Psycho-Babble Medication Thread 1096004

Shown: posts 1 to 12 of 12. This is the beginning of the thread.

 

Parnate and orthostatic hypotension

Posted by chrismeurer on November 23, 2017, at 12:08:12

Hello,

For those who take or have taken parnate, did you experience orthostatic hypotension? As you may know, dr. ken gillman sees the presence of orthostatic hypotension as a sign of minimum therapeutic dose.
I have been trying to monitor my blood pressure following his advice, but there's a few problems. I probably already had OH before starting parnate; and I take propranolol to avoid lithium side effects. One thing is for sure though, my blood pressure is a lot lower since I started parnate.
Right now, i'm taking 30 mg/day of parnate (for 6 days) and, since I clearly have hypotension and OH, was planing to keep this dose for a few weeks to access effectiveness. I'll also stop taking propranolol fow a few days and see what happens (for some reason it makes me worry of the possibility of increased anxiety, even though I don't think propranolol makes much difference.)
Well, of course I know I don't lose much waiting a few weeks to see if it helps, but the idea of being able to tell if the drug will help only because it causes a side effect is so appealing.
What do you think of it? Any thoughts are welcome :)

Chris

 

Re: Parnate and orthostatic hypotension chrismeurer

Posted by SLS on November 23, 2017, at 21:06:57

In reply to Parnate and orthostatic hypotension, posted by chrismeurer on November 23, 2017, at 12:08:12

What are the side effects of lithium that propranolol is supposed to address? Tremulousness? Is it helping?

The old way of determining therapeutic dosages of Parnate is to do an orthostatic challenge, whereby sitting blood pressure is compared to that which results immediately upon standing up. A drop of 10% is considered to be a good indicator of therapeutic levels of MAO inhibition. I don't know how taking propranolol might interfere with the interpretation of such a test. I found that dizziness is a side effect that mitigates with continued treatment. (This not necessarily true with Nardil). The presence or absence of dizziness upon standing is not a reliable index of the 10% rule.

I have come to believe strongly that with Parnate, 40-80 mg/day is the dosage range that is effective. At 30 mg/day, you might experience a temporary increase in mental energy, but I would be surprised if that dosage would end up being globally effective for you. I truly hope that you are an exception, though.


- Scott

 

Re: Parnate and orthostatic hypotension SLS

Posted by chrismeurer on November 24, 2017, at 6:18:23

In reply to Re: Parnate and orthostatic hypotension chrismeurer, posted by SLS on November 23, 2017, at 21:06:57

Yes, tremulousness. It helps, i'm taking a low dose (450 mg) of lithium CR this time though. I'll just see if it tremulousness appears without the propranolol. I've taken propranolol before to treat lithium side effects at a higher dose and to alleviate akathisia from abilify.

About parnate, at 30 mg/day I felt a great decrease in blood pressure. Orthostatic hypotension was tested in the doctor's office with a drop of 30 mmHg in systolic, so positive. I just got an upper arm BP monitor and will measure daily. So far, there's definitely a 10% drop. The only problem is that I wasn't able to measure before starting parnate, so I can't be sure if I already had it. I'm only sure that there was a general decrease in blood pressure.

The good things is I definitely feel much less anxious, it's a wonderful feeling after so long. 6 days since my last xanax.

I see no harm in increasing the dosage to 40 mg, it's a matter of assessing necessity, but after that I guess it would be reasonable to give at least 1 month. I will think about it.

Thank you

Chris

 

Re: Parnate and orthostatic hypotension chrismeurer

Posted by pedr on November 24, 2017, at 8:24:26

In reply to Parnate and orthostatic hypotension, posted by chrismeurer on November 23, 2017, at 12:08:12

> Hello,
>
> For those who take or have taken parnate, did you experience orthostatic hypotension? As you may know, dr. ken gillman sees the presence of orthostatic hypotension as a sign of minimum therapeutic dose.

Hi again Chris,

yes, I experienced a very clear drop upon standing and tracked it twice daily as GIllman recommends (sitting, immediate standing, standing). Unfortunately after 2 weeks of doing OK, my mood absolutely crashed into a severe depression and showed no signs of lifting. Hence I'm hot-swapping for Nardil which I've done OK on before. A lot fatter and tireder but OK :/

A couple of observations from my experience with it:
- my insomnia simply disappeared overnight at the same time the depression increased. It was pretty bad up until that point. That was about 3.5 weeks in.
- around the same time I noticed my systolic wasn't going down any more upon standing, just my diastolic which was curious.
- for 2 days I got very strong heart palpitations all day long. It took me a while to recognise it and it was surprisingly uncomfortable. But I have a lot of upper GI issues which probably worsened my perception of it.

I hope the Parnate continues to work out for you, good luck,
Pete

 

Re: Parnate and orthostatic hypotension

Posted by SLS on November 24, 2017, at 8:49:53

In reply to Re: Parnate and orthostatic hypotension SLS, posted by chrismeurer on November 24, 2017, at 6:18:23

> Yes, tremulousness. It helps, i'm taking a low dose (450 mg) of lithium CR this time though. I'll just see if it tremulousness appears without the propranolol. I've taken propranolol before to treat lithium side effects at a higher dose and to alleviate akathisia from abilify.
>
> About parnate, at 30 mg/day I felt a great decrease in blood pressure. Orthostatic hypotension was tested in the doctor's office with a drop of 30 mmHg in systolic, so positive. I just got an upper arm BP monitor and will measure daily. So far, there's definitely a 10% drop. The only problem is that I wasn't able to measure before starting parnate, so I can't be sure if I already had it. I'm only sure that there was a general decrease in blood pressure.
>
> The good things is I definitely feel much less anxious, it's a wonderful feeling after so long. 6 days since my last xanax.
>
> I see no harm in increasing the dosage to 40 mg, it's a matter of assessing necessity, but after that I guess it would be reasonable to give at least 1 month. I will think about it.
>
> Thank you
>
> Chris

Let the dosage sink in. Your orthostatic challenge might yield a smaller reduction of BP over time. I wouldn't worry too much about heart palpitations. It is not uncommon early in treatment, but is likely to mitigate as you continue to take the drug. You might very well experience a re-emergence of autonomic side effects with each dosage increase. Try to hang-in there. Just follow your BP whenever you increase the dosage to be sure that you don't experience an acute pressor reaction.


- Scott

 

Re: Parnate and orthostatic hypotension pedr

Posted by chrismeurer on November 24, 2017, at 8:56:08

In reply to Re: Parnate and orthostatic hypotension chrismeurer, posted by pedr on November 24, 2017, at 8:24:26

Thank you for the info Pete. I'm sorry Parnate wasn't good for you, but it's great you have Nardil. I'll remember your observations. Interestingly, i'm sleeping really well, so insomnia isn't a problem, at least not yet. My blood pressure is really low, i'm measuring it following the recommendations. Once I have enough measurements, I will plot.

Good luck friend, we'll be fine :)

 

Re: Parnate and orthostatic hypotension

Posted by chrismeurer on November 24, 2017, at 9:01:53

In reply to Re: Parnate and orthostatic hypotension, posted by SLS on November 24, 2017, at 8:49:53

> Let the dosage sink in. Your orthostatic challenge might yield a smaller reduction of BP over time. I wouldn't worry too much about heart palpitations. It is not uncommon early in treatment, but is likely to mitigate as you continue to take the drug. You might very well experience a re-emergence of autonomic side effects with each dosage increase. Try to hang-in there. Just follow your BP whenever you increase the dosage to be sure that you don't experience an acute pressor reaction.
>
>
> - Scott

Ok, thank you Scott

 

Re: Parnate and orthostatic hypotension

Posted by baseball55 on November 24, 2017, at 17:52:28

In reply to Re: Parnate and orthostatic hypotension, posted by chrismeurer on November 24, 2017, at 9:01:53

I was in the hospital when I started parnate, so my BP was being monitored and I definitely had postural hypotension - pretty dramatic actually. For the first several months, I regularly felt dizzy upon standing and needed to hold on to something for a couple of minutes until it passed. Then that stopped. However, this summer I had surgery and a visiting nurse took my BP sitting, then standing. When she took it standing, she said, do you know your BP drops when you stand up. I replied that it was because of parnate, but that it didn't really seem to drop much anymore. She said - actually it's 80/50.

I was surprised. Because I never feel dizzy anymore.

 

Re: Parnate and orthostatic hypotension baseball55

Posted by chrismeurer on November 24, 2017, at 18:25:43

In reply to Re: Parnate and orthostatic hypotension, posted by baseball55 on November 24, 2017, at 17:52:28

> I was in the hospital when I started parnate, so my BP was being monitored and I definitely had postural hypotension - pretty dramatic actually. For the first several months, I regularly felt dizzy upon standing and needed to hold on to something for a couple of minutes until it passed. Then that stopped. However, this summer I had surgery and a visiting nurse took my BP sitting, then standing. When she took it standing, she said, do you know your BP drops when you stand up. I replied that it was because of parnate, but that it didn't really seem to drop much anymore. She said - actually it's 80/50.
>
> I was surprised. Because I never feel dizzy anymore.

Yes, my blood pressure is around that when I stand. I also feel dizzy.
So, how is the treatment going? Thank you for the reply :)

Chris

 

Re: Parnate and orthostatic hypotension

Posted by baseball55 on November 25, 2017, at 18:22:29

In reply to Re: Parnate and orthostatic hypotension baseball55, posted by chrismeurer on November 24, 2017, at 18:25:43

I don't take my BP. My sitting BP has always been normal 120/80 range. I only worry about the postural hypotension if it makes me dizzy. It really doesn't anymore. I guess the brain gets used to it or something. Several months ago, I was having problems with bad depression again and raised my parnate dose. I could barely stand, I would get so dizzy. So I cut back down again.

I'm good on 30mg. I know many people on this list use a lot more, but 30mg seems to work for me.

 

Re: Parnate and orthostatic hypotension baseball55

Posted by chrismeurer on November 26, 2017, at 10:51:47

In reply to Re: Parnate and orthostatic hypotension, posted by baseball55 on November 25, 2017, at 18:22:29

> I don't take my BP. My sitting BP has always been normal 120/80 range. I only worry about the postural hypotension if it makes me dizzy. It really doesn't anymore. I guess the brain gets used to it or something. Several months ago, I was having problems with bad depression again and raised my parnate dose. I could barely stand, I would get so dizzy. So I cut back down again.
>
> I'm good on 30mg. I know many people on this list use a lot more, but 30mg seems to work for me.

That's great! I'd like to see more people good on lower dosages. Thank you

Chris

 

Re: Parnate and orthostatic hypotension chrismeurer

Posted by MightyKondrian on December 5, 2017, at 16:39:23

In reply to Parnate and orthostatic hypotension, posted by chrismeurer on November 23, 2017, at 12:08:12

> Hello,
>
> For those who take or have taken parnate, did you experience orthostatic hypotension? As you may know, dr. ken gillman sees the presence of orthostatic hypotension as a sign of minimum therapeutic dose.
> I have been trying to monitor my blood pressure following his advice, but there's a few problems. I probably already had OH before starting parnate; and I take propranolol to avoid lithium side effects. One thing is for sure though, my blood pressure is a lot lower since I started parnate.
> Right now, i'm taking 30 mg/day of parnate (for 6 days) and, since I clearly have hypotension and OH, was planing to keep this dose for a few weeks to access effectiveness. I'll also stop taking propranolol fow a few days and see what happens (for some reason it makes me worry of the possibility of increased anxiety, even though I don't think propranolol makes much difference.)
> Well, of course I know I don't lose much waiting a few weeks to see if it helps, but the idea of being able to tell if the drug will help only because it causes a side effect is so appealing.
> What do you think of it? Any thoughts are welcome :)
>
> Chris
>

At least with Nardil orthostatic hypotension began AFTER the benefits presented themselves.
I will be finding out about Parnate soon perhaps.
Marplan also causes it. Why all 3 irreversible MAOIs? I best read the above.
One way around it is to increase salt (sodium) intake


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