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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Cseagraves on April 12, 2009, at 16:27:20
Question.
If Nardil makes you sleepy during the day and sleepless and night, would taking provigil be O.K.? Would that help to straighten your sleep cycle or would you still be awake all night?
Have others here tried taking provigil with an maoi? If so, how did you do with that combo?
Just curious.
Courtney
Posted by shasling on April 12, 2009, at 17:10:14
In reply to Nardil and Provigil, posted by Cseagraves on April 12, 2009, at 16:27:20
Are you saying this because nardil has done this already?If not seems you have many fears on nardil and i think its best you just ease in on it and see how it feels.
However provigal could be used,there is also a cheaper version of it called olmifon which actualy is touted by many to work better,its about to be released in the u.s under a different name,i assume when this happens it will be much harder to obtain from overseas as olmifon.
Posted by SLS on April 12, 2009, at 18:40:23
In reply to Nardil and Provigil, posted by Cseagraves on April 12, 2009, at 16:27:20
> Question.
>
> If Nardil makes you sleepy during the day and sleepless and night, would taking provigil be O.K.? Would that help to straighten your sleep cycle or would you still be awake all night?
>
> Have others here tried taking provigil with an maoi? If so, how did you do with that combo?
>
> Just curious.
>
> Courtney
I really like the idea of combining Provigil with an MAOI. I would have added it to Nardil if it had not made my depression worse when I tried it by itself.The only thing is, I have no anecdotal reports to provide you with. You would be a pioneer of sorts.
In any event, your logic regarding the improvement of circadian rhythms using Provigil while taking Nardil is sound. I think it is worth a try. At this point, I am unaware of any contraindication for this combination.
Good luck.
- Scott
******************************************: Sleep Med. 2004 Sep;5(5):509-11.Click here to read Links
Concomitant use of modafinil and tranylcypromine in a patient with narcolepsy: a case report.
Clemons WE, Makela E, Young J.Michael S. Aldrich Sleep Disorders Laboratory, Department of Neurology, University of Michigan, 8D 8702 University Hospital, Box 0117, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0117, USA. ec2285@msn.com
This is a case report of a patient with narcolepsy treated simultaneously with modafinil and tranylcypromine. The concurrent use of these two medications is normally contraindicated based on theoretical concerns. To our knowledge this is the first report of the combined use of these two medications in a patient for any reason. This combination of medications was particularly effective in the treatment of the patient's narcoleptic symptoms and was well tolerated, with no evidence of the potential cardiovascular side effects. Due to modafinil's lack of sympathomimetic activity and unique pharmacological profile, it may be well tolerated with monoamine oxidase inhibitor's (MAOI's) in humans with respect to hemodynamic parameters and concerns of hypertensive crisis. Further investigation would help clarify cardiovascular safety issues in using this combined therapy. We believe that with proper informed consent from the patient and careful monitoring, a combination of an MAOI and modafinil may be a viable treatment alternative in refractory cases of narcolepsy.
PMID: 15341899 [PubMed - indexed for MEDLINE]
- Scott
Posted by gardenergirl on April 13, 2009, at 1:53:53
In reply to Re: Nardil and Provigil, posted by SLS on April 12, 2009, at 18:40:23
I used these together, and the Provigil helped with the daytime fatigue I would get from Nardil. Provigil didn't keep me up at night, though I was already using Ambien at night to help with the early awakening I would get on Nardil. Provigil did a very good job for me in regulating my sleep/wake cycle without making me feel amped up.
gg
Posted by Cseagraves on April 13, 2009, at 12:39:57
In reply to Re: Nardil and Provigil, posted by gardenergirl on April 13, 2009, at 1:53:53
How long have you been taking Nardil and how is it working for you. I am hoping it will kick this extreme anxiety and social phobia I have. What is your current dosage and have you been stable on it for a while?
When did you start adding Provigil to the Nardil?
Thanks,
Courtney
Posted by gardenergirl on April 13, 2009, at 14:53:15
In reply to Re: Nardil and Provigil - gardengirl, posted by Cseagraves on April 13, 2009, at 12:39:57
> How long have you been taking Nardil and how is it working for you. I am hoping it will kick this extreme anxiety and social phobia I have. What is your current dosage and have you been stable on it for a while?
>
> When did you start adding Provigil to the Nardil?
>
> Thanks,
> CourtneyI was on Nardil for about four and a half to five years at anywhere from 45 mg to 67.5 mg. I think I added Provigil after two years or so at 200 mg for two reasons: I was hoping it would help the inattentive ADD symptoms I have, and I needed something to help with daytime fatigue from Nardil. Nardil has been the best AD I've ever taken as far as targeting my symptoms of atypical depression. The side effects were tolerable while I was on it.
I had to go off of Nardil for some outpatient surgery in Feb., so I've been off of it now for about two months. I've since started taking Cymbalta, as I'd rather not go back on Nardil if I can avoid it. I don't want to face the start-up side effects and weight gain of Nardil if something else might work reasonably well.
Cymbalta's not cutting it for me at 60 mg at the moment. My plan is to continue for a couple more weeks to give it a full eight weeks, maybe go up to 90 mg, then see.
Good luck to you. I hope you find good relief from Nardil.
gg
Posted by Cseagraves on April 13, 2009, at 17:30:25
In reply to Re: Nardil and Provigil - gardengirl » Cseagraves, posted by gardenergirl on April 13, 2009, at 14:53:15
Hi Gardengirl,
Thanks for the response. Did the fatigue that Nardil caused not ever get better? I know that it can cause weight gain, would you mind me asking how much weight it caused you to gain?
I was hoping with proper diet and exercise I could keep the weight down, but the thought of being constantly fatigued bothers me. I thought that it eased up after time.
Courtney
Posted by metric on April 13, 2009, at 18:05:59
In reply to Re: Nardil and Provigil, posted by SLS on April 12, 2009, at 18:40:23
> I really like the idea of combining Provigil with an MAOI. I would have added it to Nardil if it had not made my depression worse when I tried it by itself.
>I've had that thought as well -- that modafinil + an MAOI would be very effective for depression.
I'm suprised you find such a combination attractive if modafinil made you more depressed on its own. Did you feel more depressed during its peak or as it wore off? If the latter, perhaps Nardil would mitigate the crash.
Posted by Cseagraves on April 15, 2009, at 20:15:30
In reply to Re: Nardil and Provigil » SLS, posted by metric on April 13, 2009, at 18:05:59
Another question.
If I had to end up augmenting later on with the Nardil, because my problem is mostly anxiety, what do you think would be a good augment? Lamital maybe?
CS :-)
Posted by desolationrower on April 16, 2009, at 1:02:13
In reply to Re: Nardil and Provigil, posted by Cseagraves on April 15, 2009, at 20:15:30
you said benzos haven't agreed with you? maybe lpyrica
-d/r
Posted by Shaner9 on April 27, 2009, at 15:47:03
In reply to Nardil and Provigil, posted by Cseagraves on April 12, 2009, at 16:27:20
I currently take 400mg of the Canadian brand of Provigil (Allertec) with 90mg Nardil and I've also taken it with Parnate in the past. I started slowly and I check my blood pressure every day. I did go up to 800mg Allertec for a month or so but my psychiatrist didn't like me going that high. Actually I think that much only made me nauseated anyway with no other benefit. I've had benefits over that last couple years with both Nardil and Parnate along with clonazepam and Allertec which have not been consistent-basically up and down. It seems like I've been doing the best the last 2 months since gradually quitting clonazepam (which was only 0.5mg) and going to a high dose of Nardil 105mg-90mg with the Allertec. I wouldn't recommend anyone try that high of a dose of Provigil because everyone is different and it could be very risky. I find I have to take some early and later in the day (but not too late). It helps but I still get very tired spells and need naps. I'll probably try reducing it to 200mg soon. My sleep schedule is pretty messed up probably because I do shift work, but I'd say Provigil could potentially help someone reset their sleep schedule if you stay away from napping or sleeping in too late.
Posted by 3y2l on July 31, 2009, at 8:55:34
In reply to Re: Nardil and Provigil, posted by Shaner9 on April 27, 2009, at 15:47:03
I currently take 45 mg of nardil and 200 mg of Provigil split once in morning and once in evening due to developing narcolepsy recently (from the nardil). There has been no I'll effects with this combination other than the cost of the provigil which will not be feasible for long. The provigil has mo other effects except to do what it's supposed to which is keep me awake. At $10 a pill and no insurance I will have to stop and have thought of Strattera or getting off nardil which will be a bummer because it really works. I do have very severe weight gain on the nardil though despite eating very little and healthy. Hth. If anyone has recommendations please share!
Posted by SLS on July 31, 2009, at 9:27:55
In reply to Re: Nardil and Provigil, posted by 3y2l on July 31, 2009, at 8:55:34
What about combining Nardil with desipramine?
I have been on that combination a few times without having any dangerous untoward events.
- Scott
Posted by emilyp on July 31, 2009, at 9:31:20
In reply to Re: Nardil and Provigil, posted by 3y2l on July 31, 2009, at 8:55:34
Why don't you try dexedrine. There are generics so it won't cost much. I know that some doctors won't combine stimulants with MAOI's but if done correctly, it works. There has been literature to support this. See this:
Posted by 3y2l on July 31, 2009, at 10:25:45
In reply to Re: Nardil and Provigil, posted by emilyp on July 31, 2009, at 9:31:20
Unfortunately, my pdoc won't consider ADs or stimulants. It was tough enough to get him to prescribe Provigil. I'd like to find a reliable source out of the country but
worried about quality.
Posted by emilyp on July 31, 2009, at 13:38:50
In reply to Re: Nardil and Provigil, posted by 3y2l on July 31, 2009, at 10:25:45
You do need to find another doctor. Unless you have a specific problem (which obviously could be the case), then substituting dexedrine for provigil is something that can be done. That is a shame he won't consider it.
Posted by softheprairie on August 5, 2009, at 3:34:41
In reply to Re: Nardil and Provigil, posted by 3y2l on July 31, 2009, at 8:55:34
I take it your narcolepsy is verified/diagnosed by your medical provider? That is likely your ticket! With no insurance coverage for Provigil and not being able to afford it as prescribed, you might be able to get it free from the company that makes it! For so many users of Provigil, they are SOL since it's use is off-label, but it looks like your use is the rare real narcolepsy, (one of the 3 FDA-approved indications for it's use)!? I don't know this first-hand, but read on CrazyMeds that the pharma. maker of Provigil adds in it's own requirement that the use be on-label for people to get it from the company's patient assistance program.
> I currently take 45 mg of nardil and 200 mg of Provigil split once in morning and once in evening due to developing narcolepsy recently (from the nardil). There has been no I'll effects with this combination other than the cost of the provigil which will not be feasible for long. The provigil has mo other effects except to do what it's supposed to which is keep me awake. At $10 a pill and no insurance I will have to stop and have thought of Strattera or getting off nardil which will be a bummer because it really works. I do have very severe weight gain on the nardil though despite eating very little and healthy. Hth. If anyone has recommendations please share!
Posted by 3y2l on August 5, 2009, at 23:59:19
In reply to Re: Nardil and Provigil » 3y2l, posted by softheprairie on August 5, 2009, at 3:34:41
The weight gain is impossible to control despite vigorous exercise and a low calorie diet as well as other side effects so unfortunately i have decided to d/c the nardil. I've already tried parnate so I'm not sure what I will be doing
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