Posted by Adam on May 5, 2000, at 0:46:46
In reply to Re: Parnate+Selegeline - Adam, posted by Judy on May 3, 2000, at 20:49:24
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> You mentioned the similarities in structure of Parnate and Selegiline. At low doses of both, wouldn't that tend to work in my favor?Not necessarily. Augmentation strategies usually try to exploit differences in drug action to yield a beneficial effect from the combination. Of course, Parnate and Selegiline are not the same, just similar in some ways. But inhibition of MAO-B on 60mg of Parnate should be fairly complete. I don't think adding a very low dose of selegiline would enhance that effect much, but if it did, it probably wouldn't be dangerous. However, selegiline and Parnate do all kinds of things besides inhibit MAO. There could be benefits, and risks. Again, I'm not saying such an augmentation strategy couln't work. The truth is, I have no idea. What I'm saying is it seems highly unlikely that selegiline contributed to your experience when initiating Parnate, for the simple fact that there was essentially no selegiline in your system when you began Parnate.
>What exactly might be the physical risks in combining the two? Hypertension? I had notable postural hypertension with Nadil...
Hypertension could be a risk, as well as serotonin syndrome. One thing to ask: What enzymes are responsible for metabolizing Parnate and selegiline? If both are substrates of, say, the same member of the cytochrome P450 family, then the effective dose of one or the other could be dramatically increased. That could be quite dangerous.
Conversely, hypotension (I assume you meant postural or orthostatic HYPOtension above) could also be a risk. This seems to be a fairly common side effect of selegiline at low doses, and it can also be a side effect of other MAOIs, as you know from your experience. In fact, dangerous hypotension has been implicated as a possible explanation for a disturbing phenomenon: in some clinical surveys, it was noted that mortality _increased_ on average for people taking selegiline+levodopa vs. levodopa alone, quite the opposite effect one would hope for. How reliable this observation is, I don't know, but it's something to think about. Especially for the elderly, severe hypotension can be deadly, and it certainly can lead to fainting spells and accidents for anyone.
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> I have taken lithium alone before. It was a horrendous experience - made me suicidally sedated; but I did consider trying it with Parnate (perhaps I had that in mind from one of Elizabeth's old threads) before I got this bee in my bonnet.
>I wish she were around so she could advise you. She's way more up on this stuff than I am. I believe lithium, when used to augment an antidepressant, is administered at lower doses than one would if, say, they were using it to treat bipolar illness. However, I don't know what dose you were taking, so it's hard then to say if it would be a good thing for you or not.
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>I'll make a deal with you - if you'll call the doctor Anthony mentioned and he even touches on the positive, I'll gladly be the guinea pig!
>I feel like a bit of a hypocrite, since I have cast aspersions at pdocs before for sometimes behaving like everything the PDR says is
holy writ. However, what Ant described actually made me squirm. Maybe only 1 in 50,000 people would die if you gave them Prozac and Parnate together, but I wouldn't want to try it, and I suspect the odds are worse. I am taking 30mg/day of selegiline right now alone, and have already had one hypertensive episode: I goofed up and ate some bad chicken. Put my b.p. through the roof (UNpleasant). That means inhibition of MAO-A is near complete, or high enough to worry about, at any rate. ANY dose of Parnate worth taking plus 30mg/day selegiline sounds dangerous to me. I wouldn't mess with something like this unless I had no other options. 5mg/day is one thing, but 30mg/day is just out there, IMO.
poster:Adam
thread:31946
URL: http://www.dr-bob.org/babble/20000429/msgs/32358.html