Fenfluramine Amitriptyline

Additional ADRs linked to diet pills include psychosis myocardial ischemia drug interactions, such as the interaction of fenfluramine with imipramine, fenfluramine with amitriptyline or desipramine, or the toxic reaction between fluoxetine and phentermine and the release of serotonin while inhibiting its reuptake, contributing to hyperserotonin reactions. When the next craze takes hold of patients and their physicians, hopefully physicians and pharmacists will take a more vocal position and recommend restraint, xmtil some proof of efficacy and lack of toxicity is shown for new faddish off-label combinations. 

Noninterfering acetaminophen, aspirin, amitriptyline, huprenorphine, caffeine, carba-mazepine, chlorpromazine, desipramine, dextromethorphan, doxepin, ephedrine, fenfluramine, imipramine, lidocaine, loxapine, meperidine, methadone, methaqualone, naloxone, naltrexone, nicotine, orphenadrine, oxycodone, papaverine, pentazocine, phendimetra-zine, phenmetrazine, phentermine, phenylpropanolamine, phenytoin, primidone, procaine, promethazine, propoxyphene, propyphenazone, theobromine, theophylline, trazodone, triflupromazine, trimethoprim, trimipramine... 

Also analyzed amitriptyline, amphetamine, chlorpromazine, desipramine, desmethyldox-epin, diethylpropion, doxepin, ephedrine, fenfluramine, imipramine, mesoridazine, meth-amphetamine, nortriptyline, phentermine, phenylpropanolamine, promazine, thioridazine, thiothixene, trifluoperazine... 

Simultaneous amoxapine, clovoxamine, desipramine, fenfluramine, fluvoxamine, nor-fluoxetine, nortriptyline, propranolol, protriptyline, sertraline Noninterfering amitriptyline, atenolol, bupropion, carbamazepine, chlordiazepoxide, ci-talopram, clomipramine, clozapine, cyclobenzaprine, doxepin, imipramine, loxapine, me-toprolol, mianserin, moclobemide, nomifensine, pindolol, thioridazine, tranyl[Pg.626]

SLC6A4 (SERT) SERT plays a role in the reuptake and clearance of serotonin in the brain. Like the other SLC6A family members, SERT transports its substrates in a Na+-dependent fashion and is dependent on CL and possibly on the countertransport of K+. Substrates of SERT include serotonin (5-HT), various tryptamine derivatives, and neurotoxins such as 3,4-methylene-dioxymethamphetamine (MDMA ecstasy) and fenfluramine. SERT is the specific target of the selective serotonin reuptake inhibitors (e.g., fluoxetine and paroxetine) and one of several targets of tricyclic antidepressants e.g., amitriptyline). Genetic variants of SERT have been associated with an array of behavioral and neurological disorders. The precise mechanism by which a reduced activity of SERT, caused by either a genetic variant or an antidepressant, ultimately affects mood and behavior is not known. 

Exacerbation of depression has been seen in some patients given fenfluramine and several cases of withdrawal depression have been observed in patients taking amitriptyline and fenfluramine, following episodes of severe depression. The manufacturers have advised that fenfluramine should not be used in patients with a history of depression or in those being treated with antidepressants. On the other hand it has also been claimed that fenfluramine can be used safely and effectively with tricyclic antidepressants." One report describes a rise in the plasma levels of amitriptyline when fenfluramine 60 mg daily was given to patients taking amitriptyline 150 mg daily. ... 

Gunne L-M, Antonijevic S, Jonsson J. Effect of fenfluramine on steady state plasma levels of amitriptyline. PostgradMedJ( 915 ) 51 (Suppl 1), 117. 

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