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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Optimist on January 22, 2005, at 12:30:50
I'm going to be starting Parnate in about 3 weeks... waiting till my Prozac washes out. I'm trying to become an informed as patient as possible before starting, and have been preparing for my next pdoc appt to colaborate a treatment protocol.
I have a question regarding how one should titrate Parnate to ensure maximum treatment response.
1. I've noticed many have titrated slowly to a low dose, waited 2 or 3 months for effect, and then increased dosage further from there if more response was needed.
An example: 10,20,30,30,30,30,30,30,30(no treatment responce),40,40,40,40(treatment response,maintenance), etc...
2. Another titration schedule which seems to be more aggressive is to keep increasing the dosage until a response is noticed, then titrate downwards for maintenance therapy.
An example: Increasing 10 mg per unit time, 10,20,30,40,50,60(treatment response),50,50,40,40,30(loss of treatment response),40(regain of treatment response, maintenance),etc...
Titration schedule number 2 would seem to have more side effects, but a much faster treatment effect.
Would anyone have any research papers, articles, or personal experiences they could offer for help?
I would be interested in hearing from Nardil users as well since there are many similarities between the two meds.
Thanks in advance!
Brian
Posted by SLS on January 22, 2005, at 14:31:32
In reply to Parnate/MAOi titration, posted by Optimist on January 22, 2005, at 12:30:50
Regarding the titration of Parnate, I think it first makes sense to decide beforehand what your initial target dosage should be. I recommend 40mg as the minimum. Start at 10mg. You should be able to go up 10mg every 3-4 days. You should certainly be up to 40mg by the end of week two. I would spend perhaps 3 weeks at that dosage to look for improvement. I don't think making an adjustment every three weeks is rushing things if no improvement is observed. It depends on your clinical response. If you begin to improve at a given dosage after 3 weeks, you can remain on it for perhaps another 3 weeks to see if the trend toward improvement continues. I guess this represents the ideal situation. If you are particularly sensitive to the hypotensive effects, you might have to slow down. You might want to begin thinking about how you will address insomnia of it should occur as a side effect. It is common.
Parnate is a good drug. I wish you well with it.
- Scott
Posted by Maxime on January 22, 2005, at 15:57:22
In reply to Re: Parnate/MAOi titration, posted by SLS on January 22, 2005, at 14:31:32
Scott's method is how my doctor did it. He said that if I didn't feel an improvement at 40 mg then it wasn't going to be the med for me. I feel improvement at 30mg, very slight, but I felt it.
Maxime
> Regarding the titration of Parnate, I think it first makes sense to decide beforehand what your initial target dosage should be. I recommend 40mg as the minimum. Start at 10mg. You should be able to go up 10mg every 3-4 days. You should certainly be up to 40mg by the end of week two. I would spend perhaps 3 weeks at that dosage to look for improvement. I don't think making an adjustment every three weeks is rushing things if no improvement is observed. It depends on your clinical response. If you begin to improve at a given dosage after 3 weeks, you can remain on it for perhaps another 3 weeks to see if the trend toward improvement continues. I guess this represents the ideal situation. If you are particularly sensitive to the hypotensive effects, you might have to slow down. You might want to begin thinking about how you will address insomnia of it should occur as a side effect. It is common.
>
> Parnate is a good drug. I wish you well with it.
>
>
> - Scott
Posted by Optimist on January 22, 2005, at 23:10:44
In reply to Re: Parnate/MAOi titration, posted by SLS on January 22, 2005, at 14:31:32
> Regarding the titration of Parnate, I think it first makes sense to decide beforehand what your initial target dosage should be. I recommend 40mg as the minimum. Start at 10mg. You should be able to go up 10mg every 3-4 days. You should certainly be up to 40mg by the end of week two. I would spend perhaps 3 weeks at that dosage to look for improvement. I don't think making an adjustment every three weeks is rushing things if no improvement is observed. It depends on your clinical response. If you begin to improve at a given dosage after 3 weeks, you can remain on it for perhaps another 3 weeks to see if the trend toward improvement continues. I guess this represents the ideal situation. If you are particularly sensitive to the hypotensive effects, you might have to slow down. You might want to begin thinking about how you will address insomnia of it should occur as a side effect. It is common.
>
> Parnate is a good drug. I wish you well with it.
>
>
> - ScottThanks for the info Scott. It helps to get all the info I can get since my pdoc doesn't seem to be very knowledgable with MAOi's.
I'm hoping insomnia won't be too much of a problem. I didn't have any problems on my Prozac/Wellbutrin/Adderall combo so I'm crossing my fingers. I regularily take my last dose of Wellbutrin before bed which doesn't seem to cause any problems either. I've heard of others having problems with that schedule. I know Parnate is notorious for causing insomnia though.
Thanks for the well wishing. :)
Brian
Posted by cubbybear on January 24, 2005, at 9:43:53
In reply to Re: Parnate/MAOi titration » SLS, posted by Optimist on January 22, 2005, at 23:10:44
My method over the years was always this: (keep in mind that everyone's different and some people need much higher doses)
20 mg. for first 2 days,
30 mg. for next 3 days,
then 40 mg/day.
I'd get a favorable response after about 3 weeks from the initial starting date. Then, after a few weeks of being stabilized on 40 mg., I could drop down to a maintenance dose of 30 mg.[I find it very ironic to reply about this, since I've had to raise my dose back up to 40 mg. this past week, and have posted a thread about that] Good luck. Wouldn't it be great if it was as simple as 1+1=2??
Posted by eeyorena on January 24, 2005, at 17:03:14
In reply to Re: Parnate/MAOi titration, posted by cubbybear on January 24, 2005, at 9:43:53
Optimist,
I wish you luck with Parnate. I'm on it and like it very much. (I've tried everything else.)
I would advise asking your doctor about splitting your dose. I do best on 20 mg when I wake up (at 7 am) and again between 11 am and noon.
All 40 mg in the morning is too intense. And if I take it later than 3 pm, it can disrupt my sleep.
Take care--
Posted by Optimist on January 24, 2005, at 17:18:18
In reply to Re: Parnate/MAOi titration, posted by eeyorena on January 24, 2005, at 17:03:14
> Optimist,
>
> I wish you luck with Parnate. I'm on it and like it very much. (I've tried everything else.)
>
> I would advise asking your doctor about splitting your dose. I do best on 20 mg when I wake up (at 7 am) and again between 11 am and noon.
>
> All 40 mg in the morning is too intense. And if I take it later than 3 pm, it can disrupt my sleep.
>
> Take care--I imagine I'll have to play around with the dosage schedule a bit to where it suits my needs. Insomnia has never been a problem with me, even with 20 Prozac, 450mg Wellbutrin, and 10mg Adderall XR combo. I know many people experience insomnia with these. I imagine I'll have some initial problems sleeping at first. I had that the first week or so on both Wellbutrin and Prozac.
I am quite excited about starting. 3 weeks away feels soooooo long! :)
Posted by cubbybear on January 24, 2005, at 23:10:33
In reply to Re: Parnate/MAOi titration, posted by eeyorena on January 24, 2005, at 17:03:14
> Optimist,
>
> I wish you luck with Parnate. I'm on it and like it very much. (I've tried everything else.)
>
> I would advise asking your doctor about splitting your dose. I do best on 20 mg when I wake up (at 7 am) and again between 11 am and noon.
>
> All 40 mg in the morning is too intense. And if I take it later than 3 pm, it can disrupt my sleep.
>
> Take care--That's exactly right, although I didn't mention it. It's definitely advised to split doses, and I too have always dividied mine between early morning and lunchtime.
This is the end of the thread.
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