Posted by Sad Panda on May 27, 2004, at 15:37:27
In reply to Re: Nardil food reaction, posted by harryp on May 27, 2004, at 0:18:50
> I'm taking steps to have a bp cuff, phentolamine and IV injection equipment with me when I travel.
>
> Obviously, this isn't a solution for everyone!
>
> I strongly urge everyone on MAOI's to carry a chart signed by their doctor explaining their condition, contraindicated drugs, and appropriate treatment, which is, preferentially:
>
> 5 mg phentolamine (an alpha blocker) IV--injected slowly. Phentolamine has a half-life of 15 min IV, repeated injections may be necessary over time.
>
> 2nd choice--IV labetalol (an alpha-beta blocker), titrated slowly with monitoring.
>
> an alpha-beta or beta blocker may be used for reflex tachycardia AFTER administering an alpha blocker.
>
> A beta-blocker MUST NOT be administered as a first treatment for a catecholamine-induced hypertensive crisis because of the risk of further vasodialation and bp elevation.
>
> If you go to the ER you must be aggressive about explaining your symptoms, and the fact that you belive they are caused by a MAOI-tyramine interaction. I recommend carrying a bp cuff, so you can tell the triage nurse what your bp is--that will scare them!
>
> I got instant service with the following line:
>
> "Hello! I need to see a doctor IMMEDIATELY. I am taking a MONOAMINE OXIDASE INHIBITOR and am having a HYPTERTENSIVE CRISIS from a tyramine reaction from some food I ate. MY SYSTOLIC BLOOD PRESSURE IS OVER 210!"
>
> That was a great, uncrowded ER in Houston. I was very lucky.
>
>Hi Harry,
How about Thorazine? It is a potent Alpha-1 blocker & it can treat Serotonin syndrome too with it's 5-HT2A antagonism. A distant relative, the TCA Doxepin might possibly be the best agent for MAOI users with insomnia. It is a strong Alpha-1 blocker, 5-HT2A blocker & an NE reuptake inhibitor. Tyramine enters the the nerve terminal in the same way that NE does. NE reuptake inhibitors can prevent Tyramine entering & doing it's evil voodoo, this is the reason that some TCA's are able to be taken with MAOI's. Clomipramine & Imipramine are best avoided, but you can find tests of Amitriptyline being used with MAOI's, although I think the MAOI was moclobemide.
Cheers,
Panda.
poster:Sad Panda
thread:348520
URL: http://www.dr-bob.org/babble/20040527/msgs/351184.html