Posted by Astounder on November 1, 2007, at 18:01:59
In reply to Re: Diet restrictions on EMSAM 9 MGS?, posted by trx resistant on October 31, 2007, at 12:51:31
> Thanks Astounder. Your knowledge is truly astounding! My present regime is 25mg Xanax 3X day and 5mg. at bedtime, along with 12.5 Ambien CR which doesn't seem to be helping with sleep. I noticed EMSAM negates the Ambien and I toss and turn all night. How long did you take EMSAM before you felt full benefits? Bristol said about 5 weeks.
> With regard to the food issues I am relieved by what I have read here. I will be a little cautious, no Chinese or Japanese food I guess. If I were to have a reaction would it be immediate like instant hypotensive crisis or would I get a headache? My doctor hasn't used MAIO or EMSAM before so he gives me no information. Thanks
> trx resistantI'd say the mood elevating effects maxed out with the 12 mg/d dose at I suppose around 4 weeks; past that it probably started inhibiting MAO-A, which increases serotonin levels, and I've never had a positive response to serotonergics. You might get an immediate stimulant effect because some of these cytochrome P450 enzymes that metabolize EMSAM exist past the blood-brain barrier, and will convert it into L-methamphetamine & L-amphetamine.
I went off it two weeks or so after increasing the dose from 18 mg/d to 24 mg/d, because I suddenly became delirious and had to be hospitalized. An agrypnia, a profound insomnia that left me awake for days, unresponsive to Lunesta (very similar to Ambien CR) and Remeron, was the major factor, likely because of large concentrations of amphetamine metabolites and the fact I was wearing the patches through the night. I suggest taking them off before you sleep.
There were other contributing factors, specifically too high doses of desipramine that were enough to cause frank visual and auditory hallucinations. Many of the drugs I was taking inhibited or competed for the CYP2D6 enzyme that metabolizes amphetamines. It's not that EMSAM is a bad or dangerous drug, but next time I'd rather try Azilect, which lacks amphetamine metabolites and is more potently neuroprotective.
Symptoms of the tyramine-induced hypertensive crisis are severe headache, neck stiffness, palpitations, nausea, and a cold sweat. You might want to carry a card that notes you're on a MAOI. I really wouldn't worry about it though.
poster:Astounder
thread:662533
URL: http://www.dr-bob.org/babble/20071027/msgs/792785.html