Re: Compounding MAOIs? » tj_smith

I'm not sure about Parnate, but it's my understanding that two individuals who were taking Nardil and posting to a forum on an old Web site called The Anxiety Community several years ago tried taking a compounded version of Nardil with some success. Essentially, what the first individual did was have his compounding pharmacist aim to extend the release of the phenelzine that he was taking by adding two ingredients known as Avicel and Methocel. The peak plasma concentration of the version of Nardil that Pfizer currently produces is .71 hours, or 43 minutes (Parke-Davis Division of Pfizer Inc., 2009). A review document from the U.S. Food and Drug Administration (2002) confirmed that the peak plasma concentration of the version of Nardil that was considered to be newly reformulated in 2003 was .71 hours. This figure is among the results generated by a bioequivalence study where 46 participants were administered a single 30-mg dose of the reformulated Nardil. The same bioequivalence study found the peak plasma concentration of the old version of Nardil (which was available in U.S. pharmacies until the fall of 2003) to be 1.11 hours based on results from 30-mg doses of the old Nardil being given to 47 participants (U.S. Food and Drug Administration, 2002), but an older study (Robinson et al., 1985) that involved administering 30 mg of Nardil to four participants found the peak plasma concentrations to be 3 hours for three of the participants and 4 hours for the fourth participant. So, there is some evidence to support the idea that with the older version of Nardil, phenelzine was absorbed more slowly than it is with the current version of the medication. The reports from the Anxiety Community members who indicated that they found the compounded version of Nardil that they took to be superior to the versions of Nardil that they typically took would seem to support the idea that a version of Nardil that's released more slowly might be more effective, but then again, only so much can be concluded from these reports, given their highly anecdotal nature and the obviously small sample size of two.

Other than adding ingredients to Nardil that might extend the release of the medication's active ingredient, phenelzine, altering the coating of the medication is another strategy that compounding pharmacists might conceivably be able to take to improve the medication's performance. The version of Nardil that was available in the U.S. prior to 2003 was coated with pharmaceutical glaze, also known as shellac. This ingredient is used to make enteric coatings, as it is water-insoluble at low pH levels and water-soluble at high pH levels (Pearnchob et al., 2004). Some members here on Psycho-Babble (one of whom was myself) reported noticing better results by putting the contents of their Nardil tablets into enteric capsules, but I don't think that the results obtained by using this strategy ever lasted for too long. And, as the case was with those who tried a compounded version of Nardil, reports of improved results from using enteric capsules should be considered to be highly anecdotal and based on a very small sample size.

Well, this sums up my ideas on what compounding pharmacists might be able to do to change the performance of the medications that you asked about, Nardil in particular. Feel free to let me know if you have any questions about what I've written.

Pearnchob, N., Dashevsky, A., & Bodmeier, R. (2004). Improvement in the disintegration of shellac-coated soft gelatin capsules in simulated intestinal fluid. Journal of Controlled Release, 94, 313-321. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/14744483

Robinson, D.S., Cooper, T.B., Jindal, S.P., Corcella, J., & Lutz, T. (1985). Metabolism and pharmacokinetics of phenelzine: Lack of evidence for acetylation pathway in humans. Journal of Clinical Psychopharmacology, 5, 333-337. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/4066998

U.S. Food and Drug Administration. (2002). Office of Clinical Pharmacology and Biopharmaceutics review (NDA 11-909/SCM-032). City of publication not available: Author.

"Maybe someday
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Re: Compounding MAOIs? » tj_smith

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