Posted by BrightEyed+Blueberry on July 5, 2008, at 2:26:36
In reply to Re: Considering an MAOI, posted by undopaminergic on June 3, 2008, at 12:50:11
What about hydroxyzine (Vistaril, Atarax), in your discussion quesiton #2 re: safe antihistamines to take while on an MAOI (I'm on EMSAM 6mg, possibly going up to 9mg shortly).
I ask cuz I just started taking benadryl to help me sleep, as that's the only med my doctor said I could take over the counter (for sleep or colds). She's prescribed me xanax and neurontin but that combo still wakes me up after 4 hours, and I'm not comfortable with going up on my xanax dosage, for tolerance/addiction/withdrawal issues. I mean, I hate drugging to sleep, but not sleeping is worse...My doctor won't let me try trazodone either.
She won't let me try wellbutrin under her care either, to augment my EMSAM. She said she didn't have enough malpractice insurance, so she goes my the medication insert. Not much leeway there. So, If I ever want to try other things t oaugment , like provigil or even buprenorphine, or any other stim--she said I'd have to check out doctors at places like UCSF or Stanford - ad I don't know if she was pulling that out of a hat or what!
However, may I ask, if anyone has been on Wellbutrin and an MAOI at the same time (EMSAM ideally), what was the highest dose you tolerated, and was it Wellbutrin SR or Wellbutrin XL (or the generic, I'm not picky about the generic wellbutrin issue at the moment. I just have a few full bottles of various dosages I may want to try - yes on my own, perhaps eventually. My pdoc says that it does effect Serotonin ... indirectly....(but...doesn't everything eventually balance out and effect other transmitters?) I sometimes just DONT get it.
And now that I realize I've hit the "malpractice insurance-wall/excuse" as to the limits my pdoc will go to with me in trying to remit my depression (i/we deserve more than that partial remission crapola), well, I know there are pdocs out there that will work harder with you---I assume they must carry more insurance - and hence the whew! extreme fees $$$$ they charge!
signing off, past my bedtime....
*Bright
> > > My doc and I have discussed MAOI's as an alternative.
> >
> > Hi there. Both Wellbutrin and Lamictal can be combined safely with MAOIs, just so you know.
> >
> > > I need to keep my energy up (if normal is a 10 and coma is 0, I'm about 6-7 on a good day). I've reviewed the standard lit out there about drug and food interactions and the generalized side effects.
> >
> > A lot of the lists of food interactions (even those provided by doctors, hospitals, pharmacists, etc.) are not based on well-documented case reports or accurately measured levels of biogenic amines (tyramine, etc.). I believe there's a list here on Dr. Bob's site that's more accurate.
> >
> > > 2) What kind of antihistamine do you take if you have a cold/flu?
> >
> > Antihistamines (diphenhydramine, chlorpheniramine) are safe to use with MAOIs.
> >
>
> Chlorpheniramine (CPI) was an extremely bad example, because it is one of only two antihistamines that are known to be unsafe with MAOIs (the other one is brompheniramine, BPI). The reason is that CPI and BPI are serotonin reuptake inhibitors, and their use under MAO inhibition poses the risk of serotonin syndrome.
>
> In contrast, another antihistamine - cyproheptadine (Periactin) - is an effective antidote to serotonin syndrome, due its serotonin 5-HT2A-receptor blocking property.
>
> > It's decongestants (pseudoephedrine, ephedrine, phenylpropanolamine, etc.) that you need to watch out for.
> >
>
> This is true, but they can sometimes be useful against MAOI-induced hypotension. Amphetamines are similar to the anticongestants mentioned above, and cause a dose-dependent elevation of blood pressure, and hypertensive crisis if the dose is high enough. Nevertheless, when used with caution, amphetamines can be used not only to treat hypotension, but also to augment an unsatisfactory response to MAOIs.
>
> Methylphenidate (MPH) is relatively safe and may reduce tyramine sensitivity, as well as exert a stabilising effect on blood pressure. Modafinil is likely to be even safer than MPH, and caffeine is very safe. Cocaine (COC) may theoretically cause serotonin toxicity, but there are no reports of serotonin syndrome (or hypertensive crisis) with the combination of COC and MAOIs - possibly due to COC's short duration of action.
>
> Most tricyclic antidepressants, except clomipramine and imipramine, can be used with MAOIs. So can reboxetine and atomoxetine, and like methylphenidate, they may reduce tyramine sensitivity. On the other hand, all SSRIs and SNRIs have the capacity to precipitate serotonin syndrome in combination with MAOIs. Tianeptine, on the other hand, (and amineptine) combine safely with MAOIs.
>
> Alpha2-adrenergic antagonists, such as yohimbine, idazoxan, and mirazapine, should be used with caution due to their noradrenaline-releasing properties, which may give rise to hypertensive reactions. Yohimbine may furthermore have MAOI-inhibitory features, opening the possibility for a MAOI overdose.
>
> Most antipsychotics, with the possible exception of ziprasidone - due to its monoamine reuptake inhibiting features - pose no notable risks in combination with MAOIs. Chlorpromazine is in fact an effective antidote to serotonin toxicity.
>
> Dopamine direct agonists have no propensity to interact with MAOIs, and neither do the NMDA-antagonists amantadine and memantine. However, the NMDA-antagonist and cough suppressant dextromethorphan also has significant serotonin reuptake inhibiting properties and is unsafe.
>
> Most analgesics, including aspirin and paracetamol (acetaminophen) are safe. Of the narcotic analgesics, pethidine (meperidine) and tramadol pose definite risks of serotonin toxicity, although they have sometimes been combined with MAOIs without problems. The case of fentanyl and methadone is more uncertain, but theoretical serotonergic properties have been reported, so caution is warranted. Other opiates, such as codeine, oxycodone, morphine, and buprenorphine, are very safe to use with MAOIs.
>
> Potent noradrenaline precursors, L-dopa and L-dops, have the potential to cause hypertensive reactions, whereas tyrosine and phenylalanine are relatively safe. The direct serotonin precursor 5-hydroxytryprophan (5-HTP) poses a definite risk of serotonin toxicity, and it is likely that high doses of tryptophan also are risky.
>
> The trace amine and dietary supplement phenylethylamine (PEA), and of course tyramine, are comparable to amphetamines and definitely elevate blood pressure in a dose-dependent manner, resulting in hypertensive crisis if enough is consumed rapidly enough.
>
> > > Any problems with anti-biotics?
> >
> > None that I'm aware of.
>
> Possibly linezolid, as it is a MAOI itself, and combining it with another MAOI could theoretically result in MAOI overdose.
poster:BrightEyed+Blueberry
thread:826622
URL: http://www.dr-bob.org/babble/neuro/20080418/msgs/838126.html