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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Tony P on January 24, 2008, at 10:30:50
I started to write this in a real panic, as I was in the midst of a hypertensive crisis in the wee hours, but I've calmed down a bit and so has my BP.
Anyone with knowledge of blood-pressure numbers and MAOI hypertensive crises, I need to know when I should panic & go to emerg., or go to a walk in clinic when it opens, or just relax & all will be well. My MD has been coy about giving me a "panic" BP number, and my home BP unit sometimes gives spurious super-high readings (over 200 systolic, then the next reading or the other wrist is 30 points lower).
I became aware I was having some level of crisis about 2 1/2 hours ago (0600 PST). My BP with the home wrist unit (which does tend to read high compared with my MD's) was between 173/105 - 188/96 from 0600-0700, and seems to be down now at 0800 to 167/105. No fever, no sweating, no muscle twitches so probably not Serotonin Syndrome. My pulse is very high -- 100-120 -- but that's at least partly caused by my anxiety and partly by the Robaxin I've taken to try to calm down -- about the only med that _doesn't_ interact with my AD's according to the web lists!
I'm taking a cocktail of AD's including 10 mg/day oral selegeline, which is supposed to be safe according to some sources, and my BP was only slightly elevated at my MD's the other day, but a couple of Drug Interaction web sites sound mighty scary when I add up all the possible interactions of everything I'm taking. I suspect the finishing touch was 100 mg trimipramine at 0500 (because I wasn't sleeping) and a late night snack on blue cheese.
For the record, I'm taking (in 24 hrs.):
Rx - Daily: Total daily doseHow taken
Remeron 30mg/day HS
Requip 1.5 mg/day div. (0.5-0.25-0.75hs)
Selegeline 10mg/day 5 mg bid
Clonazepam 2mg/day i bid - ii when needed
Crestor 10mg/day HS
Rx - as required:
Trimipramine 50-200mg HSi-iv hs prn for sleep, usually 2, about 1 night in 3
Nortriptylline 25-50mg HSi-ii occasional instead of Trimipramine (think I'm going to drop this, it's rated high-risk for interactions)
Seroquel 25-100mg HSi-iv hs prn (rarely) instead of Trimipramine for late-night hypomania (and I've just run out)OTC:
Robaxin750 mg12/day and up (trying to taper back)
My "normal" BP measured at home is 135/75 - 145/85 & I think the Dr. gets about the same.On the whole this combo has been working well for me, and the Selegeline, added fairly recently (Nov.'07), gave me that extra energy I was starting to lack with the others (probably been on Remeron too long, 1.5 years), so I'm reluctant to give up the Selegeline despite the warning bells.
It looks like the immediate crisis is over, but I would still like advice from those who've been there. I've read some of the old posts on this subject, and my questions boil down to:
- What BP numbers are a genuine gold-plated crisis, go to emerg., do not pass GO, etc.?
- Should I press my MD to let me carry an oral med such as nifedipine (mentioned in an old post)?
- Any other suggestions??
Posted by seldomseen on January 24, 2008, at 12:54:24
In reply to HELP - hypertensive crisis on selegiline??, posted by Tony P on January 24, 2008, at 10:30:50
Well, a lot of what constitutes a hypertensive crisis depends on the patient, their present condition and previous medical history.
But diastolic BPs of over 120 usually contstitute a hypertensive emergency.
Diastolics over 140 represent a crisis.
Now I'm not saying that you shouldn't be concerned at BPs lower than that, but that's what the data say.
I would call your doc today and let him/her know what happened.
Clonidine is a good med to have for hypertension.
Posted by Tony P on January 25, 2008, at 20:37:03
In reply to Re: HELP - hypertensive crisis on selegiline??, posted by seldomseen on January 24, 2008, at 12:54:24
> Well, a lot of what constitutes a hypertensive crisis depends on the patient, their present condition and previous medical history.
>
> But diastolic BPs of over 120 usually contstitute a hypertensive emergency.
>
> Diastolics over 140 represent a crisis.
>
> Now I'm not saying that you shouldn't be concerned at BPs lower than that, but that's what the data say.
>
> I would call your doc today and let him/her know what happened.
>
> Clonidine is a good med to have for hypertension.
Thanks for your help. Luckily, my MD was doing his day at the walk-in clinic, so I got to see him promptly. We decided: -1) My wrist BP monitor is a piece of crap and sometimes gives wildly inaccurate readings and is usually high. Toss it. (He gave me an arm-cuff for free that he just happened to have lying around!!!)
2) My BP was around normal for me (as of the last couple of months, i.e. a bit high ca. 140/85) when he measured it in the office, so probably my panic was unnecessary, and my med regime & diet are OK as is.
3) His suggestion is to consider systolic 200 or over as an immediate emergency. Taken with your diastolic figures, that gives me a much better criterion.
4) He doesn't want me to have an "emergency kit", such as nifedipine, suggested on another thread, as he's concerned about my level of preoccupation with self-treatment already.
5) My pdoc has just retired, but my MD is trying to get me in to see another one asap, & we'll defer any med. changes until then.
Thanks for responding,
Tony
Posted by trx resistant on January 27, 2008, at 2:01:47
In reply to Re: HELP - hypertensive crisis on selegiline?? » seldomseen, posted by Tony P on January 25, 2008, at 20:37:03
Tony,
Just try and not to worry about BP so much. I'm not MD, but medically well versed. BP can change every minute, every day, it can flucuate based on your position, lack of sleep, little virus, stress, water retention, and even in an ER a good nurse or dr. will, if there is any question, take your BP on each arm, twice and average it! So throw out that wrist thing and stop taking it, really, monitor once or twice a week and keep a log, if you must. But you will drive yourself crazy and cause a rise in BP!!!!
Posted by Tony P on February 1, 2008, at 15:23:57
In reply to Re: HELP - hypertensive crisis on selegiline??, posted by trx resistant on January 27, 2008, at 2:01:47
> Tony,
> Just try and not to worry about BP so much. I'm not MD, but medically well versed. BP can change every minute, every day, it can flucuate based on your position, lack of sleep, little virus, stress, water retention, and even in an ER a good nurse or dr. will, if there is any question, take your BP on each arm, twice and average it! So throw out that wrist thing and stop taking it, really, monitor once or twice a week and keep a log, if you must. But you will drive yourself crazy and cause a rise in BP!!!!
>You're absolutely right, I was driving myself crazy. Now that I have a reliable BP unit & have checked a couple of times that I'm about where expected (140/80) I can relax & assume that my med regime is as safe as can be expected, and I can eat blue cheese & olives in moderation without fear of reprisals.
I still have to avoid a few OTC meds, Sudafed & (somewhat to my surprise) Dextromethorphan.
I'm not doing particularly well at the moment -- mixed anxiety/depression keeps me housebound a lot of the time -- and I'm between pdocs, but the Selegeline helps to get me moving so I'm happy not to have to give it up. Or to have to micro-manage my BP!!
Thanks,
Tony
Posted by former trx resistant on February 2, 2008, at 3:02:11
In reply to Re: HELP - hypertensive crisis on selegiline?? » trx resistant, posted by Tony P on February 1, 2008, at 15:23:57
Tony:
We are here for you. I didn't go out for months, been there, too. 9 years, poor employment issues now, I doing extremely well- job interviews, moving, getting out to talk to people, etc. You will do great. Sit back, relax, watch Oprah or whatever and do force yourself out at least once a day. That's what I did when I started EMSAM. Walked a couple of blocks, slowly, WOW! there's a world I forgot! you will too!
Posted by Tony P on February 7, 2008, at 16:18:27
In reply to Re: HELP - hypertensive crisis on selegiline??, posted by former trx resistant on February 2, 2008, at 3:02:11
Thanks for the support, I really need it right now.
The BP "crisis" turned out to be a mirage caused by a faulty home BP wrist monitor (I have a reliable one now) but I still have to be careful -I had to cancel my dentist today because I realized at the last moment that typical freezing contains epinephrine or something similar, and that plus the novocaine or whatever could easily be a critical BP combo. Dentist phoned pharmacist, pharmacist said "absolutely not", so I have a reprieve on the dentist and instructions to stop the selegeline at least 24 hr prior to my new appointment. I actually think it should be 2 weeks as selegeline is very persistent.
So I don't have to go to the dentist today -- but the down side is I don't have anything to force me to leave the apartment! I will make myself go tou and run at least one errand however. And tomorrow I have a volunteer job for the afternoon which is always great for me - I answer phones and run a small office, and many of the calls involve helping other people with problems similar to my own, so it really helps by getting my focus off my own problems and feeling good about helping others.
Thanks again,
Tony
This is the end of the thread.
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