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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by KimS on July 18, 2004, at 8:26:39
Hi -
I started Nardil yesterday after trying every other type of drug known to man to blunt my panic disorder and depression. My mother's been on Nardil for 20 years with only one hypertensive episode after some Chinese food - she swears it was the MSG, but I don't know how that's possible. She was even given Demerol in the ER once (she was conscious and screaming at them she was on an MAOI), and amazingly enough it didn't kill her. She can eat chocolate, white wine, yogurt, etc.
However, I am scared to death because I can't seem to find any authoritative list of safe foods and drugs for MAOIs, and it seems that there isn't one because it's so highly variable. My doctor told me I could take regular Benadryl for allergic episodes, and my mother about had a fit and said it could kill me. I'm on my second day and I'm scared to eat anything, and just taking the Nardil even scares me because of the "spontaneous" hypertensive episodes I've read about. And then there are others that say the diet is too restrictive, and you can eat almost anything. I'm only on 15 mg/day for the first month (my doctor is extra cautious, my liver enzymes are a little elevated) and I feel like this drug is my last hope of having a normal life, but how normal can it be when you don't know whether what you eat is going to kill you?
Yes, I know that was a bit hysterical, but can I get a little positive reinforcement anyway? I'd be grateful.:)
Kim
Posted by King Vultan on July 18, 2004, at 12:43:10
In reply to Starting Nardil, posted by KimS on July 18, 2004, at 8:26:39
The only way Benadryl will kill you is if you take the stuff that isn't plain diphenhydramine. For instance, some versions have pseudoephedrine in them--those are dangerous and must be avoided. However, the plain stuff is an innocuous antihistamine that is perfectly safe for people on MAOIs. I have been taking 50 mg for sleep every other night for some time now, and I am up to 105 mg/day of Nardil. So rest assured, it is safe.
The best list on foods IMO is in this article (Hope I get it right--am at home on my webtv and have to type it by hand):
http://www.vh.org/adult/provider/psychiatry/CPS/19.html
The section relevant to foods has "Hypertensive Crisis." at the beginning of a paragraph. As indicated in the section, cheese seems to be the leading offender at a stunning 67 out of 80 or 84% of the cases examined for the article. However, it is the aged cheeses such as cheddar that are the problem. I have consumed large amounts of mozzarella cheese on pizza almost every week since starting Nardil, and I have also had cheeseburgers at McDonald's and Burger King, both of which use American Cheese. You can get an idea of how other cheeses compare in Table 4. My opinion is that the amount of tyramine in mozzarella may be overstated in the table--I believe it is actually much closer to zero based on information I have seen elsewhere.
As indicated in Table 7, there are other foods that absolutely must be avoided. In particular, I would point out:
tap beer
aged and cured meats (salami, pepperoni, etc.) However, ordinary bologna and hot dogs are okay.
soy sauce--some brands are apparently okay, but this can be extremely dangerous if you get one of the bad ones
sauerkraut
improperly stored meats and other protein sources that are starting to get "old"--in particular, be very careful of liver, but foods such as yogurt may also pose a problem if consumed past their expiration date.
large amounts of chocolate and caffeine, whatever that means. I have perhaps 8 or 10 cups of coffee a day but don't eat large amounts of chocolate. I'm guessing a Hershey bar wouldn't matter, at least one of normal size.
There are a few others in the table, but these are the ones I worry about in particular. The reality is that the vast majority of foods are okay. Certainly, it is far less restrictive than an Atkins Diet.
As for a spontaneous hypertensive crisis, my observation is that this seems to be much more associated with Parnate, thus the necessity of splitting the doses with that drug. Even with Nardil, though, it's probably not a bad idea and may give better antidepressant efficacy because of more efficient MAO inhibition (The body is constantly producing MAO, so by spreading the dosage throughout the day, you have an opportunity to knock off the newly formed MAO). Of course, just taking one pill a day, which is a very, very low dose--in my own case, I did notice anything until I got to 60 mg/day, YMMV--the issue of splitting the dosage is a moot point. It seems like people who take 60 mg/day tend to split it into a morning and afternoon dose. I actually take my 7 x 15 seven times a day, at 6 and 9 AM, and 12, 2, 5, 8, and 11 PM, but this is how my pdoc would prefer me to take it, and I am perhaps an unusually gung ho patient.
I do understand your apprehension about taking the Nardil, and I felt it myself at the beginning also. However, as time goes on, you begin to realize that the stuff really isn't that dangerous as long as one is relatively prudent and cautious. I do carry 2 x 10 mg nifedipine with me as an emergency treatment for a hypertensive crisis, but I do not expect to ever use it (there are different schools of thought on the advisability of prescribing this for patients--I have read both sides and prefer to carry it; for me, it is a psychological security blanket, if nothing else). I hope you are able to get up to a high enough dosage to experience the positive effects of the Nardil, and that the experience winds up being a beneficial one for you.
Todd
Posted by SLS on July 18, 2004, at 14:03:17
In reply to Starting Nardil, posted by KimS on July 18, 2004, at 8:26:39
Hi.
Todd said what I was going to say, only betterer.
I have spent much of the last 15 years taking MAOIs and eating pizza. I barely notice the restrictions, and I don't walk around trembling in fear and feeling like there's a bomb inside me waiting to go off if I do the wrong thing. MAOIs deserve a health respect for their adverse interactions, but once you become familiar with the relatively short list of no-no's, they will no longer be a threat.
As for the spontaneous hypertensive episodes, that does involve Parnate, and not Nardil. It is very infrequent, and usually occurs early in treatment if it is going to happen at all.
Stay away from pepperoni.
Good luck.
- Scott
Posted by KimS on July 18, 2004, at 19:38:05
In reply to Re: Starting Nardil » KimS, posted by King Vultan on July 18, 2004, at 12:43:10
Thanks so much for your comforting words and sound advice. I'm starting to calm down now, and have decided just to avoid everything that's questionable for a while and then try certain things in small amounts. Boy, am I going to miss cheese, though! Thanks again.
Posted by gardenergirl on July 18, 2004, at 21:22:28
In reply to Re: Starting Nardil » King Vultan, posted by KimS on July 18, 2004, at 19:38:05
Kim
Good luck with the Nardil. I have been on it since last fall, and so far, it is still working well. I take between 45 and 60 mg depending on how much stress is going on in my life.Initially, I followed the published dietary guidelines strictly. As I learned more about them, and read many posts, I began to cautiously try foods that others have done well with and that research shows are actually not necessarily risky.
Also, about benadryl, I think Todd is right. It's the pseudoephedrine (Sudafed, a decongestant) that is dangerous. That is one thing you really don't want to risk trying. But benadryl and other simple antihistamines are usually fine. I take Claritin everyday with no problem.
Once again, good luck and let us know how it goes.
gg
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