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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by H. Upmann on August 2, 2006, at 21:27:19
Just curious if it is common practice for a doctor to prescribe a blood pressure lowering med as a prophylactic in case you mess up your diet or eat something you wouldn't suspect to cause a reaction. My doc says just go to the ER as it's a bad idea to self-medicate when it comes to your blood pressure. Seems like if your in the middle of nowhere or alone and have a reaction you'd be SOL. Just curious what your docs have said if you've been prescribed Nardil or Parnate.
Posted by SLS on August 2, 2006, at 23:33:21
In reply to MAOI's and blood pressure meds, posted by H. Upmann on August 2, 2006, at 21:27:19
> Just curious if it is common practice for a doctor to prescribe a blood pressure lowering med as a prophylactic in case you mess up your diet or eat something you wouldn't suspect to cause a reaction. My doc says just go to the ER as it's a bad idea to self-medicate when it comes to your blood pressure. Seems like if your in the middle of nowhere or alone and have a reaction you'd be SOL. Just curious what your docs have said if you've been prescribed Nardil or Parnate.
The gold standard of treatments for a tyramine reaction is phentolamine. Unfortunately, it is no longer available as an oral preparation. However, it is the best treatment available in the ER as intravenous Regitine. Phentolamine was being looked at for treating erectile dysfunction a few years back. It would have been nice to have it handy in case of emergencies.I carry a nifedipine capsule around with me whenever I'm on a MAOI. There is some debate as to how desireable it is to use the sublingual preparation, however, this is the route most often chosen to study in medical literature. I haven't really investigated other alternatives. Chlorpromazine is used, but the sedation and EPS make it unattractive to me. It might be a more effective antidote, though.
- Scott
Posted by stargazer on August 2, 2006, at 23:46:03
In reply to MAOI's and blood pressure meds, posted by H. Upmann on August 2, 2006, at 21:27:19
My pdoc has always given me a few Nifidepine pills just in case my BP soars. I would rather take the pill than risk having a stroke, although it probably wouldn't happen that fast.
I only had to take the pill once, a few weeks ago, I could feel myself start to get flushed and definately knew something was happening. I realized I ate alot of pizza, rather than a slice or two, and I think it had more Parmesan cheese than the Mozz that I'm used to eating. MOzz cheese is OK to eat as long as you don't go crazy. I popped the BP pill and went to bed. I checked my BP with a cuff before doing all this and it was slightly elevated for me who normally runs 100/60. I think I was 138/88, so that's a big difference.
But you should have something you can take. Tell your doc that you have heard that other patients get Nifedipine for this and see what
(s)he says. Better to ask. Personally I wouldn't want to rely on the ER with all the GSW (gunshot wounds), etc.Today I went for a complete P.E. and I told the doc (who might have been 30) that I was on Marplan and she looked at me with 'that' look. it was obvious she knew nothing about MAO's, they don't even teach that anymore, so don't bother bringing it up with a generalist, cause they will give you that clueless look. It's a great look because docs never will admit to not knowing something. How can you know everything today? There's too much out there.
SG
Posted by jedi on August 3, 2006, at 1:56:40
In reply to MAOI's and blood pressure meds, posted by H. Upmann on August 2, 2006, at 21:27:19
> Just curious if it is common practice for a doctor to prescribe a blood pressure lowering med as a prophylactic in case you mess up your diet or eat something you wouldn't suspect to cause a reaction. My doc says just go to the ER as it's a bad idea to self-medicate when it comes to your blood pressure. Seems like if your in the middle of nowhere or alone and have a reaction you'd be SOL. Just curious what your docs have said if you've been prescribed Nardil or Parnate.
Hi,
Many doctors no long prescribe the "bite and swallow" nifedipine capsules because of the chance of a greatly lowered BP. This actually happened to me once. The tyramine reaction has a shorter duration than the nifedipine, leaving some people with a dangerously low blood pressure. When this happened to me, my PDOC at the time had prescribed 20mg capsules of nifedipine. This was too high a dosage for me, and I ended up spending the night in the hospital on IV fluids. The niphedipine brought my BP down quickly. But as the tyramine reaction subsided, the nifedipine just kept lowering my BP. Really low blood pressure can be just as dangerous as really high. I now feel kind of helpless, because I no longer carry anything as an antidote to a hypertensive crisis. And I know how fast you can get into a crowded ER. Especially, when they hear that your problem is related to a mental health issue. Go to the back of the line, have a stroke and die!PS Nardil also lowers my natural blood pressure from borderline high, to normal. Watch out for the orthostatic hypotension. I have not had it for years, but when I first started Nardil, it was pretty bad.
Good Luck,
Jedi
Posted by SLS on August 3, 2006, at 8:22:13
In reply to Re: MAOI's and blood pressure meds » H. Upmann, posted by jedi on August 3, 2006, at 1:56:40
> Many doctors no long prescribe the "bite and swallow" nifedipine capsules because of the chance of a greatly lowered BP. This actually happened to me once. The tyramine reaction has a shorter duration than the nifedipine, leaving some people with a dangerously low blood pressure. When this happened to me, my PDOC at the time had prescribed 20mg capsules of nifedipine. This was too high a dosage for me, and I ended up spending the night in the hospital on IV fluids. The niphedipine brought my BP down quickly. But as the tyramine reaction subsided, the nifedipine just kept lowering my BP.
The literature demonstrating sublingual nifedipine used 10mg. Still, I wonder if that is too much based upon what you have described. Maybe chlorpromazine is the better way to go. I don't know what dosage is appropriate, though. I believe it works as a NE alpha-1 antagonist. Perhaps prazosin would be equally effective. I don't think it has been investigated for this purpose.
- Scott
Posted by SLS on August 3, 2006, at 8:38:17
In reply to Re: MAOI's and blood pressure meds, posted by SLS on August 3, 2006, at 8:22:13
> > Many doctors no long prescribe the "bite and swallow" nifedipine capsules because of the chance of a greatly lowered BP. This actually happened to me once. The tyramine reaction has a shorter duration than the nifedipine, leaving some people with a dangerously low blood pressure. When this happened to me, my PDOC at the time had prescribed 20mg capsules of nifedipine. This was too high a dosage for me, and I ended up spending the night in the hospital on IV fluids. The niphedipine brought my BP down quickly. But as the tyramine reaction subsided, the nifedipine just kept lowering my BP.
>
> The literature demonstrating sublingual nifedipine used 10mg. Still, I wonder if that is too much based upon what you have described. Maybe chlorpromazine is the better way to go. I don't know what dosage is appropriate, though. I believe it works as a NE alpha-1 antagonist. Perhaps prazosin would be equally effective. I don't think it has been investigated for this purpose.
Ed_UK submitted a nice post:http://www.dr-bob.org/babble/20050103/msgs/438181.html
- Scott
Posted by jedi on August 3, 2006, at 13:21:27
In reply to Re: MAOI's and blood pressure meds, posted by SLS on August 3, 2006, at 8:38:17
Posted by SLS on August 3, 2006, at 14:05:35
In reply to Scott, Thanks for the valuable information. :) (nm) » SLS, posted by jedi on August 3, 2006, at 13:21:27
Posted by ed_uk on August 3, 2006, at 15:27:23
In reply to MAOI's and blood pressure meds, posted by H. Upmann on August 2, 2006, at 21:27:19
This is the end of the thread.
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