![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by victoria1063 on January 27, 2003, at 22:02:42
I was scheduled to have a root canal today, but it was canceled because the medicine the dentist used did not numb my mouth sufficiently. I don't know the name of what she used, but know that it is acceptable to use with Nardil. Unfortunately, it is also not as effective as other drugs used to numb the mouth area.
What she would like to use is 2% xylocaine with 1:100,000 epinephrine or 0.5% marcaine with 1:200,000 epinephrine.
If she uses the above, she would like me to come off my Nardil first. This is really out of the question for a root canal. I'd rather have the tooth pulled than go off Nardil to have a root canal.
I've had cavities filled with what my dentist tried to use on me today with good results, but a root canal goes deeper than a normal cavity and needs a stronger drug.
I am hoping that perhaps someone else has gone through this and knows of an alternative (stronger) drug that could be used with Nardil to complete a root canal.
Any info would be greatly appreciated. Thanks.
Vicky
Posted by Optimistic on January 28, 2003, at 9:39:27
In reply to Nardil and Dentistry, posted by victoria1063 on January 27, 2003, at 22:02:42
The epinephrine in the local anesthetic does not make it stronger than one without it. It does two things. It allows the anesthetic effect to last longer and it gives better hemostasis (control of bleeding).The dentist probably used carbocaine without a vasoconstrictor and she should still be able to get it numb enough to do the work if the local is given close enough to the main nerve trunk. The other two locals you mentioned will not get it any more numb if not given in the right spot. Also to supplement the nerve block which might not be totally effective she can inject some of the local directly into the nerve of the tooth. Hope this helps.
Posted by djmmm on January 28, 2003, at 10:05:00
In reply to Nardil and Dentistry, posted by victoria1063 on January 27, 2003, at 22:02:42
Remifentanil (Ultiva) is an opioid that can be used, also, Bupivacaine can be used.
Posted by ZeeZee on January 28, 2003, at 10:28:56
In reply to Re: Nardil and Dentistry, posted by djmmm on January 28, 2003, at 10:05:00
I had fillings, root canals, and crowns done during the 4-5 years on Nardil/Parnate, without problem. Your dentist needs to revise his/her plan first before asking you to make such a drastic change in yours.
Posted by kara lynne on January 28, 2003, at 14:52:55
In reply to Re: Nardil and Dentistry » djmmm, posted by ZeeZee on January 28, 2003, at 10:28:56
What are you supposed to be careful with during dental procedures if you're taking Nardil? I'm starting Nardil in one week; I've stopped Lexapro for a week now. I'm feeling really dizzy and having a lot of nightmares.
Posted by ZeeZee on January 28, 2003, at 15:08:37
In reply to Re: Nardil and Dentistry, posted by kara lynne on January 28, 2003, at 14:52:55
The epinephrine in the novacaine. Although I haven't been on it for years I stil have the doc reduce the amount of epinephrine when giving me novacaine because I do not like the rush of anxiety and adrenalin it causes.
Posted by kara lynne on January 28, 2003, at 15:45:26
In reply to Re: Nardil and Dentistry » kara lynne, posted by ZeeZee on January 28, 2003, at 15:08:37
Thanks for reminding me (the same with all the over the counter decongestants and nasal sprays). Now that I think of it, I didn't like the effect of those novacaine shots either. In fact the last time I needed it I tried to dissuade the doctor from using it, but he convinced me I wouldn't be happy with the alternative. Now I guess I'll have to use it anyway. This is also one of those cases where my dentist is an acquaintence of my family's and I wouldn't ordinarily tell him any meds I was taking unless it was absolutely necessary. I just hate that aspect of taking meds. I know sometimes you have to, and doctors are supposed to be professionals, but we also see them in all their judgmental splendor sometimes. Hopefully I will not be so depressed that I care that much by that time. I have heard of the intolerable side effects of Nardil though, so I'm trying not to get my hopes up. My doctor said he has one patient who reminds him a lot of me, that had tried everything up until Nardil and nothing really helped or else he had terrible side effects. He finally took Nardil and his life changed dramatically-- then he developed edema in his hands and feet to the point where he couldn't move his fingers. Now he's back to trying a little bit of this and a little bit of that and just 'bumping along' as my doctor put it. We shall see.....
Posted by ZeeZee on January 28, 2003, at 16:02:02
In reply to Nardil, Dentistry and Whether To Have Hope Or Not, posted by kara lynne on January 28, 2003, at 15:45:26
The dentist I was using at the time was a long time friend of my husbands, they grew up together. We were living in a small city at the time where everyone knew everyone else. This dentist knew me before the onset of my disorder although he knew nothing of it until I told him of the Nardil/Parnate. Turns out that this handsome bachelor about town Dentist had social phobia which is why he was still a bachelor (although he had a ton of beautiful girlfriends). We became very close after this and had great talks whenever I had to see him for his services. He had never talked about his disorder before either and I encouraged him to try the MAOI's. That was many years ago, and I've since moved states twice. When I was on the MAOI's I felt little shame or embarrassment about discussing the drug or the disorder with others (unlike now). This disinhibition (and feeling good about myself) was another benefit of this drug.
Regarding the Nardil - do it! What a wonderful drug it is! The side effects were not AWFUL at all. I didn't like being heavier, which in retrospect, was a shallow reason to switch. But then again, the Parnate did the trick just as well without the s/e's. Ask your pdoc for a low dose diuretic and an antedote for anorgasmia (I used Bethanecol? - I think) and while you're at it, ask your dentist for remedies for dry mouth (really increases the cavities).
I wish you the very best. I truly believe you'll be pleased with the effects of the Nardil and the s/e's won't be that much of an issue. Remember, if they are, you can always try Parnate or Marplan. You're lucky to have a pdoc open to using it. I've yet to find one in my town that is.
Keep us posted, you are in my thoughts.
ZeeZee
Posted by ZeeZee on January 28, 2003, at 16:11:50
In reply to Nardil, Dentistry and Whether To Have Hope Or Not, posted by kara lynne on January 28, 2003, at 15:45:26
And Yes, do your research on what to and not to take regarding your diet and drugs. I have been off of MAOI's for 5 years, yet I still follow the same regimen of OTC and prescription drugs. The reason for this is that all the drugs which are taboo while on MAOI's make me anxious or feel really weird anyway, so I just use alternatives!
Regarding the diet, if we all followed the MAOI diet, with an emphasis on fresh foods or simply prepared foods, we'd all be a lot healthier!
You're not going to miss much there either, at least I didn't!
Posted by mattdds on January 28, 2003, at 18:18:18
In reply to Nardil and Dentistry, posted by victoria1063 on January 27, 2003, at 22:02:42
Victoria,
Hi. I'm a dental student going into my fourth year. When patients come in to our school clinic taking MAOI's, we usually give them Carbocaine 3%, which is mepivacaine without a vasoconstrictor. I bet your dentist used that too. I suspect that this is more of a medicolegal thing, because there is no evidence that the amount of epinephrine in local anesthetics that dentists use is capable of inducing a hypertensive crisis. Yes, you read that correctly. So if lidocaine with epinephrine works, use it! Tell your dentist to read about it in Malamed's Handbook of Local Anesthesia, as there is pretty good evidence provided there that epinephrine is not contraindicated in patients taking MAOI's
YMMV, but Carbocaine sucks! At least that has been my experience with it. Most times that I use it I get inadequate anesthesia. When it does work, it usually wears off during the middle of the procedure. Lidocaine with epinephrine 1:100,000 is so much more effective, at least in my hands. Also, epinephrine does indeed help potentiate the effects of the local anesthetic, by keeping it in the area and concentrating it. Also, it reduces the systemic toxicity and provides hemostasis (controls bleeding).
Yagiela, a dental researcher, did a study showing that blood epinephrine levels of people taking MAOI's who received epinephrine in an anesthetic did not rise significantly. There was, however, an interaction with phenylephrine. But phenylephrine is no longer used as a vasoconstrictor in local anesthetics.
I'm sure your dentist was just trying to protect you, and even some of our clinic faculty aren't aware that this is no longer considered a contraindication.
You can also ask her about intrapulpal anesthesia; which is a technique where the anesthetic is injected under pressure, right into the pulp of the tooth after opening it up. This usually works for me when I'm doing root canals, and fail to get good anesthesia with other techniques.
Best of luck!
Matt
P.S. I'm guessing that the tooth with the root canal to be done is a lower tooth? Those are usually harder to anesthetize.
Posted by victoria1063 on January 28, 2003, at 21:37:55
In reply to No contraindication for epinephrine on MAOI's » victoria1063, posted by mattdds on January 28, 2003, at 18:18:18
Matt,
Thanks so much for the information. This situation was beginning to turn into a circus with my Pdoc taking to my dentist and coming up with all sorts of solutions to the problem which were just not acceptable to me, such as coming off the Nardil for 4 days before the root canal.
I was ready to just cancel the root canal and let my tooth rot! Your post has given me hope. I'll call my dentist tomorrow and tell her about your post.
Nothing has served to keep me up-to-date and current on Nardil more than the internet. As far as Nardil is concerned, I believe we (the users) actually know more and keep more current than our Pdocs on Nardil's benefits, contraindications, and side effects.
Thanks again. Your information may have just saved a tooth! :)
Posted by kara lynne on January 28, 2003, at 23:22:26
In reply to Re: Nardil, Dentistry and p.s. » kara lynne, posted by ZeeZee on January 28, 2003, at 16:11:50
Thanks for the info and the support. I am actually getting quite concerned about the weight gain. Five pounds on me makes me feel like a whale (I'm not very tall). Did you actually gain a lot of weight or was it mostly water retention? And have you found something else that works for you? I'm a week off Lexapro now and today was the worst day so far. I'm really tired and heavy headed, and spent most of the day crying inordinately. I'm trying to tell myself it's just the d**m chemical imbalance circus and to hang in there another week until I can start the Nardil. I never thought Lexapro did anything much for me, but it was a lot to adjust to physically and I can really feel myself un-adjusting! Thanks again, and I wish *my* dentist was attractive, single and socially phobic!!
Posted by ZeeZee on January 29, 2003, at 6:28:42
In reply to Nardil (Zee Zee), posted by kara lynne on January 28, 2003, at 23:22:26
NOTHING has ever worked for me like Nardil and Parnate. I'm only 5'2" so I have the same problem, plus I'm quite vain! I think it was a combination of weight and water retention. As soon as I stopped the Nardil to switch to the Parnate it all just came off, with no effort on my part. I am currently in the early stages of using Paxil. I have always hated the SSRI's because of how they exacerbate my panic, but my pdoc assured me that if we take it slow and use xanax I'll get through it. I'm on day 9 of only a half of the lowest tablet, so it will be quite a while before I know if this is going to help me. So far no adverse effects.
Remember, Parnate is always an alternative for you and on that you will probably maintain or lose weight.
Keep us posted!
ZZ
Posted by cosis on January 30, 2003, at 13:53:45
In reply to Re: Nardil (Zee Zee) » kara lynne, posted by ZeeZee on January 29, 2003, at 6:28:42
Sorry if I missed it, but why did you stop taking the MAO's if they were working well?
Posted by ZeeZee on January 31, 2003, at 15:54:53
In reply to Re: Nardil (Zee Zee), posted by cosis on January 30, 2003, at 13:53:45
I felt it was time to get off of this powerful drug and switched over to St. John Wort and maintained the benefits for an additional 4 years until some very major life changes occured. Although it was very helpful, considering all the possibilities (emergency surgery, dietary restrictions and drug interactions) it isn't a practical drug to stay on forever. Had I been able to predict the future I would not have stopped regardless.
Posted by Rick Alan on April 16, 2016, at 12:08:00
In reply to No contraindication for epinephrine on MAOI's » victoria1063, posted by mattdds on January 28, 2003, at 18:18:18
I found this post from years ago. I am going to need to have a tooth pulled and I am on Parnate and the dentist here in Costa Rica says it is too difficult to do it using anesthesia without epinepherine. the anesthesia would not be sufficient and quickly wears off, according to him. I was going to do a new post but found this from 2003 which says that it is ok to use anesthesia with epinepherin. Anyone else know anything to the contrary?
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.