Posted by Scott L. Schofield on March 25, 2000, at 13:18:33
In reply to Re: Parnate and cardiac toxicity? Dr. Bob?, posted by Anna P. on March 24, 2000, at 12:17:22
> Can anyone please explain to me that issue? I would like to consider Parnate as my last resort, but I've experienced alreadty the heart pain on Moclobemide, and stimulants. I know, it wasn't anxiety symptoms. My EKG was fine , but the cardiologist has said all these meds are stimulating for the heart. I take already different medicines for 5 years. what are my chances for Parnate? I was always helped by the stimulating medications. Parnate could help, as I'm bipolar II, and nothing helps so far.
Hi Anna.Parnate (tranylcypromine) is a good choice for depression in bipolar disorder.
Is the "heart pain" you experience the same as heart-palpitations? With heart-palpitations, you can feel your heart beat, but it should not be painful. If your doctor thinks that the "heart pain" is a normal side effect, I would not worry too much. I have heart palpitations sometimes when I start a new drug. Usually, it goes away.
Parnate is not supposed to be cardiotoxic. It does not hurt the heart. It can increase heart rate. For some people, it can raise blood pressure. This is not common. However, it can be dangerous. It usually happens at the beginning. Sometimes it gets better, sometimes not. It is a good idea to check your blood pressure when you start treatment. Usually, Parnate lowers blood pressure. It can make you dizzy when you first stand up, but then it goes away. Usually, the dizziness gets better with time, but doesn't always go away completely.
The dosage for Parnate that I recommend is 40mg - 80mg. You must start at a lower dose. Follow your doctor's directions. It usually takes two to three weeks to work, if the dosage is right. It will take longer if you must adjust the dosage higher.
With bipolar II, you must be careful of mania. Any antidepressant drug can cause this. It might be a good idea to take a mood-stabilizer drug like Depakote (valproate, valproic acid) or lithium. Lamictal (lamotrigine) is another mood-stabilizer drug that can also add to the antidepressant effect of Parnate. It can prevent mania, but sometimes not. Depakote is better for mania.
I put an article at the bottom about Parnate and the heart. It compares Parnate to amitriptyline. Amitriptyline is a tricyclic antidepressant (TCA). TCAs can be cardiotoxic, usually at high dosages.
Good luck.
- Scott
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Int Clin Psychopharmacol 1991 Spring;6(1):11-7 Related Articles, Books
A comparative study of the electrocardiographic effects of tranylcypromine and amitriptyline when prescribed singly and in combination.O'Brien S, McKeon P, O'Regan M
Student Health Centre, Trinity College, Dublin, Eire.
The authors treated 53 in-patients aged between 18 and 65 years who were suffering from major depression with either tranylcypromine, amitriptyline or a combination of tranylcypromine and amitriptyline. Electrocardiograms taken before and after treatment were compared. In clinically effective doses amitriptyline gave rise to a significant increase in heart rate when prescribed alone and in combination with tranylcypromine. Single tranylcypromine treatment had little effect on heart rate and gave rise to no change in cardiac conduction as measured by the electrocardiogram. Amitriptyline when prescribed in combination with tranylcypromine was associated with significant lengthening of the PR interval. None of the patients developed pathological changes in their electrocardiograms under the carefully monitored treatment conditions of the study.
poster:Scott L. Schofield
thread:26241
URL: http://www.dr-bob.org/babble/20000321/msgs/28138.html