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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by duckwheat on March 11, 2001, at 15:54:12
I am wanting to switch from Nardil to Parnate. Does anyone know if this can be done without the 14 day clean out period? I'd like to just stop the Nardil And Start the Parnate without waiting.
Posted by SalArmy4me on March 12, 2001, at 7:30:00
In reply to Switching MAOs, posted by duckwheat on March 11, 2001, at 15:54:12
I'm about to tell you something that everyone on this website will denounce me for. I say that YES, it can be done-- but only if you have some cyproheptadine with you to combat a possible serotonin syndrome. I went from Nardil to Parnate immediately and didn't have a problem. Then I went from Parnate to Remeron.
Have you also looked into Selegiline as a possible alternative? It is talked about on the Tips...
> I am wanting to switch from Nardil to Parnate. Does anyone know if this can be done without the 14 day clean out period? I'd like to just stop the Nardil And Start the Parnate without waiting.
Posted by Mr. Scott on March 12, 2001, at 10:00:16
In reply to Re: Switching MAOs, posted by SalArmy4me on March 12, 2001, at 7:30:00
How quickly were you able to switch to Remeron? How has the result been? I ask because my situation isn't so different.
Scott
Posted by SalArmy4me on March 12, 2001, at 12:14:44
In reply to Re: Switching MAOs, posted by Mr. Scott on March 12, 2001, at 10:00:16
I switched immediately...but I don't recommend you do it. I was able to do it because I live with my dad who is a doctor. And we have cyproheptadine in our medicine cabinet.
The fears of the serotonin syndrome may be blown way out of proportion, but I don't have the stats to back that up.
> How quickly were you able to switch to Remeron? How has the result been? I ask because my situation isn't so different.
>
> Scott
Posted by jb on March 12, 2001, at 19:27:01
In reply to Switching MAOs, posted by duckwheat on March 11, 2001, at 15:54:12
I've switched back and forth several times, but was always advised to wait 14 days. I think I recall someone mentioning that it's O.K. to switch from one to another right away, but I'm not sure of the order. I do know my psychdoc has never felt comfortable with anything less than two weeks, regardless of the order of switching. One last chance - speak with your pharmacist.
Posted by SLS on March 12, 2001, at 21:40:48
In reply to Re: Switching MAOs, posted by SalArmy4me on March 12, 2001, at 7:30:00
> I'm about to tell you something that everyone on this website will denounce me for. I say that YES, it can be done-- but only if you have some cyproheptadine with you to combat a possible serotonin syndrome. I went from Nardil to Parnate immediately and didn't have a problem...
Hi SalArmy4me.I am reluctant to pass by without saying a few things, but denouncement certainly is not one of them. I have heard people report that they had taken both Nardil and Parnate together as their treatment.
Yes, it does sound contrary to conventional medical practice to switch over from one MAOI to another without a 14 day wash-out period. I recently inquired of my doctor if a switch can be accomplished with only a 10 day wash-out, for this has been a more common practice lately. He replied that recent reports of adverse events occuring as a result of this have convinced him to continue with a 14 day recommendation. For what it is worth, he is an assistant professor at New York University who seems to keep himself apprised of current information.
Besides yourself, how many people are you aware of who have successfully switched from Parnate to Nardil without a wash-out period? What precedents did you use to judge its safety? I would love to be able to switch between MAOIs also.
Another important question I have is whether or not serotonin syndrome is the *only* untoward event possible due to cross-over from one MAOI to the other. Are there "antidotes" analogous to cyproheptadine to treat all of these other events, should there be any? I would just want to know how thoroughly you investigated this issue before deciding to take such an assumed risk.
Not everyone taking MAO-inhibitors who eats blue cheese will experience a tyramine reaction for any given meal. Yet, I would be reluctant to use the word YES as an answer to address someone's question about eating blue cheese, simply because I myself had no problem with it the one and only time I ate it. It might be worth considering that any one person can eat blue cheese 20 times without sequalae, yet die from a stroke on the 21st.
I want to know more about this.
Sincerely,
Scott
Posted by Lorraine on March 13, 2001, at 10:01:15
In reply to Re: Switching MAOs » SalArmy4me, posted by SLS on March 12, 2001, at 21:40:48
My pdoc says that someone with my alpha/beta waves can switch MAOs with a 5 day washout period. I am low energy. He says the people who have trouble are those at the other end of the spectrum. (I'm assuming he means aggitated depression or manic/depressive.)
Posted by SLS on March 13, 2001, at 17:00:48
In reply to Re: Switching MAOs, posted by Lorraine on March 13, 2001, at 10:01:15
> My pdoc says that someone with my alpha/beta waves can switch MAOs with a 5 day washout period. I am low energy. He says the people who have trouble are those at the other end of the spectrum. (I'm assuming he means aggitated depression or manic/depressive.)
Gosh, I would love to know where this notion comes from. I hope there are enough empirical numbers to support such a claim. I hope it is not more of a hypothesis than it is a practice.I am glad to see some flexibility here. Although I have an open mind, I can't help but to fill the role of the skeptic on the side of safety. I hope it helps to encourage a productive dialectic on so critical an issue.
- Scott
Posted by Lorraine on March 13, 2001, at 18:46:23
In reply to Re: Switching MAOs, posted by SLS on March 13, 2001, at 17:00:48
Scott: My pdoc bases his decisions on a QEEG that he does and then performs a covariance analysis using a data base of about 4000 to determine the meds most likely to work for you. He tends to be "scientific" although admittedly there is art to this as well. He claims that DSM criteria are nonsense because they are not based on physiology. He claims that he can pretty much predict who is going to have problems with hypertensive reactions to MAOs based on the QEEG info as well. He's not a kook, but time will tell if his methods work for me, right? I don't hold a lot of stock in the "established" views of mental illness. I think we basically know nothing or very close to nothing. The only thing we know is that what we thought we knew before brain scanning techniques arrived was all wrong. We have lots of "theories" and lots of "correlational" analysis and little else. Such is the state of this "science". It's terribly frustrating.... Anyway, this guy may be right or wrong, but for now, I'm throwing my lot with him because he makes more sense to me than any of the other doctors. What can I say? When I walk in with an article to discuss, his face doesn't go blank. You can learn to trust a man like that.
This is the end of the thread.
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