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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 32. Go back in thread:
Posted by Meri-Tuuli on November 2, 2005, at 3:42:59
In reply to Re: The other Nardil, posted by tecknohed on November 1, 2005, at 21:08:52
Hi Teck,
Sorry to interupt (and be nosy) but how have you got Nardil in the UK? I was led to believe (by my doc and others here) that its impossible to get it prescribed here in the UK - I was told that my best bet would be flying across to the states!!
Kind regards
Meri
>I'm in the UK and my Nardil works fine and has always had that 'melt in the mouth' quality. I'm unaware of the UK Nardil having ever been changed.
Posted by ed_uk on November 2, 2005, at 15:01:10
In reply to Re: The other Nardil » willyee, posted by Declan on November 2, 2005, at 0:00:21
I very much doubt that there's anything wrong with the 'new' Nardil. I'm just not convinced.
Ed
Posted by Chairman_MAO on November 2, 2005, at 15:47:32
In reply to Re: The other Nardil » Declan, posted by ed_uk on November 2, 2005, at 15:01:10
I agree. I am waiting someone with anything that looks to me to be a coherent understanding of pharmacy and psychopharmacology free of self-contradicting propositions to argue in favor of the New Nardil conspiracy.
I told this story to my previous psychiatrist, who insightfully told me that sounds like when his methadone patients tell him that it is or sometimes even that they can FEEL it eating away at their bones.
I am open to all evidence; please, convince me! I want to know everything.
Posted by craiggetty on November 2, 2005, at 19:59:23
In reply to Re: The other Nardil » ed_uk, posted by Chairman_MAO on November 2, 2005, at 15:47:32
I don't quite get the methadone reference, but it seems apparent that you'll have to wait until a study is done - which is very unlikely. I think it's condescending of you to describe people as conspiracy theorists just because they personally noticed a difference in the 2 nardils. If you didn't want to hear that response then you shouldn't have asked people for their opinions. The "2 different Nardil" theory is similar to people who believe that generic drugs aren't always the same as name brand. Is this true? I don't know, I haven't seen any studies. However, I wouldn't discount a personal opinion that someone has reported. I know people who work for drug manufacturing companies who assert that their companies' products are superior than generic (primarily due to the system of checks and controls). Do I know if this is a fact? No. And neither do you. If you're so antsy, go do your own research instead of whining here. Your negativity isn't helpful.
> I agree. I am waiting someone with anything that looks to me to be a coherent understanding of pharmacy and psychopharmacology free of self-contradicting propositions to argue in favor of the New Nardil conspiracy.
>
> I told this story to my previous psychiatrist, who insightfully told me that sounds like when his methadone patients tell him that it is or sometimes even that they can FEEL it eating away at their bones.
>
> I am open to all evidence; please, convince me! I want to know everything.
Posted by Declan on November 2, 2005, at 21:11:11
In reply to Re: The other Nardil, posted by craiggetty on November 2, 2005, at 19:59:23
Well Craig, he probably doesn't call himself Chairman Mao for nothing (Where is my "Little Red Book" when I want a quote?), but there is this discrepancy between the liquid Nardil thing and Nardil absorbed through the small intestine with PlasminPlus or kaolin and Acacia, not to speak of a phenelzine patch and (now the suggestion of) a suppository.
The methadone thing doesn't sound odd to me. I'm all in favour of civilized drug regulations of course. But I do know people who are on methadone and have lost teeth and bone density. Of course that could be heroin, useing etc, nobody's going to care too much.
If the double double quotes thing doesn't work above (it doesn't, not to the right author) maybe it will work on this...."Talk to the Hand" by Lynne Truss.
Blessings and peace
Declan
Posted by willyee on November 3, 2005, at 1:40:00
In reply to Re: The other Nardil » ed_uk, posted by Chairman_MAO on November 2, 2005, at 15:47:32
> I agree. I am waiting someone with anything that looks to me to be a coherent understanding of pharmacy and psychopharmacology free of self-contradicting propositions to argue in favor of the New Nardil conspiracy.
>
> I told this story to my previous psychiatrist, who insightfully told me that sounds like when his methadone patients tell him that it is or sometimes even that they can FEEL it eating away at their bones.
>
> I am open to all evidence; please, convince me! I want to know everything.Unfortunatly not everyone is on the same level as you,and can articulate technical facts as well as you.Mostly its just lamons who are comming foruth,BUT doing so by the hundreds,and numbers to me show strentgh and truth.
You might have approx 20 ordinary folk who lived years on the drug,noticed something wasnt right,and seeked answers,ended up on the board.These 20 people might not be able to discuss pharmaocology with you,but they can tell u plain and simple something isnt right.
As far as getting the technical info id go to the page,they provide more than u can want on the matter.I dont have the link,just goog keywords anxiety community NARDIL
itll be the first one.Checkk it out
Posted by SLS on November 3, 2005, at 7:20:48
In reply to The other Nardil, posted by willyee on November 1, 2005, at 18:29:13
> The other group i mention that basicaly consists of veteran nardil users struggling to deal with the reformulation of nardil.
It was discussed here quite a bit when it was first reformulated. It might be that people have adapted their treatment dosages to accomodate any difference in bioavailability that there may be between the old and the new preparations.
The preparation was changed when it was discovererd that the amount of active ingredient, phenelzine, deviated too much from one pill to the next. I don't recall if it was a quality control problem or a shelf-life problem. Perhaps it was both.
Since I am convinced that there are bioavailability differences between generics and branded preparations, I have no reason to doubt that the reformulation of Nardil could have changed its effectiveness. However, I would think that an adjustment of dosage should remedy the problem. I don't know for sure, because I haven't actually experienced this problem myself. I still have the old Nardil lying around, and I never had to cross-over to the new Nardil.
I am not aware that there are conspiracy theories involved with this Nardil situation. Can anyone summarize the contentions?
- Scott
Posted by Chairman_MAO on November 3, 2005, at 7:57:47
In reply to Re: The other Nardil, posted by craiggetty on November 2, 2005, at 19:59:23
I am in a hurry, and will respond at length later.
Of course brands can differ in pharacokinetic parameters, and brands are made to stricter standards than generics. However, that there could be such a difference for someone such that there is a COMPLETE LOSS OF THERAPEUTIC RESPONSE _AND_ a dosage adjustment doesn't work seems unlikely to me.
Please do not hurl invectives at me. I certainly wasn't whining, and I was not being sarcastic when I said that I want to know everything about this.
Not for nothing, but people who are insecure in argument generally take the tone you did with me.Please let me know how you can reconcile the fact that the "New" Nardil conspiracy proponents claim that the excipients in the tablet are the problem--because the tablet isn't dissolving SLOWLY enough or even making it to the intestine--yet a LIQUID NARDIL ELIXIR is supposed to be the answer. Enteric coated? Not enteric coated? Liquid, solid, quick release, slow release, what? And in no way was the "old" Nardil formulated as a sustained release preparation.
Moreover, that stratguitar web site even goes so far as to claim that the "new" Nardil can dissolve in the MOUTH before it gets to the intestine! Come on ...
The reason the phenelzine is formulated as a SALT is to SURVIVE the acidity of the stomach! None of them seem to get this.
Posted by craiggetty on November 3, 2005, at 14:13:38
In reply to Re: The other Nardil » craiggetty, posted by Declan on November 2, 2005, at 21:11:11
Thanks, Declan,
I'll have to check out "Talk to the Hand." It looks fun. I've enjoyed her other book, "Eats, Shoots, and Leaves."
Regards,
Craig
Posted by craiggetty on November 3, 2005, at 14:24:24
In reply to Re: The other Nardil » craiggetty, posted by Chairman_MAO on November 3, 2005, at 7:57:47
> Of course brands can differ in pharacokinetic parameters, and brands are made to stricter standards than generics. However, that there could be such a difference for someone such that there is a COMPLETE LOSS OF THERAPEUTIC RESPONSE _AND_a dosage adjustment doesn't work seems unlikely to me.
Have you considered that there might have been a gross error in the manufacturing of the med by the new company? Manufacturing errors do take place. Afterall, that's how Kellogg's Corn Flakes came into existence.
> Not for nothing, but people who are insecure in argument generally take the tone you did with me.
An argument wasn't my intention. Just a plea for you to be courteous.
> Please let me know how you can reconcile the fact that the "New" Nardil conspiracy proponents claim that the excipients in the tablet are the problem--because the tablet isn't dissolving SLOWLY enough or even making it to the intestine--yet a LIQUID NARDIL ELIXIR is supposed to be the answer. Enteric coated? Not enteric coated? Liquid, solid, quick release, slow release, what? And in no way was the "old" Nardil formulated as a sustained release preparation.
I will try to remember to ask my pharmacist when I get the chance. What did your pharmacist say? You might want to try the following website: http://www.google.com
Posted by craiggetty on November 3, 2005, at 14:26:30
In reply to Re: The other Nardil » craiggetty, posted by Chairman_MAO on November 3, 2005, at 7:57:47
> Of course brands can differ in pharacokinetic parameters, and brands are made to stricter standards than generics. However, that there could be such a difference for someone such that there is a COMPLETE LOSS OF THERAPEUTIC RESPONSE _AND_a dosage adjustment doesn't work seems unlikely to me.
Have you considered that there might have been a gross error in the manufacturing of the med by the new company? Manufacturing errors do take place. Afterall, that's how Kellogg's Corn Flakes came into existence.
> Not for nothing, but people who are insecure in argument generally take the tone you did with me.
An argument wasn't my intention. Just a plea for you to be courteous.
> Please let me know how you can reconcile the fact that the "New" Nardil conspiracy proponents claim that the excipients in the tablet are the problem--because the tablet isn't dissolving SLOWLY enough or even making it to the intestine--yet a LIQUID NARDIL ELIXIR is supposed to be the answer. Enteric coated? Not enteric coated? Liquid, solid, quick release, slow release, what? And in no way was the "old" Nardil formulated as a sustained release preparation.
I will try to remember to ask my pharmacist when I get the chance. What did your pharmacist say? You might want to try the following website: http://www.google.com
Posted by Michael Bell on November 3, 2005, at 15:51:02
In reply to Re: The other Nardil » ed_uk, posted by Chairman_MAO on November 2, 2005, at 15:47:32
I will ignore the tones of supreriority used in some posts, as no one here is an expert in pharmaceuticals. And I'm sure all of you have complained that doctors don't know the truth about certain meds, and that we as users are the ones who notice the effects - so let's not be hypocritical.
As a user of old and new nardil, here are some FACTS, not opinions:
1. New Nardil does dissolve much quicker and will be broken down by saliva in a matter of minutes
2. Put a new nardil tab and old nardil tab in a cup
of water. Observe. then post a reply.
3. Excipients are extremely important. They effect absorbancy and release rate, among othe things
4. New Nardil is not nearly as effective as Old nardil. Period.
5. Putting nardil in enteric cap - yes, it helps
6. Adding acacia to the mix - no, it didn't help
6. Adding kaolin and bees wax (invert sugar) - yes, it helps
7. Adding white wax - yes, it helps
8. Shelf life issue - yes there are issues
9. There are problems with the formula - let's just say a chemist from a company that makes it admitted as much to me.There's no conspiracy, guys. It's really quite simple - the med was changed, and many people don't metabolize it as well. That's all
Posted by ed_uk on November 3, 2005, at 16:41:19
In reply to oh boy, here we go - Chairman, ed_uk and others, posted by Michael Bell on November 3, 2005, at 15:51:02
Oh dear, I wish I hadn't posted. I'm sorry if I offended you.
>It's really quite simple - the med was changed, and many people don't metabolize it as well.
Tell us more.......
Kind regards
Ed
Posted by Chairman_MAO on November 4, 2005, at 10:37:06
In reply to oh boy, here we go - Chairman, ed_uk and others, posted by Michael Bell on November 3, 2005, at 15:51:02
If you open up the 2005 USP, you will see that tablets of phenelzine sulfate made to spec are supposed to dissolve quite readily and COMPLETELY. As a matter of fact, the test for whether it is USP or not is whether 16 out of 18 tablets dissolve completely in the specified solutions (that mimic STOMACH ACID, not the intestines).
Posted by Tepiaca on November 4, 2005, at 21:00:03
In reply to Re: The other Nardil » Chairman_MAO, posted by craiggetty on November 3, 2005, at 14:26:30
In my experience , I inmediately felt the
difference between old and new Nardil.
I made the next post 2 years ago before Knowing
that Nardil "had changed".http://www.dr-bob.org/babble/20030928/msgs/264371.html
(how con I turn on this link?
just copy- paste please !!)
This is my experience and I do believe there
is something wrong with the new one....
mmmm maybe not wrong, but different
Posted by ed_uk on November 5, 2005, at 11:19:40
In reply to Re: The other Nardil, posted by Tepiaca on November 4, 2005, at 21:00:03
Hi Tepi
When you took 75mg Nardil and suffered bad side effects, were you taking the new Nardil or the old Nardil?
Kind regards
Ed
Posted by Tepiaca on November 6, 2005, at 1:03:26
In reply to Re: The other Nardil » Tepiaca, posted by ed_uk on November 5, 2005, at 11:19:40
> Hi Tepi
>
> When you took 75mg Nardil and suffered bad side effects, were you taking the new Nardil or the old Nardil?
>
> Kind regards
>
> Edthe new one ed
saludos
tepi
Posted by ed_uk on November 6, 2005, at 14:39:16
In reply to Re: The other Nardil » ed_uk, posted by Tepiaca on November 6, 2005, at 1:03:26
Hi Tepi
Perhaps you could try 67.5mg. Gardenergirl finds 75mg too much but 60mg doesn't always work well enough for her.
Saludos!
Ed
Posted by tecknohed on November 6, 2005, at 21:51:50
In reply to Re: The other Nardil » tecknohed, posted by Meri-Tuuli on November 2, 2005, at 3:42:59
> Hi Teck,
>
> Sorry to interupt (and be nosy) but how have you got Nardil in the UK? I was led to believe (by my doc and others here) that its impossible to get it prescribed here in the UK - I was told that my best bet would be flying across to the states!!
>
> Kind regards
>
> Meri
>Hi Meri
First of all, for a doc to say it's impossible to get and to fly abroad is RIDICULOUS! You'd do yourself a favour to change docs. Half the pharmacies I visit already have some instock, so who's prescribing it?
I think that 'eventually', if you go through enough doctors, one is eventually going to think "MAOI". I been through meds for 6 years before I got lucky. Not long compared to some, but it was the amount of various meds I'd tried, combined with a pdoc who had his 'head screwed on' that the 'offer' was made.
I've always got pretty much my own way with docs (apart from MAOIs), especially GPs. I've nearly always gone in with my own suggestions and if they say no, I see a different doc untill I find one who will. Just be convincing yet 'pushy'. And always describe to them your 'worst' days. Normally does the trick.
For Nardil, if you dont have a psychiatrist, ask your GP for a referal. In Bristol it takes little more than 2 to 4 weeks for an assesment.
Gather up as much 'positive' literature as you can find on Nardil (+ your condition), making sure all print outs contain refernces. Educate yourself so they can see you 'know' what you're talking about. Then just keep on and on and on and ON at them! Eventually you'll 'get through' LOL.Its also a good idea to look for & take part in Universtiy studies, often taking part at the local Psychopharmacology clinics. Thats how I got on Nardil.
Best of luck.
Posted by ed_uk on November 7, 2005, at 14:34:36
In reply to Nardil in UK » Meri-Tuuli, posted by tecknohed on November 6, 2005, at 21:51:50
Hi Kevin
A lot of the pharmacies I've worked at have one bottle of Nardil in stock. I've never seen Parnate, as far as I can tell, no one stocks it and no one prescribes it!
Ed
Posted by tecknohed on November 8, 2005, at 15:08:17
In reply to Re: Nardil in UK » tecknohed, posted by ed_uk on November 7, 2005, at 14:34:36
Hi ya!
That doesn't suprise me about Parnate. When I went on Marplan though, the first pharmacy I went to (Boots) had half my script in stock.
One thing I think is worth mentioning is that sometimes it may not be so easy for a doctor to prescribe such a med, even if they feel it might help (though they wont tell you that). Seems that prescribing, say, Parnate, could cause them embarrasement and questioning from thier collegues. If on the NHS, thier supervisor may not even allow it. I remember one pdoc laughed at my Parnate suggestion, saying a collegue of his bought 'attention' to himself by prescribing it.
Kev.
Posted by ed_uk on November 8, 2005, at 15:30:59
In reply to Re: Nardil in UK » ed_uk, posted by tecknohed on November 8, 2005, at 15:08:17
Hi Kev
>When I went on Marplan though, the first pharmacy I went to (Boots) had half my script in stock.
Really? I've never even seen any isocarboxazid.
>Seems that prescribing, say, Parnate, could cause them embarrasement and questioning from thier collegues.
That's exactly right.
>If on the NHS, thier supervisor may not even allow it.
Consultant psychiatrists can prescribe what they want. The thing is, they're just not willing to.
Kind regards
Ed
Posted by tecknohed on November 8, 2005, at 21:29:51
In reply to Re: Nardil in UK » tecknohed, posted by ed_uk on November 8, 2005, at 15:30:59
> >If on the NHS, thier supervisor may not even allow it.
>
> Consultant psychiatrists can prescribe what they want. The thing is, they're just not willing to.
>Hi Ed.
I see what you mean. But I wonder if what may often happen is, if say your doc wanted to try Parnate but felt uncomfortable, he/she might look for some kind of 'backup' or 'go-ahead' before 'going ahead'. Either from a colleague or supervisor. If he/she cann't get it then they wont prescribe.
I say this because, like you know, with my current pdoc its often like pulling teeth. He often says he'll talk with/ask his 'supervisor' (and others) about it. In fact, I've never actually asked him what his title is, so maybe he doesn't actually have all the capabilities as standard pdocs. Is that possible? what do you think?
I just know him as Doctor. He consults at the Psychopharmacology Dept. Bristol, supervised by/part of the team run by his Proffesor (Prof. David Nutt. Heard of him?)
Cheers,
Kev.
Posted by tecknohed on November 8, 2005, at 22:57:19
In reply to Re: The other Nardil » tecknohed, posted by Iansf on November 1, 2005, at 23:55:36
Hi Iansf
Sorry this is a late reply. I missed the fact you were asking me.
> Would using it as a suppository also avoid the tyramine issue, or would there still be a danger? And would you need to use less?
I do know that when you take MDMA (and probably many drugs) as a suppository, it definitely gives a stronger effect, maybe even double. (how do I know? Use your imaginations ;-) So it would be wise to start low.
Whether it would avoid an interaction depends on whether or not MAO is found in the rectum and if it is, does tyramine reach it in an absorbable state and not broken down/unabsorbable by then. I also dont know whether Nardil is absorbable through the rectum though I imagine it is.
Here's what happens when you eat sufficiant tyramine with MAOIs:
"Monoamine oxidase is found in the gastrointestinal tract and inactivates tyramine; when drugs prevent the catabolism of exogenous tyramine, this amino acid is absorbed and displaces norepinephrine from sympathetic nerve ending and epinephrine from the adrenal glands. If a sufficient amount of pressor amines are released, a hypertensive crisis may ensue."
teck
Posted by ed_uk on November 9, 2005, at 16:33:20
In reply to Re: Nardil in UK » ed_uk, posted by tecknohed on November 8, 2005, at 21:29:51
Hi Kev
>In fact, I've never actually asked him what his title is, so maybe he doesn't actually have all the capabilities as standard pdocs. Is that possible? what do you think?
Is he a Consultant Psychiatrist?
You should be able to find out by looking on a letter that you've received from the department.
Kind regards
Ed
This is the end of the thread.
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