![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Winterlight on September 6, 1999, at 21:58:49
Read several suggestions in literature recently that the NARI reboxetine may eliminate/modify the need for dietary restrictions if administered with the classic MAO inhibitors. What's the latest scientific information on this combination. Has anyone out there tried this combination with success?
It seems to me that, if true, this MAOI/NARI cocktail might prove to be one of the most potent anti-depressant treatments ever.
Posted by JohnB on September 8, 1999, at 10:10:44
In reply to MAOI/Reboxetine Combo For "Cheese Effect", posted by Winterlight on September 6, 1999, at 21:58:49
I'm wondering if anyone from England/Europe where Edronax is available has had experience prescribing or taking this combination. Someone somewhwere has certainly tried it. It would be great to know how it worked. My doctor says he plans to test the hypothesis on himself when he gets the chance.
Thanks,JohnB.
Posted by Elizabeth on September 9, 1999, at 2:09:54
In reply to Re: MAOI/Reboxetine Combo , posted by JohnB on September 8, 1999, at 10:10:44
> My doctor says he plans to test the hypothesis on himself when he gets the chance.
Cool! (I'd like to hear statements like this one more often. )
Posted by Adam on September 13, 1999, at 18:41:16
In reply to MAOI/Reboxetine Combo For "Cheese Effect", posted by Winterlight on September 6, 1999, at 21:58:49
I've seen only one reference to support this idea:
Reboxetine prevents the tranylcypromine-induced
increase in tyramine levels in rat heart
by
Dostert P, Castelli MG, Cicioni P, Strolin Benedetti M
Farmitalia Carlo Erba,
Research and Development,
Erbamont Group, Milan, Italy.
J Neural Transm Suppl 1994; 41:149-53ABSTRACT
This study aimed to examine whether the increase in heart radioactivity levels after intravenous
injection of 14C-tyramine to rats pretreated with the irreversible MAO inhibitor tranylcypromine could be
antagonized by reboxetine, a potent and selective noradrenaline uptake blocker. Reboxetine was found
totally to abolish the effect of tranylcypromine. Heart radioactivity levels after reboxetine and
tranylcypromine were very similar to those found when tyramine was injected after reboxetine only.
These results suggest that reboxetine might be advantageously combined with tranylcypromine, or any
MAO inhibitor, in depressed patients unresponsive of either treatment given alone.Have you seen others?
Anyway, I personally have some difficulties with the leap from the authors' findings to abrogation of the "cheese effect". I'm not sure their
experimental approach has much clinical relevance. Plus, as Elizabeth pointed out somewhere, there's already some precendent for this idea in
the use of certain tricyclics (which, being fairly potent noradrenergics/NE-reuptake inhibitors might do the same thing), but nobody seems to be
using this approach in practice...I assume because it doesn't work.My guess is that since certain TCA/MAOI combos are used in treatment, adding rebox. to an MAOI ought to be safe. Umm, JohnB, how does your doc
plan on testing the idea? I know the cheese effect is rarely lethal, but it can be pretty uncomfortable, from what I understand, and is potentially
dangerous. I can imagine such an experiment might raise some serious eyebrows in certain circles. If somebody gave a Rehsus monkey rebox+parnate+a
bunch of tyramine orally and it's was OK, I might feel bit more confident this is a good idea.
> Read several suggestions in literature recently that the NARI reboxetine may eliminate/modify the need for dietary restrictions if administered with the classic MAO inhibitors. What's the latest scientific information on this combination. Has anyone out there tried this combination with success?
> It seems to me that, if true, this MAOI/NARI cocktail might prove to be one of the most potent anti-depressant treatments ever.
Posted by JohnB. on September 13, 1999, at 21:55:54
In reply to Re: MAOI/Reboxetine Combo For "Cheese Effect", posted by Adam on September 13, 1999, at 18:41:16
I should clarify. My MD has taken Parnate for years for his depression. His comment was based on Reboxetine as an augmentation for MAOIs for depression, not for any possible "tyramine effect" experimentation, which of course would be silly and unverifiable. Apparently, he knows several MD's in England who've tried small doses of Reboxetine with MAOI's, with great success so far. As for the pressor effects, it's too early to tell...
Posted by Elizabeth on September 15, 1999, at 1:42:10
In reply to Re: MAOI/Reboxetine Combo Clarification, posted by JohnB. on September 13, 1999, at 21:55:54
> I should clarify. My MD has taken Parnate for years for his depression. His comment was based on Reboxetine as an augmentation for MAOIs for depression, not for any possible "tyramine effect" experimentation, which of course would be silly and unverifiable.
Not unverifiable! There have been experiments comparing the pressor effects of tyramine in humans on various MAOIs and no MAOI. Comparing MAOI + reboxetine to MAOI + placebo would be quite doable.
>Apparently, he knows several MD's in England who've tried small doses of Reboxetine with MAOI's, with great success so far. As for the pressor effects, it's too early to tell...
That's good to hear. There's always something else to try, right?
Posted by MH on August 12, 2000, at 8:16:39
In reply to Re: MAOI/Reboxetine Combo For , posted by Adam on September 13, 1999, at 18:41:16
> I've seen only one reference to support this idea:
>
> Reboxetine prevents the tranylcypromine-induced
> increase in tyramine levels in rat heart
> by
> Dostert P, Castelli MG, Cicioni P, Strolin Benedetti M
> Farmitalia Carlo Erba,
> Research and Development,
> Erbamont Group, Milan, Italy.
> J Neural Transm Suppl 1994; 41:149-53
>
> ABSTRACT
>
> This study aimed to examine whether the increase in heart radioactivity levels after intravenous
> injection of 14C-tyramine to rats pretreated with the irreversible MAO inhibitor tranylcypromine could be
> antagonized by reboxetine, a potent and selective noradrenaline uptake blocker. Reboxetine was found
> totally to abolish the effect of tranylcypromine. Heart radioactivity levels after reboxetine and
> tranylcypromine were very similar to those found when tyramine was injected after reboxetine only.
> These results suggest that reboxetine might be advantageously combined with tranylcypromine, or any
> MAO inhibitor, in depressed patients unresponsive of either treatment given alone.
>
> Have you seen others?
>
> Anyway, I personally have some difficulties with the leap from the authors' findings to abrogation of the "cheese effect". I'm not sure their
> experimental approach has much clinical relevance. Plus, as Elizabeth pointed out somewhere, there's already some precendent for this idea in
> the use of certain tricyclics (which, being fairly potent noradrenergics/NE-reuptake inhibitors might do the same thing), but nobody seems to be
> using this approach in practice...I assume because it doesn't work.
>
> My guess is that since certain TCA/MAOI combos are used in treatment, adding rebox. to an MAOI ought to be safe. Umm, JohnB, how does your doc
> plan on testing the idea? I know the cheese effect is rarely lethal, but it can be pretty uncomfortable, from what I understand, and is potentially
> dangerous. I can imagine such an experiment might raise some serious eyebrows in certain circles. If somebody gave a Rehsus monkey rebox+parnate+a
> bunch of tyramine orally and it's was OK, I might feel bit more confident this is a good idea.
>
>
> > Read several suggestions in literature recently that the NARI reboxetine may eliminate/modify the need for dietary restrictions if administered with the classic MAO inhibitors. What's the latest scientific information on this combination. Has anyone out there tried this combination with success?
> > It seems to me that, if true, this MAOI/NARI cocktail might prove to be one of the most potent anti-depressant treatments ever.
Anyone ever heard of reversible MAOIs? (RIMAs): Aurorix (Moclobemide)/Mannerix or Brofaromine - no diet restrictions and very good I hear...
Posted by acer on August 12, 2000, at 21:47:24
In reply to Re: MAOI/Reboxetine Combo For Cheese Effect, posted by MH on August 12, 2000, at 8:16:39
I have cautiously tried this combination myself
starting with one-eighth of one tab. (4mg.) of
Reboxetine with my daily Parnate dose (50 mg.) and
within 90 min. started getting frightening feelings of not being able to breathe properly in my chest.It felt like my chest was really constricted and
lungs werw losing ability to inflate. God knows
what would have happened if I had taken a whole
tab. of Reboxetine with the Parnate. I would
advise against this combination until more is
known or studies have been done.
Posted by stjames on August 13, 2000, at 16:32:06
In reply to Re: MAOI/Reboxetine Combo For Cheese Effect, posted by acer on August 12, 2000, at 21:47:24
> It felt like my chest was really constricted and
> lungs werw losing ability to inflate. God knows
> what would have happened if I had taken a whole
> tab. of Reboxetine with the Parnate. I would
> advise against this combination until more is
> known or studies have been done.James here...
So you got the "Cheese reaction" on a combo that is
assumed to reverse this recation. Proof that what works
in animals does not always apply directly to humans.james
Posted by Ant-Rock on August 14, 2000, at 17:02:54
In reply to Re: MAOI/Reboxetine Combo For Cheese Effect, posted by MH on August 12, 2000, at 8:16:39
Funny this subject has been brought up. Today was my second day on 2mg rebox along with my 80mg of parnate. No adverse effects yet.
Anthony
Posted by AndrewB on August 18, 2000, at 15:52:17
In reply to Re: MAOI/Reboxetine Combo For Cheese Effect, posted by Ant-Rock on August 14, 2000, at 17:02:54
> Funny this subject has been brought up. Today was my second day on 2mg rebox along with my 80mg of parnate. No adverse effects yet.
>
> AnthonyWill you keep us updated Anthony?
Best wishes as always,
AndrewB
Posted by Ant-Rock on August 19, 2000, at 14:51:15
In reply to Re: MAOI/Reboxetine Combo For Cheese Effect, posted by AndrewB on August 18, 2000, at 15:52:17
I have no clue whether these meds can or should be combined, but at this point, I really don't care. Whatever happens, happens.
Anthony
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.