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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by christophrejmc on February 22, 2002, at 3:04:51
Well, my Nardil dose was increased from 75mg to 90mg. An hour after taking this, I developed a slight tingling in the back of my head, and some chest pains. My BP was about 189/99. After a few minutes it dropped to 160/87. I haven't re-tested it yet (this is about 20m since the elevation). I'm wondering when, or if, I should go to the hospital. How serious is this? If it goes down, I don't want to go.
Thanks.
Posted by christophrejmc on February 22, 2002, at 3:17:39
In reply to Hypertensive Crisis: when to go to hospital?, posted by christophrejmc on February 22, 2002, at 3:04:51
Well, now it's 117/76 (this is right after my first post). My chest still aches. Funny, I had none of the typical symptoms (well, chest pain might be one); I just could tell that something was wrong... Oh, and I smoked a cigarette right after I noticed the elevation -- could this, in any way, have been responsible for the lowered BP (it certainly helped with my anxiety)? My main concern was: who will walk the dog if I'm dead? I guess Tigre will be happy.
-Chris
Posted by ivoovi on February 22, 2002, at 4:38:01
In reply to Re: Hypertensive Crisis: when to go to hospital?, posted by christophrejmc on February 22, 2002, at 3:17:39
Hi...I would like an answer to this question though. When does high blood pressure warrent a trip to the hospital?
Also, how long can one survive with high blood pressure? (eg - 150/70)
Thank you.
Chris
Posted by OldSchool on February 22, 2002, at 10:03:18
In reply to Hypertensive Crisis: when to go to hospital?, posted by christophrejmc on February 22, 2002, at 3:04:51
> Well, my Nardil dose was increased from 75mg to 90mg. An hour after taking this, I developed a slight tingling in the back of my head, and some chest pains. My BP was about 189/99. After a few minutes it dropped to 160/87. I haven't re-tested it yet (this is about 20m since the elevation). I'm wondering when, or if, I should go to the hospital. How serious is this? If it goes down, I don't want to go.
Id go now. Your systolic pressure is way too high. You need to get this checked out. If you dont want to go to the ER, could you call your family physician and request an immediate visit?
This is nothing to mess with...
Old School
>
> Thanks.
Posted by ross on February 22, 2002, at 11:26:32
In reply to Hypertensive Crisis: when to go to hospital?, posted by christophrejmc on February 22, 2002, at 3:04:51
chris,
my pdoc gave me Procardia and told me if my BP got very high to take 20mgs bite and swallow and see where my BP went. if it stood high then to go to the ER.
did you eat something wrong? im on my second day of Nardil and had a few headaches so far. my max dose is going to be 60ms right now. i started 15mgs T.I.D
god luck
ross
Posted by christophrejmc on February 22, 2002, at 11:29:52
In reply to Re: Hypertensive Crisis: when to go to hospital?, posted by OldSchool on February 22, 2002, at 10:03:18
> If you dont want to go to the ER, could you call your family physician and request an immediate visit?
Good idea. I don't have a family physician, but I could see my neighbor.
Thanks,
Chris
Posted by IsoM on February 22, 2002, at 12:23:07
In reply to Hypertensive Crisis: when to go to hospital?, posted by christophrejmc on February 22, 2002, at 3:04:51
> Well, my Nardil dose was increased from 75mg to 90mg. An hour after taking this, I developed a slight tingling in the back of my head, and some chest pains. My BP was about 189/99. After a few minutes it dropped to 160/87. I haven't re-tested it yet (this is about 20m since the elevation). I'm wondering when, or if, I should go to the hospital. How serious is this? If it goes down, I don't want to go.
>
> Thanks.Hi Chris - this looks like a good reason for you to stop smoking now! Nicotine is a fairly powerful vasoconstrictor but only temporarily, as you found. It's possible that your symptoms seemed atypical (the tingling) because nicotine has its vasoconstricting effects on the peripheral parts of the body mainly, though the back of the neck isn't peripheral.
Out, OUT, damn butt! You're such a sweet, bright guy - *YOU* should know not to smoke! Sorry for sounding preachy but tobacco & MAO inhibitors don't make good companions, I surprised more people don't know that.
I hate the tobacco industry with a passion - grubbing, lying money-makers who couldn't care less who die. They hide and/or fudge statistics & proof, & now are trying to make themselves appear oh, SO good with a somewhat different track of advertising. Have I lost anyone to smoking? Nope. It's just the monumental hypocrisy of such a death industry along with the various governments of different countries as their bed partners sickens me.
Posted by christophrejmc on February 22, 2002, at 13:19:27
In reply to Re: Hypertensive Crisis and Nicotine » christophrejmc, posted by IsoM on February 22, 2002, at 12:23:07
> Hi Chris - this looks like a good reason for you to stop smoking now! Nicotine is a fairly powerful vasoconstrictor but only temporarily, as you found. It's possible that your symptoms seemed atypical (the tingling) because nicotine has its vasoconstricting effects on the peripheral parts of the body mainly, though the back of the neck isn't peripheral.
Well, I smoked *after* the hypertension, but I'm sure it didn't make things any better.
> Out, OUT, damn butt! You're such a sweet, bright guy - *YOU* should know not to smoke! Sorry for sounding preachy but tobacco & MAO inhibitors don't make good companions, I surprised more people don't know that.
Well, generally, they're O.K. together, atleast in moderate amounts (I smoke a pack/1-2weeks). I know I shouldn't smoke (and I HATE that I do!), but I watch a lot of foreign film -- especialy french and asian; EVERYBODY smokes, and everybody is super-cool. It's so hard to resist the urge! Then people tell me it's gonna kill me; have I got them fooled.
>
> I hate the tobacco industry with a passion - grubbing, lying money-makers who couldn't care less who die. They hide and/or fudge statistics & proof, & now are trying to make themselves appear oh, SO good with a somewhat different track of advertising. Have I lost anyone to smoking? Nope. It's just the monumental hypocrisy of such a death industry along with the various governments of different countries as their bed partners sickens me.I hate it too! And I'm even semi-involved with anti-big-tobacco groups. I quit a few months every year, but there really are no reasons for me not to start back up again.
-Chris
Posted by christophrejmc on February 22, 2002, at 13:29:19
In reply to Re: Hypertensive Crisis: when to go to hospital?, posted by ross on February 22, 2002, at 11:26:32
> chris,
> my pdoc gave me Procardia and told me if my BP got very high to take 20mgs bite and swallow and see where my BP went. if it stood high then to go to the ER.Yeah, my doc was too afraid of rebound hypotension to give me Procardia. I'm afraid of even telling her about this, she is overly careful sometimes.
> did you eat something wrong? im on my second day of Nardil and had a few headaches so far. my max dose is going to be 60ms right now. i started 15mgs T.I.D
I _hope_ that it was something I ate (it is possible). I wouldn't worry too much about the Nardil headaches (as long as they aren't from hypertension!); I think they're a quite common startup side-effect.
Good luck with Nardil!
-Chris
Posted by Elizabeth on February 22, 2002, at 13:59:29
In reply to Hypertensive Crisis: when to go to hospital?, posted by christophrejmc on February 22, 2002, at 3:04:51
Hi there. Something similar happened to me with Parnate: I took a single dose of 20 mg, and my BP got to be about as high as yours got (don't recall exact numbers) after a half-hour or so. My pdoc gave me some ProCardia (nifedipine) to take in case of such an occurrence (with directions to take 10 mg if my BP got to a certain level; again, don't recall exact numbers). It was spontaneous: not related to a food or drug interaction. This isn't very common, but it does happen to some people, for whatever reason. I think it's more common with Parnate, but it can happen with Nardil too. It's definitely dose-related (hypertension is a common symptom of MAOI overdose, for example).
Did you take the entire 90 mg all at once? If not, how much did you take?
The tingling scalp seems to be a very predictive symptom of acute hypertension (I described it as feeling like my hair was standing on end). I also had a very bad headache and some nausea, and I was sweating like -- uh, something that sweats a lot.
BTW, "hypertensive urgency" is the technical term for these brief episodes of hypertension that aren't serious enough to be life-threatening. I've had a number of such episodes, but only one true hypertensive crisis.
Most hypertensive urgencies resolve on their own, as yours did, without the need for medication. There is a risk that your BP will continue rising, leading to a hypertensive crisis, which can cause a stroke or other serious consequences (the one time I had a true hypertensive crisis, I suffered a lung hemorrhage), though, so it's best to treat it instead of waiting for it to get really bad. Your pdoc should be able to tell you at what BP you should treat it.
If you take nifedipine or a similar drug (calcium channel blocker) for acute hypertension, be sure that you get plenty of fluids in you. This can prevent your BP from "crashing." This happened to me one time (fortunately, I was in the hospital) and shortly after taking the nifedipine, I started feeling like my heart was pounding (like it was planning on jumping out of my chest or something), and there was a ringing in my ears. The resident gave me some water and I was fine within a little while.
Another note about nifedipine: it comes in gelcaps. The way to take is to bite them open and then swallow them; this produces a very rapid onset of effect. You don't need to hold them under your tongue or anything like that.
I'd say, go back down to the lower dose of phenelzine and call your pdoc to find out what you should do if this happens again. It may be a fluke; on the other hand, you may have a special sensitivity to phenelzine's pressor effect which requires a change of plans. One way to reduce the risk of spontaneous hypertensive episodes is to take the drug in divided doses. I developed hypertension whenever I tried to take 20 mg of Parnate at a time, so I restricted each dose to 10 mg. (At one point I was taking 60 mg/day in six divided doses. A pain, as you can imagine. And I actually considered going up quite a bit higher.)
I hope this helps. Let us know what your pdoc tells you; I'll be curious.
-elizabeth
Posted by christophrejmc on February 22, 2002, at 15:31:54
In reply to Re: dealing with hypertensive urgency » christophrejmc, posted by Elizabeth on February 22, 2002, at 13:59:29
> Hi there. Something similar happened to me with Parnate: I took a single dose of 20 mg, and my BP got to be about as high as yours got (don't recall exact numbers) after a half-hour or so.
Hi Elizabeth! The same thing happened to me as well. After a while, the dosing got to be an effing pain, so I went back to Nardil.
> I think it's more common with Parnate, but it can happen with Nardil too. It's definitely dose-related (hypertension is a common symptom of MAOI overdose, for example).
I've never heard of it happening with Nardil, but I would have definitely suspected that if I had.
> Did you take the entire 90 mg all at once? If not, how much did you take?
Well... I kind of lied. I was prescribed 75 and she bumped it to 90; I had been taking 90 so I bumped it to 105. Our target dose is 120, so I didn't do anything that terrible. I took it all at once.
> The tingling scalp seems to be a very predictive symptom of acute hypertension (I described it as feeling like my hair was standing on end). I also had a very bad headache and some nausea, and I was sweating like -- uh, something that sweats a lot.I was waiting for the "hit with a brick" headache! I'm almost disappointed I didn't have it. I had the tingling scalp thing with Parnate, but not the angina -- that was what worried me.
> BTW, "hypertensive urgency" is the technical term for these brief episodes of hypertension that aren't serious enough to be life-threatening. I've had a number of such episodes, but only one true hypertensive crisis.
Thanks! I had been searching for information on hypertensive crises, but most of it wasn't very helpful.
> One way to reduce the risk of spontaneous hypertensive episodes is to take the drug in divided doses. I developed hypertension whenever I tried to take 20 mg of Parnate at a time, so I restricted each dose to 10 mg.
Yeah, that worked for me with Parnate; hopefully it'll work with Nardil.
> I hope this helps. Let us know what your pdoc tells you; I'll be curious.
You always help, silly. I'll probably have to bring in some articles about the use of nifedipine in hypertensive cri, er, urgencies! She's a bit by-the-book (and by book, I mean the PDR), but she might reconsider it if I bring in some stuff to negate the PDR's warning.
Thanks!
-Christophre
Posted by christophrejmc on February 26, 2002, at 21:51:53
In reply to Re: dealing with hypertensive urgency » christophrejmc, posted by Elizabeth on February 22, 2002, at 13:59:29
e,
Do you have any idea why some people get spontaneous hypertension from Parnate (I think you once mentioned that your bp increased slightly even from 10mg, so I'm guessing it's not dose-dependent...)? It's strange that people who have experienced this can add other sympathomimetics like amphetamine without a significant rise in bp. I guess it's something that no-one really cares about researching, but it would probably be helpful to figure out.
Thanks,
Chris
Posted by Elizabeth on February 28, 2002, at 1:30:07
In reply to Re: spontaneous htn from Parnate » Elizabeth, posted by christophrejmc on February 26, 2002, at 21:51:53
> Do you have any idea why some people get spontaneous hypertension from Parnate (I think you once mentioned that your bp increased slightly even from 10mg, so I'm guessing it's not dose-dependent...)?
It is dose-dependent. My BP only increases very modestly after a 10 mg dose, but if I take 20 mg, it increases significantly, and 30 mg is quite likely to have nasty consequences.
As to why: there has been some speculation that Parnate has a metabolite that works like amphetamine, a DA/NE release enhancer. It might be that in some people, Parnate potentiates its own metabolite, causing elevated blood pressure.
> It's strange that people who have experienced this can add other sympathomimetics like amphetamine without a significant rise in bp.
Err, I had problems when I tried that! (Adderall 1.25 mg was okay....)
> I guess it's something that no-one really cares about researching, but it would probably be helpful to figure out.
Yeah, it is too bad that nobody cares enough to do research on the old drugs. I'd like to know the answer to this one too.
-elizabeth
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