn't find any.
Question: What antidepressant is close in action to Remeron?
Thank you --XXXX
Brief Answer:
Desvenlafaxine (Pristique) is an alternative
Detailed Answer:
Hello,
Thanks for writing to us.
I read your query thoroughly. In my opinion problem of QT prolongation is likely due to azithromycin. Though your pulmonologist told that some drug interaction is there and you should stop remeron, I don't think so remeron is responsible for such problem.In my clinical practice as well as in studies I didn't find any significant effect of remeron on QT interval.
Still I would like to suggest alternative if you have to stop remeron. Desvenlafexine(Pristique) is the best alternative in my opiniom as it is an serotonin norepinephrine reuptake inhibitor as well as less side effect profile than remeron. Remeron is more effective on norepinephrine system which may be adding to cardiac side effect while pristique is more effective on serotonergic system and no cardiac side effects noted.
The best thing is just discuss this issue with your psychiatrist and ask him to talk to your pulmonologist for further treatment strategy for your problem.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Desvenlafaxine (Pristique) is an alternative
Detailed Answer:
Hello,
Thanks for writing to us.
I read your query thoroughly. In my opinion problem of QT prolongation is likely due to azithromycin. Though your pulmonologist told that some drug interaction is there and you should stop remeron, I don't think so remeron is responsible for such problem.In my clinical practice as well as in studies I didn't find any significant effect of remeron on QT interval.
Still I would like to suggest alternative if you have to stop remeron. Desvenlafexine(Pristique) is the best alternative in my opiniom as it is an serotonin norepinephrine reuptake inhibitor as well as less side effect profile than remeron. Remeron is more effective on norepinephrine system which may be adding to cardiac side effect while pristique is more effective on serotonergic system and no cardiac side effects noted.
The best thing is just discuss this issue with your psychiatrist and ask him to talk to your pulmonologist for further treatment strategy for your problem.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you. I checked Medscape for drug interaction between Azithromycin and Pristiq and there was none. I tend to agree with you about Azithromycin being the culprit. It is flagged as high risk for QT prolongation in and by itself, while I've only found potential increased risk when Remeron is added.
I have an appt. wit a cardiologist in XXXXXXX and will ask further questions then.
In the meantime, I may switch to Pristiq.
Question: how do I go about transitioning from Remeron to Pristiq ?
Please answer my follow up question. Thanks.
I have an appt. wit a cardiologist in XXXXXXX and will ask further questions then.
In the meantime, I may switch to Pristiq.
Question: how do I go about transitioning from Remeron to Pristiq ?
Please answer my follow up question. Thanks.
Brief Answer:
Transition depends on dose of remeron
Detailed Answer:
Hello,
Thanks for follow up.
First of all I want to clarify that we are here to help you and give expert opinion. For any drug change or new drug prescreption better to consult your treating doctor because by chance if any unwanted side effect occurs your doctor can help you.
If remeron dose is 7.5 , you can stop it and directly start pristique. If 10-15 mg is there, pristique 50 should be started and remeron dose should be reduced to half for 10 days and stopped then.
If dose range of remeron is 15-30 mg gradual phasewise reduction of dose is needed with pristique requirement up to 100 mg depending upon severity of the symptoms in the past.
Please revert back to me with your detail dose history of remeron and brief details of symptoms at onset of problem which have been improved with remeron, so I can give more specific answer.
Dr.Chintan Solanki.
Transition depends on dose of remeron
Detailed Answer:
Hello,
Thanks for follow up.
First of all I want to clarify that we are here to help you and give expert opinion. For any drug change or new drug prescreption better to consult your treating doctor because by chance if any unwanted side effect occurs your doctor can help you.
If remeron dose is 7.5 , you can stop it and directly start pristique. If 10-15 mg is there, pristique 50 should be started and remeron dose should be reduced to half for 10 days and stopped then.
If dose range of remeron is 15-30 mg gradual phasewise reduction of dose is needed with pristique requirement up to 100 mg depending upon severity of the symptoms in the past.
Please revert back to me with your detail dose history of remeron and brief details of symptoms at onset of problem which have been improved with remeron, so I can give more specific answer.
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Raju A.T
I'm taking 15 mg of Remeron. Before I started taking it (7.5mg) in May of 2013, I had digestive problems severe enough to keep me from eating enough to keep a healthy weight (88lbs). I had a constant low grade stress and slept poorly.
Within a week of starting Remeron, the digestive problems got better and within two weeks I had gained 5 lbs. I fell asleep easily and even if waking up at night, I could go back to sleep fairly quickly. It has been a godsend and I'm hoping that Pristiq will be equally effective.
XXXX
Within a week of starting Remeron, the digestive problems got better and within two weeks I had gained 5 lbs. I fell asleep easily and even if waking up at night, I could go back to sleep fairly quickly. It has been a godsend and I'm hoping that Pristiq will be equally effective.
XXXX
Brief Answer:
Yes pristique will help
Detailed Answer:
Dear XXXX,
Thanks for info.
You can start pristique 50 in morning with your remeron. On third day of that reduce remeron to 7.5 at night. And after a week you can stop remeron. There may be chance of sleep disturbance after stopping remeron completely which can be covered by low dose benzo for short period or some sleep hygiene measures like taking a cup of warm milk before 15 mnts going to bed.
I request you consult your doctor once before following this approach.
Pristique is going to work for you. And by chance if you not satisfied with pristique fully like remeron, you can revert back to remeron after completing course of antibiotic for MAC.
Hope I have given useful opinion. I will be glad to answer more if still any query.
Regards,
Dr.Chintan Solanki.
Yes pristique will help
Detailed Answer:
Dear XXXX,
Thanks for info.
You can start pristique 50 in morning with your remeron. On third day of that reduce remeron to 7.5 at night. And after a week you can stop remeron. There may be chance of sleep disturbance after stopping remeron completely which can be covered by low dose benzo for short period or some sleep hygiene measures like taking a cup of warm milk before 15 mnts going to bed.
I request you consult your doctor once before following this approach.
Pristique is going to work for you. And by chance if you not satisfied with pristique fully like remeron, you can revert back to remeron after completing course of antibiotic for MAC.
Hope I have given useful opinion. I will be glad to answer more if still any query.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Raju A.T
Brief Answer:
Hope positive for your health
Detailed Answer:
Hello XXXX,
Thanks for your words. Yes, you can shift back to remeron if not satisfied with pristique. But think and hope positive that you will be completely fine with pristique.
Wishing you for stable health and fast recovery from MAC.
If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback so I can improve service. In future you can contact me directly if you wish with this link:
http://bit.ly/drchintansolanki
Regards,
Dr.Chintan Solanki.
Hope positive for your health
Detailed Answer:
Hello XXXX,
Thanks for your words. Yes, you can shift back to remeron if not satisfied with pristique. But think and hope positive that you will be completely fine with pristique.
Wishing you for stable health and fast recovery from MAC.
If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback so I can improve service. In future you can contact me directly if you wish with this link:
http://bit.ly/drchintansolanki
Regards,
Dr.Chintan Solanki.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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