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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by nickguy on May 29, 2006, at 14:31:40
I'd a little hesistant about taking an MAOI. I know they're not as dangerous as they're played out to be if you follow the guidelines, but a few things bother me. For those of you who have taken or are taking maoi's over a long period of time (a few years atleast), how much do the restrictions bother you? Do any of you drink or did drink before you went on, and how has that effected you? What the heck do you do when you get sick (colds and coughs)? What are you supposed to do when you need surgery or go to the emergency room ( concerning painkillers) ?
I'd really appreciate some feedback. thanks guys.
Posted by Declan on May 29, 2006, at 14:52:37
In reply to Questions for long term MAOI users, posted by nickguy on May 29, 2006, at 14:31:40
I'd worry more about somehow damaging my brain chemistry in quite unknown ways as drugs are said to do. The dietry thing is easy. OTC medicines are much harder (if you have allergies). And being knocked down by a car and needing immediate surgury is a worry too.
Posted by Oppycat on May 29, 2006, at 16:11:21
In reply to Questions for long term MAOI users, posted by nickguy on May 29, 2006, at 14:31:40
> I'd a little hesistant about taking an MAOI. I know they're not as dangerous as they're played out to be if you follow the guidelines, but a few things bother me. For those of you who have taken or are taking maoi's over a long period of time (a few years atleast), how much do the restrictions bother you? Do any of you drink or did drink before you went on, and how has that effected you? What the heck do you do when you get sick (colds and coughs)? What are you supposed to do when you need surgery or go to the emergency room ( concerning painkillers) ?
>
> I'd really appreciate some feedback. thanks guys.Up until about 3 months ago, I had taken Parnate for most of the past 17 years. Although I followed the diet fairly strictly in the beginning, as I began doing more research, I discovered that many of the foods and beverages that were previously listed as ones to be avoided were now allowed. Occasionally, doctors would also tell me about a new study that concluded so-and-so food was ok. I also began having small portions of some of the still forbidden foods. Eventually, I began eating some of them with some regularity and in larger portions. I pretty much followed the same pattern with beverages. Initially, my pdoc told me that one glass of white was ok. Eventually, I drank considerably more than that and I have probably averaged 3 glasses per day for several years. On rare occasions, I'm sure I've consumed a couple bottles of wine and several glasses of cognac in an evening with no ill effects (except for an awful hangover). I'm sure I've repeated the same behavior with red wine a number of times with a similar effect (no hypertensive reaction, but expected hangover). I'm not bragging, merely trying to convey that I've consumed most kinds of alcholic beverages without incident. I do believe, however, that my nagging depression over the past several years is due, in some part, to my regular drinking. Given some time, I could probably come up with a list of foods and beverages that I've had over that period that I was supposed to avoid. I did avoid foods that I didn't care for (who wouldn't?), along with some others that were easy to give up. I never drank much beer so I generally avoided it. Fortunately, I never needed much non-prescription medicine, but never had any problem with tylenol and that sort of thing. After some dental surgery and a back injury, I've have taken tylenol 3 and percoset, again without incident. Please remember, though, your mileage may vary. I will say this, however, the dietary restrictions are way overblown and shouldn't stop anyone from taken MAOIs for depression. The side effects are quite minimal, especially with Parnate. I hope this helps.
Michael
Posted by Jost on May 29, 2006, at 17:43:14
In reply to Questions for long term MAOI users, posted by nickguy on May 29, 2006, at 14:31:40
I took fairly high-dose parnage for about three years.
The food restrictions never were a problem. I do like Chinese food, which I had to cut out, and cheese, ditto--but I just did it. Found substitutes, and kept to them.
I did drink some wine--I just started with some amounts and waited to see the effects--which were nil. But I'm not much of a drinker, so that wasn't an issue for me. It's not a good idea to start with the hope of not having to live with the restrictions, though.
I personally think there's a lot of fearful hype about food effects. At the same time, for a while, you have to work to develop certain habits and also to be somewhat aware of salad bars, etc.
But there is emsam and eventually rasagiline. What about Emsam?
Jost
Posted by Jost on May 29, 2006, at 18:12:52
In reply to Questions for long term MAOI users, posted by nickguy on May 29, 2006, at 14:31:40
As far as colds, etc., you can use claritin, which is over the counter now (loratadine) and steroidal nasal inhalants, such as flonase.
You can't use demerol and the kind of epinephrine that dentists usually use as anesthesia, but there's another type of epinephrine that you can ask for that's safe. You should make certain to have those noted, and to check.
Jost
Posted by jaclinhyde on May 29, 2006, at 20:01:06
In reply to Questions for long term MAOI users, posted by nickguy on May 29, 2006, at 14:31:40
I have been on MAOI's for over 25 years and have only had one hypertensive reaction which was when I had some sour cream that was in the fridge too long and had went bad. I took a seroquel and was fine afterwards. The list is really easy to manage with aged cheeses being the top food culprit. As far as painkillers are concerned morphine is just fine while demerol is a huge no-no. When you get sick you can take the newer antihistamines like Claritin or Zyrtec. As far as decongestants are concerned you really can't take any. But you know what is funny? When I started taking MAOI's I felt so much better emotionally that I didn't get sick as often as when I was depressed and anxious. I swear I think that because I was feeling so much better I didn't get as sick as before I statted taking them. Obviously you will get sick sometime but it will past and you will survive. It is a more than fair trade off, believe me! As far as surgery is concerned there are many options for anesthesia as long as you get a knowledgable anesthesiologist. Here is some info plus a link to the safety of taking an MAOI and having anesthesia.
"Do MAOI interact with anesthetic drugs?
MAOI inhibit microsomal enzymes, theoretically potentiating barbituates and opioids.80 Three cases of excessive barbiturate/opioid effects were reported from 1960 to 1970.80,84 Since then, numerous reports have described uneventful anesthetics using barbiturates and various opioids: remifentanil,89 alfen-tanil,89,90 sufentanil,91 fentanyl,80,81 hydromorphone91 and morphine80,81,81,85,89 for patients continuing to take MAOI. Other agents including propofol,90,92 ket-amine,93 midazolam,92 ketorolac,92 vecuronium,92 and atracurium92 have also been used safely. Severe hypertension on induction with etomidate and atracurium has occurred, although the patient’s blood pressure was 200/90 immediately prior to induction.94 Regional anesthesia has been performed without incident when hypotension was treated appropriately with volume and direct-acting sympathomimetics.80,81,95,96 Normal responses to most anesthetic agents can be expected (grade C).Is the continuation of MAOI associated with adverse outcomes?
Much of our understanding of the interactions between MAOI and anesthetic drugs comes from reports of isolated events in individual patients. A controlled prospective evaluation of 27 patients chronically treated with MAOI undergoing 36 anesthetics reported no adverse cardiovascular responses.95 Changes in blood pressure and heart rate were not significantly different from control patients without prior MAOI exposure. Anesthetic agents included sodium thiopental, etomidate, diazepam, succinylcholine, nitrous oxide, volatiles, pancuronium, morphine, spinal tetracaine, epidural bupivacaine, and phenylephrine.95 Similarly a review of a series of 32 orthopedic patients on MAOI who underwent 46 general anesthetics and five regional anesthetics for elective surgery found no adverse hemodynamic events.96 Agents used in this series included sodium thiopental, ketamine, volatiles, morphine and meperidine. Aside from sporadic case reports, the continued use of MAOI/RIMA has not been associated with adverse perioperative events when meperidine and indirect acting catecholamines are avoided (grade B).Conclusion: MAOI
Case reports of sporadic MAOI-related drug interactions prompted many to advise discontinuation of classic MAOI two to three weeks before surgery.80,84,95 Withdrawal of MAOI is not without risks. Many patients have severe depression refractory to other treatment and are at risk for life-threatening psychiatric illness. Acute exacerbation of depression with suicidal ideation has been reported after discontinuation of MAOI prior to elective cardiac surgery.97 There is no literature specifically concerning MAOI and ambulatory anesthesia. MAOI-related drug interactions are possible and have been reported; however, patients continuing to take either classic or selective MAOI remain suitable candidates for ambulatory anesthesia if meperidine, cocaine and indirect-acting catecholamines are avoided."
The link is http://www.cja-jca.org/cgi/content/full/51/8/782#SEC16 near the bottom of the page.
Two two things you should have are a medical ID bracelet so that in case you cannot speak for yourself the doctors will know that you are on an MAOI, and a blood pressure monitor so that you can keep tabs on how the drug is affecting you. This is more important if you are taking Parnate because it can raise blood pressure even without eating the wrong foods (although not necessarily to dangerous levels.) Nardil and Marplan tend to lower blood pressure so it isn't as important to monitor it. Drinking is OK as long as you don't consume chianti wine or beer from a tap. But don't go to extreme! Moderation is the key.
Hope this helps! If you have any more questions feel free to pick my brain :-)
JH
> I'd a little hesistant about taking an MAOI. I know they're not as dangerous as they're played out to be if you follow the guidelines, but a few things bother me. For those of you who have taken or are taking maoi's over a long period of time (a few years atleast), how much do the restrictions bother you? Do any of you drink or did drink before you went on, and how has that effected you? What the heck do you do when you get sick (colds and coughs)? What are you supposed to do when you need surgery or go to the emergency room ( concerning painkillers) ?
>
> I'd really appreciate some feedback. thanks guys.
Posted by Phillipa on May 29, 2006, at 22:02:24
In reply to Re: Questions for long term MAOI users, posted by Jost on May 29, 2006, at 17:43:14
Jost what do you have to avoid on a salad bar? Love Phillipa
Posted by jedi on May 29, 2006, at 22:03:20
In reply to Questions for long term MAOI users, posted by nickguy on May 29, 2006, at 14:31:40
> I'd a little hesistant about taking an MAOI. I know they're not as dangerous as they're played out to be if you follow the guidelines, but a few things bother me. For those of you who have taken or are taking maoi's over a long period of time (a few years atleast), how much do the restrictions bother you? Do any of you drink or did drink before you went on, and how has that effected you? What the heck do you do when you get sick (colds and coughs)? What are you supposed to do when you need surgery or go to the emergency room ( concerning painkillers) ?
>
> I'd really appreciate some feedback. thanks guys.Hi,
I've used Nardil for most of the past 10 years. I have had no reactions to alcohol, sometimes in large quantities. That said, I would avoid tap beers because of the variability in the cleanliness and thus the tyramine content. Over the counter cold remedies are pretty much worthless. I take Benadryl for my allergies and as an occasional sleep aid. No problem with this. The inhaled cortisones like Flonase are no problem. I had pneumonia once; codeine is a good cough suppressant and is not a problem with MAOIs. Of course meperidine(Demerol) is a no-no.In ten years I have had two mild hypertensive problems. One was from an aged cheese and was just a space out on my part. The other was from a cough suppressant with codeine. In small print, that I could not read with my presbyopia, were the words pseudoephedrine(another no-no). The Canadian pharmacist told me it was fine with phenelzine. Big mistake on her part.
I think, when taking MAOIs, you just have to take a lot more responsibility. I no longer trust pharmacists or MDs. I do the research myself. It is my life. A med bracelet would probably be a good idea; in case you are in an accident and unconscious.
For some of us, the MAOIs are the only thing that works.
Good Luck,
Jedi
Posted by nickguy on May 29, 2006, at 22:18:47
In reply to Re: Questions for long term MAOI users » nickguy, posted by jedi on May 29, 2006, at 22:03:20
To be honest, I don't think I could wear a medical bracelet. I have social anxiety and explaining this to friends and strangers would probably be too much for me. I wish they would make them smaller, something less out there.
The OTC medical restrictions wouldn't bother me much. I hardly ever get sick and I don't have allergies. Food restrictions wouldn't bother me either. I'd have to be more responsible with alcohol though.
Posted by willyee on May 29, 2006, at 22:44:49
In reply to Questions for long term MAOI users, posted by nickguy on May 29, 2006, at 14:31:40
> I'd a little hesistant about taking an MAOI. I know they're not as dangerous as they're played out to be if you follow the guidelines, but a few things bother me. For those of you who have taken or are taking maoi's over a long period of time (a few years atleast), how much do the restrictions bother you? Do any of you drink or did drink before you went on, and how has that effected you? What the heck do you do when you get sick (colds and coughs)? What are you supposed to do when you need surgery or go to the emergency room ( concerning painkillers) ?
>
> I'd really appreciate some feedback. thanks guys.OK, my take on the things u asked.......first can u drink while on a maoi,well ur not cursed from ever having the occasional beer or two at social events or the like,just have to be careful on what ur drinking,and pace urself so u dont go over board,pay close attention to u r body,and have emergency medications on hand,and do not dose ur maoi near the time of drinking.
Now if ur a drinker period,for example my brothers routine is having his few beers every night after he is done working and everything else,he does not get phased by it,hell have his beers and be fine the next day.
Now if u r a drinker,and u know the difference between a social drinker and DRINKER,and i dont aim that at u alone,rather everyone,then my opinion,NO maois should not be an option until u are ready to halt drinking,im sure others might disaree here,its not bible,but its just my opinion,because again although unlikly,the actual interaction once it happens is it,u cant turn back the clock,u have to go forward and its a very very scary ordeal,and u will wish u paid more attention to the dangers.
Second believe it or not,i actualy feel as if parnate prevents me from getting ill,i simply dont lol,and when i do i take parnate and it over rides a common cold etc for me,now again thats for me.
I did have my appendix removed,and had no problems with the anesthics at the time,even having dosed parnate prior,BUT what i did have was a interaction AFTER,when i went home,from the remaining antesia in me.This was also after i was ASSURED i could start my drug back up,i knew better,i just let the docs advice reassure me when i truly knew it was not the right thing.I was glad to see however the inialt anteshtics did not interfere with parnate,cause BOY did i need them,and man that tank,whatever was in there,i swear to this day i tell people if they can just attach me to that tank,like on a back pack,ill be fine just let me live out my life with it lol.
I believe it was a iv mixutre of demerol and two others im not sure,but i was happy as can be sat up and found whatever was on tv literaly extremly entertaining,i think i even watched larry king live,hell i could have watched the off air color chart and been enetertained lol.
Finaly to answer ur question as a whole,my life is much more interpupted by the illness itself and the med not working to full defree then i am worrying about interactions.
I am not a light eater,i weight about 235 i eat various stuff,i have my chocalte dooughnuts,my pizza etc,and i dont worry about parnate,drinking i do but again i am allowed to have enough bevarge to feel adequate.
I always state as a rule of thumb for anyone starting a maoi,read peoples exper,thats fine,BUTNO MATTER WHAT,everyone is different,some people are way more sensative than others,so i say during ur first month on a MOAI be cautious,dont rock the boat,learn how to feel ur body when its on the drug,become familiar with that,so u will know when something isnt right,dont think cause so and so can drink beer,eat pizza and scarf on choclate cookies u can too,treat the maoi like its said to be,and use caution until u are on it a fair amount of time.........whew.
Posted by Jost on May 29, 2006, at 22:54:46
In reply to Re: Questions for long term MAOI users » Jost, posted by Phillipa on May 29, 2006, at 22:02:24
Hi, Phillipa. The problem with food on a salad bar is that foods, as they sit without refrigeration, age. This aging will produce some tyramine, most significantly in things like egg salad, chicken salad, and so forth..
Any food can undergo this kind of chemical process, although some produce more tyramine because of their composition. This same problem applies to picnics on hot days--.
Also, you can't eat pickles or sauerkraut, which can be on salad bars.
However, I mostly had in mind the deterioration of mixed salads.
Jost
Posted by Jost on May 29, 2006, at 23:03:26
In reply to Re: Questions for long term MAOI users, posted by willyee on May 29, 2006, at 22:44:49
Definitely avoid most decongestants, like sudafed, afrin, and so forth.
Many of the restrictions are overstated--but until you get stabilized on a dose, it's best not to experiment. You won't know what your sensitivity is-- and it is variable.
First get comfortable with and knowledgeable enough about the restrictions.
Later on, you can start experimenting--but again, you have to be careful.
For example, if you're getting a certain amount of mao inhibition with parnate, which is an irreversible maoi, you can break down so much tyramine in a two week period. Then you won't have more of the mao for at least two weeks (this of course is simplistic)-- so maybe you can have chinese food once or twice--but the third time, you might cross that threshold where you can't metabolize it.
So being okay one time doesn't mean you can have, say, Chinese food, whever you want.
But that's for way down the line, IMO>
Jost
Posted by nickguy on May 29, 2006, at 23:39:16
In reply to Re: Questions for long term MAOI users--Phillipa, posted by Jost on May 29, 2006, at 22:54:46
how many of you guys wear medical bracelets?
Posted by jedi on May 30, 2006, at 0:03:45
In reply to Re: Questions for long term MAOI users, med bracel, posted by nickguy on May 29, 2006, at 23:39:16
> how many of you guys wear medical bracelets?
I don't, but I know I should. One of life's little risks. I do have a medical alert on my drivers license which informs an EMT that I am on a MAOI and can not use meperidine. Not as good as a bracelet or necklace but better than nothing.
Jedi
Posted by Caedmon on May 30, 2006, at 7:14:03
In reply to Re: Questions for long term MAOI users, med bracel » nickguy, posted by jedi on May 30, 2006, at 0:03:45
I'm not a long-time user, but I can tell you that so far I have not had a problem with the diet or med restrictions. Most cold remedies are okay. For nasal congestion, I've used oxymetazoline (generic Afrin) without problem, and menthol cough drops work well. Antihistamines have been just fine.
No one has ever asked about my med bracelet. You can get other things besides a bracelet, they have dog tags and necklaces as well. You can even get a watch that is also a medical i.d. (with the info on the back of the watch face).
- Chris
Posted by naughtypuppy on May 30, 2006, at 8:02:31
In reply to medical bracelet, posted by nickguy on May 29, 2006, at 22:18:47
> To be honest, I don't think I could wear a medical bracelet. I have social anxiety and explaining this to friends and strangers would probably be too much for me. I wish they would make them smaller, something less out there.
>
> The OTC medical restrictions wouldn't bother me much. I hardly ever get sick and I don't have allergies. Food restrictions wouldn't bother me either. I'd have to be more responsible with alcohol though.Make yourself a card that you keep with your drivers license so the emergency people will find it when they try to find out who you are. You can print on it something like "I am taking Nardil (phenelzine) a MAO inhibitor which can cause a potentialy lethal hypertensive crisis if medicines such as epinephrine and Demerol are administered. Then give your pdoc and GP's name and telephone. For some people like me who seem to be swiching meds all the time this looks far more economical than a med alert bracelet.
Posted by jaclinhyde on May 30, 2006, at 9:26:53
In reply to medical bracelet, posted by nickguy on May 29, 2006, at 22:18:47
You can buy a medical alert necklace instead of the bracelt and wear it inside your shirt. This way noo one will see it but it is still there in case of an emergency. Mine used to say "Taking MAOI, NO DEMEROL!"
JH
> To be honest, I don't think I could wear a medical bracelet. I have social anxiety and explaining this to friends and strangers would probably be too much for me. I wish they would make them smaller, something less out there.
Posted by kimcrazylady on May 30, 2006, at 9:54:12
In reply to Questions for long term MAOI users, posted by nickguy on May 29, 2006, at 14:31:40
> I'd a little hesistant about taking an MAOI. I know they're not as dangerous as they're played out to be if you follow the guidelines, but a few things bother me. For those of you who have taken or are taking maoi's over a long period of time (a few years atleast), how much do the restrictions bother you? Do any of you drink or did drink before you went on, and how has that effected you? What the heck do you do when you get sick (colds and coughs)? What are you supposed to do when you need surgery or go to the emergency room ( concerning painkillers) ?
>
> I'd really appreciate some feedback. thanks guys.
I've been on and off Parnate for over 20 years and really haven't had any problems. I stay away from the really aged cheezes, but eat pizza quite a bit. I drink, but not much red wine or dark liquors like whiskey, etc. I will occasionally drink beer, but limit it to only one if it's on tap. I drink too much wine, and the only time I've ever had a reaction is when I just simply drink and eat too many restricted things in a matter of a day or two. My face will get splotches on it. It raises my blood pressure some, but not dangerously.I have an aneurysm, so my doc pulled me off Parnate last year after discovering it. I was worthless, even though I tried several drugs. Nothing has ever worked for me except Parnate, so for me it's worth the risk.
I don't wear a bracelet, but I do have a card in my wallet. I have had both scheduled and emercency surgeries while on Parnate and have had absolutely no problems with anesthisia. As long as they know you are on an MAO, there should be no issues. Same for the dentist. I had to have some work done and he just used a different novacaine formula. Again, no problems.
As far as colds, etc. You have to be careful, but there are many things available. I take Benadryl for a stuffy head and my GP has found other meds when I'm sick. Never had problems with pain killers or muscle relaxors after surgery either. Just make sure you tell every doc what you are taking and make them LOOK UP all meds. Then, I double check with the pharmacist.
Mostly, it doesn't affect me except for a few foods I'd like to eat. The smallest amount of pickle juice makes me sick and I like pickles!
Good luck.
Kim
Posted by ed_uk on June 2, 2006, at 17:45:26
In reply to Re: Questions for long term MAOI users, med bracel, posted by Caedmon on May 30, 2006, at 7:14:03
Hi Chris
>For nasal congestion, I've used oxymetazoline (generic Afrin) without problem
Best to stick to oxy in future then. Some decongestants are dangerous with Parnate. Did you measure your BP after the oxy?
Regards
Ed
Posted by Caedmon on June 2, 2006, at 18:46:08
In reply to Re: Questions for long term MAOI users, med bracel » Caedmon, posted by ed_uk on June 2, 2006, at 17:45:26
> Best to stick to oxy in future then. Some decongestants are dangerous with Parnate. Did you measure your BP after the oxy?>
Yep, I checked my blood pressure right before, and 10 and 45 minutes after. No change though. I read somewhere that only a small amount of oxymetazoline is absorbed into the bloodstream, maybe 5-10%. I only used one spray in each nostril, it lasted me all day. (Maybe using more would have been different.)
Oxymetazoline is very effective for me. Far better than the oral stuff I used in the past (pseudoephedrine, etc). I hear that it can give you bad rebound congestion though so I only used it for three days (which was really all I needed anyway).
- Chris
Posted by ed_uk on June 3, 2006, at 19:20:46
In reply to MAOI, oxymetazoline » ed_uk, posted by Caedmon on June 2, 2006, at 18:46:08
Hi C
>I hear that it can give you bad rebound congestion though
It can - although I didn't have a problem myself after I used it for a few weeks :)
Regards
Ed
This is the end of the thread.
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