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Nardil - US Prescribing Information from Pfizer

Posted by Jedi on August 13, 2005, at 19:09:27

In reply to Re: MAOI combined with tricyclic » Jedi, posted by darkhorse on August 13, 2005, at 3:57:50

> I tried Amitriptyline 25mg with Tranylcypromine 60mg with no ill effects.
> Not all TCA's are containdicated with MAOIs;the more serotonergics are more dangerous, so apart from Clomipramine,Imipramine,all SSRIs,Venlafaxine,Duloxetine(and maybe Milnacipran),any other Antidepressant would not cause a problem(e.g all other TCAs,Maprotiline,Reboxetine,Trazodone,Mirtazapine..etc)

Obviously the US prescribing information provided by Pfizer for phenelzine is overly conservative. What this does is make it very difficult for people to know what is really dangerous and what is not. I have eaten many of the foods and taken many of the medications that are warned about in the prescribing information for phenelzine and tranylcypromine. However, I will not advise another person to do the same. I do my own research and take my own chances. I have been burned in the past listening to advice from pharmacists and MDs. Once a supermarket pharmacist told me a cough syrup I asked them about would be fine with phenelzine as long as it didn’t contain dextromethorphan. That should have been my clue right there that she didn’t know what she was talking about. I had misplaced my reading glasses or I could have seen the microscopic print, 30mg pseudoephedrine hydrochloride. That was a $1000 mistake: a mild hypertensive crisis, a trip to the ER, and a CT scan later. It could have been much worse. If she didn’t know the answer for sure, that’s what those computer terminals are for.

The best source for actual MAOI food restrictions I’ve found:
This list was compiled by Elizabeth; “the guru of treatment resistant depression”. In my experience with MAOIs, I’ve found it to be very accurate. Does anyone know what Elizabeth is doing now? She was a wealth of knowledge in the earlier days of babble.

Prescribing information for phenelzine:

NARDIL should not be used in patients who are hypersensitive to the drug or its
ingredients, with pheochromocytoma, congestive heart failure, a history of liver disease,
or abnormal liver function tests.
The potentiation of sympathomimetic substances and related compounds by MAO
inhibitors may result in hypertensive crises (see WARNINGS). Therefore, patients being
treated with NARDIL should not take sympathomimetic drugs (including amphetamines,
cocaine, methylphenidate, dopamine, epinephrine, and norepinephrine) or related
compounds (including methyldopa, L-dopa, L-tryptophan, L-tyrosine, and
phenylalanine). Hypertensive crises during NARDIL therapy may also be caused by the
ingestion of foods with a high concentration of tyramine or dopamine. Therefore, patients
being treated with NARDIL should avoid high protein food that has undergone protein
breakdown by aging, fermentation, pickling, smoking, or bacterial contamination.
Patients should also avoid cheeses (especially aged varieties), pickled herring, beer, wine,
liver, yeast extract (including brewer’s yeast in large quantities), dry sausage (including
Genoa salami, hard salami, pepperoni, and Lebanon bologna), pods of broad beans (fava
beans), and yogurt. Excessive amounts of caffeine and chocolate may also cause
hypertensive reactions.

NARDIL should not be used in combination with dextromethorphan or with CNS
depressants such as alcohol and certain narcotics. Excitation, seizures, delirium,
hyperpyrexia, circulatory collapse, coma, and death have been reported in patients
receiving MAOI therapy who have been given a single dose of meperidine. NARDIL
should not be administered together with or in rapid succession to other MAO inhibitors
because HYPERTENSIVE CRISES and convulsive seizures, fever, marked sweating,
excitation, delirium, tremor, coma, and circulatory collapse may occur. ...




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