Phenelzine clonazepam

Panic disorder SSRIs Venlafaxine XR Alprazolam Clomipramine Clonazepam Imipramine Phenelzine... 

Social anxiety disorder Escitalopram Fluvoxamine Paroxetine Sertraline Venlafaxine XR Citalopram Clonazepam Buspirone Gabapentin Miitazapine Phenelzine Pregabalin... 

Benzodiazepines. The best studied of the benzodiazepines for social anxiety disorder, clonazepam has been demonstrated in controlled trials to be effective during both acute treatment (at an average dose of 2.4mg/day) and long-term maintenance therapy lasting up to 2 years. A controlled study of another high potency benzodiazepine, alprazolam, also proved effective, though it was outperformed by the MAOI antidepressant phenelzine and exhibited response rates lower than those reported with clonazepam. 

Frank JB, Kosten TR, Giller EL Jr, Dan E (1988) A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder. Am J Psychiatry 145 1289-1291 Goddard AW, Brouette T, Almai A, Jetty P, Woods SW, Charney D (2001) Early coadministration of clonazepam with sertraline for panic disorder. Arch Gen Psychiatry 58 681-686 Goodnick PJ, Goldstein BJ (1998) SSRIs in affective disorders. I. Basic pharmacology. J Psychopharmacol 12(Suppl B) S5-S20... 

A larger set of placebo-controlled studies show conclusively that imipramine is also effective for the treatment of panic disorders. Other agents shown to be effective in panic disorders include the SSRIs paroxetine, sertraline, fluvoxamine, fluoxetine and citalopram. Generally, initial treatment of moderate to severe panic disorders may require the initiation of a short course of benzodiazepines e.g. clonazepam (0.5 1 mg twice daily), and an SSRI. The patient will obtain immediate relief from panic attacks with the benzodiazepine whereas the SSRI may take 1 6 weeks to become effective. Once a patient is relieved of initial panic attacks, clonazepam should be tapered and discontinued over several weeks and SSRI therapy continued thereafter. There are no pharmacological treatments available for specific phobias, however controlled trials have shown efficacy for several agents, e.g. phenelzine, moclobemide. clonazepam, alprazolam, fluvoxamine. sertraline and paroxetine in the treatment of social phobia (Roy-Byrne and Cowlev, 2002). 

A flushing reaction has been associated with an interaction of phenelzine with clonazepam (SEDA-17, 17). 

Acetylation of drugs is also associated with genetically determined interindividual and interethnic differences. Differences in isoniazid toxicity between Asians and Caucasians are due to acetylation enzyme polymorphism. The majority (78%-93%) of Chinese and East Asians are fast acetylators, whereas only 50% of whites and African Americans are fast acetylators (Weber 1987). This is clinically important, because several psychoactive compounds (e.g., caffeine, clonazepam, nitrazepam, and phenelzine) are metabolized through acetylation (Sjoqvist et al. 1997). 

For panic disorder, tricychc antidepressants and MAO inhibitors, as well as high-potency benzodiazepines (notably alprazolam, clonazepam, and lorazepam) (see Chapter 16), are effective in blocking the autonomic expression of panic itself, thereby facilitating a comprehensive rehabilitation program. Imipramine and phenelzine are well-studied antidepressants for panic disorder. SSRIs also may be effective, but /3 adrenergic receptor antagonists, buspirone, and low-potency benzodiazepines usually are not, and bupropion can worsen anxiety. 

Augmentation is called for when there is partial or non-response to the above approaches. Combinations of SSRIs with buspirone, clonazepam, clonidine, inositol, lithium, pindolol, olanzapine, risperidone, trazodone, tryptophan, and venlafaxine have been reported, with limited benefit. To date, only two augmenting agents have been found to be effective in double-blind studies risperidone and pindolol. Augmentation of SSRIs with clomipramine (or vice versa) is a common practice in non-responders however, this combination may lead to a substantial increase in the level of tricyclics in the blood and/or increase the risk of serotonin syndrome. Phenelzine may be helpful in symmetry-related or other atypical obsessions. Electroconvulsive therapy (ECT) should be reserved for severely depressed and suicidal OCD patients. Neurosurgery is the last resort current operations include anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy, and limbic leucotomy. The outcome of such operations is questionable. 

Isolated cases of adverse reactions (chorea, severe headache, facial flushing, massive oedema, and prolonged coma) attributed to interactions between phenelzine and chlordiazepoxide, clonazepam or nitrazepam, and between isocarboxazid and chlordiazepoxide have been described. Evidence from clinical trials su ests that there is no interaction between moclobemide and benzodiazepines, although one study found a slight progressive worsening in driving performance. 

A patient who had been taking phenelzine 45 mg daily for 9 years developed a severe occipital headache after taking 500 micrograms of clonazepam. A similar but milder headache occurred the next night when she took the same dose. No blood pressure measurements were taken. Another report describes facial flushing in a patient taking clonazepam, which occurred after phenelzine was started, and which responded to a reduction in the clonazepam dose. ... 

Eppel AB. Interaction between clonazepam and phenelzine. Cm J Psychiatry 990) i5,647. 

Karagianis JL, March H. Flushing reaction associated with the interaction of phenelzine and clonazepam. Cm JPsychiatry (1991) 36,389. 

---