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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 40. Go back in thread:
Posted by Zyprexa on June 28, 2007, at 13:56:00
In reply to Re: B-Complex and Nardil, posted by GWA on June 27, 2007, at 20:21:18
Posted by GWA on June 28, 2007, at 15:15:18
In reply to Re: B-Complex - what happened? (nm) » GWA, posted by Zyprexa on June 28, 2007, at 13:56:00
I had the symptoms of coming off Nardil - nightmares, deep depression, agitation and nausea.
Posted by Zyprexa on June 28, 2007, at 18:32:29
In reply to Re: B-Complex - what happened? » Zyprexa, posted by GWA on June 28, 2007, at 15:15:18
Did the B-complex counteract the nardil. And do you know if it does this to other meds? My doctor tells me to take B-100.
Posted by Honore on June 28, 2007, at 18:42:48
In reply to Re: B-Complex - what happened? » GWA, posted by Zyprexa on June 28, 2007, at 18:32:29
Could someone give me a cite to an article or two that say vitamin b-6 destroys Nardil or any other MAOI? I've read the reverse-- ie that nardil and other MAOIs destroy vitamin B-6. And I've gotten recommendations to take B-6 when on parnate.
I'd like to see any information about the B6/ destroys Nardil connection.
Honore
Posted by GWA on June 28, 2007, at 19:48:44
In reply to Re: Could someone give me some cites on that, plea, posted by Honore on June 28, 2007, at 18:42:48
Irritatingly, I can't find the free abstract I originally read. However -
http://www.jbc.org/cgi/content/full/276/18/15107:
"carbonyl reactive reagents... react with the aldehyde group of PP [pyridoxal phosphate] and thereby block its coenzyme activity. These agents include hydrazines, which form hydrazones (examples are 1-amino-D-proline in linseed oil and several drugs, including the anti-tuberculous agent isoniazid, carbidopa, phenelzine, and hydralazine)"PDRHealth says of B6 that "Phenelzine may react with pyridoxal 5'-phosphate to yield a metabolically inactive hydrazone compound".
The abstract I'm thinking of said, essentially, not "may" but "does". Anyway, my experience of sharp decline with discontinuation symptoms, not at the time recognised as such, after taking B6, and then of recovery beginning about ten days after dropping it, is proof enough for me.
I don't know about Parnate, I'm afraid.
Posted by Honore on June 28, 2007, at 23:16:26
In reply to Re: Could someone give me some cites on that, plea » Honore, posted by GWA on June 28, 2007, at 19:48:44
Yes-- but this article is about vitamin B deficiency, and mentions nothing about depletion of Nardil, or any other MAOI.
The sentence you quote addresses the destruction of Vitamin B-6 by phenelzine, not vice versa.
"Vitamin B6 deficiency was an unexpected, incidental, finding.... There was no question of nutritional deficiency, and the explanation, therefore, had to be antagonism or de-activation of the vitamin. A range of antagonists is known...... and [the] third [antagonist of the vitamin is] carbonyl reactive reagents.....These agents include hydrazines...including the anti-tuberculous agent isoniazid, carbidopa, phenelzine, and hydralazine)..."
In other words, nardil and the other compounds named antagonize, or destroy, vitamin b. Nothing says that vitamin 6 destroys nardil. Nothing in this article or anywhere that I could find, at least.
I don't know what caused your reaction, but I feel pretty sure it had nothing to do with ingesting vitamin B. All the other articles I've seen repeat the same information about possible deficiency of Vitamin B--NOT nardil.
I really think you have made a mistake in inferring that any such relationship exists.
Honore
Posted by FredPotter on June 28, 2007, at 23:41:13
In reply to Re: Nothing suggests Vitamin b destroys Nardil » GWA, posted by Honore on June 28, 2007, at 23:16:26
Honore The following does imply they "interact" but uses only the word "react". "Interact" would imply a nonlinear relationship that destroys B6 and phenelzine. On the other hand "react" could mean they destroy each other too eg
Pb+O=PbO
"PDRHealth says of B6 that "Phenelzine may react with pyridoxal 5'-phosphate to yield a metabolically inactive hydrazone compound"."
Sorry to labour the point, but I think we need to get this right. We not talking about blocking an enzyme. The other question is does phenelzine do its MAOI work before it hits B6 or afterwards?
Fred
Posted by Honore on June 28, 2007, at 23:55:35
In reply to Re: Nothing suggests Vitamin b destroys Nardil » Honore, posted by FredPotter on June 28, 2007, at 23:41:13
The context makes it totally clear that the discussion is about Vitamin B-6 deficiency.
It simply is what that article is about. Whatever the imprecision of the sentence, in establishing the reversibility of the relationship, it's not what the sentence is about, or what anything in the article is about.
Have you looked at the articed cited, in GWA's post prior to mine? Look at it, and then tell me that you think the sentence could possibly be taken to mean that vitamin B6 in any way affects nardil.
We can discuss it better if you look at the beginning of the article, where the abstract and this sentence occur.
Honore
Posted by Honore on June 29, 2007, at 0:56:04
In reply to Re: Nothing suggests Vitamin b destroys Nardil » Honore, posted by FredPotter on June 28, 2007, at 23:41:13
Let me argue by inference also:
Vitamin B6 is a treatment for peripheral neuropathy associated with isoniazid, a tuberculous drug also the first MAOI. Isoniazid also causes vitamin B6 deficiency...
(EG:
"It is believed that isoniazid competes with pyridoxyl phosphate for the enzyme apotryptophanase which may lead to symptoms of pyridoxine (vitamin B6) deficiency. Pyridoxine administration can prevent and reverse peripheral neuropathy complicating isoniazid use. Prophylactic pyridoxine administration (e.g., 10 to 50 mg/day) should probably be given routinely in individuals predisposed to develop peripheral neuropathies secondary to isoniazid therapy (e.g., patients who are malnourished, pregnant, alcoholic, diabetic, HIV-infected, or patients receiving higher doses of isoniazid)."
If Vitamin b6 destroyed isoniazid, at least in anything like potentially problematic amounts, so as to render treatment with isozianid ineffective-- it wouldn't be prescribed. Nor would the descriptions of the drugs mention vitamin b6 deficiency caused by isozionid; they would mention that vitamin b6 makes isozianid inactive and therefore not a useful treatment.Thereupon, patients with the effect would have to be given some other drug to treat tuberculosis. Ie, the isoniazid just wouldn't work for them if they needed to take vitamin b6).
Since many sources also suggest that vitamin b6 be prescribed, or used, with phenelzine (nardil), to treat nardil-caused vitamin b6 deficiency, the same would likely be true, don't you think?
Let's assume that the competition for apotryptophanase is two-way, and that therefore some amount of isoniazid, or nardil, might also be rendered ineffective by vitamin b6. It stands to reason, that if treatment with vitamin b6 for the peripheral neuropathy or vitamin b6 deficiency caused by nardil were going to negate the effects of nardil, nardil would simply have to be withdrawn from those who showed symptoms of vitamin b6 deficiency. Plus, I would expect that to be noted in the regular PDR as a contraindication for nardil-- or as a problematic condition in its use.
There's nothing of that sort at all anywhere that I can find, including the PDR.
So, I'm going to assume that since vitamin b6 is a recommended treatment for vitamin b6 deficiency in patients using nardil, that the nardil remains effective in the presence of vitamin b6.
Nothing else stands to reason.
So, I honestly think that taking vitamin v6 with nardil is well within reason, although not necessarily required. (Not everyone who takes nardil will have vitamin b6 deficiency, although it is well-known to exist.)
Does that in any way convince you of at least the great unlikelihood that any danger or threat to nardil exists in taking vitamin b6 with it; and that, moreover, much good may very possibly be done?
Honore
Posted by Larry Hoover on June 29, 2007, at 6:47:41
In reply to Re: Nothing suggests Vitamin b destroys Nardil » GWA, posted by Honore on June 28, 2007, at 23:16:26
> In other words, nardil and the other compounds named antagonize, or destroy, vitamin b. Nothing says that vitamin 6 destroys nardil. Nothing in this article or anywhere that I could find, at least.
From GWA's post:
" PDRHealth says of B6 that 'Phenelzine may react with pyridoxal 5'-phosphate to yield a metabolically inactive hydrazone compound'."It is precisely this phrase that led me to state earlier in the thread that phenelzine concentration might also be reduced by B6. The sole functional group on phenelzine is the hydrazine moiety. If the chemical reaction with pyridoxine converts it to a hydrazone, it is no longer able to inactivate the reactive centre of monoamine oxidase. It is rendered physiologically inert.
Obviously, if true, this reaction must take place in all individuals taking phenelzine, as everybody has some amount of pyridoxine in their tissues. It would be a dynamic balance, dependent on reactant concentrations, and it could be shifted into disequilibrium in either direction.
The underlying assumption is that this mechanism explains the B6 deficiency in susceptible individuals. Individual differences in genetic (or environmental, e.g. dietary) factors might relegate it to an insignificant concern, or elevate it to a dominant regulatory position.
Lar
Posted by GWA on June 29, 2007, at 9:15:14
In reply to Re: Nothing suggests Vitamin b destroys Nardil » GWA, posted by Honore on June 28, 2007, at 23:16:26
Honore, you deleted the relevant bit.
"These agents include hydrazines, *(which form hydrazones* (examples [include] phenelzine...)"A hydrazone of phenelzine sulphate is, by definition, not phenelzine sulphate.
Posted by Honore on June 29, 2007, at 10:10:01
In reply to Re: Nothing suggests Vitamin b destroys Nardil » Honore, posted by GWA on June 29, 2007, at 9:15:14
The main point is that the article concerned vitamin b deficiency.
Where do you see any discussion of the effect of vitamin b on nardil on the article you cited, GWA?
It never mentioned or in any way addressed or considered anything about nardil, other than that it was one of the substances that caused vitamin b to become inactive, and therefore vitamin b deficiency reactions.
If the two substances compete for a an enzyme, and nardil more powerfully occupies the enzyme, there might be some reciprocal effect, particularly in individuals with certain enzyme structures, but there's no reason to think that it would cause nardil to become ineffective.
Which is borne out by many articles about vitamin b6 deficiency caused by nardil, and no articles about nardil's being rendered ineffective by vitamin b. If substances A and B compete for an enzyme, and A occupies the enzyme, it's B that will become deficient, not A.
Could you please address this? You so far haven't show me anything about loss of nardil in the body, except one ambiguous phrase in one article.
Honore
Posted by GWA on June 29, 2007, at 13:22:45
In reply to Re: Nothing suggests Vitamin b destroys Nardil » GWA, posted by Honore on June 29, 2007, at 10:10:01
Honore, Nardil is a hydrazine. It reacts with pyridoxal phosphate to form a hydrazone. When two chemicals react they produce one or more chemicals which is/are not the same as the original chemicals. Phenelzine and pyridoxal phosphate disappear, a hydrozone appears (perhaps with other compounds). "Phenelzine may react with pyridoxal 5'-phosphate to yield a metabolically inactive hydrazone compound", apart from the "may", is saying just this. It also says that a hydrozone is metabolically inactive: it doesn't do anything to you, like inhibit MAO.
Likewise, "carbonyl reactive reagents... react with the aldehyde group of PP [pyridoxal phosphate]... These agents include hydrazines, which form hydrazones (examples [include] phenelzine" is perfectly clear, and the main subject of the article doesn't change it's meaning.
Posted by Honore on June 29, 2007, at 15:22:10
In reply to Re: Nothing suggests Vitamin b destroys Nardil » Honore, posted by GWA on June 29, 2007, at 13:22:45
Right_ Nardil is a hydrazine. and according to many scientific articles, the following proposition is true.
. "Inasmuch as isonianid and OTHER HYDRAZINE DRUGS (MY CAPS) and foreign chemicals may produce a vitamin B6 deficiency in humans that can elicit seizures and lethal convulsions at high dose levels, these results suggest that the central nervous system toxicity produced by these agents might be more frequent and more severe in human slow acetylators."
This is also the point of the sentence that you quoted from the article you cited.You still haven't dealt with my main point, which is that the article calls Nardil a "vitamin b6 antagonist"-- it doesn't deal in any way with whether or to what extent anything else is true.
The proposition for which you cite that article, that vitamin b6 destroys nardil is not what the article reports, proves, or even implies.
I see some articles which suggest that vitamin b6 can, in some extreme instances, somewhat reduce the amount of isozianid or even phenelzine in the tissues. This is mostly with megadoses of vitamin b6, used in cases of neurotoxicity or overdose. I see nothing that suggests that this occurs in normal dietary, or even vitamin supplemental, doses.
So whatever the effect, which you might have had as a result of a pretty rare condition or type of metabolism of nardil vs. vitamin b6, it's as yet not at all appropriate to counsel other people to avoid vitamin b6 when they take nardil. This is particularly the case, because it is not uncommon for nardil to cause vitamin b6 deficiency. So the advice is not harmless but may cause harm. This is my concern.
You don't seem willing to deal with my main point, and if you won't, I can't do anything except let others know that it isn't at all indicated to stop taking vitamin b6 with Nardil, and that no harm is going to come from taking the two together.
I'm sorry you had the reaction you had. But the article you cite has nothing to say about why you had that reaction.
Honore
Posted by WillowGables on June 30, 2007, at 4:32:49
In reply to Re: MAOIs and vitamin B6, posted by GWA on June 27, 2007, at 8:46:33
Hi there, can anyone tell me whether phenelzine (Nardil) and pericyazine (Neulactil) are available in South Africa? Thanks.
> B6 certainly destroys phenelzine/Nardil, even in small amounts. It brought me to relapse. Don't take more than 100% of the recommended daily amount, and even then only six hours after your last phenelzine of the day.
Posted by GWA on June 30, 2007, at 9:33:53
In reply to Re: Nothing suggests Vitamin b destroys Nardil » GWA, posted by Honore on June 29, 2007, at 15:22:10
> You still haven't dealt with my main point, which is that the article calls Nardil a "vitamin b6 antagonist"
That doesn't preclude the antagonism's being mutual. The article is concentrating on its main subject, B6 deficiency, not on the tribulations of bloodstream phenelzine.
>-- it doesn't deal in any way with whether or to what extent anything else is true.
I think it does, in the sentence I've quoted twice.
>The proposition for which you cite that article, >that vitamin b6 destroys nardil is not what the >article reports, proves, or even implies.
I think it does, for the reason I've given: it says that there is a reaction between PP and the hydrazine phenelzine, which gives rise to a hydrozone; necessarily, given the most basic chemistry, this reaction eliminates the phenelzine taking part in it. I don't see how you can not understand this. If the fact is not underlined in the article, it is because, once again, and as you say, it is about B6 deficiency rather than about the less common problem of Nardil deficiency. If you don't accept this, let's agree to disagree. A B6 supplement of only 100% of the recommended daily allowance should prevent B6 deficiency while taking Nardil,
Posted by Honore on June 30, 2007, at 9:56:55
In reply to Re: Nothing suggests Vitamin b destroys Nardil » Honore, posted by GWA on June 30, 2007, at 9:33:53
I If you could point me to an article that primarily concerns the chemical effects of vitamin b6 on Nardil, in general or specifically with respect to its possible metabolism into hydrazone, I'd be grateful.
I did acknowledge the point that you're making in my last responses. I specifically said that vitamin b6 could possibly affect the amount of nardil in the tissues-- but that this must, by inference, not usually interfere with nardil's effect.
(What I said:
"I see some articles which suggest that vitamin b6 can, in some extreme instances, somewhat reduce the amount of isozianid or even phenelzine in the tissues. This is mostly with megadoses of vitamin b6, used in cases of neurotoxicity or overdose. I see nothing that suggests that this occurs in normal dietary, or even vitamin supplemental, doses.
So whatever the effect, which you might have had as a result of a pretty rare condition or type of metabolism of nardil vs. vitamin b6, it's as yet not at all appropriate to counsel other people to avoid vitamin b6 when they take nardil. ")
I'm not denying that you might have had an usual reaction to vitamin b6 in the presence of Nardil, which could have cause the Nardil to become inactive. I'm also not denying that vitamin b6 might not --possibly-- in megadoses, reduce to some degree the effect of Nardil. (This remains, in my mind, to be established, but seems possible. However, that's different from its impact in normal doses or vitamin supplements)
The articles I've read disagree about whether vitamin b6 reduces Nardil (or isozionid, where vitamin b6 deficiency seems to more a more acute problem), or whether the peripheral neuropathy one finds with Nardil is produced entirely by loss of vitamin 6, and not at all by the Maoi.
You focus on one word in a sentence. I'm not a chemist-- although I do understand the concept of a chemical reaction, by the way.
I'd be happy to read any chemical text that bears directly and clearly on the question of the effect of vitamin b6 in reducing the effectiveness of Nardil as an AD, however.
In the absense of some concrete and openly argued scientific research connecting vitamin b6 with loss of AD effect in Nardil, I'd be very concerned about advising people to restrict vitamin b6.
Do you think it's possible you might have had a unusual reaction to vitamin b6? And that therefore others might not have the problem that you did?
Honore
Posted by Honore on June 30, 2007, at 10:11:01
In reply to Re: Nothing suggests Vitamin b destroys Nardil » Honore, posted by GWA on June 30, 2007, at 9:33:53
For example, the most recent article I found on Medline (I found only three on a quick search) was the following. (They all pointed to the same relationship between nardil and vitamin b6)
Malcolm DE. Yu PH. Bowen RC. O'Donovan C. Hawkes J. Hussein M.
Authors Full Name Malcolm, D E. Yu, P H. Bowen, R C. O'Donovan, C. Hawkes, J. Hussein, M.
Institution Department of Psychiatry, Royal University Hospital, Saskatoon, Saskatchewan.
Title Phenelzine reduces plasma vitamin B6.
Source Journal of Psychiatry & Neuroscience. 19(5):332-4, 1994 Nov.Abstract
Plasma levels of the active form of vitamin B6 (pyridoxal phosphate) in 19 patients taking phenelzine were found to be reduced on the average to approximately 54% of the value in a control group. There was no correlation of pyridoxal phosphate level with phenelzine daily dosage over the range of 30 mg to 90 mg. No symptoms of vitamin B6 deficiency peripheral neuropathy were found.
Publication Type Journal Article. Research Support, Non-U.S. Gov't.Honore
Posted by GWA on June 30, 2007, at 10:36:24
In reply to Re: Nothing suggests Vitamin b destroys Nardil » GWA, posted by Honore on June 30, 2007, at 9:56:55
Yes, my reaction might have been unusual, and B6 deficiency is a real danger. I would nonetheless advise people to be wary of combining high-dose B6 with Nardil, and if they do and start to feel withdrawal symptoms, try cutting out the B6 for the time it takes them for Nardil to kick in.
Posted by FredPotter on July 1, 2007, at 15:59:46
In reply to Re: Nothing suggests Vitamin b destroys Nardil » GWA, posted by Honore on June 29, 2007, at 15:22:10
Nevertheless the oft quoted sentence is unequivocal. If A reacts with B to produce AB, you don't have A and B anymore, although this implies that the quantities of each are balanced for this reaction. Hopefully there will be some Nardil left over, but if so the B6 will run out. If vice versa, the Nardil will run out.
I think we shouldn't take too seriously the point the researchers are trying to make. If they appear to have missed something we should speak out. GWA's suggestion that we take B6 6 hours after taking Nardil is the only solution to this problem as far as I can see
Fred
Posted by Sigismund on July 1, 2007, at 16:46:24
In reply to Re: Nothing suggests Vitamin b destroys Nardil, posted by FredPotter on July 1, 2007, at 15:59:46
B6 is an essential cofactor in the production of neurotransmitters.
Is that releveant?
Posted by FredPotter on July 1, 2007, at 22:58:24
In reply to Re: Nothing suggests Vitamin b destroys Nardil, posted by Sigismund on July 1, 2007, at 16:46:24
> B6 is an essential cofactor in the production of neurotransmitters.
>
> Is that releveant?My God I expect so. We're floundering with this question without anyone to help us. There's no use in asking my Dr, as he wouldn't have the 1st clue
Posted by sobeit on July 5, 2007, at 16:52:20
In reply to Re: Nothing suggests Vitamin b destroys Nardil » Sigismund, posted by FredPotter on July 1, 2007, at 22:58:24
Should you also consider the fact that phenelzine is an irreversible inhibitor of MAO. I think both arguments have some merit, but neither provide the biochemical expertise required to answer the question.
> > B6 is an essential cofactor in the production of neurotransmitters.
> >
> > Is that releveant?
>
> My God I expect so. We're floundering with this question without anyone to help us. There's no use in asking my Dr, as he wouldn't have the 1st clue
Posted by brooke484 on July 6, 2007, at 21:13:59
In reply to Re: MAOIs and vitamin B6, posted by WillowGables on June 30, 2007, at 4:32:49
Can you call the pharmacy? I really have no idea.
brooke
Posted by Hunk20 on May 19, 2010, at 19:03:27
In reply to willowgables, posted by brooke484 on July 6, 2007, at 21:13:59
What about taking phenelzine in the morning and B6 at night?!
This is the end of the thread.
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