![[dr. bob]](/dr-bob-sm.gif)
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 Karen44 on June 7, 2006, at 22:28:14
I just had a very scary experience this afternoon. I went to a very reputable hospital for a CT scan and two MRI's. I was diagnosed with COPD last year and had neurosurgery on cervical spine last year in addition to other medical problems that developed last year. Anyway, I got depressed, was put on Parnate, and when I went for the CT scan of my lungs today(with enhancement, the nurse in radiology asked me if I was allergic to any medications. I have a very adverse reaction to benydryl, and so she said they would give me ephinephrine if I had a reaction to the contrast solution. I told her she could not do that because I am on a MAOI, and I would go into hypertensive crisis, that it could kill me. She argued this was not true, and so finally I said give me the benydryl if I have a reaction. I had none, but now I am wondering who to tell about this. Is she nuts??? thinking she can make such a decision; I now wonder what would have happened to me if they had given me the epinephrine. I think this should be reported, and I wonder what others think.
Karen44
Posted by Caedmon on June 7, 2006, at 23:25:07
In reply to MAOI and epinephrine, posted by Karen44 on June 7, 2006, at 22:28:14
MAOIs are okay with epinephrine. Most of the time, direct-acting sympathomimetics are just fine. It is the indirect-acting ones like ephedrine that are dangerous.
- Chris
Posted by willyee on June 7, 2006, at 23:40:21
In reply to Re: MAOI and epinephrine, posted by Caedmon on June 7, 2006, at 23:25:07
Lol will looks around shamefully........raises his hand ummm took those togther already slowy puts his hand down.
Teacher says,gawd is there anything u havent taken with parnate!!!!
Lol there was no interaction at fair levels,the two just stunk togther,felt sleepy and nasty.
My experiance the wors thing for me was soy sauce,its the only interaction that was immediate,with all the classic features,i remeber mostly spotting,red spots on my neck,sweating,heart palpations,heache etc.
Other than that ive had partial interactions where i felt it was bordering and knowing it when i did and taking action then always prevented it from escalting,its as if the interaction gives u at least a fair amount of time in terms of warning.
U are right about one thing,dont count on docs,i was half conscious when getting my appendix removed and on my way to the ER and i was still able to get out quite a few times i was on a maoi before i slipped into lala land on the anestia.
No precations were took and i was blown off by whoever i told,that wont happen again i have planned precations.
As far as reporting it,i think ur better off using ur resources to help urself for futre situations since u know u cant count on docs.good luck
Posted by SLS on June 8, 2006, at 6:47:42
In reply to Re: MAOI and epinephrine, posted by Caedmon on June 7, 2006, at 23:25:07
> MAOIs are okay with epinephrine. Most of the time, direct-acting sympathomimetics are just fine. It is the indirect-acting ones like ephedrine that are dangerous.
Hi.
Is there anything on the Internet you could point me to that would confirm this? I don't contend your assertions, but I would feel more comfortable with a citation.
Thanks.
- Scott
Posted by Jost on June 8, 2006, at 13:39:03
In reply to Re: MAOI and epinephrine, posted by SLS on June 8, 2006, at 6:47:42
Epinephrine is okay? that doesn't sound right.. I'd check that one out--in fact I will--but that's not my understanding.
Jost
Posted by kimcrazylady on June 8, 2006, at 15:59:07
In reply to MAOI and epinephrine, posted by Karen44 on June 7, 2006, at 22:28:14
I found this listed in information about bee stings:
****What other drugs will affect epinephrine?
Before an emergency occurs, talk to your doctor about using epinephrine injection if you are taking any of the following medications:
digoxin (Lanoxin, Lanoxicaps, Cardoxin, others);
quinidine (Cardioquin, Quinaglute, Quinidex, others);
a tricyclic antidepressant such as amitriptyline (Elavil, Endep), nortriptyline (Pamelor), doxepin (Sinequan), imipramine (Tofranil), and others; or
a monoamine oxidase inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), or phenelzine (Nardil).
You may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.Drugs other than those listed here may also interact with epinephrine injection. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.***
I have taken albuterol before without issues and most inhalers say not to take with Parnate (my drug); however, my GP did a lot of research and prescribed it. The pharmacist also said it was ok too. The warning on the label says you may need a dosage adjustment and/or close monitoring while on it. I've been on Parnate so long, my GP trusts me to monitor myself and get to an ER if I have problems, but she is very safe and I've never had any trouble with any meds she's prescribed.
Posted by Caedmon on June 8, 2006, at 18:21:42
In reply to Re: MAOI and epinephrine, posted by SLS on June 8, 2006, at 6:47:42
Hey Scott,
Excellent question. It looks like I was only *kind of* right. Here is what I came up with:
~~~
Anaphylaxis and monoamine oxidase inhibitors—the use of adrenaline
M J Fenwick and C L Muwanga
J Accid Emerg Med 2000; 17:143-144
http://emj.bmjjournals.com/cgi/content/full/17/2/143 [link to full text]~~~
There is also this:
"It is unclear if there is an interaction between MAOIs and vasoconstrictors. The termination of the pharmacological response to epinephrine is not primarily dependent on monoamine oxidase. Thus, exogenous epinephrine should not be appreciably affected by the administration of a MAOI. In one study, four healthy subjects took MAOIs and were given IV epinephrine. No significant effect on heart rate or blood pressure occurred. This same study also showed no interaction between norepinephrine and MAOI. Hansten and Horn have reported that MAOIs may slightly increase the pressor response to norepinephrine and epinephrine, an action which appeared to be due to receptor sensitivity caused by the MAOI (Drug Interactions and Updates, PD Hansten and JR Horn (eds.), 1990, Malvern, PA: Lea and Febiger) It is currently accepted practice to use caution when administering local anesthetic with vasoconstrictor in patients medicated with MAOIs."
- http://www.lexi.com/web/dentistry.jsp?id=wynn_january06
~~~
- Chris
Posted by Phillipa on June 8, 2006, at 21:18:10
In reply to Re: MAOI and epinephrine » SLS, posted by Caedmon on June 8, 2006, at 18:21:42
Well there's your answer life threatening situations and the reaction of the antibiotic could or was life threatening. Love Phillipa
Posted by Karen44 on June 8, 2006, at 22:39:25
In reply to Re: MAOI and epinephrine » SLS, posted by Caedmon on June 8, 2006, at 18:21:42
> Hey Scott,
>
> Excellent question. It looks like I was only *kind of* right. Here is what I came up with:
>
> ~~~
>
> Anaphylaxis and monoamine oxidase inhibitors—the use of adrenaline
> M J Fenwick and C L Muwanga
> J Accid Emerg Med 2000; 17:143-144
> http://emj.bmjjournals.com/cgi/content/full/17/2/143 [link to full text]
>
> ~~~
>
> There is also this:
>
> "It is unclear if there is an interaction between MAOIs and vasoconstrictors. The termination of the pharmacological response to epinephrine is not primarily dependent on monoamine oxidase. Thus, exogenous epinephrine should not be appreciably affected by the administration of a MAOI. In one study, four healthy subjects took MAOIs and were given IV epinephrine. No significant effect on heart rate or blood pressure occurred. This same study also showed no interaction between norepinephrine and MAOI. Hansten and Horn have reported that MAOIs may slightly increase the pressor response to norepinephrine and epinephrine, an action which appeared to be due to receptor sensitivity caused by the MAOI (Drug Interactions and Updates, PD Hansten and JR Horn (eds.), 1990, Malvern, PA: Lea and Febiger) It is currently accepted practice to use caution when administering local anesthetic with vasoconstrictor in patients medicated with MAOIs."
>
> - http://www.lexi.com/web/dentistry.jsp?id=wynn_january06
>
> ~~~
>
> - ChrisThanks for the responses. I can't find the citation I had seen, but I will ask my psychiatrist tomorrow when I see him. He has published some sort of disc related to drug interactions.
Karen
Posted by Jost on June 8, 2006, at 23:08:02
In reply to Re: MAOI and epinephrine, posted by Karen44 on June 8, 2006, at 22:39:25
My pdr doesn't address the issue of epinephrine directly, but says under parnate:
"12. In Patients undergoing elective surgery
Patients taking parnate....should not be given...local anesthesia containing sympathomimetic vasoconstrictors..." (p. 3113)
Under epinephrine (Epipen) it says:
"Epinephrine is a sympathomimetic drugs.. The strong vasocontrictor action of epinephrine through its effect on alpha adrenergic receptors....." (p.1122)
From this I conclude that since epinephrine is a sympathomimetic vasoconstrictor, it shouldn't be given to patients taking parnate.
There could be more recent studies suggesting that in certain cases or with supervision at certain doses, this combination isn't life-threatening, or even necessarily dangerous. (My pdr is from 2001.) But my Pdoc definitely strongly advised me to avoid it--and without sophisticated attention, I'd be afraid to be in that position.
Jost
Posted by SLS on June 9, 2006, at 8:07:19
In reply to Re: MAOI and epinephrine » SLS, posted by Caedmon on June 8, 2006, at 18:21:42
Hi Chris.
Thanks for taking the time to respond.
I would still be scared to be given epinephrine or norepinephrine while taking an MAOI.
Unfortunately, the quotation you provided does not report the dosages of MAOI that were used. In the case of anaphylaxis, the patient was taking only 15mg of Nardil. I doubt that such a low dosage would produce a degree of MAO inhibition that would be representative of a therapeutic level.
I really don't know what to think. I have safely combined high dosages of Parnate with TCA and dextroamphetamine, both of which are indirect sympathomimetics. I understand the rationale for why a direct receptor agonist might not be dangerous, but still...
Thanks again.
- Scott> Anaphylaxis and monoamine oxidase inhibitors—the use of adrenaline
> M J Fenwick and C L Muwanga
> J Accid Emerg Med 2000; 17:143-144
> http://emj.bmjjournals.com/cgi/content/full/17/2/143 [link to full text]
>
> ~~~
>
> There is also this:
>
> "It is unclear if there is an interaction between MAOIs and vasoconstrictors. The termination of the pharmacological response to epinephrine is not primarily dependent on monoamine oxidase. Thus, exogenous epinephrine should not be appreciably affected by the administration of a MAOI. In one study, four healthy subjects took MAOIs and were given IV epinephrine. No significant effect on heart rate or blood pressure occurred. This same study also showed no interaction between norepinephrine and MAOI. Hansten and Horn have reported that MAOIs may slightly increase the pressor response to norepinephrine and epinephrine, an action which appeared to be due to receptor sensitivity caused by the MAOI (Drug Interactions and Updates, PD Hansten and JR Horn (eds.), 1990, Malvern, PA: Lea and Febiger) It is currently accepted practice to use caution when administering local anesthetic with vasoconstrictor in patients medicated with MAOIs."
>
> - http://www.lexi.com/web/dentistry.jsp?id=wynn_january06
>
> ~~~
>
> - Chris
Posted by ed_uk on June 9, 2006, at 14:58:36
In reply to Re: MAOI and epinephrine » Caedmon, posted by SLS on June 9, 2006, at 8:07:19
Hi Scott
According to Stockley's drug interactions, a texbook, epinephrine does not interact seriously with MAOIs. They cite a few studies.
Ed
Posted by Karen44 on June 10, 2006, at 17:07:49
In reply to Re: MAOI and epinephrine, posted by Jost on June 8, 2006, at 23:08:02
I forgot to ask my doctor about this when I saw him yesterday. So, I may email him. The more urgent issue had to do with the fact that I take 40 mg. of Parnate per day and added Risperidone .5 mg to help me sleep at night. I ended up with what he says is a serotonin syndrome reaction, given my symptoms and the progression of the symptoms and even though there is no reported case that he is aware of when mixing the two medications.
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.