Posted by Tomatheus on July 9, 2012, at 21:00:06
In reply to Why does Nardil cause urinary retention?, posted by gilmourr on July 9, 2012, at 16:24:11
> What is in a MAOI or Nardil that causes this symptom???
Urinary retention was one of the side effects of Nardil that went away for me when I tried putting the contents of my Nardil tablets in enteric capsules. However, even when I did put the contents of my Nardil tablets into enteric capsules, there were two times when the urinary retention returned: first, when the bottles of Australian Nardil that I received from the online pharmacy I was using at the time did not have any silica gel inside of them (the bottles that I had been receiving prior to that point *did* have silica gel inside of them), and second, when I received what was most likely a bad batch of the American (Pfizer) Nardil. The fact that putting the contents of the Nardil tablets that I was taking into enteric capsules usually prevented the urinary retention from occurring, coupled with the fact that allowing my Nardil tablets to be exposed to moisture (as I did when I took the tablets from the bottles without any silica gel inside of them) brought on a return of the urinary retention, tells me that it's probably not phenelzine itself that causes urinary retention (at least not in me), but one of the byproducts of the chemical degradation of phenelzine that causes the side effect. In a post that I wrote in 2006 (http://www.dr-bob.org/babble/20060617/msgs/658844.html), I suspected that the byproduct in question might be ammonium, based on the fact that urinary retention is a known effect of ammonia toxicity. However, I don't know for certain if it is indeed ammonium (which is a byproduct of the oxidation of aqueous hydrazine) that causes urinary retention in Nardil. What I can say is that protecting the phenelzine that I took from chemical degradation (both in the stomach by putting the contents of my tablets into enteric capsules and in the pill bottles by preventing the tablets from being exposed to moisture with silica gel) seemed to prevent urinary retention from happening. At least that was the case with me.
I think that I'm sort of beating a dead horse, so to speak, by saying this, but I think that Nardil can be made to be both more effective and more tolerable than it currently is. For one thing, the coating that is used on every version of Nardil that's made in the world (at least to my knowledge) does not protect the phenelzine inside the capsules from undergoing chemical degradation in the stomach. If my reading of Gan-Lin Chen's (1986) doctoral dissertation on the degradation of phenelzine is correct, then phenelzine undergoes chemical degration some 463 times more rapidly in stomach-like conditions than in small intestine-like conditions. So, protecting phenelzine with an enteric coating is crucial to keeping phenelzine intact, which not only ensures that the phenelzine can inhibit the MAO enzymes but also prevents the phenelzine to breaking down into chemicals that may interfere with the medication's efficacy and cause unwanted side effects. Another thing is that Nardil tablets aren't always stored in conditions that protect the tablets from moisture. As I have stated in the past, when Nardil tablets are stored in excessively humid conditions (with the relative humidity being at least 80 percent), the hydrazine in the tablets undergoes rapid chemical degradation (Lovering et al., 1983). So, between the stomach and the pill bottle, there are too many opportunities for phenelzine to undergo degradation into other chemicals that may cause urinary retention and other side effects (and also contribute to a lack of effectiveness).
Chen, G.-L. (1986). The chemical kinetics of phenelzine degradation. Unpublished doctoral dissertation, University of Iowa, Iowa City.
Lovering, E. G., Matsui, F., Curran, N. M., Robertson, D. L., & Sears, R. W. (1983). Hydrazine levels in formulations of hydralazine, isoniazid, and phenelzine over a 2-year period. Journal of Pharmaceutical Sciences, 72, 965-967. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/6620160
Dx: schizoaffective disorder
Taking Abilify and 6 supplements