Posted by ChicagoKat on September 20, 2012, at 9:19:47
In reply to Re: Need out of the box suggestions » ChicagoKat, posted by SLS on September 20, 2012, at 0:43:07
> I would just add to Eric's list of drugs to avoid while taking a MAOI anything that is a serotonin reuptake inhibitor. This includes the SNRIs. It also includes the TCAs imipramine and clomipramine. The other TCAs are probably okay, although I have my doubts about protriptyline. It might be too noradrenergic and anticholinergic. I would worry about cardiovascular side effects. I know someone who did well on Nardil + doxepin. Trimipramine should not be a problem theoretically, but I don't know anyone who has taken this drug in combination with a MAOI. I would recommend desipramine and nortriptyline as first choices. They are secondary amines that are milder in anticholinergic effects and have little or no serotonin reuptake inhibition.
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> When taking TCA + MAOI, the two drugs can be started together. If one is already taking TCA, the MAOI can be added gradually. If one is already taking MAOI, adding a TCA is discouraged. I don't know why. I have done this on a few occasions and had no problem with it. I think the main concerns are cardiovascular and would include a hypertensive reaction or tachycardia. One's heart rate will almost always be increased by TCA. However, a resting rate above 120 beats per minute should raise concern. Perhaps one can use propranalol to control this, but I have never seen it done. TCAs are contraindicated if there is heart-block conductance pathology. If you are worried about this, you can get a ECG before treatment and then after you begin treatment. Desipramine is a bit harsher than nortriptyline. However, there are people who respond to one drug but not the other.
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> Other drugs to avoid because of serotonin reuptake inhibition during MAOI treatment are meperidine (Demerol) and dextromethorphan. Personally, I would stay away from ziprasidone (Geodon) and tramadol. Direct-acting noradrenergic agonists must be avoided, too. This would include decongestants (phenylpropanolamine and pseudoephedrine). So, too, are epinephrine and norepinephrine. I'm sure you can find a more comprehensive list on the Internet.
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> With MAOI, one can take Wellbutrin, amphetamine, and methylphenidate, even though these drugs are contraindicated. Since hypertensive reactions are possible, this should be done cautiously. I recommend taking your first dose of a stimulant in the doctor's office so that your blood pressure can be monitored. Dopamine agonists are also okay. I once took together Parnate, desipramine, Dexedrine, and bromocriptine. I have also added Wellbutrin to Parnate.
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> I think you should use my statements here as a guideline for you to do further research on your own rather than to assume their accuracy.
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> - ScottThanks for the info Scott. I'll continue researching, but you've given me lots to consider when I do so. I am most curious about adding Nortriptyline b/c it has more NE effect than the others. My main concern is that you say that most clinicians don't like to add a TCA after an MAOI is started. I kinda wanted to see how the MAOI did on its own in case I didn't need to add anything else. Hmmmm. And can Ritalin really for sure be used with an MAOI??? Do you have any references to articles that prove this? If that is really true, we may have found the answer for me, b/c I know low-dose Nardil helps my anxiety, but I'm worried about how much it will help my depression. Thanks in advance for any info you can provide. :)
All my best,
Kat
poster:ChicagoKat
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