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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Michael Bell on May 29, 2004, at 13:51:37
It's amazing to me that one of the best meds for SP is so hard to attain and stay on b/c of hypertensive risk. I'm not that knowledgeable about chemistry, but isn't there some kind of substance that someone can ingest to take over MAO's role of break down tyramine? Sort of like taking lactaid pills for people who can't break down lactic acid properly. Then someone on Nardil or Parnate can take that substance along with the MAOI to help prevent hypertensive crisis.
Moreover, I remember reading a study which concluded that since SNRIs (Reboxetine, Strattera) inhibit norepinephrine release, taking it with MAOIs may lessen the risk of hypertensive crisis. Does anyone have knowledge or personal experience with this combo?
Posted by btnd on May 29, 2004, at 19:43:00
In reply to Nardil, SNRIs, tyramine, hypertension, posted by Michael Bell on May 29, 2004, at 13:51:37
> It's amazing to me that one of the best meds for SP is so hard to attain and stay on b/c of hypertensive risk. I'm not that knowledgeable about chemistry, but isn't there some kind of substance that someone can ingest to take over MAO's role of break down tyramine? Sort of like taking lactaid pills for people who can't break down lactic acid properly. Then someone on Nardil or Parnate can take that substance along with the MAOI to help prevent hypertensive crisis.
Does hypertensive crisis happen only when you eat certain foods? or does it happen all on their own?Did you experience other side-effects like anorgasmia during your Nardil treatment?
> Moreover, I remember reading a study which concluded that since SNRIs (Reboxetine, Strattera) inhibit norepinephrine release, taking it with MAOIs may lessen the risk of hypertensive crisis. Does anyone have knowledge or personal experience with this combo?
If they would release NE - they probably could be of help. But they are NE reuptake inhibitors -> meaning they make NE more available/more is transmitted. They are 'activating' kinda drugs. So my call on them would be that they wouldn't lower BP. However if you read a study on it - there might be some other action or I'm simply wrong ;-) It'd be great if you could post the study or find a link to it ;-)
Posted by Michael Bell on May 29, 2004, at 21:00:01
In reply to Re: Nardil, SNRIs, tyramine, hypertension » Michael Bell, posted by btnd on May 29, 2004, at 19:43:00
Hypertensive crisis is usually caused by ingestion of tyramine rich food or use of certian medicines. Spontaneous hypertensive crisis is more common in Parnate than Nardil, but still rather rare from what I've heard.
Yes, I experienced anorgasmia from Nardil. Sucked. And while we're on the topic of sex, let me warn you - if you do decide to take Nardil, don't drink more than a couple beers with it (even the "safe" beers). Not b/c of the hypertensive issue, but b/c I had about three beers with Nardil (idiotic!) one night and had the fist episode of mania ever in my life. I'm talking full-blown, out of this world mania. I was completely out of control, and ended up having an unsafe fling with two women I met that night (something I would never, ever do and have never done before). I wish the anorgasmia had happened that night. Luckily my health is okay, but you can imagine my fear for about six months after that episode. Sorry if this is too much info, but for anyone considering Nardil, I just want them to know that it is a *powerful* drug that should not be taken lightly.
Anyway, on a random note, I got my Amisulpride today (I noticed the package on top of my mailbox just about an hour ago). You posted something about adderall + amisulpride combo, but I can't remember exactly. Do you mind telling me again how that combo works? I think it was you, anyway.
Thanks!
> > It's amazing to me that one of the best meds for SP is so hard to attain and stay on b/c of hypertensive risk. I'm not that knowledgeable about chemistry, but isn't there some kind of substance that someone can ingest to take over MAO's role of break down tyramine? Sort of like taking lactaid pills for people who can't break down lactic acid properly. Then someone on Nardil or Parnate can take that substance along with the MAOI to help prevent hypertensive crisis.
>
>
> Does hypertensive crisis happen only when you eat certain foods? or does it happen all on their own?
>
> Did you experience other side-effects like anorgasmia during your Nardil treatment?
>
>
> > Moreover, I remember reading a study which concluded that since SNRIs (Reboxetine, Strattera) inhibit norepinephrine release, taking it with MAOIs may lessen the risk of hypertensive crisis. Does anyone have knowledge or personal experience with this combo?
>
>
> If they would release NE - they probably could be of help. But they are NE reuptake inhibitors -> meaning they make NE more available/more is transmitted. They are 'activating' kinda drugs. So my call on them would be that they wouldn't lower BP. However if you read a study on it - there might be some other action or I'm simply wrong ;-) It'd be great if you could post the study or find a link to it ;-)
>
>
Posted by Ilene on May 29, 2004, at 21:28:27
In reply to Nardil, SNRIs, tyramine, hypertension, posted by Michael Bell on May 29, 2004, at 13:51:37
> It's amazing to me that one of the best meds for SP is so hard to attain and stay on b/c of hypertensive risk. I'm not that knowledgeable about chemistry, but isn't there some kind of substance that someone can ingest to take over MAO's role of break down tyramine? Sort of like taking lactaid pills for people who can't break down lactic acid properly. Then someone on Nardil or Parnate can take that substance along with the MAOI to help prevent hypertensive crisis.
>AFAIK there isn't anything like that, because it would interfere with the MAOI's mode of action. There are drugs you can take after the fact, but I think the majority of MAOI users don't have a problem as long as they are careful about what they eat and the other drugs they take. The biggest dietary no-no is aged cheese, which is pretty easy to avoid.
> Moreover, I remember reading a study which concluded that since SNRIs (Reboxetine, Strattera) inhibit norepinephrine release, taking it with MAOIs may lessen the risk of hypertensive crisis. Does anyone have knowledge or personal experience with this combo?
I don't understand how this would work. I'd be interested in this study.
I.
Posted by Michael Bell on May 29, 2004, at 21:59:32
In reply to Re: Nardil, SNRIs, tyramine, hypertension, posted by Ilene on May 29, 2004, at 21:28:27
> > It's the maoi inhibition outside of the brain that causes the dangerous side effects (hence the benefits of transdermal selegiline). SO I'm not sure it would really affect Nardil's mode of action.
Regarding Reboxetine, it inhibits the release of norepinephrine. Since norepinephrine release is the precipitating event of a hypertensive crisis, Reboxetine should have the opposite effect.
I'll post a link for that study I mentioned.
It's amazing to me that one of the best meds for SP is so hard to attain and stay on b/c of hypertensive risk. I'm not that knowledgeable about chemistry, but isn't there some kind of substance that someone can ingest to take over MAO's role of break down tyramine? Sort of like taking lactaid pills for people who can't break down lactic acid properly. Then someone on Nardil or Parnate can take that substance along with the MAOI to help prevent hypertensive crisis.
> >
>
> AFAIK there isn't anything like that, because it would interfere with the MAOI's mode of action. There are drugs you can take after the fact, but I think the majority of MAOI users don't have a problem as long as they are careful about what they eat and the other drugs they take. The biggest dietary no-no is aged cheese, which is pretty easy to avoid.
>
> > Moreover, I remember reading a study which concluded that since SNRIs (Reboxetine, Strattera) inhibit norepinephrine release, taking it with MAOIs may lessen the risk of hypertensive crisis. Does anyone have knowledge or personal experience with this combo?
>
> I don't understand how this would work. I'd be interested in this study.
>
> I.
>
Posted by TheOutsider on May 30, 2004, at 14:04:41
In reply to Re: Nardil, SNRIs, tyramine, hypertension » Ilene, posted by Michael Bell on May 29, 2004, at 21:59:32
You make some really interesting points!
I don't really understand the point made by the poster who said drugs that deanimate tyramine would interefere with MAOI's action.
Couldn't a drug be devised that would count MAOI action in the gut, not the brain?
Posted by Questionmark on May 30, 2004, at 18:57:08
In reply to Re: Nardil, SNRIs, tyramine, hypertension » Ilene, posted by Michael Bell on May 29, 2004, at 21:59:32
> > > It's the maoi inhibition outside of the brain that causes the dangerous side effects (hence the benefits of transdermal selegiline). SO I'm not sure it would really affect Nardil's mode of action.
>
> Regarding Reboxetine, it inhibits the release of norepinephrine. Since norepinephrine release is the precipitating event of a hypertensive crisis, Reboxetine should have the opposite effect.
>
> I'll post a link for that study I mentioned.
>
>
> It's amazing to me that one of the best meds for SP is so hard to attain and stay on b/c of hypertensive risk. I'm not that knowledgeable about chemistry, but isn't there some kind of substance that someone can ingest to take over MAO's role of break down tyramine? Sort of like taking lactaid pills for people who can't break down lactic acid properly. Then someone on Nardil or Parnate can take that substance along with the MAOI to help prevent hypertensive crisis.
> > >
> >
> > AFAIK there isn't anything like that, because it would interfere with the MAOI's mode of action. There are drugs you can take after the fact, but I think the majority of MAOI users don't have a problem as long as they are careful about what they eat and the other drugs they take. The biggest dietary no-no is aged cheese, which is pretty easy to avoid.
> >
> > > Moreover, I remember reading a study which concluded that since SNRIs (Reboxetine, Strattera) inhibit norepinephrine release, taking it with MAOIs may lessen the risk of hypertensive crisis. Does anyone have knowledge or personal experience with this combo?
> >
> > I don't understand how this would work. I'd be interested in this study.
> >
> > I.
Reboxetine and other NRIs do not inhibit norepinephrine release. They inhibit the reuptake of NE, allowing MORE to be available in the synapse. The reason they help prevent hypertensive reactions from MAOIs is that tyramine gets into NE-releasing neurons via the reuptake pumps, and so less tyramine is able to be absorbed into neurons because the reuptake pumps are blocked.
Posted by Ilene on May 31, 2004, at 7:18:29
In reply to Re: Nardil, SNRIs, tyramine, hypertension, posted by Questionmark on May 30, 2004, at 18:57:08
> Reboxetine and other NRIs do not inhibit norepinephrine release. They inhibit the reuptake of NE, allowing MORE to be available in the synapse. The reason they help prevent hypertensive reactions from MAOIs is that tyramine gets into NE-releasing neurons via the reuptake pumps, and so less tyramine is able to be absorbed into neurons because the reuptake pumps are blocked.
I've read that NE is also a pressor amine, so I'm not sure how much of an advantage this would be. Has anyone taken an NRI and an MAOI?
The Straterra drug information says *not* to take it within 2 weeks of taking an MAOI. I realize from experience that the patient information is not always accurate.
I.
This is the end of the thread.
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