Posted by harryp on March 17, 2004, at 1:48:17
In reply to Story: Hypertensive Crisis, posted by Questionmark on March 13, 2004, at 6:11:18
I'm really sorry about your experience. If I had a dream in which that happened, it would rank among my worst nightmares.
I agree with King Vultan (cool name BTW). Nifedipine is probably the best oral medication for a hypertensive crisis. One of my references suggests 10-20 mg bitten and swallowed (I'd go with ten) and then another in 20-30 minutes if necessary. The medicine can start to work in as little as five minutes, and reaches its peak effect in (if I remember right--about 20-30 min). I carry a blood pressure cuff when I travel, too.
I haven't heard of using oral propanolol for a bp crisis. In oral form I think its effect would be too slow and mild to do a lot of good, although I think it definitely helped you in this awful case. Nifedipine isn't ideal--but it's probably the fastest acting oral med.
I do want to say that you shouldn't worry about permenant damage. Long term hypertension can do all sorts of awful things, but in the short term the danger is stroke--and you definitely would know if you had one!
One last remark: the gold standard drug for MAOI/tyramine induced hypertension is IV phentolamine. This is the drug you should (respectfully--doctors like to be stroked) request if your ER doc is seems uncertain about what to use. It is an alpha adrenogenic blocker and directly stops the action of the epinephrine/norepinephine. The normal dose is 2.50-5mg IV, repeated after a few minutes if necessary.
The alpha/beta blocker labetolol also works well if phentolamine isn't available.
poster:harryp
thread:323875
URL: http://www.dr-bob.org/babble/20040313/msgs/325164.html