Posted by Erewhonian on January 2, 2012, at 16:08:28
In reply to Re: Emsam poop out, a new maoi?, posted by williamockham on January 2, 2012, at 11:07:12
> so if absorption is linear
Which it probably isn't. It hasn't been studied, to the best of my knowledge, but the drug manufacturer is always careful to say that it doesn't guarantee a release rate. The things I've read about emsam around the web suggest that most of what is going to be absorbed is absorbed in the first 12 hours.
> No one (AFAIK) has done tyramine pressor tests on higher Emsam doses, so it might make the diet mandatory...maybe to a lesser extent since transdermal leaves gut MAO-A pretty much intact (tested in rats up to absurd doses). If you gotta really watch the diet, and deal with multiple patches in various states of falling off, kinda defeats the benefits of Emsam vs Parnate/Marplan.
Yeah, as far as I know these http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4186b2_01_01_somerset-emsam.pdf are THE tyramine pressor studies. The 6mg/24hr and 9mg/24hr were basically non-interfering (seems the advice to adhere to the diet starting at 9mg is CYA). With the 12mg patch it seems a small percentage of people might have slight problems. (The number of people in the study is kinda small). Basically, it's going to vary from individual to individual. But I love one mental image that document paints for me, that of a bunch of scientists trying to force subjects to eat 2lbs of cheddar cheese in 30 minutes.
> Best of luck convincing the pdoc. I've certainly had my share of shy ones with MAOIs..
Thanks. I'm going to start making calls tomorrow. Hopefully I can find a pdoc.
What you said about multiple patches though, it makes me think again about something other than the insomnia that might have caused the poop out. It was an awfully hot summer here (often got 110+ Fahrenheit), which caused me to sweat off some patches. I sometimes also felt sick when I could feel the patch dumping WAY too much selegiline into me because of the heat. Maybe replacing a patch (or on at least one day I can remember, two) plus all that heat was dumping a lot more of the drug into my system. Maybe enough that I became resistant to normal dosing?I dunno. Just wondering. I started discontinuing the emsam about a week ago. I'm expecting any pdoc I can find to give me an oral maoi would want a two-week washout anyway. Plus I'm hoping a clean slate might help the new drug (hell, I've even read that it might restore the effectiveness of the emsam, but I'm not willing to potentially waste the time testing that out)
poster:Erewhonian
thread:1005595
URL: http://www.dr-bob.org/babble/20111226/msgs/1006160.html