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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by zero on July 27, 2005, at 22:19:48
Wondering if it's possible to take low-dose Nardil (15mg./day), while also taking a beta2-adrenergic agonist med. for asthma (like albuterol, Serevent or Advair).
I know Nardil would be a big help for my Social Phobia, but I sure don't want a "hypertensive crisis".
My p'doc says "no problem", my pharmacist says "contraindicated". Various online drug interaction checkers give different results.
Any experience of this would be appreciated.
Regards,
zero
Posted by Declan on July 27, 2005, at 23:27:28
In reply to Nardil and asthma meds.?, posted by zero on July 27, 2005, at 22:19:48
If you do take low dose Nardil I would be very interested in the results. I'm currently on low dose Parnate and don't really feel that I need more balancing (chemical imbalance debate) in that direction than is provided by 10mg/d. This doesn't mean my depression/whatever has been removed of course.
I'm interested in deprenyl+Nardil. Say 2mg/d deprenyl + 15mg/d Nardil, something like that.
I dunno anything about your question though.
Declan
Posted by ed_uk on July 28, 2005, at 17:45:05
In reply to Nardil and asthma meds.?, posted by zero on July 27, 2005, at 22:19:48
Hi Zero,
Albuterol and salmeterol do not appear to interact with Nardil. There is an isolated report of a man on an MAOI who felt nervous and had a racing heart after taking albuterol - these are common albuterol side effects however and do not necessarily represent an interaction.
There is no evidence that combining albuterol or salmeterol with Nardil would cause a hypertensive crisis.
>....my pharmacist says "contraindicated"......
>Various online drug interaction checkers give different results.
Beta-2 agonists are 'sympathomimetics'. Some sympathomimetics (such as ephedrine) interact with MAOIs whereas others (eg. salmeterol) do not. Some drug interaction references lump all the sympathomimetics together as if they were all identical.........but they are *not* identical!
~ed
Posted by zero on July 29, 2005, at 12:35:19
In reply to Re: Nardil and asthma meds.? » zero, posted by ed_uk on July 28, 2005, at 17:45:05
Thanks Ed!
I'm going to discuss this w. my p'doc at next appt. Would you happen to have a link to further explanation of that last paragraph (below)?
Regards,
z...("Beta-2 agonists are 'sympathomimetics'. Some sympathomimetics (such as ephedrine) interact with MAOIs whereas others (eg. salmeterol) do not. Some drug interaction references lump all the sympathomimetics together as if they were all identical.........but they are *not* identical!
")
Posted by ed_uk on July 29, 2005, at 15:32:42
In reply to Re: Nardil and asthma meds.? » ed_uk, posted by zero on July 29, 2005, at 12:35:19
Hi Zero,
>Would you happen to have a link to further explanation of that last paragraph (below)?
I don't have a link because I got my info from a texbook - Stockley's Drug Interactions.
Sympathomimetics can be divided into two main groups: directly-acting and indirectly-acting.
A directly-acting sympathomimetic is a drug which directly stimulates adrenergic receptors itself. An indirectly-acting sympathomimetic is a drug which releases NE from nerve endings.
Most directly-acting sympathomimetics do not interact with MAOIs. The selective beta-2 agonists are an example of directly-acting sympathomimetics which do not appear to interact with MAOIs.
Most indirectly-acting sympathomimetics (eg. amphetamine, ephedrine, phenylpropanolamine etc) *do* interact with MAOIs. MAOIs cause NE to accumulate inside the nerve endings of the sympathetic nervous system. NE is therefore released in abnormally large quantites if a patient on an MAOI takes an indirectly-acting sympathomimetic: hence the drug interacion. Directly-acting sympathomimetics do not release NE, hence the absense of a clinically significant interaction.
Btw, some sympathomimetic drugs are metabolised by MAO, these drugs will interact with MAOIs. I don't know how albuterol and salmeterol are metabolised, I'd have to look it up.
If you decide to combine Serevent with an MAOI, start at low doses and increase gradually.
~Ed
Posted by zero on July 29, 2005, at 17:14:17
In reply to Re: Nardil and asthma meds.? » zero, posted by ed_uk on July 29, 2005, at 15:32:42
Ed,
Thanks very much. This should definitely carry weight w. my p'doc.Will start low-dose, and go slowly (I usually tolerate only very small doses of AD's anyway).
Also, there is a drug my p'doc has mentioned, that I could carry with me to counteract the MAOI side effect reaction (should it occur).
This is very helpful - I'm impressed by your depth of knowledge!
Regards,
z...
Posted by ed_uk on July 30, 2005, at 3:21:22
In reply to Re: Nardil and asthma meds.? » ed_uk, posted by zero on July 29, 2005, at 17:14:17
Hi Z,
>Will start low-dose, and go slowly (I usually tolerate only very small doses of AD's anyway).
Good idea :-) Which asthma meds (+ doses) do you take at the moment?
>Also, there is a drug my p'doc has mentioned, that I could carry with me to counteract the MAOI side effect reaction (should it occur).
Nifedipine capsules?
Kind regards
~Ed
Posted by ed_uk on July 30, 2005, at 3:22:26
In reply to Re: Nardil and asthma meds.? » ed_uk, posted by zero on July 29, 2005, at 17:14:17
Hi again,
Perhaps you could buy a BP monitor? It would be helpful and reassuring too.
~Ed
Posted by zero on July 30, 2005, at 12:53:32
In reply to Re: Nardil and asthma meds.? » zero, posted by ed_uk on July 30, 2005, at 3:21:22
Hi Ed,
For asthma, I use Advair Diskus 250/50 in AM & PM everyday - combination dry powder inhaler containing Serevent (long acting beta2-agonist) and Flovent (corticosteroid). For emergencies (rarely now) generic albuterol inhaler.
Not sure which antidote drug my p'doc has in mind for possible Nardil side-effects (guessing this would be some kind of fast-acting blood pressure lowering drug?).
Thanks for your help w. all of this!
Regards,
z...
Posted by ed_uk on July 30, 2005, at 15:29:10
In reply to Re: Nardil and asthma meds.? » ed_uk, posted by zero on July 30, 2005, at 12:53:32
Hi Z,
>Advair Diskus
It's called the Seretide Accuhaler here :-)
>corticosteroid
Some people say that inhaled corticosteroids worsen their depression.
Kind regards
~Ed
Posted by zero on July 30, 2005, at 15:50:14
In reply to Re: Nardil and asthma meds.? » zero, posted by ed_uk on July 30, 2005, at 15:29:10
> Some people say that inhaled corticosteroids worsen their depression.
>
I know the beta2 agonists make me a bit anxious. The steroid part of the Advair Diskus doesn't affect my mood at this dose (as far as I can tell) - but, a few times when I've gotten bad bronchitis and had to take the oral steroid prednisone I was really "flying", then a big letdown after I stopped it (I'm supposed to be Bipolar II).But, hey, breathing's not "optional" (at least not yet!)
Take care,
z...
Posted by ed_uk on July 30, 2005, at 16:41:44
In reply to Re: Nardil and asthma meds.?, posted by zero on July 30, 2005, at 15:50:14
Hi Z,
>I know the beta2 agonists make me a bit anxious.
The report about anxiety on the MAOI/beta2 combination was interesting. I wonder whether it really was an interaction? Probably not. I'm hoping that Nardil will help your anxiety. Since you're on salmeterol, I guess you could start at 15mg/day, just to be on the safe/cautious side.
~Ed
Posted by FlyBoy on August 2, 2005, at 16:20:28
In reply to Re: Nardil and asthma meds.?, posted by zero on July 30, 2005, at 15:50:14
Zero, let me know if you have any problems. I am going to try low dose ACTH therapy for some inflamation issues and this would be the same sort of contraindication since ACTH stimulates cortisol output.
Posted by peridown on January 11, 2006, at 14:06:20
In reply to Re: Nardil and asthma meds.? ? zero, posted by ed_uk on July 30, 2005, at 16:41:44
Hello Ed and Z,
Z -- I'm wondering how everything went. Did you end up taking Nardil together with asthma meds? Did the Nardil help? Were there any interactions?
Ed -- I was also impressed with your knowledge.
I am also an asthmatic and about to start Parnate. I did a search here on Dr. Bob and noticed a different thread which I thought I would point out to the two of you as that person is also looking for info. (I plan to write also, but have no helpful info myself, but will mention this thread.) I don't know if this will work, but the link is:
www.dr-bob.org/babble/20041217/msgs/431064.html
It is thread #430101 begun by Kara about taking MAOIs and Asthma.Thanx.
G
Posted by zero on January 11, 2006, at 14:13:39
In reply to Re: Nardil and asthma meds.?, posted by peridown on January 11, 2006, at 14:06:20
Hi,
My pdoc. wouldn't prescribe the Nardil - says the risk is too great w. asthma meds. I took it years ago (before I was diagnosed with asthma) and it worked fabulously. Just had to stay low-dose with it so as not to get too hypomanic.
Best,z.
Posted by peridown on January 11, 2006, at 14:26:26
In reply to Re: Nardil and asthma meds.?, posted by zero on July 30, 2005, at 15:50:14
Hi again,
Oops, just noticed that thread I mentioned wasn't from a few weeks ago -- it was from 2004! I assume Tara has gotten whatever info she needs! Sorry!
I'd still like to know about any interactions. I will be taking Parnate, and currently carry an albuterol inhalor. I found the following info on drug interactions:
Monoamine Oxidase Inhibitors or Tricyclic Antidepressants: Albuterol should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents, because the action of albuterol on the vascular system may be potentiated.
Other places also said not to use an inhalor with an MAOI.
G
Posted by peridown on January 11, 2006, at 14:28:42
In reply to Re: Nardil and asthma meds.? ? peridown, posted by zero on January 11, 2006, at 14:13:39
> Hi,
> My pdoc. wouldn't prescribe the Nardil - says the risk is too great w. asthma meds. I took it years ago (before I was diagnosed with asthma) and it worked fabulously. Just had to stay low-dose with it so as not to get too hypomanic.
> Best,
>
> z.Sorry to hear that, hope you found some other help.
Thanx for replying so quickly,
G
Posted by zero on January 11, 2006, at 16:50:02
In reply to Re: Parnate and asthma meds.?, posted by peridown on January 11, 2006, at 14:26:26
Hi again G,
That's just what I bumped into - use of MAOI's such as Nardil and Parnate is *contraindicated* if also using beta2 agonist inhalers (short acting like Albuterol, long acting like Serevent). My asthma doc, pharmacist & pdoc all say this is true.(Ed-UK posted some interesting further info. on this, which would seem to OK the use of both classes of drugs - I showed this to my pdoc, but he still would not Rx Nardil for me).
Pls. post if you find out more.
Best wishes,
z.
Posted by peridown on January 11, 2006, at 19:13:11
In reply to Re: Parnate and asthma meds.? ? peridown, posted by zero on January 11, 2006, at 16:50:02
> Hi again G,
> That's just what I bumped into - use of MAOI's such as Nardil and Parnate is *contraindicated* if also using beta2 agonist inhalers (short acting like Albuterol, long acting like Serevent). My asthma doc, pharmacist & pdoc all say this is true.
>I sure hope my Dr. doesn't change his mind!! He knows about the asthma -- he did the prescribing -- but we haven't discussed that interaction. It really hasn't come up for me in ages.
> (Ed-UK posted some interesting further info. on this, which would seem to OK the use of both classes of drugs - I showed this to my pdoc, but he still would not Rx Nardil for me).
Do you know where Ed-UK posted this information? I'm not sure if it's what I've seen of his already or if I've missed something. I'd like to have it to show my doc.
>
> Pls. post if you find out more.
>Certainly.
> Best wishes,
> z.you too...
G
Posted by zero on January 11, 2006, at 19:51:28
In reply to Re: Parnate and asthma meds.? » zero, posted by peridown on January 11, 2006, at 19:13:11
1) http://www.dr-bob.org/babble/20050728/msgs/534912.html
2) http://www.dr-bob.org/babble/20050728/msgs/535343.htmlThese 2 were ed_uk's posts (hope I've got the links right)
Posted by peridown on January 14, 2006, at 8:29:52
Zero,
I've been trying to reply to your post, but get a blank white page. I hope this gets to you.
Thank you for the links -- and thanks Ed for the info.
My doctor is allowing me to go on Parnate (I begin in 2 days), stating that the albuteral inhalor has a secondary interaction with Parnate and this does not worry him very much. Considering he is VERY conservative, this is comforting; however, as I mentioned, I have a very mild asthma and can't remember the last time I used the inhalor; it generally expires without my noticing, and then I replace it! Also, we agreed I would simply not use it right now and we would continue to research the question. I did mention knowing someone who had more questions on this, but I've been bombarding him with my own questions, so...
However, I will be spending several hours there on Monday (because of my own low bp, he wants to keep me there while I start the Nardil) and he did say he can get me articles if I give him citations. So, if you have any citations, I can try to get you more info. Your case is probably different given you are on other asthma medications. I have certainly needed to go off several medications, including ones which might later be added back in (e.g. ritalin, which has been used with MAOI, despite contraindications.)
Sorry to not be of more help.
G
PS How did you get the links into your post? Can I use a different editor here?
Posted by ed_uk on January 14, 2006, at 13:34:14
In reply to Redirect Please: Parnate and asthma meds zero, posted by peridown on January 14, 2006, at 8:29:52
Hi G :)
You will not find any studies demonstrating that MAOIs interact with albuterol: no such studies exist.
Theoretically, albuterol would not be expected to interact with Nardil. It's mechanism of action is considerably different from that of other sympathomimetics which do interact with Nardil eg. ephedrine. Nevertheless, the possibility of an interaction remains, it simply hasn't received any study. I cannot say what form the interaction would take, although hypertension seems distinctly unlikely. Alone, albuterol tends to dilate blood vessels (decreasing peripheral vascular resistance) and increase the heart rate. These effects are most marked at high doses eg. when albuterol is taken orally (as tablets or syrup) or via a nebuliser. One or two puffs of the standard 100mcg Ventolin inhaler doesn't generally cause problematic side effects.
The standard warnings that albuterol should not be combined with an MAOI are not evidence based. They are a reflection of the continuing tendency to assume the worst with respect to MAOIs. The drug companies who manufacture bronchodilators will put these warnings on the 'package inserts' for their products to protect themselves from litigation if a patient alleged that a serious interaction occured. Such warnings are also a reflection of the lack of research into the potential of albuterol to interact with MAOIs. The fact that certain sympathomimetic drugs can be dangerous in combination with MAOIs means that doctors are likely to be very cautions when combining any sympathomimetic drug with an MAOI, even those such as albuterol which are markedly different from the sympathomimetics (ephedrine etc) which do interact with MAOIs. Monitoring blood pressure and heart rate would be sensible when adding an MAOI to ongoing treatment with beta agonists such as salmeterol (present in Serevent and Advair).
If you do suffer an exacerbation of asthma while taking an MAOI, a steroid inhaler + an oral steroid (eg. prednisone) might be necessary. Inhaled steroids do not interact with MAOIs. Oral steroids can cause psychiatric side effects and so caution is warranted.
A variety of bronchodilators can provide relief of asthma symptoms. Beta agonist such as albuterol work very rapidly and tend to be the most effective. Antimuscarinic bronchodilators such as ipratropium (present in the Atrovent inhaler) are more effective in the treatment of chronic bronchitis than in asthma. Nevertheless, they do relieve the symptoms of asthma in some cases, albeit more slowly than albuterol. Atrovent does not interact with MAOIs.
Take care
Ed
Posted by peridown on January 14, 2006, at 15:55:24
In reply to Re: Redirect Please: Parnate and asthma meds zero ? peridown, posted by ed_uk on January 14, 2006, at 13:34:14
Ed,
I really appreciate this, and previous info you have sent out on the subject, and other subjects as well. I will save this email in my files with other information on how asthma medications react with MAOIs -- thanx!!
I agree, many pharmacutical companies put out warnings simply to cover themselves. Thank goodness my doctor also doesn't just follow the labels, and actually looks at the info/studies/chemical behaviors, etc. of medications, and came to the same conclusion on the albuterol inhalor. (I am also lucky enough to have a very mild case of asthma and not require other meds.)
z -- I hope Ed's post can help you also.
Peri (I'm a newbie, and still debating on signing off as Peri or G -- sorry for any confusion!)
Posted by ed_uk on January 15, 2006, at 9:33:17
In reply to Re: Redirect Please: Parnate and asthma meds zero » ed_uk, posted by peridown on January 14, 2006, at 15:55:24
Hi G
>I will save this email in my files with other information on how asthma medications react with MAOIs
It's more a case of LACK of information really, hence the warnings. Albuterol *might* interact with MAOIs, but there's no research to suggest that it does.
Take care
Ed
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