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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by europerep on July 12, 2011, at 15:51:56
hello there..
I just wanted to get a couple of opinions on how to best start phenelzine (Nardil).
Initially, I thought of doing 15mg for a week, then 30mg for a week, then 45mg for a week, etc. Then I read in the prescriber's info that the usual starting dose is 3 x 15mg per day, i.e. 45mg right from the start. Now I'm not really sure. I decided I didn't want to start right away with 45mg, so today I started my phenelzine trial with 30mg split up in two doses. I'm not sure how to go on now, and I kind of feel like I'm rushing it ("why would they make 15mg pills if one is supposed to start at a higher dose than just 15mg once a day?"). This is weird, because I am actually taking less than recommended and still I feel like I'm going too high too quickly.
Right now, my idea is to do 30mg/d for three or four days, then do 45mg for a week, then 60mg for a week, and then see where I'm at. What do you guys think, and how did you start it?
Thanks in advance.
Bye,
ER
Posted by zonked on July 12, 2011, at 18:40:57
In reply to Nardil/phenelzine starting dose, posted by europerep on July 12, 2011, at 15:51:56
E - MAOI pills are weird that way. I've always started at 15 t.i.d. and gone from there. Everyone's different, but I had no side effects from that dose, other than the need to take a nap in the afternoon which came on quickly. Keep in mind I also take Klonopin though. As for how fast you go up, I'd recommend that you do your starting dose for a week or two and go from there. You know how some drugs have start up anxiety even on the lowest dose? Nardil has never done this to me. Good luck and keep us posted! -z
Posted by emmanuel98 on July 12, 2011, at 19:46:49
In reply to Nardil/phenelzine starting dose, posted by europerep on July 12, 2011, at 15:51:56
They make 15mg pills because MAOI's are fairly short acting and are supposed to be dosed three times a day, unlike SSRIs.
Posted by jono_in_adelaide on July 12, 2011, at 20:09:01
In reply to Re: Nardil/phenelzine starting dose, posted by emmanuel98 on July 12, 2011, at 19:46:49
Nardil has been on the market with a recomended starting dose of 45mg/day for 50 years.... if that wasnt a good starting dose, I think doctors would have worked it out by now.
Posted by Phillipa on July 13, 2011, at 11:08:23
In reply to Re: Nardil/phenelzine starting dose, posted by jono_in_adelaide on July 12, 2011, at 20:09:01
Does anyone know why the moai's were devoped for TB patients and they got happy hence they became ad's? What was their original purpose? Thanks Phillipa
Posted by europerep on July 13, 2011, at 16:58:32
In reply to Re: Nardil/phenelzine starting dose, posted by jono_in_adelaide on July 12, 2011, at 20:09:01
Maybe so, still I think there is a point to make for introducing a drug gradually, even if only to see whether one shows an allergic reaction to it. (True, it's very unlikely that that happens, but then so is having early-onset depression that doesn't respond to anything from exercise to psychotherapy to more than a dozen different drugs - and I managed to pull that one off, so...)
In any case, I decided to do three days on 30mg, then a week on 45mg, and then move upward. Maybe it's slower than I could do it, but I feel more comfortable doing it that way.
Thanks for the answers.
(And emanuel, I guess you're right, but then why don't they make extended-release MAOI formulations? Probably they don't want to put any more money in developing drugs that sell poorly, but still... anyhow, thanks!)
Posted by emmanuel98 on July 13, 2011, at 18:53:58
In reply to Re: Nardil/phenelzine starting dose, posted by Phillipa on July 13, 2011, at 11:08:23
> Does anyone know why the moai's were devoped for TB patients and they got happy hence they became ad's? What was their original purpose? Thanks Phillipa
I believe TCAs (not MAOIs) were first tried on TB. I don't know the origin of MAOIs. In Kramer's book (can't recall which one - Listening to Prozac or Against Depression) he cites an even earlier drug that would have TB patients dancing and singing. It was discontinued because it made people feel too good, from the perspective of MDs.
Posted by Phillipa on July 13, 2011, at 21:23:51
In reply to Re: Nardil/phenelzine starting dose, posted by emmanuel98 on July 13, 2011, at 18:53:58
Which one is it that could be the Happy Pill? Seriously thought the maois? Will google later. Thanks Phillipa
Posted by europerep on July 14, 2011, at 6:26:27
In reply to Re: Nardil/phenelzine starting dose, posted by emmanuel98 on July 13, 2011, at 18:53:58
No she's right, it was an MAOI (iproniazid to be exact) that was given to TB patients. However, it did not "make patients happy", it improved depression in patients who suffered from both depression and TB. It's not the MAOI activity that combats TD though, more modern TB drugs (like isoniazid) don't have MAOI activity.
I'm not exactly sure how they discovered TCAs though.
Posted by Phillipa on July 14, 2011, at 20:32:01
In reply to Re: Nardil/phenelzine starting dose, posted by europerep on July 14, 2011, at 6:26:27
Thanks though so don't know TCA's either? Phillipa
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