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Dr. Bob is Robert Hsiung, MD,
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Posted by TylerJ on March 5, 2006, at 22:53:41
In reply to Re: I Like and Believe In This Med For Whatever Co » Phillipa, posted by Chairman_MAO on March 2, 2006, at 20:11:18
> Not on it right at this moment but:
>
> Nardil 1mg/kg: Dysthymia/atypical depression, social phobia: Among drugs marketed as such in the US, this is without a doubt the most robust antidepressant. Actually effective for anxiety!
>
> buprenorphine sublingual 4mg qd-qid: Far and away the best pharmacological aid for addictive/compulsive beahvior. There is virtually no reason to ever subject someone to nalrexone because this exists. Can be calming and energizing at the same time. A good antidepressant (especially for those with mild-moderate chronic pain). I have a feeling this would also be good in panic disorder and perhaps even as a mood stabilizer.
>
> d-amphetamine 20mg bid-tid: If you have problems concentrating, this can help. I don't get much of a mood lift from it, and I hate the appetite suppression. If I could take it with Nardil I would actually be fully functional. Probably going to end up forgoing it and getting back on phenelzine. Great for sexual function IN LOW DOSES.Do you like it as well as "The Old Nardil"? Chairman, what are the differences between the old and the new anyway? Most people here say the "New" is not nearly as good, and I know you are very well educated in meds/drugs..in other words I trust and value your opinion. I'm doing very well on Parnate myself, however I want to be maoi educated for possible future needs. Thank you.
Tyler
Posted by yxibow on March 6, 2006, at 3:29:19
In reply to Re: I Like and Believe In This Med For Whatever Co » yxibow, posted by SLS on March 5, 2006, at 14:27:34
> That's quite a list.
>
> I hope it affords you the relief you deserve.
>
>
> - ScottThank you -- I do too. Only through polypharmacy has my disorder gone way down in the past 4 years. Its still a hideous unexplainable thing like a piano falling on your head but that's life. I know I have genetic disposition to neurochemical imbalances.
Posted by deniseuk on March 6, 2006, at 11:30:56
In reply to I Like and Believe In This Med For Whatever Condit, posted by Phillipa on March 1, 2006, at 21:53:09
Zyprexa 10mg now and again.
Used to love prothiaden 75mg
then loved Seroxat 20mg.
Foolishly came off Seroxat, was fine for 3 years then another bout of depression this time no medication apart from Zyprexa at 10mg helped.
Regret coming off Seroxat as I believe it not only helped me but also protected me. Those ten years were the best years of my life. Hopefully they'll be more to come.
I feel as though I'm owed five years of some happiness as I have very few good memories now from the age of 35 to 40. Did I break a mirror?
Denise
Posted by Chairman_MAO on March 7, 2006, at 11:48:35
In reply to Re: I Like and Believe In This Med For Whatever Co » Chairman_MAO, posted by TylerJ on March 5, 2006, at 22:53:41
I have never used the original formulation, so I cannot offer an opinion. :(
My "gut feeling" as well as logical reasoning point to the same conclusion: that the "New Nardil" is probably slightly less potent than the "Old Nardil".
This is, however, NOT due to the tablet excipients or whatever else most of the conspiracy-theory proponents argue, but simply because the "New" version is a "branded generic" (a more prototypical example of an oxymoron is difficult to imagine). The "old" version was manufactured to "A" standards which call for no more than a 10% variation from the stated amount of active drug per tablet. The "new" version is manufactured to "AB" standards, which allow up to a 20% variation in dosage. Thus, someone who was taking 90mg +/- 9mg of the old is now taking 90mg +/- 18mg of the new. As the margin of error is now in excess of one tablet, the new formulation may be weaker for some individuals, especially those taking high dosages.The old version was NOT enterically coated, nor did it contain a different active ingredient. I am not a pharmacist, but I do not see how any of the excipients in either of the formulations could have enhanced bioavailability or changed the pharmacokinetics all that much. The reason the sulfate salt is used instead of phenelzine base is because the stomach is a polar environment, and the salt is non-polar. That way, most of the dose will make it beyond the stomach--whether it is in the old formulation, new formulation, a capsule, liquid, peanut butter sandwich, jello mold, etc.
I have yet to hear any arguments in favor of the "new" Nardil being radically different that make anything resembling a modicum of sense to me. If someone could offer me what they claim is a sound rationale for a radical difference in efficacy, I would hear it with an open mind and ears.
The maintainer of www.socialfear.com agrees with me, FWIW. The "new" Nardil for me has worked so well that I cannot imagine what a dramatically better effect would be.
Posted by TylerJ on March 7, 2006, at 12:10:23
In reply to Re: I Like and Believe In This Med For Whatever Co » TylerJ, posted by Chairman_MAO on March 7, 2006, at 11:48:35
Interesting. Do you use any augmentation agents with Nardil? How long has it been working for you? Thanks for the info. :)
Tyler
Posted by Chairman_MAO on March 7, 2006, at 13:05:52
In reply to Re: I Like and Believe In This Med For Whatever Co » Chairman_MAO, posted by TylerJ on March 7, 2006, at 12:10:23
Well recently I started it again at 60mg/day and am taking 20mg d-amphetamine bid-tid. Working better than I expected after only a week; I hope my doctor will go for it. I am going to try to feel it out to see if he will; if not I will order the NARdil from overseas or find some other way to get it and keep the amphetamine script. I cannot afford to see a specialist who is comfortable with prescribing these drugs together (even though it is far from unheard of), and I have wasted too much time on the med-go-round. My blood pressure is fine, I monitor my diet, and I have an emergency antihypertensive. Frankly I notice less of an effect from the amphetamine than when I am not on Nardil, even though the benefit is greater.
This combination is much better insofar as sexual problems are concerned as well (esp "sensitivity").
Posted by ed_uk on March 7, 2006, at 14:22:27
In reply to Re: I Like and Believe In This Med For Whatever Co » TylerJ, posted by Chairman_MAO on March 7, 2006, at 13:05:52
In my opinion, the hoopla surrounding the 'new' Nardil is having a powerful reverse placebo effect on patients ie. people respond to it less well because they have been told that it doesn't work. The power of suggestion is extremely strong.
Ed
Posted by Chairman_MAO on March 7, 2006, at 15:12:19
In reply to The 'new' Nardil » Chairman_MAO, posted by ed_uk on March 7, 2006, at 14:22:27
I agree. At times I was tempted to go beyond 1mg/kg/day or try bioavailability enhancing strategies in order to ensure that I got as much benefit as the "old" Nardil was supposed to give. However, too much MAO inhibition causes a drastic fall in dopamine synthesis, viz. a very high dose of phenelzine may provide as much benefit as not enough. I found I felt better at 1mg/kg "straight up". One problem I think people may have is not taking it tid-qid. The half-life is only 2-3 hours, and there is definitely an acute anxiolytic effect not related solely to MAO inhibition. Perhaps this has to do with the pharmacokinetics of its GABA-T-inhibiting metabolite or the formation thereof. I don't know.
Posted by forgetful mary on March 7, 2006, at 16:14:36
In reply to The 'new' Nardil » Chairman_MAO, posted by ed_uk on March 7, 2006, at 14:22:27
Really now??? Well if I had known that they changed it appreciably maybe I wouldn't have had MRI's and other brain scans prompted by symptoms caused by the new nardil. Only after discovering the NPAC site, after two years unaware that the drug was so different did I realize that the drug had even changed appreciably so your theory does appear to "go out the window" on that one. Because of that I mulled over life circumstances etc to try and figure out why I was so depressed despite my tried and true Nardil--That was my first mistake which I should have learned years ago have no impact on a biological cause. My symptoms occurred before I knew the changes had been made , (I gave no thought to the look of the pill believing it was inconsequential) Reading posts of other nardil users only recently learning of the drastic change in the medication I see many others have been suffering unknowingly as well and then come upon the site or info through other means, (apparently that placebo effect works even when you are clueless???) Are you possibly a Pfizer executive who would love to disavow any knowledge of their actions??? LOL
> In my opinion, the hoopla surrounding the 'new' Nardil is having a powerful reverse placebo effect on patients ie. people respond to it less well because they have been told that it doesn't work. The power of suggestion is extremely strong.
>
> Ed
Posted by ed_uk on March 7, 2006, at 16:18:38
In reply to Re: The 'new' Nardil » ed_uk, posted by Chairman_MAO on March 7, 2006, at 15:12:19
Hi Chairman
I've never heard of anyone benefitting from more than 90mg phenelzine per day (the recommended maximum dose). In contrast, a lot of people seem to need more than 60mg tranylcypromine (the recommended maximum dose). In the UK, the manufacturer of tranylcypromine cautions against using doses in excess of 30mg per day. This is very sad.
Ed
Posted by ed_uk on March 7, 2006, at 16:21:12
In reply to Re: The 'new' Nardil » ed_uk, posted by Chairman_MAO on March 7, 2006, at 15:12:19
PS. The UK manufacturer of phenelzine suggests that patients can only receive 90mg per day if they are in hospital. How silly.
Ed
Posted by ed_uk on March 7, 2006, at 16:35:43
In reply to Re: The 'new' Nardil, posted by forgetful mary on March 7, 2006, at 16:14:36
>Well if I had known that they changed it appreciably maybe I wouldn't have had MRI's and other brain scans prompted by symptoms caused by the new nardil.
How do you know that such symptoms wouldn't have arisen even if you had continued to take the 'old' Nardil? It would be unwise to assume that Nardil was responsible.
>did I realize that the drug had even changed
The drug is the same as it always was: phenelzine sulfate. The pharmaceutical formulation changed, not the drug.
>apparently that placebo effect works even when you are clueless???
It is quite possible that many people are incorrectly attributing changes in their symptoms to the 'new' Nardil. This does not mean that the change in their symptoms was actually caused by the change in Nardil's excipients. On seeing the NPAC site, many more people may be encouraged to believe that the change in Nardil's excipients was responsible for their recent problems. This is not evidence-based medicine.
Ed
Posted by law663 on March 7, 2006, at 19:04:03
In reply to Re: I Like and Believe In This Med For Whatever Co » Phillipa, posted by yxibow on March 5, 2006, at 5:03:21
Oh my God, do you take all of that now? Whatever doctor is prescriing that is violating the ethical cannons. Is there any empirical evidence that these meds work for somatiform disorder? Don't you think that you may over-focused on meds here? Sorry to be so blut about it.
> > Please post here what med you like, what you take it for, what it does for your condition please stated it and what doseages. Thanks Phillipa
>
> Let's see.. polypharmacy for a rare visual somatiform disorder. Looking at the medical card that I made to put in my wallet. Everyone should make one of these. You never know when a EMT tech or a surgeon will need it. Seriously.
>
> Ambien -- probably used to it now, but keeps me from waking early I think. 20mg.
>
> Aprazolam (Xanax) -- PRN for a "panic button" day. Helps with an extra stressful day even on top of the Valium. More immediate gratification.
>
> Biperiden (Akineton) -- preferred anticholinergic for those rare days of necessity. More than about 1.5-2mg a day and can cause subclinical atropine toxicity. At this very moment also helps dry the mouth for a salivary awareness that is part of the entire somatiform spectrum that I had wished was gone long ago.
>
> Cymbalta -- secondary depression. 90mg. Not enamoured of the electric shocks but it works for what it is worth.
>
> Diazepam (Valium) -- high dose to fight my somatiform disorder which seems to encompass GABA and D2. 170mg for now. Used to take Klonopin -- Valium provides possibly greater anxiolytic relief. Trileptal makes it necessary to dose even higher because of P450
>
> Gapapentin (Neurontin) - augments but does not work in itself, with the Diazepam. 3600mg.
>
> Methocarbamol (Robaxin) - provides mild relief for a drug induced spasmotic condition I have. Its cousin Soma would be better but doc does not want to combine with high dose Diazepam. 3375mg. Higher and it creates a P450 serotonin syndrome situation.
>
> Propranolol (Inderal) -- PRN. Provides relief for subclinical random serotonin syndrome and extreme drug induced hand shaking. Don't use it much these days. But it works -- at least 80mg at a time is required.
>
> Seroquel -- do I love it, no, do I think about the possibility in the range of 1/4% per year or who knows of TD, no I dont like that, do I not like the intense morning sedation, no -- but I need it for its D2 action. Zyprexa would be better but it causes potential permanent pseudoparkinsonism in me. 950mg. Trileptal makes it necessary to dose even higher because of P450.
>
> Trileptal -- still at a hovering position until possible liver tests for an extremely remote reason it could harm it. I dont think I'm at a clinical enough dose. So neutral. 300mg.
>
> I think that covers the exaustive list. I'm sure I probably forgot yet another one.
>
> Better living through chemistry?
>
Posted by forgetful mary on March 7, 2006, at 19:29:41
In reply to Re: The 'new' Nardil » forgetful mary, posted by ed_uk on March 7, 2006, at 16:35:43
The numbers of people exhibitng similar symptoms which are not ascribed to other causes leads one to believe that is the case. If the drug is the same then why , oh why, did they make it with different excipients in the first place??? Was that just for the heck of it? Why are you so inclined to disbelieve the many people who know how the drug is supposed to work--and like myself had counted on it for 20 years. You can still believe it works for you without claiming to know what I feel and how my body reacted to the drug for so long I took it for granted. I hope for your sake that they do NOT choose to change the med that you count on to keep you alve and functioning at peak efficiency.Simple logic would presume If it ain't broke -don't fix it...
> >Well if I had known that they changed it appreciably maybe I wouldn't have had MRI's and other brain scans prompted by symptoms caused by the new nardil.
>
> How do you know that such symptoms wouldn't have arisen even if you had continued to take the 'old' Nardil? It would be unwise to assume that Nardil was responsible.
>
> >did I realize that the drug had even changed
>
> The drug is the same as it always was: phenelzine sulfate. The pharmaceutical formulation changed, not the drug.
>
> >apparently that placebo effect works even when you are clueless???
>
> It is quite possible that many people are incorrectly attributing changes in their symptoms to the 'new' Nardil. This does not mean that the change in their symptoms was actually caused by the change in Nardil's excipients. On seeing the NPAC site, many more people may be encouraged to believe that the change in Nardil's excipients was responsible for their recent problems. This is not evidence-based medicine.
>
> Ed
>
>
Posted by Chairman_MAO on March 8, 2006, at 0:26:09
In reply to Re: The 'new' Nardil » Chairman_MAO, posted by ed_uk on March 7, 2006, at 16:18:38
For 80% MAO inhibition, usually 0.7mg/kg/day TCP is needed. At doses above 1.5-2mg/kg/day, tranylcypromine has a whole different set of effects (this is the treatment-resistant dosage).
30mg/day is good, for, umm, a price point? Some people do seem to like this dose, though. But how much do they weigh? ;)
Posted by Chairman_MAO on March 8, 2006, at 0:29:35
In reply to Re: The 'new' Nardil » Chairman_MAO, posted by ed_uk on March 7, 2006, at 16:21:12
The therapeutic dosages for these substances in mg/kg are well-known. It's also been known for quite a long time that 80-90% MAO inhibition is the goal; thats how these dosages are figured. These drug companies haven't updated the monographs since iproniazid was on the market it seems!
Posted by ed_uk on March 8, 2006, at 14:45:38
In reply to Re: The 'new' Nardil » ed_uk, posted by Chairman_MAO on March 8, 2006, at 0:29:35
Hi Chairman
>These drug companies haven't updated the monographs since iproniazid was on the market it seems!
Drug companies only care about drugs which are $$$$ Sad but true.
Ed
Posted by ed_uk on March 8, 2006, at 15:11:07
In reply to Re: The 'new' Nardil, posted by forgetful mary on March 7, 2006, at 19:29:41
Hi
>If the drug is the same then why , oh why, did they make it with different excipients in the first place??? Was that just for the heck of it?
I've read that one of the original excipients was discontinued by the manufacturer, hence the need to alter Nardil's excipients. I'm not sure whether this is true though.
>I hope for your sake that they do NOT choose to change the med that you count on to keep you alve and functioning at peak efficiency
I take citalopram (generic Celexa). I have taken many different generics, each with different excipients. I have not noticed a difference.
>Simple logic would presume If it ain't broke -don't fix it...
It would have been better if Nardil's excipients had never been altered. The change has caused much anxiety.
Regards
Ed
Posted by Chairman_MAO on March 8, 2006, at 22:15:07
In reply to Re: The 'new' Nardil, posted by ed_uk on March 8, 2006, at 15:11:07
People are acting as if Parke-Davis had a sterling reputation for proper manufacturing procedures. My understanding is that in its pre-Pfizer days, Nardil production still had issues now and then, with most bad batches being recalled.
Posted by Michael Bell on March 10, 2006, at 11:14:16
In reply to The 'new' Nardil » Chairman_MAO, posted by ed_uk on March 7, 2006, at 14:22:27
There are a lot of people who had no idea about the change in Nardil but experienced a serious return of anxiety and depression right when the drug was reformulated. It wasn't until they stumbled across an internet site with people who had the same problems that they put 2 and 2 together. That is not coincidence. And yes, a change in excipients can have a drastic effect on the effectiveness of the drug even if the active ingredient is still the same. Absorbancy rate, half life, etc. are all effected by the type of excipients added to the drug.
Posted by ed_uk on March 10, 2006, at 14:35:20
In reply to New Nardil - Ed, read this., posted by Michael Bell on March 10, 2006, at 11:14:16
Hi
>There are a lot of people who had no idea about the change in Nardil but experienced a serious return of anxiety and depression right when the drug was reformulated.
How many is a 'lot'? Probably a small proportion of Nardil users. Inevitably, those who are not having problems will not seek information on the internet.
>Absorbancy rate.........are all effected by the type of excipients added to the drug.
In which case, adjusting the dose or frequency of administration would be effective. The 'new' Nardil is claimed to be bioequivalent to the 'old' Nardil, suggesting that if the dose did need to be altered, it would not need to be altered very much.
The 'old' Nardil did not have a complex formulation. It was not enteric coated, it was not controlled release.
Regards
Ed
Posted by forgetful mary on March 10, 2006, at 17:04:53
In reply to Re: New Nardil - Ed, read this. » Michael Bell, posted by ed_uk on March 10, 2006, at 14:35:20
It sure as heck WAS coated,...tell me Ed are you a doctor or do you just play one on tv????
Those having problems are probably older people who do not surf the net...get the point ...if you don't --feel for it on the top of your head!!!
> Hi
>
> >There are a lot of people who had no idea about the change in Nardil but experienced a serious return of anxiety and depression right when the drug was reformulated.
>
> How many is a 'lot'? Probably a small proportion of Nardil users. Inevitably, those who are not having problems will not seek information on the internet.
>
> >Absorbancy rate.........are all effected by the type of excipients added to the drug.
>
> In which case, adjusting the dose or frequency of administration would be effective. The 'new' Nardil is claimed to be bioequivalent to the 'old' Nardil, suggesting that if the dose did need to be altered, it would not need to be altered very much.
>
> The 'old' Nardil did not have a complex formulation. It was not enteric coated, it was not controlled release.
>
> Regards
>
> Ed
Posted by Michael Bell on March 11, 2006, at 10:57:32
In reply to Re: New Nardil - Ed, read this. » Michael Bell, posted by ed_uk on March 10, 2006, at 14:35:20
Ed, no offense but you are patently mistaken, buddy. Bioequivalency has nothing to do with absorbancy rate. Bioequivalency means that the same amount of an active ingredient is delivered using the same method. Absorbance rate is affected by BIOAVAILABILITY, which is the amount of time the drug takes to be absorbed in the body. Pfizer itself has stated that there is a difference in peak time of absorbance between the new and old nardil. If a reformulated drug is not absorbed properly by a percentage of people, the fact that it has the same amount of the active ingredient will not matter because the active ingredient is not being absorbed as it should be. So simply raising the dosage will not be a curall to the problem. Some people
may not be able to metabolise the new nardil as well due to the changes in excipients.And, yes, old nardil did have a sugar coating which slowed down its rate of dissolution. New nardil does not have this.
Finally, have you taken new and old Nardil Ed? What are you basing your observations on?
> Hi
>
> >There are a lot of people who had no idea about the change in Nardil but experienced a serious return of anxiety and depression right when the drug was reformulated.
>
> How many is a 'lot'? Probably a small proportion of Nardil users. Inevitably, those who are not having problems will not seek information on the internet.
>
> >Absorbancy rate.........are all effected by the type of excipients added to the drug.
>
> In which case, adjusting the dose or frequency of administration would be effective. The 'new' Nardil is claimed to be bioequivalent to the 'old' Nardil, suggesting that if the dose did need to be altered, it would not need to be altered very much.
>
> The 'old' Nardil did not have a complex formulation. It was not enteric coated, it was not controlled release.
>
> Regards
>
> Ed
Posted by ed_uk on March 11, 2006, at 12:42:31
In reply to Ed - here's why you are wrong » ed_uk, posted by Michael Bell on March 11, 2006, at 10:57:32
Hello
>Ed, no offense but you are patently mistaken, buddy.
Please don't call me buddy. I find it offensive.
>Absorbance rate is affected by BIOAVAILABILITY, which is the amount of time the drug takes to be absorbed in the body.
Actually, bioavailability is defined as the % of the drug which reaches the blood stream intact. It is not the same as the rate of absorption.
>Pfizer itself has stated that there is a difference in peak time of absorbance between the new and old nardil.
If that was the case, taking smaller but more frequent doses should help.
>Some people may not be able to metabolise the new nardil as well due to the changes in excipients.
Drug metabolism refers to the conversion of a drug to different chemicals (metabolites) in the body. Metabolism of drugs occurs mainly in the liver, but also in the wall of the intestines etc. I'm not sure what you saying here. I can't imagine that the excipients affect the metabolism of phenelzine in the liver. Excipients may be pharmaceutically active but they are, by definition, not pharmacologically active.
>And, yes, old nardil did have a sugar coating which slowed down its rate of dissolution. New nardil does not have this.
'Old' Nardil was film coated. It was not enteric coated. A film coat is not the same as an enteric coat. A film coat breaks down rapidly in the stomach, whereas an enteric coat prevent the drug from being released until it reaches the intestine. Both the 'new' Nardil tabs and the 'old' Nardil tabs disintegrate in the stomach.
>Finally, have you taken new and old Nardil Ed? What are you basing your observations on?
No, I do not take Nardil. I am basing my statements on simple logic.
Regards
Ed
Posted by SLS on March 11, 2006, at 13:13:38
In reply to Re: Ed - here's why you are wrong » Michael Bell, posted by ed_uk on March 11, 2006, at 12:42:31
> >Finally, have you taken new and old Nardil Ed? What are you basing your observations on?
> No, I do not take Nardil. I am basing my statements on simple logic.And accurate information, I'm sure.
:-)
I guess we'll have to wait and see how this thing plays out in real life. Perhaps a higher peak blood concentration is necessary for optimal tissue absorption, in which case the old Nardil would be more effective at equivalent dosages.
Remember, any small difference in tissue absorption would be magnified because Nardil inhibits its own metabolism.
Just more logic?
:-)
I'm not sure what I'm talking about. I wish I were. This is an important topic. If doctors do not take into consideration a possible difference in bioequivalency between the two preparations, he might terminate a trial prematurely.
- Scott
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