Posted by Elizabeth on August 9, 2001, at 21:53:00
In reply to Re: parnate questions » may_b, posted by Cam W. on August 9, 2001, at 19:35:58
Hi Cam.
> The guys in emerg are just going to do supportive treatment for anything that comes through the door. With the pace of scientific research these days, I'm not surprized they aren't up on the latest info.
Use of nifedipine for MAOI-associated hypertensive urgency is not exactly the latest info!
> I have heard of using the meds you mention; I think it was a European study (I am a community pharmacist and have little idea what goes on in a hospital). It seems everything is tried out in Europe (esp. Turkey, for some reason), before it makes it to the west.
Yeah, they're our guinea pigs, you know. < g >
Seriously: nifedipine is pretty commonly used for this purpose. Phentolamine isn't available in a pill form in the U.S. that I know of, but it's the recommended treatment for MAOI-associated hypertensive crisis in hospital settings (like, it's what the PI says to use). Sodium nitroprusside is another common treatment for HC in hospitals.
> I really doubt the docs here would allow a person on an MAOI to carry hypertensive crisis meds with them. There are too many liability concerns. Dosage must be considered, as must knowing what you've taken when you reach the emergency room, if the recovery didn't work.
I had no problem getting a script for nifedipine when I was
I was directed to bite and swallow one gelcap if my blood pressure got above 165/100 or so, and continue monitoring it. I was also told to go to an emergency room if I took any of it. It's not especially dangerous for a young woman in good cardiovascular health (such as myself), but like you say, better safe than sorry. The only problem I had (I think I used it two times during the 4 years or so that I was taking MAOIs) was when I accidentally took a double dose of Parnate and my BP shot up (not a food or drug interaction; just the effect Parnate has on me if I take too much at once). I didn't realise that dehydration would be a problem. My heart was pounding; it felt like it was going to jump out of my chest or something.If you don't have a reliable way to take your BP, I suppose it could be a problem.
> Also, would you know if you were having a hypertensive crisis?
This is always a question. I'm pretty sure I would know even without taking my BP because it's happened to me a few times. But a lot of things can cause headaches, nausea, etc. Hypertensive headache is pretty distinctive, but I don't know if a person who'd never experienced it would be able to identify it positively. And even if there is hypertension associated with the event, it may be misattributed. Before I realised that I was having spontaneous hypertensive episodes on Parnate, I was convinced that I'd had a reaction to some hummus.
> Also ask the doc about restarting the Parnate; five days is too long to wait.
I agree. MAOI withdrawal symptoms can be very serious.
> I would recommend a Medic Alert-type bracelet or chain for anyone taking MAOIs.
I had one of these. Never had to use it. The main issue is that you shouldn't be given Demerol.
But this brings to mind a question I've been meaning to ask: should I have a tag saying that I take buprenorphine? What I'm concerned about is the possibility that I wouldn't get adequate analgesia if I needed it because I probably have some degree of tolerance and because buprenorphine is hard to displace from mu receptors. What do you think?
> Also, learning as much as you can about the drugs you are taking (as you have) empowers a person to take charge of there illness, and not leave it all up to the doctor.
I agree absolutely. Unfortunately, taking charge of your own fate becomes a lot harder in an emergency situation where the medical professionals are people who don't know you. IME, they tend to make the assumption that you don't know what you're doing.
> It takes some finesse and understanding to properly interpret what a study is really trying to say (if anything).
Aren't they all trying to say "more research is needed" (i.e., give us more grants)? < g >
> Also be aware of what you are ordering in a restaurant and ask the waiter or waitress to ask the chef if you have any suspicions about a dish.
I think this only works in Italian restaurants. ("What kinds of cheeses are in this dish, and to what degree are they aged?")
> Follow the food guide on MAOIs; it's better to be safe than sorry (as you know).
And people should also know that the dietary restrictions have been greatly exaggerated. When patients are given overly restrictive dietary recommendations, they discover that they can cheat on some of the restrictions, and as a result they don't take them seriously in general (even the ones that they actually should take seriously). (Analogous to the way that the dangers of drug abuse are exaggerated to teenagers, so they don't take any of the warnings seriously.)
-elizabeth
poster:Elizabeth
thread:74195
URL: http://www.dr-bob.org/babble/20010809/msgs/74392.html