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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by zero on June 5, 2006, at 11:00:00
I have EMSAM samples. My psychiatrist wants me to try it, and I'd like to.
I also have asthma and use Advair daily to control it (Advair contains 2 drugs: Serevent - a long acting beta2-agonist, and Flovent - a corticosteroid).
Can I take both drugs concomitantly?
1. The EMSAM package insert doesn't mention a drug interaction/contraindication.
2. The Advair package insert does("ADVAIR DISKUS should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors").
3. My psychiatrist thinks it's safe.
4. I called the EMSAM Info. line (Somerset Pharm./Bristol-Myers Squibb), and the rep.'s answer to my question was, "we can't comment since we didn't study the 2 drugs together".Does anyone have experience taking EMSAM with ADVAIR?
I'd greatly appreciate any suggestions on resolving this.
Thanks,
zero
Posted by lymom3 on June 5, 2006, at 12:35:08
In reply to EMSAM and asthma medication ADVAIR, posted by zero on June 5, 2006, at 11:00:00
Here's what I found:
selegiline and fluticasone-salmeterol (moderate Drug-Drug)
Description:MONITOR:
While direct-acting sympathomimetic amines do not seem to be significantly potentiated by monoamine oxidase inhibitors (MAOIs), caution is nevertheless advised when beta-adrenergic agonists are used with MAOIs because of potentially cardiovascular additive effects.MANAGEMENT:
Patients should be closely monitored for blood pressure and pulse rate changes during coadministration of beta-adrenergic agonists with MAOIs or other agents which possess MAOI activity (e.g., furazolidone, linezolid, procarbazine). Preferably, at least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with beta-adrenergic agonists.
Posted by zero on June 5, 2006, at 13:00:48
In reply to Re: EMSAM and asthma medication ADVAIR, posted by lymom3 on June 5, 2006, at 12:35:08
Thanks for your post.
That's basically what I've found too.
An interesting distinction being made here: "direct-acting" sympathomimetics (i.e. albuterol, salmeterol which are deemed maybe OK w. MAOI's), vs. "indirect-acting" ones (i.e. amphetamines et. al., deemed definitely not OK w. MAOI's).
A side issue here for me is, I feel pressured by my pdoc to try the EMSAM, as I know he wants me to be his "EMSAM poster boy" (and wants to help me too). I don't want to say no, but then, I don't want a cerebral aneurysm either!
Your input is much appreciated.
zero
Posted by lymom3 on June 5, 2006, at 14:04:59
In reply to Re: EMSAM and asthma medication ADVAIR, posted by zero on June 5, 2006, at 13:00:48
You are on the wrong bandwagon for Emsam. I was my pdoc's "poster child" also. The first 2 weeks were great. I suspect because it is energizing and I have ADHD...he had me on no other stimulant medication at that time. From week 2 until week 4 when I ultimately quit, the side effects crept up and feeling great went away.
I think that the reactions are different for everyone so it's hard to know. What might be ok for me is not ok for you. It's frustrating and kind of scary to try to guess, I know.
Posted by Caedmon on June 5, 2006, at 15:13:02
In reply to EMSAM and asthma medication ADVAIR, posted by zero on June 5, 2006, at 11:00:00
I can't comment on salmeterol, but I take albuterol and fluticasone separately for my asthma and I am on Parnate (tranylcypromine). Fluticasone is obviously fine, and there is no interaction with albuterol. (I did monitor BP after inhaling albuterol, just to be sure.)
- Chris
Posted by zero on June 5, 2006, at 16:25:49
In reply to Re: EMSAM and asthma medication ADVAIR, posted by Caedmon on June 5, 2006, at 15:13:02
This is just the kind of post I was hoping for: an MAOI user also using a beta2-agonist without incident.
I can see Parnate's package insert has the sympathomimetic warning too, so it must be dependent upon which type (i.e. not all sympathomimetic agents).
I think I should be OK with the Serevent component in Advair.
This is very helpful. Thanks Chris!
zero
Posted by zero on June 5, 2006, at 16:42:48
In reply to Re: EMSAM and asthma medication ADVAIR, posted by lymom3 on June 5, 2006, at 14:04:59
Sorry EMSAM turned out to not be helpful for you.
I do have some reason to think EMSAM may be of benefit to me, though.
Years ago, before I was diagnosed with asthma (and pdoc's would Rx me MAOI's), I had very positive experiences with two: Pargyline/Eutonyl (an MAOI then marketed as an antihypertensive - very activating), and Nardil which was great, but I started feeling a bit TOO good (hypomania) after a few months.
The only class of antidepressants I've ever liked - MAOI's. I have such bad reactions to the others.
Will go slow on the EMSAM, plus we know about my Bipolar Spectrum stuff now, and which mood stabilizers work for me.
Thanks,
zero
Posted by pulse on June 5, 2006, at 17:20:24
In reply to Re: EMSAM and asthma medication ADVAIR, posted by zero on June 5, 2006, at 16:42:48
i am one for whom advair was/ is no problem whatsoever with emsam. fyi, my bp runs low to begin with.
keep in mind, i had 4 short failed trials on emsam, primarily due to very bad - for me - GI side-effects (mostly lower GI). other main, and seemingly intractible, problems were insomnia and urinary ...can't think of the word now, so i'll just call it "hard to go."
btw, ppl, i am now on my 5th trial of emsam - day six and feeling great, with NONE of the former side-effects. how did i FINALLY accomplish this?:
(once dr. bodkin responded to robert david's emails that you COULD indeed cut the patch (he said in 1/2s); i took a chance and cut it into 1/8s. not that hard to do, even on the lowest - smallest - 6 mg patch.)
***i now apply 1/4 to 3/8 of the patch - AND only this small amount for 3-4 hrs daily - about 4-5 hrs after i get up. i think it's important for ppl to know that, especially if, like me, you always need below norm doses on all ADs, that this may be a option for you, too.***
to say that i'm amazed at my results and progress is more than an understatement.
pulse
Posted by zero on June 5, 2006, at 17:37:35
In reply to Re: EMSAM and asthma medication ADVAIR » zero, posted by pulse on June 5, 2006, at 17:20:24
That's really interesting! With all AD's I have to do a low dose (sample daily doses: 2.5mg Paxil, 2mg Prozac, 15mg Nardil etc.). If I take standard doses I way overshoot normal into the zone my pdoc's call hypomania.
I'd read Rob's post(s) about cutting the patch, and had it in mind as a smart starting strategy for myself.
After reading about your experience, I'm thinking of starting out at 1/2 of the 6mg/24hr patch (my samples).
Thanks a lot for you helpful post.
zero
Posted by pulse on June 5, 2006, at 19:33:03
In reply to Re: EMSAM and asthma medication ADVAIR » pulse, posted by zero on June 5, 2006, at 17:37:35
you're most welcome.
be advised, that although i've been able - in the past - to take somewhat higher doses of some of the other meds that you've mentioned, cutting emsam only into 1/2s was still too much for me. of course, as always, ymmv.
best of luck.
pulse
Posted by Phillipa on June 5, 2006, at 20:21:07
In reply to Re: EMSAM and asthma medication ADVAIR » zero, posted by pulse on June 5, 2006, at 19:33:03
If I do decide to try EMSAM I will cut the patches small as I am med sensitive and like to start out on everything low. At least I'll be able to see a patch that's comforting to me. Love Phillipa
Posted by Jakeman on June 5, 2006, at 20:49:14
In reply to Re: EMSAM and asthma medication ADVAIR, posted by Phillipa on June 5, 2006, at 20:21:07
I guess I want to echo what's been said above... to start slow and see how you feel. My comfort level is good with Emsam because selegiline is a drug that been around a long time and has had lots of study. In fact, the transdermal delivery of Emsam probably makes it more safe because it goes into your system gradually.
warm regards, Jake
Posted by ed_uk on June 6, 2006, at 16:07:10
In reply to Re: EMSAM and asthma medication ADVAIR, posted by zero on June 5, 2006, at 16:42:48
Hi Zero
AFAIK, there is no evidence that salmeterol (Serevent) or albuterol (Ventolin) interact with MAOIs. The manufacturer's warnings are there for legal reasons. The information you may find in 'drug interaction checkers' is unreliable because it is based on the false assumption that selective beta-2 agonists would produce similar effects to ephedrine etc. when combined with MAOIs.
I think you'll be fine :) Please monitor your blood pressure.
>I had very positive experiences with two: Pargyline/Eutonyl (an MAOI then marketed as an antihypertensive - very activating)
That's interesting. When did you try it? I think you'll like selegiline. You might find it similar to pargyline.
Ed
Posted by zero on June 6, 2006, at 18:01:07
In reply to Re: EMSAM and asthma medication ADVAIR » zero, posted by ed_uk on June 6, 2006, at 16:07:10
Ed,
Thanks for your further info. on this.
I know I'd asked you a while back essentially the same question re. Nardil & beta2-agonists. I was pretty sure you were right back then, that it was a safe combination - just that my psychopharmacologist, pharmacist, package inserts et. al. said "contraindicated" (plus my psychopharm. wouldn't write me a Nardil script).
I wouldn't be surprised if the package insert warnings are merely as you say, "there for legal reasons" (big Phrma does take precautions...)
My pargyline/eutonyl experience was approx. 1990 (shortly thereafter it was pulled from the US market)
Thanks for the encouraging words. I'm hoping to start EMSAM later this week.
Wishing you the best,
zero
Posted by zero on June 7, 2006, at 23:35:10
In reply to Re: EMSAM and asthma medication ADVAIR » zero, posted by pulse on June 5, 2006, at 17:20:24
What do you do with the left over part of the patch when you first cut it? Can it be saved and used for the next day's dose, or must it be thrown away?
Glad you're having success. I will post my experience once I start.
Thanks,
zero
Posted by pulse on June 8, 2006, at 11:37:13
In reply to Re: EMSAM - the cut up pieces » pulse, posted by zero on June 7, 2006, at 23:35:10
i save all the cut-up pieces, put 2 pieces (3/8 mg.) in a multi-compartment (small) days-of-the-week pill box.
i did once wrap in aluminium foil. since the backing is still stuck tightly to the pieces, i don't see how this could cause anything untoward to happen- and it may well be a better option to ensure no degrading (?)
however, i thought i was being too fanatical, (also i'm lazy), so i switched to the box. haven't noticed any difference in efficacy.
pulse
Posted by zero on June 10, 2006, at 11:29:27
In reply to Re: EMSAM - the cut up pieces, posted by pulse on June 8, 2006, at 11:37:13
Thanks - lots of practical advice here which is very helpful.
I keep putting off my EMSAM start date. Will just have to slap it on one morning soon.
zero
Posted by sparc5 on September 14, 2007, at 2:25:31
In reply to Re: EMSAM - the cut up pieces, posted by pulse on June 8, 2006, at 11:37:13
Does anyone know if the time release technology Emsam uses is uniform over the patch, or if there are strips that get released quickly other strips that take longer do dissolve? Any ideas on this folks? I'd like to cut the strips to make them fit better (my body is all muscle, the patches tend to pull off as the muscles flex). But also I tried a dose too high for me. Would be nice if i didn't have to re-order another 3 month supply.
Posted by Phillipa on September 14, 2007, at 19:05:23
In reply to Re: EMSAM - the cut up pieces, posted by sparc5 on September 14, 2007, at 2:25:31
Yes you can cut them as when I was serious about going on this med my pdoc said I might only need a quarter of a patch. If you cut it make sure not to get it on your hands or fingers. Phillipa
This is the end of the thread.
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