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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 43. Go back in thread:
Posted by girlnterrupted78 on June 7, 2007, at 23:48:29
In reply to Re: Where you got your teva booklet, Brooke?, posted by brooke484 on June 7, 2007, at 20:03:58
I received your bable-mail, Brooke. Thank you so much, I really appreciate the info!
Posted by Honore on June 8, 2007, at 17:02:37
In reply to Re: spinach » gardenergirl, posted by girlnterrupted78 on June 7, 2007, at 23:46:47
Pharmacies (drug stores) have BP monitors. They cost about $30-60, depending (I think).
They're very easy to use; you just put on the cuff and they either pump up automatically, or you use a little hand pump that's quite simple. There's a digital readout that tells you how high the pressure is, at any point, and records the pressure you need.
They usually also tell you your pulse rate.
Honore
Posted by girlnterrupted78 on June 8, 2007, at 23:15:05
In reply to Re: spinach, posted by Honore on June 8, 2007, at 17:02:37
Thank you for the info.
I'm just not sure how to use it for the Nardil.
I mean, I eat something, and 5 minutes later I check my BP, and then either run to ER or not?
Sorry I know that sounds dumb but I simply have NO CLUE as to how would anyone use those things for an MAOI.
It doesn't seem like something you use for prevention, but once the damage's been done. It won't tell you whether the food is dangerous, it will tell you ONCE the food has been dangerous and at that point is already time to run.
Posted by Jedi on June 9, 2007, at 2:56:45
In reply to Re: spinach » Honore, posted by girlnterrupted78 on June 8, 2007, at 23:15:05
Hi,
Use your BP monitor frequently to get used to it and obtain a baseline of where your BP usually tests. Mine can easily vary by 10 or 20 points within 15 minutes.If you are eating a food that could be a marginal problem, eat a very small amount, then test your BP. Then eat a little more and test again. Sounds tedious, but as I've mentioned in other posts, taking a MAOI requires the person to be somewhat organized and be able to raise their level of responsibility. What the doctor, pharmacist or book says may be wrong for you.
Of course, a splitting headache with a BP reading that is off the charts, should mean a quick trip to the ER. Don't expect them to know anything about this type of hypertensive crisis. It may be the first time they've ever seen it. Take the prescription bottle if possible so they can quickly look up the problem. If they try to make you wait, let them know that this type of tyramine hypertensive reaction can lead to stroke and even death(very,very rare).
Good luck,
JediPS Be very wary of any over the counter cold remedies. Most contain a combination of medications where at least one is contraindicated with a MAOI.
...
> I'm just not sure how to use it for the Nardil.
>
> I mean, I eat something, and 5 minutes later I check my BP, and then either run to ER or not?
>
> Sorry I know that sounds dumb but I simply have NO CLUE as to how would anyone use those things for an MAOI.
>
> It doesn't seem like something you use for prevention, but once the damage's been done. It won't tell you whether the food is dangerous, it will tell you ONCE the food has been dangerous and at that point is already time to run.
...
Posted by stargazer2 on June 9, 2007, at 8:10:17
In reply to BP monitor for prevention of hypertensive crisis, posted by Jedi on June 9, 2007, at 2:56:45
My pdoc has always given me a script for a small number of Nifedipine pills used in the event of a hypertensive crisis which you can verify with your BP monitor. A throbbing headache is usually an early sign of a escalating BP. If you suspect that you are having a BP crisis, you can bite on the pill which releases a liquid under your tongue (the fastest way to get the BP to come down)and then using your monitor you can follow the BP as it should decline. Obviously, if the BP stays high or your symptoms persist, a trip to the ER is warranted. You should taken your medication and tell them what your BP is and that you took Nifedipine at a certain time and give them any BP readings since you took the Nifedepine.
A prudent pdoc will prescibe Nifedepine or a similar medication to anyone taking a MAO as a first line defense with reducing the BP reaction associated with a food or medication reaction. My doctor is adamant about doing this and telling me exactly when and how to use it.I have only had to take Nifedepine once but it makes sense if you are having concerns about the dietary restrictions that you carry a pill with you until you have more confdence in whatyou are eating.
Stargazer
Posted by brooke484 on June 9, 2007, at 8:39:17
In reply to BP monitor for prevention of hypertensive crisis, posted by Jedi on June 9, 2007, at 2:56:45
It's ok to take regular Tylenol or Advil with nardil right?
brooke
Posted by Jedi on June 9, 2007, at 11:29:15
In reply to jedi, posted by brooke484 on June 9, 2007, at 8:39:17
Posted by Honore on June 9, 2007, at 13:02:31
In reply to Re: spinach » Honore, posted by girlnterrupted78 on June 8, 2007, at 23:15:05
Hi, girlinterrupted.
As I think stargazer was saying below-- you;ll know if there's a problem-- your BP will be much higher-- like 160/100, or perhaps higher-- and you'll feel it in your chest and general body-- that there's a heavy, very agitated physical feeling.
My BP is rather low (98/55 mostly) so my Pdoc said he would be concerned if it went over 150/100. It's mostly the first number you have to worry about. Depending on your BP, if it goes up to 160 or 170 or higher, it's time to think about the ER, especially if you have a bad headache and tightness at the back of your head and neck, or become extremely lightheaded and feel like you might pass out.
I had a minor case of serotonin syndrome once from taking cymbalta and trazadone (PS, it's not just MAOIs that can cause serotonin syndrome)-- and you really can tell when something's wrong. It's not like normal headache or lightheadedness from low BP-- it's a much more profound and persistent unpleasant and sick-feeling sensation. My case was not that severe and was time-limited-- but I knew FOR SURE that something was definitely wrong. It really wasn't the sort of thing you aren't that clear on, when it happens.
By the way, I do think the lists of potentially tyramine-high products are overstated. It's good to be vigilant at the beginning-- and check a lot of things. But you'll find that, unless you're unusually sensitive-- most of the prohibitons are things that happened once or twice-- and suddenly got onto a list. Most don't happen again. But they stay on the list.
Once you have a sense of what to avoid-- which things are fermented, which things like wine, certain cheeses, soy sauce, etc, you're just not going to try-- you'll have a regimen that you can rely on without thinking much about it.
The only time I even gave it any thought was when I was buying something new in a health food store-- or recently, when I was taking some homeopathic meds-- which did interact. But I felt the interactions long before they posed any problem.
At the beginning, I took my BP a lot-- after a while, I almost never took it. It's like anything-- you get desensitized-- and it becomes your ordinary, everyday, unconscious way of life.
Honore
Posted by Jedi on June 9, 2007, at 14:26:52
In reply to NIfedipine for BP crisis, posted by stargazer2 on June 9, 2007, at 8:10:17
Hi,
Many MDs will no longer write nifedipine scripts. The sublingual nifedipine can cause your BP to drop too far. The affect also lasts for four to six hours, so when the tyramine reaction is wearing off, your BP can drop to dangerously low levels. If you do take nifedipine, I would suggest starting at 5mg not 10mg. The one time I took the medication, 10mg put me in the hospital overnight on IV fluids. It caused my BP to drop but then it kept dropping long after the tyramine reaction had stopped. Extremely low BP can be fatal.
Be careful,
JediReference:
http://www.tu.edu/user_files/10/19.html
Monoamine Oxidase Inhibitors: Adverse Effects
Original Author: Paul Perry, Ph.D, BCPP
...
The antihypertensive effect lasts 4-6 hours. While the use of sublingual nifedipine in this setting has been reported to be reasonably safe, the general practice of sublingual nifedipine for hypertensive emergencies has been strongly challenged (Grossman et al 1996). The authors of this review/editorial site numerous reported cases of serious, even fatal complications of sublingual nifedipine use. Coupled with the lack of any clinical documentation attesting to a benefit, the authors argue that the use of sublingual nifedipine be abandoned. Therefore, when patients taking an MAOI experience a severe headache, especially when they've recently been non-compliant with their diet, they should report to the emergency room to receive appropriate hypertensive crisis management.
...> My pdoc has always given me a script for a small number of Nifedipine pills used in the event of a hypertensive crisis which you can verify with your BP monitor. A throbbing headache is usually an early sign of a escalating BP. If you suspect that you are having a BP crisis, you can bite on the pill which releases a liquid under your tongue (the fastest way to get the BP to come down)and then using your monitor you can follow the BP as it should decline. Obviously, if the BP stays high or your symptoms persist, a trip to the ER is warranted. You should taken your medication and tell them what your BP is and that you took Nifedipine at a certain time and give them any BP readings since you took the Nifedepine.
>
>
> A prudent pdoc will prescibe Nifedepine or a similar medication to anyone taking a MAO as a first line defense with reducing the BP reaction associated with a food or medication reaction. My doctor is adamant about doing this and telling me exactly when and how to use it.
>
> I have only had to take Nifedepine once but it makes sense if you are having concerns about the dietary restrictions that you carry a pill with you until you have more confdence in whatyou are eating.
>
> Stargazer
Posted by girlnterrupted78 on June 9, 2007, at 22:00:58
In reply to Tylenol or Advil are OK (nm) » brooke484, posted by Jedi on June 9, 2007, at 11:29:15
My doctor told me to get off my Tylenol PM before starting Nardil. So he was wrong?
Posted by Quintal on June 9, 2007, at 22:37:51
In reply to Re: Tylenol or Advil are OK -- Are you sure? » Jedi, posted by girlnterrupted78 on June 9, 2007, at 22:00:58
Tylenol PM contains a sedating antihistamine called diphenhydramine in addition to acetaminophen, and can interact negatively with MAOIs. That's probably why he wanted you off it before starting Nardil. Plain ibuprofen, acetaminophen/paracetamol and aspirin are safe. Be careful of buying OTC products this because many of them contain additives like this that can be harmful. Decongestants are the most dangerous. Some people here have actually taken diphenhydramine with Nardil to treat insomnia and have been fine - it's not absolutely contraindicated, but Nardil can amplify the effects and side effects so you need to use it with caution.
Q
Posted by stargazer2 on June 11, 2007, at 11:47:24
In reply to Re: Nifedipine for BP crisis, posted by Jedi on June 9, 2007, at 14:26:52
That's very interesting since my pdoc prescribes Nifedipine as a precautionary measure for a hypertensive crisis and may not know about the study. I will print that out and give it to him. Does your pdoc precribe anything for a hypertensive crisis other than advising to go to the ER? I would prefer to have something to take to avoid the ER scene altogether, although if necessary I know I would have to go, but together with a vasodilator agent and my trusty BP cuff I would feel safer avoiding the ER, where you can really get messed up like my father being given Haldol while on Sinemet precipitating Neuroleptic Malignant Syndrone, and the ER staff being clueless about this reaction until I pointed it out. Unbelievable, that was at the holier than thou, best (not) in the nation for psychiatric illnesses, Yale New Haven Hospital. I was ready to sue them too although my father was so sick then it wouldn't have mattered and since I noticed the reaction and pointed it out to the medical staff, serious repercussions were avoided.
Haldol can never be given to someone for agitiation that has Parkinson's disease, and Haldol is given to just about everyone in the ER with agitiation. So I am extremely skeptical of ER situations and with a MAO the risk of receiving another medication that can react with it is very high. Most doctors know nothing about MAO interactions so the risk of a reaction is very high, hence my fear of ER's.
stargazer
Posted by girlnterrupted78 on June 11, 2007, at 12:03:14
In reply to Re: Nifedipine/ BP crisis/Jedi/ I'll inform my doc, posted by stargazer2 on June 11, 2007, at 11:47:24
Hey Stargazer,
You seem to be very well informed about the reactions with MAOI (Even more so than the ER themselves) would you mind just letting me know where you got educated on this? Are you a physician or have some kind of background on this? I am on my 4th day of Nardil, so I know I might be risking my life, but if the people at the best ER in the country are idiots, what can I expect from other ERs? Could you please tell us how you got to be more knowledgeable than the ER at Yale Med Hospital?
Thanks a lot
GI
Posted by Jedi on June 11, 2007, at 12:45:49
In reply to Re: Nifedipine/ BP crisis/Jedi/ I'll inform my doc, posted by stargazer2 on June 11, 2007, at 11:47:24
Hi Stargazer,
I feel exactly the way you do about going to the ER. If you are in the middle of a medication induced hypertensive crisis and are put in the waiting room without somebody even checking your BP, something is wrong. This did happen to me once. If you've ever had a MAOI hypertensive headache, it is hard to explain to someone with no knowledge of MAOIs what the problem is. My BP was so high that my home system would not even measure it. There are instructions to recalibrate the device, but when your head is exploding, it is hard to read the booklet and figure it out.As soon as the people in the ER hear the terms "medication for depression" or "mental illness" they often will assume the problem was deliberately caused.
Honestly, I would like my MD to prescribe some 5mg doses of nifedipine for emergencies. Take the small dose, then head to the hospital so they can watch and make sure your BP does not go too low.
Take care,
Jedi> That's very interesting since my pdoc prescribes Nifedipine as a precautionary measure for a hypertensive crisis and may not know about the study. I will print that out and give it to him. Does your pdoc precribe anything for a hypertensive crisis other than advising to go to the ER? I would prefer to have something to take to avoid the ER scene altogether, although if necessary I know I would have to go, but together with a vasodilator agent and my trusty BP cuff I would feel safer avoiding the ER, where you can really get messed up like my father being given Haldol while on Sinemet precipitating Neuroleptic Malignant Syndrone, and the ER staff being clueless about this reaction until I pointed it out. Unbelievable, that was at the holier than thou, best (not) in the nation for psychiatric illnesses, Yale New Haven Hospital. I was ready to sue them too although my father was so sick then it wouldn't have mattered and since I noticed the reaction and pointed it out to the medical staff, serious repercussions were avoided.
>
> Haldol can never be given to someone for agitiation that has Parkinson's disease, and Haldol is given to just about everyone in the ER with agitiation. So I am extremely skeptical of ER situations and with a MAO the risk of receiving another medication that can react with it is very high. Most doctors know nothing about MAO interactions so the risk of a reaction is very high, hence my fear of ER's.
>
> stargazer
>
>
>
>
>
Posted by stargazer2 on June 11, 2007, at 16:28:52
In reply to Re: Nifedipine/ BP crisis/Jedi/ I'll inform my doc » stargazer2, posted by girlnterrupted78 on June 11, 2007, at 12:03:14
Nurse with lots of experience finding doctor errors and oversights as it is now known that nurses find many of the physician errors that cover thir a$$es from lawsuits. Also, from 20 + years on meds know that many meds can worsen condition and cause more side effects than the condition they were designed to treat despite pdocs saying "that isn't a listed side effect" when I complained about becoming suicidal on Zoloft, I knew it was causing this effect not my depression. The latest black box warnings stating "medication for depression can induce suicidality in children and adolescents" but mark my word it can cause it in adults since I expereinced it first hand and I'm sure others have as well. The drug companies are too worried about any warnings that might affect sales despite the reality of its occurrence. It's sickening that the drug companies don't want to ever admit the short comings of any drugs despite needing to morally and ethically do this.
Nardil was the second medication ever prescribed for me after Elavil, back in 1987, and it worked like a miracle. It was truly custom ordered for me until my crazy psychiatrst keep triying to get me off it despite me telling her it was helping me. After she did this I found a new doc and got put on the SSRI's and every other AD known to man between 1989 and 2007. Marplan worked from 1992 to 1994 until Roche discontinued it and I lapsed into a long period of trying to find a med that worked. I had a few short lived successes on a few AD's but never as good as the MAOs,with the exception of Parnate.
I'm disappointed that the original Nardil is no longer available since my original dose was 15 mg twice a day and I'm already at 60 mg since the "new" pills melt in your mouth like M and M's, not like the original hard shelled pills that lasted for 12 hours vs. the 1.2 hour half life I've been reading about with the new pills.
That is why I can see this stuff more easily than the average person, lots of experience and nurses are picking up lots of errors that would go unnoticed without them, as they eliminate nurses and replace them with nurses aides who think they know everything with only a few weeks of training want to tell the nurses how to do their jobs. Those are the people hospitals are replacing nurses with to save money!
Stargazer
P.S. My father was burning up with a fever and was so rigid we couldn't uncross his legs from the effect of the Haldol, a typical NMS reaction which the staff missed and I brought to the attention of the attending MD and boy did they pay attention to me once I mentioned NMS, they looked at eachother and must have thought how does she know anything about that, I also worked in psychiatry and saw lots of reactions like that so it was a blessing I saw it and diagnosed it before permanent damage was done. You have to have someone with you in the ER to witness things despite the objections of the staff since these errors happen all the time.
Posted by girlnterrupted78 on June 11, 2007, at 18:28:01
In reply to Re: Nifedipine/ BP crisis/Jedi/ I'll inform my doc, posted by stargazer2 on June 11, 2007, at 16:28:52
Thanks a lot for your response, Stargazer.
So let me see if I understood you: You were put on Nardil, it worked, and then you were taken off it for good and never put back on it again? That sounds terrible. Why would they do that if the other meds weren't as effective? Geez. Some psychiatrists really couldn't care less about their patients.
And what about the new Nardil? I assume I'm taking the (new) Nardil, since I assume the (old + more effective) Nardil is no longer available. Am I correct? Is the old Nardil still being manufactured in some other country? Why did it stop being manufactured? WHY WHY WHY?? I mean, this is a life-saver for people who are dying inside, why on earth do they discontinue something that really helps people?
Do you think this Nardil will work the way the old one did? I'm on my 4th day, taking 15 mgs, 3 times a day. How long should it take for it to kick in? Some 3-4 weeks? Will it kick in with this dose, or will it work until I go up? Will it kick in with THIS (new) Nardil, or is the new version ineffective?
I don't even know how often I should take the 3 daily Nardil pills. My doctor said 3 times a day. I'm taking them every 6 hours. Is that ok?
Sorry for asking so many questions, but you seem to know a lot about this. Do you know where is the most updated list of food restrictions for MAOIs? There's one list here in the dr-bob website, but a lot of people told me it was outdated.
I'm vegan, and I dont know if I can eat soy yogurt, soy milk, soy cheese, etc. My first 4 days on Nardil have been basically fruit, vegetables, and some simple foods like rice, salads, etc. I'm terrified of trying something that looks "complicated" because the mix could be lethal.
Last but not least, I'm an aspiring nurse. In my first year of nursing school. What are the prospects for a psychiatric nurse in the US, if you happen to know?
Thanks a lot, I appreciate your time,
Sincerely
GI
Posted by brooke484 on June 11, 2007, at 19:30:22
In reply to Re: Nifedipine/ BP crisis/Jedi/ I'll inform my doc, posted by stargazer2 on June 11, 2007, at 16:28:52
Do you refrigerate your nardil? I read somewhere that we should do that. Also, do your pills have an odor?
And this might be a dumb question, but I don't know the answer so I'm asking it anyway. Do you think crushing up the pills and putting them in some chelated capsules would make a difference? I put one of my zinc capsules in some water and it was still floating around 5 hours later (the nardil dissolved in less than an hour). I get stomach pains right after I take my dose and am nauseous for hours afterwards, so I was wondering if this might help. I don't know...
brooke
Posted by gardenergirl on June 11, 2007, at 20:04:10
In reply to stargazer, posted by brooke484 on June 11, 2007, at 19:30:22
Mine smell like vinegar sometimes. At least the bottle does.
Do you take yours with food? That might help the stomach pains.
gg
Posted by Phillipa on June 11, 2007, at 20:14:31
In reply to Re: Nifedipine/ BP crisis/Jedi/ I'll inform my doc, posted by stargazer2 on June 11, 2007, at 11:47:24
Stargazer if completely right as I did malpractice while nursing too what happens is horrible. Not just with meds but a cast too tight so the kid who is a football hero loses his leg. Yes it happens all the time. Been there seen it. Love Phillipa
Posted by brooke484 on June 11, 2007, at 21:03:29
In reply to Re: stargazer » brooke484, posted by gardenergirl on June 11, 2007, at 20:04:10
Yes, I take it right after my breakfast. Maybe this side effect will pass in time? It's only been 2 weeks.
brooke
Posted by girlnterrupted78 on June 11, 2007, at 21:45:09
In reply to gg, posted by brooke484 on June 11, 2007, at 21:03:29
Has it been two weeks on Nardil? How do you feel so far? Has it kicked in yet?
I'm in my 4th day on Nardil. Still waiting... can't wait for it to kick in!
Posted by stargazer2 on June 11, 2007, at 22:52:36
In reply to Re: Nifedipine/ BP crisis/Jedi/ I'll inform my doc, posted by girlnterrupted78 on June 11, 2007, at 18:28:01
This article has more specific info on the food items,I think it says soy milk is OK, just reread for verification.
http://www.tu.edu/user_files/10/19.html
Nardil fell out of favor once all the "great" SSRI's came out and then Marplan worked for a while until discontinued but I remember saying to my pdoc I want to try Nardil again and he always had another "better" one for me to try. I could just kill myself for losing sight of things, which is easily done with very severe depression where you are trying so hard to follow your pdoc's recommendations. Too bad I did for so long, it was my life being wasted no one elses.
Drugs can be discontinued whenever, I think, they don't have to petition for the discontinuation or anything else why would Marplan be discontinued so abruptly back in 1994. I had no time to prepare for that, it was just gone one day after I had 2 years of stable functioning. I cried every day having that rug pulled out from under me.
Nardil supposedly was never discontinued except Pfizer took over the patent and became the manufacturor rather than Parke Davis and was allowed to make changes in the "incipient" ingredients and that was not considered a change in the basic formulation for some reason although the effects of the medication were noticed by users of the previous version, complaining to Pfizer about poor results with the new formula. To this day, Pfizer has denied any change in the efficacy or reason for the medication to act differntly. I don't understnd all the happenings with this process but this formula change has been challenged since 2003 and there is a website to file a complaint with Pfizer, but I haven't heard any proposed change back to the original formula.
All I know is that lesser amounts were needed before the formula change and new side effects, probably your GI effects, may be the result of the coating breaking down too quickly and releasing the active ingredients sooner than they should be. That is why some people require up to 90 mg when the previous formula was much lower.
The pills have a sickening sweet smell like soapy flowers, it's disgusting.
Stargazer
Posted by stargazer2 on June 11, 2007, at 23:18:35
In reply to Re: Nifedipine/ BP crisis/Jedi/ I'll inform my doc, posted by stargazer2 on June 11, 2007, at 22:52:36
FYI: Here is the website that describes the problem with the "new" Nardil and the reason so many users are challenging Pfizer's change of the proven formula replacing it with an unproven one without going through the proper FDA channels. Pfizer claims the active ingredients did not change therefore they were not required to submit new testing, but the claims of Nardil users claim the new formula completely changed the medication's efficacy resulting in their conditions deteriorating after long periods of stability and prompting new, previously unreported side effects.
http://www.stratguitar.com/nmember/activism.php
Stargazer
Posted by brooke484 on June 12, 2007, at 10:06:45
In reply to Re: gg » brooke484, posted by girlnterrupted78 on June 11, 2007, at 21:45:09
No, I still feel awful. I'm only on 15 mgs though. I'm going up to 30 tonight. I'm surprised your doctor had you start out on 45 mgs right away. Do you have any side effects?
brooke
Posted by gardenergirl on June 12, 2007, at 14:16:51
In reply to gg, posted by brooke484 on June 11, 2007, at 21:03:29
> Yes, I take it right after my breakfast. Maybe this side effect will pass in time? It's only been 2 weeks.
>I hope it does pass soon. I never had that side effct, so I don't have any personal experience to share, sorry.
Good luck!
gg
This is the end of the thread.
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