I Need Some Wise Counsel....Quickly.
 

I just had an appointment with my MDS at the University Hospital. This doctor recently came to our area after distinguished work at Mass-General Hospital and Harvard. He is brilliant and very patient and sincere during his consultations.

My dilema is this: he has put me on Azilect to be taken along with my Requip. I also take Wellbutrin XL and asked him if it was ok to continue with the Wellbutrin. He said yes,, that they had had no problems with Wellbutrin.

Well, when I went to have the Azilect Rx filled, a contraindication flag came up in the pharmacy computer regarding the Azilect and Wellbutrin and at first the pharmacist refused to fill the Azilect. After much begging and pleading, she finally agreed to fill the Azilect and I promised I would not take any more Wellbutrin until I spoke with my MDS. Problem is, my MDS is at a conference out of the country until the middle of September so I am on hold regarding the Wellbutrin until then. In the meantime, I thought I would check with this forum and see if any of y'all have had any experience with taking Azilect and Wellbutrin concominantly.

I am aware that Azilect (which is an MAO-B inhibitor) should not be taken with an SSRI, but Wellbutrin is an aminoketone. Any info anyone? I am really fermisht about all this.

Caya

According to the FDA, your pharmacist is correct
 

"buPROPion and rasagiline (Major Drug-Drug)

CONTRAINDICATED: According to the manufacturer, the acute toxicity of bupropion may be potentiated by coadministration of monoamine oxidase inhibitors (MAOIs). The mechanism of interaction has not been described.

MANAGEMENT: Concurrent use of bupropion with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, procarbazine) is considered contraindicated. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with bupropion
.

Source: FDA /druginteractions (type in as search terms)

Most pharmacies have FDA guidelines for drug interactions in their pharmacy computer program For each of the pharmacy customers, the program will automatically search the interactions of a new prescription with the customers current prescriptions and if it discovers an adverse interaction, by law, they are unable to fill the order until they have advised the prescribing physician of the interaction and suggest other possiblities.

I understand the above to say wait until your doctor gets back and has a chance to speak to your pharmacist. If you cannot wait, get a second opinion.

Best Regards,
Vicky

from - http://www.drugs.com/drug_interactions.php

Drug interaction results for the following 3 drug(s):
rasagiline (Azilect)
ropinirole (Requip)
buPROPion (Wellbutrin)
Interactions between your selected drugs

Major Drug-Drug Interaction buPROPion and rasagiline (Major Drug-Drug)
CONTRAINDICATED: According to the manufacturer, the acute toxicity of bupropion may be potentiated by coadministration of monoamine oxidase inhibitors (MAOIs). The mechanism of interaction has not been described.

MANAGEMENT: Concurrent use of bupropion with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, procarbazine) is considered contraindicated. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with bupropion.

Moderate Drug-Drug Interaction buPROPion and ropinirole (Moderate Drug-Drug)
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Other drugs that your selected drugs interact with

• There are 1073 other drugs known to interact with Azilect (rasagiline)

• There are 880 other drugs known to interact with Requip (ropinirole)

• There are 1677 other drugs known to interact with Wellbutrin (buPROPion)
Interactions between your selected drugs and food

Major Drug-Food Interaction rasagiline (Major Drug-Food)
GENERALLY AVOID: Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with monoamine oxidase inhibitors (MAOIs). The mechanism is inhibition of MAO-A, the enzyme responsible for metabolizing exogenous amines such as tyramine in the gut and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules. Although rasagiline is considered a selective inhibitor of MAO-B, the selectivity has not been established in humans and may not be absolute even at recommended dosages. Rare cases of hypertensive reactions associated with ingestion of tyramine-containing foods have been reported in patients taking the recommended daily dose of selegiline, another MAO-B inhibitor.

MANAGEMENT: Patients treated with rasagiline should preferably avoid consumption of products that contain large amounts of amines and protein foods in which aging or breakdown of protein is used to increase flavor. These foods include cheese (particularly strong, aged or processed cheeses), sour cream, wine (particularly red wine), champagne, beer, pickled herring, anchovies, caviar, shrimp paste, liver (particularly chicken liver), dry sausage, salamis, figs, raisins, bananas, avocados, chocolate, soy sauce, bean curd, sauerkraut, yogurt, papaya products, meat tenderizers, fava bean pods, protein extracts, yeast extracts, and dietary supplements. Caffeine may also precipitate hypertensive crisis so its intake should be minimized as well. At least 14 days should elapse following discontinuation of rasagiline therapy before these foods may be consumed. Specially designed reference materials and dietary consultation are recommended so that an appropriate and safe diet can be planned. Patients should also be advised to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, difficulty thinking, stupor or coma, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. The recommended dosages of rasagiline should not be exceeded, as it can increase the risk of nonselective MAO inhibition and a hypertensive crisis.

dear caya -
 

I worked in a pharmacy as a tech and mistakes -they do happen - the doctors are not pharmacist's so if they do not know -the doctors usually call the pharmacy,
listen to the Pharamacists he has a doctors degree in pharmachology -
that is usually not the MD's specialty -
call the doctor or have your pharmacy call your doctor
asap -
have peace,
tena

i thought...
 

That if you were to keep the dose of Azilect at 2mg per day, it would only inhibit monoamine oxidase B, so you would be OK, but apparently according to
http://www.peacehealth.org/kbase/multum/d00181a1.htm
it is not a good thing to do. The question is, is bupropion potentiated when only MAOIB is knocked out?
Bupropion is metabolized rapidly (and i assume reversibly) to the aminoalcohol isomers, and it is structurally a "phenethylamine". My guess is that it is potentiated when you knock out monoamine oxidase B (we take MAOIB to potentiate dopamine selectively). Her's some blurb about bupropion (all you would ever want to know ! )
http://www.rxcarecanada.com/Wellbutr...sp?prodid=1850
Caya and all- Did you guys realize that this post comes up when you do web searches? I've seen Neurotalk posts come up quite frequently when one does a search looking for answers to specific questions in this blogg room. So watch what you say, our words our like honey attracting ants out there !!!

ding ding and red flag. just went through hell in similiar situation. drug interactions can be very serious and any time there is a possibility of one, i would be very wary. 2 docs (doc of pharmacology and neuro) contradicting each other does happen. so... you need a third. or even a fourth.

psychiatrist... they are experts in the workings of meds used for anxiety/depression

internal specialist.. they are experts in all chemical balances

the drugs we take are very powerful and can reek havok if not considered with seriousness. there are side effects, interactions, weaning off and on complications yada yada yada,,, that we have GOT to be aware of. what ever you do, please do not take these meds lightly.

you are very wise in questioning this...

"ask the doctor"
 

there is an online service in Miami at the National parkinson's Foundation, where a team of neuros answer questions for patients. They are quick to reply. Good luck!

PM me for the link if you'd like

Thank you, Thank you, Thank you
 

All of y'all, thank you so much for your input and time in doing so. Right after I posted we had a family emergency and I have been out-of-pocket until just now. I decided the best thing to do was to stop the Wellbutrin and get started with the Azilect and just wait until my MDS returns in two weeks. Actually, I wanted to get off the Wellbutrin anyway so maybe there will be a silver lining in this whole mess. I sure would like to be a fly in the phone line when my MDS speaks with my pharmacist. I just find it all very scary that a specialist with the background my MDS has could make this sort of a contraindicated Rx. Does this happen a lot? Who in the world do we trust? Again folks, thank you each of you for taking time to deal with me.

Caya

Ask the Doctor
 

Caya-
I sent you a PM--let me know if you've received it, or if you have any trouble with the site let me know.