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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
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
Posted by willey on January 5, 2010, at 0:24:24
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by emmanuel98 on January 4, 2010, at 20:10:13
> 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.
Whoa hold on,first yess parnate is very dangerous,but so are most of these drugs,i remeber seeing a picture of a 14 year old foster child in a hospital on her death bed due to SERZONE destroying her liver to shreds.
As i looked in her innocent face tied to wires on christmas eve,i thought,she trusted the industry to help her,and what did she get from it?That pic still brings me near tears.
Moving on 60 mg might be the official dose on data sheets,however so was 30 mg at one time,have saved both,obviusly that was increased.
What we do have now are offical and published doucments stating therputic dose of some must end up being from the 60 to 125 range,and in fact some who never reach this and discontine never gave the drug a fair chance.
I use over 100,and carefully done,it is the perfect dose for me,ive used this dose 5 years now.
What we have here was obviously a person very anxious and nervous about the drug,hence the various posts on on sorts of augments and such.So its not surpising she would titrate up too fast,if u read her posts u can see this was possable and personaly as a parnate user was too late to intervine which i wanted to.
Last she never said her pharmacy was illegit,many people use non u.s based pharmacy,i.e canadian due to lower prices and they get pharm quality name brand parnate from glaxco smith.
As much as a person should take from this the mistake on using parnate can happen,they also should not believe that the intentioned dose was the problem,but rather the way it was done.
There are quite a few official studys showing in some they never reached remission until the dose went over a 100,also i personaly called and spoke to a chemist at glaxco numerous times,and i dont know if it was more sad or funny to the lack of knowledge they have on their drug.
After 3 times i gave up on them,and the reason they dont know much about it is because as if posted they purchased the med from a sole chemist,rather then actualy syhntezied the med themselves at its origin.
Posted by Meltingpot on January 5, 2010, at 6:21:39
In reply to up to 120mg Parnate- hypotension getting dangerous, posted by inanimate peanut on January 4, 2010, at 15:44:58
Hi,
I totally agree with Scott on this. I don't blame you for trying to do whatever it takes to escape from this depression, I've done some pretty irrational things trying to feel well again and I don't blame you for not wanting to contact your Doctor.
I think you should reduce the dose and work out a plan to increase the dose bit by bit and keep your mind fixed on the date that you will reach 80/120 just to give yourself something to aim for.
I do know somebody who is on Nardil who gets all sorts of really wierd symptoms, so it maybe that you will eventually get the same symptoms anyway but by going slow at least you will be prepared for them to happen again and can stop before you reach that point.
Also, I've often lied to my psychiatrist because if I tell them the truth they then tend to think of me as being non-compliant and I sort of get the blame then for things not working very well. However, I've been told my friends and by my mum that I should be honest with the Psychiatrist so that they can see just how desperate I am.
You shouldn't have to be in the position where you are doing this, your Doctor should have let you increase the dose to 80mg if that's what you wanted to do. After you have finished this trial with the Parnate, no matter what happens, I think you should really think about telling your psychiatrist what you have done so that they can get a true picture of you and how desperate you are feeling.
Denise
Posted by inanimate peanut on January 5, 2010, at 11:56:25
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by willey on January 5, 2010, at 0:24:24
I'm not stupid, and I'm not saying you're calling me stupid. You're right that I''m inexperienced with Parnate (I've been on it less than 6 weeks), but I know far more about it than 9 of 10 people on the street taking it for years. The reason I'm asking about augments and stuff if to try to learn as much as possible about the drug. How many people (apart from here) spend days researching their drugs, the chemical and biological systems behind it in an attempt to better understand the drug itself and the possible reasons the augments you talk and/or I've asked about would work. I'm behind the curve on this because I haven't been at it very long, which is why I ask you because you have the answers at your fingertips, but I am learning. I've got 5+ articles saying high-does Parnate treatment is safe up to about 170mg, which is what I was trying to titrate up too. I titrated up too fast and happened to have a severe blood pressure reaction. That was a mistake. People make them. I don't want you to stop asking questions and think you're liable for anything when, as I said before, you've stopped me from doing many things that I had the idea of doing.
Posted by inanimate peanut on January 5, 2010, at 12:08:23
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by willey on January 5, 2010, at 0:24:24
That last line should have read that I don't want you to stop answering questions and thinking you're liable
Posted by inanimate peanut on January 5, 2010, at 12:10:01
In reply to Re: up to 120mg Parnate- hypotension last line, posted by inanimate peanut on January 5, 2010, at 12:08:23
Everything was fine today when I got up. Barely any dizziness at all. Yesterday must have just been a fluke.
Posted by willey on January 5, 2010, at 12:24:05
In reply to All is fine today, posted by inanimate peanut on January 5, 2010, at 12:10:01
it wasnt a fluke,anyone who knows parnate knows what can happen,but being on parnate u are already established what ur willing to risk to stop depression,and the drug is simply dangerous,and like i have,and prob most users u had a close call,all that does now is make u smarter and respect it more.
If i and others dident post their experiances off what can happen when u dont pay parnate its respect due,people might do many worse things,and now u joined that club and can inform people off what it feels like when things go wrong.
I dont blame u at all,just hope u calm a little,i know the desire to get better simply by a parnate tweak seems so easy and enticing,but please email me,or any other long term users always before making any change or adjustment,a veteran of the drug is one thing,however even that doesent excuse me for example from checking out every tweak i make,be safe and good luck,glad to see ur not discourged as some posted and will continue on a med that can offer u a life change.
Posted by inanimate peanut on January 5, 2010, at 12:31:09
In reply to Re: up to 120mg Parnate- hypotension getting dange, posted by kirbyw on January 4, 2010, at 23:49:16
Ritalin can be used in small doses to help counteract orthostatic hypotension. There are people both on this board and in the academic press who have used it with success in small doses 5-10mg. They were using it for mood mostly, but there if you read research on orthostatic hypotension it works there too. There are some threads about using Ritalin if you google Ritalin and JadeKelly in the search page. The key with Ritalin is to make sure your blood pressure doesn't get too high. I bought a blood pressure cuff at Walgreens to monitor mine and it's been fine so far.
Posted by janejane on January 5, 2010, at 13:11:15
In reply to All is fine today, posted by inanimate peanut on January 5, 2010, at 12:10:01
I'm glad you feel better. :-)
I think what happened yesterday is definitely a sign to slow down. It seems like you've been doing too much too fast and need to give your body more time to adjust. Also, it seems like you're probably not staying at each level long enough to see whether it's a good dose for you. (More is not always better.) What do you think? It seems like you could easily overshoot your ideal dose by going up too fast. And then you'll never know what the right dose would have felt like.
By the way, have you noticed any improvement in your mood since you started this experiment, or has it just been giving you side effects?
Posted by Willful on January 5, 2010, at 17:17:25
In reply to All is fine today, posted by inanimate peanut on January 5, 2010, at 12:10:01
What dose of parnate did you decide to work with for now?
Willful
Posted by Shyfelyne on July 2, 2010, at 16:07:18
In reply to up to 120mg Parnate- hypotension getting dangerous, posted by inanimate peanut on January 4, 2010, at 15:44:58
I feel your pain about the troubling falling. I am on on 30mg ( can't imagine what the dose you are taking would to do me) & I have fainted once already & my blood pressure is almost constantly in the 70/50 range. I've only been on the dose for about a week. But I actually lost consciousness. I just come to not sure where I am & how I got there & I am kind of flailing around trying to get up. I of course hit my head. I had to stop Nardil for the same reason only it wss so bad that even being up walking around for an extended amount of time didn't help. I couldn't see, I couldn't hear & my roommate had to keep me from falling several times. That was the end of that drug for me.
I really wonder if this side effect will go away & how long it will take. I have wondered if a slice of cheddar cheese would help or just kill me.
> 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 ed_uk2010 on July 2, 2010, at 17:48:51
In reply to Re: up to 120mg Parnate- hypotension getting dangerous » inanimate peanut, posted by Shyfelyne on July 2, 2010, at 16:07:18
You are clearly very sensitive to MAOIs. Since you are sensitive to the side effects, perhaps you will be sensitive to the therapeutic effects too.
Maybe you should reduce back down to 10mg or 20mg of Parnate and stay at that dose for several weeks to establish whether or not you are able to obtain benefit from a low dose. This is certainly something to discuss with your doctor urgently.
Posted by inanimate peanut on July 3, 2010, at 15:34:43
In reply to Re: up to 120mg Parnate- hypotension getting dangerous » inanimate peanut, posted by Shyfelyne on July 2, 2010, at 16:07:18
I definitely wouldn't try cheese, as there's no way to know what that would do to your BP. Believe it or not, cheese (when I've accidentally eaten it) has made my BP drop. I also tried taking a small (5mg) dose of Ritalin and that helped to bring my BP closer to normal. I agree with ed that it's probably best to go down in dose until you get the dizziness under control. For me, the dizziness did go away after awhile. I'm on a lower dose now (90mg) and I rarely feel dizzy. Maybe if you say on 10-20mg until you don't feel dizzy you could try 30mg again and see if it's better then. Parnate is so tricky, isn't it!?
This is the end of the thread.
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