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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by angels78 on September 7, 2010, at 0:47:40
Whats good to augment with Nardil?
Buspar or Neurontin?
Posted by proudfoot on September 7, 2010, at 9:45:06
In reply to Whats good to augment with Nardil?, posted by angels78 on September 7, 2010, at 0:47:40
Can't speak for BuSpar, but I was on Neurontin for other reasons (1,600 mg three times a day) before recently starting Nardil, and the combined effect on reducing anxiety and depression overall has been profound. I feel the most 'normal' I've felt in many years and wish I'd discovered this combo sooner.
Posted by Phillipa on September 7, 2010, at 10:26:11
In reply to Re: Whats good to augment with Nardil? » angels78, posted by proudfoot on September 7, 2010, at 9:45:06
You say augment nardil but for what reason I didn't see what you wished to augment it for? Could be just me. Phillipa
Posted by angels78 on September 7, 2010, at 10:54:29
In reply to Re: Whats good to augment with Nardil? » angels78, posted by proudfoot on September 7, 2010, at 9:45:06
What is your Nardil dosage?
Posted by SLS on September 7, 2010, at 13:48:27
In reply to Re: Whats good to augment with Nardil? » angels78, posted by proudfoot on September 7, 2010, at 9:45:06
> Can't speak for BuSpar, but I was on Neurontin for other reasons (1,600 mg three times a day) before recently starting Nardil, and the combined effect on reducing anxiety and depression overall has been profound. I feel the most 'normal' I've felt in many years and wish I'd discovered this combo sooner.
That's great news.
Have you ever been on Nardil without Neurontin?
I wish you well on your new life.
- Scott
Posted by proudfoot on September 7, 2010, at 14:18:23
In reply to Re: Whats good to augment with Nardil? » proudfoot, posted by angels78 on September 7, 2010, at 10:54:29
Currently on Nardil 60 mg per day, but just entering my third week of treatment. I meet with my pdoc next week, and guess we'll discuss then about whether we go higher or lower on the dose.
Posted by proudfoot on September 7, 2010, at 14:30:26
In reply to Re: Whats good to augment with Nardil? » proudfoot, posted by SLS on September 7, 2010, at 13:48:27
Hi Scott,
Nope, have never been on Nardil before this time. On multiple SSRIs, an SNRI, and several APs before, but never an MAOI.
The Neurontin was prescribed for positional central vertigo I developed from taking Wellbutrin (that evil drug!). Given that life with active positional vertigo is hell and by itself almost enough to make one suicidal, I will politely refuse to give up my Neurontin if asked. My docs understand this is a quality of life issue and have no issues with continuing it indefinitely. That the Neurontin also provides some anxiety reduction and improved sleep is a convenient side effect! ;-)
Doug
Posted by ed_uk2010 on September 7, 2010, at 15:14:17
In reply to Whats good to augment with Nardil?, posted by angels78 on September 7, 2010, at 0:47:40
> Whats good to augment with Nardil?
>
> Buspar or Neurontin?Buspar is not generally combined with MAOIs.
Posted by SLS on September 7, 2010, at 15:48:36
In reply to Re: Whats good to augment with Nardil? » SLS, posted by proudfoot on September 7, 2010, at 14:30:26
> I will politely refuse to give up my Neurontin if asked.
Yes, that is where I was going. :-)
- Scott
Posted by angels78 on September 8, 2010, at 1:23:08
In reply to Whats good to augment with Nardil?, posted by angels78 on September 7, 2010, at 0:47:40
Recently, I decreased my Nardil from 75mg->60mg, I was on 60 mg for about 2 months and then realized I was eating everything in sight and decided to decrease to 30 mg. After realizing I was eating everything sugar I decided with my Pdoc to give it another try but this time not to eat junk food. So I've increased from 30 mg -> 60 mg, in a months time (yes i know long time, but my pdoc is over cautious which is a good thing), and i've been on 60 mg for about 10 days, and this time i'm not feeling enough benefit from it..kind of worrys me. How long do you think I should wait until I ramp it up to 75 mg, I think my body has adapted to this medicine somehow, I dont have any more side effects, not even insomnia. I do take Ambien at night, but no other side effects. Just curious, do you think I should give it another couple of weeks on 60 mg before I decide to move up to 75mg? Anyone whose taken Nardil before i'd like to hear what you have to say. Thanks
Posted by Tomatheus on September 8, 2010, at 2:03:57
In reply to Re: Whats good to augment with Nardil? » angels78, posted by angels78 on September 8, 2010, at 1:23:08
> Recently, I decreased my Nardil from 75mg->60mg, I was on 60 mg for about 2 months and then realized I was eating everything in sight and decided to decrease to 30 mg. After realizing I was eating everything sugar I decided with my Pdoc to give it another try but this time not to eat junk food. So I've increased from 30 mg -> 60 mg, in a months time (yes i know long time, but my pdoc is over cautious which is a good thing), and i've been on 60 mg for about 10 days, and this time i'm not feeling enough benefit from it..kind of worrys me. How long do you think I should wait until I ramp it up to 75 mg, I think my body has adapted to this medicine somehow, I dont have any more side effects, not even insomnia. I do take Ambien at night, but no other side effects. Just curious, do you think I should give it another couple of weeks on 60 mg before I decide to move up to 75mg? Anyone whose taken Nardil before i'd like to hear what you have to say. Thanks
angels78,
When I took Nardil, it took approximately two weeks following each dose increase for me to feel its antidepressant effects (and also to become less sleepy). So, based on my experience, I would definitely give the Nardil at least another two weeks before increasing the dose to 75 mg. I don't think that 10 days is enough time for you to be able to determine how you're going to react to 60 mg of Nardil this time around.
Tomatheus
Posted by SLS on September 8, 2010, at 3:42:44
In reply to Re: Whats good to augment with Nardil? » angels78, posted by Tomatheus on September 8, 2010, at 2:03:57
> When I took Nardil, it took approximately two weeks following each dose increase for me to feel its antidepressant effects (and also to become less sleepy). So, based on my experience, I would definitely give the Nardil at least another two weeks before increasing the dose to 75 mg.
I would agree that it makes sense to give each dosage of Nardil a minimum of 3 weeks to evaluate.
- Scott
Posted by angels78 on September 8, 2010, at 13:46:09
In reply to Re: Whats good to augment with Nardil? » angels78, posted by Tomatheus on September 8, 2010, at 2:03:57
Thank you for your advice.
Do you think the reason that 60 mg isn't working is because of my weight? I weigh 200 lbs. I once read that nardil dosage should be around 1MG per 2.2 lbs.
Posted by Tomatheus on September 8, 2010, at 18:28:01
In reply to Re: Whats good to augment with Nardil? » Tomatheus, posted by angels78 on September 8, 2010, at 13:46:09
> Do you think the reason that 60 mg isn't working is because of my weight? I weigh 200 lbs. I once read that nardil dosage should be around 1MG per 2.2 lbs.
angels78,
I certainly think it's possible that the reason you're not responding to 60 mg of Nardil could be because you're not taking enough for your weight. I too have read about the 1 mg/kg (1 mg/2.2 lbs) rule, so it makes sense that you might not be taking enough. I would still personally give it some more time at 60 mg, though, since 60 mg is considered to be at the bottom of the therapeutic dose range for Nardil.
Good luck getting a good response out of Nardil.
Tomatheus
Posted by angels78 on September 8, 2010, at 18:55:22
In reply to Re: Whats good to augment with Nardil? » angels78, posted by Tomatheus on September 8, 2010, at 18:28:01
Thank you and all the best to you.
Posted by proudfoot on September 8, 2010, at 21:52:47
In reply to Re: Whats good to augment with Nardil? » angels78, posted by Tomatheus on September 8, 2010, at 18:28:01
Or, from a counter-intuitive perspective, is the dose actually too high? The drug manufacturer recommends 60-90 mg for a sustained period of at least four weeks to attain full MAO inhibition and then a gradual reduction in dosage for maintenance therapy:
"The usual starting dose of Nardil is one tablet (15 mg) three times a day.
*Early phase treatment: Dosage should be increased to at least 60 mg per day at a fairly rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to 90 mg per day to obtain sufficient MAO inhibition. Many patients do not show a clinical response until treatment at 60 mg has been continued for at least 4 weeks.
*Maintenance dose: After maximum benefit from Nardil is achieved; dosage should be reduced slowly over several weeks. Maintenance dose may be as low as one tablet, 15 mg, a day or every other day, and should be continued for as long as is required."Anyone out there an expert in MAO physiology want to comment on this? I'm curious about this myself as I approach the end of my third week of Nardil 60 mg daily. My take on the above is to hit it hard early on and then back off to the lowest effective dose to minimize side effects.
Doug
> > Do you think the reason that 60 mg isn't working is because of my weight? I weigh 200 lbs. I once read that nardil dosage should be around 1MG per 2.2 lbs.
>
> angels78,
>
> I certainly think it's possible that the reason you're not responding to 60 mg of Nardil could be because you're not taking enough for your weight. I too have read about the 1 mg/kg (1 mg/2.2 lbs) rule, so it makes sense that you might not be taking enough. I would still personally give it some more time at 60 mg, though, since 60 mg is considered to be at the bottom of the therapeutic dose range for Nardil.
>
> Good luck getting a good response out of Nardil.
>
> Tomatheus
Posted by angels78 on September 8, 2010, at 22:20:42
In reply to What dose is the right dose of Nardil? » Tomatheus, posted by proudfoot on September 8, 2010, at 21:52:47
To be completely honest, I've always wondered that aswell Doug. I thought staying at a higher dose would achieve better results as most would think. Though it does say to go up to 90 mg, then titrate back down to 15mg every day or every other day.
Posted by angels78 on September 8, 2010, at 22:24:23
In reply to What dose is the right dose of Nardil? » Tomatheus, posted by proudfoot on September 8, 2010, at 21:52:47
> Or, from a counter-intuitive perspective, is the dose actually too high? The drug manufacturer recommends 60-90 mg for a sustained period of at least four weeks to attain full MAO inhibition and then a gradual reduction in dosage for maintenance therapy:
>
> "The usual starting dose of Nardil is one tablet (15 mg) three times a day.
> *Early phase treatment: Dosage should be increased to at least 60 mg per day at a fairly rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to 90 mg per day to obtain sufficient MAO inhibition. Many patients do not show a clinical response until treatment at 60 mg has been continued for at least 4 weeks.
> *Maintenance dose: After maximum benefit from Nardil is achieved; dosage should be reduced slowly over several weeks. Maintenance dose may be as low as one tablet, 15 mg, a day or every other day, and should be continued for as long as is required."
>
> Anyone out there an expert in MAO physiology want to comment on this? I'm curious about this myself as I approach the end of my third week of Nardil 60 mg daily. My take on the above is to hit it hard early on and then back off to the lowest effective dose to minimize side effects.
>
> Doug
>Being on Nardil for a few months, I'm not sure if backing off to avoid side effects is the right way to go. If your just trying to avoid the side effects i dont know how its going to help.
Posted by proudfoot on September 9, 2010, at 5:48:25
In reply to Re: What dose is the right dose of Nardil?, posted by angels78 on September 8, 2010, at 22:24:23
I didn't mean to imply that avoiding side effects was the reason for reducing dosage. My sense is that this recommendation has something to do with the level of MAO inhibition produced by the high dosage, and that a lower dosage of Nardil may be sufficient to maintain adequate MAO inhibition on an ongoing basis. Remembering that Nardil produces irreversible inhibition of MAO, it makes sense that over time a lower amount of drug would be needed for maintenance to "zap" off any new MAO sites that the body produces, whether in the gut or in the brain, as there should be fewer of these sites being produced that the Nardil needs to inactivate.
As such, extra Nardil not needed for maintenance MAO inhibition (i.e. to turn off new MAO sites) would only be producing extra side effects, thus my thinking that reducing the dose makes intuitive sense (to me). Can't get a good resource online so far to validate this thinking, but I'm going to continue to look for such. If not, may try to actually contact someone at Pfizer/P.D. to explain this recommendation about dosage reduction. In the meantime, I'm still curious about others' experiences with their pdocs having reduced their maintenance dosage of Nardil over time, and if so how low they were able to go to still maintain remission of depressive/anxious symptoms.
Doug
> Being on Nardil for a few months, I'm not sure if backing off to avoid side effects is the right way to go. If your just trying to avoid the side effects i dont know how its going to help.
This is the end of the thread.
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