Posted by TH on July 9, 2019, at 7:18:17
For several months now I have been struggling with a loss of efficacy from my previously effective dose of tranylcypromine. I have an appointment to meet with a psychiatrist who specialises in MAOIs in a few weeks, and a recommendation that increasing the dose is likely to be helpful.
That being said, a rather farfetched idea has been bothering me for a while now, about the possibility of the medication having been improperly stored somewhere along the supply chain. While this idea seems highly unlikely to be behind these issues, it does somewhat seem to fit.
After a strong response of several months to initial treatment with tranylcypromine, the effect had begun to wane. As I live in quite a remote area, I see a doctor in the city, and previously had been filling my prescription there also. At the beginning of February I began filling my prescription at my local pharmacy. While it's hard to pinpoint exactly where things began to fall apart, my internet chat history suggests that by mid-March things had significantly deteriorated. In April, I increased the dose to 40mg daily without significant improvement; the slow decline continued.
This period of March through June was characterised by alternating periods of relative wellness and depression. Suspiciously, the side effects I normally experienced from the medication were now only present during the periods of relative wellness.
At this point, there are no longer significant periods of wellness. I have returned to a more or less consistent state of depression, with a peculiar quirk: periods of side effects appear spontaneously. Just this evening I experienced a transient episode of severe orthostatic hypotension, accompanied with the dry mouth and the sedation I felt during early treatment. Upon standing my blood pressure fell so severely that I felt faint and heard a loud ringing in my ears. By the time I realised what was happening and retrieved my blood pressure monitor I had more or less recovered, however even then my blood pressure was 93/54, and my heart was beating at 133bpm. This is a more significant drop from my normal standing reading of ~130/80 than I had ever experienced during the initial stages of treatment.
These transient episodes of side effects are almost as if the medication has been completely absent from my system and has been suddenly re-introduced, a pattern than would also fit the gradually declining cycles of earlier on.
The fact that this gradually began around the time I switched pharmacies also lends itself to the theory.
I have experimented with dose times and full vs empty stomach and this appears to have no effect. Luckily I had saved all the empty packaging and checked the batch numbers and expiry dates. There was no change in batch number around that time this began, and no medication was near an expiry date.
The datasheet specifies that tranylcypromine should be stored below 25șC and while this has always been the case on my watch, I am left wondering whether this has been the case with my local pharmacy's supply. While I could find no specific mention of tranylcypromine, brief research suggests that some medications can be very sensitive to their storage conditions.
Although it strikes me as unlikely, does this seem in any way like a plausible explanation, or just the distorted over-analysis of an unwell mind?
poster:TH
thread:1105212
URL: http://www.dr-bob.org/babble/20190513/msgs/1105212.html