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Thread: Amytriptyline and Venlafaxine

  1. #1

    Amytriptyline and Venlafaxine

    My question is weather these two meds can be taken together.
    I've been on TCAs for upwards of nearly 20 years, for GAD and IBS.They worked well for many years, but eventually, I asked for a change as the chronic side effects became too much to deal with. Namely bad constipation and severe dry mouth, both of which have needed medical treatment.
    Two years ago changed to Trazodone200mg
    Which were much better for me. Fast forward to Feb last year, when after a severe bout of food poisoning, resulting 6 weeks off work and antibiotics, the IBS returned, I now know this is termed post Infective IBS and can.last for months after the event. 8 months later still suffering and now highly anxious all the time, Gp took me off Traz and switches me to low dose amytriptyline 10mg This really helped IBS and lessened the anxiety somewhat, but I found I need to increase the dose gradually over time to help with the anxiety. I'm now at 40mg, but anxiety is bad again. Very reluctant to Increase the dose, as the side effects of the amytriptyline are getting hard to tolerate.
    GP has suggested Venlafaxine, which I'm keen to try as a close family member has had some success with this. I've offered to reduce the amytriptyline, but not give it up altogether, as it helps so well with the IBS, but I really do need something to help with the anxiety as its ruling my life. Has anyone had any success on this combo. Sorry for such a long post thanks for reading.

  2. #2
    Join Date
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    Re: Amytriptyline and Venlafaxine

    Quote Originally Posted by Kitty Cat View Post
    My question is weather these two meds can be taken together.
    Yes, they can, although your GP may be wary of prescribing them because of a misplaced concern about serotonin syndrome (SS). Amitriptyline isn't a potent enough serotonin reuptake inhibitor to trigger SS with either SSRI/SNRIs, or MAOIs, despite the NHS guidelines indicating it is. If you get a blanket refusal to prescibe them from you GP you could switch to nortriptyline which is a noradrenaline, aka norepinephrine reuptake inhibiting TCA. It is the main metabolite of amitriptyline and is responsible for much of its effectiveness. Not only is it a way too weak a serotonin reuptake inhibitor to trigger SS when combined with any serotonergic AD, but it is also blocks the large temperature spike which does the damage in SS.

    I've been on TCAs for upwards of nearly 20 years, for GAD and IBS.They worked well for many years, but eventually, I asked for a change as the chronic side effects became too much to deal with. Namely bad constipation and severe dry mouth, both of which have needed medical treatment.
    Which TCAs and at what dose?

    Two years ago changed to Trazodone200mg
    Which were much better for me. Fast forward to Feb last year, when after a severe bout of food poisoning, resulting 6 weeks off work and antibiotics, the IBS returned, I now know this is termed post Infective IBS and can.last for months after the event. 8 months later still suffering and now highly anxious all the time, Gp took me off Traz
    200mg is a low dose for trazodone. Most need to take at least 225mg to get a response and 300-400mg is the usual dose range for anxiety and depression so simply increasing the dose may have worked.

    GP has suggested Venlafaxine, which I'm keen to try as a close family member has had some success with this. I've offered to reduce the amytriptyline, but not give it up altogether, as it helps so well with the IBS, but I really do need something to help with the anxiety as its ruling my life. Has anyone had any success on this combo. Sorry for such a long post thanks for reading.
    I'm not a venlafaxine fan. Despite the claims it is really only a SSRI, not SNRI, and has no advantage over the other SSRIs, and several issues not least of which being that it is regarded as the hardest AD to quit. You'd be better of switching to a real SSRI like citalopram, or escitalopram, imo.

    If a SNRI is preferred then duloxetine is a better SNRI than venlafaxine (or desvenlafaxine), however, it may induce more severe side-effects at the beginning. Other alternatives are the SNRIs milnacipran and levomilnacipran, however, I'm not sure if they are available through the NHS.

    If you've not tried imipramine (Tofranil) in the past it might be worth a shot. It has significantly less effect on muscarinic acetylcholine receptors which produce dry-mouth and constipation than amitriptyline and is usually as effective for IBS.
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  3. #3
    Join Date
    Feb 2016
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    Re: Amytriptyline and Venlafaxine

    Amitripyline at a low dose won't help anxiety but it's great for IBS, IC and some nerve pain. At a higher dose dryness is a big issue especially if you're older (ie menopausal or post-menopausal). I've been on Doxepin and recently Amitriptyline (both 10 mgs) for about 25 years and I still get some dryness issues. If you add in an antihistamine it magnifies things!

    Luckily I don't have too much anxiety as I can't take the SSRI's or SNRI's.
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