Posted by Erewhonian on January 3, 2012, at 17:16:37
In reply to Re: Emsam poop out, a new maoi?, posted by williamockham on January 3, 2012, at 13:53:11
> Fig 3 in the Emsam PI seems to indicate it's pretty linear, but maybe I'm reading this wrong.
Citing actual facts and figures instead of relying on vaguely remembered things you've read on the internet seems like cheating. But yeah, that looks like a nice line from 12 to 24 hours. Since only ~25%-30% is absorbed in 24hrs, there's a decent amount of selegiline left on the patch. But if there's a peak around 4hrs, I'd expect there'd be a valley at some point in the future, right? (Such biopharmaceutics/pharmacokinetics is beyond my knowledge, just horse sense here) Not that it would make a difference to your steady-state plasma levels if you've got a newer patch or two on.
> Huh. You know, every time I went up in dose, I'd get insomnia/physical anxiety for a few days. And every so often I'd get it without any dose increase, for a day or two--might be this same phenomena, as it was also during an occasionally scorching summer.
I wish the effects of heat on the patch were made plainer. I read the PI and Medication Guide before I started EMSAM, but this section somehow escaped my memory:
External Heat: The effect of direct heat applied to the EMSAM patch on the bioavailability of selegiline has not been studied. However, in theory, heat may result in an increase in the amount of selegiline absorbed from the EMSAM patch and produce elevated serum levels of selegiline. Patients should be advised to avoid exposing the EMSAM application site to external sources of direct heat, such as heating pads or electric blankets, heat lamps, saunas, hot tubs, heated water beds, and prolonged direct sunlight.
They should have BOLDED that section. Effect is not merely theoretical. Wish my doctor had been informed enough to mention this.
> I waited four days after stopping Emsam; pdoc thought that sufficient to get rid of the selegiline and amphetamine metabolites. "No point in waiting for MAO to regenerate if you're just going to wipe it out again."
Sounds like a knowledgeable pdoc. I wouldn't place too high a bet on me finding one that won't blindly follow the 14 day washout rule of thumb though.
Yeah, inhibited MAO is inhibited MAO, I would think (at least if it's the same MAO subtype). Most of the difference in the various MAOIs should be due to metabolites (like amphetamines with selegiline and whatever it is that causes the GABA activity of nardil). But I'm trying to play it safe (as far as I can tell from what I read) and maybe restore the response to MAO inhibition if that's what I've developed resistance to. I don't know how likely that is, it seems like doctors usually go from one MAOI trial to another without concern for that. It might be for nothing, or maybe even for ill, I don't know for sure, and I get the sense that no one else really does either. But that's the adventure of psychiatric meds!
poster:Erewhonian
thread:1005595
URL: http://www.dr-bob.org/babble/20111226/msgs/1006245.html