Posted by Jill Laplace on May 16, 2010, at 9:36:27
In reply to Re: Parnate and reduced athletic performance? » lewyfly, posted by pedr on May 10, 2010, at 23:28:24
I also had this problem on 12 mg of selegiline (EMSAM patch). When running/playing soccer/weight lifting I would encounter that leaden muscle feeling. I would also have to breathe very hard to maintain a level of activity that normally came easily. My strength was reduced by at least half and my endurance much more than that. Low blood pressure seems to me to be the likely culprit.
The selegiline lost its effect after 2-2.5 months so I discontinued it. Now I am thinking about trying isocarboxazid (Marplan) and so I was thinking about solutions to this side effect once again.
Drinking water and increasing salt intake is a good start, but didn't do enough in my case.
I was looking into fludrocortisone, which seems to be the most mentioned approach in the literature. Corticosteroids are known to have effects on mood so if you try this be sure to monitor your mood. See the psychopharmacology textbook link below for a discussion of dosage.
Another approach also mentioned in that textbook is eating small amounts of cheese. It doesn't need to be said that this is playing with fire, but it may work if the fludrocortisone fails. Personally, I accidentally consumed a small amount of soy containing vegan-mayonnaise a week after I had discontinued phenelzine (Nardil) and got a mild headache as a result. When I tried doing some push-ups, my strength seemed to be closer to normal.
If you are going to try this idea, discuss it with your health care professionals. Over the long term, I could imagine some theoretical concerns about repeated stress induced by rapid changes in blood pressure, but I don't know enough about the cardiovascular system to speculate with any confidence.
In imagining myself trying the strategy, I thought I would get a blood pressure cuff, try ingesting a small amount of cheese, and then monitor my blood pressure for the next few hours. I would do these measurements several times before exercising because presumably the exercise would further increase the blood pressure and you don't want the blood pressure to be too high. Tyramine content is variable so I would try to use a cheese or other tyramine containing product that is manufactured in a pretty standard way, something like those Sargento's cheese slices that come presliced in a plastic package (Kraft American cheese slices presumably wouldn't work since they are safe to eat with an MAOI). Even so there are still going to be variations in tyramine content so one would have to experiment with and use this strategy very cautiously.
I looked into buying pure tyramine and using it in measured quantities. You can purchase it from manufacturers like Gold BioTechnology, but it is pricey ($69 for 50 grams). The bigger problem though is that tyramine produces a mild reaction with 6 mg (mg = milligram), a moderate one with 10-25 mg, and a severe one with 25+ mg. You would want to use a scale sensitive to at least 1 mg and preferably one sensitive in the microgram range. These kinds of scales are quite pricey, well over $1,000. The price plus the risks of catastrophe if you err by a small amount makes this approach seem pretty impractical.
I'd love to hear the outcome if anyone tries the fludrocortisone or the small amount of cheese strategies. Please be very careful if you experiment with using the cheese or other tyramine containing substance.
poster:Jill Laplace
thread:943037
URL: http://www.dr-bob.org/babble/20100514/msgs/947591.html