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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Crazy Horse on February 2, 2007, at 15:50:38
I asked my Pharmacist to order Parnate for me two days ago as i will be starting it on Feb.25th. Today i talked with him and he told me it is currently unavailable, but that he would keep trying. Now i'm upset, anyone else hear of this?
-Monte
Posted by halcyondaze on February 2, 2007, at 16:27:20
In reply to Anyone having difficulty getting Parnate?, posted by Crazy Horse on February 2, 2007, at 15:50:38
I've had no problem. The pharmacy is always able to order it within two days. Did you get brand or generic? Maybe GSK is phasing out production of brand name Parnate. I hope not, since I take brand name. Location could also be an issue - I live in NYC but if you live in a smaller town perhaps it takes more time.
Posted by psychobot5000 on February 2, 2007, at 16:35:46
In reply to Anyone having difficulty getting Parnate?, posted by Crazy Horse on February 2, 2007, at 15:50:38
> I asked my Pharmacist to order Parnate for me two days ago as i will be starting it on Feb.25th. Today i talked with him and he told me it is currently unavailable, but that he would keep trying. Now i'm upset, anyone else hear of this?
>
> -MonteSounds to me like they're not doing their job properly--what kind of pharmacy would somehow be unable to order it? Like the other old MAOis, it's a little obscure, but they really should be able to get it in 1-3 days.
Maybe the pharmacist mispelled it or something?
I just got a prescription for it with no difficulties. There is no reason why they'd discontinue Parnate right now, and if they did, they'd announce it.
Posted by Crazy Horse on February 2, 2007, at 19:24:27
In reply to Anyone having difficulty getting Parnate?, posted by Crazy Horse on February 2, 2007, at 15:50:38
Posted by NYCguy on February 2, 2007, at 21:47:06
In reply to Got some thru a dif. pharmacy...relieved! :) (nm) » Crazy Horse, posted by Crazy Horse on February 2, 2007, at 19:24:27
Monte,
Do you take the Glaxo version or the generic that came out in 2006? I take the generic, I wonder if there is any difference...
Posted by Phillipa on February 2, 2007, at 21:54:48
In reply to Re: Got some thru a dif. pharmacy...relieved! :) » Crazy Horse, posted by NYCguy on February 2, 2007, at 21:47:06
Monte just glad you found it. Love Phillipa
Posted by naughtypuppy on February 3, 2007, at 9:53:56
In reply to Anyone having difficulty getting Parnate?, posted by Crazy Horse on February 2, 2007, at 15:50:38
No problems here. I deal with a large pharmacy chain and they just ship it from another outlet if there short. I could see a problem if your pharmacy is a smaller company, then they would have to get it directly from the manufacturer.
Posted by Crazy Horse on February 3, 2007, at 11:36:41
In reply to Re: Got some thru a dif. pharmacy...relieved! :) » Crazy Horse, posted by NYCguy on February 2, 2007, at 21:47:06
> Monte,
>
> Do you take the Glaxo version or the generic that came out in 2006? I take the generic, I wonder if there is any difference...I take the Glaxo version..i don't think there is any difference.
Posted by Suiram on February 7, 2007, at 0:22:01
In reply to Re: Got some thru a dif. pharmacy...relieved! :) » NYCguy, posted by Crazy Horse on February 3, 2007, at 11:36:41
Hi. This is my first post here, I think (I've used similar forums before, but can't recall having used this one, though I've read it for a while).
I used the Goldshield Tranylcypromine generic from the UK for a few months at a dose of 2.3mg/kg/day. Tried it in combination with several other drugs, all properly prescribed, including Edronax (reboxetine), Dexedrine (d-amphetamine) and Subutex (buprenorphine), with the latter being the most effective, and to date the only thing that made me feel like a human again (in fact, I soon felt remarkably like my old self, which others commented on).
However, at one point, I had to switch to another generic, called Jatrosom, from Germany. Where I live, medical care is public, and you are required to accept a generic substitute if it is cheaper, or pay the difference yourself, which I couldn't afford.
Soon thereafter, I developed acne, rashes (not S-J) and sleep abnormalities (even relative to what I had, and not just insomnia; vivid nightmares; four-level deep dream-within-a-dream waking-up sequences; periodic extreme hypersomnia, etc.).
After a few days, I started compulsively popping the acne, to the point where large areas of skin would be left a bloody mess; I still have scars from this.
After about a week, I got hypocondriac tendencies that by the end of that week bordered on psychosis.
Then I developed hallucinations, and the hypocondriac issue developed into a full-blow psychosis, including delusional parasitosis that didn't exactly help the skin issue.
After about a month (I can't believe I made it that far without someone recognizing that this stuff was really screwing me up; I'm usually a very composed person, to the point that I knew that I realized I was psychotic and had to do conscious reality testing to try to "hang on"), things got really bad blood-pressure-wise...
Now, I'm not talking about a hypertensive crisis, though I have had one of those several months later (250/180 when I administered the nifedipine on my way to the medical ward). I'm talking about the exact opposite: hypotension bordering on circulatory collapse. Fortunately, my dependant was elsewhere, and my parents could take me in and care for me.
The first measurement I have is from a visit to the medical ward (subsequent to fainting and having a brief seizure with cramping without full loss of consciousness, though I certainly wasn't truly there either) where they had to wheelchair me in so I wouldn't faint again. The doctor blinked and rechecked manually. Twice. It was 50 over 30 while sitting relaxed.
Noone had any idea what they should do, since I wasn't hypovolemic, and administering adrenaline or other pressor agents to someone on parnate... well, at least they realized they shouldn't do *that*.
I finally convinced them to make a new Rx for the Goldshield brand (we don't have to pay the extra if a doctor states that a specific brand must be used for medical reasons) and let me check back in in 3 days, rather than administering me to the hospital. My experiences with docs and pdocs have been less than satisfactory, so I didn't want to risk (in my view) that.
3 days later, I was no longer psychotic (after weeks), and the low blood pressure was slowly reversing, as were the other complications.
It took me months to recover to 90%, at which point my recovery was cut short by the second anecdote.
You see, my S.O. was also using tranylcypromine, although at doses around 30mg/day, and had to switch brands a little after I did.
She started out with rashes too (although she didn't get the "bleeding wounds" level of rash), and developed what might be called subclinical psychosis ("hysteric" would be the colloquial term for the main problem) as well, although it all developed more slowly for her, and reversed much more quickly.
When I had my hypotension problem, she was at her mother's place, which is good. However, her mother got ill from the stress of caring for her (she was going through a rough patch, and the creeping onset of the Jatrosom-induced problems wasn't helping any). Instead of trying to sort out a way to deal with this situation, her mother had a doctor (who never met her) forcefully commit her (picked up by 3 police officers) to the secure observation facility at a psychiatric hospital 3 hours away.
Now, for some, this wouldn't be a problem. For an Asperger with a history of bad run-ins with pdocs and strong issues about loosing control etc., it was rape. Pure and simple; and she has some grounds for comparison in that regard.
So I had to abort my bed rest, and band-aid myself with stimulants to the point where I could get on a plane, a taxi, two buses and another taxi (8 hours in all) and pick her up. The psychiatrist on duty had straight away confirmed that she had no need of even observation, but couldn't sign her out, as only the head pdoc can do that in the secure ward, and he wouldn't be there until the next day. Of course, they can't ship her anywhere, and no way would she trust her mother to pick her up after that incident, so I was the only one that could do it. As bad as she got from the experience she had there, I can honestly say it was the right thing to do, despite the risk to myself.
Of course, after this experience, life was walking on eggshells for months, and I was nowhere near functional yet ("broken" would be the term, as in "broken toy" or something).
A couple of days after picking her up, I got the hypertensive episode, seemingly unprovoked, though tranylcypromine has always lowered my usually slightly-elevated-but-stable blood pressure. I won't go into what that was like. If you've had one, you know what it's like, if you haven't, you don't, and should avoid finding out at any cost.
The fact that two people got similar problems from the same switch in drugs in such a way would seem to strongly support the notion that this most likely is linked to the switch, particularly since we switched at somewhat different times and both had a dose-dependant increase per unit time in the problems, and different ceiling levels.
The requirements for FDA approval for a generic are far less than for the parent drug (I seem to recall 24 patients, as opposed to 2400, being the minimum subject group, with the same inclusion criteria as the parent drug; i.e. ones rarely seen in clinical practice).
In short, switching brands may not always be harmless, although it will work fine in *most* cases. Heck, they wouldn't be producing that brand if it didn't have happy customers...
It certainly f*cked up my life and health, though, which were both really crap already, because of some idiot that refused to listen when I explained that I'm hypersensitive to antipsychotics...
Sorry for the lengthy and excessively detailed post, but it's hard not to rant with something like this.
I'm not going to suggest staying away from the generics (my original brand *was* generic), but I'd recommend sticking with whatever brand you get, just in case.
When you start low and go slow, as one usually does with tranylcypromine (parnate/jatrosom/...) to avoid the problems with transient blood pressure elevation, you'll pick up any problems early on, and can switch.
Switching when you're at 1mg/kg/dy or more is a *lot* more likely to give complications, I think. For instance, oral bioavailability can probably vary a bit between brands. Probably not enough to cause problems at the doses used in generic equivalency trials (usually 30mg or less), but it adds up at the higher doses.
Posted by ed_uk on February 7, 2007, at 14:41:35
In reply to Differences between generics and lengthy anecdote, posted by Suiram on February 7, 2007, at 0:22:01
Hi
I've read that some versions of Jatrosom contain a mixture of tranylcypromine and trifluoperazine. Did your Jatrosom contain trifluoperazine?
Ed
Posted by Suiram on February 7, 2007, at 15:53:14
In reply to Re: Differences between generics and lengthy anecdote » Suiram, posted by ed_uk on February 7, 2007, at 14:41:35
> I've read that some versions of Jatrosom contain a mixture of tranylcypromine and trifluoperazine. Did your Jatrosom contain trifluoperazine?
Yes.
Thank you.
I did not know this, *at all*. And it was not stated by the pharmacy. I became ill enough to consider tranylcypromine as a *consequence* of neuroleptics (low dose, low potency, but I'm hypersensitive). The last thing I needed was a high potency neuroleptic with a fairly malign side-effect profile.
There will be consequences. This is gross negligence on someone's part, and I will take this to the appropriate authorities.
Just as soon as I stop quivering with rage.
Posted by ed_uk on February 7, 2007, at 16:01:05
In reply to Re: Differences between generics and lengthy anecd » ed_uk, posted by Suiram on February 7, 2007, at 15:53:14
Hi again
Have you checked the box? Did your tablets definitely contain trifluoperazine? Perhaps there is a version of Jatrosom which does not contain trifluoperazine?
>I became ill enough to consider tranylcypromine as a *consequence* of neuroleptics (low dose, low potency, but I'm hypersensitive).
Which one?
Trifluoperazine is certainly a highly potent neuroleptic. EPS and akathisia are very common.
Take care
This is the end of the thread.
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