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Re: Best treatment for MAOI hypertensive crisis?

Posted by undopaminergic on June 18, 2008, at 5:40:10

In reply to Re: Best treatment for MAOI hypertensive crisis?, posted by okydoky on June 14, 2008, at 11:47:38

Since MAOI-associated hypertensive crisis results mainly from vasoconstriction due to excessive release of noradrenaline (by tyramine, ephedrine or similar), it makes sense to use a vasodilating antihypertensive agent.

Although prazosin and doxazosin would seem to address the problem most directly, the question is whether they do so fast enough.

I don't think the use of nifedipine for MAOI-type hypertension is particularly dangeous, unless too much of it is taken - which could lead to hypotension and ischaemia.

I suggested nitroglycerin, and now that I've researched it better, it does seem to be a better choice than nifedipine. Not only does it act faster, but it's safer for the heart (coronary arteries, etc.). Furthermore, nitroglycerin seems to maintain - or even improve - cerebral blood flow, whereas calcium antagonists (e.g. nifepidine and nicardipine) may disturb it.
"[Nitroglycerin in comparison with nifedipine in patients with hypertensive crisis]"
"A comparison of sublingual nifedipine versus nitroglycerin in the treatment of acute angina pectoris."
"The influence of nicardipine-, nitroglycerin-, and prostaglandin E(1)-induced hypotension on cerebral pressure autoregulation in adult patients during propofol-fentanyl anesthesia."




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