Can over-the-counter sleeping pills interfere with the work of an
anti-depressant such as Zyprexa (though traditionally used as an
anti-psychotic, my doctor says that it is gaining acceptance as an
effective anti-depressant. My dosage is 2.5mg/24hrs)?

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Request for Question Clarification by kevinmd-ga on 18 Jan 2003 15:12 PST

Hello,
Thanks for asking your question.  I want to clarify what sleeping pill
you are talking about.  It is likely something containting
diphenhydramine, but I want to be sure.  Once I receive the exact
medication, I will run it through my drug interaction programs.

Thanks,
Kevin, M.D.

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Clarification of Question by titan6400-ga on 18 Jan 2003 16:31 PST

The active ingredient in them is "doxylamine succinate, 25mg" --
they're the generic equivalent of Unisom.

The reason I ask this is because I have been noticing what I think is
a decreased effectiveness in my Zyprexa and it started around the same
time as my taking the sleeping pills. Since I know that sleeping pills
interact with neurotransmitters, I was wondering if this could be a
source of conflict. Thanks very much.

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Clarification of Question by titan6400-ga on 18 Jan 2003 17:12 PST

That does help. If you can give me a definiton of CNS depression then
I'll be more than satisfied. I know that it stands for central nervous
system depression, but what does that mean, exactly? Thanks.

Hello,
Thanks for asking your question.  You asked about the interaction
between doxylamine and zyprexa.  This was addressed in my comment
below and was a satisfactory answer from your clarification.

You further asked about the definition of CNS depression.  This is
defined here:
"CNS Depression: Depression of central nervous system. Central nervous
system is the brain and spinal cord, with their nerves and end organs
that control voluntary and involuntary acts. Includes parts of the
brain that governs consciousness and mental activities; parts of
brain, spinal cord, and their sensory and motor nerve fibers
controlling skeletal muscles; and end organs of the body wall."
http://www.pssg.org/terms.htm

Basically, this means lethargy, fatigue, and decrease in mental
functioning.  Doxylamine by itself causes CNS depression - the
addition of Zyprexa augments the effect.

Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.    
          
Thanks,           
Kevin, M.D.

Hello,
Doxylamine is in the same class as diphenhydramine (Benadryl) - they
are the most common OTC sleep aids.  See Unisom in the below chart:
"Unisom - generic equivalent: diphenhydramine or doxylamine"
http://www.sfirx.com/images/otc.htm

I will thus use diphenhydramine in the drug interaction check.  I will
use Epocrates multicheck for this:
"MultiCheck allows you to quickly check for multiple drug interactions
simultaneously. This feature is integrated with our proprietary drug 
interactions database to provide you with concise and
clinically-relevant drug interactions."
http://www.epocrates.com/products/rxpro_features_multicheck.cfm  

Typing in zyprexa and diphenhydramine led to the following:
"Caution advised: combo may increase risk of CNS depression,
psychomotor impairment, anticholinergic adverse effects (additive
effects)"

Would this suffice as an answer?  If you want I can use other drug
interaction programs but they will likely return the same result.

Thanks,
Kevin, M.D.