![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by malcolm664 on June 8, 2007, at 16:42:13
Hi: I've been on Parnate for the last 6-7 weeks and so far so good, the only problem I'm continuing to have are insomnia and daytime drowsiness. I'm not experiencing any euphoria like I did on Nardil, but it seems to work really well at relieving my anxiety.
I've asked my doc repeatedly about going on Provigil and he keeps saying that he's read one study (!) which says the combination isn't safe.
Now I understand his hesitation with prescribing the amphetamines (Desoxyn, Ritalin, Concerta, etc) with an MAOI, but from everything I've been reading on this board, there are several people who are on Provigil and and MAOI and apparently there haven't been any problems.
So does anyone have any information that I can show him (a reputable web link, perhaps) that says that Provigil and Parnate can be combined safely?
He doesn't even want me combining coffee with Parnate, but if it weren't for the caffeine tabs I've been taking, I'd be asleep for much of the day (and as it is, I already sleep too much during the day as a result of the Parnate).
The one positive thing I felt when I was on Desoxyn was that it completely eliminated all my daytime fatigue. I NEVER got tired while on it. So in that respect, it worked wonderfully. Unfortunately, it didn't do anything for my ADD-like symptoms--but then my diagnosis isn't really ADD, but something much more complicated and harder to treat - just my luck!! :-( .
Any input would be much appreciated.
thanks-
Malcolm
Posted by Honore on June 8, 2007, at 17:10:37
In reply to Combining Provigil and Parnate, posted by malcolm664 on June 8, 2007, at 16:42:13
If your pdoc disrecommends caffeine with parnate, he's on the extreme conservative edge with respect to mixing MAOIs with any type of stimulant. I can't imagine why-- but I doubt he's going to go for provigil, while banning coffee.
Honore
Posted by Tomatheus2 on June 8, 2007, at 19:08:22
In reply to Combining Provigil and Parnate, posted by malcolm664 on June 8, 2007, at 16:42:13
Malcolm,
According to a case report published in 2004, a patient with narcolepsy was successfully treated with a combination of tranylcypromine (Parnate) and modafinil (Provigil). The combination was well tolerated.
Here's a link to a Web page where you can access the article:
http://linkinghub.elsevier.com/retrieve/pii/S1389945704001145However, according to a case report published in April, a patient developed acute chorea, confusion, and hyperthermia after adding 200 mg of modafinil to 80 mg of tranylcypromine. This may be the report that your doctor was referring to.
The full text of the article can be accessed here:
http://www.ajp.psychiatryonline.org/cgi/reprint/164/4/684Another article published in April reported of a patient experiencing a fever and extrapyramidal side effects after combining modafinil with tranylcypromine. The case report is referenced here:
http://www.ingentaconnect.com/content/adis/rea/2007/00000001/00001148/art00086Considering that there is one documented case of Parnate being combined with Provigil safely, it is likely that some individuals may be able to tolerate the combination. But given the two recent case reports (both published this year) of patients responding adversely to a tranylcypromine-modafinil combo and the fact that the two medications are contraindicated, I think that most doctors would be hesitant to prescribe the two medications together.
Tomatheus
> Hi: I've been on Parnate for the last 6-7 weeks and so far so good, the only problem I'm continuing to have are insomnia and daytime drowsiness. I'm not experiencing any euphoria like I did on Nardil, but it seems to work really well at relieving my anxiety.
>
> I've asked my doc repeatedly about going on Provigil and he keeps saying that he's read one study (!) which says the combination isn't safe.
>
> Now I understand his hesitation with prescribing the amphetamines (Desoxyn, Ritalin, Concerta, etc) with an MAOI, but from everything I've been reading on this board, there are several people who are on Provigil and and MAOI and apparently there haven't been any problems.
>
> So does anyone have any information that I can show him (a reputable web link, perhaps) that says that Provigil and Parnate can be combined safely?
>
> He doesn't even want me combining coffee with Parnate, but if it weren't for the caffeine tabs I've been taking, I'd be asleep for much of the day (and as it is, I already sleep too much during the day as a result of the Parnate).
>
> The one positive thing I felt when I was on Desoxyn was that it completely eliminated all my daytime fatigue. I NEVER got tired while on it. So in that respect, it worked wonderfully. Unfortunately, it didn't do anything for my ADD-like symptoms--but then my diagnosis isn't really ADD, but something much more complicated and harder to treat - just my luck!! :-( .
>
> Any input would be much appreciated.
>
> thanks-
> Malcolm
Posted by F00TBALL on June 8, 2007, at 20:46:22
In reply to Combining Provigil and Parnate, posted by malcolm664 on June 8, 2007, at 16:42:13
some stuff I found...
http://tinyurl.com/3dj5zo (talks about safety of combining the two)
http://tinyurl.com/2u6f6n (report of a woman having great benefits combining Nardil with Provigil for 6+ months and experiencing no side-effects.)
http://tinyurl.com/3bohj8
http://tinyurl.com/2wfhuz
(articles on the safety of using stimulants in general with MAOIs)http://www.thechemblog.com/?m=200606&paged=2 (shows how Provigil is much more selective on what it effects in the brain compared to other stimulants)
So basically, in a nutshell, Provigil, is considered safer then amphetamines when combined with MAOIs, but even amphetamines have been shown to be very safe when used with caution under a doctors supervision.
However, and unfortunately, there has been no comprehensive study on the use of Provigil with MAOIs. So because of that, and because it is still not known exactly how Provigil works, some doctors may be very apprehensive about combining the two.From my personal experience of combining Provigil with Nardil, I've found Provigil to be a miracle drug. It is the only prescription drug I have ever taken that was very effective while also having zero side-effects.
Also, while I don't recommend this, consider it to be stupid, and will not do it again, I did once take over 1000 MG of Provigil while being on 75 MG of Nardil, and experienced no negative side-effects. I even checked my blood pressure after taking the Provigil, and it had not increased at all.
Posted by Phillipa on June 8, 2007, at 21:55:39
In reply to Re: Combining Provigil and Parnate, posted by F00TBALL on June 8, 2007, at 20:46:22
Football please be careful with your meds. Love Phillipa
Posted by F00TBALL on June 9, 2007, at 1:51:23
In reply to Re: Combining Provigil and Parnate » F00TBALL, posted by Phillipa on June 8, 2007, at 21:55:39
> Football please be careful with your meds. Love Phillipa
If anything positive came from experiencing a Serotonin syndrome it was developing a more careful and mature attitude in regards to taking medication.
I bought one of those weekly pill holders, with each day having a morning, noon, and afternoon section.I may be a dumb, immature, teenager, but if I'm gonna take a med like Nardil, I damn well better act twice my age.
Posted by Jedi on June 9, 2007, at 3:12:29
In reply to Meds, posted by F00TBALL on June 9, 2007, at 1:51:23
Hi,
At 80mg of Parnate it took almost three months for the daytime somnolence to abate. Be patient.
Hang in there,
Jedi
Posted by Maxime on June 9, 2007, at 20:27:13
In reply to Combining Provigil and Parnate, posted by malcolm664 on June 8, 2007, at 16:42:13
Here you go Malcolm ... print out this for him.
BTW, I was on 80-120 of Parnate and took 30 mg of Adderall XR and it had no adverse effect.Maxime
1: J Clin Psychopharmacol. 1991 Apr;11(2):127-32.
CNS stimulant potentiation of monoamine oxidase inhibitors in
treatment-refractory depression.Fawcett J, Kravitz HM, Zajecka JM, Schaff MR.
Department of Psychiatry, Rush-Presbyterian-St. Luke's Medical Center,
Chicago,
Illinois.We report on our clinical experience with a combination of a CNS stimulant (either pemoline or dextroamphetamine) and a monoamine oxidase inhibitor (MAOI) for treating 32 depressed patients (mainly outpatients) refractory to standard
antidepressant pharmacotherapy. This combination, though not approved by the FDA, appears to be safe and effective. Twenty-five (78%) of these patients experienced at least 6 months of symptom remission with a stimulant + MAOI combination. Many patients required adjunctive antidepressant treatment, including tricyclics and lithium. Side effects were not excessive, though 6 patients (3 unipolar and 3 bipolar) cycled to mania (N = 1) or hypomania (N = 5). None developed hypertensive crises. With properly motivated and complaint patients and careful clinical monitoring by the prescribing psychiatrist, stimulant potentiation of MAOIs may be a viable option for treatment-resistant depressed patients.PMID: 2056139 [PubMed - indexed for MEDLINE]
2: J Clin Psychiatry. 1985 Jun;46(6):206-9.Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.
Feighner JP, Herbstein J, Damlouji N.
Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a moral and legitimate right to innovative
therapy. Combined treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and stimulants has been resisted by practitioners because of hypertensive and hyperthermic crises noted in certain cases. This paper reports a case series demonstrating the safety and efficacy of adding a stimulant to an MAOI or to a combination of TCA and MAOI in the treatment of intractable depression.PMID: 3997787 [PubMed - indexed for MEDLINE]
MAOIs in high doses and with stimulantsDate: Sat, 1 Apr 1995 13:33:03 -0800 (PST)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Non-response to tranylcypromineThe commonest reason people do not respond to tranylcypromine (Parnate) is an inadequate dose. When using an MAOI I follow platelet MAO levels and keep increasing the dose is sufficient to reduce those levels almost to zero. This often takes > 60 mg/day of tranylcypromine.
If a month or so on 80 mg/day or so does not lead to a significant improvement, the next thing I usually do is to add a psychostimulant such as methylphenidate or dextroamphetamine to the cocktail. Starting with small doses, the dose is gradually increased until the patient is taking about 30 mg/day of dextroamphetamine, or twice as much methylphenidate.
Date: Fri, 14 Apr 1995 15:06:15 -0700 (PDT)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: MAOIs in high doses and with stimulantsThere are recently been a number of warnings posted there that MAOIs should not be prescribed together with psychostimulants. While that is the conventional wisdom, if universally implemented, it would deprive many severely and intractably depressed people from relief.
In the olden days, the early 1960s, we used to treat some patients with resistant depressions with up to 200 mg/day of tranylcypromine and if that was not effective potentiate it with dextroamphetamine, starting with 2.5 mg once a day and gradually increasing to 15 or 20 mg/day.
Until it was recently withdrawn, a 60ish year old patient of mine was only able to continue in his professional work by taking 170 mg/day of isocarboxazid + 5 mg of dextroamphetamine t.i.d. Since the isocarboxazid became unavailable, he has been doing almost as well on phenelzine 135 mg/day + the dextroamphetamine.
When treating patients with unusually hard to treat syndromes it is often necessary to use combinations [and doses] of medication that are conventionally considered to be contraindicated.
From: "Steven L. Dubovsky" <Steven.Dubovsky@UCHSC.edu>
Date: 15 Apr 95 08:47:17 MST-0700
Subject: MAOIs in high doses and with stimulantsIt is common practice where I come from to combine MAOIs and stimulants for MAOI-induced hypotension and treatment resistance. This is also mentioned in Jan Fawcett's book of a number of years ago. Also, remember Feighner's report of MAOI + TCA + stimulant in ECT-resistant depression. I have tried this a number of times and found it helpful. Since half the caucasian population are (is?) rapid acetylators, higher doses of Parnate are frequently necessary. Other patients are rapid metabolizers of hydrazide MAOIs and need high doses of those. The PDR is a legal, not a medical, document, so I don't think their doses are always reliable.
From: Donald Franklin Klein <dfk2@columbia.edu>
Date: Sun, 16 Apr 1995 23:44:11 -0400
Subject: MAOIs with stimulantsMAOIs plus methylphenidate (Ritalin) has not been a problem in my hands although theoretical risk requires discussion with patient, consent, and available nifedipine . Very useful for orthostatic hypotension.
Date: 06 Sep 95 11:38:03 EDT
From: Troy Caldwell <75112.1676@compuserve.com>
Subject: MAOIs with stimulantsNone other than my teacher, John Rush, some years ago referred just such a refractory person to me specifically to try adding a stimulant to her MAOI. This was in the days when doctors could still hospitalize and had authority to do things. Apparently, we private practitioners had a bit more autonomy than the university MDs at that time, so I got the referral.
Social commentary aside, I put the pt in the ICU and added very slowly Dexedrine or Desoxyn to the patient's regimen. It was wonderful -- a grand remission occurred -- and complications were zero. I've tried it since a few times, starting a low doses and titrating gradually upward, and each time no complications arose. Like all treatment efforts, it has been variably effective, but definitely worth trying. Of course, give them nifedipine as an antidote to carry.
Date: Fri, 09 Feb 1996 10:57:43 -0600
From: Kevin Miller <MillerKB@wpogate.slu.edu>
Subject: MAOIs with stimulantsHypotension is a frequent side-effect of MAOIs. If hypotension limits appropriate dosage increases, either based on clinical response, or on not reaching the target dose of about 1 mg/kg in the case of phenelzine (Robinson and Nies), the slow and careful addition of stimulants while monitoring BP makes wonderful sense. The hypotension is treated, the antidepressant effect is augmented, and, if methylphenidate is used, there may be pharmacokinetic effects as well. This is riskier with tranylcypromine given that spontaneous elevations of BP have been noted with this MAOI despite strict dietary adherence. It's also easier to do safely on an inpatient basis.
From: JoelSHoffm@aol.com (Joel S Hoffman)
Date: Sun, 18 Feb 1996 21:43:52 -0500
Subject: MAOIs with stimulantsThere is fortunately a small literature on combining MAOI and stimulant medication: Fawcett, J Clin Psychopharm 1991, 127-132; Feighner, J Clin Psych 1985, 206-209. Also, Clary, J Clin Psych 1990, 226-231, reported in a survey of prescribing habits of Pennsylvania psychiatrists that among those who prescribed MAOIs, use of high doses and combined use of MAOIs with stimulant meds were not unusual.
I have used this combination for the treatment of refractory depression and have at times have found it a great help and at other times useless. I do not remember it being helpful when a patient was not at least partially responsive to either the stimulant or the MAOI alone. However if there is a partial response to one of those meds, then when the two are combined, there can be either an additive or synergistic effect.
I have never had a problem with elevated BP, however I most often add the MAOI to the stimulant rather than the reverse... If I do add a stimulant to an MAOI, I start with 1.25 mg d-amphetamine or equivalent, the idea being that it probably takes at least 5 mg tyramine to precipitate a hypertensive crisis, and since the molecular weights are about the same 1.25 mg amphetamine would be sub-threshold. Starting at that level has not caused any reactions, but I still prefer to start with the stimulant and add the MAOI later.
I find that with time, as more treatment options are available, I use this combination less but there are still some patients for whom nothing else seems to work. The side effects that do cause problems include activation sometimes resembling or identical to dysphoric mania. Stereotypy and choreiform movements including bucco-facial dyskinesia can also occur. These side effects have to watched for closely. If it is essential to continue the regimen, pimozide can usually alleviate the movement disorder.
From: "David A. Kahn" <kahndav@cpmc3.cpmc.columbia.edu>
Date: Wed, 21 Feb 1996 10:31:11 EDT
Subject: MAOIs with stimulantsI'm always in the position of trying to augment an existing MAOI regimen, so it's never seemed feasible to stop the MAOI, start the stimulant, and then restart the MAOI. I just add the stimulant. The only adverse reaction I've encountered is an odd lability of blood pressure on two occasions, where supine blood pressure was somewhat elevated on a tonic basis, together with a worsening of orthostatic hypotension. The supine elevation made it impossible to think of Florinef, etc., so we had to stop the combination. Interestingly, both of these individuals had prior histories of intermittent bordereline essential hypertension which had resolved on the MAOI alone.
From: JoelSHoffm@aol.com (Joel S Hoffman)
Date: Wed, 21 Feb 1996 08:29:48 -0500
Subject: MAOIs with stimulantsBy the way, I do not get signed consent. I do not think that that holds up very well anyway. Well documented clear chart notes indicating the clinical rationale and including what is told to the patient should always be standard practice and especially with atypical treatment modalities such as this.
Posted by steel on June 10, 2007, at 2:55:50
In reply to Re: Combining Provigil and Parnate » malcolm664, posted by Tomatheus2 on June 8, 2007, at 19:08:22
These are all common cases.No new abstracts have shown up.In these some were under direct inpatient care,others watched closly,and even blood maoi levels were tested at times.This most likly wont be the case,the docs in these articles were famialir enough to know the maois well,now your lucky if a doc even knows what a maoi is.
Can it be done,well the milage will vary person to person.However i dont recmend it be considered safe,or common,rather make sure first you know your maoi well,i.e its onset and all around feel,this way if u do attempt it you can pick up on a crisis immediatly.
Also basic scieance shows due to mostly the maois fault,the chemicals will accumalte,so dont consider it long term,instead use the combo as a aid to get past a plateu,and try to stop the psycho stimulant when you hit remission,only to continue this on/off pattern when needed.
staying on a maoi and psycho stimulant is not recomended unless in very rare cases,as in these reports most times the doc invovled is one familiar and comfortable with maois,as well as the patient is usualy monitered very closly.
Maois simply dont hold this respect to pdocs today,and crappy or not the combination is not recomended by most because it is dangerous,and it does require both the patient and doc to know the maoi drugs feel very well.A new user should not be on this combo,it can be deadly,its not stated as a contradiction for light reasons as some of the maoi diet is.
Also more dangerous is some people have various tolerance,and can handle his combo fairly well,but again the risk is real,and THERE of a very fatal sitaution,be careful .
Posted by F00TBALL on June 11, 2007, at 6:52:44
In reply to Re: Combining Provigil and Parnate, posted by steel on June 10, 2007, at 2:55:50
> These are all common cases.No new abstracts have shown up.In these some were under direct inpatient care,others watched closly,and even blood maoi levels were tested at times.This most likly wont be the case,the docs in these articles were famialir enough to know the maois well,now your lucky if a doc even knows what a maoi is.
>
> Can it be done,well the milage will vary person to person.However i dont recmend it be considered safe,or common,rather make sure first you know your maoi well,i.e its onset and all around feel,this way if u do attempt it you can pick up on a crisis immediatly.
>
> Also basic scieance shows due to mostly the maois fault,the chemicals will accumalte,so dont consider it long term,instead use the combo as a aid to get past a plateu,and try to stop the psycho stimulant when you hit remission,only to continue this on/off pattern when needed.
>
> staying on a maoi and psycho stimulant is not recomended unless in very rare cases,as in these reports most times the doc invovled is one familiar and comfortable with maois,as well as the patient is usualy monitered very closly.
>
> Maois simply dont hold this respect to pdocs today,and crappy or not the combination is not recomended by most because it is dangerous,and it does require both the patient and doc to know the maoi drugs feel very well.A new user should not be on this combo,it can be deadly,its not stated as a contradiction for light reasons as some of the maoi diet is.
>
> Also more dangerous is some people have various tolerance,and can handle his combo fairly well,but again the risk is real,and THERE of a very fatal sitaution,be careful .1. As far as I know there have been ZERO reports of someone dying from combining an MAOI with Provigil
2. It's stated as a contradiction because there have been no official studies on combining the two NOT because it's known to be extremely dangerous.
3. Your post seems to be your opinion more then fact. If you're gonna make such a bold statement as to say... "the combination is not recomended by most because it is dangerous,and it does require both the patient and doc to know the maoi drugs feel very well.A new user should not be on this combo,it can be deadly,its not stated as a contradiction for light reasons as some of the maoi diet is," please provide a link that actually says this.
Posted by gardenergirl on June 11, 2007, at 7:50:44
In reply to Combining Provigil and Parnate, posted by malcolm664 on June 8, 2007, at 16:42:13
My pdoc actually "prescribed" coffee when I first talked about the Nardil fatigue. When that didn't help, she prescribed Provigil. It's worked well, and I've had no adverse effects from it save some headaches when I first started. No change in my BP, though. I was careful to monitor that for a few days.
gg
Posted by gardenergirl on June 11, 2007, at 7:56:15
In reply to Re: Combining Provigil and Parnate » malcolm664, posted by Tomatheus2 on June 8, 2007, at 19:08:22
> ... and the fact that the two medications are contraindicated, I think that most doctors would be hesitant to prescribe the two medications together.
Actually, the two meds are not contraindicated, but rather caution is advised if using the two together.
gg
Posted by steel on June 11, 2007, at 8:34:55
In reply to Re: Combining Provigil and Parnate, posted by F00TBALL on June 11, 2007, at 6:52:44
> > These are all common cases.No new abstracts have shown up.In these some were under direct inpatient care,others watched closly,and even blood maoi levels were tested at times.This most likly wont be the case,the docs in these articles were famialir enough to know the maois well,now your lucky if a doc even knows what a maoi is.
> >
> > Can it be done,well the milage will vary person to person.However i dont recmend it be considered safe,or common,rather make sure first you know your maoi well,i.e its onset and all around feel,this way if u do attempt it you can pick up on a crisis immediatly.
> >
> > Also basic scieance shows due to mostly the maois fault,the chemicals will accumalte,so dont consider it long term,instead use the combo as a aid to get past a plateu,and try to stop the psycho stimulant when you hit remission,only to continue this on/off pattern when needed.
> >
> > staying on a maoi and psycho stimulant is not recomended unless in very rare cases,as in these reports most times the doc invovled is one familiar and comfortable with maois,as well as the patient is usualy monitered very closly.
> >
> > Maois simply dont hold this respect to pdocs today,and crappy or not the combination is not recomended by most because it is dangerous,and it does require both the patient and doc to know the maoi drugs feel very well.A new user should not be on this combo,it can be deadly,its not stated as a contradiction for light reasons as some of the maoi diet is.
> >
> > Also more dangerous is some people have various tolerance,and can handle his combo fairly well,but again the risk is real,and THERE of a very fatal sitaution,be careful .
>
> 1. As far as I know there have been ZERO reports of someone dying from combining an MAOI with Provigil
>
> 2. It's stated as a contradiction because there have been no official studies on combining the two NOT because it's known to be extremely dangerous.
>
> 3. Your post seems to be your opinion more then fact. If you're gonna make such a bold statement as to say... "the combination is not recomended by most because it is dangerous,and it does require both the patient and doc to know the maoi drugs feel very well.A new user should not be on this combo,it can be deadly,its not stated as a contradiction for light reasons as some of the maoi diet is," please provide a link that actually says this.
>I dident say provigil,or maybe i dident make it clear,amphetamines.Did people actualy die,i dont know,i dont know if any of the contradictions have documented cases on Maois.
Yess of course im stating my opinion,id hope nothing anyone says here is taken as more than that,im not even really impressed with short weak abstracts either.
What i can speak of is what i know,which is ive used the combo personaly,and have read on others who have.
Maoi inhbits,and i actualy read in a google post of a dramatic case of cranial hemorage due to a combo as such,these particular chemicals stock piling up in the brain due to slow maoi acitivity just in theory alone cant be safe.
Lol dont take offense,i search for augmentation constantly,but if i dident say to choose using a amphetamine with parnate carefully then i wouldent be myself.
Provigil,caffiene etc are weaker stimulants,both maois and amphetamines are powerful drugs,and i stand behind recomending it not be a general option of augmentation.
FYI this is willyee,just a new handle,seem to stuck a cord there eh,well sorry man i have augmented parnate a long time now,and its been the scariest combo for me,i use the caffiene now which is medacore but better than nothing,i posted how it seemed to be pretty harmless,everything i post is purly opinion of course,its our job to gather it all up and make the final choice ourselves,i personaly wouldent advise anyone doing something they in there gut felt wasnt safe just because a abstract said so.
I dident feel safe with a ritalin/parnate combo,and i should have went with my gut on it.
Anyway sorry you took my info the way u did,im in the same boat as you are.Over and out.
Posted by Tomatheus2 on June 11, 2007, at 18:14:41
In reply to Re: Combining Provigil and Parnate » Tomatheus2, posted by gardenergirl on June 11, 2007, at 7:56:15
> Actually, the two meds are not contraindicated, but rather caution is advised if using the two together.
gg,
The 2004 abstract that I linked to in my previous post stated: "The concurrent use of [tranylcypromine and modafinil] is normally contraindicated based on theoretical concerns."
However, the prescribing information document for Parnate does not state that the medication is contraindicated with modafinil, which (based on my understanding of things) should mean that the two meds are not officially contraindicated. I think that it would have been best if I had referenced Parnate's prescribing information document before stating that the medication is contraindicated with modafinil (based on a sentence in a case report's abstract). I apologize for my statement. I think that you're correct in stating that tranylcypromine and modafinil are not contraindicated, and I should not have jumped to conclusions so quickly.
Tomatheus
==
Sources:
* 2004 case report on the concomitant use of modafinil and tranylcypromine in a patient with narcolepsy:
http://linkinghub.elsevier.com/retrieve/pii/S1389945704001145* Parnate tablets prescribing information:
http://us.gsk.com/products/assets/us_parnate.pdf
Posted by Phillipa on June 11, 2007, at 19:28:20
In reply to Re: Combining Provigil and Parnate, posted by steel on June 11, 2007, at 8:34:55
Steel just wanted to say hi will. Love Phillipa
Posted by steel on June 12, 2007, at 6:48:05
In reply to Re: Combining Provigil and Parnate » gardenergirl, posted by Tomatheus2 on June 11, 2007, at 18:14:41
No one should feel bad,ive spoken to what i am told was the last end of the parnate department as far as technical knowing.
Told i was speaking to a chemisct on a few occasions,and after asking a load of questions still feel the drug is vague in its use.
If youre really concerned id recomend calling the company,and being directed to a chem rep which you can ask for,they as in my case should be willing to discuss technical aspects of the medication.
Posted by gardenergirl on June 12, 2007, at 14:20:55
In reply to Re: Combining Provigil and Parnate » gardenergirl, posted by Tomatheus2 on June 11, 2007, at 18:14:41
You at least did more research than I did. :) I always use Epocrates. I trust that resource as it seems to be updated very frequently. It's also super handy to have on my PDA. Though I'm sure no one resource is 100 percent accurate.
I think I recall seeing Provigil and MAOI's listed as contraindicated at first. I have a vague memory of looking it up and thinking, "Hey, they changed it!" So maybe in 2004 it was listed as contra. and later it was modified down to caution?
Take care,
gg
Posted by psychobot5000 on June 14, 2007, at 13:30:06
In reply to Re: Combining Provigil and Parnate » Tomatheus2, posted by gardenergirl on June 12, 2007, at 14:20:55
I wanted to mention that the MAOi specialist I had a consult with once stated during that meeting that he considered Provigil and Phenelzine or tranylcipromine (parnate) to be a -relatively- safe combination, and one that he recommended to deal with the sleepiness or fatigue that can be associated with MAOis. Another doc I met with (whose specialty was sleep) explained that the guideline he followed was to prescribe a half-dose of modafinil/provigil if the patient was on an MAOi. In that case, it meant prescribing 100mg provigil per day (as an adjunct to phenelzine/nardil, which was the MAOi I was on at the time), rather than 200mg, which he considered the standard starting dose. All this was in 2006.I think that, in general, MAOis are often put on the list of contraindications even when there is little evidence they're a danger, because, liability-wise, they're too dangerous. Also, the number of MAOi using patients is too small to offer much profit to companies producing drugs that might be used as adjuncts. I don't think it's inaccurate to say that, in this context, the PDR and other 'official' sources can be more legal documents, rather than medical ones.
Don't mean to discount the case reports mentioned earlier re safety issues in the parnate/provigil combination. I don't think parnate is ever -completely- safe, after all, even on its own. But I wanted to relay what seemed relevant information.
Best,
Psychbot
Posted by steel on June 14, 2007, at 15:11:57
In reply to Re: Combining Provigil and Parnate, posted by psychobot5000 on June 14, 2007, at 13:30:06
>
> I wanted to mention that the MAOi specialist I had a consult with once stated during that meeting that he considered Provigil and Phenelzine or tranylcipromine (parnate) to be a -relatively- safe combination, and one that he recommended to deal with the sleepiness or fatigue that can be associated with MAOis. Another doc I met with (whose specialty was sleep) explained that the guideline he followed was to prescribe a half-dose of modafinil/provigil if the patient was on an MAOi. In that case, it meant prescribing 100mg provigil per day (as an adjunct to phenelzine/nardil, which was the MAOi I was on at the time), rather than 200mg, which he considered the standard starting dose. All this was in 2006.
>
> I think that, in general, MAOis are often put on the list of contraindications even when there is little evidence they're a danger, because, liability-wise, they're too dangerous. Also, the number of MAOi using patients is too small to offer much profit to companies producing drugs that might be used as adjuncts. I don't think it's inaccurate to say that, in this context, the PDR and other 'official' sources can be more legal documents, rather than medical ones.
>
> Don't mean to discount the case reports mentioned earlier re safety issues in the parnate/provigil combination. I don't think parnate is ever -completely- safe, after all, even on its own. But I wanted to relay what seemed relevant information.
>
> Best,
> PsychbotGood info,you mentioned half for nardil,nardil being more calming and using half then i wonder what parnate a "alleged" more activating one would require.I suppose half either way still including the usual benzo as needed with parnate.
This is the end of the thread.
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