Posted by Tony P on January 24, 2008, at 10:30:50
I started to write this in a real panic, as I was in the midst of a hypertensive crisis in the wee hours, but I've calmed down a bit and so has my BP.
Anyone with knowledge of blood-pressure numbers and MAOI hypertensive crises, I need to know when I should panic & go to emerg., or go to a walk in clinic when it opens, or just relax & all will be well. My MD has been coy about giving me a "panic" BP number, and my home BP unit sometimes gives spurious super-high readings (over 200 systolic, then the next reading or the other wrist is 30 points lower).
I became aware I was having some level of crisis about 2 1/2 hours ago (0600 PST). My BP with the home wrist unit (which does tend to read high compared with my MD's) was between 173/105 - 188/96 from 0600-0700, and seems to be down now at 0800 to 167/105. No fever, no sweating, no muscle twitches so probably not Serotonin Syndrome. My pulse is very high -- 100-120 -- but that's at least partly caused by my anxiety and partly by the Robaxin I've taken to try to calm down -- about the only med that _doesn't_ interact with my AD's according to the web lists!
I'm taking a cocktail of AD's including 10 mg/day oral selegeline, which is supposed to be safe according to some sources, and my BP was only slightly elevated at my MD's the other day, but a couple of Drug Interaction web sites sound mighty scary when I add up all the possible interactions of everything I'm taking. I suspect the finishing touch was 100 mg trimipramine at 0500 (because I wasn't sleeping) and a late night snack on blue cheese.
For the record, I'm taking (in 24 hrs.):
Rx - Daily: Total daily doseHow taken
Remeron 30mg/day HS
Requip 1.5 mg/day div. (0.5-0.25-0.75hs)
Selegeline 10mg/day 5 mg bid
Clonazepam 2mg/day i bid - ii when needed
Crestor 10mg/day HS
Rx - as required:
Trimipramine 50-200mg HSi-iv hs prn for sleep, usually 2, about 1 night in 3
Nortriptylline 25-50mg HSi-ii occasional instead of Trimipramine (think I'm going to drop this, it's rated high-risk for interactions)
Seroquel 25-100mg HSi-iv hs prn (rarely) instead of Trimipramine for late-night hypomania (and I've just run out)OTC:
Robaxin750 mg12/day and up (trying to taper back)
My "normal" BP measured at home is 135/75 - 145/85 & I think the Dr. gets about the same.On the whole this combo has been working well for me, and the Selegeline, added fairly recently (Nov.'07), gave me that extra energy I was starting to lack with the others (probably been on Remeron too long, 1.5 years), so I'm reluctant to give up the Selegeline despite the warning bells.
It looks like the immediate crisis is over, but I would still like advice from those who've been there. I've read some of the old posts on this subject, and my questions boil down to:
- What BP numbers are a genuine gold-plated crisis, go to emerg., do not pass GO, etc.?
- Should I press my MD to let me carry an oral med such as nifedipine (mentioned in an old post)?
- Any other suggestions??
poster:Tony P
thread:808707
URL: http://www.dr-bob.org/babble/20080124/msgs/808707.html