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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by luther on August 30, 2004, at 2:09:53
I have GAD, SAD and Dysthymia and/or Atypical Depression. I started taking 90mg Nardil and 15mg Valium in 93. It was like a magic cure after trying all the other crap out there. Yes there are some side-effects, but compared to how I felt before I could deal with them. Then Pfizer had to aquire Parke Davis and the party was over. They supposedly changed the inactive ingredients with FDA approval for just a label change, lol and I have no idea how this alone could have an effect on the performance of Nardil. If you have read much about it or seem many posts, it's not just me having the problem. It happened after the Glutein was taken out of the formula in the Fall of 03 as the FDA mandated because so many have allergic reactions to it. My life has been hell since. I do know that Nardil works on Seritonin, Noripenephrine, Dopamine and Epinephrine. The only med. I know of to work on these neurotransmitters. Parnate doesn't work much better than a SSRI, but it only works on the first two neurotransmitters I mentioned. I would like to know more about Marplan and do you think it will work in place of the old Nardil, even if not as well could it be better than the new? I can't find what neurotransmitters it works on either? Any help would be greatly appreciated.
Sincerely,
Luther
Posted by King Vultan on August 30, 2004, at 8:19:24
In reply to Chemist or Anyone, new Nardil not working, posted by luther on August 30, 2004, at 2:09:53
Nardil actually works on serotonin, norepinephrine, dopamine, and GABA. Parnate works on serotonin, norepinephrine, and dopamine. It does not do the GABA thing, which is perhaps why Nardil is generally considered to be a better anti-anxiety med. Beyond that, Nardil is also very much skewed towards serotonin, while Parnate is more skewed towards dopamine. Marplan would be more similar to Nardil than Parnate, but I don't know if it would be close enough for your particular needs. I think it might be worth a try, though.
Todd
Posted by chemist on August 30, 2004, at 12:59:32
In reply to Chemist or Anyone, new Nardil not working, posted by luther on August 30, 2004, at 2:09:53
hello there, chemist here...this reply is a courtesy, as you did address me in your posting line. in my opinion, King Vultan and Ace (the Nardil champ!) are (at least) some of the posters more in-tune to your query...i can only relate my pleasant experience with parnate a few years back, and like you, am aware that the new Nardil formulation has proven to be troublesome for many folks who take the drug, so nothing new from me....apologies for the ``dead end,'' and all the best, chemist
> I have GAD, SAD and Dysthymia and/or Atypical Depression. I started taking 90mg Nardil and 15mg Valium in 93. It was like a magic cure after trying all the other crap out there. Yes there are some side-effects, but compared to how I felt before I could deal with them. Then Pfizer had to aquire Parke Davis and the party was over. They supposedly changed the inactive ingredients with FDA approval for just a label change, lol and I have no idea how this alone could have an effect on the performance of Nardil. If you have read much about it or seem many posts, it's not just me having the problem. It happened after the Glutein was taken out of the formula in the Fall of 03 as the FDA mandated because so many have allergic reactions to it. My life has been hell since. I do know that Nardil works on Seritonin, Noripenephrine, Dopamine and Epinephrine. The only med. I know of to work on these neurotransmitters. Parnate doesn't work much better than a SSRI, but it only works on the first two neurotransmitters I mentioned. I would like to know more about Marplan and do you think it will work in place of the old Nardil, even if not as well could it be better than the new? I can't find what neurotransmitters it works on either? Any help would be greatly appreciated.
> Sincerely,
> Luther
Posted by KaraS on August 30, 2004, at 14:16:34
In reply to Chemist or Anyone, new Nardil not working, posted by luther on August 30, 2004, at 2:09:53
> I have GAD, SAD and Dysthymia and/or Atypical Depression. I started taking 90mg Nardil and 15mg Valium in 93. It was like a magic cure after trying all the other crap out there. Yes there are some side-effects, but compared to how I felt before I could deal with them. Then Pfizer had to aquire Parke Davis and the party was over. They supposedly changed the inactive ingredients with FDA approval for just a label change, lol and I have no idea how this alone could have an effect on the performance of Nardil. If you have read much about it or seem many posts, it's not just me having the problem. It happened after the Glutein was taken out of the formula in the Fall of 03 as the FDA mandated because so many have allergic reactions to it. My life has been hell since. I do know that Nardil works on Seritonin, Noripenephrine, Dopamine and Epinephrine. The only med. I know of to work on these neurotransmitters. Parnate doesn't work much better than a SSRI, but it only works on the first two neurotransmitters I mentioned. I would like to know more about Marplan and do you think it will work in place of the old Nardil, even if not as well could it be better than the new? I can't find what neurotransmitters it works on either? Any help would be greatly appreciated.
> Sincerely,
> Luther
You might also want to look into purchasing the generic phenelzine (Nardil) from reputable, legal sites overseas that require a prescription. They may use the old formula.
Posted by SLS on August 30, 2004, at 14:59:22
In reply to Chemist or Anyone, new Nardil not working, posted by luther on August 30, 2004, at 2:09:53
Have you tried increasing the dosage above 90mg? The phenelzine molecule should be exactly the same in the new preparation as in the old. The differences lie in the excipients. These differences might reduce the bioavailability of the drug, but this could be compensated for by taking more of it.
Any comments out there?
- Scott
Posted by gardenergirl on August 30, 2004, at 21:45:13
In reply to Re: Chemist or Anyone, new Nardil not working, posted by SLS on August 30, 2004, at 14:59:22
I don't have experience with the old Nardil, but I remember from prior posts about this over the last year that people who were on the old Nardil seem to require a higher dose of the new Nardil. So Scott's post makes sense to me.
gg
Posted by luther on August 30, 2004, at 22:28:13
In reply to Re: Chemist or Anyone, new Nardil not working, posted by King Vultan on August 30, 2004, at 8:19:24
Thanks Todd for the info, I can read one artical which says one thing then read another which says something different.
Nardil actually works on serotonin, norepinephrine, dopamine, and GABA. Parnate works on serotonin, norepinephrine, and dopamine. It does not do the GABA thing, which is perhaps why Nardil is generally considered to be a better anti-anxiety med. Beyond that, Nardil is also very much skewed towards serotonin, while Parnate is more skewed towards dopamine. Marplan would be more similar to Nardil than Parnate, but I don't know if it would be close enough for your particular needs. I think it might be worth a try, though.
>
> Todd
Posted by luther on August 30, 2004, at 22:47:22
In reply to Re: Chemist or Anyone, new Nardil not working, posted by SLS on August 30, 2004, at 14:59:22
Thanks Scott for the info. I would add more, but when I have done so it makes my anxiety worse, something Nardil had always helped in the past. Also I don't have insurance at this time and can't afford to take more other than the one time I tried, just to see what would happen. I was taking up to 135mg, too expensive and would cause me great anxiety to the point I couldn't even type and I started having restless leg syndrome. I don't know what to make of anything. I'm not sure what the new Nardil is really missing, could it be the GABA effect? I don't believe so because I increased my Neurontin. I think it is breaking down too soon or late in the digestive system, one of my theories. I would like to try Marplan but have not heard many comments from anyone about it as a substitute for Nardil.
Posted by SLS on August 31, 2004, at 8:51:56
In reply to Re: Chemist or Anyone, new Nardil not working » SLS, posted by luther on August 30, 2004, at 22:47:22
> Thanks Scott for the info. I would add more, but when I have done so it makes my anxiety worse, something Nardil had always helped in the past.
That's disappointing to hear. Nothing is ever easy when it comes to psychotropics.
> I think it is breaking down too soon or late in the digestive system, one of my theories.
Maybe Larry or Chemist have some idea as to what's going on.
> I would like to try Marplan but have not heard many comments from anyone about it as a substitute for Nardil.
Apparently, not too many people use it. They are chemically related, though. However, that doesn't always guarantee similarity in clinical effect. Dr. Terrence Ketter at Stanford really likes Marplan. I understand he tends to use it before Nardil. I think his main reason is that Marplan is more tolerable with regards to side effects. He must feel it is reasonably effective, or he wouldn't bother with it. If Nardil isn't working, I guess you really have nothing to lose. I have seen at least one person here report Marplan being effective for them when Nardil was not.
Is depression your main complaint, or anxiety?
- Scott
Posted by luther on August 31, 2004, at 22:55:32
In reply to Re: Chemist or Anyone, new Nardil not working » luther, posted by SLS on August 31, 2004, at 8:51:56
Actually at this time Scott I'm having problems with both, just like before I had ever began taking Nardil and was on SSRI's and other meds. that would not work for me. I know I have GAD, SAD, Dysthymia/Atypical Depression. I can't say the Nardil is not working at all, if that were the case I'd doubt if I could even write this. I would have to say my GAD is bothering me most. I have thought of trying more Valium than the 15mg I now take, but really don't think it will help. In many ways I don't feel as if the new Nardil is working on epinephrine and possibly GABA. I have done some reading and seen that Marplan works on all the same neurotransmitters as Nardil with the exception of Dopamine. This is still better than Parnate which only effects Serotonin and Noripenephrine like many other A/D's. I personally think epinephrine is the key as it is a pain reliever and without Nardil I would have the most terrible tension headachs imaginable and SSRI's would often make them worse. The forehead area around my eyes were effected most so that I could not make eye contact and this would create more anxiety until I felt as if I were carrying a house on my shoulders. As soon as Nardil 90mg and Vaium 15 mg were started in 93 all my pain and suffering went away as if by magic. Once I started the new Nardil in September of 2003 I felt as if I were taking a placebo and even had all the Nardil withdraw effects. I then went to Parnate which I knew wouldn't work, but was better than nothing. Then decided to try Nardil again and this time it worked, but only about half as well as the origional. The side-effects we not nearly as bad either. The worst for me when married was ED. This has really gone away, which was my worst symptom. So it is really kind of a trade-off. Thanks for your help.
Sincerely,
Luther
Posted by jrbecker on September 1, 2004, at 15:53:33
In reply to Re: Chemist or Anyone, new Nardil not working » SLS, posted by luther on August 31, 2004, at 22:55:32
McMan's latest newsletter actually ran a story on the trouble over the new Nardil formulation....
McMan's Depression and Bipolar Weekly
Aug 24, 2004 Vol 6 No 20........
New Nardil
Elizabeth (not her real name) writes:
"On December 3, 2003, I picked up my prescription [for Nardil] at the pharmacy. When I arrived at home I noticed that the pills were different in appearance. Not knowing if I had been given the wrong prescription I went back to the pharmacy and was told by the pharmacist that Pfizer was now manufacturing Nardil and had changed the coating."
Within a week, Elizabeth began experiencing panic attacks, memory lapses, slurred speech, unsteady gait, constant crying, depression, and periods of depersonalization and disassociation.
"Somehow, I managed to get through the holidays," she went on to say. "In January of 2004 my symptoms became more intense and I just sat in my room and cried all the time. My psychiatrist was on vacation and in all honesty I never attributed what was happening to the medication. I believed that I had a brain tumor, dementia or Alzheimer's and made an appointment with a neurologist. After examining me thoroughly, he assured me that I was not suffering from any of the aforementioned and he believed it had something to do with the medication. By the time I saw my psychiatrist several days later I was suicidal and had to be hospitalized to come off the Nardil. I had to wait one week to start another MAOI, Parnate, which took close to four months to fully work. It does not work as well as the original Nardi,l but at least I am able to function and do things once again."
Elizabeth wasn’t the only Nardil patient who experienced an unpleasant surprise. Reports Sarah (not her real name): "It was like I wasn't taking an antidepressant at all. I couldn't understand why I was so very depressed when I was taking a strong antidepressant. I experienced crying jags, and felt general malaise. In addition, I had headaches and memory problems that made me think I was an Alzheimer's candidate."
Nardil is an MAOI inhibitor approved for treating depression in 1959. Because of its burdensome side effects, it is generally a medication last resort. But being relegated to the end of the queue (except for treating atypical depression) has created a ‘last shall be first" situation in the eyes of many who see this drug as their salvation. Reports Anonymous: "I was at the end of my rope and didn't care if I took arsenic if it would help me feel better. So I started taking it and after three days I felt a lot better, after that it was absolutely like a miracle. I felt human again and sooo good. I hadn't felt that good in years and years. I went around the house dancing and singing praises ... it felt so good to feel good. No words could describe it ... like going through hell on earth for years and then to feeling good, alive for the first time. I thanked God constantly for the miracle I had been praying for."
Nardil used to be produced by Warner-Lambert, and on more than one occasion the company had quality control issues with the drug, which resulted in FDA action. In 2000, Pfizer acquired Warner-Lambert, and late last year, with FDA approval, changed the inert ingredients to the drug without notifying doctors and pharmacists. Many patients experienced a worsening of their depression, and some cynically noted that they now required extra doses at additional cost to achieve the same previous benefit.
After hearing from Nardil patients, this writer contacted Pfizer with an emailed list of detailed questions. Following is Pfizer’s response in full:
According to IMS Health data from the period of July 2002 -June 2004, 183,392 total scripts were written for Nardil in the United States.
Pfizer has received a very limited number of complaints from both physicians and patients since the switch of the formulation. All are fully evaluated.
In all cases where Pfizer has received complaints relating to product, the company addresses the issue and upon closing of the case issues a letter to the individual as long as contact information is available.
We observed an increase in the number of complaints immediately after the reformulation was introduced, followed by a steady decline. This trend is consistent with other products which have undergone a formulation change. Pfizer continues to monitor and review all complaints and forward them to the FDA.
Since the approval of Nardil in 1959, the FDA has updated its regulations based on advances in manufacturing and testing technology. To ensure that the product would continue to comply with new regulations, a modification of the existing formulation was necessary. Pfizer submitted data to the FDA that show that the old and new formulation are bio-equivalent, and that the new formulation is more stable than the old. Based on these data, the FDA approved the new formulation.
Pfizer adheres to all applicable laws and regulations related to submission of adverse events.
All batches of the reformulated product are subject to stringent quality control tests during and after manufacturing. The batches in question met all of the specifications and no quality issues existed. Where complaints against specific batches were received the manufacturing records were checked to verify total compliance.
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