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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Conundrum on March 21, 2011, at 13:53:47
My mom's doctor is switching her from EMSAM to Nardil. She is currently on 9 mg EMSAM, which will be further decreased to 6 mg tomorrow(Tuesday). She will also be starting Nardil tomorrow. Does this sound safe?
Posted by Phillipa on March 21, 2011, at 19:24:08
In reply to EMSAM --) Nardil switch, posted by Conundrum on March 21, 2011, at 13:53:47
I don't know since they are both MAOI's? Is the doc good? Phillipa
Posted by Conundrum on March 21, 2011, at 19:31:04
In reply to Re: EMSAM --) Nardil switch » Conundrum, posted by Phillipa on March 21, 2011, at 19:24:08
> I don't know since they are both MAOI's? Is the doc good? Phillipa
She is not the doc that prescribed EMSAM, and she didn't even know how to pronounce it correctly. So I hoped she checked w/ someone who knows more about MAOIs than she does.
Posted by Phillipa on March 21, 2011, at 21:54:43
In reply to Re: EMSAM --) Nardil switch » Phillipa, posted by Conundrum on March 21, 2011, at 19:31:04
Oh that is scarey. I do hope someone who has vast knowledge answers this thread. Did you try google? Phillipa
Posted by mtdewcmu on March 22, 2011, at 15:38:58
In reply to EMSAM --) Nardil switch, posted by Conundrum on March 21, 2011, at 13:53:47
I ran the combination on a drug database I have access to through work, and it says in no uncertain terms NOT to do what your mom is about to do. Here's what it says:
"Phenelzine should not be used concurrently with or in rapid succession to other monoamine oxidase inhibitors (MAOIs) (e.g., isocarboxazid, pargyline, tranylcypromine, or MAO-B inhibitors like selegiline or rasagiline) or drugs that possess MAO-inhibiting activity (e.g., furazolidone [5343], linezolid [5330], or procarbazine [5356]).[4673] The combination or rapid succession of MAOI treatment could result in severe CNS or cardiovascular reactions, including hypertensive crises, hyperpyrexia, CNS excitation, delirium, tremor, convulsions, coma, circulatory collapse or death.[4673] [5595] A patient switching from phenelzine to tranylcypromine without a prior drug-free interval died in one case report.[6400] At least 10 days should elapse between the discontinuation of phenelzine and the initiation of another MAOI or the discontinuation of another MAOI and the initiation of phenelzine [4673]; a drug-free period of up to 2 weeks is recommended for patients switched from phenelzine to tranylcypromine.[5595] The manufacturers of both rasagiline and of transdermal selegiline state that at least two weeks should elapse after stopping either product before starting therapy with any other MAOI.[8837] [9041]"
Posted by Phillipa on March 22, 2011, at 21:11:59
In reply to WARNING, posted by mtdewcmu on March 22, 2011, at 15:38:58
So glad you saw this. Hopefully the above will read this. Thanks so kindly Phillipa
Posted by mtdewcmu on March 22, 2011, at 22:02:40
In reply to Re: WARNING » mtdewcmu, posted by Phillipa on March 22, 2011, at 21:11:59
> So glad you saw this. Hopefully the above will read this. Thanks so kindly Phillipa
I babble-mailed conundrum and he or she wrote back that he/she would pass it on.
Posted by Conundrum on March 22, 2011, at 23:15:54
In reply to Re: WARNING, posted by mtdewcmu on March 22, 2011, at 22:02:40
> > So glad you saw this. Hopefully the above will read this. Thanks so kindly Phillipa
>
> I babble-mailed conundrum and he or she wrote back that he/she would pass it on.I told my mom and it turns out she is going to 6 mg today and then supposed to start nardil on saturday. Perhaps the doctor recommends this because it loses MAOAI at 6mgs and lower. She said she would ask the pharmacist and do what they say.
Thanks for the info MtDew
Posted by Phillipa on March 22, 2011, at 23:53:26
In reply to Re: WARNING, posted by mtdewcmu on March 22, 2011, at 22:02:40
Wonderful hope the pharmacist confirms and recommends what you have advised. Phillipa
Posted by mtdewcmu on March 23, 2011, at 12:41:52
In reply to Re: WARNING » mtdewcmu, posted by Phillipa on March 22, 2011, at 23:53:26
> Wonderful hope the pharmacist confirms and recommends what you have advised. Phillipa
Whenever I have asked a pharmacist about drug interactions, they have always entered the combo into a computerized drug database. So they will probably be seeing the same thing I saw.
Posted by Conundrum on March 23, 2011, at 14:49:24
In reply to Re: WARNING, posted by mtdewcmu on March 23, 2011, at 12:41:52
> > Wonderful hope the pharmacist confirms and recommends what you have advised. Phillipa
>
> Whenever I have asked a pharmacist about drug interactions, they have always entered the combo into a computerized drug database. So they will probably be seeing the same thing I saw.Pharmacist said no problem taking 6 mg Emsam w/ nardil. Not sure why it wouldn't be completely cut out by then anyway.
Posted by mtdewcmu on March 23, 2011, at 16:33:23
In reply to Re: WARNING, posted by Conundrum on March 23, 2011, at 14:49:24
> > > Wonderful hope the pharmacist confirms and recommends what you have advised. Phillipa
> >
> > Whenever I have asked a pharmacist about drug interactions, they have always entered the combo into a computerized drug database. So they will probably be seeing the same thing I saw.
>
> Pharmacist said no problem taking 6 mg Emsam w/ nardil. Not sure why it wouldn't be completely cut out by then anyway.I don't know if that pharmacist has access to better information than I do, but even on rxlist.com it says not to mix EMSAM and Nardil:
"Therefore, EMSAM should not be used in combination with selective serotonin reuptake inhibitors (SSRIs,e.g., fluoxetine, sertraline, paroxetine); dual serotonin and norepinephrine reuptake inhibitors (SNRIs,e.g.,venlafaxine and duloxetine); tricyclic antidepressants (TCAs,e.g.,imipramine and amitriptyline); oral selegiline or other MAOIs (e.g., isocarboxazid, phenelzine, and tranylcypromine);
"After stopping treatment with SSRIs; SNRIs; TCAs; MAOIs; meperidine and analgesics such as tramadol, methadone, and propoxyphene; dextromethorphan; St. John's wort; mirtazapine; bupropion HCl; or buspirone HCl, a time period equal to 4-5 half-lives (approximately 1 week) of the drug or any active metabolite should elapse before starting therapy with EMSAM."
It specifically says "other MAOIs" twice.
http://www.rxlist.com/emsam-drug.htm
Look under Warnings and Precautions.
Posted by mtdewcmu on March 23, 2011, at 16:40:13
In reply to Re: WARNING, posted by mtdewcmu on March 23, 2011, at 16:33:23
It says it again under Contraindications:
"EMSAM should not be used with oral selegiline or other MAO inhibitors (MAOIs e.g.,isocarboxazid,phenelzine,and tranylcypromine) (see WARNINGS)."
Posted by order and chaos on March 26, 2011, at 14:36:26
In reply to Re: WARNING, posted by mtdewcmu on March 23, 2011, at 16:40:13
I switched from EMSAM to Nardil a couple years ago, and I actually contacted the doctor who was in charge of its development (Alec Bodkin), and he said "I would give it a minimum of 7 days. 14 would be more conservative."
I'm sorry my response was so late (I just joined), so I hope that either you haven't switched yet, or if you did, that you're okay! I've been on nardil for over 2 years, and it's been very helpful for depression/anxiety, and the only antidepressant that hasn't pushed me into mania - so I hope it helps. I had a lot of sedation in the beginning, but once I pushed through it wore off, and wasn't a problem.
> It says it again under Contraindications:
>
> "EMSAM should not be used with oral selegiline or other MAO inhibitors (MAOIs e.g.,isocarboxazid,phenelzine,and tranylcypromine) (see WARNINGS)."
This is the end of the thread.
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