Adderall, Prozac and Paxil: Problem not solution

Drug Interactions Abound in ADHD Land

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Some antidepressants and stimulants create significant problems together, period. Some of my colleagues disagree and I will tell you why in a moment.

The media has been buzzing this particular med topic up for years. This interaction is one reason psych meds are taking much heat. This post, if considered carefully, can save you much money, significant heartache, and that hopeless feeling when nothing you are taking to fix these problems works. Young and old, you just won’t be in so much trouble.

In this post I will tell you briefly about the pharmacologic part of the problem, and the next post we can discuss how you can see it clinically, then ask the questions to unearth the gritty details.

And don’t forget Concerta and MPH Products

And the problem is present, though less obvious, with MPH products like Concerta and Ritalin which also block 2D6 pathways.

These meds simply don’t work together [rare exceptions, more about categorical thinking in a later post]: Prozac, or Paxil mixed with any amphetamine such as Adderall, mixed amphetamine salts, Dextrostat, or Dexedrine. Some may say it is “not in the literature,” but I have seen this clinically important and dangerous consequence hundreds of times, and have written about this common reaction with my son as lead author.

It’s About 2D6 The CYP 450 Pathway

We will cover more details later, but for now just remember this: Prozac and Paxil both significantly block the pathway for the metabolism of Adderall and all the amphetamine products. If you take either of these two antidepressants together with an amphetamine, just watch out. You can significantly become overdosed on the amphetamine. Often the interaction can unpredictably occur several months later. The patient becomes toxic to the amphetamine, angry, irrational, can’t sleep, can’t eat, and can become dangerously destructive. The Adderall often gets blamed. The Prozac and the Paxilare the problem. More about Adderall in a later post.

Many books document this challenging interaction, and two of my favorites, one by Cozza and Armstong:

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Drug Interaction Principles for Medical Practice

and one by Stahl, for those wishing to understand more.

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The Prescriber's Guide

The reason for the disagreement? The reason it has been missed? – This interaction often occurs much later, and appears to be unrelated to changes in the meds.

Please do send comments if you have seen this interaction, let’s talk about it.