![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by jms600 on September 20, 2009, at 14:14:25
Why isn't there a transdermal patch for Nardil?
If it cuts out (some) of the dietary restrictions, potentialy it would be a great thing, wouldn't it???
Posted by bulldog2 on September 20, 2009, at 14:15:53
In reply to Why isn't there a transdermal patch for Nardil????, posted by jms600 on September 20, 2009, at 14:14:25
> Why isn't there a transdermal patch for Nardil?
>
> If it cuts out (some) of the dietary restrictions, potentialy it would be a great thing, wouldn't it???and parnate?
Posted by desolationrower on September 20, 2009, at 17:17:34
In reply to Re: Why isn't there a transdermal patch for Nardil????, posted by bulldog2 on September 20, 2009, at 14:15:53
i think approval process is just as hard as for a completely new (or metoo) drug. and companies spent the last few decades explaining that MAOIs are dangerous, so hard to explain they aren't.
the tissue-selective maois woudl be even better
-d/r
Posted by Phillipa on September 20, 2009, at 18:40:58
In reply to Re: Why isn't there a transdermal patch for Nardil, posted by desolationrower on September 20, 2009, at 17:17:34
Expense? But wouldn't it cut down on dietary restictions? Phillipa
Posted by softheprairie on September 21, 2009, at 2:52:44
In reply to Why isn't there a transdermal patch for Nardil????, posted by jms600 on September 20, 2009, at 14:14:25
That is an intersting question!
I didn't like the patch delivery system when I tries Emsam, though. I wonder if more engineering from their side could help it, (such as stick better when we want it on, and come off less painfully when we want it off) or if most people who use it don't mind the dermatological issues like I did. I wanted to give the active ingredient, selegiline, more time, though, so I asked my pdoc about other forms of it, and I was able to take Zelapar orally disintegrating tablets at much higher doses than the on-label Parkinson's dose was for, and so I did have to follow the dietary restrictions.
Someone should contact the makers of Nardil and Parnate and inquire about it! I would love to read their answers.
Posted by gigantor on August 22, 2013, at 23:07:53
In reply to Re: Why isn't there a transdermal patch for Nardil???? » jms600, posted by softheprairie on September 21, 2009, at 2:52:44
I use Emsam. I first clean the area with rubbing alcohol and a cotton ball. I just peel it off the next day and apply a new one. It doesn't hurt. I don't apply it to skin that has very much body hair.
Posted by damnthislife on August 23, 2013, at 7:54:50
In reply to Re: Why isn't there a transdermal patch for Nardil???? » jms600, posted by softheprairie on September 21, 2009, at 2:52:44
I would be great for a patch of Nardil or Parnate. Problem is, with todays advances in SSRI/SNRI/NDRI's, doctors are more prone to prescribe those first and patients tend to react well to them. However, if you are here, you are probably suffering from long bouts of depression/anxiety with Atypical features and are probably treatment resistant, like many of us.
It took me 5 different Pdoc before I found one that would go into the MAOI arena. That's 5 Pdocs, 15 different anti-depressants over the course of 7 years.
If you want the cliff notes.... it's STUPID!
Posted by cybernut011 on February 24, 2015, at 16:20:57
In reply to Re: Why isn't there a transdermal patch for Nardil????, posted by damnthislife on August 23, 2013, at 7:54:50
Here is the response that I received from the Dr. who pioneered the EMSAM patch:
"You would not expect to avoid the tyrmamine interaction by giving a
non-selective MAOI like parnate or nardil or maplan in a patch. For
that selegiline is unique, as a type B MAOI at low concetrations and
an incresing MAO A inhibiotor at higher concentrations. Parnate, for
example inhibits MAO-A strongly at any blood concentrtion, and that's
the interaction with food problem.And its not obvious that MAOIs other than selegiline would have other
advantages by patch, tho one doesnt know without trying; there is a
very different metabolic pattern with transdermal drugs, which might
be advantageoous or disadvantageous clinically.Wish you luck.
Dr. B
>Dear Dr. Bodkin,
>
>Hope this email finds you doing well. I have a curious question and
>probably one you have answered many times before so please accept
>my apologies in advance if so, but what would be the problem with
>using a non-selective MAOI such as phenelzine or tranylcypromine in
>the patch form like to EMSAM? I am "atypical"/MDD and have responded
>better to MAOI's than newer meds, but the options are so limited.
>Thanks in advance for your time in my curiosity.
>
>Best Regards"So apparently the patch with those still dosent allow cheese or other forbidden stuff to be consumed, and the drug companies wont spend the money on it unless they are almost certain that it is a hit for them.
Posted by softheprairie on February 24, 2015, at 18:00:38
In reply to Re: Why isn't there a transdermal patch for Nardil????, posted by cybernut011 on February 24, 2015, at 16:20:57
That is neat to see his reply (but too bad it still poses problems with certain food). Thank you for the work you have done to bring us the answer.
I was last in this thread several years ago. Luckily, my mood is doing much better these days. My current psych. meds are nefazodone, a now much reduced dose of liothyronine, and perphenazine.
Posted by cybernut011 on February 25, 2015, at 9:23:01
In reply to Re: Why isn't there a transdermal patch for Nardil???? » cybernut011, posted by softheprairie on February 24, 2015, at 18:00:38
Hi softheprarie...
I knew I was as little late to the party for this thread, but I am glad that this information was helpful to you. Hopefully it will help others as well.
I have found over the last 8 years that MAOI's have been the true antidepressants that my body really responds to and hence the email to find out why we don't have more options. I am very happy to hear you are doing much better, I am doing well also with using Parnate and Klonopin as my current meds. Thank you for the feedback and I wish you well!
Posted by SLS on March 11, 2015, at 6:34:28
In reply to Re: Why isn't there a transdermal patch for Nardil????, posted by cybernut011 on February 25, 2015, at 9:23:01
Emsam inhibits MAO-A at all dosage forms available. However, it is claimed that tyramine ingestion is not dangerous at the dossge of 6 mg/24.
As per company prescribing information:"Pharmacodynamics
MAO exists as two isoenzymes, referred to as MAO-A and MAO-B. Selegiline has a greater affinity for MAO-B, compared to MAO-A. However, at antidepressant doses, selegiline inhibits both isoenzymes. In an in vivo animal model used to test for antidepressant activity (Forced Swim Test), selegiline administered by transdermal system exhibited antidepressant properties only at doses that inhibited both MAO-A and MAO-B activity in the brain. In the CNS, MAO-A and MAO-B play important roles in the catabolism of neurotransmitter amines such as norepinephrine, dopamine, and serotonin, as well as neuromodulators such as phenylethylamine."
"A diet low in tyramine content may be necessary to avoid this interaction. Studies to evaluate the potential for Emsam to inhibit tyramine metabolism have been conducted and, overall, the data for Emsam 6 mg per 24 hours support a recommendation that a modified diet is not required at this dose"
The reason why Emsam requires transdermal administration is because when taken orally, it is metabolized rapidly by the liver into L-amphetamines (L- are relatively inactive) and does not enter the brain appreciably except at the very high dosages necessary to inhibit MAO-A. Nardil needs no such delivery system to inhibit both isoenzymes. There is therefore no reason to produce a Nardil patch.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.