Posted by Chairman_MAO on August 30, 2005, at 9:40:47
In reply to Re: Parnate users,dosing amts, posted by djmmm on August 30, 2005, at 8:38:35
I am the one he was talking about in his message.
It has been proven by correlating treatment response with measurement of platelet MAO inhibition that the therapeutic dose of Parnate is 0.8mg/kg (That is, the dosage that produces 80% MAO inhibition). That is not to say that it won't elevate your mood at lower doses, but rather that you cannot say that you've given Parnate a fair trial until you've hit 0.8mg/kg.
Personally, I found 120-200mg/day easier to tolerate than 60-80mg/day: no hypotension, no sexual dysfunction. This was due to its amphetamine-like metabolites reaching significant concentrations. Furthermore, I found that if I took it all at once in the morning (I had NO problems tolerating a single dose of 200mg), sleep required far less sleep aid medication than if I took it in divided doses. However, if I took it in divided doses I felt far less anxious, because the hypotensive effect (I think) of tranylcypromine counteracted the overactivation of the amphetaminelike metabolites. All-in-all, I gave up on Parnate because it was simply impossible to get a good night's sleep--which was ruining my life--and my docs will never prescribe the amount of downer I'd need to do so.
I gave up and switched to Nardil. It works a lot better for my social phobia/anxiety/dysthymia anyway (though parnate wasn't shabby at all, that's for sure). Unfortunately, the initial success I had with cabergoline managing the sexual dysfunction is no longer; even taking doses as large as Parkinson's patients do (over 2mg/day!) had no effect!
Out of desparation last weekend I decreased my dose from 90mg/day to 75mg/day, despite the fact that 90mg/day is clearly superior. I am a 25-year-old male, and simply will not tolerate *COMPLETE* sexual dysfunction; I couldn't maintain an erection during intercourse despite cabergoline, herbs (tribulus, dodder seed, and others), AND _60mg_ of tadalafil.
While I've only been at 75mg/day for three days, I now have some spontaneous erections, some increased sensitivity, and have been able to orgasm through masturbation again (although I am still taking shilajit, dodder seed, tribulus terrestris, AND horny goat weed to increase my potency/function/libido, and plan on adding more alternative treatments). Hopefully it will continue to get better over time, as I fear 60mg/day may not be a therapeutic dose for me.
This is the only thing I really miss about Parnate: the orgasms on Parnate at 120-200mg/day were BETTER than on no medication at all. All I had to do was use 10-20mg Cialis and I was rockin' in that department. I'd really hate to give up Nardil, though, as it works a lot better for my negative self-talk and other things related to social phobias/anxiety. Even at 75mg/day, I notice some of those negative thoughts are coming back, though things are still orders of magnitude better overall than when I'm not on medication. Perhaps this will get better, though, as I'm still experiencing "brain shocks" from the dosage reduction.
I am going to talk to my doctor about perhaps trying a cholinergic medication (bethanechol, neostigmine) for the sexual dysfunction. Another option I suppose is Wellbutrin, which due to Nardil's anxiolytic properties I may be able to tolerate now. Neostigmine is sometimes used to obtain semen samples from criminals when "traditional" methods are not working for whatever reason.
poster:Chairman_MAO
thread:548486
URL: http://www.dr-bob.org/babble/20050827/msgs/548665.html