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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by laurenjb on August 15, 2005, at 18:47:48
Hi fellow Parnate users: I think I had a hypertensive episode a few days ago and could use some input. First, that day, my doctor raised my dosage from 40mg to 50mg/day. After taking my second dose (first 20mg, second 30mg), I had to drive for about an hour and a half. I began to feel very ill: headache (not excruciating, but painful and persistent), difficulty breathing, running hot and cold, nausea and my heart rate seemed fast. In addition to the higher dose, I might have accidentally eaten some Parmesan cheese the night before. I instantly went into denial, though I had a nifedipine (sp?) capsule with me, which I did not take because I worried about becoming hypotensive. I did not have my blood pressure monitor with me. When I reached my destination, I was extremely fatigued and had to lie down. For the next 2 nights, I was able to sleep without sleep meds, which hasn't happened since starting Parnate and was tired during the days. Last night, I was back to 2 hours sleep, then 6-7 hours awake, then a few hours of dozing. Although it seems to have turned out ok, I feel very stupid and fortunate for not hurting anyone while I was driving -- I should have at least pulled over until I felt better. Any thoughts? Thanks, Lauren
Posted by willyee on August 15, 2005, at 21:19:30
In reply to Parnate - hypertensive episode?, posted by laurenjb on August 15, 2005, at 18:47:48
That cheese is one of the REAL no nos,like blue chesse so its very possable and sounds like u did.
A specific weird headache is a good marker,did u have any red spots on ur neck,well either way STAY FROM THE CHESSE LOL,glad to hear u made it fine.
Posted by Declan on August 16, 2005, at 0:32:47
In reply to Parnate - hypertensive episode?, posted by laurenjb on August 15, 2005, at 18:47:48
There's a tyramine induced headache you can get, which can occur in the absence of elevated BP.
And there are spontaneous hypertensive episodes in response to a highish unit dose.
Maybe the elevated heart rate, and the other stuff is something else again, related to the amphetamine like character of Parnate.
(From memory of Elizabeth's old posts.)I know it is said that you can't tell your BP without a BP monitor, but I think you can with practise. If mine was way up I'd feel throbbing behind my eyes and maybe my temples. The difficulty breathing, I wonder if that suggests it.
Good luck, and watch out for restaurant food.
Declan
Posted by Jedi on August 16, 2005, at 4:48:02
In reply to Parnate - hypertensive episode?, posted by laurenjb on August 15, 2005, at 18:47:48
> Hi fellow Parnate users: I think I had a hypertensive episode a few days ago and could use some input.
Hi,
I currently take Nardil but I have used Parnate in the past. Unfortunately it did not relieve my atypical depression. I have had several episodes over the years while on MAOIs that felt like the reaction you described. I actually had to lie down on the floor for ten or fifteen minutes, until the symptoms went away. I have had true hypertensive episodes, and these felt like milder versions of the same thing. I believe that with Parnate you are prone to more spontaneous hypertensive reactions than with Nardil. I've read that these are more common just after dosage increases. If the Parmesan you ate was the Kraft variety, it has very little tyramine. Even the grated Italian Parmesan has less tyramine than Mozzarella. I'm not going to tell you to eat them, but I eat them all the time with no trouble. Again the hypertension problem is more of a problem with Parnate than Nardil.I used to carry Nifedipine with me all the time. My current doctor is not prescribing it because of the risk of hypotension. He feels that taking it out of a hospital setting is too dangerous. And a stroke isn't? I feel kind of uncomfortable not having it with me in case of an emergency. MAOI users: Are your doctors prescribing Nifedipine?
JediLink: This paper shows the tyramine content per serving for some common foods and other things to look out for.
http://www.vh.org/adult/provider/psychiatry/CPS/19.html
Monoamine Oxidase Inhibitors: Adverse Effects
Original Author: Paul Perry, Ph.D, BCPP
Latest Revisers: Paul Perry, Ph.D, BCPP, Brian C. Lund, Pharm.D.
Creation Date: 1996
Last Revision Date: March 2001
Peer Review Status: Internally Peer Reviewed
Posted by Ilene on August 16, 2005, at 13:43:37
In reply to Re: Parnate - hypertensive episode?, posted by Jedi on August 16, 2005, at 4:48:02
> I used to carry Nifedipine with me all the time. My current doctor is not prescribing it because of the risk of hypotension. He feels that taking it out of a hospital setting is too dangerous. And a stroke isn't? I feel kind of uncomfortable not having it with me in case of an emergency. MAOI users: Are your doctors prescribing Nifedipine?
> Jedi
>When I took Marplan I carried a Nifedipine around with me. I never had any problems with food, fortunately.
I.
Posted by fires on August 17, 2005, at 21:56:12
In reply to Parnate - hypertensive episode?, posted by laurenjb on August 15, 2005, at 18:47:48
I was on Parnate for 14+ years and never had any hypertensive episodes, and never carried nifedipine.
Of course I did experience a lot of hypotensive episodes when standing up.
Posted by laurenjb on August 18, 2005, at 21:49:40
In reply to Re: Parnate - hypertensive episode? ? laurenjb, posted by fires on August 17, 2005, at 21:56:12
My doctor dismissed the idea that I had a hypertensive episode. She said if it was the cheese, it would have happened within about an hour of eating it. She thinks it was an anxiety attack since I was having trouble breathing. I'm still curious to hear what a real hypertensive episode feels like.
Posted by Declan on August 19, 2005, at 18:54:55
In reply to Re: Parnate - hypertensive episode?, posted by laurenjb on August 18, 2005, at 21:49:40
Hi Lauren
How's things?
It shouldn't have been the cheese, eh? That was the night before.
But it was something to do with the Parnate, don't you think?
Declan
Posted by laurenjb on August 19, 2005, at 19:17:12
In reply to Re: Parnate - hypertensive episode?, posted by Declan on August 19, 2005, at 18:54:55
Hi Declan: Things aren't so good -- though I went up to 50mg a week ago, I've been really depressed. The only good part is I'm sleeping again, only too much. Have you ever heard of that on Parnate?
My doctor doesn't think my "episode" had to do with the Parnate. I had had kind of a tough week and she thinks it was an anxiety attack. Since I've only had what I would call "anxiety attacks" a few times and always directly related to not treating my depression properly, I think I disagree with her. Also, I took an Ativan and it didn't do ANYTHING. I honestly have no idea what happened. I'll just avoid the cheese (which I've been doing -- no big deal -- I'm not one of those people who adores cheese!) and try to pull myself out of this slump. I tell you, it gets harder every time and I'm worried that the Parnate is going to stop working for me completely. Things had been going pretty well and I was really thinking I'd be able to go back to work (I haven't been working for about a year and a half) but now I feel as bad as I did when I went on disability.
How are you doing? I truly hope you're feeling better than I am. Thanks for asking and for listening. Take care, Lauren
Posted by Declan on August 19, 2005, at 21:05:38
In reply to Re: Parnate - hypertensive episode? » Declan, posted by laurenjb on August 19, 2005, at 19:17:12
I have heard of tiredness on Parnate, especially during the day, but many people report nighttime insomnia.
So you've had better nighttime sleep?
I'd be sceptical ofyour docs opinion too. Whether it's working as you want or not, Parnate is pretty strong stuff. I've heard too about adverse responses to high single doses of it, which is what happened to you, isn't it? Well, maybe 30mg is not so much at once, I dunno. But as you say Ativan did nothing for it. It didn't sound like an anxiety attack to me.
I think I'm happy enough on my low dose of Parnate. 20mg didn't improve things for me, and was OK, but I thought, why bother? On 10 there is a warmth or something, it's no big deal but is an improvement for me. If I pushed it up my brain would compensate, it wouldn't be any better for me. But depression can be an awful thing for some people.
What's with the circumflex above the A? Are you from Quebec?
Declan
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