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Re: MAOIs and beer (Adam?)

Posted by Adam on June 13, 2000, at 17:21:22

In reply to Re: MAOIs and beer (Adam?), posted by Diane E. on June 13, 2000, at 13:37:58

No problem.

One of the doctors who followed me in the transdermal selegiline study told me that of the Big Three (Marplan, Nardil, Parnate), Parnate may be the worst offender as far as hypertensive reactions go, and this almost got Parnate pulled off of the market permanently. It may have something to do with the fact that the parent compound, or one of its metabolites, is sufficiently amphetamine-like to cause (among other things) increased secretion of norepinepherine. I imagine this leaves the patient with an elevated level of NE in the blood and brain from the get-go (perhaps causing spontaneous hypertensive events in some). Couple that with the massive NE dump that occurs when tyramine dispaces NE in the secretory vessicles in neurons, and the risk for hypertensive crisis might be higher. Again, I'll stress this is just "what I was told", and appears to be based more on anecdotal clinical experience than controlled studies. Still, it's something to think about.

I would say, yes definitely pick up a sphigmomanometer and stethescope. Taking b.p. isn't hard, but if neither one of you is a medical professional, I would have one give you a thorough lesson. I'm lucky enough to have a nurse practitioner for a stepmom, so I got very good training. Also, you may, after learning how, want to try out a few with different variants of cuff before you buy one. I got mine as a present, and while it's quite usable, it's damn hard to take my own b.p. The problem is trying to properly secure the velcro on the cuff with one hand to get the right fit. I get around the problem with some creative use of table tops and a little dexterity, but I sometimes have to repeat measurements (waiting for my arm to return to normal is a pain) because I didn't get the right snugness/looseness ratio. Once I do get it on properly, though, it's easy to pump the bulb and control deflation of the bladder with my left hand while holding the diaphragm of the stethescope, with my right hand, against the brachial artery. Try using the bell of the stethescope to hear those funky sounds with the Russian name (I want to say Kartikov, but I know that's not right), just for kicks.

I guess there are these "portable" automatic units, but they're really expensive. I think I was able to be adequately outfitted for around $100.

Also, get that medic alert braclet or necklace. I like the necklace because A) there's nothing on my wrist to get in the way of my work, and B) nobody asks questions about the necklace, while I think the bracelet is kind of obvious and thus not a very good guard of privacy.

It took a long time to figure out what to put on there. I basically put instructions to call the service and give them my registry number before administering any medications. I just don't trust all the paramedics to know what "sympathomimetic" is (or all the physicians for that matter). Even if they do, I don't imagine all will know offhand which drugs are OK and which one's aren't. However, this does seem a bit too sweeping a precaution, and might cost valuable time.

Any alternative instructions out there? My doctors didn't have any better suggestions.

Thanks!

> Thank you all for the input. This is just the sort of information I was seeking (especially the list of beers).
> It is actually my husband who is going to start Parnate soon (after many, many unsuccessful
> trials of many other meds.) and I agreed to help with the background research. We will proceed very,
> very, very cautiously. Sounds like we'll need a blood pressure cuff and to gather some baseline
> blood pressure data.
>
> Thanks,
> -Diane


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