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Is Captopril good for MAOI hypertensive crisis? harryp

Posted by don_bristol on May 29, 2004, at 10:54:07

In reply to Re: Nardil food reaction, posted by harryp on May 27, 2004, at 0:18:50

HARRYP wrote :
> Phentolamine is a non-selective a1+a2 antagonist, and I'm not sure if a a2 alone
> would do the trick--I'll do some more reading.
> I've dug through all the hypertension/MAOI literature I could find on Medline and
> medical texts to find the best drugs for a MAOI hypertensive crisis. Here's a
> summary:
> The general consensus now is that Nifedipine is too unpredictable in its action to be
> a good choice for treating a hp crisis. Some people have experienced heart attacks
> or hypotension from using it. (It may still be better than nothing).
> Phentolamine is the "gold-standard" in all the literature. It is very safe and
> difficult to OD on, because it only blocks the effect of sympathomemetic amines (i.e.
> tyramine, norepinephrine). It would have little or no effect on the bp of someone
> who didn't already have sympathomemetic amines in their bloodstream.
> The only problem with MAOI hp crises is that they are very rare (just as MAOI's are
> rare) and many ER personel do not know the proper treatment and what drugs are
> contraindicated. This is why I feel one should carry a signed chart and
> instructions. Phentolamine is not a common drug and is often not stocked.
> (Labetalol is an acceptable substitute, but must be used more cautiously).
> Thorazine is listed in some of the literature as an effective treatment. I haven't
> seen any information on self-administration, though. I would be very reluctant to
> take a drug that would turn me into a drooling moron (possibly for days) if I were
> far from home and needed to make decisions, drive, etc.


Harry, what you say above is of considerable interest to me as I have started to take Parnate (I couldn't get on with Nardil) and in a few weeks time I will be travelling to Europe where it will be quite hard to know about what is in the meals I am being offered.

I suspect that if I carried any hypodermics with me (even if I did know how to use them properly on myself) then I might struggle to explain it to suspicious policemen!

Last year, when I looked into what medications to take in the event of a hypertensive crisis, I came across these two documents. There may be others now.

"Dangers of Immediate-Release Nifedipine for Hypertensive Crises"

"Alternatives to Nifedipine in Hypertensive Urgencies"

From these documents it seems that Captopril might be a better alternative to Nifedipine. What do you think? I already got myself some 250 mg Captopril tablets to take.

I would be very interested in hearing your thoughts about this or those of anyone else here.





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