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Re: Nardil, SNRIs, tyramine, hypertension

Posted by Questionmark on May 30, 2004, at 18:57:08

In reply to Re: Nardil, SNRIs, tyramine, hypertension » Ilene, posted by Michael Bell on May 29, 2004, at 21:59:32

> > > It's the maoi inhibition outside of the brain that causes the dangerous side effects (hence the benefits of transdermal selegiline). SO I'm not sure it would really affect Nardil's mode of action.
>
> Regarding Reboxetine, it inhibits the release of norepinephrine. Since norepinephrine release is the precipitating event of a hypertensive crisis, Reboxetine should have the opposite effect.
>
> I'll post a link for that study I mentioned.
>
>
> It's amazing to me that one of the best meds for SP is so hard to attain and stay on b/c of hypertensive risk. I'm not that knowledgeable about chemistry, but isn't there some kind of substance that someone can ingest to take over MAO's role of break down tyramine? Sort of like taking lactaid pills for people who can't break down lactic acid properly. Then someone on Nardil or Parnate can take that substance along with the MAOI to help prevent hypertensive crisis.
> > >
> >
> > AFAIK there isn't anything like that, because it would interfere with the MAOI's mode of action. There are drugs you can take after the fact, but I think the majority of MAOI users don't have a problem as long as they are careful about what they eat and the other drugs they take. The biggest dietary no-no is aged cheese, which is pretty easy to avoid.
> >
> > > Moreover, I remember reading a study which concluded that since SNRIs (Reboxetine, Strattera) inhibit norepinephrine release, taking it with MAOIs may lessen the risk of hypertensive crisis. Does anyone have knowledge or personal experience with this combo?
> >
> > I don't understand how this would work. I'd be interested in this study.
> >
> > I.


Reboxetine and other NRIs do not inhibit norepinephrine release. They inhibit the reuptake of NE, allowing MORE to be available in the synapse. The reason they help prevent hypertensive reactions from MAOIs is that tyramine gets into NE-releasing neurons via the reuptake pumps, and so less tyramine is able to be absorbed into neurons because the reuptake pumps are blocked.


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