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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by inanimate peanut on January 4, 2010, at 15:44:58
So, this is my second day of taking 120mg of Parnate. My idea was to try up to 160mg (I found a study that used up to 170mg so I figured up to 160mg would be safe). The problem is that the hypotension is getting really, really bad. It may be smart to either leave it at the 120mg for a week to see if it works and then start to decrease or to decrease it now. Not only am I dizzy *every* time I get up, I had a couple very strange spells this morning. I got out of bed and was walking and BAM! I was on my back on the floor convulsing-- I bumped my head pretty hard on the floor. It wasn't a seizure b/c I didn't black out. I knew what was going on the whole time. I tried to get up slowly and walked a few more steps and BAM! down I went again twisting my ankle this time and flat on my back convulsing again. These were very strange. I googled convulsions and low blood pressure and can't find anything. Anyway, this is getting kind of dangerous. I think I'll try 10mg of Ritalin before I completely give up. That is supposed to help with orthostatic hypotension. I just want to get a blood pressure monitor first to make sure my blood pressure doesn't get too high with it. Anyway, has anyone else had of heard of these convulsion-type things? What do you think?
Posted by inanimate peanut on January 4, 2010, at 16:02:26
In reply to up to 120mg Parnate- hypotension getting dangerous, posted by inanimate peanut on January 4, 2010, at 15:44:58
OK, so I went ahead and took 10mg of Ritalin without having the BP monitor. I will try to buy one tonight. I just figured the Ritalin was safer than cracking my head open.
Posted by Phillipa on January 4, 2010, at 16:10:46
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by inanimate peanut on January 4, 2010, at 16:02:26
Peanut please call your doc not having experience with parnate. I'm uncomfortable advising you. Just know that there for you. Could you babblemail Scott or another about what's going on? Phillipa
Posted by janejane on January 4, 2010, at 16:11:53
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by inanimate peanut on January 4, 2010, at 16:02:26
Peanut, I'm worried for your safety. Are you doing this without your doctor's blessing? Will it be safe for you to drive (you mentioned buying a BP monitor tonight)?
Posted by Willful on January 4, 2010, at 16:21:00
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by inanimate peanut on January 4, 2010, at 16:02:26
If I had convulsions, I'd call my pdoc asap, and until I had some response from him/her that my increasing the dose was fine, I would reduce the dosage of whatever I had increased the dosage of.
But I see that your pdoc doesn't want you to go above 60 mg. You must call a doctor right away. Self-medicating in this way is not safe.
Adding ritalin strikes me as a scary when you're falling onto the floor and having convulsions.
Plus-- and t his is really an aside--it's probably not a good idea to increase the dose more than about 10 mg at a time-- that's what my pdoc had me do, even at much lower levels..
Be careful! You sound like you could be in trouble with this.
Willful
Posted by Willful on January 4, 2010, at 16:22:18
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by Willful on January 4, 2010, at 16:21:00
PS that is, 10 mg a week.
But call a doctor, please.
Willful
Posted by janejane on January 4, 2010, at 16:37:59
In reply to up to 120mg Parnate- hypotension getting dangerous, posted by inanimate peanut on January 4, 2010, at 15:44:58
Well, after reading what Willful had to say, I'm even more worried about you. Please post and let us know you're OK and not passed on the floor.
Posted by inanimate peanut on January 4, 2010, at 16:53:17
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by Willful on January 4, 2010, at 16:22:18
If I told my doc what I've been doing she would probably take away all my meds and administer them a day at a time- lol. No, seriously, between doubling my Parnate and adding Ritalin, she would kill me. I know Ritalin is safe and people on babble have used it, but my doc is old school and still thinks it's a no-no w/ Parnate. So, calling her is really not an option. I'm definitely going to get the blood pressure cuff so I can know what's actually going on with my blood pressure, though. If it happens again, even with the Ritalin, I'll definitely decrease the Parnate back down to the 60mg (none of the intermediate increases helped anyway). The convulsions only lasted a few seconds, so maybe they were just a fluke. I can't find anywhere online where convulsions are associated with low blood pressure, but I know that's what caused them because I felt my blood pressure drop right before I hit the ground. If the web doesn't know anything about convulsions with low blood pressure, you can bet docs won't either. Why tell them and freak them out?
Anyway, I know I am being stubborn and not very cautious here. I hear all of you and your concern and I wish I did have a medical professional to bounce all of this off of. I just can't tell my doc what I've been doing or she might take away Parnate altogether and I can't handle that. I'm prioritizing fighting this depression over my overall wellbeing which some may find stupid. So, I researched orthostatic hypotension, found out Ritalin helps, and I'm trying that. If that doesn't work, I will decrease the Parnate. If I continue to have these spells after decreasing the Parnate, I will be forced to go to a doctor, but that is my last resort. Thanks again for all your concern-- and you are all probably right; I just don't feel like I can do that right now.
P.S. I'm ok for driving as it's only when I try to stand up that I get dizzy. It's getting in and out of the car that's going to be the trick.
Posted by Sigismund on January 4, 2010, at 16:58:15
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by Willful on January 4, 2010, at 16:21:00
>What do you think?
God knows. What's with the convulsions? Will Ritalin help with them? I can't see why it should.
Posted by inanimate peanut on January 4, 2010, at 17:04:03
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by Sigismund on January 4, 2010, at 16:58:15
The convulsions have to be from the low blood pressure because I felt my blood pressure drop right before I hit the ground. Ritalin will help with the low blood pressure. Have you had orthostatic hypotension? You know that feeling when everything is going in and out and in and out? I think that feeling is related to the convulsions because sometimes when I lean against a wall with low blood pressure I feel my body shudder with that feeling of things rushing in and out. It's hard to explain, but hopefully Ritalin will help.
Posted by SLS on January 4, 2010, at 17:09:58
In reply to up to 120mg Parnate- hypotension getting dangerous, posted by inanimate peanut on January 4, 2010, at 15:44:58
Hi.
I don't blame you for wanting to self-medicate. The drive to do anything to escape the depression can be stronger than the intellect. I know what it is like to be impulsive in dosing a drug that you think will work if only you were to find the right dosage. You need to be more methodical. It is what you don't know about these drugs that can kill you.
I think you need to take a deep breath and slow down. If you are adamant about not contacting your doctor and being honest with him, I think you need to skip a day and not take any Parnate at all. You might then want to restart it at 60mg the next day and let your system stablilize before making any dosage adjustments. I think you should refrain from taking Ritalin at this point in time. Maybe someone else can come up with a better plan.
- Scott
Posted by bulldog2 on January 4, 2010, at 18:06:11
In reply to up to 120mg Parnate- hypotension getting dangerous, posted by inanimate peanut on January 4, 2010, at 15:44:58
> So, this is my second day of taking 120mg of Parnate. My idea was to try up to 160mg (I found a study that used up to 170mg so I figured up to 160mg would be safe). The problem is that the hypotension is getting really, really bad. It may be smart to either leave it at the 120mg for a week to see if it works and then start to decrease or to decrease it now. Not only am I dizzy *every* time I get up, I had a couple very strange spells this morning. I got out of bed and was walking and BAM! I was on my back on the floor convulsing-- I bumped my head pretty hard on the floor. It wasn't a seizure b/c I didn't black out. I knew what was going on the whole time. I tried to get up slowly and walked a few more steps and BAM! down I went again twisting my ankle this time and flat on my back convulsing again. These were very strange. I googled convulsions and low blood pressure and can't find anything. Anyway, this is getting kind of dangerous. I think I'll try 10mg of Ritalin before I completely give up. That is supposed to help with orthostatic hypotension. I just want to get a blood pressure monitor first to make sure my blood pressure doesn't get too high with it. Anyway, has anyone else had of heard of these convulsion-type things? What do you think?
Once you reach therapeutic levels (30 -60 mg) you should spend three weeks at each dose to see if it works. I agree with Scott to restart at 60 and stay there three weeks and move methodically onward. You may be missing the correct dose by plunging ahead. You have to be methodical. Once you have reached the highest level you can handle than only add in another agent. I know this is slow when you are in pain but this plan gives you a greater chance for success. Right now you might hurt yourself or get disgusted by sides and abandon your experiment. The methodical approach will minimize sides.
Posted by willey on January 4, 2010, at 18:21:30
In reply to up to 120mg Parnate- hypotension getting dangerous, posted by inanimate peanut on January 4, 2010, at 15:44:58
I dont mean to insult you,but i was gonna say to you something i wish had earlier.You had many many questions about parnate,this is good to want to know,however it also showed me that you were inexperianced at this time with the drug,some of the questions such as tyrosine augment truly scared me.
I recomend this,slowy titrate back down,if u have a benzo,hopeflly klonopin,keep it handy,and get down to ur starting dose immediatly.Then post here,on how it went.
You definalty meet the criteria to contact ur doc immediatly,however i will warn u theres a chance that the doc might be very worried u did this and remove parnate from you.
Having said that,if u ever do feel an interaction,the doc is not the one to contact,RATHER waste not a second calling er,and prepare parnates official data sheet handy to provide them with immediatly.
Again pls dont discard any form of a indictaion of a interaction,or even minimize it,instead get to er immediatly,not to scare you,but one of the possable and worst effects from a interaction is cranial hemmorage,which of course is fatal.
I feel horrable now providing some of the info i did,i forget how long ive been on the drug and how my info might be seen,i apologize to the board for a lot of the info that might have been in any way suggestive to duplicate.
I feel very bad,please be careful and go to er if u feel something is wrong,a interaction will not reverse itself once its in full process.
Posted by Maxime on January 4, 2010, at 18:51:42
In reply to Re: up to 120mg Parnate- hypotension getting dange » Sigismund, posted by inanimate peanut on January 4, 2010, at 17:04:03
I think you should go back down to 60 mg and work your way up to 80 mg if you think that 60 mg isn't enough. Doubling it wasn't the best idea.
Posted by emmanuel98 on January 4, 2010, at 20:10:13
In reply to Re: up to 120mg Parnate- hypotension getting dange » inanimate peanut, posted by Maxime on January 4, 2010, at 18:51:42
I think what you're doing is extremely dangerous. Parnate is a serious and dangerous drug with serious and dangerous side effects and interactions. 120mg is way above the therapeutic dose. Why do you think you need to go that high?? If you're not having a response to 60mg, maybe parnate isn't the drug for you and you should talk frankly with your pdoc about trying something else. Also, if your pdoc prescriped 60mg/day, where are you getting the rest of the parnate from? If not from a real pharmacy, you don't even know what you're taking.
Posted by inanimate peanut on January 4, 2010, at 20:15:00
In reply to Re: LISTEN LISTEN LISTEN !, posted by willey on January 4, 2010, at 18:21:30
None of this is your fault. I'm doing this based on my own judgment. I listened to you when you told me no tyrosine, Sam-e, etc. You haven't convinced me to do anything dangerous-- quite the opposite-- you've kept me from doing things that might have interactions. Don't worry.
Posted by floatingbridge on January 4, 2010, at 20:19:10
In reply to up to 120mg Parnate- hypotension getting dangerous, posted by inanimate peanut on January 4, 2010, at 15:44:58
Peanut,
Write us what you intend to do--please. We're scared because we care.
I know nothing about parnate except from reading other's experiences. Getting the right dose really can take months--others, it seems, find it in a snap.
The convulsions sounds like fainting caused by low blood pressure--involuntary movements can accompany a faint--but I don't know.
Someone here posted what sounds like a reasonable plan and asked if you have any benzos on hand.
Will decreasing cause discomfort or anxiety?
Write soon,
hugs,
fb
Posted by inanimate peanut on January 4, 2010, at 20:24:21
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by emmanuel98 on January 4, 2010, at 20:10:13
I'm getting the parnate from a reliable source, so don't worry about that. I probably did go up too quickly, and that was my mistake. I didn't double all at once-- I went from 60 to 80 to 100 to 120. I will go to the ER if I have any problems. I understand Parnate is dangerous but I found academic studies published in academic journals where they were using as much as 170mg safely. It just must have a stronger impact on my blood pressure than it did on those subjects'. I think the advise to go back to 60mg is unfortunately probably the smart thing to do. I just hate to think that maybe 140mg or 160mg may have been my magic dose and I never got to try them! The Ritalin is helping, though, as the hypotension has gotten better. I bought a blood pressure cuff and am monitoring my blood pressure which has been fine. I thank everyone for caring-- that means alot to me. I probably shouldn't have posted in the first place and worried everyone-- I was just scared and wondered if the convulsion stuff had ever happened to anyone else.
Posted by janejane on January 4, 2010, at 20:37:37
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by inanimate peanut on January 4, 2010, at 20:24:21
Well I'm glad you're doing OK, but please heed the recommendations to cut back. Your appointment is pretty soon and you should be able to get a better idea of what may or may not be worth trying. I know it's hard when you're desperate, but please be patient. We have all grown to care about you and don't want you to hurt yourself. Your body is rebelling against this rapid dosage escalation and you need to listen to it. Whatever you decide to do, please keep us updated with posts.
Posted by inanimate peanut on January 4, 2010, at 20:38:37
In reply to Re: up to 120mg Parnate- hypotension getting dange » inanimate peanut, posted by floatingbridge on January 4, 2010, at 20:19:10
Thanks for caring, first of all. That means alot. I didn't mean to scare people. I just wanted to see if anyone had heard of the convulsion stuff before, because it scared me. I didn't faint at all, it was just a few seconds of jerky muscle movements. I'm just mad because I bumped my head hard and sprained my ankle when I fell.
As for what I'm going to do, I suppose I will have to go back to 60mg. I'm afraid to skip a day as Scott suggested as the last time I went 20 hours without a dose I ended up crying hysterically. I do have some benzos on hand if the transition is less than smooth. I don't have much hypotension anymore on 60mg, so I won't need the Ritalin (I'm immune to the mood effects of RItalin anymore anyway). Parnate does work for me with partial improvement at 60mg, so I guess I'll just have to be happy with that. It's just too bad I'll never know if the higher doses might have meant more improvement.
Posted by Maxime on January 4, 2010, at 20:59:00
In reply to Re: up to 120mg Parnate- hypotension getting dange » floatingbridge, posted by inanimate peanut on January 4, 2010, at 20:38:37
FB is right. Movement can accompany a faint. Almost like a seizures. I'm glad you are going to reduce the dosage.
Posted by Phillipa on January 4, 2010, at 21:14:44
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by Maxime on January 4, 2010, at 20:59:00
Peanut heed what Willey says as another poster on here at one time had a brain hemmorage. I think he posted about it later. Phoenix I is his name. You might wish to google the archieves. Phillipa
Posted by floatingbridge on January 4, 2010, at 22:51:18
In reply to Re: up to 120mg Parnate- hypotension getting dange » floatingbridge, posted by inanimate peanut on January 4, 2010, at 20:38:37
> Thanks for caring, first of all. That means alot. I didn't mean to scare people.
Hi Peanut,
No worries about scaring anyone, and I'm glad you posted--why go through any of this alone? Thanks for trusting enough to post.
>the convulsion stuff before, because it scared me. I didn't faint at all, it was just a few seconds of jerky muscle movements. I'm just mad because I bumped my head hard and sprained my ankle when I fell.
I went to the walk-in doc this year for what sounds like something similar and wad relieved to find out I had fainted. The doc was really nice--no one likes to lose control she told me, even for a second. I had found myself on my back, moving around....
> As for what I'm going to do, I suppose I will have to go back to 60mg. I'm afraid
to skip a day as Scott suggested as the last time I went 20 hours without a dose I ended up crying hysterically. I do have some benzos on hand if the transition is
less than smooth. I don't have much
hypotension anymore on 60mg, so I
won't need the Ritalin (I'm immune to the mood effects of RItalin anymore anyway). Parnate does work for me with partial improvement at 60mg, so I guess
I'll just have to be happy with that. It's just too bad I'll never know if the higherdoses might have meant more improvement.I don't see why you can't try 80 if 60 doesn't work. People here talk about finding their 'sweet spot'. Maybe the process needs more time. Some have taken months w/ progressive improvement to lead them on. Don't
despair--you're just working on your dose.
Posted by SLS on January 4, 2010, at 23:43:10
In reply to Re: up to 120mg Parnate- hypotension getting dange » floatingbridge, posted by inanimate peanut on January 4, 2010, at 20:38:37
> As for what I'm going to do, I suppose I will have to go back to 60mg. I'm afraid to skip a day as Scott suggested as the last time I went 20 hours without a dose I ended up crying hysterically. I do have some benzos on hand if the transition is less than smooth. I don't have much hypotension anymore on 60mg, so I won't need the Ritalin (I'm immune to the mood effects of RItalin anymore anyway). Parnate does work for me with partial improvement at 60mg, so I guess I'll just have to be happy with that. It's just too bad I'll never know if the higher doses might have meant more improvement.
That is all-or-nothing thinking. 80mg might still be the ideal dosage for you.
For the sake of understanding - the appearance of the negative effects of increasing the dose of MAOIs is not instantaneous. They might not be seen until a few days afterwards. It is the nature of the drug mechanism. In other words, one can be lulled into a false sense of safety simply because they don't feel much different immediately after raising the dose. The effects tend to emerge all at once and hit very hard. Likewise, an antidepressant response may not emerge for a few weeks after a dose increase. It is important to consider this when evaluating the efficacy of these drugs.
As to how to handle the dosage reduction, perhaps taking 20mg at 12:00pm and 20mg at 6:00pm will work to even things out. You could then return to 60mg the next day and decide where to go from there.
- Scott
Posted by kirbyw on January 4, 2010, at 23:49:16
In reply to Re: up to 120mg Parnate- hypotension getting dange » inanimate peanut, posted by SLS on January 4, 2010, at 23:43:10
This is an interesting thread. I am having trouble getting my dose of Parnate up to 40 mg from 30, as I have been more depressed than usual for the past 5 days.
I am in Costa Rica where there are no Doctors to monitor my Parnate use. So I have to use my own judgment. This group helps a lot. I do have over 25 years of using Parnate which also helps.
Anyway, my question with respect to Peanuts situation is about the ritalin. Does that help with the low blood pressure and is it safe to use with Parnate? Its not completely clear to me from following the thread. I have to take Lopressor because of having had heart surgery so the Parnate and the Lopressor make my blood pressure so that there is a physically uncomfortable feeling, although I can walk, drive, etc. So I have hesitated to go up to 40 mg, but now I need to. So I would be interested in Ritalin. I also am on Lithium to 'boost' the Parnate, but I haven't noticed anything after 2 months on the Lithium.
Peanut, to me its not clear that you couldn't try 70 mg for say two weeks, and see how you are.
And then go up as high as 80. Just to see if you get a therapeutic effect, and as long as you don't get the dangerous hypotension. It takes more than just a couple of days to note the therapeutic effect. Also, in my case, spreading out the Parnate and taking 1 or 2 every two hours, seems to help with hypotension.
Recently, when I took 2 at the same time, I got very dizzy as soon as I stood up, and had to sit down again, as quickly as possible to avoid falling or fainting.
Anyway, i m not trying to disagree with other advice posted here, ---in some ways, all of us are on this list (or most of us) because we have problems beyond what our physicians can or will help us with. There is "medical advice" being given out on the list constantly, and I personally am glad for it. Certainly we all know that we are not "qualified physicians" but what we know seems important. And we know when to recommend that someone see their Doctor. However, that Peanut has tried an experiment, based on her internet research, seems perfect "normal" to me. These experiments seem to happen all the time among users of this list, unless I am mistaken. But as others have indicated, she must now backtrack and take another approach.
Rick in Costa Rica
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