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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by mickapoo on February 22, 2009, at 15:19:02
I am on Nardil 75 mg. My psychiatrist told me to start on Parnate and gave me a prescription for 30 mg. He did not mention if I should stop cold turkey and immediately start Parnate the next day?
I would call him, but he's part of a clinic and only comes in monthly. Plus, they are only open 3 nights per week and it is almost impossible to get a hold of anyone.
Thank you!
Posted by myco on February 22, 2009, at 18:52:39
In reply to Washout period from Nardil to Parnate?, posted by mickapoo on February 22, 2009, at 15:19:02
Hi,
Some people are able to stop cold turkey from nardil and make the switch next day to parnate (as you may have heard on here). This is highly UNADVISABLE though as it can be potentially life threatening. The standard washout period of 10 to 14 days is called for when switching between these two maois.
May I ask why you bailed on nardil? What kind of issues were you having?
myco
>I am on Nardil 75 mg. My psychiatrist told me to start on Parnate and gave me a prescription for 30 mg. He did not mention if I should stop cold turkey and immediately start Parnate the next day?
Posted by mickapoo on February 22, 2009, at 21:06:53
In reply to Re: Washout period from Nardil to Parnate? » mickapoo, posted by myco on February 22, 2009, at 18:52:39
Hi myco,
Wow, I'm glad I asked then. I don't understand why the pdoc didn't tell me that. Then again, he didn't tell me much of anything.So, do I need to decrease the dosage slowly?
To answer your question about why I stopped taking it, I have severe social phobia and Nardil has not helped at all. I've been on it about 7 months now. I'm crossing my fingers that Parnate will bring some relief.
Thank you!
Posted by Justherself54 on February 22, 2009, at 22:18:03
In reply to Re: Washout period from Nardil to Parnate? » myco, posted by mickapoo on February 22, 2009, at 21:06:53
I've always gone 14 days between MAOI's. Better to be safe than sorry.
Posted by Phillipa on February 23, 2009, at 0:12:15
In reply to Re: Washout period from Nardil to Parnate?, posted by Justherself54 on February 22, 2009, at 22:18:03
Isn't Parnate more stimulating than nardil if so how will this help social phobia? Love Phillipa
Posted by SLS on February 23, 2009, at 7:01:47
In reply to Re: Washout period from Nardil to Parnate?, posted by Justherself54 on February 22, 2009, at 22:18:03
> I've always gone 14 days between MAOI's. Better to be safe than sorry.
I have never worked with a doctor who would let me go any shorter than 14 days between drugs. One of them reported a patient at the university going only 10 days and having a stroke. Coincidence? Who knows. It certainly spooked this doctor, though.
- Scott
Posted by Larry Hoover on February 23, 2009, at 8:08:53
In reply to Washout period from Nardil to Parnate?, posted by mickapoo on February 22, 2009, at 15:19:02
Okay, I see a number of cautionary statements in this thread, but I'm at a loss to understand how this specific drug transition could lead to an adverse event. Both drugs are irreversible inhibitors of MAO. I fail to see how neurotransmitter-based interactions could be created when MAO is already taken out. What else could cause a problem here?
Lar
Posted by SLS on February 23, 2009, at 8:31:30
In reply to Re: Washout period from Nardil to Parnate?, posted by Larry Hoover on February 23, 2009, at 8:08:53
This is one of those instances where we perhaps don't know enough about these drugs to enable us to make decisions based on the theories we create.
There seem to be at least a handful of strokes reported when an abrupt switch is instituted.
For instance, when starting Parnate immediately on top of Nardil, neurons don't have any time to accomodate the stimulant metabolites of Parnate or the Parnate molecule itself. You have full MAO inhibition when these sympathomimetic substances are first applied. When Parnate is titrated in the absence of MAO inhibition, the neurons can accomodate to the stimulants before significant MAO inhibition even occurs. Stroke.
Nardil can be stimulating, too, upon dosing. I think there is something going on with Nardil besides MAO inhibition and GABA transferase inhibition. I think it may be a catecholamine releaser. If so, then the same scenario can occur with the switch from Parnate to Nardil as I described for Nardil to Parnate. Stroke.
I'm just saying...
- Scott***************************************
Just did a Google search:
http://www.ncbi.nlm.nih.gov/pubmed/6686711Good guess, if I must say so myself.
I find these scenarios to be at least plausible. They serve as an example to remind us that what we don't know can hurt us.
- Scott
Posted by myco on February 23, 2009, at 10:52:36
In reply to Re: Washout period from Nardil to Parnate? » myco, posted by mickapoo on February 22, 2009, at 21:06:53
Hey,
Ya of course you want to make it as easy on yourself as you can by slowly decreasing/tapering that nardil down to zero then waiting the washout time period (for this longer is always better, hold out until you can't anymore...within reason). This taper may take more than a few weeks. It's advisable, unless you have the head of superman, to go slow...about 10-20% per week down in dose. The pills can be cut or you can crush them up in a mortar and divide the powder into 10 lines and go 9 lines first week then 8 the second etc...if you end up feeling like sh*t at some point stop then add a little back and wait then continue down, perhaps slower unless you dont mind the bumps in the road. You can also add a little benzo to the times you feel crappy. Ideally you dont want to go 75 to 60 then 45 to 15...may be too fast but thats me.
You might also be surprised to see what nardil was actually doing for you, in terms of good, when you are fully off of it for a number of weeks. For me there are ups and downs but on average my SP is way better. Some people say parnate is good for this also but others say its too stimulating. For me it will have to be either parnate or selegiline for maoi number 2 if nardil fails after time...no marplan in canada :-(
keep smilin
myco
> So, do I need to decrease the dosage slowly?
>
> To answer your question about why I stopped taking it, I have severe social phobia and Nardil has not helped at all. I've been on it about 7 months now. I'm crossing my fingers that Parnate will bring some relief.
>
> Thank you!
>
>
>
>
Posted by mickapoo on February 23, 2009, at 13:55:01
In reply to Re: Washout period from Nardil to Parnate? » mickapoo, posted by myco on February 23, 2009, at 10:52:36
My only other choice is to increase Nardil to 90 mg and see how that goes. But my psychiatrist doesn't think it will help.
One of my biggest questions is, being that I have been on Nardil for 7 months and all the side effects have gone away, if I start Parnate and say end up going back to Nardil in a few months, will I have the same side effects all over again? And will it take me 5 months to get over them like it did the last time?
Posted by myco on February 23, 2009, at 14:59:20
In reply to Re: Washout period from Nardil to Parnate? » myco, posted by mickapoo on February 23, 2009, at 13:55:01
ok...if youve experienced absolutely no benefit (this is defined as what YOU want/need in a med not really what your doc wants...it is your life not his/hers) then bail on the med but if you saw benefit during treatment that died at some point or got a "glimpse" of it along the way...you may want to continue to 90mg but thats a tough call as i'm sure the sides will get nastier at 90.
If you decide later to go back to nardil there is a chance it will not work the same (give you any benefit at all) or feel the same...this is common among AD users...especially those you switch over and over and over with little commitment. Although this doesnt always happen.
Yes the sides will be pretty much the same going back on and it will take time again to go through them and adjust. For me the nardil sides came and went in 2 weeks in a strange order or cycle as I called it...always ending a GABA kick or relaxation. If you took 5 months to get over them, as you said, it will most likely take the same...although then you would know what to expect and would probably (psycologically anyway) find them easier to deal with (ie no surprises). 5 months says you are very med sensitive and I would suggest you go slow when you taper nardil and start slow when you begin parnate...for your own sanity.
:-)
myco
> My only other choice is to increase Nardil to 90 mg and see how that goes. But my psychiatrist doesn't think it will help.
>
> One of my biggest questions is, being that I have been on Nardil for 7 months and all the side effects have gone away, if I start Parnate and say end up going back to Nardil in a few months, will I have the same side effects all over again? And will it take me 5 months to get over them like it did the last time?
Posted by mav27 on February 23, 2009, at 16:21:38
In reply to Re: Washout period from Nardil to Parnate? » myco, posted by mickapoo on February 23, 2009, at 13:55:01
Personally i would see if you can try the higher dose first. I have social phobia and nardil was the best but i switched to parnate because of side effects (switched without a washout period) but the parnate didn't help the social phobia at all. Problem now is that i've tried nardil again a couple times and it no longer works.
> My only other choice is to increase Nardil to 90 mg and see how that goes. But my psychiatrist doesn't think it will help.
>
> One of my biggest questions is, being that I have been on Nardil for 7 months and all the side effects have gone away, if I start Parnate and say end up going back to Nardil in a few months, will I have the same side effects all over again? And will it take me 5 months to get over them like it did the last time?
Posted by mickapoo on February 23, 2009, at 19:59:24
In reply to Re: Washout period from Nardil to Parnate? » mickapoo, posted by mav27 on February 23, 2009, at 16:21:38
> Personally i would see if you can try the higher dose first. I have social phobia and nardil was the best but i switched to parnate because of side effects (switched without a washout period) but the parnate didn't help the social phobia at all. Problem now is that i've tried nardil again a couple times and it no longer works.
What dosage of Nardil were you on when it was working for you, and how long did you take it for? What side effects made you switch?
Are you taking anything now that works for you?
I've read research that says Nardil and Parnate are supposed to be so good for SP, but yet I don't think I know of anyone who has had much success with Parnate in that area.
Posted by myco on February 23, 2009, at 22:47:28
In reply to Re: Washout period from Nardil to Parnate? » mav27, posted by mickapoo on February 23, 2009, at 19:59:24
hi mickapoo,
How do you respond to benzo's in terms of social anxiety? Do they relax you enough to function without getting overly anxious? See thats what I personally believe is one of the major things going on with nardil...it provides a nice gaba effect that also feels somewhat energetic. So that 90mg dose might hit it better for you. If you are taking benzos now and along with the nardil (im not sure of the accuracy of this theory) it may be possible that the gaba effect from the benzo is making you tolerant to nardil relaxing effect but I dunno...perhaps a pharm-guru (one of many among the ranks here in babble) can make more sense of this idea. Parnate doesnt have that relaxation feel to it from what I understand...it works differently. perhaps better for you though
myco
> > Personally i would see if you can try the higher dose first. I have social phobia and nardil was the best but i switched to parnate because of side effects (switched without a washout period) but the parnate didn't help the social phobia at all. Problem now is that i've tried nardil again a couple times and it no longer works.
>
> What dosage of Nardil were you on when it was working for you, and how long did you take it for? What side effects made you switch?
>
> Are you taking anything now that works for you?
>
> I've read research that says Nardil and Parnate are supposed to be so good for SP, but yet I don't think I know of anyone who has had much success with Parnate in that area.
Posted by mav27 on February 24, 2009, at 0:28:26
In reply to Re: Washout period from Nardil to Parnate? » mav27, posted by mickapoo on February 23, 2009, at 19:59:24
I'm currently taking valproate and alprozolam which helpes a fair bit and i just started imiparmine for the depression side of things. However i was have great success with valproate and lexapro but i stopped the lexapro because i thought it was causing my recent problem of having to sleep 15 hours a day but turns out it wasn't the cause after all, havn't actually found out whats causing it yet but i know it isn't the valproate either.
The nardil worked on exactly 3 weeks taking my starting dose of 45 mg. problem was i couldn't get out of bed or i would faint non stop. I tried it later on at 30mg but no luck and when i took it to 45mg i instantly started fainting again. third time i went all out and started at 90mg :) It was like being drunk for the first week and after that the only side effect was severe constipation but after a couple months still no posative results.
> > Personally i would see if you can try the higher dose first. I have social phobia and nardil was the best but i switched to parnate because of side effects (switched without a washout period) but the parnate didn't help the social phobia at all. Problem now is that i've tried nardil again a couple times and it no longer works.
>
> What dosage of Nardil were you on when it was working for you, and how long did you take it for? What side effects made you switch?
>
> Are you taking anything now that works for you?
>
> I've read research that says Nardil and Parnate are supposed to be so good for SP, but yet I don't think I know of anyone who has had much success with Parnate in that area.
Posted by mav27 on February 24, 2009, at 0:33:34
In reply to Re: Washout period from Nardil to Parnate? » mav27, posted by mickapoo on February 23, 2009, at 19:59:24
Just to add, i'm not taking the valproate for epilepsy or bipolar. I simply had run out of anti depressents to try so i asked if i could try valproate or lithium. I liked the sound of valproate because it's action talks about increasing GABA ect. Anyway as soon as i started taking it it was like my brain woke up and has made it easier for me to want to get out of the house and be around people ect and actually to me feels like a better anti depressant than the anti depressants.
Posted by Ron Hill on February 24, 2009, at 3:27:33
In reply to Washout period from Nardil to Parnate?, posted by mickapoo on February 22, 2009, at 15:19:02
> He did not mention if I should stop cold turkey and immediately start Parnate the next day?
Mick,
The Parnate Prescribing Information document specifies a washout period of at least a week with a low dosage start-up of Parnate. See the last paragraph on page two:
http://us.gsk.com/products/assets/us_parnate.pdf
On the other hand, the Nardil Prescribing Information document specifies a washout of 14 days between the discontinuation of Nardil and the start-up of another antidepressant. The document is not clear whether or not MAOIs are to be included under the category of antidepressants. See the paragraph starting about 16 lines down from the top of page 3:
http://www.pfizer.com/files/products/uspi_nardil.pdf
If it were me, Id rather be safe than sorry. Id go with the 14 days that Scott and others have mentioned above.
Also, since your p-doc did not provide you with adequate information, you might find it beneficial to read the entire Parnate Prescribing Information document.
-- Rondx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild OCPD
300 mg/day Trileptal
200 mg/day Lamictal
250 mg/day Keppra
60 mg/day NardilP.S. I plan to switch from Nardil to Parnate in the very near future due to a 50 pound Nardil-induced weight gain.
Posted by Ron Hill on February 24, 2009, at 10:58:37
In reply to Washout period from Nardil to Parnate?, posted by mickapoo on February 22, 2009, at 15:19:02
> He did not mention if I should stop cold turkey and immediately start Parnate the next day?
Mick,In contrast to the washout times that I referenced in my prior post, Dr Ken Gillman says that a four week washout is required.
http://www.psychotropical.com/MAOIs_Interactions.shtml
-- Ron
Posted by SLS on February 24, 2009, at 11:24:33
In reply to Re: Washout period from Nardil to Parnate? » mickapoo, posted by Ron Hill on February 24, 2009, at 10:58:37
> > He did not mention if I should stop cold turkey and immediately start Parnate the next day?
>
>
> Mick,
>
> In contrast to the washout times that I referenced in my prior post, Dr Ken Gillman says that a four week washout is required.
>
> http://www.psychotropical.com/MAOIs_Interactions.shtml
>
> -- Ron
Nardil to Parnate requires more time than Parnate to Nardil.
- Scott
Posted by myco on February 24, 2009, at 11:30:05
In reply to Re: Washout period from Nardil to Parnate?, posted by Ron Hill on February 24, 2009, at 3:27:33
> P.S. I plan to switch from Nardil to Parnate in the very near future due to a 50 pound Nardil-induced weight gain.
>
50lbs? jesus man, as a nardil user I feel for you as I am already getting chubby. 50lbs eh...something to look forward to in the future for me huh lol shall I put it on the right or left butt cheek? lolmyco
Posted by bleauberry on February 24, 2009, at 18:59:46
In reply to Re: Washout period from Nardil to Parnate?, posted by SLS on February 24, 2009, at 11:24:33
Scott, I thought you did a cross taper from Nardil to Parnate? Am I mistaken on that?
Posted by SLS on February 24, 2009, at 20:41:58
In reply to Re: Washout period from Nardil to Parnate? » SLS, posted by bleauberry on February 24, 2009, at 18:59:46
> Scott, I thought you did a cross taper from Nardil to Parnate? Am I mistaken on that?
No, I just came off of the Nardil pretty fast. I think it took me about two weeks to go from 90mg to zero. At that point I waited another two weeks before starting Parnate.
- Scott
Posted by desolationrower on February 27, 2009, at 3:44:48
In reply to Re: Washout period from Nardil to Parnate? » bleauberry, posted by SLS on February 24, 2009, at 20:41:58
i think starting titration low rather than waiting is better but thats what i do with my life. people in ill health should wait
-d/r
Posted by Mickapoo on March 9, 2009, at 11:11:36
In reply to Re: Washout period from Nardil to Parnate? » mickapoo, posted by myco on February 23, 2009, at 22:47:28
> hi mickapoo,
>
> How do you respond to benzo's in terms of social anxiety? Do they relax you enough to function without getting overly anxious? See thats what I personally believe is one of the major things going on with nardil...it provides a nice gaba effect that also feels somewhat energetic. So that 90mg dose might hit it better for you. If you are taking benzos now and along with the nardil (im not sure of the accuracy of this theory) it may be possible that the gaba effect from the benzo is making you tolerant to nardil relaxing effect but I dunno...perhaps a pharm-guru (one of many among the ranks here in babble) can make more sense of this idea. Parnate doesnt have that relaxation feel to it from what I understand...it works differently. perhaps better for you though
>
> myco
>Hi Myco,
I have found that benzos really don't help for my social phobia.
This is the end of the thread.
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