Posted by Questionmark on March 13, 2004, at 6:11:18
[NOTE: Please at least read last paragraph (with seven astericks) (*******) & try to answer question if you don't want to read the whole post.] .... This was much longer than i had planned. i'm so freaking obsessive-compulsive (in the "OC Personality" / perfectionistic way) it drives me crazy. But i guess i also wanted to have a good account of what happened, in case i'm curious about it someday and i can hopefully just go on dr-bob.org and look up this post. Cuz i'm stupid like that.
Okay, i hate to tell this story (and possibly give Nardil/MAOIs any worse of a name), but it can at least serve as an example, and i want to ask a couple questions about it too. First a preface, and then the story (paragraph w/ 3 asterisks (***) at beginning-- so u can just read story if whole post too much).
The other night i-- for some reason being a complete *IDIOT* and for some reason having a total lapse of memory of something that i should not ever forget and still can't imagine how i forgot-- took 2 pills of ephedrine (containing 25mg each-- 50mg, which is alot anyway, and which would be about 6 capsules of most ephedra herb formulations, and about 3 or 4 of most extract formulations).
Now seriously i am hardly ever, if ever, this forgetful when it comes to taking a substance in an absolutely contraindicated amount/dose, with Nardil. i used to take ephedra and ephedrine all the time before getting on Parnate and then Nardil, and i never had any kind of bad reaction at all (in fact i am very much opposed to the FDA's recent ruling about it, but that's another argument). And i haven't even had one capsule of ephedra herb (containing 8mg ephedrine) since i've been on Nardil, and i wanted to try like 4mg or so-- at home with my precautionary antihypertensive meds with me-- but i have been too reluctant to find time to even do that yet. Before this last incident i have yet to have any hypertensive reactions on Nardil and only had one during my second week on Parnate (from mac & cheese). So my points are... 1)As long as you know all the restrictions (which honestly are not many) and as long as you're not stupid like i was recently, and if you're not unfortunate enough to eat some excessively old food unknowingly, you should not worry at all about having a hypertensive reaction on Nardil (and probably Parnate). ... 2)i'm not quite as stupid and forgetful as this story will make me sound.***Last night (well, two nights ago technically-- Thurs. night-- 3/11) i was riding home from a long trip down south (U.S.) with a few friends, and my friend stopped to get some ephedrine to help him stay awake driving and pass the time better. He took two tablets and asked me if i wanted some. i wanted something, as we were driving hours and hours and the boredom was killing me, but i wasn't sure if i wanted some OTC sleeping pills (antihistamine [diphenhydramine] ) or some ephedrine. Then i thought, since my two friends in back were already sleeping, and i was in front, i should try to stay awake and talk to my friend who was driving to help keep awake (and i rarely see him so it would be good anyway). So i took two tablets ephedrine as well.
It was all fine until about an hour and a half later when i lit up a cigarrette. By the time i was finished i was feeling kinda dizzy and weird. 5 to 10 minutes later i was feeling other symptoms and i realized that it felt similar to when i had the Parnate + mac & cheese hypertensive reaction before the headache started. And i realized that i had somehow completely forgotten that 50mg of ephedrine is a major no-no for me, being on Nardil (to give examples of just how bizarre this is-- just that morning i had remembered to ask for my salad without cheddar and the previous night reminded my friend how i couldn't get a beer from the tap when we were at the bar). About 20 minutes after the cigarrete, the occipital headache became apparent-- along with sweating; hot "flashes" and chills intermintently; numbness and tingling around forehead, neck, and abdomen; pounding heart; and awkward breathing. i took 0.25mg clonazepam (Klonopin) and 4 propanolols (40mg) to help (could have taken more of the former, and/or some Xanax, but i am really trying to conserve them and so reluctantly decided not to).
i then waited another 10 to 15 minutes-- not wanting to go to a hospital, for several reasons, but mostly because of the cost beyond my parents' insurance coverage. At that point my headache was finally so painful (and had travelled to top and middle of my head as well as the back) and i was scared enough that i asked my friend if he could try to find an emergency room. He stopped at a gas station and fortunately one was only six miles away.
We got to the ER, i signed some forms, and had to wait about 10 minutes before i could be seen. (i was pacing back and forth pulling my hair over my face or grasping my hands on my head/face, breathing heavy, and had a look of extreme anger or pain; everyone there was looking at me as if i was psychotic or else tweaking from crack). The first nurse saw me, had me fill out more paperwork, and i waited in a chair a little longer. Then another nurse put me on a bed (i was allowed to sit up) after having me undress and change into a gown. More paperwork and a number of annoying questions. i told her (the 4th or 5th time i said this since getting there) "i just need some IV nifedipine or thorazine." She asked me, "How do you know this? Did you read it on the internet or something?" With effort i replied back "i read it a bunch of places, including papers that my psychiatrist gave me when he prescibed me the med." She left in a little while; said doctor should be in shortly.
20 agonizing minutes later the doctor came in, asked me some questions, and left-- saying he'd be back shortly. Waited some more. Another nurse came in. i asked for something to throw up in and at this point vomited for the fourth time. She left. 5 or so more minutes went by. Another nurse walked in; talked to me briefly. He left. An intern (or something) then came in and said i needed heart rate taken. i said "it's already being taken" (as it was). He said "yes but we need a more precise measurement" or something. i then tried to sit still as he hooked me up to an EKG. i said "where's the doctor?" He said "I'm not sure. I got this order from him over the computer. He should be in shortly." i laughed and repeated "shortly." i then waited another 10 to 20 minutes.
i was constantly switching positions and moving my head back and forth every other second. i tried to meditate but it hurt more when i sat still. i hate to use the word "excruciating" vainly at all but i think it's safe to say the headache was excruciating. i was also afraid of how much damage to my blood vessels i might sustain-- IF i didn't get brain damage or have a stroke and/or die. All the while i had also intermittently been moaning or giving brief yells or calling out things like "dOctor. Where's the doctor?" Funny, as i would have never pictured myself doing anything like that, but physical pain can override just about every other concern if severe enough, i have now realized. Also, i swear two or three of the nurses who asked me what my problem was replied to me with the same sort of response when i answered them. i'd say "Hypertensive reaction to ephedrine and an an MAO inhibitor," and they would say "Hypertension?" i'd think *Are you FREAKING DEAF?!!*
One of the first nurses came back and asked me some more stupid questions and lectured me on the dangers of ephedrine. Then she left me alone and
the doctor finally came in again. He asked me yet more questions. He asked me how painful my headache was on a scale of 1 to 10. i said "10 as far as headaches go." He then said "Okay. What kind of headache is it?" or something. i said "From a hypertensive reaction to ephedrine and an MAO inhibitor." He then asked me why i was on something for high blood pressure. i said, "What?" He said "Why are you on an MAO inhibitor?" i said "Depression." He asked me which i was on, i told him Nardil, and i said "i just need some IV nifedipine or thorazine." He said "And you took ephedrine with it you say?" i said "Yeah." And he said "Don't you know you're not supposed to take that with an MAO inhibitor?" And then i mumbled to him (i forgot i said this and only vaguely rembered when my friend later told me that i had said it): "i know, i'm a f*cking idiot. i don't know how or why i forgot-- i never would have done that if i would have remembered er thought about it." He finally said something like "Alright, we'll take care of that in a jiffy."
About ten minutes later the intern or whatever came back and told me to try to hold still while he put the syringe in a vein in my hand. He took some blood out and then said he had wasn't able to get enough blood and had to see if they could process it (or something) to make it enough!! i said "i just need some IV nifedipine or thorazine. please." He said they would give me something as soon as possible but they had to do tests on my blood to make sure that nothing else was wrong that they did not know was wrong. (i think it was something like that). Finally he came back after some more long minutes of absolute torture, and put a plunger type thing on the end of the tube attached to the needle in my hand. Every minute or so he would press down the plunger a little and inject me with the blessed drug of hypertensive relief. After the second press the pain faded away and my exhausted body started to drift in and out of sleep. About 20 or 30 minutes later they woke me for some more paperwork, advice, and the like. And then i left.
i was so out of it i forgot to ask what drug they used. i'm curious. Probably nifedipine? Oh they did give me a Clonidine before they gave me the injection, but i didn't feel it at all until maybe afterward. i don't think i threw up after taking it, but i know i vomited several times after taking my own meds that i took in the car.
Also: the Parnate + mac & cheese reaction i had was bad, but not nearly as bad as this. i took .25 or .5 mg Klonopin, a few beta-blockers (30mg propranolol), and i think like 0.75mg Risperdal, and then after 30 to 40 minutes i was almost completely fine. This time i didn't have any Risperdal on me, and i don't know if that would have been enough to ease my mind (and pain) anyway. i wished (and wish) SO BAD that my pdoc would have prescribed me some oral nifedipine with the Nardil. It would have saved so much pain, money, and time. Yes you have to be careful but ... well, just use a fair amount at a time, and be cAReful. That's better than suffering through hours of horrendously agonizing, excruciating torture while cutting through the bureaucratic red tape and waiting to get the some simple medicine into your veins! Sorry.******* At its highest point, my blood pressure was 198/111 (nurse told me). From looking at the machine, i think that it was generally hovering around 186/102 or so. Can someone honestly tell me whether s/he thinks that a blood pressure that high for about two hours could have possibly caused any damage? If not any sort of brain damage, then do you think that it may have partially damaged some of my blood vessels (especially cerebral) to any extent? My heart rate was normal (for me when i'm on Nardil) in the mid-50s bpm. But blood pressure on Nardil is generally about .. shoot, i forget... i think about, 120/90 or somthing-- it's quite low, i know that. Please someone give his/her opinion on this.
Also, finally, word of advice: don't do ephedrine while on an MAOI-- especially 50mg of ephedrine.
poster:Questionmark
thread:323875
URL: http://www.dr-bob.org/babble/20040313/msgs/323875.html