Posted by Robert_Burton_1621 on July 20, 2015, at 14:36:06
In reply to Re: Stopping Parnate for surgery? Help!, posted by SLS on July 20, 2015, at 13:34:53
> Despite having a list to wave in front of an anesthesiologist, if I were him, I would still be scared to stake my career on it. You need to start coming off of Parnate now. You need time to taper. Coming off of Parnate will probably leave you with a great deal of fatigue, with or without depression. What about reducing the dosage of Parnate by 20 mg/day every 5 days?
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> - ScottSorry, didn't catch this supplementary comment before posting.
Uncouth, I would be inclined to emphasise to your treating doctor your psychiatric vulnerability - in particular your previous experience of ECT resistant depression after stopping an MAOI before. This is a mandatory relevant consideration, I would have thought, which the anesthetist ought to take into account and its seriousness may well prompt him to enquire further into alternative anaesthetics which do not require your stopping parnate. The authors of a retrospective cohort study (2012 J Clinical Psych 73.8) concluded that "[s]evere adverse hemodynamic events, such as hypertension and tachycardia, *did not* occur more frequently in users of both the irreversible MAOI tranylcypromine and the reversible MAO-A inhibitor moclobemide compared to non-users. These findings suggest that there is no longer much justification to discontinue these MAOIs before surgery, *with the considerable risk of compromising patients' psychiatric status.*"
http://www.ncbi.nlm.nih.gov/pubmed/22938842
Have you also thought of asking your surgeon to make enquiries about an alternative anesthetist who is otherwise as trusted and competent but has more advanced knowledge of and experience with MAOIs?
Good luck.
poster:Robert_Burton_1621
thread:1080645
URL: http://www.dr-bob.org/babble/20150629/msgs/1080658.html