![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by britney 27 on August 29, 2008, at 17:00:41
Hi,
Does anyone know whether it is safe to combine reboxitine (NARI) with an MAOI (tranylcypromine) and if so what are the effects?
There is little research in combining the two drugs together.
Some websites say they are to be avoided but do not give a reason and others say they make an effective combination because the NARI offsets the potential hypertensive crises due to an interaction of MAOI with tyramine.
I want to experiment and combine them to see if they give me an optimal boost in energy, motivation and drive.
Posted by SLS on August 29, 2008, at 19:36:01
In reply to MAOI and NARI interaction, posted by britney 27 on August 29, 2008, at 17:00:41
> Does anyone know whether it is safe to combine reboxitine (NARI) with an MAOI (tranylcypromine) and if so what are the effects?I am not sure.
> There is little research in combining the two drugs together.
I don't think there is any formal research at all. You might have to trust the anecdotal reports written up.
> Some websites say they are to be avoided but do not give a reason and others say they make an effective combination because the NARI offsets the potential hypertensive crises due to an interaction of MAOI with tyramine.
I'm not sure reboxetine is safe. There are theories that suggest it should be. Nothing more. There seems to be a notion that any selective NE reuptake inhibitor will prevent a hypertensive crisis from occurring by preventing the uptake of tyramine into the neuron and avoiding the displacement of NE in the synaptic vesicles.
> I want to experiment and combine them to see if they give me an optimal boost in energy, motivation and drive.I found desipramine and nortriptyline to be compatable with high-dosage Parnate. If you were to proceed with adding a NRI, I would suggest taking your blood pressure periodically at the initiation of treatment. Be careful, though, to take into consideration that Parnate monotherapy has triggered a hypertensive reaction in the absence of any other drug.
I guess I would feel more comfortable trying one of the two TCAs first. I have no doubt that they can be safe in combination with Parnate. With reboxetine, you might not find any anecdotal data suggesting its safety. I like nortriptyline precisely because it is not selective in its receptor binding properties. For instance, it can block 5-HT2a receptors, something found with drugs like Remeron and antidepressant atypical antipsychotics.
If you find anything persuasive, please post your findings.
Thanks.
- Scott
Posted by mav27 on August 29, 2008, at 21:16:48
In reply to MAOI and NARI interaction, posted by britney 27 on August 29, 2008, at 17:00:41
Ive taken nardil and reboxetine together, as well as parnate and reboxetine. I was hoping the reboxetine would raise my blood pressure but unfortunatly it just lowered it even more making the orthostatic hypotension even worse.
Posted by SLS on August 30, 2008, at 10:16:15
In reply to Re: MAOI and NARI interaction » britney 27, posted by mav27 on August 29, 2008, at 21:16:48
> Ive taken nardil and reboxetine together, as well as parnate and reboxetine. I was hoping the reboxetine would raise my blood pressure but unfortunatly it just lowered it even more making the orthostatic hypotension even worse.
I can't account for this. It has little, if any, NE alpha-1 antagonist properties.
Did any of the following occur?
* Cognitive effects: mental confusion, hypomania, hallucinations, agitation, headache, coma.
* Autonomic effects: shivering, sweating, fever, hypertension, tachycardia, nausea, diarrhea.
* Somatic effects: myoclonus/clonus (muscle twitching), hyperreflexia, tremor, muscle rigidity.
- Scott
Posted by britney 27 on August 30, 2008, at 17:18:05
In reply to Re: MAOI and NARI interaction » mav27, posted by SLS on August 30, 2008, at 10:16:15
> > Ive taken nardil and reboxetine together, as well as parnate and reboxetine. I was hoping the reboxetine would raise my blood pressure but unfortunatly it just lowered it even more making the orthostatic hypotension even worse.
>
> I can't account for this. It has little, if any, NE alpha-1 antagonist properties.
>
> Did any of the following occur?
>
> * Cognitive effects: mental confusion, hypomania, hallucinations, agitation, headache, coma.
> * Autonomic effects: shivering, sweating, fever, hypertension, tachycardia, nausea, diarrhea.
> * Somatic effects: myoclonus/clonus (muscle twitching), hyperreflexia, tremor, muscle rigidity.
>
>
> - ScottHi Scott,
I have done a bit of "experimenting" myself. In the morning I had 4mg of Edronax and 30mg of Parnate and another 4mg of Edronax at night. I experienced a frontal headache, tachycardia and a bit of restlessness and a slight blood pressure drop. I don't know if that was a result of the fact that I accidentally had blue cheese (which I forgot was contraindicated) and whether my headache is a result of the fact that I have a bit of a cold. I will keep taking the same doses but so far I think it is quite safe. (I have actually had severe serotonin toxicity twice resulting in a coma so I am very careful). I'll report to you soon!
I did manage to find one of those preview text books on google in which I psychiatrist in America states that he gives his patients reboxetine and parnate (if the patients can get hold of reboxetine in America - I don't think it is approved yet though I have to check, maybe thats why there is little research done on the combination of the two classes).
Cheers
Britney
Posted by mav27 on August 31, 2008, at 0:07:39
In reply to Re: MAOI and NARI interaction » mav27, posted by SLS on August 30, 2008, at 10:16:15
Nope.
Any drug that effects NE seems to lower my blood pressure.. so far the worst ones have been nardil, parnate, reboxetine, bupropion nortriptyline and cymbalta, in that order.
My usual pressure is 140/100.. nardil made it 80/40 down to cymbalta which was about 120/80
(so great drugs for my hypertension but unfortunatly not great as ad's for me (except the maoi's but they dropped it too much to handle)>
> I can't account for this. It has little, if any, NE alpha-1 antagonist properties.
>
> Did any of the following occur?
>
> * Cognitive effects: mental confusion, hypomania, hallucinations, agitation, headache, coma.
> * Autonomic effects: shivering, sweating, fever, hypertension, tachycardia, nausea, diarrhea.
> * Somatic effects: myoclonus/clonus (muscle twitching), hyperreflexia, tremor, muscle rigidity.
>
>
> - Scott
Posted by mav27 on August 31, 2008, at 0:10:13
In reply to Re: MAOI and NARI interaction » mav27, posted by SLS on August 30, 2008, at 10:16:15
While i'm thinking about it. I havn't looked to see if it's changed but at the time i couldnt even find hypotension listed as even a rare side effect of bupropion.. that one really baffled the doctor.
Posted by britney 27 on August 31, 2008, at 1:17:02
In reply to Re: MAOI and NARI interaction » SLS, posted by mav27 on August 31, 2008, at 0:10:13
Mav,
Why were you on 50mg of parnate? Do you think if you had lower doses (20-30mg)it wouldn't effect your blood pressure so much?
Posted by mav27 on August 31, 2008, at 2:11:26
In reply to Re: MAOI and NARI interaction, posted by britney 27 on August 31, 2008, at 1:17:02
I was only on 30mg.. 10 and 20 mg put me to sleep for hours.. 30mg woke me up but i was non stop fainting from the hypotension.
> Mav,
>
> Why were you on 50mg of parnate? Do you think if you had lower doses (20-30mg)it wouldn't effect your blood pressure so much?
Posted by SLS on August 31, 2008, at 5:35:39
In reply to Re: MAOI and NARI interaction » SLS, posted by mav27 on August 31, 2008, at 0:07:39
> Nope.
> Any drug that effects NE seems to lower my blood pressure.. so far the worst ones have been nardil, parnate, reboxetine, bupropion nortriptyline and cymbalta, in that order.
> My usual pressure is 140/100.. nardil made it 80/40 down to cymbalta which was about 120/80
> (so great drugs for my hypertension but unfortunatly not great as ad's for me (except the maoi's but they dropped it too much to handle)When I first tried Parnate, I began feeling faint at 40mg. After I had been on 60mg for awhile, hypotension disappeared. Nardil is much more troublesome with regard to hypotension. However, it did mitigate significantly over time.
- Scott
Posted by SLS on August 31, 2008, at 5:39:13
In reply to Re: MAOI and NARI interaction, posted by britney 27 on August 30, 2008, at 17:18:05
> > > Ive taken nardil and reboxetine together, as well as parnate and reboxetine. I was hoping the reboxetine would raise my blood pressure but unfortunatly it just lowered it even more making the orthostatic hypotension even worse.
> I can't account for this. It has little, if any, NE alpha-1 antagonist properties.
Titrating both drugs together is what is most recommended, so you are being prudent.
- Scott
Posted by desolationrower on September 1, 2008, at 0:29:57
In reply to Re: MAOI and NARI interaction » britney 27, posted by SLS on August 31, 2008, at 5:39:13
All the noradrenergic drugs you've tried are reuptake inhibitors; there are also alpha2 blockers. I would be very careful with that combination though.
Posted by britney 27 on September 1, 2008, at 3:42:30
In reply to Re: MAOI and NARI interaction, posted by desolationrower on September 1, 2008, at 0:29:57
Dear Des,
Theoretically (since their is no clinical trials) there is only a small risk of hypertensive crisis by combining the two drugs together so I will be careful with the combination though it does not appear to be a major risk.
Cheers
Britney
This is the end of the thread.
Psycho-Babble Neurotransmitters | 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.