Posted by Robert_Burton_1621 on July 21, 2015, at 16:36:50
In reply to Stopping Parnate for surgery? Help!, posted by Uncouth on July 20, 2015, at 10:20:26
Uncouth, I would take sceptically the assertion that the combination of parnate with strattera carries a dangerous and significant risk of causing hypertensive crisis and death.
Note that the poster who gave the warning provided no detail of the causal mechanism of the claimed risk.
There is no doubt that CNS stimulatants ought be used cautiously with MAOIs. Amphetamine has been implicated in deaths (subarachnoid hemorrhage) when combined with MAOIs, probably as a result of noradrenergic toxicity. However, chlorpromazine seems to reduce the toxity.
Amphetamine is a *releaser* (indirect agonist) of noradrenaline. Tyramine is also such a releaser, and for this reason can cause a hypertensive crisis if consumed in sufficient potency. This is why people on MAOIs must follow a restricted diet.
But not every medication with a capacity to increase noradrenergic neurotransmission acts as a *releaser". In fact, the NRIs roboxetine, nortriptyline, wellbutrin, can actually prevent a tyramine-induced hypertensive response.
Consult: http://www.psychotropical.com/maois-and-cns-stimulants, and the references there cited.
Ritalin, which acts as an NRI and DRI, has been used in combination with MAOIs for decades but Gillman, a meticulously thorough researcher, could not identify any reports of death.
Strattera is also an NRI, so it would assist in reducing the pressor effect of tyramine. It is reasonable to deduce that the risk it carries of inducing a hypertensive crisis when co-adminstered with parnate is analogous to that of ritalin or wellbutrin, which is very small when their co-administration is monitored properly.
Atomoxetine (strattera) does not appear to be a potent NRI anyway, since even overdoses up to 1500mg have not, apparently,induced death via noradrenergic toxicity.
For more well-reasoned and supported information, see Gillman's excellent site and:
Feinberg SS., "Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication," Journal of Clinical Psychiatry (2004) 65: 1520-4.
poster:Robert_Burton_1621
thread:1080645
URL: http://www.dr-bob.org/babble/20150629/msgs/1080682.html