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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on June 2, 2008, at 18:54:27
In reply to Re: Restarting Parnate, posted by Justherself54 on June 1, 2008, at 23:42:00
Wow that's a lot of work. No wonder you're tired. And you should be proud of yourself. Sounds like things are on the up for you. Congrats. Phillipa
Posted by Zeba on June 2, 2008, at 22:42:31
In reply to Re: Restarting Parnate tomorrow » Zeba, posted by okydoky on June 1, 2008, at 13:43:15
No problem. You were not being intrusive. I was out of town for the weekend to a sister-in-law. Her oldest son has three children, and the oldest just graduated high school. I can't believe it sometimes. My nephew was already four years old when my husband and I got married, but still!!!
Re the problems, I don't have kidney problems or heart problems or diabetes. Just asthma, sleep apnea, and GERD which all seem to go together. I have had hypertension for around 15 years now. My bp is around normal now and sometimes a little high and sometimes a little low. When I go to the doctor, it is high (white coat...).
Parnate worked really well for me years ago and is working for me now too. I have now tried 30 mg. in the a.m. and 10 mg. in the p.m., and this is working much better. I will talk to my pdoc about it tomorrow morning.
Thanks for your concern, and I am sorry if you thought you offended me. You did not. I just wasn't around to respond.
Posted by Zeba on June 2, 2008, at 22:46:38
In reply to Re: Restarting Parnate, posted by Justherself54 on June 1, 2008, at 23:42:00
Did you let your doctor know your bp fell quite low. This is nothing to mess around with. Sounds like it would be best to stay at 20 mg. for awhile.
When I started on Parnate, I started at 10 mg. for a few days before going to 20 mg. for a week before going to 30 mg. for a week and then 40 mg.
I think I would have been dizzy, etc. if I had started out on 20 mg. rather than a gradual increase. Maybe that would not make any difference for you??
Take care and keep taking your bp at multiple times during the day, okay???
Posted by undopaminergic on June 5, 2008, at 13:54:34
In reply to Re: Restarting Parnate » Justherself54, posted by Zeba on June 2, 2008, at 22:46:38
I recommend taking Parnate in divided doses, not only to maintain alertness throughout the day, but also in order to avoid complications.
Tranylcypromine (Parnate), in addition to its MAO-inhbiting properties, has acute amphetamine-like effects that are closely dependent upon the concentration of the drug in tissues, unlike the MAO inhibition, which persists for weeks even after cessation of the drug. This has a couple of implications:
Taking a high dose of Parnate, all at once, may provoke a so-called spontaneous hypertensive reaction, and dividing the daily dose into two or more smaller doses helps avoid this complication, which has frightened a number of people into quitting the drug prematurely. This reaction only occurs with Parnate, and not with Nardil or Marplan, because these other MAOIs lack Parnate's amphetamine-like actions. Amphetaminergic complications may occur with selegiline as well, but not with rasagiline.
The other implication of Parnate's amphetamine-like action is for the time of administration. The doses should be taken at suitable times of the day in order to maintain alertness, and to avoid worsening the insomnia that is a frequent side-effect of all MAOIs, regardless of when they are taken.
Posted by Justherself54 on June 5, 2008, at 14:36:14
In reply to Re: Restarting Parnate, posted by undopaminergic on June 5, 2008, at 13:54:34
Thanks for the info. I'm still at 20 mg..I take first dose in the morning and second mid afternoon..I will try to increase to 30 shortly as 20 has helped a lot but I still would like to feel a bit better.. That dosage is where the hypotension really becomes a problem. When I tried 30 mg before, I set my alarm so I could take the first dose really early and still get the rest in by early afternoon.
I'm going to do the increase after the weekend as I'm going to see my grandkids and if the hypotension hits, I don't want to scare the little ones if I have to drop to my hands and knees...
Wish me luck..
Posted by Zeba on June 5, 2008, at 21:15:09
In reply to Re: Restarting Parnate, posted by undopaminergic on June 5, 2008, at 13:54:34
I am doing better with the 30 mg. in the a.m. and 10 mg. around noon or 1 p.m. I am going to try a 2/20 split. If I take Parnate any later than around 3 p.m., then it affects my sleep. Otherwise, I have had no problems with insomnia. Was at the neuologist's today and bp was 140/97. I was uptight,though, and so later it went down. Taking the 40 mg. in the a.m. never caused me to develop hypertensive reaction. In fact my bp was lower. If I split the dose, I may need to take my bp med's earlier in the day rather than at bedtime. I did 40 mg. in a.m. for around a year, but I am also very careful about what I eat and drink, and only once did I develop hypertensive crisis, and that was many years ago in the 80's when I tried to kill myself on Parnate by taking a handful of Contac slow release capsules. I ended up on the Cardiac intensive Care unit of the hospital. It was horrible; I thought my head would explode. I never thought that I could make my heart explode too. Never again. I am extra careful now that I am older.
Posted by okydoky on June 5, 2008, at 21:25:29
In reply to Re: Restarting Parnate » undopaminergic, posted by Zeba on June 5, 2008, at 21:15:09
Seriously you might want to discuss the possibility of havnig Procardia at hand in the off chance of a hypertensive crisis. But I don't know how it would all be with the bp meds you already take.
oky
Posted by Zeba on June 6, 2008, at 19:41:17
In reply to Re: Restarting Parnate » Zeba, posted by okydoky on June 5, 2008, at 21:25:29
I have thought about that, and I keep forgetting to ask. My bp always goes up when I Go to the doctor--white coat thing I think. Mostly my bp is low or normal. Today I took my bp med earlier. I think I will start monitoring again now that I am taking 20 mg. in the a.m. and 20 mg. at noon. My pdoc things that is a good idea and told me, too, to do 10 jumping jacks if I start to get really sleepy. Hum. He is so funny sometimes.
Posted by okydoky on June 7, 2008, at 9:13:33
In reply to Re: Restarting Parnate » Zeba, posted by okydoky on June 5, 2008, at 21:25:29
You should, sit in the same position every time you take your bp and wait a few minutes after sitting to take it. This way it will be calmed down from any activity (even walking) before you take it and you'll have a consistent measurements for comparison. Also your arm is supposed to be at heart level or something. (Memory!)
Did he tell you to get up slowly from a sitting or laying position? Rising quickly can cause a sudden change in bp which is hypotension. So even if you have it a little you can mitigate it by doing these things slowly. I always forgot when I woke up in the morning. Ended up on the floor frequently! I guess the jumping jacks gets your blood flowing quicker or better and raise your bp a bit, but only temporarily.Nothing wrong with low bp. Ive had it with or without Parnate my whole life which is probably why when I took Parnate and it lowered it even more I had some problems. I used to take my bp often mainly because I was scared of hypertensive crisis and read I could have it without the screaming headache. My usual bp with Parnate was around 90/60,so I always had to get up slow or I would pass out.
All they gave me in the ER was Procardia. I had to wait forever unless I screamed enough and then they gave me some Procardia and then I had to wait another 5 or so hours. I was so relieved I finally got the Procardia Rx and did not have to go to the ER but I had multiple spontaneous episodes. It is probably better to go to the ER. I just had too many!
It sounds like things are going well. I am so glad.Keep us updated,
oky
Posted by okydoky on June 7, 2008, at 9:38:10
In reply to Re: Restarting Parnate » okydoky, posted by okydoky on June 7, 2008, at 9:13:33
I posted somewhere my trouble with sleeping while on Parnate. I think you were the one that had a specific suggestion? I cannot find it.
Do you recall this? Was it you or do you know what it was?
Thanks,
oky
Posted by Zeba on June 8, 2008, at 17:06:45
In reply to Re: Restarting Parnate » okydoky, posted by okydoky on June 7, 2008, at 9:13:33
I tried to post on a different computer and could not send the message as I guess the password is made longer than what one puts in for a password. Anyway, Yes I will try sitting, etc. and take my bp a number of times a day. I am not getting so sleepy now that I take 20 mg. in the a.m. and 20 mg. in the p.m. I may go back to 30/10 though as I seem to feel most depressed in the morning. I just am not sure which is best. I think I did well on the 30/10. I will try 20/20 for a few days more and then go back to 30/10 if it seems better.
Yes, hypertensive crisis is nothing to laugh at.
Take care and let us know how you are doing too.
Posted by okydoky on June 8, 2008, at 18:06:41
In reply to Re: Restarting Parnate » okydoky, posted by Zeba on June 8, 2008, at 17:06:45
I'm glad you are doing what is best for you. Not what I or somebody else or a docter or a book might say.
You sound tired. Or read so I guess.
I am alive, that's about it.
Good luck,
oky
Posted by Justherself54 on June 8, 2008, at 19:20:06
In reply to Re: Restarting Parnate » Zeba, posted by okydoky on June 8, 2008, at 18:06:41
First day at 30 mg. Here's hoping the hypotension doesn't get too bad :-(
Posted by okydoky on June 8, 2008, at 20:21:42
In reply to Re: Restarting Parnate, posted by Justherself54 on June 8, 2008, at 19:20:06
How are you taking it? Did you take it in divided doses?
Good luck,
oky
Posted by Justherself54 on June 8, 2008, at 22:56:34
In reply to Re: Restarting Parnate, posted by okydoky on June 8, 2008, at 20:21:42
> How are you taking it? Did you take it in divided doses?
>
> Good luck,
>
> oky
Yes..I'm taking it in divided doses..one in the morning, one in early afternoon and one at supper. Hopefully the last dose is early enough that it won't keep me up, although I take sleep meds. When I was on nardil I had to double my sleep meds..I quess I'll know soon enough!
Posted by Justherself54 on June 9, 2008, at 5:41:01
In reply to Re: Restarting Parnate » okydoky, posted by Justherself54 on June 8, 2008, at 22:56:34
Well that didn't take long! One day at 30 mg and got 3 hours sleep and a very restless sleep at that. I quess I'll see what happens tonight before I tweak my sleep meds.
Posted by okydoky on June 9, 2008, at 9:41:31
In reply to Re: Restarting Parnate-insomnia, posted by Justherself54 on June 9, 2008, at 5:41:01
I could not find it. Would the person plesae post it here again for us?
I looked for the post that someone made a suggestion about what to use for sleep meds on Parnate because nothing worked for me.
I would not take any in th evening. Why not 20 in the morning and 10 in the afteroon? I think most people divide thier dose into two regardless of the dose.
THanks,oky
Posted by Justherself54 on June 9, 2008, at 13:23:35
In reply to Parnate sleep med option Please post again, posted by okydoky on June 9, 2008, at 9:41:31
> I could not find it. Would the person plesae post it here again for us?
>
>
> I looked for the post that someone made a suggestion about what to use for sleep meds on Parnate because nothing worked for me.
> I would not take any in th evening. Why not 20 in the morning and 10 in the afteroon? I think most people divide thier dose into two regardless of the dose.
>
>
> THanks,
>
> okyI don't know who posted about sleep meds. I take .05 clonazapam, 25 mg. seroquel and 7.5 zopiclone. When I was on Nardil I had to increase my seroquel to 50 mg, and around 11 mg of zopiclone. That seemed to do the trick.
I took my last dose yesterday way too late, but I was travelling most of the afternoon. Today, I'll take my last dose before 3 p.m. Hopefully, I won't have to increase my sleep meds.
I hope someone responds to your question soon. I'll try searching in the archives. The above is what works for me.
Posted by okydoky on June 9, 2008, at 13:25:58
In reply to Re: Parnate sleep med option Please post again » okydoky, posted by Justherself54 on June 9, 2008, at 13:23:35
Posted by Zeba on June 9, 2008, at 20:31:29
In reply to Re: Restarting Parnate-insomnia, posted by Justherself54 on June 9, 2008, at 5:41:01
So sorry that Parnate does this to you. It used to do that to me if I took it past 2 or 3 p.m. is there a way to take the three divied doses so that the last is around mid afternoon? Maybe not as you say you get hypotension so easily.
Posted by Zeba on June 9, 2008, at 20:33:59
In reply to Re: Parnate sleep med option Please post again » okydoky, posted by Justherself54 on June 9, 2008, at 13:23:35
I have used a low dose of Seroquel for help with sleeping, and I have also used Valium to help with sleep. My pdoc says he would not worry about me and Valium, and it tends to wash out more slowly than like meds.
Posted by Justherself54 on June 9, 2008, at 22:44:19
In reply to Thanks I tried several times (nm) » Justherself54, posted by okydoky on June 9, 2008, at 13:25:58
I found lots of posts on MAOI insomnia but I'm not sure which one you are looking for...Sorry! Do you remember some key words in the post..yours or whoever responded to it? If I have a bit more information I'll keep searching (I love a good mystery) :-)).
Posted by okydoky on June 10, 2008, at 0:09:46
In reply to Re: Parnate Insomnia » okydoky, posted by Justherself54 on June 9, 2008, at 22:44:19
I think I found it: http://www.dr-bob.org/babble/20080510/msgs/828526.html
"Did you try anything with serotonin 5-HT2A-receptor antagonism? Cyproheptadine (Periactin) has that property in addition to being a sedating antihistamine. If required, combining such an agent with a benzodiazepine or Z-drug would be possible."
Thanks I think the mystery is solved:)) I don't know these medicines so I will look them up.If you need them I hope this did you some good too.
Thanks again ,I can't believe I finally found it.
oky
Posted by okydoky on June 10, 2008, at 9:56:36
In reply to Re: Parnate Insomnia » Justherself54, posted by okydoky on June 10, 2008, at 0:09:46
Cannot figure out what medications serotonin 5-HT2A-receptor antagonism would necessarily be?
oky
Posted by undopaminergic on June 11, 2008, at 9:47:08
In reply to For undopaminergic Re: Restarting Parnate, posted by okydoky on June 7, 2008, at 9:38:10
> I posted somewhere my trouble with sleeping while on Parnate. I think you were the one that had a specific suggestion? I cannot find it.
>
> Do you recall this? Was it you or do you know what it was?
>Probably cyproheptadine (Periactin), because in addition to being a sedating antihistamine, it also blocks serotonin 5-HT2-receptors, which I suspect may be involved in MAOI-related insomnia. The same would apply to SSRI- or SNRI-associated insomnia. Cyproheptadine is also useful as an antidote to serotonin toxicity, so it may turn out particularly useful to keep around during MAOI-therapy.
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