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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Cseagraves on March 16, 2009, at 20:26:09
Do you have to wait two weeks when switching from Nardil to Parnate?
Courtney
Posted by ParnateStarted2008 on March 17, 2009, at 0:09:03
In reply to Nardil to Parnate, posted by Cseagraves on March 16, 2009, at 20:26:09
Yes, its a good idea so not to risk serotonin syndrome.. Most people can switch between one Maoi and another overnight at equivalent dosages or a little less on the new MAOI.. Its commonly done but it will be against the doctors/the drug makers safety protocol.
I did Nardil 105mg/day to Parnate 40mg/day overnight. But I was desperate and Im very drug tolerant sadly. I dont recomend it but it has been don like ssri to ssri
Posted by Phillipa on March 17, 2009, at 1:02:26
In reply to Re: Nardil to Parnate » Cseagraves, posted by ParnateStarted2008 on March 17, 2009, at 0:09:03
Hi Parnate welcome back. Love Phillipa
Posted by desolationrower on March 17, 2009, at 1:05:16
In reply to Nardil to Parnate, posted by Cseagraves on March 16, 2009, at 20:26:09
yes, you probably will. if i was taking it, i would just start at a low parnate dose, but doctors 'know' you 'should' wait 2 weeks.
-d/r
Posted by bleauberry on March 17, 2009, at 16:39:12
In reply to Nardil to Parnate, posted by Cseagraves on March 16, 2009, at 20:26:09
There was a discussion here on this topic very recently. The overall consensus was that yes you definitely need a 2 week washout. Even SLS did the two week wait, and he is pretty aggressive with meds. Someone had a serious emergency when they didn't wait the two weeks. Serotonin syndrome does not seem to be the problem. There is other stuff going on. Keep in mind, these drugs do a lot more than just MAO inhibition, much of which we don't know.
Nardil to Parnate without a washout...not cool in my book. I'm sure it has been done, but that doesn't make it reasonable or safe. The MAOIs are in the big leagues, a totally different game than other psychotropic meds. In the MAOI game, the penalties for wrong moves are much stiffer.
SLS has probably one of the best psychopharmacologists. SLS himself is a pro at this stuff. If his doctor insists on a 2 week washout, and if SLS agreed himself, then that to me means it is very important.
Posted by TJ99 on March 18, 2009, at 2:55:12
In reply to Nardil to Parnate, posted by Cseagraves on March 16, 2009, at 20:26:09
> Do you have to wait two weeks when switching from Nardil to Parnate?
>
> CourtneyI didn't. I recently switched from Nardil to Parnate. I had been at 90 mg of Nardil (I weigh about 200) but was hospitalized due to bradycardia so my doctor cut my dosage to 60 mg. I wasn't really impressed with my doctor's knowledge of MAOIs in general so I switched to someone that has more experience with them. I was taking such a low (for me) dose of Nardil it wasn't doing anything for me. I didn't even have any of the side effects anymore. My new doctor had me ramp down on the Nardil and up on the Parnate simultaneously:
Wk 1: 40 mg Nardil, 10 mg Parnate
Wk 2: 30 mg Nardil, 20 mg Parnate
Wk 3: 20 mg Nardil, 40 mg Parnate
Wk 4: 0 mg Nardil, 60 mg ParnateIn reality though, I ran out of Nardil about two days into it, and didn't refill it. So I wound up quitting the Nardil cold turkey and ramping up on the Parnate. About the only things I've noticed so far, good or bad, are tremendous fatigue and insomnia (as evidenced by my being awake in bed and typing this at almost 3 am).
Good luck,
TJ
Posted by myco on March 18, 2009, at 10:33:55
In reply to Re: Nardil to Parnate » Cseagraves, posted by TJ99 on March 18, 2009, at 2:55:12
Please no offense to you or your dr but...are you sure he/she actually knows what they are doing and what risk they take, on your part, of this treatment approach. Mixing those two (search online) can literally kill you:
http://www.dr-bob.org/babble/20090313/msgs/885862.html
> > Do you have to wait two weeks when switching from Nardil to Parnate?
> >
> > Courtney
>
> I didn't. I recently switched from Nardil to Parnate. I had been at 90 mg of Nardil (I weigh about 200) but was hospitalized due to bradycardia so my doctor cut my dosage to 60 mg. I wasn't really impressed with my doctor's knowledge of MAOIs in general so I switched to someone that has more experience with them. I was taking such a low (for me) dose of Nardil it wasn't doing anything for me. I didn't even have any of the side effects anymore. My new doctor had me ramp down on the Nardil and up on the Parnate simultaneously:
>
> Wk 1: 40 mg Nardil, 10 mg Parnate
> Wk 2: 30 mg Nardil, 20 mg Parnate
> Wk 3: 20 mg Nardil, 40 mg Parnate
> Wk 4: 0 mg Nardil, 60 mg Parnate
>
> In reality though, I ran out of Nardil about two days into it, and didn't refill it. So I wound up quitting the Nardil cold turkey and ramping up on the Parnate. About the only things I've noticed so far, good or bad, are tremendous fatigue and insomnia (as evidenced by my being awake in bed and typing this at almost 3 am).
>
> Good luck,
> TJ
Posted by desolationrower on March 19, 2009, at 0:23:30
In reply to Re: Nardil to Parnate » TJ99, posted by myco on March 18, 2009, at 10:33:55
i don't think mixing the two is helpful. thats the worst option.
-d/r
Posted by Ron Hill on March 23, 2009, at 0:15:44
In reply to Nardil to Parnate, posted by Cseagraves on March 16, 2009, at 20:26:09
> Do you have to wait two weeks when switching from Nardil to Parnate?
-------------Courtney,
The Parnate Prescribing Information document says to wait "at least one week". See the bottom of page 2:
http://us.gsk.com/products/assets/us_parnate.pdf
-- Ron
Posted by SLS on March 23, 2009, at 7:04:51
In reply to Re: Nardil to Parnate » Cseagraves, posted by Ron Hill on March 23, 2009, at 0:15:44
> > Do you have to wait two weeks when switching from Nardil to Parnate?
> -------------
>
> Courtney,
>
> The Parnate Prescribing Information document says to wait "at least one week". See the bottom of page 2:
>
> http://us.gsk.com/products/assets/us_parnate.pdf
>
> -- Ron
I can't provide any proof of this (I forgot where I read it), but I think it is much more important to wait 14 days going from Nardil to Parnate than it is for the reverse. Nardil has a half-life that is 5-6 times longer than that of Parnate, and it is influenced by its own presence. It inhibits its own metabolism through the very mechanism that gives it its therapeutic effect - MAO inhibition. I think its half-life is exponential at 60mg per day and above. MAO inhibition just seems to persist longer with Nardil. I believe that the rate of elimination of Nardil and the recovery of MAO activity are just too variable to take a chance on waiting less than 2 weeks between its discontinuation and the initiation of Parnate treatment. Parnate can produce a hypertensive event in the absence of prior MAO inhibition. This risk must certainly be higher when residual MAOI is present.There are more than just a handful of anecdotes describing cerebrovascular accident (CVA) as a consequence of switching between MAOIs too quickly.
- Scott
Posted by Chihuahua on March 24, 2009, at 23:18:05
In reply to Re: Nardil to Parnate » Cseagraves, posted by TJ99 on March 18, 2009, at 2:55:12
While we are on the subject of changing from Nardil to Parnate,I would appreciate if someone has helpful experience about their personal time period it took for them to get a good feeling from taking Parnate.
I always get a very fast response to antidepressants, and yet , here I am , 3 weeks after starting Parnate, and I feel so depressed and bed bound.
Is it worth me pressing on with Parnate trial, or am i likely to be a non responder to Parnate?
How many other people out there do not respond to Parnate.
I respond brilliantly and immediately to nardil, but weight gain is massive.
Posted by Questionmark on March 26, 2009, at 16:01:26
In reply to Re: Nardil to Parnate, posted by SLS on March 23, 2009, at 7:04:51
Great post. He's absolutely right. I definitely think it is much more important to wait when going from Nardil to Parnate than vise versa. In addition to everything else mentioned, Parnate can be not only unpleasant but dangerous if enough (/any?) Nardil is still in your body. Yes, not the risk of serotonin syndrome, but a serious risk of hypertensive crisis.
I've taken even a quarter of a Parnate pill before while on Nardil 45mg and it gave me malaise and overall uncomfortable feelings, with significant nervousness and drowsiness at the same time (tiny doses of Adderall on Nardil did the same thing). I believe this is primarily mediated through improper adrenergic activity.I am not a major drug-risk spokesman, but DO NOT TAKE PARNATE UNTIL NARDIL IS SUFFICIENTLY OUT OF YOUR SYSTEM. Everyone considering this switch needs to remember this. This is not something to mess around with.
> I can't provide any proof of this (I forgot where I read it), but I think it is much more important to wait 14 days going from Nardil to Parnate than it is for the reverse. Nardil has a half-life that is 5-6 times longer than that of Parnate, and it is influenced by its own presence. It inhibits its own metabolism through the very mechanism that gives it its therapeutic effect - MAO inhibition. I think its half-life is exponential at 60mg per day and above. MAO inhibition just seems to persist longer with Nardil. I believe that the rate of elimination of Nardil and the recovery of MAO activity are just too variable to take a chance on waiting less than 2 weeks between its discontinuation and the initiation of Parnate treatment. Parnate can produce a hypertensive event in the absence of prior MAO inhibition. This risk must certainly be higher when residual MAOI is present.
>
> There are more than just a handful of anecdotes describing cerebrovascular accident (CVA) as a consequence of switching between MAOIs too quickly.
>
>
> - Scott
Posted by desolationrower on March 27, 2009, at 2:31:36
In reply to Re: Nardil to Parnate » TJ99, posted by Chihuahua on March 24, 2009, at 23:18:05
what dose of parnate?
-d/r
Posted by Chihuahua on March 28, 2009, at 5:45:45
In reply to Re: Nardil to Parnate » Chihuahua, posted by desolationrower on March 27, 2009, at 2:31:36
> what dose of parnate?
>
> -d/r
Thanks for answering my question on time taken to respond to parnate I had been on Parnate 30mg in divided doses throghout earlier part of day. My medical practitioner was allowing me ritalan 10mg in morning..After my last post I realised that I was dangerously depressed, and made the decision that after each dose of parnate, I felt worse. Thus I decided to slowly get off the parnate, and forget all about my outdated dreams of success with MAOI's.
As I cut back to 10mg parnate in am , I started to take 20mg ritalan bd. ( I am medically qualified, and i kept a close eye on my B.P. At last, I was able to get out of bed and achieve small goals. With some successful goals achieved , my depression was
lessening, and I could function physically, but by bedtime the
depression was awful.
Today, I have addressed the severe night time depression by taking a second Parnate 10mg late this afternoon. So far, so good--no ugly depression this evening.
I see my medical superviser this week. She is not a "Specialist", but she has a lot of commonsense and experience.
Thankyou once again for caring.I really appreciate your time.
Posted by desolationrower on March 28, 2009, at 20:57:35
In reply to Re: Nardil to Parnate » desolationrower, posted by Chihuahua on March 28, 2009, at 5:45:45
when starting parnate, fatigue is very common. 30mg is supposedly a good dose, but i think majority of people need more. i need at least 40mg to get an antidepressant response. the fatigue effects went away after a month at 40mg for me. i would recommend trying a higher dose before giving up on it.
if it really is fatigue that is your main problem, perhaps you have a sleep disorder? have you done stimulant monotherapy in teh past?
-d/r
Posted by Mickapoo on May 2, 2009, at 18:39:40
In reply to Nardil to Parnate, posted by Cseagraves on March 16, 2009, at 20:26:09
My pharmacist AND doctor told me you should not skip a day between the two. I decreased the dosage of Nardil until I was down to one pill a day, then the next day started Parnate.
This is the end of the thread.
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