Posted by ed_uk on May 11, 2006, at 15:32:06
In reply to Re: MAOIs » ed_uk, posted by Don_Bristol on May 11, 2006, at 7:58:13
Hi Don
>Have you been here as long as all that?
I've been here a while :)
>I guess that a lot of medicine is an art and so I am sure there are a spectrum of views.
Definitely.
>Uh oh!
You suffer from essential hypertension? What meds do you take for your blood pressure? I wasn't saying that chronic hypertension increases the risk of an MAOI causing a hypertensive crisis - there is no evidence of this. Controlled-release nifedipine (eg. Adalat LA) is often very useful in the treatment of chronic hypertension. Immediate-release nifedipine caps are not suitable for treating chronic hypertension.
>nifedipine was sedating
Nifedipine is not generally sedating. Perhaps he took some chlorpromazine or diazepam.
>I am still not too sure how I could tell a hypertensive crisis until it was too late
An MAOI-hypertensive crisis is characterised by the *abrupt* onset of symptoms such as a severe headache and neck stiffness. Symptoms occur because the rise in BP is very rapid. Chronic hypertension (eg. essential hypertension) does not cause symptoms.
An MAOI-induced hypertensive crisis should be treated rapidly. If nifedipine is used, the initial dose should be low: 5mg - a starting dose which is considered relatively safe in the UK. High initial doses can be risky. A 5mg immediate-release capsule can be chewed and swallowed. The capsules contain a viscous yellow fluid. The fluid should be swallowed (there is no reason to retain it in the mouth - as some have suggested). The dose may be repeated after 30 minutes if necessary - but only if BP is still very high. Medical advice should be obtained ASAP. Blood pressure should be measured using a cuff around the upper arm. Diazepam 10mg can be taken immediately for anxiety. Chlorpromazine 20-25mg may also be useful - both for anxiety and BP. The problem with captopril is that although it is effective against many types of hypertension, there is no evidence that it can treat an MAOI-tyramine crisis.
>Can you say anything about which doc in the UK is prescribing you MAOIs?
I've only taken moclobemide myself! Currently, I take citalopram 80mg in the morning and amitriptyline 10mg at night.
Regards
Ed
poster:ed_uk
thread:639045
URL: http://www.dr-bob.org/babble/20060510/msgs/642684.html