Misc Pregabalin + mirtazapine + diazepam...safe?

[Spurs_1882]

Sorry...another annoying combination question.

I take 150mg pregabalin per day (it does nothing for me at this dose but go into WD without it), 75mg in the morning and 75mg at night. I am about to start mirtazapine for anxiety, but intend on keeping on the pregabalin until I'm stable on the mirt. My starting dose will be small, 7.5mg (half a 15mg tablet).

So, I was due to start the mirt last night but then remembered I had taken 9mg diazepam in the afternoon at work. Considering its long half-life, I thought that I would effectively have three downers in my system so didn't do it. However, I'm planning on starting the mirtazapine tonight. Would that be safe? Again, considering the long half-life of diazepam meaning there would probably still be some in my system.

My feeling is that it would, as I am tolerant to the pregabalin, and all three doses of each drug are low. Besides, all three drugs have different modes of action. Should I reduce the pregabalin evening dose to 50mg or something just to make sure? Just wondering for some HR advice, I can't ask my GP as the diazepam is not prescribed for that purpose. I did ask them about the mirt + pregabalin combo which they said was fine.

Thank you.

 

[Hodor]

Nah, this combo is fine. As you said, you are already tolerant to the Pregabalin, and 9 mg of Diazepam isn't a lot either. If you've never taken any drugs with an antihistaminergic action before then the Mirtazapine might feel *very* sedating the first few nights, but you'll probably develop a decent tolerance within days.

 

[HeadHigh]

i second Hodor. Watch out though, you may end up sleeping for upwards of 10-12 hours on this combo. All of those cause sedation, and mirtazapine has a half life of between 20 and 40 hours.

 

[Spurs_1882]

Thank you both v much. I gave it a miss last night to be certain. Gonna try the mirtazapine tonight, and fully expect to be mainly asleep the next few days lol. Good to know for future about the combo.

 

[VaPPiano]

No problem with that combo!!

I have hade it proscribed by my doctor.
Nothing dangerous with this!

 

[VaPPiano]

Mirtazapine can make you awake as well tho! It might be very personal but i can't sleep on it. I got frome 1 mg Flunitrazepam to 2 when i started taking it.. I dont do anymore tho but it docent have to make you sleepy..

 

[kleinerkiffer]

Nah, this combo is fine. As you said, you are already tolerant to the Pregabalin, and 9 mg of Diazepam isn't a lot either. If you've never taken any drugs with an antihistaminergic action before then the Mirtazapine might feel *very* sedating the first few nights, but you'll probably develop a decent tolerance within days.

third this

9mg Diazepam is a rather low dosage and starting with half a pill of mirtazapine is a good idea

But as Hodor said, you'll most likely will be really sedated the first few nights

 

[Spurs_1882]

Mirtazapine can make you awake as well tho! It might be very personal but i can't sleep on it. I got frome 1 mg Flunitrazepam to 2 when i started taking it.. I dont do anymore tho but it docent have to make you sleepy..

What dose were you taking of the mirt? Have heard it is more stimulating when you to 30mg and beyond, so that might explain it.

 

[Spurs_1882]

third this

9mg Diazepam is a rather low dosage and starting with half a pill of mirtazapine is a good idea

But as Hodor said, you'll most likely will be really sedated the first few nights

Yes was very sedated last night and still a bit today. But much better with the half pill than a few weeks ago when I tried taking a full 15mg one. The next day I felt like a zombie, I did not feel like myself. Today, following 7.5mg last night, I still feel like myself, albeit a sluggish, lethargic version of myself.

 

[Hodor]

As I said, tolerance to antihistaminergic effects builds rapidly... the first few days it may very well floor you, but you'll soon reach a level where it will help you fall asleep in the evening without a zombiefying hangover in the morning. Hang in there

And yes, once you've developed a decent tolerance to the histamine antagonism, Mirtazapine can be stimulating - from what I understand it has a fairly unique antidepressant action where it indirectly boosts neurotransmitter levels by blocking "bad" receptors that prevent their release (as opposed to inhibiting their re-uptake like other antidepressants). What's especially interesting is that by blocking 5HT2C (the "evil" kind of serotonin receptor) it increases the release of dopamine, so it may offer superior efficacy in treatment-resistant cases involving anhedonia (an inability to feel pleasure).

 

[Spurs_1882]

As I said, tolerance to antihistaminergic effects builds rapidly... the first few days it may very well floor you, but you'll soon reach a level where it will help you fall asleep in the evening without a zombiefying hangover in the morning. Hang in there

And yes, once you've developed a decent tolerance to the histamine antagonism, Mirtazapine can be stimulating - from what I understand it has a fairly unique antidepressant action where it indirectly boosts neurotransmitter levels by blocking "bad" receptors that prevent their release (as opposed to inhibiting their re-uptake like other antidepressants). What's especially interesting is that by blocking 5HT2C (the "evil" kind of serotonin receptor) it increases the release of dopamine, so it may offer superior efficacy in treatment-resistant cases involving anhedonia (an inability to feel pleasure).

Thank you. That's very interesting about increasing dopamine. It sounds good. In choosing to go on mirtazapine, I wanted to avoid the probability of emotional blunting and the related loss of libido that go with the SSRIs. From my research this seems less likely with mirtazapine, which is likely to be to do with its different mode of action and maybe the dopamine release.

 

[Speed King]

Okay, this drug is subjective. Could/ should knock you out, might keep you up. Any real problems after a few days, call your doctor. Lot of good tips in this thread. Closed.