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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by jonh kimble on May 12, 2002, at 17:42:51
i am hoping to try deprenyl soon in addition to dexedrin, because the dex poops out to much. deprenyl increases tyrosine hydoxylase and inhibits mao-b so i think it could help. but is this dangerous? havent heard that it is, but maois are notorious for interactions. thanks for the help.
Posted by JonW on May 12, 2002, at 20:14:00
In reply to is dexedrin and deprenyl safe?, posted by jonh kimble on May 12, 2002, at 17:42:51
Combining stimulants with MAOIs is contraindicated in the literature, but many experienced psydocs use this combination.
Jon
Posted by 3 Beer Effect on May 12, 2002, at 23:02:54
In reply to is dexedrin and deprenyl safe?, posted by jonh kimble on May 12, 2002, at 17:42:51
This is a potentially deadly drug interaction!
Read the PDR US Prescribing info for Adderall, Dexedrine, or Dextrostat. It says deaths & severe hypertensive crises have been attributed to that particular combination of an amphetamine & the mao-b inhibitior l-deprenyl/selegeline.
I wouldn't bet my life on a published, known dangerous drug interaction, it's not worth it.Perhaps you should either take breaks from the Dexedrine once in awhile to prevent tolerance as pointed out below, or switch stimulant medications once in awhile to Adderall or Desoxyn or even Focalin/Concerta.
If the dex poops out, stop taking it on the weekends, and once in awhile take a "stimulant holiday" for 7 days and any tolerance to dexedrine dissapears. Also, taking the amino acid l-tyrosine 500 -1500 mg per day may prevent the onset of tolerance. It seems to work well for me, I have had good success with the "Twinlab" brand of l-tyrosine. In experiments l-tyrosine supplementation tended to work well & increased the subjective effects of amphetamine if taken on an empty stomach 5 hours before your first dexedrine dose. Vitamin B6, folic acid, and C are necessary for your body to metablolize the l-tyrosine, I wouldn't overdo it, you probably only need about the 100% RDA of those three vitamins.
Hope you heed this warning- you can probably find case reports of deaths from the combination of (Dexedrine) dextroamphetamine & Selegeline (l-deprenyl) on PUBmed/Medline if your still not convinced.
3 Beers
Posted by JonW on May 13, 2002, at 8:46:57
In reply to No! potentially fatal combination!, posted by 3 Beer Effect on May 12, 2002, at 23:02:54
Hi 3beers,
I looked at the interactions for both dextroamphetamine & selegiline on rxlist.com and didn't come across any specific mention of the two. Dextroamphetamine, of course, mentioned an interaction with MAOIs in general. I also looked on medline and couldn't find any case reports, etc. Could you post a link to where this is referenced online?
Jon
Posted by 3 Beer Effect on May 13, 2002, at 23:26:34
In reply to Re: No! potentially fatal combination! » 3 Beer Effect, posted by JonW on May 13, 2002, at 8:46:57
DRUG INTERACTIONS: "Selegiline (L-Deprenyl) can cause hypertensive crisis (fatalaties reported)--do not administer amphetamines during or within 14 days of these drugs."
Actually, I found the info in a book, I don't think its on the internet. The warning seems to apply to all U.S. available MAOIs ("these drugs") but it does specifically mention fatalaties reported with Selegiline & Amphetamines. Additionally, under the Selegiline Hydrochloride section it says "DRUG INTERACTIONS: same as with other MAO inhibitors, including severe reactions with Meperidine. Fluoxetine & possibly Sertraline & paroxetine, increase risk of CNS toxicity & muscle rigidity. TRICYCLIC ANTIDEPRESSANTS can cause severe CNS toxicity."
The book is the excellent quick reference drug book Prentice Hall "Nurse's Drug Guide 2002." That passage is under the dextroamphetamine sulfate, drug interaction section.
"Amphetamines" applies to Dextroamphetamine Sulfate-Dexedrine, Dextrostat;
Mixed salts of amphetamine- Adderall, & D-Amphetamine Combo (Barr-generic Adderall);
& Desoxyn (methamphetamine hcl) & to many of the amphetamine-related anorectics such as Didrex (Benzphetamine) & Sanorex (mazindol).The various forms of methyphenidate (Ritalin, Concerta etc) are also contraindicated with MAO inhibitors including Selegiline.
No one except Parkinson's disease patients should even be taking Selegiline/L-Deprenyl. It's a shame it is so widely available on the internet & is marketed as l-deprenyl by overseas "pharmacies" that lie & omit facts about how dangerous this drug can be. Even otc cold, asthma, or herbal weight loss medicines that contain ephedrine, ephedra, or pseudoephedrine could easily cause a hypertensive crisis with Selegiline/L-Deprenyl.
3 Beers..........
Posted by christophrejmc on May 14, 2002, at 1:16:32
In reply to Found info on interaction in PH Nurse's Drug Guide, posted by 3 Beer Effect on May 13, 2002, at 23:26:34
> Additionally, under the Selegiline Hydrochloride section it says "DRUG INTERACTIONS: same as with other MAO inhibitors, including severe reactions with Meperidine. Fluoxetine & possibly Sertraline & paroxetine,
Low-dose selegiline has been safely combined with the SSRIs... It may be risky, but hardly as much as with the non-selective MAOIs.
> "Amphetamines" applies to Dextroamphetamine Sulfate-Dexedrine, Dextrostat;
> Mixed salts of amphetamine- Adderall, & D-Amphetamine Combo (Barr-generic Adderall);
> & Desoxyn (methamphetamine hcl) & to many of the amphetamine-related anorectics such as Didrex (Benzphetamine) & Sanorex (mazindol).Low-dose selegiline has also been safely combined with d-amphetamine and other sympathomimetics.
> No one except Parkinson's disease patients should even be taking Selegiline/L-Deprenyl.
Why?
Posted by JonW on May 14, 2002, at 4:01:10
In reply to Found info on interaction in PH Nurse's Drug Guide, posted by 3 Beer Effect on May 13, 2002, at 23:26:34
Thanks for the info. One thing's for sure, anyone considering an MAOI + stimulant combination should be under the care of an expert psydoc.
Jon
Posted by JohnX2 on May 14, 2002, at 22:05:37
In reply to Re: Found info on interaction in PH Nurse's Drug Guide, posted by christophrejmc on May 14, 2002, at 1:16:32
> > Additionally, under the Selegiline Hydrochloride section it says "DRUG INTERACTIONS: same as with other MAO inhibitors, including severe reactions with Meperidine. Fluoxetine & possibly Sertraline & paroxetine,
>
> Low-dose selegiline has been safely combined with the SSRIs... It may be risky, but hardly as much as with the non-selective MAOIs.
>
> > "Amphetamines" applies to Dextroamphetamine Sulfate-Dexedrine, Dextrostat;
> > Mixed salts of amphetamine- Adderall, & D-Amphetamine Combo (Barr-generic Adderall);
> > & Desoxyn (methamphetamine hcl) & to many of the amphetamine-related anorectics such as Didrex (Benzphetamine) & Sanorex (mazindol).
>
> Low-dose selegiline has also been safely combined with d-amphetamine and other sympathomimetics.
>
> > No one except Parkinson's disease patients should even be taking Selegiline/L-Deprenyl.
>
> Why?Was there any information that says that Selegiline is any
more dangerous than a medication like Parnate?Also Christopherjmc, are you still take selegiline (you were
doing a trial a few weeks back If I recall) ?John
Posted by jonh kimble on May 14, 2002, at 23:11:09
In reply to is dexedrin and deprenyl safe?, posted by jonh kimble on May 12, 2002, at 17:42:51
thanks for the warning, but i am not totally convinced (although ill be very cautious if i do try this) i recently read things about ephedrine causing fatal reactions in people using deprenyl, but i know that ephedrine has a much greater increase in blood pressure than dex. havent heard any actual cases of people having fatal reactions to dex and dep. i actually found a couple of cases of people using the combo and doing well. many sources overdo the food restictions with maois, so it could be possible that the dex and dep interaction is unneccesarly exagerated. i certainly could be wrong, but i want to be sure. ill bet people who rail (snort) dex while on deprenyl would encounter problems, but my plan is to keep on a relatively low dose of 30 mgs dex xr, and add 5 mgs dep to increase potency. i agree that overseas companies do boast inconclusive evidence about dep being life extending and all that, but that doesnt make it a bad drug. i know to avoid ephedrine (inc. cough meds) im not trying to challenge you but what do you think about all this?
jon
Posted by BarbaraCat on May 15, 2002, at 14:06:57
In reply to Re: is dexedrin and deprenyl safe? 3beers, posted by jonh kimble on May 14, 2002, at 23:11:09
Jon,
I was taking Deprenyl for a while and it really revved me up. Had a urine test for work and it came back positive for methamphetamine. Only after frantically researching everything I could to save my job, I found out that deprenyl's metabolites are identical to methamphetamine. So, you would defintely get an additional charge to the dexedrine due to more of the same or similar substance.The area that I've never found good answers to is the MAO-A and MAO-B inhibitors isues and how safe an MAO inhibitor is with anything. Even tho' deprenyl is a reversable MAO inhibitor and supposedly safe(er), it still raises big questions. - Barbara
Posted by christophrejmc on May 15, 2002, at 18:22:45
In reply to Re: Found info on interaction in PH Nurse's Drug Guide » christophrejmc, posted by JohnX2 on May 14, 2002, at 22:05:37
> Was there any information that says that Selegiline is any
> more dangerous than a medication like Parnate?None that I could find... At the doses used for depression, it's probably about the same. I think transdermal selegiline would be much safer than Parnate at equivalent doses (assuming that most of the side-effects are due to its l-amphetamine & l-methamphetamine metabolites).
> Also Christopherjmc, are you still take selegiline (you were
> doing a trial a few weeks back If I recall) ?I couldn't tolerate it past 30mg (mainly due to cardiovascular side-effects). I really didn't get much out of it besides anxiety.
How has lithium been so far? Has it affected your memory or cognition at all?
-Chris
Posted by JohnX2 on May 15, 2002, at 18:44:27
In reply to Re: selegiline » JohnX2, posted by christophrejmc on May 15, 2002, at 18:22:45
> > Was there any information that says that Selegiline is any
> > more dangerous than a medication like Parnate?
>
> None that I could find... At the doses used for depression, it's probably about the same. I think transdermal selegiline would be much safer than Parnate at equivalent doses (assuming that most of the side-effects are due to its l-amphetamine & l-methamphetamine metabolites).
>
> > Also Christopherjmc, are you still take selegiline (you were
> > doing a trial a few weeks back If I recall) ?
>
> I couldn't tolerate it past 30mg (mainly due to cardiovascular side-effects). I really didn't get much out of it besides anxiety.
>That's too bad. At least you gave it a good run. I know its really
hard to try and change medicines..have to be really brave.> How has lithium been so far? Has it affected your memory or cognition at all?
>I've only been on the lithium since Monday. So far I haven't really
experienced any adverse effects. I haven't had a hypomanic episode.
I hope it gives me an AD boost. I'm glad I didn't feel like the medicine
was dragging me into the toilet after a few days like other people have
reported. Cross my fingers...Take Care,
John> -Chris
Posted by christophrejmc on May 15, 2002, at 20:36:36
In reply to Re: selegiline » christophrejmc, posted by JohnX2 on May 15, 2002, at 18:44:27
Posted by 3 Beer Effect on May 16, 2002, at 1:25:28
In reply to Re: is dexedrin and deprenyl safe? 3beers, posted by jonh kimble on May 14, 2002, at 23:11:09
i'm not sure if they exaggerated those warnings or not. Either way, you are taking an increased risk and if you are wrong the result is hyptensive crisis & a trip to the ER or Purgatory, depending on how severe it is. I hope you have one of those electronic blood pressure monitor & monitor it closely.
Why do you take Dexedrine XR/Spansules instead of the immediate release? I don't remember the exact numbers, but if you read the Official US prescribing info the immediate release tablets produce a MUCH higher peak blood level (ng/ML) than the spansules. I've also heard the spansules are erratic, & might PDoc flat out said they don't work after I asked if I should take the Dexedrine Spansules.
I take 2 10 mg Dextrostat tablets twice per day for a total of 40 mg & this (Dexedrine/Dextrostat/Dextroamphetamine) is some pretty powerful stuff! You might just want to switch to Dexedrine immediate release tablets instead of using Selegeline. That's what i'd do if I were you.
Thanks & Good luck,
3 Beers.....
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