Posted by Mike on September 23, 1999, at 13:45:40
In reply to Drug interaction (specifically Parnate or Nardil , posted by Laurie on September 22, 1999, at 13:58:39
> Hi, I'm new here so please forgive (and correct) me if my ettiquette is lacking.
> My phychiatrist told me he would like to try me on either Nardil or Parnate and told me that if I wanted to have a better involvement in my treatment that I should research them on the internet. So far what I have seen of either (indications, contra-indications, etc.) quite frankly, scare me. I am currently taking Flovent and (occasionally Ventolin) for asthma and Flonase for a chronic allergy problem which is immune to antihistamines. My problem is this; from what I have read, if I understand correctly, with my asthma and allergy meds, Parnate should not even be an option. Nardil doesn't seem to contra-indicate these meds but there is a possibility of some very scary side-effects with both. Also, less importantly though still a concern, weight gain is mentioned as a common side-effect for the Nardil. I am beginning to lose hope that I can ever be successfully treated! I have already, in the distant and near past, been through Prozac, Effexor, Serzone, Amytriptaline, and Zoloft.
> Zoloft was the only one to show a marked impact of a positive nature and I developed an immunity to it only somewhat mre slowly than I have to all antihistamines and painkillers to which I've been exposed in the past.
> I don't know what to tell my Dr. when I see him except, perhaps, that I fear I may be medicinally un-treatable. Is there an option out there that I don't know about or, am I, once again, over-reacting? Please, someone, help?I think there are a couple of issues you and your psychiatrist should sort through. First, if he was not able or unwilling to provide you with the information you need on MAO inhibitors, such as Nardil or Parnate, then I would switch psychiatrists. You can likely find a knowledgable psychopharmacologist at a University based Anxiety Disorders Clinic. Second, I'm not sure of the condition for which you're seeking treatment. Is is social phobia or panic? Third, if it is one of these, then Nardil (Phenelzine) and Parnate (Tranylcypromine) could be appropriate. Nardil is usually almost 100% effective. However, weight gain is common, as it is with many of the SSRI (Selective Serotonin Re-uptake Inhibitors). With Parnate, weight gain is not a problem (frequently there's some weight loss). However, there's much less out there in terms of controlled studies showing efficacy in treating social phobia or panic. Also, it's structure is different from Nardil. Nardil is a hydrazine (therefore affects GABA levels) and Parnate is not a hydrazine. I'm just mentioning this as a reaon for differences in therapeutic effect and side effect profile. Third, the dietary restrictions, in my opinion, are somewhat overblown. Definitely avoid red wine and aged meat and aged cheeses, for instance. The medical contraindications are more important. Most cold and allergy medications are a no-no. Your pharmacist could tell you based upon what you're taking if MAOI's are contraindicated. Fourth, you have another alternative in terms of benzodiazepines. Klonopin (Clonazepam), for example, has been shown to be highly effective in long-term treatment of social phobia and panic. It also has not been subject to abuse. You can take it up to 10 mg/day, but more common dosages for social phobia and panic would be 2.0 to 3.0 mg/day.
Good luck and, if I were you, I would likely consider switching psychiatrists.
poster:Mike
thread:11894
URL: http://www.dr-bob.org/babble/19990914/msgs/11960.html