![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by ChicagoKat on September 25, 2012, at 17:02:52
Hi guys,
Do either of you have references that I can find and take to my pdoc next week on the use of an MAOI + a TCA? He is aware this is done, but is not real familiar with it, and is especially unclear as to whether it is safer to start the two together or start one then add the other. Also helpful would be information on dosage. I will be on a low dose of Nardil - 45mg/day b/c of the ataxia I experience at higher doses. Thanks so much for any info you can provide.
Regards,
Kat
Posted by jono_in_adelaide on September 25, 2012, at 18:16:00
In reply to Juno and/or Scott:Nardil + Nortryptiline, posted by ChicagoKat on September 25, 2012, at 17:02:52
Generaly its best to start both together at a low dose, and slowly build up over a couple of weeks to the normal theraputic range.
I'll play around on google and pubmed and see if I can get you some evidence - though Scott is better at that than I am :)
Posted by jono_in_adelaide on September 25, 2012, at 19:04:16
In reply to Re: Juno and/or Scott:Nardil + Nortryptiline, posted by jono_in_adelaide on September 25, 2012, at 18:16:00
I'd aim for 75mg per day of nortriptyline at bedtime (start at 25mg at bedtime and build up to 75mg over 2 weeks), then after you've been on that dose for a couple of weeks, get bloods done to make sure that you're in the theraputic window, and increase or decrease as per the blood work.
As for Nardil, I'd go for whatever dose got you to your "sweet spot" before.
If you're bothered by diziness/postural hypotension, a daily dose of Florinef can be very helpful, it causes the body to hold sodium and water, and thus keeps the blood pressure stable.
Posted by ChicagoKat on September 25, 2012, at 21:27:24
In reply to Re: Juno and/or Scott:Nardil + Nortryptiline, posted by jono_in_adelaide on September 25, 2012, at 19:04:16
> I'd aim for 75mg per day of nortriptyline at bedtime (start at 25mg at bedtime and build up to 75mg over 2 weeks), then after you've been on that dose for a couple of weeks, get bloods done to make sure that you're in the theraputic window, and increase or decrease as per the blood work.
>
> As for Nardil, I'd go for whatever dose got you to your "sweet spot" before.
>
> If you're bothered by diziness/postural hypotension, a daily dose of Florinef can be very helpful, it causes the body to hold sodium and water, and thus keeps the blood pressure stable.Thanks so much for the info Juno. I will do some research on the internet to see what I can find as far as articles to give to my pdoc, though he usually trusts my recommendations as I am a PharmD, and you seem to know what you are talking about too. But I will certainly research it. As far as the BP goes, I suffer from hypertension so MAOIs are a godsend. I go from being on 3 antihypertensives (in part b/c of Ritalin) to none, and I have no problem dealing with postural hypotension, I'm good at standing up slowly and bending over quickly when I feel the hypotension coming on :)
Thanks again,
Kat
Posted by jono_in_adelaide on September 25, 2012, at 22:17:31
In reply to Re: Juno and/or Scott:Nardil + Nortryptiline » jono_in_adelaide, posted by ChicagoKat on September 25, 2012, at 21:27:24
Also, send Dr Ken Gillman a message (www.psychotropical.com.au) - he is an Australia psychiatrist of the old school, who is a big supporter of pulling out all stops to get the patient better. he is very familiar with MAOI drugs, and is well known in the literature.
He does online consults via Skype, and would very likely be able to give you some infomation to take to your doctor.
His service is free, but you can make a small donation toward the running of his (very useful) site if you wish.
Posted by ChicagoKat on September 26, 2012, at 13:25:03
In reply to Re: Juno and/or Scott:Nardil + Nortryptiline, posted by jono_in_adelaide on September 25, 2012, at 22:17:31
> Also, send Dr Ken Gillman a message (www.psychotropical.com.au) - he is an Australia psychiatrist of the old school, who is a big supporter of pulling out all stops to get the patient better. he is very familiar with MAOI drugs, and is well known in the literature.
>
> He does online consults via Skype, and would very likely be able to give you some infomation to take to your doctor.
>
> His service is free, but you can make a small donation toward the running of his (very useful) site if you wish.I tried that website Juno, and it didn't work. It said unable to connect.
Posted by jono_in_adelaide on September 26, 2012, at 19:35:33
In reply to Re: Juno and/or Scott:Nardil + Nortryptiline » jono_in_adelaide, posted by ChicagoKat on September 26, 2012, at 13:25:03
Send him an email at the following address, asking for a skype consult, and he will get back to you
Realy worth the effort, this guy is briliant
Posted by ChicagoKat on September 27, 2012, at 14:36:02
In reply to Re: Juno and/or Scott:Nardil + Nortryptiline, posted by jono_in_adelaide on September 26, 2012, at 19:35:33
> Send him an email at the following address, asking for a skype consult, and he will get back to you
>
> Realy worth the effort, this guy is briliant
>
> ken.psychotropical@gmail.comThanks Juno! I really appreciate it :)
Kat
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.