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Dr. Bob is Robert Hsiung, MD,
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Posted by ace on April 2, 2010, at 12:36:53
In reply to Nardil Europhic Question Please Read VETS, posted by mike0388 on April 2, 2010, at 2:09:03
> I start my Nardil 15 mg to begin with, then 30 mg for the rest of the month, my question is:
>
> I understand there will be some "Europhic" with this medicationNot necessarily. Furthermore, it is hard to distinguish between the euphoria and therapeutic effects. I have seen Nardil cause euphoria in many. However, this euphoria does not impair the senses or cause self-destructive behavior. Only rarely, I have seen some people get a little over-excited and overspend, or get very very talkative and friendly (myself being one of them!)
and I do understand that poops out.
Once again, not always. I have seen great reactions sustained over very long periods of times- decades. If 'poop-out' (tachyphylaxis) happens, there is ways to retain the great effects.
But this isnt the reason I want to take the medication. The reason I want to take it is to help with my severe social phobia.It is the best treatment for SP. A side effect may indeed be a feeling of happiness or euphoria. That's not a bad side effect! And, like I said, I don't think any bad will come of it. Unfortunately the drugs are not targeted well enough to treat any psychiatric syndrome exclusively...as we really don't know what is causing these problems!
> Now will Nardil continue to work even though the "Europhic" phase is gone?This phase might not go. It may be inherent to the treatment.
But really, try not to worry about this too much. Just have faith. I remembered worrying about all sorts of things before taking Nardil- then I thought "what the heck was I worried for!?"
Peace,
Ace
Posted by conundrum on April 2, 2010, at 13:33:34
In reply to Re: To the VETERANS on this board MAOI Question » mike0388, posted by ace on April 2, 2010, at 12:25:12
interestingly my grandmom found 60 was too high and said that she remembers it starting to work much sooner. She was suffering from phobias mainly.
Posted by ace on April 2, 2010, at 14:09:58
In reply to Re: To the VETERANS on this board MAOI Question » ace, posted by conundrum on April 2, 2010, at 13:33:34
> interestingly my grandmom found 60 was too high and said that she remembers it starting to work much sooner. She was suffering from phobias mainly.
That doesn't greatly surprise me, older people generally need lower doses. I thought Mike was a young individual.
Posted by mike0388 on April 2, 2010, at 14:14:20
In reply to Re: To the VETERANS on this board MAOI Question » conundrum, posted by ace on April 2, 2010, at 14:09:58
I am in my mid twenties. I was just trying to gradually adapt to the medication. Should I wait a month to go up to 45 mg?
Posted by mike0388 on April 2, 2010, at 14:16:30
In reply to Re: Nardil Europhic Question Please Read VETS » mike0388, posted by ace on April 2, 2010, at 12:36:53
Man! Thanks for the awesome response.
Should I wait a month to go up to 45 mg, should I talk to my Pdoc about this? My first dose is 15 mg for four days, then 30 mg taken twice a day.
Posted by mike0388 on April 2, 2010, at 19:33:50
In reply to Nardil Europhic Question Please Read VETS, posted by mike0388 on April 2, 2010, at 2:09:03
Ace -
Sorry for the double post, I have a question maybe you can help me out since your also on Nardil.Like i said before, i'm on 15 mg for 4 days, then 30 mg the rest of the 90 pills I have been prescribed. I was reading you said 30 mg isn't goign to help that much, do you think after half of the 90 pills I should call my pdoc and ask if i can up the dosage to 45 mg, or should i take all 90 pills at the 30 mg rate and then wait to up the dosage?
Posted by ace on April 2, 2010, at 20:02:30
In reply to Re: Nardil Europhic Question Please Read VETS, posted by mike0388 on April 2, 2010, at 19:33:50
> Ace -
> Sorry for the double post, I have a question maybe you can help me out since your also on Nardil.That's OK!
>
> Like i said before, i'm on 15 mg for 4 days, then 30 mg the rest of the 90 pills I have been prescribed.You will be taking 15mg twice a day?
I was reading you said 30 mg isn't goign to help that much,
It MAY, but I doubt it strongly.
do you think after half of the 90 pills I should call my pdoc and ask if i can up the dosage to 45 mg, or should i take all 90 pills at the 30 mg rate and then wait to up the dosage?
You get 100 pills in a bottle, right?
Well, I would ask your psychiatrist how much he prescribes Nardil. He may or may not be reluctant to up the dosage. I would personally sort out a dosing schedule. The one I recommend, and this comes not only from my experience, but from reading a LOT on Nardil, is thus:
1. Raise dose slowly for 14 days up to 60mg. Within this period, if s/effects too strong, drop the dose temporarily.
2. Once you reach the 14 day mark, you should be up to a dose of 60mg. Stay on this for 4 weeks.
Please feel free to ask further qstns:)
Ace
Posted by ace on April 2, 2010, at 20:06:02
In reply to Re: Nardil Europhic Question Please Read VETS, posted by mike0388 on April 2, 2010, at 14:16:30
> Man! Thanks for the awesome response.
>
> Should I wait a month to go up to 45 mg, should I talk to my Pdoc about this?Talk to him! I think he may be being overly cautious. You know about the diet and possible s/effects?
My first dose is 15 mg for four days,
then 30 mg taken twice a day.that's 15mg twice daily? i.e. total of 30mg daily?
Posted by mike0388 on April 2, 2010, at 22:46:14
In reply to Re: Nardil Europhic Question Please Read VETS » mike0388, posted by ace on April 2, 2010, at 20:06:02
It's 1 tablet of 15mg day for the first 4 days (starting tomorrow) then 4 days later, 30mg total a day. He wrote my prescription over a month ago, I was tapering off my Zoloft 200 mg prescription and I got auto filled again, so now I have 90 nardil 15 mg pills.
He told me when I asked for Nardil because I've been on several SSRI's at max doses and it didn't at all help my social phobia. I am not depressed, but suffer from severe social phobia, it really sucks. I asked him if i could try Nardil and he said he hadn't prescribed an MAOI in twenty years, but he didnt have any problem prescribing it to me. He said there was food restrictions which we looked in his book and discussed about and drug restrictions, but I don't know if I should just take the max dose of 30mg/day until all those 90 pills run out, or half way through it call him up and set up an appt. and ask to go to 45mg/day.
Posted by Ron Hill on April 3, 2010, at 9:02:24
In reply to Re: To the VETERANS on this board MAOI Question, posted by mike0388 on April 2, 2010, at 14:14:20
> Should I wait a month to go up to 45 mg?
Mike,
Many p-docs quoted in the literature say the proper dosage is typically 1 mg/kg (i.e.; 1 mg of Nardil per kg of body weight).
With regard to how fast you ramp up the dosage, here is the Prescribing Information document for Nardil published by Pfizer, the maker of Nardil. On page eleven, read the Initial dose and the Early phase treatment sections. However, pay no attention to the Maintenance dose section; lowering the dosage in the maintenance phase is a bunch of baloney. Ask Ace; he knows. Here's the link:
http://www.pfizer.com/files/products/uspi_nardil.pdf
-- Ron
dx: Bipolar II with ultra rapid cycling, and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
1.9 mg/day Deplin (taken with methyl B-12 and P-5-P)
Dark therapy via LowBlueLight glasses
High dosage of fish oil, 300 mg/day phosphatidylserene, and several other vitamins and supplements
Posted by mike0388 on April 3, 2010, at 15:46:50
In reply to Re: To the VETERANS on this board MAOI Question » mike0388, posted by Ron Hill on April 3, 2010, at 9:02:24
Thank you Ron Hill for the response. What I found most interesting from the link is, it says once you reach the max. benefit from Nardil, to decrease over several weeks, even down to 1 15mg pill a day? Is this because the nardil is in your system already and there is no need for multiple pills?
DOSAGE AND ADMINISTRATION
Initial dose: The usual starting dose of NARDIL is one tablet (15 mg) three times a day.
Early phase treatment: Dosage should be increased to at least 60 mg per day at a fairly
rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to
90 mg per day to obtain sufficient MAO inhibition. Many patients do not show a clinical
response until treatment at 60 mg has been continued for at least 4 weeks.
Maintenance dose: After maximum benefit from NARDIL is achieved, dosage should be
reduced slowly over several weeks. Maintenance dose may be as low as one tablet, 15
mg, a day or every other day, and should be continued for as long as is required.
Posted by mike0388 on April 3, 2010, at 16:17:02
In reply to Re: To the VETERANS on this board MAOI Question » Ron Hill, posted by mike0388 on April 3, 2010, at 15:46:50
Hey everyone I have a question. On the link provided by pfizer (above) says to take 3 tablets of 15mg a day.
Now my pdoc has prescribed me 1 15mg a day, and at the 4th day to increase up to 2 tablets of 15mg a day so total of 30 mg a day. Which contradicts what Pfizer says, I dont know what to believe.
I read that link to my mother and she disagreed and said I should listen to the pdoc to take 2 15mg tablets a day (total of 30mg/day) from the fourth day and on. Any suggetions what I should do?
Posted by ace on April 5, 2010, at 8:39:56
In reply to Re: Nardil Europhic Question Please Read VETS, posted by mike0388 on April 2, 2010, at 22:46:14
>
I've been on several SSRI's at max doses and it didn't at all help my social phobia.doesn't surprise me greatly.
I am not depressed, but suffer from severe social phobia, it really sucks.
What are your main symptoms?
I asked him if i could try Nardil and he said he hadn't prescribed an MAOI in twenty years, but he didnt have any problem prescribing it to me.He sounds like a good MD!
He said there was food restrictions which we looked in his book and discussed about and drug restrictionsThere is, and you must adhere to this. Look for 'A revised MAOI diet'. The diet really isn't so bad. Never ever take an SSRI with Nardil. Before starting any drug with Nardil, if you absolutely must, make sure there is no interaction. Ask your doctor, pharmacy and on this board. You must never take Demerol either.
but I don't know if I should just take the max dose of 30mg/day until all those 90 pills run out, or half way through it call him up and set up an appt. and ask to go to 45mg/day.
Bump it up to 45mg, then 60mg ASAP.
Ace
Posted by ace on April 5, 2010, at 8:41:15
In reply to Re: To the VETERANS on this board MAOI Question » mike0388, posted by Ron Hill on April 3, 2010, at 9:02:24
> > Should I wait a month to go up to 45 mg?
>
> Mike,
>
> Many p-docs quoted in the literature say the proper dosage is typically 1 mg/kg (i.e.; 1 mg of Nardil per kg of body weight).Correct.
> With regard to how fast you ramp up the dosage, here is the Prescribing Information document for Nardil published by Pfizer, the maker of Nardil. On page eleven, read the Initial dose and the Early phase treatment sections. However, pay no attention to the Maintenance dose section;lowering the dosage in the maintenance phase is a bunch of baloney.
I would agree! Never seen or heard of this work.
Ask Ace; he knows. Here's the link:
>
> http://www.pfizer.com/files/products/uspi_nardil.pdf
>
> -- Ron
>
> dx: Bipolar II with ultra rapid cycling, and mild OCPD
>
> 600 mg/day Trileptal
> 200 mg/day Lamictal
> 500 mg/day Keppra
> 90 mg/day Nardil
> 1.9 mg/day Deplin (taken with methyl B-12 and P-5-P)
> Dark therapy via LowBlueLight glasses
> High dosage of fish oil, 300 mg/day phosphatidylserene, and several other vitamins and supplements
>
>
>
Posted by ace on April 5, 2010, at 8:47:00
In reply to Re: To the VETERANS on this board MAOI Question » Ron Hill, posted by mike0388 on April 3, 2010, at 15:46:50
> Thank you Ron Hill for the response. What I found most interesting from the link is, it says once you reach the max. benefit from Nardil, to decrease over several weeks, even down to 1 15mg pill a day? Is this because the nardil is in your system already and there is no need for multiple pills?
I don't know why they state that. You have to achieve what's called "MAO inhibition" (-%80)
A reduction in dose would lessen this, thus reducing (or obliterating) the therapeutic effects.I have not seen any evidence to support this maintenance dose recommendation
> DOSAGE AND ADMINISTRATION
> Initial dose: The usual starting dose of NARDIL is one tablet (15 mg) three times a day.
> Early phase treatment: Dosage should be increased to at least 60 mg per day at a fairly
> rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to
> 90 mg per day to obtain sufficient MAO inhibition. Many patients do not show a clinical
> response until treatment at 60 mg has been continued for at least 4 weeks.
> Maintenance dose: After maximum benefit from NARDIL is achieved, dosage should be
> reduced slowly over several weeks. Maintenance dose may be as low as one tablet, 15
> mg, a day or every other day, and should be continued for as long as is required.
Posted by ace on April 5, 2010, at 8:58:50
In reply to Re: To the VETERANS on this board MAOI Question » mike0388, posted by mike0388 on April 3, 2010, at 16:17:02
> Hey everyone I have a question. On the link provided by pfizer (above) says to take 3 tablets of 15mg a day.
That is a general recommendation. Everyone is different.
> Now my pdoc has prescribed me 1 15mg a day,I wouldn't start on only 15mg. However, your MD may just be concerned about side effects- which can be very noticeable early on with Nardil.
It conked me out- but I loved it!and at the 4th day to increase up to 2 tablets of 15mg a day so total of 30 mg a day.
Personally, i would start from DAY 1 on this.
Which contradicts what Pfizer says, I dont know what to believe.
Like I said, it is a general recommendation. In psychiatry things are very much in the "grey zone"
Please try and not get anxious about this.>
> I read that link to my mother and she disagreed and said I should listen to the pdoc to take 2 15mg tablets a day (total of 30mg/day) from the fourth day and on. Any suggetions what I should do?Sure. Ask your MD to start your dose of at 30mg. By the end of the second week reach a maximum of 60mg (of course, if side effects too strong drop dose by 15mg TEMPORARILY). Then stay put on this for 4 weeks.
Ask him if you can do this.
If he would rather not, ask why. He sounds like he is just be overly cautious, which isn't such a bad thing, and he is worried about possible s/effects.
Adhere to the diet, speak to your doctor, and get back to me.
In the meantime, try to have faith all will be OK!Your on Nardil now- all WILL be OK!!
Ace
Posted by Ron Hill on April 5, 2010, at 10:21:43
In reply to Re: To the VETERANS on this board MAOI Question » Ron Hill, posted by mike0388 on April 3, 2010, at 15:46:50
Mike,
> What I found most interesting from the link is, it says once you reach the max. benefit from Nardil, to decrease over several weeks, even down to 1 15mg pill a day? Is this because the nardil is in your system already and there is no need for multiple pills?
You are referring to the Maintenance dose section and this is what I said to ignore in my prior post when I wrote:
>> However, pay no attention to the Maintenance dose section; lowering the dosage in the maintenance phase is a bunch of baloney.
> Maintenance dose: After maximum benefit from NARDIL is achieved, dosage should be reduced slowly over several weeks. Maintenance dose may be as low as one tablet, 15 mg, a day or every other day, and should be continued for as long as is required.
I have never heard of this dosage reduction method working for anyone. And, as you can see from Ace's post above, he agrees. I have been on Nardil for three years, and if I reduced my dosage to 15 mg/day I would immediately fall into a deep depression.
Mike, I know you are using Nardil to treat your social phobia as opposed to my use of Nardil to treat my depression. None the less, Ace uses Nardil to treat social phobia, and he agrees that the reduction of dosage in the maintenance phase does not work.
-- Ron
dx: Bipolar II with ultra rapid cycling, and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
1.9 mg/day Deplin (taken with methyl B-12 and P-5-P)
Dark therapy via LowBlueLight glasses
High dosage of fish oil, 300 mg/day phosphatidylserene, and several other vitamins and supplements
Posted by Ron Hill on April 5, 2010, at 12:03:56
In reply to Re: To the VETERANS on this board MAOI Question » mike0388, posted by mike0388 on April 3, 2010, at 16:17:02
Mike,
You have no choice; you have to follow your p-doc's instructions because he is writing the scripts. And, you definitely do not want to run out of your Nardil supply.
If I were you, I'd take the Pfizer Prescribing Information document to your p-doc. If he will not listen, I'd find a different p-doc.
As I said before, your effective dosage will likely be 1 mg of Nardil for every kg of your body weight. Or, since 1 kg = 2.2 lb (U.S.), your effective dosage will likely be about 1 mg of Nardil per 2.2 lb of your body weight. So, weigh yourself in lbs and divide your weight by 2.2; the result is the mgs of Nardil you will likely need to take to resolve your social phobia. However, this is only a general rule, and everyone is different. The reason to ramp up slowly to your effective dosage level is to avoid start-up side effects.
Nardil will cause your body weight to increase. So, watch what you eat and exercise a lot right from the beginning. Also, erectile dysfunction is common with Nardil.
-- Ron
-------------------------------
> Hey everyone I have a question. On the link provided by pfizer (above) says to take 3 tablets of 15mg a day.
>
> Now my pdoc has prescribed me 1 15mg a day, and at the 4th day to increase up to 2 tablets of 15mg a day so total of 30 mg a day. Which contradicts what Pfizer says, I dont know what to believe.
>
> I read that link to my mother and she disagreed and said I should listen to the pdoc to take 2 15mg tablets a day (total of 30mg/day) from the fourth day and on. Any suggetions what I should do?
Posted by mike0388 on April 5, 2010, at 17:06:33
In reply to Re: To the VETERANS on this board MAOI Question » mike0388, posted by ace on April 5, 2010, at 8:58:50
Thanks for the support and help guys I do appreciate it.
Just wanted to make sure, I take 2 Ambien a night, a sometimes 1mg of Xanax a day? Should be okay with Nardil right? Benzo's dont conflict with MAOI's correct?
Posted by ace on April 5, 2010, at 19:07:15
In reply to Re: To the VETERANS on this board MAOI Question, posted by mike0388 on April 5, 2010, at 17:06:33
> Thanks for the support and help guys I do appreciate it.
>
>
> Just wanted to make sure, I take 2 Ambien a night, a sometimes 1mg of Xanax a day? Should be okay with Nardil right? Benzo's dont conflict with MAOI's correct?There is no interaction at all, except for possibly making you more sedated.
Nardil, at high enough dosage, effects GABA, so you may find that you do not even need to continue the Xanax.
Posted by mike0388 on April 5, 2010, at 20:17:33
In reply to Re: To the VETERANS on this board MAOI Question » mike0388, posted by ace on April 5, 2010, at 19:07:15
Ace you are top notch! Thanks for all the help, I will keep everyone posted how well i'm doing in a couple weeks. Thanks again :)
Posted by mike0388 on April 5, 2010, at 20:38:03
In reply to Re: To the VETERANS on this board MAOI Question » ace, posted by mike0388 on April 5, 2010, at 20:17:33
Ace, do you ever eat fast food? I tend to love burgers with fries, I should be fine w/ a burger with fries aslong as the burger isnt with cheese right?
Posted by ace on April 6, 2010, at 4:13:06
In reply to Re: To the VETERANS on this board MAOI Question » ace, posted by mike0388 on April 5, 2010, at 20:17:33
> Ace you are top notch! Thanks for all the help, I will keep everyone posted how well i'm doing in a couple weeks. Thanks again :)
It's a pleasure mate. I wish you the very best!
Ace
Posted by ace on April 6, 2010, at 4:21:29
In reply to Re: To the VETERANS on this board MAOI Question, posted by mike0388 on April 5, 2010, at 20:38:03
> Ace, do you ever eat fast food? I tend to love burgers with fries, I should be fine w/ a burger with fries aslong as the burger isnt with cheese right?
I do eat fast food. very minimally but.My first Hypertensive reaction was due to a burger from a corner store I strongly feel, their was soy sauce or something...I forget.
I would avoid any cheese and get the burger from a franchise.
Do you want me to get some MAOI diet links for you?
Posted by mike0388 on April 6, 2010, at 14:23:43
In reply to Re: To the VETERANS on this board MAOI Question » mike0388, posted by ace on April 6, 2010, at 4:21:29
Yes can you please Ace.
Also, do you recommend spreading out the dosage of Nardil, throughout the day or taken at one time?
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Dr. Bob is Robert Hsiung, MD,
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