Posted by SLS on December 12, 2000, at 11:05:11
In reply to maoi drugs, insomnia, and fainting, posted by zelda on December 12, 2000, at 10:07:31
> hi. i'm curious to know if anyone has had problems with fainting or dizziness due to low blood pressure while taking an maoi drug.
>
> also, what can be done about insomnia and restlessness as a result of maoi drugs? i've tried ambian and xanax for sleep, but they only work for five hours or so.
>
> i recently switched to selegiline (eldapryl) because i was passing out too much on nardil and parnate.
>
> suggestions and anecdotes are welcome! thank you very much.
I have had problems with both fainting due to low blood pressure and the inability to urinate while taking Nardil. The fainting (orthostatic hypotension) can be addressed using a drug called Floranef (fludrocortisone). This drug is usually effective to remedy the low blood pressure. If you find it difficult to initiate urination, bethanacol works pretty well. For me, these side effects were amplified because I was taking desipramine or imipramine (tricyclic antidepressants) at the same time. I found that after a month or so, the low blood pressure got much better without further need of using Fluranef.For insomnia, you will need to use a drug that lasts longer than Ambien and is a stronger sleep medication than Xanax. Trazodone (Desyrel) has become popular for use with MAOIs. You may also opt for using Ambien and adding another sleep medication to it. Ambien is strong and will do a good job to put you to sleep. The problem is keeping you to sleep. You may want to ask your doctor about taking the longer acting drugs like Ativan (lorazepam), Restoril (temazepam), trazodone (Desyrel), or possibly Klonopin (clonazepam).
I am sure there are other good suggestions that will be offered by others here.
Good luck.
- Scott
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DRUG TREATMENT for Orthostatic Hypotension
Certain medications may be helpful, usually as a combination. Most useful drugs are Florinef, erythropoetin and Midodrine.Two strong cups of coffee in the morning
Florinef (forces more salt into the bloodstream, 0.1 mg daily starting dose). Blood pressure raises gradually over several days with maximum effect at 1-2 weeks. Alter doses at weekly or biweekly intervals. Hypokalemia (low potassium) occurs in 50%, and hypomagnesemia in 5%. These may need to be corrected with supplements. Florinef should not be used in persons with CHF (congestive heart failure). Headache is a common side effect.
Effexor (an antidepressant which raises blood pressure as a side effect).
Inderal and other beta-blockers (small doses are used for positional-orthostatic-tachycardia syndrome (POTS), start inderal at 10 mg/d, increase to 30-60 mg/d over 2-3 weeks. Other useful agents are Nadolol (10 mg qd), and atenolol (25).
Motrin or Indocin (blocks blood-pressure lowering effects of prostaglandins).
Midodrine. An alpha-1 agonist. Causes increased blood pressure, vasoconstriction, pupil dilation, and "hair standing on end". Other common side effects are paresthesia of the scalp or itching. Usual doses are 2.5 mg at breakfast and lunch or three times daily. Doses are increased quickly until a response occurs or a dose of 30 mg/day is attained (Wright et al, 1998). Midodrine does not cross the blood-brain barrier and it is thus not associated with CNS effects. Most patients on Midodrine also take Florinef (see above).
Erythropoietin. This agent is used if there is also anemia and other measures have failed. Doses of 25 to 75 U/kg TIW are used, by injection.
Phenobarbital may improve POTS.
poster:SLS
thread:50414
URL: http://www.dr-bob.org/babble/20001130/msgs/50416.html