sertraline and ethylphenidate

[34-Empathy]

hey everyone,
I'm going over to a mates tomorrow and have 2g of eethylphenidate. she is on sertraline 100mg. will it be safe to share it with her? advice asap would be great
thanks
J

 

[Venrak]

Yes it is safe, it's a DRI and NRI, it is safe to combine with an SSRI.

 

[34-Empathy]

soo even if she does 1000mg of the ethylphen she will be fine? thanks

 

[Venrak]

That's quite excessive for anyone. Iit runs the same risks as extreme binging on any stimulant.

I would bring no more than 750mg-1g total for the both of you. And even then, it feels like you'd be pushing it.

Make sure to stay hydrated, nourished, and well rested.

 

[34-Empathy]

thanks for replying. I will make sure she doesnt take to much. I find it much more forgiving than MDPV. so glad I cant get that anymore

 

[pasha]

Stimulants can elevate the blood levels of SSRI drugs to a dangerous level which can massively increase the risk of serotonin syndrome. The two are often co-prescribed but only at therapeutic dosages, with the SSRI dosage usually kept at an extremely low level. Please be careful.

 

[Venrak]

Through which mechanism? MAO competition?

 

[pasha]

It's a good question to a well documented side-effect but I'm not exactly sure about the answer. It's listed on the methylphenidate and several other stimulants data-sheets. I think it alters its metabolism somehow.

Ritalin and other stimulants may elevate the blood
levels of SSRI antidepressants (e.g., Paxil, Prozac)

http://www.psychatlanta.com/documents/ritalin.pdf

I try to look into it as to exactly why or maybe others can shed some knowledge.

 

[Swimmingdancer]

This source says methylphenidate increases serotonin in certain areas of the brain.

Here is a case report on methylphenidate + sertraline causing serotonin syndrome: Serotonin syndrome induced by augmentation of SSRI with methylphenidate

However this small study on augmenting SSRIs with methylphenidate concluded:

The empirical use of methylphenidate added to ineffective or only partially effective SSRI treatment appeared to be a rapid, safe, and efficacious alternative to existing augmentation strategies for the treatment of major depression.

Note that this was at normal therapeutic doses of methylphenidate. I would assume it could potentially be much riskier taking large recreational doses of ethylphenidate and would proceed with caution.

 

[Venrak]

^Thanks for catching that. I wasn't aware of methylphenidate's serotonergic effects; never came across it in my reading.

This source says methylphenidate increases serotonin in certain areas of the brain.

...amphetamine (3 mg/kg) and methylphenidate (30 mg/kg) increased levels of 5HIAA in striatum and frontal cortex, two brain regions which receive serotonergic projections from the dorsal raphe nucleus.

Just for a bit of perspective, that is a monster dose. Extreme caution should be taken even at low doses, and perhaps it shouldn't be done at all.

My bad OP for giving you false information. Mind letting us know if you went through with it and if so, how it turned out?

 

[pasha]

Through which mechanism? MAO competition?

My guess regarding methylphenidate affecting SSRI metabolism was seemingly correct:

The coadministration with methylphenidate may increase the plasma concentrations of selective serotonin reuptake inhibitors (SSRIs). According to the manufacturer, human pharmacologic studies have shown that methylphenidate may inhibit the metabolism of SSRIs, and there have been reports that methylphenidate augments the clinical response to SSRIs.

http://www.drugs.com/drug-interacti...lin-la-1013-565-1606-1578.html?professional=1

I'm yet to find that specific study they mentioned but I've found one on TCA and methylphenidate. I think it's a contributing factor to the serotonin toxicity that can occur during co-administration in excessive dosages.

 

[Swimmingdancer]

^Yeah I can't find such a study anywhere either and can only find mention of it raising the blood levels of tricyclic antidepressants and being unsafe to take with MAOI antidepressants. Methylphenidate is often used with an SSRI but that's under a doctor's supervision in low doses, so that would not lead me to assume it's ok to take high doses of ethylphenidate while on an SSRI. It's unfortunate that it's so hard to find out an estimate on how risky this combo would be.

 

[pasha]

^It's actually interesting you provided those studies, because I was having a similar discussion with someone just last week in ED but I wasn't able to find the studies you've provided. I've seen a handful of medical websites that state mixing stimulants with SSRI drugs can lead to SSRI toxicity (in turn possibly serotonin syndrome), and that most cases of it are due to that. No studies as you mentioned however. I think raising the serum levels of the SSRI to possibly dangerous levels, coupled with the serotonergic activity of methylphenidate (and other stimulants) as you've indicated definitely warrants a concern when mixing stimulants and SSRI drugs. As you mentioned, best to only do it under a doctors supervision.