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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by ndlsdz on August 1, 2002, at 22:43:29
Hi,
I'm new to this board and have got a lot of good information about maoi's by reading through old posts. Anyway, after five years of short-lived miraculous successes with zoloft and prozac, and useless trials of many more AD's and combinations, I've become pretty desperate and have convinced my current pdoc to prescribe Nardil (I've just finished the necessary wash-out period).
My pdoc is rather cautious and has instructed me to start at 30mg for two weeks before stepping up to 45mg. I am interested in knowing at what dosages people typically start and how many days pass before increasing the dosage. Thanks.
Posted by LLL on August 2, 2002, at 20:39:57
In reply to beginning dosage/ rate of increase for Nardil, posted by ndlsdz on August 1, 2002, at 22:43:29
It all depends upon how sensitive you are to medicines and how well you tolerate side effects. It's usually recommended you start with the lowest dose (15) and increase by the same every 7 days. However, not knowing your symptoms, or their severity, that may be a torturous long time to get to your therapeutic dose.
Posted by ndlsdz on August 3, 2002, at 1:51:14
In reply to Re: beginning dosage/ rate of increase for Nardil » ndlsdz, posted by LLL on August 2, 2002, at 20:39:57
> It all depends upon how sensitive you are to medicines and how well you tolerate side effects. It's usually recommended you start with the lowest dose (15) and increase by the same every 7 days. However, not knowing your symptoms, or their severity, that may be a torturous long time to get to your therapeutic dose.
I don't think I'm especially sensitive to meds. I've had virtually no side effects from SSRI's and others. But it's quite likely Nardil will be a different story. I doubt I'll do as told and stay at 30mg for two weeks before a dosage increase. Even waiting a week between 15mg increases seems like it would take forever. My hesitant doctor has very little experience with MAOI's and wouldn't even prescribe something in case of a hypertensive crisis, and said that one such crisis would mean the end of Nardil.
I guess my real question is what would happen if the dosage increase were too rapid?
thanks
Jeff
Posted by LLL on August 3, 2002, at 9:18:13
In reply to Re: beginning dosage/ rate of increase for Nardil » ndlsdz, posted by ndlsdz on August 3, 2002, at 1:51:14
Probably nothing but an increase in intensity of side effects. There are many posts, both recent and not so distant past on Nardil and its side effects. One good article for to read is at this link:
http://www.vh.org/Providers/Conferences/CPS/19.html
Good Luck
Posted by missliz on August 4, 2002, at 4:01:34
In reply to Re: beginning dosage/ rate of increase for Nardil » ndlsdz, posted by LLL on August 3, 2002, at 9:18:13
Nardil is totally unlike any beast you've met before, and starting at 30 mg is way too high. Most people don't have side effects from SSRI's- why do you think every GP and OBGYN hands them out like candy?
Start at one tab, in the morning. Some people have a paradoxical effect and find it sedating, so you may prefer to take it at bedtime. Most people get trouble with insomnia, for which the best thing is Ambien. Do not take Desyryl or trazodone with an MAOI. Do not use Zyprexa with an MAOI, use Risperdal if you need it. Tegretol/Trileptal are now off limits too.Moniter your blood pressure and heart rate. I assume you have the current redone Johns Hopkins diet? And the list of cold medicine that can kill you? Google Nardil and look around.
I took this drug for years and it's great, but you have to be fully informed. MAOIs are a lifestyle.
Many doctors at iffy residency programs have never been trained in the use of these drugs as they were dissed as relics from the past after SSRI's came out., and I wonder if all your guy knows about Nardil is from a quick peek at the PDR. 30 to 60 mg is the average maintence dose, not the starting dose. You need to titrate this up slowly. MAOIs metabolize into amphetamines, and this is really quite cool,it's an enjoyable drug but thats why you start slowly. It can screw with your heart if you overload the system, It can flip you into mania if you turn out to be BP1, or even if you're not. You have to keep a constant dose on a constant schedule. I was up to 100mg a day on Prozac, but when I went to Nardil 30 mg was all I needed. Throw those assumptions out the window!
This is a great medication, but it demands respect and informed use. once you get there, Nardil is great. It takes about eight weeks, but you'll be amazed how together your head will get. It does a big rewiring job.Miss Liz
I didn't mean to dis your doctor- I'm sorry if it came over that way. Unfortunatly a lot of pdocs weren't trained in MAOIs and they do require a slow titration and informed supervision.
Posted by ndlsdz on August 4, 2002, at 15:21:30
In reply to Re: beginning dosage/ rate of increase for Nardil, posted by missliz on August 4, 2002, at 4:01:34
> Nardil is totally unlike any beast you've met before, and starting at 30 mg is way too high. Most people don't have side effects from SSRI's- why do you think every GP and OBGYN hands them out like candy?
> Start at one tab, in the morning. Some people have a paradoxical effect and find it sedating, so you may prefer to take it at bedtime. Most people get trouble with insomnia, for which the best thing is Ambien.Thanks, I'll keep that in mind. I've used Ambien in the past.
Do not take Desyryl or trazodone with an MAOI. Do not use Zyprexa with an MAOI, use Risperdal if you need it. Tegretol/Trileptal are now off limits too.
not a problem as I'm unipolar, but yes now many medications are off limits
Moniter your blood pressure and heart rate. I assume you have the current redone Johns Hopkins diet? And the list of cold medicine that can kill you? Google Nardil and look around.
> I took this drug for years and it's great, but you have to be fully informed. MAOIs are a lifestyle.
> Many doctors at iffy residency programs have never been trained in the use of these drugs as they were dissed as relics from the past after SSRI's came out., and I wonder if all your guy knows about Nardil is from a quick peek at the PDR. 30 to 60 mg is the average maintence dose, not the starting dose. You need to titrate this up slowly. MAOIs metabolize into amphetamines, and this is really quite cool,it's an enjoyable drug but thats why you start slowly. It can screw with your heart if you overload the system, It can flip you into mania if you turn out to be BP1, or even if you're not.That would be a welcome change.
You have to keep a constant dose on a constant schedule. I was up to 100mg a day on Prozac, but when I went to Nardil 30 mg was all I needed. Throw those assumptions out the window!
> This is a great medication, but it demands respect and informed use. once you get there, Nardil is great. It takes about eight weeks, but you'll be amazed how together your head will get. It does a big rewiring job.
>
> Miss Liz
Thanks for the advice. I suppose I should adopt a somewhat more cautious attitude.
Posted by missliz on August 5, 2002, at 0:36:43
In reply to Re: beginning dosage/ rate of increase for Nardil » missliz, posted by ndlsdz on August 4, 2002, at 15:21:30
Nah, you don't want to be bi polar 1, you want to be bi polar 2. ;) No scary full blown psychotic mania, just intermittent hypomania. You'll be free to wander the streets feeling jolly while you irritate the heck out of freinds and strangers alike:)) (snicker)
No, seriously, I hope it works for you. I spent most of my life so deeply depressed I could barely move. Nardil was my big introduction to how the rest of the world does it.Miss Liz
This is the end of the thread.
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