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Re: Treatment of MAOI hypertensive crisis » ed_uk2010

Posted by SLS on January 30, 2015, at 7:22:01

In reply to Re: Treatment of MAOI hypertensive crisis, posted by ed_uk2010 on January 29, 2015, at 13:21:28

> >Even if phenolamine was available, it probably wouldn't be available in time....
>
> I think I misunderstood you. Phentolamine isn't available here at all, in any form. The injection was discontinued years ago. Even when it was marketed here, I think it's highly unlikely that most emergency departments would stock it.
>

Believe it or not, oral phentolamine was being investigated to treat erectile dysfunction about 15 years ago. I was hoping it would be approved so as to give me the option of carrying it around with me instead of nifedipine for MAOI hypertension. It proved ineffective for ED. For reasons that I don't understand, I read that phentolamine administered as Regetine i.v. is recommended unless a CCB has already been taken. Even chlorpromazine is used in emergencies.

The authors of the following article prefer giving nifedipine.


- Scott


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http://www.currentpsychiatry.com/home/article/mao-inhibitors-an-option-worth-trying-in-treatment-resistant-cases/96a7893d1afac665461082759805d989.html?tx_ttnews%5BsViewPointer%5D=1

"Advise patients taking MAOIs to purchase a blood pressure cuff or finger sphygmomanometer and learn how to take their own blood pressure. If they experience a normal headache and their systolic blood pressure is not elevated by at least 30 mm Hg, they are not having a cheese reaction and do not need to worry. MAOI headaches are typically unmistakable (they feel as if ones head is splitting apart), and blood pressure is markedly elevated.

We give patients starting on MAOIs 10-mg tablets of nifedipine and advise them that if symptoms suggesting a hypertensive crisis appear, they should bite into one tablet to release the fluid inside and then swallow it. We tell patients to repeat this in 15 minutes if the headache is not receding; if the headache persists, they should visit the emergency ward or the internists office for observation.

Although there has been concern about the risk of MI or stroke with the hypotensive effect of nifedipine, we believe it is still the best option for acute severe hypertension in patients who do not have chronic hypertension. Chlorpromazine tablets (50 mg) also will stop the headache and lower blood pressure but will leave the patient groggy for about 24 hours, with possible extrapyramidal symptoms.

In the rare instance that a hypertensive crisis occurs, the official labeling recommendation is to give IV phentolamine, but we find emergency rooms either no longer stock the drug or do not remember to do this. Send any patient who is hurting and panicky to an ER, and call to suggest what the attending might do (i.e., IV phentolamine or oral nifedipine or chlorpromazine, or the emergency physicians preference for hypertensive crisis)."

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Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw

 

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