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serotonin/NE reuptake inhibitor & L-DOPA interactions

A

Albert Einstein

Greenlighter
Joined
Oct 11, 2013
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8
I have a fairly technical question and I'm almost certain that if anyone else besides the good ol boys at Advanced Drug Discussion try to answer it, all I'll get is gobbledygook. Did ADD get deleted or something? Or name changed? Or what, can someone please fill me in?

In case someone off-chance reading this can give me an answer, here's my question:
Would a serotonin/NE reuptake inhibitor like venlafaxine have any obvious negative reactions with someone prescribed and taking L-DOPA?

If my slightly-above-layman knowledge of pharmacology serves me right, L-DOPA is metabolized into dopamine which is subsequently metabolized into norepinephrine. Now, just seems like that would be all kinds of bad news for someone taking an SNRI, and the above-normal levels of norepinephrine caused by both of the aforementioned drugs would be compounded and reach unsafe levels -- well it just so happens I know someone prescribed both, and they show all the signs of hyperactivity, restlessness, agitation, and anxiety one would expect from someone experiencing a drug-induced overload of norepinephrine.

To make matters worse, their seemingly negligent doctor also prescribed them tramadol for pain, and since tramadol is possibly the most notorious drug for provoking unwanted interactions I can think of on the planet (short of someone injecting vitamin C and battery acid), I'd say the noradrenergic affinity of all three drugs (tramadol, L-DOPA, and venlafaxine) has triple-compounded this unfortunate individual's levels of norepinephrine to maniacal proportions.

Or maybe I'm wrong. I don't really know. Maybe the norepinephrine resulting from L-DOPA isn't made available to the NE transporter which venlafaxine affects; still, tramadol being thrown in the cocktail just smells like negligent doctors haphazardly prescribing drugs prone to causing negative and quite violent interactions (grand mal seizures anyone?) with each other.
 
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Wait, is it because I'm newly registered? I feel like a dumb dumb if that's it. Any way this topic could be put into ADD?

Also continuing on the post above, I'd push to have this acquaintance of mine tapered down off venlafaxine and put on a simple, non-noradrenergic SSRI instead, and also at least temporarily replace the tramadol with something else that isn't a clusterfuck of drug interactions, like codeine - tylenol #2s or something.

I just want to make sure this individual is safe; the combo they're on just sounds disgusting - I couldn't fathom having to take L-DOPA, venlafaxine, AND tramadol; sounds like being stuck in one long day with fuzzy tunnel vision and half your brain blasting you with incoherent chatter static from La La land
 
Thanks for helping my thread find its way to ADD; any responses I could get would be greatly appreciated... You'd think I could just ask a doctor if the combination would be bad, but when you ask them about interactions they wheel over to their computer and see what some never-updated pharm program on their computer has to say about the combo. What were they learning in med school again?

Why does it seem like drug users are more cautious about interactions than doctors are? Sheesh
 
It shouldn't. Besides, anything but humongous doses of L-DOPA taken w/o a DOPA decarboxylase inhibitor is virtually placebo.
 
In that case, I think you should be asking your doctor. Neither SNRIs nor carbidopa should be self prescribed.

However, I don't think that levodopa typically acts as a norepinephrinergic drug. You should be OK
 
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