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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by saturn on February 1, 2007, at 23:00:57
And how can I post a topic subject line with no message (nm)?
Posted by Phillipa on February 1, 2007, at 23:18:46
In reply to Why don't they make a transdermal Nardil?, posted by saturn on February 1, 2007, at 23:00:57
I don't know but that would be the answer for me both anxiety and depression at once the perfect med. Love Phillipa
Posted by UgottaHaveHope on February 2, 2007, at 1:14:24
In reply to Re: Why don't they make a transdermal Nardil? » saturn, posted by Phillipa on February 1, 2007, at 23:18:46
These meds, the way you take them in a patch through the bloodstream rather than a pill with dietary restrictions, are the meds of the future, make no mistake about it. There will be a lot of profit for the drug companies to make off a Nardil patch.
Posted by djmmm on February 2, 2007, at 6:07:58
In reply to Why don't they make a transdermal Nardil?, posted by saturn on February 1, 2007, at 23:00:57
> And how can I post a topic subject line with no message (nm)?
unfortunately, there is no money to be gained from a transdermal form of a 50 year old medication. :(
Posted by UgottaHaveHope on February 2, 2007, at 13:08:37
In reply to Re: Why don't they make a transdermal Nardil?, posted by djmmm on February 2, 2007, at 6:07:58
My guess is that they will make something close to Nardil, call it something else, and then sell it as a new thing.
Posted by psychobot5000 on February 2, 2007, at 13:16:18
In reply to Why don't they make a transdermal Nardil?, posted by saturn on February 1, 2007, at 23:00:57
Because Nardil is unselective for MAO, so there would still be dietary restrictions at any dosage.
It's the fact that selegiline is only a moderately powerful, reversible inhibitor of MAO-a, COMBINED with the transdermal release, that allows enough gut-MAO to be available to keep us safe from tyramine in the EMSAM preparation.
That said, it does seem as though a transdermal release of tranylcypromine or nardil would at least reduce somewhat the risk (and severity?) of hypertensive crisis--allowing us to breathe a little easier. But I doubt it would change the labeling restrictions. It'd just let people eat 20mg/day of dietary tyramine instead of 8mg. Or something like that.
Psychbot
PS--last time I heard, EMSAM was not doing well financially, so it seems to be unlikely we'll see any other MAOis in that format any time soon. Pity.
Posted by ed_uk on February 2, 2007, at 14:37:48
In reply to Re: Why don't they make a transdermal Nardil?, posted by psychobot5000 on February 2, 2007, at 13:16:18
Most drugs are not suitable for transdermal administration. There are many reasons for this. Some drugs are poorly absorbed transdermally, some drugs irritate the skin etc. No drug company is going to make a transdermal formulation of Nardil. Even if it was possible (I don't know whether it is), sales would be too low to justify the expense of development.
Ed
Posted by halcyondaze on February 2, 2007, at 14:43:45
In reply to Re: Why don't they make a transdermal Nardil? » psychobot5000, posted by ed_uk on February 2, 2007, at 14:37:48
It is very hard to make a drug that can adequately cross the blood brain barrier without being absorbed through the gut. When there is financial incentive, there is reason to make alternate formulations (i.e. transdermal methylphenidate, orally disintigrating olanzapine, intramuscular risperidone) but it seems like the market is just not there for MAOIs. Especially given the poor sales of EMSAM.
Posted by Iansf on February 2, 2007, at 18:15:28
In reply to Re: Why don't they make a transdermal Nardil? » psychobot5000, posted by ed_uk on February 2, 2007, at 14:37:48
> Even if it was possible (I don't know whether it is), sales would be too low to justify the expense of development.
>
> EdI don't see why sales would be lower than for Emsam, nor that it would be any more expensive to develop transdermal Nardil than it was to develop transdermal selegiline.
Posted by halcyondaze on February 2, 2007, at 18:40:54
In reply to Re: Why don't they make a transdermal Nardil?, posted by Iansf on February 2, 2007, at 18:15:28
> > Even if it was possible (I don't know whether it is), sales would be too low to justify the expense of development.
> >
> > Ed
>
> I don't see why sales would be lower than for Emsam, nor that it would be any more expensive to develop transdermal Nardil than it was to develop transdermal selegiline.Yes, but remember, EMSAM was supposed to be free of dietary restrictions and therefore much more marketable than Parnate or Nardil.
Though the so-called evidence for EMSAM's dietary restrictions are really not supported (i.e. there were studies where no subjects on any dose followed any kind of diet and there were no hypertensive reactions) and I didn't follow the diet on 9 mg of EMSAM - at all - I ate cheddar and soy and all those lovely foods that would kill me on Parnate, the FDA wanted to be careful.
Posted by Phillipa on February 2, 2007, at 18:57:04
In reply to Re: Why don't they make a transdermal Nardil?, posted by psychobot5000 on February 2, 2007, at 13:16:18
Probably because of the cost. And insurances not paying for it? Love Phillipa
Posted by NYCguy on February 2, 2007, at 21:44:55
In reply to Re: Why don't they make a transdermal Nardil? » psychobot5000, posted by Phillipa on February 2, 2007, at 18:57:04
No kidding, Phillipa! Emsam is what, $500 a month and a lot of plans do not cover it. Of course it isn't selling well. That's $6000 a year. If it were the miracle drug then I could understand and would gladly pay, but it does not seem to be that for most (not all) who have tried.
> Probably because of the cost. And insurances not paying for it? Love Phillipa
Posted by psychobot5000 on February 2, 2007, at 22:07:02
In reply to Re: Why don't they make a transdermal Nardil? » Phillipa, posted by NYCguy on February 2, 2007, at 21:44:55
Yeah, the cost is really...almost obscene. I just don't know how they thought that was a good marketing idea--what insurance provider would pick it up? How many patients could pay for it?
And word will never get around about it--no wave of marketing enthusiasm, if patient and provider experiences are limited by the extreme cost. Poor decision-making from the marketing department, say I.
Posted by ed_uk on February 3, 2007, at 9:27:16
In reply to Re: Why don't they make a transdermal Nardil?, posted by Iansf on February 2, 2007, at 18:15:28
Hi
>I don't see why sales would be lower than for Emsam
Dietary restrictions would be necessary with Nardil. I don't think many doctors would prescribe it.
Regards
Ed
Posted by Phillipa on February 3, 2007, at 19:10:15
In reply to Re: Why don't they make a transdermal Nardil? » Iansf, posted by ed_uk on February 3, 2007, at 9:27:16
Why? Love PJ O
Posted by laima on February 4, 2007, at 10:45:56
In reply to Re: Why don't they make a transdermal Nardil?, posted by djmmm on February 2, 2007, at 6:07:58
Ah- but same could have been said about selegeline! The novelty, the new market would come from having a safer and hence more appealing version of a medication many have shunned due to the risks involved with oral version. I'm sure other maoi patches are on the way- someone posted around here somewhere that selegeline was the first to be developed into patch technology because it is the one most easily absorbed through skin- so it was the technically simplest one to start with. (Something like that.) So now they got THAT down, they can continue to work with the technology, build on it, and tackle some more difficult conversions.
> > And how can I post a topic subject line with no message (nm)?
>
> unfortunately, there is no money to be gained from a transdermal form of a 50 year old medication. :(
Posted by laima on February 4, 2007, at 10:50:08
In reply to Re: Why don't they make a transdermal Nardil?, posted by halcyondaze on February 2, 2007, at 14:43:45
We can entertain the idea that poor sales could stem from the fact selegeline never was known to be a super powerful antidepressent in the first place. Let me toss out a speculation- now that they've spent how many billions of dollars to develope the patch technology- why would they want to throw it all away? I bet there must be some minds at work now, trying to figure out what they can do with some of the technology they developed using selelgeline- like trying to decide which other maoi might ne the next most promising to tackle. They could conceivanly build on some of what they've already learned, perhaps then the next one won't be so expensive to develope. Kind of like consumer electronics...
> It is very hard to make a drug that can adequately cross the blood brain barrier without being absorbed through the gut. When there is financial incentive, there is reason to make alternate formulations (i.e. transdermal methylphenidate, orally disintigrating olanzapine, intramuscular risperidone) but it seems like the market is just not there for MAOIs. Especially given the poor sales of EMSAM.
Posted by laima on February 4, 2007, at 10:59:58
In reply to Re: Why don't they make a transdermal Nardil? » halcyondaze, posted by laima on February 4, 2007, at 10:50:08
Oh I made some typos in above post due to my excitement!
Really- why would a for-profit company just toss out all that expensive research? And that research, I bet, is the bulk of the Emsam cost. And per the other poster (and I'm so sorry I can't recall where I read that here on babble, or who it was) selegeline was the simplest MAOI to get started with. That's why they picked it- not because anyone thought it was the greatest MAOI ever. I've noticed in the package insert that it says not that dietary restrictions are a must on the higher patches- but that no research was done, so better not risk it yourself. So, I do think it's plausable that they can pick another MAOI, build on what they've already learned, and offer an attractive new product in the future. And it wasn't long ago that "experts" were saying that no ingredients could cross through the skin, though I think what I was reading about was the ingredients in beauty products. But now that's known to not be true. I think there is still considerable hope. Perhaps the costs will start to go down as more various patches are developed- again- kind of like the economics of electronics.
Posted by Phillipa on February 4, 2007, at 18:16:45
In reply to Re: Why don't they make a transdermal Nardil? » laima, posted by laima on February 4, 2007, at 10:59:58
Well they have estrogen and progesterone patches. And the scapalomine for sea sickness. Not we need one for anxiety and insomnia too. Love Phillipa
Posted by psychobot5000 on February 5, 2007, at 11:50:00
In reply to Re: Why don't they make a transdermal Nardil? » ed_uk, posted by Phillipa on February 3, 2007, at 19:10:15
> Why? Love PJ O
The reason is because Nardil is an unselective, irreversible inhibitor of MAO. It's inhibiton, on both types of the enzyme, is just too powerful. Even without sending the chemical through the digestive track directly, it would still snap up too much MAO.
It's selegiline's relative weakness (and reversability) at blocking MAO-a, combined with avoiding the gut (by skin delivery), that makes EMSAM so much safer about tyramine.
This is the end of the thread.
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