How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr Basu Your Own Question
Dr Basu
Dr Basu, Experienced Specialist
Category: Medical
Satisfied Customers: 28198
Experience:  MD
23744323
Type Your Medical Question Here...
Dr Basu is online now
A new question is answered every 9 seconds

What specialist is best qualified to help me with drug interaction

This answer was rated:

What specialist is best qualified to help me with drug interaction problems? I am taking Gleevec and had a terrible interaction with Prozac, switched to bupropion and am experiencing problems. Need to find a antidepressant that is compatable. Have drug breakdown pathway enzyme defiencies

Mysticdoc :

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

Mysticdoc :

Hi there,


I am Mysticdoc, experienced Internal Medicine Specialist.


I am here to help you with your concerns.

Mysticdoc :

do you know which enzym deficiency you have?

Customer:

My concerns are detailed in my question

Mysticdoc :

what reactions you are experiencing?

Customer:

vertigo and nausea when I take my wellbutrin. Started out with 100mg increaqsed to 150, eas still experiencing depression symptoms so increases to 300mg.... backed down when symtoms appeared but still dizzy and nauseated. Was on prozac since 1990 with good results but experienced severe cerebral edema when started on Gleevec. I am a CRNA so I understand medical terms.

Mysticdoc :

ok these symptoms are indeed concerning.

Mysticdoc :

vertigo and dizziness can be experienced with wellbutrin.

Mysticdoc :

Now, did you have any heart test done?

Customer:

cyp3a4 and cyp2d6 defiencies. Have had recent EKG for preop before last surgery in Jan 2013. Was normal

Mysticdoc :

ok

Mysticdoc :

That is complex.

Mysticdoc :

This will be challenging as these are major pathways.

Mysticdoc :

Low dose anti depressant should be tried.

Mysticdoc :

Effexor or venlafaxine can be a viable alternative.

Customer:

yes, seems all my docs are at a loss to find an antidepressant that doesn't compete with Gleevec for those emzymes. Can I just switch to one of these from wellbutrin?

Mysticdoc :

But dose should not exceed 150 mg in a day.

Customer:

dose of what

Customer:

do I need to wean off wellbutrin before going on one of these other drugs?

Mysticdoc :

I meant effexor.

Mysticdoc :

Besides effexor other optinos are:

Mysticdoc :

Other options are:

Mysticdoc :

1. Mirtazapine starting at 15 mg daily at bedtime then increasing by 15 mg up to 45 mg daily.

Mysticdoc :

2. Nortiptyline 25 mg daily at bedtime then at 25 mg increments up to 75 mg daily.

Mysticdoc :

Yes, wellbutrin will be gradually tapered off while introducing other medication.

Mysticdoc :

I will prefer mirtazapine now that I noticed you also have 2d6 deficiency.

Mysticdoc :

most of mirtazapine does not go through those pathways

Mysticdoc :

You should ideally see a good psychiatrist.

Customer:

thank you

Mysticdoc :

very welcome

Mysticdoc :

It was my pleasure to help you today.


Best wishes,


Please rate the chat Good or Excellent, if you are satisfied with our conversation and do not have any further question, so that I get rewarded for my time & effort. Thank you!


Please bookmark my profile for asking further questions!
This is the link to my profile:
http://www.justanswer.com/medical/expert-mysticdoc/

Dr Basu and 4 other Medical Specialists are ready to help you