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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by akston on February 15, 2007, at 14:15:22
I stopped Prozac on Dec. 1, 06 in preperation for starting Nardil. Was so depressed that on Jan. 8, 9, and 10 I took a 20mg tab of Prozac, but none since.
Is it now safe to start Nardil?
Posted by Phillipa on February 15, 2007, at 19:40:50
In reply to Prozac and Nardil, posted by akston on February 15, 2007, at 14:15:22
Think it's five weeks in between. Love Phillipa
Posted by ace on February 15, 2007, at 20:32:55
In reply to Prozac and Nardil, posted by akston on February 15, 2007, at 14:15:22
> I stopped Prozac on Dec. 1, 06 in preperation for starting Nardil. Was so depressed that on Jan. 8, 9, and 10 I took a 20mg tab of Prozac, but none since.
>
> Is it now safe to start Nardil?To be 100% safe you need a 3 month washout with prozac......
Prozac has a very long half life....
I havent done the maths but that is the guideline....however, I have often changed below the guidline and been fine,,, however, with Anafranil, I ceased Nardil and startined this agent 10 days later: naught Ace! I had a moderate seotonin syndrome...
be careful....
Cheers!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Ace (The Nardil Man Inc. Pty. Ltd.)
Posted by ace on February 15, 2007, at 20:34:03
In reply to Re: Prozac and Nardil » akston, posted by Phillipa on February 15, 2007, at 19:40:50
> Think it's five weeks in between. Love Phillipa
It's 12 weeks. I'm sure. If I am wrong, you can skin me alive!
Ace
Posted by Phillipa on February 15, 2007, at 21:47:28
In reply to Re: Prozac and Nardil » Phillipa, posted by ace on February 15, 2007, at 20:34:03
Ace never my King and I'm sure you're correct. My apolgies to the poster I answered just glad Ace the Nardil Champ was here. Love Phillipa
Posted by akston on February 16, 2007, at 4:54:16
In reply to Re: Prozac and Nardil » akston, posted by ace on February 15, 2007, at 20:32:55
Thanks all.
"12 weeks"! And "be careful"!
OK. I'll hang in there till around May 10.
My VA doc was ready to have me start after only 2 weeks. Gave me Clonodine in case of a serotinon (sp?) syndrome. I don't trust that.
Posted by akston on February 16, 2007, at 4:57:04
In reply to Re: Prozac and Nardil, posted by akston on February 16, 2007, at 4:54:16
> Thanks all.
>
> "12 weeks"! And "be careful"!
>
> OK. I'll hang in there till around May 10.
>
> My VA doc was ready to have me start after only 2 weeks. Gave me Clonodine in case of a serotinon (sp?) syndrome. I don't trust that.Sorry, it's Clonidine.
Posted by Larry Hoover on February 16, 2007, at 5:58:54
In reply to Re: Prozac and Nardil, posted by akston on February 16, 2007, at 4:54:16
> Thanks all.
>
> "12 weeks"! And "be careful"!
>
> OK. I'll hang in there till around May 10.
>
> My VA doc was ready to have me start after only 2 weeks. Gave me Clonodine in case of a serotinon (sp?) syndrome. I don't trust that.I'm going to disagree with previous posters. Twelve weeks would be an abundance of prudence even if you had been on Prozac for an extended period of time; the half-life increases the longer you're on it. However, you had not even reached a stable plasma concentration level, with but three days of intake. Far from it.
The mathematics is not worth trying to explain, but two weeks washout was more than adequate, in your case. You're three times that already. And, having clonidine on hand, should the symptoms arise, you're golden.
I would not delay initiating the Nardil, were I in your shoes.
Lar
Posted by akston on February 16, 2007, at 6:09:37
In reply to Re: Prozac and Nardil » akston, posted by Larry Hoover on February 16, 2007, at 5:58:54
Lar,
Thanks. I'll give 72 hours for the alcohol to be gone, and I'm going for it. The depression is too deep, thus the alcohol.
> > Thanks all.
> >
> > "12 weeks"! And "be careful"!
> >
> > OK. I'll hang in there till around May 10.
> >
> > My VA doc was ready to have me start after only 2 weeks. Gave me Clonodine in case of a serotinon (sp?) syndrome. I don't trust that.
>
> I'm going to disagree with previous posters. Twelve weeks would be an abundance of prudence even if you had been on Prozac for an extended period of time; the half-life increases the longer you're on it. However, you had not even reached a stable plasma concentration level, with but three days of intake. Far from it.
>
> The mathematics is not worth trying to explain, but two weeks washout was more than adequate, in your case. You're three times that already. And, having clonidine on hand, should the symptoms arise, you're golden.
>
> I would not delay initiating the Nardil, were I in your shoes.
>
> Lar
>
Posted by kaleidoscope on February 16, 2007, at 15:52:53
In reply to Re: Prozac and Nardil, posted by akston on February 16, 2007, at 4:57:04
Hi
I don't know why your doc would give you clonidine. The risk of combining Prozac with Nardil is the serotonin syndrome. Clonidine is not a treatment for the serotonin syndrome.
K
Posted by Quintal on February 16, 2007, at 16:10:21
In reply to Re: Prozac and Nardil, posted by kaleidoscope on February 16, 2007, at 15:52:53
I think he might be confusing serotonin syndrome with a hypertensive crisis, for which clonidine would lower blood pressure, though nifedipine seems a more popular choice for this purpose. What you really need for serotonin syndrome is Periactin (cyproheptadine) but you should really be monitored in hospital if you ever developed symptoms of serotonin syndrome.
Q
Posted by Quintal on February 16, 2007, at 16:12:54
In reply to Re: Prozac and Nardil » kaleidoscope, posted by Quintal on February 16, 2007, at 16:10:21
Sorry, that was meant as a general comment. Not intended to patronise K's extensive knowledge on the subject........... :o)
Q
Posted by ace on February 16, 2007, at 19:34:59
In reply to Re: Prozac and Nardil ?akston, posted by Larry Hoover on February 16, 2007, at 5:58:54
> > Thanks all.
> >
> > "12 weeks"! And "be careful"!
> >
> > OK. I'll hang in there till around May 10.
> >
> > My VA doc was ready to have me start after only 2 weeks. Gave me Clonodine in case of a serotinon (sp?) syndrome. I don't trust that.
>
> I'm going to disagree with previous posters.!
Twelve weeks would be an abundance of prudence even if you had been on Prozac for an extended period of time; the half-life increases the longer you're on it.This is very true. And, I believe I was being overly prudent, but whenever I here of strong seretonergic agent being used after an MAOI red flags spin around my head.
The half-life of Prozac after one dose is 2 days, with a range of 1-5 days. I have personally seen and read that it is best to wait 12 weeks when starting Nardil after Prozac therapy. However, I have also seen 2 weeks, 5 weeks, 6 weeks, 8 weeks.
There IS variation (sometimes slight) based on the individual biology.
However, you had not even reached a stable plasma concentration level, with but three days of intake. Far from it.
>
> The mathematics is not worth trying to explain, but two weeks washout was more than adequate, in your case. You're three times that already. And, having clonidine on hand, should the symptoms arise, you're golden.
>
> I would not delay initiating the Nardil, were I in your shoes.All the above is correct. However, I urge you to titrate the drug slow. If you EVER suffer serotonin syndrome a drug called Periactin can reverse symptomatology. Worth having on hand.
Finally, before starting see a psychiatrist or doctor (preferably one who is older than 35!)
Cheeeeeers and sorry for any confusion,
Ace.
> Lar
>
Posted by akston on February 16, 2007, at 20:05:52
In reply to Re: Prozac and Nardil » Larry Hoover, posted by ace on February 16, 2007, at 19:34:59
This is getting scarier and scarier. Hope I can squeeze in to see the VA doc to ask him about Periactin. I can carry on longer, but was hoping to start Nardil on Wed. Feb. 21. If he sees the value and necessity of Periactin it's no problem to get the prescription that day (Mon., I hope).
> > > Thanks all.
> > >
> > > "12 weeks"! And "be careful"!
> > >
> > > OK. I'll hang in there till around May 10.
> > >
> > > My VA doc was ready to have me start after only 2 weeks. Gave me Clonodine in case of a serotinon (sp?) syndrome. I don't trust that.
> >
> > I'm going to disagree with previous posters.
>
> !
>
>
> Twelve weeks would be an abundance of prudence even if you had been on Prozac for an extended period of time; the half-life increases the longer you're on it.
>
> This is very true. And, I believe I was being overly prudent, but whenever I here of strong seretonergic agent being used after an MAOI red flags spin around my head.
> The half-life of Prozac after one dose is 2 days, with a range of 1-5 days. I have personally seen and read that it is best to wait 12 weeks when starting Nardil after Prozac therapy. However, I have also seen 2 weeks, 5 weeks, 6 weeks, 8 weeks.
> There IS variation (sometimes slight) based on the individual biology.
>
>
>
>
> However, you had not even reached a stable plasma concentration level, with but three days of intake. Far from it.
> >
> > The mathematics is not worth trying to explain, but two weeks washout was more than adequate, in your case. You're three times that already. And, having clonidine on hand, should the symptoms arise, you're golden.
> >
> > I would not delay initiating the Nardil, were I in your shoes.
>
> All the above is correct. However, I urge you to titrate the drug slow. If you EVER suffer serotonin syndrome a drug called Periactin can reverse symptomatology. Worth having on hand.
>
> Finally, before starting see a psychiatrist or doctor (preferably one who is older than 35!)
>
> Cheeeeeers and sorry for any confusion,
> Ace.
>
>
>
>
> > Lar
> >
>
>
Posted by akston on February 17, 2007, at 8:12:29
In reply to Re: Prozac and Nardil » Larry Hoover, posted by ace on February 16, 2007, at 19:34:59
I should have mentioned that my doc has set the prescription for only 15mg to start. He knows that I'm unusually sensitive to meds. Said if it goes well we'll increase it over time up to three 15mg/day.
Posted by ace on February 19, 2007, at 19:59:52
In reply to Re: Prozac and Nardil ?ace, posted by akston on February 17, 2007, at 8:12:29
> I should have mentioned that my doc has set the prescription for only 15mg to start. He knows that I'm unusually sensitive to meds. Said if it goes well we'll increase it over time up to three 15mg/day.
Relax bro! I have thought of this more: you should be AOK!!!!
Ace!
Posted by akston on February 19, 2007, at 20:05:12
In reply to Re: Prozac and Nardil » akston, posted by ace on February 19, 2007, at 19:59:52
Ace,
Thanks much. Been worried to death about all this. But will start on Sunday Feb. 25.
> > I should have mentioned that my doc has set the prescription for only 15mg to start. He knows that I'm unusually sensitive to meds. Said if it goes well we'll increase it over time up to three 15mg/day.
>
> Relax bro! I have thought of this more: you should be AOK!!!!
>
> Ace!
>
>
Posted by Chairman_MAO on February 21, 2007, at 5:36:36
In reply to Re: Prozac and Nardil » akston, posted by ace on February 15, 2007, at 20:32:55
Hahaha, "The Nardil Man, Pty. Ltd." Nice, you always crack me up.
Glad to see you're still doing well on "the juice".
Keep it up! ;)
Posted by Chairman_MAO on February 21, 2007, at 5:38:55
In reply to Re: Prozac and Nardil, posted by akston on February 16, 2007, at 20:05:52
Cyproheptadine is not reliable in the treatment of severe serotonin syndrome. The best thing to carry around would be good ol' chlorpromazine (Thorazine, Largactil). Not only does it have a proven track record of treating serotonin syndrome, it can also be used to lower blood pressure in case of a hypertensive crisis.
It's also good if you don't want to be able to think for 36 hours. ;)
Posted by Chairman_MAO on February 21, 2007, at 5:40:00
In reply to Re: Prozac and Nardil » ace, posted by akston on February 19, 2007, at 20:05:12
The usual therapeutic dose is 1mg/kg/day. But of course, YMMV and go with what your doctor says first.
Posted by laima on February 21, 2007, at 6:38:30
In reply to serotonin syndrome: treatment, posted by Chairman_MAO on February 21, 2007, at 5:38:55
I thought my doctor told me there is no reliable treatment for seratonin syndrome, that all they can do is try to stabilize one's vital signs in the hospital and basically wait it out? It's a teaching hospital he's with, too- so they tend to be up on treatments.
> Cyproheptadine is not reliable in the treatment of severe serotonin syndrome. The best thing to carry around would be good ol' chlorpromazine (Thorazine, Largactil). Not only does it have a proven track record of treating serotonin syndrome, it can also be used to lower blood pressure in case of a hypertensive crisis.
>
> It's also good if you don't want to be able to think for 36 hours. ;)
Posted by Chairman_MAO on February 21, 2007, at 13:05:03
In reply to Re: serotonin syndrome: treatment » Chairman_MAO, posted by laima on February 21, 2007, at 6:38:30
In a sense that's correct; treatment of it consists of supportive care. Taking Thorazine is not going to make it all "go away", but it will help a lot.
Your doctor is correct if his point was that you always should go to the emergency room regardless of what "antidote" you took.
Posted by akston on February 21, 2007, at 13:54:27
In reply to serotonin syndrome: treatment, posted by Chairman_MAO on February 21, 2007, at 5:38:55
Any contraindications with Prilosec?
This is the end of the thread.
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