Posted by Questionmark on April 27, 2008, at 1:37:08
In reply to Re: Husbands Suggestion of Nardil for me/racer, posted by undopaminergic on April 20, 2008, at 0:06:30
Good point(s) undopaminergic. There are definitely things you can do to combat most of Nardil's side effects, especially the vomiting (and especially if that was the only or main thing preventing you/her from staying on Nardil). But i must disagree with the following:
"... and noradrenergic agents (ephedrine, pseudoephedrine, phenylephrine, etc.) are usually effective. While stimulants are typically contraindicated with MAOIs, when you're suffering from severe hypotension, the risk of hypertensive crisis from the introduction of a stimulant is minimal."
Stimulants are sometimes ok, yes-- methylphenidate in particular at least. But noradrenergic agents are VERY dangerous to mess with while on an MAOI. I mean it would seem like you're right, but just a tad too much and you could be propelled into the heart of a hypertensive crisis-- even if you're normally quite hypotensive with the MAOI.
> > After 25 years on this merry-go-round and another med failure due to side effects I refuse to do that anymore. Some may not agree with my rationale of what I'm prepared to tolerate with side effects from any med be it a SSRI, SNRI, TCA or mood stab, and that is if it shoots my anxiety sky high, nope, not going there. If it knocks me out for 12 hours after the first dose and leaves me feeling like I have the world's worse hangover without the booze, not going there either. If it leaves me unable to string a sentence together, not going there. With Nardil, I was vomiting in my sleep every night, can't go there, due to the obvious risk of that particular one. If it makes me gain a ton of weight to the point where I now have a fridge magnet that says "I'm not fat, I'm fluffy", not going there. Perhaps my attitude will come back to bite me in the bum but man oh man enough already..
> >
> > I'm very happy for people who have lasting success with meds with minimal side effects. I am so not one of them. That is why MAOI's were the next step. My pdoc and I were simply hoping I could get some longevity from them. I knew there would be side effects but I sure wasn't prepared for the hurling in my sleep. I still go into each drug trial with hope. Next step for me is a retrial of Parnate. The first trial got muddied as it coincided with a surgery I had. Hypotension was its major side effect. I'll drop down on my hands and knees again for awhile, but if it doesn't abate within a reasonable amount of time or is severe enough that I'm afraid to walk down a flight of stairs with my grandchild in my arms, not going there.
> >
> > I asked my pdoc what now if the MAOI's don't work? His answer was "I guess we're going to have to get really creative".
> >
>
> I think creativity is indeed what you need more of. Many of the side effects you mentioned can be treated, if they don't go away by themselves in a reasonable period of time. Treating the adverse effects is particularly worthwhile if the drug is otherwise effective, as in the case of Nardil, for example.
>
> For vomiting, there are a number of anti-emetic drugs. For example, the -setron serotonin 5-HT3-receptor antagonists (granisetron, tropisetron, ondansetron, etc.). Another major class of antiemetics are dopamine antagonists (domperidone, sulpiride, metoclopramide, chlorpromazine, etc.). There are also anticholinergics (scopolamine, atropine, etc.) and anticholinergic antihistamines (cyclizine, diphenhydramine, promethazine, etc.). Last, but possibly not least, cannabinoids (dronabinol, nabilone) may be effective.
>
> For sedation, stimulants (modafinil, methylphenidate, amphetamines) are usually effective.
>
> For hypotension, some stimulants (methylphenidate, amphetamines) and noradrenergic agents (ephedrine, pseudoephedrine, phenylephrine, etc.) are usually effective. While stimulants are typically contraindicated with MAOIs, when you're suffering from severe hypotension, the risk of hypertensive crisis from the introduction of a stimulant is minimal.
>
> For weight gain, metformin, stimulants, and beta2-adrenergic agonists (clenbuterol, salbutamol, etc.) may be worth trying.
>
> For anxiety, benzodiazepines are often useful.
poster:Questionmark
thread:823803
URL: http://www.dr-bob.org/babble/20080420/msgs/825747.html