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Dr. Bob is Robert Hsiung, MD,
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Posted by Bobbiedobbs on July 16, 2002, at 23:00:35
In reply to hypertensive experiences? , posted by cybercafe on July 16, 2002, at 14:55:23
I've taken nardil for 15 years and parnate for 2 years. Nardil dose was 30-60 mg. parnate dose has been 20-40 mg. I've eaten zads of pepperoni, pizza with sausage, pepperoni, etc. (but being careful to confine the cheese on it to mozarrela and ricotta), and had way too much wine and beer on a number of occasions. The only thing I've really avoided has been aged cheese, Miso soup and the various decongestants and other conflicting medications.
Only two reactions in that time:
(a) 15 years ago took a decongestant by mistake. It was pretty ugly. I started sweating and getting a piercing headache immediately and blood pressure was way high. On doc's advice, I took Melaril to bring blood pressure down. then I took a second Melaril and it did the trick. Second reaction was from a Turkish pizza that the server swore up and down (in Turkish, perhaps) had no cheese. Reaction was sweating and a blinding headache that lasted for several hours; however, blood pressure did not rise all that much. I know several people taking Parnate and/or Nardil and the only reaction was to a dufus who ate a "three-cheese pizza". The drug company says you have several hours to get to a hospital. The manufacturer recommends a particular antidote whose name escapes me, if it is important I can tell you. My current doctor gave me a different antidote which I carry around just in case. Phil.
Posted by Bobbiedobbs on July 16, 2002, at 23:29:54
In reply to Re: MAOI diet short list » KellyM, posted by LLL on July 16, 2002, at 16:22:57
Sorry you didn't get as much help as I did. All I can think of is that (a) I was asking stuff that went beyond the list they already provided, so they were apparently willing to cooperate (b) I was previously a consumer reporter and can be pretty persistent/solicitous - a good combination generally (c) I was fortunate on the two occasions I called. (d) they were swamped with calls from people who saw the phone #. If you really get stuck on something you can let me know what the question is and I'll give it a try. Actually, I've had pretty good luck with my own pharmacist on a few occasions. Phil.
Posted by ayrity on July 16, 2002, at 23:54:53
In reply to hypertensive experiences? , posted by cybercafe on July 16, 2002, at 14:55:23
Hi cyber-
I wrote before about a hypertensive reaction I had on 30 mg Parnate- I've been on it about 4 weeks now. The first time I had a reaction I thought it was food related, since it was about 1 hour after lunch, but I did not eat anything unusual or provocative.Since then, I've had multiple high spikes in my BP within 1/2 hour after taking a dose of Parnate, unrelated to food, whether I've eaten or not. Spontaneous hypertensive reactions, though rare, are known to occur with Parnate. It figures I'd be one of the rare ones! Like I wrote before, every med I've tried I've gotten all of the side effects and none of the benefit. Very frustrating. I was hoping this would work this time- I've been through Celexa, Celexa + Wellbutrin, Wellbutrin alone, Effexor, Provigil- never felt better on any of them, only side effects. Since it seems I have atypical depression (for which MAOIs are often the best choice), my doc and I had high hopes for Parnate.
We spread out the dose of Parnate over the day, which seems to help a bit but my BP still spikes occasionally. I might have to stop it and switch to Nardil or Marplan if there's no improvement.
Posted by jsarirose on July 17, 2002, at 1:02:18
In reply to Re: hypertensive experiences? , posted by Bobbiedobbs on July 16, 2002, at 23:00:35
I have had two "accidents" as well with similar results. Once I ate a seafood stew which had smoked clams in it (everything else was fresh so I assumed the clams were too). And another time I had Vietnamese Pho which has anchovy paste in it. (Took a while to figure that one out!)
Both times I got a pounding, sudden migraine about an hour after eating. It hurt horribly. The first time I called and my doctor was out. The doctor on call wanted me to take my blood pressure which, of course, I couldn't at home. He wouldn't let me take my "emergency" pill and suggested I take some Advil and lie down. Well, the last thing you can do when you have a migraine is lie down. I took to pain pills I had left over from surgery and eventually it faded.
The second time I called my doctor. She said to take the "emergency" pill. If my blood pressure was high it would bring it down and if not it wouldn't hurt me. I took it and one pain pill. I started to feel better very soon. Both times I had residual headaches (not migraines) for a couple days after and slept a lot.
RE: the emergency pill. My doctor prescribed Chlorpromazine (thorazine). It doesn't give you the famous drooling side effects if you only take it very occasionally. It's also safe to take even if you aren't technically in hypertensive crisis.
I also bought a home electronic blood pressure kit. I didn't think I'd be able to take my blood pressure manually in a crisis, but the automatic one is easy. I take it periodically to maintain a diary of my regular blood pressure too.
-Jessica
Posted by cybercafe on July 17, 2002, at 1:22:01
In reply to Re: hypertensive experiences? , posted by ayrity on July 16, 2002, at 23:54:53
> Hi cyber-
> I wrote before about a hypertensive reaction I had on 30 mg Parnate- I've been on it about 4 weeks now. The first time I had a reaction IHey thanks a lot for replying -- much appreciated.
Might I ask if you have any health condition that might be implicated in this spontaneous reaction?
... oh btw how bad were the spikes? and did they involve physical symptoms like majorly painful headache?
Posted by cybercafe on July 17, 2002, at 1:28:14
In reply to Re: hypertensive experiences? , posted by jsarirose on July 17, 2002, at 1:02:18
hey Jess.. you don't remember me from ASDM? :)would you happen to know if all Pho is bad... or just that particular one?
Posted by jsarirose on July 17, 2002, at 1:36:15
In reply to Re: hypertensive experiences? , posted by cybercafe on July 17, 2002, at 1:28:14
>
> hey Jess.. you don't remember me from ASDM? :)
>
> would you happen to know if all Pho is bad... or just that particular one?Of course I do! I always remember my fellow Parnate ingestors. When I looked up Pho recipes on the web I found some contained anchovy paste and some did not. I called the restaurant I ate at and they did use paste in their broth. Since many Pho restaurants are run by heavily accented workers, I decided it would be risky to try it again.
I would be careful about Pho unless you can ask the employee about the ingredients and be sure he gives you a clear and honest answer. It has also made me much more wary about other asian dishes. I still eat ethnic, but if I don't know the ingredients I always ask. And if I'm not sure about the language barrier I don't chance it. After two attacks - I definitely don't want another! Of course, even if I knew it had anchovy paste in it I wouldn't necessarily known it wasn't allowed. I had to look that up too!
-Jessica
Posted by LLL on July 17, 2002, at 9:30:57
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 23:29:54
Well if you wouldn't mind - I'm still unsure (anxious) about some things. NO Broad beans - are Sugar Snap Peas in their pods included? Again, soy protein and soy flour - OK? Someone posted a reaction to buttermilk pancakes with soy flour! If I make my own chicken broth and thus eliminate the yeast extract found in canned broth, and then freeze it, do I have to worry about the age of the broth before using? And in regard to Marsala wine - I don't drink wine, but I cook with it, if the Marsala wine is used in making a sauce and cooked is that OK? Lastly, are there any frozen convenience foods out there that can be consumed that don't contain autolyzed yeast extract or yeast extract (both no-no's)?
Thanks
Lisa
Posted by jsarirose on July 17, 2002, at 14:11:03
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by LLL on July 17, 2002, at 9:30:57
> Well if you wouldn't mind - I'm still unsure (anxious) about some things. NO Broad beans - are Sugar Snap Peas in their pods included? Again, soy protein and soy flour - OK? Someone posted a reaction to buttermilk pancakes with soy flour! If I make my own chicken broth and thus eliminate the yeast extract found in canned broth, and then freeze it, do I have to worry about the age of the broth before using? And in regard to Marsala wine - I don't drink wine, but I cook with it, if the Marsala wine is used in making a sauce and cooked is that OK? Lastly, are there any frozen convenience foods out there that can be consumed that don't contain autolyzed yeast extract or yeast extract (both no-no's)?
> Thanks
> Lisa
Broad beans are specific type of bean, same as fava beans. They aren't very common, but you need to be aware. Other beans and peas are just fine.Soy protein & soy flour should be fine, it was probably the buttermilk that created the reaction. (This is my opinion gleaned from the information I have read - not fact.)
Making your own chicken broth and freezing it is just fine. Some of the organic broths are also made without out yeast.
Marsala wine in cooking is fine. In fact, unless it's homemade - wines in moderation are just fine. I can't imagine needing so much to cook with (and consuming enough of the dish) that you would ingest more than the equivalent of two glasses of wine!
I've had a hard time finding frozen/convenience foods too. I seem to have better luck in the natural or organic section of the store although they are pricier. Things without sauces tend to be yeast free as well. (Yeast isn't the enemy, just autolyzed yeast and yeast extract - I say yeast in these foods because it's easier to type.)
-Jessica
ps - you'll get the hang of it soon and be able to figure things out on your own, it just takes a while to get the basic reasoning down.
Posted by SLS on July 17, 2002, at 14:31:46
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 0:23:58
Hi Phil.
You invested yourself wonderfully in taking the time to answer questions regarding MAOIs. It looks like you have ton of valuable research into the matter. I was wondering if you might want to put together for us your own short list of the of foods and medications that you know to be particularly dangerous. If not, perhaps you could list a few Web URLs that you think are worth looking at.
I have been on and off MAOIs for twenty years, and have not yet come across anything as definitive as the information it looks like you have compiled.
Thanks.
- Scott
Posted by SLS on July 17, 2002, at 15:03:20
In reply to Re: hypertensive experiences? , posted by jsarirose on July 17, 2002, at 1:36:15
Hi.
What are the best drugs to use to treat an MAOI reaction?
I have carried nifedipine (Procardia) around. Is that the best? I had never heard of the usage of Mellaril until someone here mentioned it.
The old recommendation for treating an MAOI hypertensive crisis in the hospital was to use Regitine, an injectable form of phentolamine. Phentolamine is a nonselective NE alpha receptor antagonist that I believe works to relax blood vessels. I'm pretty sure that an oral form was once available, but not since at least 1982. I was hoping that an oral form of phentolamine would once again appear, as it was being looked at for treating erectile dysfunction. However, I don't think the initial clinical studies showed enough efficacy to pursue it as such.
- Scott
Posted by jsarirose on July 17, 2002, at 15:24:49
In reply to Re: hypertensive experiences? , posted by SLS on July 17, 2002, at 15:03:20
I can't say what is the best, but I can say what my doctor gave me: Chlorpromazine (50mg), aka: Thorazine. It works well for me and I like the idea that it won't harm me if I'm having an attack but my blood pressure isn't necessarily heightened (couldn't always tell before I had my own BP monitor). It does make me tired for while - but it works pretty quickly.
-Jessica
Posted by JonW on July 17, 2002, at 18:18:48
In reply to Re: hypertensive experiences? , posted by SLS on July 17, 2002, at 15:03:20
> I have carried nifedipine (Procardia) around. Is that the best? I had never heard of the usage of Mellaril until someone here mentioned it.
My pdoc, Dr. Liebowitz, gave me nifedipine as well. My pharmacist also thinks very highly of it for hypertensive crisis.
Jon
Posted by Seamus2 on July 17, 2002, at 19:27:16
In reply to Re: hypertensive experiences? , posted by SLS on July 17, 2002, at 15:03:20
IIRC, phentolamine is under investigation now for use as an pecker picker upper, a la Viagra.
Posted by ayrity on July 17, 2002, at 19:30:41
In reply to Re: hypertensive experiences? , posted by cybercafe on July 17, 2002, at 1:22:01
> Hey thanks a lot for replying -- much appreciated.
> Might I ask if you have any health condition that might be implicated in this spontaneous reaction?
> ... oh btw how bad were the spikes? and did they involve physical symptoms like majorly painful headache?Hi again: no I have no underlying medical conditions that might explain the reactions. I've never had blood pressure problems in my life.
Only the first episode I wrote about involved a severe headache. Since then, I've spiked as high as 170-180/90s with some ringing in my ears and palpitations but no headache.
I saw my doctor yesterday. We're going to give it one more week- if no improvement I'll probably have to stop the Parnate and try a different MAOI.
Posted by SLS on July 17, 2002, at 20:56:03
In reply to Re: hypertensive experiences? , posted by jsarirose on July 17, 2002, at 15:24:49
Hi Jessica.
> I can't say what is the best, but I can say what my doctor gave me: Chlorpromazine (50mg), aka: Thorazine. It works well for me and I like the idea that it won't harm me if I'm having an attack but my blood pressure isn't necessarily heightened (couldn't always tell before I had my own BP monitor). It does make me tired for while - but it works pretty quickly.
Have you actually had MAOI food reactions? How often have you had them? What other drugs have you used besides Thorazine? (I'm assuming that you don't take Thorazine on a daily basis).
Forgive me if you have already answered this question along this thread, but I am unable to read (concentrate) more than a few posts a day.
Thanks.
- Scott
Posted by SLS on July 17, 2002, at 20:58:23
In reply to Re: hypertensive experiences? , posted by JonW on July 17, 2002, at 18:18:48
> > I have carried nifedipine (Procardia) around. Is that the best? I had never heard of the usage of Mellaril until someone here mentioned it.
>
> My pdoc, Dr. Liebowitz, gave me nifedipine as well. My pharmacist also thinks very highly of it for hypertensive crisis.
>
> JonMichael Liebowitz? He was the first doctor that diagnosed me as having an affective disorder. Real nice guy.
- Scott
Posted by SLS on July 17, 2002, at 21:11:41
In reply to Re: hypertensive experiences? , posted by ayrity on July 17, 2002, at 19:30:41
> > ... oh btw how bad were the spikes? and did they involve physical symptoms like majorly painful headache?
> no I have no underlying medical conditions that might explain the reactions. I've never had blood pressure problems in my life.> Only the first episode I wrote about involved a severe headache. Since then, I've spiked as high as 170-180/90s with some ringing in my ears and palpitations but no headache.
How did you know when you were having these spikes? Did you display symptoms or did you just routinely check your pressure?
> I saw my doctor yesterday. We're going to give it one more week- if no improvement I'll probably have to stop the Parnate and try a different MAOI.
Nardil does much more for me than Parnate. I'm bipolar with atypical depressive features and social anxiety. I should think that Nardil has a better chance of working than Marplan, although Marplan usually has milder side effects. Still, I have heard of some people responding to Marplan who had not responded to either Parnate or Nardil.
- Scott
Posted by ayrity on July 17, 2002, at 23:55:30
In reply to Re: hypertensive experiences? » ayrity, posted by SLS on July 17, 2002, at 21:11:41
> How did you know when you were having these spikes? Did you display symptoms or did you just routinely check your pressure?
> Nardil does much more for me than Parnate. I'm bipolar with atypical depressive features and social anxiety. > - ScottThanks for the reply, Scott.
After the first hypertensive reaction, which was symptomatic, I started checking my BP regularly throughout the day and found this pattern where my BP would spike pretty high about 1/2 hour after a dose, unrelated to food. It seems to be getting a bit better. We're giving it one more week to see if my body adjusts and the hypertension no longer reoccurs.I have atypical depression and extreme fatigue is the prominent symptom- since Parnate has a stimulant effect we went with that first. My doc prefers Marplan (fewer side effects, though knowing me...) instead of Parnate if the stimulant effect is not required, or as second choice if the Parnate doesn't work out.
Posted by jsarirose on July 18, 2002, at 1:03:00
In reply to Re: hypertensive experiences? » jsarirose, posted by SLS on July 17, 2002, at 20:56:03
> Have you actually had MAOI food reactions? How often have you had them? What other drugs have you used besides Thorazine? (I'm assuming that you don't take Thorazine on a daily basis).
>
> Forgive me if you have already answered this question along this thread, but I am unable to read (concentrate) more than a few posts a day.
>
> Thanks.
>
> - ScottI've had three attacks total. Two were absolutely food related (smoked, canned clams in a stew and anchovy paste in Vietnamese Pho). The third was two days after the first and we never figured out what triggered it. I ate breakfast (2 eggs, toast) but I'd eaten the exact same thing many times before and the exact same type of bread, etc.
All three times I did not have a home blood pressure monitor and was in far too much pain to drive to a drug store to test it (as one stupid doctor suggested). Two times I took one Thorazine pill and a pain pill (oxycodone that was left over from surgery) and two Aleve. That seemed to do the trick, it slowly subsided and I was left with a dull, but manageable headache for a couple days. I was also very tired for a day or so. The Thorazine pill was hugely successful. When I just took a pain pill and Aleve it didn't help nearly as quickly or as well as when I took the Thorazine. I haven't tried any other emergency pills. And I don't take it regularly at all - only for a crisis.
I also now own a home blood pressure kit. I bought the automatic one because I didn't think I could handle the manual if I was in the throes of a migraine/attack. I stronly recommend it. I keep a rough estimate of my regular blood pressure, measure it when it feels elevated, and measure it when I feel very dizzy. The chart helps me look for abnormalities.
Hope this helps.
-Jessica
Posted by Bobbiedobbs on July 18, 2002, at 2:26:30
In reply to Re: hypertensive experiences? , posted by SLS on July 17, 2002, at 15:03:20
Regarding the best drug to carry around:
The manufacturer currently recommends the Phentolamine (Regitine) to which you alluded, at a dosage of 5 mg administered intravenously. IV is not my idea of a good time plus given some of the places I go I can't always be sure of getting to a hospital that quickly.
Like you, I carry around with me Nifedpine (Procardia). Have never used it, though. Be careful about it melting in hot weather if carried in a glove compartment of a car (as with all encapsulated forms of medicine).
I used the Mellaril and as I said, it worked. One must be careful about taking too much of this as it can lower your blood pressure to a dangerous level as well.
I'll try to compile a list of food do's and don'ts within a few days. One of the folks who posted in this link recently put up some good web sites, although they all vary in degree of restrictivity. The manufacturer's is overally restrictive, as you would expect, given its desire to avoid any possible liability.
Posted by Bobbiedobbs on July 18, 2002, at 2:37:10
In reply to Re: hypertensive experiences? » ayrity, posted by SLS on July 17, 2002, at 21:11:41
On the Nardil vs. parnate question I could write a book. The short version is that while Nardil definitely was of greater help in my social phobia and anxiety, Parnate had far fewer side effects. Nardil really gave me a buzz-on. Loved it - my social life (what there was of it) definitely improved. But it became too hard to tolerate. If you look at historical discussions on this subject, you'll find all sorts of opinions. The drugs seem to work differently depending on the user. There used to be a Web site anxietynetwork.com, which said, "we (?) have found that in general Parnate, as opposed to Nardil, is more effective with generalized social anxiety disorder. The site recommended P. over N. due to Parnate's "added noradrenergic and dopaminergic effects." I'd have stayed on the Nardil if it wasn't for the site effects. I'd be interestd in hearing anyone's experiences with Marplan, which was off the market for years.
's
Posted by cybercafe on July 18, 2002, at 13:38:45
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by LLL on July 17, 2002, at 9:30:57
>Again, soy protein and soy flour - OK? Someone posted a reaction to buttermilk pancakes with soy
... i certainly wouldn't want to say this applies to everyone.... but i just guzzle down that soy drink like there is no tomorrow, ... and i have no problems... "So good" and others like that... the strawberry or chocolately goodness
Posted by JonW on July 18, 2002, at 17:19:07
In reply to Re: hypertensive experiences? » JonW, posted by SLS on July 17, 2002, at 20:58:23
> Michael Liebowitz? He was the first doctor that diagnosed me as having an affective disorder. Real nice guy.
Yeah, Michael R. Liebowitz from NYC. I think he's nice too, but sometimes he moves so fast that I don't know what to think. He really seems to be understanding my situation and hopefully he'll solve the problem soon :)
Jon
Posted by LLL on July 19, 2002, at 9:03:44
In reply to Re: hypertensive experiences? » SLS, posted by JonW on July 18, 2002, at 17:19:07
I'm glad to hear so many of you are so luck to have found a competent doctor. After moving here almost a year ago I discovered that all the competent and cutting edge doc's are in the Houston Medical Center (which is comprised of about 6 major hospitals and Universities). However, with panic/disorder/agoraphobia (thus the need for the Parnate - only MAOI's have ever helped)driving from the suburbs to the inner city (about 2 hours with traffic)is like asking me to skydive. My current doc (closer) who reluctantly agreed to begin to prescribe again the Parnate refuses to also prescribe Procardia for a hypertensive crisis, since cardiac drugs are out of her area of expertise (this is a common anecdote for patients to carry and is prescribed with the MAOI). Soooooo, does anyone out there know how I can find a competent psychiatrist who's not afraid of MAOI's in the WEST Houston,TX area????
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