Posted by Tony P on December 22, 2008, at 2:29:55
In reply to Re: Whats your sleep med? If bad Med induced insom, posted by desolationrower on December 21, 2008, at 12:36:52
> Hey vincent. Remeron with MAOI is sort of like selegiline with and ssri...it can be dangerous if you happen to be one of those people who metabolizes the drug VERY slowly, maybe .5% of the population. But its the kind of problem you'll know RIGHT AWAY, when your heart tries to jackhammer its way out of your chest.
TP: Agreed, YMMV. I've been simultaneously on selegeline (low dose: 10 mg/day oral), Remeron, Cymbalta & a couple of other meds., including an occasional TCA (trimipramine) for sleep, much to the worry of my pdoc & pharmacist. I also started taking Inderal with them to help with shakiness and minimize any BP side effects from the combo, but if you have postural hypotension that might not be a good idea.
The above combination worked fine for me; no BP rise, no Serotonin Syndrome. I stopped the selegeline mostly because it was making me so physically shaky and a bit too hypomanic.
*** There is one common OTC med that should (AFAIK) NEVER be combined with selegeline or any MAOI: dextromethorphan (DM or DXM in cough mistures). I nearly took it without thinking, then checked the web first just to be sure & was horrified. That combo can be deadly without any warning; there's one account of someone on a low dose of selegeline (I think) who took a normal does of DM cough mixture & was found dead in front of his TV with his dinner half-eaten. Psuedoephedrine (Sudafed), which is in a lot of cold/allergy remedies, is also quite dangerous with any MAOI -- see below for more comments.
Apart from those combos, I think most A/Ds including MAOIs can be tried together if you 1) start with very low doses 2) know the danger signs to watch out for and 3) have a good home BP monitor & use it, because dangerously high BP can be silent -- at most a headache.
------------------->Still, i would recommend cyproheptadine, maybe even 15-20mg. ...[snip]... cyproheptadine is OTC in canada, and you're in quebec right, so that would be a possibility if you haven't tried. >
TP: I'm in Canada, BC, & I asked my pharmacist about cyproheptadine; he said it was Rx only. The Rx schedules on a few meds vary from province to province in Canada, unfortunately.
*** Can anyone from BC confirm that cyproheptadine is Rx-only here?
> > On other side, i'm sure the pharmacist don't know what he talk about, for the MAOI'S at least... he just take a website about drugs and read the interractions to me...> > As a kid, I had STRONG allergy seasonal problems in the summer, and I took a lot of Chlorphenamine (Chlor-Tripolon), for that reason, I think the sedation effect have lost is action on me since a long time.
>
> oh hey, thats the one you can't take with an maoi, it is an sri as well as a antihistamine. and also with a similar name, bropheanamine i think.
>
TP: that would be brompheniramine maleate, common brand name Dimetapp. I don't know for sure, but I would suspect the problem with Clortripolon (chlorpheniramine) and Dimetapp is not the antihistamine so much as that the brand name product is often combined with pseudoephedrine (Sudafed) which IS definitely quite risky with any MAOI -- catastrophic BP rise is the culprit. I take Dimetapp _liquid_ when I need an antihistamine/decongestant, and didn't have a problem with selegeline (once again, YMMV); the liquid does NOT contain sudafed -- at least here: but _check_the_label, as the formula is often different under the same brand name in different countries, and sometimes they change the formula without changing the brand name, a very dangerous practice IMHO. If the label doesn't list pseudoephedrine, but has phenylephrine instead, that one's _relatively_ safe with MAOIs, according to my pet pharmacist.Agreed, most pharmacists just look up the official interaction tables -- after all, they have to be careful & assume the worst. My guy is very helpful, though, he will always tell me whether it's a possible mild interaction, a moderate one, or a high-risk one. Just press your pharmacist for more detailed info -- they have the relative interaction ratings available if they check the right web site -- and you can do the same, there are several good check-your-own-meds sites that give the 3-level interaction ratings.
I'd like to hear more about anyone's experience with doxylamine (Unisom-2), that one IS available OTC here for sure.
Tony P
poster:Tony P
thread:866872
URL: http://www.dr-bob.org/babble/20081214/msgs/870204.html