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Dr. Bob is Robert Hsiung, MD,
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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????
Posted by jsarirose on July 19, 2002, at 14:55:45
In reply to Re: hypertensive experiences?, posted by LLL on July 19, 2002, at 9:03:44
> 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????
Have you ever seen another psychiatrist who prescribed Parnate? If so, he/she might be willing to do a phone consultation with your regular doctor and your local doctor could prescribe it with the other doc's blessing, so to speak. My regular doctor didn't feel comfortable prescribing all the meds I was on one time and I had her talk to my psychiatrist. After talking with the pdoc, she fell comfortable enough to let me get my prescriptions through her.
It's worth a try. Maybe one of the docs at Houston Medical would even talk to your regular doc without an in-person consultation with you first, especially if she's willing to prescribe the Parnate but not the "emergency" pill.
-Jessica
Posted by LLL on July 19, 2002, at 17:31:51
In reply to Re: hypertensive experiences?, posted by jsarirose on July 19, 2002, at 14:55:45
Thank you for your help and support - it's much appreciated I will attempt to get some communication going between my psychiatrist and my general practioner. I just feel if this psychiatrist was really competent she'd take the time to investigate the possible ramifications of this drug and be willing to invest the time with me to prescribe the "emergency pill". I'm very frustrated by the the degree of ignorance about MAOI's by medical professionals.
Lisa
Posted by jsarirose on July 19, 2002, at 17:54:07
In reply to Re: hypertensive experiences?, posted by LLL on July 19, 2002, at 17:31:51
> Thank you for your help and support - it's much appreciated I will attempt to get some communication going between my psychiatrist and my general practioner. I just feel if this psychiatrist was really competent she'd take the time to investigate the possible ramifications of this drug and be willing to invest the time with me to prescribe the "emergency pill". I'm very frustrated by the the degree of ignorance about MAOI's by medical professionals.
> Lisa
Absolutely! Many doctors are afraid of them because they have so many restrictions and ramifications. And they don't take the time to fully understand them. But they are also extremely good drugs for those of us who haven't been helped by anything else. And I'm constantly shocked by how many people I've talked to who get an MAOI prescribed without any type of "emergency" pill. Usually their doctors tell them to go to the hospital if they have a crisis. Well, in my experience that's not necessary if you have a little pill! I take thorazine (only in an emergency, not regularly). I like it because even if my blood pressure hasn't spiked it's still safe to take.Good luck,
Jessica
Posted by cybercafe on July 20, 2002, at 5:00:04
In reply to Re: hypertensive experiences?, posted by jsarirose on July 19, 2002, at 17:54:07
>been helped by anything else. And I'm constantly shocked by how many people I've talked to who get an MAOI prescribed without any type of "emergency" pill. Usually their doctors tell them to go to the hospital if they have a crisis. Well, in my experience that's not
Actually my doc says it's pretty much impossible for me to have a hypertensive crisis... and if I do, it will be mild and I should just be able to take some ibuprofen or acetaminofin or something....
... and my doc is by far one of the most knowledgable docs i have ever seen, so i am quite prone to believe him -- though yes, i would feel much better with some nifedepine (Adalat??) ...
(it's too bad... my father just stopped taking the drug and used up his last pill)
Posted by cybercafe on July 20, 2002, at 5:02:01
In reply to Re: hypertensive experiences?, posted by LLL on July 19, 2002, at 9:03:44
okay so you can't get nifedepine without the expertise of a cardiologist
you can't see a psychiatrist cuz they are all too busy or not knowledgable of MAOIs
but how hard would it be for you to get an appointment with a cardiologist?
... i'm not sure how things work in the states... would you have to pay to see a cardiologist? ...
> 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????
Posted by LLL on July 20, 2002, at 10:08:36
In reply to Re: hypertensive experiences?, posted by cybercafe on July 20, 2002, at 5:02:01
I am seeing a psychiatrist, she's the one prescribing the Parnate. My point is, since this is the drug she is prescribing and psychiatric literature clearly outlines what to do for the patient in case of a hypertensive crisis, including Procardia sublingual 10-20 mg., as well as a trip to the ER (I've had 2 such experiences and do not want to go through it ever again),then she should provide the antedote. Instead I have to now involve my PCP who because he is not a psychiatrist is not familiar with MAOI's and see's them all as "bad" drugs. Good care should not be fragmented! I've had excellent psychiatrists in the past in other parts of this country, this doesn't encourage me as receiving good care.
Regarding hypertensive crisis and it being rare - I consumed a small piece of teriyaki chicken breast and had a "ride to hell" as a result. Not only did I require a trip via ambulance to the ER, I was subjected to terrible care by personnel who kept asking in unsympathetic fashion "why did you try to kill yourself"?
Posted by cybercafe on July 20, 2002, at 11:38:27
In reply to Re: hypertensive experiences?, posted by LLL on July 20, 2002, at 10:08:36
>is the drug she is prescribing and psychiatric literature clearly outlines what to do for the patient in case of a hypertensive crisis, including Procardia sublingual 10-20 mg., as well
ahh so it actually says in the literature to perscribe it but she won't?? ... that sounds rather strange ... :)
>not be fragmented! I've had excellent psychiatrists in the past in other parts of this country, this doesn't encourage me as receiving good care.
believe me i can totally relate...
.. i was caught off guard in london because i waited 4 months.. and then had an *excellent* doc ... i was like "i bet you want to put me on valporate" and then "holy shit YOU have heard of lamictal?? You have USED lamictal??" ... VERY impressed.... and then i moved a few blocks away and it was like "sorry i cannot legally see you anymore because you are no longer in my area" ... if i had known you could go above 200 mg on lamotrigine, i would have raised it myself, .. but i wasn't very knowledgable back then...
to this day i wonder if lamictal might have been a wonder drug for me... and if i have lost 3 years of my life unneccessarily ....
but i feel much much better now that i have taken things into my own hands .... (thank you Parnate)
> Regarding hypertensive crisis and it being rare - I consumed a small piece of teriyaki chicken breast and had a "ride to hell" as a
hmmm.. i wonder if it is easier on my system because i am tall and slim? ... i can't think of what else it could be...
i just had some teriyaki chicken in fact, .. but there was no soya sauce on it, if that is what did it for you?
Posted by may-b on July 20, 2002, at 11:43:51
In reply to Re: hypertensive experiences?, posted by LLL on July 20, 2002, at 10:08:29
> Regarding hypertensive crisis and it being >rare - I consumed a small piece of teriyaki >chicken breast and had a "ride to hell" as a >result. Not only did I require a trip via >ambulance to the ER, I was subjected to >terrible care by personnel who kept asking in >unsympathetic fashion "why did you try to kill >yourself"?
I had a similar experience -- disrespectful ER 'care' and the same offensive question. The idea that I would have to deal with more unenlightened medical personnel has scared me away from using Parnate, the only AD that has actually helped.
Best wishes,
may-b
Posted by Bobbiedobbs on July 20, 2002, at 12:50:15
In reply to Re: hypertensive experiences? » LLL, posted by may-b on July 20, 2002, at 11:43:51
In response to the last few posts:
(1) I've had teriyaki chicken breast and teriyaki on lots of other thinks - never a reaction. Could it possibly be the type of soy sauce used? The watered-down soy used in most commercial sauces and even some Chinese restaurants (soy blanded to suit American tastes) is probably harmless.
(2) Re yeast in frozen dinners. That is all I eat. I would estimate that I have eaten approximately 3000 frozen dinners since taking up to 60 mg. of Nardil and 50 mg. of Parnate and narry the slightest hint of a reaction (you do have to be careful not to have a TV dinner with cheese, broad bean pods, etc.) I take this to reflect the amount of yeast in these dinners and the condition of it by the time it gets combinecd with the thousands of other chemicals.
3) I too get the "no one has ever heard of what you're taking" or (they stopped prescribed that in the 60's, for good reason) type of reactions from doctors and others. One good thing about this on-line community is that you realize you are NOT the only one taking an MAO - and I've gotten better info here than from some doctors.
Posted by LLL on July 20, 2002, at 13:09:52
In reply to Re: hypertensive experiences?, posted by Bobbiedobbs on July 20, 2002, at 12:50:15
I agree, I've received more help from this site than from any health care professionals (at least while living here).
The teriyaki chicken was prepared in a restaurant and from the saltiness I remember, it may have in fact been soaked in soy sauce. I used soy (stuck with the same brand) in small amounts with no problem.
Regarding frozen foods, I'd stay away from the autolyzed yeast extract, at least I'm not going to chance it. I found canned chicken stock and some frozen foods in the Kosher food section with all natural ingredients as well as some frozen foods with no additives in the organic food section. My remaining concern is with eating out for in the past I felt confined to boring sauce free/cheese free dishes.
If you are able to get the info on the soy protein and soy flour I'd much appreciate it.
Thanks,
Lisa
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