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Posted by Mark25 on November 10, 2011, at 10:09:55
In reply to Re: Questions on phenelzine/Nardil (@jedi and others) » ger man, posted by europerep on October 6, 2011, at 14:09:37
How did Nardil work out for you after Parnate / Jatrosom failed? Could you please tell me how the import procedure works? Thanks!
- Mark
Posted by Mark25 on November 10, 2011, at 10:11:38
In reply to Re: Questions on phenelzine/Nardil (@jedi and others) » ger man, posted by europerep on October 6, 2011, at 14:09:37
How did Nardil work out for you after Parnate / Jatrosom failed? Could you please tell me how the import procedure works? Thanks!
- Mark
Posted by Mark25 on November 12, 2011, at 12:12:21
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by Mark25 on November 10, 2011, at 10:11:38
Is it worth to give Nardil a shot altough Parnate didn't help me and caused really troublesome hypotension / dizziness? My major problem is social anxiety disorder, so the +GABAergic / calming action of Nardil could be better suited for that.
At the moment I take 8mg Klonopin a day as prescribed, but it doesn't make me want to socialize at all, just helps with the anxiety and in the end I'll have to taper down that stuff.
Nardil / Phenelzine isn't even available in my country, but as I live in the EU I should be able to import it from e.g. the UK with a valid (private) prescription I guess?
Posted by jedi on November 12, 2011, at 12:22:43
In reply to 2nd MAOI after the first one failed?, posted by Mark25 on November 12, 2011, at 12:12:21
> Is it worth to give Nardil a shot altough Parnate didn't help me and caused really troublesome hypotension / dizziness? My major problem is social anxiety disorder, so the +GABAergic / calming action of Nardil could be better suited for that.
>
> At the moment I take 8mg Klonopin a day as prescribed, but it doesn't make me want to socialize at all, just helps with the anxiety and in the end I'll have to taper down that stuff.
>
> Nardil / Phenelzine isn't even available in my country, but as I live in the EU I should be able to import it from e.g. the UK with a valid (private) prescription I guess?
Mark,
Nardil can and does work where Parnate fails. That is a S**tload of clonazepam! I used up to 5mg while I was waiting for Nardil to kick in the first time. Phenelzine is the "BOMB" for social anxiety and atypical depression. In my opinion it should be 2nd tier and not last resort for this diagnosis. It is a bloody crime that it is not available in your country. The stuff saved my life more than once! You can probably get all of the worthless SSRIs you want! Sorry! The MAOIs work where all others fail. I have been preaching about it on here for years. I did have 2 failed Parnate trials. Google some of my posts. This S**T works!
Good Luck,
Jedi
Posted by Mark25 on November 12, 2011, at 13:18:34
In reply to Re: 2nd MAOI after the first one failed? » Mark25, posted by jedi on November 12, 2011, at 12:22:43
> Mark,
> Nardil can and does work where Parnate fails. That is a S**tload of clonazepam! I used up to 5mg while I was waiting for Nardil to kick in the first time. Phenelzine is the "BOMB" for social anxiety and atypical depression. In my opinion it should be 2nd tier and not last resort for this diagnosis. It is a bloody crime that it is not available in your country. The stuff saved my life more than once! You can probably get all of the worthless SSRIs you want! Sorry! The MAOIs work where all others fail. I have been preaching about it on here for years. I did have 2 failed Parnate trials. Google some of my posts. This S**T works!
> Good Luck,
> JediThanks for you encouraging post! I know that's really much clonazepam, but less wouldn't do anything for me. Haven't taken it for too long without breaks (5 weeks).
I also have atypical depression since like 10+ years. Tried about 30 meds / combos, but to no avail.
My psychiatrist is cool and old-school, so getting a script for Nardil / phenelzine shouldn't be a problem. I don't know about import regulations, but guess - as the drug is approved in another EU country (UK) - it shouldn't be a problem. Other users from above were also able to get it. Insurance will very likely not pay for it, but that's OK.
PS: What's your Nardil dose?
- Mark
Posted by europerep on November 12, 2011, at 15:50:38
In reply to Re: 2nd MAOI after the first one failed?, posted by Mark25 on November 12, 2011, at 13:18:34
Hello there,
jedi knows more about that particular drug than I do, but it is generally accepted that, while tranylcypromine and phenelzine are both irreversible MAOIs, they do have their own pharmacological profile, so it's probably worth a try...
I was just going to say that, as a EU citizen, you shouldn't have too much trouble getting the drug even if it's not marketed in your particular country. There are two possiblities: what definitely works is take a prescription from your doctor to a pharmacy in a country where phenelzine is sold (UK, Belgium, Netherlands, Luxemburg, maybe others...). Per EU law, your prescription is valid in all 27 member countries.
In at least some countries, such as Germany, you can also have the drug imported by your pharmacy. I'm not familiar with how (and if) that procedure works in other member states though.
If you have more questions on that subject, let me know...
ER
Posted by Mark25 on November 12, 2011, at 16:34:05
In reply to Re: 2nd MAOI after the first one failed? » Mark25, posted by europerep on November 12, 2011, at 15:50:38
Thanks! Some bigger pharmacies here do import drugs from other EU countries.
I know that Parnate is considered more stimulating (altough I never felt that effect). And one metabolite of Nardil / Phenenlzine raises brain GABA levels which should make it more calming in general.
Could you please answer those short questions:
1) What shall my doctor write on the prescription (except the usual stuff)? The generic (english?) drug name or brand name?
Phenelzin(e) or Nardil or Nardelzine? I see Nardelzine is 15mg Phenelzine a 100 tablets, right? How much does it cost / did you pay?
Thanks in advance.
Posted by europerep on November 13, 2011, at 6:05:35
In reply to Re: 2nd MAOI after the first one failed?, posted by Mark25 on November 12, 2011, at 16:34:05
> Could you please answer those short questions:
>
> 1) What shall my doctor write on the prescription (except the usual stuff)? The generic (english?) drug name or brand name?
>
> Phenelzin(e) or Nardil or Nardelzine? I see Nardelzine is 15mg Phenelzine a 100 tablets, right? How much does it cost / did you pay?
>Hey there,
what your doctor should write on the prescription depends on what he wants to prescribe you. In the UK and the Netherlands, phenelzine is available as Nardil. In Belgium and Luxemburg it's Nardelzine.
I went to a Belgian pharmacy with my script that said "Nardelzine 100 tbl." and it worked fine. I'm not sure what the script has to say if you want to import a medicine, but I would assume that similar rules apply. If you want to be sure, go to a pharmacy near you and ask them about what your script must say in order to be valid.
When bought locally, Nardelzine costs around 34 per 100 tablets. When importing it, the price may be somewhat higher. I'm not sure about the price of Dutch or British Nardil. They all shouldn't be really expensive though, because phenelzine has been off-patent for a long, long time.
I hope that helps...
ER
Posted by jedi on November 13, 2011, at 8:01:07
In reply to Re: 2nd MAOI after the first one failed?, posted by Mark25 on November 12, 2011, at 13:18:34
> PS: What's your Nardil dose?
>Mark,
I'm currently off phenelzine. I've been off several times in the 13 years I have been taking the medication. This time I tapered down very slowly from 60mg. Took over 3 months. Right now, I'm only taking .5mg of clonazepam daily, on the way to zero.I'm a large male and the lowest effective dose for me is 60mg. 45mg does not provide the degree of MAO inhibition to knock back a major depression. I have been on 90mg for long periods. Even up to 120mg for a month or so. The side effects at 90mg are so much worse for me. I gained a lot of weight at first, but have taken most of that off. Watch for the hypomania when the med first kicks in. It hit me and many others on this board. It is not the true antidepressant effect, but it is very intoxicating, especially if you have been depressed for a long time. Don't chase the dragon!
I used to quote the 1mg/kg effective dosage that is published. If this was accurate, I would have to be on 120mg for the med to work. That is not the case for me. Everybody reacts to these medications differently. There are blood tests for MAO inhibition, but trial and error seems to be the way to judge. I have been on phenelzine enough that I can tell the dosage I need. I can feel the level of MAO inhibition in my body. It does take time to get there, but this drug is very predictable for me.
For me, there is also a synergism with phenelzine and clonazepam. They both effect GABA and this transmitter seems to be involved, to a high degree,in social anxiety and atypical depression.
Good luck my friend. Sounds like your symptoms and diagnosis are very similar to mine. I have been on 45+ different combinations of ADs and augmenters that did not work. Phenelzine can work when all others fail.
Jedi
Posted by ed_uk2010 on November 13, 2011, at 11:27:56
In reply to Re: 2nd MAOI after the first one failed? » Mark25, posted by europerep on November 13, 2011, at 6:05:35
>When bought locally, Nardelzine costs around 34 per 100 tablets. When importing it, the price may be somewhat higher. I'm not sure about the price of Dutch or British Nardil. They all shouldn't be really expensive though, because phenelzine has been off-patent for a long, long time.
If you had a private prescription for 100 Nardil tablets in the UK, it would cost about £25. This is about 30 euros.
If you were trying to import it from the UK it would probably be dramatically more expensive, especially since it is a fridge line.
Posted by Mark25 on November 14, 2011, at 9:18:13
In reply to Re: 2nd MAOI after the first one failed? » europerep, posted by ed_uk2010 on November 13, 2011, at 11:27:56
> If you had a private prescription for 100 Nardil tablets in the UK, it would cost about £25. This is about 30 euros.
>
> If you were trying to import it from the UK it would probably be dramatically more expensive, especially since it is a fridge line.
My local pharmacy asked their wholesaler and they can get me Nardelzine 100 tablets for 90 Euros.@jedi: I've read about the hypomania many feel at the beginning. Considering my body weight I plan to use 75-90mg for 8-10 weeks. That should be enough time to see if it works.
I'll tell you when I have started the treatment and keep you updated. Thanks for all answers.
Best wishes, Mark
Posted by ed_uk2010 on November 14, 2011, at 17:02:26
In reply to Re: 2nd MAOI after the first one failed?, posted by Mark25 on November 14, 2011, at 9:18:13
>If you had a private prescription for 100 Nardil tablets in the UK, it would cost about £25. This is about 30 euros.
> >
> > If you were trying to import it from the UK it would probably be dramatically more expensive, especially since it is a fridge line.
>
> My local pharmacy asked their wholesaler and they can get me Nardelzine 100 tablets for 90 Euros.That makes sense. If it is not marketed in your country, it will certainly be a lot more expensive.
>Considering my body weight I plan to use 75-90mg for 8-10 weeks. That should be enough time to see if it works.
I think it is unwise to decide on a 'target dose' before starting treatment. Response to psychiatric drugs is very individual. You will need to adjust the dose gradually based on how you *feel* (not how much you weigh). The correct dose is the lowest dose that provides adequate benefit and tolerable side effects.
Posted by europerep on November 16, 2011, at 8:46:23
In reply to Re: 2nd MAOI after the first one failed?, posted by Mark25 on November 14, 2011, at 9:18:13
> My local pharmacy asked their wholesaler and they can get me Nardelzine 100 tablets for 90 Euros.
>Hi there...
Depending on where you live in Europe, this may be a good deal or not. If you happen to live in say, Cologne, or Lille, it may be easier to just drive across the border and get Nardelzine in a Belgian pharmacy. If you don't live in one of the neighboring countries, then 90 euros is probably cheaper than if you went to buy it yourself.
Do you know if your insurance will cover the Nardelzine?
Posted by europerep on November 16, 2011, at 8:51:52
In reply to Re: 2nd MAOI after the first one failed? » europerep, posted by ed_uk2010 on November 13, 2011, at 11:27:56
> If you were trying to import it from the UK it would probably be dramatically more expensive, especially since it is a fridge line.
>Hey ed,
good to see you here again. You know, you are probably the one person here on the board who may have an answer to my question about the European Nardil/Nardelzine.
I don't understand why both the British Nardil and the Belgian Nardelzine (produced in the UK) are a fridge line, when the American Nardil isn't. That must mean that it's not actually the phenelzine that is sensitive to above-fridge temperatures, but something else that's in the tablets. I mean, even if the ingredients for the European versions are cheaper, that would most likely be offset by what it costs to have the products sit in a cooled warehouse, no? Do you have any idea why that is?
I'm just curious...
ER
Posted by pedr on November 16, 2011, at 9:12:11
In reply to Re: 2nd MAOI after the first one failed? » Mark25, posted by jedi on November 12, 2011, at 12:22:43
Hi,
I don't wish to hijack this thread but since we're talking about switching between MAOI's, can anyone tell me what wash-out period is required when changing from Nardil 45mg to Parnate? AFAIAA whilst they both inhibit MAO, they are chemically very different so my guess would be the recommended 2 week period.
And as a cheeky adjunct, does anyone have a "discontinuation rate" (e.g. decrease 15mg every week) for Nardil they'd recommend?
Thanks,
Pedr
Posted by Mark25 on November 16, 2011, at 11:00:30
In reply to Re: 2nd MAOI after the first one failed? » Mark25, posted by europerep on November 16, 2011, at 8:46:23
> > My local pharmacy asked their wholesaler and they can get me Nardelzine 100 tablets for 90 Euros.
> >
>
> Hi there...
>
> Depending on where you live in Europe, this may be a good deal or not. If you happen to live in say, Cologne, or Lille, it may be easier to just drive across the border and get Nardelzine in a Belgian pharmacy. If you don't live in one of the neighboring countries, then 90 euros is probably cheaper than if you went to buy it yourself.
>
> Do you know if your insurance will cover the >Nardelzine?Hi!
I asked at a bigger pharmacy specialized in importing drugs and they can get me 100 tablets Nardelzine for 60 Euros, which is OK for me. Travelling would cost more and take many hours.
If I respond well my doctor can write a letter to the insurance company and then they would very likely cover it.
-Mark
Posted by ed_uk2010 on November 16, 2011, at 12:57:34
In reply to Re: 2nd MAOI after the first one failed? » ed_uk2010, posted by europerep on November 16, 2011, at 8:51:52
>good to see you here again....
Thanks!
>That must mean that it's not actually the phenelzine that is sensitive to above-fridge temperatures, but something else that's in the tablets.
The stability of drugs (such as phenelzine) can be affected by the excipients which are used, either in the tablet core or the coating. I think it's likely that the stability of phenelzine is improved by the excipients/formulation used in America, and so refrigeration to maintain stability is not needed.
The formulation licensed in the UK requires refrigeration in order to maintain an 18 month expiry date from manufacture. Without refrigeration, the expiry date would be unattractive, especially since it's such a slow-moving product. It can, however, be kept out of the fridge for short periods without a problem.
>I mean, even if the ingredients for the European versions are cheaper, that would most likely be offset by what it costs to have the products sit in a cooled warehouse, no? Do you have any idea why that is?
Although fridge lines are more costly to distribute than ambient products, it would potentially be expensive for Archimedes UK to change the tablet formulation. Any changes would have to be tested and approved by the MHRA or EMEA. Given that sales are very low, I don't think they would consider it worthwhile to make any changes at this stage. The cost of the excipients themselves is not likely to be relevent, they all cost very little.
Sorry not to be of more help.
Posted by europerep on November 19, 2011, at 8:47:52
In reply to Re: 2nd MAOI after the first one failed? » europerep, posted by ed_uk2010 on November 16, 2011, at 12:57:34
> Sorry not to be of more help.
Oh don't worry, you offered a reasonable explanation actually. I assumed that the non-active ingredients of pharmaceuticals were the same everywhere. But, there are lots of examples of drugs that are only approved on one side of the pond, so it would make some sense if the same was true for fillers and so on as well.At any rate, I can live with that explanation, so until someone offers a better one I'll take that as the probable reason for why Nardil needs to be kept in the fridge over here. Thanks! :)
Posted by ed_uk2010 on November 19, 2011, at 12:39:18
In reply to Re: 2nd MAOI after the first one failed? » ed_uk2010, posted by europerep on November 19, 2011, at 8:47:52
>it would make some sense if the same was true for fillers
Archimedes UK (the marketing authorisation holder) could choose to alter the excipients if they so desired, but they don't really have much incentive to do so. If they wanted to change the formulation so that it was the same as American Nardil, testing and MHRA approval would still be needed. I don't think they would view this as worthwhile, even if it meant that their product didn't need to be stored in the fridge anymore. I imagine that all the excipients used in American Nardil are readily available here but that's not the problem. I just don't think Archimedes would want to invest any money into a slow selling product.
Posted by europerep on November 20, 2011, at 14:17:34
In reply to Re: 2nd MAOI after the first one failed? » europerep, posted by ed_uk2010 on November 19, 2011, at 12:39:18
>If they wanted to change the formulation so that it was the same as American Nardil, testing and MHRA approval would still be needed.
Ah, I think now I got it. I thought that regulatory bodies such as the MHRA or its counterparts in other countries (or the EMA) would basically say "here is box A with all the drugs that we have approved, and here is box B with all the fillers, excipiens etc. that we approved as well. Throw together any combination of those substances and you are free to sell it." I didn't know that preparations (and not just the active drugs they contain) had to be approved too. Good to know though, thanks for explaining it to me! :)
Posted by ed_uk2010 on November 20, 2011, at 14:42:58
In reply to Re: 2nd MAOI after the first one failed? » ed_uk2010, posted by europerep on November 20, 2011, at 14:17:34
>Throw together any combination of those substances and you are free to sell it.
That would not be good at all! The bioavailability could be changed if the composition of the tablet was altered.
>I didn't know that preparations (and not just the active drugs they contain) had to be approved too.
Yes, everything has to be approved. The composition of the tablet, the manufacturing site, the manufacturing process, the packaging etc. For example, if a company is launching a generic version of a product, they may choose to use some different ingredients (for example a different colouring). They will need to do tests to show that the drug is still absorbed from the tablet in the same way.
If Archimedes wanted to change the ingredients in Nardil, they would have to get approval for all of the changes. They would have to do studies to show that the tablets still dissolve the same way, that the new tablet manufacturing process is appropriate and that the phenelzine is still absorbed into the body at the same rate and in the same quantity. All this would cost money. For a low volume product which is only distributed to a few large wholesalers, why bother?
I noticed that Archimedes UK don't even mention Nardil on their website. Hmm, that's not too encouraging.
Posted by europerep on November 29, 2011, at 8:10:40
In reply to Re: 2nd MAOI after the first one failed? » europerep, posted by ed_uk2010 on November 20, 2011, at 14:42:58
Thanks for clarifying this, ed! *thumbsup*
Now that I think about it, it does make sense that drug preparations need to be assessed for bioavailability and all that... nice to have that question cleared up!
ER
Posted by kakalak on December 12, 2011, at 15:44:53
In reply to Re: 2nd MAOI after the first one failed? » Mark25, posted by jedi on November 12, 2011, at 12:22:43
> Nardil can and does work where Parnate fails. That is a S**tload of clonazepam! I used up to 5mg while I was waiting for Nardil to kick in the first time. Phenelzine is the "BOMB" for social anxiety and atypical depression. In my opinion it should be 2nd tier and not last resort for this diagnosis. It is a bloody crime that it is not available in your country. The stuff saved my life more than once! You can probably get all of the worthless SSRIs you want! Sorry! The MAOIs work where all others fail. I have been preaching about it on here for years. I did have 2 failed Parnate trials. Google some of my posts. This S**T works!
> Good Luck,
> Jedi
>Parnate did not work for me. Besides the first few days I took it and directly after a dosage increase, I never felt energized like many others. By late afternoon every day I was exhausted, my vision was blurry, and I struggled to keep up yet could never sleep. I tried altering the dosing times and the afternoon drag didn't improve. Ambien was the only thing that seemed to work for my insomnia and some nights it didn't work at all. The Ambien left me feeling groggy whenever I couldn't get 8 hours of consecutive sleep (which was often) and the memory loss was awful. Because I have an infant and need to be able to wake during the night if need be, I cannot continue taking Ambien or any similar sleep aid every single night. One of the other big problems was the Parnate didn't help my general anxiety and it seemed to increase my social anxiety.
Before abandoning MAOIs, my pdoc suggested I try Nardil even though insomnia is a main side effect. He said since my body is already used to an MAOI, I should know within a few weeks if the Nardil side effects are tolerable. While I don't want to waste any more time, I wonder if a few weeks is enough time.
I've spent years trying to find the right combo of meds that worked for me and the last few taking Effexor combined with Buspar. While the Effexor side effects were pretty crappy, I got used to them but after taking it for so long it pooped out on me and no longer worked. One of the main reasons my pdoc selected Parnate was to eradicate some of the side effects caused by Effexor. Unfortunately the side effects on Parnate were worse for me. I can't help but wonder if I should have stuck with the Effexor and tried adding different meds? (My insurance would not approve a higher dose.)
I feel like I have to choose between spending the rest of my life miserable with depression and anxiety or be happier yet have insomnia, weight gain, no libido, etc. It's a vicious cycle. If Nardil isn't the solution for me, where do I go from there? I've tried many SSRIs, many atypical antidepressants, & now 2 MAOIs. I've never tried a TCAs.
Any suggestions?
Thanks,
kakalak
Posted by enrtwo on May 28, 2014, at 12:14:33
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by ger man on October 4, 2011, at 6:26:14
Hello,
can someone please tell me where I might possibly get a prescription for Nardil in Germany? I'v tried from online pharmacies in the UK, but they cannot supply it at the moment, but since it worked so well for my social anxiety, I really need another prescription. Please help.Best regards
Posted by europerep on May 28, 2014, at 13:52:47
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on May 28, 2014, at 12:15:48
Hi,
Are you looking for a doctor who prescribes phenelzine (Nardil) or a pharmacy that sells it? Phenelzine is available in Belgium, under the brand name Nardelzine, and Belgian pharmacies accept German prescriptions. Does that help you?
ER
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