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Thread: Lexapro and mdma

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    Lexapro and mdma 
    #1
    Bluelighter beech's Avatar
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    From my understanding and reading on Bluelight whilst on SSRI's it is pointless taking MDMA because it simply won't work. Is this the case? I was discussing it with a friend who is pretty well read in the area and he saw no reason why this should be the case.

    The main part of my question is: I am currently taking Lexapro 10mg daily and it is my birthday coming up soon. IF I wanted to have a big night out on my birthday and take pills how long beforehand would I have to discontinue my medication?
    I realise this may not be a great idea and I am obviously on the medication for a reason but it is just something I am considering. I'm also assuming that the time period will be differ for everyone but surely there is a ballpark figure.
    Any help would be appreciated.

    Beech out
     

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    #2
    Bluelight Crew phase_dancer's Avatar
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    Briefly, SSRI's work by reducing/ preventing reuptake of serotonin into 5HT neurons. As MDMA also enters the neurons via a similar mechanism, SSRI's if the affinity/efficacy is higher than for MDMA (most are) then it is expected that the effects from MDMA will be less.

    I don't wish to lecture, but please think seriously before deciding to take MDMA if you're are on a SSRI. By stopping days or weeks before the roll, you might find the comedown phase from MDMA is much worse, as you will possibly feel a combination affect from MDMA induced low serotonin levels and reduced release of reserves due the absence of the SSRI.
     

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    #3
    Bluelighter beech's Avatar
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    ^^^I've only recently started on lexapro about 2 weeks ago so I would imagine the comedown effect from it wouldn't be that great. I haven't made a firm decision yet but how long would you imagine I would need to be off medication before taking mdma?



    Beech
     

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    #4
    Bluelight Crew phase_dancer's Avatar
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    From MIMS

    Drug Interactions:

    MAOIs (see Contra); 5HT agonists incl sumatriptan, tramadol; St John's wort; omeprazole; lithium; TCAs; metoprolol; cimetidine; tryptophan; alcohol; others, see full PI


    Excretion.

    The elimination half-life (t1/2beta) after multiple dosing is about 30 hours and the oral plasma clearance (Cloral) is about 0.6 L/minute.


    Escitalopram and major metabolites are, like racemic citalopram, assumed to be eliminated both by the hepatic (metabolic) and the renal routes with the major part of the dose excreted as metabolites in urine. Approximately 8.0% of escitalopram is eliminated unchanged in urine and 9.6% as the S-demethylcitalopram metabolite based on escitalopram 20 mg data. Hepatic clearance is mainly by the P450 enzyme system.

    The pharmacokinetics of escitalopram are linear over the clinical dosage range. Steady-state plasma levels are achieved in about one week. Average steady-state concentrations of 50 nanomoles/L (range 20 to 125 nanomoles/L) are achieved at a daily dose of 10 mg.
    Color added; p_d


    I would suggest allowing a good few days depending on what dosages you're on. Note that tryptophan is contraindicated, so I incase you're thinking of it, I wouldn't take 5HTP too close to taking Lexapro.
     

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    #5
    Bluelighter beech's Avatar
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    I'm on 10mg once a day of Lexapro. This is the pretty standard dose of the drug according to the doc.
    If I decide to do it I guess I will discontinue taking Lexapro 3 days before my birthday.
    1 other quick question. This is all probably stuff I should have asked the doctor but didn't because well I didn't really feel comfortable discussing various other issues let alone drug use. Am I right in understanding that it is ok to use other drugs such as speed, ketamine and GHB (not all at the same time) whilst on SSRI's? Am I right to understand these drugs do not clash with SSRI's? I'm quite sure I read in an FAQ on here somewhere that it was ok. However, friends I've spoken to have insisted that its a very bad idea.
    Thanx for the help thus far.

    Beech
     

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    #6
    Bluelight Crew phase_dancer's Avatar
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    However, friends I've spoken to have insisted that its a very bad idea.
    I tend to agree. If you're prescribed a drug to help with a problem, why take thing that are known to cause similar probs? There are some contraindications listed with lexapro for approved pharmaceuticals, but that's not to say there might not also be some with rec drugs - which aren't specifically listed in MIMS



    FROM MIMS
    Other events observed during the postmarketing evaluation of escitalopram. Although no causal relationship to escitalopram treatment has been found, the following adverse events have been reported in association with escitalopram treatment in at least three patients (unless otherwise noted) and not described elsewhere in the Adverse Reactions section (total of 1,720,000 patients estimated to have been treated with escitalopram).

    Stomatitis, drug interaction NOS, feeling abnormal, hypersensitivity NOS, nonaccidental overdose, injury NOS, dysgeusia.

    In addition, although no causal relationship to racemic citalopram treatment has been found, the following adverse events have been reported to be temporally associated with racemic citalopram treatment subsequent to the marketing of racemic citalopram and were not observed during the premarketing evaluation of escitalopram or citalopram: acute renal failure, akathisia, anaphylaxis, choreoathetosis, delirium, dyskinesia, epidermal necrolysis, erythema multiforme, gastrointestinal haemorrhage, haemolytic anemia, hepatic necrosis, myoclonus, neuroleptic malignant syndrome, nystagmus, pancreatitis, priapism, prolactinaemia, prothrombin decreased, QT prolonged, rhabdomyolysis, spontaneous abortion, thrombocytopenia, thrombosis, torsades de pointes, ventricular arrhythmia and withdrawal syndrome.
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    Interactions

    Coadministration with monoamine oxidase inhibitors (MAOIs) may cause serotonin syndrome (see Contraindications).

    Coadministration with serotonergic drugs (e.g. tramadol, sumatriptan), may lead to an enhancement of serotonergic effects. Similarly, Hypericum perforatum (St John's wort) should be avoided, as adverse interactions have been reported with a range of drugs including antidepressants.

    There have been reports of enhanced effects when SSRIs have been given with lithium or tryptophan and therefore concomitant use of SSRIs with these drugs should be undertaken with caution.

    Given the primary CNS effects of escitalopram, caution should be used when it is taken in combination with other centrally acting drugs.

    Escitalopram has a low potential for clinically significant drug interactions. In vitro studies have shown that the biotransformation of escitalopram to its demethylated metabolites depends on three parallel pathways (cytochrome P450 (CYP) 2C19, 3A4 and 2D6). Escitalopram is a very weak inhibitor of isoenzymes CYP1A2, 2C9, 2C19, 2E1 and 3A, and a weak inhibitor of 2D6.

    Effects of other drugs on escitalopram in vivo. The pharmacokinetics of escitalopram was not changed by coadministration with ritonavir (CYP3A4 inhibitor). Furthermore coadministration with ketoconazole (potent CYP3A4 inhibitor) did not change the pharmacokinetics of racemic citalopram.

    Coadministration of racemic citalopram with cimetidine (potent CYP2D6, 3A4 and 1A2 inhibitor) resulted in increased plasma concentrations of the racemate (< 45% increase). Thus, caution should be exercised at the upper end of the dose range of escitalopram when used concomitantly with high doses of cimetidine.

    Coadministration of medicinal products that inhibit CYP2C19 (e.g. omeprazole) can result in elevated plasma concentrations of escitalopram. A reduction in the dose of escitalopram may be necessary.

    Effects of escitalopram on other drugs in vivo. Escitalopram is an inhibitor of the enzyme CYP2D6. Caution is recommended when escitalopram is coadministered with medicinal products that are mainly metabolised by this enzyme, and that have a narrow therapeutic index, e.g. flecainide, propafenone and metoprolol (when used in cardiac failure), or some CNS acting medicinal products that are mainly metabolised by CYP2D6, e.g. antidepressants such as desipramine, clomipramine and nortryptyline or antipsychotics like risperidone, thioridazine and haloperidol. Dosage adjustment may be warranted.

    Coadministration with desipramine (a CYP2D6 substrate) resulted in a twofold increase in plasma levels of desipramine. Therefore, caution is advised when escitalopram and desipramine are coadministered. A similar increase in plasma levels of desipramine, after administration of imipramine, was seen when given together with racemic citalopram.

    Coadministration with metoprolol (a CYP2D6 substrate) resulted in a twofold increase in the plasma levels of metoprolol. However, the combination had no clinically significant effects on blood pressure and heart rate.

    The pharmacokinetics of ritonavir (CYP3A4 inhibitor) was not changed by coadministration with escitalopram.

    Furthermore, pharmacokinetic interaction studies with racemic citalopram have demonstrated no clinically important interactions with carbamazepine (CYP3A4 substrate), triazolam (CYP3A4 substrate), theophylline (CYP1A2 substrate), warfarin (CYP3A4 and CYP2C9 substrate), levomepromazine (CYP2D6 inhibitor), lithium and digoxin.

    Alcohol. The combination of SSRIs and alcohol is not advisable.
    This is far from my area of expertise. I would suggest going to a doctor [another doctor perhaps?] and asking about adverse reactions with any drugs you might think you want to take. However, don't be surprised if you get a similar response.
     

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