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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Mishal on September 11, 2007, at 1:24:20
I am planning to take selegiline in its fullest. Since Emsam patches are not available in this part of world, I have no options other than rely on oral selegiline.
Currently I am on Prozac plus selegiline 15mg. Prozac doesn't seem to help much but selegiline does. I feel an urge to stop prozac and up the selegiline dose to either 30mg daily or more.
I know it can be a different story if I go up with selegiline far beyond 15mg daily. I will have to observe a special diet. I don't know what is allowed to take and what is not.
Can you help please? I know there are many people here on more hard MAOIs like Nardil. Those people can certainly help me to take Selegiline safely. Please...
Posted by tecknohed on September 11, 2007, at 8:39:10
In reply to MAO Diet: please help!, posted by Mishal on September 11, 2007, at 1:24:20
This link will take you to one of the Tips pages here at this site. Should answer your question pretty well:
Posted by gardenergirl on September 11, 2007, at 9:30:25
In reply to MAO Diet: please help!, posted by Mishal on September 11, 2007, at 1:24:20
Aren't selegine and Prozac contraindicated?
gg
Posted by tecknohed on September 11, 2007, at 10:53:17
In reply to Re: MAO Diet: please help!, posted by gardenergirl on September 11, 2007, at 9:30:25
> Aren't selegine and Prozac contraindicated?
>
> ggAppears you're right gg! Every selegiline info site I've looked at so far warns against the combination of selegiline & SSRIs, even at 10mg/day.
Mishal, be especially wary of Serotonin Syndrome if you increase the dose of your selegiline which, as you know, loses selectivity for MAO-b at higher than normal doses. Even though you intend to stop Prozac first, remember it has a very long half life and can stay in the blood for 5 weeks after stopping.
Posted by Phillipa on September 11, 2007, at 12:46:00
In reply to Re: MAO Diet: please help! » gardenergirl, posted by tecknohed on September 11, 2007, at 10:53:17
I thought so too but since not on an maoi didn't want to just think and not know. Please be careful maybe call your doc? Phillipa
Posted by cumulative on September 11, 2007, at 14:18:43
In reply to MAO Diet: please help!, posted by Mishal on September 11, 2007, at 1:24:20
Oral selegiline won't be the same as EMSAM (or sublingual selegiline), as EMSAM avoids first-pass metabolism. You will be getting much more metabolite.
If you take the dose sublingually, remember to take lower doses as, like in EMSAM, 6mg sublingually equals = 20mg oral.
You need to wait 2 weeks for the prozac to wash out or you are taking a serious risk.
Posted by Meagan on September 13, 2007, at 11:15:02
In reply to MAO Diet: please help!, posted by Mishal on September 11, 2007, at 1:24:20
Although other posters are correct that one must be careful about combining segeline with prozac, very experienced and knowledgeable practioners, like mine, do it all the time with great success. Note that segeline is a drug used for people with Parkinsons disease who take it in addition to Prozac, w/o any problems.
I, like you, have just started segeline (low dose right now) and take it in addition to my prozac (40 mgs. If it works well, I'll be weaned off Prozac, and since we have the patch available, may start using it. Frankly, Segeline has worked like a magic bullet and is pulling me right out of my depression.
I'd follow suggestions of a recent poster on tips re: the MAOI diet, but it sounds to me that it is well worth it. What part of the world are you from?
Meagan
> I am planning to take selegiline in its fullest. Since Emsam patches are not available in this part of world, I have no options other than rely on oral selegiline.
>
> Currently I am on Prozac plus selegiline 15mg. Prozac doesn't seem to help much but selegiline does. I feel an urge to stop prozac and up the selegiline dose to either 30mg daily or more.
>
> I know it can be a different story if I go up with selegiline far beyond 15mg daily. I will have to observe a special diet. I don't know what is allowed to take and what is not.
>
> Can you help please? I know there are many people here on more hard MAOIs like Nardil. Those people can certainly help me to take Selegiline safely. Please...
Posted by blueboy on September 16, 2007, at 11:18:09
In reply to Re: MAO Diet: please help!, posted by Meagan on September 13, 2007, at 11:15:02
I'll trust you on this, although I personally wouldn't do it. It is an extraordinarly complex issue. Selegine/seligine/seligiline (l-deprenyl) at low dosage is a selective MAO-b rather than general MAOI. It does have a weak reversible MAO-a effect, but at low dosage it actually inhibits, rather than potentiates, the dangerous catecholamine-releasing effect of general MAOI's.
Unfortunately, at some dosage point (generally over 10mg oral per day), seligiline will begin to inhibit MAO-a generally. My understanding is that this would make any SSRI extremely dangerous.
I say unfortunately, because its effectiveness as an anti-depressant comes primarily at higher dosages. I imagine that is why it might be commonly given with Prozac to Parkinson's patients. You would see the 2x5mg dosage more often for Parkinson's than for depression.
So, your statement that Prozac combined with 10mg seligine is commonly prescribed and generally safe may be entirely correct, I don't know.
But you really wouldn't want to make a mistake with your seligine dosage, much less intentionally increase it much past 10mg/day while your system still had Prozac metabolites.
> Although other posters are correct that one must be careful about combining segeline with prozac, very experienced and knowledgeable practioners, like mine, do it all the time with great success. Note that segeline is a drug used for people with Parkinsons disease who take it in addition to Prozac, w/o any problems.
>
> I, like you, have just started segeline (low dose right now) and take it in addition to my prozac (40 mgs. If it works well, I'll be weaned off Prozac, and since we have the patch available, may start using it. Frankly, Segeline has worked like a magic bullet and is pulling me right out of my depression.
>
> I'd follow suggestions of a recent poster on tips re: the MAOI diet, but it sounds to me that it is well worth it. What part of the world are you from?
>
> Meagan
Posted by Jedi on September 17, 2007, at 0:57:43
In reply to Re: MAO Diet: please help!, posted by blueboy on September 16, 2007, at 11:18:09
Prozac washout is generally agreed to be five weeks, while the other SSRIs are two. I agree with Blueboy, anything other than a very low dose of selegiline combined with Prozac could result in serotonin syndrome and the long dirt nap.
Be careful,
JediReference:
[Serotonin syndrome: report of a fatal case and review of the literature][Article in Spanish]Rev Clin Esp. 2002 Apr;202(4):209-11.
Bilbao Garay J, Mesa Plaza N, Castilla Castellano V, Dhimes Tejada P.
Servicio de Medicina Interna, Fundación Hospital Alcorcón, Madrid, Spain. jbilbao@fhalcorcon.esWe report here the case of a patient with fluoxetine and selegiline induced serotonin syndrome, which presented as encephalopathy, generalized myoclonias, fever, stiffness and sweating, complicated with acute renal failure, rhabdomyolysis and disseminated intravascular coagulation findings. The patient died 6 days after admission. This syndrome is discussed, with an analysis of its causes, pathophysiology and therapy. A special emphasis is placed on the clinical issues and differential diagnosis with the malignant neuroleptic syndrome and other clinical entities with which it could be mistaken. General recommendations are provided to avoid this poorly characterized syndrome that, as in our patient, may have a fatal outcome.
PMID: 12003730 [PubMed - indexed for MEDLINE]
Posted by Phillipa on September 17, 2007, at 19:32:00
In reply to Re: MAO Diet: please help!, posted by Jedi on September 17, 2007, at 0:57:43
Jedi wow DIS you bleed out and die usually how horrible. Be very careful with the meds. Phillipa
Posted by Phillipa on September 17, 2007, at 19:33:39
In reply to Re: MAO Diet: please help! » Jedi, posted by Phillipa on September 17, 2007, at 19:32:00
Oops supposed to be DIC type error. Sorry Phillipa
This is the end of the thread.
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