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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 AZLIZZY on September 21, 2008, at 0:38:57
Hi. I was hoping someone who has taken Nardil would be able to help me. I have been slowly increasing the dosage of Nardil I was prescribed by 15 mg since I began taking it in the middle of August. I am currently at 75 mg and have been for about 3 weeks. After the first 1 1/2 weeks on 75 mg, I felt better than I have in years. However, the last week has been really tough. I have become increasingly irritable and have had problems with anxiety cropping up again. I was wondering if anyone else has experienced this problem. Should I increase my dosage to 90 mg? What is the regular effective dosage? It seemed so hopeful. I'm really scared that I have run out of options. Any help or suggestions would be appreciated.
Posted by azalea on September 21, 2008, at 1:51:54
In reply to Nardil Dosage, posted by AZLIZZY on September 21, 2008, at 0:38:57
> Hi. I was hoping someone who has taken Nardil would be able to help me. I have been slowly increasing the dosage of Nardil I was prescribed by 15 mg since I began taking it in the middle of August. I am currently at 75 mg and have been for about 3 weeks. Should I increase my dosage to 90 mg? What is the regular effective dosage? It seemed so hopeful. I'm really scared that I have run out of options. Any help or suggestions would be appreciated.
>
I posted this in another thread, but will gladly repeat it here. A general rule for Nardil is 1mg/kg of body weight/day. If you're 150lbs (68kg), 75mg should be an effective dose. If you're closer to 200lbs (90kg), 90mg would be the target dose.Are you taking any other medications?
Re: running out of options, there are many combinations you could try, augmenting agents like Lithium, Deplin, even adding a low-dose TCA under close physician supervision.
Glad to hear the Nardil is providing some benefit.
Posted by AZLIZZY on September 21, 2008, at 9:22:12
In reply to Re: Nardil Dosage » AZLIZZY, posted by azalea on September 21, 2008, at 1:51:54
> I posted this in another thread, but will gladly repeat it here. A general rule for Nardil is 1mg/kg of body weight/day. If you're 150lbs (68kg), 75mg should be an effective dose. If you're closer to 200lbs (90kg), 90mg would be the target dose.Thank you for the info. My only concern is that by those calculations, I would be taking about 145 mg. Is that even safe? Maybe I just need to ask for something to supplement the Nardil. I seem to be having enough trouble with these side effects alone, without adding something else. I am taking Ativan as needed, but it doesn't seem to be doing anything for the irritation.
Posted by azalea on September 21, 2008, at 18:01:30
In reply to Re: Nardil Dosage, posted by AZLIZZY on September 21, 2008, at 9:22:12
Nardil 90 mg/day is the maximum according to the prescribing information. However, there are reports of some patients who respond well to 120 mg/day. You mentioned irritability and anxiety as side effects. Are you experiencing any other side effects? How is your sleep? Do you feel dizzy or light-headed when you go from sitting to standing?
>
> > I posted this in another thread, but will gladly repeat it here. A general rule for Nardil is 1mg/kg of body weight/day. If you're 150lbs (68kg), 75mg should be an effective dose. If you're closer to 200lbs (90kg), 90mg would be the target dose.
>
> Thank you for the info. My only concern is that by those calculations, I would be taking about 145 mg. Is that even safe? Maybe I just need to ask for something to supplement the Nardil. I seem to be having enough trouble with these side effects alone, without adding something else. I am taking Ativan as needed, but it doesn't seem to be doing anything for the irritation.
Posted by AZLIZZY on September 21, 2008, at 20:05:42
In reply to Re: Nardil Dosage » AZLIZZY, posted by azalea on September 21, 2008, at 18:01:30
> Nardil 90 mg/day is the maximum according to the prescribing information. However, there are reports of some patients who respond well to 120 mg/day. You mentioned irritability and anxiety as side effects. Are you experiencing any other side effects? How is your sleep? Do you feel dizzy or light-headed when you go from sitting to standing?
>
Thanks so much for your response. I do have some unpleasant side effects, namely diarrhea, muscle/joint pain in my knees and legs, insomnia, and jaw clenching. The diarrhea has gotten alot better over time, but the knee and leg pain has actually gotten worse. I have never had the lightheadedness or dizzyness related to the drug. I'm still willing to ride it out if it helps. The irritability and insomnia are things I have had for a long time before I started the nardil. I think they are signs of depression that is coming back. Each of the last few days have gotten a little bit worse. I don't know if I need to increase the dose or start something new. If I begin an SSRI, I will have to wait 2 weeks to start something else. I really crashed hard the last time I had nothing in my system. I have tried most classes of drugs over the last ten years. I have to get this under control before I can be released to go back to work. Thanks for your help.
Posted by azalea on September 21, 2008, at 21:41:16
In reply to Re: Nardil Dosage, posted by AZLIZZY on September 21, 2008, at 20:05:42
Have you tried a mood stabilizer like Lithium or Lamictal (lamotrigine)? The combination of anxiety, irritability, and depression could be "soft bipolar disorder." The website psycheducation.org has more information. It is written by Dr. Jim Phelps, author of the book "Why am I still depressed?"
You're right about the 2 week wash-out period between stopping Nardil and starting an SSRI. Since you're already on a therapeutic dose of Nardil, perhaps consider adding an augmenting agent before giving up. Options include Lithium, Lamictal, Deplin, possibly others--talk to your pdoc and see what your choices are. Best wishes and let us know what you decide.
> > Nardil 90 mg/day is the maximum according to the prescribing information. However, there are reports of some patients who respond well to 120 mg/day. You mentioned irritability and anxiety as side effects. Are you experiencing any other side effects? How is your sleep? Do you feel dizzy or light-headed when you go from sitting to standing?
> >
> Thanks so much for your response. I do have some unpleasant side effects, namely diarrhea, muscle/joint pain in my knees and legs, insomnia, and jaw clenching. The diarrhea has gotten alot better over time, but the knee and leg pain has actually gotten worse. I have never had the lightheadedness or dizzyness related to the drug. I'm still willing to ride it out if it helps. The irritability and insomnia are things I have had for a long time before I started the nardil. I think they are signs of depression that is coming back. Each of the last few days have gotten a little bit worse. I don't know if I need to increase the dose or start something new. If I begin an SSRI, I will have to wait 2 weeks to start something else. I really crashed hard the last time I had nothing in my system. I have tried most classes of drugs over the last ten years. I have to get this under control before I can be released to go back to work. Thanks for your help.
>
Posted by Tomatheus on September 21, 2008, at 22:56:24
In reply to Nardil Dosage, posted by AZLIZZY on September 21, 2008, at 0:38:57
AZLIZZY,
Your response to Nardil sounds similar to my response to the Australian Nardil before I started putting the contents of my Nardil tablets into enteric capsules. When I just took 75 mg/day of the Australian Nardil as it was manufactured, I responded for about two weeks before losing the antidepressant response. And after the antidepressant response faded, I did notice some irritability.
After I started preparing my Australian Nardil tablets in emptied-out enteric capsules, I went into full remission on 75 mg/day of the medication for a month (which is admittedly still a short period of time, but longer than the mere two-week response that I had before I tried using the capsules). I then switched to the version of Nardil that Pfizer manufactures for the U.S. market and started preparing those tablets in the enteric capsules, and I responded to the medication at 60 mg/day for two months.
When it comes to the film-coated Nardil, responses seem to vary from one individual to the next. A lot of patients found Nardil to be significantly less effective and less tolerable after Pfizer changed the medication from an enteric-coated product to a film-coated product in 2003. Still, some patients did not notice a difference. Other patients reported that it took a higher dose of the "new" Nardil to get the same effects of the "old" Nardil. It could very well be the case that you might respond to Nardil on a long-term basis if you increase your dose to 90 mg/day. I think that this option is definitely worth trying.
I do, however, suspect based on my experiences with Nardil that if you increase your dose that you very well may experience more of the same: a good response for about a week and a half, followed by a loss of efficacy and the emergence of irritability. I'm not saying that increasing the dose to 90 mg/day isn't worth trying. I think it is. I guess what I'm trying to do is anticipate what might happen next so you could take the next step if things don't work out at 90 mg. I know that this course of action sounds extreme, but I would actually recommend putting the contents of your Nardil tablets into enteric capsules if you could afford to do so. Of course, I'd completely understand if you were uneasy about taking this course of action.
If you're interested in using the enteric capsule approach, I'll give you the links of two old Psycho-Babble posts that describe how it's done:
http://www.dr-bob.org/babble/20050527/msgs/505052.html
http://www.dr-bob.org/babble/alter/20050510/msgs/506644.htmlAs far as I know, Psycho-Babble member Michael Bell is the first person to try transferring the contents of Nardil tablets into emptied-out enteric-coated PlasminPlus capsules to protect the medication from chemical degradation in the stomach. As I mentioned in a previous Psycho-Babble post, a Ph.D. thesis written by Gan-Lin Chen (1986) showed that Nardil's active ingredient undergoes chemical degradation 463 times as rapidly in stomach-like conditions (pH 1.94, hydrochloric acid buffer, aerobic conditions) than in conditions more similar to those in the small intestine (pH 7.33, phosphate buffer, anaerobic conditions).
Whatever you decide to do, I wish you luck in your trial with Nardil. I know that it can be a wonderful medication when its effectiveness is harnessed, but I also understand how frustrating it can feel when it stops working. I hope you find some of what I wrote to be helpful.
Tomatheus
==
REFERENCE
Chen, G.-L. (1986). The chemical kinetics of phenelzine degradation. Unpublished doctoral dissertation, University of Iowa, Iowa City.
==
> Hi. I was hoping someone who has taken Nardil would be able to help me. I have been slowly increasing the dosage of Nardil I was prescribed by 15 mg since I began taking it in the middle of August. I am currently at 75 mg and have been for about 3 weeks. After the first 1 1/2 weeks on 75 mg, I felt better than I have in years. However, the last week has been really tough. I have become increasingly irritable and have had problems with anxiety cropping up again. I was wondering if anyone else has experienced this problem. Should I increase my dosage to 90 mg? What is the regular effective dosage? It seemed so hopeful. I'm really scared that I have run out of options. Any help or suggestions would be appreciated.
>
>
Posted by AZLIZZY on September 21, 2008, at 23:44:31
In reply to Re: Nardil Dosage » AZLIZZY, posted by Tomatheus on September 21, 2008, at 22:56:24
Thank you all for your responses. I may see if the 90 mg tabs work. I'm starting to wonder if I may have some bipolar symptoms. I seem to be cycling between depression, anxiety and irritability. I don't know if bipolar has any of these features. I never considered it because I have never experienced euphoria, only anger and irritability. Thanks again for your help and the links.
Posted by ja on October 1, 2008, at 9:50:04
In reply to Re: Nardil Dosage, posted by AZLIZZY on September 21, 2008, at 20:05:42
I was wondering if anyone has experienced bad side effects almost immediately after reducing the dosage on Nardil? I started Nardil 3 months ago and started at 15mg and worked myself up to 90 mg. At 60 mg, I started noticing some positive changes. I went up to 90 and was there a few weeks. The Nardil continued to work but I wasn't experiencing anymore positive effect than at 60mg, and had some increased side effects. I decided that since the side effects weren't as bad at 60mg, that I would drop to 75mg for 1 week and then down to 60mg and stay there.
Unfortunately I have taken a big step back as a result of this. My depression and anxiety has resurfaced, and I regret so much having done this.
I have decided to go back up to 90mg and I am hoping that I will return to the person I was just a few weeks ago. I did not think that my reducing back down to 60mg, where I was once content, that I would have to be in this bad situation that I am in.Has anyone experienced this type of situation? Should I stay at 60mg and eventually the side effects will pass? Should I go back up to 90mg and hope for a positive return to stability? I am supposed to be at 90mg according to my body weight. However like I said I did not feel any positive difference between 60 and 90, but I have felt a horrible difference by reducing my dosage 30mg. What is the best way to taper down off Nardil, if I decide to reduce my dosage again?
I have also been experiencing some bad aches and pains throughout my body for a few weeks. I have read where this is a common side effect of Nardil. Will this eventually pass with time.
Posted by AZLIZZY on October 1, 2008, at 10:15:09
In reply to Re: Nardil Dosage » AZLIZZY, posted by ja on October 1, 2008, at 9:50:04
> I was wondering if anyone has experienced bad side effects almost immediately after reducing the dosage on Nardil? I started Nardil 3 months ago and started at 15mg and worked myself up to 90 mg. At 60 mg, I started noticing some positive changes. I went up to 90 and was there a few weeks. The Nardil continued to work but I wasn't experiencing anymore positive effect than at 60mg, and had some increased side effects. I decided that since the side effects weren't as bad at 60mg, that I would drop to 75mg for 1 week and then down to 60mg and stay there.
> Unfortunately I have taken a big step back as a result of this. My depression and anxiety has resurfaced, and I regret so much having done this.
> I have decided to go back up to 90mg and I am hoping that I will return to the person I was just a few weeks ago. I did not think that my reducing back down to 60mg, where I was once content, that I would have to be in this bad situation that I am in.
>
> Has anyone experienced this type of situation? Should I stay at 60mg and eventually the side effects will pass? Should I go back up to 90mg and hope for a positive return to stability? I am supposed to be at 90mg according to my body weight. However like I said I did not feel any positive difference between 60 and 90, but I have felt a horrible difference by reducing my dosage 30mg. What is the best way to taper down off Nardil, if I decide to reduce my dosage again?
>
> I have also been experiencing some bad aches and pains throughout my body for a few weeks. I have read where this is a common side effect of Nardil. Will this eventually pass with time.I'm sorry that you are having such a hard time w/ the nardil dosage. I don't know if I can help answer your questions. I've been on nardil since the middle of August. Once I got to 75 mg, it really started helping me for about a week or two. However, it stopped working and I still had the side effects, including the aches and pains you wrote about. I didn't go up to 90 mg, because I was concerned about more intense side effects. The doctor put me on Abilify a couple of weeks ago, in addition to the nardil and it has made a world of difference. My side effects from the nardil are gone now. However, I don't know if it's that time has passed or if the abilify is counteracting the nardil effects. I hope that your side effects do lessen or go away with time. Good luck!
Posted by Mickapoo on October 3, 2008, at 10:05:55
In reply to Re: Nardil Dosage, posted by AZLIZZY on September 21, 2008, at 20:05:42
>> I do have some unpleasant side effects, namely diarrhea, muscle/joint pain in my knees and legs, insomnia, and jaw clenching.>
I, too, had jaw clenching for a little while but this did go away for me. I'm on 75mg.
This is the end of the thread.
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