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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Tyrannosaur on May 25, 2013, at 19:22:29
I've been on Nardil for several months and I've taken dosages up to 150mg/d and I never got a headache.
A few days ago i started getting a throbbing pain at the back of my head, at the lower right side behind the ear. It only occurs about an hour after i take my Nardil dose, and it disappears after roughly 30 minutes. This happens even when taking as little as 45mg, and the higher dose i take the stronger the headache gets.
My blood pressure at the time of the headache is usually around 150/100, so it's not dangerously high. Any ideas why this this happens?
Posted by Willful on May 25, 2013, at 21:15:44
In reply to Nardil Headache, posted by Tyrannosaur on May 25, 2013, at 19:22:29
I would infer from your description that probably you're doing something that's causing you to have a mild version of serotonin syndrome -- which comes from eating something or taking a contraindication medication-- and is a potentially dangerous complication of taking MAOIs.
The symptoms you describe were described to me as signs of this problem-- so it's important figure out what's causing it, in order to stop doing it. Maybe you're at a point where the syndrome is relatively mild (only relatively) and where it resolves on its own between doses. However, this might not be a stable situation-- and you could end up with a more severe reaction.
If the headache and the elevated blood pressure get worse, go to a doctor or hospital, and tell them you're taking nardil and having the symptoms you're having.
Incidentally, 150/100 is not considered an okay blood pressure. It's actually pretty high-- and if it gets any higher than that-- it's really time to take action.
The usual things that cause bad reactions to Maois, as you probably know are aged food of any kind-- such as cheese, soy sauce, certain red wines, and anything actually that might be somewhat spoiled, for example, from being left outside the refrigerator-- There are also medications that interact with maois to cause it-- so if you've started any other meds recently that could be the issue. There are lists of these things on babble if you check--
Whatever it is--if it's caused by 45 mg, I would stop taking the nardil until you figure out what's going on-- and also call your pdoc right away to let him/her know what's happening.
I don't mean to be alarmist-- but until a doctor rules this, or similar syndromes, out-- I would proceed with extreme caution.
Posted by Tyrannosaur on May 25, 2013, at 23:24:54
In reply to Re: Nardil Headache, posted by Willful on May 25, 2013, at 21:15:44
Thank you Willful for your concern.
But i have to add that this only happens when taking Nardil on an empty stomach, so we can rule out a tyramine reaction.
And I'm not taking any other medications.
You're also correct that having 150SYS / 100DIA blood pressure is not okay to have on a regular basis. But having it temporarily for a period of an hour is not considered dangerous.
As I've mentioned I've taken very high doses of Nardil before (150mg) without feeling this headache. And serotonin syndrome is quite difficult to experience on a single medication as it usually happens when mixing medications. I've read extensively about serotonin syndrome, and getting it from pretty low doses of MAOIs (45mg) is unheard of.
Posted by SLS on May 26, 2013, at 1:00:25
In reply to Nardil Headache, posted by Tyrannosaur on May 25, 2013, at 19:22:29
I have no definitive explanations to offer.
It sounds like you are experiencing an occipital headache that is often indicative of a tyramine reaction when one is taking an MAOI. Tyramine reactions can be erratic in their temporal presentations between dosing, eating, and onset. Also, the headache is not always tied to a spike in peripheral blood pressure. It is serious, nonetheless.
When I took Nardil, I would experience a brief period of stimulation within 30 minutes of dosing. It is unlikely that this is due to a spike in MAO inhibition. My guess is that this experience is due to some other property of Nardil not yet described. Perhaps your headache is associated with such a reaction.
- Scott
Posted by Willful on May 26, 2013, at 12:47:20
In reply to Re: Nardil Headache, posted by Tyrannosaur on May 25, 2013, at 23:24:54
The only time you can get it on a low dose is if your ability to metabolize tyramine is compromised by previously doing something in the recent time that used up mao-- which is greatly reduced on maois.
Then it can d efinitely happen-- because it takes about 2 weeks to fully regain the ability to matabolize tyramine-- which is why I suggested that it could be a hypertensive episode-- which can be serious.
I would agree that 150/100 on a transient basis isn't a problem-- except if it gets worse.
I'm glad you;'ve researched serotonin-- and are being careful-- however, I would stress that we aren't doctors, with clinical experience of the varieties of rarer reactions that are out there--so it makes sense to me to discuss this sooner rather than later with your pdoc. I personally would call mine right away-- but that's my take on worrisome reactions.
If you're confident that everything is ok-- I would still consult him/her because you just should be on the safe side.
Even if you've taken 150 mg, these reactions sometimes don't happen right away-- I don't know how long you've been taking nardil, or how long you took 150 mg-- etc-- but for example, if you eat soy sauce several times within a few days or week for example, the threat increases each time-- so even things that on one dose or ingestion aren't a problem can become a problem if you consume them several times in a short period--
You know your reactions better than anyone-- and you're taking precautions-- but still I don't think it's a good idea to go it alone on symptoms such as you're experiencing.
Posted by Topdog on May 26, 2013, at 15:20:31
In reply to Re: Nardil Headache, posted by Willful on May 26, 2013, at 12:47:20
I used to get headaches when i absorbed too many pills at a time. Once i divided them more over the hours, i got no headaches. The headaches were bad thou ..the kind where you bang your head against the wall in order to ease the pain.
Good luck with the Nardil, this is some really good shi*
Topdog
Posted by jono_in_adelaide on May 26, 2013, at 23:11:31
In reply to Re: Nardil Headache, posted by Topdog on May 26, 2013, at 15:20:31
Agree with SlS, Nardil has a lot of effectsd besides MAO inhibition, and one of these could be causing your headache.
You could try
* taking a simple analgesic (say ibuprofen 400mg) with your nardil to maks the headache
* taking after food so that peak levels arnt so high, and hopefully avoid the headache
* carefully review your diet to make sure you arnt ingesting anything on the no-no list
Posted by jono_in_adelaide on May 26, 2013, at 23:12:15
In reply to Re: Nardil Headache, posted by Topdog on May 26, 2013, at 15:20:31
oh, and of course, mention it to your docotr at your next appointment
Posted by Cee on May 27, 2013, at 0:15:32
In reply to Re: Nardil Headache, posted by Topdog on May 26, 2013, at 15:20:31
Hello
The best way to take your Nardil is to cut each dose in half and put it into a enteric coated capsule ,now what this does is pass the Nardil through the stomach and into the small intestine where it will metabolize properly.this cuts way down on the side effects . But remember that aim talking about the new Nardil
Cee
Posted by Tyrannosaur on May 27, 2013, at 23:52:20
In reply to Re: Nardil Headache, posted by Cee on May 27, 2013, at 0:15:32
Today the headache was gone when taking Nardil on an empty stomach, it's just strange.
Thanks for the input guys. And speaking to my doctor about such things is not an option due to the risk of he taking me off it. He has never used Nardil or a MAOI before in his life. (He barely knew what it was). It was i that brought it up with him, and that I'd like to use it.
Posted by Willful on May 28, 2013, at 10:23:40
In reply to Re: Nardil Headache, posted by Tyrannosaur on May 27, 2013, at 23:52:20
Glad to hear you've found a work-around. Just be careful please!
I understand your concern about your pdocs' pulling the nardil-- but in order to keep the option of making intermediate adjustments, don't endanger yourself either--
are there any nearby cities with more sophisticated docs? or could you get a consult once or twice with someone more knowledgeable somewhere else? If you pdoc is the only one in your town-- you may need to look further- elsewhere- to make the best choice even among MAOIs.
Or just to make sure all is ok.--
I hate to go on about risks-- but if the headache occurs again, I sincerely would advise you to find someone who can evaluate it much better than he can.
Posted by Tyrannosaur on May 28, 2013, at 16:40:15
In reply to Re: Nardil Headache, posted by Willful on May 28, 2013, at 10:23:40
I believe it's important to mention all the risks when giving advice over the internet, so no worries.
I'm from Scandinavia, and all MAOIs were discontinued early 90s due to the tyramine reaction risk, and the introduction of SSRIs. As a result almost no psychiatrists have heard or used MAOIs, and the knowledge about them is beyond poor. I have to rely on the internet as my main source of information.
This is the end of the thread.
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