Question:

Caren asked...

My Dr. increased my dosage to 60 mg of Celexa a day which I just read on this site is over the maximum dosage. I don't feel any better. I did at first but then started feeling worse and the Dr increased my dosage. I take a number of other medications. They include, OxyContin 120mg 2 x a day, Prilosec 40 mg a day, verapamil 360 mg a day, Klonopin 1mg 3 times a day, Seroquel 50mg 50mg a day. I think that's it. I was on Paxil for years but decided to change due to I was feeling more depressed. I don't know what to do. I want to feel happy again and it gets harder and harder to go on every day. Suicide is not an option although I wished I could I would never do that because I am a christian and really don't want to find out what happens plus I have children and grandchildren. But I am so tired of feeling this way. Does anyone have any suggestions. Thank you, Caren.
 

Answer:

Dear Caren,

There are cases when increasing the dosage of Celexa to 60 mg a day is warranted. Here's a bit of information that from the PDR:

"Although certain patients may require a dose of 60 mg/day, the only study pertinent to dose response for effectiveness did not demonstrate an advantage for the 60 mg/day dose over the 40 mg/day dose; doses above 40 mg are therefore not ordinarily recommended."

Who coordinates all your various medications? Assuming they're prescribed by different doctors, do these doctors consult with each other? Often, it's our primary care physician who keeps an eye out to be sure that the combination of medications we take present no interactions and don't interfere with each other. Just for information, I ran your list of medications through the PDR interaction checker. It showed:

1. Klonopin Tablets (Clonazepam) may interact with:
   • OxyContin Tablets (Oxycodone Hydrochloride)
   Result: (Potentiates CNS-depressant action).
   
   • Seroquel Tablets (Quetiapine Fumarate).
   Result: (Potentiates CNS-depressant action). 
    
2. Celexa Tablets (Citalopram Hydrobromide). The labeling of this product lists no interactions with the other products entered.
    
3. OxyContin Tablets (Oxycodone Hydrochloride) may interact with:
   • Seroquel Tablets (Quetiapine Fumarate).
   Result: (Concurrent use with the usual dose of OxyContin may result in respiratory depression, profound sedation or coma; reduced dosage (1/3 to 1/2 of the usual dosage) may be necessary). 
    
4. Prilosec OTC Tablets (Omeprazole magnesium)  may interact with:
   • Klonopin Tablets (Clonazepam).
   Result: (Potential for metabolism interaction via cytochrome P450 system). 
    
5. Seroquel Tablets (Quetiapine Fumarate) may interact with:
   • Covera-HS Tablets (Verapamil Hydrochloride).
   Result: (Co-administration with an inhibitor of CYP4503A may reduce oral clearance of quetiapine, resulting in an increase in maximum plasma concentration of quetiapine; dose adjustment of quetiapine will be necessary). 
    
6. Covera-HS Tablets (Verapamil Hydrochloride). The labeling of this product lists no interactions with the other products entered.

Your medication combination may be just fine for you, but why not start with something obvious and ask your doctors about this information? If there are any medication interactions going on, that could contribute to how you're feeling.