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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Elizabeth on January 20, 2000, at 9:30:38
Hi everyone. Yesterday I tried adding Adderall to Marplan, but it made my blood pressure shoot up. So it looks like that is a no-go.
My choices seem to be:
1. Cylert. My pdoc doesn't like this idea because of recently increased concern about liver trouble (the recommendation is now apparently to get tested every 2 weeks -- what a PITA). However, I took Cylert by itself in college for a while and it definitely made a difference.
2. Desoxyn. Another thing my pdoc isn't too sure about. However, it does have a higher ratio of central to peripheral effects, which might be good since I seem to get elevated BP at the drop of a hat on these things. (OTOH, I think at least some of the cardiovascular effects of amphetamines are centrally mediated, so maybe this wouldn't help. Experiences?)
3. Aricept. One of the weird ideas my pdoc has mentioned at various points. Seems like a stretch but might be worth a try.
4. Switch back to Parnate (may have to wait, since I don't want to do the MAOI withdrawal thing while classes are in session again!) and add an antihypertensive. My therapist mentioned this idea, suggesting maybe a calcium channel blocker. Anybody used Ca++ blockers (especially, but not only, with MAOIs)? How are they? I've only taken Procardia a couple times.
Thanks....
Posted by Annie on January 20, 2000, at 12:15:45
In reply to stimulants; Aricept; Ca++ blockers; Parnate, posted by Elizabeth on January 20, 2000, at 9:30:38
> Anybody used Ca++ blockers (especially, but not only, with MAOIs)? How are they? I've only taken Procardia a couple times.
>
> Thanks....Elizabeth, I take Covera HS(Verapamil Hydrochloride) with Parnate. It is a calcium channel blocker like Procardia, but it has a 4-5 hour delay in drug delivery (vs 30 minutes)and is extended-release. I haven't had any problems with the combination and my BP has stayed relatively constant on the Parnate. Since I had a spontaneous hypertensive crises the last time I trialed Parnate, this has alleviated a lot of my fear. I have hypertension, so if your BP is normal, the combination with Parnate could cause a more profound hypotension. It also intensifies the action of Lithium so if you are still taking it, you may have to adjust it to avoid possible toxicity.
Annie
Posted by Scott L. Schofield on January 20, 2000, at 14:58:03
In reply to Re: Ca++ blockers; Parnate , posted by Annie on January 20, 2000, at 12:15:45
> > Anybody used Ca++ blockers (especially, but not only, with MAOIs)? How are they? I've only taken Procardia a couple times.
> Elizabeth, I take Covera HS(Verapamil Hydrochloride) with Parnate. It is a calcium channel blocker like Procardia, but it has a 4-5 hour delay in drug delivery (vs 30 minutes)and is extended-release. I haven't had any problems with the combination and my BP has stayed relatively constant on the Parnate. Since I had a spontaneous hypertensive crises the last time I trialed Parnate, this has alleviated a lot of my fear. I have hypertension, so if your BP is normal, the combination with Parnate could cause a more profound hypotension. It also intensifies the action of Lithium so if you are still taking it, you may have to adjust it to avoid possible toxicity.
Hi Annie.
I am curious. Did this hypertensive episode with Parnate occur early on in treatment? From the stuff I read a few years ago, I got the impression that the chances of this happening were slim once one got past the first few days or weeks. Unfortunately, I read that Elizabeth can have this occur well into treatment any time the dosage exceeds 30 mg (?) or so.It really sucks being in one of those "slim-chance" positions. I was initially told that I was lucky to have this illness - that the great majority (85% or so) got well with the drugs that were available at the time. Once the SSRIs and other psychotropics came along, the chances of being refractory to treatment had been reduced to 5%. Guess what?
I wonder if taking an antihypertensive during a Parnate "break-in" period might be effective in preventing a rise in blood-pressure, after which it can be discontinued. Parnate did cause me quite a bit of dizziness early on. You may be right in your thoughts regarding some sort of cumulative hypotensive effects when combining the two. That would be undesirable.
I used to carry a capsule of Procardia (nifedipine) with me just in case I was lured into participating in a pepperoni-eating contest ("pepperoni-effect"). Thankfully, I never had to use it. The first time I was prescribed an MAO-inhibitor (Parnate), I was told by the doctor that the best way to treat a hypertensive crisis was to use a drug named Regitine (phentolamine), a nonselective alpha-adrenoceptor antagonist that is used as an antihypertensive. I think it works by dialating peripheral blood vessels. It is now used quite a bit for surgery. It was once available in both oral and injectable forms. I'm not sure why, but the manufacture discontinued the oral form quite a few years ago.
An oral preperation of phentolamine is currently being investigated as a treatment for ED (erectile dysfunction - impotence). Many studies have shown it to be effective. I'm sure there will be more studies to make sure that things hold-up. If it is approved for ED, I'm hoping my doctor will allow me to carry some around for hypertensive and other emergencies.
- ScottIt's snowing here.
Posted by Rick on January 20, 2000, at 15:10:06
In reply to stimulants; Aricept; Ca++ blockers; Parnate, posted by Elizabeth on January 20, 2000, at 9:30:38
I came into this thread a little late, but I infer that MAOI's make your blood pressure rise. For me the situation was just the opposite, to the MAX. I started out with BP of 140-150/90-100 and ended up three weeks later at 80-90/60-65 after taking Nardil alone. (I'm sure this was just a coincidence, but it started happening just after some fairly heavy drinking, the first since starting Nardil. Since going on Klonopin, I'm careful to imbibe minimally; usually not at all.) It's known that MAOI's can cause hypotension, but for me it was like a bolt out of the sky. Perhaps the effect would not have lasted (although it persisted for three weeks after I stopped the Nardil), but anyone who could market a blood pressure medication with this kind of effect would make a mint. Of course, mine was an extreme case (lucky me).
Rick
-----
> Hi everyone. Yesterday I tried adding Adderall to Marplan, but it made my blood pressure shoot up. So it looks like that is a no-go.
>
> My choices seem to be:
>
> 1. Cylert. My pdoc doesn't like this idea because of recently increased concern about liver trouble (the recommendation is now apparently to get tested every 2 weeks -- what a PITA). However, I took Cylert by itself in college for a while and it definitely made a difference.
>
> 2. Desoxyn. Another thing my pdoc isn't too sure about. However, it does have a higher ratio of central to peripheral effects, which might be good since I seem to get elevated BP at the drop of a hat on these things. (OTOH, I think at least some of the cardiovascular effects of amphetamines are centrally mediated, so maybe this wouldn't help. Experiences?)
>
> 3. Aricept. One of the weird ideas my pdoc has mentioned at various points. Seems like a stretch but might be worth a try.
>
> 4. Switch back to Parnate (may have to wait, since I don't want to do the MAOI withdrawal thing while classes are in session again!) and add an antihypertensive. My therapist mentioned this idea, suggesting maybe a calcium channel blocker. Anybody used Ca++ blockers (especially, but not only, with MAOIs)? How are they? I've only taken Procardia a couple times.
>
> Thanks....
Posted by michael on January 20, 2000, at 16:43:02
In reply to Re: stimulants; Aricept; Ca++ blockers; Parnate, posted by Rick on January 20, 2000, at 15:10:06
> I came into this thread a little late, but I infer that MAOI's make your blood pressure rise. For me the situation was just the opposite, to the MAX. I started out with BP of 140-150/90-100 and ended up three weeks later at 80-90/60-65 after taking Nardil alone. (I'm sure this was just a coincidence, but it started happening just after some fairly heavy drinking, the first since starting Nardil. Since going on Klonopin, I'm careful to imbibe minimally; usually not at all.) It's known that MAOI's can cause hypotension, but for me it was like a bolt out of the sky. Perhaps the effect would not have lasted (although it persisted for three weeks after I stopped the Nardil), but anyone who could market a blood pressure medication with this kind of effect would make a mint. Of course, mine was an extreme case (lucky me).
>
> Rick
>
> -----
> > Hi everyone. Yesterday I tried adding Adderall to Marplan, but it made my blood pressure shoot up. So it looks like that is a no-go.
> >
> > My choices seem to be:
> >
> > 1. Cylert. My pdoc doesn't like this idea because of recently increased concern about liver trouble (the recommendation is now apparently to get tested every 2 weeks -- what a PITA). However, I took Cylert by itself in college for a while and it definitely made a difference.
> >
> > 2. Desoxyn. Another thing my pdoc isn't too sure about. However, it does have a higher ratio of central to peripheral effects, which might be good since I seem to get elevated BP at the drop of a hat on these things. (OTOH, I think at least some of the cardiovascular effects of amphetamines are centrally mediated, so maybe this wouldn't help. Experiences?)
> >
> > 3. Aricept. One of the weird ideas my pdoc has mentioned at various points. Seems like a stretch but might be worth a try.
> >
> > 4. Switch back to Parnate (may have to wait, since I don't want to do the MAOI withdrawal thing while classes are in session again!) and add an antihypertensive. My therapist mentioned this idea, suggesting maybe a calcium channel blocker. Anybody used Ca++ blockers (especially, but not only, with MAOIs)? How are they? I've only taken Procardia a couple times.
> >
> > Thanks....Elizabeth,
Just wondering what the adderal was attempting to address...fatigue?
Posted by Elizabeth on January 20, 2000, at 22:04:48
In reply to Re: Ca++ blockers; Parnate , posted by Scott L. Schofield on January 20, 2000, at 14:58:03
> I am curious. Did this hypertensive episode with Parnate occur early on in treatment? From the stuff I read a few years ago, I got the impression that the chances of this happening were slim once one got past the first few days or weeks. Unfortunately, I read that Elizabeth can have this occur well into treatment any time the dosage exceeds 30 mg (?) or so.
It happens when I go higher than 10mg in a single dose. (Parnate has a short half-life, about 2 hours.) I took it for a year or so before switching to Marplan; the BP problem was still happening at the end of that year.
> I wonder if taking an antihypertensive during a Parnate "break-in" period might be effective in preventing a rise in blood-pressure, after which it can be discontinued. Parnate did cause me quite a bit of dizziness early on. You may be right in your thoughts regarding some sort of cumulative hypotensive effects when combining the two. That would be undesirable.
I have low baseline BP, so, well, yeah. (Parnate + pindolol was pretty freaky for me.)
> I used to carry a capsule of Procardia (nifedipine) with me just in case I was lured into participating in a pepperoni-eating contest ("pepperoni-effect"). Thankfully, I never had to use it.
I've used it a couple times (the most recent being yesterday). It was effective in bringing down my BP, had some pretty unpleasant tachycardia.
> The first time I was prescribed an MAO-inhibitor (Parnate), I was told by the doctor that the best way to treat a hypertensive crisis was to use a drug named Regitine (phentolamine), a nonselective alpha-adrenoceptor antagonist that is used as an antihypertensive. I think it works by dialating peripheral blood vessels. It is now used quite a bit for surgery. It was once available in both oral and injectable forms. I'm not sure why, but the manufacture discontinued the oral form quite a few years ago.
Probably 'cause they hate us. :-}
> An oral preperation of phentolamine is currently being investigated as a treatment for ED (erectile dysfunction - impotence). Many studies have shown it to be effective. I'm sure there will be more studies to make sure that things hold-up. If it is approved for ED, I'm hoping my doctor will allow me to carry some around for hypertensive and other emergencies.
And then you can have wild passionate sex! :-)
> It's snowing here.
Here too.
Posted by Elizabeth on January 20, 2000, at 22:06:45
In reply to Re: stimulants; Aricept; Ca++ blockers; Parnate, posted by michael on January 20, 2000, at 16:43:02
> Just wondering what the adderal was attempting to address...fatigue?
No, ADD.
Posted by jd on January 21, 2000, at 0:07:28
In reply to stimulants; Aricept; Ca++ blockers; Parnate, posted by Elizabeth on January 20, 2000, at 9:30:38
I currently take verapamil SR, ostensibly for hypertension but I was eager to try it because of its reputation as a mood-regulator. The good news: it improved my mood a bit (especially at the start); the bad news: it didn't do much for the hypertension, so I added an ACE inhibitor--which worked better, at least in combination. Actually, there's growing evidence that ACE inhibitors can affect mood too. (What doesn't?)
From researching the calcium channel blockers a bit, my sense was that verapamil was probably the easiest to tolerate. (There are a few different sub-classes of CCBs, with varied side-effect profiles.) It's important to use an extended-release version to avoid any rebound problems.
--jd
Posted by Annie on January 21, 2000, at 14:12:31
In reply to Re: Ca++ blockers; Parnate , posted by Scott L. Schofield on January 20, 2000, at 14:58:03
Scott,
Yes, The hypertensive episode did occur after a few days of when I started the Parnate the last time. I think the use of an antihypertensive might be a good idea at least at the beginning. I would suggest that you start it before you start the Parnate. Depending on which you choose, you want to give it time to kick in.
Annie
Posted by S. Suggs on January 21, 2000, at 14:15:35
In reply to stimulants; Aricept; Ca++ blockers; Parnate, posted by Elizabeth on January 20, 2000, at 9:30:38
Hello Elizabeth, how about adding pindolol, start slow and work up if necessary? May provide some augmentation effect as well? Blessings,
S. Suggs
Posted by Elizabeth on January 21, 2000, at 22:02:43
In reply to Re: stimulants; Aricept; Ca++ blockers; Parnate, posted by S. Suggs on January 21, 2000, at 14:15:35
> Hello Elizabeth, how about adding pindolol, start slow and work up if necessary? May provide some augmentation effect as well? Blessings,
Did that (5mg t.i.d.) last time I took Parnate, actually. My BP was very low at baseline during this time, but I still wasn't able to take higher doses of Parnate.
Posted by bigbertha on January 22, 2000, at 2:22:39
In reply to Re: stimulants; Aricept; Ca++ blockers; Parnate, posted by Elizabeth on January 21, 2000, at 22:02:43
> > Hello Elizabeth, how about adding pindolol, start slow and work up if necessary? May provide some augmentation effect as well? Blessings,
>
> Did that (5mg t.i.d.) last time I took Parnate, actually. My BP was very low at baseline during this time, but I still wasn't able to take higher doses of Parnate.Would a beta-blocker such as Toprol work in either this
case or the stims?
This is the end of the thread.
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