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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 FrequentFryer on May 7, 2013, at 23:00:21
Hi all, Hope you are doing well.
I have been taking 50mg's of Parnate now for about two weeks. Fortunately the full on narcolepsy tiredness has gone.
Anyways I just take my 50mg's in the mourning. Sometimes lately I have been getting those head shocks like I haven't taken it.
I was just hoping everyone else could share their Dosing schedule also it would be good if you could state how much you take and what effects you get from the different times.
This would be much appreciated and I would be happy to share any other info I have on enhancing Parnate other meds and dealing with Treatment resistant depression in generall.
Regards.
FF
Posted by jono_in_adelaide on May 8, 2013, at 0:18:01
In reply to Optimal Parnate Dosing times, posted by FrequentFryer on May 7, 2013, at 23:00:21
I'd suggest splitting the dose in half, taking say 30mg in the morning, and 20mg in the evening
If parnate alone doesnt get you where you need to be, you can add nortriptyline onto your Parnate, starting at 25mg at night, and increasing over 2 weeks or so to between 75 and 150mg at night (simple blood tests are a good way of finding the correct dose for any individual)Other "boosters" might include a low dose atypical antipsychotic, lithium or t3 thyroid hormone
Posted by SLS on May 8, 2013, at 3:00:24
In reply to Re: Optimal Parnate Dosing times, posted by jono_in_adelaide on May 8, 2013, at 0:18:01
> I'd suggest splitting the dose in half, taking say 30mg in the morning, and 20mg in the evening
If Parnate causes insomnia, you can split the daily dose into two (b.i.d.); taking one dose in the morning and the other in the early afternoon. You don't want to take Parnate any later than 3:00 PM in this case. If Parnate does not cause insomnia, you can dose it several times a day. That might help mitigate hypotension. I currently take Parnate 3 times a day (t.i.d.); morning, afternoon, and evening.
Good luck.
- Scott
Posted by vanvog on May 8, 2013, at 7:30:25
In reply to Re: Optimal Parnate Dosing times, posted by SLS on May 8, 2013, at 3:00:24
I was going to write a post on that.
Gillmann writes:
"If [Parnate] causes subjective symptoms which require action then spreading the dose out will help. In order to understand the how and why of dosing it is useful to understand that the half life of Parnate is very short. It varies in different people but it is generally less than 2 hours (8-10). This is relevant for its possible (non-therapeutic) effects not related to MAO inhibition (e.g. via TAA receptors, see other notes). However because it is an irreversible inhibitor its half life is not relevant to what we think is the main therapeutic effect, which is MAO inhibition.
So, what this almost certainly means is that for MAOI therapeutic effect it does not matter at all whether you take one single dose or split it up. Indeed it is probably possible to take it on alternate days. Is all that matters is whether the total dose taken is sufficient to inhibit any new enzyme which has been synthesised by the body since the last dose. However, to the extent that other effects may be mediated in other ways, those are likely to be dependent on the concentration of the drug in the blood and tissues, then the half life is relevant. Therefore, if the objective is to minimise side effects by spreading the effect as evenly as possible in the first part of the day it is logical to take a dose every couple of hours."
"For many people Parnate has less side effects than most other drugs, but insomnia is one of the commoner undesirable effects. It seems clear that, in the majority of people, the earlier in the day that the dose is taken the less insomnia is experienced. If it is possible to take the whole daily dose first thing in the morning (on waking) that is the ultimate way of minimising insomnia. If that does not work then splitting the dose up into smaller bits taken at intervals of about two hours or so is the next best solution. It is usually best not to take any of the doses after the middle of the day. However, there are no absolute rules and experimenting to find out what is best for each individual usually gives a satisfactory resolution for any problems."
Posted by Phillipa on May 8, 2013, at 9:42:00
In reply to Optimal Parnate Dosing times, posted by FrequentFryer on May 7, 2013, at 23:00:21
Narcolepsy has just been added to autoimmune diseases. No idea what the treatment is. Sorry to change topic P
Posted by Willful on May 8, 2013, at 10:18:34
In reply to Optimal Parnate Dosing times, posted by FrequentFryer on May 7, 2013, at 23:00:21
You could supplement with modafinal (provigil), if you have issues with tiredness.
when I took parnate, I took in in two doses, as other have suggested. If it causes insomnia, I would suggest taking the second dose in the middle to late afternoon rather than later.
Willful
Posted by SLS on May 8, 2013, at 11:24:05
In reply to Re: Optimal Parnate Dosing times, posted by vanvog on May 8, 2013, at 7:30:25
> Indeed it is probably possible to take it on alternate days.
This has not been true in my case. As a matter of fact, if I miss a single dose, I experience REM rebound that night along with feeling noticeably worse the next day.
> Therefore, if the objective is to minimise side effects by spreading the effect as evenly as possible in the first part of the day it is logical to take a dose every couple of hours.
I have done this in the past to reduce hypotension. I am no longer susceptible to this side effect.
- Scott
Posted by vanvog on May 8, 2013, at 15:26:41
In reply to Re: Optimal Parnate Dosing times » vanvog, posted by SLS on May 8, 2013, at 11:24:05
> > Indeed it is probably possible to take it on alternate days.
>
> This has not been true in my case. As a matter of fact, if I miss a single dose, I experience REM rebound that night along with feeling noticeably worse the next day.
I think Gillmann is referring to MAO inhibition effect of Parnate and MAO inhibition ONLY in this sentence. He is probably right.
Please read the second paragraph I posted again.
Posted by SLS on May 8, 2013, at 17:23:36
In reply to Re: Optimal Parnate Dosing times, posted by vanvog on May 8, 2013, at 15:26:41
> > > Indeed it is probably possible to take it on alternate days.
> >
> > This has not been true in my case. As a matter of fact, if I miss a single dose, I experience REM rebound that night along with feeling noticeably worse the next day.
>
>
> I think Gillmann is referring to MAO inhibition effect of Parnate and MAO inhibition ONLY in this sentence. He is probably right.
>
> Please read the second paragraph I posted again.I still find it difficult to believe that dosing Parnate every other day would work unless the dosage were very high. Speaking for myself only, I relapse after 48 hours of a 10 mg/day reduction in dosage. Would that be an indicator of a recovery of MAO activity?
The half-time of MAO recovery has been reported to be 3.6 days in the brain.
http://link.springer.com/article/10.1007%2FBF00508078
How many people are you aware of who dose Parnate every other day?
I'm not buying it.
- Scott
Posted by Tyrannosaur on May 8, 2013, at 18:02:18
In reply to Re: Optimal Parnate Dosing times » vanvog, posted by SLS on May 8, 2013, at 17:23:36
http://link.springer.com/article/10.1007%2FBF00508078
"Tranylcypromine is not an irreversible inhibitor"
http://www.gsk.ca/english/docs-pdf/Parnate_2010.pdf
Official prescribing information from GlaxoSmithKline: "Tranylcypromine differs from other MAO inhibitors in being a reversible inhibitor"
Although 99,9% of relevant pages on the net seem to agree that Parnate is irreversible. Hmm.
Posted by vanvog on May 9, 2013, at 8:40:20
In reply to Re: Optimal Parnate Dosing times, posted by Tyrannosaur on May 8, 2013, at 18:02:18
> Official prescribing information from GlaxoSmithKline: "Tranylcypromine differs from other MAO inhibitors in being a reversible inhibitor"
>
> Although 99,9% of relevant pages on the net seem to agree that Parnate is irreversible. Hmm.
>
>
You could have quoted the whole paragraph:
"Tranylcypromine differs from other MAO inhibitors in being a reversible inhibitor. When
tranylcypromine is withdrawn, monoamine oxidase activity is generally restored within a
week, although the drug is excreted in 24 hours."
A week!
"Return of MAO activity is more rapid after tranylcypromine is discontinued than after phenelzine is stopped, which may reflect slow reversibility, rather than complete irreversibility, of its action on the enzyme."
(found in Drug Interactions in Psychiatry, Domenic A. Ciraulo)
"Parnate is not 100% irreversible and has a shorter half life of MAO inhibition than Nardil does. However, Parnate still binds far longer and more tightly than does the reversible MAOI moclobemide, for instance. Marplan is similar to Nardil in this regard, but I am not sure exactly how selegiline compares." (another babble user)
I found a very good, easy to understand explanation of the whole process by another babble user, Larry:
"Every day, every hour, your body churns out a little bit of the enzyme monoamine oxidase. At about the same rate as it is synthesized, some of it is destroyed/recycled back to the constituent amino acids. So, at any point in time, the total amount of this enzyme is relatively constant, as the rate of formation is roughly equal to rate of destruction. That's called a dynamic equilibrium. The whole cycle is thought to take as little as two weeks, but might be a little longer.
There are some drugs that interact with the MAO enzyme, inhibiting its "designed" activity, which is to break down monoamine neurotransmitters, and similar. Inhibitors fall into two broad classes, the reversible and the irreversible. A reversible inhibitor binds to the enzyme in such a way as to block its action, but it does not affect the molecular structure. If the inhibitor breaks contact with the MAO, then its inhibition is reversed. The fully functional MAO enzyme can go back to what it was intended to do. It's like somebody parking their car in your spot. You can't park there until it moves on. Moclobemide is one such inhibitor.
In contrast, some inhibitors change the function of the MAO by chemical disruption. They either permanently bond to the enzyme active site, or damage it and leave. In either case, the enzyme cannot function. The inhibition is irreversible. Like frying an egg.
Recall, though, that I said your body churns out a little bit of MAO every hour. If the newly formed MAO does not encounter an inhibitor, it can immediately start to function. Of course, the total MAO effect also relies on the accumulated enzyme concentration over a few weeks of normal production. So, if you stop taking an irreversible inhibitor, the concentration of functional MAO will gradually build. After a week or so, the total MAO activity will be perhaps a half of normal. By two weeks or so, it will have gotten back pretty much to normal."
Posted by Tyrannosaur on May 9, 2013, at 9:35:41
In reply to Re: Optimal Parnate Dosing times, posted by vanvog on May 9, 2013, at 8:40:20
Thanks for the insight, now i understand it better.
Posted by FrequentFryer on May 9, 2013, at 16:00:05
In reply to Re: Optimal Parnate Dosing times, posted by jono_in_adelaide on May 8, 2013, at 0:18:01
Thanks mate.
I Have tried Nortrip with it before and didn't like it. I take a stimulant & baclofen and have been feeling good on this for months. First time I have been stable this long.> I'd suggest splitting the dose in half, taking say 30mg in the morning, and 20mg in the evening
>
>
> If parnate alone doesnt get you where you need to be, you can add nortriptyline onto your Parnate, starting at 25mg at night, and increasing over 2 weeks or so to between 75 and 150mg at night (simple blood tests are a good way of finding the correct dose for any individual)
>
> Other "boosters" might include a low dose atypical antipsychotic, lithium or t3 thyroid hormone
Posted by FrequentFryer on May 9, 2013, at 16:15:01
In reply to Re: Optimal Parnate Dosing times, posted by Tyrannosaur on May 8, 2013, at 18:02:18
Thanks heaps for the in depth info Guys. I will try splitting the dose.
I take 40 to 80mg's of Phentermine (depending how awake / active I want to be. And allot of baclofen which is one of my favorite drugs especially for social anxiety (I strongly recommend trying it, it's similar to Gabapentin but allot cheaper over here). Tolerance is bad though so I cycle it with Klonaz)and have been feeling good on this for months. First time I have been stable this long.
My GABA system is probably badly hammered from the Baclofen and all the benzo's I have tken.
Would any of you know if taking a supplement like L-Glutamate reduce my tolerance to GABA related drugs, or make them more effective?
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