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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by okydoky on May 27, 2008, at 18:46:32
CAn this be done? Selegiline with Sub...? Parnate with oxycontin? I thought this was okay but now I read on another site that perhpas not?
I'm about ready to stop tryng anyway.
I'm tired. I don't knw how some of you deep this up. You're stronger than me I guess.
Good luck everybody,oky
Posted by Phillipa on May 27, 2008, at 20:29:44
In reply to Parnate and Suboxone?, posted by okydoky on May 27, 2008, at 18:46:32
What are you giving up on? Love Phillipa
Posted by okydoky on May 27, 2008, at 21:56:04
In reply to Re: Parnate and Suboxone? » okydoky, posted by Phillipa on May 27, 2008, at 20:29:44
Phillipa,
Trying to live. Not literally die. Just tryig to live.
But this post belongs in some other board. Not sure which.Thanks for caring,
oky
Posted by Sky Brite Line on May 27, 2008, at 23:54:09
In reply to Re: Parnate and Suboxone? » Phillipa, posted by okydoky on May 27, 2008, at 21:56:04
Please dont do anyhing dumb. The same thing with barbiturates is the same thing.
I hate opiates, there dumb, they make you drugged, i just need "anxiety" relief.
Posted by Phillipa on May 28, 2008, at 0:18:53
In reply to Re: Parnate and Suboxone? » Phillipa, posted by okydoky on May 27, 2008, at 21:56:04
Sounds like it does belong here as is about meds. Could post on psychology if any psychological issues you need help with. I'm usually around too. Phillipa
Posted by undopaminergic on May 28, 2008, at 6:25:47
In reply to Parnate and Suboxone?, posted by okydoky on May 27, 2008, at 18:46:32
> CAn this be done? Selegiline with Sub...? Parnate with oxycontin? I thought this was okay but now I read on another site that perhpas not?
>Most opioids can be used with MAOIs. However, tramadol, pethidine (meperidine), and possibly high doses of propoxyphene and methadone, can interact with MAOIs to produce serotin syndrome. However, some people have used tramadol with MAOIs without significant hyperserotonergia, so even those combinations may be safe if they are initiated with caution - that is, starting with very low doses.
Posted by SLS on May 28, 2008, at 6:46:47
In reply to Re: Parnate and Suboxone?, posted by undopaminergic on May 28, 2008, at 6:25:47
Hi UD
Can you comment specifically on the combination of Nardil + suboxone?
Thanks.
> Most opioids can be used with MAOIs. However, tramadol, pethidine (meperidine), and possibly high doses of propoxyphene and methadone, can interact with MAOIs to produce serotin syndrome. However, some people have used tramadol with MAOIs without significant hyperserotonergia, so even those combinations may be safe if they are initiated with caution - that is, starting with very low doses.
Posted by undopaminergic on May 28, 2008, at 11:28:26
In reply to Re: Parnate and Suboxone? » undopaminergic, posted by SLS on May 28, 2008, at 6:46:47
> Hi UD
>
> Can you comment specifically on the combination of Nardil + suboxone?
>
> Thanks.
>There is a single abstract on PubMed mentioning both drugs, and it suggests that the combination is free from any obvious interactions:
http://www.ncbi.nlm.nih.gov/pubmed/3345281As far as I know, no-one has tested the combination in humans.
Posted by SLS on May 28, 2008, at 12:14:46
In reply to Re: Parnate and Suboxone?, posted by undopaminergic on May 28, 2008, at 11:28:26
> > Hi UD
> >
> > Can you comment specifically on the combination of Nardil + suboxone?
> >
> > Thanks.
> >
>
> There is a single abstract on PubMed mentioning both drugs, and it suggests that the combination is free from any obvious interactions:
> http://www.ncbi.nlm.nih.gov/pubmed/3345281
>
> As far as I know, no-one has tested the combination in humans.
Darn. A friend of mine is taking suboxone for heroin addiction, but his depressive and anxiety symptoms make him a candidate for Nardil treatment, especially since he has been mostly resistant to other antidepressants.Thanks for the feedback.
- Scott
Posted by undopaminergic on May 28, 2008, at 14:03:41
In reply to Re: Parnate and Suboxone? » undopaminergic, posted by SLS on May 28, 2008, at 12:14:46
> > > Hi UD
> > >
> > > Can you comment specifically on the combination of Nardil + suboxone?
> > >
> > > Thanks.
> > >
> >
> > There is a single abstract on PubMed mentioning both drugs, and it suggests that the combination is free from any obvious interactions:
> > http://www.ncbi.nlm.nih.gov/pubmed/3345281
> >
> > As far as I know, no-one has tested the combination in humans.
>
>
> Darn. A friend of mine is taking suboxone for heroin addiction, but his depressive and anxiety symptoms make him a candidate for Nardil treatment, especially since he has been mostly resistant to other antidepressants.
>Why "darn"? Because it hasn't been tested in humans, or because the combination appears to be safe?
Posted by SLS on May 28, 2008, at 14:10:19
In reply to Re: Parnate and Suboxone?, posted by undopaminergic on May 28, 2008, at 14:03:41
> > > > Hi UD
> > > >
> > > > Can you comment specifically on the combination of Nardil + suboxone?
> > > >
> > > > Thanks.
> > > >
> > >
> > > There is a single abstract on PubMed mentioning both drugs, and it suggests that the combination is free from any obvious interactions:
> > > http://www.ncbi.nlm.nih.gov/pubmed/3345281
> > >
> > > As far as I know, no-one has tested the combination in humans.
> >
> >
> > Darn. A friend of mine is taking suboxone for heroin addiction, but his depressive and anxiety symptoms make him a candidate for Nardil treatment, especially since he has been mostly resistant to other antidepressants.
> >
>
> Why "darn"? Because it hasn't been tested in humans, or because the combination appears to be safe?I was hoping that there would be more evidence of the safety of this combination. He really needs to try Nardil. He has tried everything except for the MAOIs. Much of what he experiences besides moderate depression is social anxiety.
Do you know of anyone having used this treatment who demonstrated its safety?
Thanks again.
- Scott
Posted by undopaminergic on May 29, 2008, at 23:14:21
In reply to Re: Parnate and Suboxone? » undopaminergic, posted by SLS on May 28, 2008, at 14:10:19
>
> I was hoping that there would be more evidence of the safety of this combination. He really needs to try Nardil. He has tried everything except for the MAOIs. Much of what he experiences besides moderate depression is social anxiety.
>
> Do you know of anyone having used this treatment who demonstrated its safety?
>No, but I know that the opioids currently known to interact with MAOIs all affect the reuptake of serotonin, and according to one expert on serotonin toxicity, Dr. Ken Gillman, "Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs.".
One possible danger that may be unique to phenelzine and that doesn't apply to other MAOIs is the interactions of phenelzine's GABAergic metabolites with buprenorhpine (BUP). Co-administration of BUP and benzodiazepines has resulted in some deaths, but these were mostly in intravenous polysubstance abusers. If phenelzine is titrated with caution, this seems unlikely to be a serious danger.
Has this guy who "really needs to try Nardil" tried stimulants and memantine in combination with BUP? I'm wondering about this especially as there is theoretical potential for synergism between these drugs.
Posted by SLS on May 30, 2008, at 4:59:07
In reply to Re: Parnate and Suboxone?, posted by undopaminergic on May 29, 2008, at 23:14:21
Thanks a bunch for the information. I would not have known which opioids were safe to use in combination with Nardil.
As far as using stimulants, that would make sense to try first. Unfortunately, as a former substance abuser, his doctor will probably keep clear of them.
Out of curiosity, how does the synergism work among the four drugs: stimulants, Nardil, memantine, and suboxone?
Thanks for your time.
- Scott
Posted by okydoky on May 30, 2008, at 10:02:54
In reply to Re: Parnate and Suboxone?, posted by undopaminergic on May 29, 2008, at 23:14:21
Thanks for this information. I might start Suboxone next week. I am waiting until I know what pain med I am on to try any more antidepressatn meds. Parnate is on my short list as is Selegiline and trying th AMineptine with Suboxone. All this helps
oky
Posted by Crotale on June 1, 2008, at 12:32:04
In reply to Parnate and Suboxone?, posted by okydoky on May 27, 2008, at 18:46:32
I've been taking Buprenex + Parnate for several years now with no problems.
There are a few opioids, like meperidine/pethidine, that interact with MAOIs, but to the best of my knowledge buprenorphine is not one of them.
Good luck to you.
Crotale
Posted by undopaminergic on June 1, 2008, at 17:49:36
In reply to Re: Parnate and Suboxone? » undopaminergic, posted by SLS on May 30, 2008, at 4:59:07
> Thanks a bunch for the information. I would not have known which opioids were safe to use in combination with Nardil.
>By the way, the full article on MAOIs and opioids by Dr. Gillman is freely available:
http://bja.oxfordjournals.org/cgi/content/full/95/4/434
http://bja.oxfordjournals.org/cgi/reprint/95/4/434.pdf> As far as using stimulants, that would make sense to try first. Unfortunately, as a former substance abuser, his doctor will probably keep clear of them.
>The abuse risk can be substantially minimised by using stimulants that are difficult (ie. not worth the effort) to use in a non-intended manner, such as Concerta or Vyvanse, and further by prescribing limited amounts at a time.
> Out of curiosity, how does the synergism work among the four drugs: stimulants, Nardil, memantine, and suboxone?
>As a partial mu-agonist buprenorphine (BUP) quenches GABA output in the vental tegmental area (VTA), resulting in disinhibition and increased firing of VTA dopamine (DA) neurons, causing enhanced DA release in the nucleus accumbens (NAc). BUP also blocks kappa-opioid receptors (KORs), some of which are located on DA nerve terminals (in the NAc an elsewhere) and inhibit DA release when stimulated by endogenous dynorphin or exogenous kappa-agonists. Because stimulants seem to increase dynorphin release in the NAc, the blockade of KORs by BUP contributes to preventling a dynorphin-mediated attenuation of DA release in the NAc. Furthermore, stimulation of KORs produces deleterious changes in the longer term, including a reduction in DA D2-receptor density (pre- and postsynaptic) and a downregulation of the dopamine transporter protein, of which both mechanisms diminish responsiveness to stimulants. Moreover, activation of somatodentritic KORs located on a subset of VTA DA neurons projecting to the prefrontal cortex (PFC), inhibits the firing of these neurons and results in a decline of DA levels in the target region (PFC) - this can be expected to impact working memory, executive function, and some other higher cognitive functions.
Memantine, probably via its blockade of NMDA-receptors (I haven't studied the precise details), prevents, attenuates or reverses tolerance to opioids, such as BUP, and thus helps maintain efficacy of the drug. Because memantine also shows considerable promise in diminishing the development of tolerance to stimulants, the opportunity for synergism is further increased. Since memantine has antidepressant and stimulant-like qualities of its own, it may provide benefits beyond the prevention of tolerance to other drugs.
I currently don't have any data on how Nardil might interact with memantine or BUP. However the increased synaptic concentrations of DA resulting from BUP and/or stimulants would be further enhanced by the MAO inhibition of Nardil, although the increase would be attenuated by stimulation of presynaptic autoreceptors. There is also the complication of diminished synthesis of neurotransmitters in response to MAO inhibition, and I would not expect a significant effect on this from the other drugs, although the possibility can't be ruled out. One possiblity is that the combined use of the other drugs might rended low doses of Nardil effective, allowing maintenance of a degree of MAO inhibition low enough not to trigger the downregulation of neurotransmitter synthesis. This is mostly unexplored - or at least undocumented - territory.
Posted by Crotale on June 2, 2008, at 16:51:23
In reply to Re: Parnate and Suboxone?, posted by undopaminergic on June 1, 2008, at 17:49:36
This is interesting. I think I will think about asking my pdoc if he's willing to prescribe memantine or amantadine.
Dextromethorphan is known to interact with MAOIs, but it's a SRI. I don't know of any reports in the literature of interactions between MAOIs and NMDA antagonists that aren't SRIs.
Crotale
Posted by undopaminergic on June 3, 2008, at 4:56:03
In reply to Re: Parnate and Suboxone? » undopaminergic, posted by Crotale on June 2, 2008, at 16:51:23
Amantadine may not be potent enough, but it's worth a try because its so much cheaper.
Memantine is pricey, unless you buy it in bulk as a research chemical. (Contact me in private if you're interested in that.)
This is the end of the thread.
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