Posted by Elizabeth on February 22, 2002, at 13:59:29
In reply to Hypertensive Crisis: when to go to hospital?, posted by christophrejmc on February 22, 2002, at 3:04:51
Hi there. Something similar happened to me with Parnate: I took a single dose of 20 mg, and my BP got to be about as high as yours got (don't recall exact numbers) after a half-hour or so. My pdoc gave me some ProCardia (nifedipine) to take in case of such an occurrence (with directions to take 10 mg if my BP got to a certain level; again, don't recall exact numbers). It was spontaneous: not related to a food or drug interaction. This isn't very common, but it does happen to some people, for whatever reason. I think it's more common with Parnate, but it can happen with Nardil too. It's definitely dose-related (hypertension is a common symptom of MAOI overdose, for example).
Did you take the entire 90 mg all at once? If not, how much did you take?
The tingling scalp seems to be a very predictive symptom of acute hypertension (I described it as feeling like my hair was standing on end). I also had a very bad headache and some nausea, and I was sweating like -- uh, something that sweats a lot.
BTW, "hypertensive urgency" is the technical term for these brief episodes of hypertension that aren't serious enough to be life-threatening. I've had a number of such episodes, but only one true hypertensive crisis.
Most hypertensive urgencies resolve on their own, as yours did, without the need for medication. There is a risk that your BP will continue rising, leading to a hypertensive crisis, which can cause a stroke or other serious consequences (the one time I had a true hypertensive crisis, I suffered a lung hemorrhage), though, so it's best to treat it instead of waiting for it to get really bad. Your pdoc should be able to tell you at what BP you should treat it.
If you take nifedipine or a similar drug (calcium channel blocker) for acute hypertension, be sure that you get plenty of fluids in you. This can prevent your BP from "crashing." This happened to me one time (fortunately, I was in the hospital) and shortly after taking the nifedipine, I started feeling like my heart was pounding (like it was planning on jumping out of my chest or something), and there was a ringing in my ears. The resident gave me some water and I was fine within a little while.
Another note about nifedipine: it comes in gelcaps. The way to take is to bite them open and then swallow them; this produces a very rapid onset of effect. You don't need to hold them under your tongue or anything like that.
I'd say, go back down to the lower dose of phenelzine and call your pdoc to find out what you should do if this happens again. It may be a fluke; on the other hand, you may have a special sensitivity to phenelzine's pressor effect which requires a change of plans. One way to reduce the risk of spontaneous hypertensive episodes is to take the drug in divided doses. I developed hypertension whenever I tried to take 20 mg of Parnate at a time, so I restricted each dose to 10 mg. (At one point I was taking 60 mg/day in six divided doses. A pain, as you can imagine. And I actually considered going up quite a bit higher.)
I hope this helps. Let us know what your pdoc tells you; I'll be curious.
-elizabeth
poster:Elizabeth
thread:95075
URL: http://www.dr-bob.org/babble/20020222/msgs/95121.html